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Xu B, Kim S, Blais RK, Nadel M, Cai Q, Tanev KS. Longitudinal changes in the PTSD symptom network following trauma-focused treatment in military populations: Identifying central symptoms and the role of military sexual trauma. J Anxiety Disord 2024; 104:102872. [PMID: 38703664 DOI: 10.1016/j.janxdis.2024.102872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition affecting military populations, with a higher prevalence compared to the general population. Despite the development of first-line trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), a significant proportion of patients continue to experience persistent PTSD symptoms following treatment. This study utilized network analysis to explore the PTSD symptom network's dynamics pre- and post- trauma-focused treatment and investigated the role of military sexual trauma (MST) history in shaping the network. Network analysis is a novel approach that can guide treatment target areas. The sample was comprised of 1648 service members and veterans who participated in a two-week intensive PTSD treatment program, which included completion of evidenced-based individual therapy as well as skill-building focused group therapy. PTSD severity was assessed using the PTSD Checklist for DSM-5 at baseline and post-treatment. Network analyses revealed strong connections within symptom clusters, with negative emotions emerging as one of the most central symptoms. Interestingly, the symptom network's overall structure remained stable following treatment, whereas global strength significantly increased. MST history did not significantly impact the network's structure or its change relative to treatment. Future research should further examine whether targeting negative emotions optimizes PTSD treatment outcomes for military populations.
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Affiliation(s)
- Bingyu Xu
- Psychology Department, Arizona State University, Tempe, AZ, USA.
| | - Soyeong Kim
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rebecca K Blais
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Molly Nadel
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Qiyue Cai
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Kaloyan S Tanev
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Jeffrey H, Yamagishi H. Identifying post-traumatic stress symptom typologies in clinical and non-clinical healthcare staff: a latent profile analysis. Eur J Psychotraumatol 2024; 15:2351323. [PMID: 38753619 PMCID: PMC11100435 DOI: 10.1080/20008066.2024.2351323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
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. .
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Affiliation(s)
- Holly Jeffrey
- The Humber and North Yorkshire Resilience Hub , York, UK
- NAViGO Health and Social Care CIC, Grimsby, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Hina Yamagishi
- The Humber and North Yorkshire Resilience Hub , York, UK
- NAViGO Health and Social Care CIC, Grimsby, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
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Park EH, Jon DI, Hong HJ, Jung MH, Hong N. Latent Classes based on Clinical Symptoms of Military Recruits with Mental Health Issues and Their Distinctive Clinical Responses to Treatment over 6 Months. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:778-786. [PMID: 37859451 PMCID: PMC10591162 DOI: 10.9758/cpn.23.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 10/21/2023]
Abstract
Objective : This study aimed (1) to identify distinct subgroups of psychiatric patients referred for a mental health certificate for military service suitability and (2) to determine whether there is a difference in clinical features such as treatment responsiveness and prognosis among certain subgroups. Methods : We conducted latent profile analysis (LPA) using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical profiles of the participants. Linear mixed model analysis was performed to examine changes in the severity of clinical symptoms and functional level according to the treatment period of the latent classes derived from the LPA. Results : The results indicated that the best-fitting model was a three-class model, comprising Class 1 (mild maladjustment), Class 2 (neurotic depression and anxiety), and Class 3 (highly vulnerable and hypervigilant). We demonstrated that the three subgroups displayed different characteristics in treatment responsiveness and clinical course based on their Clinical Global Impression-Severity and Global Assessment of Functioning scores over a treatment period of 6 months. While subjects in Classes 1 and 2 significantly improved over 6 months, those in Class 3 showed little or no improvement in our clinical parameters. Conclusion : This study has yielded data with clinical implications for treatment planning and interventions for each subgroup classified that were based on MMPI-2 clinical profiles of military recruits who might be maladjusted to serve.
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Affiliation(s)
- Eun-Hee Park
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Hallym University Suicide and School Mental Health Institute, Seoul, Korea
| | - Hyun Ju Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Hallym University Suicide and School Mental Health Institute, Seoul, Korea
| | - Myung Hun Jung
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Hallym University Suicide and School Mental Health Institute, Seoul, Korea
| | - Narei Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Hallym University Suicide and School Mental Health Institute, Seoul, Korea
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Sanghvi DE, Rackoff GN, Newman MG. Latent class analysis of post-traumatic stress disorder symptoms following exposure to Hurricane Ike. Soc Sci Med 2023; 327:115942. [PMID: 37210980 PMCID: PMC10519432 DOI: 10.1016/j.socscimed.2023.115942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/05/2023] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is substantial heterogeneity in how people react to potentially traumatic events (PTEs). Although some literature has explored this heterogeneity, there are only a few studies identifying factors associated with it within the disaster literature. OBJECTIVE The current investigation identified latent classes of post-traumatic stress disorder (PTSD) symptoms and differences between these classes after exposure to Hurricane Ike. METHODS Adults living in Galveston and Chambers County, Texas, (n = 658) completed a battery of measures during an interview conducted two to five months after Hurricane Ike. Latent class analysis (LCA) was performed to identify latent classes of PTSD symptoms. Additionally, gender, age, racial or ethnic minority status, depression severity, anxiety severity, quality of life, perceived need for services, and disaster exposure were examined to explore class differences. RESULTS LCA supported a 3-class model with low (n = 407, 61.9%), moderate (n = 191, 29.0%), and high PTSD symptoms (n = 60, 9.1%). Women appeared most at-risk for a moderate-severity presentation as compared to a low-severity presentation. Further, racial or ethnic minority groups appeared most at-risk for a high-severity presentation as compared to a moderate-severity presentation. Overall, the high symptom class had the poorest well-being, the most perceived need for services, and the highest exposure to the disaster, followed by the moderate symptom class, and finally the low symptom class. CONCLUSIONS PTSD symptom classes appeared to be differentiated primarily by overall severity as well as important psychological, contextual, and demographic dimensions.
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Abolhadi E, Divsalar P, Mosleh-Shirazi MA, Dehesh T. Latent classes of posttraumatic stress disorder among survivors of the Bam Earthquake after 17 years. BMC Psychiatry 2022; 22:603. [PMID: 36088363 PMCID: PMC9464409 DOI: 10.1186/s12888-022-04216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify latent classes of the severity of post-traumatic stress disorder (PTSD) among the survivors of the earthquake in Bam, south-eastern Iran, 17 years after the disaster. The most influential predictor variables of PTSD classes were also investigated. METHODS Eight hundred survivors of the Bam earthquake who were at least four years old in that disaster were selected by multistage sampling. The PTSD Checklist-Civilian Version was used. Latent class analysis was performed to identify subgroups of people with different PTSD symptom profiles. Latent class regression analysis was used to explore the influence of demographic and traumatic variables on each class membership. RESULTS We found three latent classes of PTSD, with the following profiles emerging: Low Symptom (56.6% of the participants), Moderate Symptom (23.5%), and Severe Symptom (19.9%). Old age [OR = 2.20, 95% CI = (1.46, 3.32)], physical injury [OR = 1.95, 95% CI = (1.24, 3.06)], being trapped under the rubble [OR = 1.81, 95% CI = (1.15, 2.86)], and death of a family member [OR = 1.86, 95% CI = (1.12, 3.09)] were positive risk factors for PTSD and increased the chance of being in classes having more severe symptoms. Having a high educational level was a negative risk factor [OR = 0.86, 95% CI = (0.67, 1.11)]. CONCLUSIONS The severity of PTSD 17 years after the earthquake shows that natural disasters such as earthquakes have long-term consequences, and earthquake survivors must have psychological support and long term health care. After any catastrophic earthquake, governments should establish psychology and psychotherapy centers for earthquake victims, and these centers should support earthquake victims for a sufficiently long time.
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Affiliation(s)
- Elham Abolhadi
- grid.412105.30000 0001 2092 9755Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Parisa Divsalar
- grid.412105.30000 0001 2092 9755Neuroscience Research Center, Institute of Neuropharmacology, Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Amin Mosleh-Shirazi
- grid.412571.40000 0000 8819 4698Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Physics Unit, Department of Radio-Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tania Dehesh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Staniaszek K, Cyniak-Cieciura M, Zawadzki B. Posttraumatic stress disorder symptom profiles – The role of temperament, traumatization, and cognitive factors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Keulen J, Spuij M, Deković M, Boelen PA. Heterogeneity of posttraumatic stress symptoms in bereaved children and adolescents: Exploring subgroups and possible risk factors. Psychiatry Res 2022; 312:114575. [PMID: 35500332 DOI: 10.1016/j.psychres.2022.114575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
Bereaved youths are at risk of developing posttraumatic stress (PTS), but there are large individual differences in presentation and severity of PTS symptoms among bereaved youths. The study sought to identify subgroups based on the distribution of self-rated loss-related PTS symptoms in a sample of 264 bereaved youths (aged 7-18). Based on latent class analysis, we identified three subgroups: no disturbance (37.9%), intermediate disturbance (39.0%) and pervasive disturbance (23.1%). Subgroups differed in PTS severity and symptom configuration. Specifically, avoidance was relatively more pronounced in bereaved youth with no and intermediate PTS disturbance, whereas emotional numbing was relatively more pronounced in bereaved youth with intermediate and pervasive PTS disturbance. Associations between subgroup membership, emotional stability and demographic and loss-related variables were also examined. Multinomial logistic regression indicated that youths in the pervasive disturbance subgroup reported lower emotional stability than youths in the no disturbance subgroup. Other variables were unrelated to subgroup membership. The study highlights the importance of considering the heterogeneity in PTS symptomatology in the diagnoses and treatment of loss-related traumatic stress in bereaved youth. Moreover, it underscores the need for further research on possible risk and protective factors involved in the maintenance and development of this traumatic stress.
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Affiliation(s)
- Janna Keulen
- Department of Clinical Child & Family Studies, Utrecht University, Utrecht, the Netherlands.
| | - Mariken Spuij
- Department of Clinical Child & Family Studies, Utrecht University, Utrecht, the Netherlands
| | - Maja Deković
- Department of Clinical Child & Family Studies, Utrecht University, Utrecht, the Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
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Cáceres C, Leiva-Bianchi M, Ormazábal Y, Mena C, Cantillana JC. Post-traumatic stress in people from the interior drylands of the Maule region, Chile in the context of climate change. GEOSPATIAL HEALTH 2022; 17. [PMID: 35592924 DOI: 10.4081/gh.2022.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
Progressive changes in local environmental scenarios, accelerated by global climate change, can negatively affect the mental health of people who inhabit these areas. The magnitude of these effects may vary depending on the socioeconomic conditions of people and the characteristics of the environment, so certain territories can be more vulnerable than others. In this context, the present study aimed to geographically analyse the levels of psychosocial impact and the types of disruptive responses related to the new territorial scenarios caused by climate change in the coastal drylands of the Maule region, Chile. For this purpose, 223 people from two communes (Curepto and Pencahue) were psychosocially evaluated for post-traumatic stress disorder (PTSD) together with a survey of the prevailing sociodemographic and socioeconomic conditions in relation to the environmental variables of the territory. All information was georeferenced, stored within an ArcGIS Desktop geographic information system (GIS) and then investigated by application of contingency tables, ANOVA and local clustering analysis using SSP statistical software. The results indicated a high level of PTSD in the population, with significant differences related to age and education as well as employment conditions and income. The spatial results showed high PTSD values in the communal capital of Curepto in the central agricultural valley near the estuary of the local river, while the existence of coldspots was observed in the central valley of the Pencahue commune. It was concluded that proximity to population centres and surface water sources played the greatest role for the development of PTSD.
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Affiliation(s)
- Cristian Cáceres
- Faculty of Psychology, Laboratory of Methodology, Behavioural Sciences and Neuroscience, Universidad de Talca.
| | - Marcelo Leiva-Bianchi
- Faculty of Psychology, Laboratory of Methodology, Behavioural Sciences and Neuroscience, Universidad de Talca.
| | - Yony Ormazábal
- Faculty of Economics and Business, Universidad de Talca.
| | - Carlos Mena
- Faculty of Economics and Business, Universidad de Talca.
| | - Juan Carlos Cantillana
- Faculty of Administration and Economics, Universidad Tecnológica Metropolitana del Estado de Chile.
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Profiles of post-migration stressors and mental health in refugees: A latent class analysis. Psychiatry Res 2022; 311:114494. [PMID: 35287045 DOI: 10.1016/j.psychres.2022.114494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/27/2022] [Accepted: 03/05/2022] [Indexed: 11/23/2022]
Abstract
Studies have documented the mental health effects of pre-migration trauma on resettled refugees and identified distinct psychological symptom profiles using person centred statistical techniques (e.g., latent class analysis; LCA). These techniques have advanced our understanding of the complex presentation of trauma and psychopathology in refugees. The current study employs LCA to examine patterns of exposure to stressors including post-migration stressors, allowing us to identify patterns of post-migration stress exposure and their association with mental health outcomes. Participants were 1085 Arabic, Farsi, Tamil, or English speaking adult refugees. Pre-migration trauma, post-migration stressors, PTSD, depression, anger, and functional impairment was measured. LCA was conducted to identify distinct classes of post-migration stressors and associations with mental health and adjustment in the resettlement environment. Latent class analysis revealed 5 classes of participants: high difficulties class (7.2%), immigration fear class (14.4%), social disconnection class (17.3%), moderate difficulties class (28.9%) and a low difficulties class (32.3%). Each of the five classes shared commonalities in addition to key differences associated with specific demographic characteristics and psychopathology. Post-migration stressors appear to map onto distinct profiles, which uniquely contribute to functional impairment and mental health outcomes in refugees. These findings have substantial implications for public health and social services working with resettled refugee communities.
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Rudenstine S, Schulder T, Bhatt KJ, McNeal K, Ettman CK, Galea S. Suicidal ideation during COVID-19: The contribution of unique and cumulative stressors. Psychiatry Res 2022; 310:114475. [PMID: 35219267 PMCID: PMC8858638 DOI: 10.1016/j.psychres.2022.114475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/05/2022] [Accepted: 02/19/2022] [Indexed: 12/23/2022]
Abstract
The link between large-scale disasters and population-level risk of suicide remains unclear. The present study sought to investigate suicidal ideation (SI) in relation to COVID-19 related stress, including material and social stress, in a predominantly low-SES ethno-racially diverse sample in New York City during a peak in COVID-19 cases in April 2020. Using binary logistic regressions of data collected with self-report surveys, we found that individuals who identified as Asian, as well as those with high total, material, and social stress levels, and persons without access to primary care providers had significantly higher adjusted odds of SI. These results indicate the specific burden faced by Asian participants due to increases in targeted racism, the importance of cumulative stress and specific stressor type, as well as the role of healthcare access on SI during the pandemic. Such findings suggest the need for specific interventions that target individuals who may be at higher risk of suicide after large-scale traumatic events and during the ongoing pandemic.
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Affiliation(s)
- Sasha Rudenstine
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031.
| | - Talia Schulder
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031
| | - Krish J. Bhatt
- Mailman School of Public Health, Columbia University, 722W 168th St, New York, NY 10032
| | - Kat McNeal
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St, Boston, MA 02118
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Zhen R, Zhou X. Latent Patterns of Posttraumatic Stress Symptoms, Depression, and Posttraumatic Growth Among Adolescents During the COVID-19 Pandemic. J Trauma Stress 2022; 35:197-209. [PMID: 34339577 PMCID: PMC8426724 DOI: 10.1002/jts.22720] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/24/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
Researchhas shown that posttraumatic reactions can co-occur in trauma-exposed individuals. Many studies have assessed the co-occurring patterns of two types of reactions, but few have assessed the patterns of multiple reactions. To build on existing knowledge, the present study examined co-occurring patterns of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and posttraumatic growth (PTG) among adolescents during the COVID-19 pandemic. Participants (N = 683) were adolescents selected from an area in China severely affected by COVID-19 who completed the PTSD Checklist, a measure of depression, a PTG inventory, and a cognitive emotional regulation questionnaire. Latent profile analysis and multinomial logistic regression were used for the data analyses. The results showed three heterogeneous patterns characterized by growth (n = 248, 36.3%), distress (n = 101, 14.8%), and struggle (n = 334, 48.9%). Positive refocusing and reappraisal were associated with membership in the growth group compared with distress group, OR = 0.83, 95% CI [0.75, 0.93] and OR = 0.78, 95% CI [0.68, 0.90], whereas rumination, catastrophizing, and "putting into perspective" were associated with membership in the distress group compared with growth group, ORs = 1.15-1.44. These findings suggest that posttraumatic reactions show heterogeneous characteristics: struggle, rather than growth or distress, is common among adolescents during COVID-19; and distinct cognitive emotional regulation strategies have distinguishing roles in the three patterns of posttraumatic reactions.
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Affiliation(s)
- Rui Zhen
- School of EducationHangzhou Normal UniversityHangzhouChina
| | - Xiao Zhou
- Department of Psychology and Behavioral SciencesZhejiang UniversityHangzhouChina
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12
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Zhen R, Li L, Li G, Zhou X. Social Isolation, Loneliness, and Mobile Phone Dependence among Adolescents During the COVID-19 Pandemic: Roles of Parent-Child Communication Patterns. Int J Ment Health Addict 2021; 21:1-15. [PMID: 34785993 PMCID: PMC8584639 DOI: 10.1007/s11469-021-00700-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
During the COVID-19 pandemic, mobile phone dependence (MPD) became a common addictive behavior among adolescents because of social isolation. To understand the underlying mechanisms of the impact of social isolation on MPD, this study examined the mediating role of loneliness and the moderating role of parent-child communication patterns on social isolation and MPD. Six hundred and eighty-three adolescents from a middle school in Huang'gang city, China, were recruited to complete a self-report questionnaire. Data analysis comprised latent profile analysis and structural equation modelling. The results showed that social isolation had a significant and positive indirect effect on MPD via loneliness. In addition, three types of parent-child communication patterns were observed: complex, adaptive, and maladaptive. For adolescents with complex parent-child communication, the indirect relation of social isolation to MPD via loneliness is weaker than that of adolescents with maladaptive parent-child communication. These findings suggested that the indirect effect of social isolation on MPD via loneliness was moderated by parent-child communication patterns. Psychological intervention for MPD should emphasize relieving adolescents' loneliness and improving the quality of their communication with parents during the COVID-19 pandemic.
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Affiliation(s)
- Rui Zhen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, 311121 China
| | - Lu Li
- The No. 1 Middle School of Xiaochi Town in Huangmei County, Huang’gang, 435500 China
| | - Guoqiang Li
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, 311121 China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028 China
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Wang S, Sit HF, Garabiles MR, Blum D, Hannam K, Chérie Armour, Hall BJ. A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China. J Psychiatr Res 2021; 140:337-345. [PMID: 34134057 DOI: 10.1016/j.jpsychires.2021.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly comorbid with sleep dysfunction. This association was previously explained based on cognitive and emotional dysfunction. The current study extends this literature by investigating the symptom level comorbidity of sleep dysfunction and DSM-5 PTSD utilizing a network approach. Participants were trauma-exposed female Filipino domestic workers (N = 1241). Network analysis was applied to 23 items: 18 items from PCL-5 measuring PTSD (Community 1) and 5 items from PSQI assessing sleep dysfunction (Community 2). The results showed that the symptoms within each community had the strongest correlations. Bridge connections were identified between the sleep dysfunction and PTSD symptom communities. Symptoms with the highest bridge strength were concentration difficulties, recklessness, irritability, and sleep disturbance. This is among the first studies investigating the comorbidity between PTSD and sleep dysfunction from the network approach. Future interventions may be developed that emphasize the bridge symptoms to address comorbidity among trauma exposed migrants.
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Affiliation(s)
- Siyuan Wang
- New York University (Shanghai), People's Republic of China
| | - Hao Fong Sit
- New York University (Shanghai), People's Republic of China
| | | | - Daniel Blum
- New York University (Shanghai), People's Republic of China
| | - Kevin Hannam
- University of St. Joseph, Macao (SAR), People's Republic of China
| | - Chérie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK; New York University (Shanghai), Shanghai, China
| | - Brian J Hall
- New York University (Shanghai), People's Republic of China; School of Global Public Health, New York University, New York, NY, USA.
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Duan W, Guan Q, Jin Q. Latent Profiles and Influencing Factors of Posttraumatic Stress Symptoms Among Adults During the COVID-19 Pandemic. Front Public Health 2021; 9:620521. [PMID: 34249828 PMCID: PMC8264580 DOI: 10.3389/fpubh.2021.620521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic severely affected public health and the prevalence of posttraumatic stress symptoms among adults in Hubei Province, China. In this study, a total of 2,930 (662 males and 2,268 females) adults answered a questionnaire obtaining information on their demographics, posttraumatic stress symptoms (i.e., intrusion and avoidance), social media exposure, social media involvement, and self-efficacy. Results of the latent profile analysis identified four latent profiles of posttraumatic stress symptoms, which are, no symptoms, high intrusion–low avoidance, moderate symptoms, and high symptoms. The multinomial logistic regression analyses revealed the contributors to the posttraumatic stress symptoms subgroups. Adults with high social media involvement were classified into the high intrusion–low avoidance group, whereas adults with low self-efficacy were included in the moderate symptoms group. Meanwhile, adults with high social media involvement and low self-efficacy were included in the high symptoms group. Interventions may focus on decreasing social media involvement for the adults in the high Intrusion–low avoidance group, improving self-efficacy for the adults in the moderate symptoms group, and reducing social media involvement and improving self-efficacy for the adults in the high symptoms group.
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Affiliation(s)
- Wenjie Duan
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Qiujie Guan
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Qiuping Jin
- School of Labor and Human Resources, Renmin University of China, Beijing, China
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15
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Ren Z, Zhou Y, Liu Y. The psychological burden experienced by Chinese citizens during the COVID-19 outbreak: prevalence and determinants. BMC Public Health 2020; 20:1617. [PMID: 33109156 PMCID: PMC7588950 DOI: 10.1186/s12889-020-09723-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The present study is aims to investigate the prevalence and determinants of depression and anxiety among the general population in the context of coronavirus disease 2019 (COVID-19) outbreak in China. METHODS A cross-sectional self-report survey methodology was used to gather the following data from Chinese citizens: sociodemographic information, physical and mental health disorder history, daily online time, social media exposure, feeling toward social media exposure, perception of the disease, infection cases in the local area, and previous experiences with stressful life incidents. Levels of anxiety and depression were self-reported employing the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively. RESULTS Among the 6130 participants, the prevalence of anxiety and depression was 7.1 and 12%, respectively. Multiple logistic regression analysis revealed that psychological disturbances were associated with gender, people with religious background, being a medical professional, having physical or mental health disease, difficulty accessing medical aids, experience with traumatic incidents, the perceived possibility of sequelae after being cured of COVID-19, daily online time, the source of the information relevant to COVID-19, frequency of receiving information regarding COVID-19, and negative feelings triggered by social media. CONCLUSIONS There needs to be a consistent message from authorities to reduce the panic and confusion of the public, and to decrease public exposure to persistently negative information. It is necessary to help people transform their negative experiences into positive changes especially for individuals with physical illness, individuals with mental health disorders, and medical professionals.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical Psychology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Yuchu Zhou
- Daka Education Consulting Co.Ltd., Chengdu, Sichuan, China
| | - Yanhong Liu
- Department of psychology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China.
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Lenferink LIM, Egberts MR, Kullberg ML, Meentken MG, Zimmermann S, L Mertens Y, A T Schuurmans A, Sadeh Y, Kassam-Adams N, Krause-Utz A. Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive. Eur J Psychotraumatol 2020; 11:1717156. [PMID: 32128042 PMCID: PMC7034476 DOI: 10.1080/20008198.2020.1717156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children. Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history). Method: A sample of 2287 children and adolescents (5-18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach. Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury). Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.
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Affiliation(s)
- Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marthe R Egberts
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sarah Zimmermann
- Department of Developmental Psychology and Clinical Psychology across the Lifespan, University of Siegen, Siegen, Germany
| | - Yoki L Mertens
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Angela A T Schuurmans
- Calm Kids, Center for Child Psychology and Game Therapy, Duiven, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yaara Sadeh
- The Edmond and Lily Safra Children's Hospital, The Sheba Medical Center, Ramat Gan, Israel.,The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Nancy Kassam-Adams
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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17
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Zhou X, Gao M, Wang W, Wu X. Patterns of posttraumatic stress disorder symptoms among cancer patients: A latent profile analysis. J Psychosom Res 2019; 125:109788. [PMID: 31421322 DOI: 10.1016/j.jpsychores.2019.109788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE It has been documented that posttraumatic stress disorder symptoms (PTSS) in traumatized individuals have naturally heterogeneous characteristics; studies have recently begun to assess the specific heterogeneous patterns of PTSS. However, most of them used the DSM-IV criteria for PTSS and focused on victims following combat, interpersonal violence, and natural disasters, with no studies focusing on cancer patients. To extend the existing literature and fill the gaps in previous studies, this study aims to examine the specific patterns of PTSS and their predictors. METHOD One hundred and ninety-one cancer patients were selected to complete self-reported questionnaires; the data analysis involved latent profile analysis and multinomial logistic regression. RESULTS Three patterns of PTSS were found: the non-symptom group (n = 29, 15.3%), the hyperarousal symptoms group (n = 84, 44.2%), and the severe PTSS group (n = 77, 40.5%). In addition, a longer elapsed time since diagnosis was related to fewer hyperarousal symptoms [OR (95%CI) = 0.98 (0.95-1.00)] and severe PTSS [OR (95%CI) = 0.98 (0.95-1.00)]; a greater fear of cancer recurrence was related to more hyperarousal symptoms [OR (95%CI) = 1.09 (1.00-1.19)] and severe PTSS [OR (95%CI) = 1.32 (1.18-1.47)]; and individuals with higher household incomes [OR (95%CI) = 1.65 (0.96-2.84)] and female patients [OR (95%CI) = 0.37 (0.16-0.87)] had more severe PTSS. CONCLUSIONS Cancer patients exhibited heterogeneous PTSS patterns.
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Affiliation(s)
- Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Mengqi Gao
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
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18
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Kucharska J. Religiosity and the psychological outcomes of trauma: A systematic review of quantitative studies. J Clin Psychol 2019; 76:40-58. [DOI: 10.1002/jclp.22867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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PTSD symptom profiles among Louisiana women affected by the 2010 Deepwater Horizon Oil Spill: A latent profile analysis. J Affect Disord 2019; 250:289-297. [PMID: 30875671 PMCID: PMC6461508 DOI: 10.1016/j.jad.2019.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/01/2019] [Accepted: 03/04/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms. METHODS To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes. RESULTS Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis. LIMITATIONS This study was limited by use of self-reported data and one-time assessment of PTSD symptoms. DISCUSSION Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted.
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20
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Felix ED, Binmoeller C, Nylund-Gibson K, Benight CC, Benner A, Terzieva A. Addressing Disaster Exposure Measurement Issues With Latent Class Analysis. J Trauma Stress 2019; 32:56-66. [PMID: 30698859 PMCID: PMC6386627 DOI: 10.1002/jts.22368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023]
Abstract
Disaster exposure can put survivors at greater risk for subsequent mental health (MH) problems. Within the field of disaster MH research, it is important to understand how the choice of analytic approaches and their implicit assumptions may affect results when using a disaster exposure measure. We compared different analytic strategies for quantifying disaster exposure and included a new analytic approach, latent class analysis (LCA), in a sample of parents and youth. Following exposure to multiple floods in Texas, a sample of 555 parents and 486 youth were recruited. Parents were predominantly female (70.9%) and White (60.8%). Parents were asked to have their oldest child between the ages of 10 and 19 years old participate (M = 13.74 years, SD = 2.57; 52.9% male). Participants completed measures on disaster exposure, posttraumatic stress, depression, and anxiety. The LCA revealed four patterns of exposure in both parents and youth: high exposure (15.5% parent, 9.5% child), moderate exposure (19.8% parent, 28.2% child), community exposure (45.9% parent, 34.4% child), and low exposure (18.8% parent, 27.8% child). In terms of MH, there were similarities across analytic approaches, but the LCA highlighted a threshold effect, with the high exposure class doing worse than all others, d = 1.12. These results have important implications in understanding the different exposure experiences of survivors and the linkage to MH outcomes. The findings are also informative in the development and use of screening tools used in postdisaster contexts in determining who may or may not need MH services.
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Affiliation(s)
- Erika D. Felix
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa, Barbara, California, USA
| | - Cecile Binmoeller
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa, Barbara, California, USA
| | - Karen Nylund-Gibson
- Department of Education, University of California, Santa Barbara, California, USA
| | - Charles C. Benight
- Psychology Department and Trauma, Health & Hazards Center, University of Colorado, Colorado Springs, Colorado, USA
| | - Aprile Benner
- Department of Human Development and Family Sciences, University of Texas, Austin, Texas, USA
| | - Antoniya Terzieva
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa, Barbara, California, USA
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21
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Zhou X, Zhen R, Wu X. Trajectories of academic burnout in adolescents after the Wenchuan earthquake: A latent growth mixture model analysis. SCHOOL PSYCHOLOGY INTERNATIONAL 2018. [DOI: 10.1177/0143034318810318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Changes in academic burnout in adolescents have attracted much research attention; however, most studies assume that adolescent academic burnout is characterized by overall homogenous change and overlook the heterogeneity of burnout change. To address this issue, this study examined distinct latent trajectories of academic burnout in adolescents following the Wenchuan earthquake, China. Adolescents were surveyed at 1 (T1), 1.5 (T2), 2 (T3), and 2.5 years (T4) after the earthquake. Self-reported questionnaires were administered to 391 participants aged 12- to 19-years-old. The results identified three academic burnout trajectories: Increasing (3.9%), low (85.4%), and decreasing (10.7%). Additionally, intrusive post-traumatic stress disorder (PTSD) symptoms were more likely in the increasing group, avoidance PTSD symptoms were more likely in the decreasing group, and PTSD hyperarousal symptoms were more likely in the decreasing group, but less likely in the increasing group. These findings indicate that adolescents experienced heterogeneous academic burnout changes following the earthquake.
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Affiliation(s)
| | - Rui Zhen
- Hangzhou Normal University, China
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22
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Sripada RK, Hoff R, Pfeiffer PN, Ganoczy D, Blow FC, Bohnert KM. Latent classes of PTSD symptoms in veterans undergoing residential PTSD treatment. Psychol Serv 2018; 17:84-92. [PMID: 30284867 DOI: 10.1037/ser0000284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Rani Hoff
- Veteran Affairs Northeast Program Evaluation Center
| | | | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research
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23
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Allen J, Brown LM, Alpass FM, Stephens CV. Longitudinal health and disaster impact in older New Zealand adults in the 2010-2011 Canterbury earthquake series. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:701-718. [PMID: 29989482 DOI: 10.1080/01634372.2018.1494073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pre-existing longitudinal studies of people affected by disasters provide opportunities to examine the effects of these events on health. Data used in the current investigation were provided by participants in the New Zealand Health, Work and Retirement longitudinal surveys conducted in 2010, 2012 and 2014 (n = 428; aged 50-83), who lived in the Canterbury region of New Zealand during the 2010-2011 earthquakes. Latent profile growth analyses were used to identify groups of respondents who had similar pre-post-disaster physical and mental health profiles. These groups were compared in terms of demographic factors, personal impact of the earthquakes assessed in 2012 and the overall negative-positive impact of the earthquake assessed in 2014. There was little evidence of change in health status overtime. Groups did not differ in their experiences of threat or disruption, however those in poorest health reported greatest distress and a more negative overall impact of the earthquake. Although results suggest little impact of disasters on health of surviving older adults, pre-disaster vulnerabilities were associated with distress. Social workers and agencies responsible for disaster response can play a key role in pre-disaster planning and assessment of vulnerabilities of older adults to enhance potential for positive outcomes post-disaster.
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Affiliation(s)
- Joanne Allen
- a School of Psychology , Massey University , Palmerston North , New Zealand
| | - Lisa M Brown
- b Trauma Program , Palo Alto University , Palo Alto , California , USA
| | - Fiona M Alpass
- a School of Psychology , Massey University , Palmerston North , New Zealand
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24
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Davis EB, Kimball CN, Aten JD, Andrews B, Van Tongeren DR, Hook JN, Davis DE, Granqvist P, Park CL. Religious meaning making and attachment in a disaster context: A longitudinal qualitative study of flood survivors. THE JOURNAL OF POSITIVE PSYCHOLOGY 2018. [DOI: 10.1080/17439760.2018.1519592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Edward B. Davis
- Department of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, IL, USA
| | - Cynthia N. Kimball
- Department of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, IL, USA
| | - Jamie D. Aten
- Department of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, IL, USA
| | - Benjamin Andrews
- Department of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, IL, USA
| | | | - Joshua N. Hook
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Don E. Davis
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, USA
| | - Pehr Granqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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25
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Longitudinal patterns of PTSD symptom classes among US National Guard service members during reintegration. Soc Psychiatry Psychiatr Epidemiol 2018; 53:911-920. [PMID: 29947860 DOI: 10.1007/s00127-018-1542-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to identify posttraumatic stress disorder (PTSD) symptom groups and assess their longitudinal progression during their first year of reintegration among United States (US) National Guard (NG) service members. METHODS A cohort of NG service members (n = 886) completed surveys at 6 and 12 months following their return from deployment to Iraq or Afghanistan. Latent class analysis (LCA) and latent transition analysis (LTA) were used to empirically derive groups based on their PTSD symptoms and examine their longitudinal course, respectively. RESULTS The best fitting model at both assessments was the four-class model, comprising an asymptomatic class (6 months = 54%; 12 months = 55%), a mild symptom class with elevated hyperarousal symptoms (6 months = 22%; 12 months = 17%), a moderate symptom class (6 months = 15%; 12 months = 15%), and a severe symptom class (6 months = 10%; 12 months = 13%). Based on LTA, stability of class membership at the two assessments was 0.797 for the asymptomatic class, 0.453 for the mild class, 0.560 for the moderate class, and 0.580 for the severe class. Estimated transition probabilities were greater with respect to transitioning to less severe, rather than more severe, classes over time. CONCLUSIONS The four latent PTSD classes were distinguished primarily by severity; however, the mild symptom class was characterized by higher levels of hyperarousal than other symptoms. Although the absolute number of individuals within classes remained fairly constant between 6 and 12 months, there was movement between severity classes. Most NG service members without symptoms continued to do well during the first year, with only an estimated 7% moving to the moderate or severe class.
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Patterns and predictors of posttraumatic stress disorder in refugees: A latent class analysis. J Affect Disord 2018; 232:252-259. [PMID: 29499508 DOI: 10.1016/j.jad.2018.02.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although elevated rates of posttraumatic stress disorder (PTSD) have been well-documented in refugees, no study has investigated the heterogeneity of DSM-5 PTSD symptomatology in such populations. This study aimed to determine whether there are unique patterns of DSM-5 defined PTSD symptomatology in refugees, and investigate whether factors characteristic of the refugee experience, including trauma exposure and post-migration stress, predict symptom profiles. METHODS Participants were 246 refugees and asylum-seekers from an Arabic-, English-, Farsi-, or Tamil-speaking background who had been resettled in Australia. Participants completed measures of post-migration living difficulties, trauma exposure, PTSD symptoms and functional disability. Latent class analysis was used to identify PTSD symptom profiles, and predictors of class membership were elucidated via multinomial logistic regression. RESULTS Four classes were identified: a high-PTSD class (21.3%), a high-re-experiencing/avoidance class (15.3%), a moderate-PTSD class (23%), and a no PTSD class (40.3%). Trauma exposure and post-migration stress significantly predicted class membership and classes differed in degree of functional disability. LIMITATIONS The current study employed a cross-sectional design, which precluded inferences regarding the stability of classes of PTSD symptomatology. CONCLUSIONS This study provides evidence for distinct patterns of PTSD symptomatology in refugees. We identified a novel class, characterized by high-re-experiencing and avoidance symptoms, as well as classes characterized by pervasive, moderate, and no symptomatology. Trauma exposure and post-migration stress differentially contributed to the emergence of these profiles. Individuals with high and moderate probability of PTSD symptoms evidenced substantial disability. These results support conceptualizations of PTSD as a heterogeneous construct, and highlight the importance of considering sub-clinical symptom presentations, as well as the post-migration environment, in clinical contexts.
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Bondjers K, Willebrand M, Arnberg FK. Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis. Eur J Psychotraumatol 2018; 9:1546083. [PMID: 30479702 PMCID: PMC6249547 DOI: 10.1080/20008198.2018.1546083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Individuals express symptoms of posttraumatic stress in various ways, noted for example in the many symptom combinations in the diagnostic manuals. Studies aiming to examine differences of symptom presentations by extracting latent classes or profiles indicate both the presence of subtypes with differing symptomatology and subtypes distinguished by severity levels. Few studies have examined subtype associations with long-term outcomes. Objective: The current study aimed to apply latent profile analysis on posttraumatic stress (PTS) in a highly homogenous sample of Swedish tourists exposed to the 2004 Southeast Asia tsunami and to examine if classes differed in their long-term outcome. Methods: An latent profile analysis was conducted using self-report data collected one year after the disaster from 1638 highly exposed survivors that endorsed ≥ 1 symptom of PTS. Associations were examined between the classes and predictors of PTS (loss of a relative or friend, subjective life threat) and levels of PTS at a three-year follow up. Results: The latent profile analysis indicated four classes: minimal, low, moderate, and severe symptoms. The classes were distinguished mainly by their levels of PTS. Loss of a relative or friend and subjective life threat were associated with a higher likelihood of belonging to any other class than the minimal class. The severity level of the classes at one year were predictive of PTS severity at the three-year follow-up. Conclusions: Homogeneous profiles of posttraumatic stress differing mainly in symptom severity were found in this sample of disaster survivors. Profile diversity may be related to sample variation and unmeasured confounders rather than reflect qualitatively different disorders.
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Affiliation(s)
- Kristina Bondjers
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Mimmie Willebrand
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Filip K Arnberg
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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28
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Greene T, Gelkopf M, Grinapol S, Werbeloff N, Carlson E, Lapid L. Trajectories of traumatic stress symptoms during conflict: A latent class growth analysis. J Affect Disord 2017; 220:24-30. [PMID: 28577426 DOI: 10.1016/j.jad.2017.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/24/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ways in which traumatic stress symptoms unfold under situations of ongoing threat and trauma exposure are poorly understood. The current study aims to identify traumatic stress symptom trajectories during conflict, as well as potential risk factors. METHODS Experience sampling methods were used to study traumatic stress symptoms during the 2014 Israel-Gaza conflict in 100 Israeli civilians exposed to rocket fire. Summary reports of traumatic symptoms were made twice-daily for 30 days via mobile phone. RESULTS Latent class growth analysis revealed four distinct classes (low, reducing, moderate, and high) characterised by their trajectory of traumatic stress symptoms during the conflict. Female gender, not being in a relationship, and higher prior trauma exposure were identified as potential risk factors. LIMITATIONS Data were not collected in the early phase of the conflict, the sample was relatively small, and only traumatic stress symptoms were investigated as outcomes. CONCLUSIONS This study identified heterogeneous traumatic stress symptom trajectories among civilians during a conflict, with different subgroups showing distinct response patterns over time, associated with various risk factors. Investigating responses to ongoing trauma, and identifying predictors of different stress symptom trajectories has clinical implications for the targeted delivery of interventions. Further exploration of heterogeneous trajectories could potentially elucidate mechanisms that drive resilience and recovery, including in situations of ongoing exposure such as during conflict.
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Affiliation(s)
- T Greene
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel.
| | - M Gelkopf
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel; NATAL, Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
| | - S Grinapol
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel
| | - N Werbeloff
- Division of Psychiatry, University College London, UK
| | - E Carlson
- National Center for PTSD and VA Palo Alto Health Care System, Dept. of Veterans Affairs, USA
| | - L Lapid
- The Department of Community Mental Health, University of Haifa, 199 Aba Houshy Ave, Haifa, Israel; NATAL, Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
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Carra KA, Curtin M. Posttraumatic Growth Among Australian Farming Women After a Flood. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1310506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kylie A. Carra
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Michael Curtin
- Department for Michael Curtin, School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
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Armour C, Fried EI, Deserno MK, Tsai J, Pietrzak RH. A network analysis of DSM-5 posttraumatic stress disorder symptoms and correlates in U.S. military veterans. J Anxiety Disord 2017; 45:49-59. [PMID: 27936411 DOI: 10.1016/j.janxdis.2016.11.008] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/09/2016] [Accepted: 11/24/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recent developments in psychometrics enable the application of network models to analyze psychological disorders, such as PTSD. Instead of understanding symptoms as indicators of an underlying common cause, this approach suggests symptoms co-occur in syndromes due to causal interactions. The current study has two goals: (1) examine the network structure among the 20 DSM-5 PTSD symptoms, and (2) incorporate clinically relevant variables to the network to investigate whether PTSD symptoms exhibit differential relationships with suicidal ideation, depression, anxiety, physical functioning/quality of life (QoL), mental functioning/QoL, age, and sex. METHOD We utilized a nationally representative U.S. military veteran's sample; and analyzed the data from a subsample of 221 veterans who reported clinically significant DSM-5 PTSD symptoms. Networks were estimated using state-of-the-art regularized partial correlation models. Data and code are published along with the paper. RESULTS The 20-item DSM-5 PTSD network revealed that symptoms were positively connected within the network. Especially strong connections emerged between nightmares and flashbacks; blame of self or others and negative trauma-related emotions, detachment and restricted affect; and hypervigilance and exaggerated startle response. The most central symptoms were negative trauma-related emotions, flashbacks, detachment, and physiological cue reactivity. Incorporation of clinically relevant covariates into the network revealed paths between self-destructive behavior and suicidal ideation; concentration difficulties and anxiety, depression, and mental QoL; and depression and restricted affect. CONCLUSION These results demonstrate the utility of a network approach in modeling the structure of DSM-5 PTSD symptoms, and suggest differential associations between specific DSM-5 PTSD symptoms and clinical outcomes in trauma survivors. Implications of these results for informing the assessment and treatment of this disorder, are discussed.
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Affiliation(s)
- Cherie Armour
- Psychology Research Institute, Coleraine Campus, University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK.
| | - Eiko I Fried
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Marie K Deserno
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, CT, USA
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Social Factors Associated With Psychological Distress and Health Problems Among Elderly Members of a Disaster-Affected Population: Subgroup Analysis of a 1-Year Post-disaster Survey in Ishinomaki Area, Japan. Disaster Med Public Health Prep 2016; 11:64-71. [PMID: 27842614 DOI: 10.1017/dmp.2016.147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to investigate the influence of social factors, especially social support, on psychological distress and the prevalence of health problems (HPs) among victims living in their homes 14 to 21 months after the Great East Japan Earthquake and tsunami. METHODS A subgroup analysis was performed for elderly participants of a cross-sectional household survey in Ishinomaki area, Japan. The prevalence of psychological HPs was assessed by using a psychological distress questionnaire (K6) and by recording the number of subjective HPs. Perceived social support was assessed in 3 dimensions: informational, emotional, and instrumental support. Univariate and multivariate logistic regression models were used to examine the association between social factors and psychological health. RESULTS An elderly subgroup with 879 participants was used for analyses. Psychological distress (K6 score≥9) was observed in 6.8% of the participants aged 65 to 74 years and in 8.0% of those aged ≥75 years. Receiving a long-term care service was associated with having HPs, and discontinuation of attendance at a hospital as an outpatient was associated with psychological distress. Receiving emotional support was associated with lower psychological distress and not having HPs. CONCLUSIONS Emotional support was found to be an important factor for promoting health among elderly disaster victims. (Disaster Med Public Health Preparedness. 2017;11:64-71).
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Guffanti G, Geronazzo-Alman L, Fan B, Duarte CS, Musa GJ, Hoven CW. Homogeneity of Severe Posttraumatic Stress Disorder Symptom Profiles in Children and Adolescents Across Gender, Age, and Traumatic Experiences Related to 9/11. J Trauma Stress 2016; 29:430-439. [PMID: 27727511 DOI: 10.1002/jts.22134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with a posttraumatic stress disorder (PTSD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) will very likely not share all of the same symptoms, a consequence of the polythetic approach used in the DSM. We examined heterogeneity in the latent structure of PTSD symptoms using data from a previously published sample of 8,236 youth a subset of which had been exposed to the September 11, 2001 attacks (N = 6,670; Hoven et al., 2005). Latent class analysis was applied (a) to PTSD symptoms alone, (b) to symptoms in combination with impairment indicators, and (c) to PTSD symptoms when stratified by age and gender, as well as by empirically defined classes of exposure. We identified 4 symptom classes: no disturbance (49.4%), intermediate disturbance (2 classes; 21.5% and 18.6%, respectively), and severe disturbance (10.5%). These classes varied not only in the severity of symptoms, but also in the configuration of symptoms. We observed a high probability of endorsing both PTSD symptoms and indicators of impairment only in the severe disturbance class. A similar 4-class structure was found when the data were stratified by age, gender, and exposure classes. There were no significant differences as a function of age, gender, or exposure in the presence of severe PTSD. Heterogeneity was observed at intermediate levels of PTSD symptom severity. The specific PTSD symptoms that defined the severe PTSD profile could constitute the pathogenic aspects of a largely invariant and clinically meaningful PTSD syndrome.
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Affiliation(s)
- Guia Guffanti
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Lupo Geronazzo-Alman
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Bin Fan
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - George J Musa
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Christina W Hoven
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA.
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Hebenstreit CL, Madden E, Koo KH, Maguen S. Minimally adequate mental health care and latent classes of PTSD symptoms in female Iraq and Afghanistan veterans. Psychiatry Res 2015; 230:90-5. [PMID: 26330305 DOI: 10.1016/j.psychres.2015.08.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 07/24/2015] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
Abstract
Female veterans of Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) represent a growing segment of Department of Veterans Affairs (VA) health care users. A retrospective analysis used national VA medical records to identify factors associated with female OEF/OIF/OND veterans' completion of minimally adequate care (MAC) for PTSD, defined as the completion of at least nine mental health outpatient visits within a 15-week period or at least twelve consecutive weeks of medication use. The sample included female OEF/OIF/OND veterans with PTSD who initiated VA health care between 2007-2013, and were seen in outpatient mental health (N=2183). Multivariable logistic regression models examined factors associated with completing MAC for PTSD, including PTSD symptom expression (represented by latent class analysis), sociodemographic, military, clinical, and VA access factors. Within one year of initiating mental health care, 48.3% of female veterans completed MAC. Race/ethnicity, age, PTSD symptom class, additional psychiatric diagnoses, and VA primary care use were significantly associated with completion of MAC for PTSD. Results suggest that veterans presenting for PTSD treatment should be comprehensively evaluated to identify factors associated with inadequate completion of care. Treatments that are tailored to PTSD symptom class may help to address potential barriers.
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Affiliation(s)
- Claire L Hebenstreit
- San Francisco VA Medical Center, General Medicine, 4150 Clement St., San Francisco, CA 94121, USA; University of California San Francisco, School of Medicine, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Erin Madden
- San Francisco VA Medical Center, General Medicine, 4150 Clement St., San Francisco, CA 94121, USA
| | - Kelly H Koo
- San Francisco VA Medical Center, General Medicine, 4150 Clement St., San Francisco, CA 94121, USA; University of California San Francisco, School of Medicine, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Shira Maguen
- San Francisco VA Medical Center, General Medicine, 4150 Clement St., San Francisco, CA 94121, USA; University of California San Francisco, School of Medicine, 500 Parnassus Avenue, San Francisco, CA 94143, USA
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34
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Cao X, Wang L, Cao C, Zhang J, Liu P, Zhang B, Wu Q, Zhang H, Zhao Z, Fan G, Elhai JD. Patterns of DSM-5 posttraumatic stress disorder and depression symptoms in an epidemiological sample of Chinese earthquake survivors: A latent profile analysis. J Affect Disord 2015; 186:58-65. [PMID: 26231442 DOI: 10.1016/j.jad.2015.06.058] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps. METHODS LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors. RESULTS A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment. LIMITATIONS A sample exposed to specific traumatic events was assessed by self-report measures. CONCLUSIONS The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations.
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Affiliation(s)
- Xing Cao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | - Chengqi Cao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China
| | - Jianxin Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China; People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Biao Zhang
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Qi Wu
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Hong Zhang
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Zhihong Zhao
- Hanwang People's Hospital, Deyang, Sichuan, China
| | - Gaolin Fan
- Hanwang People's Hospital, Deyang, Sichuan, China
| | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, Toledo, USA
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35
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Hebenstreit C, Madden E, Maguen S. Latent classes of PTSD symptoms in Iraq and Afghanistan female veterans. J Affect Disord 2014; 166:132-8. [PMID: 25012421 DOI: 10.1016/j.jad.2014.04.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 04/25/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies have used latent class analysis (LCA) to identify subgroups of individuals who share similar patterns of PTSD symptom endorsement; however, further study is needed among female veterans, whose PTSD symptom expression may vary from that of their male counterparts. The current study examined latent PTSD symptom classes in female veterans who returned from recent military service in Iraq and Afghanistan, and explored military and demographic variables associated with distinct PTSD symptom presentations. METHODS A retrospective analysis was conducted using existing medical records from female Iraq and Afghanistan veterans who were new users of VA mental health outpatient (MHO) care, had received a PTSD diagnosis anytime during the post-deployment period, and completed the PTSD checklist within 30 days of their first MHO visit (N=2425). RESULTS The LCA results identified four latent classes of PTSD symptom profiles in the sample: High Symptom, Intermediate Symptom, Intermediate Symptom with High Emotional Numbing (EN), and Low Symptom. Race/ethnicity, age, time since last deployment, and distance from a VA facility emerged as predictors of PTSD symptom presentation. LIMITATIONS The current study was cross-sectional and utilized administrative data. The results may not be generalizable to female veterans from other service eras. CONCLUSIONS Longer times between end of last deployment and initiation of MHO services were associated with more symptomatic classes. Exploration of PTSD symptom presentation may enhance our understanding of the service needs of female veterans with PTSD, and suggests potential benefits to engaging veterans in MHO soon after last deployment.
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Affiliation(s)
- Claire Hebenstreit
- San Francisco VA Medical Center, San Francisco, CA, United States; University of California, San Francisco, CA, United States.
| | - Erin Madden
- University of California, San Francisco, CA, United States
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, CA, United States; University of California, San Francisco, CA, United States
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