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Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review. Drug Alcohol Rev 2024; 43:897-926. [PMID: 38316529 DOI: 10.1111/dar.13816] [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: 03/30/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
ISSUE Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods. APPROACH Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs. KEY FINDINGS Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30). IMPLICATIONS AND CONCLUSION Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jia Y Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Birk N, Russo J, Heagerty P, Parker L, Moloney K, Bulger E, Whiteside L, Moodliar R, Engstrom A, Wang J, Palinkas L, Abu K, Zatzick D. Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury? Psychiatry 2024; 87:134-148. [PMID: 38497603 PMCID: PMC11116057 DOI: 10.1080/00332747.2024.2323367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions. METHOD This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms. RESULTS A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time. CONCLUSIONS Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.
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Affiliation(s)
- Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick Heagerty
- Department of Biostatistics University of Washington School of Medicine, Seattle, Washington, USA
| | - Lea Parker
- Department of Psychology Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lawrence Palinkas
- Department of Public Health and Longevity Science, University of California, San Diego, California, USA
| | - Khadijah Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Knutzen T, Bulger E, Iles-Shih M, Hernandez A, Engstrom A, Whiteside L, Birk N, Abu K, Shoyer J, Conde C, Ryan P, Wang J, Russo J, Heagerty P, Palinkas L, Zatzick D. Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol. Contemp Clin Trials 2024; 136:107380. [PMID: 37952714 PMCID: PMC11025340 DOI: 10.1016/j.cct.2023.107380] [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: 08/10/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Each year in the US, approximately 1.5-2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. METHODS The single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. CONCLUSIONS The overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations. TRIAL REGISTRATION Clinicaltrials.govNCT05632770.
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Affiliation(s)
- Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA.
| | - Larry Palinkas
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Lee J, Shin J, Chae S, Chun J, Choi JW, Lee JY, Park TW, Kim KM, Kim K, Kim JW. The Factors Affecting Longitudinal Course of Posttraumatic Stress Disorder Symptoms in Sexual Assault Victims. Psychiatry Investig 2023; 20:1061-1068. [PMID: 37997334 PMCID: PMC10678143 DOI: 10.30773/pi.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/05/2023] [Accepted: 08/22/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE This study aimed to identify the factors affecting posttraumatic stress disorder (PTSD) symptom remission prospectively through a 1-year follow-up of sexual assault (SA) victims. METHODS A total 65 female SA victims who visited the crisis intervention center were included. Self-administered questionnaires regarding PTSD symptoms and PTSD related prognostic factors were conducted at both recruitment (T1) and 1 year after recruitment (T2). The multivariate analyses were used to determine the significant predictors of PTSD remission/non-remission state 1 year after SA. RESULTS In logistic regression analysis, both anxiety and secondary victimization were identified as significant factors explaining the results on PTSD remission/non-remission state at T2 (Beck's Anxiety Inventory [BAI], p=0.003; Secondary Victimization Questionnaire, p=0.024). In a linear mixed analysis, both depression and anxiety were found to be significant variables leading to changes in Posttraumatic Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition from T1 to T2 (BAI, p<0.001; Center for Epidemiological Studies Depression Scale, p<0.001). CONCLUSION Depression, anxiety symptoms, and secondary victimization after SA were associated with PTSD symptom non-remission 1 year after SA.
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Affiliation(s)
- Jaewon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiyoon Shin
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soohyun Chae
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Chun
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Choi
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Tae-Won Park
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Kihyun Kim
- Department of Social Welfare, College of Social Sciences, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae-Won Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
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5
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Smárason O, Guzick AG, Goodman WK, Salloum A, Storch EA. Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care. J Child Adolesc Psychopharmacol 2023; 33:316-324. [PMID: 37861988 PMCID: PMC10616955 DOI: 10.1089/cap.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Introduction: Computer-assisted cognitive behavioral therapy (CCBT) for childhood anxiety disorders may aid the dissemination of CBT, while maintaining treatment fidelity. Although CCBT is an effective intervention, not everyone benefits equally from treatment. Identifying patient characteristics that predict who will benefit from treatment and to what extent can help with matching patients to suitable interventions, and allow researchers and clinicians to modify, and individualize, their treatment formats more effectively. Such predictors and moderators have not yet been examined for CCBT outcomes in anxious children and studies of more traditional treatment formats have yielded inconsistent results. Methods: Using data from a randomized clinical trial evaluating CCBT for children with anxiety disorders, this study examined predictors and moderators of treatment outcomes in a sample of 100 children (age: mean [M] = 9.82, standard deviation [SD] = 1.82), randomized to either CCBT (n = 49) or standard community care (n = 51). Potential predictors and moderators were identified from the literature and examined in stepwise multiple linear regression models, using posttreatment anxiety severity and global impairment as outcomes. Results: Parent-rated internalizing symptoms predicted posttreatment anxiety severity for both treatment groups. High pretreatment levels of anxiety severity predicted higher global impairment at posttreatment for the group receiving community care, but not for the CCBT group. Conclusion: Further research is needed to clarify which patient characteristics are associated with CCBT outcomes in a consistent way. ClinicalTrials.gov identifier: NCT01416805.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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6
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Kim R, Lin T, Pang G, Liu Y, Tungate AS, Hendry PL, Kurz MC, Peak DA, Jones J, Rathlev NK, Swor RA, Domeier R, Velilla MA, Lewandowski C, Datner E, Pearson C, Lee D, Mitchell PM, McLean SA, Linnstaedt SD. Derivation and validation of risk prediction for posttraumatic stress symptoms following trauma exposure. Psychol Med 2023; 53:4952-4961. [PMID: 35775366 DOI: 10.1017/s003329172200191x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS. METHODS Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale - Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample). RESULTS Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms. CONCLUSIONS These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.
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Affiliation(s)
- Raphael Kim
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA
| | - Tina Lin
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Gehao Pang
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yufeng Liu
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, Carolina Center for Genome Sciences, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama, Birmingham, AL, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate State Health System, Springfield, MA, USA
| | - Robert A Swor
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Robert Domeier
- Department of Emergency Medicine, St Joseph Mercy Health System, Ann Arbor, MI, USA
| | | | | | - Elizabeth Datner
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Detroit Receiving, Detroit, MI, USA
| | - David Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Patricia M Mitchell
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
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7
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Norbury A, Seeley SH, Perez-Rodriguez MM, Feder A. Functional neuroimaging of resilience to trauma: convergent evidence and challenges for future research. Psychol Med 2023; 53:3293-3305. [PMID: 37264949 PMCID: PMC11350638 DOI: 10.1017/s0033291723001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Resilience is broadly defined as the ability to adapt successfully following stressful life events. Here, we review functional MRI studies that investigated key psychological factors that have been consistently linked to resilience to severe adversity and trauma exposure. These domains include emotion regulation (including cognitive reappraisal), reward responsivity, and cognitive control. Further, we briefly review functional imaging evidence related to emerging areas of study that may potentially facilitate resilience: namely social cognition, active coping, and successful fear extinction. Finally, we also touch upon ongoing issues in neuroimaging study design that will need to be addressed to enable us to harness insight from such studies to improve treatments for - or, ideally, guard against the development of - debilitating post-traumatic stress syndromes.
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Affiliation(s)
- Agnes Norbury
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Queen Square Institute of Neurology and Mental Health Neuroscience Department, Applied Computational Psychiatry Lab, Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | - Saren H. Seeley
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Dworkin ER, Jaffe AE, Bedard-Gilligan M, Fitzpatrick S. PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies. TRAUMA, VIOLENCE & ABUSE 2023; 24:497-514. [PMID: 34275368 PMCID: PMC8766599 DOI: 10.1177/15248380211032213] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Sexual assault is associated with higher rates of posttraumatic stress disorder (PTSD) than other traumas, and the course of PTSD may differ by trauma type. However, the course of PTSD after sexual assault has not been summarized. The aim of this meta-analysis was to identify the prevalence and severity of PTSD and changes to the average rate of recovery in the 12 months following sexual assault. METHOD Authors searched four databases for prospective studies published before April 2020 and sought relevant unpublished data. Eligible studies assessed PTSD in at least 10 survivors of sexual assault in at least two time points, starting within 3 months postassault. Random effects linear-linear piecewise models were used to identify changes in average recovery rate and produce model-implied estimates of monthly point prevalence and mean symptom severity. RESULTS Meta-analysis of 22 unique samples (N = 2,106) indicated that 74.58% (95% confidence interval [CI]: [67.21, 81.29]) and 41.49% (95% CI: [32.36, 50.92]) of individuals met diagnostic criteria for PTSD at the first and 12th month following sexual assault, respectively. PTSD symptom severity was 47.94% (95% CI: [41.27, 54.61]) and 29.91% (95% CI: [23.10, 36.73]) of scales' maximum severity at the first and 12th month following sexual assault, respectively. Most symptom recovery occurred within the first 3 months following sexual assault, after which point the average rate of recovery slowed. CONCLUSIONS Findings indicate that PTSD is common and severe following sexual assault, and the first 3 months postassault may be a critical period for natural recovery.
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Affiliation(s)
- Emily R Dworkin
- 12353University of Washington School of Medicine, Seattle, WA, USA
| | - Anna E Jaffe
- University of Nebraska, Lincoln-Lincoln, NE, USA
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9
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Rahimi MP, Wafa MH, Stanikzai MH, Rahimi BA. Post-traumatic stress disorder (PTSD) probability among parents who live in Kandahar, Afghanistan and lost at least a child to armed conflict. Sci Rep 2023; 13:3994. [PMID: 36899175 PMCID: PMC10006089 DOI: 10.1038/s41598-023-31228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
The last 4 decades of conflict in Afghanistan resulted in incalculable deaths, injuries, and millions of displacements. Although there are routine reports on casualties of the warfare, the information on its long-term psycho-social sequelae is somehow discounted. This study aimed to assess post-traumatic stress disorder (PTSD) probability and its associated factors among parents who live in Kandahar, the southern province of Afghanistan, and lost at least one child to armed conflict. We conducted a health-facility-based cross-sectional study involving 474 bereaved parents in Kandahar province from November/2020 to January/2021. The questionnaire was composed of sections on socio-demographic characteristics and mental and medical histories of the parent, features of the traumatic event and the time elapsed since then, age and gender of the lost child, and PCL-5. We performed multivariable logistic analysis to determine factors associated with PTSD probability in such parents. A staggering number of the parents (430; 90.72%) scored > 33 on PCL-5 denoting presence of probable PTSD. We noticed that several attributes of the bereaved parents (rural residence [AOR = 3.71 (95% CI 1.37-9.97)], older age [AOR = 2.41 (95% CI 1.03-5.57)], experiencing more than one traumatic event [AOR = 2.91 (95% CI 1.05-7.94)], pre-existing medical condition [AOR = 3.5 (95% CI 1.55-8.05)], and losing a < 5-years-old child [AOR = 2.38 (95% CI 1.16-4.70)] were significantly associated with PTSD probability. We assert that a very high number of bereaved parents are susceptible to probable PTSD. This finding signifies the eminent necessity of mental health services in such settings and provides implicit insights to relevant humanitarian assistance providers.
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Affiliation(s)
- Mohammad Paiman Rahimi
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Hashim Wafa
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.,Neuropsychiatric and Behavioral Science Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Muhammad Haroon Stanikzai
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan. .,Public Health Department, Faculty of Medicine, Kandahar University, Near Ayno Mena, 10th District, Kandahar, Afghanistan.
| | - Bilal Ahmad Rahimi
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.,Pediatrics Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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10
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The Posttaumatic Adjustment Scale (PAS) is an effective measure in predicting psychological distress in patients following major trauma. Injury 2023; 54:502-507. [PMID: 36437165 DOI: 10.1016/j.injury.2022.11.019] [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: 03/13/2022] [Revised: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS To determine whether a psychological screening tool - the Posttraumatic Adjustment Scale (PAS), predicts later psychological distress for admissions to a Major Trauma Centre (MTC) and to identify whether there was an unmet need in relation to the psychological support offered. METHODS Patient demographics and details of their injuries were retrieved from the Trauma Audit & Research Network (TARN) database. All patients admitted to Leeds General Infirmary MTC were approached for inclusion in the study over a three-month period. The PAS was administered to all participants at baseline. Following discharge, patients were sent two validated psychological measures via post, the Impact of Events Scale - Revised (IES-R) and the Clinical Outcomes in Routine Evaluation System (CORE-10). Relationships between continuous variables were examined using a Spearman's rank test (SR). The diagnostic accuracy of the different psychological screening systems was examined and compared using Receiver Operator Characteristic (ROC) analysis. RESULTS Eighty-two patients completed the PAS, 26 of whom had been referred to clinical psychology and 56 who were not. Fifty-seven of these patients (70%) returned follow-up IES-R and CORE-10 data, 20 who had been referred to psychology and 37 who had not. The PAS-P score recorded shortly after admission correlated strongly with the CORE-10 (SR rs 0.54, p<0.0001) and IES-R (SR rs 0.63, p<0.0001) scores recorded at early follow up. A PAS-P of more than 10 predicted the development of PTSD symptoms (IES-R 33 or more) or moderate global psychological distress (CORE-10 15 or more) with 72% sensitivity and 71% specificity. To identify patients who went on to develop psychological symptoms according to either measure (IES-R 33 or more or CORE-10 15 or more), the PAS-P was more sensitive than clinician referral (71% vs 52%, p<0.05) with similar specificity (72% vs 75%, p=0.78). CONCLUSIONS In an unselected group of trauma inpatients treated in a MTC, the PAS is an effective means of identifying those who are likely to go on to suffer PTSD symptoms or psychological distress. It may useful to use the PAS as a measure to formalise psychology referrals.
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Feasibility of Risk Factor-Based Screening for Posttraumatic Stress Disorder in Trauma. J Trauma Nurs 2023; 30:27-33. [PMID: 36633342 DOI: 10.1097/jtn.0000000000000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) following traumatic injury can have severe psychiatric consequences. Current recommendations from the American College of Surgeons Committee on Trauma require implementing PTSD screening but specify neither who should be screened nor how. It is unknown whether narrowed screening selection criteria could identify an acceptable proportion of patients with PTSD. OBJECTIVE This study aimed to determine the feasibility of implementing risk factor-based PTSD screening in trauma patients by evaluating the sensitivity and clinical practicality. METHODS This is a prospective diagnostic study of a consecutive series of general ward patients at an urban Level I trauma center from December 2021 to March 2022. Screening indications included (a) interpersonal injury, (b) surgery, (c) intracranial hemorrhage, (d) less than 30 years of age, or (e) clinical suspicion. The protocol was assessed by measuring the proportion of positive screens captured by only clinical suspicion to estimate sensitivity and by qualitatively evaluating barriers to implementation. RESULTS Among the 200 patients screened, the number of patients who screened positive was 51 (25.5%). Eight patients were screened on clinical suspicion alone, seven (87.5%) of whom had positive screens, compared with 44 of the 192 (22.9%) patients who were screened for indications. Thus, 7 of 51 (13.7%; 95% confidence interval: 6.8%-26.7%) patients with PTSD-level symptoms would not have been screened on the basis of their risk factors. There were also practical difficulties in implementation. CONCLUSION Limiting PTSD screening to only those injured patients with additional risk factors would have reduced overall sensitivity at our center. Consequently, we have implemented universal screening instead.
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Dell’Acqua C, Mura F, Messerotti Benvenuti S, Patron E, Palomba D. Reduced heart rate variability and expressive suppression interact to prospectively predict COVID-19 pandemic-related post-traumatic stress symptoms. Sci Rep 2022; 12:21311. [PMID: 36494439 PMCID: PMC9734110 DOI: 10.1038/s41598-022-25915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic is a unique period of stress that, in some cases, led to post-traumatic stress symptoms (PTSSs). Emotion regulation strategies are known to modulate the emotional response to stressful events. Expressive suppression (ES) is a maladaptive strategy related to the exacerbation of the physiological stress response. Heart rate variability (HRV), an index of cardiac autonomic balance strictly related to ES, was also shown to predict PTSSs. This was the first study to investigate whether the pre-pandemic ES use and resting-state HRV predicted pandemic-related PTSSs. Before the pandemic, 83 (58 females) university students completed the Emotion Regulation Questionnaire (ERQ), self-report measures of anxiety and depressive symptoms, and a three-minute resting-state electrocardiogram recording. After 12 months, 61 (45 females) participants completed a self-report measure of pandemic-related PTSSs and repeated the self-report psychological measures. Pre-pandemic anxiety symptoms prospectively predicted greater PTSSs. Moreover, a significant interaction between HRV and ES in predicting PTSSs emerged, whereby those who had higher levels of ES and reduced HRV showed higher PTSSs. These findings suggest that an integrated assessment of HRV and ES might be useful for identifying individuals who are more vulnerable to the development of PTSSs during crises.
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Affiliation(s)
- Carola Dell’Acqua
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Francesca Mura
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Simone Messerotti Benvenuti
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy ,grid.411474.30000 0004 1760 2630Hospital Psychology Unit, Padua University Hospital, Padua, Italy
| | - Elisabetta Patron
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy
| | - Daniela Palomba
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
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Hink AB, Atkins DL, Rowhani-Rahbar A. Not All Survivors Are the Same: Qualitative Assessment of Prior Violence, Risks, Recovery and Perceptions of Firearms and Violence Among Victims of Firearm Injury. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14368-NP14396. [PMID: 33884906 DOI: 10.1177/08862605211005157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Qualitative exploration into the risk, experiences, and outcomes of victims of firearm injury is imperative to informing not only further research, but prevention and intervention strategies. The purpose of this study was to explore prior violent exposures, risks, recovery, supportive services, outcomes, and views of firearms and violence among survivors of firearm assaults and unintentional injuries. Adults treated at a level 1 trauma center in Seattle, WA, for assault and unintentional firearm injuries were interviewed utilizing a semistructured instrument. Interview responses were coded to identify common themes and representative quotes are reported. Sixteen participants were interviewed. Notable themes included the following: (a) prior violent exposures were experienced by half of survivors, mostly through community violence; (b) risk for firearm injury was felt to be related to general societal violence, unsafe communities, and firearm practices; (c) important aspects of recovery included family/social support, mental health care and financial support services; (d) notable outcomes included psychological problems such as PTSD and anxiety, changes in relationships, and developing a new sense of purpose or mission in life; (e) generally negative views toward firearms, supporting restricted access and firearm safety practices; (f) acknowledgement of the complexity of firearm violence in society with prevention geared toward equitable education, economic opportunities and safety net programs to reduce community violence; and (g) disappointment in the criminal justice system. These findings demonstrate the varied experiences, needs, and outcomes after injury, but highlight the significance of community and societal violence, and need for improved mental health services. Integration of mental health services and victim assistance programs into trauma centers and hospital-based violence intervention programs is imperative for all survivors. Encouraging survivors to engage in new aspirations after injury can be empowering, and there is an unmet need for victim support and advocacy within the criminal justice system.
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Affiliation(s)
- Ashley B Hink
- Medical University of South Carolina, Charleston, SC, USA
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Screening tools for predicting posttraumatic stress disorder in acutely injured adult trauma patients: A systematic review. J Trauma Acute Care Surg 2022; 92:e115-e126. [PMID: 34991124 DOI: 10.1097/ta.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes. METHODS PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines. RESULTS Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%) and specificity (67-94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up. CONCLUSION Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies. LEVEL OF EVIDENCE Systematic review, level III.
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Weber H, Maihofer AX, Jaksic N, Bojic EF, Kucukalic S, Dzananovic ES, Uka AG, Hoxha B, Haxhibeqiri V, Haxhibeqiri S, Kravic N, Umihanic MM, Franc AC, Babic R, Pavlovic M, Mehmedbasic AB, Aukst-Margetic B, Kucukalic A, Marjanovic D, Babic D, Bozina N, Jakovljevic M, Sinanovic O, Avdibegović E, Agani F, Warrings B, Domschke K, Nievergelt CM, Deckert J, Dzubur-Kulenovic A, Erhardt A. Association of polygenic risk scores, traumatic life events and coping strategies with war-related PTSD diagnosis and symptom severity in the South Eastern Europe (SEE)-PTSD cohort. J Neural Transm (Vienna) 2022; 129:661-674. [PMID: 34837533 PMCID: PMC9188618 DOI: 10.1007/s00702-021-02446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is triggered by extremely stressful environmental events and characterized by high emotional distress, re-experiencing of trauma, avoidance and hypervigilance. The present study uses polygenic risk scores (PRS) derived from the UK Biobank (UKBB) mega-cohort analysis as part of the PGC PTSD GWAS effort to determine the heritable basis of PTSD in the South Eastern Europe (SEE)-PTSD cohort. We further analyzed the relation between PRS and additional disease-related variables, such as number and intensity of life events, coping, sex and age at war on PTSD and CAPS as outcome variables. METHODS Association of PRS, number and intensity of life events, coping, sex and age on PTSD were calculated using logistic regression in a total of 321 subjects with current and remitted PTSD and 337 controls previously subjected to traumatic events but not having PTSD. In addition, PRS and other disease-related variables were tested for association with PTSD symptom severity, measured by the Clinician Administrated PTSD Scale (CAPS) by liner regression. To assess the relationship between the main outcomes PTSD diagnosis and symptom severity, each of the examined variables was adjusted for all other PTSD related variables. RESULTS The categorical analysis showed significant polygenic risk in patients with remitted PTSD and the total sample, whereas no effects were found on symptom severity. Intensity of life events as well as the individual coping style were significantly associated with PTSD diagnosis in both current and remitted cases. The dimensional analyses showed as association of war-related frequency of trauma with symptom severity, whereas the intensity of trauma yielded significant results independently of trauma timing in current PTSD. CONCLUSIONS The present PRS application in the SEE-PTSD cohort confirms modest but significant polygenic risk for PTSD diagnosis. Environmental factors, mainly the intensity of traumatic life events and negative coping strategies, yielded associations with PTSD both categorically and dimensionally with more significant p-values. This suggests that, at least in the present cohort of war-related trauma, the association of environmental factors and current individual coping strategies with PTSD psychopathology was stronger than the polygenic risk.
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Affiliation(s)
- Heike Weber
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Nenad Jaksic
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Elma Feric Bojic
- Department for Genetic and Biotechnology, International Burch University, Sarajevo, Bosnia and Herzegovina
| | - Sabina Kucukalic
- Department of Psychiatry, University Clinical Center, Sarajevo, Bosnia and Herzegovina
| | | | - Aferdita Goci Uka
- Department of Psychiatry, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Blerina Hoxha
- Department of Psychiatry, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Valdete Haxhibeqiri
- Department of Medical Biochemistry, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Shpend Haxhibeqiri
- Institute of Kosovo Forensic Psychiatry, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Nermina Kravic
- Department of Psychiatry, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | | | - Ana Cima Franc
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Romana Babic
- Department of Psychiatry, University Clinical Center of Mostar, Mostar, Bosnia and Herzegovina
| | - Marko Pavlovic
- Department of Psychiatry, University Clinical Center of Mostar, Mostar, Bosnia and Herzegovina
| | | | | | - Abdulah Kucukalic
- Department of Psychiatry, University Clinical Center, Sarajevo, Bosnia and Herzegovina
| | - Damir Marjanovic
- Department for Genetic and Biotechnology, International Burch University, Sarajevo, Bosnia and Herzegovina
- Center for Applied Bioanthropology, Institute for Anthropological Researches, Zagreb, Croatia
| | - Dragan Babic
- Department of Psychiatry, University Clinical Center of Mostar, Mostar, Bosnia and Herzegovina
| | - Nada Bozina
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Miro Jakovljevic
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Osman Sinanovic
- Department of Neurology, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Esmina Avdibegović
- Department of Psychiatry, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Ferid Agani
- Faculty of Medicine, University Hasan Prishtina, Prishtina, Kosovo
| | - Bodo Warrings
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Alma Dzubur-Kulenovic
- Department of Psychiatry, University Clinical Center, Sarajevo, Bosnia and Herzegovina
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Department of Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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Emotional processing prospectively modulates the impact of anxiety on COVID-19 pandemic-related post-traumatic stress symptoms: an ERP study. J Affect Disord 2022; 303:245-254. [PMID: 35172175 PMCID: PMC8842094 DOI: 10.1016/j.jad.2022.02.027] [Citation(s) in RCA: 2] [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: 07/29/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Considering that the elevated distress caused by the COVID-19 pandemic, in some cases, led to post-traumatic stress symptoms (PTSS), it has been proposed as a specific traumatic event. The present longitudinal study investigated pre-pandemic motivated attention to emotional stimuli, as indexed by Late Positive Potential (LPP) amplitude, in relation with the potential differential role of anxiety and depressive symptoms in predicting PTSS severity related to the COVID-19 pandemic. METHODS A total of 79 university students initially completed self-report measures of depression and anxiety along with a passive viewing task of emotional (pleasant, unpleasant) and neutral pictures while electroencephaloghic activity was recorded. In December 2020, 57 participants completed a questionnaire assessing PTSS. RESULTS Significant interactions between anxiety and LPP emerged in predicting pandemic-related PTSS, where greater anxiety symptoms predicted PTSS only in individuals with greater LPP to unpleasant or with reduced LPP to pleasant stimuli. LIMITATIONS The prevalence of the female sex, the relatively young age of the participants, as well as the fact that they were all enrolled in a University course might not allow the generalization of the findings. CONCLUSIONS Taken together, the present longitudinal study provided novel evidence on EEG predictors of pandemic-related PTSS that might be useful for the prevention and treatment of PTSS. Indeed, assessing anxiety symptoms and pre-trauma LPP to emotional stimuli might be a useful target for identifying individuals that are more vulnerable to the development of PTSS during times of crisis.
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Hink AB, Killings X, Bhatt A, Ridings LE, Andrews AL. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. CURRENT TRAUMA REPORTS 2022; 8:41-53. [PMID: 35399601 PMCID: PMC8976221 DOI: 10.1007/s40719-022-00223-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
Purpose of Review This provides up-to-date epidemiology of adolescent suicide and risk factors for suicide and highlights the overlap of risks for suicide and injury. It reviews signs and symptoms, and the up-to-date evidence on screening for depression, post-traumatic stress disorder (PTSD), suicide, substance abuse, and lethal means, and offers strategies of implementation in trauma centers. Recent Findings The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities. The risk factors are complex, but many pre-existing risk factors and sequela after injury such as exposures to violence, suicidal behaviors, substance abuse, depression and post-traumatic stress disorder, and specific injuries including traumatic brain injury and spinal cord injury have further emerged as risks. Studies show rates of suicidality as high as 30% in the acute care setting. There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients. Step-up models of care for PTSD are promising to increase screening and services after injury. Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide. Summary Suicide is the second leading cause of death in US adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. Trauma centers should strongly consider screening adolescents, establish strategies for mental health support and referrals, and provide lethal means counseling to help prevent suicide.
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Jayan D, deRoon-Cassini TA, Sauber G, Hillard CJ, Fitzgerald JM. A cluster analytic approach to examining the role of cortisol in the development of post-traumatic stress and dysphoria in adult traumatic injury survivors. Psychoneuroendocrinology 2022; 135:105450. [PMID: 34775251 PMCID: PMC8686692 DOI: 10.1016/j.psyneuen.2021.105450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
Identification of specific risk factors for posttraumatic stress disorder (PTSD) versus depression after trauma has been challenging, in part due to the high comorbidity of these disorders. As exposure to trauma triggers activation of the hypothalamic-pituitary-adrenal (HPA)-axis, examining atypical stress responses via HPA-axis hormones, namely cortisol, may help in the delineation of these disorders. Indeed, extant research demonstrates that, following stress, individuals with chronic PTSD exhibit hypocortisolism (e.g., lower cortisol response than controls), while those with chronic depression exhibit hypercortisolism (e.g., higher response than controls). Less is known about the role of cortisol and these seemingly disparate profiles immediately following traumatic injury as well as whether cortisol can be used as a predictor of future development of PTSD versus depression symptoms. In this study cortisol was measured blood from 172 traumatic injury survivors during hospitalization (on average 2.5 days post-injury). PTSD and depression severity were assessed from Clinician Assessed PTSD Scale (CAPS-5) six-eight months later using a two-factor dimensional approach that measures trauma-specific symptoms of PTSD versus dysphoria (akin to depression). Cluster analysis was used to group individuals based on post-injury cortisol, PTSD, and dysphoria. Results demonstrated that trauma survivors who only developed symptoms of dysphoria at six months (with minimal symptoms of PTSD) were differentiated by high post-injury cortisol compared to other groups. By contrast, individuals who developed symptoms of both PTSD and dysphoria were differentiated by low post-injury cortisol and most severe symptoms of PTSD. Findings provide support for the presence of subgroups of trauma survivors defined, in part, by post-trauma cortisol.
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Affiliation(s)
- Devi Jayan
- Department of Psychology, Marquette University, 317 Cramer Hall, Milwaukee 53233, USA
| | - Terri A deRoon-Cassini
- Departments of Trauma & Acute Care Surgery, Psychiatry & Behavioral Medicine, and the Institute for Health & Equity, Comprehensive Injury Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Garrett Sauber
- Department of Pharmacology and Toxicology and Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Cecilia J Hillard
- Department of Pharmacology and Toxicology and Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Jacklynn M Fitzgerald
- Department of Psychology, Marquette University, 317 Cramer Hall, Milwaukee 53233, USA.
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Smith RN, Tracy BM, Smith S, Johnson S, Martin ND, Seamon MJ. Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP306-NP326. [PMID: 32370593 DOI: 10.1177/0886260520914557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Retained bullets are common after firearm injuries, yet their management remains poorly defined. Surgeon members of the Eastern Association for the Surgery of Trauma (N = 427) were surveyed using an anonymous, web-based questionnaire during Spring 2016. Indications for bullet removal and practice patterns surrounding this theme were queried. Also, habits around screening and diagnosing psychological illness in victims of firearm injury were asked. Most respondents were male (76.5%, n = 327) and practiced at urban (84.3%, n = 360), academic (88.3%, n = 377), Level 1 trauma centers (72.8%, n = 311). Only 14.5% (n = 62) of surgeons had institutional policies for bullet removal and 5.6% (n = 24) were likely to remove bullets. Half of the surgeons (52.0%, n = 222) preferred to remove bullets after the index hospitalization and pain (88.1%, n = 376) and a palpable bullet (71.2%, n = 304) were the most frequent indications for removal. Having the opportunity to follow-up with patients to discuss bullet removal was significantly predictive of removal (odds ratio (OR) = 2.25, 95% confidence interval (CI) = [1.05, 4.85], p = .04). Furthermore, routinely asking about retained bullets during outpatient follow-up was predictive of new psychological illness screening (OR = 1.94, 95% CI [1.19, 3.16], p = .01) and diagnosis (OR = 1.86, 95% CI = [1.12, 3.09], p = .02) in victims of firearm injury. Thus, surgeons should be encouraged to allot time for patients concerning retained bullet management so that a shared decision can be reached.
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Affiliation(s)
- Randi N Smith
- Emory University School of Medicine, Atlanta, GA, USA
| | - Brett M Tracy
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Sean Johnson
- University of Pennsylvania, Philadelphia, PA, USA
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Brienza A, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW, Pacella-LaBarbara ML. The role of specific sources of social support on postinjury psychological symptoms. Rehabil Psychol 2021; 66:600-610. [PMID: 34398631 PMCID: PMC8648976 DOI: 10.1037/rep0000388] [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] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury. RESULTS Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family. CONCLUSIONS/IMPLICATIONS MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Oddo ER, Maldonado L, Hink AB, Simpson AN, Andrews AL. Increase in Mental Health Diagnoses Among Youth With Nonfatal Firearm Injuries. Acad Pediatr 2021; 21:1203-1208. [PMID: 34119719 DOI: 10.1016/j.acap.2021.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Firearm injury is a leading cause of mortality for US youth. For every youth who dies from a firearm injury, at least 4 more survive. Little is known about the mental health consequences of non-fatal firearm injury in youth. Our objective was to quantify new mental health diagnoses after nonfatal firearm injury. METHODS MarketScan Medicaid and commercial data were used to identify youth age 0 to 17 years with an initial encounter for a nonfatal firearm injury in 2016 to 2017. The International Classification of Diseases, Tenth Revision codes determined the presence of mental health conditions in the 12 months preinjury, during the index encounter, and in the 12 months postinjury. Logistic regression analysis was performed to determine factors associated with new mental health diagnoses during the 12 months postinjury. RESULTS About 2178 patients (1769 Medicaid, 409 commercial) were identified for inclusion. 844 (38.8%) patients had a mental health diagnosis identified during the 12-month preinjury period. During the index encounter, 184 (8.5%) patients had a newly diagnosed mental health disorder. In the 12 months postinjury, 559 (25.7%) patients had a newly diagnosed mental health disorder. The most common new diagnosis categories were trauma disorders, substance abuse, and disruptive disorders. Medicaid insurance and a prior complex chronic condition were predictors of new mental health diagnosis. CONCLUSION Over a quarter of youth with nonfatal firearm injury were diagnosed with a new mental health condition in the 12 months after their injury. Health care providers should be vigilant about mental health screening and ensuring access to mental health care services in this population.
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Affiliation(s)
- Elizabeth R Oddo
- Department of Pediatrics, College of Medicine, Medical University of South Carolina (ER Oddo), Charleston, SC.
| | - Lizmarie Maldonado
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina (L Maldonado), Charleston, SC
| | - Ashley B Hink
- Department of Surgery, College of Medicine, Medical University of South Carolina (AB Hink), Charleston, SC
| | - Annie N Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina (AN Simpson), Charleston, SC
| | - Annie L Andrews
- Department of Pediatrics, College of Medicine, Medical University of South Carolina (AL Andrews), Charleston, SC
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22
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Verstraeten BSE, Elgbeili G, Hyde A, King S, Olson DM. Maternal Mental Health after a Wildfire: Effects of Social Support in the Fort McMurray Wood Buffalo Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:710-718. [PMID: 33172310 PMCID: PMC8320544 DOI: 10.1177/0706743720970859] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Following disasters, perinatal women are vulnerable to developing post-traumatic stress disorder (PTSD)-like symptoms. Little is known about protective factors. We hypothesized that peritraumatic stress would predict PTSD-like symptoms in pregnant and postpartum women and would be moderated by social support and resilience. METHOD Women (n = 200) who experienced the 2016 Fort McMurray Wood Buffalo wildfire during or shortly before pregnancy completed the Peritraumatic Distress Inventory (PDI), Peritraumatic Dissociative Experiences Questionnaire, and the Impact of Event Scale-Revised for current PTSD-like symptoms. They also completed scales of social support (Social Support Questionnaire-Short Form) and resilience (Connor-Davidson Resilience Scale). RESULTS Greater peritraumatic distress (r = 0.56) and dissociative experiences (r = 0.56) correlated with more severe PTSD-like symptoms. Greater social support satisfaction was associated with less severe post-traumatic stress symptoms but only when peritraumatic distress was below average; at more severe levels of PDI, this psychosocial variable was not protective. CONCLUSIONS Maternal PTSD-like symptoms after a wildfire depend on peritraumatic distress and dissociation. Higher social support satisfaction buffers the association with peritraumatic distress, although not when peritraumatic reactions are severe. Early psychosocial interventions may protect perinatal women from PTSD-like symptoms after a wildfire.
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Affiliation(s)
| | - Guillaume Elgbeili
- 26632Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Ashley Hyde
- 12357Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne King
- Department of Psychiatry, 5620McGill University, Montréal, Québec, Canada
| | - David M Olson
- Department of Obstetrics & Gynecology, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Physiology, 3158University of Alberta, Edmonton, Alberta, Canada
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23
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Hyde A, Verstraeten BSE, Olson JK, King S, Brémault-Phillips S, Olson DM. The Fort McMurray Mommy Baby Study: A Protocol to Reduce Maternal Stress Due to the 2016 Fort McMurray Wood Buffalo, Alberta, Canada Wildfire. Front Public Health 2021; 9:601375. [PMID: 34222163 PMCID: PMC8249202 DOI: 10.3389/fpubh.2021.601375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Data show that maternal stress triggered by exposure to a natural disaster before, during or just after pregnancy is associated with adverse pregnancy and newborn outcomes. In this paper, the first aim is to describe our efforts to test a simple, low-cost intervention to large numbers of women following a major natural disaster. The second aim is to outline the challenges faced and lessons learned during the execution of this natural disaster study. Methods: The setting was the May 2016 Fort McMurray Wood Buffalo wildfire in northern Alberta, Canada. Women who were pregnant or preconception at the time of the disaster were invited to participate via social media. This prospective cohort study included a randomized controlled trial to test the effectiveness of an expressive writing intervention on the levels of prenatal maternal stress and maternal, birth, and early childhood outcomes. At recruitment and at multiple timepoints postpartum, a battery of questionnaires was administered to evaluate objective and subjective stress exposure to the fire as well as maternal mental health, resilience and its contributing factors as well as infant developmental milestones. Qualitative content analysis of the expressive writing was conducted. Discussion: There is an increasing need to develop effective, wide-spread, rapid, and low-cost interventions to reduce prenatal maternal stress, increase resilience, and improve pregnancy outcomes following a natural disaster. Though analysis of data is ongoing, we highlight the strengths of this study which include strong community participation, rapid recruitment of eligible participants, low-cost intervention and data acquisition, and successful testing of the intervention. We acknowledge the challenges we encountered including the high rate of participant disqualifications or losses due to incomplete collection of online data; evacuation, dispersal, and inconsistent return to homes; and the high levels of stress accumulated post-disaster which led to inability to complete the study. Despite potential challenges, there remains a need for such research amid natural disasters.
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Affiliation(s)
- Ashley Hyde
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Joanne K Olson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Suzanne King
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - David M Olson
- Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
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24
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Joseph NM, Benedick A, Flanagan CD, Breslin MA, Vallier HA. Risk Factors for Posttraumatic Stress Disorder in Acute Trauma Patients. J Orthop Trauma 2021; 35:e209-e215. [PMID: 33724967 DOI: 10.1097/bot.0000000000001990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify risk factors for posttraumatic stress disorder (PTSD) after traumatic injury. SETTING Single urban Level I trauma center. DESIGN Prospective. PATIENTS/PARTICIPANTS Three hundred men (66%) and 152 women treated for traumatic injuries were administered the PTSD checklist for a Diagnostic and Statistical Manual of Mental Disorders fifth edition (PCL-5) survey during their first post-hospital visit over a 15-month period. INTERVENTION Screening for PTSD in trauma patients. MAIN OUTCOME MEASUREMENT The prevalence of disease and risk factors for the development of PTSD based on demographic, medical, injury, and treatment variables. RESULTS One hundred three patients screened positive for PTSD (26%) after a mean of 86 days after injury. Age less than 45 years was an independent risk factor for the development of PTSD [odds ratio (OR) 2.64, 95% confidence interval (CI) (1.40-4.99)]. Mechanisms of injury associated with the development of PTSD included pedestrians struck by motor vehicles [OR 7.35, 95% CI (1.58-34.19)], motorcycle/all terrain vehicle crash [OR 3.17, 95% CI (1.04-9.65)], and victims of crime [OR 3.49, 95% CI (0.99-9.20)]. Patients sustaining high-energy mechanism injuries and those who were victims of crime scored higher on the PCL-5 [OR 2.39, 95% CI (1.35-4.22); OR 4.50, 95% CI (2.52-8.05), respectively]. CONCLUSIONS One quarter of trauma patients screened positive for PTSD at 3 months after their injury. A mechanism of injury is a risk factor for PTSD, and younger adults, victims of crime, and pedestrians struck by motor vehicles are at higher risk. These findings offer the potential to more effectively target and refer vulnerable patient populations to appropriate treatment. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a compete description of levels of evidence.
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Affiliation(s)
- Noah M Joseph
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, affiliated with the Case Western Reserve University
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25
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Zatzick D, Jurkovich G, Heagerty P, Russo J, Darnell D, Parker L, Roberts MK, Moodliar R, Engstrom A, Wang J, Bulger E, Whiteside L, Nehra D, Palinkas LA, Moloney K, Maier R. Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial. JAMA Surg 2021; 156:430-474. [PMID: 33688908 DOI: 10.1001/jamasurg.2021.0131] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration ClinicalTrials.gov Identifier: NCT02655354.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Gregory Jurkovich
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, University of California, Los Angeles
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, Seattle
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26
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Tang F, Tan J, Guo X, Huang J, Yi J, Wang L. Risk factors for post-traumatic stress disorder in acute trauma patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25616. [PMID: 33907115 PMCID: PMC8084095 DOI: 10.1097/md.0000000000025616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is one of the most commonly reported mental health consequences, followed by disasters and traumatic events, either natural or man-made. At present, there are no unified results for the prevalence rate of PTSD in patients suffering from acute trauma and related influencing factors. Therefore, the purpose of this study is to systematically evaluate the existing literatures, thus obtaining a comprehensive estimation of the combined prevalence rate of PTSD and related factors in trauma patients, so as to provide evidence support for clinical disease prediction models and intervention strategies. METHODS Published articles will be retrieved from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Research reports will be searched in March 2021. STATA 14.0 software will be applied for data analysis. Mantel-Haenszel fixed effect model or DerSimonian-Laird random effect model will be selected to estimate the pooled prevalence of PTSD in patients with acute trauma and associated factors. RESULTS We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSIONS The results of this analysis can be used to establish a risk prediction model of PTSD in patients experiencing acute trauma, so as to provide intervention strategies. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/Z275U.
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Affiliation(s)
| | | | | | | | | | - Lang Wang
- Department of Metabolic Endocrinology, Zhuzhou Central Hospital, Zhuzhou, Hunan province, China
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27
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Wheaton MG, Patel SR, Andersson E, Rück C, Simpson HB. Predicting Treatment Outcomes From Internet-Based Cognitive Behavior Therapy for Obsessive-Compulsive Disorder. Behav Ther 2021; 52:77-85. [PMID: 33483126 PMCID: PMC7826445 DOI: 10.1016/j.beth.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 11/29/2022]
Abstract
Internet-based cognitive-behavioral therapy (ICBT) with therapist support shows promise as a treatment for obsessive-compulsive disorder (OCD). Yet, not all patients respond to ICBT. It is therefore important to identify predictors of ICBT outcomes to determine who is likely to benefit. Relative to the large literature on predictors of outcomes for in-person CBT for OCD, very few studies have investigated ICBT predictors. Therefore, we analyzed predictors of outcome in an open trial (n=30) of ICBT for OCD using the OCD-NET platform, which consists of 10 online modules delivered with therapist support. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was administered by independent raters as the primary outcome measure at baseline and posttreatment. In this sample, greater baseline OCD severity and OCD-related avoidance behaviors were associated with higher end-state OCD symptoms (i.e., poorer outcome). Patients with a past history of face-to-face CBT for OCD also had worse outcomes. Although these results require replication, these factors may identify individuals at risk for poor ICBT outcomes.
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Affiliation(s)
- Michael G. Wheaton
- Department of Psychology, Barnard College, Columbia University, New York, NY, USA,New York State Psychiatric Institute/Columbia Psychiatry,corresponding author Michael G. Wheaton, PhD, Assistant Professor of Psychology, Department of Psychology, Barnard College, Columbia University, (212) 853-1692,
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28
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Kirven JC, Everhart JS, DiBartola AC, Jones J, Flanigan DC, Harrison R. Interventional Efforts to Reduce Psychological Distress After Orthopedic Trauma: A Systematic Review. HSS J 2020; 16:250-260. [PMID: 33088239 PMCID: PMC7534886 DOI: 10.1007/s11420-019-09731-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unanticipated severe injury to part of the musculoskeletal system, referred to as orthopedic trauma, can be debilitating. It can also be accompanied by equally debilitating psychological distress, but little is known about the effective interventions for psychological sequelae of orthopedic trauma. QUESTIONS/PURPOSES We sought to determine the effectiveness of interventions on psychological outcomes, such as post-traumatic stress disorder (PTSD), depression, and pain catastrophizing (feelings of helplessness, excessive rumination, and exaggerated description of pain), after major orthopedic trauma. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement as guidelines, we systematically searched Scopus, PubMed, and Google Scholar. Studies included for review were English-language interventional studies in an orthopedic trauma population that included assessment of post-injury psychological distress or disability as either a primary or secondary aim. RESULTS Twelve studies were identified, including six randomized trials, three prospective cohort studies, and three retrospective cohort studies. Study sample sizes ranged from 48 to 569 patients, the mean age ranged from 29 to 52.8 years, and the percentage of male patients ranged from 38 to 90%. We examined four categories of interventions. Peer group treatment (one study) significantly reduced rates of depression but had low participation rates. Brief interventions to teach coping and self-efficacy skills (two studies) decreased depression, pain catastrophizing, and anxiety scores while increasing self-efficacy on short-term follow-up. Individualized counseling and rehabilitation (four studies) resulted in a consistent reduction in the risk of PTSD. Early amputation was found to result in lower rates of PSTD than limb salvage in US military personnel (four studies). One study examined surgeons' confidence in dealing with possible psychological distress; surgeons who participated in a program on collaborative care were significantly more confident that they could help their patients with such issues. CONCLUSION Interventional strategies, including group interventions, brief individual interventions, longitudinal counseling, and consideration of early amputation in selected populations have proved effective in reducing negative psychological sequelae of major orthopedic trauma. Further research that determines the effects of interventions in this population is needed.
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Affiliation(s)
- James C. Kirven
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Joshua S. Everhart
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Alex C. DiBartola
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Jeremy Jones
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - David C. Flanigan
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Cartilage Restoration Program, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Ryan Harrison
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
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Linnstaedt SD, Zannas AS, McLean SA, Koenen KC, Ressler KJ. Literature review and methodological considerations for understanding circulating risk biomarkers following trauma exposure. Mol Psychiatry 2020; 25:1986-1999. [PMID: 31863020 PMCID: PMC7305050 DOI: 10.1038/s41380-019-0636-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022]
Abstract
Exposure to traumatic events is common. While many individuals recover following trauma exposure, a substantial subset develop adverse posttraumatic neuropsychiatric sequelae (APNS) such as posttraumatic stress, major depression, and regional or widespread chronic musculoskeletal pain. APNS cause substantial burden to the individual and to society, causing functional impairment and physical disability, risk for suicide, lost workdays, and increased health care costs. Contemporary treatment is limited by an inability to identify individuals at high risk of APNS in the immediate aftermath of trauma, and an inability to identify optimal treatments for individual patients. Our purpose is to provide a comprehensive review describing candidate blood-based biomarkers that may help to identify those at high risk of APNS and/or guide individual intervention decision-making. Such blood-based biomarkers include circulating biological factors such as hormones, proteins, immune molecules, neuropeptides, neurotransmitters, mRNA, and noncoding RNA expression signatures, while we do not review genetic and epigenetic biomarkers due to other recent reviews of this topic. The current state of the literature on circulating risk biomarkers of APNS is summarized, and key considerations and challenges for their discovery and translation are discussed. We also describe the AURORA study, a specific example of current scientific efforts to identify such circulating risk biomarkers and the largest study to date focused on identifying risk and prognostic factors in the aftermath of trauma exposure.
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Affiliation(s)
- Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony S Zannas
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Departments of Psychiatry and Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
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Abstract
Objective To determine the prevalence of positive screening for posttraumatic stress disorder (PTSD) amongst trauma patients. Design Prospective, longitudinal study. Setting Single urban US level 1 trauma center. Patients and methods Four hundred fifty-two adult trauma patients were administered the PTSD checklist for DSM-V (PCL-5) survey upon posthospital outpatient clinic visit. This included 300 men (66%) and 152 women with mean age 43.8 years and mean Injury Severity Score (ISS) 11.3, with 83% having fractures of the pelvis and/or extremities. Medical and injury related variables were recorded. Multivariate logistic regression analysis was performed to identify factors predictive of screening positive for PTSD. Main outcome measurement Prevalence and risk factors for screening positive for PTSD amongst the trauma patient population. Results Twenty-six percent of trauma patients screened positive for PTSD after mean 86 days following injury. These patients were younger (35 vs 46 years old, P < 0.001) and more commonly African American (56% vs 43% Caucasian, P < 0.001). Pedestrians struck by motor vehicles (OR 4.70, P = 0.040) and victims of crime (OR 4.12, P = 0.013) were more likely to screen positive. Psychiatric history, injury severity (ISS), and injury type did not predict positive screening. Conclusion One-in-four patients suffering traumatic injuries screened positive for PTSD suggesting the prevalence of PTSD among trauma patients far exceeds that of the general population. Predictive factors included victims of crime and pedestrians struck by motor vehicles. Screening measures are needed in orthopaedic trauma surgery clinics to refer these at-risk patients for proper evaluation and treatment. Level of evidence Prognostic; Level II.
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31
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The scales of recovery: Balancing posttraumatic stress with resilience in the violently injured. J Trauma Acute Care Surg 2020; 89:208-214. [DOI: 10.1097/ta.0000000000002622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Firearm injury research and epidemiology: A review of the data, their limitations, and how trauma centers can improve firearm injury research. J Trauma Acute Care Surg 2020; 87:678-689. [PMID: 31033891 DOI: 10.1097/ta.0000000000002330] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Johnson L, Lodge C, Vollans S, Harwood PJ. Predictors of psychological distress following major trauma. Injury 2019; 50:1577-1583. [PMID: 31196596 DOI: 10.1016/j.injury.2019.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to identify variables that may predict later psychological distress in patients following admission to a Major Trauma Centre (MTC) and to determine whether a psychological screening tool, the Posttraumatic Adjustment Screen (PAS), administered on admission was able to contribute to this. METHODS Patients referred to the MTC clinical psychology service completed the PAS during their inpatient stay over an eight-month period. Following discharge from hospital, patients were telephoned (1 month, 3 months and 6 months post injury) by a member of the clinical psychology team and asked two validated questionnaires; the Impact of Events Scale revised (IES-R) (measure of posttraumatic stress symptoms) and the CORE-10 (measure of global psychological distress). In addition, patients' data from the local Trauma Audit & Research Network (TARN) database was reviewed to identify information related to injury and other demographic data. Patients were divided into groups for comparison based upon their PAS scores using previously described severity cut offs for posttraumatic stress symptoms and depression. Receiver Operator Characteristic and Multiple Linear Regression analysis was used to examine for significant baseline predictors of psychological distress during follow up according to the IES and CORE-10 scores. RESULTS One hundred and fourteen patients completed the PAS over the study period. Follow-up psychological data was available for 63 (56%) of patients. Except for the patient's home address, no baseline parameter examined in this study regarding patient demographics, injury or treatment was associated with reported psychological symptoms in the first six months post injury as measured by the IES-R or CORE-10 scores. Multiple linear regression analysis revealed that both PAS-P and PAS-D were significant predictor variables for patients reporting significant symptoms of posttraumatic stress and global psychological distress (according to IES-R and CORE-10 scores) in the first six months post injury. CONCLUSIONS Psychological screening on admission may be helpful in identifying patients admitted to MTCs who are at risk at developing posttraumatic stress symptoms and psychological distress following major trauma.
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Affiliation(s)
- L Johnson
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom.
| | - C Lodge
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
| | - S Vollans
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
| | - P J Harwood
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
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deRoon-Cassini TA, Hunt JC, Geier TJ, Warren AM, Ruggiero KJ, Scott K, George J, Halling M, Jurkovich G, Fakhry SM, Zatzick D, Brasel KJ. Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. J Trauma Acute Care Surg 2019; 87:440-450. [PMID: 31348404 PMCID: PMC6668348 DOI: 10.1097/ta.0000000000002370] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic injury affects over 2.6 million U.S. adults annually and elevates risk for a number of negative health consequences. This includes substantial psychological harm, the most prominent being posttraumatic stress disorder (PTSD), with approximately 21% of traumatic injury survivors developing the disorder within the first year after injury. Posttraumatic stress disorder is associated with deficits in physical recovery, social functioning, and quality of life. Depression is diagnosed in approximately 6% in the year after injury and is also a predictor of poor quality of life. The American College of Surgeons Committee on Trauma suggests screening for and treatment of PTSD and depression, reflecting a growing awareness of the critical need to address patients' mental health needs after trauma. While some trauma centers have implemented screening and treatment or referral for treatment programs, the majority are evaluating how to best address this recommendation, and no standard approach for screening and treatment currently exists. Further, guidelines are not yet available with respect to resources that may be used to effectively screen and treat these disorders in trauma survivors, as well as who is going to bear the costs. The purpose of this review is: (1) to evaluate the current state of the literature regarding evidence-based screens for PTSD and depression in the hospitalized trauma patient and (2) summarize the literature to date regarding the treatments that have empirical support in treating PTSD and depression acutely after injury. This review also includes structural and funding information regarding existing postinjury mental health programs. Screening of injured patients and timely intervention to prevent or treat PTSD and depression could substantially improve health outcomes and improve quality of life for this high-risk population. LEVEL OF EVIDENCE: Review, level IV.
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Affiliation(s)
- Terri A deRoon-Cassini
- From the Division of Trauma and Acute Care Surgery, Department of Surgery (T. A. d-C., T. D., T.J.G., M.H.), Milwaukee, Wisconsin; Baylor University Medical Center (A.M.W.), Baylor Scott and White Medical Psychology Consultants, Dallas, Texas; Medical University of South Carolina (K.J.R.), Departments of Nursing and Psychiatry, Charleston, South Carolina; University of Florida College of Medicine-Jacksonville, Department of Surgery, Division of Acute Care Surgery, Critical Care, TraumaOne (K.S.), Jacksonville, Florida; Parkland Health and Hospital System (J.G.), Rees-Jones Trauma Center, Dallas, Texas; University of California Davis Health (G.J.), Department of Surgery, Sacramento, California; Reston Hospital Center (S.M.F.), Trauma Surgery, Reston, Virginia; University of Washington School of Medicine (D.Z.), Department of Psychiatry and Behavioral Sciences, Seattle, Washington; and Oregon Health and Science University (K.J.B.), Department of Surgery, Portland, Oregon
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Traynham S, Kelley AM, Long CP, Britt TW. Posttraumatic Stress Disorder Symptoms and Criminal Behavior in U.S. Army Populations: The Mediating Role of Psychopathy and Suicidal Ideation. AMERICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.5406/amerjpsyc.132.1.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Whereas past research has demonstrated the relationship between posttraumatic stress disorder (PTSD) and criminal behavior, the present study examines the underlying mechanisms driving this association. The primary objective was to determine the role of psychopathy and suicidal ideation as mediating factors in the relationship between military PTSD symptoms and criminal behavior (defined as incarceration status). A correlational study using archival data from the U.S. Disciplinary Barracks (USDB) and a control population of U.S. Army soldiers was conducted. The USDB provided data from 310 incarcerated male U.S. Army soldiers. Data were also collected from 310 nonincarcerated, male U.S. Army soldiers in the greater Fort Rucker, Alabama area. Data validity checks eliminated some cases, thus yielding a final dataset of 246 USDB and 252 control participants. The results suggested partial mediation, in that PTSD symptoms had a direct effect on incarceration status, and significant indirect effects through suicidal ideation and psychopathy while controlling for intelligence and warmth. In furnishing evidence of how psychopathy and suicidal ideation mediate the relationship between PTSD and incarceration status in military personnel, this research highlights specific internalization and externalization mechanisms that may increase the tendencies of people with greater PTSD symptoms to engage in criminal behaviors. By adding to the small amount of prior research on why PTSD sometimes leads people to engage in criminal behaviors, our research provides specific, observable symptoms that clinicians may use to identify, treat, and possibly ameliorate facets of PTSD that can lead affected people to engage in criminal behaviors.
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Geier TJ, Hunt JC, Nelson LD, Brasel KJ, deRoon-Cassini TA. Detecting PTSD in a traumatically injured population: The diagnostic utility of the PTSD Checklist for DSM-5. Depress Anxiety 2019; 36:170-178. [PMID: 30597679 PMCID: PMC6373876 DOI: 10.1002/da.22873] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/20/2018] [Accepted: 12/08/2018] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Timothy J Geier
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joshua C Hunt
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D Nelson
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen J Brasel
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
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Papini S, Pisner D, Shumake J, Powers MB, Beevers CG, Rainey EE, Smits JA, Warren AM. Ensemble machine learning prediction of posttraumatic stress disorder screening status after emergency room hospitalization. J Anxiety Disord 2018; 60:35-42. [PMID: 30419537 PMCID: PMC6777842 DOI: 10.1016/j.janxdis.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/23/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Abstract
Posttraumatic stress disorder (PTSD) develops in a substantial minority of emergency room admits. Inexpensive and accurate person-level assessment of PTSD risk after trauma exposure is a critical precursor to large-scale deployment of early interventions that may reduce individual suffering and societal costs. Toward this aim, we applied ensemble machine learning to predict PTSD screening status three months after severe injury using cost-effective and minimally invasive data. Participants (N = 271) were recruited at a Level 1 Trauma Center where they provided variables routinely collected at the hospital, including pulse, injury severity, and demographics, as well as psychological variables, including self-reported current depression, psychiatric history, and social support. Participant zip codes were used to extract contextual variables including population total and density, average annual income, and health insurance coverage rates from publicly available U.S. Census data. Machine learning yielded good prediction of PTSD screening status 3 months post-hospitalization, AUC = 0.85 95% CI [0.83, 0.86], and significantly outperformed all benchmark comparison models in a cross-validation procedure designed to yield an unbiased estimate of performance. These results demonstrate that good prediction can be attained from variables that individually have relatively weak predictive value, pointing to the promise of ensemble machine learning approaches that do not rely on strong isolated risk factors.
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Affiliation(s)
- Santiago Papini
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States.
| | - Derek Pisner
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | - Jason Shumake
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | - Mark B. Powers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin,Baylor University Medical Center
| | - Christopher G. Beevers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | | | - Jasper A.J. Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
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Darnell DA, Parker LE, Wagner AW, Dunn CW, Atkins DC, Dorsey S, Zatzick DF. Task-shifting to improve the reach of mental health interventions for trauma patients: findings from a pilot study of trauma nurse training in patient-centered activity scheduling for PTSD and depression. Cogn Behav Ther 2018; 48:482-496. [PMID: 30499372 DOI: 10.1080/16506073.2018.1541928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite high rates of posttraumatic stress disorder (PTSD) and depression among traumatically injured patients, engagement in session-based psychotherapy early after trauma is limited due to various service utilization and readiness barriers. Task-shifting brief mental health interventions to routine trauma center providers is an understudied but potentially critical part of the continuum of care. This pilot study assessed the feasibility of training trauma nurses to engage patients in patient-centered activity scheduling based on a Behavioral Activation paradigm, which is designed to counteract dysfunctional avoidance/withdrawal behavior common among patients after injury. Nurses (N = 4) and patients (N = 40) were recruited from two level II trauma centers. A portion of a one day in-person workshop included didactics, demonstrations, and experiential activities to teach brief intervention delivery. Nurses completed pre- and posttraining standardized patient role-plays prior to and two months after training, which were coded for adherence to the intervention. Nurses also completed exit interviews to assess their perspectives on the training and addressing patient mental health concerns. Findings support the feasibility of training trauma nurses in a brief mental health intervention. Task-shifting brief interventions holds promise for reaching more of the population in need of posttrauma mental health care.
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Affiliation(s)
- Doyanne A Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Lea E Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Amy W Wagner
- Department of Mental Health, Portland Department of Veteran Affairs Medical Center , Portland , OR , USA
| | - Christopher W Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington , Seattle , DC , USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
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Culp BL, Roden-Foreman JW, Thomas EV, McShan EE, Bennett MM, Martin KR, Powers MB, Foreman ML, Petrey LB, Warren AM. Better with age? A comparison of geriatric and non-geriatric trauma patients' psychological outcomes 6 months post-injury. Cogn Behav Ther 2018; 48:406-418. [PMID: 30392449 DOI: 10.1080/16506073.2018.1533578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This is the first study to compare both physical and psychological outcomes in geriatric and non-geriatric patients (n = 268) at baseline and 6 months post-trauma. Demographic, clinical, and psychological data, including screens for alcohol use, depressive symptoms, and post-traumatic stress symptoms (PTSS) were collected from 67 geriatric patients (70.7 ± 8.0 years) and 201 non-geriatric patients (40.2 ± 12.8 years) admitted to a Level I trauma center for ≥ 24 h. Geriatric patients were significantly less likely to screen positive for alcohol use at baseline, and depression, PTSS, and alcohol use at follow-up. When not controlling for discharge to rehabilitation or nursing facility, geriatric patients had significantly lower odds of alcohol use at follow-up. There was no significant difference in injury severity, resilience, or pre-trauma psychological status between the two groups. Results indicate that geriatric trauma patients fare better than their younger counterparts at 6 months post-trauma on measures of alcohol use, depression, and PTSS. Screenings and interventions for both age groups could improve psychological health post-trauma, but younger patients may require additional attention.
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Affiliation(s)
- Brittney L Culp
- a Department of Surgery, Baylor Scott & White - Grapevine , Grapevine , TX , USA
| | - Jacob W Roden-Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Estrella V Thomas
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Evan Elizabeth McShan
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Monica M Bennett
- c Baylor Scott & White Health, Center for Clinical Effectiveness , Dallas , TX , USA
| | - Katherine Riley Martin
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Mark B Powers
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Michael L Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Laura B Petrey
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Ann Marie Warren
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
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Weis CN, Belleau EL, Pedersen WS, Miskovich TA, Larson CL. Structural Connectivity of the Posterior Cingulum Is Related to Reexperiencing Symptoms in Posttraumatic Stress Disorder. CHRONIC STRESS 2018; 2. [PMID: 30569027 PMCID: PMC6295657 DOI: 10.1177/2470547018807134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Posttraumatic stress disorder is a heterogeneous disorder with disturbances in
hyperarousal or avoidance behaviors and intrusive or reexperiencing thoughts.
The uncinate fasciculus and cingulum bundle are white matter pathways implicated
in stress and trauma pathophysiology, yet their structural integrity related to
posttraumatic stress disorder symptom domains is yet to be understood.
Forty-four trauma-exposed young adults underwent structural and
diffusion-weighted magnetic resonance imaging. Stress and trauma exposure
indices and severity of posttraumatic stress disorder symptoms were collected
and used to predict current integrity of the uncinate fasciculus and cingulum
bundle. Severity of reexperiencing posttraumatic stress disorder symptoms was
significantly related to increased fractional anisotropy
(r = .469 p < .001) and decreased mean
diffusivity (r = −.373, p = .013) of the
right posterior cingulum bundle. No other findings emerged with respect to
stress exposure or of hyperarousal (p’s > 0.05) or avoidance
(p’s > 0.2) posttraumatic stress disorder symptoms. The
posterior cingulum connects medial temporal lobe structures with visual areas in
the occipital lobe and has been implicated in visual memory and self-referential
thought. Increased structural connectivity along this pathway may therefore
explain the emergence of reexperiencing posttraumatic stress disorder symptoms.
This along with the lack of results with respect to stress exposure suggests
that structural aberrations in white matter pathways are more strongly linked
with the actual experience of stress-related psychological symptoms than just
exposure to stress.
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Affiliation(s)
- Carissa N Weis
- University of Wisconsin - Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | | | - Walker S Pedersen
- Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, USA
| | | | - Christine L Larson
- University of Wisconsin - Milwaukee, Department of Psychology, Milwaukee, WI, USA
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Kendrick D, Baker R, Hill T, Beckett K, Coupland C, Kellezi B, Joseph S, Barnes J, Sleney J, Christie N, Morriss R. Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: Multicentre cohort study. J Psychosom Res 2018; 112:15-24. [PMID: 30097131 DOI: 10.1016/j.jpsychores.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To quantify psychological morbidity and identify baseline factors associated with depression, anxiety and post-traumatic distress symptoms up to 12 months post-injury. METHODS Multicentre cohort study of 668 adults, aged 16 to 70, admitted to 4 UK NHS hospital trusts. Data on injury, socio-demographic characteristics and health status was collected at recruitment. Depression, anxiety and post-traumatic distress were measured at 1, 2, 4 and 12 months post-injury. Multilevel linear regression assessed associations between patient and injury characteristics and psychological outcomes over 12 months follow-up. RESULTS Depression, anxiety and post-traumatic distress scores were highest 1 month post-injury, and remained above baseline at 2, 4 and 12 months post-injury. Moderate or severe injuries, previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age (45-64 years), greater deprivation and lower pre-injury quality of life (QoL) were associated with higher depression scores post-injury. Previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age, greater deprivation and lower pre-injury QoL were associated with higher anxiety scores post-injury. Traffic injuries or injuries from being struck by objects, multiple injures (≥3), being female, previous psychiatric diagnoses, higher pre-injury anxiety scores and greater deprivation were associated with higher post-traumatic distress scores post-injury. CONCLUSION A range of risk factors, identifiable shortly after injury, are associated with psychological morbidity occurring up to 12 months post-injury in a general trauma population. Further research is required to explore the utility of these, and other risk factors in predicting psychological morbidity on an individual patient basis.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - R Baker
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - T Hill
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - K Beckett
- Centre for Health & Clinical Research, University of the West of England, BS16 1DD, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - B Kellezi
- Department of Psychology, Nottingham Trent University, NG1 4BU, UK
| | - S Joseph
- School of Education, University of Nottingham, NG8 1BB, UK
| | - J Barnes
- Loughborough Design School, Loughborough University, LE11 3TU, UK
| | - J Sleney
- Department of Sociology, University of Surrey, GU2 7XH, UK
| | - N Christie
- Centre for Transport Studies, University College London, WC1E 6BT, UK
| | - R Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, NG7 2TU, UK
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Paredes Molina CS, Berry S, Nielsen A, Winfield R. PTSD in civilian populations after hospitalization following traumatic injury: A comprehensive review. Am J Surg 2018; 216:745-753. [PMID: 30103902 DOI: 10.1016/j.amjsurg.2018.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Injuries and their comorbidities affect victims far beyond their physical recovery period. Some study-measures show that more than half of patients hospitalized for a traumatic injury suffer from Acute Stress Disorder, alcohol dependence, and recurrent trauma. Overall, this literature review serves to review risk factors for PTSD, screening tools, follow-up strategies, and gaps in the literature for achieving feasible patient-centered interventions for the prevention of PTSD after a traumatic injury. DATA SOURCES A literature review was performed from August 1, 2017 to March 19, 2018, from 3 Databases: PubMed, CINAHL and Cochrane, with keywords: "PTSD", "Post-traumatic Stress Disorder", "Civilians", "Traumatic", "Injury", "Follow-up", "Treatment", "Referral", "surgery", "surgical", "Intervention", and "Insured", "underinsured". CONCLUSIONS Reported risk factors for PTSD were: prior psychiatric disorder, gunshots, and lack of social support. Most articles use the Posttraumatic Stress Disorder Checklist - Civilian version. Follow-up strategies mainly focus on multidisciplinary intervention protocols, including social workers, behavioral health specialists, and psychiatrists. Finally, gaps in the literature show the need for bilingual/bicultural patient-centered care for elderly, diverse ethnic backgrounds, and insured vs. uninsured patients.
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Affiliation(s)
| | - Stepheny Berry
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Alexandra Nielsen
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Robert Winfield
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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Coping strategies as mediators in relation to resilience and posttraumatic stress disorder. J Affect Disord 2018; 225:153-159. [PMID: 28837948 PMCID: PMC5626644 DOI: 10.1016/j.jad.2017.08.049] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/15/2017] [Accepted: 08/14/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Resilience has been shown to protect against the development of posttraumatic stress disorder (PTSD) in the aftermath of trauma. However, it remains unclear how coping strategies influence resilience and PTSD development in the acute aftermath of trauma. The current prospective, longitudinal study investigated the relationship between resilience, coping strategies, and the development of chronic PTSD symptoms. METHODS A sample of patients was recruited from an emergency department following a Criterion A trauma. Follow-up assessments were completed at 1-, 3-, and 6-months post-trauma to assess PTSD symptom development (N = 164). RESULTS Resilience at 1-month positively correlated with the majority of active coping strategies (all p < .05) and negatively correlated with the majority of avoidant coping strategies (all p < .05), as well as future PTSD symptoms (p < .001). Additionally, all avoidant coping strategies, including social withdrawal, positively correlated with future PTSD symptoms (all p < .01). After controlling for demographic and clinical variables, social withdrawal at 3-months fully mediated the relationship between resilience at 1-month and PTSD symptoms at 6-months. LIMITATIONS Limitations include participant drop out and the conceptual overlap between avoidant coping and PTSD. CONCLUSIONS These data suggest that resilience and social withdrawal may be possible therapeutic targets for mitigating the development of chronic PTSD in the aftermath of trauma.
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Roden-Foreman K, Robinson R, Bennett M, Roaten K, Petrey L, Powers MB, Warren AM. Posttraumatic growth in a heterogeneous sample of traumatically injured patients 1 year postinjury. J Clin Psychol 2017; 74:989-1003. [PMID: 29193058 DOI: 10.1002/jclp.22563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/05/2017] [Accepted: 09/21/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Posttraumatic growth (PTG) describes positive change resulting from challenging life events. The current study examined factors associated with PTG in traumatically injured patients 1 year postinjury. METHOD Participants (N = 221) in this prospective cohort study included adults admitted to a Level I trauma center. Over half the participants (60%) were male, with a mean age of 47. Participants completed baseline measures during hospitalization. PTG was assessed at 12-month follow-up. RESULTS Greater PTG was associated with minority race/ethnicity, lower income, automotive collision, and premorbid psychological disorder other than depression or posttraumatic stress (PTS). These variables are also known to predict PTS in trauma patients. Analysis confirmed that greater PTS at follow-up was associated with more growth. CONCLUSION Participants with the most growth also experienced the most distress. This finding demonstrates the importance of implementing psychological screening and intervention for trauma patients in the acute care setting to reduce PTS and facilitate growth.
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Johnson JA, Jakubovski E, Reed MO, Bloch MH. Predictors of Long-Term Risky Driving Behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2017; 27:747-754. [PMID: 28771386 PMCID: PMC5651934 DOI: 10.1089/cap.2017.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examines predictors of later risky driving behavior in children with attention-deficit/hyperactivity disorder (ADHD). METHODS Stepwise logistic regression and receiver operating characteristic (ROC) analysis were used to explore baseline predictors of risky driving behavior for adolescents who completed the 8-year follow-up assessment in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA). RESULTS Stepwise logistic regression analysis explained 19% of the total variance in risky driving behavior. Increased likelihood of risky driving behavior was associated with parental history of conduct disorder, low parental monitoring and supervision, and increased age. ROC analysis identified discriminative predictors for adolescents older and younger than 16 years of age at follow-up. The most discriminative predictors of later risky driving behavior were parental stress at baseline (for children 16 years or older) and increased child-rated parental protectiveness (for children less than 16 years old). CONCLUSION Risky driving behavior was significantly predicted by baseline characteristics for the MTA cohort. Aspects of parenting behavior (or the child's perception of them), including parental stress levels, parental protectiveness, and parental levels of monitoring and supervision, were most informative in predicting these outcomes. Our results suggest that interventions to reduce high-risk behaviors in these high-risk children with ADHD might involve targeted parenting interventions.
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Affiliation(s)
- Jessica A. Johnson
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.,Syracuse University, Syracuse, New York
| | - Ewgeni Jakubovski
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Psychiatry, Social Psychology and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Margot O. Reed
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.,College of the Holy Cross, Worcester, Massachusetts
| | - Michael H. Bloch
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
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Gabriel D, Jakubovski E, Taylor JH, Artukoglu BB, Bloch MH. Predictors of treatment response and drop out in the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study. Psychiatry Res 2017; 255:248-255. [PMID: 28595147 DOI: 10.1016/j.psychres.2017.05.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 01/19/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022]
Abstract
The Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) compared the efficacy of risperidone, olanzapine, and molindone over 8 weeks in 119 youths age 8-19 years with early-onset schizophrenia or schizoaffective disorder. From this large dataset, we examined predictors of treatment response and drop out using stepwise regression and receiver operating characteristics curve (ROC) analysis. Treatment response was defined as having both a ≥ 20% improvement in Positive and Negative Syndrome Scale (PANSS) score and a Clinical Global Impression-Improvement (CGI-I) score < 3. More severe baseline symptoms, having a history of being in an early education program, and previous prescription of a mood stabilizer increased the likelihood of responding to treatment. Anhedonia and poor community functioning predicted a reduction in symptom severity on the PANSS. Random assignment to different antipsychotic treatment was not predictive of outcome. Parental report of aggressive behaviors at baseline and being African American were associated with a greater likelihood of drop out. Our results suggest youth with more severe psychotic symptoms are most likely to benefit from treatment with antipsychotics and that aggressive youth may require additional support to improve treatment adherence. Further investigation is needed to understand potentially modifiable predictors of response like early education programs.
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Affiliation(s)
- Daniel Gabriel
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Ewgeni Jakubovski
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jerome H Taylor
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Bekir B Artukoglu
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Michael H Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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khodadadi-hassankiadeh N, Dehghan-Nayeri N, Shahsavari H, Yousefzadeh-Chabok S, Haghani H. Psycho-social and Mental Variables and Post-Traumatic Stress Disorder in Traffic Accident Survivors in Northern Iran. Bull Emerg Trauma 2017; 5:197-205. [PMID: 28795065 PMCID: PMC5547208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To assess the psycho-social and mental variables associated with post-traumatic stress disorder (PTSD) in a series of Iranian patients. METHODS A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS (DSM-V version) for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables. RESULTS There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, (p<0.001), injured situation, (p<0.001), current depression, (p<0.001), RTW (p<0.001), and family communication (p=0.01). CONCLUSION Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account.
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Affiliation(s)
| | - Nahid Dehghan-Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- School of Nursing and Midwifery. Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Yousefzadeh-Chabok
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran.
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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Reed MO, Jakubovski E, Johnson JA, Bloch MH. Predictors of Long-Term School-Based Behavioral Outcomes in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2017; 27:296-309. [PMID: 28253029 PMCID: PMC5439457 DOI: 10.1089/cap.2015.0168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore predictors of 8-year school-based behavioral outcomes in attention-deficit/hyperactivity disorder (ADHD). METHODS We examined potential baseline predictors of school-based behavioral outcomes in children who completed the 8-year follow-up in the multimodal treatment study of children with ADHD. Stepwise logistic regression and receiver operating characteristic (ROC) analysis identified baseline predictors that were associated with a higher risk of truancy, school discipline, and in-school fights. RESULTS Stepwise regression analysis explained between 8.1% (in-school fights) and 12.0% (school discipline) of the total variance in school-based behavioral outcomes. Logistic regression identified several baseline characteristics that were associated with school-based behavioral difficulties 8 years later, including being male (associated with truancy and school discipline), African American (school discipline, in-school fights), increased conduct disorder (CD) symptoms (truancy), decreased affection from parents (school discipline), ADHD severity (in-school fights), and study site (truancy and school discipline). ROC analyses identified the most discriminative predictors of truancy, school discipline, and in-school fights, which were Aggression and Conduct Problem Scale Total score, family income, and race, respectively. CONCLUSIONS A modest, but nontrivial portion of school-based behavioral outcomes, was predicted by baseline childhood characteristics. Exploratory analyses identified modifiable (lack of paternal involvement, lower parental knowledge of behavioral principles, and parental use of physical punishment), somewhat modifiable (income and having comorbid CD), and nonmodifiable (African American and male) factors that were associated with school-based behavioral difficulties. Future research should confirm that the associations between earlier specific parenting behaviors and poor subsequent school-based behavioral outcomes are, indeed, causally related and independent cooccurring childhood psychopathology. Future research might target increasing paternal involvement and parental knowledge of behavioral principles and reducing use of physical punishment to improve school-based behavioral outcomes in children with ADHD.
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Affiliation(s)
- Margot O. Reed
- College of the Holy Cross, Worcester, Massachusetts.,Yale Child Study Center, New Haven, Connecticut
| | - Ewgeni Jakubovski
- Yale Child Study Center, New Haven, Connecticut.,Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Michael H. Bloch
- Yale Child Study Center, Department of Psychiatry, Yale University, New Haven, Connecticut
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Sullivan E, Shelley J, Rainey E, Bennett M, Prajapati P, Powers MB, Foreman M, Warren AM. The association between posttraumatic stress symptoms, depression, and length of hospital stay following traumatic injury. Gen Hosp Psychiatry 2017. [PMID: 28622816 DOI: 10.1016/j.genhosppsych.2017.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The present study examined the relationship between posttraumatic stress symptoms (PTSS) and depression symptoms with hospital outcome measures to explore how psychiatric factors relate to hospital length of stay (LOS). METHOD Participants were adults admitted to a large Level I Trauma Center for longer than 24h. Depression was assessed at hospitalization using the Patient Health Questionnaire (PHQ-8), and PTSS was measured by the Primary Care PTSD Screen (PC-PTSD). Hospital outcome information was collected from the hospital's trauma registry. Pearson correlations were performed. RESULTS 460 participants (mean age=44years, SD=16.8; 65.4% male) completed the study. Baseline PTSS and depression were significantly correlated with longer hospital LOS while controlling for demographics and injury severity (p=0.026; p=0.023). Both PTSS-positive and depression-positive groups had an average increased hospital LOS of two days. CONCLUSIONS A significant proportion of individuals who are admitted to the hospital following trauma may be at risk for depression and PTSS, which may then increase hospital LOS. As national attention turns to reducing healthcare costs, early screenings and interventions may aid in minimizing psychiatric symptoms in trauma patients, in turn reducing the cost and outcomes associated with total hospital LOS.
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Affiliation(s)
- Erin Sullivan
- University of North Texas, 1155 Union Circle, Denton, TX 76203, United States.
| | - Jordin Shelley
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Evan Rainey
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Monica Bennett
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Purvi Prajapati
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Mark B Powers
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Michael Foreman
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Ann Marie Warren
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
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50
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Agtarap S, Boals A, Holtz P, Roden-Foreman K, Rainey EE, Ruggero C, Warren AM. The effect of depressive symptoms on social support one year following traumatic injury. J Affect Disord 2017; 207:398-405. [PMID: 27770732 DOI: 10.1016/j.jad.2016.08.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/26/2016] [Accepted: 08/24/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression is a common mental health outcome after traumatic injury, negatively impacting physical outcomes and increasing the cost of care. Research shows that the presence and quality of support is a leading protective factor against depression post-injury; however, research is vague on the directional effects of both factors over the course of recovery. METHODS 130 patients admitted to a Level I Trauma Center were recruited to a prospective study examining overall outcomes one-year after injury. Effects of social support and depression at baseline and 12-months post-injury were examined using correlational and cross-lagged path model analyses. Additional follow-up analyses were conducted for depression on specific types of social support. RESULTS Findings replicated previous research suggesting depression and social support were inversely related. Initial depression at time of traumatic injury was predictive of social support 12-months after their injury, but initial social support levels did not significantly predict depression at 12-months. Additionally, initial depression significantly predicted attachment, social integration, reassurance of worth, and guidance 12-months later. LIMITATIONS Findings of the analyses are limited by lack of experimentation and inability to control for other related variables. CONCLUSIONS Findings of the present study support the notion that initial depression predicts poorer social support in recovery, in lieu of prevailing theory (i.e., initial support buffers against later depression) in a sample of trauma patients. These findings highlight the need for medical staff to target specific factors during inpatient stay, such as addressing depressive symptoms and preparing family members and caregivers prior to discharge.
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Affiliation(s)
| | - Adriel Boals
- University of North Texas, Denton, TX, United States
| | - Pamela Holtz
- University of North Texas, Denton, TX, United States
| | | | - Evan E Rainey
- Baylor Research Institute, Dallas, TX, United States
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