Post-traumatic stress disorder, resilience and vulnerability

A comparative study of posttraumatic stress disorder in two post-conflict communities in Benue state Nigeria

Background

The attendant long-term mental health consequence of the conflict of various kinds in Nigeria is yet to be thoroughly investigated. The Tiv-Fulani farmer-herdsmen crisis is one such conflict that occurred in 2013/2014 in Guma local government in Benue state.

Aims

This study seeks to find out some years after the crisis, the prevalence difference in posttraumatic stress disorder (PTSD) between a community (Uikpiam) with direct exposure to the conflict and another (Daudu) with indirect exposure, the pattern of distribution of PTSD symptoms and the associate factors of PTSD.

Methods

It is a cross-sectional one that employed a multi-stage cluster sampling method to select 413 participants; 135 from Uikpiam and 278 from Daudu. The study instruments administered included a questionnaire with some socio-demographic variables and an extract from the PTSD module of the Composite International Diagnostic Interview.

Results

The prevalence rate of PTSD was higher in Uikpiam (16.3%) when compared to Daudu (4.3%). A high proportion of sub-threshold symptoms of PTSD was recorded in both communities. An association was found between a lower educational qualification and PTSD (χ2 = 8.373; p = 0.039).

Conclusion

PTSD can be a prolonged mental ill-effect of crisis and proximity to trauma sites increases vulnerability including lower education. This study looked at PTSD only as an outcome of this crisis, but mental health adverse outcomes of the crisis may not be limited to this alone, hence the need for further investigations for relevant stakeholders to act.

Resilience as Mediator in Relation to Parental Attachment and Posttraumatic Stress Disorder in Adolescents Following the Yancheng Tornado

Resilience and secure parental attachment have been proven as important factors to alleviate the posttraumatic stress disorder (PTSD). However, the effects of the two factors on PTSD and the mechanisms of its effect at different time points in the aftermath of trauma are still unclear. This study explores the relationship among parental attachment, resilience, and development of PTSD symptoms in adolescents from a longitudinal perspective following the Yancheng Tornado. Using cluster sampling method, a total of 351 Chinese adolescents, survivors of a severe tornado, were tested on their PTSD, parental attachment and resilience at 12-months and 18-months after experiencing the natural disaster. The results showed that our proposed model fit the data well: χ2/df = 3.197, CFI = 0.967, TLI = 0.950, RMSEA = 0.079. It revealed that the resilience at 18-months partially mediated the relationship between parental attachment at 12-months and PTSD at 18-months. Research results showed that parental attachment and resilience are key resources for coping with trauma.

Cerebral cortical thinning in brain regions involved in emotional regulation relates to persistent symptoms in subjects with posttraumatic stress disorder

A considerable proportion of individuals exposed to trauma experience chronic and persistent posttraumatic stress disorder (PTSD). However, the specific brain and clinical features that render trauma-exposed individuals more susceptible to enduring symptoms remain elusive. This study investigated 112 trauma-exposed participants who had been diagnosed with PTSD and 112 demographically-matched healthy controls. Trauma-exposed participants were classified into those with current PTSD (persistent PTSD, n = 78) and those without (remitted PTSD, n = 34). Cortical thickness analysis was performed to discern group-specific brain structural characteristics. Coping strategies and resilience levels, assessed as clinical attributes, were compared across the groups. The persistent PTSD group displayed cortical thinning in the superior frontal cortex (SFC), insula, superior temporal cortex, dorsolateral prefrontal cortex, superior parietal cortex, and precuneus, relative to the remitted PTSD and control groups. Cortical thinning in the SFC was associated with increased utilization of maladaptive coping strategies, while diminished thickness in the insula correlated with lower resilience levels among trauma-exposed individuals. These findings imply that cortical thinning in brain regions related to coping strategy and resilience plays a vital role in the persistence of PTSD symptoms.

Social Support, Internalized HIV Stigma, Resilience and Depression Among People Living with HIV: A Moderated Mediation Analysis

Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.

Mental health symptoms of youth initiating psychiatric care at different phases of the COVID-19 pandemic

OBJECTIVE

To examine differences in caregiver and youth reported mental health symptoms for youth initiating mental health treatment through phases of the Coronavirus Disease (COVID-19) pandemic, compared with symptomology reported the prior year.

STUDY DESIGN

This retrospective study analyzes group differences in mental health symptoms (Pediatric Symptom Checklist; PSC-35) based on 7874 youth seeking treatment in publicly funded mental health treatment programs during California's Stay-At-Home order (March-May, 2020) and the prolonged pandemic (May-December, 2020) phases of the COVID-19 pandemic as compared with matching groups in 2019.

RESULTS

Youth entering mental health treatment services, and their caregivers, reported significantly increased internalizing, externalizing, and attention-related symptoms during the prolonged pandemic phase, but not during the acute stay-at-home phase of the COVID-19 pandemic, and with small effect sizes. Group comparison analyses did not detect a significantly larger effect for Sexual and Gender Diverse (SGD) youth who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex, and Black, Indigenous, People of Color (BIPOC).

CONCLUSIONS

A large-scale comparison of youth mental health symptoms before and during the COVID-19 pandemic suggests that mental health was disrupted for youth seeking treatment as the pandemic prolonged throughout 2020.

Cross-Sectional Study of Factors Influencing Perceived Threat and Stress among the Arab Minority in Israel during the COVID-19 Pandemic

This study aimed to examine the impact of the locus of control, coping strategies and loneliness on perceived threat and stress among the Arab minority in Israel during the first COVID-19 closure. This was a cross-sectional online study, with 486 participants who completed a questionnaire measuring the study variables during the period of 28-31 March 2020. Statistical analyses included t-tests and analyses of variance. Means, standard deviations and intercorrelations for the study variables were calculated. The results revealed a moderate-low level of stress and a moderate-high level of perceived threat. Higher stress was related to higher perceived threat, a greater external locus of control, lower problem-focused coping, higher emotion-focused coping and social support-seeking and higher loneliness. Perceived threat was positively related to both problem-focused coping and emotion-focused coping. The results show that the Arab population in Israel coped as a strong minority group. This study contributes to our understanding of how minority groups cope in the current epidemic and to the identification of effective strategies for reducing stress during this challenging period. The study's results may help devise intervention programs that foster more effective coping capabilities among this and other minority populations.

Traumatic events, post-traumatic stress disorders, and gender among Yazidi population after ISIS invasion: A post conflict study in Kurdistan - Iraq

BACKGROUND

Traumatic experiences can lead to a range of mental health problems such as depression, anxiety and post-traumatic stress disorder. The prevalence of post-traumatic stress disorder depends on the cumulative exposure to traumatic stress. The Yazidis (Êzidî) are a Kurdish religious minority living in the north of Iraq, western Iran, eastern Turkey, and northern Syria. Islamic State of Iraq and Syria (ISIS) had sought to destroy the Yazidis population through killings; sexual slavery, enslavement, torture, degrading treatment, and forcible migration causing serious physical and mental disorders. The objectives of the study were to estimate the prevalence of traumatic events and post-traumatic stress disorder among Yazidi population in Yazidi community and to assess the association between post-traumatic stress disorder and gender.

METHODS

A cross-sectional study was conducted during period from June to August 2019. The participants were chosen by a random sampling method from Chammshko camp in Zakho district that it's a city in Kurdistan region - Iraq. The questionnaire consisted of questions for demographical characteristics (e.g., gender, age, marital status, education, and job), and PTSD symptoms was assessed by using Harvard Trauma Questionnaire.

RESULTS

The females consisted 54.7% of the subjects. The majority of the participants were married (54.1%) and 98 (54.1%) of them were uneducated. About 79% of the subjects had PTSD symptoms. There was a statistically significant association between gender and PTSD, the female subjects had higher mean of trauma and PTSD symptoms scores (17.84 ± 3.5), (117.34 ± 13.8) respectively compare to that of male subjects (15.95 ± 3.1), (104.61 ± 18.8) respectively (p < .001).

CONCLUSION

High rate of PTSD among Yazidi population, Female subjects highly suffered from trauma and PTSD.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice

Introduction: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. Objective: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. Methods: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. Results: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. Conclusion: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

Correlates of COVID-19 Pandemic on Anxiety among Adults in Appalachia, USA

BACKGROUND

Anxiety problems have increased in the COVID-19 pandemic worldwide. However, very little is known about the anxiety rates in the new normal phase of the disease when adults have been assumed to be adjusted. The study aimed to find out the difference in anxiety in a convenience sample of Appalachian adults during the new normal phase of the COVID-19 pandemic, examine its association with sociodemographic factors, and compare it with the anxiety levels before the pandemic as recalled by the participants.

STUDY DESIGN

A cross-sectional study.

METHODS

The Generalized Anxiety Disorder-7 scale was used in the present study. The Chi-square test was used to examine the difference between the severity of anxiety before and during the new normal phase of the COVID-19 pandemic in terms of sociodemographic and behavioral correlates. Pearson correlation was used to see the strength of the association between anxiety and age.

RESULTS

Although the anxiety rate was stabilized by the time people approached the new normal phase of the COVID-19 pandemic, its severity increased significantly among those with preexisting anxiety (P=0.001). Anxiety was found highly associated with female and minority gender, student status, lower education and income level, marital status, cohabitation with parents, and cigarette consumption (P=0.001). A slight inverse association was observed between age and anxiety before and during the new normal phase of the COVID-19 pandemic (P=0.001).

CONCLUSION

The young and females seem to be suffering from a higher burden of anxiety. Research is suggested to identify ways to develop social support-based community programs to address this issue.

Predictors of Psychological Distress and Resilience in the Post-COVID-19 Era

Background

The COVID-19 global pandemic has had profound effects on mental health and wellbeing. The present study examined trends in distress and recovery in the aftermath of COVID-19 in China. Predictors that might increase risks or provide protections again distress were explored.

Method

Participants were recruited using social media during the COVID-19 pandemic to complete a baseline and 6-week follow-up survey (N = 241). The change patterns of PTSD symptoms from baseline to follow-up were characterized using latent class growth analysis (LCGA). A repeated-measures ANOVA was conducted to explore the differences in the depressive symptoms across trajectory groups. Multinominal logistic regression was performed to investigate potential predictors of the outcome trajectories.

Results

Four longitudinal outcome trajectories were identified: chronic (PTSD symptoms remained high; 14.9%), resilient (symptoms remained low; 43.2%), recovered (symptoms decreased from symptomatic levels to asymptomatic; 19.5%), and delayed (symptoms increased from asymptomatic levels to symptomatic; 22.4%). Hopelessness and maladaptive coping strategies were unique predictors of distress and resilience as well as longer-term trajectories.

Conclusion

Individuals evidenced four outcome trajectories of distress in the aftermath of COVID-19 in China. Despite the uncertainty and high levels of stress related to the pandemic, the majority of the sample demonstrated resilience and recovery. It is essential to identify individuals at risk for chronic and delayed distress in order to build resilience.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12529-021-10036-8.

Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak

BACKGROUND

Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak.

METHODS

A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates.

RESULTS

The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43-4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47-2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36-2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75-3.33), worried about delays in working (AOR 1.71, 95%CI 1.27-.31), or worried about decreased income (AOR 1.45, 95%CI 1.14-1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51-0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence.

CONCLUSION

It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.

The Relationship Between Social Support and Internet Addiction Among Chinese Adolescents During the COVID-19 Pandemic: A Multiple Mediation Model of Resilience and Post-Traumatic Stress Disorder Symptoms

INTRODUCTION

Lockdowns and online homeschooling during the COVID-19 coronavirus pandemic have significantly increased Internet use and adolescents' risk of developing or reinforcing related addictive behaviors. While various theoretical propositions have suggested that social support, resilience, and post-traumatic stress disorder (PTSD) symptoms can predict Internet addiction, no study has yet examined the combined influence of these factors on Internet addiction. This study therefore aimed to investigate the mediating roles of resilience and PTSD symptoms in the relationship between perceived social support and the Internet addiction of Chinese adolescents in the context of COVID-19.

METHODS

This study included 2544 adolescents living in the south China city of Qinzhou. The participants completed a self-report questionnaire one week before their return to classes after homeschooling. To examine whether resilience and PTSD symptoms mediated the relationship between social support and Internet addiction, we performed serial mediation analysis using the Model 6 PROCESS macro developed by Hayes (2013).

RESULTS

Social support was negatively and directly associated with Internet addiction and indirectly via resilience, PTSD symptoms, and by the multiple mediation of resilience to PTSD symptoms.

DISCUSSION

The results of this study suggest that, to address Internet addiction, it may be more effective to focus not on addictive behaviors themselves but on individuals' existing mental health. It is important to provide adequate social support to improve the resilience of adolescents, thereby reducing PTSD symptoms and Internet addiction.

Prevalence of Psychological Distress and Associated Factors in Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study

Little is known about psychological distress and its associated factors during the COVID-19 pandemic among nursing students, especially during the initial spread. The present study aimed to investigate the prevalence of psychological distress among Japanese nursing students after the first semester of 2020 with shifted classes and practice online. Furthermore, we examined whether factors such as health issues and resilience were associated with psychological distress. The data were obtained from a cross-sectional, self-administered questionnaire survey at a Japanese nursing college from September to November 2020 (n = 289). We collected data such as sociodemographic variables, medical history, insomnia, and resilience (Bidimensional Resilience Scale). Psychological distress was measured using the K6 scale (scores ≥ 5). The prevalence of psychological distress was 58.5%. The multivariate Poisson regression analysis found a negative association between innate resilience factors, and positive associations between medical history, insomnia, and psychological distress. The present study showed that more than half of the study participants experienced high levels of psychological distress. Our results suggest the importance of monitoring mental health among nursing students, focusing not only on health issues, but also personality components such as innate resilience during the prolonged COVID-19 pandemic.

Acceptance and Strategic Resilience: An Application of Conservation of Resources Theory

The definition of individual resilience remains ambiguous. This article responds to that ambiguity by first deriving a definition of individual resilience from conservation of resources (COR) theory. Accordingly, to the extent individuals have sufficient resources and behave according to two key principles of COR theory, they will exhibit resilience in response to significant adversity. A second development builds upon the COR distinction between resources deployed in response to adversity which are resource-preserving as distinct from resource-enhancing, which generate what are here labeled acceptance resilience and strategic resilience, respectively. It is proposed that behaviors associated with acceptance resilience support relative continuity of environments, relationships, and life goals, with strategic resilience behaviors often involving changing environments, relationships, or life goals. Acceptance resilience is related to earlier COR understandings of resilience and relevant resources, while strategic resilience requires distinct or additional resources. Individuals demonstrating the two types of resilience will diverge in terms of openness to new experiences, persistence, loss aversion, and the valuation of future resources. It is further proposed that acceptance resilience is more common than strategic resilience and that organizations which find resilience valuable will tend to support acceptance resilience, in part because strategic resilience may generate turnover in response to adversity. The analysis addresses related issues, including coping, career change, burnout, as well as teams and organizations. Implications for theory, practice, and future research conclude the work.

External locus-of-control partially mediates the association between cumulative trauma exposure and posttraumatic stress symptoms among adolescents from diverse background

Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background.

Cross-sectional study.

LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist.

Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R² = .24; F_2,3823 = 619.01; p < .01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß = .14; 95% BC CI [.10, .20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families.

The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents.

Neuroimaging Markers of Resiliency in Youth at Clinical High Risk for Psychosis: A Qualitative Review

Psychotic disorders are highly debilitating and constitute a major public health burden. Identifying markers of psychosis risk and resilience is a necessary step toward understanding etiology and informing prevention and treatment efforts in individuals at clinical high risk (CHR) for psychosis. In this context, it is important to consider that neural risk markers have been particularly useful in identifying mechanistic determinants along with predicting clinical outcomes. Notably, despite a growing body of supportive literature and the promise of recent findings identifying potential neural markers, the current work on CHR resilience markers has received little attention. The present review provides a brief overview of brain-based risk markers with a focus on predicting symptom course. Next, the review turns to protective markers, examining research from nonpsychiatric and schizophrenia fields to build an understanding of framing, priorities, and potential, applying these ideas to contextualizing a small but informative body of resiliency-relevant CHR research. Four domains (neurocognition, emotion regulation, allostatic load, and sensory and sensorimotor function) were identified and are discussed in terms of behavioral and neural markers. Taken together, the literature suggests significant predictive value for brain-based markers for individuals at CHR for psychosis, and the limited but compelling resiliency work highlights the critical importance of expanding this promising area of inquiry.

Factors associated with the mental health status of medical students during the COVID-19 pandemic: a cross-sectional study in Japan

OBJECTIVE

The COVID-19 pandemic had a substantial impact on university students, including those in medical schools, with disruption in routine education causing significant psychological distress. The objective of this study was to evaluate the factors associated with psychological distress among medical students during the period of enforced home quarantine from March through May 2020.

DESIGN

A cross-sectional study.

SETTING

One Japanese medical school.

PARTICIPANTS

571 medical students.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-administered electronic questionnaires including the K-6 scale for psychological distress, the Rosenberg Self-Esteem Scale (RSES) for self-esteem and the General Self-Efficacy Scale (GSES) for self-efficacy were distributed. To assess the determinant factor for psychological distress, variables such as sex, grade in school, living conditions, and RSES and GSES scores were evaluated in regression analysis.

RESULTS

163 respondents (28.5%) scored ≥5 on the K-6 scale, indicating a significant degree of psychological distress. Logistic regression revealed that a higher score on RSES (p<0.001) and GSES (p<0.01) was an independent factor associated with lower levels of psychological distress. Multiple regression analysis focusing on students with a K-6 score ≥5 revealed that higher scores on RSES correlated with lower levels of psychological distress. By contrast, those with higher GSES scores also scored higher for indicators of psychological distress.

CONCLUSIONS

This study identified that self-efficacy and self-esteem were both influential factors for predicting psychological distress during the current COVID-19 pandemic. Medical schools should provide support for mental health and educational initiatives directed at enhancing self-esteem and self-efficacy, with a focus on improving personal resilience. In emergency situations, such as that faced in response to the COVID-19 pandemic, initial programmes might target students with higher levels of self-efficacy. By contrast, under routine situations, these efforts should be directed towards students with lower self-esteem as primary means to prevent depression.

Psychological Antecedents of Refugee Integration (PARI)

The successful management of refugee immigration, including refugee integration in host societies, requires a sound understanding of underlying psychological processes. We propose the psychological antecedents of refugee integration (PARI) model, highlighting perceived forcedness (i.e., coercion and loss of control from “push” factors) and ensuing perils (risks and potential suffering during migration) as distinctive factors of refugee (vs. voluntary) migration. According to our model, perceptions and subjective representations of forcedness and associated perils activate specific psychological processes relevant to refugee integration and thus moderate responses to the demands and stressors of the immigration situation. We conceptualize these distinctive influences for integration-relevant processes in both refugees and in residents. By pinpointing the unique features of refugee migration, PARI generates novel and specific hypotheses about psychological processes predicting refugee integration. For instance, refugees’ memories of forcedness and associated perils should lead to a high level of preoccupation with the restoration of basic needs after arrival in a receiving country that interferes with integration-related activities. Conversely, residents’ perceptions of forcedness and related perils may enhance empathy with refugees but may also magnify feelings of anxiety and threat. Implications for refugee integration are discussed for the domains of occupational work, education, and mental health.

An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial

BACKGROUND

This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience.

METHODS AND FINDINGS

We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up.

CONCLUSIONS

Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings.

TRIAL REGISTRATION

The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.

Adverse childhood experiences and their relationship to gender and depression among young adults in Iraq: a cross-sectional study

Background

Adverse childhood experiences (ACEs) are considered as universal public health problem that associate with mental disorders and risky behaviors during adulthood. The aims of the paper are to estimate the prevalence of Adverse childhood experiences (ACEs) among young adults in Iraq as well as to estimate the association between ACEs and depression.

Methods

A convenience sample of young adults of 18–20 years was chosen from centre and west of Iraq, mainly from universities. The adverse childhood experiences were measured by Adverse Childhood Experiences Questionnaire. A depression scale was derived from the Depression, Anxiety and Stress Scales (DASS). Statistical tests: chi square was used to measure the association between adverse childhood experiences and other variables like gender and depression. Odds ratios were computed to estimate the risk for depression. A P value of less than 0.05 was considered statistically significant.

Results

The total number of participants was 401, 38.9% of the subjects were men, while 61.1% were women. The mean age of the participants was 18.88 ± 0.745. The results revealed that the most common forms of ACEs among the subjects were physical neglect (19.8%) and emotional neglect (19.2%) followed by physical abuse (17.21%) while sexual abuse was 7.52%.

There was statistically significant association between most forms of adverse childhood experiences especially emotional abuse, emotional neglect, physical abuse and physical neglect with depression.

Conclusion

ACEs are not uncommon among young adults in Iraq and are associated with depression in adulthood. National programmes to support mental health rehabilitation might be necessary to reduce the effect of ACEs among Iraqi people, especially for adolescents and young adults.

A classical twin study of PTSD symptoms and resilience: Evidence for a single spectrum of vulnerability to traumatic stress

BACKGROUND

To examine shared genetic and environmental risk factors across PTSD symptoms and resilience.

METHODS

Classical twin study of 2010-2012 survey data conducted among 3,318 male twin pairs in the Vietnam Era Twin Registry. Analyses included: (a) estimates of genetic and environmental influences on PTSD symptom severity (as measured by the PTSD Checklist) and resilience (assessed with the Connor-Davidson Resilience Scale-10); (b) development of a latent model of traumatic stress, spanning both PTSD and resilience; and (c) estimates of genetic and environmental influences on this spectrum.

RESULTS

The heritability of PTSD was 49% and of resilience was 25%. PTSD and resilience were correlated at r = -.59, and 59% of this correlation was attributable to a single genetic factor, whereas the remainder was due to a single non-shared environment factor. Resilience was also influenced by common and unique environmental factors not shared with PTSD, but there was no genetic factor specific to resilience. Confirmatory factor analysis supported the Development of a revised phenotype reflecting the broader dimension of traumatic stress, with biometric models suggesting increased heritability (66%) of this spectrum compared to PTSD or resilience individually.

CONCLUSIONS

Genetic factors contribute to a single spectrum of traumatic stress reflecting resilience at one end and high symptom severity at the other. This carries implications for phenotype refinement in the search for molecular genetic markers of trauma-related psychopathology. Rather than focusing only on genetic risk for PTSD, molecular genetics research may benefit from evaluation of the broader spectrum of traumatic stress.

Building Team Resilience and Debriefing After Difficult Clinical Events: A Resilience Curriculum for Team Leaders

INTRODUCTION

Burnout is prevalent among medical trainees and faculty. Resilience, the ability to cope well with stress and thrive during challenges, has been a focus of initiatives to combat burnout. However, curricula teaching resilience skills are needed. Since residents experience challenging and stressful clinical events often, and would like to discuss these events with their teams, resilience skills may help trainees cope after such events. Additionally, resilience skills may help trainees address other challenges they face as team leaders. Leadership training is an important component of physician professional development.

METHODS

This advanced resilience training curriculum consists of two interactive workshops that include didactics, skills practice, and reflection. The first workshop focuses on applying resilience skills to team leadership, while the second focuses on structured team debriefing after difficult clinical events. This curriculum is intended for learners who are health care team leaders, such as senior residents, fellows, or faculty. It may be used with learners who have completed introductory resilience training or with those without prior training.

RESULTS

The curriculum was rated highly by senior residents, who reported feeling more comfortable leading their teams after difficult clinical events and talking about these events following this curriculum. The majority of residents thought the workshops should be continued.

DISCUSSION

This novel curriculum teaches learners to apply resilience skills during team leadership and difficult clinical scenarios. It was well received by senior residents and may be used with a variety of learners across health professions and training levels.

A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans

Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.

The evolution of the molecular response to stress and its relevance to trauma and stressor-related disorders

The experience of "stress", in its broadest meaning, is an inevitable part of life. All living creatures have evolved multiple mechanisms to deal with such threats and challenges and to avoid damage to the organism that may be incurred from these stress responses. Trauma and stressor-related disorders are psychiatric conditions that are caused specifically by the experience of stress, though depression, anxiety and some other disorders may also be unleashed by stress. Stress, however, is not a mandatory criterion of these diagnoses. This article focuses on the evolution of the neurochemicals involved in the response to stress and the systems in which they function. This includes the skin and gut, and the immune system. Evidence suggests that responses to stress are evolutionarily highly conserved, have wider involvement than the hypothalamic pituitary adrenal stress axis alone, and that excessive stress responses can produce stressor-related disorders in both humans and animals.

The Association of Social Inhibition and Posttraumatic Stress Disorder: A Vicious Circle?: Results From the Population-Based KORA F4 Study With 1232 Participants With Trauma Exposure

This cross-sectional analysis investigated the association between posttraumatic stress disorder (PTSD) and social inhibition (SI). A total of 1232 individuals aged 32-71 years with a history of traumatic experience were identified from the population-based Cooperative Health Research in the Region of Augsburg F4 study conducted in 2006-2008. PTSD was assessed by the Impact of Event Scale, Posttraumatic Diagnostic Scale, and interview data. SI was measured by the SI subscale of the German version of the Type-D scale and dichotomized in a high (score of ≥10) and nonhigh group. Even in the fully adjusted multinomial logistic regression model (adjusted for age, sex, sociodemographic and metabolic risk factors, anxiety, depression), high levels of SI were significantly associated with PTSD (partial: odds ratio, 1.58; 95% confidence interval, 1.19-2.09; p = 0.002; full: odds ratio, 2.45; 95% confidence interval, 1.25-4.82; p = 0.009). Our findings suggest a dose-response relationship between PTSD and SI and should be integrated in individual therapy plans, especially of patients with interpersonal violence experience.

Resilience and post-traumatic stress disorder in the acute aftermath of rape: a comparative analysis of adolescents versus adults

BACKGROUND

Rape trauma contributes significantly to the mental burden of disease, affecting resilience and vulnerabilities at every developmental life stage. Appropriate resilience-promoting strategies could potentially buffer or protect trauma-exposed individuals from psychopathology.

AIM

This study aimed to assess and compare (using validated measuring instruments) resilience, post-traumatic stress disorder (PTSD) and other variables in the acute aftermath of rape, between adolescent and adult females and to assess associations with these variables.

METHOD

We conducted a comparative analysis of resilience, PTSD, prior trauma, demographic variables and psychiatric morbidity in 41 adolescent and 47 adult female rape survivors six weeks post-rape. We assessed the relationship of resilience to PTSD, demographic variables and prior trauma and investigated if resilience levels predicted PTSD after adjusting for prior trauma.

RESULTS

We found no significant differences in resilience levels between the groups, but the adolescent PTSD rate (40%) was double that in adults (20%). In adults, a significant negative correlation was evident between resilience and PTSD symptoms scores.

CONCLUSION

More knowledge of resilience versus stress susceptibility for PTSD throughout the lifespan is needed and can inform the development of more effective clinical assessment and resilience-promoting strategies.

Treatment of Sleep Disturbances in Post-Traumatic Stress Disorder: A Review of the Literature

Sleep disturbances are among the most commonly endorsed symptoms of post-traumatic stress disorder (PTSD). Treatment modalities that are effective for the waking symptoms of PTSD may have limited efficacy for post-traumatic sleep problems. The aim of this review is to summarize the evidence for empirically supported and/or utilized psychotherapeutic and pharmacological treatments for post-traumatic nightmares and insomnia. While there are few controlled studies of the applicability of general sleep-focused interventions to the management of the sleep disturbances in PTSD, evidence is growing to support several psychotherapeutic and pharmacological treatments. Future investigations should include trials that combine treatments focused on sleep with treatments effective in managing the waking symptoms of PTSD.

Work Volition Among U.S. Veterans

The present study examined correlates of work volition—the perceived capacity to make occupational choices despite constraints—with a diverse sample of 213 U.S. veterans. Veterans with higher levels of formal education, higher yearly incomes, were married, and were employed, endorsed greater work volition. Those who experienced lower posttraumatic stress disorder (PTSD) symptoms, endorsed lower levels of neuroticism, higher levels of conscientiousness, and higher levels of internal locus of control, also demonstrated greater levels of work volition. A structural model was run where PTSD symptoms, neuroticism, and conscientiousness were hypothesized to predict work volition via locus of control and compared with an alternative model. After identifying a best fitting model, bootstrapping analyses demonstrated that locus of control fully mediated the relations between PTSD symptoms, neuroticism, and conscientiousness to work volition. Specifically, the key reason PTSD symptoms, neuroticism, and conscientiousness were related to work volition was their effect on general locus of control. Practical implications are discussed.

Association between traumatic events and post-traumatic stress disorder: results from the ESEMeD-Spain study

BACKGROUND

The relative importance of traumatic events (TEs) in accounting for the social burden of post-traumatic stress disorder (PTSD) could vary according to cross-cultural factors. In that sense, no such studies have yet been conducted in the Spanish general population. The present study aims to determine the epidemiology of trauma and PTSD in a Spanish community sample using the randomly selected TEs method.

METHODS

The European Study of the Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional household survey of a representative sample of adult population. Lifetime prevalence of self-reported TEs and lifetime and 12-month prevalence of PTSD were evaluated using the World Health Organization (WHO) Composite International Diagnostic Interview. Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE.

RESULTS

Road accident was the most commonly self-reported TE (14.1%). Sexual assault had the highest conditional risk of PTSD (16.5%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (36.4% of all cases) and sexual assault (17.2%). Being female and having a low educational level were associated with low risk of overall TE exposure and being previously married was related to higher risk. Being female was related to high risk of PTSD after experiencing a TE.

CONCLUSIONS

Having an accident is commonly reported among Spanish adults, but two TE are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.

High-Intensity Sports for Posttraumatic Stress Disorder and Depression: Feasibility Study of Ocean Therapy With Veterans of Operation Enduring Freedom and Operation Iraqi Freedom

In this study, we conducted a pretest–posttest investigation of a sports-oriented occupational therapy intervention using surfing in an experiential, skills-based program to support veterans with symptoms of posttraumatic stress disorder (PTSD) in their transition to civilian life. The purpose of this feasibility study was to evaluate the intervention for attendance rates and retention in the program provided in 5 sessions over 5 wk. Fourteen veterans from a specialty postdeployment clinic at a Veterans Affairs hospital were enrolled; 11 completed the study, and 10 attended ≥3 sessions. Participants reported clinically meaningful improvement in PTSD symptom severity (PTSD Checklist—Military Version, Wilcoxon signed rank Z = 2.5, p = .01) and in depressive symptoms (Major Depression Inventory, Wilcoxon signed rank Z = 2.05, p = .04). The results of this small, uncontrolled study suggest that a sports-oriented occupational therapy intervention has potential as a feasible adjunct intervention for veterans seeking mental health treatment for symptoms of PTSD.

Resilience and professional quality of life among military healthcare providers

The retention of qualified military healthcare providers is a top priority for Department of Defense (DoD) leaders. The purpose of this study is to examine the relationship between resilience and professional quality of life and to explore differences among providers who had been deployed and those who had never been deployed. Results indicated high resilience scores among all providers, and significant relationships between dimensions of professional quality of life and resilience. There were significant differences in professional quality of life based on deployment. Recommendations for future research are included, particularly as retention is an important issue for the DoD.

A longitudinal study of posttraumatic stress disorder symptoms and its relationship with coping skill and locus of control in adolescents after an earthquake in China

Background/Objectives

Post-traumatic stress disorder is a common psychological maladaptation among adolescents after undergoing an earthquake. Knowledge about the prevalence and maintenance of post-traumatic stress disorder symptoms and the changes of its predictors over time can help medical providers assist adolescent survivors with mitigating long-term impacts. This study examined the changes in posttraumatic stress disorder symptoms and its relationship with coping skill and locus of control among adolescent earthquake survivors in China.

Methodology/Findings

The study used an observational longitudinal design. A total of 1420 adolescents were evaluated twice after the earthquake by using the Post-traumatic stress disorder Checklist-Civilian Version, The Internality, Powerful others and Chance scale and the Coping Styles Scale. The results indicated that the mean scores of posttraumatic stress disorder symptoms were decreased significantly and the positive rates of posttraumatic stress disorder symptoms also declined remarkably at 17 months compared to the 3 months post-earthquake. Internality locus of control and problem solving coping skill were effective resilient factors for the development and maintenance of posttraumatic stress disorder symptoms, while chance locus of control was a powerful risk factor of posttraumatic stress disorder symptoms as well as being female, being injured and property loss.

Conclusions/Significance

Continuous screening is recommended to identify adolescent earthquake survivors with posttraumatic stress disorder symptoms. More attention should be paid to adolescent survivors who are prone to adopt passive coping strategies responding to trauma events and who own external causal attribution.

PTSD in paramedics: resilience and sense of coherence

BACKGROUND

Paramedics are frequently subjected to traumatic experiences and have higher PTSD prevalence rates than people in the general population. However, the vast majority of paramedics do not develop PTSD. While several risk factors for PTSD have been established, little is known about protective factors. It has been suggested that a good sense of coherence (SOC) and high resilience lower the risk for developing PTSD.

AIMS

To examine whether SOC and resilience are associated with PTSD severity in paramedics.

METHOD

A cross-sectional study investigated SOC, resilience and PTSD in paramedics (N = 668). PTSD was assessed with the Posttraumatic Stress Diagnostic Scale (PDS); resilience and SOC were measured with the Resilience Scale (RS-11) and the Sense of Coherence Scale (SOC-L9). Further measures included preparation of dealing with traumatic events and availability of psychological help.

RESULTS

As expected, both resilience and SOC were negatively correlated with PTSD symptoms. The regression analysis showed that 19.2% of the total variance in symptom severity was explained by these variables. However, SOC was a better predictor than resilience for PTSD severity, as it accounted for more unique variance. Paramedics who were prepared for dealing with work-related traumatic events and who received psychological help had less severe PTSD symptoms and higher SOC scores than paramedics for whom these services were not available.

CONCLUSIONS

Enhancing resilience, and especially SOC, seems a promising approach to reduce PTSD symptom severity in high risk groups like paramedics.

The clinical implications of mouse models of enhanced anxiety

Mice are increasingly overtaking the rat model organism in important aspects of anxiety research, including drug development. However, translating the results obtained in mouse studies into information that can be applied in clinics remains challenging. One reason may be that most of the studies so far have used animals displaying 'normal' anxiety rather than 'psychopathological' animal models with abnormal (elevated) anxiety, which more closely reflect core features and sensitivities to therapeutic interventions of human anxiety disorders, and which would, thus, narrow the translational gap. Here, we discuss manipulations aimed at persistently enhancing anxiety-related behavior in the laboratory mouse using phenotypic selection, genetic techniques and/or environmental manipulations. It is hoped that such models with enhanced construct validity will provide improved ways of studying the neurobiology and treatment of pathological anxiety. Examples of findings from mouse models of enhanced anxiety-related behavior will be discussed, as well as their relation to findings in anxiety disorder patients regarding neuroanatomy, neurobiology, genetic involvement and epigenetic modifications. Finally, we highlight novel targets for potential anxiolytic pharmacotherapeutics that have been established with the help of research involving mice. Since the use of psychopathological mouse models is only just beginning to increase, it is still unclear as to the extent to which such approaches will enhance the success rate of drug development in translating identified therapeutic targets into clinical trials and, thus, helping to introduce the next anxiolytic class of drugs.