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Hughes L, Taylor RM, Beckett AE, Lindner OC, Martin A, McCulloch J, Morgan S, Soanes L, Uddin R, Stark DP. The Emotional Impact of a Cancer Diagnosis: A Qualitative Study of Adolescent and Young Adult Experience. Cancers (Basel) 2024; 16:1332. [PMID: 38611010 PMCID: PMC11010824 DOI: 10.3390/cancers16071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The biographical disruption that occurs in adolescents and young adults following a cancer diagnosis can affect various important psychosocial domains including relationships with family and friends, sexual development, vocational and educational trajectories, and physical and emotional wellbeing. While there is evidence of the physical impact of cancer during this period, less is known about the impact on emotional wellbeing and especially on the barriers for young people accessing help and support. We aimed to obtain a more in-depth understanding of young people's experiences of their diagnosis, treatment, psychological impact, and range of resources they could or wanted to access for their mental health. We conducted an in-depth qualitative study using semi-structured interviews with 43 young people who had developed cancer aged 16 to 39 years and were either within 6 months of diagnosis or 3-5 years after treatment had ended. Framework analysis identified three themes: the emotional impact of cancer (expressed through anxiety, anger, and fear of recurrence); personal barriers to support through avoidance; and support to improve mental health through mental health services or adolescent and young adult treatment teams. We showed the barriers young people have to access care, particularly participant avoidance of support. Interrupting this process to better support young people and provide them with flexible, adaptable, consistent, long-term psychological support has the potential to improve their quality of life and wellbeing.
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Affiliation(s)
- Luke Hughes
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Rachel M. Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
- Department of Targeted Intervention, University College London, London WC1E 6BT, UK
| | - Angharad E. Beckett
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, UK; (A.E.B.); (J.M.)
| | - Oana C. Lindner
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK;
| | - Joanne McCulloch
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, UK; (A.E.B.); (J.M.)
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Leeds Teaching Hospitals NHS Foundation Trust, Leeds LS9 7TF, UK;
| | | | - Rizwana Uddin
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
| | - Dan P. Stark
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
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Stileman HM, Jones CA. Revisiting the debriefing debate: does psychological debriefing reduce PTSD symptomology following work-related trauma? A meta-analysis. Front Psychol 2023; 14:1248924. [PMID: 38204890 PMCID: PMC10779682 DOI: 10.3389/fpsyg.2023.1248924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
Psychological debriefing is an early post-trauma intervention which aims to prevent the development of PTSD and accelerate normal recovery through discussing, validating, and normalising group members responses to trauma. While originally designed in the 1980s for groups of emergency service personnel, the scope of psychological debriefing extended to individual primary victims of trauma. A Cochrane review in 2002 concluded that psychological debriefing was ineffective, yet some authors have argued that many of the studies that informed the Cochrane review did not adhere to key elements of psychological debriefing. This meta-analysis sought to re-examine the effectiveness of psychological debriefing in preventing or reducing PTSD symptoms following work-related trauma. Appropriate studies were selected from three databases (MEDLINE, Embase and PsycINFO). Inclusion criteria was intentionally broad so that features of psychological debriefing that may determine its effectiveness could be explored through a series of subgroup analyses. The overall synthesis did not find consistent evidence that psychological debriefing helps to prevent or reduce PTSD symptoms following work-related trauma. Shortcomings in the methodology and reporting of many of the studies meant that several important subgroup analyses could not be conducted. Further well-designed studies in this field are warranted to ensure that employees exposed to potentially traumatic events receive the effective support they need and deserve.
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Affiliation(s)
- Harry M. Stileman
- Centre of Applied Psychology, University of Birmingham, Birmingham, United Kingdom
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher A. Jones
- Centre of Applied Psychology, University of Birmingham, Birmingham, United Kingdom
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3
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Billings J, Zhan Yuen Wong N, Nicholls H, Burton P, Zosmer M, Albert I, Grey N, El-Leithy S, Murphy D, Tehrani N, Wheatley J, Bloomfield MAP, Greene T. Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance. Eur J Psychotraumatol 2023; 14:2281751. [PMID: 38032045 PMCID: PMC10990448 DOI: 10.1080/20008066.2023.2281751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.
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Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Nicholls
- Division of Psychiatry, University College London, London, UK
| | - Peter Burton
- Division of Psychiatry, University College London, London, UK
| | - Maya Zosmer
- Division of Psychiatry, University College London, London, UK
| | - Idit Albert
- King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nick Grey
- University of Sussex, Falmer, UK
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | | | - Dominic Murphy
- King’s College London, London, UK
- Combat Stress, London, UK
| | | | - Jon Wheatley
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Michael A. P. Bloomfield
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Talya Greene
- Clinical, Educational and Health Psychology, University College London, London, UK
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Fisher MP, Lavender CD. Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State. Community Ment Health J 2023; 59:1341-1351. [PMID: 36947386 PMCID: PMC10031720 DOI: 10.1007/s10597-023-01121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
This study examined opportunities and challenges faced by individuals working to advance mental health policy and programming for first responders. We utilized qualitative content analysis and interviews with 16 firefighters, emergency medical services professionals, law enforcement officers, and others involved in programming or policy in the U.S. state of Ohio. Six themes characterized opportunities and challenges encountered: (1) variations in programming and policy exist across jurisdictions; (2) opportunities exist to enhance mental health awareness and self-care training for first responders; (3) need exists for specialized mental health clinicians accustomed to and capable of effectively working with first responders; (4) confidentiality protections are lacking for peer supporters not trained in critical incident stress management; (5) having an internal champion and broader support is key to program and policy advancement; and (6) interdepartmental collaboration provides opportunities for sharing resources and best practices. Results illustrate continued need for strategic policymaking, program development, and coordination.
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Affiliation(s)
- Michael P Fisher
- Department of Health Policy, Management & Leadership, School of Public Health, West Virginia University, P.O. Box 9190, Morgantown, WV, 26505, USA.
| | - Catherine D Lavender
- Department of Occupational Therapy & Occupational Science, College of Health Professions, Towson University, 8000 York Road, Linthicum Hall, Towson, MD, 21252, USA
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Sá M, Pereira PA, Castro-Vale I. General Practitioners' Own Traumatic Experiences and Their Skills in Addressing Patients' Past History of Adversities: A Cross-Sectional Study in Portugal. Healthcare (Basel) 2023; 11:2450. [PMID: 37685484 PMCID: PMC10487406 DOI: 10.3390/healthcare11172450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Addressing trauma has been found to be important for primary care patients, as it can improve their health-related outcomes. We aimed to assess how Portuguese general practitioners' (GPs) past history of traumatic events (TEs) and adverse childhood experiences (ACEs) influence their clinical communication skills when addressing their patients' past history of adversities. An online survey was circulated by email to GPs' associations and through GPs' social media groups. A sample of 143 GPs participated in this study. GPs' exposure to ACEs and TEs was assessed using the Childhood Trauma Questionnaire-Short Form and the Life Events Checklist for the DSM-5. To evaluate clinical communication skills, we adapted the Self-confidence Scale and used the Jefferson Scale of Physician Empathy. GPs identified barriers to addressing trauma routinely, including a lack of time (86.7%) and a fear of causing further patient suffering (56.6%). GPs' exposure to TEs and ACEs was positively correlated with scores in some dimensions of self-confidence and empathy (r values varying from 0.170 to 0.247). GPs exposed to traumatic experiences felt more confident when addressing their patients' adversities and were more empathic when conducting therapeutic relationships. This study shows that GPs with a history of traumatic experiences are able to address their patients' adversities; however, they lack proper training and better patient care conditions, such as more time and more resources available for patient guidance.
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Affiliation(s)
- Mariana Sá
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Unidade de Saúde Familiar Famílias, Agrupamento de Centros de Saúde Entre Douro e Vouga I—Feira/Arouca, 4535-086 Lourosa, Portugal
| | - Paulo Almeida Pereira
- Institute of Management and Health Organizations, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal;
| | - Ivone Castro-Vale
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S-Institute of Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal
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Obuobi-Donkor G, Eboreime E, Shalaby R, Agyapong B, Adu MK, Owusu E, Mao W, Oluwasina F, Pazderka H, Agyapong VIO. Evaluating Community Resilience and Associated Factors One Year after the Catastrophic Fort McMurray Flood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16153. [PMID: 36498243 PMCID: PMC9741375 DOI: 10.3390/ijerph192316153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Resilience after natural disasters is becoming an increasingly key area of research. In April 2020, parts of Fort McMurray were affected by severe floods. The flooding caused the loss of properties, evacuation of some residents, and effects on their mental health. OBJECTIVE This study explores the prevalence and associated factors between flood experience and low resilience a year after the 2020 floods in Fort McMurray. METHOD Data collection was accomplished one year after the flood, from 24 April to 2 June 2021, using an online survey. The data were analyzed with SPSS version 25 using univariate analysis with the chi-squared test and binary logistic regression analysis. RESULTS The prevalence of low resilience was 37.4%. Respondents under 25 years were nearly 26 times more likely to show low resilience (OR = 0.038; 95% CI 0.004-0.384) than respondents 40 years and above. Responders with a history of depression (OR = 0.258 95% CI: 0.089-0.744) and a history of anxiety (OR = 0.212; CI 95% 0.068-0.661) were nearly four to five times more likely to show low resilience than those without a history. Similarly, respondents willing to receive mental health counselling (OR = 0.134 95% CI: 0.047-0.378) were 7.5 times more likely to show low resilience. Participants residing in the same house before the flood were almost 11 times more likely to show low resilience (OR = 0.095; 95% CI 0.021-0.427) than those who relocated. Participants who received support from the Government of Alberta were less likely to express low resilience than those who received no or limited support (OR = 208.343; 95% CI 3.284-13,218.663). CONCLUSION The study showed a low resilience rate among respondents following the 2020 flooding in Fort McMurray. Factors contributing to low resilience include age, history of depression or anxiety, and place of residence after the flood. After the flood, receiving support from the government was shown to be a protective factor. Further studies are needed to explore robust risk factors of low resilience and measures to promote normal to high resilience among flood victims in affected communities.
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Affiliation(s)
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Medard K. Adu
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Folajinmi Oluwasina
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Hannah Pazderka
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Quand l’événement traumatique frappe au travail : une analyse du soutien social de l’entourage professionnel. PERSPECTIVES INTERDISCIPLINAIRES SUR LE TRAVAIL ET LA SANTÉ 2022. [DOI: 10.4000/pistes.7190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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McBain SA, Stoycos S, Doenges T. Breaking Silos to Address Medical Trauma: The Need for Integration of Trauma and Health Psychology Training. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09897-2. [PMID: 35841442 DOI: 10.1007/s10880-022-09897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) following a traumatic injury is a significant public health concern impacting approximately a third of traumatically injured patients. In 2018, the American College of Surgeons (ACS) Committee on Trauma recommended implementation of PTSD screening and brief intervention in level 1 trauma centers to meet the mental health needs of this underserved population. In March 2022, ACS revised its standards to include a requirement for mental health screening and referral process in level 1 and level 2 trauma centers. However, implementation of these programs has been limited. One barrier to implementation has been the lack of cross-trained trauma and health psychologists to support the development and implementation of trauma-focused programs in acute and critical care settings. This paper is a call to action to bring together experts in the fields of trauma and health psychology to effectively address training gaps in post-injury PTSD and medical traumatic stress. Through development of trauma and health psychology cross-training models, the field of psychology can collaborate to meet the increasing demand for trauma-focused psychologists in acute and critical care settings.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry & Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Sarah Stoycos
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Tim Doenges
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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Evaluating the Prevalence and Predictors of Moderate to Severe Depression in Fort McMurray, Canada during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127090. [PMID: 35742346 PMCID: PMC9222250 DOI: 10.3390/ijerph19127090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
Background: The Coronavirus disease (COVID-19) pandemic has produced adverse health consequences, including mental health consequences. Studies indicate that residents of Fort McMurray, a community which has experienced trauma from flooding and wildfires in the past, may be more vulnerable to the mental health effects of the pandemic. Objective: This study aimed to examine the prevalence and predictors of likely Major Depressive Disorder (MDD) among residents of Fort McMurray during the COVID-19 pandemic. Methods: A cross-sectional approach was adopted utilizing an online survey questionnaire to gather sociodemographic data, COVID-19 related data, and clinical information, including likely MDD using the Patient Health Questionnaire (PHQ-9) scale, from the residents of Fort McMurray between the period of 24 April to 2 June 2021. Results: Overall, 186 individuals completed the survey out of 249 residents who accessed the online survey, yielding a completion rate of 74.7%. The prevalence of likely MDD among respondents was 45%. Respondents willing to receive mental health counselling were five times more likely to experience MDD during the COVID-19 pandemic (OR = 5.48; 95% CI: 1.95–15.40). Respondents with a history of depression were nearly five folds more likely to report MDD during the era of the pandemic than residents without a history of depression (OR = 4.64; 95% CI: 1.49–14.44). Similarly, respondents with a history of taking hypnotics (sleeping tablets) were nearly six-fold more likely to express MDD than respondents with no history of receiving sleeping tablets (OR = 5.72; 95% CI: 1.08–30.30). Finally, respondents who reported receiving only partial support from the employer had three times higher odds of having likely MDD than those who received absolute support from the employer (OR = 3.50; 95% CI: 1.24–9.82). Conclusion: In addition to the effect of the pandemic and other measures taken to curb the psychopathological impact of the pandemic, policymakers need to implement policies to manage individuals with preexisting mental health conditions and provide strong employer support.
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10
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One Year after the Flood: Prevalence and Correlates of Post-Traumatic Stress Disorder among Residents in Fort McMurray. Behav Sci (Basel) 2022; 12:bs12030069. [PMID: 35323388 PMCID: PMC8944971 DOI: 10.3390/bs12030069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The 2020 Fort McMurray (FMM) and area flood caused more than $228 million in insured damage, affected over 1200 structures, and more than 13,000 people were evacuated. Objective: This study sought to determine the prevalence of post-traumatic stress disorder (PTSD)-like symptoms and the risk predictors among the population of FMM one year after the 2020 flooding. Methods: An online quantitative cross-sectional survey was distributed to residents of FMM via REDCap between 24 April to 2 June 2021 to collect sociodemographic, clinical, and flood-related information. The PTSD checklist for DSM-5 (PCL-C) was used to assess likely PTSD among respondents. Results: 186 of 249 respondents completed all essential self-assessment questionnaires in the analysis, yielding a response rate of 74.7%. The prevalence of likely PTSD was 39.6% (65). Respondents with a history of depression were more likely to develop PTSD symptoms (OR = 5.71; 95% CI: 1.68–19.36). Similarly, responders with limited and no family support after the disaster were more prone to report PTSD symptoms ((OR = 2.87; 95% CI: 1.02–8.05) and (OR = 2.87; 95% CI: 1.06–7.74), respectively). Conclusions: Our research indicated that history of depression and the need for mental health counseling significantly increased the risk of developing PTSD symptoms following flooding; family support is protective. Further studies are needed to explore the relations between the need to receive counseling and presenting with likely PTSD symptoms.
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Quaglieri A, Lausi G, Fraschetti A, Burrai J, Barchielli B, Pizzo A, Cordellieri P, De Gennaro L, Gorgoni M, Ferlazzo F, Sdoia S, Zivi P, Giannini AM, Mari E. "Stay at Home" in Italy during the COVID-19 Outbreak: A Longitudinal Study on Individual Well-Being among Different Age Groups. Brain Sci 2021; 11:993. [PMID: 34439611 PMCID: PMC8394798 DOI: 10.3390/brainsci11080993] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 02/05/2023] Open
Abstract
The restrictions imposed by the Italian government because of the coronavirus outbreak have been shown to be demanding on the Italian population. Data were collected at four different time points from 29 March 2020 to 3 May 2020 and during the final follow-up survey on 12 October 2020. In the present study, we provided longitudinal evidence on the relationship between the lockdown and mental health dimensions, such as emotional state, perceived stress, and time perspective, for three age groups. The results allowed us to observe their psychological status from different perspectives at five different time points. Notably, a negative effect of the lockdown individual well-beings emerged as a trend, and differences in individual adaptation strategies to a prolonged stressful situation were observed at the follow-up. Indeed, pairwise comparisons between age groups showed that the young adult group (18-23 years old) seemed to be the most psychologically affected by the lockdown. The findings are discussed according to the most recent literature on the topic. To the best of our knowledge, this is one of the first longitudinal studies carried out in Italy concerning the general psychological effects of the coronavirus lockdown.
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Affiliation(s)
- Alessandro Quaglieri
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Giulia Lausi
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Angelo Fraschetti
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Jessica Burrai
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy;
| | - Benedetta Barchielli
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy;
| | - Alessandra Pizzo
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Pierluigi Cordellieri
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Luigi De Gennaro
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Maurizio Gorgoni
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Fabio Ferlazzo
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Stefano Sdoia
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Pierpaolo Zivi
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Anna Maria Giannini
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
| | - Emanuela Mari
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (G.L.); (A.F.); (J.B.); (A.P.); (P.C.); (L.D.G.); (M.G.); (F.F.); (S.S.); (P.Z.); (A.M.G.); (E.M.)
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12
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Posttraumatic stress disorder and growth: Examination of joint trajectories in children and adolescents. Dev Psychopathol 2021; 34:1353-1365. [PMID: 34092267 DOI: 10.1017/s0954579421000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Positive health endpoints are not the opposite of negative endpoints. Previous studies examining posttraumatic stress disorders (PTSD) and posttraumatic growth (PTG) trajectories have overlooked the co-existence of PTSD and PTG, making it difficult to accurately distinguish individuals with various posttraumatic presentations, causing the effects of targeted interventions to be discounted. To fill this gap, the current study sought to examine joint PTSD and PTG trajectories in children and adolescents. Eight hundred and seventy-six Chinese children and adolescents were recruited to complete self-report questionnaires 6, 12, and 18 months after the Ya'an earthquake. Multiple-process growth mixture modeling analysis was used to test the study proposal. Five distinct joint PTSD and PTG trajectory types were found: recovery, growth, struggling, resistant, and delayed symptoms. Female students and students who felt trapped or fearful were more likely to be in the struggling group, and students who experienced injury to themselves or family members were more likely to belong to the delayed symptom group. These findings suggest that postdisaster psychological services should be provided to relieve delayed symptoms in individuals who experience injury to themselves or their family members, and individuals in the struggling group should be supported to achieve growth.
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13
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De Brier N, Borra V, Dockx K, Scheers H, Stroobants S, De Buck E, Lauwers K, Vandekerckhove P. Best Available Evidence on Communicative First Aid Interventions by Laypeople for Preventing and Relieving Posttraumatic Stress Disorder-Related Symptomatology Following Traumatic Events. J Trauma Stress 2021; 34:538-550. [PMID: 33217083 DOI: 10.1002/jts.22625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/07/2020] [Accepted: 10/17/2020] [Indexed: 11/09/2022]
Abstract
Trauma-exposed individuals are at risk of developing mental health problems, including posttraumatic stress disorder (PTSD). As an exposed individual's friend or family member may be the first person to provide posttrauma relief, informing and training laypeople in psychosocial first aid may benefit mental health outcomes of trauma-exposed individuals. We aimed to (a) collect the best available evidence on communication as a first aid intervention in assisting individuals following traumatic events and (b) formulate practical recommendations. Systematic literature searches were conducted in three databases (March 2019). Following study selection, the extracted data were tabulated and synthesized narratively. The evidence was appraised according to the GRADE methodology and evaluated by a multidisciplinary expert panel to formulate recommendations for practice. Out of 1,724 articles, no experimental studies were identified, showing a complete lack of high-quality controlled studies on the efficacy of communicative practices. However, when lower-quality study designs were included, nine cross-sectional studies constituted the best available evidence. The studies suggested that positive communication by family members, r = -.38, aOR = 0.26, β = -.22, p < .001-p < .05, and expressive coping by the victim, β = -.62, p < .001, were associated with PTSD diagnosis and/or symptom severity; however, the evidence was of very low certainty. The expert panel took the methodological limitations into account when formulating weak practical recommendations. Cross-sectional studies currently provide the best possible evidence for developing guidelines on psychosocial first aid. High-quality controlled studies are needed to establish casual associations and identify the most effective interventions.
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Affiliation(s)
- Niels De Brier
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Mechelen, Belgium
| | - Kim Dockx
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Hans Scheers
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | | | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Karen Lauwers
- Humanitarian Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
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14
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Physiological parameters of mental health predict the emergence of post-traumatic stress symptoms in physicians treating COVID-19 patients. Transl Psychiatry 2021; 11:169. [PMID: 33723233 PMCID: PMC7957277 DOI: 10.1038/s41398-021-01299-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022] Open
Abstract
Lack of established knowledge and treatment strategies, and change in work environment, may altogether critically affect the mental health and functioning of physicians treating COVID-19 patients. Thus, we examined whether treating COVID-19 patients affect the physicians' mental health differently compared with physicians treating non-COVID-19 patients. In this cohort study, an association was blindly computed between physiologically measured anxiety and attention vigilance (collected from 1 May 2014 to 31 May 31 2016) and self-reports of anxiety, mental health aspects, and sleep quality (collected from 20 April to 30 June 2020, and analyzed from 1 July to 1 September 2020), of 91 physicians treating COVID-19 or non-COVID-19 patients. As a priori hypothesized, physicians treating COVID-19 patients showed a relative elevation in both physiological measures of anxiety (95% CI: 2317.69-2453.44 versus 1982.32-2068.46; P < 0.001) and attention vigilance (95% CI: 29.85-34.97 versus 22.84-26.61; P < 0.001), compared with their colleagues treating non-COVID-19 patients. At least 3 months into the pandemic, physicians treating COVID-19 patients reported high anxiety and low quality of sleep. Machine learning showed clustering to the COVID-19 and non-COVID-19 subgroups with a high correlation mainly between physiological and self-reported anxiety, and between physiologically measured anxiety and sleep duration. To conclude, the pattern of attention vigilance, heightened anxiety, and reduced sleep quality findings point the need for mental intervention aimed at those physicians susceptible to develop post-traumatic stress symptoms, owing to the consequences of fighting at the forefront of the COVID-19 pandemic.
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15
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Dworkin ER. Risk for Mental Disorders Associated With Sexual Assault: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2020; 21:1011-1028. [PMID: 30585128 PMCID: PMC6707905 DOI: 10.1177/1524838018813198] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Sexual assault (SA) is a common form of trauma that is associated with numerous deleterious outcomes. Understanding the relative prevalence of psychiatric diagnoses in people who have been sexually assaulted versus people who have not been assaulted could help to prioritize assessment and intervention efforts, but there has been no quantitative review of this topic. A search of PsychINFO, ProQuest Digital Dissertations and Theses, and Academic Search Premier for articles dated between 1970 and 2014 was conducted, and unpublished data were obtained. Eligible studies used diagnostic interviews to assess Diagnostic and Statistical Manual of Mental Disorders diagnoses in both individuals experiencing adolescent/adult and/or lifetime SA and unassaulted individuals. The search yielded 171 eligible effects from 39 studies representing 88,539 participants. Meta-regression was used to aggregate the prevalence of psychiatric diagnoses in sexually assaulted and unassaulted samples as well as calculate odds ratios reflecting the difference between these prevalence estimates. Results indicated that most disorders were more prevalent in survivors of SA, and depressive disorders and posttraumatic stress disorder (PTSD) were especially prevalent. Disorder-specific differences in odds ratios were observed as a function of sample type, type of comparison group, and time frame of SA. Service providers should be prepared to address depressive disorders and PTSD in survivors of SA, and interventions that prevent the development of these disorders are especially needed.
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Affiliation(s)
- Emily R Dworkin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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16
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Linnstaedt SD, Zannas AS, McLean SA, Koenen KC, Ressler KJ. Literature review and methodological considerations for understanding circulating risk biomarkers following trauma exposure. Mol Psychiatry 2020; 25:1986-1999. [PMID: 31863020 PMCID: PMC7305050 DOI: 10.1038/s41380-019-0636-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022]
Abstract
Exposure to traumatic events is common. While many individuals recover following trauma exposure, a substantial subset develop adverse posttraumatic neuropsychiatric sequelae (APNS) such as posttraumatic stress, major depression, and regional or widespread chronic musculoskeletal pain. APNS cause substantial burden to the individual and to society, causing functional impairment and physical disability, risk for suicide, lost workdays, and increased health care costs. Contemporary treatment is limited by an inability to identify individuals at high risk of APNS in the immediate aftermath of trauma, and an inability to identify optimal treatments for individual patients. Our purpose is to provide a comprehensive review describing candidate blood-based biomarkers that may help to identify those at high risk of APNS and/or guide individual intervention decision-making. Such blood-based biomarkers include circulating biological factors such as hormones, proteins, immune molecules, neuropeptides, neurotransmitters, mRNA, and noncoding RNA expression signatures, while we do not review genetic and epigenetic biomarkers due to other recent reviews of this topic. The current state of the literature on circulating risk biomarkers of APNS is summarized, and key considerations and challenges for their discovery and translation are discussed. We also describe the AURORA study, a specific example of current scientific efforts to identify such circulating risk biomarkers and the largest study to date focused on identifying risk and prognostic factors in the aftermath of trauma exposure.
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Affiliation(s)
- Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony S Zannas
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Departments of Psychiatry and Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
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17
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Benhamou K, Piedra A. CBT-Informed Interventions for Essential Workers During the COVID-19 Pandemic. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020; 50:275-283. [PMID: 32836379 PMCID: PMC7367784 DOI: 10.1007/s10879-020-09467-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Essential workers during the COVID-19 pandemic face heightened levels of anxiety and depression due to increased work demands, lack of adequate personal protective equipment, fear of contracting the virus, and fear of spreading it to loved ones. This is a time of urgent need for mental health support for workers affected by the pandemic crisis. Clinicians may employ empirically supported interventions derived from cognitive behavioral therapy (CBT) and related therapies. Psychological First Aid, an evidence-based crisis intervention, may be utilized to emphasize basic needs and support, but is intended as an acute disaster intervention. Given that a pandemic is an ongoing and prolonged stressor, additional CBT-informed interventions are likely needed to fully support essential workers during these times. It is recommended that clinicians help essential worker clients meet their basic needs by modifying health and sleep habits where possible and helping them advocate for their needs using interpersonal effectiveness skills. Empathic listening, validation of the crisis at hand, and values clarification can aid the therapeutic relationship, help them feel a renewed sense of purpose and meaning in their careers and with their families, and facilitate behavior change consistent with chosen values. Self-monitoring through a daily diary can help clients focus their thoughts and recognize maladaptive patterns in their thoughts and behaviors. In tandem with these techniques, behavioral activation and coping strategies including relaxation, distress tolerance, and acceptance promote engaging in positive and adaptive activities. Finally, therapists can help clients reduce anxiety related to the pandemic by helping them limit information intake.
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Affiliation(s)
- Kathy Benhamou
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Alexandra Piedra
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
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18
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The role of glucocorticoid receptors in the induction and prevention of hippocampal abnormalities in an animal model of posttraumatic stress disorder. Psychopharmacology (Berl) 2020; 237:2125-2137. [PMID: 32333135 DOI: 10.1007/s00213-020-05523-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE Since the precise mechanisms of posttraumatic stress disorder (PTSD) remain unknown, effective treatment interventions have not yet been established. Numerous clinical studies have led to the hypothesis that elevated glucocorticoid levels in response to extreme stress might trigger a pathophysiological cascade which consequently leads to functional and morphological changes in the hippocampus. OBJECTIVES To elucidate the pathophysiology of PTSD, we examined the alteration of hippocampal gene expression through the glucocorticoid receptor (GR) in the single prolonged stress (SPS) paradigm, a rat model of PTSD. METHODS We measured nuclear GRs by western blot, and the binding of GR to the promoter of Bcl-2 and Bax genes by chromatin immunoprecipitation-qPCR as well as the expression of these 2 genes by RT-PCR in the hippocampus of SPS rats. In addition, we examined the preventive effects of a GR antagonist on SPS-induced molecular, morphological, and behavioral alterations (hippocampal gene expression of Bcl-2 and Bax, hippocampal apoptosis using TUNEL staining, impaired fear memory extinction (FME) using the contextual fear conditioning paradigm). RESULTS Exposure to SPS increased nuclear GR expression and GR binding to Bcl-2 gene, and decreased Bcl-2 mRNA expression. Administration of GR antagonist immediately after SPS prevented activation of the glucocorticoid cascade, hippocampal apoptosis, and impairment FME in SPS rats. CONCLUSION The activation of GRs in response to severe stress may trigger the pathophysiological cascade leading to impaired FME and hippocampal apoptosis. In contrast, administration of GR antagonist could be useful for preventing the development of PTSD.
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19
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Long-Term Mental Health Effects of a Devastating Wildfire Are Amplified by Sociodemographic and Clinical Antecedents in College Students. Disaster Med Public Health Prep 2020; 15:707-717. [PMID: 32536354 DOI: 10.1017/dmp.2020.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study is to assess prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in students of Keyano College 18 months after a wildfire and to determine the predictors of likely MDD, GAD, and PTSD in the respondents. METHODS A quantitative cross-sectional survey was used to collect data through self-administered, paper-based questionnaires to determine likely MDD, GAD, and PTSD using the PHQ 9, GAD-7, and the PTSD Checklist for DSM 5, Part 3, respectively. Data were analyzed with SPSS version 20 (IBM Corp, Armonk, NY) using univariate analysis with chi-square tests. RESULTS Eighteen months after the wildfire, the 1-month prevalence rates for MDD, GAD, and PTSD among the college students were 23.4%, 18.7%, and 11.0%, respectively. There were statistically significant associations between multiple sociodemographic variables and the likelihood respondents presented with MDD, GAD, and PTSD 18 months after the wildfire. There were also associations between the likely MDD, GAD, and PTSD and abuse/dependence on alcohol and substances in respondents at 18 months. CONCLUSION Our study has established prevalence rates for MDD, GAD, and PTDS among college students 18 months after the Fort McMurray wildfires. Further studies are needed to explore the impact of college-based mental health interventions on the long-term mental health effects of the wildfires.
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20
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O'Donnell ML, Lau W, Fredrickson J, Gibson K, Bryant RA, Bisson J, Burke S, Busuttil W, Coghlan A, Creamer M, Gray D, Greenberg N, McDermott B, McFarlane AC, Monson CM, Phelps A, Ruzek JI, Schnurr PP, Ugsang J, Watson P, Whitton S, Williams R, Cowlishaw S, Forbes D. An Open Label Pilot Study of a Brief Psychosocial Intervention for Disaster and Trauma Survivors. Front Psychiatry 2020; 11:483. [PMID: 32670099 PMCID: PMC7332836 DOI: 10.3389/fpsyt.2020.00483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the aftermath of disaster, a large proportion of people will develop psychosocial difficulties that impair recovery, but for which presentations do not meet threshold criteria for disorder. Although these adjustment problems can cause high distress and impairment, and often have a trajectory towards mental health disorder, few evidence-based interventions are available to facilitate recovery. OBJECTIVE This paper describes the development and pilot testing of an internationally developed, brief, and scalable psychosocial intervention that targets distress and poor adjustment following disaster and trauma. METHOD The Skills fOr Life Adjustment and Resilience (SOLAR) program was developed by an international collaboration of trauma and disaster mental health experts through an iterative expert consensus process. The resulting five session, skills-based intervention, deliverable by community-based or frontline health or disaster workers with little or no formal mental health training (known as coaches), was piloted with 15 Australian bushfire survivors using a pre-post with follow up, mixed-methods design study. RESULTS Findings from this pilot demonstrated that the SOLAR program was safe and feasible for non-mental health frontline workers (coaches) to deliver locally after two days of training. Participants' attendance rates and feedback about the program indicated that the program was acceptable. Pre-post quantitative analysis demonstrated reductions in psychological distress, posttraumatic stress symptoms, and impairment. CONCLUSIONS This study provides preliminary evidence that the delivery of the SOLAR program after disaster by trained, frontline workers with little or no mental health experience is feasible, acceptable, safe, and beneficial in reducing psychological symptoms and impairment among disaster survivors. Randomized controlled trials of the SOLAR program are required to advance evidence of its efficacy.
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Affiliation(s)
- Meaghan Louise O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Winnie Lau
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Julia Fredrickson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Kari Gibson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Richard Allan Bryant
- School of Psychology, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
| | - Susie Burke
- Australian Psychological Society, Melbourne, VIC, Australia
| | - Walter Busuttil
- Department of Psychiatry, Combat Stress, UK, Leatherhead, United Kingdom
| | | | - Mark Creamer
- Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Debbie Gray
- Mental Health Promotion and Illness Prevention, Addiction Mental Health - Alberta Health Services, Calgary, AB, Canada
| | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Andrea Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Josef I Ruzek
- National Center for PTSD, Dissemination and Training Division, US Department of Veterans Affairs, Palto Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, CA, United States
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, US Department of Veterans Affairs, White River Junction, VT, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth, Hanover, NH, United States
| | | | - Patricia Watson
- National Center for PTSD, Dissemination and Training Division, US Department of Veterans Affairs, Palto Alto, CA, United States
| | - Shona Whitton
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, Wales, United Kingdom
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
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21
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Christian-Brandt AS, Santacrose DE, Farnsworth HR, MacDougall KA. When Treatment is Traumatic: An Empirical Review of Interventions for Pediatric Medical Traumatic Stress. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:389-404. [PMID: 31617588 DOI: 10.1002/ajcp.12392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pediatric medical traumatic stress (PMTS) is common among injured/ill children and is associated with elevated distress, treatment non-adherence, and poor health outcomes. As survivorship of life-threatening pediatric injury and illness continues to increase alongside rapid medical advancements, rates of PMTS and negative sequelae are expected to grow; however, research on prevention and treatment of PMTS is limited. The current study sought to systematically review the literature using a developmental framework to highlight research gaps. Sixteen peer-reviewed studies were identified via a systematic literature search. Consistent with best practices for treatment of childhood trauma, caregiver involvement and CBT principles served as the foundation for most interventions. All studies reported improvements in PMTS; however, among the most methodologically rigorous, few found statistically superior reductions in PMTS between intervention and control groups. While many studies focused on a specific developmental stage and discussed developmental considerations, others took a "one-size-fits" approach. Interventions that demonstrated the most promising findings were online, self-guided, or time-limited. Future research would benefit from expanding diversity of participants, continuing to evaluate novel delivery methods, and integrating developmental considerations along with trauma-informed care (TIC) approaches, given their useful framework for understanding child traumatic stress responses and avenues for prevention and treatment.
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22
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Kindermann D, Jenne MP, Schmid C, Bozorgmehr K, Wahedi K, Junne F, Szecsenyi J, Herzog W, Nikendei C. Motives, experiences and psychological strain in medical students engaged in refugee care in a reception center- a mixed-methods approach. BMC MEDICAL EDUCATION 2019; 19:302. [PMID: 31382943 PMCID: PMC6683371 DOI: 10.1186/s12909-019-1730-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/25/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND The UN Refugee Agency has reported that an increasing number of people are being forcibly displaced worldwide. Despite this, global health issues, especially initiatives focusing on physical and psychological conditions of refugees, are still rarely considered in medical curricula. Furthermore, there is little evidence regarding the experiences and possible related psychological strain of medical students who work with refugees. Therefore, the present study aimed to investigate motivations, learning achievements and experiences, as well as psychological strain and possible protective factors, in medical students volunteering in a reception center for refugees. METHODS In this prospective study using a mixed-methods approach, we applied (1) qualitative content analysis of semi-standardized interviews in a pre-post design in a subsample of n = 16 students. The aims were to analyze (1a) the students' motivations and experiences in the reception center, and (1b) the students' perceived learning achievement. We further administered (2) psychometric questionnaires using a cross-sectional approach to n = 62 students in order to examine (2a) the students' psychological strain, in terms of secondary traumatization, depression, anxiety and health-related quality of life, and (2b) possible protective factors such as attachment style and sense of coherence. RESULTS The content analysis of the students' interviews revealed three main categories before the assignment and four main categories subsequently, displaying a broad variety of perspectives. Quantitative analysis identified that 3.2% of the students showed moderate secondary traumatization, and a correlation emerged between the number of shifts and symptom severity of secondary traumatization. The students displayed significantly reduced scores for depression and anxiety, when compared to a sample of first-year medical students. Sense of coherence was identified as a protective factor concerning secondary traumatization. CONCLUSION A rather small proportion of the medical students working in the reception center displayed explicit symptoms of psychological strain in terms of secondary traumatic stress. Due to their assignments, students were able to improve their cultural awareness, which they reported to be highly relevant for their future occupation. In view of increasing globalization, theoretical and practical courses on issues of flight and global health might therefore be implemented as an obligatory part of medical curricula.
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Affiliation(s)
- David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Marie P. Jenne
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Carolin Schmid
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Wahedi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen,University of Tübingen, Tübingen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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23
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Agyapong VIO, Juhas M, Omege J, Denga E, Nwaka B, Akinjise I, Corbett SE, Brown M, Chue P, Li XM, Greenshaw A. Prevalence Rates and Correlates of Likely Post-Traumatic Stress Disorder in Residents of Fort McMurray 6 Months After a Wildfire. Int J Ment Health Addict 2019. [DOI: 10.1007/s11469-019-00096-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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24
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Cunningham T, Ducar DM, Keim-Malpass J. “The Pause”: A Delphi Methodology Examining an End-of-Life Practice. West J Nurs Res 2019; 41:1481-1498. [DOI: 10.1177/0193945919826314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
“The Pause” was first practiced by a nurse at a Level 1 trauma center to honor the death of a deceased patient. This practice has spread internationally and is used in emergency departments, intensive care, transplant, and oncology units, in addition to pre-hospital settings. There is a paucity of research published on the effects of The Pause for health care workers. We used a three-staged Delphi methodology to understand the barriers, benefits, and language used in The Pause. Analyses of email communication and interview transcripts suggest that The Pause poses minimal risk and has considerable benefits. Benefits include increased perceived team cohesion, a moment for reflection, and a method by which to honor a deceased patient. The Pause allows nurses to feel more present to meet the needs of the next patient they care for during a shift. Further research is merited.
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Affiliation(s)
- Tim Cunningham
- University of Virginia School of Nursing, Charlottesville, USA
| | - Dallas M. Ducar
- University of Virginia School of Nursing, Charlottesville, USA
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Oosterbaan V, Covers MLV, Bicanic IAE, Huntjens RJC, de Jongh A. Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault. Eur J Psychotraumatol 2019; 10:1682932. [PMID: 31762949 PMCID: PMC6853210 DOI: 10.1080/20008198.2019.1682932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 12/19/2022] Open
Abstract
Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.
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Affiliation(s)
- Veerle Oosterbaan
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Milou L V Covers
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iva A E Bicanic
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rafaële J C Huntjens
- Department of Experimental Psychotherapy & Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Ad de Jongh
- Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Psychotrauma Expertise Center (PSYTREC), Bilthoven, The Netherlands.,Institute of Health and Society, University of Worcester, Worcester, UK.,Queen's University Belfast, Belfast, Northern Ireland, UK
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Gong AT, Kamboj SK, Curran HV. Post-traumatic Stress Disorder in Victims of Sexual Assault With Pre-assault Substance Consumption: A Systematic Review. Front Psychiatry 2019; 10:92. [PMID: 30918487 PMCID: PMC6424881 DOI: 10.3389/fpsyt.2019.00092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) and substance consumption commonly co-occur in victims of sexual assault. Substance consumption can occur pre- andi/or post-assault. Pre-assault substance consumption may have an impact on the subsequent development of PTSD. This review aims to provide an overview of current understanding of the effects of acute substance intoxication and chronic pre-assault problematic substance use on symptoms of PTSD amongst individuals who were victims of sexual assault. Methods: PsycINFO, EMBASE, and MEDLINE were searched using terms related to PTSD, sexual assault, and substance consumption. These yielded 2,121 articles, 268 of which were retrieved for more detailed evaluation and 13 of these met inclusion criteria and were appraised in full. Results: Overall, the reviewed papers supported our hypothesis that acute substance intoxication and chronic pre-assault problematic substance use are associated with fewer initial PTSD symptoms but less improvement over time, resulting in slower overall PTSD recovery. They also highlighted post-assault characterological self-blame and negative social reactions as mediators of recovery in the context of pre-assault substance consumption. Conclusions: Acute substance intoxication and chronic pre-assault problematic substance use appear to have an impact on the development of PTSD symptoms amongst victims of sexual assault. The importance of developing early interventions and routine screening and assessment for PTSD and pre-assault substance consumption is emphasized. The limited research on male victims and on substances other than alcohol is highlighted.
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Affiliation(s)
- An Tong Gong
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Helen Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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27
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Ennis N, Sijercic I, Monson CM. Internet-Delivered Early Interventions for Individuals Exposed to Traumatic Events: Systematic Review. J Med Internet Res 2018; 20:e280. [PMID: 30429113 PMCID: PMC6300083 DOI: 10.2196/jmir.9795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background Over 75% of individuals are exposed to a traumatic event, and a substantial minority goes on to experience mental health problems that can be chronic and pernicious in their lifetime. Early interventions show promise for preventing trauma following psychopathology; however, a face-to-face intervention can be costly, and there are many barriers to accessing this format of care. Objective The aim of this study was to systematically review studies of internet-delivered early interventions for trauma-exposed individuals. Methods A literature search was conducted in PsycINFO and PubMed for papers published between 1991 and 2017. Papers were included if the following criteria were met: (1) an internet-based intervention was described and applied to individuals exposed to a traumatic event; (2) the authors stated that the intervention was intended to be applied early following trauma exposure or as a preventive intervention; and (3) data on mental health symptoms at pre-and postintervention were described (regardless of whether these were primary outcomes). Methodological quality of included studies was assessed using the Downs and Black checklist. Results The interventions in the 7 studies identified were categorized as selected (ie, delivered to an entire sample after trauma regardless of psychopathology symptoms) or indicated (ie, delivered to those endorsing some level of posttraumatic distress). Selected interventions did not produce significant symptom improvement compared with treatment-as-usual or no intervention control groups. However, indicated interventions yielded significant improvements over other active control conditions on mental health outcomes. Conclusions Consistent with the notion that many experience natural recovery following trauma, results imply that indicated early internet-delivered interventions hold the most promise in future prevention efforts. More studies that use rigorous methods and clearly defined outcomes are needed to evaluate the efficacy of early internet-delivered interventions. Moreover, basic research on risk and resilience factors following trauma exposure is necessary to inform indicated internet-delivered interventions.
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Affiliation(s)
- Naomi Ennis
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Iris Sijercic
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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28
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Prevalence Rates and Correlates of Probable Major Depressive Disorder in Residents of Fort McMurray 6 Months After a Wildfire. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-0004-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Khan K, Charters J, Graham TL, Nasriani HR, Ndlovu S, Mai J. A Case Study of the Effects of Posttraumatic Stress Disorder on Operational Fire Service Personnel Within the Lancashire Fire and Rescue Service. Saf Health Work 2018; 9:277-289. [PMID: 30370159 PMCID: PMC6130001 DOI: 10.1016/j.shaw.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/10/2017] [Accepted: 11/13/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lancashire Fire and Rescue Service (LFRS), the subject of this evaluative research document employs 1400 people. 80% of employees are operational firefighters and officers whom operate across a range of duty systems and support functions, providing prevention, protection and emergency response to the communities of Lancashire. METHODS The overarching purpose of this epidemiological study is to assess the prevalence of post-traumatic stress disorder (PTSD) amongst operational LFRS personnel and to analyse the effects upon those who may be suffering from it, whether brought about by a single traumatic event or by repeated exposure to traumatic occurrences over a period of time. A combination of primary and secondary research was carried out. Primary data was collated using two recognised clinical questionnaires and statistical analysis was conducted with the aid of the software package SPSS. RESULTS The findings and statistical analysis showed that out of the 100 people surveyed, 30% of respondents had signs of probable distress. Of this quota, 4% showed symptoms of PTSD. The study considers how an organisation can recognise and manage PTSD and provides recommendations to assist in better recognising and managing the associated risks. CONCLUSION Based upon the findings, the authors conclude that the level of PTSD within LFRS is slightly lower than those found in other studies undertaken within the Fire and Rescue Service sector. The paper provides recommendations for future studies and a series of actions for consideration by LFRS senior management to improve PTSD support services for employees.
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Affiliation(s)
- Khalid Khan
- School of Engineering, University of Central Lancashire, Preston, Lancashire, UK
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30
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Wagner AC, Jaworsky D, Logie CH, Conway T, Pick N, Wozniak D, Rana J, Tharao W, Kaida A, de Pokomandy A, Ion A, Chambers LA, Webster K, MacGillivray SJ, Loutfy M. High rates of posttraumatic stress symptoms in women living with HIV in Canada. PLoS One 2018; 13:e0200526. [PMID: 30024901 PMCID: PMC6053147 DOI: 10.1371/journal.pone.0200526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/28/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Women living with HIV experience high levels of trauma exposure before and after diagnosis. One of the most challenging outcomes following trauma exposure is posttraumatic stress disorder. Despite high exposure to traumatic events, the presence and contributors to posttraumatic stress disorder symptoms have not been examined in women living with HIV in Canada. METHODS The current study examines the presence of, contributors to, and geographical regions associated with self-reported posttraumatic stress symptoms (PTSS) among 1405 women enrolled in the Canadian HIV Women's Sexual & Reproductive Health Cohort Study (CHIWOS). RESULTS Separate linear regression models were run for the three provinces in the cohort: British Columbia, Ontario and Québec. Scores consistent with posttraumatic stress disorder were reported by 55.9%, 39.1% and 54.1% of the participants in each province, respectively (F(2, 1402) = 13.53, p < .001). CONCLUSIONS The results demonstrate that women living with HIV have high rates of PTSS, and that rates and variables associated with these symptoms vary by province. These results suggest the need for trauma-informed practices and care for women living with HIV in Canada, which may need to be tailored for the community and identities of the women.
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Affiliation(s)
- Anne C. Wagner
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Denise Jaworsky
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Denise Wozniak
- CHIWOS Community Advisory Board, Mission, British Columbia, Canada
| | - Jesleen Rana
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Allyson Ion
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Lori A. Chambers
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ladds E, Redgrave N, Hotton M, Lamyman M. Systematic review: Predicting adverse psychological outcomes after hand trauma. J Hand Ther 2018; 30:407-419. [PMID: 28237074 DOI: 10.1016/j.jht.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION AND PURPOSE OF THE STUDY After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited. METHODS A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed. RESULTS Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes. DISCUSSION AND CONCLUSION Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Emma Ladds
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - Nathalie Redgrave
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Matthew Hotton
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Michael Lamyman
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Boykin DM, Orcutt HK. Treatment Use Among College Women Following a Campus Shooting. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2018; 28:261-280. [PMID: 31467476 PMCID: PMC6715303 DOI: 10.1080/10926771.2018.1480548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/20/2018] [Accepted: 05/21/2018] [Indexed: 06/10/2023]
Abstract
Despite increases in campus shootings, there is limited research on treatment utilization after these tragic events. The present study prospectively examined the prevalence and predictors of treatment use among college women following a campus shooting. Predictors included age, race/ethnicity, education level, severity of exposure to shooting, and post-shooting sequelae (i.e., social support, posttraumatic stress disorder [PTSD] severity, depression severity). Present data were obtained from 516 women on campus at the time of the shooting. They completed electronic and online surveys across three time points - pre-shooting (T1), 1-month post-shooting (T2), and 6-months post-shooting (T3). As expected, few participants (14.4%) sought any treatment. Of note, 77.5% of participants endorsed at least one risk factor for PTSD. Prevalence rates of probable PTSD significantly decreased from 51.8% of the full sample at T2 to 12.9% at T3. Results showed that a significantly higher proportion of participants with probable PTSD at T3 sought treatment than those participants at minimal to no risk for PTSD. Psychotherapy was sought at higher rates than medication or combined treatment across risk groups. No reliable predictors of treatment use were observed for at-risk participants or those with probable PTSD. Research and clinical suggestions for optimizing post-disaster recovery and improving treatment utilization among students following campus shootings are discussed.
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Affiliation(s)
- Derrecka M Boykin
- Department of Psychology, Northern Illinois University, DeKalb, Illinois, USA
| | - Holly K Orcutt
- Department of Psychology, Northern Illinois University, DeKalb, Illinois, USA
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Williams JL, Rheingold AA. Novel Application of Skills for Psychological Recovery as an Early Intervention for Violent Loss: Rationale and Case Examples. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:179-196. [PMID: 29570030 DOI: 10.1177/0030222818766138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes a novel application of Skills for Psychological Recovery (SPR)-a brief, early intervention developed by the National Center for Posttraumatic Stress Disorder and the National Child Traumatic Stress Network-for families grieving the violent death of a loved one. Drawing on conservation of resources theory, SPR incorporates cognitive-behavioral skills-building modules to help survivors cope with trauma-related distress and posttrauma resource loss. The authors describe the intervention and illustrate the use of SPR for violent loss by presenting data from two cases involving a suicide survivor and a homicide survivor. Implications for future research are discussed.
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Affiliation(s)
- Joah L Williams
- University of Missouri-Kansas City, MO, USA.,Medical University of South Carolina, Charleston, SC, USA
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Kim JE, Dager SR, Jeong HS, Ma J, Park S, Kim J, Choi Y, Lee SL, Kang I, Ha E, Cho HB, Lee S, Kim EJ, Yoon S, Lyoo IK. Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey. PLoS One 2018; 13:e0190630. [PMID: 29304155 PMCID: PMC5755833 DOI: 10.1371/journal.pone.0190630] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
Repeated exposure to traumatic experiences may put professional firefighters at increased risk of developing posttraumatic stress disorder (PTSD). To date, however, the rate of PTSD symptoms, unmet need for mental health treatment, and barriers to treatment have only been investigated in subsamples rather than the total population of firefighters. We conducted a nationwide, total population-based survey of all currently employed South Korean firefighters (n = 39,562). The overall response rate was 93.8% (n = 37,093), with 68.0% (n = 26,887) complete responses for all variables. The rate of current probable PTSD was estimated as 5.4%. Among those with current probable PTSD (n = 1,995), only a small proportion (9.7%) had received mental health treatment during the past month. For those who had not received treatment, perceived barriers of accessibility to treatment (29.3%) and concerns about potential stigma (33.8%) were reasons for not receiving treatment. Although those with higher PTSD symptom severity and functional impairment were more likely to seek treatment, greater symptom severity and functional impairment were most strongly associated with increased concerns about potential stigma. This nationwide study points to the need for new approaches to promote access to mental health treatment in professional firefighters.
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Affiliation(s)
- Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Stephen R. Dager
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Hyeonseok S. Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jiyoung Ma
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Shinwon Park
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yera Choi
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Suji L. Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Ilhyang Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Han Byul Cho
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States of America
| | - Sunho Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Eui-Jung Kim
- Department of Psychiatry, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
- * E-mail:
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35
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Eckford RD, Barnett DL. Comparing Paper-and-Pencil and Internet Survey Methods Conducted in a Combat-Deployed Environment. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rachel D. Eckford
- United States Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Sembach, Germany
| | - Donell L. Barnett
- 528th Medical Detachment, United States Army 44th Medical Brigade, Fort Bragg, North Carolina
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Oz I, Tatsa-Laur L, Kreiss Y, Fructer E, Itzhak A, Sarid O. Early psychological intervention following the 2014 Nepal snowstorm. DISASTER AND MILITARY MEDICINE 2017; 2:10. [PMID: 28265444 PMCID: PMC5329947 DOI: 10.1186/s40696-016-0020-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/10/2016] [Indexed: 11/10/2022]
Abstract
The following is a case study of the blizzard of October 2014, an Israeli rescue team, the Special Mental Health Team (SMHT) of the Israeli Defense Forces Medical Corps, was sent to the disaster area to rescue Israeli trekkers. The SMHT intervention was provided immediately following the traumatic events with the purpose of lowering stress-related symptoms, shortening recovery time and reducing post-traumatic stress disorder symptoms that could occur in the future. Forty Israeli trekkers were assessed by SMHT: 75 % (n = 30) had mild acute stress reaction (ASR) symptoms and 25 % (n = 10) had severe acute stress disorder (ASD) symptoms. All participating trekkers receiving the intervention as a way to alleviate symptoms reported no symptoms of ASR and ASD following the intervention. Trekkers with mild ASR reported full recovery after 1 week and trekkers with ASD reported full recovery after 3 months. This case study describes the psychological intervention conducted by SMHT for the surviving trekkers following the blizzard and aims to extend the knowledge base of mental health intervention at the early phases of disaster. A research study should be conducted to develop a measurement tool capable of evaluating the effect of a short-term intervention conducted in the field.
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Affiliation(s)
- Idit Oz
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | | | - Yitshak Kreiss
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel ; Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Eyal Fructer
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel ; CIR, UCS-School of Social Work, Los Angeles, California USA
| | | | - Orly Sarid
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
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37
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Manguy AM, Joubert L, Bansemer L. Psychosocial service needs of pediatric transport accident survivors: Using clinical data-mining to establish demographic and service usage characteristics. SOCIAL WORK IN HEALTH CARE 2016; 55:595-613. [PMID: 27586428 DOI: 10.1080/00981389.2016.1207746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
The objectives in this article are the exploration of demographic and service usage data gained through clinical data mining audit and suggesting recommendations for social work service delivery model and future research. The method is clinical data-mining audit of 100 sequentially sampled cases gathering quantitative demographic and service usage data. Descriptive analysis of file audit data raised interesting trends with potential to inform service delivery and usage; the key areas of the results included patient demographics, family involvement and impact, and child safety and risk issues. Transport accidents involving children often include other family members. Care planning must take into account psychosocial issues including patient and family emotional responses, availability of primary carers, and other practical needs that may impact on recovery and discharge planning. This study provides evidence to plan for further research and development of more integrated models of care.
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Affiliation(s)
- Alys-Marie Manguy
- a Social Work Department , The Royal Children's Hospital , Melbourne , Australia
| | - Lynette Joubert
- b Department of Social Work, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Australia
| | - Leah Bansemer
- a Social Work Department , The Royal Children's Hospital , Melbourne , Australia
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Supporting Community Health Workers After a Disaster: Findings From a Mixed-Methods Pilot Evaluation Study of a Psychoeducational Intervention. Disaster Med Public Health Prep 2016; 10:754-761. [PMID: 27349586 DOI: 10.1017/dmp.2016.40] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Community health workers (CHWs) in disaster-affected areas are at risk for emotional distress, as they support others while they may be in the process of rebuilding their own lives. The Resilience and Coping for the Healthcare Community (RCHC) intervention was developed in response to the stress CHWs faced after Hurricane Sandy. The intervention uses psychoeducation to help participants identify common stress responses, recognize signs of job burnout, and utilize healthy coping strategies. METHODS A mixed-methods pilot of the RCHC intervention was conducted in 2013 with a convenience sample of staff from 6 federally qualified health centers (n=69). Validated measures of stress, coping, compassion fatigue and satisfaction, burnout, stress, and social provisions and a measure of perceived knowledge were administered at baseline, after the workshop, and at a 3-week follow-up. Semi-structured interviews were conducted with 10 randomly selected participants and were analyzed by using content analysis. RESULTS From baseline to the post-workshop assessment, perceived knowledge scores increased from 24.59 to 30.34, t(62)=5.16 (P<0.001), and acute stress scores decreased significantly from 10.53 to 6.78, t(64)=4.74 (P<0.001). Significant increases from baseline to the 3-week follow-up (n=45) were found for perceived knowledge (24.05 to 27.24; t(40)=5.37; P<0.001), and social provisions (27.34 to 28.39; t(44)=2.15; P<0.05). CONCLUSIONS Our qualitative findings indicated that the respondents valued learning about common stress responses and incorporating coping as part of a daily routine. Team building and normalization of emotions were seen as ancillary benefits that would reduce stress levels in the workplace. In conclusion, the RCHC intervention shows promise and should be investigated further in experimental studies. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).
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McNally RJ, Bryant RA, Ehlers A. Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress? Psychol Sci Public Interest 2016; 4:45-79. [DOI: 10.1111/1529-1006.01421] [Citation(s) in RCA: 357] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal history of emotional disorder heightens risk, as does negative appraisal of one's stress reactions (e.g., as a sign of personal weakness) and dissociation during the trauma (e.g., feeling unreal or experiencing time slowing down). However, the vast majority of trauma survivors recover from initial posttrauma reactions without professional help. Accordingly, the efficacy of interventions designed to mitigate acute distress and prevent long-term psychopathology, such as PTSD, needs to be evaluated against the effects of natural recovery. The need for controlled evaluations of early interventions has only recently been widely acknowledged. Psychological debriefing—the most widely used method—has undergone increasing empirical scrutiny, and the results have been disappointing. Although the majority of debriefed survivors describe the experience as helpful, there is no convincing evidence that debriefing reduces the incidence of PTSD, and some controlled studies suggest that it may impede natural recovery from trauma. Most studies show that individuals who receive debriefing fare no better than those who do not receive debriefing. Methodological limitations have complicated interpretation of the data, and an intense controversy has developed regarding how best to help people in the immediate wake of trauma. Recent published recommendations suggest that individuals providing crisis intervention in the immediate aftermath of the event should carefully assess trauma survivors' needs and offer support as necessary, without forcing survivors to disclose their personal thoughts and feelings about the event. Providing information about the trauma and its consequences is also important. However, research evaluating the efficacy of such “psychological first aid” is needed. Some researchers have developed early interventions to treat individuals who are already showing marked stress symptoms, and have tested methods of identifying those at risk for chronic PTSD. The single most important indicator of subsequent risk for chronic PTSD appears to be the severity or number of posttrauma symptoms from about 1 to 2 weeks after the event onward (provided that the event is over and that there is no ongoing threat). Cognitive-behavioral treatments differ from crisis intervention (e.g., debriefing) in that they are delivered weeks or months after the trauma, and therefore constitute a form of psychotherapy, not immediate emotional first aid. Several controlled trials suggest that certain cognitive-behavioral therapy methods may reduce the incidence of PTSD among people exposed to traumatic events. These methods are more effective than either supportive counseling or no intervention. In this monograph, we review risk factors for PTSD, research on psychological debriefing, recent recommendations for crisis intervention and the identification of individuals at risk of chronic PTSD, and research on early interventions based on cognitive-behavioral therapy. We close by placing the controversy regarding early aid for trauma survivors in its social, political, and economic context.
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Affiliation(s)
| | | | - Anke Ehlers
- Institute of Psychiatry, King's College London, London, United Kingdom
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Abstract
Extinction serves as the leading theoretical framework and experimental model to describe how learned behaviors diminish through absence of anticipated reinforcement. In the past decade, extinction has moved beyond the realm of associative learning theory and behavioral experimentation in animals and has become a topic of considerable interest in the neuroscience of learning, memory, and emotion. Here, we review research and theories of extinction, both as a learning process and as a behavioral technique, and consider whether traditional understandings warrant a re-examination. We discuss the neurobiology, cognitive factors, and major computational theories, and revisit the predominant view that extinction results in new learning that interferes with expression of the original memory. Additionally, we reconsider the limitations of extinction as a technique to prevent the relapse of maladaptive behavior and discuss novel approaches, informed by contemporary theoretical advances, that augment traditional extinction methods to target and potentially alter maladaptive memories.
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Howlett JR, Stein MB. Prevention of Trauma and Stressor-Related Disorders: A Review. Neuropsychopharmacology 2016; 41:357-69. [PMID: 26315508 PMCID: PMC4677144 DOI: 10.1038/npp.2015.261] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/09/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a common, frequently chronic, and disabling condition which, along with acute stress disorder (ASD), is categorized as a trauma- and stressor-related disorder by the DSM-5. These disorders are unique in requiring exposure to a severe stressor, which implies that potential sufferers could be identified and helped before developing a disorder. Research on prevention strategies for stress-related disorders has taken a number of avenues, including intervention before and after trauma and the use of both psychosocial and somatic approaches. Despite advances in neurobiological understanding of response to trauma, clinical evidence for preventive interventions remains sparse. This review provides an overview of prevention approaches and summarizes the existing literature on prevention of ASD and PTSD, including clinical and preclinical studies. Given the potential benefits to trauma survivors and society, the development of effective preventive interventions should be given greater priority. Resources should be directed to adequately test promising interventions in clinical trials, and research should be conducted according to translational research principles in which preclinical research informs the design of clinical studies.
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Affiliation(s)
- Jonathon R Howlett
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Aucott C, Soni A. Reflections on the use of Critical Incident Stress Debriefing in schools. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2015. [DOI: 10.1080/02667363.2015.1112257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Helitzer D, Graeber D, LaNoue M, Newbill S. Don't Step on the Tiger's Tail: A Mixed Methods Study of the Relationship Between Adult Impact of Childhood Adversity and Use of Coping Strategies. Community Ment Health J 2015; 51:768-74. [PMID: 25536941 PMCID: PMC4480186 DOI: 10.1007/s10597-014-9815-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
A mixed methods study examined the relationship between childhood adversity (ACE) and coping among individuals grouped by perceived impact of ACE in adulthood. Groups did not differ on mean total ACE scores and total ACE score was not associated with any coping strategy. Differences between groups were found in 6 of 14 coping strategies. Planning and active coping were endorsed the most by both groups, despite their being used in significantly different amounts and in different ways. How individuals with ACE rate its impact in their current lives is a significant factor in the use and meaning of coping strategies.
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Affiliation(s)
- Deborah Helitzer
- Department of Family and Community Medicine, School of Medicine, MSC 09-5040, University of New Mexico, Albuquerque, NM, 87121-0001, USA.
| | - David Graeber
- Department of Psychiatry, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Marnie LaNoue
- Department of Family and Community Medicine, Jefferson Medical College, Philadelphia, PA, USA
| | - Sharon Newbill
- Department of Family and Community Medicine, School of Medicine, MSC 09-5040, University of New Mexico, Albuquerque, NM, 87121-0001, USA
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44
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Shechtman Z, Mor M. Groups for Children and Adolescents with Trauma-Related Symptoms: Outcomes and Processes. Int J Group Psychother 2015; 60:221-44. [DOI: 10.1521/ijgp.2010.60.2.221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Abstract
The phrase primum non nocere ("first, do no harm") is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of hazardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psychotherapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practitioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide insight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies.
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Abstract
The debate over the use of psychological debriefing in the early aftermath of a traumatic event has raged for decades, yet little attention has been paid to its use with perhaps the most vulnerable of victims, children and adolescents. While recommendations against the use of group debriefing with adults seem to have been made based on research of individual debriefing, recommendations regarding its use with children have been made based on the adult literature. In this review, we outline the possible mechanisms of harm and benefit of debriefing with a discussion of developmental concerns. The available empirical and nonempirical literature on the use of debriefing with youth is summarized. While research does not currently evidence harm in the use of debriefing with children, there is no strong support for its use either. We present both clinical considerations and research implications as they relate to debriefing as well as what this debate has taught us about the challenges to disseminating and evaluating early crisis interventions in general.
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Affiliation(s)
- Anne K Jacobs
- Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,
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47
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Tylee DS, Chandler SD, Nievergelt CM, Liu X, Pazol J, Woelk CH, Lohr JB, Kremen WS, Baker DG, Glatt SJ, Tsuang MT. Blood-based gene-expression biomarkers of post-traumatic stress disorder among deployed marines: A pilot study. Psychoneuroendocrinology 2015; 51:472-94. [PMID: 25311155 PMCID: PMC4199086 DOI: 10.1016/j.psyneuen.2014.09.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/20/2014] [Accepted: 09/22/2014] [Indexed: 01/01/2023]
Abstract
The etiology of post-traumatic stress disorder (PTSD) likely involves the interaction of numerous genes and environmental factors. Similarly, gene-expression levels in peripheral blood are influenced by both genes and environment, and expression levels of many genes show good correspondence between peripheral blood and brain tissues. In that context, this pilot study sought to test the following hypotheses: (1) post-trauma expression levels of a gene subset in peripheral blood would differ between Marines with and without PTSD; (2) a diagnostic biomarker panel of PTSD among high-risk individuals could be developed based on gene-expression in readily assessable peripheral blood cells; and (3) a diagnostic panel based on expression of individual exons would surpass the accuracy of a model based on expression of full-length gene transcripts. Gene-expression levels in peripheral blood samples from 50 U.S. Marines (25 PTSD cases and 25 non-PTSD comparison subjects) were determined by microarray following their return from deployment to war-zones in Iraq or Afghanistan. The original sample was carved into training and test subsets for construction of support vector machine classifiers. The panel of peripheral blood biomarkers achieved 80% prediction accuracy in the test subset based on the expression of just two full-length transcripts (GSTM1 and GSTM2). A biomarker panel based on 20 exons attained an improved 90% accuracy in the test subset. Though further refinement and replication of these biomarker profiles are required, these preliminary results provide proof-of-principle for the diagnostic utility of blood-based mRNA-expression in PTSD among trauma-exposed individuals.
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Affiliation(s)
- Daniel S. Tylee
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory (PsychGENe Lab);Departments of Psychiatry and Behavioral Sciences & Neuroscience and Physiology; Medical Genetics Research Center; SUNY Upstate Medical University; Syracuse, NY; U.S.A
| | - Sharon D. Chandler
- Center for Behavioral Genomics; Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A
| | - Caroline M. Nievergelt
- VA Center of Excellence for Stress and Mental Health; San Diego, CA; U.S.A,Veterans Affairs San Diego Healthcare System; San Diego, CA; U.S.A,Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A
| | - Xiaohua Liu
- Center for Behavioral Genomics; Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A,Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joel Pazol
- Center for Behavioral Genomics; Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A
| | - Christopher H. Woelk
- Veterans Affairs San Diego Healthcare System; San Diego, CA; U.S.A,Department of Medicine; University of California, San Diego; La Jolla, CA; U.S.A
| | - James B. Lohr
- VA Center of Excellence for Stress and Mental Health; San Diego, CA; U.S.A,Veterans Affairs San Diego Healthcare System; San Diego, CA; U.S.A,Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A
| | - William S. Kremen
- Center for Behavioral Genomics; Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A,VA Center of Excellence for Stress and Mental Health; San Diego, CA; U.S.A,Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A
| | | | - Dewleen G. Baker
- VA Center of Excellence for Stress and Mental Health; San Diego, CA; U.S.A,Veterans Affairs San Diego Healthcare System; San Diego, CA; U.S.A,Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A
| | - Stephen J. Glatt
- Psychiatric Genetic Epidemiology & Neurobiology Laboratory (PsychGENe Lab);Departments of Psychiatry and Behavioral Sciences & Neuroscience and Physiology; Medical Genetics Research Center; SUNY Upstate Medical University; Syracuse, NY; U.S.A,To whom correspondence should be addressed: Stephen J. Glatt, Ph.D., SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, U.S.A. Phone: 1-(315) 464-7742, Fax: 1-(315) 464-7744,
| | - Ming T. Tsuang
- Center for Behavioral Genomics; Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A,VA Center of Excellence for Stress and Mental Health; San Diego, CA; U.S.A,Veterans Affairs San Diego Healthcare System; San Diego, CA; U.S.A,Department of Psychiatry; University of California, San Diego; La Jolla, CA; U.S.A,Institute of Genomic Medicine; University of California, San Diego; La Jolla, CA; U.S.A,Harvard Institute of Psychiatric Epidemiology and Genetics; Department of Epidemiology; Harvard School of Public Health; Boston, MA; U.S.A
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Litz BT. Resilience in the aftermath of war trauma: a critical review and commentary. Interface Focus 2014; 4:20140008. [PMID: 25285196 DOI: 10.1098/rsfs.2014.0008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The resilience construct has received a great deal of attention as a result of the long wars in Iraq and Afghanistan. The discourse about resilience, especially the promise of promoting it and mitigating risk for serious post-traumatic negative outcomes among service members and veterans, is hopeful and encouraging. Remarkably, most service members exposed to horrific war trauma are not incapacitated by the experience. Yet, resilience is elusive and fleeting for many veterans of war. In this paper, I address some of the complexities about resilience in the context of exposure to war stressors and I offer some assumptions and heuristics that stem from my involvement in the dialogue about resilience and from experiences helping prevent post-traumatic stress disorder among active-duty service members with military trauma. My goal is to use my observations and applied experiences as an instructive context to raise critical questions for the field about resilience in the face of traumatic life-events.
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Affiliation(s)
- Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center , VA Boston Healthcare System , Boston, MA , USA ; Departments of Psychology and Psychiatry , Boston University , Boston, MA , USA
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49
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Mancini AD, Bonanno GA, Sinan B. A Brief Retrospective Method for Identifying Longitudinal Trajectories of Adjustment Following Acute Stress. Assessment 2014; 22:298-308. [DOI: 10.1177/1073191114550816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research increasingly indicates that prototypical trajectories of resilience, recovery, delayed, and chronic distress characterize reactions to acute adversity. However, trajectory research has been limited by the practical and methodological difficulties of obtaining pre-event and longitudinal data. In two studies, we employed a novel method in which trained interviewers provided a graphical depiction of prototypical stress trajectories to participants and asked them to select the one that best described their experience. In Study 1, self-identified trajectories from 21 high-exposure survivors of the September 11th World Trade Center attacks distinguished variation in posttraumatic stress disorder and depression symptoms at 7 and 18 months, and were consistent with trajectories based on longitudinal outcomes and friend/relative ratings. In Study 2, we examined self-identified trajectories from 115 bereaved spouses at 1.5 to 3 years. Persons who identified a resilient trajectory, compared with recovery and chronic distress trajectories, had fewer interviewer-rated symptoms of grief, depression, and posttraumatic stress disorder were rated as functioning more effectively by friends, reported higher life satisfaction, and had fewer somatic complaints. The present results provide initial evidence for the construct validity of a cross-sectional and less demanding method for identifying acute stress trajectories.
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50
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Robinson GE. Pregnancy loss. Best Pract Res Clin Obstet Gynaecol 2013; 28:169-78. [PMID: 24047642 DOI: 10.1016/j.bpobgyn.2013.08.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/25/2013] [Accepted: 08/22/2013] [Indexed: 01/19/2023]
Abstract
Women who lose desired pregnancies by miscarriage, stillbirth, or genetic termination are at risk of suffering from grief, anxiety, guilt and self-blame that may even present in subsequent pregnancies. It is important to find effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging the parents to view and hold the baby. This approach has been questioned as possibly causing persistent anxiety and post-traumatic stress disorder. Women who miscarry are currently encouraged to find ways to memorialise the lost fetus. Couples who decide to terminate a pregnancy after discovering a defect may deal not only with sadness but also guilt. Immediate crisis intervention and follow-up care should be available, recognising that individual women may experience different reactions and their specific post-loss needs must be assessed.
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Affiliation(s)
- Gail Erlick Robinson
- University of Toronto, University Health Network, Toronto General Hospital, Eaton Wing North, 8th Floor, Room 231, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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