Predictors of posttraumatic stress disorder after burn injury

The day-to-day relationship between posttraumatic stress symptoms and social support after sexual assault

Background: Experiencing sexual assault is associated with a significant increase in risk for developing posttraumatic stress disorder and related concerns (e.g. alcohol misuse). Cross-sectional and longitudinal evidence suggests that social support may be both broadly protective against and eroded by posttraumatic stress symptoms. However, little is known about how different aspects of social support and posttraumatic stress symptoms influence each other in the weeks and months immediately following sexual assault, when posttraumatic stress (PTS) symptoms first emerge.Objective: The present study assessed the day-to-day relationship between social support and PTS in a sample of distressed, alcohol-using, recently-assaulted female survivors participating in a clinical trial of an app-based intervention (N = 41).Method: Participants completed 3 weeks of daily diaries starting within 10 weeks of sexual assault. Mixed-effects models were used to examine prior-day and same-day relationships between PTS and four social support constructs (social contact, emotional support, pleasantness of social interactions, and talking about sexual assault).Results: Results indicate that higher quantity and pleasantness of social interactions over the full sampling period was associated with lower PTS symptoms on any given day. Experiencing better-than-typical social interactions on one day was associated with lower than typical PTS symptoms on that day and the next day. On days when participants discussed their sexual assault with others, they tended to be having higher than usual PTS symptoms.Conclusions: Findings suggest that increasing the quantity and pleasantness of social interactions soon after sexual assault might protect against worsening posttraumatic stress symptoms.Trial registration: ClinicalTrials.gov identifier: NCT03703258.

Bringing mental health to the frontlines: A proactive team-based model for healthcare workers during the COVID-19 pandemic

OBJECTIVE

A novel team-based service was developed at the beginning of the pandemic in which sixty liaisons were assigned to provide proactive, tailored psychological support for healthcare workers (HCWs) across three of NewYork-Presbyterian's Weill Cornell affiliated hospitals.

METHOD

The program took the proactive approach of bringing mental health awareness to every department and major division that interfaced with COVID-19 patients. Virtual and in-person team-based "town hall" meetings were offered to provide psychoeducation, facilitate discussion, foster adaptive coping and social cohesion, and identify employees who would benefit from further individualized support.

RESULTS

The program's success was reflected in the number of town halls (1000+) and attendees (6000+) and in qualitative feedback from departments who requested ongoing services.

CONCLUSIONS

This article presents the development, implementation, challenges, and opportunities in designing a team-based support model for HCWs. This model may be useful for organizations that seek to develop similar programs.

Longitudinal associations between interpersonal relationship functioning and posttraumatic stress disorder (PTSD) in recently traumatized individuals: differential findings by assessment method

BACKGROUND

The role of interpersonal relationship functioning in trauma recovery is well-established. However, much of this research has been done with cross-sectional samples, often years after trauma exposure, using self-report methodology only, and is focused on intimate relationship adjustment.

METHODS

The current study investigated the longitudinal associations between interpersonal (intimate and non-intimate) relationship functioning and clinician- and self-reported posttraumatic stress disorder (PTSD) symptoms in 151 recently (within the past 6 months) traumatized individuals. Participants were assessed at four time points over 1 year.

RESULTS

Approximately 53% of the sample was diagnosed with PTSD at initial assessment, with declining rates of diagnostic status over time to 16%. Latent difference score (LDS) modeling revealed nonlinear declines in both clinician-assessed and self-reported PTSD symptom severity, with faster declines in earlier periods. Likewise, LDS models revealed nonlinear declines in negative (conflict) aspects of interpersonal relationship functioning, but linear declines in positive (support, depth) aspects. The relationship between PTSD and relationship functioning differed for clinician- and self-reported PTSD. Bivariate LDS modeling revealed significant cross-lagged effects from relationship conflict to clinician-assessed PTSD, and significant cross-lagged effects from self-reported PTSD to relationship conflict over time.

CONCLUSIONS

These results highlight that the variability in prior results may be related to the method of assessing PTSD symptomatology and different relational constructs. Implications for theory and early intervention are discussed.

Clinical therapeutic effects of platelet-rich plasma in patients with burn wound healing: A protocol for systematic review and meta-analysis

BACKGROUND

In clinical settings, burn wounds are frequently encountered. Since burn wounds are a form of physical injury, they can have long-term adverse effects on the human body. It has been a significant challenge to treat burn wounds completely. Since traditional treatment strategies have been unable to heal burn wounds completely, they lack the efficacy to cure the wounds without long-term effects, such as heavy scarring. Reportedly, platelet-rich plasma (PRP) has shown potential to accelerate wound healing. Yet, there are no conclusive reports on a methodological comparative study of research that has assessed the medical benefits of PRP for treating individuals carrying burn wounds. Thus, the present meta-analysis and systematic study aims to assess the medical benefits of PRP for treating patients carrying burn wounds.

METHODS

The authors will conduct a comprehensive search for randomized controlled trials that evaluate the safeness and efficiency of PRP to treat burn wounds. The search includes 3 Chinese language databases (WanFang database, Chinese BioMedical Literature database, and China National Knowledge Infrastructure) and 4 English language databases (Cochrane Library, EMBASE, Web of Science, and MEDLINE). These electronic databases will be searched from their establishment till May 2021. A pair of independent authors will be selecting eligible studies for extracting data. The same authors will employ the Cochrane risk of bias tool to evaluate the bias risk. We will make use of RevMan (version: 5.3) software to complete data synthesis.

RESULTS

The present protocol will establish practical and targeted results evaluating the efficacy and safeness of using PRP to treat burn wounds. The current study also provides a reference for clinical use of PRP.

CONCLUSION

Stronger evidence about the effectiveness and safety of using PRP to treat and heal burn wounds will be provided for clinicians to refer.

ETHICS AND DISSEMINATION

Ethics approval is unrequired.

REGISTRATION NUMBER

March 31, 2021.osf.io/whauj. (https://osf.io/whauj/).

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study

BACKGROUND

The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned.

AIMS

We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster.

METHOD

Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events.

RESULTS

When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events.

CONCLUSIONS

Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event.

Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis

OBJECTIVE

PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations.

METHODS

A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies.

RESULTS

From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.

A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder

Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.

Burn severity and long-term psychosocial adjustment after burn injury: The mediating role of body image dissatisfaction

BACKGROUND

Persons with severe burns often develop long-term psychosocial difficulties such as posttraumatic stress disorder (PTSD) and depression. Significant appearance changes following burn injury (e.g., scarring and disfigurement) can lead to body image dissatisfaction (BID) that causes psychological problems. Using a two-wave longitudinal design, this study examined the association between burn severity and psychosocial adjustment after burns (symptoms of PTSD and depression), particularly through the mediating role of BID.

METHOD

Participants were 111 burn survivors of the 2015 Formosa Fun Coast Water Park explosion. The mean age was 24.23 years, and 62.2% were female. The average TBSA burned was 50.3%, and the mean length of stay (LOS) in hospital was 85.44 days. Data were collected two (Time 1, T1) and three years (Time 2, T2) after the 2015 explosion. A composite burn severity score (CBSS) was additionally created based on TBSA and LOS.

RESULTS

Three main findings emerged: (1) burn severity (TBSA, LOS, and CBSS) were significantly associated with T1 BID and T2 depressive symptoms, but not with T2 PTSD symptoms; (2) T1 BID significantly mediated the relationship between burn severity (TBSA and CBSS) and T2 PTSD symptoms, after controlling for T1 PTSD symptoms; and (3) T1 BID significantly mediated the relationship between burn severity (TBSA, LOS, and CBSS) and T2 depressive symptoms, after controlling for T1 depressive symptoms.

CONCLUSIONS

The current findings highlight the importance of BID in the development and maintenance of psychosocial maladjustment long after burn injury.

Overexpressing of caveolin-1 in mesenchymal stem cells promotes deep second-degree burn wound healing

Burn injury is one of the most common physical injuries in clinic. It is a big challenge to find an ideal treatment for burn injury. Mesenchymal stem cells (MSCs) have been suggested as a promising candidate for wound healing. However, it is critical to improve the therapeutic efficiency of MSCs for treatment of burn injury. Here, we demonstrated that overexpression of caveolin-1, the main component of the caveolae plasma membranes, promoted the proliferation of MSCs both in vitro and in vivo. Moreover, transplantation of MSCs overexpressing caveolin-1 facilitated the expression of various growth factors and immunoregulatory cytokines and accelerated deep second-degree burn wound healing in a rat model of burn injury. Our results suggest that overexpression of caveolin-1 can improve the therapeutic efficiency of MSCs, which may be a promising strategy for the treatment of deep second-degree burn injury in clinic.

Context- and Subgroup-Specific Language Changes in Individuals Who Develop PTSD After Trauma

Post-traumatic stress disorder (PTSD) is a very common condition with more than 3 million new cases per year in the US alone. The right diagnosis in a timely manner is key to ensuring a prompt treatment that could lead to a full recovery. Unfortunately, avoidance of trauma reminders, social stigma, self-presentation, and self-assessment biases often prevent individuals from seeking timely evaluation, leading to delays in treatment and suboptimal outcomes. Previous studies show that various mental health conditions are associated with distinct patterns of language use. Analyzing language use may also help to avoid response bias in self-reports. In this study, we analyze text data from online forum users, showing that language use differences between PTSD sufferers and controls. In all groups of PTSD sufferers, the usage of singular first-person pronouns was higher and that of plural first-person pronouns was lower than in control groups. However, the analysis of other word categories suggests that subgroups of people with the same mental health disorder (here PTSD) may have salient differences in their language use, particularly in word usage frequencies. Additionally, we show that word usage patterns may vary depending on the type of the text analyzed. Nevertheless, more studies will be needed to increase precision by further examine a variety of text types and different comorbidities. If properly developed, such tools may facilitate earlier PTSD diagnosis, leading to timely support and treatment, which are associated with better outcomes.

Bidirectional Relationships Between Posttraumatic Stress Disorder and Social Functioning During Cognitive Processing Therapy

This study investigated temporal relationships between posttraumatic stress symptoms and two indicators of social functioning during cognitive processing therapy. Participants were 176 patients (51.5% female, M age = 39.46 [SD = 11.51], 89.1% White, 42.6% active duty military/veteran) who participated in at least two assessment time points during a trial of cognitive processing therapy. Posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-IV) and interpersonal relationship and social role functioning problems (Outcome Questionnaire-45) were assessed prior to each of 12 sessions. Multivariate multilevel lagged analyses indicated that interpersonal relationship problems predicted subsequent PTSD symptoms (b = .22, SE = 0.09, cr = 2.53, p = .01, pr = .46) and vice versa (b = .05, SE = 0.02, cr = 2.11, p = .04, pr = .16); and social role functioning problems predicted subsequent PTSD symptoms (b = .21, SE = 0.10, cr = 2.18, p = .03, pr = .16) and vice versa (b = .06, SE = 0.02, cr = 3.08, p < .001, pr = .23). Military status moderated the cross-lag from social role functioning problems to PTSD symptoms (b = -.35, t = -2.00, p = .045, pr = .16). Results suggest a robust association between PTSD symptoms and social functioning during cognitive processing therapy with a reciprocal relationship between PTSD symptoms and social functioning over time. Additionally, higher social role functioning problems for patients with military status indicate smaller reductions in PTSD symptoms from session to session.

Event-related clinical distress in college students: Responses to the 2016 U.S. Presidential election

Objectives: College students have cited the 2016 U.S. presidential election as a significant source of stress. The current study examined the prevalence and demographic correlates of clinically significant election-related avoidance and intrusion symptoms among college students 2-3 months after the election. Participants: College students attending a large public university (N = 769; M_age = 19.19; 48.2% female; 58.4% White) were surveyed in January and February 2017. Methods: Participants completed a validated measure of clinically significant event-related distress symptoms (eg, intrusive thoughts, avoidance) and demographic questions. Results: One out of four students met criteria for clinically significant symptoms related to the election. Regression analyses suggested that sex, political party, religion, and perceived impact of the election on relationships were more useful predictors of stress symptoms than race or social class. Conclusions: The high level of event-related distress is concerning because elevated symptoms of event-related stress are predictive of future distress and subsequent PTSD diagnoses.

Qualitative research investigating the mental health care service gap in Chinese burn injury patients

BACKGROUND

Psychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients.

METHODS

The researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers.

RESULTS

An explorative model was generated from the data, and the relationships among the categories were identified. People's beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions.

CONCLUSION

The model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed.

PTSD in civilian populations after hospitalization following traumatic injury: A comprehensive review

BACKGROUND

Injuries and their comorbidities affect victims far beyond their physical recovery period. Some study-measures show that more than half of patients hospitalized for a traumatic injury suffer from Acute Stress Disorder, alcohol dependence, and recurrent trauma. Overall, this literature review serves to review risk factors for PTSD, screening tools, follow-up strategies, and gaps in the literature for achieving feasible patient-centered interventions for the prevention of PTSD after a traumatic injury.

DATA SOURCES

A literature review was performed from August 1, 2017 to March 19, 2018, from 3 Databases: PubMed, CINAHL and Cochrane, with keywords: "PTSD", "Post-traumatic Stress Disorder", "Civilians", "Traumatic", "Injury", "Follow-up", "Treatment", "Referral", "surgery", "surgical", "Intervention", and "Insured", "underinsured".

CONCLUSIONS

Reported risk factors for PTSD were: prior psychiatric disorder, gunshots, and lack of social support. Most articles use the Posttraumatic Stress Disorder Checklist - Civilian version. Follow-up strategies mainly focus on multidisciplinary intervention protocols, including social workers, behavioral health specialists, and psychiatrists. Finally, gaps in the literature show the need for bilingual/bicultural patient-centered care for elderly, diverse ethnic backgrounds, and insured vs. uninsured patients.

Prevalence and Predictors of Posttraumatic Stress Symptomatology Among Burn Survivors: A Systematic Review and Meta-Analysis

Burns can be a traumatic and stressful experience, although each patient may respond in very different ways. The aim of this study was to explore the variability on posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) prevalence and evaluate the specific weight of different variables on PTSD development among adult burn patients. A systematic review was carried out to explore the prevalence of ASD and PTSD and identify their predictors. Meta-analytical methods were used to explore the strength of association between PTSD and the latter. From an initial pool of 190 studies, 24 were used in the systematic review, and only 19 studies could be used for the meta-analysis because of different methodological limitations. The prevalence of ASD at baseline ranged from 2 to 30% and prevalence of PTSD ranged from 3 to 35% at 1 month, 2 to 40% between 3 and 6 months, 9 to 45% in the year postinjury and ranged 7 to 25% more than 2 years later. Life threat perception was the strongest predictor for PTSD occurrence, followed by acute intrusive symptoms and pain associated with burn injuries. Predictive variables identified in this research may be useful in targeting burn patients who are at risk for developing posttraumatic stress symptoms and stress-related psychological symptoms.

Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress?

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.

Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study

INTRODUCTION

Trauma is a major public health problem worldwide that leads to high medical and societal costs. Overall, improved understanding of the full spectrum of the societal impact and burden of injury is needed. The main purpose of the Brabant Injury Outcome Surveillance (BIOS) study is to provide insight into prevalence, predictors and recovery patterns of short-term and long-term health-related quality of life (HRQoL) and costs after injury.

MATERIALS AND METHODS

This is a prospective, observational, follow-up cohort study in which HRQoL, psychological, social and functional outcome, and costs after trauma will be assessed during 24 months follow-up within injured patients admitted in 1 of 10 hospitals in the county Noord-Brabant, the Netherlands. Data will be collected by self-reported questionnaires at 1 week (including preinjury assessment), and 1, 3, 6, 12 and 24 months after injury. If patients are not capable of filling out the questionnaires, proxies will be asked to participate. Also, information about mechanism and severity of injury, comorbidity and indirect and direct costs will be collected. Mixed models will be used to examine the course of HRQoL, functional and psychological outcome, costs over time and between different groups, and to identify predictors for poor or good outcome.

RELEVANCE

This study should make a substantial contribution to the international collaborative effort to assess the societal impact and burden of injuries more accurately. The BIOS results will also be used to develop an outcome prediction model for outcome evaluation including, besides the classic fatal, non-fatal outcome.

TRIAL REGISTRATION NUMBER

NCT02508675.

Challenges in the retrospective assessment of trauma: comparing a checklist approach to a single item trauma experience screening question

BACKGROUND

Research on trauma and its impact on mental health typically relies on self-reports which can be influenced by recall bias and an individual's subjective interpretation of events. This study aims to compare responses on a checklist of life events with a trauma experience screening question, both of which assessed trauma experience retrospectively.

METHODS

A community sample of adults were asked about life events from a checklist before asking them whether they ever had a trauma experience, i.e. "an event that either puts them or someone close to them at risk of serious harm or death".

RESULTS

Less than half of the sample who reported at least one life event on the checklist that qualified as a trauma reported a trauma experience that they perceived put them or close others at risk of serious harm. Women responders, those reporting early life traumas, and a greater number of lifetime trauma events were more likely to report a trauma experience. Current symptoms of Common Mental Disorder did not account for differences in reporting of trauma experiences.

CONCLUSIONS

Epidemiological approaches which require participants to make subjective judgement on the severity of the trauma experience will capture individual differences that we have shown are influenced by gender and previous trauma experience.

Sense of coherence as a key to improve homebound status among older adults with urinary incontinence

AIM

Being homebound is regarded as a negative condition for social participation in Japan. However, little is known about the possibility of psychological resilience to prevent being homebound among older adults with urinary incontinence. The present study aimed to examine the association between sense of coherence as a measure of psychological resilience and being homebound among older adults with urinary incontinence.

METHODS

A cross-sectional study was carried out in Chiba, Japan. We trained 95 care managers as interviewers, and they collected the data from 411 community-dwelling frail older adults using a pretested structured questionnaire. Logistic regression analysis was run to identify factors associated with being homebound among the participants with urinary incontinence.

RESULTS

Of the participants, 158 (38.4%) had urinary incontinence. Among the participants with urinary incontinence, 52 (32.9%) were homebound. As a result of logistic regression analysis adjusting for age, sex, living status, hobby, types of prevalent diseases, walking ability, perceived social support and subjective social capital, lower meaningfulness in their lives, which is a component of a sense of coherence, remained positively associated with being homebound (adjusted odds ratio 0.79, 95% confidence interval 0.65-0.96).

CONCLUSIONS

Being homebound is less prevalent among those who feel challenges, or worthy of investment or engagement in daily life. By improving a sense of meaningfulness, homebound status might be improved among older adults with urinary incontinence. To encourage active social participation of the target population, their psychological resilience (particularly meaningfulness) should be addressed more.

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

OBJECTIVE

We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC).

METHOD

In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics.

RESULTS

The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r = .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery.

CONCLUSION

There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae.

Does a non-destructive earthquake cause posttraumatic stress disorder? A cross-sectional study

This study evaluated the prevalence and symptoms of posttraumatic stress disorder (PTSD) among adolescents who experienced non-destructive, moderate magnitude earthquake. Four hundred and fifty students (214 girls and 236 boys between the ages of 12-14) were selected from secondary schools located within Konya province in Turkey, 6 months after the earthquake. They were chosen to participate in this cross-sectional study by simple random sampling. The students were evaluated by the child posttraumatic stress reaction index. Of all the students, we found that 3.5% had very severe, 20.8% had severe, 28.4% had moderate and 20% had mild symptoms of PTSD and that 24.3% had probable PTSD diagnoses. The most common PTSD symptoms were trauma-related fears, social avoidance, emotional detachment and the concentration difficulty. Limitations and implications for research studies are included in the discussion.

Psychobiology of PTSD in the acute aftermath of trauma: Integrating research on coping, HPA function and sympathetic nervous system activity

Research on the psychobiological sequelae of trauma has typically focused on long-term alterations in individuals with chronic posttraumatic stress disorder (PTSD). Far less is known about the nature and course of psychobiological risk factors for PTSD during the acute aftermath of trauma. In this review, we summarize data from prospective studies focusing on the relationships among sympathetic nervous system activity, hypothalamic-pituitary-adrenal function, coping strategies and PTSD symptoms during the early recovery (or non-recovery) phase. Findings from pertinent studies are integrated to inform psychobiological profiles of PTSD-risk in children and adults in the context of existing models of PTSD-onset and maintenance. Data regarding bidirectional relations between coping strategies and stress hormones is reviewed. Limitations of existing literature and recommendations for future research are discussed.

Exploratory factor analysis of the Brazilian version of the Post-Traumatic Stress Disorder Checklist: civilian version (PCL-C)

OBJECTIVE

To evaluate the factor structure of the Brazilian Portuguese version of the Post-Traumatic Stress Disorder Checklist-civilian version (PCL-C), in order to complement its validation process in Brazil.

METHOD

An exploratory factor analysis with promax rotation was conducted in 175 ambulance workers of the Emergence Rescue Group (GSE from Portuguese) of the Rio de Janeiro fire brigade and 343 military police officers (MP) (150 from an elite unit of the state of Goiás). RESULTS The results revealed a two-factor solution: re-experience/avoidance, numbing/hyperarousal. All variables loaded highly in at least one factor, except for one; variable 16. This item may have had a bad performance because the analysis was based on a sample of police officers, whose professional activity demands hypervigilance as one of its basic characteristics. Internal consistency values were acceptable.

CONCLUSIONS

Avoidance and numbing seem to be independent dimensions, differently from what is expected according to the DSM-IV. Therefore, new trials should be carried out in other populations, with victims of different kinds of trauma, and including females, to verify these findings.

The influence of emergency contraception on post-traumatic stress symptoms following sexual assault

Conservative estimates indicate that 18-25% of women in the United States will be exposed to some form of sexual assault in their lifetime. A great number of these women will develop post-traumatic stress disorder (PTSD). The current study explores the relationship between emergency contraception (EC) administration and subsequent post-traumatic stress symptoms in female sexual assault (SA) survivors. In a study population of 111 participants, post-traumatic stress symptoms were assessed approximately six months after the SA. Women who were already taking hormonal contraception (HC) at the time of the SA and those who declined EC were compared to women who took either Ogestrel or Plan B following the SA. While the administration of traditional HC and both types of EC were associated with fewer intrusive symptoms, women who took Ogestrel reported significantly lower post-traumatic stress total symptom levels than did those who took Plan B or those who declined EC. The results suggest that the manipulation of sex hormone levels with HC and EC in the immediate aftermath of trauma may influence subsequent post-traumatic stress symptoms. The current results may be useful in guiding the choice of EC.

A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury

BACKGROUND

Psychologic problems are common after burns, and symptoms of posttraumatic stress disorder (PTSD) are some of the most prevalent. Risk factors for PTSD have been identified, but little is known about the onset and course of these symptoms. The objective was to investigate whether there are different PTSD symptom trajectories after burns.

METHODS

Ninety-five adults with burns were enrolled in a prospective study from in-hospital treatment until 12 months after burn. Symptoms of PTSD were assessed with the Impact of Event Scale-Revised and scores at 3, 6, and 12 months after the burn were used in a cluster analysis to detect trajectories. The trajectories were compared regarding known risk factors for PTSD using non-parametric analysis of variance.

RESULTS

Four clusters were identified: (1) resilient, with low levels of PTSD symptoms that decreased over time; (2) recovery, with high levels of symptoms that gradually decreased; (3) delayed, with moderate symptoms that increased over time; and (4) chronic, with high levels of symptoms over time. The trajectories differed regarding several risk factors for PTSD including life events, premorbid psychiatric morbidity, personality traits, avoidant coping, in-hospital psychologic symptoms, and social support. The resilient trajectory consistently had fewer of the risk factors and differed the most from the chronic trajectory.

CONCLUSIONS

There are subgroups among patients with burns that have different patterns of PTSD symptom development. These findings may have implications for clinical practice, such as the timing of assessment and the management of patients who present with these symptoms.

Trauma and victims: epidemiology of post-traumatic stress disorder

Scopo- Presentare una esaustivareviewdegli studi riguardanti l'epidemiologia del DPTS condotti nella popolazione generale, tra i soggetti a rischio, e, infine, tra gruppi clinicamente selezionati.Disegno- AttraversoExcepta Medica PsychiatryCD-ROM 1980-1993 (ottobre), utilizzando come parola chiave «Post-Traumatic Stress Disorder», sono stati identificati 1.057 articoli pubblicati nel periodo considerate Sono stati anche consultati altridata basedella letteratura medica (MEDLINE CD-ROM 1988-1993); è stata quindi operata una ricerca manuale su tutti i numeri delJournal of Traumatic Stress. Risultati- In totale, 135 lavori che hanno soddisfatto i criteri di inclusione prescelti sono stati inclusi nella review. I due terzi (n = 86, 64%) di queste ricerche sono state condotte negli USA. Solo 8 (6%) sono le indagini effettivamente realizzate nei paesi del Terzo Mondo. L'ampiezza del campione varia da un minimo di 11 soggetti, numero riscontrato in due studi, sino ad un massimo di 22.436, per un campione medio di 500 e mediano di 108. Per quanto attiene ai metodi di valutazione, in un terzo degli studi (n = 45, 33%), i ricercatori hanno impiegato un questionario (auto- o etero- somministrato). In un altro terzo delle ricerche elencate (n = 44, 33%) e stata somministrata un'intervista strutturata (la DIS, la SCID, o la SADS), mentre nei rimanenti studi la valutazione diagnostica si è basata o su una procedura clinica non strutturata, o sulla somministrazione di altri strumenti specifici dai quali è possibile inferire una diagnosi di DPTS (M-PTSD, IES, SCL-90-R,o pochi altri). In 77 studi (57%) i ricercatori hanno basato la loro valutazione sui criteri diagnostici propri del DSM-III, mentre in altri 55 (41%) su quelli del DSM-III-R. La prevalenza del DPTS e analizzata quindi separatamente per le diverse popolazioni studiate.Conclusioni- Nell'arco di soli 13 anni, a partire cioe dalla definizione di criteri diagnostici operazionali ben definiti per il DPTS, sono stati condotti numerosi studi volti ad indagare la prevalenza, i fattori di rischio, la storia naturale, il decorso e l' esito di questo disturbo tra campioni diversi di popolazioni a rischio; inoltre, anche il livello qualitativo di queste ricerche, per quanto attiene alia sofisticazione metodologica, si è accresciuto sensibilmente in un tempo tutto sommato breve. Molte aree, pero', restano tuttora inesplorate, ed inoltre appare imperativo avviare ricerche estensive tra le popolazioni dei paesi in via di sviluppo, maggiormente esposte a disastri naturali o provocati dall'uomo.

Psychological resilience in OEF-OIF Veterans: application of a novel classification approach and examination of demographic and psychosocial correlates

A growing number of studies have examined the prevalence and correlates of psychopathology in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF), but few have examined determinants of resilience in this population. This study employed a novel approach to classify psychological resilience in a cross-sectional sample of OEF-OIF Veterans. A total of 272 predominantly older reserve/National Guard OEF/OIF Veterans completed a mail survey that assessed combat exposure, psychopathology, psychosocial functioning, and aspects of social support. Cluster analysis of scores on measures of combat exposure and PTSD symptoms revealed that a three-group solution best fit the data: Controls (low combat exposure, low PTSD symptoms); PTSD (high combat exposure, high PTSD symptoms); and Resilient (high combat exposure, low PTSD symptoms). Compared to the PTSD group, the Resilient group was more likely to be in a relationship and active duty; they also scored lower on a measure of psychosocial dysfunction, and higher on measures of psychological resilience and postdeployment social support. Logistic regression analysis revealed that being in a relationship, having fewer psychosocial difficulties, and reporting greater perceptions of purpose/control and family support and understanding were significantly associated with resilient group membership. Results of this study demonstrate a novel approach to classifying psychological resilience and suggest that interventions to mitigate psychosocial difficulties, enhance perceptions of purpose and control, and bolster family support and understanding may help promote resilience to combat-related PTSD in OEF-OIF Veterans.

PTSD after traumatic injury: an investigation of the impact of injury severity and peritraumatic moderators

Presence of injury is often examined as a risk factor for posttraumatic stress disorder (PTSD); however, results have been mixed regarding the relationship between injury severity and PTSD symptoms (PTSS). The present study examined subjective and objective injury severity ratings in traumatic injury victims to determine if they differentially predict PTSS. Results demonstrated that subjective, not objective, injury severity predicted PTSS at six weeks and three months post-trauma. The moderating impact of peritraumatic factors was also examined. Peritraumatic dissociation moderated the impact of subjective injury severity on PTSS. Findings indicate that subjective injury severity should be incorporated into early screeners for PTSD risk.

Research on integrative healthcare: context and priorities

It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on well-being as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a framework for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

Psychiatric aspects of burn

Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychological outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.

Emotional associations with skin: differences between burned and non-burned individuals

INTRODUCTION

The appearance of skin is crucial for our physical and psychological integrity, and is strongly associated with our emotional self-awareness. Burn victims have to cope with negative and even threatening sensations resulting from the changed appearance of their skin after injury and also linked to experiences during the treatment. The aim of this study was to analyse differences regarding the emotional associations with skin in burn victims (burn group) to persons not having subdued any burn (control group).

METHODS

In the first instance over 960 volunteers were recruited for the rating of emotional associations with skin in the control group and thereby a representative profile for non-injured individuals. In the second part, 44 burn patients of the Vienna Burn Center answered the same questionnaire. The quantitative rating of emotional associations with skin was performed with a newly designed questionnaire using a semantic differential on eight dimensions with a 5-point scale system.

RESULTS

Both groups have positive associations with skin. One significant difference (p=0.0090, Chi-square test for trend) was the overall rating of the item "importance": for burn victims skin is more "important" than for controls. Patients with visible burns tended to put more emphasize on the possible exposure to danger ("threatened") of skin, and patients with >/=20% TBSA rated skin as more "noticeable" and "strong" as compared to small burns (<20% TBSA). Patients with burns to the face, hands and neck ("visible burns") were more likely to judge skin as threatened item.

DISCUSSION

Our poll suggests that despite long treatment, rehabilitation and even near-death experiences burn patients continue to have positive associations with skin. This in turn, should encourage all specialists dealing with burns to engage in a continuous follow-up as well as enhance psychological and social support.

Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries

PURPOSE

Symptoms of posttraumatic stress disorder (PTSD) in patients with hand injuries may delay return to work, even when criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV are not met. This study investigated which biomedical and psychosocial factors relate to symptoms of acute PTSD in hand-injured patients.

METHODS

Sixty-seven employed patients with hand injuries completed a number of questionnaires. The following factors were investigated: sociodemographic characteristics, injury severity, accident location, pain, satisfaction with hand functioning, aesthetics of the hand, social support, and coping styles. The primary outcome measure was the number of symptoms of PTSD. We analyzed factors that were univariately significantly associated with symptoms of PTSD using linear regression analysis, and explored interaction effects.

RESULTS

One patient met the criteria for PTSD; 44 patients experienced symptoms but did not meet the criteria (median, 1; interquartile range (IQR), 0-2); 22 patients experienced no symptoms of PTSD. Patients had a median pain score of 30 (IQR, 10-45), median satisfaction score of 60 (IQR, 45-70), median aesthetics score of 66.7 (IQR, 45.8-79.2), median palliative coping style score of 16 (IQR, 14.8-17.3), and median avoidance coping style of 15 (IQR, 13-16). Symptoms of PTSD were associated with pain (r, .530; p < .001), satisfaction with hand function (r, -.451; p < .001), aesthetics (r, -.320; p = .009), palliative coping style (r, .281; p = .022) and avoidance coping style (r, .283; p = .022). Pain and aesthetics remained significant after regression analysis. No interaction effects were significant.

CONCLUSIONS

Pain and aesthetics statistically predict symptoms of acute PTSD in patients with acute hand injuries. Patients with disproportionate pain or dissatisfaction with aesthetics should be evaluated for PTSD.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Mental disorders among acute burn patients

OBJECTIVE

To investigate mental disorders among acute hospitalized burn patients.

METHOD

Consecutive acute adult burn patients (n=107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered.

RESULTS

The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q=6.40, df=1, p=0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q=13.00, df=1, p<0.001) in acute care.

CONCLUSIONS

Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium.

Propranolol does not reduce risk for acute stress disorder in pediatric burn trauma

OBJECTIVE

Acute stress disorder (ASD) can interfere with satisfactory recovery of children with severe burn injuries. Recent studies have found propranolol to be effective in reducing posttraumatic symptoms, but the benefits of this medication with ASD are unknown. Therefore, we hypothesized that individuals who were administered propranolol acutely would be less likely to develop ASD than those who were not.

METHOD

A review of electronic medical records was conducted on the children included in a previous blinded randomized-control trial, in which the participants received propranolol or no propranolol during the acute phase of recovery (first 30 days). These data were merged with electronic information regarding medication treatment for ASD. The psychologists and clinicians who had previously assessed for ASD for purposes of treating the children's distress were blinded to who received propranolol and who did not.

RESULTS

There were 363 participants (232 boys, 131 girls) and the mean total body surface area was 56%. Of this sample, 22 participants had been previously diagnosed and treated for ASD, and 341 were in a non-ASD group. Eight percent of those children who received propranolol required treatment for ASD, whereas 5% of children who received no propranolol also required treatment for ASD. No statistically significant difference was noted.

CONCLUSIONS

Propranolol was not found to influence the risk for subsequent ASD. This finding is in contrast to the observed benefit of propranolol reported in other studies with different at risk populations. Further exploration is warranted to assess the possible long-term benefit on posttraumatic symptoms in pediatric burn survivor patients.

Injury-specific predictors of posttraumatic stress disorder

OBJECTIVE

Posttraumatic stress disorder (PTSD) is an important source of morbidity in military personnel, but its relationship with characteristics of battle injury has not been well defined. The aim of this study was to characterise the relationship between injury-related factors and PTSD among a population of battle injuries.

PATIENTS AND METHODS

A total of 831 American military personnel injured during combat between September 2004 and February 2005 composed the study population. Patients were followed through November 2006 for diagnosis of PTSD (ICD-9 309.81) or any mental health outcome (ICD-9 290-319).

RESULTS

During the follow-up period, 31.3% of patients received any type of mental health diagnosis and 17.0% received a PTSD diagnosis. Compared with minor injuries those with moderate (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.61-3.48), serious (OR, 4.07; 95% CI, 2.55-6.50), and severe (OR, 5.22; 95% CI, 2.74-9.96) injuries were at greater risk of being diagnosed with any mental health outcome. Similar results were found for serious (OR, 3.03; 95% CI, 1.81-5.08) and severe (OR, 3.21; 95% CI, 1.62-6.33) injuries with PTSD diagnosis. Those with gunshot wounds were at greater risk of any mental health diagnosis, but not PTSD, in comparison with other mechanisms of injury (OR 2.07; 95% CI, 1.35, 3.19). Diastolic blood pressure measured postinjury was associated with any mental health outcome, and the effect was modified by injury severity.

CONCLUSIONS

Injury severity was a significant predictor of any mental health diagnosis and PTSD diagnosis. Gunshot wounds and diastolic blood pressure were significant predictors of any mental health diagnosis, but not PTSD. Further studies are needed to replicate these results and elucidate potential mechanisms for these associations.

A comparison of posttraumatic stress disorder between combat casualties and civilians treated at a military burn center

BACKGROUND

Posttraumatic stress disorder (PTSD) has been identified in 12% to 20% of noninjured veterans and in 32% of combat casualties. Eight percent of the US general population experience PTSD symptoms, whereas 25.5% of civilians with major burns have PTSD. Known predictors of physical outcomes of patients with burn are age, total body surface area (TBSA) burned, and Injury Severity Score (ISS). The United States Army Institute of Surgical Research Burn Center provides burn care for combat casualties and civilians. We hypothesized that we would find no difference in PTSD incidence between these two populations and that age, TBSA, and ISS are associated with PTSD.

METHOD

We retrospectively examined the clinical records of 1,792 patients admitted between October 2003 and May 2008. Records were stratified by PTSD, age, TBSA, and ISS. PTSD scores were compared. Descriptive analyses were used.

RESULTS

Four hundred ninety-nine patients (372 military [74.5%]; 127 civilians [25.5%]) were assessed for PTSD using PTSD checklist military and civilian versions. PTSD was defined as >or=44 on the PTSD checklist instruments. We found no significant difference in PTSD between combat casualties and civilians (25% vs. 17.32%, p = 0.761). TBSA and ISS were significantly associated with PTSD; however, no association between age and PTSD was found.

CONCLUSION

The incidence of PTSD is not significantly different in burned combat casualties and civilians treated at the same burn unit. These findings suggest that PTSD is related to the burn trauma and not to the circumstances surrounding the injury.

Numbing symptoms as predictors of unremitting posttraumatic stress disorder

This prospective longitudinal study examined the ability of re-experiencing, avoidance, numbing, and hyperarousal symptoms to predict persistence of posttraumatic stress disorder (PTSD) in disaster workers followed for 2 years. Cluster analyses suggested that overall severity was the best predictor of PTSD at follow up, but for groups with PTSD of moderate severity, numbing symptoms were also associated with PTSD at the 2-year follow up. Regression analyses with all four symptom groups as independent variables found that only numbing and re-experiencing symptoms predicted PTSD at the 1 year follow up, and only numbing symptoms predicted PTSD at the 2-year follow up. Findings suggest that numbing symptom severity could be used as a risk index of very chronic PTSD, especially when the overall PTSD severity falls in the moderate range.