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Reuman L, Thompson-Hollands J. Family accommodation in PTSD: Proposed considerations and distinctions from the established transdiagnostic literature. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:453-464. [PMID: 38390036 PMCID: PMC10881198 DOI: 10.1111/cpsp.12375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
Accommodation is widely documented and studied among internalizing disorders; however, the conceptualization and study of accommodation in the context of posttraumatic stress disorder (PTSD) is relatively nascent. PTSD entails many diagnostic criteria-including exposure to a distinct Criterion A event, emotional numbing, and anger-that may uniquely influence accommodation and merit special consideration. Our aim was to review the impact of accommodation in PTSD, compare and contrast accommodation in PTSD to other disorders with a strong empirical evidence base regarding accommodation, and highlight considerations unique to PTSD and associated implications for accommodation. We conclude by providing considerations for future research and practice.
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Affiliation(s)
- Lillian Reuman
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Johanna Thompson-Hollands
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
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2
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Campbell-Sills L, Kautz JD, Ray C, Lester PB, Choi KW, Naifeh JA, Aliaga PA, Kessler RC, Stein MB, Ursano RJ, Bliese PD. Associations of active-duty mental health trajectories with post-military adjustment: Results from the STARRS Longitudinal Study. J Affect Disord 2023; 340:535-541. [PMID: 37553016 DOI: 10.1016/j.jad.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Many servicemembers experience difficulties transitioning from military to civilian life. We examined whether changes in mental health observed during active duty were associated with indices of post-military adjustment. METHODS Survey data from the multi-wave Army STARRS Pre/Post Deployment Study (PPDS; conducted 2012-2014) were linked to follow-up data from wave 1 of the STARRS Longitudinal Study (STARRS-LS1; conducted 2016-2018). Empirical Bayes estimates of intercepts and slopes of posttraumatic stress, problematic anger, and depressive symptoms during the PPDS were extracted from mixed-effects growth models and evaluated as predictors of life stress among 1080 participants who had separated or retired from the Army at STARRS-LS1; and of job satisfaction among 586 veterans who were employed at STARRS-LS1. RESULTS Higher average levels and larger increases in posttraumatic stress, anger, and depression over the deployment period were each associated with increased stress and (in the case of anger and depression) reduced job satisfaction. Posttraumatic stress and anger slopes were associated with overall stress (b = 5.60, p < 0.01 and b = 15.64, p = 0.04, respectively) and relationship stress (b = 5.50, p = 0.01 and b = 22.86, p = 0.01, respectively) beyond the average levels of those symptoms. LIMITATIONS Some transition-related difficulties may have resolved before outcome assessment; some measures were not previously validated. CONCLUSIONS Larger increases in posttraumatic stress and anger over a deployment period were associated with increased stress after leaving the Army, even after controlling for average symptom levels during the same period. Monitoring changes in mental health during active duty may help identify personnel who need additional support to facilitate the military-to-civilian transition.
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Affiliation(s)
- Laura Campbell-Sills
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Jason D Kautz
- Department of Organizations, Strategy, and International Management, University of Texas at Dallas, Dallas, TX, USA
| | - Caitlin Ray
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Paul B Lester
- Graduate School of Defense Management, Naval Postgraduate School, Monterey, CA, USA
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Paul D Bliese
- Department of Management, Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
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Marini CM, Yorgason JB, Pless Kaiser A, Erickson LD. Marital Quality and Loneliness Among Aging Vietnam-Era Combat Veterans: The Moderating Role of PTSD Symptom Severity. Clin Gerontol 2023:1-15. [PMID: 37888842 DOI: 10.1080/07317115.2023.2274052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES We examined links between marital quality and loneliness among aging veterans and explored whether veterans' PTSD symptom severity moderated these associations. METHODS Data came from 269 Vietnam-Era combat veterans who had a spouse/partner (M age = 60.50). Utilizing two waves of data spanning six years, we estimated multiple regression models that included positive and negative marital quality, PTSD symptom severity, and loneliness in 2010 as predictors of loneliness in 2016. RESULTS Facets of positive (but not negative) marital quality were associated with veterans' loneliness. Companionship - spousal affection and understanding - was associated with lower subsequent loneliness among veterans with low/moderate - but not high - PTSD symptom severity. Conversely, sociability - the degree to which one's marriage promotes socializing with others - was associated with lower subsequent loneliness regardless of PTSD symptom severity. CONCLUSIONS Companionship and sociability were each associated with veterans' subsequent loneliness. Whereas benefits of companionship were attenuated at higher levels of PTSD symptom severity, benefits of sociability were not. CLINICAL IMPLICATIONS For veterans with higher PTSD symptoms, recommending mental health treatment to decrease symptom severity may help them to reap the benefits of close/intimate relationships. However, bolstering veterans' social participation more broadly may provide an additional means of reducing their loneliness.
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Affiliation(s)
- Christina M Marini
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, United States
| | - Jeremy B Yorgason
- School of Family Life, Brigham Young University, Provo, United States
| | - Anica Pless Kaiser
- Department of Psychiatry, National Center for PTSD, New York, United States
- Department of Psychiatry, VA Boston Healthcare System, New York, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine,New York, United States
| | - Lance D Erickson
- Sociology Department, Brigham Young University, Provo, United States
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Kanaan RA, Oliver G, Dharan A, Sendi S, Maier A, Mohebbi M, Ng C, Back SE, Kalivas P, Berk M. A multi-centre, double-blind, 12-week, randomized, placebo-controlled trial of adjunctive N-Acetylcysteine for treatment-resistant PTSD. Psychiatry Res 2023; 327:115398. [PMID: 37540942 DOI: 10.1016/j.psychres.2023.115398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND PTSD may involve oxidative stress, and N-acetylcysteine (NAC) may reduce the impact of oxidative stress in the brain. This study aims to investigate the efficacy of adjuvant NAC in people with treatment-resistant PTSD. METHODS A multicentre, randomised, double-blind, placebo-controlled trial for adults with PTSD unresponsive to first-line treatment. The intervention was either oral NAC 2.7 g/day or placebo for 12 weeks. The primary outcome was change in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks compared with baseline. Secondary outcomes included depression and substance craving. Follow-up measures were obtained at 16 and 64-weeks. RESULTS 133 patients were assessed, with 105 randomised; 81 participants completed the 12-week trial, 79 completed week-16 follow-up, and 21 completed week-64 follow-up. There were no significant differences between those taking NAC and those taking placebo in CAPS-5 scores at week 12, nor in secondary outcomes. Significant between-group differences were observed at week 64 in craving duration (Cohen's d = 1.61) and craving resistance (Cohen's d = 1.03), both in favour of NAC. CONCLUSION This was the first multicentre, double-blind, randomised, placebo-controlled trial of adjunctive NAC for treatment-resistant PTSD. No benefit of NAC was observed in this group beyond that provided by placebo at end of the trial. TRIAL REGISTRATION ACTRN12618001784202, retrospectively registered 31/10/2018, URL: http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376004.
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Affiliation(s)
- Richard A Kanaan
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia.
| | - Gina Oliver
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia; University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Richmond, VIC, Australia
| | - Anita Dharan
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Shahbaz Sendi
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Alice Maier
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Mohammadreza Mohebbi
- School of Medicine, Barwon Health, Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia; Deakin University, Faculty of Health, Biostatistics Unit, Geelong, Australia
| | - Chee Ng
- University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Richmond, VIC, Australia
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Peter Kalivas
- Department of Neuroscience, Medical University of South Carolina, USA; Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Michael Berk
- School of Medicine, Barwon Health, Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Zaks I, Dekel R, Zuckerman YS, Horesh D. Study protocol: A multimethod psychophysiological randomized controlled trial of a couple therapy for post-traumatic stress disorder. Contemp Clin Trials 2023; 132:107280. [PMID: 37419309 DOI: 10.1016/j.cct.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) sequelae often have ripple effects on victims' families and spouses. Yet there has been a lag in the development and study of couple therapy for PTSD. To fill this gap, we present here a protocol for a study examining the efficacy of Cognitive Behavioral Conjoint Therapy (CBCT), a 15- session couple therapy protocol meant to alleviate PTSD and improve relationship satisfaction, in the Israeli context. The study will be a randomized controlled trial examining outcomes and processes of change via self-report questionnaires, qualitative interviews, and physiological measures (e.g., both partners' heart rate variability and electrodermal activity). We will employ a modified remote treatment protocol via video conferencing. The study will examine whether there is a reduction in couples' levels of symptomatic, emotional, and behavioral difficulties following CBCT and whether relationship satisfaction and couples' physiological synchrony increases. The study will also examine physiological and psychological change mechanisms in CBCT. Sixty Israeli couples (n = 120) will be randomly assigned to either a CBCT group or a wait-list control group. Outcomes will be assessed at four timepoints: before treatment, during treatment, post-treatment, and four months after treatment. The proposed study has the potential to shed light on the unique psychological and physiological mechanisms underlying CBCT and will be the first RCT study to employ this unique methodology in CBCT research, particularly in a video conferencing setting. This study may increase our ability to offer effective, cost-efficient, and attainable treatments for patients with PTSD and their spouses.
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Affiliation(s)
- Ilil Zaks
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel.
| | - Rachel Dekel
- Bar-Ilan University School of Social Work, Ramat Gan 590002, Israel.
| | | | - Danny Horesh
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel; Grossman School of Medicine, Department of Psychiatry, New York University, 550 First Avenue, New York, NY 10016, USA.
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Jukić M, Malenica L, Đuričić V, Talapko J, Lukinac J, Jukić M, Škrlec I. Long-Term Consequences of War Captivity in Military Veterans. Healthcare (Basel) 2023; 11:1993. [PMID: 37510434 PMCID: PMC10379024 DOI: 10.3390/healthcare11141993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Numerous studies on the health and functioning of veterans and former prisoners of war have shown that the experience of war captivity is one of the most difficult human experiences. Captivity is often characterized by extremely difficult and inhumane conditions, as well as exposure to various forms of both psychological and physical abuse. Such traumatic experiences can lead to serious psychological consequences that can last for years, even decades after release from captivity. The aim of this paper is to present a brief overview of research that points to the specifics of wartime captivity and the long-term psychological consequences in veterans of former camp detainees, as well as the consequences suffered by their families and factors that, apart from the intensity of the trauma, contribute to the emergence and persistence of psychological disorders. From the presented research, it can be concluded that former prisoners of the camp represent an extremely vulnerable group of the social community and require long-term appropriate treatment, while the needs of veterans' families should not be neglected, with the necessity of including spouses and children in psychological and psychosocial treatments.
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Affiliation(s)
- Melita Jukić
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Luka Malenica
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vanja Đuričić
- Department of Psychiatry, National Memorial Hospital Vukovar, 32000 Vukovar, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jasmina Lukinac
- Faculty of Food Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marko Jukić
- Faculty of Food Technology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Kılıç A, Gürcan MB, Kökrek Z, Tatar Y. Evaluation of the relationship between theory of mind relating to cognitive performance and post-traumatic stress disorder in Syrian refugee amputees living in Turkey. Ir J Med Sci 2023; 192:785-793. [PMID: 36952128 DOI: 10.1007/s11845-023-03349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/19/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND According to the available literature, studies examining the relationship between theory of mind (ToM) and post-traumatic stress disorder (PTSD) have a small sample size and are few in number. AIMS This study aims to investigate the relationship between the potential presence of PTSD in Syrian refugee amputees living in Turkey, ToM skills measured by Reading the Mind in the Eyes Test (RMET), and variables related to amputation. METHOD Our 69 follow-up amputee patients answered a socio-demographic and amputation data form, and the RMET, PTSD checklist for DSM-5 (PCL-5), and Beck Depression Inventory-II (BDI-II) completed a ToM task. RESULTS Those with potential PTSD were significantly less educated than those without (p = .017). Prosthesis usage time (p = .002) and duration of post-amputation (p = .033) were significantly shorter in those with potential PTSD compared to those without. The RMET neutral valence (p = .035) and RMET total (p = .017) accuracy scores were significantly lower in patients with potential PTSD. Those with potential PTSD were higher significantly more depressed (p < .001). In our regression analyses, lower education level (p < .05), shorter prosthesis usage time (p = .008), and lower RMET neutral valence (p = .006) / RMET total (p = .032) accuracy scores predicted the presence of potential PTSD. CONCLUSIONS Lower education level, prosthesis use for a shorter period, and poor mind-reading skills from neutral and total eye expressions were predictive of the potential presence of PTSD in amputees, even though they were largely exposed to similar traumas. Our findings suggest that treatment and follow-up of PTSD should also target deficits in cognitive and emotional abilities.
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Affiliation(s)
- Alperen Kılıç
- Department of Psychiatry, Faculty of Medicine, Istanbul University-Cerrahpasa, Cerrahpaşa, Koca Mustafapaşa Cd. No:51 Fatih, 34098, Istanbul, Turkey.
| | - Mehmet Buğrahan Gürcan
- Department of Psychiatry, Istanbul Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey
| | - Zekeriya Kökrek
- Department of Psychology, Faculty of Humanities and Social Sciences, Istanbul Commerce University, Istanbul, Turkey
| | - Yaşar Tatar
- Department of Sports Health, Faculty of Sports Sciences, Marmara University, Istanbul, Turkey
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Bhalla A, Bamer AM, Temes C, Roaten K, Carrougher GJ, Schneider JC, Stoddard FJ, Stewart B, Gibran NS, Wiechman SA. Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study. J Burn Care Res 2023; 44:27-34. [PMID: 35866527 PMCID: PMC9990905 DOI: 10.1093/jbcr/irac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.
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Affiliation(s)
- Arjun Bhalla
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Christina Temes
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick J. Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Shelley A. Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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9
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Senior E, Clarke A, Wilson-Menzfeld G. The military spouse experience of living alongside their serving/veteran partner with a mental health issue: A systematic review and narrative synthesis. PLoS One 2023; 18:e0285714. [PMID: 37200312 DOI: 10.1371/journal.pone.0285714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/01/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Military healthcare studies have reported a wide range of mental health issues amongst military personnel. Globally, mental health issues are one of the main causes of ill health. Military personnel have a greater prevalence of mental health issues than that of the general population. The impact of mental health issues can be wide and far reaching for family and carers. This systematic narrative review explores the military spouse experience of living alongside their serving or veteran partner with a mental health issue. METHODS The systematic review performed was based on the PRISMA guide for searching, screening, selecting papers for data extraction and evaluation. Studies were identified from CINHAL, ASSIA, Proquest Psychology, Proquest Nursing & Allied Health source, Proquest Dissertations & Theses, ETHOS, PsychArticles, Hospital collection, Medline, Science Direct Freedom Collection and hand searching of citations and reference lists. RESULTS Twenty-seven studies were included in the narrative synthesis. Five overarching themes from the experiences of military spouses' living alongside their serving/veteran partners mental health issue were identified: caregiver burden, intimate relationships, psychological/psychosocial effects on the spouse, mental health service provision and spouse's knowledge and management of symptoms. CONCLUSIONS The systematic review and narrative synthesis identified that the majority of studies focused on spouses of veterans, very few were specific to serving military personnel, but similarities were noted. Findings suggest that care burden and a negative impact on the intimate relationship is evident, therefore highlight a need to support and protect the military spouse and their serving partner. Likewise, there is a need for greater knowledge, access and inclusion of the military spouse, in the care and treatment provision of their serving partner's mental health issue.
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Affiliation(s)
- Emma Senior
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - Amanda Clarke
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - Gemma Wilson-Menzfeld
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
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10
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May CL, Wisco BE, Fox VA, Marx BP, Keane TM. Posttraumatic stress disorder-related anhedonia as a predictor of psychosocial functional impairment among United States veterans. J Trauma Stress 2022; 35:1334-1342. [PMID: 35405033 PMCID: PMC9790620 DOI: 10.1002/jts.22832] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 12/30/2022]
Abstract
Prior research suggests that anhedonia symptoms related to posttraumatic stress disorder (PTSD; i.e., diminished interest, detachment from others, and difficulty experiencing positive emotions) are consistently associated with a higher degree of impairment in psychosocial functioning beyond that associated with other PTSD symptoms. Unfortunately, much of this research has used cross-sectional study designs; relied upon outdated DSM diagnostic criteria; and failed to control for potentially confounding variables, such as the presence of co-occurring depression. This study used data from Waves 2 and 4 (n = 1,649) of the Veterans' After-Discharge Longitudinal Registry (Project VALOR), a longitudinal dataset of U.S. Army and Marine veterans. As measured using the Inventory of Psychosocial Functioning, Wave 4 psychosocial functioning was regressed on seven PTSD symptom factors at Wave 2 (i.e., intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal) and potential Wave 2 confounds. The Anhedonia factor, β = .123, most strongly predicted later psychosocial functional impairment beyond the impact of other PTSD symptom factors, βs = -.076-.046. Clinical implications of these findings are also discussed.
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Affiliation(s)
- Casey L. May
- Department of PsychologyUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Blair E. Wisco
- Department of PsychologyUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Victor A. Fox
- Department of PsychologyUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Brian P. Marx
- National Center for PTSDVA Boston Healthcare SystemBostonMassachusettsUSA,Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Terence M. Keane
- National Center for PTSDVA Boston Healthcare SystemBostonMassachusettsUSA,Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
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11
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Takarangi MKT, Moeck EK, Peters J, Stirling NSJ. Posttraumatic stress disorder symptom severity and functional impairment in the education domain. J Anxiety Disord 2022; 88:102573. [PMID: 35525074 DOI: 10.1016/j.janxdis.2022.102573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/21/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022]
Abstract
To comprehensively understand and treat Posttraumatic Stress Disorder (PTSD), we need to accurately assess how PTSD symptoms affect people's daily functioning (e.g., in work, study, and relationships). However, the predominant use of self-report functional impairment measures-which are not validated against observable behavior-limits our understanding of this issue. To address this gap, we examined the relationship between posttraumatic stress (PTS) symptoms (including symptom clusters) and subjective and objective measures of functional impairment in the education domain. University students completed online self-report measures of educational impairment, PTS symptoms, intelligence and childhood trauma. We accessed participants' average grades at the end of the semester in which they participated. After controlling for IQ and childhood trauma, increased PTS symptoms were associated with both higher subjective educational impairment and lower Grade Point Average; this relationship was strongest for subjective global ratings of educational impairment, compared to educational impairment assessed according to specific examples. Our results suggest conceptual overlap between symptoms and impairment, and point to the benefit of using both objective and subjective modes of assessing impairment.
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Affiliation(s)
| | - Ella K Moeck
- Flinders University, Australia; University of Melbourne, Australia
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12
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K Blais R, K Zalta A, S Livingston W. Interpersonal Trauma and Sexual Function and Satisfaction: The Mediating Role of Negative Affect Among Survivors of Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5517-NP5537. [PMID: 32990170 DOI: 10.1177/0886260520957693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Healthy sexual function among women service members/veterans (SM/Vs) is associated with higher quality of life, lower incidence and severity of mental health diagnoses, higher relationship satisfaction, and less frequent suicidal ideation. Although trauma exposure has been established as a predictor of poor sexual function and satisfaction in women SM/Vs, no study to date has examined whether specific trauma types, such as military sexual trauma (MST), increase risk for sexual issues. Moreover, the possible mechanisms of this association have not been explored. The current study examined whether posttraumatic stress disorder (PTSD) and depression symptom clusters mediated the association of trauma type and sexual function and satisfaction in 426 trauma-exposed women SM/Vs. Two hundred seventy participants (63.4%) identified MST as their index trauma. Path analyses demonstrated that MST was related to poorer sexual function and lower satisfaction relative to the other traumas (χ2[28, N = 426] = 43.3, p = 0.03, CFI = 1.00, TLI = 0.99, and RMSEA = 0.04), and this association was mediated by higher non-somatic depressive symptoms and PTSD symptom clusters of anhedonia and negative alterations in cognition and mood (NACM). Causality cannot be inferred due to the cross-sectional nature of the data. However, our findings suggest that interventions aimed at decreasing sexual issues among female SM/Vs with MST should target depressogenic symptoms, whether the origin is depression or PTSD. Longitudinal research exploring the etiological processes that contribute to sexual dysfunction among those with MST is needed.
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Bharati T. The long shadow of the Kargil War: The effect of early-life stress on education. ECONOMICS AND HUMAN BIOLOGY 2022; 44:101097. [PMID: 34953360 DOI: 10.1016/j.ehb.2021.101097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
The paper examines the long-term impact of the India-Pakistan war of 1999 on the educational attainment of children born to families of soldiers who survived the war. Based on the assumption that military families faced higher levels of psychological stress than civilian families during the war period, the paper uses a difference-in-difference methodology with household fixed effects to show that the education of military children exposed to the war during their formative years suffered significantly. An examination of the consumption expenditure pattern of military and civilian households suggests that the effect was unlikely to be via resource-related channels. The improbability of other direct pathways through which the war could affect these families suggests that the negative effect might have resulted from the psychological stress that the war generated for the affected families.
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Affiliation(s)
- Tushar Bharati
- University of Western Australia Business School, M251, 35 Stirling Highway, Crawley, WA, Australia.
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Thomas JL, Cleveland S, Pietrzak RH, Dunkel Schetter C, Sumner JA. Elucidating posttraumatic stress symptom dimensions and health correlates among postpartum women. J Affect Disord 2021; 294:314-321. [PMID: 34311331 PMCID: PMC9663210 DOI: 10.1016/j.jad.2021.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with interpersonal dysfunction and adverse maternal health during the perinatal period (extending from conception through one year postpartum). However, PTSD is a heterogeneous disorder, and little is known about which aspects of this disorder may be particularly deleterious to the health of new mothers. Such data may inform more personalized approaches to PTSD prevention and treatment among postpartum women. METHODS Using confirmatory factor analysis, we compared three models of PTSD symptom structure-the four-factor dysphoria model, four-factor emotional numbing model, and five-factor dysphoric arousal model-in 1,663 postpartum women from the Community and Child Health Network (CCHN). We examined associations between PTSD symptom dimensions of the best-fitting model with four correlates relevant to maternal health and functioning-parenting stress, partner relationship stress, relationship satisfaction, and contraceptive use. RESULTS Though all models fit well, the five-factor dysphoric arousal model provided optimal fit. Symptom dimensions from this model-re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal-evidenced differential associations with the maternal health indicators. Numbing symptoms were most strongly associated with indicators of poor interpersonal functioning, whereas dysphoric arousal symptoms were most strongly related to low-efficacy contraceptive use. LIMITATIONS Our cross-sectional study assessed DSM-IV PTSD symptoms. CONCLUSIONS PTSD symptoms among postpartum women are best-represented by five factors. Numbing symptoms (e.g., restricted affect, detachment) are most strongly associated with interpersonal difficulties, whereas dysphoric arousal symptoms (e.g., agitation, irritability) are linked with low-efficacy contraceptive use. Screening for these symptoms may help promote the health of new mothers.
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Affiliation(s)
- Jordan L. Thomas
- Department of Psychology, University of California, Los Angeles, CA,Corresponding author: Jordan L. Thomas, MA, Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, 2244B Franz Hall, Los Angeles, CA 90095-1563; ; Tel.: 319-230-9256; Fax: 310-206-5895
| | - Shiloh Cleveland
- Department of Psychology, University of California, Los Angeles, CA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT,Department of Veteran Affairs, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT
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15
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Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
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Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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16
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Sun LN, Gu JW, Huang LJ, Shang ZL, Zhou YG, Wu LL, Jia YP, Liu NQ, Liu WZ. Military-related posttraumatic stress disorder and mindfulness meditation: A systematic review and meta-analysis. Chin J Traumatol 2021; 24:221-230. [PMID: 34099359 PMCID: PMC8344114 DOI: 10.1016/j.cjtee.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posttraumatic stress disorder (PTSD) is a significant global mental health concern, especially in the military. This study aims to estimate the efficacy of mindfulness meditation in the treatment of military-related PTSD, by synthesizing evidences from randomized controlled trials. METHODS Five electronic databases (Pubmed, EBSCO Medline, Embase, PsychINFO and Cochrane Library) were searched for randomized controlled trials focusing on the treatment effect of mindfulness meditation on military-related PTSD. The selection of eligible studies was based on identical inclusion and exclusion criteria. Information about study characteristics, participant characteristics, intervention details, PTSD outcomes, as well as potential adverse effects was extracted from the included studies. Risk of bias of all the included studies was critically assessed using the Cochrane Collaboration's tool. R Statistical software was performed for data analysis. RESULTS A total of 1902 records were initially identified and screened. After duplicates removal and title & abstract review, finally, 19 articles in English language with 1326 participants were included through strict inclusion and exclusion criteria. The results revealed that mindfulness meditation had a significantly larger effect on alleviating military-related PTSD symptoms compared with control conditions, such as treatment as usual, present-centered group therapy and PTSD health education (standardized mean difference (SMD) = -0.33; 95% CI [-0.45, -0.21]; p < 0.0001). Mindfulness interventions with different control conditions (active or non-active control, SMD = -0.33, 95% CI [-0.46, -0.19]; SMD = -0.49, 95% CI [-0.88, -0.10], respectively), formats of delivery (group-based or individual-based, SMD = -0.30, 95% CI [-0.42, -0.17], SMD = -0.49, 95% CI [-0.90, -0.08], respectively) and intervention durations (short-term or standard duration, SMD = -0.27, 95% CI [-0.46, -0.08], SMD = -0.40, 95% CI [-0.58, -0.21], respectively) were equally effective in improving military-related PTSD symptoms. CONCLUSION Findings from this meta-analysis consolidate the efficacy and feasibility of mindfulness meditation in the treatment of military-related PTSD. Further evidence with higher quality and more rigorous design is needed in the future.
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Affiliation(s)
- Lu-Na Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Jing-Wen Gu
- The Battalion 3 of Cadet Brigade, School of Basic Medicine, Naval Medical University, Shanghai, 200433, China
| | - Li-Jun Huang
- Department of Radiology, Changshu Hospital Affiliated to Suzhou University, Changshu, 215500, Jiangsu Province, China
| | - Zhi-Lei Shang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Yao-Guang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Li-Li Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Yan-Pu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Nian-Qi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Wei-Zhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Department of Radiology, Changshu Hospital Affiliated to Suzhou University, Changshu, 215500, Jiangsu Province, China,Corresponding author. Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
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17
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Development of a Brief Adjunctive Intervention for Family Members of Veterans in Individual PTSD Treatment. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:193-209. [DOI: 10.1016/j.cbpra.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Walter KH, LeardMann CA, Carballo CE, McMaster HS, Donoho CJ, Stander VA. Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New-Onset Depression Among Military Spouses. J Trauma Stress 2021; 34:229-240. [PMID: 32885510 PMCID: PMC7984456 DOI: 10.1002/jts.22575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/08/2022]
Abstract
Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member-spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new-onset depression among military spouses. Over the 3-year study period, 14.4% of these military spouses met the criteria for new-onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new-onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new-onset depression in military spouses, which has implications for treatment provision.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCA
| | - Cynthia A. LeardMann
- LeidosRestonVA,Deployment Health DepartmentNaval Health Research CenterSan DiegoCA
| | - Carlos E. Carballo
- LeidosRestonVA,Deployment Health DepartmentNaval Health Research CenterSan DiegoCA
| | - Hope Seib McMaster
- LeidosRestonVA,Deployment Health DepartmentNaval Health Research CenterSan DiegoCA
| | - Carrie J. Donoho
- Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMaryland
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19
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Reizer A, Koslowsky M, Geffen L. Living in fear: The relationship between fear of COVID-19, distress, health, and marital satisfaction among Israeli women. Health Care Women Int 2020; 41:1273-1293. [DOI: 10.1080/07399332.2020.1829626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Abira Reizer
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Meni Koslowsky
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Lilach Geffen
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
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20
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Maier A, Dharan A, Oliver G, Berk M, Redston S, Back SE, Kalivas P, Ng C, Kanaan RA. A multi-centre, double-blind, 12-week, randomized, placebo-controlled trial to assess the efficacy of adjunctive N-Acetylcysteine for treatment-resistant PTSD: a study protocol. BMC Psychiatry 2020; 20:397. [PMID: 32762663 PMCID: PMC7409699 DOI: 10.1186/s12888-020-02793-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most patients with Posttraumatic Stress Disorder (PTSD) suffer residual symptoms following first-line treatment. Oxidative stress has been implicated in the pathophysiology of PTSD. N-acetylcysteine (NAC) is a precursor of the brain's primary antioxidant, glutathione, and may diminish oxidative cellular damage. An 8-week pilot study of NAC in veterans with PTSD found that symptoms were significantly reduced in the NAC group compared to placebo. This study aims to confirm these findings with a larger sample in a double-blind, placebo-controlled trial to further explore the efficacy of NAC as an adjunctive therapy in treatment-resistant PTSD. METHODS A multicentre, randomised, double-blind, placebo-controlled trial for adult patients who still meet criteria for PTSD following first-line treatment. The intervention comprises either NAC as a fixed dose regime of 2.7 g/day (900 mg three times daily) administered orally for 12 weeks, or placebo. Standard care for PTSD will continue in addition, including other pharmacotherapies. Detailed clinical data will be collected at randomisation and weeks 4, 8, 12, 16, and 64 post-randomisation, with self-report measures completed weekly from baseline to 16 weeks and at 64 weeks post-randomisation. Blood-based biomarkers will be collected at baseline and 12 weeks to assess the mechanism of effect. The primary outcome measure will be change in Clinician-Administered PTSD Scale for DSM-5 at 12 weeks compared with baseline. Secondary outcomes will be change in quality of life, depression, anxiety, substance use and craving, and somatic symptoms. With 126 completed participants (63 per arm), the study is powered at 80% to detect a true difference in the primary outcome measure using a two-tailed analysis with alpha = 0.05, beta = 0.2. DISCUSSION This is the first multicentre, double blind, randomised, placebo-controlled trial of adjunctive NAC for treatment-resistant PTSD. NAC has an established safety profile, is readily available and easy to administer, and has a favourable tolerability profile, therefore making it an attractive adjunctive therapy. Inclusion of blood analyses to assess potential target engagement biomarkers of oxidative stress and neuroinflammation may help gauge the biological mechanisms of effect of NAC. TRIAL REGISTRATION ACTRN12618001784202, retrospectively registered 31/10/2018, URL: http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376004 .
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Affiliation(s)
- Alice Maier
- grid.1008.90000 0001 2179 088XDepartment of Psychiatry, Austin Health, University of Melbourne, LTB10, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Anita Dharan
- grid.1008.90000 0001 2179 088XDepartment of Psychiatry, Austin Health, University of Melbourne, LTB10, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Gina Oliver
- grid.1008.90000 0001 2179 088XDepartment of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, VIC Australia
| | - Michael Berk
- IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, Australia ,grid.1008.90000 0001 2179 088XOrygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Suzy Redston
- grid.410678.cAustin Health, Heidelberg, VIC Australia
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; Ralph H. Johnson VA Medical Center, Charleston, SC USA
| | - Peter Kalivas
- grid.259828.c0000 0001 2189 3475Department of Neuroscience, Medical University of South Carolina, Charleston, USA ,grid.280644.c0000 0000 8950 3536Ralph H Johnson VA Medical Center, Charleston, SC USA
| | - Chee Ng
- grid.1008.90000 0001 2179 088XDepartment of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, VIC Australia
| | - Richard A. Kanaan
- grid.1008.90000 0001 2179 088XDepartment of Psychiatry, Austin Health, University of Melbourne, LTB10, 145 Studley Road, Heidelberg, VIC 3084 Australia ,grid.410678.cAustin Health, Heidelberg, VIC Australia
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21
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Graham B, Garcia NM, Bergman HE, Feeny NC, Zoellner LA. Prolonged Exposure and Sertraline Treatments for Posttraumatic Stress Disorder Also Improve Multiple Indicators of Social Functioning. J Trauma Stress 2020; 33:488-499. [PMID: 32662191 PMCID: PMC7719061 DOI: 10.1002/jts.22570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/23/2020] [Accepted: 04/29/2020] [Indexed: 11/07/2022]
Abstract
Trauma survivors with posttraumatic stress disorder (PTSD) frequently also suffer from difficulties in social functioning that range across emotional, cognitive, and environmental domains. A detailed evaluation of the differential impacts of effective PTSD treatments on social functioning is needed. Men and women (N = 200) with chronic PTSD received 10 weeks of prolonged exposure (PE) or sertraline in a randomized clinical trial and were followed for 24 months. A secondary data analysis examined changes in social functioning with regard to fear of intimacy; receipt of social support; and distress, avoidance, and negative cognitions in social situations. Effects were examined between treatments over time, controlling for baseline functioning. There were large, durable improvements across all indices. Compared to sertraline, PE was more efficient at reducing fear of intimacy and distress from negative social cognitions by posttreatment, ds = 0.94-1.14. Patients who received sertraline continued to improve over the course of follow-up, ds = 0.54-1.17. The differential speed of therapeutic effects may argue for more direct mechanisms in cognitive behavioral interventions versus cascade effects in serotonin reuptake inhibitors. Notably, both treatments produced substantial social benefits for trauma survivors with social functioning difficulties, and effect sizes were comparable to typical reductions in PTSD, depression, and anxiety.
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Affiliation(s)
- Belinda Graham
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Natalia M. Garcia
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Hannah E. Bergman
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Norah C. Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lori A. Zoellner
- Department of Psychology, University of Washington, Seattle, Washington, USA
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22
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Sparrow K, Dickson H, Kwan J, Howard L, Fear N, MacManus D. Prevalence of Self-Reported Intimate Partner Violence Victimization Among Military Personnel: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2020; 21:586-609. [PMID: 29911508 DOI: 10.1177/1524838018782206] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Research on intimate partner violence (IPV) in the military has tended to focus on military personnel as perpetrators and civilian partners/spouses as victims. However, studies have found high levels of IPV victimization among military personnel. This article systematically reviews studies of the prevalence of self-reported IPV victimization among military populations. METHODS Searches of four electronic databases (Embase, Medline, PsycINFO, and Web of Science) were supplemented by reference list screening. Meta-analyses of the available data were performed, where possible, using the random effects model. RESULTS This review included 28 studies with a combined sample of 69,808 military participants. Overall, similar or higher prevalence rates of physical IPV victimization were found among males compared to females and this was supported by a meta-analytic subgroup analysis: pooled prevalence of 21% (95% confidence interval [CI] = [17.4, 24.6]) among males and 13.6% among females (95% CI [9.5, 17.7]). Psychological IPV was the most prevalent type of abuse, in keeping with findings from the general population. There were no studies on sexual IPV victimization among male personnel. Evidence for the impact of military factors, such as deployment or rank, on IPV victimization was conflicting. DISCUSSION Prevalence rates varied widely, influenced by methodological variation among studies. The review highlighted the lack of research into male IPV victimization in the military and the relative absence of research into impact of IPV. It is recommended that future research disaggregates results by gender and considers the impact of IPV, in order that gender differences can be uncovered.
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Affiliation(s)
- Katherine Sparrow
- Forensic and Neurodevelopmental Sciences Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Hannah Dickson
- Forensic and Neurodevelopmental Sciences Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Jamie Kwan
- Department of Psychological Medicine, Weston Education Centre, London, United Kingdom
| | - Louise Howard
- David Goldberg Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Nicola Fear
- Department of Military Mental Health, Psychological Medicine, Weston Education Centre, King's College London, London, United Kingdom
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Sciences Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Richardson JD, Ketcheson F, King L, Forchuk CA, Hunt R, St Cyr K, Nazarov A, Shnaider P, McIntyre-Smith A, Elhai JD. Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment. Mil Med 2020; 185:68-74. [PMID: 31268528 DOI: 10.1093/milmed/usz163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/07/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. MATERIALS AND METHODS Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction. RESULTS Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse. CONCLUSIONS Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.
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Affiliation(s)
- J Don Richardson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Felicia Ketcheson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Lisa King
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Callista A Forchuk
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada
| | - Renée Hunt
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Kate St Cyr
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St. Rm 500, Toronto, ON, M5T 3M7, Canada
| | - Anthony Nazarov
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Philippe Shnaider
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | | | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, 2801 Bancroft St, Toledo, OH, 43606
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Lahav Y, Price N, Crompton L, Laufer A, Solomon Z. Sexual Satisfaction in Spouses of Ex-POWs: The Role of PTSD Symptoms and Self-Differentiation. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:755-766. [PMID: 30924723 DOI: 10.1080/0092623x.2019.1594478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Spouses of former prisoners-of-war (ex-POWs) are at risk for posttraumatic stress symptoms (PTSS) and marital distress. This study assessed the implications of PTSS and self-differentiation for sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses from the 1973 Yom Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.
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Affiliation(s)
- Yael Lahav
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| | - Naomi Price
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
| | - Laura Crompton
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| | - Avital Laufer
- School of Behavioral Sciences, Netanya Academic College , Netanya, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
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Elman I, Borsook D. The failing cascade: Comorbid post traumatic stress- and opioid use disorders. Neurosci Biobehav Rev 2019; 103:374-383. [DOI: 10.1016/j.neubiorev.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/03/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
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Kugler J, Andresen FJ, Bean RC, Blais RK. Couple‐based interventions for PTSD among military veterans: An empirical review. J Clin Psychol 2019; 75:1737-1755. [DOI: 10.1002/jclp.22822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jordan Kugler
- Department of PsychologyUtah State University Logan Utah
| | | | - Ron C. Bean
- Department of PsychologyUtah State University Logan Utah
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Leifker FR, Marshall AD. The impact of negative attributions on the link between observed partner social support and posttraumatic stress disorder symptom severity. J Anxiety Disord 2019; 65:19-25. [PMID: 31125840 DOI: 10.1016/j.janxdis.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 04/19/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
Lack of perceived social support is one of the strongest correlates of the development and maintenance of posttraumatic stress disorder (PTSD). However, little is known about observed social support and PTSD. The stress buffering effect of social support may be partly determined by the subjective experience of support, which is created by attributions regarding support behaviors. We examined negative attributions about partner-provided support as a moderator of the expected relation between observed support during couple discussions and PTSD symptom severity. Participants included 128 individuals from 64 heterosexual married or cohabitating couples. Per clinician-administered interview, 72 (56%) participants met subthreshold or diagnostic criteria for PTSD. Receipt of relatively more partner support was modestly associated with lower PTSD symptom severity. Negative causal attributions about partner support were not associated with the amount of support received, but were associated with higher PTSD severity. Additionally, the frequency and quality of received partner support was associated with lower PTSD symptom severity only among those who did not make strong negative causal attributions about partner support. Thus, negative causal attributions may dampen the positive effects of social support on PTSD symptoms. PTSD treatments may more effectively facilitate recovery from trauma by decreasing negative support attributions.
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Affiliation(s)
- Feea R Leifker
- Department of Psychology, The Pennsylvania State University, 140 Moore Building, State College, PA 16802, United States
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, 140 Moore Building, State College, PA 16802, United States.
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Avery ML, McDevitt-Murphy ME, Zakarian RJ. Using Latent Variable Mixture Modeling to Understand Trauma-Related Outcomes in Undergraduate Women. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:673-687. [PMID: 31027470 DOI: 10.1080/0092623x.2019.1610120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) and sexual functioning problems often co-occur after trauma. Researchers have linked certain factors (e.g., depression, relationship satisfaction) to PTSD and sexual functioning, but it is unclear how these variables interact. Adult undergraduate female trauma survivors (N = 280) completed self-report measures via an online survey. Latent variable mixture modeling generated four groups that differed in terms of their PTSD symptom severity, sexual functioning, sexual pain, relationship status, and relationship functioning. ANOVAs explored group differences. Classes were not differentiated by trauma, relationship satisfaction, or drug use. Results highlight the complex relations between sexual functioning and post-trauma symptomology.
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Affiliation(s)
- Megan L Avery
- Department of Psychology, University of Memphis , Memphis , TN , USA
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Toomey R, Alpern R, Reda DJ, Baker DG, Vasterling JJ, Blanchard M, Eisen SA. Mental health in spouses of U.S. Gulf War veterans. Psychiatry Res 2019; 275:287-295. [PMID: 30953873 DOI: 10.1016/j.psychres.2019.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
Veterans' spouses are at risk for mental distress and substance use. We examined long term psychological functioning in spouses from a national cohort of 1991 Gulf War era veterans. From clinical interviews, spouses of deployed veterans (n = 488) did not have a greater prevalence of post-war mental disorders compared to spouses of non-deployed veterans (n = 536); however, in couples that were living together since the war, there was an increased risk of anxiety disorders or any one disorder. On questionnaires, the impact varied but was most consistently observed in more severe depression and greater functional impairment in spouses of deployed compared to non-deployed veterans. If a veteran developed post-war anxious/depressive disorders or any one mental disorder, the matched spouse was more likely to develop post-war anxious/depressive disorders or any one mental disorder, respectively. Veteran combat exposure did not similarly increase the risk of spouse post-war mental disorders. Greater spouse self-reported symptomatology was observed in spouses of veterans with anxious/depressive disorders even when controlling for deployment. In summary, the war conferred greater risk for spouse mental disorders and distress for spouses of veterans with mental health disorders, with some increased risk for spouses of deployed veterans, especially in couples together since the war.
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Affiliation(s)
- Rosemary Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - Renee Alpern
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Domenic J Reda
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jennifer J Vasterling
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Seth A Eisen
- School of Medicine, Washington University, St. Louis, MO, USA
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Letica-Crepulja M, Stevanović A, Protuđer M, Popović B, Salopek-Žiha D, Vondraček S. Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Clin Med 2019; 8:jcm8040432. [PMID: 30934864 PMCID: PMC6518171 DOI: 10.3390/jcm8040432] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 01/02/2023] Open
Abstract
Background: The problems in sexual functioning among patients with post-traumatic stress disorder (PTSD) are often overlooked, although scientific research confirms high rates of sexual dysfunctions (SD) particularly among veterans with PTSD. The main objective of this study was to systematically identify predictors of SD among veterans with PTSD. Methods: Three hundred veterans with PTSD were included in the cross-sectional study. The subjects were assessed by the Mini-International Neuropsychiatric Interview (MINI) and self-report questionnaires: PCL-5, i.e., PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with Criterion A, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), and Relationship Assessment Scale (RAS). Several hierarchical multiple regressions were performed to test for the best prediction models for outcome variables of different types of SD. Results: 65% of participants received a provisional diagnosis of SD. All tested prediction models showed a good model fit. The significant individual predictors were cluster D (Trauma-Related Negative Alterations in Cognition and Mood) symptoms (for all types of SD) and in a relationship status/relationship satisfaction (all, except for premature ejaculation (PE)). Conclusions: The most salient implication of this study is the importance of sexual health assessment in veterans with PTSD. Therapeutic interventions should be focused on D symptoms and intended to improve relationship functioning with the aim to lessen the rates of SD. Psychotropic treatment with fewer adverse sexual effects is of utmost importance if pharmacotherapy is applied. Appropriate prevention, screening, and treatment of medical conditions could improve sexual functioning in veterans with PTSD.
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Affiliation(s)
- Marina Letica-Crepulja
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia.
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia.
| | - Aleksandra Stevanović
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia.
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia.
- Department of Basic Medical Sciences, Faculty of Health Studies, University of rijeka, 51000 Rijeka, Croatia.
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Koek RJ, Luong TN. Theranostic pharmacology in PTSD: Neurobiology and timing. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:245-263. [PMID: 30529001 DOI: 10.1016/j.pnpbp.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
Recent reviews and treatment guidelines regard trauma-focused cognitive-behavior therapies as the treatments of choice for chronic post-traumatic stress disorder (PTSD). However, many patients do not engage in this treatment when it is available, drop out before completion, or do not respond. Medications remain widely used, alone and in conjunction with psychotherapy, although the limitations of traditional monoamine-based pharmacotherapy are increasingly recognized. This article will review recent developments in psychopharmacology for PTSD, with a focus on current clinical data that apply putative neurobiologic mechanisms to medication use-i.e., a theranostic approach. A theranostic approach however, also requires consideration of timing, pre, peri or post trauma in conjunction with underlying dynamic processes affecting synaptic plasticity, the HPA axis, hippocampal activation, PFC-amygdala circuitry and fear memory.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.
| | - Tinh N Luong
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Olive View Medical Center, Sylmar, CA, USA
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Tanichi M, Nagamine M, Shigemura J, Yamamoto T, Sawamura T, Takahashi Y, Obara A, Saito T, Toda H, Yoshino A, Shimizu K. General psychological distress among Japan Self-Defense Forces personnel dispatched on United Nations peacekeeping operations and their spouses. Psychiatry Clin Neurosci 2019; 73:77-83. [PMID: 30506835 PMCID: PMC6849727 DOI: 10.1111/pcn.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/10/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM The importance of family care during international deployment is emphasized within military organizations, but mental health interactions between deployed personnel and their spouses have not yet been assessed. This study addressed this gap by examining couples' mental health throughout a deployment period. METHODS The mental health of 324 spousal dyads of Japan Self-Defense Forces personnel dispatched for a half-year United Nations Disengagement Observer Force mission was examined, using longitudinal data derived from a survey at four time points: one-month pre-deployment, initial deployment, middle deployment, and immediately after homecoming. The 30-item General Health Questionnaire was used to evaluate general psychological distress, with high scores (≥7) indicating adverse mental health. RESULTS The spouses' general psychological distress was significantly higher compared with the deployed personnel (P < 0.001). The high general psychological distress of personnel was significantly related to that of their spouses (odds ratio = 2.24; 95% confidence interval, 1.32-3.80), and vice versa (odds ratio = 2.38; 95% confidence interval 1.39-4.08). CONCLUSION Mental health care will be beneficial for not only deployed personnel but also their spouses.
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Affiliation(s)
- Masaaki Tanichi
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Masanori Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Jun Shigemura
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Taisuke Yamamoto
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Takehito Sawamura
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Yoshitomo Takahashi
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Asuka Obara
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Taku Saito
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hiroyuki Toda
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Aihide Yoshino
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Kunio Shimizu
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
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Stadtmann MP, Maercker A, Binder J, Schnepp W. Mastering life together - symptom management, views, and experiences of relatives of persons with CPTSD: a grounded theory study. J Patient Rep Outcomes 2018. [PMCID: PMC6195499 DOI: 10.1186/s41687-018-0070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Complex posttraumatic stress disorder is described as a chronic condition with several severe and concurrent symptoms. Symptoms influence and impair not only the affected individuals but also their social surroundings and their relatives. The literature describes relatives as a key factor in managing symptoms, both as a barrier and a facilitator. Aim This research aimed to explore and to reconstruct the views, perceptions, experiences, facilitations and barriers of relatives who support the symptom management of persons with CPTSD in everyday life. Methods A theoretical sampling was used to recruit for an interview 18- to 65-year-old relatives of patients with diagnosed CPTSD. The 17 semi-structured interviews were audio-recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on that of Corbin and Strauss was used to analyse the data. Results We provide a process model with 5 interacting phases: the initial situation, state of permanence, being an anchor, recognizing limits, and potential outcomes. Each phase is further divided into subcategories. Discussion Participants experienced their condition as unpredictable. Although they mastered different strategies through own exploration and in cooperation, there is a clear need for more education, advice and support for relatives caring for those affected by CPTSD. Health care services should consider providing family support, educational services and increase the involvement of relatives in treatment. Over all, well-supported relatives can play a facilitative, key role in improving symptom management. Trial registration Ethical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268.
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Nessaibia I, Fouache A, Lobaccaro JMA, Tahraoui A, Trousson A, Souidi M. Stress as an immunomodulator: liver X receptors maybe the answer. Inflammopharmacology 2018; 27:15-25. [PMID: 30467620 DOI: 10.1007/s10787-018-0546-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/03/2018] [Indexed: 02/07/2023]
Abstract
Stress is a reflex response, both psychological and physiological, of the body to a difficult situation that requires adaptation. Stress is at the intersection of the objective event and the subjective event. The physiological mechanisms involved in chronic stress are numerous and can contribute to a wide variety of disorders, in all systems including the immune system. Stress modifies the Th1/Th2 balance via the HPA axis and a set of immune mediators. This will make the body more vulnerable to external infections in a scientific way while others claim the opposite, stress could be considered immune stimulatory. The development of synthetic LXR ligands such as T0901317 and GW3965 as well as an understanding of the direct involvement of these receptors in the regulation of proopiomelanocortin (POMC) gene expression and indirectly by producing a variety of cytokines in a stressor response, will open in the near future new therapeutic methods against the undesirable effects of stress on the behavior of the immune system.
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Affiliation(s)
- Issam Nessaibia
- CNRS UMR 6293, Laboratory GReD, INSERM U 1103, Clermont Auvergne University, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.
- Laboratory of Applied Neuro-Endocrinology, Department of Biology, Badji-Mokhtar University, Annaba, Algeria.
| | - Allan Fouache
- CNRS UMR 6293, Laboratory GReD, INSERM U 1103, Clermont Auvergne University, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Jean-Marc A Lobaccaro
- CNRS UMR 6293, Laboratory GReD, INSERM U 1103, Clermont Auvergne University, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Abdelkrim Tahraoui
- Laboratory of Applied Neuro-Endocrinology, Department of Biology, Badji-Mokhtar University, Annaba, Algeria
| | - Amalia Trousson
- CNRS UMR 6293, Laboratory GReD, INSERM U 1103, Clermont Auvergne University, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Maâmar Souidi
- Institut de radioprotection et de sûreté nucléaire, Direction de la radioprotection de l'homme, IRSN, Fontenay-aux-Roses Cedex, France
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Posttraumatic stress disorder and relationship functioning: A comprehensive review and organizational framework. Clin Psychol Rev 2018; 65:152-162. [PMID: 30205286 DOI: 10.1016/j.cpr.2018.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 01/02/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. Beyond the abundance of research that has demonstrated this basic link, more recent research has begun to explore possible mediators and moderators of this association. The present paper reviews and synthesizes existing literature in the context of an overarching organizational framework of potential ways in which PTSD impacts relationship functioning. The framework organizes findings in terms of specific elements of PTSD and comorbid conditions, mediators (factors that are posited to explain or account for the association), and moderators (factors that are posited to alter the strength of the association). Specific symptoms of PTSD, comorbid symptoms, and many of the potential mediators explored have extensive overlap, raising questions of possible tautology and redundancy in findings. Some findings suggest that non-specific symptoms, such as depression or anger, account for more variance in relationship impairments than trauma-specific symptoms, such as re-experiencing. Moderators, which are characterized as individual, relational, or environmental in nature, have been the subject of far less research in comparison to other factors. Recommendations for future research and clinical implications of the findings reviewed are also presented.
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Bachem R, Levin Y, Zhou X, Zerach G, Solomon Z. The Role of Parental Posttraumatic Stress, Marital Adjustment, and Dyadic Self-Disclosure in Intergenerational Transmission of Trauma: A Family System Approach. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:543-555. [PMID: 28869760 DOI: 10.1111/jmft.12266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans' wives and offspring (secondary traumatic stress; STS). However, the interplay between family members' characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers' PTSS, mothers' STS, marital adjustment, and self-disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent-child transmission. Combat veterans and former prisoners of war (N = 123), their spouses, and adult offspring were investigated in a multiple-step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers' PTSS to offspring.
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Affiliation(s)
- Rahel Bachem
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
| | - Yafit Levin
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
| | - Xiao Zhou
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
| | | | - Zahava Solomon
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
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The association between PTSD and facial affect recognition. Psychiatry Res 2018; 265:298-302. [PMID: 29778050 DOI: 10.1016/j.psychres.2018.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/11/2018] [Accepted: 04/28/2018] [Indexed: 11/23/2022]
Abstract
The major aims of this study were to examine how, if at all, having higher levels of PTSD would be associated with performance on a facial affect recognition task in which facial expressions of emotion are superimposed on emotionally valenced, non-face images. College students with trauma histories (N = 90) completed a facial affect recognition task as well as measures of exposure to traumatic events, and PTSD symptoms. When the face and context matched, participants with higher levels of PTSD were significantly more accurate. When the face and context were mismatched, participants with lower levels of PTSD were more accurate than were those with higher levels of PTSD. These findings suggest that PTSD is associated with how people process affective information. Furthermore, these results suggest that the enhanced attention of people with higher levels of PTSD to affective information can be either beneficial or detrimental to their ability to accurately identify facial expressions of emotion. Limitations, future directions and clinical implications are discussed.
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Ross J, Murphy D, Armour C. A network analysis of DSM-5 posttraumatic stress disorder and functional impairment in UK treatment-seeking veterans. J Anxiety Disord 2018; 57:7-15. [PMID: 29886306 DOI: 10.1016/j.janxdis.2018.05.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/10/2018] [Accepted: 05/26/2018] [Indexed: 12/21/2022]
Abstract
Network analysis is a relatively new methodology for studying psychological disorders. It focuses on the associations between individual symptoms which are hypothesized to mutually interact with each other. The current study represents the first network analysis conducted with treatment-seeking military veterans in UK. The study aimed to examine the network structure of posttraumatic stress disorder (PTSD) symptoms and four domains of functional impairment by identifying the most central (i.e., important) symptoms of PTSD and by identifying those symptoms of PTSD that are related to functional impairment. Participants were 331 military veterans with probable PTSD. In the first step, a network of PTSD symptoms based on the PTSD Checklist for DSM-5 was estimated. In the second step, functional impairment items were added to the network. The most central symptoms of PTSD were recurrent thoughts, nightmares, negative emotional state, detachment and exaggerated startle response. Functional impairment was related to a number of different PTSD symptoms. Impairments in close relationships were associated primarily with the negative alterations in cognitions and mood symptoms and impairments in home management were associated primarily with the reexperiencing symptoms. The results are discussed in relation to previous PTSD network studies and include implications for clinical practice.
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Affiliation(s)
- Jana Ross
- Psychology Research Institute, Faculty of Life & Health Sciences, Ulster University, Coleraine, Northern Ireland, UK.
| | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, UK; King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK.
| | - Cherie Armour
- Psychology Research Institute, Faculty of Life & Health Sciences, Ulster University, Coleraine, Northern Ireland, UK.
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Norman SB, Haller M, Kim HM, Allard CB, Porter KE, Stein MB, Venners MR, Authier CC, Rauch SAM. Trauma related guilt cognitions partially mediate the relationship between PTSD symptom severity and functioning among returning combat veterans. J Psychiatr Res 2018; 100:56-62. [PMID: 29486403 DOI: 10.1016/j.jpsychires.2018.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/23/2018] [Accepted: 02/08/2018] [Indexed: 12/13/2022]
Abstract
Trauma related guilt, a distressing emotion associated with negative cognitions regarding one's actions or inaction during a traumatic event, is common among individuals with posttraumatic stress disorder (PTSD). We hypothesized that trauma related guilt cognitions would partially explain the relationship between PTSD symptom severity and functioning. The sample consisted of 254 combat veterans or active duty military personnel who served in Operation Enduring Freedom, Operation Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) who consented to participate in a larger PTSD treatment study. Results revealed a significant relationship between PTSD severity and guilt cognitions (standardized β = 0.40), as well as PTSD and overall functioning (β = 0.49). Guilt cognitions (β's = 0.13 to 0.32) were significantly associated with nearly all domains of functioning, including overall functioning (β = 0.27), and partially explained the relationship between PTSD and functioning. This study lends support to the addition of guilt as a symptom of PTSD in the DSM-5 as it contributes significantly to functional impairment even when accounting for other symptoms of PTSD, although co-occurring mental health problems may also contribute to functional impairments associated with PTSD. Future studies are needed to investigate whether reductions in traumatic guilt are related to improved functional outcomes in PTSD treatments.
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Affiliation(s)
- S B Norman
- National Center for PTSD, 215 N. Main Street, White River Junction, VT 05009, United States; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC116B, San Diego, CA 92161, United States; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, United States.
| | - M Haller
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC116B, San Diego, CA 92161, United States; University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, United States
| | - Hyungjin Myra Kim
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, United States; Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, United States; University of Michigan, Consulting for Statistics, Computing and Analytics Research, 3550 Rackham, 950 E. Washington Street, Ann Arbor, MI, 48109, United States
| | - C B Allard
- University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, United States; VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA 92161, United States; Solara Mental Health, 1321 Garnet Ave, San Diego, CA 92109, United States
| | - K E Porter
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, United States; University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI, 48109, United States
| | - M B Stein
- University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, United States; VA San Diego Healthcare System, 3350 Villa La Jolla Drive, San Diego, CA 92161, United States
| | - M R Venners
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, United States
| | - C C Authier
- University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI, 48109, United States
| | - S A M Rauch
- Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, United States; Emory University School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, United States
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Hunnicutt-Ferguson K, Wyka KE, Peskin M, Cukor J, Olden M, Difede J. Posttraumatic Stress Disorder, Functional Impairment, and Subjective Distress in World Trade Center Disaster Workers. J Trauma Stress 2018. [PMID: 29539098 DOI: 10.1002/jts.22268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with functional deficits, poor physical health, and diminished quality of life. Limited research has examined PTSD symptom clusters and their associations with functioning and distress among disaster recovery workers, a population at high risk for PTSD due to potential for repeated trauma. The purpose of this study was to investigate associations between overall PTSD severity, as well as PTSD symptom clusters, and social and occupational functioning and subjective distress in World Trade Center (WTC) disaster workers after the terrorist attacks on September 11, 2001 (9/11). Disaster workers deployed to the site of the attacks completed assessments at three time points over approximately 5 years post-9/11. Our sample consisted of participants who met criteria for PTSD or subthreshold PTSD at baseline (n = 514), 1-year (n = 289), and 2-year follow-up (n = 179). Adjusted linear regression indicated that Clinician Administered PTSD Scale (CAPS)-rated PTSD severity was positively associated with subjective distress, and deficits in social and occupational functioning, over time, CAPS Criterion F items; βs = .20 to .62, ps < .001. The reexperiencing and avoidance/numbing symptom clusters were associated with increased subjective distress, the avoidance/numbing and hyperarousal clusters were associated with deficits in social functioning, and the reexperiencing and hyperarousal clusters were associated with worse occupational functioning. These associations were consistent across the study period. Findings point to the importance of targeting PTSD symptom clusters associated with specific areas of functional impairment, with the goal of improving global outcomes.
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Affiliation(s)
| | - Katarzyna E Wyka
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA.,City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Melissa Peskin
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Judith Cukor
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Megan Olden
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - JoAnn Difede
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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Thompson-Hollands J, Litwack SD, Ryabchenko KA, Niles BL, Beck JG, Unger W, Sloan DM. Alliance across group treatment for veterans with posttraumatic stress disorder: The role of interpersonal trauma and treatment type. GROUP DYNAMICS-THEORY RESEARCH AND PRACTICE 2018; 22:1-15. [PMID: 29755256 PMCID: PMC5947998 DOI: 10.1037/gdn0000077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Examine initial levels and pattern of change of alliance in group treatment for posttraumatic stress disorder (PTSD) for veterans. METHOD One hundred and seventy-eight male veterans with PTSD were recruited for this study. Participants were randomly assigned to either group cognitive behavioral therapy (GCBT) or to group present-centered therapy (GPCT). Alliance with fellow group members was assessed every other session throughout the group (total of seven assessments). Hierarchical linear modeling was used to determine whether treatment condition or index trauma type (interpersonal or non-interpersonal) impacted initial levels of alliance or change in alliance over time. RESULTS Alliance increased significantly throughout treatment in both conditions. The presence of an interpersonal index event, compared to a non-interpersonal index event, did not significantly impact either initial levels of alliance or change in alliance over time. Participants in the GCBT condition experienced significantly greater growth in alliance over time compared to those in the GPCT condition (p > .05), but did not have significantly different initial alliance ratings. CONCLUSIONS The components and focus of the GCBT treatment may have facilitated more rapid bonding among members. Interpersonal traumatic experience did not negatively impact group alliance.
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Affiliation(s)
- Johanna Thompson-Hollands
- National Center for PTSD, Behavioral Science Division
- VA Boston Healthcare System
- Boston University School of Medicine
| | | | - Karen A. Ryabchenko
- National Center for PTSD, Behavioral Science Division
- VA Boston Healthcare System
- Boston University School of Medicine
| | - Barbara L. Niles
- National Center for PTSD, Behavioral Science Division
- VA Boston Healthcare System
- Boston University School of Medicine
| | | | | | - Denise M. Sloan
- National Center for PTSD, Behavioral Science Division
- VA Boston Healthcare System
- Boston University School of Medicine
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Bakhurst M, McGuire A, Halford WK. Trauma Symptoms, Communication, and Relationship Satisfaction in Military Couples. FAMILY PROCESS 2018; 57:241-252. [PMID: 28271505 DOI: 10.1111/famp.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Trauma symptoms are negatively correlated with couple relationship satisfaction, which is of particular importance in the relationships of military personnel who are often exposed to trauma whilst on overseas deployment. This study tested a model in which communication mediated an association between trauma symptoms and low relationship satisfaction. Thirty-one Australian military couples were observationally assessed during a communication task, and assessed on their relationship satisfaction and individual functioning. As expected, trauma symptoms in the male military spouse were associated with low satisfaction in both spouses. Females' low positive communication fully mediated the relationship between males' trauma symptoms and low female satisfaction, but not male relationship satisfaction. Unexpectedly, males' negative communication behaviors were associated with high male relationship satisfaction, and partially mediated the association between trauma symptoms and male satisfaction. Discussion focused on how some communication usually thought of as negative might be associated with relationship satisfaction in military couples.
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Affiliation(s)
| | | | - W Kim Halford
- The University of Queensland, Brisbane, Qld, Australia
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Fegert JM, Diehl C, Leyendecker B, Hahlweg K, Prayon-Blum V. Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services. Child Adolesc Psychiatry Ment Health 2018; 12:5. [PMID: 29344083 PMCID: PMC5765601 DOI: 10.1186/s13034-017-0210-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 12/29/2022] Open
Abstract
This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.
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Affiliation(s)
- J. M. Fegert
- grid.410712.1Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhoevelstrasse 5, 89075 Ulm, Germany
| | - C. Diehl
- 0000 0001 0658 7699grid.9811.1University of Konstanz, Konstanz, Germany
| | - B. Leyendecker
- 0000 0004 0490 981Xgrid.5570.7Ruhr-Universitaet Bochum, Bochum, Germany
| | - K. Hahlweg
- 0000 0001 1090 0254grid.6738.aTechnische Universitaet Braunschweig, Braunschweig, Germany
| | - V. Prayon-Blum
- grid.410712.1Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhoevelstrasse 5, 89075 Ulm, Germany
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Sippel LM, Watkins LE, Pietrzak RH, Hoff R, Harpaz-Rotem I. The Unique Roles of Emotional Numbing and Arousal Symptoms in Relation to Social Connectedness Among Military Veterans in Residential Treatment for PTSD. Psychiatry 2018; 81:271-282. [PMID: 30015602 DOI: 10.1080/00332747.2017.1395313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE While poor social connectedness is often a consequence of living with posttraumatic stress disorder (PTSD) symptoms, little is known about whether PTSD symptom clusters may be uniquely related to different aspects of social connectedness. This information can inform case conceptualization and treatment planning to potentially facilitate sustained recovery for individuals with PTSD. METHOD We examined associations among a five-factor model of PTSD and two aspects of social connectedness-distress related to problems getting along with others and days of contact with supportive loved ones in the past 30 days-in a sample of 2,600 U.S. military veterans seeking residential treatment for PTSD. RESULTS A large proportion of veterans reported experiencing distress related to problems getting along with others (66.2%) and few days of contact with supportive people (43.5%). Ordinal regression models controlling for intercorrelations among PTSD symptom clusters revealed that emotional numbing symptoms were independently associated with greater distress (β = 0.130, p < 0.001) and fewer days of contact (β = -0.159, p < 0.001); dysphoric arousal symptoms were associated with more distress (β = 0.236, p < 0.001), while anxious arousal was associated with more days of contact (β = 0.058, p < 0.05). CONCLUSIONS Findings reveal high rates of difficulties in social connectedness and distinct associations among these difficulties with emotional numbing, dysphoric arousal, and anxious arousal symptoms in veterans receiving residential treatment for PTSD. Future studies should examine whether targeting poor social connectedness during treatment improves interpersonal functioning and supports sustained trauma recovery, which may be particularly beneficial to veterans with more severe emotional numbing and dysphoric arousal symptoms.
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Birk JL, Rogers AH, Shahane AD, Urry HL. The heart of control: Proactive cognitive control training limits anxious cardiac arousal under stress. MOTIVATION AND EMOTION 2017. [DOI: 10.1007/s11031-017-9659-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Woodward SH, Jamison AL, Gala S, Holmes TH. Canine companionship is associated with modification of attentional bias in posttraumatic stress disorder. PLoS One 2017; 12:e0179912. [PMID: 29020064 PMCID: PMC5636264 DOI: 10.1371/journal.pone.0179912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/06/2017] [Indexed: 12/01/2022] Open
Abstract
Attentional bias towards aversive stimuli has been demonstrated in the anxiety disorders and in posttraumatic stress disorder, and attentional bias modification has been proposed as a candidate treatment. This study rigorously assessed attentional bias towards aversive and pleasant visual imagery associated with the presence or absence of a familiar service canine in 23 veterans with chronic military-related posttraumatic stress disorder. Participants were repeatedly tested with and without their service canines present on two tasks designed to elicit spontaneous visual attention to facial and scenic image pairs, respectively. Each stimulus contrasted an emotive image with a neutral image. Via eye-tracking, the difference in visual attention directed to each image was analyzed as a function of the valence contrast and presence/absence of the canine. Across both tasks, the presence of a familiar service canine attenuated the normative attentional bias towards aversive image content. In the facial task, presence of the service canine specifically reduced attention toward angry faces. In that task, as well, accumulated days with the service canine similarly modulated attention toward facial emotion. The results suggest that the presence of a familiar service canine is associated with attenuation of attentional bias to aversive stimuli in chronic military-service-related posttraumatic stress disorder. Questions remain regarding the generalization of such effects to other populations, their dependence on the familiarity, breed, and training of the canine, and on social context.
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Affiliation(s)
- Steven H. Woodward
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- * E-mail:
| | - Andrea L. Jamison
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Sasha Gala
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Tyson H. Holmes
- Human Immune Monitoring Center (HIMC), Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, United States of America
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Psychosocial rehabilitation after war trauma with adaptive disclosure: Design and rationale of a comparative efficacy trial. Contemp Clin Trials 2017; 61:10-15. [DOI: 10.1016/j.cct.2017.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/06/2017] [Accepted: 07/13/2017] [Indexed: 12/31/2022]
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Lester P, Rauch P, Loucks L, Sornborger J, Ohye B, Karnik NS. Posttraumatic Stress Disorder and Military-Connected Families: The Relevance of a Family-Centered Approach. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:420-428. [PMID: 31975873 DOI: 10.1176/appi.focus.20170027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the September 11, 2001, terrorist attacks, military service in the United States has been linked to a range of behavioral health and physical injuries in a significant number of the almost three million service members who have returned from wartime deployment. These injuries have occurred in the larger context of wartime military service, which is characterized by an array of stressors that have been associated with increased risk for behavioral health problems not only for service members but also for their family members. For the past 15 years, military-connected (defined as active-duty, reserve component, and veteran) family members have shared their own experiences of military service, including multiple deployments in the context of danger, high operational stress within their communities, and living with the physical and behavioral health injuries and ongoing care needs of a loved one. This article provides an overview of the evolving research on the specific impact of posttraumatic stress disorder (PTSD) and other war zone-related behavioral health problems among families in the context of contemporary warfare, as well as research on the impact of family adjustment on veteran recovery and care. We propose an empirically supported, family-centered framework to inform a continuum of prevention and care for veterans with PTSD and their families. Gaps in the current continuum of behavioral health services for veterans with PTSD are identified, as well as efforts underway to develop trauma-informed, family-centered screening, prevention, and treatment approaches. Future research recommendations are provided.
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Affiliation(s)
- Patricia Lester
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Paula Rauch
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Laura Loucks
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Jo Sornborger
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Bonnie Ohye
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Niranjin S Karnik
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
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Slanbekova G, Chung MC, Abildina S, Sabirova R, Kapbasova G, Karipbaev B. The impact of coping and emotional intelligence on the relationship between posttraumatic stress disorder from past trauma, adjustment difficulty, and psychological distress following divorce. J Ment Health 2017; 26:334-341. [DOI: 10.1080/09638237.2017.1322186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gulnara Slanbekova
- Department of Psychology, Karaganda State University, Karagandy, Kazakhstan and
| | - Man Cheung Chung
- Department of Educational Psychology, Ho Tim Building, Faculty of Education, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - Saltanat Abildina
- Department of Psychology, Karaganda State University, Karagandy, Kazakhstan and
| | - Raikhan Sabirova
- Department of Psychology, Karaganda State University, Karagandy, Kazakhstan and
| | - Gulzada Kapbasova
- Department of Psychology, Karaganda State University, Karagandy, Kazakhstan and
| | - Baizhol Karipbaev
- Department of Psychology, Karaganda State University, Karagandy, Kazakhstan and
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Feldman DB. Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2017; 13:113-133. [PMID: 28753122 DOI: 10.1080/15524256.2017.1346543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8-16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 ), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, & Griffin, 2002 ), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 ) and a case study is used to demonstrate its application.
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Affiliation(s)
- David B Feldman
- a Department of Counseling Psychology , Santa Clara University , Santa Clara , California , USA
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