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Sabahi Z, Hasani P, Salehi-Pourmehr H, Beheshti R, Sadeghi-Bazargani H. What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review. J Nerv Ment Dis 2024; 212:104-116. [PMID: 38290103 DOI: 10.1097/nmd.0000000000001739] [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] [Indexed: 02/01/2024]
Abstract
ABSTRACT Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.
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Affiliation(s)
- Zahra Sabahi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parham Hasani
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rasa Beheshti
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Chow J, Lancman B. Psychiatric sequelae and interventions in critically ill trauma survivors. Curr Opin Anaesthesiol 2023; 36:147-152. [PMID: 36745063 DOI: 10.1097/aco.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Psychiatric disorders following trauma impact functional recovery in trauma survivors and are a significant source of disability. Although research has traditionally focused on the physical sequelae of trauma, more attention is being directed towards the significant morbidity and mortality associated with the psychologic sequelae of trauma. This review evaluates the existing literature. RECENT FINDINGS Use of multidisciplinary collaborative programmes in combination with psychiatric treatment and pharmacotherapy may be necessary to improve the care of trauma patients with psychiatric sequelae. Improving identification of vulnerable patients may help in the prevention and treatment of psychiatric disorders and is an area of current research initiatives. SUMMARY There are few interventions that have demonstrated efficacy in managing the psychiatric sequelae of trauma. The development of strategies to guide early identification of at-risk patients and recommend prevention and treatment may improve the care of trauma survivors.
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Affiliation(s)
- Jarva Chow
- University of Chicago, Anesthesia & Critical Care, Chicago, Illinois, USA
| | - Benn Lancman
- Department of Anaesthesiology & Perioperative Medicine, Alfred Health, Melbourne, Victoria, Australia
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Reid BO, Næss-Pleym LE, Haugland H, Dale J, Uleberg O, Nordstrand AE. Posttraumatic Stress Responses and Psychological Well-being in Norwegian Medical Helicopter Personnel. Air Med J 2022; 41:292-297. [PMID: 35595337 DOI: 10.1016/j.amj.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of anxiety, depression, and posttraumatic stress symptoms in Norwegian medical helicopter personnel and to determine to what degree they report personal growth or deprecation due to exposure to work-related events. METHODS This was a web-based, cross-sectional survey performed among rescue paramedics and physicians staffing helicopter emergency medical services and search and rescue helicopters between May 5, 2021, and July 5, 2021. Questions included demographic data, the traumatic events exposure index, the Generalized Anxiety Disorder 7 scale, the Patient Health Questionnaire 9 (Depression), the posttraumatic change scale, and the posttraumatic symptom scale. RESULTS Of the 245 eligible participants, 10 declined to take part and 74 failed to answer, producing a response rate of 66% (72 rescue paramedics and 89 physicians). Of the study population, 3.9 % reported manifest posttraumatic stress disorder symptoms, and 1.9% described moderate to severe depression and anxiety. The majority (76%) described posttraumatic emotional growth because of their work experience. CONCLUSION Despite exposure to several traumatic stressors, participants reported a lower prevalence of posttraumatic stress symptoms, depression, and anxiety compared with a Norwegian adult population.
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Affiliation(s)
- Bjørn Ole Reid
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway; Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway.
| | - Lars Eide Næss-Pleym
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway; Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway
| | - Jostein Dale
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Andreas Espetvedt Nordstrand
- Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway; Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Herrera-Escobar JP, El Moheb M, Ranjit A, Weed C, Brasel K, Kasotakis G, Kaafarani HMA, Velmahos G, Nehra D, Haider AH, Jarman M, Salim A. Sex differences in long-term outcomes after traumatic injury: A mediation analysis. Am J Surg 2021; 222:842-848. [PMID: 33541687 DOI: 10.1016/j.amjsurg.2021.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We sought to examine the association and potential mediators between sex and long-term trauma outcomes. METHODS Moderately-to-severely injured patients admitted to 3 level-1 trauma centers were contacted between 6 and 12-months post-injury to assess for functional limitations, use of pain medications, and posttraumatic stress disorder (PTSD). Multivariable adjusted regression analyses were used to compare long-term outcomes by sex. Potential mediators of the relationship between sex and outcomes was explored using mediation analysis. RESULTS 2607 patients were followed, of which 45% were female. Compared to male, female patients were more likely to have functional limitations (OR: 1.45; 95% CI: 1.31-1.60), take pain medications (OR: 1.17; 95% CI: 1.02-1.38), and screen positive for PTSD (OR: 1.60; 95% CI: 1.46-1.76) post-injury. Age, extremity injury, previous psychiatric illness, and pre-injury unemployment, partially mediated the effect of female sex on long-term outcomes. CONCLUSIONS There are significant sex differences in long-term trauma outcomes, which are partially driven by patient and injury-related factors.
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Affiliation(s)
- Juan P Herrera-Escobar
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mohamad El Moheb
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anju Ranjit
- Department of Obstetrics and Gynecology, Howard University Hospital, Washington, D.C, USA
| | - Christina Weed
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Karen Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - George Kasotakis
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Haytham M A Kaafarani
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George Velmahos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Aga Khan University School of Medicine, Karachi, Pakistan
| | - Molly Jarman
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Grupp F, Skandrani S, Moro MR, Mewes R. Relational Spirituality and Transgenerational Obligations: The Role of Family in Lay Explanatory Models of Post-traumatic Stress Disorder in Male Cameroonian Asylum Seekers and Undocumented Migrants in Europe. Front Psychiatry 2021; 12:621918. [PMID: 33959046 PMCID: PMC8093444 DOI: 10.3389/fpsyt.2021.621918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Context: Diasporic Cameroonians are increasingly leading a transnational life in which family members are sustained through networks of relations and obligations. However, before arriving in Europe, the vast majority of African migrants who take the Mediterranean route are exposed to trauma and hardship. Moreover, the joint occurrence of forced displacement, trauma, and extended separation from families has a significant impact on mental health. Objectives: This study explores the role of culture-specific conceptualizations of family structures and transnationalism in explanatory models of post-traumatic stress disorder (PTSD) among male Cameroonian asylum-seekers and undocumented migrants in Europe. Methods: An in-depth study of two samples of Cameroonian migrants with a precarious residency status in Europe was conducted. Focus group discussions and interviews were carried out with asylum seekers in Germany (n = 8) and undocumented migrants and failed asylum seekers in France (n = 9). The verbatim transcripts of these interviews served as the data for interpretative phenomenological analyses. Results, Analysis, and Discussion: Family was conceptualized in religious and spiritual terms, and relational spirituality appeared to be a crucial element of family cohesion. Explanatory models of PTSD were mainly based on an intersection of family and spirituality. The disrespect of transgenerational, traditional, and spiritual obligations toward parents and ancestral spirits represented a crucial causal attribution for post-traumatic symptoms. Conclusions: Conceptualizations of post-traumatic stress were based on a collective family and spiritual level instead of an individualized illness-centered perception. The Western psychological and psychiatric perspective on post-traumatic stress might conflict with traditional, religious, and spiritual practices in the context of family conceptualizations of Cameroonian forced migrants with a precarious residency status.
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Affiliation(s)
- Freyja Grupp
- Division of Clinical Psychology, Department of Psychology, University of Marburg, Marburg, Germany
| | - Sara Skandrani
- University of Paris Nanterre, Hospital Cochin Paris, Paris, France
| | - Marie Rose Moro
- University of Paris, Hospital Cochin AP-HP, Unite Inserm 1018, CESP, Paris, France
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching, and Practice, Faculty of Psychology, University of Vienna, Wien, Austria
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6
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Fullana MA, Tortella-Feliu M, Fernández de la Cruz L, Chamorro J, Pérez-Vigil A, Ioannidis JPA, Solanes A, Guardiola M, Almodóvar C, Miranda-Olivos R, Ramella-Cravaro V, Vilar A, Reichenberg A, Mataix-Cols D, Vieta E, Fusar-Poli P, Fatjó-Vilas M, Radua J. Risk and protective factors for anxiety and obsessive-compulsive disorders: an umbrella review of systematic reviews and meta-analyses. Psychol Med 2020; 50:1300-1315. [PMID: 31172897 DOI: 10.1017/s0033291719001247] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A multitude of risk/protective factors for anxiety and obsessive-compulsive disorders have been proposed. We conducted an umbrella review to summarize the evidence of the associations between risk/protective factors and each of the following disorders: specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder, and to assess the strength of this evidence whilst controlling for several biases. METHODS Publication databases were searched for systematic reviews and meta-analyses examining associations between potential risk/protective factors and each of the disorders investigated. The evidence of the association between each factor and disorder was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of cases (>1000), random-effects p-values, 95% prediction intervals, confidence interval of the largest study, heterogeneity between studies, study effects, and excess of significance. RESULTS Nineteen systematic reviews and meta-analyses were included, corresponding to 216 individual studies covering 427 potential risk/protective factors. Only one factor association (early physical trauma as a risk factor for social anxiety disorder, OR 2.59, 95% CI 2.17-3.1) met all the criteria for convincing evidence. When excluding the requirement for more than 1000 cases, five factor associations met the other criteria for convincing evidence and 22 met the remaining criteria for highly suggestive evidence. CONCLUSIONS Although the amount and quality of the evidence for most risk/protective factors for anxiety and obsessive-compulsive disorders is limited, a number of factors significantly increase the risk for these disorders, may have potential prognostic ability and inform prevention.
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Affiliation(s)
- Miquel A Fullana
- Institute of Neurosciences, Hospital Clinic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miquel Tortella-Feliu
- University Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Mallorca, Spain
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Jacobo Chamorro
- Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain
| | - Ana Pérez-Vigil
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Aleix Solanes
- FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Mental Health, Florence Public Health Center, Florence, Italy
| | - Ana Vilar
- Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí-La Mina, Parc de Salut Mar, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Abraham Reichenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mar Fatjó-Vilas
- FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain
| | - Joaquim Radua
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
- Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
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Wrenger M, Lange C, Langer M, Heuft G, Burgmer M. Psychiatric disorders after an accident: Predictors and the influence of the psychiatric condition prior to an accident. Eur Psychiatry 2020; 23:434-40. [DOI: 10.1016/j.eurpsy.2008.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 12/12/2007] [Accepted: 02/10/2008] [Indexed: 11/26/2022] Open
Abstract
AbstractBackgroundThe goal of this study is to assess prevalence and incidence of psychiatric sequelae in a sample of inpatient accident survivors. Such an attempt to assess psychiatric conditions that originate due to an accident seems to be important; this does not include psychiatric conditions already present prior to the accident.Method208 accident victims were consecutively examined over a period of 12 months using DSM-IV diagnostic assessment, CAPS, and self-evaluating questionnaires as well as ISS for injury severity. A predictor model for psychiatric disorders was set up.ResultsIncidence of newly developed Axis I disorders in our sample was 14.2% (6 months) and 12.3% (12 months). Incidence of PTSD was 5.9% (6 months) and 2.5% (12 months). Comorbidity was a general phenomenon. The psychiatric condition prior to the accident could be identified as a predictor for the development of Axis I disorders. The subjectively evaluated intensity of experienced threat to life and female gender were the main predictors for the development of PTSD.ConclusionsAccidents can lead to different psychiatric disorders. PTSD as a single diagnosis is rare. Without taking into account pre-existing disorders, the incidence may be overestimated. Two predictor models for the development of PTSD and other mental disorders are presented.
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Abstract
Generalized anxiety disorder (GAD) is a common and disabling illness that is often underdiagnosed and undertreated. Patients with GAD are at increased risk for suicide as well as cardiovascular-related events and death. Most patients can be diagnosed and managed by primary care physicians. Symptoms include chronic, pervasive anxiety and worry accompanied by nonspecific physical and psychological symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances). Effective treatments include psychotherapy (often cognitive behavioral therapy) and pharmacotherapy, such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors.
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Affiliation(s)
- Jeremy DeMartini
- University of California, Davis, Sacramento, California (J.D., G.P., T.L.F.)
| | - Gayatri Patel
- University of California, Davis, Sacramento, California (J.D., G.P., T.L.F.)
| | - Tonya L Fancher
- University of California, Davis, Sacramento, California (J.D., G.P., T.L.F.)
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9
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Herrera-Escobar JP, Al Rafai SS, Seshadri AJ, Weed C, Apoj M, Harlow A, Brasel K, Kasotakis G, Kaafarani HMA, Velmahos G, Salim A, Haider AH, Nehra D. A multicenter study of post-traumatic stress disorder after injury: Mechanism matters more than injury severity. Surgery 2018; 164:1246-1250. [PMID: 30170820 DOI: 10.1016/j.surg.2018.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/03/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic injury is strongly associated with long-term mental health disorders, but the risk factors for developing these disorders are poorly understood. We report on a multi-institutional collaboration to collect long-term patient-centered outcomes after trauma, including screening for post-traumatic stress disorder. The objective of this study is to determine the prevalence of and risk factors for the development of post-traumatic stress disorder after traumatic injury. METHODS Adult trauma patients (aged 18-64) with moderate to severe injuries (Injury Severity Score ≥ 9) admitted to 3 level I trauma centers were screened between 6 and 12 months after injury for post-traumatic stress disorder. Patients were divided by mechanism: fall, road traffic injury, and intentional injury. Multiple logistic regression models were used to determine the association between baseline patient and injury-related characteristics and the development of post-traumatic stress disorder for the overall cohort and by mechanism of injury. RESULTS A total of 450 patients completed the screen. Overall 32% screened positive for post-traumatic stress disorder, but this differed significantly by mechanism, with the lowest being after a fall (25%) and highest after intentional injury (60%). Injury severity was not associated with post-traumatic stress disorder for any group, but lower educational level was associated with post-traumatic stress disorder within all the groups. Only 21% of patients who screened positive for post-traumatic stress disorder were receiving treatment at the time of the survey. CONCLUSION Post-traumatic stress disorder is common after traumatic injury, and the prevalence varies significantly by injury mechanism but is not associated with injury severity. Only a small proportion of patients who screen positive for post-traumatic stress disorder are currently receiving treatment.
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Affiliation(s)
- Juan P Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Syeda S Al Rafai
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Anupamaa J Seshadri
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Christina Weed
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | - Michel Apoj
- Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA
| | - Alyssa Harlow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Karen Brasel
- Department of Surgery, Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - George Kasotakis
- Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA
| | - Haytham M A Kaafarani
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ali Salim
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA; Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Deepika Nehra
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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10
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The Impact of the United States Air Force Deployment Transition Center on Postdeployment Mental Health Outcomes. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Lin JE, Neylan TC, Epel E, O'Donovan A. Associations of childhood adversity and adulthood trauma with C-reactive protein: A cross-sectional population-based study. Brain Behav Immun 2016; 53:105-112. [PMID: 26616398 PMCID: PMC5189980 DOI: 10.1016/j.bbi.2015.11.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 12/12/2022] Open
Abstract
Mounting evidence highlights specific forms of psychological stress as risk factors for ill health. Particularly strong evidence indicates that childhood adversity and adulthood trauma exposure increase risk for physical and psychiatric disorders, and there is emerging evidence that inflammation may play a key role in these relationships. In a population-based sample from the Health and Retirement Study (n=11,198, mean age 69 ± 10), we examine whether childhood adversity, adulthood trauma, and the interaction between them are associated with elevated levels of the systemic inflammatory marker high sensitivity C-reactive protein (hsCRP). All models were adjusted for age, gender, race, education, and year of data collection, as well as other possible confounds in follow-up sensitivity analyses. In our sample, 67% of individuals had experienced at least one traumatic event during adulthood, and those with childhood adversity were almost three times as likely to have experienced trauma as an adult. Childhood adversities and adulthood traumas were independently associated with elevated levels of hsCRP (β=0.03, p=0.01 and β=0.05, p<0.001, respectively). Those who had experienced both types of stress had higher levels of hsCRP than those with adulthood trauma alone, Estimate=-0.06, 95% CI [-0.003, -0.12], p=0.04, but not compared to those with childhood adversity alone, Estimate=-0.06, 95% CI [0.03, -0.16], p=0.19. There was no interaction between childhood and adulthood trauma exposure. To our knowledge, this is the first study to examine adulthood trauma exposure and inflammation in a large population-based sample, and the first to explore the interaction of childhood adversity and adulthood trauma with inflammation. Our study demonstrates the prevalence of trauma-related inflammation in the general population and suggests that childhood adversity and adulthood trauma are independently associated with elevated inflammation.
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Affiliation(s)
- Joy E Lin
- School of Medicine, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States; San Francisco Veteran's Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, United States.
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States; San Francisco Veteran's Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, United States.
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States.
| | - Aoife O'Donovan
- Department of Psychiatry, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States; San Francisco Veteran's Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, United States.
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12
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Isaac L, Main KL, Soman S, Gotlib IH, Furst AJ, Kinoshita LM, Fairchild JK, Yesavage JA, Ashford JW, Bayley PJ, Adamson MM. The impact of depression on Veterans with PTSD and traumatic brain injury: a diffusion tensor imaging study. Biol Psychol 2015; 105:20-8. [PMID: 25559772 DOI: 10.1016/j.biopsycho.2014.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 12/15/2014] [Accepted: 12/23/2014] [Indexed: 12/20/2022]
Abstract
A significant proportion of military personnel deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom were exposed to war-zone events associated with traumatic brain injury (TBI), depression (DEP) and posttraumatic stress disorder (PTSD). The co-occurrence of TBI, PTSD and DEP in returning Veterans has recently increased research and clinical interest. This study tested the hypothesis that white matter abnormalities are further impacted by depression. Of particular relevance is the uncinate fasciculus (UF), which is a key fronto-temporal tract involved in mood regulation, and the cingulum; a tract that connects to the hippocampus involved in memory integration. Diffusion tensor imaging (DTI) was performed on 25 patients with a combination of PTSD, TBI and DEP and 20 patients with PTSD and TBI (no DEP). Microstructural changes of white matter were found in the cingulum and UF. Fractional anisotropy (FA) was lower in Veterans with DEP compared to those without DEP.
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Affiliation(s)
- Linda Isaac
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Keith L Main
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Salil Soman
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Ansgar J Furst
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lisa M Kinoshita
- The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA
| | - J Kaci Fairchild
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA
| | - Jerome A Yesavage
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA
| | - J Wesson Ashford
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Maheen M Adamson
- War Related Illness and Injury Study Center, The Veterans Affairs Palo Alto HealthCare System, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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13
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Diène E, Geoffroy-Perez B, Cohidon C, Gauvin S, Carton M, Fouquet A, Fatras JY, Imbernon E. Psychotropic drug use in a cohort of workers 4 years after an industrial disaster in France. J Trauma Stress 2014; 27:430-7. [PMID: 25158636 DOI: 10.1002/jts.21940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium-term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium-term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.
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Affiliation(s)
- Eloi Diène
- Institut de Veille Sanitaire (InVS), Saint-Maurice, France
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14
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Aziz S, Aslam N. Psychiatric Morbidity and Work and Social Adjustment Among Earthquake Survivors Extricated from under the Rubble. Indian J Psychol Med 2012; 34:346-9. [PMID: 23723542 PMCID: PMC3662131 DOI: 10.4103/0253-7176.108215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This cross-sectional study examined psychiatric co-morbidity and work and social adjustment after a natural disaster among survivors who were extricated from under the rubble. MATERIALS AND METHODS Individuals (N=40) belonging to district Muzaffarabad, a severely earthquake affected area on 8(th) October 2005, were interviewed. The examination included the MINI International Neuropsychiatric Interview for DSM-IV Axis I disorders, Work and Social Adjustment Scale, and questions covering background characteristics and disaster exposure. RESULTS The most prevalent disorders were posttaumatic stress disorder (32.5%), major depressive disorder (17.5%), dysthymia (15.0%), agoraphobia (25.0%), and panic disorder (20.0%). Moreover, 77% of the respondents have been diagnosed with at least one psychiatric disorder. Work and soical adjustment was found to have an inverse relationship with the psychiatric co-morbidity. CONCLUSION Small sample size and lack of comparison group from non-earthquake struck areas may limit the generalizability of the psychatric disorders. Psychiatric disorders other than PTSD, especially depressive and anxiety disorders, are of clinical importance when considering long-term mental health effect of disasters.
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Affiliation(s)
- Shamaila Aziz
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
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15
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Chen Z, Zhang Y, Liu Z, Liu Y, Dyregrov A. Structure of the Children's Revised Impact of Event Scale (CRIES) with children and adolescents exposed to debris flood. PLoS One 2012; 7:e41741. [PMID: 22936980 PMCID: PMC3427319 DOI: 10.1371/journal.pone.0041741] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 06/27/2012] [Indexed: 11/18/2022] Open
Abstract
AIM PTSD symptoms were pervasive among children and adolescents after experiencing or exposure to traumatic events. Screening and diagnosis of PTSD symptoms is crucial in trauma-related research and practice. The 13-item Children's Revised Impact of Event Scale (CRIES) has been demonstrated to be a valid and reliable tool to achieve this goal. This study was designed to examine the psychometric properties of the 13-item CRIES in a sample of Chinese debris flood victims. METHODS A total of 268 participants (145 girls, 123 boys) aged 8-18 years were recruited from an integral part of a service oriented project, supported by the Institute of Psychology, Chinese Academy of Sciences following the debris flood. The participants were given the 13-item CRIES 3 months after the debris flood. RESULTS The results of confirmatory factor analysis indicated that a two-factor structure (intrusion+arousal vs avoidance) emerged as the model best fit in total sample, boys and girls subsamples, respectively. The scale was also demonstrated to have good internal consistency (Cronbach's alpha = 0.83). CONCLUSION The study confirmed the good psychometric properties of the CRIES and its' applicability to Chinese children and adolescents. Moreover, these findings imply that the CRIES factor structure is stable across age, gender, and different types of trauma.
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Affiliation(s)
- Zhenggen Chen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Graduate University of the Chinese Academy of Sciences, Beijing, China
| | - Yuqing Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Graduate University of the Chinese Academy of Sciences, Beijing, China
- * E-mail:
| | - Zhengkui Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Graduate University of the Chinese Academy of Sciences, Beijing, China
| | - Yin Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Graduate University of the Chinese Academy of Sciences, Beijing, China
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16
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Abstract
AbstractTraumatic stress stems from a threat to an individual's or a group's very existence. The impact of the existential threat may be compounded by an inability to cope, which affects the perception of helplessness and loss of lawfulness. A model is proposed in which the traumatic process is conceptualized to develop through three stages: (1) alert; (2) impact; and (3) post-trauma. In this model, treatment of traumatic stress emphasizes the need to control and expand life, and to achieve lawfulness and meaningfulness. In the proposed model of treatment, there are essential differences at each of the stages of the traumatic process: (1) primary prevention at the stage of alert focuses on planning strategies for coping; (2) secondary prevention at the stage of impact is based on forward treatment and debriefing; and (3) tertiary treatment at the post-trauma stage attends to coping with internal chaos and arbitrariness.
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Perkins ZB, De'Ath HD, Sharp G, Tai NRM. Factors affecting outcome after traumatic limb amputation. Br J Surg 2012; 99 Suppl 1:75-86. [PMID: 22441859 DOI: 10.1002/bjs.7766] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Traumatic leg amputation commonly affects young, active people and leads to poor long-term outcomes. The aim of this review was to describe common causes of disability and highlight therapeutic interventions that may optimize outcome after traumatic leg amputation. METHODS A comprehensive search of MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature databases was performed, using the terms 'leg injury', 'amputation' and 'outcome'. Articles reporting outcomes following traumatic leg amputation were included. RESULTS Studies demonstrated that pain, psychological illness, decreased physical and vocational function, and increased cardiovascular morbidity and mortality were common causes of disability after traumatic leg amputation. The evidence highlights that appropriate preoperative management and operative techniques, in conjunction with suitable rehabilitation and postoperative follow-up, can lead to improved treatment outcome and patient satisfaction. CONCLUSION Patients who undergo leg amputation after trauma are at risk of poor long-term physical and mental health. Clinicians involved in their care have many opportunities to improve their outcome using a variety of therapeutic variables. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Z B Perkins
- Trauma Clinical Academic Unit, The Royal London Hospital, Whitechapel, London, UK.
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18
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Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study. Brain Behav Immun 2012; 26:642-9. [PMID: 22366689 PMCID: PMC3322304 DOI: 10.1016/j.bbi.2012.02.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/23/2022] Open
Abstract
Exposure to traumatic psychological stress increases risk for disease events and mortality in patients with cardiovascular disease (CVD). While the biological mechanisms of these effects are not known, inflammation may play a key role as it is both elevated by psychological stress and involved in the development and progression of CVD. In a prospective study of patients with stable CVD (n=979), we examined if higher lifetime trauma exposure was associated with elevated levels of inflammation at baseline and at five-year follow-up, and with greater increases in inflammation over time. Inflammation was indexed by a composite score incorporating the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and resistin. In follow-up analyses, we adjusted for sociodemographic factors, psychiatric disorders and health behaviors that were significantly associated with trauma exposure. Higher trauma exposure was associated with elevated inflammation at baseline (β=.09, p=.01) and at five-year follow-up (β=.09, p=.03). While levels of inflammation increased from baseline to follow-up in the sample, there was no significant association between trauma exposure and rate of change in inflammation. Findings were robust to adjustments for sociodemographic factors and psychiatric disorders, but health behaviors appeared to contribute to the association between trauma and inflammation at follow-up. This is the first large-scale demonstration of an association between lifetime trauma exposure and inflammation. High lifetime exposure to traumatic stress may contribute to an accelerated rate of CVD progression through elevated inflammation.
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19
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Predictors of acute posttraumatic stress disorder symptoms following civilian trauma. J Trauma Acute Care Surg 2012; 72:629-35; discussion 635-7. [DOI: 10.1097/ta.0b013e31824416aa] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Carlson EB, Smith SR, Palmieri PA, Dalenberg C, Ruzek JI, Kimerling R, Burling TA, Spain DA. Development and validation of a brief self-report measure of trauma exposure: the Trauma History Screen. Psychol Assess 2011; 23:463-77. [PMID: 21517189 DOI: 10.1037/a0022294] [Citation(s) in RCA: 257] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure.
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Affiliation(s)
- Eve B Carlson
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Menlo Park, CA 94025, USA.
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21
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Bryant RA, O'Donnell ML, Creamer M, McFarlane AC, Silove D. Posttraumatic intrusive symptoms across psychiatric disorders. J Psychiatr Res 2011; 45:842-7. [PMID: 21159353 DOI: 10.1016/j.jpsychires.2010.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/19/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
Abstract
Reexperiencing symptoms are a key feature of posttraumatic stress disorder (PTSD). This study investigated the pattern of reexperiencing symptoms in non-PTSD posttraumatic disorders. This study recruited 1084 traumatically injured patients during hospital admission and conducted follow-up assessment 12 months later (N = 817, 75%). Twelve months after injury, 22% of patients reported a psychiatric disorder they had never experienced prior to the traumatic injury. One-third of patients with a non-PTSD disorder satisfied the PTSD reexperiencing criteria. Whereas patients with a non-PTSD disorder were more likely to experience intrusive memories, nightmares, psychological distress and physiological reactivity to reminders, only patients with PTSD were likely to experience flashback memories (OR: 11.41, 95% CI: 6.17-21.09). The only other symptom that was distinctive to PTSD was dissociative amnesia (OR: 4.50, 95% CI: 2.09-9.71). Whereas intrusive memories and reactions are common across posttraumatic disorders, flashbacks and dissociative amnesia are distinctive to PTSD.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney NSW 2052, Australia.
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22
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Chouliaras L, Sierksma ASR, Kenis G, Prickaerts J, Lemmens MAM, Brasnjevic I, van Donkelaar EL, Martinez-Martinez P, Losen M, De Baets MH, Kholod N, van Leeuwen F, Hof PR, van Os J, Steinbusch HWM, van den Hove DLA, Rutten BPF. Gene-environment interaction research and transgenic mouse models of Alzheimer's disease. Int J Alzheimers Dis 2010; 2010. [PMID: 20953364 PMCID: PMC2952897 DOI: 10.4061/2010/859101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 07/31/2010] [Indexed: 01/08/2023] Open
Abstract
The etiology of the sporadic form of Alzheimer's disease (AD) remains largely unknown. Recent evidence has suggested that gene-environment interactions (GxE) may play a crucial role in its development and progression. Whereas various susceptibility loci have been identified, like the apolipoprotein E4 allele, these cannot fully explain the increasing prevalence of AD observed with aging. In addition to such genetic risk factors, various environmental factors have been proposed to alter the risk of developing AD as well as to affect the rate of cognitive decline in AD patients. Nevertheless, aside from the independent effects of genetic and environmental risk factors, their synergistic participation in increasing the risk of developing AD has been sparsely investigated, even though evidence points towards such a direction. Advances in the genetic manipulation of mice, modeling various aspects of the AD pathology, have provided an excellent tool to dissect the effects of genes, environment, and their interactions. In this paper we present several environmental factors implicated in the etiology of AD that have been tested in transgenic animal models of the disease. The focus lies on the concept of GxE and its importance in a multifactorial disease like AD. Additionally, possible mediating mechanisms and future challenges are discussed.
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Affiliation(s)
- L Chouliaras
- School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Walter KH, Palmieri PA, Gunstad J. More than symptom reduction: changes in executive function over the course of PTSD treatment. J Trauma Stress 2010; 23:292-5. [PMID: 20419740 DOI: 10.1002/jts.20506] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Persons with posttraumatic stress disorder (PTSD) have neuropsychological impairments in multiple cognitive domains, though particularly in executive function. This exploratory study examined whether these cognitive impairments were alleviated following trauma-focused treatment. Fifteen women underwent neuropsychological testing within a week of treatment onset and approximately 3 months later. Results suggest medium-sized improvement in multiple aspects of executive function, including tests of cognitive flexibility/set-shifting and organization/planning. If replicated in larger samples, such findings raise the possibility that treatment may alleviate neuropsychological impairment in persons with PTSD and thus reduce risk for poor outcome.
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Affiliation(s)
- Kristen H Walter
- Department of Psychology, Kent State University and Cincinnati VA Medical Center, 3200 Vine Street, Mental Health Care Line A926, Cincinnati, Ohio 45220, USA.
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Wang L, Zhang Y, Wang W, Shi Z, Shen J, Li M, Xin Y. Symptoms of posttraumatic stress disorder among adult survivors three months after the Sichuan earthquake in China. J Trauma Stress 2009; 22:444-50. [PMID: 19718756 DOI: 10.1002/jts.20439] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study investigated the symptoms of posttraumatic stress disorder (PTSD) and associated risk factors among adult survivors 3 months after the 2008 Sichuan earthquake in China. One thousand five hundred sixty-three earthquake survivors in two communities participated in the study. The prevalence of probable PTSD was 37.8% and 13.0%, respectively, in the two communities that were affected differently by the earthquake. The significant predictive factors for the severity of PTSD symptoms were female gender, subnationality, lower educational level, lower social support, and higher initial exposure level. The results indicate that PTSD is also a common mental health problem among earthquake survivors in China. Given inadequate knowledge and practices concerning the mental health of disaster victims in China, the information provided by this study is useful for directing, strengthening, and evaluating disaster-related mental health needs and interventions after the earthquake.
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Affiliation(s)
- Li Wang
- Key Laboratory of Mental Health, and the Psychological Crisis Intervention Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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25
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Krastel B, Margraf J. Depressive and Anxious Symptomatology After September 2001. SWISS JOURNAL OF PSYCHOLOGY 2009. [DOI: 10.1024/1421-0185.68.4.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study compares depressive and panic-related anxious symptomatology before the World Trade Center Disaster and two contemporaneous local disasters in Switzerland with data collected immediately afterward, and approximately 2 and 7 years later. Four cross-sectional surveys of representative samples of the Swiss population were conducted in March 2000 (N = 1026), October 2001 (N = 1014), October 2003 (N = 1004), and February 2008 (N = 501), using a standardized screening instrument. Immediately after the disasters, the mean depressive symptomatology score increased significantly and remained elevated but stable up to 2 years after the disasters, decreasing significantly from 2003 to 2008. However, anxious symptomatology rates did not change over time, neither immediately after the disasters nor 2 or 7 years later.
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26
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McChargue DE, Klanecky AK, Walsh K, DiLillo D. Trauma exposure influences cue elicited affective responses among smokers with and without a history of major depression. Addict Behav 2008; 33:1454-1462. [PMID: 18558464 DOI: 10.1016/j.addbeh.2008.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/28/2008] [Accepted: 04/29/2008] [Indexed: 10/22/2022]
Abstract
The current study tested the emotional reactivity of smokers with and without histories of major depression (MDD Hx) and trauma exposure (TE). Four counterbalanced conditions nested negative (e.g., dysphoric) or neutral mood inductions with in vivo versus control smoking paraphernalia cues (Neutral+Control; Neutral+Cigarette; Neg+Control; Neg+Cigarette). Mixed model analysis of covariance (ANCOVA) tested between and within subjects differences in negative affective symptoms pre- to post-exposure across four groups (TE+MDD Hx; TE only; MDD Hx only; no history). Results produced two notable effects. First, TE only individuals endorsed the greatest increase in depressive symptoms across both negative mood induction conditions (regardless of smoking paraphernalia) compared with other groups. Second, dual history participants (TE+MDD Hx) show a potentiated depressive response to the Neg+Cigarette condition compared with the Neg+Control condition. Implications to a depression-specific negative affective vulnerability among TE only smokers that is independent of MDD Hx and greater than smokers with a MDD Hx are discussed.
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Kenardy J, Thompson K, Le Brocque R, Olsson K. Information-provision intervention for children and their parents following pediatric accidental injury. Eur Child Adolesc Psychiatry 2008; 17:316-25. [PMID: 18350366 DOI: 10.1007/s00787-007-0673-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2007] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study evaluated an early intervention for children and their parents following pediatric accidental injury. METHOD Information booklets provided to participants within 72 h of the initial trauma detailed common responses to trauma, the common time course of symptoms, and suggestions for minimizing any post-trauma distress. Following admission for traumatic injuries sustained in motor vehicle accidents, falls and sporting injuries a total of 103 children (aged 7-15) and their parents were evaluated at pre-intervention, 1 month, and 6 months post-trauma. The intervention (N = 33) was delivered to one of two hospitals, the second hospital was the control (N = 70). RESULTS Analyses indicated that the intervention reduced child anxiety symptoms at 1-month follow-up and parental posttraumatic intrusion symptoms and overall posttraumatic symptoms at the 6-month follow-up. No other differences between the intervention and control groups were found. CONCLUSION Overall, the information-based early intervention is simple, cost-effective method of reducing child and parent distress post-trauma.
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Affiliation(s)
- Justin Kenardy
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia.
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28
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Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med 2008; 31:341-9. [PMID: 18553129 DOI: 10.1007/s10865-008-9158-3] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 04/29/2008] [Indexed: 11/24/2022]
Abstract
The present study sought to extend prior research by using data from the National Comorbidity Survey-Replication (NCS-R) to examine the relationship between number of lifetime traumas, posttraumatic stress disorder (PTSD) and 15 self-reported chronic medical conditions. The goal was to determine whether the commonly found relationship between PTSD symptomatology and physical health were better explained by the number of lifetime traumas experienced. The NCS-R is a representative US household survey that assessed lifetime experience of a variety of traumas, lifetime diagnosis of PTSD and 15 chronic medical conditions (e.g. pain conditions, cardiovascular disorders, etc.). Two major findings emerged: (1) there was a graded relationship between trauma exposure, PTSD, and the majority of chronic medical conditions where individuals with PTSD had the highest likelihood of chronic medical condition and non-traumatized individuals had the lowest risk and; (2) with the exception of headaches, the relationship between PTSD and chronic medical conditions was explained by the number of lifetime traumas experienced when analyses were subset to traumatized individuals. The present study supports prior research suggesting that multiple traumas have a cumulative effect on physical health. The impact of trauma on health may be independent of PTSD symptomatology.
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Affiliation(s)
- Eve M Sledjeski
- Department of Psychology, Wesleyan University, Middletown, CT 06459, USA.
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Holbrook TL, Hoyt DB, Coimbra R, Potenza B, Sise M, Anderson JP. High Rates of Acute Stress Disorder Impact Quality-of-Life Outcomes in Injured Adolescents: Mechanism and Gender Predict Acute Stress Disorder Risk. ACTA ACUST UNITED AC 2005; 59:1126-30. [PMID: 16385290 DOI: 10.1097/01.ta.0000196433.61423.f2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injury is the leading cause of death and functional disability in adolescent children. Little is known about quality of life and psychological outcomes after trauma in adolescents. The Trauma Recovery Project in Adolescents is a prospective epidemiologic study designed to examine multiple outcomes after major trauma in adolescents aged 12 to 19 years, including quality of life (QoL) and psychological sequelae such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). The specific objectives of the present report are to examine ASD rates and the association of ASD with QoL outcomes in injured adolescents. METHODS Between April 26, 1999, and November 13, 2002, 401 eligible trauma patients aged 12 to 19 years triaged to five participating trauma center hospitals in a regionalized trauma system were enrolled in the study. The admission criteria for patients were as follows: (1) age 12 to 19 years and (2) injury diagnoses excluding severe traumatic brain injury (TBI) or spinal cord injury. QoL after trauma was measured using the Quality of Well-being (QWB) scale, a sensitive and well-validated functional index (range, 0 = death to 1.000 = optimum functioning). ASD (before discharge) was diagnosed with the Impact of Events Scale-Revised. Scores of 24+ were used to diagnose ASD. Patient outcomes were assessed at discharge and at 3, 6, 12, 18, and 24 months after discharge. RESULTS ASD before discharge was diagnosed in 40% of adolescent trauma survivors. ASD status was associated with large QoL deficits during follow-up, as follows: 3-month, ASD-positive QWB score = 0.667 vs. ASD-negative QWB score = 0.710, p < 0.01; 6-month, ASD-positive QWB score = 0.704 vs. ASD-negative QWB score = 0.742, p < 0.001; 12-month: ASD-positive QWB score = 0.718 vs. ASD-negative QWB score = 0.757, p < 0.01; 24-month, ASD-positive QWB score = 0.725 vs. ASD-negative QWB score = 0.769, p < 0.01. Female sex and violent mechanism predicted ASD risk (47% female vs. 36% male; odds ratio, 1.6; p < 0.05; violence 54% vs. 38%; odds ratio, 1.9; p < 0.01). CONCLUSIONS Adolescent trauma survivors have high rates of ASD. ASD severely impacts QoL outcomes and is associated with female sex and mechanism of injury in adolescents. Early recognition and treatment of ASD in seriously injured adolescents will improve QoL outcomes.
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Affiliation(s)
- Troy L Holbrook
- Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California 92103-8896, USA.
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Dodge HH, Kadowaki T, Hayakawa T, Yamakawa M, Sekikawa A, Ueshima H. Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi Study. THE GERONTOLOGIST 2005; 45:222-30. [PMID: 15799987 DOI: 10.1093/geront/45.2.222] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We examined differential effects of cognitive impairment on each of the activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks. DESIGN AND METHODS In a 3-year follow-up of community-dwelling elderly persons in Azuchi, Japan, we assessed cognition by using the Hasegawa Dementia Scale. We examined (a) the cross-sectional association between cognitive impairment and functional disability in each ADL-IADL item; (b) cognitive impairment as a risk factor for incident disability in each ADL-IADL item, through logistic regression models; and (c) probabilities of incident loss of ADL-IADL abilities or death in 3 years, using multinomial logistic regression models. We also calculated the population attributable risk (PAR%) of cognitive impairment on incident loss of task-specific ADL-IADL abilities. RESULTS Cross-sectionally, the severity of cognitive impairment was associated with disability in each ADL-IADL task, with larger effects shown for ADL items. Longitudinally, minimally or mildly cognitively impaired individuals had a significantly higher risk of losing functional abilities compared with those with intact cognition. The PAR% indicated that cognitive impairment accounts for 11% to 36% of incident disability in ADL-IADL tasks, with the highest PAR% shown for the ability to feed oneself. IMPLICATIONS Cognitively impaired subjects are heterogeneous; the severity of cognitive impairment has a different impact on incident loss of task-specific ADL-IADL abilities, and comorbidities could affect disabilities differently. Consideration of these heterogeneities will enrich future studies on the impact of cognitive impairment on ADL-IADL abilities.
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Affiliation(s)
- Hiroko H Dodge
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Holbrook TL, Hoyt DB, Coimbra R, Potenza B, Sise M, Anderson JP. Long-Term Posttraumatic Stress Disorder Persists after Major Trauma in Adolescents: New Data on Risk Factors and Functional Outcome. ACTA ACUST UNITED AC 2005; 58:764-9; discussion 769-71. [PMID: 15824653 DOI: 10.1097/01.ta.0000159247.48547.7d] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about long-term psychological outcomes after major trauma in adolescents, a leading cause of death and preventable morbidity in this age group. A prospective epidemiologic study was conducted to examine quality of life (QoL) and posttraumatic stress disorder (PTSD) outcomes in injured adolescents. The specific objectives of the present report are to describe long-term PTSD and to identify risk factors for long-term PTSD and the impact of PTSD on QoL. METHODS Between April 26, 1999, and November 13, 2002, 401 eligible trauma patients aged 12 to 19 years triaged to five participating trauma center hospitals in a regionalized trauma system were enrolled in the study. The admission criteria for patients were as follows: age 12 to 19 years and injury diagnoses excluding severe traumatic brain injury or spinal cord injury. PTSD was diagnosed with the Impact of Events Scale-Revised; scores of 24+ were used to diagnose PTSD. QoL after trauma was measured using the Quality of Well-Being scale, a sensitive and well-validated functional index (range: 0 = death to 1.000 = optimum functioning). Patient outcomes were assessed at discharge and at 3, 6, 12, 18, and 24 months after discharge. RESULTS The rate of long-term PTSD was 27%, with high rates over the follow-up period. Risk factors for long-term PTSD were perceived threat to life (odds ratio [OR], 2.2; p < 0.001.); death of a family member at the scene (OR, 4.7; p < 0.001); no control over injury event (OR, 1.7; p < 0.05), and violence-related injury (OR, 2.2; p < 0.05). PTSD in adolescents was significantly and strongly associated with female gender, older age, low socioeconomic status, drug and alcohol abuse, and other adolescent behavioral problems. Long-term PTSD was also associated with marked and significant QoL deficits throughout the 24-month follow-up interval. CONCLUSION High rates of long-term PTSD persist after major trauma in adolescents. Injury events such as perceived threat to life and control over the event are strongly associated with PTSD risk. Prolonged PTSD severely impacts QoL outcomes. Early identification and treatment of risk factors for long-term PTSD will be important to improve outcomes in injured adolescents.
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Affiliation(s)
- Troy L Holbrook
- Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California, USA.
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Affiliation(s)
- Gregory Fricchione
- Division of Psychiatry and Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Salyers MP, Evans LJ, Bond GR, Meyer PS. Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives. Community Ment Health J 2004; 40:17-31. [PMID: 15077726 DOI: 10.1023/b:comh.0000015215.45696.5f] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We conducted a state-wide survey of 251 clinicians serving people with severe mental illness (SMI) in community support programs, to identify barriers to the diagnosis and treatment of PTSD and other trauma-related problems. Most clinicians did not feel competent to effectively treat these problems. Competence/confidence and belief in utility of intervention were positively related to the percentage of clients with whom trauma and PTSD had been discussed, documented in charts, and addressed directly in treatment. Clinicians need training that develops skills and knowledge as well as conveys the value of addressing PTSD and other trauma-related problems in people with SMI.
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Affiliation(s)
- Michelle P Salyers
- Department of Psychology, LD 124, Indiana University Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN 46202-3275, USA.
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Machamer JE, Temkin NR, Dikmen SS. Neurobehavioral outcome in persons with violent or nonviolent traumatic brain injury. J Head Trauma Rehabil 2003; 18:387-97. [PMID: 12973269 DOI: 10.1097/00001199-200309000-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To broaden the investigation of those injured violently by examining neuropsychological and psychosocial outcomes in relation to circumstances of traumatic brain injury and preinjury factors. DESIGN A prospective, longitudinal study. PARTICIPANTS A total of 752 adults with traumatic brain injury was grouped into those injured by violent or nonviolent circumstances and followed to 1-year post injury. MAIN OUTCOME MEASURES Circumstance groups were compared on demographics, preexisting conditions, brain injury severity, and neuropsychological and psychosocial outcomes. RESULTS The results indicate significant differences between the groups on demographics, preexisting conditions, and head injury severity. Neuropsychological and psychosocial outcome did not differ between the circumstance groups when all other factors were taken into account. CONCLUSIONS Injury severity and characteristics of the person that predate the injury were important to outcome rather than the circumstances of the injury itself.
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Affiliation(s)
- Joan E Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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O'Donnell ML, Creamer M, Bryant RA, Schnyder U, Shalev A. Posttraumatic disorders following injury: an empirical and methodological review. Clin Psychol Rev 2003; 23:587-603. [PMID: 12788111 DOI: 10.1016/s0272-7358(03)00036-9] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although there has been a marked increase in research on psychological disorders following physical injury in recent years, there are many discrepancies between the reported findings. This paper reviews the prevalence outcomes of recent studies of the mental health sequelae of physical injury with a focus on posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression. The review critically outlines some of the methodological factors that may have contributed to these discrepancies. The phenomenological overlap between organic and psychogenic symptoms, the use of narcotic analgesia, the role of brain injury, the timing and content of assessments, and litigation are discussed in terms of their potential to confound findings with this population. Recommendations are proposed to clarify methodological approaches in this area. It is suggested that a clearer understanding of the psychological effects of physical injury will require the widespread adoption of more rigorous, standardized and transparent methodological procedures.
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Holbrook TL, Hoyt DB, Stein MB, Sieber WJ. Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men. THE JOURNAL OF TRAUMA 2002; 53:882-8. [PMID: 12435938 DOI: 10.1097/00005373-200211000-00012] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to examine gender differences in prolonged PTSD (L-PTSD) and to assess the impact of PTSD by gender on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. METHODS Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included the following: age 18 years and older; admission Glasgow Coma Scale score of 12 or greater; and length of stay greater than 24 hours. QoL was measured after injury using the Quality of Well-being (QWB) scale, a sensitive index to the well end of the functioning continuum (range: 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-, 12-, and 18-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. PTSD (L-PTSD) was diagnosed if full or partial (F + P) or full (F) PTSD Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were present at all follow-up time points. RESULTS PTSD (L-PTSD) (F + P) was diagnosed in 35% (221 of 627) of patients at follow-up. PTSD (L-PTSD) (F) was present in 32% (153 of 627). Women were at significantly higher risk of PTSD (F + P) (odds ratio = 2.4, p = 0.001) and PTSD (F) (odds ratio = 2.8, p = 0.001) than men. The association of gender with PTSD was independent of mechanism and injury event-related factors such as perceived threat to life. In multivariate logistic regression, female gender, perceived threat to life, and SASR were strongly and independently associated with PTSD risk. Women were also at risk for worse QWB outcomes; beginning at discharge through the 18-month follow-up, women had significantly lower QWB scores at each follow-up time than men, regardless of prolonged PTSD status. CONCLUSION These results provide important new evidence that high rates of PTSD persist in the long-term aftermath of major trauma. The association of gender with PTSD was independent of mechanism and injury event-related factors such as perceived threat to life. Within categories of specific mechanism of injury and injury event-related factors, women were at significantly higher risk of prolonged PTSD onset. Prolonged PTSD was associated with significantly reduced quality of life in both men and women, with markedly worse QWB outcomes in women regardless of prolonged PTSD status.
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Affiliation(s)
- Troy L Holbrook
- Department of Family and Preventive Medicine, University of California, San Diego, 92103, USA.
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Beals J, Manson SM, Shore JH, Friedman M, Ashcraft M, Fairbank JA, Schlenger WE. The prevalence of posttraumatic stress disorder among American Indian Vietnam veterans: disparities and context. J Trauma Stress 2002; 15:89-97. [PMID: 12013069 DOI: 10.1023/a:1014894506325] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.
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Affiliation(s)
- Janette Beals
- Department of Psychiatry, National Center for American Indian and Alaska Native Mental Health Research, University of Colorado Health Sciences Center, Denver 80220, USA.
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Ford BC. Violence and trauma: predicting the impact on the well-being of African American women with severe mental illness. VIOLENCE AND VICTIMS 2002; 17:219-232. [PMID: 12033556 DOI: 10.1891/vivi.17.2.219.33646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative nonsignificant relationship was found between Posttraumatic Diagnostic Scale (PDS) and wellbeing. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.
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Holbrook TL, Hoyt DB, Stein MB, Sieber WJ. Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome. THE JOURNAL OF TRAUMA 2001; 51:287-92; discussion 292-3. [PMID: 11493786 DOI: 10.1097/00005373-200108000-00010] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess the impact on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. METHODS Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. RESULTS PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow-up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in women (39%) than in men (29%) and in younger low-income patients. Other major risk factors were penetrating trauma (OR, 2.3; p < 0.001) and assaults (OR, 1.5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month follow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 months, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001). CONCLUSION These results provide new and provocative evidence that perceived threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome and QoL.
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Affiliation(s)
- T L Holbrook
- Department of Family and Preventive Medicine, University of California, San Diego, California, USA
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