Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria

Identifying post-traumatic stress symptom typologies in clinical and non-clinical healthcare staff: a latent profile analysis

Background: There has been growing concern regarding increasing levels of post-traumatic stress (PTS) symptoms experienced by healthcare workers (HCW) in the UK, particularly following the COVID-19 pandemic.Objectives: PTS symptom typologies have been investigated in other adult populations using person-centred latent variable approaches, revealing profiles showing differing symptom levels and patterns. We aimed to explore typologies among clinical and non-clinical healthcare staff to elucidate heterogeneity of presentation.  Methods: This was a retrospective study using referral data from treatment-seeking healthcare staff in the North of England (N = 1600). We employed latent profile analysis using the PTSD International Trauma Questionnaire domains as profile indicators. We included covariates relating to role-type, depression, anxiety and mental health concerns before March of 2020.   Results: A model with six profiles fit the data best. Profile names were given as follows: 'No symptom'; 'Low symptom'; 'Low symptom (moderate Sense of current threat (Th_dx) and Functional impairment (FI))'; 'Moderate symptom (low Th_dx and high Avoidance (Av_dx))'; 'Moderate symptom'; and 'High symptom'. Covariates were shown to have differential predictive power on profile membership. Conclusions: The finding of profiles with pattern differences suggests a need for both differential and specifically targeted treatments, as well as a consideration of early intervention for those individuals with subclinical PTS symptoms. As expected, anxiety and depression were both predictors of several of the symptomatic profiles, with anxiety producing a larger effect. Further research is required to fully understand the link between role-type and PTS symptom typologies among HCW. .

The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic

Background: Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic.Methods: HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the sample when controlling for sex, age, depression, anxiety, stress, and childhood adversity.Results: A structural equation model independently regressing both MI and MD onto PTSD accounted for 74.4% of the variance in PTSD symptoms. Here, MI was strongly and significantly associated with PTSD symptoms (β = .412, p < .0001) to a higher degree than MD (β = .187, p < .0001), after controlling for age, sex, depression, anxiety, stress and childhood adversity. A model regressing a combined MD and MI construct onto PTSD predicted approximately 87% of the variance in PTSD symptoms (r2 = .87, p < .0001), with MD/MI strongly and significantly associated with PTSD (β = .813, p < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity.Conclusion: Our results support a relation between MI and PTSD among HCWs and suggest that a combined MD and MI construct is most strongly associated with PTSD symptoms. Further research is needed better understand the mechanisms through which MD/MI are associated with PTSD.

Anxiety and mood disorders in forcibly displaced people across the world

PURPOSE OF REVIEW

Displaced persons around the world have intensified in the previous decade and are predicted to rise further with greater global instability. The mental health issues involved with fleeing one's home, and attempting to make a new life in a host country need to be understood and addressed.

RECENT FINDINGS

Prevalence of anxiety and mood disorders, including posttraumatic stress disorder appear to be higher for displaced peoples than for the population in the host country. This is consistent across different methods. Traumatic life events in the country of origin as well as during flight contribute to symptom severity. Factors in the host country increasing severity including isolation, discrimination, low social support. There are successfully implemented intercultural interventions at the individual level of the practitioner, as well as at the institutional level.

SUMMARY

There are many possibilities for successful interventions in displaced people, realizing this at a scale appropriate to the size of the problem remains a challenge.

Steroid Hormones as Modulators of Emotional Regulation in Male Urogenital Cancers

BACKGROUND

Tumors develop within an organism operating in a specific social and physical environment. Cortisol and dehydroepiandrosterone (DHEA), two of the most abundant steroid hormones in humans, are involved in both emotional regulation and the tumor progression. Several studies reported preclinical findings that DHEA can have preventive and therapeutic efficacy in treating major age-associated diseases, including cancer, although the mechanisms of action are not yet defined. The main aim of current study was to investigate the relationship between psychological and physiological emotional regulation and cancer development.

METHOD

This study assessed the quality of life of urogenital cancer male patients using several validated tools, including the Functional Assessment of Cancer Therapy-General and the Profile of Mood States. Saliva samples were collected to monitor peripheral activity of both cortisol and DHEA. It was hypothesized that patients with a better quality of life would have higher levels of the DHEA/cortisol ratios.

RESULTS

We found that the quality of life was positively related to DHEA, but not cortisol levels. Negative mood increases were related to lower levels of DHEA. Logistic regression of the predictors of metastases indicated three main independent factors involved: DHEA, age, and cortisol. In other words, the higher the DHEA levels in comparison to cortisol levels, controlling for age, the lower the probability of metastases.

CONCLUSION

Our results appear to support the hypothesis that emotional dysregulation mediated by DHEA/cortisol activity is a key factor in the probability of metastasis in urogenital cancers.

Mapping PTSD, depression, and anxiety: A network analysis of co-occurring symptoms in treatment-seeking first responders

First responders are at high risk for a range of co-occurring mental health conditions due to their repeated exposure to traumatic events. When first responders present for treatment, their complex presentation of symptoms including posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) can prove challenging to differentiate for clinical purposes. Network analysis provides a means to identify the nuanced associations between the symptoms of these conditions and to identify groups of related symptoms. In this study, a treatment-seeking sample of first responders (N = 432) completed self-report measures of PTSD, depression, and GAD. Network analysis was used to identify symptom clusters within the sample. Our cross-sectional data yielded six empirically distinct communities: depression symptoms, GAD symptoms, and four communities comprising PTSD symptoms - intrusion and avoidance; irritability and aggression; negative affect; and arousal and sleep. Network associations underscore the heterogeneity of PTSD and also highlight overlapping and diverging symptoms of depression and GAD. These findings are discussed within the context of existing research on first responders, and recommendations for further study and treatment interventions are provided.

Exploring gender differences in the relationships among childhood maltreatment, PTSD, and depression in young adults through network analysis

BACKGROUND AND OBJECTIVES

College students who have experienced childhood maltreatment commonly exhibit adverse psychological consequences such as post-traumatic stress disorder (PTSD) and depression. The aim of this study is to use network analysis to investigate the gender differences in complex connections among various types of childhood maltreatment, PTSD, and depression.

METHODS

This study involved 481 participants (M = 19.25 years, 54.5 % female) who were selected from a larger sample of 5231 college students. These participants had experienced childhood maltreatment and exhibited significant clinical symptoms of PTSD and depression. The participants completed validated measures that assessed childhood trauma, PTSD, and depression.

RESULTS

The network analysis performed on the entire sample revealed robust connections among various types of childhood maltreatment, symptom clusters of PTSD, and depression. The most central symptom that emerged was negative alterations in cognitions and mood (NACM), with emotional abuse displaying the highest centrality measure among the various types of childhood maltreatment. Upon comparing the subnetworks, the centrality analysis identified significant gender differences in nodes such as sexual abuse, physical neglect, emotional neglect, and avoidance.

CONCLUSIONS

The study's findings confirm that various forms of childhood abuse have intricate and multifaceted connections with depression and PTSD symptoms in adulthood. The study suggests that NACM could be the most significant symptom, and emotional abuse may play a vital role in adverse psychological outcomes. Furthermore, notable gender discrepancies were identified in the relationship between various forms of maltreatment and psychopathological symptoms.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of Veterans

OBJECTIVE

Veterans can present at nongovernment (Department of Defense, Department of Veterans Affairs) mental health agencies with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no veteran study has validated these measures on a treatment-seeking sample of veterans outside the DoD and VA.

METHODS

We used a treatment-seeking sample of veterans ( N = 493) to validate measures that assess these constructs (PTSD Checklist 5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7).

RESULTS

The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting model of the depression measure was a two-factor structure, cognitive-affective, and somatic depression. The measure of generalized anxiety was a unidimensional model.

LIMITATIONS

Follow-up studies should validate these measures on nontreatment-seeking discharged veterans.

CONCLUSIONS

We interpret these findings within the veteran scholarship and explore clinical implications for providers.

Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees

Importance

Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms.

Objective

To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees.

Design, Setting, and Participants

For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers.

Exposure

Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises.

Main Outcomes and Measures

Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance.

Results

For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health.

Conclusions and Relevance

The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics.

The Role of Emotion Dysregulation in the Relationship Between Sleep Disturbances and PTSD Symptom Severity

ABSTRACT

Emotion dysregulation is implicated in the development, maintenance, and treatment of sleep disturbances and posttraumatic stress disorder (PTSD) separately. However, few studies have assessed interactions among these variables. To address this gap, this study examined whether the associations of sleep quality and sleep quantity with PTSD severity were stronger at higher levels of negative and positive emotion dysregulation in a community sample of 199 trauma-exposed individuals. This study found that both poorer sleep quality and lower sleep quantity were associated with greater PTSD severity at low to average (but not high) levels of negative emotion dysregulation. Positive emotion dysregulation did not moderate the relationships between sleep quality or quantity and PTSD severity. Exploratory additive multiple moderation analyses showed significant associations between poorer sleep quality and lower sleep quantity with greater PTSD severity at low to average levels of negative emotion dysregulation, coupled with any level of positive emotion dysregulation. Findings inform theoretical perspectives on the sleep-PTSD relationship and clinical applications of targeting emotion dysregulation in the treatment of sleep disturbances and PTSD symptoms for trauma-exposed individuals.

Affective Depression Mediates PTSD to Suicide in a Sample of Treatment-Seeking First Responders

OBJECTIVE

The aim of this study was to examine the associations of comorbid posttraumatic stress disorder (PTSD), affective or somatic depression, and suicide among first responders (FRs).

METHOD

We used baseline data from FRs ( N = 232) who sought services at a nonprofit mental health agency specializing in treating trauma exposed FRs. We conducted two PROCESS simple mediation models with PTSD as the predictor, affective depression and somatic depression as the mediators, and suicidality as the dependent variable.

RESULTS

Affective depression significantly mediated the relationship between PTSD and suicidality, whereas somatic depression did not. The direct effect of PTSD on suicidality was not significant.

LIMITATIONS

These data are cross-sectional and should be followed up with longitudinal analyses across the course of treatment.

CONCLUSIONS

To reduce suicide risk, it is recommended that clinicians target affective depression instead of PTSD symptoms.

Network analysis of distress, suicidality, and resilience in a treatment seeking sample of first responders

INTRODUCTION

First responders are routinely and regularly exposed to traumatic events that can clinically manifest with a symptom constellation of posttraumatic stress disorder (PTSD), generalized anxiety, depression, and suicidality.

METHODS

We used network analysis to examine baseline data from treatment seeking first responders (n = 308) to examine the interrelatedness of those constructs, including a measure of resilience. We estimated two models: a regularized partial correlation network and a Bayesian Directed Acyclic Graph (DAG).

RESULTS

The models reveal converging evidence highlighting the central role of negative alterations in cognitions and mood PTSD cluster along with affective depression. These nodes did not significantly differ, though they were among the strongest in the partial correlation network and shared the most variance with the other nodes. The DAG results suggested that the negative alterations in cognitions and mood PTSD cluster predicted downstream constructs of affective depression; intrusion, hyperarousal, and avoidance PTSD clusters; and resilience. Only resilience and affective depression exhibited direct effects on suicidality. Both somatic depression and suicidality were endogenous endpoints in the DAG. Resilience exhibited an inverse path to suicide. However, resilience was relatively independent of the other constructs in the models and the DAG suggested that it was a consequence of PTSD related distress.

LIMITATIONS

The data is cross-sectional in nature that should be followed up in longitudinal studies.

CONCLUSION

Findings are discussed in respect to the role of distress and emotional dysregulation as common factors underlying a broad range of internalizing problems.

An examination of the heterogeneity of the relationships between posttraumatic stress disorder, self-compassion and gratitude

Previous research has found both self-compassion and gratitude to be protective against overall posttraumatic stress disorder (PTSD) symptom severity. PTSD is a highly heterogeneous disorder; however, it is unclear if these protective constructs are differentially associated with each cluster of PTSD. The present study examined differences in the association of self-compassion and gratitude with the four clusters of PTSD as indicated by the DSM-5. Participants were 1424 trauma-exposed individuals recruited via Amazon's Mechanical Turk. The mean age of participants was 31.49 (SD = 11.25) years old, and 55.3% of the sample identified as female. A structural equation model (SEM) approach was used to examine relationships between factors of gratitude, self-compassion and the four PTSD symptom clusters. A two-factor model of self-compassion best fits the data. Both the self-compassion and gratitude factors were significantly associated with all symptom clusters of PTSD. Wald chi-square tests indicated self-compassion and gratitude to have the strongest association with negative alterations in cognitions and mood (NACM) PTSD symptoms. These findings may have important implications for treatment targets to reduce specific symptoms of PTSD, particularly in PTSD symptoms related to negative affect.

Pediatric Medical Traumatic Stress in Inflammatory Bowel Disease, Pancreatitis, and Cystic Fibrosis

OBJECTIVES

Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to (1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, (2) explore potential risk factors for PMTS, and (3) explore potential consequences of PMTS.

METHODS

This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives.

RESULTS

Over two-thirds of children reported a medical potentially traumatic event (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work.

CONCLUSIONS

A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children's health and quality of life.

Order effects in PTSD network analysis: important implications for diagnostic conceptualization, treatment refinement, and research

BACKGROUND

For decades confirmatory factor analysis (CFA) has been the preeminent method to study the underlying structure of posttraumatic stress disorder (PTSD); however, methodological limitations of CFA have led to the emergence of other analytic approaches. In particular, network analysis has become a gold standard to investigate the structure and relationships between PTSD symptoms. A key methodological limitation, however, which has significant clinical implications, is the lack of data on the potential impact of item order effects on the conclusions reached through network analyses.

METHODS

The current study, involving a large sample (N = 5055) of active duty army soldiers following deployment to Iraq, assessed the vulnerability of network analyses and prevalence rate to item order effects. This was done by comparing symptom networks of the DSM-IV PTSD checklist items to these same items distributed in random order. Half of the participants rated their symptoms on traditionally ordered items and half the participants rated the same items, but in random order and interspersed between items from other validated scales. Differences in prevalence rate and network composition were examined.

RESULTS

The prevalence rate differed between the ordered and random item samples. Network analyses using the ordered survey closely replicated the conclusions reached in the existing network analyses literature. However, in the random item survey, network composition differed considerably.

CONCLUSION

Order effects appear to have a significant impact on conclusions reached from PTSD network analysis. Prevalence rates were also impacted by order effects. These findings have important diagnostic and clinical treatment implications.

Incidences of anxiety disorders among active duty service members between 1999 and 2018

PURPOSE

Anxiety disorders can impact the health, performance, and retention of military service members. To inform prevention initiatives and long-term treatment planning, incidence rates across anxiety disorders were evaluated among U.S. active-duty service members over a 20-year period.

METHOD

Data were extracted from the Defense Medical Epidemiological Database to examine incidence rates of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), obsessive compulsive disorder (OCD), agoraphobia with panic disorder (AWPD), agoraphobia without history of panic disorder (AWOPD), and unspecified anxiety disorder (UAD) among 151,844 service members between 1999 and 2018 in relation to sex, age, race, marital status, military pay grade, service branch.

RESULTS

Incidence rates of anxiety disorders increased significantly over the 20-year period. Anxiety disorder incidence rates ranged widely from 0.01 to 23.70 (per 1000 service members). There were significant differences in observed versus expected diagnostic rates across all demographic variables examined (p < 0.001).

CONCLUSION

Incidence rates varied considerably across the anxiety disorders, with UAD being the highest. These data highlight the importance of health care professionals attending to anxiety disorders, in order to plan for service member needs, develop preventative interventions, address early detection, and deliver treatments to improve combat readiness.

The nosographic structure of posttraumatic stress symptoms across trauma types: An exploratory network analysis approach

The nosographic structure of posttraumatic stress disorder (PTSD) remains unclear, and attempts to determine its symptomatic organization have been unsatisfactory. Several explanations have been suggested, and the impact of trauma type is receiving increasing attention. As little is known about the differential impact trauma type in the nosographic structure of PTSD, we explored the nosology of PTSD and the effect of trauma type on its symptomatic organization. We reanalyzed five cross-sectional psychopathological networks involving different trauma types, encompassing a broad range of traumatic events in veterans, war-related trauma in veterans, sexual abuse, terrorist attacks, and various traumatic events in refugees. The weighted topological overlap was used to estimate the networks and attribute weights to their links. Coexpression differential network analysis was used to identify the common and specific network structures of the connections across different trauma types and to determine the importance of symptoms across the networks. We found a set of symptoms with more common connections with other symptoms, suggesting that these might constitute the prototypical nosographic structure of PTSD. We also found a set of symptoms that had a high number of specific connections with other symptoms; these connections varied according to trauma type. The importance of symptoms across the common and specific networks was ascertained. The present findings offer new insights into the symptomatic organization of PTSD and support previous research on the impact of trauma type on the nosology of this disorder.

Longitudinal PTSD symptom trajectories: Relative contributions of state anxiety, depression, and emotion dysregulation

BACKGROUND

Prospective research on the development and trajectory of PTSD symptoms after a traumatic event is crucial for assessment and early intervention. Further, examining predictors of PTSD pathology provides a better conceptualization of the temporal course of PTSD in trauma victims.

METHODS

The present study examined PTSD symptom severity in individuals presenting to the emergency department (ED) following a traumatic event. Participants (N = 147) were assessed at four timepoints: 2-weeks, 3-months, between 6 and 9 months, and 12-months after ED admission. Growth curve modeling was conducted to examine changes in PTSD symptom severity over time. Age, sex, state anxiety, trait anxiety, emotion dysregulation, depression, and trauma type (motor vehicle accident [MVA] and assault), and PTSD diagnosis were included as covariates in the model.

RESULTS

Results demonstrated that baseline PTSD symptom severity was positively associated with severity of depression and state (but not trait) anxiety, emotion dysregulation, and PTSD diagnosis. Results also revealed significant associations with PTSD symptom changes over time; greater state anxiety and depression symptoms at baseline were associated with steeper declines in PTSD symptoms over time.

LIMITATIONS

Data were collected at only four timepoints over the course of 12-months. Results may be different with more measurement points over longer periods and inclusion of pre-, peri- and post-trauma risk factors.

CONCLUSIONS

Results illustrate the relevance of assessing state anxiety, depression, and emotion dysregulation in following trauma victims for trauma-related psychopathology over the course of time to alleviate the negative impact of the same.

Adverse Childhood Experiences, Mindfulness, and Grit in College Students in China

This study investigated the effect of ACEs and COVID-19 on grit and whether this effect is mediated by mindfulness. Although current scholarship has found that adverse childhood experiences (ACEs) have harmful consequences to individuals across the life span, less is known about the relationship between ACEs and grit. Grit is predictive of educational success and subjective wellbeing. A cross-sectional online survey administered to junior and senior students from 12 universities spread across China was conducted from September 20, 2020 to October 5, 2020. The universities were selected from geographically diverse regions of China to ensure a diverse sample. We received 1,871 completed responses from 2,229 invited students. The survey response rate was 83.9%. The results indicated that ACEs had significantly negative effects on grit, while mindfulness had significantly positive effects on grit. Once controlling for level of mindfulness, the effects of ACEs on grit largely reduced and became insignificant. The findings of this research indicate that mindfulness has a significant mediational effect on the relation between ACEs and grit and call for mindfulness-based interventions for enhancing grit for the population at risks.

Objective Cognitive Outcomes and Subjective Emotional Sequelae in Litigating Adults with a Traumatic Brain Injury: The Impact of Performance and Symptom Validity Measures

OBJECTIVE

This study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance.

METHOD

Participants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression.

RESULTS

A total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance.

CONCLUSION

Validity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.

Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention

Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.

Anxiety, depression and post-traumatic stress symptoms among injury patients and the association with outcome after injury

BACKGROUND

Injury patients are at risk for mental health problems, which could result in slower recovery and affect health-related quality of life (HRQoL), health care utilization, and return to work (RTW).

OBJECTIVE

In this study, we determined the prevalence of symptoms indicative of probable depression, anxiety, and post-traumatic stress disorder (PTSD) and their association with HRQoL, health care utilization, and RTW in adult injury patients.

METHOD

Data on unintentional injuries in adult patients were retrieved from the Dutch Injury Surveillance System (DISS) and a six-month follow-up questionnaire that included the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R) to assess depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and items on HRQoL (measured with the EQ-5D-5 L and EQ visual analogue scale), health care utilization and RTW. Logistic regression analyses assessed the association between depression, anxiety, and PTSD and HRQoL, health care utilization, and RTW.

RESULTS

At six months post-injury, 22% (n = 665/3060) of included patients had scores indicative of probable anxiety disorder (14%), depression (16%), and/or PTSD (6%). These patients had reduced EQ-5D utility scores [β: -0.26 (95% CI: -0.28, -0.23)] and were less likely to RTW [OR: 2.12 (95% CI: 1.34, 3.37)] compared to their counterparts. Both mental and physical health care utilization were significantly higher in patients with symptoms indicative of depression, anxiety, and/or PTSD.

CONCLUSIONS

In injury patients, there is a high occurrence of depression, anxiety, and PTSD symptoms, which is associated with lower HRQoL, higher health care utilization, and lower RTW rates. These results underline the importance of screening and treatment of these symptoms in this population to enhance good recovery of injury patients.

Comparison of Posttraumatic Stress Disorder Checklist Instruments From Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition vs Fifth Edition in a Large Cohort of US Military Service Members and Veterans

IMPORTANCE

The definition of posttraumatic stress disorder (PTSD) changed markedly between the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and DSM-5, creating challenges for studies and in medical settings spanning this transition.

OBJECTIVE

To evaluate the ability to compare and assess PTSD, based on DSM-IV and DSM-5 criteria, using PTSD Checklists (PCLs).

DESIGN, SETTING, AND PARTICIPANTS

This diagnostic study was conducted with survey data collected in October 2019, from the Millennium Cohort Study, a population-based US military cohort study. The population for the present study was restricted to a subset of initial web responders of the 2019 survey cycle, randomly assigned to 1 of 4 survey groups.

EXPOSURES

Each group received the DSM-IV and DSM-5 PCL (PCL-Civilian [PCL-C] version and PCL for DSM-5 [PCL-5]). PCL instruments were counterbalanced to control for order effects.

MAIN OUTCOMES AND MEASURES

Survey data were used to assess PTSD (using the PCL-C and PCL-5), major depressive disorder (using the Patient Health Questionnaire), generalized anxiety (using the Generalized Anxiety Disorder scale), and problem drinking (using the Patient Health Questionnaire). Demographic and military characteristics included age, sex, race/ethnicity, marital status, education, service branch, pay grade, enrollment panel, and military service status.

RESULTS

Among the 1921 participants (mean [SD] age, 50.1 [12.5] years), 1358 (70.7%) were men, 1638 (85.3%) were non-Hispanic White individuals, 1440 (75.0%) were married, and 1190 (61.9%) had at least a bachelor's degree; 295 (15.4%) had probable PTSD according to DSM-IV criteria with PCL-C compared with 286 (14.9%) using DSM-5 criteria with PCL-5 (κ = 0.77). There was substantial agreement between PCLs for probable PTSD based on DSM-IV criteria (295 [15.4%] with PCL-C; 316 [16.4%] with PCL-5; κ = 0.80) and DSM-5 criteria (286 [14.9%] with PCL-5; 258 [13.4%] with PCL-C; κ = 0.77). Estimated PTSD sum scores showed excellent agreement with observed scores. Using an established crosswalk, PCL-5 sum scores estimated with the PCL-C were similar to observed PCL-5 scores. Of the 17 corresponding items between the 2 instruments, 16 had substantial agreement. Appending 2 additional PCL-C items to the PCL-5 did not significantly alter estimates. The PCL-C and PCL-5 had nearly identical associations with comorbid conditions.

CONCLUSIONS AND RELEVANCE

The findings of this diagnostic study suggest that PTSD can be successfully assessed and compared over time with either PCL instrument in veteran and military populations.

Passion and Persistence: Investigating the Relationship Between Adverse Childhood Experiences and Grit in College Students in China

Adverse childhood experiences (ACEs) are known to have deleterious effects on individuals across the life span, but less is known about how they affect grit, a strong predictor of achievements and well-being. This study seeks to investigate the effect of ACEs on grit in a sample of Chinese college students during the COVID-19 pandemic. Data were collected from 1,871 students across 12 universities in China. Findings indicated a significant effect of ACEs on grit, particularly abuse and neglect dimensions of ACE. Since grit is particularly important for professional success, those who have experienced abuse and neglect victimization may struggle throughout their education, and subsequently, in their careers. This calls for interventions to buffer the effects of ACEs on grit.

Psychiatric Co-Morbidities in Post-Traumatic Stress Disorder: Detailed Findings from the Adult Psychiatric Morbidity Survey in the English Population

Post Traumatic Stress Disorder (PTSD) is a condition which causes great sufferance to the individuals affected. The occurrence of comorbidities in PTSD is a frequent event with a negative impact on outcome. This study investigated the frequency of PTSD in relation to comorbidities by analyzing the results of the 2007 'Adult Psychiatric Morbidity Survey' in the English population, which included data on comorbidities. A population study conducted in the United Kingdom, this survey investigated the frequency of PTSD in the community and the relationship to comorbidities by adopting a random design to minimize selection bias, stratified by region and socioeconomic characteristics, and weighted according to design and non-response. The survey interviewed 7403 adults living in private households. Socio-demographic characteristics and psychiatric morbidity were systematically assessed. Results indicated that PTSD prevalence was 2.9%, with an excess in women (3.3%) compared to men (2.4%) as reported by the 2007 survey. Comorbidity was a very frequent occurrence in PTSD reaching 78.5% in affected cases. Major depression was the commonest condition and its frequency increased with symptoms severity up to 54%. Among anxiety disorders, social phobia was the most frequent, followed by generalized anxiety disorder, obsessive-compulsive disorder, agoraphobia and panic disorder. Substance use disorders were also common. The presence of psychotic symptoms was particularly significant with over 30% prevalence in PTSD. These results indicate that attention needs to be devoted to the presence of comorbidities. In view of the impact of comorbidities on PTSD severity, chronicity and functional impairment, early detection and treatment are likely to improve outcome.

Dissociative Symptoms In Posttraumatic Stress Disorder: A Systematic Review

Objectives: Research on dissociative symptomatology in the context of Posttraumatic Stress Disorder (PTSD) has been gaining traction, with dissociation being studied as a set of complex symptoms following trauma exposure and as a specific subtype of PTSD. The aims of this review are to summarize the literature as it stands, examine the efficacy of existing interventions in treating dissociative symptomatology within the context of PTSD, and offer potential suggestions for future research. Methods: A systematic approach was taken to locate empirical studies on PTSD that included dissociation as an outcome in the PubMed, Scopus, and PsycINFO databases. Recent experimental designs with adult subjects (18+ years) in the English language were included, yielding 103 potentially eligible studies. Thirty-three full-text articles were screened with 17 articles meeting criteria for inclusion in the systematic review. Results: Designs, populations, treatments, and inventories were extremely diverse. Most therapies did not target dissociation specifically, although the results of this review suggest that PTSD patients who experience dissociative symptoms could benefit from trauma-focused treatments, which often significantly reduced dissociative and trauma-related symptoms. Conclusion: Future work should consider the evaluation of dissociation as a unique outcome to gain understanding about the nature of traumatic stress and to develop treatment options for its many presentations. The current literature displays limited generalizability to the treatment of individuals with high dissociation, which is a line of inquiry that should be explored. More RCTs are needed.

Symptom structure of PTSD and co-morbid depressive symptoms - a network analysis of combat veteran patients

BACKGROUND

Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.

METHODS

PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.

RESULTS

The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.

CONCLUSIONS

Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.

The Relationship of Acculturation, Traumatic Events and Depression in Female Refugees

Recent research has identified significant correlations between traumatic events and depression in refugees. However, few studies have addressed the role of acculturation strategies in this relationship. This study explored the relationship between cultural orientation, traumatic events and depression in female refugees from Syria, Afghanistan, Eritrea, Iran, Iraq, and Somalia living in Germany. We expected acculturation strategies to moderate the effect of traumatic experiences on depression. The sample included 98 female refugees in Germany. The depression scale of the Hopkins Symptom Checklist (HSCL) represented the dependent measure. The trauma checklists derived from the Post-traumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ) as well as the Frankfurt Acculturation Scale (FRACC) were used as independent measures for traumatic events and orientation toward the host culture as well as orientation toward the culture of origin, respectively. A moderation analysis was conducted to examine whether the relationship between the number of traumatic events and depression was influenced by the women's orientation toward the culture of origin and the host culture. We identified a significant model explaining 26.85% of the variance in depressive symptoms (Cohen's f2 = 0.37). The number of traumatic events and the orientation toward the host culture exerted significant effects on depressive symptoms. The moderating effect was not significant, indicating that the effect of the number of traumatic events was not influenced by cultural orientation. Based on our results, orientation toward the host culture as well as traumatic experiences exert independent effects on depressive symptoms in refugees.

The role of emotion dysregulation in negative affect reactivity to a trauma cue: Differential associations through elicited posttraumatic stress disorder symptoms

BACKGROUND

Recent research has linked emotion dysregulation with increases in subjective ratings of negative affect (NA reactivity) to trauma reminders, a central symptom of posttraumatic stress disorder (PTSD). The current study adds to this burgeoning line of research by exploring elicited PTSD symptoms as a mechanism explicating the relation between emotion dysregulation and NA reactivity following trauma cue exposure.

METHODS

Participants were 60 treatment-seeking marijuana users with insomnia symptoms who reported exposure to a traumatic event. Participants were administered questionnaires assessing emotion dysregulation, PTSD symptoms, and NA prior to and/or after listening to a personalized trauma script, and subsequently completed a diagnostic interview.

RESULTS

Results demonstrated that greater emotion dysregulation was associated with heightened NA reactivity through re-experiencing symptoms, but not avoidance or dissociation symptoms, even after accounting for past 30-day PTSD symptom severity and pre-trauma script NA. These effects were driven by the dimensions of emotion dysregulation characterized by nonacceptance of negative emotions and limited access to effective emotion regulation strategies.

LIMITATIONS

This study requires replication among other clinical samples, and is limited by use of self-report measures.

CONCLUSIONS

Findings provide novel empirical support for one mechanism through which emotion dysregulation may confer vulnerability to PTSD symptomology, and offer implications for refining PTSD treatments.

The short-term dynamics of posttraumatic stress disorder symptoms during the acute posttrauma period

BACKGROUND

The manner in which posttraumatic stress disorder (PTSD) develops remains largely unknown. PTSD is comprised of 20 symptoms across 4 clusters. These clusters were hypothesized to reflect a failure of recovery model in which intrusive symptoms appear first. Intrusive symptoms led to avoidance of trauma-related stimuli, which resulted in sustained arousal. The sustained arousal ultimately led to dysphoria.

METHODS

This hypothesized symptom progression was evaluated during the acute posttrauma period (the first 30 days postevent). Participants (N = 80) reported their PTSD symptoms for 30 days via mobile devices. Using a short-term dynamic modeling framework, a temporal and contemporaneous model of PTSD symptoms was obtained.

RESULTS

In the temporal network, a fear-conditioning component was identified that supported the hypothesized set of relations among symptom clusters. The contemporaneous network was classified by two subnetworks. The first corresponded to a fear-conditioning model that included symptoms of intrusions and avoidance. The second included symptoms of dysphoria and arousal.

CONCLUSIONS

These findings suggest that, after a trauma, there may be a fear-conditioning process that involves intrusions, avoidance, and arousal symptoms. Dysphoric symptoms were also present but developed as a partially distinct component.

Acute Restraint Stress Evokes Anxiety-Like Behavior Mediated by Telencephalic Inactivation and GabAergic Dysfunction in Zebrafish Brains

Acute stress is an important factor in the development of anxiety disorders. Zebrafish are an organism model widely used by studies that aim to describe the events in the brain that control stress-elicited anxiety. The goal of the current study was to evaluate the pattern of cell activation in the telencephalon of adult zebrafish and the role of the GABAergic system on the modulation of anxiety-like behavior evoked by acute restraint stress. Zebrafish that underwent acute restraint stress presented decreased expression of the c-fos protein in their telencephalon as well as a significant decrease in GABA release. The data also supports that decreased GABA levels in zebrafish brains have diminished the activation of GABAA receptors eliciting anxiety-like behavior. Taken together these findings have helped clarify a neurochemical pathway controlling anxiety-like behavior evoked by acute stress in zebrafish while also opening the possibility of new perspective opportunities to use zebrafish as an animal model to test anxyolitic drugs that target the GABAergic system.

Predictors of Depression, Anxiety and Stress Indicators in a Cohort of Women with Chronic Pelvic Pain

OBJECTIVE

Establishing predictors of mental health outcomes is a crucial precursor to the development and assessment of psychological interventions for women with chronic pelvic pain (CPP). The objective of this study was to identify predictors of depression, anxiety and stress in a cohort of women with CPP.

DESIGN

Cross-sectional analytic study.

METHODS

Pre-treatment questionnaires were collected from 212 women with CPP, who had attended a private specialist pelvic pain clinic over a period of 18 months. Multivariate linear regression with backwards elimination was used to determine the best joint predictors of depression, anxiety and stress scores on the Depression, Anxiety and Stress Scale-21 item (DASS 21).

RESULTS

Of 19 potential predictor variables, seven key predictors of depression, anxiety and stress indicators were identified. Higher depression scores were associated with higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, having experienced pain as a child, and never having been pregnant before. Higher anxiety scores were associated with higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, younger age of menarche, and younger age. Predictors of high-stress scores were higher current pain severity, a history of stabbing pains, prior experience of a sexually distressing event, and being younger.

CONCLUSION

We have identified several important predictors of mental health in women with CPP. Using this information, psychological assessment and treatment for these women may be better tailored to client needs.

Efficacy of eye movement desensitization & reprocessing versus cognitive behavioral therapy in Post-Traumatic Stress and Depressive Symptoms: Study protocol for a Randomized Controlled Trial

Post-Traumatic Stress Disorder(PTSD) develops after exposure to or witnessing traumatic events. PTSD is highly comorbid and individuals with PTSD usually report Depressive Symptoms(DS). Common treatment choices for PTSD and DS are either EMDR or CBT, however, little is known about their comparative efficacy, especially in Pakistan. Therefore, this Randomized Controlled Trial(RCT) aims at determining the comparative efficacy of EMDR vs CBT in Pakistan. This study will also examine the association between reduction in symptoms of PTSD and DS over course of treatment. In this regard, two arms Crossover Randomized Controlled Trial(RCT) with Repeated Measures Design will be selected. This study will be conducted at two rehabilitation centers and patients will be screened at Time:01, baseline; Time:02, during treatment; Time:03, post treatment and Time:04, 06 months follow-up. All analyses will be performed according to intention-to-treat principle. Variations in symptoms will be analysed by using descriptive statistics, χ 2 tests, t-tests, and one way ANOVA. To examine changes in PTSD and DS across time and to check efficacy of each treatment, a series of Linear Mixed Models will be run. Furthermore, a series of multi-level lagged mediation analysis will be performed to check bi-directional mediation between changes PTSD and DS over time. This protocol has outlined the rationale for determining efficacy of EMDR and CBT in Pakistan. It will help in answering a broad range of questions concerning efficacy of newly developed evidence-based treatments. Moreover, it may also guide future research on the treatment of PTSD and DS in the developing countries.

Post-traumatic stress and major depressive disorders in parent caregivers of children with a chronic disorder

Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are the most common psychiatric consequences among caregivers of pediatric patients affected by severe chronic illnesses. The aims of this study were to describe rates of PTSD and MDD in a sample of parents of epileptic children, and to examine the correlations between symptoms of post-traumatic stress and depression. Parents of children with epilepsy were enrolled and screened by means of the PTSD module of the Semi-Structured Clinical Interview for DSM-5 (SCID-5) and of the Hamilton Rating Scale for depression (HAM-D). They also completed the Trauma and Loss Spectrum Self-Report (TALS-SR), an international instrument to evaluate post-traumatic stress spectrum symptoms. Results revealed PTSD rates of 15.7% (19.5% mothers, 8,1% fathers; p = .043) and MDD rates of 7.5% (10.2% mothers,1.8% fathers; p = .064). A model of multiple linear regression indicated a significant B linear regression coefficient between being mothers (p = .012), witnessing tonic-clonic seizures (p = .015) and having higher TALS-SR total score (p < .001) as predictors of HAM-D total score. Our findings highlight the relationship between PTSD and MDD, evidencing the need for further studies on pediatric caregivers aimed to develop specific intervention programs of healthcare prevention and assistance.

Trauma-associated anterior cingulate connectivity during reward learning predicts affective and anxiety states in young adults

BACKGROUND

Trauma exposure is associated with development of depression and anxiety; yet, some individuals are resilient to these trauma-associated effects. Differentiating mechanisms underlying development of negative affect and resilience following trauma is critical for developing effective interventions. One pathway through which trauma could exert its effects on negative affect is reward-learning networks. In this study, we examined relationships among lifetime trauma, reward-learning network function, and emotional states in young adults.

METHODS

One hundred eleven young adults self-reported trauma and emotional states and underwent functional magnetic resonance imaging during a monetary reward task. Trauma-associated neural activation and functional connectivity were analyzed during reward prediction error (RPE). Relationships between trauma-associated neural functioning and affective and anxiety symptoms were examined.

RESULTS

Number of traumatic events was associated with greater ventral anterior cingulate cortex (vACC) activation, and lower vACC connectivity with the right insula, frontopolar, inferior parietal, and temporoparietal regions, during RPE. Lower trauma-associated vACC connectivity with frontoparietal regions implicated in regulatory and decision-making processes was associated with heightened affective and anxiety symptoms; lower vACC connectivity with insular regions implicated in interoception was associated with lower affective and anxiety symptoms.

CONCLUSIONS

In a young adult sample, two pathways linked the impact of trauma on reward-learning networks with higher v. lower negative affective and anxiety symptoms. The disconnection between vACC and regions implicated in decision-making and self-referential processes may reflect aberrant regulatory but appropriate self-focused mechanisms, respectively, conferring risk for v. resilience against negative affective and anxiety symptoms.

Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury

OBJECTIVES

Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4-1/2 years prior to evaluation.

METHODS

Retrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center.

RESULTS

One-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments.

CONCLUSIONS

Results confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.

The Prevalence of PTSD Symptoms and Depressive Symptoms and Related Predictors in Children and Adolescents 3 Years After the Ya'an Earthquake

The objectives of this study were to investigate the prevalence of post-traumatic stress disorder (PTSD) symptoms and depressive symptoms in teenage survivors three years after the Ya'an earthquake to assess the differences between left-behind (LBC) and non-left-behind (non-LBC) children, and to explore predictors for PTSD symptoms and depressive symptoms. The participants were assessed using children's revised impact of event scale (CRIES) and short mood and feelings questionnaire (SMFQ), after which t tests, Chi square tests, and a multivariate logistic regression were conducted to examine the differences in the LBC and identify the associated predictors. It was found that the PTSD and depressive symptom prevalences were 13.10% and 20.75%, with the LBC having a significantly higher prevalence than the non-LBC. The PTSD and depression symptoms tended to be highly comorbid (r = .52, p < .001). Being female, being aged less than 15, having siblings, being an LBC, and having higher exposure were found to be associated with PTSD and depressive symptoms.

The symptoms at the center: Examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis

Comorbid mental health disorders are highly common in trauma-exposed individuals with posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) among the most common co-occurring conditions. Network models of psychopathology offer a novel method to understand how this comorbidity manifests. The present study examined the presence of symptom communities (groups of highly connected symptoms) within a network of these disorders and hub symptoms (symptoms that connect such communities). Cross-sectional data were obtained from a community sample (N = 1184) of trauma exposed adults. Network analyses identified 5 communities: 1 containing all depression and GAD symptoms and 4 for PTSD. The PTSD communities corresponded to symptoms of intrusion and avoidance, hyperarousal, dysphoria, and negative affect. These communities had varying levels of connectivity to the Depression & GAD community. Symptoms of GAD (inability to relax) and PTSD (restricted or diminished positive emotion) were identified as key hub symptoms for the network. The results suggest symptoms of depression and GAD are highly interrelated and that PTSD is heterogeneous. The comorbidity among these diagnoses is thought to stem from their overlap with negative affect.

Detecting PTSD in a traumatically injured population: The diagnostic utility of the PTSD Checklist for DSM-5

BACKGROUND

The posttraumatic stress disorder (PTSD) Checklist for DSM-5 (PCL-5) is among few validated measures of PTSD severity in line with the DSM-5. Validation efforts among veteran samples have recommended cut scores of 33 and 38 to indicate PTSD; cut scores vary across populations depending on factors such as trauma type. The purpose of this study was to evaluate the diagnostic utility of and identify optimal cut scores for the PCL-5 in relation to the gold standard Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) among traumatically injured individuals 6 months after discharge from a level I trauma center.

METHODS

A total of 251 participants completed the PCL-5 and CAPS-5 6 months after discharge from a level I trauma center following traumatic injury. Receiver operating characteristic curve analyses detailed diagnostic accuracy of the PCL-5 and identified the optimal cut score via Youden's J index. Cut scores were also broken down by intentional versus nonintentional injury.

RESULTS

The PCL-5 produces satisfactory diagnostic accuracy, with adequate sensitivity and specificity, in a traumatically injured population. Estimates indicate the optimal cut score as >30; the optimal cut score for intentional injuries was >34 and >22 for nonintentional injuries.

CONCLUSIONS

This investigation provides support for the PCL-5 in detection of PTSD among injured individuals 6 months after discharge from a level I trauma center. PCL-5 specificity and sensitivity suggest clinicians working with this population can feel confident in using this measure over more onerous structured interviews (e.g., CAPS-5). This study signifies a move toward ensuring those experiencing mental health difficulties after traumatic injury are identified and connected to resources.

Changes in the levels of depressive symptoms and anxiety in Ansan city after the 2014 Sewol ferry disaster

BACKGROUND

In April 2014, a ferry carrying 476 passengers sunk on the coast of Korea, resulting in 304 deaths. Of these, 250 were local high school students, and the disaster significantly affected their community. This study aimed to examine the prevalence of depressive symptoms and anxiety among Ansan city residents to understand their recovery process after the accident.

METHODS

Two cross-sectional surveys (survey 1, after 4-6 months and survey 2, after 16-18 months of disaster) were used to compare prevalence among residents of Ansan city and adjacent cities. Symptoms were determined by the Center for Epidemiologic Studies-Depression Scale and the Generalized Anxiety Disorder 7-item Scale.

RESULTS

A total of 1,773 and 1,748 participants were included in Survey 1 and Survey 2, respectively. Survey 1 showed a significantly higher prevalence of depressive symptoms (19.0%; 95% confidence interval [CI], 16.9-21.1) and anxiety (6.1%; 95% CI, 5.0-7.5) among Ansan city, compared to participants from adjacent cities (depressive symptoms: 14.3%; 95% CI, 12.7-16.1; anxiety: 3.6%; 95% CI, 2.9-4.5). Survey 2 showed a decreased prevalence of depression (15.8%; 95% CI, 14.0-17.9) and anxiety (5.0%; 95% CI, 4.0-6.4) among Ansan city residents. Depressive symptoms and anxiety adjusted odds ratio in survey 2 compared with survey 1 were 0.74 (95% CI 0.62-0.89) and 0.81 (0.60-1.08) among Ansan city, respectively.

LIMITATIONS

Cross-sectional study design and lack of pre-disaster baseline data for comparison are limitations of this study.

CONCLUSIONS

Psychological distress occurred at a population level, not only among survivors and their families, but also among Ansan city residents indirectly impacted by the traumatic event. Although populations indirectly affected by a disaster show a natural recovery process, timely population-based interventions may be helpful.

Risk Factors, Clinical Presentations, and Functional Impairments for Generalized Anxiety Disorder in Military Personnel and the General Population in Canada

OBJECTIVE

This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP).

METHOD

Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 ( N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 ( N = 8,161; response rate = 79.8%).

RESULTS

The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD.

CONCLUSION

GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile.

Crowdsourcing Trauma: Psychopathology in a Trauma-Exposed Sample Recruited via Mechanical Turk

Although crowdsourcing websites like Amazon's Mechanical Turk (MTurk) allow researchers to conduct research efficiently, it is unclear if MTurk and traditionally recruited samples are comparable when assessing the sequela of traumatic events. We compared the responses to validated self-report measures of posttraumatic stress disorder (PTSD) and related constructs that were given by 822 participants recruited via MTurk and had experienced a DSM-5 Criterion A traumatic event to responses obtained in recent samples of participants recruited via traditional methods. Results suggested that the rate of PTSD in the present sample (19.8%) was statistically higher than that found in a recent systematic review of studies that used only traditional recruitment methods. The severity of PTSD reported in the MTurk sample was significantly greater than that reported in a college sample, d = 0.24, and significantly less than that reported in a veteran sample, d = 0.90. The factor structure of PTSD found in the MTurk sample was consistent with prevailing models of PTSD. Findings indicate that crowdsourcing may improve access to this hard-to-reach population.

Heterogeneity in the Strength of the Relation Between Social Support and Post-Trauma Psychopathology

Potentially traumatic events (PTEs) increase risk for psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Social support (SS) is associated with reduced symptoms for each disorder. Each disorder, however, is highly heterogeneous such that they are comprised of clusters of different symptoms. It is unclear if SS is associated with all clusters equally. The current study examined the relation between SS and the symptom clusters of each disorder. Participants completed a battery of self-report assessments for PTSD, MDD, GAD, and SS. All participants experienced a Criterion A traumatic event. Although SS was significantly associated with all symptom clusters, the strength of relations varied. The relation between SS and MDD-affective was significantly stronger than its association with all other factors. The relations between SS and GAD, MDD-somatic, PTSD-AAR, and PTSD-NACM did not significantly differ. These relations were stronger than the relations between SS and the remaining PTSD factors. There was no significant difference in the relations between SS and PTSD-intrusions or PTSD-avoidance. These results suggest that SS is more closely aligned to specific aspects of post-trauma psychopathology.

A network analysis of DSM-5 posttraumatic stress disorder and functional impairment in UK treatment-seeking veterans

Network analysis is a relatively new methodology for studying psychological disorders. It focuses on the associations between individual symptoms which are hypothesized to mutually interact with each other. The current study represents the first network analysis conducted with treatment-seeking military veterans in UK. The study aimed to examine the network structure of posttraumatic stress disorder (PTSD) symptoms and four domains of functional impairment by identifying the most central (i.e., important) symptoms of PTSD and by identifying those symptoms of PTSD that are related to functional impairment. Participants were 331 military veterans with probable PTSD. In the first step, a network of PTSD symptoms based on the PTSD Checklist for DSM-5 was estimated. In the second step, functional impairment items were added to the network. The most central symptoms of PTSD were recurrent thoughts, nightmares, negative emotional state, detachment and exaggerated startle response. Functional impairment was related to a number of different PTSD symptoms. Impairments in close relationships were associated primarily with the negative alterations in cognitions and mood symptoms and impairments in home management were associated primarily with the reexperiencing symptoms. The results are discussed in relation to previous PTSD network studies and include implications for clinical practice.