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McBain SA, Cleavenger K, Bull C, Payakachat N, Greer M. Perceptions of tech-based mental health screening. Trauma Surg Acute Care Open 2024; 9:e001198. [PMID: 38390474 PMCID: PMC10882365 DOI: 10.1136/tsaco-2023-001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/22/2023] [Indexed: 02/24/2024] Open
Abstract
Background An estimated one-third of patients experience post-traumatic stress disorder (PTSD) or depression in the year following a traumatic injury. The American College of Surgeons requires postinjury PTSD and depression screening in trauma centers, although implementation has been limited. Tech-based solutions have been proposed to improve uptake of postinjury mental health screening. The goals of this pilot study were to assess the usability and acceptability of Blueprint, a tech-based mental health screening platform, and explore attitudes toward tech-based screening and intervention. Methods This pilot study included trauma patients (n=10) admitted to the trauma service. Participants completed the PTSD Checklist-5 and Patient Health Questionnaire-9 using Blueprint to test usability and acceptability of the platform. Participants completed the System Usability Scale (SUS) and a semi-structured interview to assess several domains including attitudes toward tech-based screening, potential barriers to implementation, and its usefulness in a postinjury context. Summative Template Analysis, a data abstraction procedure, was used to analyze qualitative data. Results Blueprint received an average SUS score of 93.25/100 suggesting participants found the interface to be an 'excellent' means to assess postinjury mental health concerns. Participants were supportive of universal screening and identified several benefits to engaging in tech-based routine monitoring of postinjury PTSD and depressive symptoms including convenience, personalization, and trauma-informed care. Regarding intervention, patients valued web-based psychoeducation on topics related to their overall care and local resources. Conclusions Tech-based mental health screening was highly usable and valuable to trauma patients at risk for postinjury PTSD and depression. Participants valued web-based psychoeducation and resources, but overall preferred Blueprint be used to facilitate access to in-person mental health services. Further evaluation of Blueprint as a means of assessment, intervention, and referral is needed.
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Affiliation(s)
- Sacha A McBain
- Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kylie Cleavenger
- Department of Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Chelsey Bull
- Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melody Greer
- Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Price M, Hidalgo JE, Bird YM, Bloomfield LSP, Buck C, Cerutti J, Dodds PS, Fudolig MI, Gehman R, Hickok M, Kim J, Llorin J, Lovato J, McGinnis EW, McGinnis RS, Norton R, Ramirez V, Stanton K, Ricketts TH, Danforth CM. A large clinical trial to improve well-being during the transition to college using wearables: The lived experiences measured using rings study. Contemp Clin Trials 2023; 133:107338. [PMID: 37722484 PMCID: PMC10591842 DOI: 10.1016/j.cct.2023.107338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION The transition to college is a period of elevated risk for a range of mental health conditions. Although colleges and universities strive to provide mental health support to their students, the high demand for these services makes it difficult to provide scalable, cost-effective solutions. OBJECTIVE To address these issues, the present study aims to compare the efficacy of three different treatments using a large cohort of 600 students transitioning to college. Interventions were selected based on their potential for generalizability and cost-effectiveness on college campuses. METHODS The study is a Phase II parallel-group, four-arm, randomized controlled trial with 1:1 allocation that will assign 600 participants to one (n = 150 per condition) of four arms: 1) group-based therapy, 2) physical activity program, 3) nature experiences, or 4) weekly assessment condition as a control group. Physiological data will be collected from all participants using a wearable device to develop algorithmic mental and physical health functioning predictions. Once recruitment is complete, modeling strategies will be used to evaluate the outcomes and effectiveness of each intervention. DISCUSSION The findings of this study will provide evidence as to the benefits of implementing scalable and proactive interventions using technology with the goal of improving the well-being and success of new college students.
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Affiliation(s)
- Matthew Price
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA.
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Yoshi M Bird
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Laura S P Bloomfield
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA; Gund Institute for Environment, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Rubenstein School of Environment and Natural Resources, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Casey Buck
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Janine Cerutti
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Peter Sheridan Dodds
- MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA; Department of Computer Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Mikaela Irene Fudolig
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Rachel Gehman
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Marc Hickok
- UVM Athletics, 2 Colchester Ave, Burlington VT 05405, USA
| | - Julia Kim
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Jordan Llorin
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Juniper Lovato
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Ellen W McGinnis
- Department of Psychiatry, University of Vermont College of Medicine, 2 Colchester Ave, Burlington VT 05405, USA
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Richard Norton
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Vanessa Ramirez
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Kathryn Stanton
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Taylor H Ricketts
- Gund Institute for Environment, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Rubenstein School of Environment and Natural Resources, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Christopher M Danforth
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA; Gund Institute for Environment, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Department of Mathematics & Statistics, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
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Novel Mechanisms and Interventions for PTSD. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:286-287. [PMID: 37404964 PMCID: PMC10316218 DOI: 10.1176/appi.focus.23021010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
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4
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Brier ZMF, Hidalgo JE, Espeleta HC, Davidson T, Ruggiero KJ, Price M. Assessment of Traumatic Stress Symptoms During the Acute Posttrauma Period. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:239-246. [PMID: 37404969 PMCID: PMC10316216 DOI: 10.1176/appi.focus.20230001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
A substantial majority of adults in the United States will experience a potentially traumatic event (PTE) in their lifetime. A considerable proportion of those individuals will go on to develop posttraumatic stress disorder (PTSD). Distinguishing between those who will develop PTSD and those who will recover, however, remains as a challenge to the field. Recent work has pointed to the increased potential of identifying individuals at greatest risk for PTSD through repeated assessment during the acute posttrauma period, the 30-day period after the PTE. Obtaining the necessary data during this period, however, has proven to be a challenge. Technological innovations such as personal mobile devices and wearable passive sensors have given the field new tools to capture nuanced in vivo changes indicative of recovery or nonrecovery. Despite their potential, there are numerous points for clinicians and research teams to consider when implementing these technologies into acute posttrauma care. The limitations of this work and considerations for future research in the use of technology during the acute posttrauma period are discussed.
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Affiliation(s)
- Zoe M F Brier
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Hannah C Espeleta
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Tatiana Davidson
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Kenneth J Ruggiero
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
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Farrell D, Moran J, Zat Z, Miller PW, Knibbs L, Papanikolopoulos P, Prattos T, McGowan I, McLaughlin D, Barron I, Mattheß C, Kiernan MD. Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury—An RCT study. Front Psychol 2023; 14:1129912. [PMID: 37063579 PMCID: PMC10100089 DOI: 10.3389/fpsyg.2023.1129912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/22/2023] [Indexed: 04/01/2023] Open
Abstract
ObjectiveFrontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol—GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery.MethodsThe study’s design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre—treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences – International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study.ResultsResults highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study’s findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic.ConclusionThe NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.
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Affiliation(s)
- Derek Farrell
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
- School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom
- *Correspondence: Derek Farrell,
| | - Johnny Moran
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Zeynep Zat
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Paul W. Miller
- School of Nursing, Magee Campus, Ulster University, Northern Ireland, United Kingdom
| | - Lorraine Knibbs
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Penny Papanikolopoulos
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Tessa Prattos
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Iain McGowan
- School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom
| | - Derek McLaughlin
- School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom
| | - Ian Barron
- Centre for International Education, College of Education, University of Massachusetts, Amherst, MA, United States
| | - Cordula Mattheß
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Matthew D. Kiernan
- Northern Hub for Veteran and Military Families’ Research, Northumbria University, Newcastle upon Tyne, United Kingdom
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6
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Bernard DL, O’Loughlin K, Davidson TM, Rothbaum A, Anton MT, Ridings LE, Cooley JL, Gavrilova Y, Hink AB, Ruggiero KJ. Differences in mental health engagement and follow-up among Black and White patients after traumatic injury. J Trauma Acute Care Surg 2023; 94:117-124. [PMID: 35358156 PMCID: PMC9525457 DOI: 10.1097/ta.0000000000003604] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe injury necessitating hospitalization is experienced by nearly three million US adults annually. Posttraumatic stress disorder and depression are prevalent clinical outcomes. The mechanisms by which programs equitably promote mental health recovery among trauma-exposed patients are understudied. We evaluated clinical outcomes and engagement among a cohort of Black and White patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate mental health recovery after traumatic injury. METHODS Trauma Resilience and Recovery Program is a four-step model that includes (1) bedside psychoeducation about mental health recovery following traumatic injury, (2) a text-messaging symptom tracking system, (3) a 30-day postinjury mental health screen, and (4) referrals to mental health services. Data describe 1,550 patients enrolled in TRRP within a Level I trauma center ( Mage = 40.86; SD, 17.32), 611 of whom identified as Black (74.5% male) and 939 of whom identified as White (67.7% male). RESULTS Enrollment in TRRP was nearly universal (97.9%) regardless of race or injury mechanism. Enrollment and usage of the text-message system were statistically similar between Black (35.7%) and White patients (39.5%). Trauma Resilience and Recovery Program reengaged Black and White patients at a similar rate at the 30-day postinjury follow-up. However, Black patients were more likely to report peritraumatic distress at the bedside and clinical elevations in posttraumatic stress disorder and depression on the 30-day screen. Referrals were more likely to be accepted by Black patients relative to White patients with clinically elevated symptoms. CONCLUSION Enrollment and engagement were comparable among Black and White patients served by TRRP. Data provide preliminary evidence to suggest that TRRP is feasible and acceptable and engages patients in mental health follow-up equitably. However, research that includes careful measurement of social determinants of health and long-term follow-up examining initiation, completion, and benefit from treatment is needed. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Donte L. Bernard
- Department of Psychological Sciences, University of Missouri, Columbia, MO, 65211, USA
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Kerry O’Loughlin
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M. Davidson
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Alex Rothbaum
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Leigh E. Ridings
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - John L. Cooley
- Department of Psychological Sciences, Texas Tech University
| | - Yulia Gavrilova
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Ashley B. Hink
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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7
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The role of sensory processing sensitivity in the early traumatic stress reaction: Predicting posttraumatic stress symptoms following motor vehicle accidents. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Singh L, Kanstrup M, Gamble B, Geranmayeh A, Göransson KE, Rudman A, Dahl O, Lindström V, Hörberg A, Holmes EA, Moulds ML. A first remotely-delivered guided brief intervention to reduce intrusive memories of psychological trauma for healthcare staff working during the ongoing COVID-19 pandemic: Study protocol for a randomised controlled trial. Contemp Clin Trials Commun 2022; 26:100884. [PMID: 35036626 PMCID: PMC8752164 DOI: 10.1016/j.conctc.2022.100884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 01/10/2023] Open
Abstract
Addressing the mental health needs of healthcare staff exposed to psychologically traumatic events at work during the COVID-19 pandemic is a pressing global priority. We need to swiftly develop interventions to target the psychological consequences (e.g., persistent intrusive memories of trauma). Interventions for healthcare staff must be brief, flexible, fitted around the reality and demands of working life under the pandemic, and repeatable during ongoing/further trauma exposure. Intervention delivery during the pandemic should be remote to mitigate risk of infection; e.g., here using a blend of digitalized self-administered materials (e.g., video instructions) and guided (remote) support from a researcher. This parallel groups, two-arm, randomised controlled trial (RCT) with healthcare staff working during the COVID-19 pandemic is the first evaluation of whether a digitalized form of a brief cognitive task intervention, which is remotely-delivered (guided), reduces intrusive memories. Healthcare staff who experience intrusive memories of work-related traumatic event(s) during the COVID-19 pandemic (≥2 in the week before inclusion) will be randomly allocated (1:1) to receive either the cognitive task intervention or an active (attention placebo) control, and followed up at 1-week, 1-month, 3-months, and 6-months post-intervention. The primary outcome will be the number of intrusive memories reported during Week 5; secondary and other outcomes include the number of intrusive memories reported during Week 1, and other intrusive symptoms. Findings will inform further development and dissemination of a brief cognitive task intervention to target intrusive memories.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - Marie Kanstrup
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Anahita Geranmayeh
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ann Rudman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Oili Dahl
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Veronica Lindström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department for Health Promoting Science Sophiahemmet University Stockholm, Sweden.,Samariten, Ambulance Stockholm, Sweden
| | - Anna Hörberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Australia
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9
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Joormann J, Ziobrowski HN, King A, Gildea SM, Lee S, Sampson NA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Koenen KC, McLean SA, Kessler RC. Prior histories of posttraumatic stress disorder and major depression and their onset and course in the three months after a motor vehicle collision in the AURORA study. Depress Anxiety 2022; 39:56-70. [PMID: 34783142 PMCID: PMC8732322 DOI: 10.1002/da.23223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/17/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A better understanding of the extent to which prior occurrences of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) predict psychopathological reactions to subsequent traumas might be useful in targeting posttraumatic preventive interventions. METHODS Data come from 1306 patients presenting to 29 U.S. emergency departments (EDs) after a motor vehicle collision (MVC) in the advancing understanding of recovery after trauma study. Patients completed self-reports in the ED and 2-weeks, 8-weeks, and 3-months post-MVC. Associations of pre-MVC probable PTSD and probable MDE histories with subsequent 3-months post-MVC probable PTSD and probable MDE were examined along with mediation through intervening peritraumatic, 2-, and 8-week disorders. RESULTS 27.6% of patients had 3-month post-MVC probable PTSD and/or MDE. Pre-MVC lifetime histories of these disorders were not only significant (relative risk = 2.6-7.4) but were dominant (63.1% population attributable risk proportion [PARP]) predictors of this 3-month outcome, with 46.6% prevalence of the outcome among patients with pre-MVC disorder histories versus 9.9% among those without such histories. The associations of pre-MVC lifetime disorders with the 3-month outcome were mediated largely by 2- and 8-week probable PTSD and MDE (PARP decreasing to 22.8% with controls for these intervening disorders). Decomposition showed that pre-MVC lifetime histories predicted both onset and persistence of these intervening disorders as well as the higher conditional prevalence of the 3-month outcome in the presence of these intervening disorders. CONCLUSIONS Assessments of pre-MVC PTSD and MDE histories and follow-ups at 2 and 8 weeks could help target early interventions for psychopathological reactions to MVCs.
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Affiliation(s)
- Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew King
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, 02930, USA
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Providence, RI, 02930, USA
- Rhode Island Hospital, Providence, RI, 02930, USA
- The Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C. Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T. Germine
- Department of Biomedical Engineering, Emory University, Atlanta, GA, 30332, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Kenneth A. Bollen
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L. Pascual
- Department of Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St. Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, 2006, Australia
- Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
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Tobar-Santamaria A, Kiefer R, Godin J, Contractor AA, Weiss NH. Sexual victimization and disordered eating among community individuals: The influence of negative and positive emotion dysregulation. Eat Behav 2021; 43:101567. [PMID: 34562858 PMCID: PMC8629879 DOI: 10.1016/j.eatbeh.2021.101567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Individuals with a history of sexual victimization are at increased odds of developing an eating disorder in their lifetime. Emotion dysregulation has been identified as an outcome of sexual victimization and a vulnerability factor in the emergence and maintenance of disordered eating. However, research in this area has been limited by its narrow focus on dysregulation stemming from negative emotions. The aim of the current study was to explore the potential moderating roles of negative and positive emotion dysregulation in the relations between sexual victimization and disordered eating. METHOD Study participants included 473 community individuals who endorsed a history of sexual assault (Mage = 34.66; 44.8% male; 78.4% White). Participants completed measures assessing sexual victimization, negative and positive emotion dysregulation, and disordered eating. Data was collected from January to April of 2020 via Amazon's Mechanical Turk. RESULTS Results indicated significant positive relations among sexual victimization, negative and positive emotion dysregulation, and disordered eating. Sexual victimization was found to be more strongly associated with disordered eating at high (vs. low) levels of negative and positive emotion dysregulation. DISCUSSION This study provides evidence for the strengthening roles of both high negative and positive emotion dysregulation in the relation between sexual victimization and disordered eating, suggesting the potential utility of targeting both negative and positive emotion dysregulation in disordered eating interventions among individuals with a history of sexual victimization.
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11
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Singh L, Kanstrup M, Depa K, Falk AC, Lindström V, Dahl O, Göransson KE, Rudman A, Holmes EA. Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses. JMIR Form Res 2021; 5:e27473. [PMID: 33886490 PMCID: PMC8158532 DOI: 10.2196/27473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19-related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach. OBJECTIVE The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. METHODS We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. RESULTS After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. CONCLUSIONS The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - Marie Kanstrup
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Katherine Depa
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Charlotte Falk
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Veronica Lindström
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Samariten Ambulance, Stockholm, Sweden
| | - Oili Dahl
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ann Rudman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Abstract
E-health offers great potential in the field of traumatic stress to deliver training, assessment, prevention, and treatment of adverse outcomes after trauma worldwide. In order to encourage research on E-health applications in the field of traumatic stress, this current special issue of the European Journal of Psychotraumatology presents a series of papers divided into three emergent topics: I) development of digital interventions, II) the use of digital interventions to foster self-management and deliver therapy, and III) digital methods to improve prediction, assessment, and monitoring of post-trauma outcomes. These studies show acceptance of the tools by various end-user groups and improvements of current research and clinical practices, but also areas for improvement regarding the development process and making even better use of technological capabilities of E-Health. We propose three general themes to accelerate the quality of e-Health interventions and studies in this area in the coming years: optimizing user engagement and adherence, conducting more (innovative) research, and increasing implementation and dissemination activities. This issue appears in the midst of the COVID-19 pandemic. It is exactly at times like these that we need effective online interventions and we see an enormous increase in the use of e-Health. We hope this issue will contribute to help those affected and to serve the community worldwide.
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Affiliation(s)
- Anne Bakker
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Heleen Riper
- Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience Research Institute & Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands
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13
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Price M, Legrand AC, Brier ZMF, Gratton J, Skalka C. The short-term dynamics of posttraumatic stress disorder symptoms during the acute posttrauma period. Depress Anxiety 2020; 37:313-320. [PMID: 31730736 PMCID: PMC8340953 DOI: 10.1002/da.22976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/14/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The manner in which posttraumatic stress disorder (PTSD) develops remains largely unknown. PTSD is comprised of 20 symptoms across 4 clusters. These clusters were hypothesized to reflect a failure of recovery model in which intrusive symptoms appear first. Intrusive symptoms led to avoidance of trauma-related stimuli, which resulted in sustained arousal. The sustained arousal ultimately led to dysphoria. METHODS This hypothesized symptom progression was evaluated during the acute posttrauma period (the first 30 days postevent). Participants (N = 80) reported their PTSD symptoms for 30 days via mobile devices. Using a short-term dynamic modeling framework, a temporal and contemporaneous model of PTSD symptoms was obtained. RESULTS In the temporal network, a fear-conditioning component was identified that supported the hypothesized set of relations among symptom clusters. The contemporaneous network was classified by two subnetworks. The first corresponded to a fear-conditioning model that included symptoms of intrusions and avoidance. The second included symptoms of dysphoria and arousal. CONCLUSIONS These findings suggest that, after a trauma, there may be a fear-conditioning process that involves intrusions, avoidance, and arousal symptoms. Dysphoric symptoms were also present but developed as a partially distinct component.
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Affiliation(s)
- Matthew Price
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont,Corresponding Author: Matthew Price, PhD, Phone: 802-656-1341, Fax: Not Available, Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT 05405,
| | - Alison C. Legrand
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont
| | - Zoe M. F. Brier
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont
| | - Jennifer Gratton
- Division of Acute Care Surgery, Department of Surgery, Larner College of Medicine, University of Vermont
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14
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The Association Between Pain Trajectories With Posttraumatic Stress Disorder, Depression, and Disability During the Acute Posttrauma Period. Psychosom Med 2020; 82:862-868. [PMID: 33156263 PMCID: PMC7665839 DOI: 10.1097/psy.0000000000000866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Exposure to a traumatic event is common among US adults, yet only a small fraction develops posttraumatic stress disorder (PTSD). Higher pain after a traumatic injury has been associated with higher PTSD symptoms and thus may be a risk factor. However, few studies have examined how pain during the period immediately after a trauma, referred to as the acute posttrauma period, relates later to PTSD outcomes. METHODS A sample of (n = 87) individuals who had experienced a traumatic injury assessed their pain through daily mobile assessments for the first month after injury. PTSD, depression, and functional impairment were assessed at the time of trauma and 1 and 3 months later. RESULTS Using latent class growth analysis, three trajectories of pain were identified: low pain (41.3%), decreasing pain (43.7%), and high pain (14.9%). At baseline, the high-pain class reported higher levels of depression and functional impairment than did the low-pain group. From baseline to 3 months, the low-pain class experienced a reduction in PTSD, depression, and functional impairment, whereas the high-pain class experienced an increase in PTSD symptoms, persistent depression, and functional impairment. CONCLUSIONS These results demonstrate that there are distinct trajectories of pain after a traumatic injury. Persistent elevated pain is associated with more severe psychopathology in the period immediately after a traumatic injury.
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15
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Wshah S, Skalka C, Price M. Predicting Posttraumatic Stress Disorder Risk: A Machine Learning Approach. JMIR Ment Health 2019; 6:e13946. [PMID: 31333201 PMCID: PMC6681635 DOI: 10.2196/13946] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A majority of adults in the United States are exposed to a potentially traumatic event but only a handful go on to develop impairing mental health conditions such as posttraumatic stress disorder (PTSD). OBJECTIVE Identifying those at elevated risk shortly after trauma exposure is a clinical challenge. The aim of this study was to develop computational methods to more effectively identify at-risk patients and, thereby, support better early interventions. METHODS We proposed machine learning (ML) induction of models to automatically predict elevated PTSD symptoms in patients 1 month after a trauma, using self-reported symptoms from data collected via smartphones. RESULTS We show that an ensemble model accurately predicts elevated PTSD symptoms, with an area under the curve (AUC) of .85, using a bag of support vector machines, naive Bayes, logistic regression, and random forest algorithms. Furthermore, we show that only 7 self-reported items (features) are needed to obtain this AUC. Most importantly, we show that accurate predictions can be made 10 to 20 days posttrauma. CONCLUSIONS These results suggest that simple smartphone-based patient surveys, coupled with automated analysis using ML-trained models, can identify those at risk for developing elevated PTSD symptoms and thus target them for early intervention.
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Affiliation(s)
- Safwan Wshah
- University of Vermont, Burlington, VT, United States
| | | | - Matthew Price
- University of Vermont, Burlington, VT, United States
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16
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Affiliation(s)
- Josef I Ruzek
- Center for m2 Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Carolyn M Yeager
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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