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Hahn C, Caraway J, Hansen K, Ranum E. Exposure to traumatic events, emotion regulation, and traumatic stress among infertility patients: a moderation analysis. HUM FERTIL 2021; 24:136-143. [PMID: 30938554 PMCID: PMC6774900 DOI: 10.1080/14647273.2019.1593517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
Exposure to traumatic events and emotion regulation were examined as predictors of posttraumatic stress symptoms (PTSS) among women seeking medical treatment for infertility. Emotion regulation difficulties were hypothesized to moderate the association between traumatic events and PTSS severity. Sixty-six participants completed the Trauma History Questionnaire, Posttraumatic Check List for DSM-5, and Difficulties in Emotion Regulation Scale. Regression analyses were conducted. Emotion regulation difficulties predicted PTSS. The interaction between lifetime exposure to traumatic events and emotion regulation significantly predicted PTSS (b = 0.02, p = 0.002) and the model accounted for 31% of the variance in symptoms. Among women pursuing medical fertility treatment with past exposure to traumatic events, brief interventions that enhance emotional regulation skills may decrease PTSS.
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Affiliation(s)
- Christine Hahn
- Medical University of South Carolina – Psychiatry, 67 President Street MSC 861, IOP 2-South, Charleston, South Carolina 29425, United States
| | - Jean Caraway
- University of South Dakota – Psychology, Vermillion, South Dakota, United States
| | - Keith Hansen
- University of South Dakota - School of Medicine, Vermillion, South Dakota, United States
| | - Emma Ranum
- University of South Dakota – Psychology, Vermillion, South Dakota, United States
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Smith AM, Stewart K, Baul T, Valentine SE. Peer delivery of a brief cognitive-behavioral treatment for posttraumatic stress disorder: A hybrid effectiveness-implementation pilot study. J Clin Psychol 2020; 76:2133-2154. [PMID: 32632945 PMCID: PMC7665989 DOI: 10.1002/jclp.23020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/02/2020] [Accepted: 06/04/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) treatment delivery by peer specialist providers could increase access to and engagement with PTSD treatment in low resource settings. The current pilot study tested the feasibility, acceptability, and initial effectiveness of a peer-delivered, brief cognitive-behavioral therapy for PTSD. METHOD Four certified peer specialists delivered the intervention to 18 participants with probable PTSD. We assessed PTSD symptoms weekly and administered surveys and interviews at baseline and posttreatment. RESULTS Our mixed-methods approach suggests that the intervention was feasible and acceptable, demonstrating high client satisfaction. We also found significant improvements in PTSD, depressive, anxiety, and general stress symptoms. CONCLUSIONS Peer-delivered interventions may be a good fit for addressing posttraumatic stress symptoms for people accessing care in low resource settings. Future research should evaluate peer-delivered PTSD treatment as a strategy for both reducing symptoms and improving access and engagement in professional care.
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Affiliation(s)
- Ashley M. Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
| | - Kaylee Stewart
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
| | - Tithi Baul
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
| | - Sarah E. Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
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Matthews LR, Quinlan MG, Bohle P. Posttraumatic Stress Disorder, Depression, and Prolonged Grief Disorder in Families Bereaved by a Traumatic Workplace Death: The Need for Satisfactory Information and Support. Front Psychiatry 2019; 10:609. [PMID: 31543835 PMCID: PMC6728923 DOI: 10.3389/fpsyt.2019.00609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
The impact of traumatic workplace death on bereaved families, including their mental health and well-being, has rarely been systematically examined. This study aimed to document the rates and key correlates of probable posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and prolonged grief disorder (PGD) in family members following a workplace injury fatality. The hidden nature of the target population necessitated outreach recruitment techniques, including the use of social media, newspaper articles, radio interviews, and contact with major family support organizations. Data were collected using a cross-sectional design and international online survey. The PCL-C (PTSD), the PHQ-8 (MDD), and PG-13 (PGD) were used to measure mental health disorders. All are well-established self-report measures with strong psychometric qualities. Participants were from Australia (62%), Canada (17%), the USA (16%), and the UK (5%). The majority were females (89.9%), reflecting the gender distribution of traumatic workplace deaths (over 90% of fatalities are male). Most were partners/spouses (38.5%) or parents (35%) and over half (64%) were next of kin to the deceased worker. Most deaths occurred in the industries that regularly account for more than 70 percent of all industrial deaths-construction, manufacturing, transport, and agriculture forestry and fishing. At a mean of 6.40 years (SD = 5.78) post-death, 61 percent of participants had probable PTSD, 44 percent had probable MDD, and 43 percent had probable PGD. Logistic regressions indicated that a longer time since the death reduced the risk of having each disorder. Being next of kin and having a self-reported mental health history increased the risk of having MDD. Of the related information and support variables, having satisfactory support from family, support from a person to help navigate the post-death formalities, and satisfactory information about the death were associated with a decreased risk of probable PTSD, MDD, and PGD, respectively. The findings highlight the potential magnitude of the problem and the need for satisfactory information and support for bereaved families.
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Affiliation(s)
- Lynda R. Matthews
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Michael G. Quinlan
- School of Management, UNSW Business School, University of New South Wales, Sydney, NSW, Australia
| | - Philip Bohle
- Work and Health Research Team, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Bhardwaj V, Angkaw AC, Franceschetti M, Rao R, Baker DG. Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans. Aggress Behav 2019; 45:417-426. [PMID: 30835866 DOI: 10.1002/ab.21827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/04/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
Abstract
Hostility, anger, and aggression are conceptually related but unique constructs found to occur more often among veterans with posttraumatic stress disorder (PTSD) than among civilians or veterans without PTSD. However, the pathways between PTSD, depression, hostility, anger, and aggression have not been comprehensively characterized. Therefore, drawing on a sample of returning Operation Enduring Freedom/Operation Iraqi Freedom combat veterans ( N = 175; 95% male; mean age 30 years), this study sought to examine the direct and indirect relationships among PTSD, depression, hostility, anger, and four types of aggression: verbal, and physical toward self, others, and objects. Functional modeling of direct effects was done using multiple least-squares regression and bootstrapped mediation analyses were carried out to test indirect effects. Results indicate that PTSD is not the overall direct contributor to different forms of aggression, supporting the mediating role of depression and trait anger. Depression symptoms explain part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward self and trait anger explains part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward others. Our findings support the importance of assessing for anger, depression, and different types of aggression among veterans presenting for PTSD treatment to develop individualized treatment plans that may benefit from early incorporation of interventions.
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Affiliation(s)
- Vinnu Bhardwaj
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Abigail C. Angkaw
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
| | - Massimo Franceschetti
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Ramesh Rao
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Dewleen G. Baker
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- VA Center of Excellence for Stress and Mental HealthSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
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Fillo J, Holliday SB, DeSantis A, Germain A, Buysse DJ, Matthews KA, Troxel WM. Observed Relationship Behaviors and Sleep in Military Veterans and Their Partners. Ann Behav Med 2017; 51:879-889. [PMID: 28488231 PMCID: PMC5680152 DOI: 10.1007/s12160-017-9911-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Emerging research has begun to examine associations between relationship functioning and sleep. However, these studies have largely relied on self-reported evaluations of relationships and/or of sleep, which may be vulnerable to bias. PURPOSE The purpose of the study was to examine associations between relationship functioning and sleep in military couples. This is the first research to examine associations between observed relationship behaviors and subjective and polysomnographically measured sleep in a sample at-risk for both sleep and relationship problems. METHODS The sample included 35 military veterans and their spouses/partners. Marital functioning was coded from a videotaped conflict interaction. Analyses focused on behavioral codes of hostility and relationship-enhancing attributions. Sleep was assessed via self-report and in-home polysomnography. RESULTS Greater hostility was associated with poorer sleep efficiency for oneself (b = -0.195, p = .013). In contrast, greater relationship-enhancing attributions were associated with higher percentages of stage N3 sleep (b = 0.239, p = .028). Partners' hostility was also positively associated with higher percentages of stage N3 sleep (b = 0.272, p = .010). Neither hostility nor relationship-enhancing attributions was associated with self-reported sleep quality, percentage of REM sleep, or total sleep time. CONCLUSIONS Both partners' positive and negative behaviors during conflict interactions were related to sleep quality. These findings highlight the role that effective communication and conflict resolution skills may play in shaping not only the marital health of veterans and their spouses but also the physical health of both partners as well. Understanding the links between relationship functioning and sleep may be important targets of intervention in the aftermath of war.
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Affiliation(s)
- Jennifer Fillo
- Research Institute on Addictions, University at Buffalo, The State University of New York, 1021 Main Street, Buffalo, NY, 14203, USA
| | | | - Amy DeSantis
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Wendy M Troxel
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
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Childhood physical and sexual abuse experiences associated with post-traumatic stress disorder among pregnant women. Ann Epidemiol 2017; 27:716-723.e1. [PMID: 29079333 DOI: 10.1016/j.annepidem.2017.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/05/2017] [Accepted: 09/20/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE We sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV). METHODS In-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women aged 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version. Multivariate logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Compared to women with no childhood abuse, the odds of PTSD were increased 4.31-fold for those who reported physical abuse only (95% CI, 2.18-8.49), 5.33-fold for sexual abuse only (95% CI, 2.38-11.98), and 8.03-fold for those who reported physical and sexual abuse (95% CI, 4.10-15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Furthermore, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (OR = 20.20; 95% CI, 8.18-49.85). CONCLUSIONS Childhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women's mental health.
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Abstract
Patients suffering from severe mental illness (SMI) are considered especially vulnerable to stress. In this study, their use of acute stress services in a military context affecting civilian populations was assessed, using naturally occurring data. The proportion of patients with a previously known SMI, defined as any chronic psychotic disorder or bipolar disorder, among all civilians examined at a center for treatment of stress during a military conflict versus at the ER in usual times, was compared, using the Chi square statistical test. Among 354 subjects examined at the center for treatment of stress, 12 had a SMI diagnosis. Among 404 subjects examined at the ER in usual times, 16 had a SMI diagnosis. Patients with SMI were under-represented, but not in a statistically significant manner, at the center for treatment of stress (χ2 = 0.31, p = ns). Although these results may imply that patients with SMI are not more vulnerable to external stress than the general population, we believe that they may have difficulties in seeking immediate help in such traumatogenic contexts. In order to reduce the occurrence of PTSD and gain efficacy in the treatment of the primary disorder, psychiatric services should perhaps make a reaching out effort to identify and examine these patients in the community. .
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van den Berg DPG, van der Vleugel BM, de Bont PAJM, Thijssen G, de Roos C, de Kleine R, Kraan T, Ising H, de Jongh A, van Minnen A, van der Gaag M. Exposing therapists to trauma-focused treatment in psychosis: effects on credibility, expected burden, and harm expectancies. Eur J Psychotraumatol 2016; 7:31712. [PMID: 27606710 PMCID: PMC5015638 DOI: 10.3402/ejpt.v7.31712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment. OBJECTIVE This feasibility study explores the impact of specialized training on therapists' beliefs about trauma-focused treatment within a randomized controlled trial. METHOD Therapist-rated (n=16) credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed. RESULTS Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists' expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD) in patients with psychotic disorders (n=79), pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists. CONCLUSIONS These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists' credibility, burden, and harm beliefs concerning trauma-focused treatment.
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Affiliation(s)
| | | | - Paul A J M de Bont
- Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, The Netherlands
| | - Gwen Thijssen
- Parnassia Psychiatric Institute, Den Haag, The Netherlands
| | | | - Rianne de Kleine
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Centre for Anxiety Disorders Overwaal, MHO Pro Persona, Nijmegen, The Netherlands
| | - Tamar Kraan
- Parnassia Psychiatric Institute, Den Haag, The Netherlands
| | - Helga Ising
- Parnassia Psychiatric Institute, Den Haag, The Netherlands
| | - Ad de Jongh
- Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,School of Health Sciences, Salford University, Manchester, United Kingdom
| | - Agnes van Minnen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Centre for Anxiety Disorders Overwaal, MHO Pro Persona, Nijmegen, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, Den Haag, The Netherlands.,Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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McNeill SA, Galovski TE. Coping Styles Among Individuals with Severe Mental Illness and Comorbid PTSD. Community Ment Health J 2015; 51:663-73. [PMID: 26044653 DOI: 10.1007/s10597-015-9887-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
There is little known about coping styles used by individuals with severe mental illness (SMI) and even less known about the influence of a comorbid posttraumatic stress disorder (SMI-PTSD) diagnosis on coping. The current study examines differences in utilization of coping strategies, overall psychological distress, and exposure to traumatic events between SMI only and SMI-PTSD individuals seeking community mental health clinic services (N = 90). Results demonstrate that overall psychological distress and use of avoidance coping were significantly higher among the SMI-PTSD sample. Avoidance coping partially mediated the relationship between PTSD symptom severity and psychological distress. Findings suggest that the experience of PTSD for those with SMI is associated with increases in avoidance coping, a coping style that significantly contributes to psychological distress. Implications for further study and treatment within community mental health clinics are considered.
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Affiliation(s)
- Shannon A McNeill
- Department of Psychology, University of Missouri - St. Louis, One University Blvd, St. Louis, MO, 63121, USA,
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Lu W, Yanos PT, Gottlieb JD, Duva SM, Silverstein SM, Xie H, Rosenberg SD, Mueser KT. Use of fidelity assessments to train clinicians in the CBT for PTSD program for clients with serious mental illness. Psychiatr Serv 2012; 63:785-92. [PMID: 22854726 PMCID: PMC3888865 DOI: 10.1176/appi.ps.201000458] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE One barrier to disseminating evidence-based practices for persons with serious mental illness is the difficulty of training frontline clinicians. This study evaluated whether frontline clinicians could be trained to implement an empirically supported cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) among persons with serious mental illness when a standardized fidelity measure was used to provide clinicians with feedback on practice cases. METHODS Twenty-five clinicians (23 master's level) at five agency sites were trained in the CBT for PTSD program and delivered it to 35 clients (practice cases) over six months. Supervisors or consultants used the fidelity measure to rate audio-recorded sessions and provide feedback. A criterion of competence was established to designate program certification. Clients' PTSD and depression symptoms were monitored. Clinicians' satisfaction with training was also assessed. RESULTS Two clinicians dropped out, and 21 of the remaining 23 clinicians (91%) achieved program certification with their first case; the remaining two (9%) achieved it with their second case. Clients' symptoms, measured by the PTSD Checklist and the Beck Depression Inventory, decreased significantly during treatment, suggesting clinical benefits of the program. Clinicians reported that group supervision was very helpful and written feedback was helpful or very helpful. All rated the training as excellent. CONCLUSIONS Results support the feasibility of training frontline clinicians in the CBT for PTSD program by using regular feedback based on the fidelity measure and indicate that most clinicians can achieve competence in the model with a single practice case.
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey, Scotch Plains, New Jersey, USA
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Chen MJ, Grobman WA, Gollan JK, Borders AEB. The use of psychosocial stress scales in preterm birth research. Am J Obstet Gynecol 2011; 205:402-34. [PMID: 21816383 PMCID: PMC3205306 DOI: 10.1016/j.ajog.2011.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/13/2011] [Accepted: 05/01/2011] [Indexed: 10/18/2022]
Abstract
Psychosocial stress has been identified as a potential risk factor for preterm birth. However, an association has not been found consistently, and a consensus on the extent to which stress and preterm birth are linked is still lacking. A literature search was performed with a combination of keywords and MeSH terms to detect studies of psychosocial stress and preterm birth. Studies were included in the review if psychosocial stress was measured with a standardized, validated instrument and if the outcomes included either preterm birth or low birthweight. Within the 138 studies that met inclusion criteria, 85 different instruments were used. Measures that had been designed specifically for pregnancy were used infrequently, although scales were sometimes modified for the pregnant population. The many different measures that have been used may be a factor that accounts for the inconsistent associations that have been observed.
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Affiliation(s)
- Melissa J Chen
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Dailey DE, Humphreys JC, Rankin SH, Lee KA. An exploration of lifetime trauma exposure in pregnant low-income African American women. Matern Child Health J 2011; 15:410-8. [PMID: 18253820 PMCID: PMC3150846 DOI: 10.1007/s10995-008-0315-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of this study was to describe the occurrence of lifetime trauma exposure in relation to perinatal health outcomes in low-income African American women. METHODS One hundred and sixteen pregnant African American women recruited from two public prenatal clinics participated in this exploratory study. Information was obtained about psychological symptoms, medical conditions, prenatal care utilization, and health behaviors. To measure lifetime trauma exposure, women completed the Trauma History Questionnaire. Maternal and infant outcome data were obtained from the medical records following delivery. RESULTS The occurrence of trauma exposure was high, with 87% of the women reporting at least one traumatic event. Their mean age was 25 years, 21% were primiparas, and they reported a mean of 4.3 ± 3.5 (median = 3) traumatic events during their lifetime. Crime-related experiences were common and included incidents of family or friends being murdered or killed (40%), robberies (23%), home burglaries (14%), attacks with weapons (13%), and muggings (12%). Lifetime trauma exposure was significantly associated with depressive symptoms, anxiety, and generalized stress. Women with greater lifetime trauma exposure had a higher rate of tobacco use, higher rate of premature rupture of membranes, and longer maternal hospital stay. CONCLUSION Low-income African American women in this sample experienced a variety of traumatic events. Lifetime trauma exposure was associated with adverse perinatal health. Findings suggest the need to further investigate trauma across the lifespan to better understand the impact of these experiences on the reproductive health and well-being of women and their infants.
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Affiliation(s)
- Dawn E Dailey
- Family, Maternal & Child Health Programs, Department of Public Health, Contra Costa Health Services, 597 Center Avenue, Martinez, CA, USA.
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Yufik T, Simms LJ. A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 119:764-76. [PMID: 21090877 PMCID: PMC4229035 DOI: 10.1037/a0020981] [Citation(s) in RCA: 240] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Converging lines of evidence have called into question the validity of conceptualizations of posttraumatic stress disorder (PTSD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and suggested alternative structural models of PTSD symptomatology. We conducted a meta-analysis of 40 PTSD studies (N = 14,827 participants across studies) that used a DSM-based measure to assess PTSD severity. We aggregated correlation matrices across studies and then applied confirmatory factor analysis to the aggregated matrices to test the fit of competing models of PTSD symptomatology that have gained support in the literature. Results indicated that both prominent 4-factor models of PTSD symptomatology yielded good model fit across subsamples of studies; however, the model comprising Intrusions, Avoidance, Hyperarousal, and Dysphoria factors appeared to fit better across studies. Results also indicated that the best fitting models were not moderated by measure or sample type. Results are discussed in the context of structural models of PTSD and implications for the diagnostic nosology.
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Affiliation(s)
- Tom Yufik
- Department of Psychology, University at Buffalo, The State University of New York, NY, USA.
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Frueh BC, Grubaugh AL, Cusack KJ, Elhai JD. Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies. Behav Modif 2008; 33:66-81. [PMID: 18723837 DOI: 10.1177/0145445508322619] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) remains largely untreated among adults with severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes precedence in the care of adults with SMI. Such oversight is problematic in that PTSD in SMI populations is common (19%-43%), contributes a significant illness burden, and hinders mental health care. Yet few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the article is to describe strategies and efforts to disseminate trauma-focused empirically based practices in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are to set clear goals, nurture broad-based organizational commitment and key stakeholder involvement, implement specialty training efforts to provide information and change attitudes, provide ongoing supervision, conduct fidelity monitoring, and ensure accountability to the extent possible.
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Floen SK, Elklit A. Psychiatric diagnoses, trauma, and suicidiality. Ann Gen Psychiatry 2007; 6:12. [PMID: 17448229 PMCID: PMC1858696 DOI: 10.1186/1744-859x-6-12] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 04/20/2007] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. METHODS During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%). RESULTS Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. CONCLUSION Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment.
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Affiliation(s)
- Silje K Floen
- BUP for Nordhordland, Kvassnesvegen 44, N-5914 Isdalstø, Norge
| | - Ask Elklit
- Department of Psychology, University of Aarhus, Jens Chr. Skous Vej 4, DK-8000 Aarhus C, Denmark
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Salyers MP, Evans LJ, Bond GR, Meyer PS. Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives. Community Ment Health J 2004; 40:17-31. [PMID: 15077726 DOI: 10.1023/b:comh.0000015215.45696.5f] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We conducted a state-wide survey of 251 clinicians serving people with severe mental illness (SMI) in community support programs, to identify barriers to the diagnosis and treatment of PTSD and other trauma-related problems. Most clinicians did not feel competent to effectively treat these problems. Competence/confidence and belief in utility of intervention were positively related to the percentage of clients with whom trauma and PTSD had been discussed, documented in charts, and addressed directly in treatment. Clinicians need training that develops skills and knowledge as well as conveys the value of addressing PTSD and other trauma-related problems in people with SMI.
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Affiliation(s)
- Michelle P Salyers
- Department of Psychology, LD 124, Indiana University Purdue University Indianapolis, 402 N. Blackford Street, Indianapolis, IN 46202-3275, USA.
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