Risk Factors for Posttraumatic Stress Symptoms Among Avalanche Survivors: A 16-Year Follow-Up

The impact of pre- and post-trauma financial problems on posttraumatic stress symptoms, anxiety and depression symptoms, and emotional support: A prospective population-based comparative study

Potentially traumatic events (PTEs) are associated with a higher risk of mental health problems and a lack of emotional support. The extent to which pre- and/or post-trauma financial problems further increase this risk, while controlling for pre-trauma mental health problems and lack of support and compared to nonvictims, is largely unknown. To better understand this risk, data was extracted from four surveys of VICTIMS study using the Dutch population-based longitudinal LISS-panel. Multivariate logistic regression analyses (MLRA) showed that nonvictims (n^{nonvictims total}=5003) with persistent financial problems (present at T1 and present at T2 one year later) more often suffered from severe anxiety and depression symptoms (ADS; Adjusted OR (aOR)= 1.72) and lack of emotional support (aOR=1.96) than nonvictims without these problems, and that victims of PTEs (n^{victims total}=872) with persistent financial problems more often suffered moderate ADS (aOR=2.10) than nonvictims with persistent financial problems. MLRA showed that victims with pre- and/or post-trauma financial problems were more at risk of probable PTSD than victims without financial problems (aORs ≥ 2.02). Victim services and (mental) health care professionals should screen for pre- and post-trauma financial problems and, when found, refer the victims to relevant professionals since these problems can significantly hinder recovery.

Psychological impairment and extreme weather event (EWE) exposure, 1980-2020: A global pooled analysis integrating mental health and well-being metrics

Extreme Weather Events (EWEs) impose a substantial health and socio-economic burden on exposed populations. Projected impacts on public health, based on increasing EWE frequencies since the 1950s, alongside evidence of human-mediated climatic change represents a growing concern. To date, the impacts of EWEs on mental health remain ambiguous, largely due to the inherent complexities in linking extreme weather phenomena with psychological status. This exploratory investigation provides a new empirical and global perspective on the psychological toll of EWEs by exclusively focusing on psychological morbidity among individuals exposed to such events. Morbidity data collated from a range of existing psychological and well-being measures have been integrated to develop a single ("holistic") metric, namely, psychological impairment. Morbidity, and impairment, were subsequently pooled for key disorders-, specifically PTSD, anxiety and depression. A "composite" (any impairment) post-exposure pooled-prevalence rate of 23% was estimated, with values of 24% calculated for depression and ⁓17% for both PTSD and anxiety. Notably, calculated pooled odds ratios (pOR = 1.9) indicate a high likelihood of any negative psychological outcome (+90%) following EWE exposure. Pooled analyses of reported risk factors (p < 0.05) highlight the pronounced impacts of EWEs among individuals with higher levels of event exposure or experienced stressors (14.5%) and socio-demographic traits traditionally linked to vulnerable sub-populations, including female gender (10%), previous history (i.e., pre-event) of psychological impairment (5.5%), lower socio-economic status (5.5%), and a lower education level (5.2%). Inherent limitations associated with collating mental health data from populations exposed to EWEs, and key knowledge gaps in the field are highlighted. Study findings provide a robust evidence base for developing and implementing public health intervention strategies aimed at ameliorating the psychological impacts of extreme weather among exposed populations.

Survivors of avalanche accidents: posttraumatic stress disorder symptoms and quality of life: a multicentre study

BACKGROUND

As any traumatic event, avalanches could trigger psychological disorders on survivors. Our objectives were to determine the prevalence of post-traumatic stress disorder among avalanche survivors and to evaluate post-traumatic stress disorder risks factors as well as the impact on quality of life.

METHODS

A multicentre study was conducted in victims included in the North Alpine Avalanche Registry from 2014 to 2018. Data were collected through a standard questionnaire during semi-directed phone interviews. The primary outcome was the total score on the Impact of Event Scale Revised. Secondary outcomes were the Mental Component Scale and the Physical Component Scale scores of the Short Form 12 questionnaire.

RESULTS

During the study period, 132 of 211 victims survived. Among the 107 victims included, 55 (51.4%) phone interviews were obtained. Six patients (10.9, 95% CI 1.76-20.05) had an Impact of Event Scale Revised score ≥ 33 indicating a strong probability for post-traumatic stress disorder. Median Mental Component Scale score was 39.0 (IQR 30.5-46.3) for post-traumatic stress disorder patients and 40.1 (IQR 36.5-43.4) for non post-traumatic stress disorder (p = 0.76). Median Physical Component Scale score was 39.4 (37.2-44.3) for post-traumatic stress disorder patients and 44.2 (39.1-46.8) for non post-traumatic stress disorder (p = 0.39). No significant difference in the quality of life in both populations was observed, and no independent risk factors of post-traumatic stress disorder was identified.

CONCLUSION

Avalanche accidents may induce post-traumatic stress disorders among survivors in a comparable prevalence to the most traumatic event already studied. Early recognition and preventive measures should be set up in order to reduce the psychological burden in these victims.

TRIAL REGISTRATION

NCT03936738 .

Identifying predictors of probable posttraumatic stress disorder in children and adolescents with earthquake exposure: A longitudinal study using a machine learning approach

BACKGROUND

Evidence has identified risk factors associated with individuals with trauma exposure who develop posttraumatic stress disorder (PTSD). How to combine risk factors to predict probable PTSD in young survivors using machine learning is limited. The study aimed to integrated multiple measures at 2 weeks after the earthquake using machine learning for the prediction of probable PTSD at 3 months after earthquake.

METHODS

A total of 2099 young survivors with earthquake exposure were included. We integrated multiple domains of variables to 'train' a machine learning algorithm (XGBoost). Thirty-one combination types were implemented and evaluated. The resulting XGBoost was utilized in identifying individual participants as either probable PTSD or no PTSD.

RESULTS

Any combination type predicted young survivor probable PTSD, with prediction accuracies ranging between 66%-80% (p < 0.05). In particular, the combination of earthquake experience, everyday functioning, somatic symptoms and sleeping correctly predicted 683 out of 802 cases of probable PTSD, translating to a classical accuracy of 74.476% (85.156% sensitivity and 60.366% specificity) and an area under the curve of 0.80. The most relevant variables (e.g. age, sex, property loss and a sedentary lifestyle) revealed in the present study.

LIMITATIONS

Participants from a specific district might limit the generalizability of our results. Self-report questionnaires and non-standardized measures were used to assess symptoms.

CONCLUSION

Detection of probable PTSD according to self-reported measurement data is feasible, may improve operational efficiencies via enabling targeted intervention, before manifestation of symptoms.

The trajectory of symptom burden in exposed and unexposed survivors of a major avalanche disaster: a 30 year long-term follow-up study

BACKGROUND

Limited research exists concerning the long-term effects of avalanches on survivors' mental health beyond the first years after the accident. The aims of this study were to describe and evaluate possible differences in long-term mental health symptoms after a major avalanche disaster between exposed and unexposed soldiers using a longitudinal design.

METHOD

Present mental health symptoms were examined among avalanche exposed (n = 12) and unexposed (n = 9) soldiers by PTSS-10, IES-15 and STAI-12 in four waves (1986-1987 and 2016).

RESULTS

Binary logistic regression revealed that the odds to score above the cut-off were significantly lower for both groups after one year compared to baseline for PTSS-10 (p = 0.018) and significantly lower after 30 days compared to baseline for IES-15 (p = 0.005). Data did not reveal significant differences between the exposed and unexposed groups regarding adjusted PTSS-10, IES-15 or STAI-12 mean scores compared. Linear mixed model-analyses revealed significant effects of time. The adjusted mean scores declined over time for both groups: PTSS-10 (p = 0.001), IES-15 (p = 0.026) and STAI-12 (p = 0.001), and the time trajectories for PTSS-10 were significantly different between the groups (p = 0.013). Although not significant (all p > 0.05), results indicated that a larger proportion of soldiers in the exposed group experienced posttraumatic stress symptoms (5/12) (PTSS-10 score ≥ 4) and distress symptoms (6/12) (IES-15 score ≥ 26) above cut-off points, 30 years post-disaster.

CONCLUSIONS

The course of mental health symptoms may persist, and even increase, in selected and trained military personnel 30 years after exposure to a natural disaster. These findings may be of great importance for health authorities planning appropriate follow-up.

Sleep quality problems three decades post-disaster

STUDY OBJECTIVES

Sleep quality problems are a core feature of posttraumatic stress disorder (PTSD). The aims of this study were to describe and evaluate possible differences regarding sleep quality problems and hyperarousal symptoms between exposed and unexposed survivors after an avalanche. Further, we wanted to describe any association between avalanche exposure and survivors' self-reported sleep quality problems and posttraumatic stress (disorder) symptoms with and without hyperarousal symptoms.

METHOD

The participants were soldiers who had survived an avalanche (n = 12) and a sample of unexposed soldiers (n = 9). Subjective sleep quality problems and posttraumatic stress (disorder) symptoms were assessed using well-validated measures: Pittsburgh Sleep Quality Index (PSQI), Posttraumatic Symptom Scale-10 (PTSS-10), and Impact of Event Scale-15 (IES-15). Hyperarousal symptoms were assessed using a 3-item hyperarousal-index from PTSS-10 (PTSS-10/Hyp index).

RESULTS

No significant difference in sleep quality problems was revealed between the exposed and unexposed groups. There was a significant association between those with PTSS-10 ≥ 4 combined with hyperarousal symptoms and sleep quality problems (p = .046), 30 years after the avalanche. Likewise, no significant associations was revaled between those with sleep quality problems and IES-15 ≥ 26 with and without hyperarousal. Binary logistic regression showed that those with sleep quality problems (PSQI > 5) 30 years post-disaster, had 2.5 times greater odds (OR = 2.49, 95%CI [0.95-6.55], p = .064) of having hyperarousal symptoms during the whole follow-up period compared to those without sleep quality problems.

CONCLUSION

Our findings may indicate an association between sleep quality problems (PSQI > 5) and hyperarousal symptoms in soldiers with scores above cut-off point for posttraumatic stress (disorder) symptoms.

Sixteen-year follow-up of childhood avalanche survivors

BACKGROUND

Every year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on children's health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures.

OBJECTIVE

Among childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood.

METHODS

Childhood survivors (aged 2-19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis.

RESULTS

Response rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F=5.96, p<0.05). When adjusted for age and sex, PTSD symptoms were associated with lower education (F=7.62, p<0.001), poor financial status (F=12.21, p<0.001), and unemployment and/or disability (F=3.04, p<0.05). In a multivariable regression model, when adjusting for age and sex, lack of social support (t=4.22, p<0.001) and traumatic reactions of caregivers (t=2.49, p<0.05) in the aftermath of the disaster independently predicted PTSD 16 years post-trauma.

CONCLUSIONS

Lingering PTSD symptoms after childhood exposure to a disaster may negatively influence socioeconomic development in adulthood. Strengthening children's support systems post-disaster may prevent the long-term sequelae of symptoms.