Comparing the stability of diagnosis in full vs. partial posttraumatic stress disorder

Association of PTSD With Longitudinal COVID-19 Burden in a Mixed-Serostatus Cohort of Men and Women: Weathering the Storm

OBJECTIVES

This study of people with HIV (PWH) and those without HIV conducted during the COVID-19 pandemic in the United States in 2020 examines the impact of posttraumatic stress disorder (PTSD) on COVID-19 burden, defined as pandemic-related disruptions.

METHODS

Data consisted of survey responses on PTSD among participants (N = 2434) enrolled in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV (WIHS) cohorts. Unadjusted and adjusted regression models were used to examine the association of PTSD with COVID-19 burden (overall and domain-specific burdens). Quasi-Poisson regression models were used to assess associations with the COVID-19 burden score and 2 domain-specific burdens: (1) changes in resources and (2) interruptions in health care. Analyses was adjusted for age, race/ethnicity, HIV serostatus, current smoking status, number of comorbidities, education, and study regions.

RESULTS

Study participants were a median age of 58 (interquartile range, 52-65) years. In both bivariate and multivariable models, PTSD severity was associated with greater overall COVID-19 burden. PTSD severity was associated with the number of resource changes and number of interruptions in medical care. These findings were also consistent across cohorts (MACS/WIHS) and across HIV serostatus, suggesting a greater risk for COVID-19 burden with greater PTSD severity, which remained significant after controlling for covariates.

CONCLUSIONS

This study builds on emerging literature demonstrating the impact of mental health on the burden and disruption associated with the COVID-19 pandemic, providing context specific to PWH. The ongoing pandemic requires structural and social interventions to decrease disruption to resources and health resource needs among these vulnerable populations.

Measurement Strategies for Evidence-Based Psychotherapy for Posttraumatic Stress Disorder Delivery: Trends and Associations with Patient-Reported Outcomes

We sought to develop a quality standard for the delivery of psychotherapy for posttraumatic stress disorder (PTSD) that is both consistent with the underlying evidence supporting psychotherapy as a treatment for PTSD and associated with the best levels of symptom improvement. We quantified psychotherapy receipt during the initial year of PTSD treatment in a 10-year national cohort of Department of Veterans Affairs (VA) users who completed patient-reported outcome measurement as part of routine practice. We added progressively stringent measurement requirements. The most stringent requirement was associated with superior outcomes. Quality of psychotherapy for PTSD in the VA improved over time.

Efficacy of Self-Management Smartphone-Based Apps for Post-traumatic Stress Disorder Symptoms: A Systematic Review and Meta-Analysis

Post-traumatic stress disorder (PTSD) symptoms are prevalent in both civilian and military service members. As the number of smartphone-based applications (apps) grows rapidly in health care, apps are also increasingly used to help individuals with subthreshold PTSD or full PTSD. Yet, if the apps are self-managed, the feasibility and efficacy of such interventions are still rather unclear in these two populations with PTSD symptoms. Hence, the present meta-analysis set out to evaluate the effect of self-management smartphone-based apps on PTSD and depressive symptoms in populations with subthreshold PTSD or full PTSD. Studies were included if they conducted randomized controlled trials or pre-post comparisons. Six studies (n = 2 randomized controlled trials) were identified for meta-analysis. In pre-post comparisons, N = 209 participants were included in the analyses. In randomized controlled trials, N = 87 participants received smartphone-based self-management interventions and N = 82 participants were in waitlist control conditions. Meta-analysis for pre-post comparisons concluded an effect of g = 0.55 (p < 0.001) regarding the overall reduction in PTSD symptoms (n = 6) and g = 0.45 (p < 0.001) for reduction in depressive symptoms (n = 5). Yet, in randomized controlled trials, no significant difference was found between app-based treatment and waitlist control groups (g = 0.09, p = 0.574). The duration of the interventions did not significantly influence the results. Overall, despite positive pre-post effects, current results indicate that smartphone-apps for PTSD patients are not significantly more effective than waitlist control conditions. Nevertheless, a combined smartphone and standard therapy approach may be a fruitful field for future research.

Identifying clusters of health symptoms in deployed military personnel and their relationship with probable PTSD

OBJECTIVE

Among military personnel posttraumatic stress disorder is strongly associated with non-specific health symptoms and can have poor treatment outcomes. This study aimed to use machine learning to identify and describe clusters of self-report health symptoms and examine their association with probable PTSD, other psychopathology, traumatic deployment exposures, and demographic factors.

METHOD

Data were from a large sample of military personnel who deployed to the Middle East (n = 12,566) between 2001 and 2009. Participants completed self-report measures including health symptoms and deployment trauma checklists, and several mental health symptom scales. The data driven machine learning technique of self-organised maps identified health symptom clusters and logistic regression examined their correlates.

RESULTS

Two clusters differentiated by number and severity of health symptoms were identified: a small 'high health symptom cluster' (HHSC; n = 366) and a large 'low health symptom cluster' (LHSC; n = 12,200). The HHSC had significantly higher proportions of (Gates et al., 2012 [1]) scaled scores indicative of PTSD (69% compared with 2% of LHSC members), Unwin et al. (1999a) [2] scores on other psychological scales that were indicative of psychopathology, and (Graham et al., n.d. [3]) deployment trauma. HHSC members with probable PTSD had a stronger relationship with subjective (OR 1.25; 95% CI 1.12, 1.40) and environmental (OR 1.08; 95% CI 1.03, 1.13) traumatic deployment exposures than LHSC members with probable PTSD.

CONCLUSION

These findings highlights that health symptoms are not rare in military veterans, and that PTSD is strongly associated with health symptoms. Results suggest that there may be subtypes of PTSD, differentiated by health symptoms.

The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury

OBJECTIVE

Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors.

METHODS

Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes.

RESULTS

Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f ²  = 0.130; P = .005) and chronic headache related-disability (Cohen's f ²  = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f ²  = 0.105; P = .012) and chronic headache-related disability (Cohen's f ²  = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance).

CONCLUSION

Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with reductions in disability and negative physical health sequelae associated with PTSS and chronic headache.

An App a Day Keeps the Doctor Away: Guided Education and Training via Smartphones in Subthreshold Post Traumatic Stress Disorder

Post traumatic stress disorder (PTSD) symptoms are common in military service members (SMs), but stigma can impede treatment initiation. Smartphone applications (apps) are available anywhere, anytime, with the potential to both mitigate the impact of stigma and reduce PTSD symptom severity. We provided 144 SMs or family members, with subthreshold PTSD symptoms (PTSD Checklist [PCL] scores of 28-49), with apps promoting psychoeducation, social engagement, and relaxation and randomized them to 6 weeks of resilience enhancement (brief cognitive-behavioral session, followed by daily text messages directing app use) or a control group (daily text messages of inspirational quotes). Participants (54 percent males, 87 percent SMs) in both groups reported reductions in PTSD, anxiety, and depression symptoms during the 6-week intervention, which were sustained at 3 months, but exhibited partial rebound at 6-12 months. Our preliminary results suggest that app use, with or without specific direction, feasibly and effectively reduces symptom severity. Future studies should consider a longer intervention, enhanced compliance tracking, or boosters to sustain benefits.

Examining PTSD treatment choice among individuals with subthreshold PTSD

Subthreshold posttraumatic stress disorder (PTSD) is associated with impairment and has a prevalence rate comparable to full PTSD. Yet, little is known regarding treatment preferences among individuals with subthreshold PTSD, even though they seek trauma-related treatment at a similar rate to those with full PTSD. This study explored subthreshold diagnostic PTSD diagnostic category and treatment preference in undergraduate (N = 439) and trauma-exposed community (N = 203) samples. Participants completed the Posttraumatic Stress Diagnostic Scale (PDS), viewed standardized treatment rationales, and made a hypothetical PTSD treatment choice: prolonged exposure (PE), sertraline, combination treatment, or no treatment. The PDS was used to categorize individuals into four PTSD categories: no trauma exposure, trauma exposure only, subthreshold PTSD, and full PTSD. Within the samples, 8.9% (n = 39) of undergraduates and 16.7% (n = 34) of community members met subthreshold PTSD criteria. The majority of individuals with subthreshold PTSD in each sample reported impairment, 59.0% of undergraduates and 76.5% of community members. Within subthreshold PTSD groups, the most commonly selected treatments were PE (61.5%) for undergraduates and combination treatment (47.1%) for community members. Findings underscore the necessity of further examining subthreshold PTSD, which may hold important clinical implications for treatment processes and outcomes.

Levels of symptom severity and functioning in four different definitions of subthreshold posttraumatic stress disorder in primary care veterans

Four definitions of subthreshold posttraumatic stress disorder (PTSD) were compared in 815 veterans seen in Veterans Affairs Medical Center primary care clinics. We compared PTSD Checklist (PCL) scores and Short Form 36 (SF-36) scores between participants meeting criteria for one of the subthreshold PTSD definitions (based on Schnurr, Marshall, Blanchard, or Stein) to those with and without PTSD. Using regression, those meeting subthreshold criteria by any of the four definitions had lower mental and physical health functioning and higher PCL scores relative to those without PTSD; they also had higher mental health functioning and lower PCL scores relative to those with PTSD. With SF-36 physical functioning scores, only those meeting the Stein definition differed from the group with PTSD. Thus, these definitions appear to distinguish individuals who are qualitatively different from individuals with no PTSD or with PTSD and are nearly equivalent in their ability to discriminate individuals.

Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military

OBJECTIVE

Subthreshold posttraumatic stress disorder (PTSD) has garnered recent attention because of the significant distress and functional impairment associated with the symptoms as well as the increased risk of progression to full PTSD. However, the clinical presentation of subthreshold PTSD can vary widely and therefore is not clearly defined, nor is there an evidence-based treatment approach. Thus, we aim to further the understanding of subthreshold PTSD symptoms by reporting the use of a virtual combat environment in eliciting distinctive psychophysiological responses associated with PTSD symptoms in a sample of subthreshold recently deployed US service members.

METHODS

Heart rate, skin conductance, electromyography (startle), respiratory rate, and blood pressure were monitored during three unique combat-related virtual reality scenarios as a novel procedure to assess subthreshold symptoms in a sample of 78 service members. The Clinician-Administered PTSD Scale was administered, and linear regression analyses were used to investigate the relationship between symptom clusters and physiological variables.

RESULTS

Among the range of psychophysiological measures that were studied, regression analysis revealed heart rate as most strongly associated with Clinician-Administered PTSD Scale-based measures hyperarousal (R = 0.11, p = .035,) reexperiencing (R = 0.24, p = .001), and global PTSD symptoms (R = 0.17, p = .003).

CONCLUSIONS

Our findings support the use of a virtual reality environment in eliciting physiological responses associated with subthreshold PTSD symptoms.

The perspective of psychosocial support a decade after Bam earthquake: achievements and challenges

The 2003 Bam earthquake was one of the most catastrophic disasters to have struck Iran. This article summarizes the short-term and long-term psychological, social, and economic impacts of the Bam earthquake on survivors across a decade since its occurrence. Identification and definition of capability as well as recognizing the nature and extent of personal and social capabilities in a community are priceless in preventing disasters and reducing their consequent destruction.