PTSD and comorbid depression: Social support and self-efficacy in World Trade Center tower survivors 14-15 years after 9/11

Big-five personality traits and depression: chain mediation of self-efficacy and walking

Background

Depression is a major global public health concern, with research indicating a correlation between personality traits and depression. This study aimed to explore the potential mediating roles of self-efficacy and walking in the relationship between personality traits and depression among Chinese residents.

Methods

A cross-sectional questionnaire survey was conducted from July 10 to September 15, 2021, involving 11,031 Chinese residents across 23 provinces, 5 autonomous regions, and 4 municipalities Participants provided data on demographics, personality traits (using the Ten-Item Personality Inventory), self-efficacy (using the New General Self-Efficacy Scale), chronic disease self-management (using the Chronic Disease Self-Management Study Measures), and depression (using the Patient Health Questionnaire-9). After screening, data from 8,499 participants were analyzed. Sequential mediation models were employed, with the Big Five personality traits as predictors, depression as the outcome, and self-efficacy and walking as the mediators.

Results

Extraversion, agreeableness, conscientiousness, and emotional stability were negatively correlated with depression, with self-efficacy and walking as positive mediators in these relationships. Conversely, openness was positively associated with depression, and the self-efficacy-walking chain did not mediate this relationship but rather masked the effect of openness on depression.

Conclusions

Our findings suggest that self-efficacy and walking are significant mediators in the relationship between personality traits and depression, potentially mitigating the risk of depressive episodes.

Long-term PTSD prevalence and associated adverse psychological, functional, and economic outcomes: a 12-15 year follow-up of adults with suspected serious injury

Background: An increasing number of longitudinal studies investigates long-term PTSD, related outcomes and potential gender differences herein. However, a knowledge gap exists when it comes to studies following individual civilian trauma beyond a decade post-trauma.Objective: To investigate the long-term PTSD prevalence, associated adverse psychological, functional and economic outcomes related to (suspected) serious injury of 12-15 years ago in Dutch adults, as well as potential gender differences herein.Method: N = 194 trauma-exposed adults (34% women) admitted to an emergency department following suspected serious injury completed a follow-up assessment 12-15 years (M = 14.30, SD = 1.00) post-trauma. Participants completed assessments of clinician-rated PTSD symptom severity, as well as self-report questionnaires on psychological, functional and economic outcomes.Results: Nine participants (4.8%) fulfilled the DSM-5 diagnostic criteria for PTSD related to the index trauma of 12-15 years ago. Results showed that PTSD symptom severity (CAPS-5) was significantly associated with more severe symptoms of anxiety (HADS) and depression (QIDS), lower well-being (WHO-5) and (health-related) quality of life (WHOQOL; EQ-5D-5L), but not with alcohol use (AUDIT), productivity loss at work (iPCQ) and health care use (iMCQ). No significant gender differences in the long-term PTSD prevalence nor in its related psychological, functional and economic outcomes were found.Conclusions: Our findings underscore the long-term presence of PTSD and associated adverse psychological and functional outcomes in a proportion of adults who experienced (suspected) serious injury over a decade ago. PTSD is already widely recognized for its substantial impact in the aftermath of a trauma. The current study emphasizes the potential long-term consequences of individual civilian trauma, highlighting the importance of accurate screening and prevention for PTSD.

Perceived social support and longitudinal trajectories of depression and anxiety in World Trade Center responders

PURPOSE

While severely distressing events are known to affect mental health adversely, some survivors develop only short-lived or no psychiatric symptoms in the aftermath of a disaster. In the WTC Health Program General Responder Cohort (WTCHP GRC) we examined whether social support was protective against the development of depression or anxiety symptoms after the 9/11 WTC attacks and explored in a subsample whether trait resilience moderated this relationship.

METHODS

We analyzed data from 14,033 traditional and 13,478 non-traditional responders who attended at least three periodic health monitoring visits between 2002 and 2019. Linear mixed-effects models were used to examine depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder screener; GAD-7) scores. In a subsample of 812 participants, we also assessed if the association between social support and symptoms was moderated by an individual's trait resilience level (Connor-Davidson Resilience Scale, CD-RISC).

RESULTS

For both traditional and non-traditional responders, perceived social support around 9/11 was associated with lower levels of depressive (β = - 0.24, S.E. = 0.017, z = - 14.29, p < 0.001) and anxiety symptoms (β = - 0.17, S. E. = 0.016, z = - 10.48, p < 0.001). Trait resilience scores were higher in responders with at least one source of social support during the aftermath of 9/11 compared to those without (mean 71.56, SD 21.58 vs mean 76.64, SD 17.06; β = 5.08, S.E. = 0.36, p < 0.001). Trait resilience moderated the association between social support and depressive (p < 0.001) and anxiety trajectories (p < 0.001) for traditional responders.

CONCLUSION

Our findings suggest that perceived social support around a severely distressing event may have long-term protective effects on symptoms of depression and anxiety.

The association between family adaptability and adolescent depression: the chain mediating role of social support and self-efficacy

Objective

Previous research has shown a correlation between family adaptability and adolescent depression. However, there is a lack of studies that have investigated the underlying mechanism between family adaptability and adolescent depression. Based on the Ecological Systems Theory, this study aims to investigate the link between family adaptability and depression in adolescents, mediated by the sequential roles of social support and self-efficacy.

Methods

The sample consisted of 1086 students randomly selected from seven public middle schools in Shandong Province, Eastern China. All the participants filled in the structured self-report questionnaires on family adaptability, social support, self-efficacy, and depression. The data were analyzed using SPSS 25.0 and Structural Equation Modeling (SEM) in AMOS 24.0.

Results

The findings of this study are as follows: (1) Family adaptability is negatively associated with adolescent depression; (2) Social support plays a mediating role between family adaptability and adolescent depression; (3) Self-efficacy plays a mediating role between family adaptability and adolescent depression; (4) Social support and self-efficacy play a chain mediation role between family adaptability and adolescent depression.

Conclusion

It is suggested that early interventions and support should be provided to facilitate adolescents' family adaptability, social support, and self-efficacy, thus reducing their depression and improving mental health of adolescents.

Development and initial validation of the Mount Sinai Resilience Scale

OBJECTIVE

The construct of psychological resilience has received increasing attention in the mental health field. This article describes the development and initial validation of a novel self-report resilience scale, which addresses gaps in the resilience measurement literature by assessing thoughts and behaviors that help promote resilience rather than traits, and simultaneously evaluating multiple factors previously associated with resilience.

METHOD

Following consensus meetings focused on scale development, we conducted an online study (n = 1,864) of U.S. adults to develop and validate an initial version of the Mount Sinai Resilience Scale (MSRS).

RESULTS

An exploratory factor analysis in a random 50% of the sample suggested a seven-factor solution; this solution was then generally supported by a follow-up confirmatory factor analysis in the remaining 50% of the sample. After removing poor-fitting items, a revised 24-item scale correlated in the expected directions with established measures of perceived resilience and resilience-related constructs (e.g., social support and optimism).

CONCLUSIONS

Collectively, the results of this study provide initial support for the convergent and discriminant validity of the MSRS and describe its factor structure. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bullying Victimization and Comorbid Patterns of PTSD and Depressive Symptoms in Adolescents: Random Intercept Latent Transition Analysis

Many studies have examined post-traumatic stress disorder (PTSD) or depressive symptoms in adolescents under the background of school bullying, but not their comorbidities and changes over time. This study used random intercept latent transition analysis (RI-LTA) to examine the transitions in comorbid patterns of PTSD and depressive symptoms among 815 adolescents (45.0% boys; Mage-baseline = 13.69, SD = 1.60), who reported their symptoms in a 3-year longitudinal study. Three comorbid patterns were found: low symptoms, predominantly PTSD symptoms, and symptoms of comorbidity. Among these patterns, five trends were found through 3 years: stable low symptoms, stable PTSD symptoms, improving symptoms, worsening symptoms, and an inverted-U pattern. Age, time that parents spend with their child, being an only child, family income and experiencing relational bullying were predictors of these transitions. These suggest that patterns of PTSD and depressive symptoms are heterogeneous and may change over time since trauma events. Developing targeted interventions based on underlying factors through distinct patterns and transitions may help us better optimize and utilize intervention resources to alleviate symptoms from bullying victims.

A house is not a home: a network model perspective on the dynamics between subjective quality of living conditions, social support, and mental health of refugees and asylum seekers

BACKGROUND

Providing adequate living conditions for forcibly displaced people represents a significant challenge for host countries such as Germany. This study explores refugee mental health's reciprocal, dynamic relationship with post-migration living conditions and social support.

METHODS

The study sample included 325 Arabic- or Farsi-speaking asylum seekers and refugees residing in Germany since 2014 and seeking mental health treatment. Associations between reported symptoms of post-traumatic stress and depression and the subjective quality of living conditions and perceived social support were analyzed using a two-level approach including multiple linear regression and network analyses.

RESULTS

Post-migration quality of living conditions and perceived social support were significantly associated with negative mental health outcomes on both levels. In the network, both post-migration factors were negatively connected with overlapping symptoms of psychiatric disorders, representing potential target symptoms for psychological treatment.

CONCLUSION

Post-migration quality of living conditions and social support are important factors for refugee mental health and should be targeted by various actors fostering mental well-being and integration.

Cumulative stressful events and mental health in young adults after 10 years of Wenchuan earthquake: the role of social support

ABSTRACTBackground: After a natural disaster, stressful events often continue to accumulate, affecting individuals in a different manner than the original disaster never occurred. However, few studies have examined these associations, the cumulative impacts of stressful events on mental health outcomes, and the role of social support. This study examined the prospective association between cumulative stressful events and mental health problems and the role of social support in young adults.Methods: 695 participants provided available data on earthquake exposure, childhood maltreatment, other negative life events, and social support at baseline. Depressive symptoms and posttraumatic stress disorder were assessed at baseline and 10 years after the earthquake (T_10y). A cumulative stressful events index was used to evaluate the levels of cumulative stressful events. Linear regressions were used to explore the predictive effects.Results: Of 695 participants, 41.3%, 28.5%, and 7.9% reported one, two, and three stressful events, respectively. The associations between cumulative stressful events and mental health problems at T_10y presented a dose-response pattern: those who experienced three events had the highest risk of mental health problems, followed by those who experienced two events and those who reported one event. Additionally, higher social support partially reduced the negative impact of cumulative stressful events on mental health.Conclusions: Cumulative stressful events are associated with mental health problems 10 years later in young earthquake survivors. Social support could reduce the negative impact, but its protective role disappears when stressful events accumulate at the highest level. These findings highlight the importance of assessing the cumulative impacts of stressful events and social support available to young disaster survivors and intervening to prevent worse mental health outcomes.

Temporal Associations Between Posttraumatic Stress Symptoms and Depression in Response to Online Expressive Writing Interventions in a Hispanic Sample

Some expressive writing (EW) interventions targeting posttraumatic stress symptoms (PTSS) may reduce both PTSS and comorbid depression symptoms. The temporal associations between PTSS and depression symptom levels in response to EW interventions are unknown. This study examined the directionality of PTSS and depression symptom levels from baseline to 1-week, 1-month, and 3-month follow-ups of two online EW interventions in a Hispanic sample with diverse trauma experiences. Participants (n = 70) completed either emotion-focused or fact-focused writing for 3 consecutive days online. A manifest autoregressive model with cross-lagged effects and treatment condition was analyzed. All but one first-order autoregressive path were statistically significant, with later PTSS and depression scores significantly predicted by those scores at preceding time points. The cross-lagged effects findings suggest that earlier PTSS levels influenced later depression levels, but earlier depression did not influence later PTSS, demonstrating a unidirectional temporal association. Severe PTSS may hinder EW treatment gains in depression. Superior outcomes for emotion-focused writing relative to fact-focused writing were also found.

Relative efficacy of psychological interventions following interpersonal trauma on anxiety, depression, substance use, and PTSD symptoms in young people: A meta-analysis

AIM

Interpersonal trauma exposures are associated with anxiety, depression, and substance use in youth populations (aged 12-25 years). This meta-analysis reports on the efficacy of psychological interventions on these symptom domains in addition to post-traumatic stress.

METHODS

Following PRISMA guidelines, a search of electronic databases was performed for randomized controlled trials (RCTs) assessing interventions for young people following interpersonal trauma exposure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Data were analysed using random-effects meta-analyses.

RESULTS

Of the 4832 records screened, 78 studies were reviewed, and 10 RCTs, involving 679 participants (mean age 15.6 years), were analysed. There was a large pooled effect size for post-traumatic stress (7 studies, g = 1.43, 95% CI [0.37, 2.15], p = .002) and substance use (2 studies, g = 0.70, 95% CI [-0.11, 1.22], p < .001) and small effect sizes for anxiety (4 studies, g = 0.30, 95% CI [0.10, 0.49], p = .003), and trend-level effect for depression (10 studies, g = 0.27, 95% CI [0.00, 0.54], p = .052). Heterogeneity was significant for post-traumatic stress and moderate for depression.

CONCLUSIONS

High-quality RCTs of psychological interventions for anxiety, depression, substance use, and post-traumatic stress symptoms in young people exposed to interpersonal trauma are scarce. While available studies show either statistically significant or trend-level efficacy for psychological interventions in reducing these symptoms, wide confidence intervals, heterogeneity and small sample size mean that results need to be interpreted with caution.

Depression and PTSD in the aftermath of strict COVID-19 lockdowns: a cross-sectional and longitudinal network analysis

Background: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are two highly comorbid psychological outcomes commonly studied in the context of stress and potential trauma. In Hubei, China, of which Wuhan is the capital, residents experienced unprecedented stringent lockdowns in the early months of 2020 when COVID-19 was first reported. The comorbidity between PTSD and MDD has been previously studied using network models, but often limited to cross-sectional data and analysis. Objectives: This study aims to examine the cross-sectional and longitudinal network structures of MDD and PTSD symptoms using both undirected and directed methods. Methods: Using three types of network analysis - cross-sectional undirected network, longitudinal undirected network, and directed acyclic graph (DAG) - we examined the interrelationships between MDD and PTSD symptoms in a sample of Hubei residents assessed in April, June, August, and October 2020. We identified the most central symptoms, the most influential bridge symptoms, and causal links among symptoms. Results: In both cross-sessional and longitudinal networks, the most central depressive symptoms included sadness and depressed mood, whereas the most central PTSD symptoms changed from irritability and hypervigilance at the first wave to difficulty concentrating and avoidance of potential reminders at later waves. Bridge symptoms showed similarities and differences between cross-sessional and longitudinal networks with irritability/anger as the most influential bridge longitudinally. The DAG found feeling blue and intrusive thoughts the gateways to the emergence of other symptoms. Conclusions: Combining cross-sectional and longitudinal analysis, this study elucidated central and bridge symptoms and potential causal pathways among PTSD and depression symptoms. Clinical implications and limitations are discussed.

Association Between Feeling Threatened, Behaviour and Symptoms of Anxiety and Depression: Two and a Half Years After the Terrorist Attacks in Belgium

Feeling threatened by terrorism can be associated with mental health problems and behavioural changes. However, few studies look at the association in the long-term. Using a survey, the population in Brussels, Belgium was studied using a representative database delivered by the national post service. The Patient Health Questionnaire-4 (PHQ-4) assessed mental health, and self-made questions avoidance behaviour. 170 people answered: 60% women and 50% higher educated, 28.2% between 56 and 65 years and 62.4% had a partner. 43.5% felt threatened by the terrorist attacks and 45.9% experienced no mental health problems. Both terrorist threat (p < 0.001) and avoidance behaviour (p < 0.001) significantly predicted PHQ-4 scores, while controlling for gender, age, social support, education level, and traumatic events. There is a relation between terrorist threat and anxiety/depressive symptoms 2.5 years after the last study on terrorist threat in Brussels, but it has weakened. Avoidance behaviour seems to be more present than threat.

The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis

Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. We used data from 23,165 World Trade Center Health Registry (WTCHR) enrollees who were exposed to the 9/11 attacks and participated in the first four WTCHR surveys (Wave 1 (2003−2004) to Wave 4 (2015−2016)). PTSD symptoms were measured using the 17-item PTSD Checklist. Perceived social support was measured using the five-item version of the Modified Social Support Survey. We used a cross-lagged panel analysis and found an inverse relationship between PTSD symptoms and social support. PTSD at Wave 2 (W2) predicted less social support at Wave 3 (W3) (β = −0.10, p < 0.01), and PTSD at W3 predicted less social support at W4 (β = −0.05, p < 0.01). Conversely, social support at W3 buffered PTSD symptoms at W4 (β = −0.03, p < 0.05). Sub-analyses by types of perceived social support suggest greater effects of PTSD on emotional support than tangible support and in community members than rescue/recovery workers. Our findings suggest a bidirectional effect between PTSD symptoms and social support in a longitudinal study of 9/11-exposed populations.

PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak

Background:

Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic.

Objective:

To explore Healthcare Workers’ mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes.

Methods:

74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression).

Results:

A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group.

Conclusion:

Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.

Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors

Following exposures to traumatic events on 9/11, survivors have reported heightened levels of posttraumatic stress disorder (PTSD). Multiple factors contribute to both the exacerbation and amelioration of PTSD symptoms, including social integration and support. This cross-sectional study aimed to understand and identify associations of embeddedness and psychosocial risk factors by PTSD status for survivors and first responders of 9/11. Results indicate that those with chronic PTSD had the lowest prevalence of both social and emotional embeddedness and many who reported no PTSD symptoms following 9/11 reported moderate levels of social and emotional embeddedness. Overall, our findings suggest those individuals who reported little to no PTSD also reported the most social/emotional embeddedness; whereas those individuals who report greater or chronic PTSD report the least social/emotional embeddedness. As such, it may be beneficial for clinicians across multiple care disciplines and contexts to consider and address the social lives and needs of those individuals experiencing symptoms of PTSD to ensure their emotional and physical needs are truly being met.

Prevalence of post-traumatic stress disorder in the United States: a systematic literature review

OBJECTIVE

This study synthesized evidence regarding the prevalence of post-traumatic stress disorder (PTSD) in the United States (US).

METHODS

A systematic literature review (SLR) identified recently published (2015-2019) observational studies of PTSD prevalence in the US via the MEDLINE, EMBASE, and PsycINFO databases. Eligible studies' most recent data were collected no earlier than 2013. Data elements extracted included study design, sample size, location, data source/year(s), study population(s), traumatic event type, prevalance estimates with corresponding look-back periods, and clinical metrics.

RESULTS

Data from 38 identified articles were categorized by population, diagnostic criteria, and lookback period. Among civilians, point prevalence ranged from 8.0% to 56.7%, 1-year prevalence from 2.3% to 9.1%, and lifetime prevalence from 3.4% to 26.9%. In military populations, point prevalence ranged from 1.2% to 87.5%, 1-year prevalence from 6.7% to 50.2%, and lifetime prevalence from 7.7% to 17.0%. Within these ranges, several estimates were derived from relatively high quality data; these articles are highlighted in the review. Prevalence was elevated in subpopulations including emergency responders, refugees, American Indian/Alaska Natives, individuals with heavy substance use, individuals with a past suicide attempt, trans-masculine individuals, and women with prior military sexual trauma. Female sex, lower income, younger age, and behavioral health conditions were identified as risk factors for PTSD.

CONCLUSIONS

PTSD prevalence estimates varied widely, partly due to different study designs, populations, and methodologies, and recent nationally representative estimates were lacking. Efforts to increase PTSD screening and improve disease awareness may allow for a better detection and management of PTSD.

Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima

BACKGROUND

Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types.

OBJECTIVE

This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic.

METHODS

Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively.

RESULTS

COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network.

CONCLUSIONS

PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.

Hiding from danger, not from fear: Lockdown as a risk factor of probable PTSD among civilians after Strasbourg Christmas market terror attack

On December 11, 2018, five people were killed and 11 injured during a terrorist attack on Strasbourg's Christmas market. As the attacker was on the run during the night, part of the population was locked down for several hours. Our study aimed at assessing factors associated with the development of PTSD and health services use among the victims. Four hundred and twelve victims were followed up from 6 to 11 months after the attacks through phone calls by psychologists. The presence of probable PTSD was assessed with the Trauma Screening Questionnaire. In addition, we evaluated the type and level of exposure, and health services use after the attacks. Two hundred and twelve participants completed the phone interview. The prevalence of probable PTSD was 26.4%. Being locked down during the attack and the level of exposure were associated with probable PTSD (OR = 2.32 [1.17-4.59], p = 0.016 and OR = 1.49 [1.10-2.03], p = 0.010 respectively). Lockdown was especially associated with symptoms suggesting adrenergic hyperactivation (startle at surprise, dreams about the event). General and mental health services use was frequent among our sample (83% consulted either their GP or a mental health professional), but people living alone tend to use these health services more infrequently than these living with others. Though necessary, measures taken to protect victims, such as lockdown, may foster PTSD. Victims of terror attacks having been subjected to lockdown may have experienced powerlessness, fostering prolonged stress and fear. These victims may benefit from mental health support over the following months.

Evaluating the mental health of children in a local hospital outpatient clinic

BACKGROUND

The 30-item Questionnaire for Triage and Assessment (QTA30) is a standardized triage and assessment tool for assessing pediatric psychosomatic disorders. It is estimated that one in 10 children in Japan experience difficulties in their school life. Using the QTA30 we evaluated mental health in children at an outpatient clinic in a local hospital.

METHODS

All elementary and junior high school students (≥9 years) who visited our institution between December 1 2019 and March 31 2020 were asked to complete the QTA30.

RESULT

A total of 372 children responded. Half of the children with a psychosomatic disorder and 9% of children with other chronic disorders were suspected to have poor mental health. Suspected poor mental health was associated with higher odds of female gender (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.07-3.39), junior high school students (OR: 3.73, 95% CI: 2.11-6.73), and not enjoying exercise (OR: 2.13, 95% CI: 1.16-3.9). The mean ± standard deviation total QTA30 score was significantly worse in children with psychosomatic disorders (38.0 ± 19.1) among children with other chronic diseases; however, only the score in children with central precocious puberty (27.4 ± 13.7) showed no difference.

CONCLUSION

Based on our survey, the percentage of children suspected to have mental health problems manifesting as non-psychosomatic chronic disorders was similar to the proportion of children suspected to experience difficulties with their school life. Pediatricians should carefully consider the possibility of mental health problems when children are seen in regular visits to the outpatient clinic.

Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

Fear of missing out (FoMO) mediate relations between social self-efficacy and life satisfaction

The purpose of this study was to examine whether fear of missing out (FoMO) mediate relations between social self-efficacy and life satisfaction among undergraduates. The participants involved 323 undergraduates (female, 66.3%; male, 33.7%). The age of participants ranged between 18 and 32 years (M = 21.52, SD = 2.69). The study data was gathered using the Fear of Missing out Scale, the Social Efficacy and Social Outcome Expectation Scale and the Satisfaction with Life Scale. The research data were analyzed using the structural equation model and bootstrapping method. As a result of the structural equation model, FoMO mediates the relationship between social self-efficacy and life satisfaction. As a result of the bootstrapping analysis, it was seen that all direct and indirect effects are significant. The results, recommendations, and limitations of the study were discussed.

The negative association between trait mindfulness and post-traumatic stress disorder: A 4.5-year prospective cohort study

OBJECTIVE

Post-traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to investigate the association between trait mindfulness and PTSD over a period of 54 months. The secondary objective is to provide an exhaustive description of PTSD trajectories after the Bataclan attack.

METHODS

We designed a prospective cohort study of 133 subjects present in the Bataclan concert hall during the November 2015 terrorist attack in Paris, France. Data were recorded 6, 18, 30, and 54 months after the attack. The primary endpoint was evaluated using the PTSD Check List Scale. Trait mindfulness was measured by the 14-item Freiburg Mindfulness Inventory.

RESULTS

FMI scores were consistently, significantly, and negatively associated with PCL-5 scores. Adjusted odds ratios were at 0.81 (6 months), 0.88 (18 months) 0.82 (30 months), and 0.81 (54 months). PTSD prevalence 6 months after the event was 77%; it remained at 41% after 54 months. PTSD status of subjects is fluctuating. Latent class analysis divided the cohort into 3 groups: 21% of subject who remained below PTSD threshold throughout, 30% who remained above throughout, and 49% who steadily reduced their PTSD scores over time.

CONCLUSION

In our cohort, mindfulness is negatively associated with PTSD. Mindfulness programs are designed to improve global resilience and treat anxiety and mood disorders. Further research is needed to investigate if improving trait mindfulness is possible and beneficial for patients suffering from PTSD.

Unpacking the impact of the COVID-19 pandemic: identifying structural domains

Background: The novel coronavirus-19 (COVID-19) pandemic is a collective crisis that imposed an abrupt and unprecedented impact on college students, as universities were closed with little warning. Paired with the challenges associated with physical distancing (e.g. economic stress, job loss, food insecurity, housing challenges) and the simultaneous need to balance continued and new academic demands, impact will be wide-ranging. It is critical to determine the structure of the impact of this heterogeneous stressor (e.g. health concerns, pandemic worry, financial concerns) for prevention and intervention planning. Objective: Through an existing recruitment pipeline we were in a unique position to study the wide-ranging reach of this pandemic in a cohort of students for whom their university experiences were like no other cohort in history. Method: Data were collected from students who were in their third year of college during the onset of the pandemic; of the N = 1,899 in the cohort who were invited to participate in this COVID-related survey, 897 (47.2%) completed measures of impact between May and July of 2020. Results: A series of confirmatory and exploratory models were fit to examine the structure of the pandemic-related domains. Following estimation of a single-factor model, a correlated five factors model, as well as two second-order factor structures, the five correlated factors (exposure, worry, housing/food instability, social media, substance use) model was found to represent the data most appropriately, while producing an interpretable solution. Conclusions: These measurement model analyses set the stage for future research to examine how these correlated factors impact psychiatric, substance, and academic outcomes in this vulnerable population.

Co-occurrence Pattern of Posttraumatic Stress Disorder and Depression in People Living With HIV: A Latent Profile Analysis

Background: The comorbidity of posttraumatic stress disorder (PTSD) and depression is common among people living with the HIV (PLWH). Given the high prevalence and serious clinical consequences of the comorbidity of these two disorders, we conducted a latent profile analysis to examine the co-occurrence pattern of PTSD and depression in PLWH.

Methods: The data for this cross-sectional study of PLWH were collected from 602 patients with HIV in China. A secondary analysis using latent profile analysis was conducted to examine HIV-related PTSD and depression symptoms.

Results: A four-class solution fits the data best, with the four classes characterized as asymptomatic (42.9%), mild symptoms (33.9%), low to moderate symptoms (19.8%), and high to moderate symptoms (3.4%). The severity of PTSD and depression symptoms was comparable in this solution, and no group was dominated by PTSD or depression.

Conclusion: The absence of a distinct subcluster of PLWH with only PTSD or depression symptoms supports that PTSD and depression in PLWH are psychopathological manifestations after traumatic exposures. Health care staff should pay more attention to the existence of comorbid symptoms of individuals, develop integrated interventions for the symptoms cluster, and evaluate their effectiveness in clinical practice.

Dopamine, endocannabinoids and their interaction in fear extinction and negative affect in PTSD

There currently exist few frameworks for common neurobiology between reexperiencing and negative cognitions and mood symptoms of PTSD. Adopting a dopaminergic framework for PTSD unites many aspects of unique symptom clusters, and this approach also links PTSD symptomology to common comorbidities with a common neurobiological deficiency. Here we review the dopamine literature and incorporate it with a growing field of research that describes both the contribution of endocannabinoids to fear extinction and PTSD, as well as the interactions between dopaminergic and endocannabinoid systems underlying this disorder. Based on current evidence, we outline an early, preliminary model that links re-experiencing and negative cognitions and mood in PTSD by invoking the interaction between endocannabinoid and dopaminergic signalling in the brain. These interactions between PTSD, dopamine and endocannabinoids may have implications for future therapies for treatment-resistant and comorbid PTSD patients.

Mitigating adolescent social anxiety symptoms: the effects of social support and social self-efficacy in findings from the Young-HUNT 3 study

Adolescents' exposure to negative life events (NLEs) and potentially traumatic events is highly prevalent and increases their risk of developing psychological disorders considerably. NLE exposure has also been linked to the development of social anxiety disorder (SAD) among older children and young adolescents. Despite the relatively low treatment efficacy reported for children and adolescents suffering from SAD, few studies have addressed the extent to which resilience factors, such as social support and social self-efficacy, are associated with SAD symptoms. This study examined whether social support and social self-efficacy predict, and buffer against SAD symptoms using a large, population-based sample of adolescents, among whom a large proportion have experienced NLEs. The results reveal that NLEs are significantly associated with SAD symptoms, while social support and social self-efficacy are both negatively associated with SAD symptoms. Only the NLEs × social support interaction significantly predicted SAD symptoms, with social support attenuating the association between NLEs and SAD symptoms. Moreover, increases in both social self-efficacy and social support were associated with reduced SAD symptoms, over and above variance explained by social support alone. Our cumulative results suggest that interventions that can modify both social support and social self-efficacy may help reduce SAD symptoms in at-risk adolescents.

Goal-Oriented Attention Self-Regulation Training Improves Executive Functioning in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

Difficulties in executive-control functions are common sequelae of both traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The goal of this study was to assess whether a cognitive rehabilitation training that was applied successfully in civilian and military TBI would be effective for military Veterans with comorbid PTSD and mild TBI (mTBI). In the previous study, Veterans with a history of mild to severe TBI improved significantly after goal-oriented attentional self-regulation (GOALS) training on measures of attention/executive function, functional task performance, and emotional regulation. The objective of this study was to assess effects of GOALS training in Veterans with comorbid PTSD and mTBI. Forty Veterans with a current PTSD diagnosis and history of mTBI (6+ months post) were randomized to either five weeks of GOALS or Brain-Health Education (BHE) training matched in time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance, and self-report measures of emotional functioning/regulation. After GOALS but not BHE training, participants significantly improved from baseline on primary outcome measures of: overall complex attention/executive function neuropsychological performance composite (F = 12.35, p = 0.001; Cohen d = 0.48), and overall mood disturbance -POMS emotional regulation self-report (F = 4.29, p = 0.05, Cohen d = 0.41). In addition, GOALS but not BHE participants indicated a significant decrease in PTSD symptoms (PCL-M Total Score) (F = 4.80, p = 0.05, Cohen d = 0.60), and demonstrated improvement on complex functional task performance-GPS Learning and Memory (F = 5.06, p = 0.05, Cohen d = 0.56]. Training in attentional self-regulation applied to participant-defined goals may improve cognitive functioning in Veterans with comorbid PTSD and mTBI. Improving cognitive control functioning may also improve functioning in other domains such as emotional regulation and functional performance, potentially making it particularly relevant for Veterans with a history of mTBI and comorbid psychiatric symptoms.

A psychological health support scheme for medical teams in COVID-19 outbreak and its effectiveness

Background

Medical staff fighting the COVID-19 pandemic are experiencing stress from high occupational risk, panic in the community and the extreme workload. Maintaining the psychological health of a medical team is essential for efficient functioning, but psychological intervention models for emergency medical teams are rare.

Aims

To design a systematic, full-coverage psychological health support scheme for medical teams serving large-scale emergent situations, and demonstrate its effectiveness in a real-world study in Leishenshan Hospital during the COVID-19 epidemic in Wuhan, China.

Methods

The scheme integrates onsite and online mental health resources and features team-based psychosocial support and evidence-based interventions. It contained five modules, including a daily measurement of mood, a daily mood broadcast that promotes positive affirmation, a daily online peer-group activity with themes based on the challenges reported by the team, Balint groups and an after-work support team. The daily mood measurement provides information to the other modules. The scheme also respects the special psychological characteristics of medical staff by promoting their strengths.

Results

The scheme economically supported a special medical team of 156 members with only one onsite psychiatrist. Our data reflected that the entire medical team maintained an overall positive outlook (7–9 out of 10 in a Daily Mood Index, DMI) for nearly 6 weeks of continuous working. Since the scheme promoted self-strengths and positive self-affirmation, the number of self-reports of life-related gains were high and played a significant effect on the DMI. Our follow-up investigations also revealed that multiple modules of the scheme received high attention and evaluation levels.

Conclusion

Our quantitative data from Leishenshan hospital, Wuhan, China, show that the programme is adequate to support the continuous high workload of medical teams. This scheme could be applied to medical teams dealing with emergent situations.

Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature

Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.

The role of alexithymia in the mental health problems of home-quarantined university students during the COVID-19 pandemic in China

Objective

While it is well known that mental health problems are common consequences of deadly pandemics, the association with alexithymia is less clear. This study examined this association in an evaluation of home-quarantined university students during the 2019/2020 COVID-19 pandemic in China.

Methods

In total, 2501 home-quarantined students from six southwest Chinese universities completed the following questionnaires: the 20-item Toronto Alexithymia Scale (TAS-20), the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL—C), and the Patients Health Questionnaire-9 (PHQ-9), after which structural equation modeling (SEM) and mediation analyses were employed to extract and evaluate the possible associations.

Results

It was found that participants with probable depression or PTSD also reported more severe alexithymia features, such as difficulties in identifying feelings (DIF) or describing feelings (DDF). Alexithymia was also found to partially mediate the effect of number of exposures on mental health problems.

Conclusion

These results suggested that implementing strategies to assist young people identify and deal with their own emotions and those of others could prevent or mitigate the mental health problems associated with deadly pandemic events. However, future longitudinal studies are needed to examine the specific involvement of DIF or DDF in people with mental health problems.

Risk and protective factors associated with comorbid PTSD and depression in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Converging evidence suggests that veterans with co-occurring PTSD/MDD represent a high-risk group for poor mental health compared to those with PTSD alone. To date, however, little is known about the specific factors that may increase vulnerability for and buffer risk for comorbid PTSD/MDD. The purpose of this study was to provide a population-based characterization of sociodemographic, risk, and protective variables associated with comorbid PTSD/MDD among U.S. military veterans. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans (n = 2,732). Analyses (1) compared veterans with PTSD alone and co-occurring PTSD/MDD on sociodemographic, military, and psychosocial characteristics; and (2) examined variables independently associated with PTSD/MDD status. Multivariable logistic regression analyses revealed that racial/ethnic minority status (odds ratio [OR] = 12.5), number of lifetime traumas (OR = 1.3), and time spent engaged in private religious/spiritual activities (OR = 1.8) were associated with PTSD/MDD status, while higher scores on measures of community integration (OR = 0.6) and dispositional optimism (OR = 0.7) were negatively associated with comorbid PTSD/MDD status. Relative importance analyses revealed that dispositional optimism (34%) and community integration (24%) explained the largest proportions of variance in PTSD/MDD comorbidity. Taken together, results of this study suggest that racial/ethnic minority status, greater lifetime trauma burden, and engagement in private religious/spiritual activities are key distinguishing characteristics of U.S. military veterans with comorbid PTSD/MDD vs. PTSD alone. They further underscore the need to study whether targeting community integration and optimism in prevention and treatment efforts may enhance clinical outcomes in this population.