Posttraumatic stress disorder in the World Mental Health Surveys

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Causal relationship between inflammatory cytokines and posttraumatic stress disorder: a Mendelian randomization study and potential mechanism analysis

Background: Post-traumatic stress disorder (PTSD) is a complex condition linked to inflammation. The causality between inflammatory cytokines and PTSD risk remains unclear.Methods: We conducted a bidirectional two-sample Mendelian randomization (MR) study using genome-wide association study (GWAS) data from 41 inflammatory cytokines and PTSD. Additional analyses included differential gene expression, protein-protein interaction, and functional enrichment to explore underlying mechanisms.Results: MR analysis indicated that higher levels of stem cell factor (SCF) and interleukin-4 (IL-4) are associated with a reduced risk of PTSD. Genes POGZ and LRIG2 were identified as mediators, implicated in the TGF-beta signalling pathway.Conclusion: Our findings suggest a protective role of certain cytokines against PTSD and highlight potential molecular mediators. This knowledge could inform future therapeutic strategies for PTSD.

The relationship between childhood trauma, rs1360780 genotypes, FKBP5 intron 7 methylation and posttraumatic stress disorder in women who have experienced rape

Background: Posttraumatic stress disorder (PTSD) is a common sequela of rape. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, a core regulator of the stress response, has been implicated in the aetiology and chronicity of PTSD. FK506 binding protein (FKBP5) is a co-chaperone and functional regulator of the glucocorticoid receptor and the HPA-axis.Objective: This study investigated main and interaction effects of childhood trauma and the FKBP5 rs1360780 genotype on longitudinal FKBP5 intron 7 methylation, and whether change in FKBP5 methylation over time was associated with PTSD symptom severity over time.Method: Women who experienced rape (n = 96) were recruited from post-rape care services in KwaZulu Natal, South Africa. Total PTSD symptom scores, derived from the Davidson Trauma Scale, were assessed at baseline, 3-months and 6-months post-rape. Methylation levels at five FKBP5 intron 7 CpG sites were determined using EpiTYPER Sequenom MassArray technology. Genotyping of rs1360980 was completed using the Agena MassArray genotyping system. Mixed linear regression models were used to analyse the data.Results: The interaction between rs1360780 genotype and childhood trauma was a significant predictor of FKBP5 methylation over time. There was a significant positive correlation between childhood trauma and methylation levels in participants with the CT and TT genotypes, while there was a significant negative correlation between childhood trauma and methylation in CC genotype carriers. FKBP5 methylation was not a predictor of PTSD scores over time.Conclusion: This is the first study to investigate longitudinal change in FKBP5 methylation in a demographically homogenous same-trauma sample. The findings implicate childhood trauma and FKBP5 rs1360980 genotype in the trajectory of FKBP5 methylation levels in the aftermath of rape. Further research is needed to investigate the longitudinal role of FKBP5 intron 7 methylation in relation to PTSD symptom trajectories post-rape.

C-METTA reduces PTSD-related guilt and shame following interpersonal violence

Background: PTSD patients who experienced interpersonal violence are susceptible to trauma-related guilt and shame and often show unsatisfactory treatment response. C-METTA combines cognitive techniques and loving-kindness meditation. It has shown promising effects in reducing trauma-related guilt and shame.Objective: We examined the effectiveness of C-METTA within a quasi-experimental one-group pretest-posttest trial focusing on survivors of interpersonal violence, who suffered from trauma-related guilt and shame. An additional objective was to examine variables potentially associated with lower treatment response (childhood trauma, cumulative trauma, and PTSD chronicity).Method: We treated 25 individuals (age = 19-61, 96% women) with PTSD following interpersonal violence. We predicted that C-METTA would significantly reduce (a) PTSD symptoms (measured by the Clinician Administered PTSD Scale, the PTSD Symptom-Checklist Version 5, and the Posttraumatic Cognitions Inventory), (b) feelings of guilt (measured by the Trauma Related Guilt Inventory) and (c) feelings of shame (measured by the Trauma Related Shame Inventory). To analyse treatment effects, we conducted repeated-measures MANOVAs. Further, we investigated the impact of childhood trauma, cumulative trauma and PTSD chronicity symptoms on treatment effectiveness exploratively via additional MANCOVAs.Results: Analyses showed significant and large effects of C-METTA on reducing PTSD symptoms (ranging from d = 1.12 to d = 1.67), feelings of guilt (d = 1.54) and shame (d = 1.26). Childhood trauma, cumulative trauma and PTSD chronicity did not affect treatment effectiveness.Conclusion: Our findings support previous research concerning the effectiveness of C-METTA and add promising evidence for the effectiveness of C-METTA to reduce PTSD following interpersonal violence. Effectiveness was independent of childhood trauma, trauma-duration and PTSD chronicity. Regression to the mean should be considered as a confounding factor. We suggest more research to support the results. C-METTA might increase PTSD treatment diversity and offer patients a greater bandwidth of options according to their preferences and the respective symptomatology.

Effectiveness in routine care: trauma-focused treatment for PTSD

Objective: The efficacy of trauma-focused cognitive behaviour therapy (tf-CBT) has been well established in randomized controlled trials (RCTs). More research is needed to demonstrate the effectiveness of tf-CBT in routine clinical care settings.Method: Eighty-five patients (68 female) with a primary diagnosis of PTSD received tf-CBT at two German outpatient centres (Münster and Mannheim) between 2014 and 2016. Treatment was delivered mainly by therapists in training and treatment duration was based on symptom course. The treatment consisted of a preparation phase, a trauma-focused phase (comprising imaginal exposure, discrimination training, changing dysfunctional appraisals) and a phase of reclaiming-your-life assignments, and relapse prevention. In an intent-to-treat-analysis (ITT), linear mixed effects models were fitted for self-assessments of traumatic symptom severity using the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Potential moderators for treatment outcome, e.g. number of suicide attempts, were investigated.Results: The observed treatment effect was large for both the CAPS-5 (ITT: Cohen's d = 2.07, CI [1.62, 2.51]; completers d = 2.34, CI [1.84, 2.83]) and PCL-5 respectively (ITT: d = 2.02, CI [1.56, 2.48]; completers d = 2.15, CI [1.66, 2.64]), and remained stable six months and one-year post-treatment. N = 27 patients (31.48%) were defined as study dropout and of these, n = 12 (14.12%) dropped out of the study but completed treatment. None of the fixed-effect estimates for treatment predictors interacted significantly with the effect of time.Conclusions: Tf-CBT is well-tolerated and it can be effectively delivered in routine clinical care. Its large treatment effects underline the practicability and benefits of the approach. This trial demonstrates its broad applicability among individuals with diverse patterns of clinical characteristics and comorbidities.

The role of anhedonia symptoms in symptomatology of posttraumatic stress disorder and related functional impairments among traumatized Chinese adults

Background: Posttraumatic stress disorder (PTSD) is a mental disorder comprised of heterogeneous clinical symptoms. Various studies have demonstrated that anhedonia is a distinct symptom dimension of PTSD. However, the association between anhedonia dimension and different aspects of PTSD symptomatology remains unclear.Objective: This study examined the associations between anhedonia symptoms and PTSD diagnosis, overall symptom severity, and both psychosocial and physical functional impairments.Method: A total of 1,063 adult survivors of the 2008 Wenchuan earthquake were assessed nine years after the disaster. PTSD symptoms and functional outcomes were measured using the PTSD Checklist for DSM-5 (PCL-5) and the Short Form Health Survey (SF-36). Multiple regression analyses were conducted to examine the associations between anhedonia and key outcomes, controlling for relevant covariates. Partial correlation analyses were used to provide supplementary effect size estimates.Results: Anhedonia symptoms were significantly associated with both PTSD diagnosis and levels of overall symptoms, and specifically associated with psychosocial function impairments rather than physical function impairments. Relative to the other PTSD symptom dimensions anhedonia showed the second highest correlation with PTSD diagnosis and levels of overall symptoms and medium correlation with psychosocial function impairments.Conclusions: These findings suggest that anhedonia may represent an important symptom dimension within PTSD, particularly in relation to symptom severity and psychosocial functioning. The results highlight the potential value of further investigating anhedonia in both PTSD assessment and cross-diagnostic research.

Experts in traumatic stress are concerned about global impact of what is happening in U.S

Trauma is a global issue and public health concern. Political decisions may directly impact rates of trauma exposure, be it individual trauma or mass disaster, and guide how we deal with the consequences of trauma. In this editorial, we warn that the current U.S. administration's decisions are impacting exposure to and consequences of trauma worldwide as well as disrupting the field of traumatic stress in research and practice.

Repeated presentation of visual threats drives innate fear habituation and is modulated by threat history and acute stress exposure

To survive predation, animals must be able to detect and appropriately respond to predator threats in their environment. Such defensive behaviors are thought to utilize hard-wired neural circuits for threat detection, sensorimotor integration, and execution of ethologically-relevant behaviors. Despite being hard-wired, defensive behaviors (i.e. fear responses) are not fixed, but rather show remarkable flexibility, suggesting that extrinsic factors such as threat history, environmental contexts, and physiological state may alter innate defensive behavioral responses. The goal of the present study was to examine how extrinsic and intrinsic factors influence innate defensive behaviors in response to visual threats. In the absence of a protective shelter, our results indicate that mice showed robust freezing behavior following both looming (proximal) and sweeping (distal) threats, with increased behavioral vigor in response to looming stimuli, which represent a higher threat imminence. Repeated presentation of looming or sweeping stimuli at short inter-trial intervals resulted in robust habituation of freezing, which was accelerated at longer inter-trial intervals, regardless of contextual cues. Finally, prior stress history such as acute foot shock further disrupted innate freezing habituation, resulting in a delayed habituation phenotype, consistent with a heightened fear state. Together, our results indicate that extrinsic factors such as threat history, environmental familiarity, and stressors have robust and diverse effects on defensive behaviors, highlighting the behavioral flexibility in how mice respond to predator threats.

Implementation of evidence-based psychotherapies for posttraumatic stress disorder in Azerbaijan

Background: Following the second Karabakh War, mental health services in Azerbaijan encountered significant challenges due to an increased number of traumatised individuals. To address the needs of people with post-traumatic stress disorder (PTSD), two evidence-based treatments, Cognitive Processing Therapy (CPT) and Written Exposure Therapy (WET), have been selected for future implementation in the country.Objective: This study aims to present preliminary findings on the training and implementation of CPT and WET.Method: Forty-two clinicians participated in the training programme, with 24 enrolled in CPT training and 18 in WET training. The programme included a self-administered online course, workshops, and consultations. Following each phase of training, clinicians completed the Perceived Characteristics of Intervention Scale (PICS) to assess the effectiveness and legitimacy of trauma-focused therapies.Results: Our results indicated a positive trend in perception from one assessment to another (F(2, 82) = 20.2, p < .001, η2p = .330), along with a decrease in perceived risk associated with treatment (F(2, 82) = 5.3, p < .007, η2p = .114). Additionally, the study found that belonging to either the CPT or WET training group did not significantly influence positive perception.Conclusions: These findings confirm the feasibility of utilising CPT and WET by clinicians providing services for PTSD patients in Azerbaijan.

Integration of Metabolomic and Brain Imaging Data Highlights Pleiotropy Among Posttraumatic Stress Disorder, Glycoprotein Acetyls, and Pallidum Structure

Background

The development of posttraumatic stress disorder (PTSD) is attributable to the interplay between exposure to severe traumatic events, environmental factors, and biological characteristics. Blood and brain imaging markers have been associated with PTSD. However, to our knowledge, no study has systematically investigated the genetic relationship between PTSD, metabolic biomarkers, and brainwide imaging.

Methods

We integrated genome-wide data informative of PTSD, 233 metabolic biomarkers, and 3935 brain imaging-derived phenotypes (IDPs). Pleiotropy was assessed by applying global and local genetic correlation, colocalization, and genetically inferred causality.

Results

We observed significant genetic overlap between PTSD and glycoprotein acetyls (GlycA) (a stable inflammatory biomarker) in 2 independent cohorts (discovery r g = 0.26, p = 1.00 × 10-4; replication r g = 0.23, p = 5.99 × 10-19). Interestingly, there was no genetic correlation between anxiety and GlycA (p = .33). PTSD and GlycA were both genetically correlated with median T2∗ in the left pallidum (IDP-1444: r g = 0.14, p = 1.39 × 10-5; r g = -0.38, p = 2.50 × 10-3, respectively). Local genetic correlation between PTSD and GlycA was observed in 7 genetic regions (p < 2.0 × 10-5), mapping genes related to immune and stress response, inflammation, and metabolic processes. Furthermore, we identified 1 variant, rs12048743, with evidence of horizontal pleiotropy linking GlycA and IDP-1444 (z IDP-1444 = 17.14, z GlycA = -6.07, theta p = 2.06 × 10-8). Regional colocalization was observed among GlycA, IDP-1444, and tissue-specific transcriptomic regulation for brain frontal cortex and testis (rs12048743-chr1q32.1; posterior probability > 0.8). While we also tested causality between PTSD, metabolomic biomarkers, and brain IDPs, these were not consistent across different genetically informed causal inference methods.

Conclusions

Our findings highlight a new putative pleiotropic mechanism that links systemic inflammation and pallidum structure to PTSD.

Empirically supported treatments for all: Realizing equitable coverage of care for trauma survivors globally

Global mental health is focused on reducing inequities in treatment access for mental health disorders. A core social determinant of mental health is trauma (e.g., violence, disasters, wars), contributing to myriad psychosocial outcomes such as posttraumatic stress disorder (PTSD), depression, anxiety, and functional impairment. Despite the development of numerous efficacious empirically supported treatments (ESTs), trauma survivors remain a particularly vulnerable group and rarely receive quality trauma-informed treatment. In this paper, we argue that in order to reduce global inequities in mental health treatment access, we need to fully embrace Chambless and Hollon's (1998) criteria for ESTs - that they be efficacious, effective in routine clinical contexts, feasible to deploy and scale up, and cost-effective. While the field of clinical science has made impressive strides in developing efficacious treatments, we argue that we ought to place greater emphasis on an EST being effective across contexts, feasible for delivery by a wide cadre of providers, and cost-effective to scale to improve equity. We discuss efforts in the field of global mental health that use innovative paradigms to fully realize the latter criteria, which have been under-appreciated in clinical science. We conclude with recommendations to improve EST access by applying an equity lens within and between contexts.

A Warm Water Immersion Intervention for Symptoms of PTSD in Military Veterans: A Qualitative Descriptive Study

BackgroundPost-Traumatic Stress Disorder (PTSD) is a substantial problem for Veterans and active members of armed forces across the globe, resulting in debilitating mental and physical comorbidities. Evidence-based treatments have demonstrated some success; however, many Veterans remain symptomatic mandating the urgent need for innovative treatment strategies.PurposeThe purpose of this study was to explore the lived experience of military Veterans with PTSD symptoms who participated in a therapeutic warm water immersion intervention aimed at reducing their symptoms.Methods and ProceduresA standardized warm 33 °C (92 °F) water immersion intervention to the chest, lasting 45 min was implemented. Semi-structured interviews were conducted with the 13 participants (age 23-41) after engaging in the intervention. Using a qualitative descriptive design informed by phenomenology, thematic analysis was completed, applying criteria of rigor throughout the process.ResultsFive main themes explicated the participants' experience: the rhythm of relaxed, embracing the properties of the water, the pain floats away, acclimatize to calmness, and a place to set your mind. Participants described a sense of relaxation, calmness, pain reduction, and a means to control intrusive thoughts. All indicated they would recommend the intervention and provided feedback on how to refine it.ConclusionsAs a component of a larger study, these qualitative findings revealed the potential for therapeutic effects of a novel water immersion intervention. The findings serve to inform revisions to the intervention for future research and practice. Immersion provides a fast-acting, non-stigmatizing adjunct therapy for Veterans who continue to experience symptoms during and after standard evidence-based treatment.

Quantifying the independent impact of social determinants of health and posttraumatic stress disorder on resource utilization and health outcomes in civilians

Social determinants of health (SDoH) and posttraumatic stress disorder (PTSD) are well-documented risk factors for poor health outcomes, yet their independent contributions to healthcare resource utilization (HCRU) and patient-reported quality of life remain unclear. This retrospective study, using the All of US database, compared civilians with and without PTSD (n = 747, matched on age, sex at birth, race, and ethnicity) and examined whether differences in SDoH, beyond the matched demographics, were associated with poorer health outcomes. Multiple linear regressions were conducted for twelve health outcomes related to HCRU and patient-reported well-being to separate the independent contributory effect of PTSD and SDoH. Across both HCRU and patient-reported well-being, PTSD patients had worse outcomes. SDoH factors accounted for 23.2 % of Outpatient Visits and 50.1 % of Emergency Room Visits among civilians, translating to a $8.82 billion health system burden. The SDoH domains of Employment Status, Stress, and Discrimination were significantly associated with increased HCRU. Further, SDoH factors contributed to more than half (52.4-84.5 %) of poor self-rated well-being outcomes compared with PTSD itself. Self-reported outcomes were affected by a variety of SDoH domains, most prominently Employment Status, Education, and Relationships. These results offer insight into the potential significant independent contribution of unfavorable SDoH in worsening health outcomes among civilians with PTSD.

Preliminary Insights Into the Relationship Between the Gut Microbiome and Host Genome in Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) may develop following trauma exposure; however, not all trauma-exposed individuals develop PTSD, suggesting the presence of susceptibility and resilience factors. The gut microbiome and host genome, which are interconnected, have been implicated in the aetiology of PTSD. However, their interaction has yet to be investigated in a South African population. Using genome-wide genotype data and 16S rRNA (V4) gene amplicon sequencing data from 53 trauma-exposed controls and 74 PTSD cases, we observed no significant association between the host genome and summed abundance of Mitsuokella, Odoribacter, Catenibacterium and Olsenella, previously reported as associated with PTSD status in this cohort. However, PROM2 rs2278067 T-allele was significantly positively associated with the summed relative abundance of these genera, but only in individuals with PTSD and not trauma-exposed controls (p < 0.014). Polygenic risk scores generated using genome-wide association study summary statistics from the PGC-PTSD Overall Freeze 2 were not predictive of gut microbial composition in this cohort. These preliminary results suggest a potential role for the interaction between genetic variation and gut microbial composition in the context of PTSD, underscoring the need for further investigation.

An Update on the Psychiatric Genomics of Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD) is a prevalent psychiatric condition characterized by intrusive thoughts, hyperarousal, avoidance, and negative cognitive alterations following traumatic events. While a significant portion of individuals experience trauma, only 5% to 30% develop PTSD, with certain groups at higher risk. Research indicates that PTSD's pathophysiology involves altered fear processing, neuroendocrine dysfunction, and immune system changes. Genetic studies, particularly twin studies, suggest a heritability estimate of 30% to 40% for PTSD. Initially focused on gene-environment interactions, recent advancements in genome-wide association studies have identified significant genetic markers enhancing understanding of PTSD's genetic underpinnings.

Using machine learning methods to predict the outcome of psychological therapies for post-traumatic stress disorder: A systematic review

BACKGROUND

A number of treatments are available for post-traumatic stress disorder (PTSD), however, there is currently a lack of data-driven treatment selection and adaptation methods for this condition. Machine learning (ML) could potentially help to improve the prediction of treatment outcomes and enable precision mental healthcare in practice.

OBJECTIVES

To systematically review studies that applied ML methods to predict outcomes of psychological therapy for PTSD in adults (e.g., change in symptoms, dropout rate), and evaluate their methodological rigour.

METHODS

This was a pre-registered systematic review (CRD42022325021), which synthesised eligible clinical prediction studies found across four research databases. Risk of bias was assessed using the PROBAST tool. Study methods and findings were narratively synthesised, and adherence to ML best practice evaluated.

RESULTS

Seventeen studies met the inclusion criteria, including samples derived from experimental and observational study designs. All studies were assessed as having a high risk of bias, notably due to inadequately powered samples and a lack of sample size calculations. Training sample size ranged from N < 36-397. The studies applied a diverse range of ML methods such as decision trees, ensembling and boosting techniques. Five studies used unsupervised ML methods, while others used supervised ML. There was an inconsistency in the reporting of hyperparameter tuning and cross-validation methods. Only one study performed external validation.

CONCLUSIONS

ML has the potential to advance precision psychotherapy for PTSD, but to enable this, ML methods must be applied with greater adherence to best practice guidelines.

Psychological interventions for adult posttraumatic stress disorder: A systematic review of published meta-analyses

OBJECTIVE

A large and growing number of published meta-analyses have examined the efficacy of psychological interventions for post-traumatic stress disorder (PTSD). Conclusions drawn from these meta-analyses on treatment efficacy greatly influence clinical practice. This study aimed to provide a comprehensive review of meta-analyses of randomized controlled trials (RCTs) on psychological interventions for adult PTSD, focusing on their content, methodology, and reporting quality.

METHOD

Systematic database searches were conducted in March 2024 using MEDLINE, PsycInfo, PTSDpubs, Web of Science, and the Cochrane Database of Systematic Reviews. The quality of meta-analyses was assessed using AMSTAR 2. The systematic review was registered on PROSPERO (CRD42020151234).

RESULTS

Overall, 55 meta-analyses with 93 meta-analytic comparisons at treatment endpoint and 28 comparisons at follow-up were included. Meta-analyses most consistently showed superiority of psychological interventions over control conditions. However, beneficial long-term effects exceeding one-month post-treatment were limited to trauma-focused cognitive behavior interventions (TF-CBT) and eye movement desensitization and reprocessing (EMDR). There was a substantial overlap of primary RCTs, indicating redundancy between meta-analyses. Furthermore, the quality of meta-analyses varied substantially.

CONCLUSIONS

There is a need to enhance the methodological and reporting quality of meta-analyses, avoid the production of redundant meta-analyses, and conduct more high-quality, large RCTs with long-term assessments.

The prevalence, clinical impact, and therapeutic considerations of trauma in adults with bipolar disorder: A systematic review

BACKGROUND

Exposure to severe stressful life events (e.g., physical, sexual, emotional abuse and/or physical or emotional neglect) is common among adults with bipolar disorder (BD) and is associated with poor prognosis and clinical outcomes. This systematic review aims to evaluate the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD.

METHODS

A systematic review of primary research was conducted using Embase, PsycInfo, MEDLINE, and PubMed databases from inception to January 2025, following PRISMA criteria. Sixteen human studies evaluating the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD were included.

RESULTS

Prevalence rates of trauma range from approximately 40-60 % of adults with BD. Childhood physical maltreatment is highly associated with comorbidities and symptom severity in adults with BD. Childhood emotional maltreatment is associated with an earlier age of onset, greater illness severity, comorbidity and suicidality in BD. The moderating effects of trauma in BD treatment response across disparate modalities of treatment are not adequately characterized.

CONCLUSIONS

Trauma, particularly childhood trauma, is prevalent and has a severe negative clinical impact on the presentation, progression, treatment, and outcomes of adults with BD. The research strategic priority is to characterize the biosignature of trauma in BD, the impact of trauma on treatment outcomes, and to empirically evaluate integrated models of care in persons with BD with a history of trauma.

Trauma type affects the perceived severity of symptoms and intensity of the recommended intervention in laypeople's perspective on PTSD

Post-Traumatic Stress Disorder (PTSD) is a prevalent mental health condition that can significantly impair individual's daily life. PTSD literacy can help not only those affected cope with the condition but also facilitate laypeople's interactions with those who have experienced or currently suffer from PTSD. However, it is not well-established whether and how the perceived severity of the traumatic event and the supposed need for intervention depend on the causes of PTSD. In the present experiment, we systematically varied the cause across vignettes while holding other aspects constant. Analyses revealed significant differences in severity ratings of the traumatic experience across conditions. The sexual assault and military combat conditions stood out with the highest ratings. Furthermore, severity ratings predicted the intensity of the intervention participants recommended, and both ratings were higher for female participants compared to male participants. While the study confirms the impact of the cause of PTSD on the severity assumed by laypeople, our results diverge from earlier findings in that sexual assault led to particularly high ratings in the current study.

Examining Posttraumatic Stress Symptoms and Substance Use in Latine College Students

Background: Latine young adults often experience turmoil leading to trauma exposure and symptoms in their native countries, frequently leading to migration, making it valuable for psychologists across the Americas to understand trauma-based mental health in Latines. Given the disproportionate experience of trauma and posttraumatic stress symptoms (PTSS) among Latine young adults and the common age of onset for problematic substance use, there is a need to explore how PTSS relates to substance use in this population. Methods: Using data from a sample of college students (n = 687; ages 17-25) living in Latin America, this study examined the relation between PTSS and substance use and considered the role of demographic variables. We hypothesized that individuals who indicated higher PTSS would also report higher substance use. Results: Moderation analyses revealed a main effect of PTSS on substance use severity, t = 2.06, p = 0.04, as well as a main effect of age on substance use frequency, t = 2.56, p = 0.01. Exploratory findings showed some PTSS, age, and sex main and interaction effects in relation to the frequency and/or severity of tobacco, alcohol, cannabis, cocaine, stimulant, sedative, and opioid use. Notably, 26.1% of our sample demonstrated clinically significant symptoms of PTSS - substantially higher than published prevalence rates in the U.S. Conclusions: Considering increased risk for PTSS and substance use in this population, culturally appropriate clinical resources regarding comorbidity should be prioritized, especially among young adults.

Post-traumatic stress disorder, attention deficit and hyperactivity disorder, and 24 gastrointestinal diseases: Evidence from Mendelian randomization analysis

Post-traumatic stress disorder (PTSD) and Attention deficit and hyperactivity disorder (ADHD) are common mental illnesses. Observational studies have indicated that these conditions often co-occur with gastrointestinal diseases. However, the causal relationship between PTSD and ADHD with gastrointestinal diseases remain unclear. We conducted Mendelian randomization (MR) analysis to investigate these associations. We selected genetic instrument data with genome-wide significance levels for PTSD and ADHD from the psychiatric genomics consortium open genome-wide association study platform. Summary statistics for the 24 gastrointestinal diseases were obtained from the FinnGen study. We used the "TwoSampleMR" package in R to perform a 2-sample MR analysis and conducted sensitivity analysis of the results. We found that genetic susceptibility to PTSD was associated with 1 gastrointestinal disease, specifically pancreatic cancer (P = .003; odds ratios [OR] = 1.295; 95% CI, 1.094-1.531). Genetic susceptibility to ADHD was associated with 4 gastrointestinal diseases: gastroesophageal reflux (P = .014; OR = 1.100; 95% CI, 1.020-1.186), gastric ulcer (P = .004; OR = 1.208; 95% CI, 1.061-1.376), duodenal ulcer (P = .020; OR = 1.206; 95% CI, 1.029-1.413), and chronic gastritis (P = .021; OR = 1.122; 95% CI, 1.018-1.237). This study provides MR evidence supporting causal relationship between PTSD and ADHD with specific gastrointestinal diseases.

Prevalence of common mental disorders and sleep disorder among adolescents and young adults with HIV: a systematic review and meta-analysis

OBJECTIVE

Adolescents and young adults (AYA) with HIV are a population at high risk of experiencing mental issues and sleep disorder. We aim to summarise the global prevalence and risks of depression, anxiety, post-traumatic stress disorder (PTSD) and sleep disorder among AYA with HIV.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Web of Science, Embase and PsycINFO were searched from inception to 3 August 2024.

ELIGIBILITY CRITERIA

Observational studies reporting the prevalence of depression, anxiety, PTSD or sleep disorder among AYA with HIV and published in English were included. Reviews, case reports, conference papers, notes, editorials and non-observational research were excluded.

DATA EXTRACTION AND SYNTHESIS

Titles, abstracts and full texts were reviewed and screened, and data were independently extracted. A modified Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate study quality. Heterogeneity was assessed by I2 statistics, and subgroup analysis was performed to identify the source of heterogeneity. The pooled prevalence and the risks of depression, anxiety, PTSD and sleep disorder by comparison with HIV-uninfected peers were measured with random-effects and fixed-effects models. Publication bias was examined using Egger's correlation tests and funnel plot. The Grading of Recommendations Assessment, Development and Evaluation was used to assess the certainty of evidence.

RESULTS

56 articles were included in the final analysis. According to the modified NOS, 13 (23.2%) studies were considered good, 38 (67.9%) were satisfactory and 5 (8.9%) were unsatisfactory. 51 studies including 21 735 AYA with HIV contributed data for the pooled prevalence of depression (28%, 95% CI 24% to 32%, I2=98.68%; low certainty evidence); 21 studies including 8021 cases contributed data for the pooled prevalence of anxiety (22%, 95% CI 17% to 27%, I2=98.35%; low certainty evidence); 9 studies including 3691 cases contributed data for the pooled prevalence of PTSD (12%, 95% CI 8% to 17%, I2=95.60%; low certainty evidence); and 4 studies including 1909 cases contributed data for the pooled prevalence of sleep disorder (51%, 95% CI 31% to 70%, I2=98.37%; low certainty evidence). Compared with AYA without HIV, those with HIV had a higher risk of depression (OR=2.67, 95% CI 1.63 to 5.90, I2=84.0%), anxiety (OR=1.89, 95% CI 1.32 to 2.69, I2=50.3%), PTSD (OR=1.58, 95% CI 1.23 to 2.04, I2=40.1%) and sleep disorder (OR=2.11, 95% CI 1.51 to 2.95, I2=0.0%). A subgroup analysis found that studies conducted in Asia had a lower prevalence of depression (21.7% vs 29.6%, p<0.001) and anxiety (14.7% vs 21.9%, p<0.001) than studies conducted in Africa. Egger's test indicated that there was significant publication bias in the estimates of the prevalence of depression (p<0.001), anxiety (p<0.001) and PTSD (p=0.049), but not in the estimates of the prevalence of sleep disorder (p=0.861).

CONCLUSIONS

AYA with HIV are a population at high risk of experiencing depression, anxiety, PTSD and sleep disorder. More sensitive screening strategies and more comprehensive intervention methods are needed. However, in view of the high heterogeneity, the differences between studies need to be considered and the pooled estimates interpreted with caution.

Anxiety, depression, and post-traumatic stress and associated risk factors among out-of-school girls in western Kenya

BACKGROUND

Many adolescent girls drop out of school in sub-Saharan Africa. Mental health problems in this population and their risk factors are a neglected research area.

METHODS

This community-based cross-sectional survey studied 904 out-of-school girls in rural western Kenya. Outcome variables were a positive screen for anxiety (GAD-7), depression (PHQ-A), post-traumatic stress disorder (PTSD; PCL-C), and a composite measure for overall symptom severity. Survey data were analysed with univariable and multivariable binary logistic and multiple linear regression analyses using SPSS 29.0.

FINDINGS

The prevalence of probable anxiety was 10.6%, of probable depression 15.9%, and of probable PTSD 18.0%. One of the three items on suicidal ideation or past suicide attempt was reported by 40.2% of girls. In multivariable analyses controlling for age, fear of sexual assault and functional limitations due to menstruation were uniquely associated with each of the outcome variables, and exposure to physical violence to each outcome except anxiety. Other risk factors showed a less consistent relationship with outcome. The cross-sectional study design precludes any temporal and causal inference for the reported significant associations.

CONCLUSION

Out-of-school girls constitute a vulnerable group with high levels of PTSD and suicide risk. Multi-level and multi-sector interventions are needed to help these girls cope with their mental health problems and to address mutable risk factors such as gender-based partner and non-partner sexual and physical violence, poor menstrual hygiene, and poverty.

The Impact of Non-Criterion A Traumas in Intimate Relationships on Posttraumatic Stress Symptoms: A Systematic Review

Currently, the diagnosis of posttraumatic stress disorder necessitates exposure to a traumatic event as defined by DSM-5-TR Criterion A. Nevertheless, evidence suggests that experiences not meeting Criterion A stressor definitions, specifically related to intimate relationships (e.g., psychological abuse) can also elicit clinically significant posttraumatic stress symptoms (PTSS). However, the literature examining the unique role of non-Criterion A intimate relationship stressors on PTSS is sparse. This systematic review synthesized the literature examining the influence of non-Criterion A intimate relationship stressors on PTSS. Electronic searches of three databases (i.e., PsychInfo, Scopus, and PubMed) identified 3257 articles which underwent title and abstract screening and, if potentially eligible, full-text review. Nine articles met inclusion criteria; four of which examined PTSS after a conflict in a relationship and/or divorce, two studies focused on infidelity, and three studies focused on partner psychological abuse in an intimate relationship. Results revealed that relationship conflict and divorce, infidelity, and psychological abuse can lead to clinically significant PTSS, however, these findings were not consistent across all studies. Findings reveal considerable variability in the frequency and severity of PTSS following non-Criterion A intimate relationship stressors that is in line with the variability found in Criterion A-exposed samples. Nevertheless, given the limited number of studies identified, further research is needed. Understanding the impact of these stressors may have important implications for diagnostic and treatment considerations and will provide valuable insights for our understanding of the PTSD construct in its entirety.

Between Struggle and Strength: A Rapid Review of Dual-Trauma Couples

Although several studies have shown that one person's trauma is associated with romantic relationship difficulties for both partners in adulthood, most have overlooked the particularity of dual-trauma couples, in which both partners have experienced traumatic experiences. This rapid review investigated the dynamics and challenges within dual-trauma couples. A rapid review methodology was employed to consolidate and evaluate existing knowledge in this field. Fifteen empirical research studies meeting the inclusion criteria were identified through a comprehensive search across multiple databases, including CINAHL, Family Studies Abstracts, PsycInfo, PubMed, Google Scholar, Web of Science, and Dissertations and Theses Global. Studies included encompassed different methodological approaches. The review focused on studies explicitly addressing dual-trauma couples, excluding those examining secondary trauma or broader impacts of trauma on couples without a specific analysis of dual-trauma dynamics. Key findings revealed a comprehensive understanding of the complexities faced by these couples, including relationship dynamics, communication patterns, psychological impacts of trauma, and factors influencing relationship satisfaction. The review showed that despite facing significant challenges, dual-trauma couples demonstrate remarkable strengths and resilience, emphasizing the importance of open communication and mutual support in coping with past traumas. The review underscored the need for tailored interventions and trauma-informed care to address the unique needs of dual-trauma couples. Through a focused exploration of existing literature, this review provides valuable insights for clinicians, researchers, and professionals working in the field of trauma and relationships, aiming to enhance understanding and support for these vulnerable couples.

An exploration of trauma-informed care curricula in chiropractic programs: A scoping document analysis protocol

BACKGROUND

Trauma is a significant public health issue that affects both mental and physical health. Healthcare delivery based on trauma-informed care (TIC) principles is designed to mitigate the risk of re-traumatization in healthcare settings to improve patient outcomes. Chronic pain is a common comorbidity of trauma and a common reason that people seek healthcare, including chiropractic care. The extent to which TIC training is integrated into chiropractic education and Doctor of Chiropractic Programs (DCPs) remains unclear.

OBJECTIVE

This study aims to evaluate the presence of TIC principles in educational curricula documents from accredited DCPs across the United States and Canada to identify potential gaps in trauma-sensitive education within chiropractic training.

METHODS

A scoping document analysis will be conducted using educational curricula documents (program handbooks, course catalogs, and course syllabi) from DCPs accredited by the Council on Chiropractic Education (CCE-USA). Documents will be evaluated for TIC-related search terms based on established frameworks from the Substance Abuse and Mental Health Services Administration and the Harvard Medical School TIC Core Competencies. The analysis will assess the presence of TIC principles such as safety, trust, empowerment, and cultural sensitivity. A phased approach will be used for data extraction, ensuring a comprehensive review of TIC integration.

RESULTS

The study will quantify the inclusion of TIC principles in chiropractic education in the United States and Canada and identify trends or gaps related to TIC education.

CONCLUSION

Our findings can inform future curriculum review and development, ensuring DCPs integrate TIC effectively to enhance care for trauma-exposed patients.

Depression or anxiety and long-term mortality among adult survivors of intensive care unit: a population-based cohort study

BACKGROUND

Many patients who survive intensive care unit (ICU) stays experience persistent mental impairments. It is estimated that one-third of ICU survivors suffer from psychiatric disorders. However, research into how these disorders affect long-term outcomes in this population is scarce. Therefore, the aim of this study is to investigate the association between depression or anxiety and long-term mortality among ICU survivors.

METHODS

This population-based cohort study included patients admitted to the ICU between January 1, 2015 and December 31, 2019, who survived at least 1 year after ICU discharge. Exclusions were made for patients admitted for non-medical reasons and those who had been in the ICU in the previous 2 years, and 799,645 patients were included in the study. Follow-up data were obtained for up to 7 years. The primary outcome was long-term cumulative mortality. Mortality rates for patients with and without diagnoses of depression or anxiety were compared.

RESULTS

Of the 799,645 adult ICU survivors, 98,530 (12.3%) were newly diagnosed with depression or anxiety post-discharge, and 265,092 (33.2%) had been diagnosed prior to ICU admission. Multivariate Cox proportional hazards regression analysis revealed that the adjusted hazard ratio (HR) for long-term mortality was 1.17 (95% CI, 1.16-1.19) for those newly diagnosed with depression or anxiety, 1.28 (95% CI, 1.26-1.30) for depression alone, and 1.08 (95% CI, 1.06-1.11) for anxiety alone. For those with prior diagnoses, the adjusted HR was 1.08 (95% CI, 1.07-1.09) overall, 1.12 (95% CI, 1.11-1.14) for depression, and 1.04 (95% CI, 1.03-1.05) for anxiety.

CONCLUSIONS

ICU survivors newly diagnosed with depression or anxiety exhibit higher long-term mortality rates compared to those without such diagnoses, including those diagnosed before ICU admission. Particularly, newly diagnosed depression is associated with an elevated mortality rate. These findings underscore the need for psychological interventions to enhance long-term survival among ICU survivors.

Psychological therapies for post-traumatic stress disorder in children and adolescents

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (i.e. benefits and harms) of psychological therapies for post-traumatic stress disorder and complex post-traumatic stress disorder in children and adolescents.

Stress-induced changes in the molecular processes underlying fear memories: implications for PTSD and relevant animal models

Most of the fear literature on humans and animals tests healthy individuals. However, fear memories can differ between healthy individuals and those previously exposed to traumatic stress, such as a car accident, sexual abuse, military combat and personal assault. Traumatic stress can lead to post-traumatic stress disorder (PTSD) which presents alterations in fear memories, such as an impairment of fear extinction and extinction recall. PTSD-like animal models are exposed to a single highly stressful experience in the laboratory, such as stress immobilization or single-prolonged stress. Some days later, animals exposed to a PTSD-like model can be tested in fear procedures that help uncover molecular mechanisms of fear memories. In this review, there are discussed the molecular mechanisms in stress-induced fear memories of patients with PTSD and PTSD-like animal models. The focus is on the effects of estradiol and cortisol/corticosterone hormones and of different genes, such as FKBP prolyl isomerase 5 gene (FKBP5) - FK506 binding protein 51 (FKBP51), pituitary adenylate cyclase-activating peptide (PACAP) - pituitary adenylate cyclase-activating polypeptide type I receptor (PAC1R), endocannabinoid (eCB) system and the tropomyosin receptor kinase B (TrkB) - brain-derived neurotrophic factor (BDNF). The conclusion is that greater emphasis should be placed on investigating the molecular mechanisms of fear memories in PTSD, through direct testing of patients with PTSD or the use of relevant PTSD-like models.

Trauma exposure, post-traumatic stress disorder and alcohol and other drug use among Australian public safety personnel

OBJECTIVE

This study investigated the rates of workplace trauma exposure, probable post-traumatic stress disorder (PTSD) and alcohol and other drug use among Australian public safety personnel (PSP). It also identified factors associated with hazardous or harmful alcohol and other drug use.

METHOD

Data were collected through an online survey distributed to PSP in three Australian agencies between May and October 2021. A total of 539 PSP completed the survey. The survey included questions about demographic and work-based characteristics, trauma exposure, PTSD and alcohol and other drug use.

RESULTS

Most participants (86.8%) had experienced at least one type of traumatic event at work. Probable PTSD was identified in 39.4% of respondents. Hazardous or harmful alcohol use was reported by 33.1% of participants, while 13.3% reported harmful drug use. Analyses revealed that probable PTSD and higher numbers of workplace traumatic event types were significantly associated with greater odds of hazardous or harmful alcohol use (ORs 1.88 and 1.04, respectively). Identifying as female and meeting criteria for probable PTSD was associated with greater odds of harmful drug use (OR = 1.86) and identifying as male with lower odds of harmful drug use (OR = 0.23).

CONCLUSION

The study highlights the high prevalence of trauma exposure, probable PTSD and hazardous or harmful substance use among Australian PSP. The findings suggest a need for targeted interventions to address the mental health and substance use challenges in this population, particularly those aimed at mitigating the effects of workplace trauma and providing support for PTSD and substance use disorders.

High Prevalence of Posttraumatic Stress Disorder Symptoms Found in Well-Treated People with HIV after the Introduction of Patient-Reported Outcome Measures

People with HIV (PWH) are at greater risk of experiencing mental health problems, such as depression and post-traumatic stress disorder (PTSD). The purpose of our study was to determine the prevalence of posttraumatic stress disorder PTSD in PWH. PWH in care Amsterdam University Medical center (Amsterdam UMC) with access to the electronic patient portal were offered patient-reported outcome measures (PROMs) between May 2022 and May 2023, including the PC-PTSD-5 screen for PTSD as part of routine clinical care. Risk factors for a clinically relevant PC-PTSD-5 score were determined using univariate and multiple logistic regression analyses. Of 2476 PWH included, 1384 (55.9%) had access to the electronic patient portal of whom 474 (34.2%) completed the PC-PTSD-5. PWH without access to the patient portal were more often female, born in low- and middle-income countries, acquired HIV more often via heterosexual contact, and had worse HIV-related outcomes compared to those with access. Of 474 PWH who completed the PC-PTSD-5 screening question, 62 (13.1%) reached the threshold for clinically relevant PTSD. Age less than 50 years (OR 2.29, 95% CI: 1.21-4.35), and having originated from low- or middle-income countries (OR 2.02, 95% CI: 1.09-3.76) were associated with PTSD. Our findings show that 13% of PWH with a well-controlled HIV infection with access to the electronic patient portal at Amsterdam UMC experienced clinically relevant PTSD complaints.

Prevalence of anxiety disorders in Latin America: a systematic review and meta-analysis

Background

The prevalence of anxiety disorders among the adult population in Latin America (LATAM) and its association with development indicators is insufficiently characterised. We estimated pooled regional, country, and sex-specific prevalence rates of anxiety disorders in LATAM based on International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Additionally, we examined the association between its prevalence and four country-level development indicators: Human Development Index (HDI), income inequality (Gini coefficient), Gender Inequality Index (GII), and Intentional Homicide Rate (IHR).

Methods

We conducted a systematic review and meta-analysis of population-based studies on the prevalence of ICD/DSM anxiety disorders in LATAM from 1990 to 2024, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO, LILACS, and grey literature. Study quality was assessed using JBI's critical appraisal tools. Pooled estimates were generated using random-effects meta-analysis, and heterogeneity was evaluated using the I-squared (I 2) statistic. Meta-regression analyses were performed to examine the ecological association between anxiety disorders prevalence and four development indicators. The study was registered with PROSPERO (CRD42020190238).

Findings

Using data from 36 studies in LATAM, we calculated the lifetime, 12-month, and current prevalence of ICD/DSM anxiety disorders at 14.55% (95% Confidence Interval 12.32%-17.11%; I 2 = 97.9%); 6.61% (5.20-8.37; I 2 = 98.1%), and 3.27% (2.34-4.56; I 2 = 97.5%), respectively. Heterogeneity was high across prevalence periods, sexes, and countries (all I 2 ≥ 91.4%), warranting caution in interpreting pooled estimates. Elevated 12-month and current prevalence rates of anxiety disorders were associated with higher Gini coefficients (p ≤ 0.0013). Additionally, higher current prevalence was associated with lower HDI (p = 0.0103) and higher GII (p = 0.0023), while elevated 12-month prevalence was associated with higher IHR (p = 0.011).

Interpretation

This study shows that approximately one in seven people in LATAM experience anxiety disorders at some point in their lives. These findings highlight the need to strengthen mental health systems in the region, and evidence the association between prevalence of anxiety disorders and development indicators. Our results can serve as a baseline for tracking anxiety disorders and for informed decision-making at the national and regional levels. The substantial heterogeneity between studies and the underrepresentation of some countries underscore the imperative for enhancing regional mental health capacities.

Funding

Pfizer Independent Medical Education Grant (69879319).

Antidepressants in the acute treatment of post-traumatic stress disorder in adults: a systematic review and meta-analysis

Currently, there are few pharmacotherapy options for clinicians treating post-traumatic stress disorder (PTSD), and antidepressants are usually the medication of choice. This meta-analysis aimed to review the efficacy of antidepressants in the acute treatment of PTSD in adults while investigating the contribution of study design and placebo response to the findings of these studies. Randomized, double-blind, placebo-controlled clinical trials that compared antidepressants with placebo for acute treatment of PTSD were selected. Standardized mean difference (SMD) in change in Clinician-Administered PTSD Scale scores were pooled after examining for heterogeneity. A random-effects meta-analysis was performed. Twenty-nine antidepressant-placebo comparisons, involving 4575 subjects, were analyzed. The SMD among all studies was 0.25, a small to medium effect size, lower than that in studies of antidepressants in adult major depressive disorder. The SMDs for low and high mean placebo responses, were 0.27 and 0.22, respectively. The overall SMD for paroxetine studies was in the moderate range (0.43) and that for sertraline studies was in the small range (0.12). Our findings suggest that antidepressants have modest efficacy in alleviating PTSD symptoms. Patient-level meta-analyses are required to further explore the potential clinical relevance of sertraline for PTSD.

Trauma-analogue symptom variability predicted by inhibitory control and peritraumatic heart rate

The reasons why some individuals who experience trauma develop post-traumatic stress disorder (PTSD) while others do not remain poorly understood, highlighting the complex interplay of encoding-related and intrapersonal factors. This study aimed to examine factors predicting variability in trauma-related symptom development. Using a trauma film paradigm in a healthy sample (N = 32), we investigated how inhibitory control and peritraumatic responses relate to the development of intrusive memories and self-assessed event impact. Peritraumatic heart rate was associated with more frequent, vivid, and distressing memory intrusions during the week following trauma-analogue exposure. It also predicted hyperarousal and avoidance symptoms, with the latter further linked to lower inhibitory control. In a cognitive-interference task conducted approximately one day after trauma-analogue exposure, negative trauma reminders increased response latencies. This reduced interference control was predicted by both lower inhibitory control and higher peritraumatic heart rate, and it was especially pronounced in individuals who reported a heightened overall event impact. In conclusion, inhibitory control and peritraumatic heart rate emerged as predictors of subsequent reminder interference, intrusions, and self-assessed event impact. These findings provide insights into physiological and behavioural mechanisms underlying variability in the development of trauma-analogue symptoms and related cognitive interference when exposed to trauma reminders in a healthy sample without a trauma history.

Effectiveness of Emotional Freedom Techniques in Alleviating Symptoms Associated with Posttraumatic Stress Disorder: A Systematic Review and Meta-analysis

INTRODUCTION

Energy psychology, particularly emotional freedom techniques (EFT), has gained attention as a non-pharmacological treatment for posttraumatic stress disorder (PTSD). We conducted a meta-analysis to assess the efficacy of EFT in alleviating PTSD symptoms.

METHODS

This meta-analysis follows PRISMA guidelines. We conducted a literature search on PubMed, Embase, Cochrane, Web of Science, Airiti Library, and ClinicalTrials.gov for relevant studies published before December 31, 2024.

RESULTS

The meta-analysis included 13 studies involving 621 patients. Our findings showed that EFT significantly improved PTSD symptoms compared to the baseline (standardized mean difference [SMD]: - 0.901; 95% confidence intervals [CI]: - 1.130- - 0.671; Hedge's g: -0.865) and was more effective than the control group (SMD: - 2.106; 95% CI: - 2.759- - 1.452; Hedge's g: -2.062). Furthermore, anxiety (SMD: - 0.591; 95% CI: - 0.726- - 0.456; Hedge's g: -0.567) and depression (SMD: - 0.516; 95% CI: - 0.654- - 0.377; Hedge's g: -0.495) scores decreased significantly compared to the baseline. Notably, these treatment effects were sustained for up to three months for PTSD severity (SMD: - 0.757; 95% CI: - 0.967- - 0.547; Hedge's g: -0.723), anxiety (SMD: - 0.522; 95% CI: - 0.683- - 0.361; Hedge's g: -0.498), and depression (SMD: - 0.420; 95% CI: - 0.542- - 0.298; Hedge's g: -0.402). The subgroup analysis of veterans revealed that EFT effectively reduced PTSD symptoms (SMD: - 1.159; 95% CI: - 1.441- - 0.877; Hedge's g: -1.102), anxiety (SMD: - 0.715; 95% CI: - 0.943- -0.487; Hedge's g: -0.676), and depression (SMD: - 0.627; 95% CI: - 0.803- - 0.451; Hedge's g: -0.597).

CONCLUSIONS

EFT effectively treated PTSD and reduced comorbid symptoms, including anxiety and depression. Moreover, its therapeutic effect could be applied in veteran populations and sustained for up to three months.

Psychotherapies for adults with complex presentations of PTSD: a clinical guideline and five systematic reviews with meta-analyses

OBJECTIVE

To develop a clinician-guided, research-based guideline for adult outpatient psychotherapy for complex presentations of post-traumatic stress disorder (PTSD).

METHODS

We used state-of-the-art methods to develop clinical guideline recommendations and conduct systematic reviews with meta-analyses for five research questions: (Q1) When treating adults with PTSD, should trauma-focused psychotherapy include exposure? Which psychotherapies are effective for PTSD with co-occurring: (Q2) personality disorder; (Q3) depression; and (Q4) dissociative disorder? (Q5) for complex PTSD (C-PTSD)?

RESULTS

(Q1) We found no evidence of a difference between trauma-focused psychotherapies with or without exposure on PTSD symptoms (standardised mean difference (SMD) 0.02, 95% CI -0.11 to 0.15, p=0.75, I2=64%). (Q2) Dialectical behaviour therapy (DBT-for-PTSD) showed beneficial effects over cognitive processing therapy (CPT) on co-occurring borderline personality disorder (BPD) symptoms (mean difference (MD) -0.58, 95% CI -0.94 to -0.22, p=0.003). (Q3) Mindfulness and body-focused psychotherapies, prolonged exposure (PE), narrative exposure therapy (NET) and CPT showed beneficial effects on symptoms of PTSD and co-occurring depression. Results for present-centred therapy (PCT) were uncertain. (Q4) No statistically significant differences were found among psychotherapies for PTSD with co-occurring dissociation. (Q5) Skills training appeared promising for C-PTSD.

CONCLUSION

Weak clinical recommendations were reached for trauma-focused therapies with or without exposure for PTSD; DBT-for-PTSD for PTSD with co-occurring BPD; CPT, NET, PE and Mindfulness and body-focused psychotherapies for PTSD with co-occurring depression; and Skills training for C-PTSD. A weak recommendation was reached against PCT for PTSD with co-occurring depression. It is good practice to include interventions targeting dissociation for PTSD with co-occurring dissociation. Overall, the certainty of evidence was low; high-quality trials are needed to strengthen the recommendations.

PROSPERO REGISTRATION NUMBER

CRD42022376117.

Trauma Burden Affected People with Multiple Sclerosis During SARS-CoV-2 Pandemic

Background/Objectives: Trauma is a psychological injury resulting from a distressing or overwhelming event. The SARS-CoV-2 pandemic has been disruptive and traumatic for many people with multiple sclerosis (pwMS). The relationship between patient characteristics and trauma in pwMS during the pandemic has not yet been thoroughly explored. The aim of this bicentric prospective cohort study was to analyze the prevalence and development of probable post-traumatic stress disorder (PTSD) among pwMS during the SARS-CoV-2 pandemic and to identify patient parameters associated with this condition. Methods: We have assessed pwMS for probable PTSD before and after the approval of the first SARS-CoV-2 vaccines in Germany using an adapted version of the Trauma Screening Questionnaire (TSQ). We compared pwMS with probable PTSD (TSQ sum score ≥ 6) with those without probable PTSD (TSQ sum score < 6) regarding sociodemographic and MS-specific clinical characteristics, polypharmacy status, comorbidities, anxiety/depression levels, personality traits, mental/physical/social burden, and general vaccination willingness. Results: Out of the 149 pwMS included, 8.1% were identified as having probable PTSD. These patients had significantly higher rates of pre-pandemic abnormal anxiety (66.7% vs. 18.5%, p < 0.001) and depression scores (45.5% vs. 12.6%, p = 0.013). The patients with probable PTSD exhibited a distinct personality profile, with significantly higher neuroticism and harm avoidance scores and lower conscientiousness, cooperativeness, and self-directedness scores. They were also significantly more likely to report severe or very severe mental/physical/social burdens during the pandemic compared to those without probable PTSD (p ≤ 0.045). Conclusions: Medical and social services should be provided to support patients who experienced serious stress or trauma. The development of concepts for education and vaccination procedures should be accompanied by comprehensive and clear communication that recognizes individual risk factors and addresses possible concerns with evidence-based and convincing arguments.

How Fear Memory is Updated: From Reconsolidation to Extinction?

Post-traumatic stress disorder (PTSD) is a psychiatric disorder caused by traumatic past experiences, rooted in the neurocircuits of fear memory formation. Memory processes include encoding, storing, and recalling to forgetting, suggesting the potential to erase fear memories through timely interventions. Conventional strategies such as medications or electroconvulsive therapy often fail to provide permanent relief and come with significant side-effects. This review explores how fear memory may be erased, particularly focusing on the mnemonic phases of reconsolidation and extinction. Reconsolidation strengthens memory, while extinction weakens it. Interfering with memory reconsolidation could diminish the fear response. Alternatively, the extinction of acquired memory could reduce the fear memory response. This review summarizes experimental animal models of PTSD, examines the nature and epidemiology of reconsolidation to extinction, and discusses current behavioral therapy aimed at transforming fear memories to treat PTSD. In sum, understanding how fear memory updates holds significant promise for PTSD treatment.

Causal relationships between hundreds of plasma metabolites and PTSD: a bidirectional mendelian randomization study

BACKGROUND

Recent studies have indicated a connection between plasma metabolites and Post-traumatic stress disorder (PTSD). Nevertheless, the precise causal relationship remains unclear.

METHODS

We performed bidirectional Mendelian Randomization (MR) using two metabolite and two PTSD GWAS datasets to examine causal relationships between PTSD and 1009 plasma metabolites. Forward MR tested metabolite causally effects on PTSD, while reverse MR assessed PTSD causally effects on metabolites. Primary analysis employed the IVW method, supported by four supplementary methods. Four IVW results per direction were meta-analyzed to identify high-credibility metabolites. Venn diagrams intersected results from the four IVW analyses, and this intersection was further compared with meta-analysis findings to generate a second Venn diagram. Sensitivity analyses addressed horizontal pleiotropy for robust results.

RESULTS

After sensitivity analyses, a robust set of 775 metabolites in the forward MR analysis and a set of 566 ones in the reverse process were identified. The meta-analysis of IVW method results (four results between two metabolites GWAS and two PTSD GWAS) revealed that 58 metabolites were significantly associated with the risk of PTSD (P < 0.05) in the forward MR analysis, and 19 metabolites might exhibit significant changes in PTSD (P < 0.05) in the reverse progress. Further Venn diagram intersection analysis among those four IVW results unveiled 4 metabolites with promoting or inhibiting effects on PTSD (P < 0.05) and 1 metabolites with notably increased plasma levels in PTSD (P < 0.05). The subsequent Venn diagram intersection analysis of the meta-analysis outcomes and the initial Venn diagram results identified 3 metabolites. In the forward analysis, 5-hydroxy-2-methylpyridine sulfate (OR = 1.05, P = 0.004) and levulinoylcarnitine (OR = 1.08, P = 0.005) from the Xenobiotics pathway were significantly associated with an increased risk of PTSD. Additionally, cysteinylglycine from the Amino Acid pathway significantly reduced the risk of PTSD (OR = 0.918, 95%CI: 0.868-0.971, P = 0.003). In the reverse analysis, no significant changes in plasma metabolites at the genetic level were found to causally influence the development of PTSD.

CONCLUSIONS

Our findings provide potential biomarkers for predicting and preventing PTSD, as well as possible therapeutic targets for that. However, further research is needed to confirm the clear mechanism.

Psychiatric genetics in the diverse landscape of Latin American populations

Psychiatric disorders are highly heritable and polygenic, influenced by environmental factors and often comorbid. Large-scale genome-wide association studies (GWASs) through consortium efforts have identified genetic risk loci and revealed the underlying biology of psychiatric disorders and traits. However, over 85% of psychiatric GWAS participants are of European ancestry, limiting the applicability of these findings to non-European populations. Latin America and the Caribbean, regions marked by diverse genetic admixture, distinct environments and healthcare disparities, remain critically understudied in psychiatric genomics. This threatens access to precision psychiatry, where diversity is crucial for innovation and equity. This Review evaluates the current state and advancements in psychiatric genomics within Latin America and the Caribbean, discusses the prevalence and burden of psychiatric disorders, explores contributions to psychiatric GWASs from these regions and highlights methods that account for genetic diversity. We also identify existing gaps and challenges and propose recommendations to promote equity in psychiatric genomics.

A behavioral screening method for predicting PTSD-like phenotypes: Novel application to female rats

BACKGROUND

Only a small percentage of trauma-exposed subjects develop PTSD, with females being twice as likely. Most rodent models focus on males and fail to account for inter-individual variability in females.

NEW METHOD

We tested a behavioral PTSD model in female rats to distinguish between susceptible and resilient individuals. In Experiment 1, female rats underwent footshocks paired with social isolation, a PTSD risk factor. They were re-exposed to the conditioned context to test memory retention, and assessed in the Elevated Plus Maze (EPM) and Social Interaction (SI) tests for anxiety and social behavior.

RESULTS

Footshock-exposed rats showed fear memory retention up to 16 days, indicated by elevated freezing behavior during re-exposure. They also exhibited reduced exploration in the EPM and less SI time compared to controls. In Experiment 2, we classified rats into normal responders, susceptible, and resilient groups based on locomotor activity after trauma, correlating with memory retention and anxiety.

COMPARISON WITH EXISTING METHODS

Unlike existing models focused on males and lacking predictive variables before trauma, our method identifies PTSD-like susceptibility and resilience in female rats by using exploratory behavior as a predictor before trauma exposure.

CONCLUSIONS

Exploratory activity in a novel environment after trauma and before extinction is a reliable predictor of PTSD-like phenotypes and differentiates between susceptible and resilient female rats.

Chlorogenic acid improves SPS-induced PTSD-like behaviors in rats by regulating the crosstalk between Nrf2 and NF-κB signaling pathway

Post-traumatic stress disorder (PTSD) is a long-term delayed mental disorder caused by sudden, threatening or catastrophic life events. Chlorogenic acid (CGA) is a polyphenolic acid rich in Eucommia ulmoides and other plants with potential neuroprotective effects, effectively enhances learning and memory, and exerts a beneficial impact on improving mood and attention. However, the effects and mechanisms of CGA on PTSD-like behaviors remain uncertain. This study is to explore the effects and mechanisms of CGA on PTSD by using network pharmacology analysis, molecular docking and experimental validation, and try to provide new strategies for the treatment of PTSD. The results indicated that 9 core targets with a strong binding affinity with CGA were screened out, and they were mainly enriched in apoptosis, inflammation, and oxidative stress. The followed vivo experiments indicated that CGA could alleviate single prolonged stress (SPS)-induced PTSD-like behaviors, and improve hippocampal pathological damage, apoptosis and synaptic plasticity through antioxidant and anti-inflammatory effects by regulating Nrf2 and NF-κB pathways. Thus, CGA may inhibit hippocampal neuronal apoptosis, reduce neuroinflammatory and oxdiative stress response, and enhance hippocampal synaptic plasticity through regulating the crosstalk between Nrf2 and NF-κB signaling pathway, thereby improving SPS-induced PTSD-like behaviors.

Post-traumatic stress and joint hypermobility in children and adolescents of Nepal after exposure to an earthquake

A substantial body of literature has traditionally addressed the connection between the exposure to catastrophic events and the development of Post-Traumatic Stress disorder (PTSD), especially in the vulnerable stratum of children and adolescents. However, little is known about their biological predisposing factors, and further research is needed, especially in the context of the recent earthquakes in Turkey and Syria. The data of this study was collected 4 months after the 2015 earthquakes in Nepal, with the objective of providing new evidence to the field and documenting the role of a new potential predisposing factor: the Joint Hypermobility Syndrome (JHS). 941 subjects from three different regions of the country, aged 8-18 years, were assessed in a school-based cross-sectional investigation. PTSD, as the main response variable, was assessed using the Child PTSD Symptom Scale (CPSS) questionnaire and analysed considering three sub-dimensions: the severity of symptoms, the severity of impairment, and both taken together. JHS was assessed using the Screening Questionnaire to detect Hypermobility (SQ-CH) questionnaire. The severity of symptoms was strongly predicted by the distance to the epicentre. Females showed more severe symptomatology, but a lower perturbation in the daily functioning. Younger children reported a greater functional impairment. JHS group showed more severe PTSD than non-JHS group. We observed variability in the severity of PTSD according to previously known risk factors such as the distance to the epicentre, sex, and age. We also found an association between PTSD and JHS, which is discussed in reference to the neuroconnective endophenotype. It might be useful to consider the role of each variable when planning a mass intervention after a disaster.

Safety and efficacy of methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in post-traumatic stress disorder: An overview of systematic reviews and meta-analyses

OBJECTIVE

To critically evaluate published and unpublished systematic reviews and meta-analyses on the safety and efficacy of methylenedioxymethamphetamine-assisted psychotherapy for post-traumatic stress disorder.

METHODS

Six bibliometric databases and grey literature were searched from inception to 9 May 2024 for systematic reviews on the safety and efficacy of methylenedioxymethamphetamine (MDMA)-assisted psychotherapy compared to psychotherapy alone among adults with post-traumatic stress disorder. Quality assessment using the AMSTAR-2 tool was conducted independently by two investigators.

RESULTS

Fourteen systematic reviews comprising 20 primary studies involving up to 353 participants were included. All reviews included studies of one-to-three sessions of 50-125 mg MDMA-assisted psychotherapy (some with supplemental dosage) compared to either 25-40 mg of MDMA or inactive placebo with psychotherapy. Four were deemed high quality. Meta-analyses reported substantial benefits of MDMA-assisted psychotherapy in improving post-traumatic stress disorder symptoms (standardised mean difference, 0.8-1.3), response rate (relative risk, 1.3-3.5) and remission rate (relative risk, 2.3-2.9) compared to psychotherapy alone. However, for reviews that assessed the certainty of evidence, the evidence was rated as low to very low certainty due to high risk of bias, indirectness and imprecision. There was moderate-quality evidence that MDMA-assisted psychotherapy was associated with an increased odd of transient adverse events. However, reviews noted reliance on spontaneous rather than systematic adverse event reporting, discrepancies between adverse events reported in published studies and clinical trial registries, and a lack of long-term safety data.

CONCLUSION

Four high-quality systematic reviews suggest low to very low certainty evidence for efficacy outcomes and moderate to very low quality evidence for safety outcomes.

Cultural adaptation of a brief psychological intervention for PTSD in severe mental illness: a Botswana context

High rates of trauma exposure among patients with severe mental illness (SMI) in Botswana highlight the need for appropriate interventions. Culturally adapted interventions have been reported to be more acceptable, effective and feasible. This study aimed to culturally adapt the Brief Relaxation, Education and Trauma Healing (BREATHE), a brief psychological intervention to treat post-traumatic stress disorder (PTSD) among people with SMI in Botswana. The cultural adaptation process followed the steps outlined by previous research. They included a community assessment to identify needs, selecting an appropriate intervention and consultations with experts and stakeholders. Individual interviews and focus groups were conducted with patients living with SMI and mental health professionals, respectively, to inform domains of the intervention to be adapted. BREATHE was adapted to be culturally congruent to Botswana by following the ecological validity model framework and using data from the interviews. Examples of the adaptation include language that was translated to Setswana, and spoken English and the content that was revised to reflect the traumatic experiences and demographics of the Botswana population. The study underscores the utility of using evidence-based frameworks to culturally adapt interventions. The adaptation process resulted in a culturally relevant BREATHE for patients with comorbid PTSD and SMI in Botswana.

Serotonergic psychedelics as potential therapeutics for post-COVID-19 syndrome (or Long COVID): A comprehensive review

RATIONALE

In our ongoing battle against the coronavirus 2019 (COVID-19) pandemic, a major challenge is the enduring symptoms that continue after acute infection. Also known as Long COVID, post-COVID-19 syndrome (PCS) often comes with debilitating symptoms like fatigue, disordered sleep, olfactory dysfunction, and cognitive issues ("brain fog"). Currently, there are no approved treatments for PCS. Recent research has uncovered that the severity of PCS is inversely linked to circulating serotonin levels, highlighting the potential of serotonin-modulating therapeutics for PCS. Therefore, we propose that serotonergic psychedelics, acting mainly via the 5-HT2A serotonin receptor, hold promise for treating PCS.

OBJECTIVES

Our review aims to elucidate potential mechanisms by which serotonergic psychedelics may alleviate the symptoms of PCS.

RESULTS

Potential mechanisms through which serotonergic psychedelics may alleviate PCS symptoms are discussed, with emphasis on their effects on inflammation, neuroplasticity, and gastrointestinal function. Additionally, this review explores the potential of serotonergic psychedelics in mitigating endothelial dysfunction, a pivotal aspect of PCS pathophysiology implicated in organ dysfunction. This review also examines the potential role of serotonergic psychedelics in alleviating specific PCS symptoms, which include olfactory dysfunction, cognitive impairment, sleep disturbances, and mental health challenges.

CONCLUSIONS

Emerging evidence suggests that serotonergic psychedelics may alleviate PCS symptoms. However, further high-quality research is needed to thoroughly assess their safety and efficacy in treating patients with PCS.

The age of trauma: the prevalence and psychological impact of potentially traumatic exposures in South Korea

Background

Exposure to potentially traumatic events (PTE) is associated with a range of negative mental health outcomes, including post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD). Although exposure to PTEs is highly prevalent, and their impact on mental health is pervasive, research is mostly limited to diagnosed populations or specific trauma cohorts in the post-pandemic era.

Methods

We conducted an online survey of 1,000 Seoul residents from October 6-12, 2023, using a stratified sampling method. Participants were asked about their traumatic experiences, mental health outcomes, and experiences with mental health services.

Results

Most participants (98.8%) reported that they had experienced at least one PTE. The average number of PTEs reported was 9.19 (SD=7.908). Ninety participants (9%) were categorized as having probable PTSD (2.8% with PTSD only, and 6.2% with cPTSD). The sum of direct and indirect exposures to PTEs of individuals was associated with mental health outcomes, including PTSD symptom severity. Only 34.4% of patients with probable PTSD reported that they had received appropriate mental health services.

Conclusion

Our results suggest that PTE exposures are highly prevalent, and self-awareness of mental health conditions and utilization of mental health services are low in South Korea. Given the lasting effects of traumatic events and the large number of untreated cases, this study highlights the need for proactive responses to traumatic events and better access to short- and long-term services for traumatized individuals.

Time-varying mediation analysis for incomplete data with application to DNA methylation study for PTSD

DNA methylation (DNAm) has been shown to mediate causal effects from traumatic experiences to post-traumatic stress disorder (PTSD). However, the scientific question about whether the mediation effect changes over time remains unclear. In this paper, we develop time-varying structural equation models to identify cytosine-phosphate-guanine (CpG) sites where DNAm mediates the effect of trauma exposure on PTSD, and to capture dynamic changes in mediation effects. The proposed methodology is motivated by the Detroit Neighborhood Health Study (DNHS) with high-dimensional and longitudinal DNAm measurements. To handle the non-monotone missing DNAm in the dataset, we propose a novel Longitudinal Multiple Imputation (LMI) method utilizing dependency among repeated measurements, and employ the generalized method of moments to integrate the multiple imputations. Simulations confirm that the proposed method outperforms existing approaches in various longitudinal settings. In DNHS data analysis, our method identifies several CpG sites where DNAm exhibits dynamic mediation effects. Some of the corresponding genes have been shown to be associated with PTSD in the existing literature, and our findings on their time-varying effects could deepen the understanding of the mediation role of DNAm on the causal path from trauma exposure to PTSD risk.

Brain Fog and Cognitive Dysfunction in Posttraumatic Stress Disorder: An Evidence-Based Review

The term "brain fog" has long been used both colloquially and in research literature in reference to various neurocognitive phenomenon that detract from cognitive efficiency. We define "brain fog" as the subjective experience of cognitive difficulties, in keeping with the most common colloquial and research use of the term. While a recent increase in use of this term has largely been in the context of the post-coronavirus-19 condition known as long COVID, "brain fog" has also been discussed in relation to several other conditions including mental health conditions such as post-traumatic stress disorder (PTSD). PTSD is associated with both subjective cognitive complaints and relative deficits on cognitive testing, but the phenomenology and mechanisms contributing to "brain fog" in this population are poorly understood. PTSD psychopathology across cognitive, affective and physiological symptom domains have been tied to "brain fog". Furthermore, dissociative symptoms common in PTSD also contribute to the experience of "brain fog". Comorbid physical and mental health conditions may also increase the risk of experiencing "brain fog" among individuals with PTSD. Considerations for the assessment of "brain fog" in PTSD as part of psychodiagnostic assessment are discussed. While standard psychological intervention for PTSD is associated with a reduction in subjective cognitive deficits, other cognitive interventions may be valuable when "brain fog" persists following PTSD remission or when "brain fog" interferes with treatment. Limitations of current research on "brain fog" in PTSD include a lack of consistent definition and operationalization of "brain fog" in the literature, as well as limited tools for measurement. Future research should address these limitations, as well as further evaluate the use of cognitive remediation as an intervention for "brain fog".

Post-traumatic stress disorder and its associated factors among internally displaced people due to conflict in Northwest Ethiopia

Background

Post-traumatic stress disorder (PTSD) is a mental health condition that develops after being exposed to trauma, such as experiencing or witnessing life-threatening events, including war and other natural disasters. Despite the high levels of conflict, little attention has been given to post-traumatic stress disorder, particularly in low- and middle-income countries. Therefore, this study aimed to determine the prevalence of post-traumatic stress disorder and its associated factors among internally displaced people in Northwest Ethiopia.

Methods

A cross-sectional study design was employed from June to July 2022 in Northwest Ethiopia among internally displaced people. Simple random sampling was used to recruit 410 study participants. The standard tools used in this study included the Post-Traumatic Stress Disorder Checklist for DSM-5 (PLC-5), Kessler-10, and Oslo Social Support Scale to assess various variables. Binary logistic regression analysis was used to identify factors associated with post-traumatic stress disorder. Statistically significant factors were selected at a 95% confidence interval (CI) with adjusted odds ratio (AOR).

Results

The prevalence of post-traumatic stress disorder among internally displaced people was 54.3%, with a 95% CI (49.5, 59.3). Current substance use [AOR 95% CI: 2.01(1.16, 3.48)]; living arrangements, such as living alone or with non-relatives [AOR = 2.13; 95% CI (1.17, 3.86) and AOR = 2.39; 95% CI: (1.21, 4. 70), respectively]; being violated [AOR = 2.49; 95% CI: (1.26, 4.94)]; and psychological distress [AOR = 3.21; 95% CI: (4.35, 9.34)] were significantly associated with post-traumatic stress disorder.

Conclusion

The prevalence of post-traumatic stress disorder among internally displaced people was high. Therefore, stakeholders should provide immediate interventions that include further assessments using diagnostic criteria. In addition, Eye Movement Desensitization and Reprocessing psychotherapy along with selective serotonin reuptake inhibitors as psycho-pharmacological treatment are recommended. Furthermore, efforts should be made to reduce the identified risk factors to improve outcomes for individuals with post-traumatic stress disorder.