The epidemiology of trauma, PTSD, and other posttrauma disorders

Potential effect of social support on perceived stress and anxiety in college students during public health crisis: Multiple interactions of gender

The COVID-19 pandemic has affected college students, leading to increased anxiety and emotional distress. This study investigated how perceived public health crises relate to anxiety levels in college students, and how social support and gender influence this relationship. Data from 3,165 college students from six universities in Shaanxi Province, China, were collected and analyzed by using AMOS and SPSS PROCESS 4.0. Results showed that perceived COVID-19 risk significantly impacted anxiety levels, and social support moderated this relationship. Gender also had multiple interaction effects with social support and perceived pandemic risk on anxiety. Overall, the study confirms that COVID-19 quarantine and perceived risk increase stress and anxiety in college students, with social support playing a buffering role, albeit with variations based on gender.

Reward Neurocircuitry Predicts Longitudinal Changes in Alcohol Use Following Trauma Exposure

BACKGROUND

Trauma is a risk factor for developing maladaptive alcohol use. Preclinical research has shown that stress alters the processing of midbrain and striatal reward and incentive signals. However, little research has been conducted on alterations in reward-related neurocircuitry posttrauma in humans. Neuroimaging markers may be particularly useful because they can provide insight into the mechanisms that may make an individual vulnerable to developing trauma-related psychopathologies. In this study, we aimed to identify reward-related neural correlates associated with changes in alcohol use after trauma exposure.

METHODS

Participants were recruited from U.S. emergency departments for the AURORA study (n = 286; 178 female). Trauma-related change in alcohol use at 8 weeks posttrauma relative to pretrauma was quantified as a change in 30-day total drinking per the PhenX Toolkit Alcohol 30-Day Quantity and Frequency measure. Reward-related neurocircuitry activation and functional connectivity were assessed 2 weeks posttrauma using functional magnetic resonance imaging during a monetary reward task using region of interest and whole-brain voxelwise analyses.

RESULTS

Greater increase in alcohol use from pretrauma to 8 weeks posttrauma was predicted by 1) greater ventral tegmental area, 2) greater cerebellum activation during gain > loss trials measured 2 weeks posttrauma, and 3) greater seed-based functional connectivity between the ventral tegmental area and lateral occipital cortex and precuneus.

CONCLUSIONS

Altered ventral tegmental area activation and functional connectivity early posttrauma may be associated with reward seeking and processing, thereby contributing to greater alcohol use posttrauma. These data provide novel evidence of neural correlates that underlie increased alcohol use early posttrauma that may be targeted via early interventions to prevent the development of maladaptive alcohol use.

Acute and chronic cannabis vapor exposure produces immediate and delayed impacts on phases of fear learning in a sex specific manner

RATIONALE

Current treatment options for PTSD have unreliable efficacy, with many individuals unable to achieve complete remission. Cannabis and cannabinoids that act through the endogenous cannabinoid (endocannabinoid) system to help promote trauma recovery by means of enhanced extinction learning are potential therapeutic, pharmacological candidates. Using a preclinical model of translationally-relevant cannabis administration in rodents, we examined the impact of cannabis exposure on aversive memory.

OBJECTIVES

Our study investigated the effects of acute cannabis exposure prior to (1) fear conditioning and (2) fear extinction, as well as (3) chronic cannabis exposure prior to fear conditioning, on the behavioural representations of fear memory dynamics in a Pavlovian auditory conditioning paradigm.

METHODS

Male and female Sprague Dawley rats were acutely or chronically exposed to THC-dominant cannabis extract or vehicle vapor as described above. We then assessed both passive (freezing) and active (darting) fear behaviours during conditioning, extinction, retrieval, and spontaneous recovery.

RESULTS

Acute cannabis exposure prior to conditioning had no immediate effects on fear acquisition, but impaired fear recall in females 24 h later and prevented spontaneous recovery of conditioned fear following a two-week retrieval test in both male and female rats. Acute cannabis exposure prior to extinction training impaired extinction in females while enhancing extinction acquisition in males. Finally, chronic THC exposure prior to fear conditioning initially potentiated fear responses, predominately in females, but produced no differences in spontaneous recovery in a two-week retrieval test.

CONCLUSIONS

Cannabis exposure has complex dynamics on fear memory, however, acute cannabis exposure prior to fear learning appears to result in destabilization of the fear memory long term, which could have potential implications for PTSD.

Personal Narratives in Trauma-Related Disorders: Contributions from a Metacognitive Approach and Treatment Considerations

Traumatic experiences are significant life events that are thought to impact one's personal life narrative and narrative identity. Individuals who have experienced trauma may display fragmented memories and decreased narrative cohesion, resulting in trauma narratives that are disjointed and poorly integrated into the larger picture of their lives. Metacognition, defined as the ability to form increasingly complex and integrated ideas about the self, others, and the wider world, offers a framework to better understand life narratives and has been proposed as a construct that allows personal narratives to evolve in response to new experiences. In this paper, we will review the alterations commonly observed in trauma narratives. We will utilize the integrated model of metacognition as a framework to understand these deviations with an eye toward clinical implications. Although treatments that focus on trauma narratives exist, we argue that the study of metacognition provides unique insights into the process of integration of traumatic experience into an evolving personal narrative and may allow for more complete treatment of trauma-related disorders.

Exploring the impact of biological sex on intrinsic connectivity networks in PTSD: A data-driven approach

INTRODUCTION

Sex as a biological variable (SABV) may help to account for the differential development and expression of post-traumatic stress disorder (PTSD) symptoms among trauma-exposed males and females. Here, we investigate the impact of SABV on PTSD-related neural alterations in resting-state functional connectivity (rsFC) within three core intrinsic connectivity networks (ICNs): the salience network (SN), central executive network (CEN), and default mode network (DMN).

METHODS

Using an independent component analysis (ICA), we compared rsFC of the SN, CEN, and DMN between males and females, with and without PTSD (n = 47 females with PTSD, n = 34 males with PTSD, n = 36 healthy control females, n = 20 healthy control males) via full factorial ANCOVAs. Additionally, linear regression analyses were conducted with clinical variables (i.e., PTSD and depression symptoms, childhood trauma scores) in order to determine intrinsic network connectivity characteristics specific to SABV. Furthermore, we utilized machine learning classification models to predict the biological sex and PTSD diagnosis of individual participants based on intrinsic network activity patterns.

RESULTS

Our findings revealed differential network connectivity patterns based on SABV and PTSD diagnosis. Males with PTSD exhibited increased intra-SN (i.e., SN-anterior insula) rsFC and increased DMN-right superior parietal lobule/precuneus/superior occipital gyrus rsFC as compared to females with PTSD. There were also differential network connectivity patterns for comparisons between the PTSD and healthy control groups for males and females, separately. We did not observe significant correlations between clinical measures of interest and brain region clusters which displayed significant between group differences as a function of biological sex, thus further reinforcing that SABV analyses are likely not confounded by these variables. Furthermore, machine learning classification models accurately predicted biological sex and PTSD diagnosis among novel/unseen participants based on ICN activation patterns.

CONCLUSION

This study reveals groundbreaking insights surrounding the impact of SABV on PTSD-related ICN alterations using data-driven methods. Our discoveries contribute to further defining neurobiological markers of PTSD among females and males and may offer guidance for differential sex-related treatment needs.

Alliance processes in eating disorders with childhood maltreatment sequelae: Preliminary implications

BACKGROUND

Effective eating disorder (ED) treatments are drastically needed for patients with experiences of sustained and prolonged emotional, physical and sexual childhood maltreatment (CM) that often results in post-traumatic sequelae such as severe, complex posttraumatic stress disorder (cPTSD). EDs with comorbid cPTSD (cPTSD-ED) have protracted treatment courses and poorer prognoses.

AIM

To summarise the knowledge base on cPTSD-ED with specific emphasis on disturbances in self-organisation (DSO) in relation to therapeutic alliance (TA) processes.

METHOD

Expert opinions based on current relevant literature are critically examined.

RESULTS

Preliminary insights on change and alliance processes suggest that neglecting to address emotional-relational processes in the conceptualisation and treatment of cPTSD-ED impedes treatment progress.

CONCLUSION

We hypothesise that the DSO construct inherent in cPTSD-ED calls for a focus on TA processes in addition to traditional ED treatment elements such as nutritional rehabilitation and behaviour change, and regardless of ED treatment provided. More process research on a larger scale is urgently called for.

PTSD, dysregulation profile and substance use: exploring differences in a sample of adolescents in an outpatient clinic

Introduction

Experiencing traumatic events (TEs), especially interpersonal TEs, is related to an increased risk of developing post-traumatic stress disorder (PTSD). Both TEs and PTSD are associated with a higher risk of substance use and problems in emotion regulation. Little is known about the associations between specific types of TEs, problems with general self-regulation (including cognitive and behavioral components) and substance use severity in adolescents. Knowledge on these associations could provide important approaches for prevention and therapy for adolescents with a history of trauma.

Methods

This study investigated associations between different types of TEs and PTSD, self-regulation and substance use severity. Moreover, participants were categorized into three groups according to their trauma status: (I) no history of TEs (noTEs), (II) history of TEs but no PTSD diagnosis (TEs), and (III) history of TEs and PTSD diagnosis (PTSD). Differences between the three groups were analyzed in terms of self-regulation and substance use severity. Our sample consisted of N = 89 adolescents aged 12 to 18 years in a child and adolescent psychiatric outpatient clinic in Germany. Substance use severity was only assessed in a smaller subsample (n = 37). Data were obtained from standardized diagnostic procedures and included information on types of TEs and PTSD diagnosis according to ICD-10, problems in self-regulation assessed with the Child Behavior Checklist (CBCL)/ Youth Self Report (YSR) Dysregulation Profile (DP), and substance use severity measured with the Drug Use Disorders Identification Test (DUDIT).

Results

We found that interpersonal TEs were significantly associated with higher rates of PTSD diagnosis compared to non-interpersonal TEs. We found no significant associations between different types of TEs and both problems in self-regulation and substance use severity. Moreover, our findings do not indicate differences in both self-regulation and substance use severity between trauma statuses (noTEs, TEs, PTSD).

Discussion

Future studies should consider other characteristics of TEs such as timing and duration when investigating associations with self-regulation. Longitudinal studies are needed to investigate developmental pathways, as a better understanding of the role of characteristics of TEs and self-regulation in the development of PTSD and substance use problems would provide opportunities for prevention and therapy for trauma-exposed patients.

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment

PURPOSE OF REVIEW

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring.

RECENT FINDINGS

PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

Paying attention to uncertainty: A stochastic multimodal transformers for post-traumatic stress disorder detection using video

BACKGROUND AND OBJECTIVES

Post-traumatic stress disorder is a debilitating psychological condition that can manifest following exposure to traumatic events. It affects individuals from diverse backgrounds and is associated with various symptoms, including intrusive thoughts, nightmares, hyperarousal, and avoidance behaviors.

METHODS

To address this challenge this study proposes a decision support system powered by a novel multimodal deep learning approach, based on a stochastic Transformer and video data. This Transformer has the ability to take advantage of its stochastic activation function and layers that allow it to learn sparse representations of the inputs. The method leverages a combination of low-level features extracted using three modalities, including Mel-frequency cepstral coefficients extracted from audio recordings, Facial Action Units captured from facial expressions, and textual data obtained from the audio transcription. By considering these modalities, our proposed model captures a comprehensive range of information related to post-traumatic stress disorder symptoms, including vocal cues, facial expressions, and linguistic content.

RESULTS

The deep learning model was trained and evaluated on the eDAIC dataset, which consists of clinical interviews with individuals with and without post-traumatic disorder. The model achieved state-of-the-art results, demonstrating its effectiveness in accurately detecting PTSD, showing an impressive Root Mean Square Error of 1.98, and a Concordance Correlation Coefficient of 0.722, signifying the model's superior performance compared to existing approaches.

CONCLUSION

This work introduces a new method for post-traumatic stress disorder detection from videos by utilizing a multimodal stochastic Transformer model. The model makes use of a variety of modalities, such as text, audio, and visual data, to gather comprehensive and varied information in order to make the detection.

Sex differences in fear expression and persistence in an animal model of Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a complex psychiatric condition arising from traumatic experiences, marked by abnormal fear memories. Despite women are twice as likely as men to develop PTSD, the biological mechanisms underlying this disparity remain inadequately explored, particularly in preclinical studies involving female subjects. Previous research shows that female rats exhibit active fear responses, while males display passive behaviors. Additionally, sex differences in ultrasonic vocalizations (USVs) during fear conditioning have been observed, indicating varying emotional responses. Here, we validated a traumatic stress model consisting of footshock exposure paired with social isolation - originally developed in male rats - on females for the first time, focusing on sex differences in fear memory expression, retention and extinction. Our findings reveal that only during trauma exposure, males predominantly exhibited passive responses, whereas females demonstrated more active responses, despite both sexes emitting similar numbers of alarm USVs. Females also showed lower levels of freezing and USV emissions throughout extinction sessions and displayed a higher extinction rate compared to males. Notably, only males displayed a conditioned fear response when triggered by a single mild stressor. These findings highlight sex differences in trauma responses and fear memory processes. The study emphasizes the importance of incorporating 22-kHz USV evaluations along with other behavioral metrics for a comprehensive understanding of fear memory. This research contributes to the existing literature on traumatic stress models as well as underscores the necessity of including female subjects in preclinical studies to better inform treatment and prevention strategies tailored to both sexes.

Psychiatric disorders endorsed by trauma-exposed premenopausal women enrolled in a cardiovascular research study: a 2-year report

INTRODUCTION

Women are more likely than men to experience interpersonal trauma, with 1 in 3 women affected globally. This paper aims to give a 2-year report of the demographics, trauma history [i.e., non-interpersonal and interpersonal including adverse childhood event (ACEs)] and psychiatric disorders endorsed by premenopausal women screened for our cardiovascular research study.

METHODS

Premenopausal women were recruited from the Twin-Cities area using flyers. Interested participants were screened for this study via REDCap. Age, race, history of psychiatric disorders, menopausal status, contraceptives, and current medications were collected. Participants who met the eligibility criteria were enrolled and completed additional questionnaires focusing on trauma exposure and mental health.

RESULTS

The first 2 years our study was open to accrual, a total of 447 premenopausal women were screened. The majority (~ 71%) of our participants were between 18 and 30 years old. Among the 447 women, 35% reported a diagnosis of posttraumatic stress disorder (PTSD), while 46% reported depression and 53% an anxiety disorder, according to DSM-5. Further, we found that women between the ages of 21-25 years reported the most (23%) psychiatric disorders, mainly PTSD. The main type of trauma reported was interpersonal trauma (~ 62%), of which 76% were ACEs.

CONCLUSION

Among the trauma-exposed women enrolled in our study, the age group between 21 and 25 years old endorsed the most psychiatric disorders, possibly stemming from ACEs. Our findings shed the light on the rising rate of psychiatric disorders in premenopausal women and support the growing public health burden of trauma exposure, particularly in childhood.

Distressing memories: A continuum from wellness to PTSD

BACKGROUND

Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events.

METHODS

Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis.

RESULTS

In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD.

CONCLUSION

DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability.

The Shield of Self-Esteem: Buffering against the Impact of Traumatic Experiences, Fear, Anxiety, and Depression

BACKGROUND

Adverse life occurrences (e.g., severe accidents, violence/abuse, organic disorders such as COVID-19) can elicit traumatic responses that heighten fear, anxiety, and depression. However, scientific research has shown that certain variables, such as self-esteem, based on theories like terror management theory (TMT) and the anxiety-buffering hypothesis (ABH), can mitigate the negative effects of trauma. This study aimed to test the ABH by assessing the buffering role of self-esteem in the relationships among the impact of traumatic experiences, fear, anxiety, and depression.

METHOD

An observational research design was used. This study involved 321 participants who experienced COVID-19 as a traumatic experience. A sequential multiple-mediation model with observed variables (path analysis) was used to test the impact of the traumatic experience on fear, anxiety, and depression, examining the protective role of self-esteem.

RESULTS

A path analysis revealed that fear and anxiety mediated the relationship between the impact of the traumatic experience of COVID-19 and depression. Additionally, in line with the ABH, self-esteem was found to mediate the relationship between the predictors and their adverse psychological consequences. This suggests that self-esteem played a buffering role, mitigating the negative impact of traumatic experiences on mental health outcomes.

CONCLUSIONS

These findings underscore the central mediating role of self-esteem, as well as fear and anxiety, in the pathway from trauma-related factors to depression. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with traumatic experiences, fostering adaptation, and supporting psychological health.

Genetic association between post-traumatic stress disorder and cardiovascular disease: A scoping review

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a complex psychiatric disorder associated with adverse long-term health outcomes, including cardiovascular disease (CVD). Despite growing evidence that PTSD is positively associated with CVD, the biological mechanisms underlying this association are poorly understood. This review provides an overview of the current state of science on the genetic association between PTSD and CVD.

MATERIAL AND METHODS

This scoping review identified studies from Pubmed, Embase, PsycINFO, and Web of Science. The search terms were a combination of PTSD, CVD/CVD-related traits, and a set of genetic molecules and related terms. This review followed the PRISMA Extension for Scoping Reviews guidelines. Eligible criteria included original studies that have genetic factors related to PTSD or CVD, conducted in humans, written in English, and published between 2003 and 2023 in peer-reviewed journals.

RESULTS

A total of twenty-three studies were included; PTSD correlated with genetic variants in CVD-related traits and gene expression in regulatory pathways contributing to CVD development. Common CVD-related traits involved in genetic associations with PTSD were inflammation, cellular aging, increased blood pressure, hypothalamus-pituitary-adrenal axis dysregulation, metabolic syndrome, and oxidative stress. These traits may explain potential underlying mechanisms between PTSD and CVD. Evidence of a causal relationship between the two diseases was insufficient.

DISCUSSION

PTSD and CVD/CVD-related traits are genetically associated. Further research is needed to comprehensively explore gene-environment interactions and the cumulative impact of behavioral and psychological factors on the pathophysiological mechanisms between PTSD and CVD.

Understanding the structure of autobiographical memories: A study of trauma memories from the 1994 Rwandan genocide

How do we remember traumatic events, and are these memories different in individuals who experience post-traumatic stress? Some evidence suggests that traumatic events are mnemonically enhanced, or include more episodic detail, relative to other types of memories. Simultaneously, individuals with post-traumatic stress disorder (PTSD) have more non-episodic details in all of their memories, a pattern hypothesized to result from impairment in executive function. Here, we explore these questions in a unique population that experienced severely traumatic events more than 20 years ago - individuals who lived through the 1994 genocide in Rwanda. Participants recalled events from the genocide, negative events unrelated to the genocide, neutral events, and positive events. We used the Autobiographical Interview method to label memory details as episodic or non-episodic. We found that memories from the genocide showed robust mnemonic enhancement, with more episodic than non-episodic details, and contained more details overall than any other memory type. This pattern was not impacted by post-traumatic stress. Overall, this study provides evidence that traumatic events create vivid long-lasting episodic memories, in this case even more than 20 years later.

Posttraumatic stress disorder (PTSD) prevalence: an umbrella review

Posttraumatic stress disorder (PTSD) is one of the most serious and incapacitating mental diseases that can result from trauma exposure. The exact prevalence of this disorder is not known as the literature provides very different results, ranging from 2.5% to 74%. The aim of this umbrella review is to provide an estimation of PTSD prevalence and to clarify whether the prevalence depends on the assessment methods applied (structured interview v. self-report questionnaire) and on the nature of the traumatic event (interpersonal v. not-interpersonal). A systematic search of major databases and additional sources (Google Scholar, EBSCO, Web of Science, PubMed, Galileo Discovery) was conducted. Fifty-nine reviews met the criteria of this umbrella review. Overall PTSD prevalence was 23.95% (95% confidence interval 95% CI 20.74-27.15), with no publication bias or significant small-study effects, but a high level of heterogeneity between meta-analyses. Sensitivities analyses revealed that these results do not change after removing meta-analysis also including data from underage participants (23.03%, 95% CI 18.58-27.48), nor after excluding meta-analysis of low quality (24.26%, 95% CI 20.46-28.06). Regarding the impact of diagnostic instruments on PTSD prevalence, the results revealed a lack of significant differences in PTSD prevalence when structured v. self-report instruments were applied (p = 0.0835). Finally, PTSD prevalence did not differ following event of intentional (25.42%, 95% CI 19.76-31.09) or not intentional (22.48%, 95% CI 17.22-27.73) nature (p = 0.4598). The present umbrella review establishes a robust foundation for future research and provides valuable insights on PTSD prevalence.

Characterizing primary care patients with posttraumatic stress disorder using electronic medical records: a retrospective cross-sectional study

BACKGROUND

Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data.

METHODS

This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). This study included 1,574 primary care providers located in 7 Canadian provinces. There were 689,301 patients that visited a CPCSSN provider between 1 January 2017 and 31 December 2019. We describe associations between PTSD and patient characteristics using descriptive statistics, chi-square, and multiple logistic regression models.

RESULTS

Among the 689,301 patients included, 8,817 (1.3%, 95% CI 1.2-1.3) had a diagnosis of PTSD. On multiple logistic regression analysis, patients with depression (OR 4.4, 95% CI 4.2-4.7, P < 0.001), alcohol abuse/dependence (OR 1.7, 95% CI 1.6-1.9, P < 0.001), and/or drug abuse/dependence (OR 2.6, 95% CI 2.5-2.8, P < 0.001) had significantly higher odds of PTSD compared with patients without those conditions. Patients residing in community areas considered the most material deprived (OR 2.1, 95% CI 1.5-2.1, P < 0.001) or the most socially deprived (OR 2.8, 95% CI 2.7-5.3, P < 0.001) had higher odds of being diagnosed with PTSD compared with patients in the least deprived areas.

CONCLUSIONS

The prevalence of PTSD in Canadian primary care is 1.3% (95% CI 1.25-1.31). Using EMR records we confirmed the co-occurrence of PTSD with other mental health conditions within primary care settings suggesting benefit for improved screening and evidence-based resources to manage PTSD.

The cumulative contribution of direct and indirect traumas to the production of PTSD

OBJECTIVE

Posttraumatic Stress Disorder (PTSD) affects millions of people worldwide. While the relationship between direct exposure to traumatic events and PTSD is well-established, the influence of indirect trauma exposure on PTSD remains unclear. It is similarly unclear what role cumulative exposure to direct and indirect traumas play in the risk of PTSD.

METHODS

The study uses data from the Houston Trauma and Recovery Study, conducted on 2020-2021, and involved a random sampling of 1,167 individuals residing in Houston during Hurricane Harvey in 2017. Participants were asked about their experiences related to both Hurricane Harvey and the subsequent COVID-19 pandemic. Exposures were categorized as direct or indirect traumas, in line with the criteria delineated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Cumulative exposures were also calculated.

RESULTS

Among participants, 12.6% were experiencing current PTSD. There were significant associations between both direct [OR = 3.18, 95% CI 1.85, 5.46] and indirect [OR = 1.91, 95% CI 1.05, 3.46] traumas related to Harvey, as well as direct [OR = 2.13, 95% CI 1.20, 3.77] and indirect [OR = 1.69, 95% CI 0.93, 3.09] traumas due to COVID and the risk of PTSD in fully adjusted models. Further, significant associations were found between the cumulative exposure to traumas from both Hurricane Harvey and COVID-19 and the risk of PTSD, considering both direct [OR = 2.53, 95% CI 1.36, 4.70] and indirect exposures [OR = 2.79, 95% CI 1.47, 5.28].

CONCLUSIONS

Our study offers support for connections between exposure to both direct and indirect traumas stemming from large-scale disasters and PTSD. Moreover, we show that cumulative exposures to multiple large-scale events increase the risk of PTSD. This highlights the importance of the consideration of a range of exposures as risks for PTSD, particularly in a time of compounding disasters and broad population exposures to these events.

The neuropsychological presentation of women with epilepsy: Clinical considerations and future directions

Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.

Diagnostic Accuracy of the Primary Care PTSD for DSM-5 Screen (PC-PTSD-5) in Demographic and Diagnostic Subgroups of Veterans

BACKGROUND

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening instrument designed to identify patients with probable PTSD and is mandated to be used in VA primary care settings. However, validation of the diagnostic accuracy of the instrument is lacking in various demographic and diagnostic groups.

OBJECTIVE

To evaluate the diagnostic accuracy of the PC-PTSD-5 in demographically and diagnostically stratified groups of VA primary care patients.

DESIGN, SETTING, AND PARTICIPANTS

Based on a sample of 519 VA primary care patients (40.61% response rate), the PC-PTSD-5 was evaluated against a criterion measure, examining its sensitivity, specificity, and other diagnostic properties. Evaluations were conducted in demographically stratified patient groups, including gender, age, race/ethnicity, marital status, and education, as well as diagnostically stratified groups, in patients with and without a depression, alcohol use, and drug use disorder.

MAIN MEASURES

The MINI-International Neuropsychiatric Interview was the criterion measure against which the PC-PTSD-5 was evaluated.

KEY RESULTS

Among the 10 demographically stratified groups of patients, the PC-PTSD-5 demonstrated a sensitivity between 81.25% (95% C.I.: 54.35 - 05.95) and 100% (95% C.I.: 63.06 - 1000) and its specificity ranged from 80.54% (95% C.I.: 74.70 - 85.55) to 88.31% (95% C.I.: 83.45 - 92.15). Among the 6 diagnostically stratified groups of patients (with and without depression, alcohol use, and drug use disorders), the PC-PTSD-5 exhibited a sensitivity between 88.89% (95% C.I.: 65.29 - 98.62) and 95.92% (95% C.I.: 86.02 - 99.50), and its specificity varied from 60.00% (95% C.I.: 40.60 - 77.34) to 88.14% (95% C.I.: 84.50 - 91.19).

CONCLUSIONS

The PC-PTSD-5, suitable for a diverse range of VA primary care patients, shows satisfactory sensitivity and specificity across various demographic and diagnostic groups. Healthcare providers should be cautious of false positives in patients with depression or substance use disorders, given the potential symptom overlap with PTSD.

Neurobiology and systems biology of stress resilience

Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.

A Functional Magnetic Resonance Imaging Meta-Analysis of Childhood Trauma

BACKGROUND

Traumatic experiences during childhood significantly impact the developing brain and contribute to the development of numerous physical and mental health problems. To date, however, a comprehensive understanding of the functional impairments within the brain associated with childhood trauma histories does not exist. Previous functional magnetic resonance imaging (fMRI) meta-analytical tools required homogeneity of task types and the clinical populations studied, thus preventing the comprehensive pooling of brain-based deficits present in children who have trauma histories. We hypothesized that the use of the novel, data-driven Bayesian author-topic model approach to fMRI meta-analyses would reveal deficits in brain networks that span fMRI task types in children with trauma histories.

METHODS

To our knowledge, this is the first study to use the Bayesian author-topic model approach to fMRI meta-analyses within a clinical population. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we present data-driven results obtained by combining activation patterns across heterogeneous tasks from 1428 initially screened studies and combining data from 14 studies that met study criteria (285 children with trauma histories, 297 healthy control children).

RESULTS

Altered brain activity was revealed within 2 clusters in children with trauma histories compared to control children: the default mode/affective network/posterior insula and the central executive network. Our identified clusters were associated with tasks pertaining to cognitive processing, emotional/social stress, self-referential thought, memory, unexpected stimuli, and avoidance behaviors in youths who have experienced childhood trauma.

CONCLUSIONS

Our results reveal disturbances in children with trauma histories within the modulation of the default mode and central executive networks-but not the salience network-regardless of whether children also presented with posttraumatic stress symptoms.

Out of touch? How trauma shapes the experience of social touch - Neural and endocrine pathways

Trauma can shape the way an individual experiences the world and interacts with other people. Touch is a key component of social interactions, but surprisingly little is known about how trauma exposure influences the processing of social touch. In this review, we examine possible neurobiological pathways through which trauma can influence touch processing and lead to touch aversion and avoidance in trauma-exposed individuals. Emerging evidence indicates that trauma may affect sensory touch thresholds by modulating activity in the primary sensory cortex and posterior insula. Disturbances in multisensory integration and oxytocin reactivity combined with diminished reward-related and anxiolytic responses may induce a bias towards negative appraisal of touch contexts. Furthermore, hippocampus deactivation during social touch may reflect a dissociative state. These changes depend not only on the type and severity of the trauma but also on the features of the touch. We hypothesise that disrupted touch processing may impair social interactions and confer elevated risk for future stress-related disorders.

Reduced pre-attentive threat versus nonthreat signal discrimination in clinically healthy military personnel with recurrent combat exposure history: A preliminary event-related potential (ERP) study

Evidence now suggests that traumatic-stress impacts brain functions even in the absence of acute-onset post-traumatic stress disorder (PTSD) symptoms. These neurophysiological changes have also been suggested to account for increased risks of PTSD symptoms later developing in the aftermath of subsequent trauma. However, surprisingly few studies have explicitly examined brain function dynamics in high-risk populations, such as combat exposed military personnel without diagnosable PTSD. To extend available research, facial expression sensitive N170 event-related potential (ERP) amplitudes were examined in a clinically healthy sample of active service military personnel with recurrent combat exposure history. Consistent with several established theories of delayed-onset PTSD vulnerability, higher N170 amplitudes to backward-masked fearful and neutral facial expressions correlated with higher levels of past combat exposure. Significantly elevated amplitudes to nonthreatening neutral facial expressions also resulted in an absence of normal threat-versus-nonthreat signal processing specificity. While a modest sample size and cross-sectional design are key limitations here, ongoing prospective-longitudinal follow-ups may shed further light on the precise aetiology and prognostic utility of these preliminary findings in the near future.

The effectiveness of two novel approaches to prevent intrusions: A pilot study comparing Tetris_dualtask and imagery rescripting to control

BACKGROUND AND OBJECTIVES

Post-traumatic stress disorder (PTSD) is a global health problem. Although effective treatments for it exist, early interventions that prevent PTSD from developing are lacking. The aim of this pilot analogue trauma study was to compare the effects of two potential early intervention strategies, namely Tetris_dualtask and imagery rescripting (IR) to a no-intervention control group on intrusion frequency and the vividness and emotionality of aversive film memory.

METHODS

Sixty healthy students were subjected to the trauma film paradigm and randomly allocated to either: Tetris_dualtask, IR or no-intervention. Main outcomes were the number of film-related intrusions at one week and vividness and emotionality ratings of the most aversive film memory. Secondary outcomes were PTSD-like symptoms, intrusion intensity, and explicit film memory.

RESULTS

The Tetris_dualtask group reported significant fewer intrusions compared to the no-intervention group; whereas the IR group did not. No effect was found on vividness and emotionality ratings, PTSD-like symptoms, intrusion intensity, and explicit memory.

LIMITATIONS

The sample size was small, and analogue trauma in healthy individuals was examined, thus generalizability may be limited. Also, to increase comparability between interventions, the duration of Tetris_dualtask and IR was standardized. As a result, the IR intervention was shorter compared to other studies, which might have decreased its efficacy.

CONCLUSIONS

The results of this pilot study suggest that playing Tetris during retrieval of traumatic images, might hold potential as an early intervention strategy to reduce intrusions in the early aftermath of trauma and adversity. However, future large-scale replication research is needed.

Microbial composition, functionality, and stress resilience or susceptibility: unraveling sex-specific patterns

BACKGROUND

Following exposure to traumatic stress, women are twice as likely as men to develop mood disorders. Yet, individual responses to such stress vary, with some people developing stress-induced psychopathologies while others exhibit resilience. The factors influencing sex-related disparities in affective disorders as well as variations in resilience remain unclear; however, emerging evidence suggests differences in the gut microbiota play a role. In this study, using the single prolonged stress (SPS) model of post-traumatic stress disorder, we investigated pre- and post-existing differences in microbial composition, functionality, and metabolites that affect stress susceptibility or resilience in each sex.

METHODS

Male and female Sprague-Dawley rats were randomly assigned to control or SPS groups. Two weeks following SPS, the animals were exposed to a battery of behavioral tests and decapitated a day later. Based on their anxiety index, they were further categorized as SPS-resilient (SPS-R) or SPS-susceptible (SPS-S). On the day of dissection, cecum, and selected brain tissues were isolated. Stool samples were collected before and after SPS, whereas urine samples were taken before and 30 min into the SPS.

RESULTS

Before SPS exposure, the sympathoadrenal axis exhibited alterations within male subgroups only. Expression of tight junction protein claudin-5 was lower in brain of SPS-S males, but higher in SPS-R females following SPS. Across the study, alpha diversity remained consistently lower in males compared to females. Beta diversity revealed distinct separations between male and female susceptible groups before SPS, with this separation becoming evident in the resilient groups following SPS. At the genus level, Lactobacillus, Lachnospiraceae_Incertae_Sedis, and Barnesiella exhibited sex-specific alterations, displaying opposing abundances in each sex. Additionally, sex-specific changes were observed in microbial predictive functionality and targeted functional modules both before and after SPS. Alterations in the microbial short-chain fatty acids (SCFAs), were also observed, with major and minor SCFAs being lower in SPS-susceptible males whereas branched-chain SCFAs being higher in SPS-susceptible females.

CONCLUSION

This study highlights distinct pre- and post-trauma differences in microbial composition, functionality, and metabolites, associated with stress resilience in male and female rats. The findings underscore the importance of developing sex-specific therapeutic strategies to effectively address stress-related disorders. Highlights SPS model induces divergent anxiety and social behavioral responses to traumatic stress in both male and female rodents. SPS-resilient females displayed less anxiety-like behavior and initiated more interactions towards a juvenile rat than SPS-resilient males. Sex-specific pre-existing and SPS-induced differences in the gut microbial composition and predictive functionality were observed in susceptible and resilient rats. SPS-resilient males displayed elevated cecal acetate levels, whereas SPS-susceptible females exhibited heightened branched-chain SCFAs.

The impact of isolation on comorbidity of PTSD symptoms and depression: evidence from PTRP-5-6 in China

BACKGROUND

The Omicron pandemic struck Shanghai, China, resulting in impairments of both physical and psychological health on those patients who were confirmed and transferred to the Fangcang shelters. The way of isolation led to high risk of posttraumatic stress symptoms (PTSS) and depressive symptoms among the patients in Fangcang shelters. We aim to estimate the prevalence and comorbidity of PTSS and depressive symptoms in patients from China's Fangcang shelters during the epidemic.

METHODS

Demographic information questionnaire, the posttraumatic stress disorder checklist for DSM-5 (PCL-5), and Patient Health Questionnaire (PHQ-9) were used in the study. The data were collected online via mobile phones during 10th April to 20th April, 2022, as part of our Psychological Trauma Recover Project-5-6 (PTRP-5-6), a longitudinal study focusing on individuals who have experienced trauma.

RESULTS

A total of 336 subjects were included in the analysis. The results revealed (1) the prevalence of depressive symptoms, and PTSS were 30.1% (cut-off = 10) and 6% (cut-off = 33); (2) Multiple logistic regression showed that female (OR = 3.04, p < 0.05), suffering from dyspnea (OR = 5.83, p < 0.05) or gastrointestinal symptoms (OR = 6.38, p < 0.05) were risk factors for PTSS; higher education level (OR = 3.27, p < 0.05) and suffering from dizziness or headache (OR = 2.46, p < 0.05) were risk factors for depressive symptoms; (3)Respectively, 85% of the patients who reported PTSS also experienced depressive symptoms, 16.8% of the patients who reported depressive symptoms presented PTSS.

CONCLUSION

In the context of COVID-19, the comorbidity rate of PTSS and depressive symptoms among patients in Fangcang shelters increased with the severity of depressive symptoms.

Post-traumatic stress disorder symptom remission and cognition in a large cohort of civilian women

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit.

METHODS

Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively.

RESULTS

Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression.

CONCLUSION

Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms.

Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors

OBJECTIVE

Studies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes.

METHOD

Participants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety.

RESULTS

Latent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe.

CONCLUSIONS

Results suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.

Psychological Distress Among Domestic Burglary Victims: A Systematic Review of Possible Risk and Protective Factors

Domestic burglary victimization is a potentially traumatic experience, because most people consider their home as an extension of the self and a place where the self is protected against others. Intrusions to such a highly valued place are therefore considered as attacks to both one's personhood and one's safety and privacy and may render victims at risk of psychological distress. In view of the legal obligations most countries have with regard to screening crime victims for psychological distress, this study systematically reviewed the literature on determinants of psychological distress in domestic burglary victims. Web of Science, EBSCO, and ProQuest databases and reference lists were searched between February and July 2022 to identify relevant studies. In all, 10 studies met all inclusion criteria and were evaluated according to the Cambridge Quality Checklists. These checklists have been developed to assess the methodological qualities of observational research. Findings of included studies suggest that female sex, damages caused by the burglary, and evaluations of the police response are potential determinants of psychological distress. However, given the dearth of research and the old age and theoretical and methodological limitations of included studies, it is too early to draw definite conclusions about the predictive value of these and other factors and to provide directions for screening policies. Future research should use prospective designs to overcome these limitations and ensure that domestic burglary victims at risk of psychological distress are timely referred to adequate professional help services.

Examining student well-being: Development and initial validation of the perceived vulnerability and hardiness scale

OBJECTIVES

The primary aim was to assess the factor structure and establish measurement invariance across sex for the Perceived Vulnerability and Hardiness Scale.

PARTICIPANTS

Sample 1 (N = 377) and Sample 2 (N = 401) were volunteers from six large southern universities.

METHODS

Iterative and collaborative survey-based focus groups were used to create the final version of the PVHS.

RESULTS

A two-factor model was identified through exploratory and confirmatory factor analyses. The psychological hardiness subscale was found to positively correlate with hardiness and resilience, and negatively correlate with psychosocial functioning, depression, and anxiety. The vulnerability subscale was found to positively, strongly correlate with the anxiety, psychological vulnerability, and psychosocial functioning, and negatively correlate with the hardiness and resilience. Men and women interpreted the PVHS in an equivalent manner.

CONCLUSIONS

This brief measure provides researchers, counselors, and administrations a method for general assessment, intervention effectiveness, and evaluation of campus climates.

Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD

Purpose of Review

Research demonstrates a strong association between alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). However, less is known about sex- and gender-based differences among individuals with AUD + PTSD. This narrative review examines recent literature in this area and aims to be a reference for future research endeavors.

Recent Findings

Extant literature shows that intertwining biological systems increase females' risk of developing PTSD and experiencing more adverse effects from AUD compared to males. Sex-based physiological differences further interact with gendered sociocultural environments to influence the risk of AUD + PTSD. Emerging research suggests potential gender-specific pathways between PTSD, coping, and AUD which may inform prevention and treatment. However, barriers to care are often gender-specific and tailored approaches are needed to improve reach and uptake.

Summary

Additional research is needed to examine intersectional and contextual factors that synergistically influence sex/gender differences in AUD + PTSD, particularly beyond cisgender identities, and mechanisms of action.

Lifetime and Acute Stress Predict Functional Outcomes Following Stroke: Findings From the Longitudinal STRONG Study

BACKGROUND

Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status.

METHODS

Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported.

RESULTS

Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31-3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18, P<0.001), which predicted lower 3-month Fugl-Meyer Upper Arm Assessment scores (β=-0.19, P<0.001), lower Stroke Impact Scale 3.0 Activities of Daily Living scores at 3 months (β=-0.21, P<0.001) and 12 months (β=-0.21, P<0.001), higher modified Rankin Scale scores at 3 months (β=0.23, P<0.001) and 12 months (β=0.22, P<0.001), and lower 12-month Telephone Montreal Cognitive Assessment scores (β=-0.20, P<0.001). Acute stress predicted 12-month tMoCA (χ2[1]=5.29, P=0.022) more strongly, 3-month and 12-month modified Rankin Scale and SIS scores as strongly (all Ps>0.18), but Fugl-Meyer scores (χ2[1]=7.01, P=0.008) less strongly than baseline National Institutes of Health Stroke Scale.

CONCLUSIONS

Lifetime stress/trauma is associated with more poststroke acute stress, which is associated with greater motor and cognitive impairment and disability 3 and 12 months poststroke. Poststroke interventions for acute stress may help mitigate stroke-related disability.

Fear-Conditioning to Unpredictable Threats Reveals Sex and Strain Differences in Rat Fear-Potentiated Startle (FPS)

Fear-potentiated startle (FPS) has been widely used to study fear processing in humans and rodents. Human studies showed higher startle amplitudes and exaggerated fear reactivity to unpredictable vs. predictable threats in individuals suffering from post-traumatic stress disorder (PTSD). Although human FPS studies use both sexes, a surprisingly limited number of rodent FPS studies use females. Here we investigate the effects of signal-threat contingency, signal-threat order and threat predictability on FPS in both sexes. We use a classic fear-conditioning protocol (100% contingency of cue and shock pairings, with forward conditioning such that the cue co-terminates with the shock) and compare it to modified fear-conditioning protocols (70% contingency; backward conditioning; or cue and shock un-paired). Although there are no sex differences in the startle amplitudes when corrected for body weight, females consistently demonstrate higher shock reactivity during fear-conditioning. Both sexes and strains demonstrate comparable levels of cued, non-cued, and contextual fear in the classic FPS and FPS following fear-conditioning with 70% contingency or backward order (cue co-starts with shock). However, in the classic FPS, Sprague-Dawley females show reduced proportion between cued fear and cue-elicited vigilant state than males. Lastly, a prominent sex difference is uncovered following unpredictable fear-conditioning (cue and shock un-paired), with Wistar, but not Sprague-Dawley, females showing significantly higher startle overall during the FPS recall, regardless of trial type, and higher contextual fear than males. This striking sex difference in processing unpredictable threats in rodent FPS might help to understand the mechanisms underlying higher incidence of PTSD in women.

Post-traumatic stress symptoms and benefit finding: a longitudinal study among Italian health workers during the COVID-19 pandemic

PURPOSE

Research has highlighted that the exposure of healthcare professionals to the COVID-19 pandemic for over two years can lead to the development and persistence of symptoms characteristic of Post-Traumatic Stress Disorder (PTSD), with serious consequences on both the individual well-being and the quality of care provided. The present study was aimed at investigating the role of benefit finding in moderating post-traumatic stress symptoms (PTSS) over time.

METHODS

The longitudinal study, conducted between April and October 2020, involved 226 Italian health workers (44.7% nurses and midwives, 35% doctors, 20.3% technical and rehabilitation professionals), who filled out an online survey at the beginning of the study (T1), after three months (T2), and after six months (T3). Participants (77.4% women; mean age = 41.93, SD = 12.06) completed the PTSD Checklist for DSM-5 (PCL-5) and Benefit Finding, a 17-item questionnaire measuring the perceived level of positive consequences derived from stressful experiences. A hierarchical regression analysis highlighted the moderating effect of benefit finding (T2) on the association between PTSS values at T1 and T3.

RESULTS

A buffering effect was observed, with higher benefit finding levels reducing the magnitude of the bivariate association between PTSS assessed at the beginning and at the end of the study.

CONCLUSION

Findings suggest the potential mental health related benefits of interventions allowing health professionals to identify positive aspects in the experience of working under prolonged emergency circumstances, such as the pandemic ones.

The Influence of Multiple Community Level Traumatic Event Types on Mental Health Outcomes

Lebanon witnessed three large-scale negative community level events in 2020; a severe economic crisis, the COVID-19 pandemic, and an explosion in the port of the capital city, Beirut, which resulted in the deaths of 218 individuals and several thousand injured. The current study examined the relationship between the number of community level events individuals identified as personally impactful and corresponding levels of anxiety, depression, and symptoms of PTSD. The study also examined the roles of specific protective factors including perceived social support, resilience, and religious coping. A total of 406 participants aged between 18 to 64 years completed validated self-report measures online in February 2021. Results indicated elevated levels of mental health difficulties within the sample with over half of the participants reporting moderate to severe anxiety and moderate to severe depression and meeting the cut-off for probable PTSD. Females had significantly higher scores on measures of depression, anxiety, and PTSD. Individuals reporting all three events as negatively impactful were 47% more likely to meet the cut-off for PTSD than individuals identifying a single event. Resilience appeared to be the strongest protective factor against elevated scores on all three mental health outcomes. Higher scores on negative religious coping were also associated with elevated PTSD scores. Low levels of resilience, higher negative religious coping, and being a female were identified as significant predictors of reaching the PTSD cut-off using binary logistic regression analysis.

The role of avoidance in modulating single prolonged stress effects on emotional memory in male and female rats

The incidence of post traumatic stress disorder (PTSD) is greater in women than men, but mechanisms via which this difference manifests remain under explored. The single prolonged stress (SPS) rodent model of traumatic stress has been used to identify mechanisms through which traumatic stress leads to deficits in retaining extinction (a core PTSD symptom), but has been mostly utilized in male model systems. Recent studies have observed that SPS leads to changes in persistent fear memory in female rats, though these results are variable. This variability could be driven by changes in behavioral strategy in females during extinction, but this possibility has not been sufficiently explored. To address this, we examined the impact of SPS on freezing and avoidance (a core PTSD symptom) during extinction in male and female rats. In male rats, SPS enhanced acquisition of conditioned freezing, but did not enhance freezing during extinction training or testing. SPS also decreased avoidance during extinction training, but not extinction testing. In female rats, SPS had no impact on conditioned freezing. Avoidance was not observed in control rats, but emerged in SPS/female rats during extinction testing. Furthermore, avoidance was negatively correlated with freezing in female rats (high avoidance associated with lower freezing), but this relationship was disrupted with SPS. The results suggest that introducing avoidance during extinction negates SPS effects on extinction retention in male and female rats, control/female rats engage in avoidance to regulate fear expression, and this relationship is disrupted with SPS.

Genomic risk for post-traumatic stress disorder in families densely affected with alcohol use disorders

Recent genome-wide association studies (GWAS) have identified genetic markers of post-traumatic stress disorder (PTSD) in civilian and military populations. However, studies have yet to examine the genetics of PTSD while factoring in risk for alcohol dependence, which commonly co-occur. We examined genome-wide associations for DSM-IV PTSD among 4,978 trauma-exposed participants (31% with alcohol dependence, 50% female, 30% African ancestry) from the Collaborative Study on the Genetics of Alcoholism (COGA). We also examined associations of polygenic risk scores (PRS) derived from the Psychiatric Genomics Consortium (PGC)-PTSD Freeze 2 (N = 3533) and Million Veterans Program GWAS of PTSD (N = 5200) with PTSD and substance dependence in COGA, and moderating effects of sex and alcohol dependence. 7.3% of COGA participants met criteria for PTSD, with higher rates in females (10.1%) and those with alcohol dependence (12.3%). No independent loci met genome-wide significance in the PTSD meta-analysis of European (EA) and African ancestry (AA) participants. The PGC-PTSD PRS was associated with increased risk for PTSD (B = 0.126, p < 0.001), alcohol dependence (B = 0.231, p < 0.001), and cocaine dependence (B = 0.086, p < 0.01) in EA individuals. A significant interaction was observed, such that EA individuals with alcohol dependence and higher polygenic risk for PTSD were more likely to have PTSD (B = 0.090, p < 0.01) than those without alcohol dependence. These results further support the importance of examining substance dependence, specifically alcohol dependence, and PTSD together when investigating genetic influence on these disorders.

A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents

Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.

How we can protect the protectors: learning from police officers and staff involved in child sexual abuse and exploitation investigations

Background

Police officers and staff who work in child sexual abuse and exploitation (CSAE) investigations are routinely exposed to traumatic materials and situations. Despite support services, working in this space can have negative impacts on wellbeing. This paper explores the experiences and perceptions held by police officers and staff involved in CSAE investigations in the United Kingdom, regarding work-related wellbeing support and barriers to accessing such support.

Method

A sample of 661 serving police officers and staff working in CSAE investigations participated in a United Kingdom-wide 'Protecting the Protectors' survey. We analysed quantitative and qualitative responses relating to participants' experiences and perceptions regarding three main areas: (1) availability, usage and helpfulness of existing work-based well-being support; (2) barriers to accessing support; and (3) desired support services.

Findings

Five interconnected themes emerged from the qualitative data that represented participants' experiences and views of work-based wellbeing support and the barriers to accessing it. These were 'Lack of trust', 'Stigma', 'Organisational approaches to wellbeing', 'Support services', and 'Internalised barriers'. The findings suggest that whilst respondents were aware of work-based support, they indicated most frequently that they 'never or almost never' used them. Respondents also identified barriers to accessing support, which related to a perception of a critical or judgmental workplace culture and indicating a lack of trust in their organisations.

Conclusion

Stigma regarding mental ill health has a pervasive and harmful impact on emotional health and wellbeing of police officers and staff involved in CSAE investigations, which creates a sense of lack of emotional safety. Therefore, eliminating stigma and creating a workplace culture that explicitly values and prioritises the emotional health and wellbeing of the workforce would improve the wellbeing of officers and staff. Police organisations could further improve CSAE teams' wellbeing by developing a continuum of care which is available to workers from recruitment to the end of the role, training managers and supervisors to better support CSAE teams, improving workplace practices, and ensuring high quality, specialist support services are readily and consistently available across forces.

On the Stress of Being a Woman: The synergistic contribution of sex as a biological variable and gender as a psychosocial one to risk of stress-related disorders

Stress-related disorders (SRD) disproportionately affect women. Cortisol blunting, a failure to demonstrate a typical rise and fall of cortisol in response to stress, is associated with SRDs and has been found to be more pronounced among women. Cortisol blunting relates to both sex as a biological variable (SABV; e.g., estrogens and their fluctuations, impact on neural circuits) and gender as a psychosocial variable (GAPSV; e.g., discrimination, harassment, gender roles). I suggest a theoretical model linking experience, sex- and gender-related factors, and neuroendocrine substrates of SRD to the heightened risk among women. The model thus bridges multiple gaps in the literature to create a synergistic conceptual framework with which to understand the stress of being a woman. Utilizing such a framework in research may allow identifying targeted, sex-and gender-dependent risk factors, informing psychological treatment, medical advice, educational and community programming, and policy. DATA AVAILABILITY: All references are cited as required, no other data is reported.

Preconception maternal posttraumatic stress and child negative affectivity: Prospectively evaluating the intergenerational impact of trauma

The developmental origins of psychopathology begin before birth and perhaps even prior to conception. Understanding the intergenerational transmission of psychopathological risk is critical to identify sensitive windows for prevention and early intervention. Prior research demonstrates that maternal trauma history, typically assessed retrospectively, has adverse consequences for child socioemotional development. However, very few prospective studies of preconception trauma exist, and the role of preconception symptoms of posttraumatic stress disorder (PTSD) remains unknown. The current study prospectively evaluates whether maternal preconception PTSD symptoms predict early childhood negative affectivity, a key dimension of temperament and predictor of later psychopathology. One hundred and eighteen women were recruited following a birth and prior to conception of the study child and were followed until the study child was 3-5 years old. Higher maternal PTSD symptoms prior to conception predicted greater child negative affectivity, adjusting for concurrent maternal depressive symptoms and sociodemographic covariates. In exploratory analyses, we found that neither maternal prenatal nor postpartum depressive symptoms or perceived stress mediated this association. These findings add to a limited prospective literature, highlighting the importance of assessing the mental health of women prior to conception and providing interventions that can disrupt the intergenerational sequelae of trauma.

PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies

OBJECTIVE

Sexual assault is associated with higher rates of posttraumatic stress disorder (PTSD) than other traumas, and the course of PTSD may differ by trauma type. However, the course of PTSD after sexual assault has not been summarized. The aim of this meta-analysis was to identify the prevalence and severity of PTSD and changes to the average rate of recovery in the 12 months following sexual assault.

METHOD

Authors searched four databases for prospective studies published before April 2020 and sought relevant unpublished data. Eligible studies assessed PTSD in at least 10 survivors of sexual assault in at least two time points, starting within 3 months postassault. Random effects linear-linear piecewise models were used to identify changes in average recovery rate and produce model-implied estimates of monthly point prevalence and mean symptom severity.

RESULTS

Meta-analysis of 22 unique samples (N = 2,106) indicated that 74.58% (95% confidence interval [CI]: [67.21, 81.29]) and 41.49% (95% CI: [32.36, 50.92]) of individuals met diagnostic criteria for PTSD at the first and 12th month following sexual assault, respectively. PTSD symptom severity was 47.94% (95% CI: [41.27, 54.61]) and 29.91% (95% CI: [23.10, 36.73]) of scales' maximum severity at the first and 12th month following sexual assault, respectively. Most symptom recovery occurred within the first 3 months following sexual assault, after which point the average rate of recovery slowed.

CONCLUSIONS

Findings indicate that PTSD is common and severe following sexual assault, and the first 3 months postassault may be a critical period for natural recovery.

DNA topoisomerase Top3β is impacted by early life stress in the developing female and male rat brain

DNA topoisomerases are essential for preserving genomic integrity. DNA topoisomerases induce breakage of DNA to facilitate replication and transcription by relaxing DNA and relieving supercoiling. Aberrant expression and deletions of topoisomerases are associated with psychiatric disorders such as schizophrenia and autism. Our study investigated the effects of early life stress (ELS) on three topoisomerases, Top1, Top3α, and Top3β in the developing rat brain. Newborn rats were exposed to a predator odor stress on postnatal days 1, 2, and 3; brain tissue was collected either 30 min after the last stressor on postnatal day 3 or during the juvenile period. We found that exposure to predator odor resulted in a decrease in Top3β expression levels in the neonatal male amygdala and in the juvenile prefrontal cortex of males and females. These data suggest that developing males and females respond differently to predator odor-induced stress. As ELS results in lower Top3β levels, these data suggest that ELS experienced during development may have consequences for genomic structural integrity and increased mental health risk.

Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery

Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.

Fear-conditioning to unpredictable threats reveals sex differences in rat fear-potentiated startle (FPS)

Fear-potentiated startle (FPS) has been widely used to study fear processing in humans and rodents. Human studies have shown higher startle amplitudes and exaggerated fear reactivity to unpredictable vs. predictable threats in individuals suffering from post-traumatic stress disorder (PTSD). Although human FPS studies often use both sexes, a surprisingly limited number of rodent FPS studies use females. Here we investigate the effects of signal-threat contingency, signal-threat order and threat predictability on FPS in both sexes. We use a classic fear-conditioning protocol (100% contingency of cue and shock pairings, with forward conditioning such that the cue co-terminates with the shock) and compare it to modified fear-conditioning protocols (70% contingency; backward conditioning; or cue and shock unpaired). Although there are no sex differences in the startle amplitudes when corrected for body weight, females demonstrate higher shock reactivity during fear-conditioning. Both sexes demonstrate comparable levels of cued, non-cued, and contextual fear in the classic FPS but females show reduced fear discrimination vs. males. Fear-conditioning with 70% contingency or backward order (cue co-starts with shock) induces similar levels of cued, non-cued, and contextual fear in both sexes but they differ in contextual fear extinction. Lastly, a prominent sex difference is uncovered following unpredictable fear-conditioning protocol (cue and shock un-paired), with females showing significantly higher startle overall during the FPS recall, regardless of trial type, and higher contextual fear than males. This striking sex difference in processing unpredictable threats in rodent FPS might help to understand the mechanisms underlying higher incidence of PTSD in women.

Highlights

Male and female rats have comparable startle amplitudes when corrected for body weightFemale rats show higher foot-shock reactivity than males during fear-conditioningFemale rats show reduced fear discrimination vs. males in the classic FPSReversed signal-threat order increases contextual fear in both sexesExposure to unpredictable threats increases startle in general and contextual fear only in females.

The role of estrogen receptor manipulation during traumatic stress on changes in emotional memory induced by traumatic stress

RATIONALE

Traumatic stress leads to persistent fear, which is a core feature of post-traumatic stress disorder (PTSD). Women are more likely than men to develop PTSD after trauma exposure, which suggests women are differentially sensitive to traumatic stress. However, it is unclear how this differential sensitivity manifests. Cyclical changes in vascular estrogen release could be a contributing factor where levels of vascular estrogens (and activation of estrogen receptors) at the time of traumatic stress alter the impact of traumatic stress.

METHODS

To examine this, we manipulated estrogen receptors at the time of stress and observed the effect this had on fear and extinction memory (within the single prolonged stress (SPS) paradigm) in female rats. In all experiments, freezing and darting were used to measure fear and extinction memory.

RESULTS

In Experiment 1, SPS enhanced freezing during extinction testing, and this effect was blocked by nuclear estrogen receptor antagonism prior to SPS. In Experiment 2, SPS decreased conditioned freezing during the acquisition and testing of extinction. Administration of 17β-estradiol altered freezing in control and SPS animals during the acquisition of extinction, but this treatment had no effect on freezing during the testing of extinction memory. In all experiments, darting was only observed to footshock onset during fear conditioning.

CONCLUSION

The results suggest multiple behaviors (or different behavioral paradigms) are needed to characterize the nature of traumatic stress effects on emotional memory in female rats and that nuclear estrogen receptor antagonism prior to SPS blocks SPS effects on emotional memory in female rats.

Survival in a Collapsed Stable for 37 Days After Avalanche Burial in 1755

In 1755 in Bergemoletto, Italy, an avalanche buried 4 people (2 women, a girl, and a boy) and several animals in a stable. After 37 d in a pitch-dark confined space, 3 of the 4 people were rescued alive. The 3 survivors had only goat milk, a few chestnuts, a few kg of raw kid meat, and meltwater for nutrition. We describe the longest-known survival in an avalanche burial and discuss the medical and psychological problems of the survivors. The boy died. When they were extricated, all 3 survivors were exhausted, cachectic, and unable to stand or walk. They were severely malnourished and were experiencing tingling, tremors, and weakness in the legs; constipation; changes in taste; and amenorrhea. One of the women had persistent eye problems and developed symptoms consistent with post-traumatic stress disorder. The survivors were given slow refeeding. It took from 1 to 6 wk before they could walk. We compare this case to other long-duration burials, especially mining accidents, and describe the rescue and patient care after long-duration burials. This case demonstrates that people can overcome extremely adverse conditions and survive.

Differences in gut microbiota associated with stress resilience and susceptibility to single prolonged stress in female rodents

Exposure to traumatic stress is a major risk factor for the development of neuropsychiatric disorders in a subpopulation of individuals, whereas others remain resilient. The determinants of resilience and susceptibility remain unclear. Here, we aimed to characterize the microbial, immunological, and molecular differences between stress-susceptible and stress-resilient female rats before and after exposure to a traumatic experience. Animals were randomly divided into unstressed controls (n = 10) and experimental groups (n = 16) exposed to Single Prolonged Stress (SPS), an animal model of PTSD. Fourteen days later, all rats underwent a battery of behavioral tests and were sacrificed the following day to collect different organs. Stool samples were collected before and after SPS. Behavioral analyses revealed divergent responses to SPS. The SPS treated animals were further subdivided into SPS-resilient (SPS-R) and SPS-susceptible (SPS-S) subgroups. Comparative analysis of fecal 16S sequencing before and after SPS exposure indicated significant differences in the gut microbial composition, functionality, and metabolites of the SPS-R and SPS-S subgroups. In line with the observed distinct behavioral phenotypes, the SPS-S subgroup displayed higher blood-brain barrier permeability and neuroinflammation relative to the SPS-R and/or controls. These results indicate, for the first time, pre-existing and trauma-induced differences in the gut microbial composition and functionality of female rats that relate to their ability to cope with traumatic stress. Further characterization of these factors will be crucial for understanding susceptibility and fostering resilience, especially in females, who are more likely than males to develop mood disorders.