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Moreland AD, Rancher C, Davies F, Bottomley J, Galea S, Abba-Aji M, Abdalla SM, Schmidt MG, Vena JE, Kilpatrick DG. Posttraumatic Stress Disorder Among Adults in Communities With Mass Violence Incidents. JAMA Netw Open 2024; 7:e2423539. [PMID: 39058488 PMCID: PMC11282439 DOI: 10.1001/jamanetworkopen.2024.23539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/15/2024] [Indexed: 07/28/2024] Open
Abstract
Importance Mass violence incidents (MVIs) are prevalent in the US and can have profound and long-lasting psychological consequences on direct survivors, but their outcomes among the broader communities where the MVI occurred are unknown. Objective To investigate the prevalence of and factors associated with past-year and current posttraumatic stress disorder (PTSD) among adults in communities that experienced an MVI. Design, Setting, and Participants This cross-sectional survey was completed between February and September 2020 with a household probability sample of adults from 6 communities that had experienced an MVI between 2015 and 2019: Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. Address-based sampling was used to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered paper or online survey. Data analysis was performed from September to November 2023. Main Outcomes and Measures The primary outcome was presumptive diagnostic-level past-year PTSD and current (past month) PTSD determined using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria. Results A total of 6867 adults aged 18 years or older accessed the website with a description of the study and consent materials. Of these, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. Most of the 5991 respondents were female (3825 individuals [53.5%]) and had a mean (SD) age of 45.56 (17.58) years. A total of 1261 of 5931 individuals (21.0%) reported high exposure to the MVI (either they or a close friend and/or family member was on site during the shooting). Nearly one-quarter (23.7%; 1417 of 5977 participants reporting PTSD) met presumptive DSM-5 diagnostic criteria for past-year PTSD, with 8.9% (530 participants) meeting the criteria for current PTSD. Regression analyses found that being female (odds ratio, 2.32; 95% CI, 2.01-2.68) and having a history of both physical or sexual assault and other potentially traumatic events (odds ratio, 9.68; 95% CI, 7.48-12.52) were associated with the greatest risk of past-year PTSD. Conclusions and Relevance In this survey study of 5991 participants, presumptive PTSD was quite prevalent long after the MVI among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs.
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Affiliation(s)
- Angela D. Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Caitlin Rancher
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Faraday Davies
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Jamison Bottomley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
| | | | - Salma M. Abdalla
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michael G. Schmidt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Chen B, Zhang J, Yu S, Yu NX. Trajectories and determinants of acute stress disorder during the COVID-19 centralized quarantine: A latent class growth analysis. Stress Health 2024; 40:e3351. [PMID: 38018760 DOI: 10.1002/smi.3351] [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] [Received: 11/01/2022] [Revised: 05/04/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
COVID-19 centralized quarantine may cause acute stress disorder (ASD). However, it is unknown how individuals present heterogeneous ASD trajectories during the COVID-19 centralized quarantine and what factors contribute to these patterns. This study aimed to identify the ASD trajectories and their determinants during the centralized quarantine period, and the mediating effects of resilience on these associations. A longitudinal survey with three waves was conducted in a randomly selected quarantine hotel in Shenzhen, China from October to November 2020. A total of 273 participants completed online measures assessing ASD symptoms, Eysenck's personality constructs of extraversion (E), neuroticism (N), psychoticism (P), and resilience on Day 1, and reported ASD symptoms on Days 7 and 14 during their 14-day centralized quarantine periods. Latent class growth analysis identified three trajectories: constantly high symptoms (CHS, 4.76%), decreasing symptoms (DS, 11.72%), and constantly low symptoms (CLS, 83.52%). The CHS and DS subgroups both reported lower E and higher N scores, but not P, compared with the CLS subgroup. Resilience mediated the effects of three personality constructs on ASD trajectories, except for the association between N and DS membership. Our study highlights the heterogeneity in stress responses to the COVID-19 centralized quarantine. The high-risk subgroup with persistent ASD symptoms was characterized by lower E and higher N. The resilience process accounted for the effects of personality in shaping distinct ASD trajectories. Our findings have implications to detect the populations vulnerable to ASD and provide insights for developing timely resilience enhancement intervention programs.
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Affiliation(s)
- Bowen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Jun Zhang
- School of Nursing, Wuhan University, Wuhan, China
| | - Shuxin Yu
- School of Nursing, Wuhan University, Wuhan, China
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
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Wang X, Huang J, Yang X, Liu Z, Zhou X. Trajectories of parental posttraumatic stress disorder and children's mental health following Super Typhoon Lekima: The mediating role of feeling of safety. J Adolesc 2023; 95:1590-1602. [PMID: 37530099 DOI: 10.1002/jad.12228] [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: 01/18/2023] [Revised: 07/07/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Several studies have examined the impact of parents' posttraumatic stress disorder (PTSD) on their children's mental health, but few have evaluated the role of parents' specific PTSD trajectories. The aim of this study was to assess the mechanisms underlying distinct trajectories of parental PTSD that affect children's PTSD and depression through the feeling of safety. METHODS The final sample comprised 242 dyads of parents and their children who experienced Super Typhoon Lekima in 2019. All participants were surveyed at three time points after the typhoon: 3 months (T1), 15 months (T2), and 27 months (T3). Parental PTSD symptoms at three time points and children's PTSD, depression, and feeling of safety at T3 were analyzed. RESULTS Four parental PTSD trajectories were identified: recovery, resilience, delayed, and coping. Compared with the resilient group, children of parents with delayed PTSD trajectories reported higher levels of depression at T3, while children of parents in the coping group were more likely to experience severe PTSD at T3. Children of parents in the recovery group, with a reduced feeling of safety, exhibited more severe depression and PTSD at T3, whereas children of parents in the delayed group were at an increased risk of PTSD at T3. CONCLUSIONS These findings highlight the heterogeneity of parental PTSD trajectories following natural disasters and their distinct effects on children's PTSD and depression. Furthermore, feeling of safety emerges as a crucial mechanism in this process.
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Affiliation(s)
- Xuan Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Jiali Huang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Xima Yang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Zhengyi Liu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
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Shah N, Goodwin AJ, Verdin R, Clark JT, Rheingold AA, Ruggiero KJ, Simpson AN, Ford DW. Evaluation of a Telehealth-Enabled Pilot Program to Address Intensive Care Unit Health Care Worker Mental Health Distress. TELEMEDICINE REPORTS 2023; 4:249-258. [PMID: 37637378 PMCID: PMC10457649 DOI: 10.1089/tmr.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/29/2023]
Abstract
Introduction Health care workers (HCWs) are at heightened risk of adverse mental health events (AMHEs) and burnout with resultant impact on health care staffing, outcomes, and costs. We piloted a telehealth-enabled mental health screening and support platform among HCWs in the intensive care unit (ICU) setting at a tertiary care center. Methods A survey consisting of validated screening tools was electronically disseminated to a potential cohort of 178 ICU HCWs. Participants were given real-time feedback on their results and those at risk were provided invitations to meet with resiliency clinicians. Participants were further invited to engage in a 3-month longitudinal assessment of their well-being through repeat surveys and a weekly text-based check-in coupled with self-help tips. Programmatic engagement was evaluated and associations between at-risk scores and engagement were assessed. Qualitative input regarding programmatic uptake and acceptance was gathered through key informant interviews. Results Fifty (28%) HCWs participated in the program. Half of the participants identified as female, and most participants were white (74%) and under the age of 50 years (93%). Nurses (38%), physicians-in-training (24%), and faculty-level physicians (20%) engaged most frequently. There were 19 (38%) requests for an appointment with a resiliency clinician. The incidence of clinically significant symptoms of AMHEs and burnout was high but not clearly associated with engagement. Additional programmatic tailoring was encouraged by key informants while time was identified as a barrier to program engagement. Discussion A telehealth-enabled platform is a feasible approach to screening at-risk HCWs for AMHEs and can facilitate engagement with support services.
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Affiliation(s)
- Nihar Shah
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew J. Goodwin
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Telehealth Center of Excellence; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - John T. Clark
- Biomedical Informatics Center; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Annie N. Simpson
- Department of Healthcare, Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W. Ford
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Liu T, Li Y, Li J, Fan H, Cao C. Temporal Trend and Research Focus of Injury Burden from 1998 to 2022: A Bibliometric Analysis. J Multidiscip Healthc 2023; 16:1869-1882. [PMID: 37425247 PMCID: PMC10327907 DOI: 10.2147/jmdh.s414859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background Injury is one of the leading causes of mortality and disability worldwide. It is a major contributor to the overall burden of disease. This study aimed to analyze the temporal trend, research focus and future direction of research related to injury burden. Methods Publications on injury burden published between January 1998 and September 2022 were extracted from the Web of Science Core Collection (WoSCC) through topic advanced search strategy. Microsoft Excel, RStudio, VOSviewer, and CiteSpace were used to extract, integrate, and visualize bibliometric information. Results A total of 2916 articles and 783 reviews were identified. The number of publications on injury burden showed a steady upward trend. The United States of America (USA) (n=1628) and the University of Washington (n=1036) were the most productive country and institution. High-income countries started research in this domain earlier, while research in low- and middle-income countries began in recent years. Lancet was the most influential journal. Public, environmental occupational health, general medicine and neurology were the predominant research domains. Based on keyword co-occurrence analysis, the research focus was divided into five clusters: injury epidemiology and prevention, studies related to the global burden of disease (GBD), risk factors for injury, clinical management of injury, and injury outcome assessment and economic burden. Conclusion The burden of injury has drawn increasing attention from various perspectives over the years. The research field on injury burden is also becoming more and more extensive. However, there are some gaps among different countries or regions, and more attention needs to be paid to low and middle-income countries.
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Affiliation(s)
- Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Yue Li
- College of Management and Economics, Tianjin University, Tianjin, People’s Republic of China
| | - Ji Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
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Brier ZMF, Hidalgo JE, Espeleta HC, Davidson T, Ruggiero KJ, Price M. Assessment of Traumatic Stress Symptoms During the Acute Posttrauma Period. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:239-246. [PMID: 37404969 PMCID: PMC10316216 DOI: 10.1176/appi.focus.20230001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
A substantial majority of adults in the United States will experience a potentially traumatic event (PTE) in their lifetime. A considerable proportion of those individuals will go on to develop posttraumatic stress disorder (PTSD). Distinguishing between those who will develop PTSD and those who will recover, however, remains as a challenge to the field. Recent work has pointed to the increased potential of identifying individuals at greatest risk for PTSD through repeated assessment during the acute posttrauma period, the 30-day period after the PTE. Obtaining the necessary data during this period, however, has proven to be a challenge. Technological innovations such as personal mobile devices and wearable passive sensors have given the field new tools to capture nuanced in vivo changes indicative of recovery or nonrecovery. Despite their potential, there are numerous points for clinicians and research teams to consider when implementing these technologies into acute posttrauma care. The limitations of this work and considerations for future research in the use of technology during the acute posttrauma period are discussed.
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Affiliation(s)
- Zoe M F Brier
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Hannah C Espeleta
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Tatiana Davidson
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Kenneth J Ruggiero
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
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Liu Y, Zou L, Yan S, Zhang P, Zhang J, Wen J, Mao J, Li L, Wang Y, Fu W. Burnout and post-traumatic stress disorder symptoms among medical staff two years after the COVID-19 pandemic in Wuhan, China: Social support and resilience as mediators. J Affect Disord 2023; 321:126-133. [PMID: 36280200 PMCID: PMC9585849 DOI: 10.1016/j.jad.2022.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evidence on the relationship between burnout and post-traumatic stress disorder (PTSD) is limited. We aimed to evaluate the association between burnout and PTSD symptoms among medical staff two years after the coronavirus disease 2019 (COVID-19) pandemic in Wuhan, China, and explore the mediating roles of social support and psychological resilience. METHODS A multicenter survey was conducted online from January to March 2022 among healthcare professionals from six general hospitals. Hierarchical linear regression was used to detect the predictors of PTSD symptoms. Structural equation modeling (SEM) was used to analyze the pathways from burnout to PTSD symptoms. RESULTS Hierarchical linear regression showed that burnout, social support, and psychological resilience were significant predictors of PTSD symptoms among medical staff. In the SEM, the standardized total effect of burnout on PTSD symptoms was 0.336(bias-corrected 95 % confidence interval [0.303, 0.367], P < 0.001). Social support and psychological resilience partially mediated the relationship between burnout and PTSD symptoms (indirect effects accounted for 22.3 % of the total effect). LIMITATIONS Owing to the cross-sectional design, only clues to causal explanations can be provided. CONCLUSIONS Burnout has significant direct and indirect effects on PTSD symptoms. Furthermore, social support and psychological resilience might be effective ways to reduce the impact of burnout on PTSD symptoms in medical staff after a major public health outbreak.
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Affiliation(s)
- Yifang Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zou
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shijiao Yan
- Department of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China,School of Public Health, Hainan Medical University, Haikou, China
| | - Pu Zhang
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jun Zhang
- Department of Endocrinology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Wen
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longti Li
- Department of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Ying Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenning Fu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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The role of sensory processing sensitivity in the early traumatic stress reaction: Predicting posttraumatic stress symptoms following motor vehicle accidents. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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