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Dell'Osso L, Amatori G, Giovannoni F, Massimetti E, Cremone IM, Carpita B. Rumination and altered reactivity to sensory input as vulnerability factors for developing post-traumatic stress symptoms among adults with autistic traits. CNS Spectr 2024; 29:119-125. [PMID: 38224059 DOI: 10.1017/s1092852924000014] [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] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Recent literature has suggested that individuals with autism spectrum disorder (ASD) or autistic traits (ATs) would be more likely to encounter traumatic events in their lifetime and to develop post-traumatic stress disorder (PTSD). However, the nature of this relationship has not yet been fully elucidated. The aims of this study were to evaluate the relationship between AT and PTSD and to investigate which specific autistic dimension was more associated with trauma and stress-related symptoms. METHODS A total of 68 subjects with ASD and 64 healthy controls (HCs) were assessed with the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Trauma and Loss Spectrum (TALS) questionnaires. Statistical analyses included Mann-Whitney U test, chi-square test, calculation of Spearman's coefficients, and logistic regression analysis. RESULTS Patients with significant AT reported a 30% rate of PTSD and higher TALS total and domain scores than HCs, among whom no PTSD was found instead. Significant positive correlations were reported between AdAS Spectrum and TALS-SR scores in the whole sample. AdAS Spectrum total scores were statistically predictive of the presence of PTSD. High scores at AdAS Spectrum Inflexibility and adherence to routine and Restrictive interest and rumination domains were identified as positive predictors of a probable PTSD. CONCLUSION Compared to HCs, subjects with significant AT are more likely to present symptoms of PTSD. In particular, AT related to ruminative thinking, narrow interests, and sensorial reactivity would seem to predict the presence of post-traumatic stress symptomatology.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Giovannoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Conti L, Fantasia S, Violi M, Dell’Oste V, Pedrinelli V, Carmassi C. Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review. Brain Sci 2023; 13:1730. [PMID: 38137178 PMCID: PMC10741474 DOI: 10.3390/brainsci13121730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Emotional dysregulation (ED) has recently been conceptualized as a transnosographic entity in major mental disorders, and increasing evidence has suggested association between ED and post-traumatic stress symptoms (PTSS), though the nature of this association is unclear. The aim of the present review was to examine the possible interplay between ED and trauma exposure in the literature, as well as a possible role for the comorbidity of PTSD or PTSS in adolescents and young adults. In particular, we explored whether ED may represent a risk factor for PTSD or, conversely, a consequence of traumatic exposure. This systematic review was conducted according to PRISMA 2020 guidelines in three databases (PubMed, Scopus, and Embase). The 34 studies included showed a wide heterogeneity in terms of the populations selected and outcomes examined. Most studies used the Difficulties in Emotion Regulation Scale (DERS) and examined the relationship between ED, trauma, and psychopathological manifestations after the occurrence of trauma, with a focus on child abuse. Although current data in the literature are heterogeneous and inconclusive, this research highlights the role of ED as a mechanism that may mediate vulnerability to PTSD, but also as a predictor of severity and maintenance of typical, atypical, or associated PTSD symptoms, suggesting prevention programs for PTSD and other mental disorders should support the development of emotion regulation strategies.
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Affiliation(s)
- Lorenzo Conti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy (M.V.); (V.P.); (C.C.)
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Carmassi C, Cruz-Sanabria F, Gravina D, Violi M, Bonelli C, Dell’Oste V, Pedrinelli V, Frumento P, Faraguna U, Dell’Osso L. Exploratory Study on the Associations between Lifetime Post-Traumatic Stress Spectrum, Sleep, and Circadian Rhythm Parameters in Patients with Bipolar Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3566. [PMID: 36834262 PMCID: PMC9967425 DOI: 10.3390/ijerph20043566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The present study aimed at exploring whether lifetime post-traumatic stress spectrum symptoms are associated with chronotype in patients with bipolar disorder (BD). Moreover, we explored whether the chronotype can moderate the potential associations between lifetime post-traumatic stress spectrum symptoms and rest-activity circadian and sleep-related parameters. A total of 74 BD patients were administered the Trauma and Loss Spectrum Self-Report (TALS-SR) lifetime version for lifetime post-traumatic stress spectrum symptoms, the Pittsburgh Sleep Quality Index (PSQI) for self-reported sleep quality, and the Reduced Morningness-Eveningness Questionnaire (rMEQ) to discriminate evening chronotypes (ETs), neither chronotype (NT), and morning chronotype (MT). Actigraphic monitoring was used to objectively evaluate sleep and circadian parameters. Patients classified as ET reported significantly higher scores in the re-experiencing domain, as well as poorer sleep quality, lower sleep efficiency, increased wake after sleep onset, and delayed mid-sleep point compared with both NT and MT (p-value ≤ 0.05). Moreover, ET presented significantly higher scores in the TALS-SR maladaptive coping domain than NT and lower relative amplitude than MT (p-value ≤ 0.05). Moreover, higher TALS-SR total symptomatic domains scores were significantly correlated with poor self-reported sleep quality. Regression analyses showed that the PSQI score maintained the association with the TALS total symptomatic domains scores after adjusting for potentially confounding factors (age and sex) and that no interaction effect was observed between the chronotype and the PSQI. Conclusions: This exploratory study suggests that patients with BD classified as ET showed significantly higher lifetime post-traumatic stress spectrum symptoms and more disrupted sleep and circadian rhythmicity with respect to other chronotypes. Moreover, poorer self-reported sleep quality was significantly associated with lifetime post-traumatic stress spectrum symptoms. Further studies are required to confirm our results and to evaluate whether targeting sleep disturbances and eveningness can mitigate post-traumatic stress symptoms in BD.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francy Cruz-Sanabria
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Miriam Violi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Valerio Dell’Oste
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, 56126 Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Wang N, Chung MC, Zhang J, Fang S. Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents. J Affect Disord 2022; 309:461-470. [PMID: 35513114 DOI: 10.1016/j.jad.2022.04.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/14/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis. METHODS 867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28. RESULTS Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG. LIMITATIONS The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes. CONCLUSIONS Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Man Cheung Chung
- Department of Psychology, Zayed University, Dubai, United Arab Emirates
| | - Jieting Zhang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Siqi Fang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong.
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Nourkova VV, Gofman AA. Event Time Perspective in Adaptation to the COVID-19 Pandemic: Preliminary Insights from Two Chinese Samples. TIMING & TIME PERCEPTION 2022. [DOI: 10.1163/22134468-bja10051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Little is known about the impact of the COVID-19 pandemic on the way people construct their time perspective (TP). This study investigated past and future TP in Hubei, China, comparing a ‘pre-pandemic’ sample collected before the pandemic (late 2019, n = 138) to a ‘habitual-pandemic’ sample collected when the pandemic was largely under control (beginning 2021, n = 109). Using the time line paradigm, participants generated significant past and future personal events indicating dates, emotional valence, and intensity for each. We used these data to test the predictions that the COVID-19 pandemic would shorten TP and evoke pessimism for the future and disappointment for the past. Counter to these predictions, we found: (a) typical levels of positivity in both samples for both past and future events; (b) a higher proportion of positive memories in the habitual-pandemic sample than pre-pandemic one; (c) past and future time extension in the habitual-pandemic sample; and (d) the future was more often completed with one’s own ‘peaceful death’ in the habitual-pandemic sample. To determine whether the ‘peaceful death’ phenomenon is adaptive or maladaptive we examined its coincidence with other timeline characteristics. The analyses indicated that the ‘peaceful death’ phenomenon in both samples was associated with a moderately positive TP and a plurality of prospects with frequent references to travel. These results allow to propose that an elongated TP and a distant ‘peaceful death’ may buffer pandemic-related uncertainty and that an accelerated TP functions in the service of self-continuity and well-being.
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Affiliation(s)
- Veronika V. Nourkova
- Lomonosov Moscow State University, Department of General Psychology, Moscow, 125009, Russia
- Institute for Social Sciences, RANEPA, Moscow, 119571, Russia
| | - Alena A. Gofman
- Lomonosov Moscow State University, Department of General Psychology, Moscow, 125009, Russia
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Mazurkiewicz DW, Strzelecka J, Piechocka DI. Terrorism’s Impact on Mental Health Outcomes among Directly and Indirectly Exposed Victims and the Development of Psychopathology. J Clin Med 2022; 11:jcm11092630. [PMID: 35566764 PMCID: PMC9104983 DOI: 10.3390/jcm11092630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
After the events of 9/11, many police-responders developed post-traumatic stress disorder (PTSD) and were potentially vulnerable to developing depression and/or anxiety; in addition, nearly half of police with probable PTSD had comorbid depression and anxiety. Having in mind that victims who experience the effects of terrorism are exposed to high levels of psychological damage, we thus aimed to determine how sequelae of a terrorist act directly and indirectly affect victims. Quantitative synthesis findings were concluded on the basis of 200 records that met the inclusion criteria out of a total of 650. We grouped the patients according to their level of exposure to the WTC terrorist attack on 11 September 2001. The Level I group included individuals who had experienced the traumatic event and/or those who had observed the attack. The Level II group consisted of rescuers and/or persons who cleaned up debris in the area after the attack. The Level III group comprised the victims’ families. Our research enabled us to create a profile for those who were most vulnerable to mental disorders after the WTC terrorist attack. Patients who had survived the terrorist attack and/or those who had observed the incident exhibited fewer traumatic symptoms and a lower percentage of suicidal thoughts in comparison to individuals who had worked as rescuers or cleaning staff in the area after the attack. The number of symptoms rose along with increased contact time with the stressor. The dominant symptom was the triad of intrusion, avoidance, and hyperarousal. The findings may confirm the positive effect of protracted court cases in legal proceedings for compensation on the maintenance and development of psychopathology. Our research may contribute to a better understanding of the consequences of terrorism outcomes on the human psyche and be used in the development of standards for dealing with victims of terrorism’s impact.
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Affiliation(s)
| | - Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, Al. Żwirki and Wigury 63A Street, 02-091 Warsaw, Poland;
| | - Dorota Izabela Piechocka
- Department of Gynecology and Practical Obstetrics, Medical University of Bialystok, Szpitalna 37 Street, 15-295 Bialystok, Poland;
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Fox R, Hyland P, Coogan AN, Cloitre M, Power JM. Posttraumatic stress disorder, complex PTSD and subtypes of loneliness among older adults. J Clin Psychol 2022; 78:321-342. [PMID: 34287862 PMCID: PMC8770684 DOI: 10.1002/jclp.23225] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Research examining the relationship between loneliness and Complex Posttraumatic Stress Disorder (CPTSD) is scarce, particularly among older adults. CPTSD includes the core symptoms of PTSD along with additional symptoms reflecting "disturbances in self-organisation" (DSO). This study examined the cross-sectional relationships between loneliness (emotional and social loneliness) and CPTSD symptoms (i.e., PTSD and DSO symptoms) in older adults. METHODS Structural equation modelling was used to examine these relationships in a nationally representative sample of US adults aged 60-70 years (n = 456). RESULTS Controlling for covariates, emotional loneliness was associated with PTSD (β = 0.31) and DSO (β = 0.57) symptoms whereas social loneliness was only associated with DSO symptoms (β = 0.25). The model explained 35.0% of the variance in PTSD symptoms and 71.3% in DSO symptoms. CONCLUSION These findings have important implications for treating and understanding PTSD/CPTSD and their correlates among older adults.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Marylène Cloitre
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
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Abstract
OBJECTIVE Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms. The main aim of this investigation is to better understand the impact of post-traumatic stress symptomatology, using a specific self-assessment questionnaire, in subjects experiencing occupational stress with the rationale to address the variegated symptoms expressed by this particular population in a post-traumatic dimensional perspective. METHODS Authors collected socio-demographic, occupational, and clinical data. They utilized Trauma and Loss Spectrum Self Report (TALS-SR), a questionnaire investigating post-traumatic stress symptoms. The population size was 345 subjects who presented at the Occupational Health Department of a university hospital over a 3 years period (2016-2018). RESULTS Data analysis revealed 33.9% of subjects who met post-traumatic stress disorder (PTSD) criteria. Gender distribution of this set was (36.4% female, 31% male). A family history or personal history of mental disorders were related to higher scores in almost all TALS-SR domains and were related, respectively, to higher scores of criterion B "intrusion symptoms" (P = .014), criterion D "negative alterations in cognitions and mood" (P = .023), and criterion E "arousal" (P = .033) of PTSD. Differences in TALS-SR scores also emerged based on age and gender. CONCLUSIONS PTSD symptoms manifest at a significant level in those who experience work-related stress. Personal background of individuals, both in terms of family and personal history for mental disorders, seems to increase their vulnerability to develop post-traumatic stress symptoms. This study suggests the importance of evaluating occupational stress from a post-traumatic stress perspective also at an early stage.
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Do somatic symptoms relate to PTSD and gender after earthquake exposure? A cross-sectional study on young adult survivors in Italy. CNS Spectr 2021; 26:268-274. [PMID: 32248878 DOI: 10.1017/s1092852920000097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Increasing evidence confirms a strict relationship between mental disorders and physical health. Particularly, stressful life events and post-traumatic stress disorder (PTSD) have been closely correlated with various physical disorders and somatic symptoms, such as chronic pain, gastrointestinal disorders, and headaches. The aim of this study was to investigate the emergence of somatic symptoms in a sample of young adult survivors 21 months after exposure to the L'Aquila 2009 earthquake, with particular attention to PTSD and gender impact. METHODS Four hundred and fifty high-school senior students (253 male and 197 female) exposed to the 2009 L'Aquila earthquake, 21 months earlier, were enrolled and evaluated by the Trauma and Loss Spectrum Self-Report (TALS-SR), for symptomatological PTSD, and the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR) "rhythmicity and vegetative functions" domain, for somatic symptoms. RESULTS Significantly higher rates of endorsement of the MOODS-SR somatic symptoms emerged in survivors with PTSD compared to those without. Females reported higher rates of endorsement of at least one MOODS-SR somatic symptom compared to males; however, a Decision Tree model and a two-way analysis of variance model confirmed a significant effect of PTSD only. A multivariate logistical regression showed a significant association between the presence of at least one MOOD-SR somatic symptom and re-experiencing and maladaptive coping TALS-SR domains. CONCLUSION This study corroborates a relevant impact of symptomatological PTSD, across both the genders, on somatic symptoms occurring in young adults after months from exposure to a massive earthquake.
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Fox R, McHugh Power J, Coogan AN, Beekman ATF, van Tilburg TG, Hyland P. Posttraumatic stress disorder and loneliness are associated over time: A longitudinal study on PTSD symptoms and loneliness, among older adults. Psychiatry Res 2021; 299:113846. [PMID: 33706195 DOI: 10.1016/j.psychres.2021.113846] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
Loneliness has a pernicious effect on mental health in later life and is likely to have a bidirectional relationship with psychopathology. However, longitudinal research examining loneliness and posttraumatic stress symptoms among older adults is scarce. This study aimed to examine the longitudinal relationship between different types of loneliness (social and emotional) and posttraumatic stress symptoms. Using two waves of an older adult sample (n = 1,276) from the Longitudinal Aging Study Amsterdam (LASA), this longitudinal relationship was examined using a multivariate two wave-latent change score (2W-LCS) model. There were significant, however, very small increases in both posttraumatic stress symptoms and emotional loneliness over time, whereas, average social loneliness scores did not significantly increase/decrease over time. Changes in both social (β = .16) and emotional loneliness (β = .15) were associated with small changes in posttraumatic stress symptoms, consistent with the existence of a longitudinal association between the constructs, net of covariate effects. Results provide evidence of the existence of a longitudinal association between subtypes of loneliness and posttraumatic stress symptoms, among older adults. Results have implications for clinicians who should identify individuals at risk of developing posttraumatic stress symptoms, and for the theory of both posttraumatic stress disorder and loneliness.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland; Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin.
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland; UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; GGZ inGeest, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
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Carmassi C, Bertelloni CA, Dell'Oste V, Luperini C, Marazziti D, Rossi R, Dell'Osso L. PTSD and Suicidal Behaviors Amongst L'Aquila 2009 Earthquake Young Survivors. Front Public Health 2021; 9:590753. [PMID: 33643987 PMCID: PMC7902690 DOI: 10.3389/fpubh.2021.590753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is one of the most frequent and severe psychiatric consequences of natural disasters, frequently associated with suicidality. The aim of this study was at examining the possible relationships between suicidal behaviors and full-blown or partial PTSD, in a sample of young earthquake survivors. The second aim was at investigating the specific role of PTSD symptoms on suicidality. Methods: A total of 475 young adults who survived the L'Aquila 2009 earthquake, one of the most severe Italian disasters of the last decades, were recruited and assessed after 21 months from the catastrophe. Participants were evaluated by two questionnaires assessing subthreshold psychopathology, the Trauma and Loss Spectrum Self-Report (TALS-SR) to investigate both full and partial PTSD, and two specific Mood Spectrum Self-Report (MOODS-SR) sub-domains exploring suicidality, namely suicidal ideation and suicide attempts. Results: The ensuing findings showed that suicidal ideation and suicide attempts were present, respectively, in 40 (8.4%) and 11 (2.3%) survivors. Rates of suicidal ideation were significantly more elevated in full-blown PTSD subjects (group 1), as compared with those suffering from partial (group 2) or no PTSD (group 3). Interestingly, group 2 subjects showed significantly more suicidal ideation than healthy individuals, and less than those of group 1, while the frequency of suicide attempts was similar across the three groups. Suicidal ideation was associated with higher scores in the following TALS-SR domains: grief-reactions, re-experiencing, avoidance and numbing, maladaptive coping, and personal characteristics/risk factor. Conclusions: The results of the present study support and extend previous findings on the role of PTSD symptoms in suicidality after a severe earthquake. However, as compared with available literature, they also highlight the significant impact of sub-threshold PTSD manifestations in increasing the suicide risk in survivors of a mass disaster.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Chiara Luperini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Exploring mood symptoms overlap in PTSD diagnosis: ICD-11 and DSM-5 criteria compared in a sample of subjects with Bipolar Disorder. J Affect Disord 2020; 276:205-211. [PMID: 32697700 DOI: 10.1016/j.jad.2020.06.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/20/2020] [Accepted: 06/23/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The latest edition of the ICD (ICD-11) introduced relevant modifications to Post-traumatic Stress Disorder (PTSD) diagnostic criteria with respect to those of the DSM-5, including the exclusion of DSM-5 symptoms that potentially overlapped with mood disorders. To date, no study has yet investigated the differences in PTSD and its related symptoms, according to the two diagnostic systems in subjects with mood disorders. The aim of the present study was to compare the DSM-5 and ICD-11 diagnostic criteria for PTSD in a sample of patients with Bipolar Disorder (BD). METHODS An overall sample of 210 in-patients with BD completed the Trauma and Loss Spectrum-Self Report, assessing post-traumatic stress symptoms, to compare symptomatological PTSD diagnosis according to either the DSM-5 or the ICD-11 criteria. RESULTS DSM-5 PTSD was detected in 41% of the whole sample, whereas ICD-11 PTSD in 31.8%. The two diagnostic systems showed good concordance (Cohen's k = 0.643), whereas the concordance of re-experiencing and arousal criteria were moderate (Cohen's k = 0.578) and good (Cohen's k = 0.791), respectively. Almost all the subjects with a diagnosis of ICD-11 PTSD (92.5%) endorsed the "negative alterations in cognitions and mood" DSM-5 criterion. LIMITATIONS The small size, the use of a self-report instrument. CONCLUSION Our findings show high rates of PTSD and post-traumatic stress symptoms among subjects with BD according to both DSM-5 and ICD-11 criteria, despite significantly lower with the latter. However, potentially DSM-5 mood overlapping symptoms appear to be significantly higher among bipolar patients with ICD-11 PTSD with respect to those without.
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Carmassi C, Porta I, Bertelloni CA, Impagnatiello P, Capone C, Doria A, Corsi M, Dell'Osso L. PTSD and post-traumatic stress spectrum in the Italian Navy Operational Divers Group and corps of Coast Guard Divers employed in search and rescue activities in the Mediterranean refugees emergences and Costa Concordia shipwreck. J Psychiatr Res 2020; 129:141-146. [PMID: 32912594 DOI: 10.1016/j.jpsychires.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
Rescue personnel is at high risk for Post-traumatic Stress Disorder (PTSD) because of the possible repetitive exposition to "cruel details of traumatic events" (DSM-5). Literature reported PTSD rates in combat exposed veterans, although the Italian Navy military personnel has been frequently involved in no-war activities in most recent years, such as Search and Rescue (SAR) activities of civilians involved in catastrophic events. The study aimed at exploring the prevalence of PTSD and its impact on social and work functioning among divers of the Italian Navy employed in the SAR activities for the Costa Concordia shipwreck (2012), the collapsed control tower of the Genoa harbour (2013), and the "Mare Nostrum" and "Triton" immigrant emergency Operations in the Mediterranean Sea. The 85 Italian Navy and Coast Guard Divers on duty for these activities were involved in the study and forty fulfilled the assessments, including the: Impact Event Scale (IES-r), Trauma and Loss Spectrum Self-Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). In the three years before enrollment 77.5% of the sample (n = 31) performed at least one rescue operation, with full and partial DSM-5 PTSD rates being 7.5% and 22.5%, respectively. A correlation emerged between WSAS domains or total scores and TALS-SR score domains for PTSD. Rescue Navy personnel resulted to be at risk for post-traumatic stress symptoms, and these subthreshold PTSD manifestations appear to impact on functioning. Further studies are needed to better investigate PTSD risk and resilience factors in this particular group of workers.
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Affiliation(s)
- Claudia Carmassi
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | | | - Carlo Antonio Bertelloni
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | | | | | | | - Martina Corsi
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | - Liliana Dell'Osso
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
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14
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Carmassi C, Bertelloni CA, Avella MT, Cremone I, Massimetti E, Corsi M, Dell'Osso L. PTSD and Burnout are Related to Lifetime Mood Spectrum in Emergency Healthcare Operator. Clin Pract Epidemiol Ment Health 2020; 16:165-173. [PMID: 32874191 PMCID: PMC7431684 DOI: 10.2174/1745017902016010165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
Background: PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy. Methods: N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV. Results: Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains. Conclusion: A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Massimetti
- ASST, Bergamo Ovest, SSD Servizio Psichiatrico diagnosi e cura, Treviglio, Italy
| | - Martina Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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15
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Carmassi C, Dell'Oste V, Pedrinelli V, Barberi FM, Rossi R, Bertelloni CA, Dell'Osso L. Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective. J Sex Med 2020; 17:1770-1778. [PMID: 32641255 DOI: 10.1016/j.jsxm.2020.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/02/2020] [Accepted: 05/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mental disorders are frequently related to sexual dysfunction (SD) but scant data are still available on trauma-related disorders, particularly post-traumatic stress disorder (PTSD). AIM To evaluate the relationships between SD and PTSD in 2009 L'Aquila (Italy) earthquake young adult survivors, with particular attention to gender differences. METHODS Five hundred twelve high-school senior students were assessed 21 months after exposure by the following: Trauma and Loss Spectrum-Self-Report (TALS-SR), for post-traumatic spectrum symptoms; Mood Spectrum-Self-Report (MOODS-SR) lifetime version, for mood spectrum symptoms (including SD-related symptoms). Descriptive and inferential statistics were adopted. OUTCOMES TALS-SR and MOODS-SR scores were analyzed to evaluate PTSD- and SD-related symptoms. RESULTS Around 6.5% of subjects reported SD-related symptoms with males showing higher rates than females in each symptom, with a statistically significant difference in item n = 154 (…less sexually active). Survivors with symptomatological PTSD reported rates up to 10%, with higher ratio of endorsing at least one SD-related symptom than with NO-PTSD. Significantly higher total MOODS-SR SD-related symptom scores emerged in survivors with symptomatological PTSD than in those with NO-PTSD, and a 2-way ANOVA showed a significant main effect of symptomatological PTSD and gender and gender × PTSD interaction. CLINICAL IMPLICATIONS SD-related symptoms are reported among young adult survivors to earthquake exposure and the number of symptoms is related to PTSD, particularly in males, suggesting the need for accurate evaluation. STRENGTHS & LIMITATIONS Strengths are the large sample of young adult survivors to a massive natural disaster; the long-time frame from exposure corroborating the role of PTSD; the assessment of symptoms specifically occurring after exposure. Limitations are as follows: the lack of a specific scale for SD; the self-report instruments other than clinical interviews, that may be less accurate; the lack of information on the presence of somatic illness and other mental disorders; the lack of a control group; the young age of the sample because of the lifetime sexual experiences of the subjects, in addition to the lack of a comparison measure of sexual functioning before the earthquake. CONCLUSIONS Our results highlight relevant rates of SD-related symptoms in young adults exposed to the L'Aquila earthquake, particularly males and subjects with PTSD, suggesting SD may represent a specific male gender-related somatic complaint. Our results highlight the need for accurate investigation of SD in such population to improve clinical management and appropriate treatment. Carmassi C, Dell'Oste V, Pedrinelli V, et al. Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective. J Sex Med 2020;17:1770-1778.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Filippo Maria Barberi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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16
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Holliday SB, Dubowitz T, Haas A, Ghosh-Dastidar B, DeSantis A, Troxel WM. The association between discrimination and PTSD in African Americans: exploring the role of gender. ETHNICITY & HEALTH 2020; 25:717-731. [PMID: 29490467 PMCID: PMC6113108 DOI: 10.1080/13557858.2018.1444150] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
Background: Research has demonstrated the adverse impact that discrimination has on physical and mental health. However, few studies have examined the association between discrimination and symptoms of posttraumatic stress disorder (PTSD). There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity. Purpose: To examine the association between discrimination and PTSD among a cross-sectional sample largely comprising African American women, controlling for other psychosocial stressors (psychological distress, neighborhood safety, crime). Methods: A sample of 806 participants was recruited from two low-income predominantly African American neighborhoods. Participants completed self-report measures of PTSD symptoms, perceived discrimination, perceived safety, and psychological distress. Information on neighborhood crime was obtained through data requested from the city. Multivariate linear regression models were estimated to assess adjusted relationships between PTSD symptoms and discrimination. Results: Discrimination was significantly associated with PTSD symptoms with a small effect size, controlling for relevant sociodemographic variables. This association remained consistent after controlling for psychological distress, perceived safety, and total neighborhood crime. There was no evidence of a gender by discrimination interaction. Participants who experienced any discrimination were significantly more likely to screen positive for PTSD. Conclusions: Discrimination may contribute to the disparate rates of PTSD experienced by African Americans. PTSD is associated with a range of negative consequences, including poorer physical health, mental health, and quality of life. These results suggest the importance of finding ways to promote resilience in this at-risk population.
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Affiliation(s)
| | - Tamara Dubowitz
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
| | - Ann Haas
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
| | | | - Amy DeSantis
- RAND Corporation, 20 Park Plaza, 9 Floor, Suite 920, Boston, MA
| | - Wendy M. Troxel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
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17
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Carmassi C, Dell'Oste V, Bertelloni CA, Foghi C, Diadema E, Mucci F, Massimetti G, Rossi A, Dell'Osso L. Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors. Front Psychiatry 2020; 11:492006. [PMID: 33304278 PMCID: PMC7701044 DOI: 10.3389/fpsyt.2020.492006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | | | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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18
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Nöthling J, Suliman S, Martin L, Simmons C, Seedat S. Differences in Abuse, Neglect, and Exposure to Community Violence in Adolescents With and Without PTSD and Depression. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:4357-4383. [PMID: 27777370 DOI: 10.1177/0886260516674944] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
South African adolescents are exposed to high levels of violence and trauma, including community violence, abuse, and neglect. Violence and trauma are associated with negative mental health outcomes, including posttraumatic stress disorder (PTSD) and depression. Demographic characteristics, additional exposure to trauma, community violence, and types of childhood abuse and neglect may place adolescents at greater risk of developing PTSD. This study aimed to first assess the weighted contribution of demographic factors, trauma load, community violence, and types of abuse and neglect in predicting PTSD symptom severity. Second, we aimed to determine group differences in demographic factors, trauma load, community violence, and types of abuse and neglect among participants with no disorder, PTSD only, PTSD and depression, and depression only. Participants were 215 adolescents identified with emotional and/or behavioral problems and referred to an adolescent trauma clinic from schools in the Western Cape region of South Africa. Clinical assessments were undertaken to assess community violence exposure; physical, sexual, and emotional abuse; physical and emotional neglect; and a clinical diagnosis of PTSD and comorbidity. Trauma-exposed adolescents with PTSD and depression reported significantly higher levels of emotional abuse and community violence exposure in comparison with trauma-exposed adolescents without a disorder. Emotional abuse, community violence exposure, and female gender were significant predictors of PTSD in regression analysis. These findings underscore the contribution of different types of trauma in the development of PTSD. Interventions focused on preventing trauma, PTSD, and depression should be multifaceted and be targeted at various levels, for example, individual/interpersonal level (reduce abuse in the household and immediate environment) and community/societal level (reduce crime rates in communities and strengthen conviction policies). Traumatized youth should routinely be screened for a history of abuse and particularly exposure to community violence, given their strong association with PTSD.
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Affiliation(s)
| | | | - Lindi Martin
- Stellenbosch University, Cape Town, South Africa
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19
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Dell'Osso L, Carpita B, Bertelloni CA, Diadema E, Barberi FM, Gesi C, Carmassi C. Subthreshold autism spectrum in bipolar disorder: Prevalence and clinical correlates. Psychiatry Res 2019; 281:112605. [PMID: 31629303 DOI: 10.1016/j.psychres.2019.112605] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND While few previous studies highlighted a higher prevalence of autistic traits among adults with Bipolar Disorder (BD), little is known about their clinical significance in this population. METHOD 143 subjects with BD were enrolled at the adult psychiatric inpatient clinic of the University of Pisa. Assessments included the SCID-5, the MOODS-SR, the AQ and the AdAS Spectrum. RESULTS 42.7% of the sample scored positively for significant levels of autistic traits. Subjects with high autistic traits showed a greater likelihood of a very early onset of BD, greater length of current in-hospital stay, significantly higher rates of anxiety disorders and lower rates of substance use disorders compared to patients with low autistic traits. They also show significantly greater depressive symptoms and suicidality across the lifetime. Suicidality was associated with the altered responsiveness to sensory input and inversely related to adherence to routine and inflexibility. CONCLUSION The study is a first exploration of the clinical significance of autistic traits among BD patients. Our results highlight the clinical significance of autistic traits in patients with BD, supporting the usefulness of a dimensional approach to the autism spectrum.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | | | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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20
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Dell'Osso L, Carpita B, Cremone IM, Muti D, Diadema E, Barberi FM, Massimetti G, Brondino N, Petrosino B, Politi P, Aguglia E, Lorenzi P, Carmassi C, Gesi C. The mediating effect of trauma and stressor related symptoms and ruminations on the relationship between autistic traits and mood spectrum. Psychiatry Res 2019; 279:123-129. [PMID: 30366638 DOI: 10.1016/j.psychres.2018.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 12/28/2022]
Abstract
An increasing number of studies highlighted significant correlations between autistic traits (AT) and mood spectrum symptoms. Moreover, recent data showed that individuals with high AT are likely to develop trauma and stressor-related disorders. This study aims to investigate the relationship between AT and mood symptoms among university students, focusing in particular on how AT interact with ruminations and trauma-related symptomatology in predicting mood symptoms. 178 students from three Italian Universities of excellence were assessed with The Structured Clinical Interview for DSM-5 (SCID-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Trauma and Loss Spectrum (TALS) and the Moods Spectrum (MOODS). Considering the AdAS Spectrum total scores, 133 subjects (74.7%) were categorized as "low scorers" and 45 subjects (25.3%) as "high scorers". Students in the high scorer group showed significantly higher scores on RRS, TALS-SR and MOOD-SR total scores. Total and direct effects of AdAS Spectrum total score on MOODS-SR total score were both statistically significant. AdAS Spectrum total score also showed a significant indirect effect on MOODS-SR total score through TALS and RRS total scores. Results showed a significant relationship between AT and mood spectrum, which is partially mediated by ruminations and trauma/stressor-related symptomatology.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Dario Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, Pavia 27100, Italy
| | - Beatrice Petrosino
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, Pavia 27100, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Primo Lorenzi
- Clinical Psychology and Psychotherapy, University of Florence, Careggi Hospital, Florence, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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21
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Carpita B, Muti D, Muscarella A, Dell’Oste V, Diadema E, Massimetti G, Signorelli M, Fusar Poli L, Gesi C, Aguglia E, Politi P, Carmassi C, Dell’Osso L. Sex Differences in the Relationship between PTSD Spectrum Symptoms and Autistic Traits in a Sample of University Students. Clin Pract Epidemiol Ment Health 2019; 15:110-119. [PMID: 31819759 PMCID: PMC6882188 DOI: 10.2174/1745017901915010110] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/27/2019] [Accepted: 07/27/2019] [Indexed: 04/16/2023]
Abstract
BACKGROUND While growing literature is stressing the link between Autistic Traits (AT) and trauma-/stress-related disorders, in both conditions significant differences have been separately reported. OBJECTIVE This study aims to evaluate the relationship between AT and trauma-/stress-related symptoms with respect to sex. METHODS 178 university students were assessed with the Structured Clinical Interview for DSM-5, the Trauma and Loss Spectrum (TALS) and the Adult Autism Subthreshold Spectrum (AdAS). In order to evaluate sex differences in trauma-/stress-related symptoms among subjects with higher or lower AT, the sample was split in two groups with an equal number of subjects on the basis of the median score reported on AdAS Spectrum ("AdAS high scorers" and "AdAS low scorers"). RESULTS Females reported significantly higher TALS total score, Loss events and Grief reaction domain scores than males in the whole sample, while AdAS high scorers reported significantly higher TALS total and domain scores than AdAS low scorers. A significant interaction between high/low AdAS score and sex emerged for TALS domains, with females scoring significantly higher than males only among AdAS low scorers, specifically on Loss events, Grief reaction, Re-experiencing and Personal characteristics/Risk factors domains. Finally, among AdAS high scorers a significantly higher rate of subjects fulfilled symptomatological criteria for PTSD than among AdAS low scorers, without sex differences. CONCLUSION Our results confirm a significant relationship between AT and trauma-/stress-related symptoms, which seems to prevail on sex differences among high-risk subjects.
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Affiliation(s)
- B. Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Address correspondence to this author at Department of Clinical and Experimental Medicine, Section of Psichiatry, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; Tel: +39 3911105675; E-mail: barbara.carpita
| | - D. Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A. Muscarella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V. Dell’Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E. Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G. Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M.S. Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - L. Fusar Poli
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, Pavia 27100, Italy
| | - C. Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E. Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - P. Politi
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, Pavia 27100, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L. Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Suicidality, posttraumatic stress, and depressive reactions after earthquake and maltreatment: A cross-sectional survey of a random sample of 6132 chinese children and adolescents. J Affect Disord 2018; 232:363-369. [PMID: 29510354 DOI: 10.1016/j.jad.2018.02.081] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/07/2018] [Accepted: 02/25/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Surviving an earthquake can greatly increase the risk of suicidality among children and adolescents, especially if they experience physical and emotional neglect or abuse within the family after the earthquake. How various types of childhood adversity affect the vulnerability of adolescents to suicidality after exposure to a natural disaster is not well understood. This study examined the relationships among different types of earthquake exposure, childhood trauma, psychopathology and suicidality. METHODS Suicidality, the level of earthquake exposure, post-traumatic stress disorder (PTSD), depression, and maltreatment, including physical and emotional abuse and neglect, were assessed in 6132 child and adolescent survivors randomly selected from three primary schools, five junior high schools, two senior high schools and one six-year high school in Baoxing, Lushan and Tianquan counties, which were the areas most severely affected by the 2013 Ya'an earthquake. RESULTS The Suicidal Behaviors Questionnaire-Revised (SBQ-R) scores were high, with 27.8% of the participants scoring at or above the cut-off score of 7. Multivariate regression showed that emotional abuse and depression experienced after the earthquake contributed to the suicide risk, whereas emotional neglect and PTSD made somewhat smaller contributions. The mediation analysis suggested that PTSD and depression symptoms partially mediated the association of suicidality with emotional neglect or abuse. The PTSD, depression and suicidality scores were generally higher for females than for males, whereas the depression and suicidality scores were higher for older than younger respondents. CONCLUSIONS Our results highlight the need for the implementation of school-based, adolescent-centered suicide prevention programs in the long-term aftermath of exposure to traumatic events. Interventions may also need to be tailored to gender and developmental stage. Suicidality is independently associated with emotional abuse, neglect, depression and PTSD symptoms in this disaster-exposed young population. Longitudinal studies should explore whether depression and PTSD symptoms mediate the relationship between past emotional abuse or neglect and the current suicide risk.
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Dell'Osso L, Corsi M, Gesi C, Bertelloni CA, Massimetti G, Peroni D, Bonuccelli A, Orsini A, Carmassi C. Adult Autism Subthreshold Spectrum (AdAS Spectrum) in parents of pediatric patients with epilepsy: Correlations with post-traumatic stress symptoms. Compr Psychiatry 2018; 83:25-30. [PMID: 29549876 DOI: 10.1016/j.comppsych.2018.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/22/2018] [Accepted: 02/07/2018] [Indexed: 12/28/2022] Open
Abstract
Increasing literature has shown the usefulness of a dimensional approach to mental disorders, particularly when exploring subjects exposed to traumatic experiences such as a severe illness in one's child. Recent evidence suggests an increased vulnerability in subjects with autism spectrum symptoms to develop post-traumatic stress symptoms. The aim of the present study was to evaluate the presence of adult autism subthreshold spectrum in a sample of parents of children with epilepsy and its impact on post-traumatic stress spectrum symptoms in the same study sample. Results revealed noteworthy correlations between post-traumatic stress symptoms and adult autism subthreshold spectrum (AdAS Spectrum) only in the subgroup of the fathers. In particular, were evidenced correlations between AdAS Spectrum domain of rumination and narrow interests and some TALS-SR nuclear domains: reaction to traumatic events, reexperiencing and arousal. These findings corroborate the hypothesis that subthreshold autistic features may influence the possible psychopathological reaction to trauma.
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Affiliation(s)
- L Dell'Osso
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - M Corsi
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - C Gesi
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - C A Bertelloni
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - G Massimetti
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - D Peroni
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - A Bonuccelli
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - A Orsini
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - C Carmassi
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
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Dell'Osso L, Carpita B, Gesi C, Cremone IM, Corsi M, Massimetti E, Muti D, Calderani E, Castellini G, Luciano M, Ricca V, Carmassi C, Maj M. Subthreshold autism spectrum disorder in patients with eating disorders. Compr Psychiatry 2018; 81:66-72. [PMID: 29268154 DOI: 10.1016/j.comppsych.2017.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022] Open
Abstract
AIM Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours. METHODS 138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R). RESULTS participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs. CONCLUSIONS Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
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Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - B Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - D Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Calderani
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - M Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Carmassi C, Gesi C, Corsi M, Cremone IM, Bertelloni CA, Massimetti E, Olivieri MC, Conversano C, Santini M, Dell'Osso L. Exploring PTSD in emergency operators of a major University Hospital in Italy: a preliminary report on the role of gender, age, and education. Ann Gen Psychiatry 2018; 17:17. [PMID: 29755579 PMCID: PMC5935923 DOI: 10.1186/s12991-018-0184-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 04/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency services personnel face frequent exposure to potentially traumatic events, with the potential for chronic symptomatic distress. The DSM-5 recently recognized a particular risk for post-traumatic stress disorder (PTSD) among first responders (criterion A4) but data are still scarce on prevalence rates and correlates. OBJECTIVE The aim of the present study was to explore the possible role of age, gender, and education training in a sample of emergency personnel diagnosed with DSM-5 PTSD. METHODS The Trauma and Loss Spectrum-Self-Report (TALS-SR) and the Work and Social Adjustment Scale (WSAS) were administered to 42 between nurses and health care assistants, employed at the emergency room of a major University Hospital (Pisa) in Italy. RESULTS 21.4% of the sample reported DSM-5 PTSD with significantly higher scores in the TALS-SR domain exploring the acute reaction to trauma and losses among health care assistants, older, and non-graduated subjects. A significant correlation between the number of the TALS-SR symptoms endorsed, corresponding to DSM-5 PTSD diagnostic criteria emerged in health care assistants. CONCLUSIONS Despite further studies are needed in larger samples, our data suggest a high risk for PTSD and post-traumatic stress spectrum symptoms in nurses and health care workers operating in an emergency department, particularly among health care assistants, women, older, and non-graduated operators.
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Affiliation(s)
- Claudia Carmassi
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Camilla Gesi
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Martina Corsi
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Ivan M Cremone
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Carlo A Bertelloni
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Enrico Massimetti
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | | | - Ciro Conversano
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Massimo Santini
- Emergency Medicine and Emergency Room Unit, AOUP, Pisa, Italy
| | - Liliana Dell'Osso
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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Zhang X, Zhang J, Wang L, Zhang W. Altered Gray Matter Volume and Its Correlation With PTSD Severity in Chinese Earthquake Survivors. Front Psychiatry 2018; 9:629. [PMID: 30555358 PMCID: PMC6284061 DOI: 10.3389/fpsyt.2018.00629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/06/2018] [Indexed: 12/25/2022] Open
Abstract
Objective: To detect the changes of gray matter volume (GMV) and their correlation with severity of symptom in patients with post-traumatic stress disorder (PTSD) who were defined with updated DSM-5 diagnostic criteria. Method: 71 participants were assigned into PTSD group (n = 35) or trauma-exposed control (TEC) group (n = 36) with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Voxel-based morphometry analysis was used to detect alterations in GMV in the PTSD group. Results: We found that the PTSD group had larger GMV in the left middle temporal gyrus (MTG) and in the right dorsal medial prefrontal cortex (dmPFC), and smaller GMV in the region of the right temporal pole (TP) than the TEC group. We also found that PTSD Checklist for DSM-5 (PCL-5) scores correlated positively with the left MTG and right dmPFC GMV, and negatively with left TP GMV. These correlations were consistent with the findings of the between-group comparisons. Conclusions: GMV alterations in the MTG, dmPFC, and TP are detected in the group comparisons and correlated with symptom severity when classifying PTSD individuals according to DSM-5 diagnostic criteria within an earthquake-exposed population.
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Affiliation(s)
- Xiaoyu Zhang
- Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jianxin Zhang
- Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wencai Zhang
- Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Kuester A, Köhler K, Ehring T, Knaevelsrud C, Kober L, Krüger-Gottschalk A, Schäfer I, Schellong J, Wesemann U, Rau H. Comparison of DSM-5 and proposed ICD-11 criteria for PTSD with DSM-IV and ICD-10: changes in PTSD prevalence in military personnel. Eur J Psychotraumatol 2017; 8:1386988. [PMID: 29163862 PMCID: PMC5687795 DOI: 10.1080/20008198.2017.1386988] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/20/2017] [Indexed: 11/02/2022] Open
Abstract
Background: Recently, changes have been introduced to the diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Objectives:This study investigated the effect of the diagnostic changes made from DSM-IV to DSM-5 and from ICD-10 to the proposed ICD-11. The concordance of provisional PTSD prevalence between the diagnostic criteria was examined in a convenience sample of 100 members of the German Armed Forces. Method: Based on questionnaire measurements, provisional PTSD prevalence was assessed according to DSM-IV, DSM-5, ICD-10, and proposed ICD-11 criteria. Consistency of the diagnostic status across the diagnostic systems was statistically evaluated. Results: Provisional PTSD prevalence was the same for DSM-IV and DSM-5 (both 56%) and comparable under DSM-5 versus ICD-11 proposal (48%). Agreement between DSM-IV and DSM-5, and between DSM-5 and the proposed ICD-11, was high (both p < .001). Provisional PTSD prevalence was significantly increased under ICD-11 proposal compared to ICD-10 (30%) which was mainly due to the deletion of the time criterion. Agreement between ICD-10 and the proposed ICD-11 was low (p = .014). Conclusion: This study provides preliminary evidence for a satisfactory concordance between provisional PTSD prevalence based on the diagnostic criteria for PTSD that are defined using DSM-IV, DSM-5, and proposed ICD-11. This supports the assumption of a set of PTSD core symptoms as suggested in the ICD-11 proposal, when at the same time a satisfactory concordance between ICD-11 proposal and DSM was given. The finding of increased provisional PTSD prevalence under ICD-11 proposal in contrast to ICD-10 can be of guidance for future epidemiological research on PTSD prevalence, especially concerning further investigations on the impact, appropriateness, and usefulness of the time criterion included in ICD-10 versus the consequences of its deletion as proposed for ICD-11.
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Affiliation(s)
- Annika Kuester
- Department of Clinical Psychology and Psychotherapy, Freie University Berlin, Berlin, Germany
| | - Kai Köhler
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Freie University Berlin, Berlin, Germany
| | - Louisa Kober
- Department of Psychological Assessment, Methodology and Legal Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | | | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Ulrich Wesemann
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
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Jha A, Shakya S, Zang Y, Pathak N, Pradhan PK, Bhatta KR, Sthapit S, Niraula S, Nehete R. Identification and treatment of Nepal 2015 earthquake survivors with posttraumatic stress disorder by nonspecialist volunteers: An exploratory cross-sectional study. Indian J Psychiatry 2017; 59:320-327. [PMID: 29085091 PMCID: PMC5659082 DOI: 10.4103/psychiatry.indianjpsychiatry_236_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT In April 2015, a major earthquake struck northern regions of Nepal affecting one-third of the population, and many suffered mental health problems. AIMS This study aimed to conduct a preliminary investigation of prevalence and feasibility of brief therapy for posttraumatic stress disorder (PTSD) among earthquake survivors. SETTINGS AND DESIGN This is an exploratory cross-sectional study of prevalence and feasibility of brief trauma-focused therapy for PTSD among survivors 3 and 11 months after the earthquake in affected areas near Kathmandu. METHODOLOGY A team of local nonspecialist mental health volunteers was trained to identify survivors with PTSD using the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) (cutoff score 38). They were trained to deliver either shortened versions of narrative exposure therapy (NET)-revised or group-based control-focused behavioral treatment (CFBT). RESULTS Altogether, 333 survivors were surveyed (130 in July 2015 and 203 in March 2016) with PCL-5 as the screening instrument, using the cutoff score of 38 or more for diagnosing PTSD. A PTSD prevalence of 33% was noted in 2015 and 28.5% in 2016. This drop of 4.5% prevalence in the intervening 8 months suggests that a significant number of survivors are still suffering from PTSD. Most participants were female, aged 40 or above, married, and poorly educated. Compared to the brief (four sessions) individual NET-revised, a group-based CFBT was found more acceptable and affordable. CONCLUSIONS PTSD is common following earthquake trauma, and if untreated, survivors continue to suffer for a long time. Management of PTSD should be included in future disaster management plans.
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Affiliation(s)
- Arun Jha
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Suraj Shakya
- Department of Psychiatry and Mental Health, TU Teaching Hospital, Kathmandu, Nepal
| | - Yinyin Zang
- Department of Psychiatry, Centre for the Treatment and Study of Anxiety, School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | | | - Khem Raj Bhatta
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Sabitri Sthapit
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Shanta Niraula
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Rajesh Nehete
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
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DSM-5 criteria for PTSD in parents of pediatric patients with epilepsy: What are the changes with respect to DSM-IV-TR? Epilepsy Behav 2017; 70:97-103. [PMID: 28412608 DOI: 10.1016/j.yebeh.2017.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/21/2022]
Abstract
Increasing literature suggests the need to explore for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy. The aim of the present study was to estimate full and partial PTSD rates among parents of children with epilepsy comparing DSM-5 and DSM-IV-TR criteria. Further, the aim of the present study was to examine possible gender differences between mothers and fathers. Results showed 9.1% and 12.1% PTSD rates in the total sample, according to DSM-5 or DSM-IV-TR criteria, respectively, with an overall consistency of 92.9% (Kohen's K=0.628, p=.453). Significant gender differences emerged for Avoidance/Numbing and Hyperarousal symptoms diagnosed by means of DSM-IV-TR criteria, as well as for Negative alterations in cognitions/mood and Hyperarousal symptoms, when adopting DSM-5 criteria. This study underscores the relevance of detecting PTSD in parents of children with a chronic illness such as epilepsy.
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Carmassi C, Bertelloni CA, Gesi C, Conversano C, Stratta P, Massimetti G, Rossi A, Dell'Osso L. New DSM-5 PTSD guilt and shame symptoms among Italian earthquake survivors: Impact on maladaptive behaviors. Psychiatry Res 2017; 251:142-147. [PMID: 28199913 DOI: 10.1016/j.psychres.2016.11.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/16/2016] [Accepted: 11/18/2016] [Indexed: 11/17/2022]
Abstract
Important changes were introduced concerning posttraumatic-stress disorder (PTSD) by the DSM-5 recognizing the role of negative emotions such as guilt and shame, but little evidence is yet available on their prevalence in population assessed by means of DSM-5 criteria. In this study we explored the rates of guilt and shame DSM-5 PTSD diagnostic symptoms among Italian survivors to a massive earthquake and their possible correlation with PTSD and maladaptive behaviors. 869 residents of the town of L'Aquila exposed to the earthquake of April 6th, 2009 were investigated by the Trauma and Loss Spectrum-Self Report (TALS-SR) with particular attention to guilt and shame feelings. DSM-5 symptomatological PTSD was reported by 41.7% of survivors, further 11.6% endorsed at least one guilt/shame symptoms, with significantly higher rates of endorsement were in PTSD respect to No-PTSD subjects, and in the subgroup with at least one maladaptive behavior respect to those with none. There was a significant main effects of PTSD and at least one guilt/shame symptom on TALS-SR symptomatological domains. Mean TALS-SR Maladaptive coping domain score appeared significantly higher in the subgroup with at least one guilt/shame symptom. Further study are needed to investigate guilt and shame feelings in survivors to a natural disaster.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | | | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Stratta
- Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Mikolajewski AJ, Scheeringa MS, Weems CF. Evaluating Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Posttraumatic Stress Disorder Diagnostic Criteria in Older Children and Adolescents. J Child Adolesc Psychopharmacol 2017; 27:374-382. [PMID: 28170306 PMCID: PMC5439440 DOI: 10.1089/cap.2016.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Few studies have assessed how the diagnostic criteria for posttraumatic stress disorder (PTSD) apply to older children and adolescents. With the introduction of a new, developmentally sensitive set of criteria for very young children (age 6 years and younger) in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), this raises new questions about the validity of the criteria for older children and adolescents. The current study investigated how diagnostic changes in DSM-5 impact diagnosis rates in 7-18-year olds. METHODS PTSD, impairment, and comorbid psychopathology were assessed in 135 trauma-exposed, treatment-seeking participants. Children (ages 7-12) were examined separately from adolescents (ages 13-18) to assess for potential developmental differences. RESULTS A significantly higher proportion of 7-12-year-old children met criteria for DSM-5 diagnosis (53%) compared to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (37%). However, among 13-18-year-old adolescents, the proportions diagnosed with DSM-5 (73%) and DSM-IV (74%) did not differ. Participants who met criteria for DSM-5 only (17%) did not differ from those diagnosed with DSM-IV in terms impairment or comorbidity. Using the newly accepted age 6 years and younger criteria resulted in a significantly higher proportion of 7-12-year-old (but not 13-18-year olds) children meeting criteria compared to DSM-IV or DSM-5. However, these children showed less impairment and comorbidity than those diagnosed with DSM-IV. CONCLUSION These findings suggest that DSM-5 criteria may be more developmentally sensitive than DSM-IV criteria, and may lead to higher prevalence rates of PTSD for 7-12-year-old children, but not for adolescents. Using the very young children criteria for 7-12-year-old children may further increase prevalence, but capture children with less severe psychopathology.
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Affiliation(s)
- Amy J. Mikolajewski
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Michael S. Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Carl F. Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa
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32
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Weathers FW. Redefining posttraumatic stress disorder for DSM-5. Curr Opin Psychol 2017; 14:122-126. [PMID: 28813310 DOI: 10.1016/j.copsyc.2017.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) was substantially redefined for DSM-5, with significant changes in nosology, definition of a traumatic stressor, and number and nature of symptom criteria. These updates, motivated by decades of empirical findings and clinical observation, provide better coverage of the full range of trauma-related clinical presentations while maintaining backward compatibility with previous versions of PTSD. Nonetheless, they have been criticized as being unwarranted, creating excessively complex criteria, and generating unacceptable levels of diagnostic discordance. However, when the goals and expectable effects of the DSM-5 PTSD revision process are considered in light of a growing number of relevant studies, the DSM-5 PTSD criteria perform well and represent a valuable incremental step in the ongoing evolution of the PTSD construct.
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Zhou X, Zhen R, Wu X. Posttraumatic stress disorder symptom severity and control beliefs as the predictors of academic burnout amongst adolescents following the Wenchuan Earthquake. Eur J Psychotraumatol 2017; 8:1412227. [PMID: 29296242 PMCID: PMC5738653 DOI: 10.1080/20008198.2017.1412227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/21/2017] [Indexed: 11/01/2022] Open
Abstract
Background: Previous studies indicate that posttraumatic stress disorder (PTSD) and control beliefs can affect burnout and their unique role in this situation has been examined, but fewer studies have examined their combined role in adolescent's academic burnout following traumatic events. Objective: This study examined the combined effect of PTSD symptom severity and control beliefs on academic burnout among adolescents, and assessed the moderating role of primary and secondary control beliefs in the relation between PTSD symptom severity and academic burnout. Methods: Seven hundred and forty-five adolescents were investigated using self-report questionnaires, and a series of regression equations examined the impact of PTSD severity and control beliefs on academic burnout. Results: PTSD symptom severity is associated positively with academic burnout, while primary and secondary control beliefs have a negative relation with academic burnout. In addition, primary control beliefs buffer the positive effects of PTSD symptom severity on academic burnout. We found that the positive relation between PTSD symptom severity and academic burnout in the low primary control beliefs group is more intense than that found in the high primary control beliefs group. Conclusions: PTSD symptom severity is a risk factor, whereas primary and secondary control beliefs are protective factors in academic burnout. In addition, PTSD symptom severity and primary control beliefs have a combined effect on academic burnout in adolescents following natural disasters.
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Affiliation(s)
- Xiao Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.,I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Rui Zhen
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Wang TY, Wei HT, Liou YJ, Su TP, Bai YM, Tsai SJ, Yang AC, Chen TJ, Tsai CF, Chen MH. Risk for developing dementia among patients with posttraumatic stress disorder: A nationwide longitudinal study. J Affect Disord 2016; 205:306-310. [PMID: 27552595 DOI: 10.1016/j.jad.2016.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/06/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Previous studies suggested a relationship between posttraumatic stress disorder (PTSD) in the specific population (i.e., war survivors and veterans) and subsequent dementia risk. However, whether patients with PTSD in the general population were at an increased risk for developing dementia in later life remained unclear. METHODS The Cox regression analysis was performed using data from the Taiwan National Health Insurance Research Database. The study sample comprised 1750 patients diagnosed with PTSD between 2001 and 2009 and 7000 age-/sex-matched individuals without PTSD. Those who developed dementia during follow-up to the end of 2011 were identified. RESULTS After adjusting for demographic data and medical and psychiatric comorbidities, PTSD was an independent risk factor for the risk for subsequent dementia (hazard ratio [HR]=4.37; 95% confidence interval [CI]: 2.53-7.55). There was a dose-dependent relationship between PTSD severity indicated by the frequency of psychiatric clinics visiting of PTSD (times per year) and the risk of subsequent dementia (<5: HR: 2.81, 95% CI: 1.50-5.29; 5-10: 6.90, 95% CI: 3.09-15.40;>10: HR: 18.13, 95% CI: 9.13-36.00). Furthermore, patients with depressive disorder and medical comorbidities, such as cerebrovascular diseases, diabetes mellitus, and head injuries, exhibited a higher risk for developing dementia. DISCUSSIONS Our study suggested a significant dose-dependent association between PTSD and its severity and an increased risk of developing dementia later in life. The importance of mental care for trauma victims would increase in the coming century, and our findings broadened another era for the end result of a widely prevalent psychiatric disorder.
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Affiliation(s)
- Tsung-Yang Wang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Forensic and Neurodevelopmental Sciences, London, United Kingdom
| | - Han-Ting Wei
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Psychiatry, Kunming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Ying-Jay Liou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Abstract
The first part of the series of three articles on posttraumatic stress disorder (PTSD) in Court to appear in the journal reviews the history of the construct of PTSD and its presentation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013) and the ICD-11 (International Classification of Diseases, 11th Edition; World Health Organization, 2018). There are 20 symptoms of PTSD in the DSM-5. PTSD symptoms are arranged into a four-cluster model, which has received partial support in the literature. Other four-factor models have been found that fit the data even better than that of the DSM-5. There is a five-factor dysphoria model and two six-factor models that have been found to fit better the DSM-5 PTSD symptoms. Finally, research is providing support for a hybrid seven-factor model. An eighth factor on dissociation seems applicable to the minority of people who express the dissociative subtype. At the epidemiological level, individuals can expect trauma exposure to take place about 70% over one's lifetime. Also, traumatic exposure leads to traumatic reactions in about 10% of cases, with PTSD being a primary diagnosis for trauma. Once initiated, PTSD becomes prolonged in about 10% of cases. Polytrauma and comorbidities complicate these prevalence statistics. Moreover, the possibility of malingered PTSD presents confounds. However, the estimate for malingered PTSD varies extensively, from 1 to 50%, so that the estimate is too imprecise for use in court without further research. This first article in the series of three articles appearing in the journal on PTSD in Court concludes with discussion of complications related to comorbidities and heterogeneities, in particular. For example, PTSD and its comorbidities can be expressed in over one quintillion ways. This complexity in its current structure in the DSM-5 speaks to the individual differences involved in its expression.
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Affiliation(s)
- Gerald Young
- Glendon Campus, York University, Toronto, Ontario, Canada.
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Milchman MS. Forensic implications of changes in DSM-5 criteria for responses to trauma and stress. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:163-182. [PMID: 27806889 DOI: 10.1016/j.ijlp.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
DSM-5 significantly changed the diagnostic criteria for Posttraumatic Stress Disorder (PTSD) relative to DSM-IV/DSM-IV-TR. These changes do not alter its basic approach to diagnosing mental disorders, which treats each disorder as a separate category. This article analyzes the strengths and weaknesses of the categorical approach, and reviews empirical evidence regarding the impact of changes within it on the ease or difficulty of receiving the PTSD diagnosis. It especially analyzes the impact of newly included symptoms that are meant to identify cases in which trauma exposure was associated with changes in more serious PTSD cases, known as Complex PTSD (C-PTSD). It proposes some effects that the changes could have on psychological injury claims. Many changes could support plaintiffs' claims while others could support defense claims. Some changes could support either. Overall, DSM-5 PTSD diagnosis is more responsive to individual differences in symptom presentations and appears able to diagnose some C-PTSD cases. The thesis throughout the article is that PTSD diagnostic accuracy could be improved further, especially for C-PTSD cases, by complementing its current exclusive reliance on behavioral symptoms that are characteristic of victims in general with assessment of the meaning that the symptoms have for individual victims. The article proposes some principles to guide interpretation of the individualized meaning of victims' symptoms, which help make the reasoning behind the interpretations explicit.
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Stratta P, Sanità P, Bonanni RL, de Cataldo S, Angelucci A, Rossi R, Origlia N, Domenici L, Carmassi C, Piccinni A, Dell'Osso L, Rossi A. Clinical correlates of plasma brain-derived neurotrophic factor in post-traumatic stress disorder spectrum after a natural disaster. Psychiatry Res 2016; 244:165-70. [PMID: 27479108 DOI: 10.1016/j.psychres.2016.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/26/2016] [Accepted: 07/09/2016] [Indexed: 12/30/2022]
Abstract
Clinical correlates of plasma Brain-Derived Neurotrophic Factor (BDNF) have been investigated in a clinical population with Post Traumatic Stress Disorder (PTSD) symptoms and healthy control subjects who survived to the L'Aquila 2009 earthquake. Twenty-six outpatients and 14 control subjects were recruited. Assessments included: Structured Clinical Interview for DSM-IV Axis-I disorders Patient Version, Trauma and Loss Spectrum-Self Report (TALS-SR) for post-traumatic spectrum symptoms. Thirteen patients were diagnosed as Full PTSD and 13 as Partial PTSD. The subjects with full-blown PTSD showed lower BDNF level than subjects with partial PTSD and controls. Different relationship patterns of BDNF with post-traumatic stress spectrum symptoms have been reported in the three samples. Our findings add more insight on the mechanisms regulating BDNF levels in response to stress and further proofs of the utility of the distinction of PTSD into full and partial categories.
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Affiliation(s)
- Paolo Stratta
- Department of Mental Health, ASL 1, L'Aquila, Italy.
| | - Patrizia Sanità
- General Pathology and Immunology Laboratory, Department Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | | | - Adriano Angelucci
- General Pathology and Immunology Laboratory, Department Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | - Luciano Domenici
- Neuroscience Institute, CNR, Pisa, Italy; Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Armando Piccinni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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DiGangi J, Ohanian D, Jason LA. A Factor Analysis of PTSD with Latino Samples with Substance Use Disorders. ACTA ACUST UNITED AC 2016; 4. [PMID: 29201943 PMCID: PMC5708568 DOI: 10.13188/2330-2178.1000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective The Post - Traumatic Stress Disorder (PTSD) factor structure is not a generally agreed upon concept. It has remained controversial and its’ efficacy regarding different trauma presentations is still in question. Therefore, it is imperative that we evaluate different conceptualizations of the PTSD factor structure. This study aims to understand how PTSD is structured when comorbid with Substance Use Disorder (SUD). Method We evaluated presentations of PTSD - SUD from a Latino community based sample. This was done using several accepted models of the PTSD factor structure. We then performed an exploratory factor analysis of the factor structure of PTSD when comorbid with SUD. Results We found that the factor structure of PTSD - SUD was different from the structure presented in the DSM - IV and other empirically validated structural models. Conclusion The factor structure of PTSD may need to include a separate structure when PTSD is comorbid with SUD. Cultural differences when structuring the PTSD diagnosis should also be considered.
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Affiliation(s)
- Julia DiGangi
- Center for Community Research, DePaul University, Chicago, USA
| | - Diana Ohanian
- Center for Community Research, DePaul University, Chicago, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, USA
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Carmassi C, Stratta P, Calderani E, Bertelloni CA, Menichini M, Massimetti E, Rossi A, Dell'Osso L. Impact of Mood Spectrum Spirituality and Mysticism Symptoms on Suicidality in Earthquake Survivors with PTSD. JOURNAL OF RELIGION AND HEALTH 2016; 55:641-649. [PMID: 26112609 DOI: 10.1007/s10943-015-0072-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to explore the correlations between Spirituality/Mysticism/Psychoticism symptoms and suicidality in young adult survivors of the L'Aquila earthquake. The sample included 475 subjects recruited among high school seniors who had experienced the April 6, 2009, earthquake. Assessments included: Trauma and Loss Spectrum-Self Report and Mood Spectrum-Self Report (MOODS-SR). Mysticism/Spirituality dimension and suicidality were evaluated by means of some specific items of the MOOD-SR. The Spirituality/Mysticism/Psychoticism MOODS-SR factor score was significantly higher among subjects with PTSD diagnosis with respect to those without. Similarly, subjects with suicidal ideation, as well as those who committed a suicide attempt, reported significantly higher scores than those without.
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Affiliation(s)
- Claudia Carmassi
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | - P Stratta
- Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - E Calderani
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - C A Bertelloni
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - M Menichini
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - E Massimetti
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - A Rossi
- Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - L Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy
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40
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Dai W, Chen L, Tan H, Wang J, Lai Z, Kaminga AC, Li Y, Liu A. Association between social support and recovery from post-traumatic stress disorder after flood: a 13-14 year follow-up study in Hunan, China. BMC Public Health 2016; 16:194. [PMID: 26924178 PMCID: PMC4770534 DOI: 10.1186/s12889-016-2871-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/16/2016] [Indexed: 11/25/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is one of the most prevalent long-term psychiatric disorders among survivors of traumatic events. It is well established that social support has been related to the onset of PTSD after natural disasters. However, very little is known whether or not social support has had an influence on the recovery from the PTSD that was diagnosed after floods. This study, therefore, made a follow-up assessment of PTSD in flood victims 13–14 years after they were diagnosed with PTSD in 2000 to measure the prevalence rate of PTSD among them and identify the association between social support and their recovery from PTSD. Methods Victims who had experienced Dongting Lake flood in 1998 and had been diagnosed as having PTSD in 2000 were enrolled in this study. A follow-up survey was done between the years 2013 and 2014 to diagnose the victims again of PTSD using the DSM-IV criteria. Social support and its three dimensions were measured using the Chinese version of Social Support Rating Scale (SSRS), including objective support, subjective support and support utilization. Data were collected through face-to-face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were used to examine the relationship between social support and the recovery from PTSD after flood. Results Out of 321 subjects with prior PTSD, 51 (15.89 %) were diagnosed as still having PTSD. Logistic regression analyses indicated that the recovery from prior PTSD was significantly associated with social support (odds ratio (OR) =0.202, 95 % confidence interval (95 % CI): 0.047–0.878), subjective support (OR = 0.236, 95 % CI: 0.080–0.694) and support utilization (OR = 0.245, 95 % CI: 0.071–0.844). Conclusions The prevalence rate of current PTSD indicates that natural disasters, such as floods, may affect the mental health of victims for a long time. Social support was significantly associated with the recovery from prior PTSD, especially subjective support and support utilization.
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Affiliation(s)
- Wenjie Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China.
| | - Long Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China. .,Zhuhai Center for Disease Control and Prevention, Guangdong, China.
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China.
| | - Jieru Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China. .,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA.
| | - Zhiwei Lai
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China.
| | - Atipatsa C Kaminga
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China.
| | - Yan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China.
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China.
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41
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Carmassi C, Gesi C, Simoncini M, Favilla L, Massimetti G, Olivieri MC, Conversano C, Santini M, Dell'Osso L. DSM-5 PTSD and posttraumatic stress spectrum in Italian emergency personnel: correlations with work and social adjustment. Neuropsychiatr Dis Treat 2016; 12:375-81. [PMID: 26937192 PMCID: PMC4762463 DOI: 10.2147/ndt.s97171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) has recently recognized a particular risk for posttraumatic stress disorder (PTSD) among first responders (criterion A4), acknowledging emergency units as stressful places of employment. Little data is yet available on DSM-5 among emergency health operators. The aim of this study was to assess DSM-5 symptomatological PTSD and posttraumatic stress spectrum, as well as their impact on work and social functioning, in the emergency staff of a major university hospital in Italy. One hundred and ten subjects (doctors, nurses, and health-care assistants) were recruited at the Emergency Unit of the Azienda Ospedaliero-Universitaria Pisana (Italy) and assessed by the Trauma and Loss Spectrum-Self Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). A 15.7% DSM-5 symptomatological PTSD prevalence rate was found. Nongraduated persons reported significantly higher TALS-SR Domain IV (reaction to loss or traumatic events) scores and a significantly higher proportion of individuals presenting at least one maladaptive behavior (TALS-SR Domain VII), with respect to graduate ones. Women reported significantly higher WSAS scores. Significant correlations emerged between PTSD symptoms and WSAS total scores among health-care assistants, nongraduates and women. Our results showed emergency workers to be at risk for posttraumatic stress spectrum and related work and social impairment, particularly among women and nongraduated subjects.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Marly Simoncini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Luca Favilla
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Maria Cristina Olivieri
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Emergency Medicine and Emergency Room Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Massimo Santini
- Emergency Medicine and Emergency Room Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Soberón C, Crespo M, Del Mar Gómez-Gutiérrez M, Fernández-Lansac V, Armour C. Dimensional structure of DSM-5 posttraumatic stress symptoms in Spanish trauma victims. Eur J Psychotraumatol 2016; 7:32078. [PMID: 27974133 PMCID: PMC5156862 DOI: 10.3402/ejpt.v7.32078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Confirmatory factor analytic studies have shown that posttraumatic stress disorder (PTSD) symptoms included in the fifth edition of the Diagnostic and Statistical Manual Disorders (DSM-5) may be better explained by two 6-factor models (the Externalizing Behaviours model and the Anhedonia model) and a 7-factor Hybrid model. The latter model comprises the symptom clusters of intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, and anxious and dysphoric arousal. This model has received empirical support mainly in American samples. Of note, there have been a limited number of studies conducted on samples from other countries. OBJECTIVE This study aimed to examine the underlying dimensionality of DSM-5 PTSD symptoms in a Spanish clinical sample exposed to a range of traumatic events. METHOD Participants included 165 adults (78.8% females) seeking treatment in trauma services in the Madrid area (Spain). PTSD was assessed using the Global Assessment of Posttraumatic Stress Scale 5, a Spanish self-report instrument assessing posttraumatic symptoms according to the DSM-5 criteria. Confirmatory factor analyses were conducted in Mplus. RESULTS Both the 7-factor Hybrid model and the 6-factor Anhedonia model demonstrated good and equivalent fit to the data. CONCLUSIONS The findings of this study replicate and extend previous research by providing support for both the 7-factor Hybrid model and the 6-factor Anhedonia model in a clinical sample of Spanish trauma survivors. Given equivalent fit for these two models and the fewer number of latent factors in the Anhedonia model, it was selected as optimal in a traumatized Spanish sample. Implications and future research directions are discussed.
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Affiliation(s)
- Carmen Soberón
- Department of Clinical Psychology, Complutense University, Madrid, Spain
| | - María Crespo
- Department of Clinical Psychology, Complutense University, Madrid, Spain;
| | | | | | - Cherie Armour
- Psychology Research Institute, University of Ulster, Coleraine, Northern Ireland
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43
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Predictors of the new criteria for probable PTSD among older adults. Psychiatry Res 2015; 230:777-82. [PMID: 26586141 DOI: 10.1016/j.psychres.2015.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/12/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
The definition of post-traumatic stress disorder (PTSD) changed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) and it is yet unclear how these changes affect the diagnosis of PTSD among older adults. The present study examined the contribution of demographic characteristics, functioning status, health related factors, as well as exposure to rocket attacks to prediction of probable PTSD in older adults. Three-hundred and thirty-nine community-dwelling adults (age range 50-90; M=65.44, SD=9.77) were sampled through random dialing to Jewish residents in the south of Israel. Participants completed a phone-questionnaire that collected background information and reports of relevant symptoms. Analyses showed that self-rated health, incidence of depression episodes, and exposure to rocket attacks predicted the DSM-5 definition of PTSD as well as the subscale of negative alternations in cognition and mood. The current study delineates the unique set of predictors of probable PTSD in older adults, with an emphasis on negative alternations in cognition and mood. Greater attention to unique predictors of PTSD in the second half of life is called for.
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44
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Rosellini AJ, Stein MB, Colpe LJ, Heeringa SG, Petukhova MV, Sampson NA, Schoenbaum M, Ursano RJ, Kessler RC. APPROXIMATING A DSM-5 DIAGNOSIS OF PTSD USING DSM-IV CRITERIA. Depress Anxiety 2015; 32:493-501. [PMID: 25845710 PMCID: PMC4490033 DOI: 10.1002/da.22364] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Diagnostic criteria for DSM-5 posttraumatic stress disorder (PTSD) are in many ways similar to DSM-IV criteria, raising the possibility that it might be possible to closely approximate DSM-5 diagnoses using DSM-IV symptoms. If so, the resulting transformation rules could be used to pool research data based on the two criteria sets. METHODS The pre-post deployment study (PPDS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) administered a blended 30-day DSM-IV and DSM-5 PTSD symptom assessment based on the civilian PTSD Checklist for DSM-IV (PCL-C) and the PTSD Checklist for DSM-5 (PCL-5). This assessment was completed by 9,193 soldiers from three US Army Brigade Combat Teams approximately 3 months after returning from Afghanistan. PCL-C items were used to operationalize conservative and broad approximations of DSM-5 PTSD diagnoses. The operating characteristics of these approximations were examined compared to diagnoses based on actual DSM-5 criteria. RESULTS The estimated 30-day prevalence of DSM-5 PTSD based on conservative (4.3%) and broad (4.7%) approximations of DSM-5 criteria using DSM-IV symptom assessments were similar to estimates based on actual DSM-5 criteria (4.6%). Both approximations had excellent sensitivity (92.6-95.5%), specificity (99.6-99.9%), total classification accuracy (99.4-99.6%), and area under the receiver operating characteristic curve (0.96-0.98). CONCLUSIONS DSM-IV symptoms can be used to approximate DSM-5 diagnoses of PTSD among recently deployed soldiers, making it possible to recode symptom-level data from earlier DSM-IV studies to draw inferences about DSM-5 PTSD. However, replication is needed in broader trauma-exposed samples to evaluate the external validity of this finding.
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Affiliation(s)
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California,VA San Diego Healthcare System, San Diego, California
| | - Lisa J. Colpe
- National Institute of Mental Health, Bethesda, Maryland
| | - Steven G. Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts,Correspondence to: Ronald C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston MA 02115. Tel. (617) 432-3587, Fax (617) 432-3588,
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Ciocca G, Carosa E, Stornelli M, Limoncin E, Gravina GL, Iannarelli R, Sperandio A, Di Sante S, Lenzi A, Lauro D, Jannini EA. Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L'Aquila earthquake. Acta Diabetol 2015; 52:513-21. [PMID: 25408297 DOI: 10.1007/s00592-014-0686-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
AIM After natural and collective catastrophes, many behavioral phenomena can occur through psychobiological responses that involve also the diabetic condition.The aim of this study was to investigate post-traumatic stress disorder (PTSD) and coping strategies in type 2 diabetic patients after L'Aquila earthquake, with a particular attention to the newly diagnosed patients and to the gender differences. METHODS Among the local diabetic population, we recruited 100 diabetic patients (46 women and 54 men). Sixty of these had diabetes before the earthquake (pre-quake patients), and other 40 received diabetes diagnosis after the earthquake (post-quake patients). A psychometric protocol composed by Davidson Trauma Scale for PTSD and Brief-COPE for coping strategies was administered. RESULTS We found significant differences in the levels of PTSD when comparing both post-quake with pre-quake patients (post-quake = 51.72 ± 26.05 vs. pre-quake = 31.65 ± 22.59; p < 0.05) and the female patients with males (women = 53.50 ± 27.01 vs. men = 31.65 ± 23.06; p < 0.05) and also in the prevalence [post-quake = 27/40 (67.5 %) vs. pre-quake = 20/60 (33.3 %); p < 0.05], [women = 27/46 (58.69 %) vs. men = 16/54 (29.62 %); p < 0.05]. Moreover, maladaptive coping was a predictive factor for PTSD in the post-quake group only (OR 1.682; 95 % CI 1.155-2.450; p = 0.006). CONCLUSIONS Our results revealed that PTSD may be considered an important comorbidity factor in newly diagnosed patients and in diabetic women. Hence, a psychological support seems particularly important in these patients after a collective traumatic event to help them react to both PTSD and diabetes and to help them improve their coping skills.
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Affiliation(s)
- Giacomo Ciocca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Impact of DSM-5 PTSD and gender on impaired eating behaviors in 512 Italian earthquake survivors. Psychiatry Res 2015; 225:64-69. [PMID: 25454114 DOI: 10.1016/j.psychres.2014.10.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/16/2014] [Accepted: 10/05/2014] [Indexed: 11/22/2022]
Abstract
Considerable comorbidity rates between Post-traumatic Stress Disorder (PTSD) and eating disorders have been recently reported, as well as increased obesity and underweight conditions. The aim of the present study was to investigate the possible associations between DSM-5 PTSD, gender and impaired eating habits in a sample of 512 Italian earthquake survivors evaluated by the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Mood Spectrum-Self Report (MOODS-SR). Alterations in eating behaviors were assessed by means of four MOODS-SR items: n=150 (…there was no food that appealed to you or tasted good to you?), n=151 (…you constantly craved sweets or carbohydrates?), n=152 (…your appetite or weight decreased?), n=153 (…your appetite or weight increased?). In a Decision Tree procedure subjects with PTSD with respect to those without and, in the No-PTSD subgroup, females with respect to males, had a significantly higher ratio of at least one MOODS-SR eating behavior item (MOODS-SR EB). In the No-PTSD subgroup only, subjects with at least one MOODS-SR EB presented a significantly higher mean TALS-SR symptomatological domains total score with respect to those without MOODS-SR EB. In conclusion, alterations in eating behaviors were associated with PTSD after the L׳Aquila earthquake; among survivors without PTSD significant a correlation emerged between MOODS-SR EB and PTSD symptoms.
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Dell'Osso B, Albert U, Atti AR, Carmassi C, Carrà G, Cosci F, Del Vecchio V, Di Nicola M, Ferrari S, Goracci A, Iasevoli F, Luciano M, Martinotti G, Nanni MG, Nivoli A, Pinna F, Poloni N, Pompili M, Sampogna G, Tarricone I, Tosato S, Volpe U, Fiorillo A. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatr Dis Treat 2015; 11:1885-909. [PMID: 26257524 PMCID: PMC4525786 DOI: 10.2147/ndt.s83130] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy ; Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Torino, Italy
| | - Anna Rita Atti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Arianna Goracci
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, and Clinical Science, University G.d Annunzio, Chieti-Pescara, Italy
| | - Maria Giulia Nanni
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandra Nivoli
- Psychiatric Institute, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy ; Bipolar Disorder Unit, CIBERSAM, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Nicola Poloni
- Department of Clinical and Experimental Medicine, Psychiatric Division, University of Insubria, Varese, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Umberto Volpe
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Alterations in circadian/seasonal rhythms and vegetative functions are related to suicidality in DSM-5 PTSD. BMC Psychiatry 2014; 14:352. [PMID: 25496184 PMCID: PMC4297401 DOI: 10.1186/s12888-014-0352-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alterations in rhythmicity and vegetative functions have been reported as correlates of suicidality, particularly in patients with mood disorders. No investigation has addressed their impact on patients with post-traumatic stress disorder (PTSD). Aim of the present study was to fulfill this gap. METHODS Sixty-five out- and inpatients with DSM-5 PTSD were assessed by using the Mood Spectrum-Self Report-Lifetime Version (MOODS-SR), a questionnaire for lifetime mood spectrum symptomatology including alterations in circadian/seasonal rhythms and vegetative functions. Six items of the MOODS-SR were combined and dichotomized to assess suicidal ideation and/or attempts. RESULTS Significant and positive associations were found between symptoms of lifetime dysregulations in rhythmicity and vegetative functions and suicidal ideation and/or attempts. All MOODS-SR sub-domains (rhythmicity, sleep, appetite/weight, sexual function, physical symptoms) were associated with an increased likelihood of suicidal ideation, but only changes in appetite/weight were associated with greater odd ratios of suicide attempts (OR = 2.099, 95% CI 1.148-3.841). CONCLUSIONS Our results suggest that lifetime dysregulations in rhythmicity and vegetative functions may represent correlates of suicidality in patients with DSM-5 PTSD.
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Carmassi C, Dell’Osso L, Manni C, Candini V, Dagani J, Iozzino L, Koenen KC, de Girolamo G. Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: analysis from the World Mental Health Survey Initiative. J Psychiatr Res 2014; 59:77-84. [PMID: 25266475 PMCID: PMC4313080 DOI: 10.1016/j.jpsychires.2014.09.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/28/2022]
Abstract
Epidemiological studies have examined the relative importance of Traumatic Events (TEs) in accounting for the societal burden of post-traumatic stress disorder (PTSD). However, most studies used the worst trauma experienced, which can lead to an overestimation of the conditional risk of PTSD. Although a number of epidemiological surveys on PTSD have been carried out in the United States, only a few studies in limited sample have been conducted in Italy. This study, carried out in the framework of the World Mental Health Survey Initiative, is a cross-sectional household survey of a representative sample of the Italian adult population. Lifetime prevalence of TEs and 12-month prevalence of PTSD were evaluated using the Composite International Diagnostic Interview (CIDI). Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Network events was the most commonly reported class of TEs (29.4%). War events had the highest conditional risk of PTSD (12.2%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (24.1%) and having seen atrocities (18.2%). Being female was related to high risk of PTSD after experiencing a TE. Exposure to network events is commonly reported among Italian adults, but two TEs are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.
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Affiliation(s)
- Claudia Carmassi
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Italy.
| | - Liliana Dell’Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa. Via Roma 67, 56126
| | - Corrado Manni
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Italy.
| | - Valentina Candini
- IRCCS St John of God Clinical Research Centre, Via Pilastroni 4, 25125 Brescia, Italy.
| | - Jessica Dagani
- IRCCS St John of God Clinical Research Centre, Via Pilastroni 4, 25125 Brescia, Italy.
| | - Laura Iozzino
- IRCCS St John of God Clinical Research Centre, Via Pilastroni 4, 25125 Brescia, Italy.
| | - Karestan C. Koenen
- Department Of Epidemiology, Mailman School Of Public Health, Columbia University, 722 West 168th Street, Room 720G, New York, NY 10032
| | - Giovanni de Girolamo
- IRCCS St John of God Clinical Research Centre, Via Pilastroni 4, 25125 Brescia, Italy.
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50
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Hafstad GS, Dyb G, Jensen TK, Steinberg AM, Pynoos RS. PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway. J Affect Disord 2014; 169:40-6. [PMID: 25129534 DOI: 10.1016/j.jad.2014.06.055] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/02/2014] [Accepted: 06/30/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnostic criteria for Posttraumatic Stress Disorder (PTSD) have been revised for DSM-5. Two key changes include alteration of the clustering of PTSD symptoms and new PTSD symptom criteria related to negative alterations in cognition and mood. In this study, we empirically investigated these changes. METHODS We interviewed 325 adolescents and young adults who survived the 2011 youth camp shooting at Utøya Island, Norway. The UCLA PTSD Reaction Index for DSM-IV was used to assess symptoms of PTSD. In addition, 11 questions were added to assess the four new symptom criteria within the new DSM-5 symptom categories. RESULTS PTSD prevalence did not differ significantly whether DSM-IV (11.1%) or DSM-5 (11.7%) criteria were used and the Cohen׳s Kappa for consistency between the diagnoses was 0.061. Confirmatory factor analyses showed that the four-factor structure of the DSM-5 fit the data adequately according to the conceptual model outlined. LIMITATIONS The homogeneity of this sample of highly exposed subjects may preclude generalization to less severely exposed groups. Also, we did not assess criterion G in regard to symptoms causing clinically significant distress and functional impairment. CONCLUSION The prevalence of PTSD was quite similar regardless of diagnostic system. The relatively low concordance between the diagnoses has implications for eligibility for a diagnosis of PTSD.
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Affiliation(s)
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tine K Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Alan M Steinberg
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Robert S Pynoos
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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