The impact of depression and PTSD symptom severity on trauma memory

Neuroticism and posttraumatic stress disorder: A Mendelian randomization analysis

OBJECTIVE

Epidemiological studies revealed an unestablished association between neuroticism and posttraumatic stress disorder (PTSD) and we conducted mendelian randomization (MR) analyses to examine whether neuroticism clusters of worry, depressed affect, and sensitivity to environmental stress and adversity (SESA) were involved in the development of PTSD.

METHOD

We obtained data on three neuroticism clusters, PTSD, and nine other psychiatric disorders from genome-wide association studies summary statistics and employed univariable, multivariable, and mediation MR analyses to explore causal associations among them.

RESULTS

Neuroticism clusters were linked with PTSD (depressed affect (odds ratio [OR]: 2.94 [95% confidence interval: 2.21-3.92]); SESA (2.69 [1.95-3.71]; worry (1.81 [1.37-2.99])). Neuroticism clusters were also associated with psychiatric disorders, with the depressed effect on panic disorder (PD) (2.60 [1.14-5.91]), SESA on anorexia nervosa (AN) (2.77 [1.95-3.94]) and schizophrenia (2.55 [1.99-3.25]), worry on major depressive disorder (MDD) (2.58 [2.19-3.05]). In multivariable MR, only the SESA-PTSD association remained (2.60 [2.096, 3.107]) while worry-PTSD and depressed affect-PTSD associations attenuated to nonsignificance. Mediation MR analyses suggested that PD mediated 3.76% of the effect of depressed effect on PTSD and AN mediated 10.33% of the effect of SESA on PTSD.

CONCLUSION

Delving deeper into neuroticism clusters, we comprehensively understand the role of neuroticism in PTSD.

Do positive memory characteristics influence daily-level trajectories of posttraumatic stress disorder symptoms? an exploratory daily diary study

BACKGROUND AND OBJECTIVES

Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time.

DESIGN AND METHODS

A sample of 238 trauma-exposed participants (Mage = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys.

RESULTS

Days with greater PTSD symptom severity than an individual's average associated with less vividness (b = -0.02, p < .001) and accessibility (b = -0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = -1.06, p < .001) and accessibility (b = -0.93, p < .001) than an individual's average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = -0.04, p  = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days.

CONCLUSIONS

Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.

Effect of Emotional Content on Memory Characteristics: Emotional Valence, Emotional Intensity, and Individual Emotions

The aim of the present study is to examine the relationships between the emotional valence and emotional intensity of autobiographical memories and the phenomenological characteristics of memories in the context of individual emotions and memory types. Seven hundred and sixty-four students (514 female, 250 male) from Dokuz Eylul University participated in the study. Participants were asked to recall an childhood memory, a self-defining memory, or a romantic relationship memory. After thinking about the memory they remember, they were requested to fill out the Autobiographical Memory Characteristics Questionnaire and a scale for intensity of individual emotions. Regression analyses showed that emotional intensity of the memories predicted the sensory details, rehearsal, and preoccupation with emotions. In moderated-mediation analyses, mediating effects for emotional intensity were detected between individual emotions and memory characteristics, except for the negative self-esteem emotions. Among these analyses, a moderating effect of memory types was detected only for the relationships between hostile emotions and anxiety-related emotions and the memory characteristics through the mediation of emotional intensity. While the intensity of singular emotions showed stronger relationship with emotional valence, the main variable that predicted memory characteristics overall was the emotional intensity.

Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention

Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.

Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak

BACKGROUND

Nurses tend to experience a lot of Secondary Traumatic Stress (STS) during the outbreak of the COVID-19. This study aimed to evaluate the prevalence of STS and comparing depression, anxiety, and Suicidal Ideation (SI) in nurses with and without STS symptoms during the COVID-19 outbreak.

METHOD

The research method of this study was descriptive-comparative. The statistical sample consisted of 315 nurses working in hospitals of Malayer city, western Iran, selected through census method. Data were collected using the STS Scale, Beck's Depression Inventory (BDI-13), Anxiety Inventory (BAI), and SI scale. Data were analyzed using the independent t-test, multivariate analysis of variance (MANOVA), and multivariate analysis of covariance (MANCOVA).

RESULTS

This study showed that 161 nurses (51.11%) had symptoms of STS. The prevalence of STS symptoms in nurses in emergency, ICU/CCU, medical emergencies, and other wards was 62.27%, 62.02%, 51.61%, and 26.32%, respectively. The results of the MANCOVA showed that the nurses with STS symptoms received higher scores in depression, anxiety, and SI than the ones without STS symptoms (p < 0.01).

CONCLUSION

Hospital authorities and nursing psychiatrists should pay more attention to the STS symptoms in nurses during the COVID-19 outbreak, and its effects on depression, anxiety, and SI.

Web-Based Assessment of the Phenomenology of Autobiographical Memories in Young and Older Adults

Autobiographical memories (ABMs) produce rich phenomenological experiences. Although few standardized and comprehensive measures of the phenomenology of ABMs have been developed, a web-based assessment of the full range of phenomenological properties is still missing. In the present study, we aimed to fill this gap and tested the psychometric properties of a web-based version of the Assessment of the Phenomenology of Autobiographical Memory (APAM) in a group of young and older adults. Specifically, taking advantage of the flexibility of web-based assessment methodology, we tested the rating consistency of APAM items, asking participants to rate the phenomenology of their ABMs with respect to seven cues, administered in one per day in seven different days. In each session, we also collected ratings of mood and arousal. Using linear mixed modeling (LMM), we could examine whether the phenomenology ratings differed with respect to age group while controlling for sex, age of the memory, arousal, mood, and specificity of the memory. Results revealed an adequate level of consistency of ratings in both young and older adults. Moreover, LMMs revealed a more intense experience of recollection and reliving (i.e., sensory and emotional) and a higher confidence in memory accuracy in older compared to younger adults. The theoretical and practical usefulness of a web-based assessment of the phenomenology of ABMs are discussed.

Associations between memory loss and trauma in US asylum seekers: A retrospective review of medico-legal affidavits

BACKGROUND

The U.S. immigration system mandates that persons seeking asylum prove their persecution claim is credible and their fear of returning home is well-founded. However, this population represents a highly trauma-exposed group, with neuropsychiatric symptoms consequent to prior torture or maltreatment that may interfere with cognitive function and their ability to recall their trauma. These memory lapses may be incorrectly perceived by asylum adjudicators as indicators of dishonesty and jeopardize the person's credibility and asylum claim. Our retrospective mixed methods study seeks to present associations between trauma and memory loss in a sample of persons seeking asylum to the U.S. and describe how memory impairments manifest in this trauma-exposed population.

METHODS

We randomly selected 200 medico-legal affidavits from 1346 affidavits collected in the past 30 years, as part of the Physicians for Human Rights Asylum Network connecting clinicians with legal providers for medical and/or psychiatric affidavits of U.S. asylum seekers and persons seeking other forms of humanitarian relief (hereafter, "asylum seekers"). Data was extracted from these affidavits using a coding manual informed by the Istanbul Protocol, the global standard for torture documentation. Seven affidavits were excluded due to missing age. We used multiple logistic regression to assess the association of memory loss with neuropsychiatric diagnoses: head trauma, post-traumatic stress disorder (PTSD), and depression. We supplemented these findings with a qualitative content analysis of the affidavits documenting memory loss. Memory loss presented among the asylum seekers' affidavits in several ways: memory gaps of the traumatic event; challenges with presenting a clear chronology of the trauma, avoidance of traumatic memories, and persistent short-term memory loss interfering with daily activity.

RESULTS

A majority of the sample received a neuropsychiatric diagnosis: 69% (n = 132) of asylum-seekers received a diagnosis of PTSD and 55% (n = 106) of depression. Head trauma was reported among 30% (n = 58) of affidavits. Further, 68% (n = 131) reported being subject to physical violence and 20% (n = 39) were documented as being at risk of suicide. Memory loss was documented among 21% (n = 40) asylum-seekers. In adjusted models, both PTSD and depression, but not head trauma, were associated with memory loss (p<0.05).

CONCLUSION

Stakeholders in the asylum process, spanning the medical, legal and immigration enforcement sectors, must be aware of the interplay of trauma and memory loss and how they might impact immigration proceedings for this vulnerable population.

Clinical efficacy of trauma-focused psychotherapies in treatment-resistant depression (TRD) in-patients: A randomized, controlled pilot-study

In major depressive disorder (MDD) patients, life stress events represent a risk factor for a severe, early-onset, treatment-resistant and chronic endophenotype. Treatment-resistant depression (TRD) patients who have experienced traumatic events could benefit from evidence-based trauma-focused psychotherapies. Because this topic has never been investigated, the aim of this pilot trial was to evaluate whether trauma-focused cognitive-behavioural therapy (TF-CBT) and/or eye movement desensitization and reprocessing (EMDR) can help achieve depressive symptom remission in TRD patients. We carried out a single-blind randomized controlled trial with TRD patients and we compared EMDR (N = 12) with TF-CBT (N = 10). Patients received 3 individual sessions per week over a period of 8 weeks. The symptomatological assessments were performed at 4 timepoints: baseline (T0), 4 (T4), 8 (T8) and 12 (T12) weeks. After 24 weeks, a clinical interview was carried out by phone. All TRD patients showed a significant improvement in depressive symptomatology; however, post hoc comparisons showed a significant difference between the two treatment groups, with lower depressive symptom scores in the EMDR than in the TF-CBT group at the follow-up (T12). This effect was partly maintained at 24 weeks. This pilot study suggests that evidence-based trauma-focused psychotherapies, particularly EMDR, can represent effective interventions to treat TRD patients.

Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing-which is epitomized by, but not limited to, flashbacks-is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self-referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.

Stressful Life Memories Relate to Ruminative Thoughts in Women With Sexual Violence History, Irrespective of PTSD

More than one in every four women in the world experience sexual violence (SV) in their lifetime, most often as teenagers and young adults. These traumatic experiences leave memories in the brain, which are difficult if not impossible to forget. We asked whether women with SV history experience stronger memories of their most stressful life event than women without SV history and if so, whether strength relates to ruminative and trauma-related thoughts. Using the Autobiographical Memory Questionnaire (AMQ), women with SV history (n = 64) reported this memory as especially strong (p < 0.001), remembering more sensory and contextual details, compared to women without SV history (n = 119). They further considered the event a significant part of their personal life story. The strength of the memory was highly correlated with posttraumatic cognitions and ruminative thoughts, as well as symptoms of depression and anxiety (p's < 0.001, n = 183). A third (33%) of the women with SV history were diagnosed with posttraumatic stress disorder (PTSD), but PTSD alone did not account for the increase in memory strength (p's < 0.001). These data suggest that the experience of SV increases the strength of stressful autobiographical memories, which are then reexperienced in everyday life during posttraumatic and ruminative thoughts. We propose that the repeated rehearsal of vivid stressful life memories generates more trauma memories in the brain, making the experience of SV even more difficult to forget.