Examining a comprehensive model of disaster-related posttraumatic stress disorder in systematically studied survivors of 10 disasters

Psychological first aid in the intensive care unit

The intensive care unit (ICU) is a stressful environment for patients and their families as well as healthcare workers (HCWs). Distress, which is a negative emotional or physical response to a stressor is common in the ICU. Psychological first aid (PFA) is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning. The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients, caregivers, and HCWs. This is the first such review to apply PFA to the ICU setting.

Posttraumatic stress disorder (PTSD) prevalence: an umbrella review

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

Impact of Natural Disasters on Mental Health: Evidence and Implications

Natural disasters are large-scale catastrophic events, and they are increasing in frequency and severity. Converging evidence indicates that the mental health consequences of disasters are extensive and are often associated with trauma and the disruption of personal and socioeconomic factors in people's lives. Although most individuals experiencing disaster-related traumatic events do not develop mental illnesses, some experience adverse psychological effects of disasters. These mental health effects begin immediately following a disaster and may persist for extended periods. In this article, we summarize the literature findings to provide a narrative review that focuses on the mental health consequences of natural disasters. An overview of the disaster mental health research field is provided, and the findings are ordered into theoretical frameworks. Then, the development and course of psychopathology regarding disaster aftermath are described in a methodological context. Next, understanding a disaster as an event of transition is highlighted, and the impact of this disaster-specific transition is discussed. Lastly, a potential relationship between the transitional impact of a disaster and mental health consequences is speculated on, and the implications are discussed. The impact of disasters on mental health can be direct or indirect, short-term or long-term, and to some extent depends on the recovery process of the affected community. Also, we propose the possible merits of using the Transitional Impact Scale in the context of disaster mental health research by assessing the features of disaster-related transition and its effects on mental health. We conclude by suggesting a direction for future research in terms of measuring the disaster mental health effects in community settings (affected vs. non-affected) and also considering cross-cultural and cross-regional differences. In recent decades, a large amount of knowledge has been gathered from disaster mental health research, but, still, more research is needed to resolve some irregular findings through refining the methodological variations.

Epigenetic Age Acceleration and Disparities in Posttraumatic Stress in Women in Southeast Louisiana: NIMHD Social Epigenomics Program

Importance

Disasters experienced by an entire community provide opportunities to understand individual differences in risk for adverse health outcomes over time. DNA methylation (DNAm) differences may help to distinguish individuals at increased risk following large-scale disasters.

Objective

To examine the association of epigenetic age acceleration with probable posttraumatic stress disorder (PTSD) and PTSD symptom severity in women.

Design, Setting, and Participants

This prospective cohort study examined data from participants in the Women and Their Children's Health cohort, who were characterized longitudinally following the Deepwater Horizon oil spill (DHOS) in 2010 and through numerous hurricanes in the Gulf Coast region of the US. Wave 1 occurred August 6, 2012, through June 26, 2014, and wave 2 occurred September 2, 2014, through May 27, 2016. Data were analyzed between August 18 and November 4, 2023. Address-based sampling was used to recruit women aged 18 to 80 years and residing in 1 of the 7 Louisiana parishes surrounding the DHOS-affected region. Recruitment consisted of 2-stage sampling that (1) undersampled the 2 more urban parishes to maximize probability of participant oil exposure and (2) proportionally recruited participants across census tracts in the 5 other parishes closest to the spill.

Exposure

Posttraumatic stress subsequent to the DHOS.

Main Outcome and Measures

Epigenetic age acceleration was measured by DNAm assayed from survey wave 1 blood samples. Posttraumatic stress disorder was assessed using the PTSD Checklist for DSM-5 at survey wave 2, and lifetime trauma exposure was assessed using the Life Events Checklist for DSM-5. General linear models were used to examine the association between wave 1 DNAm age and wave 2 probable PTSD diagnosis and symptom severity.

Results

A total of 864 women (mean [SD] age, 47.1 [12.0] years; 328 Black [38.0%], 19 American Indian [2.2%], 486 White [56.3%], and 30 of other racial groups, including uknown or unreported [3.5%]) were included. Black and American Indian participants had a higher age acceleration at wave 1 compared with White participants (β = 1.64 [95% CI, 1.02-2.45] and 2.34 [95% CI, 0.33-4.34], respectively), and they had higher PTSD symptom severity at wave 2 (β = 7.10 [95% CI, 4.62-9.58] and 13.08 [95% CI, 4.97-21.18], respectively). Epigenetic age acceleration at wave 1 was associated with PTSD symptom severity at wave 2 after adjusting for race, smoking, body mass index, and household income (β = 0.38; 95% CI, 0.11-0.65).

Conclusions and Relevance

In this cohort study, epigenetic age acceleration was higher in minoritized racial groups and associated with future PTSD diagnosis and severity. These findings support the need for psychoeducation about traumatic responses to increase the likelihood that treatment is sought before years of distress and entrenchment of symptoms and comorbidities occur.

Contemporaneous and temporal network analysis of complex Posttraumatic stress disorder among Chinese college students with Childhood adversity: A longitudinal study

OBJECTIVE

To enhance understanding of the longitudinal progression of complex posttraumatic stress disorder (CPTSD) symptoms, this longitudinal study examined how CPTSD symptoms interact over time in Chinese college students with childhood trauma.

METHODS

From 18,933 college students who took part in two surveys 12 months apart, 4,006 participants who reported adverse childhood experiences were screened. Cross-sectional network comparisons and cross-lagged panel network (CLPN) analysis characterized interactions among CPTSD symptoms.

RESULTS

In the cross-sectional networks, feeling like a failure and avoid activities reminiscent of the trauma were the central symptoms. Takes long time to calm down and exaggerated startle are important bridge symptoms in the two networks respectively. The comparison of cross-sectional networks indicates that the global network strength was stable. The findings of the CLPN model reveal that feel worthless and feel like a failure had the highest "out" expected influence; exaggerated startle and avoid thoughts and feelings about the trauma had the highest "in" expected influence.

CONCLUSIONS

By conducting cross-sectional network analyses, the study illuminated the attributes of CPTSD networks across various time points. Additionally, the CLPN analysis uncovered the longitudinal patterns of CPTSD symptoms.

Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study

BACKGROUND

Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events.

AIMS

This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure.

METHOD

The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode).

RESULTS

Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors.

CONCLUSIONS

Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Molecular pathways underlying sympathetic autonomic overshooting leading to fear and traumatic memories: looking for alternative therapeutic options for post-traumatic stress disorder

The sympathoadrenal medullary system and the hypothalamic-pituitary-adrenal axis are both activated upon stressful events. The release of catecholamines, such as dopamine, norepinephrine (NE), and epinephrine (EPI), from sympathetic autonomic nerves participate in the adaptive responses to acute stress. Most theories suggest that activation of peripheral β-adrenoceptors (β-ARs) mediates catecholamines-induced memory enhancement. These include direct activation of β-ARs in the vagus nerve, as well as indirect responses to catecholamine-induced glucose changes in the brain. Excessive sympathetic activity is deeply associated with memories experienced during strong emotional stressful conditions, with catecholamines playing relevant roles in fear and traumatic memories consolidation. Recent findings suggest that EPI is implicated in fear and traumatic contextual memories associated with post-traumatic stress disorder (PTSD) by increasing hippocampal gene transcription (e.g., Nr4a) downstream to cAMP response-element protein activation (CREB). Herein, we reviewed the literature focusing on the molecular mechanisms underlying the pathophysiology of memories associated with fear and traumatic experiences to pave new avenues for the treatment of stress and anxiety conditions, such as PTSD.

Tobacco and Illicit Drug Use and Drug Use Disorders Among Employees of Businesses Affected by the 9/11 Attacks on the World Trade Center in New York City

OBJECTIVE

To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders.

METHODS

A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders.

RESULTS

Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11.

CONCLUSIONS

The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.

Disseminating early interventions for disaster mental health response using the ECHO model

Extension for Community Healthcare Outcomes (ECHO)-based telementoring was evaluated for disseminating early disaster interventions, Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR), to school professionals throughout rural, disaster-affected communities further affected by COVID-19. PFA and SPR complemented their Multitiered System of Support: PFA complemented tier 1 (universal) and SPR tier 2 (targeted) prevention. We evaluated the outcomes of a pretraining webinar (164 participants, January 2021) and four-part PFA training (84 participants, June 2021) and SPR training (59 participants, July 2021) across five levels of Moore's continuing medical education evaluation framework: (1) participation, (2) satisfaction, (3) learning, (4) competence, and (5) performance, using pre-, post-, and 1-month follow-up surveys. Positive training outcomes were observed across all five levels, with high participation and satisfaction throughout, and high use at the 1-month follow-up. ECHO-based telementoring may successfully engage and train community providers in these underused early disaster response models. Recommendations regarding training format and using evaluation to improve training are provided.

Mental Health: Pandemics, Epidemics and Tau Protein

Background

It is well established that a wide range of psychological disorders are influenced by the way people live, with lifestyle-related factors playing a substantial role. During the past decade, the effects of major disasters on mental health have drawn a lot of attention.

Aim

In this review, we compare clinical studies reporting a link between COVID-19 and other pandemics and mental health. Importantly, we also shed light on Tau protein and neurotransmitters as neurobiological factors that might explain this link.

Methods

A thorough PubMed search was done to gather and summarize published data on the COVID-19 pandemic's effect on mental health. Additionally, these studies were compared to previous research published on PubMed, triggering other pandemic and epidemic impacts on mental health.

Results

The COVID-19 epidemic has had the biggest impact on raising awareness about mental health. Moreover, the past century has seen an increase in the frequency of disease outbreaks like MERS-CoV, Ebola, and Influenza, which all had an impact on mental health. However, the exact role of these epidemics on mental health and brain functions is poorly understood.

Conclusion

Future research on the underlying pathways may yield essential information for the treatment and prevention of prospective mental diseases in light of the ongoing decline in mental health during the past 10 years.

Utilization of Mental Health Support Systems in the Aftermath of Disasters in Japan: Statistical Data of the Miyagi Disaster Mental Health Care Center

Large-scale natural disasters have a significant effect on residents' mental health. The Miyagi Disaster Mental Health Care Center (DMHCC) was established as a long-term mental health care center in response to the 2011 Great East Japan Earthquake and Tsunami (GEJE). Although six DMHCCs have been established in Japan, their exact role and functioning are still unclear. This study aimed to explore which population used the center in each recovery phase. Logistic regression was performed to identify the residents' characteristics according to the consultation pathways using the data collected by the Miyagi DMHCC. These data included personal information of the residents who were supported by the center from 2013 to 2018. The working-age unemployed men sought help by themselves, and the isolated older females were supported by home visits through the health survey. Long-term mental health care centers should observe community recovery and provide appropriate support. The implications of this result and future research directions are discussed.

A Qualitative Longitudinal Study of Injuries and Medical Care, Assistance, and Losses Recounted by Oklahoma City Bombing Survivors after Nearly a Quarter Century

Introduction:

Terrorist incidents occur with alarming frequency. Much is known about acute injuries and psychopathology arising from terrorism, as well as medical care and functional status assessed in early post-disaster periods. Survivors’ memories of these experiences may change over subsequent decades, and their perspectives may evolve. Little information is available on how survivors describe these experiences decades later.

Study Objective:

This longitudinal qualitative study of directly-exposed survivors of the 1995 Oklahoma City bombing was conducted nearly a quarter century after the disaster. It collected systematic, open-ended descriptions of survivors’ injuries and medical care, assistance received and given, and disaster-associated losses. It sought to illuminate whether survivors recall long-term consequences of disaster exposure so long after the event, providing important details with great clarity and associated emotion, or alternatively lose memory and sharpness of recollection for these aspects of their bombing experience.

Methods:

A sample of 182 bombing survivors was randomly recruited from a state registry of 1,092 bombing survivors and interviewed at approximately six months after the bombing (71% participation). The sample was re-interviewed an average of 23 years after the disaster (72% follow-up participation) using an open-ended interview with survivors describing in their own words their personal experience of the bombing and its effects on their lives. The interviews were audio recorded and professionally transcribed. Themes were identified in the text of the interviews, and passages were coded using qualitative software, achieving excellent inter-rater reliability for each theme. This article covers three of twelve total themes identified.

Results:

Nearly a quarter century after the bombing, this highly trauma-exposed Oklahoma City bombing survivor sample had memories that were still vivid, graphic, and evocative. They described injuries and medical care, assistance given and received, and losses with great detail and intensity. Despite the continuing strong emotions expressed by these survivors in relation to the bombing, the qualitative content suggested that lasting psychopathology was not a central concern.

Conclusion:

This is one of the longest prospective longitudinal, qualitative studies ever conducted with highly trauma-exposed survivors of a terrorist bombing. These findings are critical to disaster emergency response and effective management of the disaster response and early care for the survivors, as the effects of the disaster may shape the rest of their lives.

Moderating Effect of Personal and Community Resilience on the Relationship Between Disaster Trauma, Disaster Conflict, Economic Loss, and Post-traumatic Stress Disorder

OBJECTIVE

This study aimed to investigate the effects of disaster trauma, disaster conflict, and economic loss on posttraumatic stress disorder (PTSD), and to verify the moderating effect of personal and community resilience in these relationships. The data of 1914 people, aged 20 or above, who had experienced natural disasters (earthquake, typhoon, flooding) were used.

METHODS

Hayes's (2013) PROCESS macro (Model 1) was conducted to verify the moderation effect of personal and community resilience between PTSD and disaster trauma, disaster conflict, and economic loss.

RESULTS

Disaster trauma, disaster conflict, and economic loss were found to be positively related to PTSD. Personal and community resilience were negatively related to PTSD. Resilience had a moderating effect on the relationship between disaster trauma, economic loss, and PTSD. However, there was no moderating effect on the relationship between disaster conflict and PTSD. Community resilience had a moderating effect on the relationship between economic loss and PTSD. However, there was no moderating effect on the relationship between disaster trauma, disaster conflict, and PTSD.

CONCLUSIONS

The results suggest that personal and community resilience could be used for prevention and therapeutic interventions for disaster victims who experience PTSD.

The 50th anniversary of May 4, 1970 is associated with elevations of distress but no increase in mental health symptoms

Anniversaries of traumatic events are associated with increased symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety, especially in individuals with prior mental health symptoms. However, research has largely focussed on 1-year anniversaries, and it is unclear whether symptom exacerbation persists for more distal, or milestone, anniversaries. Symptoms typically decrease over time after traumatic events, but major anniversaries may be associated with increases in mental health symptoms. During and 3 months after the 50th anniversary of the political protest violence at Kent State University on May 4, 1970, 115 individuals completed measures of PTSD, depression, anxiety, and anniversary-related stress. Participants reported greater stress (t(97) = 4.04 p ≤ .001) during the 50th anniversary compared to 3 months later, but there were no differences in total PTSD (t(114) = .65, p = .52) or depression/anxiety symptoms (all p's > .05). Even in higher-risk individuals (those who previously received mental health services), symptoms did not differ during versus after the anniversary. In general, long-term anniversaries may contribute to transient increases in distress but do not induce major changes in mental health symptoms.

Making Meaning of Disaster Experience in Highly Trauma-exposed Survivors of the Oklahoma City Bombing

Survivors of disasters can be expected to form meaningful perspectives on their experiences that shape their trajectories of recovery; thus, these perspectives are important to study. If humans are naturally compelled to create meaning from traumatic experiences, the creation of meaning should be evident in survivors' discussion of the effects of the disaster in their lives. Therefore, the purpose of this study of highly trauma-exposed disaster survivors was to identify meaningful aspects or outcomes of their disaster experiences in their perspectives. This study examined a random sample (N=182) of survivors of the Oklahoma City bombing six months after the disaster using open-ended questions. Text responses (N=650) were compiled, themes identified by multiple coders, responses coded into the themes, interrater reliability established, and the themes were then interpreted. Six themes were identified and grouped into three general categories: personal aspirations (reprioritizing life and altruism and self-improvement), connection with others (a freestanding category/theme), and making meaning (appreciation for life, religion and spirituality, and contemplating life, death, and humanity), which contained the majority of the responses. The findings from this study affirm the human need to make meaning from the experience of a traumatic disaster and suggest the potential relevance to survivors' recovery of therapies based on the creation of meaning and the promotion of positive growth.

Association between resilience, social support, and institutional trust and post-traumatic stress disorder after natural disasters

Disasters can cause significant personal and social distress and adversely affect mental health. Compared with research on the risk factors of post-disaster post-traumatic stress disorder (PTSD), limited studies have reported protective factors against PTSD. We investigated whether resilience, social support, and trust in government were associated with PTSD in disaster survivors, after adjustment for the perceived damage and demographic variables including sex, age, and economic status. We investigated 2311 disaster survivors, using data from the "Long-term survey on the change of life of Disaster victim" performed by NDMI(National Disaster Management Research Institute). Hierarchical regression analysis was used in this study. A high level of trust in institutions was associated with few PTSD symptoms after adjustment for resilience and social support. Among the subfactors of institutional trust, psychological counseling and environmental and facility restoration were associated with PTSD. Psychological counseling and environmental and facility restoration support for disaster survivors were associated with reduced PTSD symptoms. Post-disaster policy support, including psychological counseling and environmental and facility restoration services, is important. Our findings highlight the protective factors against PTSD symptoms and may serve as guidelines for specific interventions for the management of post-disaster PTSD.

Perspectives of Survivors of the Oklahoma City Bombing with and without PTSD 17 Months Postdisaster: A Qualitative Study

This study compared perspectives of highly trauma-exposed Oklahoma City bombing survivors (N=141) with and without PTSD. Survivors' responses to questions about the effects of the bombing on their perspectives were hand-recorded and transcribed, six themes identified, and interrater reliability established. Both diagnostic groups (with and without PTSD) expressed greater appreciation for life, greater concern with human vulnerability and mortality, and positive changes in religion/spirituality as consequences of the bombing. Survivors with PTSD also expressed negative religious/spiritual changes and substantive gains in self-confidence. Results indicate that disaster survivors may experience profound changes in their perspectives with ramifications for their mental health.

Perceived coping mitigates anxiety symptoms in the context of COVID-19 stress in an urban university student sample

Perceived coping and its two subprocesses, trauma-focused coping (finding meaning in the details and memory of a potential trauma or stressor) and forward-focused coping (focusing on planning for the future) have been shown to be important in the context of potentially traumatic events. The COVID-19 pandemic and its associated stressors have negatively impacted population mental health, and preliminary investigations have demonstrated the importance of perceived abilities to cope during the pandemic. The current study sought to examine the potentially moderating role of each subprocess on the relationship between stress and anxiety symptoms in a low-income student sample during COVID-19 (N = 2364). We computed two hierarchical multiple linear regressions to assess for significant interactions between stress and perceived coping subprocess scores on anxiety outcomes. Our results demonstrated that both trauma-focused coping and forward-focused coping served as effect modifiers in the relationship between COVID-19related stress and anxiety. Such findings highlight the importance of interventions that incorporate both forms of coping for low-income students during a chronic stressor.

Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older Adults

Background and Objectives

Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure.

Research Design and Methods

We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane.

Results

We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks.

Discussion and Implications

Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.

The nature of posttraumatic stress disorder in treatment-seeking first responders

BACKGROUND

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD.

OBJECTIVE

This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD.

METHOD

Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger.

RESULTS

First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger.

CONCLUSIONS

These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.

Mental Health of COVID-19 Survivors at 6 and 12 Months Postdiagnosis: A Cohort Study

OBJECTIVE

As COVID-19 persists around the world, it is necessary to explore the long-term mental health effects in COVID-19 survivors. In this study, we investigated the mental health outcomes of survivors of COVID-19 at 6 and 12 months postdiagnosis.

METHODS

Posttraumatic stress disorder (PTSD checklist for the DSM-5, PCL-5), depression (PHQ-9), anxiety (Generalized Anxiety Disorder Scale, GAD-7), resilience (Connor-Davidson Resilience Scale, CD-RISC-10), perceived social support (PSSS), personality traits (Chinese Big Five Personality Inventory-15, CBF-PI-15), and sociodemographic information were examined among 511 survivors of COVID-19 (48.1%, females; M _age = 56.23 years at first assessment) at 6 and 12 months postdiagnosis. The data were analyzed with Wilcoxon signed rank tests and multivariable logistic regression models.

RESULTS

The prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) at 6 and 12 months after diagnosis was 13.31% and 6.26%; 20.35% and 11.94%; and 13.11% and 6.07%, respectively. The risk factors for all symptoms were as follows: higher neuroticism; lower openness, extraversion, agreeableness, and resilience; greater life disruptions due to COVID-19; poorer living standards; and increased symptoms of PTSD or depression at 6 months postdiagnosis.

CONCLUSION

The mental health of COVID-19 survivors improved between 6 and 12 months postdiagnosis. Mental health workers should pay long-term attention to this group, especially to survivors with risk factors.

Personality and psychiatric disorders among employees of New York City workplaces affected by the 9/11 attacks on the World Trade Center

OBJECTIVE

Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disasters. This exploratory study of employees of workplaces affected by the September 11, 2001, attacks on the World Trade Center in New York City examined the specific relationships of personality variables (specifically, novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence) to incident postdisaster psychiatric disorders and resistance to the persistence/recurrence of preexisting psychiatric disorders after the disaster.

METHODS

Approximately 3 years after the 9/11 attacks, 379 employees were recruited from 8 selected affected workplaces (3 in the World Trade Center towers, 5 at varied distances in the geographic area). Lifetime predisaster and postdisaster psychiatric disorders were assessed retrospectively with the Diagnostic Interview Schedule for DSM-IV, disaster experience details were collected with the Disaster Supplement, and personality was assessed with the Temperament and Character Inventory.

RESULTS

Underdeveloped executive functioning (low self-directedness and/or low cooperativeness) was associated with incident postdisaster psychopathology, and components of resilience (low harm avoidance, high self-directedness, and high persistence) were associated with postdisaster resistance to persistence/recurrence of preexisting psychiatric illness.

CONCLUSIONS

Personality is related to both incident and persistent/recurrent portions of postdisaster psychopathology, not clearly distinguished in previous research. Personality variables related to executive functioning and resilience may aid in assessing risk and developing treatments to prevent disaster-related psychopathology.

Symbolic disempowerment and Donald Trump's 2016 presidential election: Mental health responses among Latinx and white populations

The 2016 election of United States (U.S.) President Donald Trump was a political event that may have affected population-level mental health. A prominent theme in the Trump election was anti-immigrant policy that contributed to a racist and xenophobic sociopolitical climate. Applying a symbolic dis/empowerment framework, this study examines whether there was an effect of the Trump election on the mental health of the U.S. population that differed by race/ethnicity, language of interview, and state-level support for Trump or Clinton. We used data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System 2011-2018 to examine trends in poor mental health days in the five months after the U.S Presidential election (November 2016 to March 2017) compared to all other survey months. We conducted difference-in-differences analyses using negative binomial regression models to examine the effect of the five post-election months on the rate of poor mental health days, comparing six population categories: 1) non-Latinx white populations in Trump states, 2) non-Latinx white populations in Clinton states, 3) English-speaking Latinx populations in Trump states, 4) English-speaking Latinx populations in Clinton states, 5) Spanish-speaking Latinx populations in Trump states, and 6) Spanish-speaking Latinx populations in Clinton states. White populations in Clinton states reported more poor mental health days in response to the five months post-election period compared to white populations in Trump states. English-speaking Latinx people living in Trump states experienced higher than expected poor mental health days in November 2016 and February 2017. Spanish-speaking Latinx people, by contrast, reported fewer poor mental health days in the post-election period. The 2016 U.S. presidential election preceded population-level changes in mental health that support a symbolic dis/empowerment framework. We discuss possible explanations and the mental health implications for future major political events.

COVID-19 related posttraumatic stress disorder in children and adolescents in Saudi Arabia

INTRODUCTION

The COVID-19 pandemic resulted in quarantine/lockdown measures in most countries. Quarantine may create intense psychological problems including post-traumatic stress disorder (PTSD) especially for the vulnerable critically developing children/adolescents. Few studies evaluated PTSD associated with infectious disasters but no Saudi study investigated PTSD associated with COVID-19 in children/adolescents. This study was undertaken to screen for PTSD in children/adolescent in Saudi Arabia to identify its prevalence/risk factors during COVID-19 pandemic and its quarantine.

METHODS

A cross-sectional survey was conducted after 2 months form start of quarantine for COVID-19 pandemic utilizing the original English version and an Arabic translated version for the University of California at Los Angeles Brief COVID-19 Screen for Child/Adolescent PTSD that can be parent-reported or self-completed by older children/adolescents. Participants (Saudi citizens/non-Saudi residents) were approached online via social media.

RESULTS

Five hundred and thirty seven participants were enrolled. The participants were 262 boys and 275 girls with a mean age of 12.25±3.77 years. Symptoms of no, minimal, mild and potential PTSD were identified in 15.5%, 44.1%, 27.4% and 13.0% of children/adolescents, respectively. The age, gender, school grade, and residence were not predictive of PTSD symptoms. Univariate analysis of risk factors for PTSD revealed that work of a close relative around people who might be infected was significantly different between groups of PTSD symptoms, but this difference disappeared during multivariate analysis. Children/adolescents of Saudi citizens had significantly lower median total PTSD score than children/adolescents of expatriate families (p = 0.002).

CONCLUSION

PTSD associated with the COVID-19 and its resultant quarantine shouldn't be overlooked in different populations as it is expected in a considerable proportion of children/adolescents with variable prevalence, risk factors and severity. Parents/healthcare providers must be aware of PTSD associated with COVID-19 or similar disasters, so, they can provide children/adolescent with effective coping mechanisms.

Internet Addiction Increases in the General Population During COVID-19: Evidence From China

BACKGROUND AND OBJECTIVES

COVID-19-related quarantine and stress have likely escalated the crisis of Internet addiction. This study aimed to determine the impact of the COVID-19 pandemic on Internet use and related risk factors among the general public in China.

METHODS

A large-sample cross-sectional online survey was conducted from March 24 to April 30, 2020, in China, and 20,472 participants completed the survey. We investigated the prevalence and severity of Internet addiction based on the Internet Addiction Test (IAT), and explored the risk factors related to increases in time spent on Internet use and severity of Internet addiction, as well as severe Internet addiction.

RESULTS

The overall prevalence of Internet addiction was 36.7% among the general population during the pandemic, and that of severe Internet addiction was 2.8%, according to IAT scores. Time spent on recreational Internet use had significantly increased during the pandemic, and almost half of participants reported increases in the severity of Internet addiction. Risk factors for increases in time spent on Internet use and severity of Internet addiction and severe Internet addiction included having fewer social supporters, perceiving pressure and impact on mental health status due to COVID-19, and being over-engaged in playing videogames.

DISCUSSION AND CONCLUSIONS

The COVID-19 pandemic adversely impacted Internet use and increased the prevalence and severity of Internet addiction among the general population in China, especially in vulnerable populations.

SCIENTIFIC SIGNIFICANCE

This study provides evidence for policymakers to refine public health policies to control the pandemic and make efforts to provide population-specific prevention and interventions for people at risk of developing Internet addiction. (Am J Addict 2021;00:00-00).

The dynamic course of psychological outcomes following the Victorian Black Saturday bushfires

OBJECTIVES

To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster.

METHOD

The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1; 3-4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems.

RESULTS

Relative to their status 3-4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months.

CONCLUSION

Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.

Lifetime risk of suicide among survivors of the atomic bombings of Japan

AIMS

The long-term physical health effects of the atomic bombings of Hiroshima and Nagasaki are well characterised, but the psychological effects remain unclear. Therefore, we sought to determine whether measures of exposure severity, as indirect measures of psychological trauma arising from exposure to the atomic bombings, are associated with suicide mortality among atomic bomb survivors.

METHODS

The Life Span Study is a prospective cohort study of 93 741 Japanese atomic bomb survivors who were located within 10 km of the hypocentre in Hiroshima or Nagasaki at the time of the bombings in 1945, and 26 579 residents of Hiroshima and Nagasaki who were not in either city at the time of the bombings, matched to survivors on city, sex and age. Measures of exposure severity included: proximity to the hypocentre, type of shielding between the survivor and the blast and self-reported occurrence of acute radiation and thermal injuries. Date of death was obtained from the Japanese National Family Registry system. Cause of death was obtained from death certificates. Adjusted hazard ratios (HRs) were estimated from Cox regression models overall and stratified by sex and age.

RESULTS

During the 60-year follow-up period (1950-2009), 1150 suicide deaths were recorded among 120 231 participants (23.6 per 100 000 person-years): 510 among 70 092 women (17.2 per 100 000 person-years) and 640 among 50 139 men (33.6 per 100 000 person-years). Overall, there was no association of proximity, type of shielding or the occurrence of acute injuries with suicide mortality. Among those <25 years of age at the time of the bombings, increased suicide risk was observed for survivors outside v. shielded inside any structure (HR: 1.24; 95% confidence interval (CI): 1.03, 1.48; interaction p = 0.054) and for those who reported flash burns (HR: 1.32; 95% CI: 1.00, 1.73; interaction p = 0.025). Sex-stratified analyses indicated that these associations were limited to men. Among women, closer proximity to the hypocentre was associated with a non-significant increase in suicide risk, with a positive association between proximity and suicide risk observed among women <15 years of age (HR: 1.09 per km; 95% CI: 1.00, 1.18; interaction p = 0.067).

CONCLUSIONS

Proximity to the hypocentre, shielding and acute injury presence do not generally appear to influence suicide mortality among atomic bomb survivors. However, heterogeneity may exist by age and sex, with younger survivors potentially more sensitive to psychological trauma. Coupled with other studies, our results suggest the importance of long-term monitoring of mental health among young populations exposed to catastrophic events or mass trauma.

The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin

Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or no disaster were assessed in 1986–1987 with structured diagnostic interviews. This vintage dataset collected several decades ago provides new information to this field because of the methodological rigor that is unparalleled in this literature. Disaster-related PTSD and incident postdisaster disorders in children were associated, respectively with disaster-related PTSD and incident postdisaster disorders in the chief caregiver and mother. More flood-only than dioxin-only exposed parents reported great harm by the disaster, but neither children nor parents in these two groups differed in incident psychiatric disorders. Although this study did not determine the direction of causal influences, its findings suggest that clinicians working with disaster-exposed families should work with children and adult members together, as their mental health outcomes may be intertwined.

Associations between News Media Coverage of the 11 September Attacks and Depression in Employees of New York City Area Businesses

Research has examined the association between contact with media coverage of mass trauma events and various psychological outcomes, including depression. Disaster-related depression research is complicated by the relatively high prevalence of the major depressive disorder in general populations even without trauma exposure. The extant research is inconclusive regarding associations between disaster media contact and depression outcomes, in part, because most studies have not distinguished diagnostic and symptomatic outcomes, differentiated postdisaster incidence from prevalence, or considered disaster trauma exposures. This study examined these associations in a volunteer sample of 254 employees of New York City businesses after the 11 September 2001, terrorist attacks. Structured interviews and questionnaires were administered 35 months after the attacks. Poisson and logistic regression analyses revealed that post-9/11 news contact significantly predicted the number of postdisaster persistent/recurrent and incident depressive symptoms in the full sample and in the indirect and unexposed groups. The findings suggest that clinical and public health approaches should be particularly alert to potential adverse postdisaster depression outcomes related to media consumption in disaster trauma-unexposed or indirectly-exposed groups.

Prevalence and predictors of posttraumatic stress disorder, depression and anxiety among hospitalized patients with coronavirus disease 2019 in China

BACKGROUND

Coronavirus disease 2019 (COVID-19) has affected more than 5 million people around the world and killed more than 300,000 people; thus, it has become a global public health emergency. Our objective was to investigate the mental health of hospitalized patients diagnosed with COVID-19.

METHODS

The PTSD checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Trauma Exposure Scale, abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC-10), Perceived Social Support Scale (PSSS) and Demographic Questionnaire were used to examine posttraumatic stress disorder (PTSD), depression, anxiety, trauma exposure, resilience and perceived social support among 898 patients who were hospitalized after being diagnosed with COVID-19 in China. The data were analyzed with t tests, one-way ANOVA and multivariable logistic regression analysis.

RESULTS

The results showed that the prevalence of PTSD, depression and anxiety was 13.2, 21.0 and 16.4%, respectively. Hospitalized patients who were more impacted by negative news reports, had greater exposure to traumatic experiences, and had lower levels of perceived social support reported higher PTSD, depression and anxiety.

CONCLUSIONS

Effective professional mental health services should be designed to support the psychological wellbeing of hospitalized patients, especially those who have severe disease, are strongly affected by negative news and have high levels of exposure to trauma.

The Symptom Structure of Postdisaster Major Depression: Convergence of Evidence from 11 Disaster Studies Using Consistent Methods

Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have identified characteristic postdisaster depressive symptom structures. This study examined the symptom structure of major depression across two databases of 1181 survivors of 11 disasters studied using consistent research methods and full diagnostic assessment, addressing limitations of prior self-report symptom-scale studies. The sample included 808 directly-exposed survivors of 10 disasters assessed 1–6 months post disaster and 373 employees of 8 organizations affected by the September 11, 2001 terrorist attacks assessed nearly 3 years after the attacks. Consistent symptom patterns identifying postdisaster major depression were not found across the 2 databases, and database factor analyses suggested a cohesive grouping of depression symptoms. In conclusion, this study did not find symptom clusters identifying postdisaster major depression to guide the construction and validation of screeners for this disorder. A full diagnostic assessment for identification of postdisaster major depressive disorder remains necessary.

Double jeopardy; What happens when an epidemic is followed by an earthquake?

A crisis is an immediate threat to the functioning of society, while disaster is an actual manifestation of a crisis. Both are now even more critically socially constructed. In the middle of battle with the COVID-19 pandemic, the Republic of Croatia's capital of Zagreb was afflicted with another disaster - two severe earthquakes. Restrictive public health measures were already in place, including restriction on public transport, travel between regions, closure of educational and other public institutions, alongside measures of physical distancing. Most previous cases of COVID-19 were centered in Zagreb, leading to concern of spreading the disease into disease-free communities. It seems that earthquakes did not have an effect on disease transmission - the number of COVID-19 cases remained stable through the 14-day incubation period, with a linear pandemic curve in Croatia in April, and flattened in May. This leads to a conclusion that the earthquake did not have a direct effect on disease spread. Despite the fact that the current pandemic and its responses are unique, this paradox can have interesting repercussions on how we conceptualize and approach notions as vulnerability and resilience.

A Nosological Exploration of PTSD and Trauma in Disaster Mental Health and Implications for the COVID-19 Pandemic

The coronavirus disease of 2019 (COVID-19) pandemic rapidly spread around the world, resulting in massive medical morbidity and mortality and substantial mental health consequences. Post-traumatic stress disorder (PTSD) is an important psychiatric disorder associated with disasters, and many published scientific articles have reported post-traumatic stress syndromes in populations studied for COVID-19 mental health outcomes. American diagnostic criteria for PTSD have evolved across editions of the manual, and the current definition excludes naturally occurring medical illness (such as viral illness) as a qualifying trauma, ruling out this viral pandemic as the basis for a diagnosis of PTSD. This article provides an in-depth nosological consideration of the diagnosis of PTSD and critically examines three essential elements (trauma, exposure, and symptomatic response) of this diagnosis, specifically applying these concepts to the mental health outcomes of the COVID-19 pandemic. The current criteria for PTSD are unsatisfying for guiding the response to mental health consequences associated with this pandemic, and suggestions are made for addressing the conceptual diagnostic problems and designing research to resolve diagnostic uncertainties empirically. Options might be to revise the diagnostic criteria or consider categorization of COVID-19-related psychiatric syndromes as non-traumatic stressor-related syndromes or other psychiatric disorders.

Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8-10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21-65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.

Outcomes and Correlates of Major Depression in 11 Disaster Studies Using Consistent Methods

This study investigated psychosocial functioning and employment status in association with postdisaster major depression and its course in survivors of 11 different disasters in a sample of 808 directly-exposed survivors of 10 disasters and 373 survivors of the 11 September 2001 (9/11), terrorist attacks on New York City’s World Trade Center (total n = 1181). Participants were assessed between 1987 and 2007 with structured diagnostic interviews in a prospective longitudinal design. Consistent research methods allowed merging of the disaster databases for analysis using multivariate modeling. Postdisaster major depression in the study cohort from the 9/11 disaster was more than twice as prevalent as in the other disasters, possibly reflecting the greater psychosocial/interpersonal loss and bereavement experienced by 9/11 disaster survivors. At follow up, employment was associated with remission of postdisaster major depression, non-development of PTSD, and coping via family or friends. Functioning problems were associated with disaster injuries, but not with persistent major depression. This study is unprecedented in its large sample of survivors across the full range of disaster typology studied using consistent methods and full structured interview diagnostic assessment. These findings may help guide future interventions to address postdisaster depression.

COVID-19 quarantine: Post-traumatic stress symptomatology among Lebanese citizens

BACKGROUND

In the light of the global spread of the novel Coronavirus known as COVID-19 and in the absence of an approved treatment and vaccination, Lebanon has taken national measures, among which was home quarantine of the general public in an attempt to flatten the epidemic curve and avoid flooding the health care system.

AIM

This study aimed at evaluating the prevalence of post-traumatic stress symptomatology (PTSS) during the times of COVID-19 quarantine among Lebanese citizens.

METHOD

This quantitative cross-sectional study recruited 950 civilians and is aimed at measuring the prevalence of PTSS among the Lebanese citizens at an interval of 2 weeks and 1 month of COVID-19 quarantine.

RESULTS

The results have shown that quarantine in Lebanon has started to give rise to Post-traumatic Stress Disorder symptomatology during the second week which was worsened in the fourth week of COVID-19 quarantine.

CONCLUSION

COVID-19 quarantine has influenced the psychology of Lebanese citizens and might have persistent effects after the end of this phase which is recommended to be explored.

Non-linear Dynamic Shifts in Distress After Wildfires: Further Tests of the Self-Regulation Shift Theory

Worldwide exposure to explosive wildfires has become increasingly common. The psychological impact of these fires is substantial, demanding a deeper understanding of post-wildfire adaptation. This paper consists of two studies aiming to test self-regulation shift theory and its predicted non-linear shifts in distress using cusp catastrophe analyses. Study 1 tested a cusp catastrophe model on distress after the Waldo Canyon wildfire, Colorado (June, 2012). Results of study 1 showed that coping self-efficacy early after the wildfire was a significant bifurcation factor affecting when a shift in distress levels occurred from a lower state to an upper state. Perceived loss was a significant asymmetry controlling factor affecting the relative strength of each state. These findings indicate that a non-linear shift is more likely to occur at lower levels of coping self-efficacy and higher perceived loss. Study 2 tested the same model among survivors of several wildfires in California during 2017 and 2018. Results of study 2 confirmed the importance of coping self-efficacy again as a significant bifurcation factor. In this case, peritraumatic dissociation was found to be a significant asymmetry controlling factor instead of loss. These results indicate that an upward shift in distress occurs when coping self-efficacy is lower and peritraumatic dissociation is higher. Collectively, the combined findings suggest that coping self-efficacy is a pivotal variable consistent with self-regulation shift theory predictions. Intervention implications are discussed.

Association of PTSD symptom groups with functional impairment and distress in trauma-exposed disaster survivors

BACKGROUND

In the nearly a quarter of a century since the addition of the clinically significant distress/impairment criterion to the definition of PTSD in DSM-IV, little research has been done to examine the association of this criterion with symptom group criteria and with the numbing subgroup specifically. This study was conducted to examine these relationships in a large database of disaster survivors consistently studied across 12 different incidents of the full range of disaster typology.

METHODS

Analysis was conducted on a merged database representing 1187 trauma-exposed survivors of 12 different disasters studied systematically. DSM-IV-TR criteria for disaster-related PTSD were assessed with the Diagnostic Interview Schedule.

RESULTS

PTSD Group C (avoidance/numbing) and numbing specifically were less common and more associated than other symptom groups with criterion F (distress/impairment). Consistently in multivariable models, group C and numbing were independently associated with criterion F. Group D (hyperarousal) was less strongly associated with criterion F. Neither group B (intrusion) nor avoidance were associated with criterion F.

CONCLUSIONS

In this and other studies, group C and numbing specifically have been shown to be associated with criterion F, which is consistent with the demonstration that group C and the numbing component specifically are central to the psychopathology of PTSD. The addition of the distress/impairment requirement broadly across the psychiatric diagnoses in DSM-IV added little value to PTSD symptom criteria. Future revisions of diagnostic criteria may benefit by carefully considering these findings to possibly re-include a prominent numbing symptom section.

Identifying predictors of probable posttraumatic stress disorder in children and adolescents with earthquake exposure: A longitudinal study using a machine learning approach

BACKGROUND

Evidence has identified risk factors associated with individuals with trauma exposure who develop posttraumatic stress disorder (PTSD). How to combine risk factors to predict probable PTSD in young survivors using machine learning is limited. The study aimed to integrated multiple measures at 2 weeks after the earthquake using machine learning for the prediction of probable PTSD at 3 months after earthquake.

METHODS

A total of 2099 young survivors with earthquake exposure were included. We integrated multiple domains of variables to 'train' a machine learning algorithm (XGBoost). Thirty-one combination types were implemented and evaluated. The resulting XGBoost was utilized in identifying individual participants as either probable PTSD or no PTSD.

RESULTS

Any combination type predicted young survivor probable PTSD, with prediction accuracies ranging between 66%-80% (p < 0.05). In particular, the combination of earthquake experience, everyday functioning, somatic symptoms and sleeping correctly predicted 683 out of 802 cases of probable PTSD, translating to a classical accuracy of 74.476% (85.156% sensitivity and 60.366% specificity) and an area under the curve of 0.80. The most relevant variables (e.g. age, sex, property loss and a sedentary lifestyle) revealed in the present study.

LIMITATIONS

Participants from a specific district might limit the generalizability of our results. Self-report questionnaires and non-standardized measures were used to assess symptoms.

CONCLUSION

Detection of probable PTSD according to self-reported measurement data is feasible, may improve operational efficiencies via enabling targeted intervention, before manifestation of symptoms.

The Association between General and Pathological Dissociation and Disaster-Related Psychopathology in Directly Exposed Survivors

Objective: Dissociation and trauma have a well-documented relationship, and dissociation is assumed to result from trauma exposure. If trauma generates dissociative psychopathology, it should be observed after exposure to disaster and be associated with disaster-related psychopathology. Few studies have focused specifically on dissociation as an outcome of disaster trauma. This study examined dissociation and its association with disaster-related psychopathology in survivors of five different disasters. Methods: In the first 6 postdisaster months, directly exposed survivors (N = 216) of mass shootings, floods, or a firestorm completed structured diagnostic interviews providing lifetime predisaster and postdisaster prevalent/incident psychiatric diagnoses and the Dissociative Experiences Scale (DES) 1-3 years after baseline. Results: DES scores were very low; only 1% met the DES Taxon signifying pathological dissociation. In multivariate models including predisaster lifetime major depression, lifetime panic disorder, lifetime generalized anxiety disorder, and lifetime alcohol use disorder; disaster-related PTSD; and number of incident somatoform symptoms as independent covariates, predisaster lifetime major depression and alcohol use disorder were independently associated with both general (DES score) and pathological (DES Taxon) dissociation, and postdisaster incident somatization symptoms were also associated with general dissociation, but postdisaster psychopathology including disaster-related PTSD was not associated with general or pathological dissociation. Conclusions: Neither general nor pathological dissociation was independently associated with disaster-related PTSD or other incident psychopathology. The only psychiatric disorders associated with dissociation were present before the disasters. Coupled with the low dissociation rates, these findings indicate that dissociation does not appear to be a mental health outcome of disaster trauma.

Partial Predictability in Avoidance Acquisition and Expression of Wistar-Kyoto and Sprague-Dawley Rats: Implications for Anxiety Vulnerability in Uncertain Situations

Individual differences or vulnerabilities must exist which bias some individuals toward psychopathology while others remain resilient in the face of trauma. Recent work has studied the effects of uncertainty on individuals expressing behavioral inhibition (BI). The current study extended this work with uncertainty to Wistar Kyoto (WKY) rats which are a behaviorally inhibited inbred strain that models learning vulnerabilities for anxiety disorders and posttraumatic stress disorder (PTSD). WKY rats exhibit superior avoidance performance in a signaled bar press avoidance task in which a tone conditioned stimulus (CS) signals a foot shock unconditional stimulus (US) when compared with non-inhibited Sprague-Dawley (SD) rats. In addition, WKY rats express enhanced eyeblink conditioning. Recent work with behaviorally inhibited humans has indicated that this enhanced eyeblink conditioning is more evident in conditions that insert CS- or US-alone trials into CS-US paired training, resulting in uncertain and suboptimal learning conditions. The current study examined the effects of partial predictability training, in which the CS signaled the US only one-half of the time, on the acquisition and expression of avoidance. Standard training with a fixed 60-s CS which predicted shock on 100% of trials was compared with training in which the CS predicted shock on 50% of trials (partial predictability) using a pseudorandom schedule. As expected, WKY rats acquired avoidance responses faster and to a greater degree than SD rats. Partial predictability of the US essentially reduced SD rats to escape responding. Partial predictability also reduced avoidance in WKY rats; however, adjusting avoidance rates for the number of potential pairings of the CS and US early in training suggested a similar degree of avoidance expression late in the last session of training. Enhanced active avoidance expression, even in uncertain learning conditions, can be interpreted as behaviorally inhibited WKY rats responding to the expectancy of the shock by avoiding, whereas non-inhibited SD rats were responding to the presence of the shock by escaping. Future work should explore how WKY and SD rats as well as behaviorally inhibited humans acquire and extinguish avoidance responses in uncertain learning situations.

Perceptions of Mental Health and Wellbeing Following Residential Displacement and Damage from the 2018 St. John River Flood

Climate change has spurred an increase in the prevalence and severity of natural disasters. Damage from natural disasters can lead to residential instability, which negatively impacts mental health and wellbeing. However, research on the mental health of residents who are displaced after natural disasters is relatively novel and needs more study. This study investigates experiences of mental health in residents in New Brunswick, Canada, who experienced residential damage and/or displacement during the 2018 spring flood. Lived experiences were studied through focus groups with 20 residents and perceptions of community mental health and wellbeing were captured during key informant interviews with 10 local community leaders. Data collection and analysis employed grounded theory. Findings indicate that those who had residential displacement or damage due to the flooding experienced negative mental health impacts, both during and following the flood. While natural disasters have devastating impacts on mental health, the data also indicate that the communities were positively impacted by a collective and collaborative response to the flood. This paper argues for the utility of communal coping as a concept to describe the experiences of communities following residential damage and/or displacement following natural disasters.

A study of dissociation in survivors of 5 disasters

This study examined dissociation as an outcome to disaster in dissociative data collected from 423 highly-exposed survivors of 5 different disasters using consistent methodology. Ten items selected for conceptual relevance to disaster experience were administered from the Dissociative Disorders Interview Schedule, a structured interview for lifetime dissociative disorders. Structured psychiatric interviews provided data on incident somatization symptoms, disaster-related PTSD, and lifetime predisaster psychopathology. The Temperament and Character Inventory assessed personality. Observed levels of dissociation were low and not usually postdisaster. Dissociation level was associated with female sex, number of incident somatization symptoms, personality (underdeveloped executive functioning), PTSD, and predisaster psychopathology in bivariate analyses. In multiple linear regression models, dissociation was associated with the low number of incident somatoform symptoms observed independent of the effects of PTSD, hyperarousal specifically (but not intrusion or avoidance/numbing), personality, predisaster psychopathology, and demographic variables which were not independently associated with dissociation. The low levels of dissociation found in this study and the lack of association between dissociation and indicators of psychopathology point to a largely nonpathological nature of the dissociative phenomena measured. These findings do not indicate the development of dissociative psychopathology as a prevalent mental health outcome of disasters.

The Benefit of Interventions to Reduce Posttraumatic Stress in Youth Exposed to Mass Trauma: A Review and Meta-Analysis

Numerous interventions to address posttraumatic stress (PTS) in youth exposed to mass trauma have been delivered and evaluated. It remains unclear, however, which interventions work for whom and under what conditions. This report describes a meta-analysis of the effect of youth mass-trauma interventions on PTS to determine if interventions were superior to inactive controls and describes a moderator analysis to examine whether the type of event, population characteristics, or income level of the country where the intervention was delivered may have affected the observed effect sizes. A comprehensive literature search identified randomized controlled trials (RCTs) of youth mass-trauma interventions relative to inactive controls. The search identified 2,232 references, of which 25 RCTs examining 27 trials (N = 4,662 participants) were included in this meta-analysis. Intervention effects were computed as Hedge's g estimates and combined using a random effects model. Moderator analyses were conducted to explain the observed heterogeneity among effect sizes using the following independent variables: disaster type (political violence versus natural disaster); sample type (targeted versus non-targeted); and income level of the country where the intervention was delivered (high- versus middle- versus low-income). The correlation between the estimates of the intervention effects on PTS and on functional impairment was estimated. The overall treatment effect size was converted into a number needed to treat (NNT) for a practical interpretation. The overall intervention effect was statistically significant (g = 0.57; P < .0001), indicating that interventions had a medium beneficial effect on PTS. None of the hypothesized moderators explained the heterogeneity among the intervention effects. Estimates of the intervention effects on PTS and on functional impairment were positively correlated (Spearman's r = 0.90; P < .0001), indicating a concomitant improvement in both outcomes. These findings confirm that interventions can alleviate PTS and enhance functioning in children exposed to mass trauma. This study extends prior research by demonstrating improvement in PTS with interventions delivered to targeted and non-targeted populations, regardless of the country income level. Intervention populations and available resources should be considered when interpreting the results of intervention studies to inform recommendations for practice.

Do remittances alleviate negative impacts of disaster on mental health? A case of the 2015 Nepal earthquake

This paper contributes to two strands of literature: disaster literature on post-disaster mental health and economics literature on migration. Remittances are a sizable source of income in many developing countries. Evidence suggests, however, that when adults migrate in order to support their families via remittances, family members left behind often experience poorer physical and mental health. We study the effects of remittances on the mental health of victims of a disaster, the earthquake (EQ) that hit Nepal in 2015. We used three waves of data from 335 individuals in 6 villages in Western Nepal in which emigration is prevalent. The first wave of the survey was conducted one year before the 2015 EQ. In the third wave, which was conducted one year after the EQ, the respondents aged 15 and older were assessed for post-traumatic stress disorder (PTSD) and depressive symptoms. PTSD symptoms were evaluated by the 17-item Checklist Civilian (PCL-C), and depressive symptoms were measured by the 20-question Epidemiologic Studies Depression Scales (CESD) questionnaire. In order to avoid capturing the impacts of remittances for daily expenses and reduce possible endogeneity in the remittance variables, we measured the change in remittances following the EQ. After controlling for pre-disaster body-mass index and asset holdings, we found that the increase in remittances sent to HHs reduced psychological distress measured by the PTSD and depression severity scores. The remittance variables, however, did not alleviate mental disorder as defined by the international-standard cutoff points of PCL-C and CES-D.

Concerns and future preparedness plans of a vulnerable population in New Jersey following Hurricane Sandy

Knowing how people prepare for disasters is essential to developing resiliency strategies. This study examined recalled concerns, evacuation experiences, and the future preparedness plans of a vulnerable population in New Jersey, United States, following Hurricane Sandy in 2012. Understanding the responses of minority communities is key to protecting them during forthcoming disasters. Overall, 35 per cent of respondents were not going to prepare for an event. Intended future preparedness actions were unrelated to respondents' ratings of personal impact. More Blacks and Hispanics planned on preparing than Whites (68 versus 55 per cent), and more Hispanics planned on evacuating than did others who were interviewed. A higher percentage of respondents who had trouble getting to health centres were going to prepare than others. Respondents' concerns were connected to safety and survival, protecting family and friends, and having enough food and medicine, whereas future actions included evacuating earlier and buying sufficient supplies to shelter in place.

Ethnic differences in risk: experiences, medical needs, and access to care after hurricane Sandy in new jersey

This survey investigation assessed an economically challenged and largely minority population regarding concerns, evacuation status, medical needs and access to care during, and after, Hurricane Sandy by ethnicity status for patients using New Jersey's Federally Qualified Health Centers (FQHC). Data obtained contribute to understanding risk from disasters, and improving environmental justice for vulnerable populations following disasters. FQHCs provide medical and dental services for 5% of New Jersey 's population; 95% of those served are uninsured, underinsured, or live below the poverty level. Economically vulnerable individuals are more at risk and were disproportionately harmed by Sandy. There were ethnic differences in days evacuated, days without power and heat, self-rating of personal/family impact, center use, need and access, and interruptions of care and medications. Hispanics and Blacks reported needing centers significantly more than White population. Primary medical conditions were diabetes, asthma, hypertension, and arrhythmia and heart disease, which did not vary ethnically. Understanding medical needs and concerns of vulnerable populations may help policymakers and practitioners prepare and respond promptly to disasters, reducing risk, and building resiliency for the medical care system.

Prospective Study of the Effectiveness of Paroxetine on the Onset of Posttraumatic Stress Disorder, Depression, and Health and Functional Outcomes After Trauma

OBJECTIVES

To determine whether the administration of medication for posttraumatic stress disorder (PTSD) to injured trauma survivors prevents or mitigates PTSD.

DESIGN

Double-blinded, placebo-controlled.

SETTING

Level I trauma center.

PATIENTS

One hundred twenty patients admitted for traumatic orthopaedic injury.

INTERVENTION

Either paroxetine or placebo starting 2 weeks postinjury.

MAIN OUTCOME MEASUREMENTS

PTSD symptoms were measured with the PTSD Checklist for DSM-IV. The Quick Inventory of Depressive Symptomatology (QIDS) assessed the presence and severity of DSM-IV-TR major depressive symptoms. The SF-36 measured postinjury quality of life and social functioning. The Short Musculoskeletal Functional Assessment rated postinjury musculoskeletal function.

RESULTS

The paroxetine group did not differ from the placebo group in proportions with PTSD as assessed at the 6- or 12-month follow-up or in proportions with major depression symptoms since the injury as assessed at the 3-month follow-up. The groups also did not differ at the 8-week follow-up in the amount of change from baseline in QIDS scores. The paroxetine group had a marginally greater increase from baseline in SF-36 functioning score at the 12-month follow-up as compared with the placebo group and a marginally greater reduction from baseline in Short Musculoskeletal Functional Assessment musculoskeletal functioning at the 12-month follow-up as compared with the placebo group.

CONCLUSIONS

These results suggest the potential for psychotropic medication to prevent or reduce posttraumatic stress symptoms and to improve the function and health of trauma patients. Further research is needed to confirm paroxetine's use for this purpose.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Prevalence and predictors of postdisaster major depression: Convergence of evidence from 11 disaster studies using consistent methods

The objective of this study was to examine predictors of postdisaster major depression in two separate datasets of survivors of various disasters. Postdisaster major depression was examined in two disaster databases using consistent research methodology, permitting combination of databases into a combined dataset including 1181 survivors of 11 disasters representing all major disaster typologies with full diagnostic assessment using structured diagnostic interviews from two databases. The first database includes 808 directly-exposed survivors of 10 disasters. The second includes 373 survivors of the September 11, 2001 attacks on New York City's World Trade Center, recruited from employees of eight organizations affected by the disaster. This rich dataset permitted comparison of predictors of postdisaster major depression between databases and across survivors of different disasters. Identical models applied to both databases found postdisaster major depression to be independently associated with pre-existing major depression, indirect exposure to disaster trauma through family/friends, and disaster-related PTSD. In a final model limited to directly-exposed disaster across both databases, postdisaster major depression was independently associated with terrorism in addition to the 3 variables that predicted postdisaster major depression in the two separate databases. Replication of findings from one model to the next across different types of disasters and populations in this study suggests that these three variables could potentially provide a powerful tool for estimating likelihood of postdisaster major depression.