Adjustment to trauma exposure: prevalence and predictors of posttraumatic stress disorder symptoms in mountain guides

Three distinct patterns of mental health response following accidents in mountain sports: a follow-up study of individuals treated at a tertiary trauma center

The restorative effect of physical activity in alpine environments on mental and physical health is well recognized. However, a risk of accidents and post-accident mental health problems is inherent to every sport. We aimed to characterize mental health in individuals following mountain sport accidents requiring professional medical management. Adult victims of mountain sport accidents treated at the hospital of the Medical University of Innsbruck (Austria) between 2018 and 2020 completed a cross-sectional survey at least 6 months following the admission (median 44 months, n = 307). Symptoms of post-traumatic stress disorder (PTSD, PCL-5), anxiety, depression, and somatization (PHQ), resilience (RS-13), sense of coherence (SOC-9L), post-traumatic growth (PTGI), and quality of life (EUROHIS-QOL), as well as sociodemographic and clinical information, were obtained from an online survey and extracted from electronic health records. Mental health outcome patterns were investigated by semi-supervised medoid clustering and modeled by machine learning. Symptoms of PTSD were observed in 19% of participants. Three comparably sized subsets of participants were identified: a (1) neutral, (2) post-traumatic growth, and (3) post-traumatic stress cluster. The post-traumatic stress cluster was characterized by high prevalence of symptoms of mental disorders, low resilience, low sense of coherence, and low quality of life as well as by younger age, the highest frequency of pre-existing mental disorders, and persisting physical health consequences of the accident. Individuals in this cluster self-reported a need for psychological or psychiatric support following the accident and more cautious behavior during mountain sports since the accident. Reliability of machine learning-based prediction of the cluster assignment based on 40 variables available during acute medical treatment of accident victims was limited. A subset of individuals show symptoms of mental health disorders including symptoms of PTSD when assessed at least 6 months after mountain sport accident. Since early identification of these vulnerable patients remains challenging, psychoeducational measures for all patients and low-threshold access to mental health support are key for a successful interdisciplinary management of victims of mountain sport accidents.

Someone to watch over me: exposure to war events and trust in the armed forces in Israel as factors in war-related stress

This study examined the role of trust in the national armed and security forces in Israel as a potential protective factor in post-war stress symptoms, alongside other known correlates such as exposure to war events, sense of danger, and demographics. A cluster sample of 870 residents of the town of Kiryat-Shemona in Israel participated in this correlational study. The town was under heavy bombing during the second Lebanon war, and data collection took place about a year after the end of the war. Our results suggest that while sense of danger and exposure to war events are the strongest correlates of stress related symptoms, trust in the armed forces was negatively correlated with stress, even after controlling for demographics; therefore supporting our hypothesis. Theoretical, methodological and practical implications are discussed in light of our findings.

Assessment of a prevention program for work-related stress among urban police officers

OBJECTIVE

To determine the efficacy of a primary prevention program designed to improve psychobiological responses to stress among urban police officers.

METHODS

A random sample of 37 police cadets received complementary training in psychological and technical techniques to reduce anxiety and enhance performance when facing a series of police critical incidents. Training was done by Special Forces officers, trained by the authors in imaging. A random sample of 38 cadets, receiving training as usual, was followed in parallel. Assessment of somatic and psychological health, and stress biomarkers, was done at baseline, immediately following training, and after 18 months as regular police officers. Comparison was done using two-way repeated analysis of variance (ANOVA) and logistic regression.

RESULTS

The intervention group improved their general health and problem-based coping as compared to the control group. They also demonstrated lower levels of stomach problems, sleep difficulties, and exhaustion. Training was associated with an OR of 4.1 (95% CI, 1.3-13.7; p < 0.05) for improved GHQ scores during the study as compared to no changes or worsening score.

CONCLUSIONS

This first primary prevention study of high-risk professions demonstrates the validity and functional utility of the intervention. Beneficial effects lasted at least during the first 2 years on the police force. It is suggested that preventive imagery training in first responders might contribute to enhanced resiliency.

Assessment of a prevention program for work-related stress among urban police officers

OBJECTIVE

To determine the efficacy of a primary prevention program designed to improve psychobiological responses to stress among urban police officers.

METHODS

A random sample of 37 police cadets received complementary training in psychological and technical techniques to reduce anxiety and enhance performance when facing a series of police critical incidents. Training was done by Special Forces officers, trained by the authors in imaging. A random sample of 38 cadets, receiving training as usual, was followed in parallel. Assessment of somatic and psychological health, and stress biomarkers, was done at baseline, immediately following training, and after 18 months as regular police officers. Comparison was done using two-way repeated analysis of variance (ANOVA) and logistic regression.

RESULTS

The intervention group improved their general health and problem-based coping as compared to the control group. They also demonstrated lower levels of stomach problems, sleep difficulties, and exhaustion. Training was associated with an OR of 4.1 (95% CI, 1.3-13.7; p < 0.05) for improved GHQ scores during the study as compared to no changes or worsening score.

CONCLUSIONS

This first primary prevention study of high-risk professions demonstrates the validity and functional utility of the intervention. Beneficial effects lasted at least during the first 2 years on the police force. It is suggested that preventive imagery training in first responders might contribute to enhanced resiliency.

Search for a curvilinear relationship between the sense of coherence and the intensity of PTSD in MVA survivors

The relationship between the sense of coherence (SOC) and the intensity of posttraumatic stress disorder (PTSD) was examined in order to determine its nature and to resolve the inconsistencies between (1) a growing body of empirical research that indicates a linear relationship between these variables, and (2) the schema-based theories of PTSD that suggest a curvilinear relationship between cognitions and the intensity of PTSD. In this cross-sectional study an attempt was also made to identify some psychological factors that moderate this relationship. Participants were a sample of 1132 motor vehicle accident (MVA) survivors. The results showed that gender and temperamental predisposition to PTSD constituted moderator variables of the relationship between SOC and the intensity of PTSD. This supported both the empirical evidence on the linear and negative relationship between SOC and the intensity of PTSD and the theories that postulated the curvilinear relationship.

Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth

This study examined the course of psychological problems in women from late pregnancy to six months postpartum, the rates of psychiatric, especially depressive and post-traumatic stress symptoms and possible related antecedent variables. During late pregnancy, one to three days postpartum, six weeks and six months postpartum, 47 of the 60 participating women completed a battery of questionnaires including the General Health Questionnaire, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the PTSD Symptom Scale. In general, most women recovered from psychiatric and somatic problems over the period of investigation. However, depressive and post-traumatic stress symptoms in particular were not found to decline significantly. Six weeks postpartum, 22% of the women had depressive symptoms, with this figure remaining at 21.3% six months postpartum. In addition, 6% of the women studied reported clinically significant PTSD symptoms at six weeks postpartum with 14.9% reporting such symptoms at six months postpartum. The most important predictor for depressive and post-traumatic stress symptoms was the block variable "anxiety in late pregnancy". Other predictors were the variables "psychiatric symptoms in late pregnancy", "critical life events" and the "experience of delivery". The results of our study show a high prevalence rate of psychiatric symptoms in women after childbirth and suggest, besides the experience of the delivery itself, a vulnerability or predisposing history that makes the development of psychiatric symptoms after childbirth more probable.

Psychoendokrinologie der Angst

Zusammenfassung. Ätiologie, Symptomatik und Verlauf von Angststörungen sind multikausal zu erklären. Ein Teilaspekt der psychobiologischen Erklärungsansätze von Angststörungen sind endokrine Auffälligkeiten, anhand derer bestimmte Unterformen pathologischer Angst charakterisiert werden können. Vor allem die Hypothalamus-Hypophysen-Nebennierenrinde-Achse und das sympathiko-adrenomedulläre System werden im Zusammenhang mit Emotionsregulation und pathologischer Angst untersucht. Beide Hormonsysteme spielen bei der Anpassung an individuelle Belastungssituationen eine bedeutende Rolle und beeinflussen die psychobiologische Anpassung an angstauslösende Situationen nachhaltig. In dieser Überblicksarbeit werden endokrine Dysregulationen der o.g. Hormonsysteme für verschiedene Unterformen von Angststörungen aufgezeigt und bzgl. ihrer ätiologischen Bedeutsamkeit, auch unter Berücksichtigung genetischer Befunde, diskutiert. Darüber hinaus werden erste therapeutische Ansätze, bei denen psychoendokrinologische Methoden genutzt werden, aufgezeigt.