Predictors of post-traumatic stress symptoms following occupational accidents: A longitudinal study

Sickness absence after work accidents and post-traumatic stress among white-collar workers in the retail and wholesale industry; a longitudinal Swedish cohort study

BACKGROUND

Most studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers.

AIM

To examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry.

METHODS

A prospective population-based cohort study of all 192,077 such workers aged 18-67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012-2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit.

RESULTS

35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly.

CONCLUSIONS

About a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Underlying Role of Rumination-Mediated Attachment Style Plays in PTSD after TIA and Stroke

Objective: Attachment and rumination were examined as the intermediary variables on post-traumatic stress disorder and medication compliance in stroke or TIA patients. Methods: A total of 300 participants with stroke or TIA from the Second Hospital of Hebei Province were selected. Patients accomplished NIHSS, ABCD2, ECR, RSQ, and RRS on admission. After 3 months, the PCL-C and MMAS were collected. Results: In the stroke or TIA patients, the incident of PTSD was 7.7%; PTSD scores were significantly associated with attachment anxiety (r = 0.225, p < 0.01), symptom rumination (r = 0.197, p < 0.01), and obsessive thinking (r = 0.187, p < 0.01). After the Sobel test analysis and verification by the Baron and Kenny’s stepwise approach we found that ruminant mediated the relationship between attachment anxiety and PTSD; obsessive thinking mediated the relationship between attachment anxiety and PTSD. Conclusions: The relationship between attachment anxiety and PTSD was positively predicted by rumination and obsessive thinking. Adult attachment style, rumination, and PTSD scores may not predict medication compliance.

Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination

OBJECTIVE

Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination.

METHOD

As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models.

RESULTS

Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor.

CONCLUSIONS

The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.