Incidence and predictors of acute psychological distress and dissociation after motor vehicle collision: a cross-sectional study

A Wellness Prescription for Parkinson's: Mid to Late-Stage Disease

The mid- to late-stages of Parkinson's disease (PD) bring increasing disability that may challenge independence and lower quality of life. Many people with PD struggle to remain hopeful and cope with an uncertain future due to the progression of the disease. Although disability in PD is due chiefly to motor impairment, nonmotor symptoms and psychosocial distress are also major contributors that are amenable to treatment. Interventions that address nonmotor symptoms and psychosocial distress can improve daily function and quality of life even as motor function worsens with disease progression. This manuscript proposes a patient-centered, proactive strategy to promote psychosocial adaptation to decrease the impact of motor, nonmotor, and psychosocial distress on quality of life and function in people with PD.

Experimental induction of peritraumatic dissociation: The role of negative affect and pain and their psychophysiological and neural correlates

While research has elucidated processes underlying dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises. To experimentally investigate causes and concomitants of peritraumatic dissociation, we subjected sixty-nine healthy women to aversive-audiovisual and painful-electrical stimulation in a 2(aversive/neutral film) x 2(pain/no pain) within-subject design while recording psychophysiological and fMRI-BOLD responses. Afterwards, participants rated negative-affect, pain, and dissociation for each condition. Using Bayesian multilevel regression models, we examined (1) whether aversive-audiovisual and painful-electrical stimulation elicit higher dissociation-levels than control conditions and (2) whether stronger negative-affect and pain responses (operationalized via self-report, psychophysiological, and neural markers) correlate with higher dissociation-levels. Several key findings emerged: Both aversive-audiovisual and painful-electrical stimulation elicited dissociation. Dissociation was linked to higher self-reported negative-affect, but we did not find enough evidence linking it to psychophysiological and neural negative-affect markers. However, dissociation was associated with higher levels of self-reported pain, a skin-conductance-response-based pain marker, and the fMRI-BOLD-based Neurologic-Pain-Signature. Results indicate that both aversive-audiovisual and painful stimuli can independently cause dissociation. Critically, pain responses captured via self-report, psychophysiological, and neural markers were consistently linked to higher dissociation-levels suggesting a specific, evolutionary meaningful, contribution of pain to the rise of dissociation.

Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape

Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R² = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R² = .619; p < .001) and depressive symptoms (R² = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.

Injury perceptions and their association with recovery outcomes in adults with traumatic orthopaedic injuries: a scoping review

PURPOSE

How people perceive their injury may be associated with recovery. This scoping review used the Common Sense Model of Illness Perceptions (CSM) as a framework to: (1) characterise injury perceptions; (2) describe biopsychosocial factors related to injury perceptions, and (3) determine how injury perceptions are associated with recovery outcomes.

MATERIALS AND METHODS

A broad search strategy was used across eight databases to identify studies exploring injury perceptions and related concepts in adults with traumatic orthopaedic injuries. Two reviewers independently screened and extracted data. Quality appraisal was performed using the Mixed Methods Appraisal Tool.

RESULTS

The search yielded 9736 records, of which 22 publications were included; 12 quantitative and 10 qualitative studies. Overall, the quality of the evidence was low to moderate. Consistent with the CSM, injury perceptions comprised beliefs relating to the injury diagnosis, consequences, causes, recovery duration, and treatments. Perceptions of injury were multidimensional and influenced by personal, inter-personal, and socio-cultural factors. Negative injury perceptions were associated with worse functional outcomes.

CONCLUSIONS

Although this review provided some insight into the characteristics of injury perceptions, relationships between injury perceptions and recovery, and characteristics of perceptions across different socio-cultural or clinical settings are still poorly understood.Implications for rehabilitationA person's perception of their injury is complex; it emerges from dynamic interactions between personal, interpersonal and socio-cultural elements.People who perceive that their injury represents a threat to them typically report higher pain, negative affect, and worse general health than people with more positive perceptions of injury.Rehabilitation providers should consider how they might positively influence perceptions of traumatic orthopaedic injury.Perceptions of injury might be influenced at the individual level (e.g., during healthcare encounters), or at a system level, such as through endorsement of codes of practice for rehabilitation clinicians or funding of psychologically informed treatments to help people better understand their injuries.

Exploring Social Determinants of Posttraumatic Pain, Distress, Depression, and Recovery Through Cross-Sectional, Longitudinal, and Nonlinear Trends

OBJECTIVES

Pain, distress, and depression are predictors of posttrauma pain and recovery. We hypothesized that pretrauma characteristics of the person could predict posttrauma severity and recovery.

METHODS

Sex, age, body mass index, income, education level, employment status, pre-existing chronic pain or psychopathology, and recent life stressors were collected from adults with acute musculoskeletal trauma through self-report. In study 1 (cross-sectional, n=128), pain severity was captured using the Brief Pain Inventory (BPI), distress through the Traumatic Injuries Distress Scale (TIDS) and depression through the Patient Health Questionnaire-9 (PHQ-9). In study 2 (longitudinal, n=112) recovery was predicted using scores on the Satisfaction and Recovery Index (SRI) and differences within and between classes were compared with identify pre-existing predictors of posttrauma recovery.

RESULTS

Through bivariate, linear and nonlinear, and regression analyses, 8.4% (BPI) to 42.9% (PHQ-9) of variance in acute-stage predictors of chronicity was explainable through variables knowable before injury. In study 2 (longitudinal), latent growth curve analysis identified 3 meaningful SRI trajectories over 12 months. Trajectory 1 (start satisfied, stay satisfied [51%]) was identifiable by lower TIDS, BPI, and PHQ-9 scores, higher household income and less likely psychiatric comorbidity. The other 2 trajectories (start dissatisfied, stay dissatisfied [29%] versus start dissatisfied, become satisfied [20%]) were similar across most variables at baseline save for the "become satisfied" group being mean 10 years older and entering the study with a worse (lower) SRI score.

DISCUSSION

The results indicate that 3 commonly reported predictors of chronic musculoskeletal pain (BPI, TIDS, PHQ-9) could be predicted by variables not related to the injurious event itself. The 3-trajectory recovery model mirrors other prior research in the field, though 2 trajectories look very similar at baseline despite very different 12-month outcomes. Researchers are encouraged to design studies that integrate, rather than exclude, the pre-existing variables described here.

Responding to Repeated Disasters: Time to Recovery in Public Health Workers

OBJECTIVE

In times of repeated disaster events, including natural disasters and pandemics, public health workers must recover rapidly to respond to subsequent events. Understanding predictors of time to recovery and developing predictive models of time to recovery can aid planning and management.

METHODS

We examined 681 public health workers (21-72 y, M(standard deviation [SD]) = 48.25(10.15); 79% female) 1 mo before (T1) and 9 mo after (T2) the 2005 hurricane season. Demographics, trauma history, social support, time to recover from previous hurricane season, and predisaster work productivity were assessed at T1. T2 assessed previous disaster work, initial emotional response, and personal hurricane injury/damage. The primary outcome was time to recover from the most recent hurricane event.

RESULTS

Multivariate analyses found that less support (T1; odds ratio [OR] = .74[95% confidence interval [CI] = .60-.92]), longer previous recovery time (T1; OR = 5.22[95%CI = 3.01-9.08]), lower predisaster work productivity (T1; OR = 1.98[95%CI = 1.08-3.61]), disaster-related personal injury/damage (T2; OR = 3.08[95%CI = 1.70-5.58]), and initial emotional response (T2; OR = 1.71[95%CI = 1.34-2.19]) were associated with longer recovery time (T2).

CONCLUSIONS

Recovery time was adversely affected in disaster responders with a history of longer recovery time, personal injury/damage, lower work productivity following prior hurricanes, and initial emotional response, whereas responders with social support had shorter recovery time. Predictors of recovery time should be a focus for disaster preparedness planners.

The role of specific sources of social support on postinjury psychological symptoms

PURPOSE/OBJECTIVE

The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury.

RESULTS

Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family.

CONCLUSIONS/IMPLICATIONS

MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trait dissociation as a predictor of induced dissociation by ketamine or esketamine in treatment-resistant depression: Secondary analysis from a randomized controlled trial

Dissociative symptoms are common, possibly severe, side effects associated with the use of ketamine and esketamine in depression. We investigated the relationship between trait dissociation and dissociation induced by ketamine and esketamine used as augmentation therapy in treatment-resistant depression (TRD). Adults with TRD were randomly assigned to receive a single intravenous infusion, with a duration of 40 min, of either esketamine 0.25 mg/kg or ketamine 0.5 mg/kg. We assessed trait dissociation with the Dissociative Experience Scale (DES) and, to evaluate induced dissociation, the Clinician-Administered Dissociative States Scale (CADSS) was used. Thirty-two subjects received esketamine and 29 received ketamine. The groups had similar median DES scores (p = 0.26). More than 30% of the patients in both groups had DES scores ≥30 points. The median CADSS score in the esketamine group was equivalent to that in the ketamine group (p = 0.40). Every 5 points increment in the DES was associated with a 10.9% (95% CI 4.5-17.8%) increase in the CADSS, in an exponential fashion when the two groups were pooled together. Subjects with high trait dissociation had a higher risk of induced dissociation state (relative risk [RR] 1.41, 95% CI 1.11-1.78) and very high induced dissociation (RR 3.05, 95% CI 1.14-8.15). Induced dissociation was not a serious adverse effect. The findings suggest that trait dissociation is a predictor of induced dissociation by Ketamine or Esketamine in TRD subjects. Screening for trait dissociation and counseling patients with high trait dissociation on the risks of dissociation by these drugs are recommended.

Positive cognitive appraisal "buffers" the long-term effect of peritraumatic distress on maternal anxiety: The Queensland Flood Study

BACKGROUND

Limited research has evaluated distinct aspects of disaster experience as predictors of affective symptoms. In this study, we examined the extent to which maternal depression and anxiety over time were predicted by (1) objective hardship from a flood during pregnancy, (2) peritraumatic distress and (3) cognitive appraisal of the flood's consequences.

METHODS

Data were drawn from the 2011 Queensland Flood Study, a prospective, longitudinal study of pregnancy (n = 183). Mothers' disaster experience was measured within 1 year after the flood. Their levels of depression, anxiety and stress were measured at 16 months, 30 months, 4 years and 6 years after childbirth. Linear mixed models were employed to evaluate symptom trajectories.

RESULTS

There were no time-dependent effects of disaster-related variables. Objective hardship did not predict outcomes. Peritraumatic distress significantly predicted depression and anxiety symptoms when cognitive appraisal was negative. Conversely, when cognitive appraisal was neutral or positive, the effect of peritraumatic distress was "buffered". For anxiety, but not depression, this interaction survived Bonferroni correction. Neutral/positive cognitive appraisal similarly moderated the effect of peritraumatic dissociation.

LIMITATIONS

The generalizability of our findings is limited by overall low levels of depression and anxiety, along with a predominantly Caucasian, higher socioeconomic status sample. Potential confounders such as pre-disaster anxiety were not controlled for.

CONCLUSION

In line with previous evidence, this study supports the predictive validity of peritraumatic distress for post-disaster depression and anxiety. Our findings suggest that cognitive appraisal could be a relevant target for interventions aimed at fostering maternal resilience.

A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury

OBJECTIVE

Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients.

METHODS

From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment.

RESULTS

Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months.

CONCLUSIONS

We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.

Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19

Purpose

Health care professionals, particularly nurses, are considered a vulnerable group to experience acute stress disorder (ASD) and subsequent psychological distress amid COVID‐19 pandemic. This study aims to establish the prevalence of acute stress disorder and predictors of psychological distress among Jordanian nurses.

Methods

A quantitative, cross‐sectional, descriptive and comparative design was used. Data were collected using a Web‐based survey. A total of 448 Jordanian nurses (73% females) completed and returned the study questionnaire.

Results

The majority of nurses (64%) are experiencing ASD due to the COVID‐19 pandemic and thus are at risk for PTSD predisposition. More than one‐third of nurses (41%) are also suffering significant psychological distress. Among our sample, age, ASD and coping self‐efficacy significantly predicted psychological distress. More specifically, younger nurses are more prone to experience psychological distress than older ones. While higher scores on ASD showed more resultant psychological distress, coping self‐efficacy was a protective factor.

Conclusion

Given that individuals who suffer from ASD are predisposed to PTSD, follow‐up with nurses to screen for PTSD and referral to appropriate psychological services is pivotal. Coping self‐efficacy is found to ameliorate the effect of psychological distress on nurses' traumatic experience. Such findings warrant intensive efforts from health care institutions to provide psychosocial support services for nurses and ongoing efforts to screen them for traumatic and psychological distress symptoms.

Implications for Nursing Management

Nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID‐19 crisis. They need to implement stress‐reduction strategies for nurses through providing consecutive rest days, rotating allocations of complex patients, arranging support services and being accessible to staff. They also need to ensure nurses' personal safety through securing and providing personal safety measures and undertake briefings to ensure their staff's physical and mental well‐being, as well as providing referrals to appropriate psychological services.

Pain and Evil: From Local Nociception to Misery Following Social Harm

Experiencing pain, especially when chronic, is an excruciating condition that should be regarded as a syndrome, if not a disease. People suffering from chronic pain tend to develop psychological discomfort mostly due to lack of acceptance, disbelief, blame. The complexity of pain pathophysiology, plus a wide range of negative psychosocial factors, leads to a more complex suffering that deserves attention and multidisciplinary treatments. The possibility that chronic pain may occur following physical aggression, torture, or persecution raises the issue of evil as a major contributor to pain in its worst representation - when individuals or groups are attacked based on racial, social, gender, religious, political, or other grounds. To explore the complex issue of chronic pain following physical or psychological harm, and to underscore the need for a multidisciplinary approach to reduce the burden of chronic pain, we discuss the biological mechanisms underlying pain state. We seek to clarify those factors leading to pain chronification, as well as personal and social attitudes that confound patients with chronic pain. The importance of family and social environment is also investigated, as well as personality traits of chronic pain patients that may further hamper successful treatment. The presence of chronic pain, modulated by, for example, acceptance of being a victim of premeditated physical and social violence, makes the issue more difficult to comprehend.

The Association between General and Pathological Dissociation and Disaster-Related Psychopathology in Directly Exposed Survivors

Objective: Dissociation and trauma have a well-documented relationship, and dissociation is assumed to result from trauma exposure. If trauma generates dissociative psychopathology, it should be observed after exposure to disaster and be associated with disaster-related psychopathology. Few studies have focused specifically on dissociation as an outcome of disaster trauma. This study examined dissociation and its association with disaster-related psychopathology in survivors of five different disasters. Methods: In the first 6 postdisaster months, directly exposed survivors (N = 216) of mass shootings, floods, or a firestorm completed structured diagnostic interviews providing lifetime predisaster and postdisaster prevalent/incident psychiatric diagnoses and the Dissociative Experiences Scale (DES) 1-3 years after baseline. Results: DES scores were very low; only 1% met the DES Taxon signifying pathological dissociation. In multivariate models including predisaster lifetime major depression, lifetime panic disorder, lifetime generalized anxiety disorder, and lifetime alcohol use disorder; disaster-related PTSD; and number of incident somatoform symptoms as independent covariates, predisaster lifetime major depression and alcohol use disorder were independently associated with both general (DES score) and pathological (DES Taxon) dissociation, and postdisaster incident somatization symptoms were also associated with general dissociation, but postdisaster psychopathology including disaster-related PTSD was not associated with general or pathological dissociation. Conclusions: Neither general nor pathological dissociation was independently associated with disaster-related PTSD or other incident psychopathology. The only psychiatric disorders associated with dissociation were present before the disasters. Coupled with the low dissociation rates, these findings indicate that dissociation does not appear to be a mental health outcome of disaster trauma.

Early Screening for Posttraumatic Stress Disorder and Depression Among Injured Emergency Department Patients: A Feasibility Study

BACKGROUND

Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury.

METHODS

In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL).

RESULTS

Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL.

CONCLUSIONS

These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.

Psychological Reactions, Social Support, and Coping Styles in Pakistani Female Burn Survivors

This study was aimed to explore the level of psychological distress and posttraumatic stress among female burn survivors in Pakistan. It was also intended to study the kind of social support available to these burn survivors in a society where women right violation is common. The sample consisted of 35 female burn victims selected from two hospitals. General Health Questionnaire, posttraumatic stress disorder Checklist-Specific, and Social Support Scale were used to measure study variables in addition to a short open-ended questionnaire to identify coping strategies of these burn survivors. Consistent with the hypothesis, results found a high level of psychological reaction among female burn survivors. About one-quarter of the sample (23%) presented severe symptoms of psychological distress whereas 20% of the sample reported to experience severe posttraumatic stress disorder symptoms. There was a significant inverse relationship between psychological reactions and social support as hypothesized. Majority of female burn victims found to use emotion-focused coping (EFC) mainly including prayers, emotional discourse, and using drugs. The findings of the study would be helpful to plastic surgeons, dermatologists, psychologists, and social workers to understand the patient's psychological reactions, their copying styles, and the role of social support in the rehabilitation program for these survivors.

Peritraumatic distress: A review and synthesis of 15 years of research

CONTEXT

Although the subjective trauma exposure criterion was removed from the DSM-5 criteria set for posttraumatic stress disorder (PTSD), emerging literature suggests that peritraumatic distress may be useful in predicting outcomes after exposure to a stressful event.

METHOD

We conducted a comprehensive review of the literature examining the association between peritraumatic distress and PTSD and other psychiatric outcomes. The 57 studies herein varied in both experimental design and target populations.

RESULTS

Forty-eight studies found associations between peritraumatic distress and PTSD outcome measures, 23 found associations between peritraumatic distress and other psychiatric outcomes, and three found associations between peritraumatic distress and PTSD-related symptoms or other psychiatric outcomes after non-Criterion A stressful events by DSM-5 criteria.

CONCLUSION

Peritraumatic distress is associated with PTSD symptom severity, other psychiatric symptoms, and severity of PTSD-related symptoms after exposure to non-Criterion A events, suggesting that peritraumatic distress is a risk factor for various psychiatric outcomes and furthering our understanding of the impact of subjective experience on trauma psychopathology.

The Association between Daily Posttraumatic Stress Symptoms and Pain over the First 14-days after Injury: An Experience Sampling Study

OBJECTIVES

Psychosocial factors and responses to injury modify the transition from acute to chronic pain. Specifically, posttraumatic stress disorder symptoms (PTSS; reexperiencing, avoidance, and hyperarousal symptoms) exacerbate and co-occur with chronic pain. Yet no study has prospectively considered the associations among these psychological processes and pain reports using experience sampling methods (ESM) during the acute aftermath of injury. This study applied ESM via daily text messaging to monitor and detect relationships among psychosocial factors and post-injury pain across the first 14-days after emergency department (ED) discharge.

METHODS

We recruited 75 adults (59% male; M age = 33) who experienced a potentially traumatic injury (i.e., involving life threat or serious injury) in the past 24-hours from the EDs of two Level 1 trauma centers. Participants received 5 questions per day via text messaging from Day-1 to Day-14 post-ED discharge; three questions measured PTSS, one question measured perceived social support, and one question measured physical pain.

RESULTS

Sixty-seven participants provided sufficient data for inclusion in the final analyses, and the average response rate per subject was 86%. Pain severity score decreased from a mean of 7.2 to 4.4 over 14 days and 50% of the variance in daily pain scores was within-person. In multilevel structural equation models, pain scores decreased over time, and daily fluctuations of hyperarousal (b = 0.22, 95% CI [0.08, 0.36]) were uniquely associated with daily fluctuations in reported pain level within each person.

CONCLUSIONS

Daily hyperarousal symptoms predict same-day pain severity over the acute post-injury recovery period. We also demonstrated feasibility to screen and identify patients at risk for pain chronicity in the acute aftermath of injury. Early interventions aimed at addressing hyperarousal (e.g. anxiolytics) could potentially aid in reducing experience of pain. This article is protected by copyright. All rights reserved.

Gender Differences in Pain Experience and Treatment after Motor Vehicle Collisions: A Secondary Analysis of the CRASH Injury Study

PURPOSE

Little is known about gender differences in the treatment of pain after motor vehicle collisions (MVCs) in an emergency department (ED). We aimed to describe gender differences in pain experiences and treatment, specifically the use of opioids and benzodiazepines after ED discharge, for MVC-related pain.

METHODS

This was a secondary analysis of previously collected data from the CRASH Injury studies. We included patients who were seen and discharged from an ED after an MVC and who were enrolled in 1 of 2 multicenter longitudinal prospective cohort studies (1 black/non-Hispanic and 1 white/non-Hispanic). First, we compared the experience of pain as defined by self-reported moderate-to-severe axial pain, widespread pain, number of somatic symptoms, pain catastrophizing, and peritraumatic distress between women and men using bivariate analyses. We then determined whether there were gender differences in the receipt of prescription medications for post-MVC pain symptoms (opioids and benzodiazepines) using multivariate logistic regression adjusting for demographic characteristics, pain, and collision characteristics.

FINDINGS

In total, 1878 patients were included: 61.4% were women. More women reported severe symptoms on the pain catastrophizing scale (36.8% vs 31.0%; P = 0.032) and peritraumatic distress following the MVC (59.7% vs 42.5%; P < 0.001), and women reported more somatic symptoms than men (median, 3.9; interquartile range, 3.7-4.0 vs median, 3.3; interquartile range, 3.1-3.5; P < 0.001). Unadjusted, similar proportions of women and men were given opioids (29.2% vs 29.7%; P = 0.84). After adjusting for covariates, women and men remained equally likely to receive a prescription for opioids (relative risk = 0.83; 95% confidence interval, 0.58-1.19). Women were less likely than men to receive a benzodiazepine at discharge from an ED (relative risk = 0.53; 95% confidence interval, 0.32-0.88).

IMPLICATIONS

In a large, multicenter study of ED patients treated for MVC, there were gender differences in the acute psychological response to MVC with women reporting more psychological and somatic symptoms. Women and men were equally likely to receive opioid prescriptions at discharge. Future research should investigate potential gender-specific interventions to reduce both posttraumatic distress and the risk of developing negative long-term outcomes like chronic pain.

Predisposing and Precipitating Factors for Dissociation During Labor in a Cohort Study of Posttraumatic Stress Disorder and Childbearing Outcomes

INTRODUCTION

Peritraumatic dissociation is an important predictor of posttraumatic stress disorder (PTSD), depression, and impaired bonding following childbirth. The purpose of this study was to follow up on an earlier finding that peritraumatic dissociation in labor was associated with adverse postpartum outcomes by identifying predictors of dissociation in labor.

METHODS

This analysis used data from a prospective cohort study of primiparous women from southeast Michigan. There were 564 women included in the analysis; the primary outcome measure was the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) score measuring dissociation during labor.

RESULTS

The prevalence of dissociation in labor for this sample was 7.4%. Important predictors of dissociation in labor included both predisposing (eg, childhood maltreatment trauma, preexisting psychopathology) and precipitating (eg, perception of care, negative appraisal of labor) factors. Overall, these predictors explained 14.7% of variance in PDEQ score. In 3 separate, simple linear regression models, the PDEQ score explained 20% of variance in postpartum PTSD, 13% of variance in postpartum depression, and 9% of variance in impaired bonding.

DISCUSSION

Women with maltreatment history and PTSD are at risk to be retraumatized or overwhelmed by birth and to dissociate. Although it would be optimal to assess for dissociative coping prenatally, assessing with the PDEQ following birth could contribute to evaluation of risk for postpartum psychopathology.

Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section

Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender differences in the assessment and treatment of pain conditions in emergency care settings.