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McBain SA, Cordova MJ. Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings. J Clin Psychol Med Settings 2024; 31:501-512. [PMID: 39095585 DOI: 10.1007/s10880-024-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 08/04/2024]
Abstract
Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry and Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA, 94304, USA
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2
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Vollert J, Kumar A, Coady EC, Cullinan P, Dyball D, Fear NT, Gan Z, Miller EF, Sprinckmoller S, Schofield S, Bennett A, Bull AMJ, Boos CJ, Rice ASC, Kemp HI. Pain after combat injury in male UK military personnel deployed to Afghanistan. Br J Anaesth 2024; 132:1285-1292. [PMID: 38521656 PMCID: PMC11129277 DOI: 10.1016/j.bja.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Chronic pain after injury poses a serious health burden. As a result of advances in medical technology, ever more military personnel survive severe combat injuries, but long-term pain outcomes are unknown. We aimed to assess rates of pain in a representative sample of UK military personnel with and without combat injuries. METHODS We used data from the ADVANCE cohort study (ISRCTN57285353). Individuals deployed as UK armed forces to Afghanistan were recruited to include those with physical combat injuries, and a frequency-matched uninjured comparison group. Participants completed self-reported questionnaires, including 'overall' pain intensity and self-assessment of post-traumatic stress disorder, anxiety, and depression. RESULTS A total of 579 participants with combat injury, including 161 with amputations, and 565 uninjured participants were included in the analysis (median 8 yr since injury/deployment). Frequency of moderate or severe pain was 18% (n=202), and was higher in the injured group (n=140, 24%) compared with the uninjured group (n=62, 11%, relative risk: 1.1, 95% confidence interval [CI]: 1.0-1.2, P<0.001), and lower in the amputation injury subgroup (n=31, 19%) compared with the non-amputation injury subgroup (n=109, 26%, relative risk: 0.9, 95% CI: 0.9-1.0, P=0.034). Presence of at least moderate pain was associated with higher rates of post-traumatic stress (RR: 3.7, 95% CI: 2.7-5.0), anxiety (RR: 3.2, 95% CI: 2.4-4.3), and depression (RR: 3.4, 95% CI: 2.7-4.5) after accounting for injury. CONCLUSION Combat injury, but not amputation, was associated with a higher frequency of moderate to severe pain intensity in this cohort, and pain was associated with adverse mental health outcomes.
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Affiliation(s)
- Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Alexander Kumar
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK
| | - Emma C Coady
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Dyball
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK; Academic Department of Military Mental Health, King's College London, London, UK
| | - Zoe Gan
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Eleanor F Miller
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, UK
| | - Stefan Sprinckmoller
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, UK
| | - Suzie Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Alexander Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Christopher J Boos
- Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, UK
| | - Andrew S C Rice
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Harriet I Kemp
- Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Marson F, Naor-Ziv R, Paoletti P, Glicksohn J, Harris T, Elliott MA, Carducci F, Ben-Soussan TD. When the body fosters empathy: The interconnectivity between bodily reactivity, meditation, and embodied abstract concepts. PROGRESS IN BRAIN RESEARCH 2024; 287:217-245. [PMID: 39097354 DOI: 10.1016/bs.pbr.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
Empathy is a fundamental social ability that allows humans to infer others' emotions and intentions. Empathy is thought to be rooted in bodily sensations coming from the autonomic nervous system. In parallel, the functionality and perceptions coming from the autonomic nervous system could be improved by practicing activities that involve mind-body interactions, such as meditation. Furthermore, perceptions from the autonomic nervous system are thought to be important in the embodiment of abstract concepts. Consequently, in the current study, we collected data online from 581 participants and explored the associations between levels of empathy and (1) the practice of meditation, music, and sports; (2) the impact of self-report measures on bodily awareness and reactivity; and (3) the embodiment of abstract concepts in interoception. In line with previous studies, Meditators were found to have higher empathy scores than Non-Meditators. In addition, lower levels of autonomic reactivity in organs above the diaphragm were associated with higher empathy. Finally, we also observed that empathy was positively associated with interoceptive components of abstract concepts in those participants with high autonomic reactivity. Taken together, the results suggest that meditation practice and having low autonomic reactivity are associated with empathy, arguably through the downregulation of autonomic responses. Implications for mind-body interaction in meditation and its role in promoting empathy are discussed.
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Affiliation(s)
- Fabio Marson
- Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation for Development and Communication, Assisi, Italy; Neurophysiology and Pharmacology Department, La Sapienza University, Rome, Italy.
| | - Revital Naor-Ziv
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Patrizio Paoletti
- Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation for Development and Communication, Assisi, Italy
| | - Joseph Glicksohn
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel; The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Tadhg Harris
- School of Psychology, University of Galway, Galway, Ireland
| | - Mark A Elliott
- School of Psychology, University of Galway, Galway, Ireland
| | - Filippo Carducci
- Neurophysiology and Pharmacology Department, La Sapienza University, Rome, Italy
| | - Tal Dotan Ben-Soussan
- Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation for Development and Communication, Assisi, Italy
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Sangimino M, Babbitt K, Lee HS, Park S. Bodily experiences of trauma and psychosis risk. Psychiatry Res 2024; 337:115961. [PMID: 38754253 DOI: 10.1016/j.psychres.2024.115961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
Bodily self-disturbances including anomalous embodiment of emotions are observed in psychosis-spectrum conditions. Psychosis is also associated with trauma exposure but the relationship between altered bodily experiences and trauma has not been extensively investigated in individuals at risk for psychosis (HR). We implemented a mapping task to localize felt sensations associated with trauma. Results show that trauma experiences were always localized in the body. HR reported increased rates of traumatic experiences than low-risk group (LR). HR reported sensations associated with trauma across widespread body areas. Further research is needed to elucidate how trauma might lead to psychotic-like experiences via bodily self-disturbances.
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Affiliation(s)
- Michael Sangimino
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Kathryn Babbitt
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Hyeon-Seung Lee
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA.
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Shabat N, Bechor U, Yavnai N, Tatsa-Laur L, Shelef L. The Link Between Somatization and Dissociation and PTSD Severity in Veterans Who Sought Help From the IDF Combat Stress Reaction Unit. Mil Med 2024:usae118. [PMID: 38554277 DOI: 10.1093/milmed/usae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU). MATERIALS AND METHODS This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined. RESULTS Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r = 0.544; P < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P < 0.001) and somatization (OR = 4.792, P < 0.001). The entire model reached 40.8% of the shared variance in the regression. CONCLUSIONS While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD.
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Affiliation(s)
- Nizan Shabat
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Uzi Bechor
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Nirit Yavnai
- Department of Community Dentistry, Faculty of Dental Medicine, Hebrew University, Hadassah Ein Kerem Campus, Jerusalem 91120, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Leah Shelef
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
- The School of Social Work, Sapir Academic College, D. N. Hof Ashkelon 79165, Israel
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Rojnic Kuzman M, Padberg F, Amann BL, Schouler-Ocak M, Bajic Z, Melartin T, James A, Beezhold J, Artigue Gómez J, Arango C, Jendricko T, Ismayilov J, Flannery W, Chumakov E, Başar K, Vahip S, Dudek D, Samochowiec J, Mihajlovic G, Rota F, Stoppe G, Dom G, Catthoor K, Chkonia E, Heitor Dos Santos MJ, Telles D, Falkai P, Courtet P, Patarák M, Izakova L, Skugarevski O, Barjaktarov S, Babic D, Racetovic G, Fiorillo A, Carpiniello B, Taube M, Melamed Y, Chihai J, Cozman DCM, Mohr P, Szekeres G, Delic M, Mazaliauskienė R, Tomcuk A, Maruta N, Gorwood P. Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries. Eur Psychiatry 2024; 67:e24. [PMID: 38450651 PMCID: PMC10988156 DOI: 10.1192/j.eurpsy.2024.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.
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Affiliation(s)
- Martina Rojnic Kuzman
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Benedikt L. Amann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
- Mental Health Institute Hospital del Mar and Hospital del Mar Research Institute, Barcelona, CIBERSAM, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital Berlin, Berlin, Germany
| | - Zarko Bajic
- Research Unit “Dr. Mirko Grmek”, Psychiatric Clinic “Sveti Ivan”, Zagreb, Croatia
| | - Tarja Melartin
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Julian Beezhold
- Great Yarmouth Acute Service, Northgate Hospital/Norfolk & Suffolk NHS Foundation Trust, Great Yarmouth, UK
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | - William Flannery
- Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Egor Chumakov
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Koray Başar
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Simavi Vahip
- Affective Disorders Unit, Department of Psychiatry, Ege University Medicine Faculty, Izmir, Turkey
| | - Dominika Dudek
- Psychiatry and Department of Adult Psychiatry, Collegium Medicum Jagiellonian University, Cracow, Poland
| | | | - Goran Mihajlovic
- Clinic for Psychiatry, University of Kragujevac, Kragujevac, Serbia
| | - Fulvia Rota
- Swiss Society for Psychiatry and Psychotherapy, Switzerland
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
| | - Kirsten Catthoor
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
| | - Eka Chkonia
- Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
| | - Maria João Heitor Dos Santos
- Psychiatry and Mental Health Department, Hospital Beatriz Ângelo, Loures, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Diogo Telles
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post Acute Care, Hôspital Lapeyronie, CHU Montpellier,Montpellier, France
| | - Michal Patarák
- Department of Psychiatry, Slovak Medical University, Bratislava, Slovakia
- Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Lubomira Izakova
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Oleg Skugarevski
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Stojan Barjaktarov
- University Clinic of Psychiatry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Dragan Babic
- Psychiatry Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Goran Racetovic
- Community Mental Health Center, Health Center Prijedor, Prijedor, Bosnia and Herzegovina
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Bernardo Carpiniello
- University of Cagliari and Psychiatry Unit, Section of Psychiatry, Department of Medical Sciences and Public Health, University Hospital, Cagliari, Italy
| | - Maris Taube
- Department of Psychiatry and Narcology, Riga Stradiņš University, Riga Centre of Psychiatry and Narcology, Riga, Latvia
| | | | - Jana Chihai
- Department of Mental Health, Medical Psychology and Psychotherapy, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Kishinev, Moldova
| | | | - Pavel Mohr
- Clinical Department, National Institute of Mental Health, Klecany, Czechia
- Third School of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Ramunė Mazaliauskienė
- Psychiatric Clinic, Lithuanian Health Sciences University Kaunas Hospital, Kaunas, Lithuania
| | | | - Nataliya Maruta
- Institute of Neurology, Psychiatry and Narcology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Philip Gorwood
- Université Paris Cité, INSERM UMR1266, Paris, France
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
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Wolf E, Priebe G. The self-perceived impact of sexual abuse on daily life and general health - an issue to consider in dental care. Dent Traumatol 2024; 40 Suppl 2:43-52. [PMID: 37818985 DOI: 10.1111/edt.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND/AIM To analyse, from the perspective of adults with a history of sexual abuse, the impact of the experience on their general health and well-being. MATERIAL AND METHODS The participants comprised 12 strategically selected informants (10 women), aged 19-56; all sexually abused during child- and/or adulthood. They were interviewed in-depth and encouraged to describe the impact of the sexual abuse on their daily lives. The consequences of sexual abuse on oral health have previously been reported. The interviews were recorded digitally, transcribed verbatim and analysed according to qualitative content analysis with an inductive approach. RESULTS The overall theme illustrating the latent content was Sexual abuse experience-limiting long-term consequences, always present in body and mind. The first category covering the manifest content was 'A lost foothold', with two subcategories: (i) emotional repercussions and (ii) physical health repercussions. The second category was 'The significance of distance to trauma', with two subcategories (i) keeping a distance and tending to escape and (ii) processing the trauma experience-a struggle towards balance. CONCLUSIONS A history of sexual abuse cannot be understood in isolation: the long-term repercussions pervade daily life. However, after disclosure of the abuse and processing the trauma, it is possible to ameliorate some of the negative effects. In this context, the dental setting emerges as a potentially important venue for disclosure as almost every person, sooner or later, visits the dentist.
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Affiliation(s)
- Eva Wolf
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Gisela Priebe
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
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Krzyściak W, Bystrowska B, Karcz P, Chrzan R, Bryll A, Turek A, Mazur P, Śmierciak N, Szwajca M, Donicz P, Furman K, Pilato F, Kozicz T, Popiela T, Pilecki M. Association of Blood Metabolomics Biomarkers with Brain Metabolites and Patient-Reported Outcomes as a New Approach in Individualized Diagnosis of Schizophrenia. Int J Mol Sci 2024; 25:2294. [PMID: 38396971 PMCID: PMC10888632 DOI: 10.3390/ijms25042294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Given its polygenic nature, there is a need for a personalized approach to schizophrenia. The aim of the study was to select laboratory biomarkers from blood, brain imaging, and clinical assessment, with an emphasis on patients' self-report questionnaires. Metabolomics studies of serum samples from 51 patients and 45 healthy volunteers, based on the liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS/MS), led to the identification of 3 biochemical indicators (cortisol, glutamate, lactate) of schizophrenia. These metabolites were sequentially correlated with laboratory tests results, imaging results, and clinical assessment outcomes, including patient self-report outcomes. The hierarchical cluster analysis on the principal components (HCPC) was performed to identify the most homogeneous clinical groups. Significant correlations were noted between blood lactates and 11 clinical and 10 neuroimaging parameters. The increase in lactate and cortisol were significantly associated with a decrease in immunological parameters, especially with the level of reactive lymphocytes. The strongest correlations with the level of blood lactate and cortisol were demonstrated by brain glutamate, N-acetylaspartate and the concentrations of glutamate and glutamine, creatine and phosphocreatine in the prefrontal cortex. Metabolomics studies and the search for associations with brain parameters and self-reported outcomes may provide new diagnostic evidence to specific schizophrenia phenotypes.
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Affiliation(s)
- Wirginia Krzyściak
- Department of Medical Diagnostics, Jagiellonian University Medical College, Faculty of Pharmacy, 30-688 Krakow, Poland;
| | - Beata Bystrowska
- Department of Biochemical Toxicology, Jagiellonian University Medical College, Faculty of Pharmacy, 30-688 Krakow, Poland;
| | - Paulina Karcz
- Department of Electroradiology, Jagiellonian University Medical College, Faculty of Health Sciences, 31-126 Krakow, Poland;
| | - Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Faculty of Medicine, 31-503 Krakow, Poland; (R.C.); (A.B.); (T.P.)
| | - Amira Bryll
- Department of Radiology, Jagiellonian University Medical College, Faculty of Medicine, 31-503 Krakow, Poland; (R.C.); (A.B.); (T.P.)
| | - Aleksander Turek
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (A.T.); (N.Ś.); (M.S.); (P.D.); (K.F.); (M.P.)
| | - Paulina Mazur
- Department of Medical Diagnostics, Jagiellonian University Medical College, Faculty of Pharmacy, 30-688 Krakow, Poland;
| | - Natalia Śmierciak
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (A.T.); (N.Ś.); (M.S.); (P.D.); (K.F.); (M.P.)
| | - Marta Szwajca
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (A.T.); (N.Ś.); (M.S.); (P.D.); (K.F.); (M.P.)
| | - Paulina Donicz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (A.T.); (N.Ś.); (M.S.); (P.D.); (K.F.); (M.P.)
| | - Katarzyna Furman
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (A.T.); (N.Ś.); (M.S.); (P.D.); (K.F.); (M.P.)
| | - Fabio Pilato
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Tamas Kozicz
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Faculty of Medicine, 31-503 Krakow, Poland; (R.C.); (A.B.); (T.P.)
| | - Maciej Pilecki
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (A.T.); (N.Ś.); (M.S.); (P.D.); (K.F.); (M.P.)
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Shatrova D, Cáncer PF, Caperos JM. The role of interoception in reducing trauma-associated distress: a feasibility study. Eur J Psychotraumatol 2024; 15:2306747. [PMID: 38289065 PMCID: PMC10829842 DOI: 10.1080/20008066.2024.2306747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024] Open
Abstract
Background: Altered interoception plays an important role in chronic stress and posttraumatic stress disorder. The aim of this study was to evaluate the feasibility of a Trauma Sensitive Yoga (TSY) intervention for improving emotional distress and psychological discomfort in women living under circumstances of social and gender vulnerability. We assessed the effect of the treatment on the interoceptive mechanisms, and whether the psychological improvements were mediated by the changes in these mechanisms.Methods: The study involved a sample of 62 women who attended public community centres dedicated to supporting women victims of gender-based violence or who were socially and economically disadvantaged because of their gender. Participants underwent a six-week TSY programme. We evaluated dropout rate, adherence, and intervention satisfaction. We measured emotional distress, psychological discomfort, interoceptive mechanisms, and two nonequivalent dependent variables to enhance internal validity. We compared pre-post differences using paired samples t-test and a structural equation model (SEM) analysis was performed to compare the changes in the outcomes with the changes in the nonequivalent dependent variables. Mediation models were adjusted to evaluate the role of changes in interoception on outcome changes.Results: Fourteen (23%) women dropped out, mainly after the first intervention session. Intervention adherence (mean attendance 5.3 over 6 sessions) and acceptability were high (mean satisfaction 3.4 over 4). We observed post-intervention improvements in anxiety, depression, psychological discomfort, body responsiveness, and interoceptive awareness. The changes in the outcomes were larger than the changes in the nonequivalent dependent variables. Additionally, we found that the changes in body responsiveness partially mediated the change in anxiety and psychological discomfort but not in depression.Conclusions: TSY could be an interesting therapeutic approach for women experiencing chronic posttraumatic stress symptomatology. Our findings underscore the role of interoceptive mechanisms in traumatic stress and emphasize the importance of addressing these aspects.
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Affiliation(s)
- Daria Shatrova
- UNINPSI, Dpto. de Psicología, Universidad Pontificia Comillas, Madrid, Spain
| | - Pablo F. Cáncer
- UNINPSI, Dpto. de Psicología, Universidad Pontificia Comillas, Madrid, Spain
| | - Jose Manuel Caperos
- UNINPSI, Dpto. de Psicología, Universidad Pontificia Comillas, Madrid, Spain
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10
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Nordström EEL, Kaltiala R, Kristensen P, Thimm JC. Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack. Eur J Psychotraumatol 2024; 15:2300585. [PMID: 38214224 PMCID: PMC10791101 DOI: 10.1080/20008066.2023.2300585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.
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Affiliation(s)
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Pål Kristensen
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jens C. Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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11
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Pathak GA, Singh K, Choi KW, Fang Y, Kouakou MR, Lee YH, Zhou X, Fritsche LG, Wendt FR, Davis LK, Polimanti R. Genetic Liability to Posttraumatic Stress Disorder Symptoms and Its Association With Cardiometabolic and Respiratory Outcomes. JAMA Psychiatry 2024; 81:34-44. [PMID: 37910111 PMCID: PMC10620678 DOI: 10.1001/jamapsychiatry.2023.4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
Importance Posttraumatic stress disorder (PTSD) has been reported to be a risk factor for several physical and somatic symptoms. However, the genetics of PTSD and its potential association with medical outcomes remain unclear. Objective To examine disease categories and laboratory tests from electronic health records (EHRs) that are associated with PTSD polygenic scores. Design, Setting, and Participants This genetic association study was conducted from July 15, 2021, to January 24, 2023, using EHR data from participants across 4 biobanks. The polygenic scores of PTSD symptom severity (PGS-PTSD) were tested with all available phecodes in Vanderbilt University Medical Center's biobank (BioVU), Mass General Brigham (MGB), Michigan Genomics Initiative (MGI), and UK Biobank (UKBB). The significant medical outcomes were tested for overrepresented disease categories and subsequently tested for genetic correlation and 2-sample mendelian randomization (MR) to determine genetically informed associations. Multivariable MR was conducted to assess whether PTSD associations with health outcomes were independent of the genetic effect of body mass index and tobacco smoking. Exposures Polygenic score of PTSD symptom severity. Main Outcomes and Measures A total of 1680 phecodes (ie, International Classification of Diseases, Ninth Revision- and Tenth Revision-based phenotypic definitions of health outcomes) across 4 biobanks and 490 laboratory tests across 2 biobanks (BioVU and MGB). Results In this study including a total of 496 317 individuals (mean [SD] age, 56.8 [8.0] years; 263 048 female [53%]) across the 4 EHR sites, meta-analyzing associations of PGS-PTSD with 1680 phecodes from 496 317 individuals showed significant associations to be overrepresented from mental health disorders (fold enrichment = 3.15; P = 5.81 × 10-6), circulatory system (fold enrichment = 3.32; P = 6.39 × 10-12), digestive (fold enrichment = 2.42; P = 2.16 × 10-7), and respiratory outcomes (fold enrichment = 2.51; P = 8.28 × 10-5). The laboratory measures scan with PGS-PTSD in BioVU and MGB biobanks revealed top associations in metabolic and immune domains. MR identified genetic liability to PTSD symptom severity as an associated risk factor for 12 health outcomes, including alcoholism (β = 0.023; P = 1.49 × 10-4), tachycardia (β = 0.045; P = 8.30 × 10-5), cardiac dysrhythmias (β = 0.016, P = 3.09 × 10-5), and acute pancreatitis (β = 0.049, P = 4.48 × 10-4). Several of these associations were robust to genetic effects of body mass index and smoking. We observed a bidirectional association between PTSD symptoms and nonspecific chest pain and C-reactive protein. Conclusions and Relevance Results of this study suggest the broad health repercussions associated with the genetic liability to PTSD across 4 biobanks. The circulatory and respiratory systems association was observed to be overrepresented in all 4 biobanks.
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Affiliation(s)
- Gita A. Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
| | - Kritika Singh
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karmel W. Choi
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Yu Fang
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Manuela R. Kouakou
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
| | - Younga Heather Lee
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Xiang Zhou
- Department of Biostatistics, School of Public Health, University of Michigan Medicine, Ann Arbor
| | - Lars G. Fritsche
- Department of Biostatistics, School of Public Health, University of Michigan Medicine, Ann Arbor
- Rogel Cancer Center, University of Michigan Medicine, Ann Arbor
- Center for Statistical Genetics, School of Public Health, University of Michigan Medicine, Ann Arbor
| | - Frank R. Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
- Department of Anthropology, University of Toronto, Mississauga, Ontario, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lea K. Davis
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veteran Affairs Connecticut Healthcare Center, West Haven
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12
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Verveen A, Wynberg E, van Willigen HDG, Davidovich U, Lok A, Moll van Charante EP, de Jong MD, de Bree G, Prins M, Knoop H, Nieuwkerk PT. Mental health up to 12 months following SARS-CoV-2 infection: A prospective cohort study. J Psychosom Res 2023; 175:111520. [PMID: 37852167 DOI: 10.1016/j.jpsychores.2023.111520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate to what extent individuals report clinically relevant levels of depression, anxiety, post-traumatic stress disorder (PTSD) symptoms and concentration problems up to 12 months following COVID-19 symptom onset, using validated questionnaires. METHODS RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled both hospitalized and community-dwelling adult participants diagnosed with SARS-CoV-2. Symptoms of depression and anxiety were assessed with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 1, 3, 6 and 12 months following illness onset. The DSM-V PTSD checklist was administered at month 3 and 9. Concentration problems were assessed using the Checklist Individual Strength concentration subscale at month 1 and 12. Generalized Estimating Equations were used to determine factors related with clinically relevant levels of depression-, anxiety- and PTSD-symptoms and concentration problems over time. RESULTS In 303 individuals, the prevalence of clinically relevant symptoms of depression, anxiety and concentration problems was 10.6% (95%CI = 7.2-15.4), 7.0% (95%CI = 4.4-11.2) and 33.6% (95%CI = 27.7-40.1), respectively, twelve months after infection. Nine months after illness onset, 4.2% (95%CI = 2.3-7.7) scored within the clinical range of PTSD. Risk factors for an increased likelihood of reporting mental health problems during follow up included initial severe/critical COVID-19, non-Dutch origin, psychological problems prior to COVID-19 and being infected during the first COVID-19 wave. CONCLUSION Our findings highlight that a minority of patients with COVID-19 face clinically relevant symptoms of depression, anxiety or PTSD up to 12 months after infection. The prevalence of concentration problems was high. This study contributes to the identification of specific groups for which support after initial illness is indicated.
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Affiliation(s)
- Anouk Verveen
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands.
| | - Elke Wynberg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Hugo D G van Willigen
- Amsterdam UMC location University of Amsterdam, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Medical Microbiology & Infection Prevention, Meibergdreef 9, Amsterdam, the Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam Public Health, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Center for Urban Mental Health, University of Amsterdam, the Netherlands
| | - Eric P Moll van Charante
- Amsterdam Public Health, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Public & Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of General Practice, Meibergdreef 9, Amsterdam, the Netherlands
| | - Menno D de Jong
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Medical Microbiology & Infection Prevention, Meibergdreef 9, Amsterdam, the Netherlands
| | - Godelieve de Bree
- Amsterdam UMC location University of Amsterdam, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Hans Knoop
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
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13
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Ciotti S. "I Get It, I'm Sick Too": An Autoethnographic Study of One Researcher/Practitioner/Patient With Chronic Illness. QUALITATIVE HEALTH RESEARCH 2023; 33:1305-1321. [PMID: 37843470 DOI: 10.1177/10497323231201027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This autoethnographic research utilizes reflexivity as a method to explore my self-experience of Lyme disease while holding co-occurring identities as a researcher, health professional, and mother. Awareness of self is central in psychotherapy so that therapists do not adversely impact their clients. This is similar for researchers who are ethically required to acknowledge and reduce any potential risk(s) of harm to their participants. In this study, I describe and systematically analyze my experiences as a patient with symptom-persistent Lyme disease, contextualized through co-occurring identities as a mother, a regulated (mental) health professional, and a scholar investigating the embodied experience of being a Lyme disease patient in the Canadian context. The central research question guiding this study is: "What are my experiences with symptom-persistent Lyme disease?" The results of this study suggest reflexivity is an important practice in both health research and healthcare. Relationships with health professionals have a significant impact on patients' healthcare experiences, and engaging in reflexive practice may improve the responsivity of healthcare professionals toward patients' needs and embodied experiences and serve as a check on pre-existing power relations in healthcare. Further, this research contributes to the current academic knowledge on symptom-persistent Lyme disease by offering a reflexive representation of my experiences as a researcher who is also a health professional and a patient within the Canadian healthcare system. Representations of patients' experiences are critical in advancing health research and ensuring equitable care for patients. Autoethnography offers important insights into patients' disease experiences.
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Affiliation(s)
- Sarah Ciotti
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada
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14
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Pirard P, Motreff Y, Stene LE, Rabet G, Vuillermoz C, Vandentorren S, Baubet T, Messiah A. Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks. Arch Public Health 2023; 81:207. [PMID: 38031202 PMCID: PMC10685664 DOI: 10.1186/s13690-023-01206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors. METHODS Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation. RESULTS Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims. CONCLUSION The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.
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Affiliation(s)
- Philippe Pirard
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France.
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Yvon Motreff
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Gabrielle Rabet
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- UMR 1219, Bordeaux Population Health Research Center, PHARes Team, University of Bordeaux, Bordeaux, France
| | - Thierry Baubet
- Université Sorbonne Paris Nord, UTRPP EA 4403, Villetaneuse, France
- AP-HP, Hôpital Avicenne, Bobigny, France
- Resources and Resilience National Centre (CN2R), LilleParis, France
| | - Antoine Messiah
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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15
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Zeghari R, Gindt M, Guivarch J, Auby P, Robert P, Rolling J, Schröder C, Valo P, Askenazy F, Fernandez A. July 14th 2016 Nice Terrorist Attack Court Trial: A Protocol on Sleep Quality and Somatic Symptoms as Markers of Risk for Traumatic Reactivation in Adolescents Exposed to This Attack. Healthcare (Basel) 2023; 11:2953. [PMID: 37998445 PMCID: PMC10671086 DOI: 10.3390/healthcare11222953] [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: 09/17/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
The court trial of the 14th of July 2016 terrorist attack in Nice (France) opened in September 2022 and ended in December 2022. Engaging in court proceedings, whether as a victim or a witness, can lead to a significant risk of traumatic reactivation (i.e., the re-emergence of post-traumatic stress symptoms). The present protocol aimed to improve knowledge of the pathophysiology of traumatic reactivation due to the media coverage of the trial by assessing sleep disturbances and somatic symptoms that could reappear if there is a traumatic reactivation. Method and Analysis: This is a monocentric longitudinal study, with recruitment solely planned at the Nice Pediatric Psychotrauma Center (NPPC). We intended to include 100 adolescents aged 12 to 17 years who were directly or indirectly exposed to the attack and included in the "14-7" program). Assessments began one month before the trial, in August 2022, and were scheduled once a month until the end of the trial. A smartwatch recorded sleep activity. Somatic and PTSD symptoms and sleep were assessed through validated questionnaires. The main analyses comprised the variance and regression analyses of predictors of clinical evolution over time. Ethics and Dissemination: The National Ethics Committee "NORD OUEST III" approved the "14-7" program protocol (number 2017-A02212-51). The specific amendment for this research was approved in April 2022 by the same national ethical committee. Inclusions started in August 2022.
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Affiliation(s)
- Radia Zeghari
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Morgane Gindt
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Jokthan Guivarch
- Department of Child Psychiatry, APHM, 13009 Marseille, France;
- CANOP Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix Marseille University, 13005 Marseille, France
- Faculty of Medicine, Aix-Marseille University, 13005 Marseille, France
| | - Philippe Auby
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Philippe Robert
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Julie Rolling
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, 67000 Strasbourg, France
- CNRS UPR3212-Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, 67000 Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, 67091 Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, 67091 Strasbourg, France
| | - Carmen Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, 67000 Strasbourg, France
- CNRS UPR3212-Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, 67000 Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, 67091 Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, 67091 Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, 67000 Strasbourg, France
| | - Petri Valo
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Florence Askenazy
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Arnaud Fernandez
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
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16
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Davis LL, Urganus A, Gagnon-Sanschagrin P, Maitland J, Qu W, Cloutier M, Guérin A, Aggarwal J. Patient journey before and after a formal post-traumatic stress disorder diagnosis in adults in the United States - a retrospective claims study. Curr Med Res Opin 2023; 39:1523-1532. [PMID: 37817472 DOI: 10.1080/03007995.2023.2269839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE To describe post-traumatic stress disorder (PTSD)-related symptoms and frequent psychiatric comorbidities, treatments received, healthcare resource utilization (HRU), and healthcare costs pre- and post-PTSD diagnosis among adults in the United States. METHODS Adults with PTSD who received a PTSD-related pharmacological treatment (selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor [SNRI], atypical antipsychotic [AA]) within 24 months of the first observed PTSD diagnosis (index date) were identified using MarketScan Commercial Database (2015-2020). Study outcomes were assessed during the 6-month pre-diagnosis and 24-month post-diagnosis periods. Subgroup analyses included patients treated or not treated with AAs post-PTSD diagnosis. RESULTS Of the overall patients (N = 26,306; mean age at diagnosis 39.5 years; 73.3% female), 85.9% had PTSD-related symptoms and frequent psychiatric comorbidities during the 6 months pre-diagnosis. Patients treated with AAs post-PTSD diagnosis (N = 9,298) tended to have higher rates of PTSD-related symptoms and comorbidities at diagnosis than those not treated with AAs (N = 7,011). Following diagnosis, the most commonly observed first-line treatments were SSRI (67.4%), AA (23.4%), and SNRI (22.6%). The rate of PTSD-related symptoms and comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs increased during the 6 months post-diagnosis relative to the 6 months pre-diagnosis and then declined over time during the 24 months post-diagnosis. CONCLUSIONS The PTSD diagnosis was associated with increased rates of symptoms and frequent psychiatric comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs, pointing to increased patient monitoring. Within 6 to 12 months after the PTSD diagnosis, these outcomes tended to reduce, perhaps as patients were obtaining targeted and effective care.
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Affiliation(s)
- Lori L Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | | | | | | | - Wendi Qu
- Analysis Group, Inc, Montréal, Canada
| | | | | | - Jyoti Aggarwal
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
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Mitchell HR, Antoni MH, Shaffer KM, Kim Y. Correlates of posttraumatic stress in cancer patients and their family caregivers across two years following diagnosis. Psychooncology 2023; 32:1736-1743. [PMID: 37789570 DOI: 10.1002/pon.6227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To examine risk-factors of cancer-related PTSS in the 2-years post-diagnosis in adult colorectal cancer patients and caregivers. METHODS Patients with colorectal cancer and their caregivers (N = 130 dyads) self-reported sociodemographic, psychosocial, and medical factors at diagnosis/treatment initiation (T1), at 1- (T2), and 2-year (T3) post-diagnosis. Cancer-related PTSS were assessed, and path analysis examined associations between proposed correlates and PTSS. RESULTS Among patients, higher neuroticism and greater physical symptom distress were concurrently associated with higher PTSS (Bs ≥ 0.10, ps ≤ 0.02); greater physical symptom distress at T1 and greater social support at T2 were associated with higher PTSS at T3 (Bs ≥ 0.37, ps ≤ 0.04). Among caregivers, female gender, higher neuroticism (Bs ≥ 0.12, ps < 0.01), and lower social support (Bs ≤ -0.24, ps ≤ 0.02) were associated with higher concurrent PTSS; lower patient physical symptom distress and social support at T1 (Bs ≤ -0.27, ps ≤ 0.03) and longer hours spent caregiving at T2 (B = 0.03, p = 0.05) were associated with higher PTSS at T3. CONCLUSIONS Findings identify cancer-specific risk factors (physical symptoms, hours caregiving), in addition to established risk factors (female, neuroticism, social support) in non-medical populations. The identified subgroups should receive ongoing screening and psychosocial referral for cancer-related PTSS.
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Affiliation(s)
- Hannah-Rose Mitchell
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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18
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Fernandez A, Meurice L, Franke F, Vuillermoz C, Gindt M, Askenazy F, Vandentorren S. Impact of the 7/14/2016 Nice terrorist attack on pediatric emergency department visits thanks to syndromic surveillance: a descriptive study. Front Public Health 2023; 11:1248993. [PMID: 37915811 PMCID: PMC10616791 DOI: 10.3389/fpubh.2023.1248993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Objective Study the impact of 14th July 2016 Nice terrorist attack on Pediatric Emergency Department (PED) visits by youth under 18 years of age. Methods PED visits diagnoses (ICD10) were clustered and analyzed based on retrospective data from the syndromic surveillance system of the Children's university hospital of Nice (Southern France). The studied period ranges from 2013 to 2019, i.e., 3 years before and after the terrorist attack of 14th July 2016. Results Among 416,191 PED visits, the number of visits for stress in 4-17 years old appeared to increase in the 3 years after the attack compared to the 3 years before, particularly in September 2016 (acute effect) with 11 visits compared to an average of 2.3 visits per month from September 2013 to 2016 (p = 0.001827). In September 2017, we noticed 21 visits compared to an average of 4.8 visits per month during the following period (2013-2019). In 2017, PED visits for stress among 4-17 year olds were higher in comparison to the other years of the study: 107 visits compared to an annual average of 57. Conclusion To our knowledge, this is the first study of the use of the pediatric care system before and after a terrorist attack involving syndromic surveillance. This suggests acute and long-term effects of the terrorist attack on PED use by youth for mental health issues. Further studies of the pediatric care system involving syndromic surveillance are needed in the context of mass violent events, such as terrorist attacks.
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Affiliation(s)
- Arnaud Fernandez
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Laure Meurice
- Santé publique France, French National Public Health Agency, Nouvelle-Aquitaine Regional Office, Bordeaux, France
| | - Florian Franke
- Santé Publique France, French National Public Health Agency, Regional Unit (CIRE, Provence-Alpes-Côte d'Azur and Corsica), Marseille, France
| | - Cecile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Social Epidemiology Research Team, Paris, France
| | - Morgane Gindt
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Stéphanie Vandentorren
- Université Bordeaux, Inserm, UMR1219, Vintage Team, Bordeaux, France
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
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Ramos N, Marr MC. Traumatic Stress and Resilience Among Transgender and Gender Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:667-682. [PMID: 37739627 PMCID: PMC10914351 DOI: 10.1016/j.chc.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Traumatic stress increases the risk for mental health conditions and adversely impacts health, academic performance, and coping. Transgender and gender diverse (TGD) youth experience higher rates of abuse and maltreatment and interpersonal and community-embedded discrimination than their cisgender peers. Neurobiologic stress responses and social stress theory provide useful frameworks for understanding the effects of discrimination, stigma, and rejection. Despite facing higher rates of interpersonal trauma, TGD youth are quite resilient when able to access supports and affirming trauma-informed services. Clinicians play an important role in identifying and addressing traumatic stress impacting TGD youth and bolstering resilience.
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Affiliation(s)
- Natalia Ramos
- University of California, Los Angeles David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience, Los Angeles, CA 90095, USA.
| | - Mollie C Marr
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR 97239-3098, USA
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20
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Gao CX, Menssink J, Campbell TCH, Smith CL, Ikin JF, Lane T, Abramson MJ, Carroll M. Somatic symptoms, psychological distress and trauma after disasters: lessons from the 2014 Hazelwood mine fire and 2019-20 Black Summer bushfires. BMC Public Health 2023; 23:1573. [PMID: 37596570 PMCID: PMC10436633 DOI: 10.1186/s12889-023-16501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Wildfires cause significant physical and mental ill-health. How physical and mental symptoms interact following wildfire smoke exposure is unclear, particularly in the context of repeated exposures. In this cross-sectional study we investigated how posttraumatic stress and general psychological distress associated with somatic symptoms in a community exposed to multiple smoke events. METHODS A random weighted sample of 709 adults exposed to smoke during the 2014 Hazelwood coal mine fire in south-eastern Australia completed a survey in 2020. The survey coincided with the Black Summer wildfires that caused a similar period of smoke haze in the region. Participants self-reported somatic symptoms (PHQ-15) and mine fire-related posttraumatic stress (IES-R) experienced over the previous week, general psychological distress (K10) experienced over the previous four weeks, lifetime health diagnoses and demographic information. Associations between posttraumatic stress, general psychological distress, and each PHQ-15 somatic symptom were analysed using ordinal logistic regression models. RESULTS Overall, 36.2% of participants reported moderate- or high-level somatic symptomology. The most frequent somatic symptoms were fatigue, limb pain, trouble sleeping, back pain, headaches, and shortness of breath. After controlling for confounding factors, general psychological distress and posttraumatic stress were independently associated with all somatic symptoms (except menstrual problems in females for posttraumatic stress). CONCLUSIONS Results highlight the high prevalence of somatic symptoms and their association with general psychological distress and posttraumatic stress within a community in the midst of a second large-scale smoke event. It is essential that healthcare providers and public health authorities consider the interconnections of these conditions when supporting communities affected by climate-related disasters.
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Affiliation(s)
- Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Jana Menssink
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Timothy C H Campbell
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tyler Lane
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Matthew Carroll
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia.
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Nishimi K, Tan J, Scoglio A, Choi KW, Kelley DP, Neylan TC, O’Donovan A. Psychological Resilience to Trauma and Risk of COVID-19 Infection and Somatic Symptoms Across 2 Years. Psychosom Med 2023; 85:488-497. [PMID: 37199425 PMCID: PMC10524129 DOI: 10.1097/psy.0000000000001215] [Citation(s) in RCA: 1] [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] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Exposure to trauma increases the risk of somatic symptoms, as well as acute and chronic physical diseases. However, many individuals display psychological resilience, showing positive psychological adaptation despite trauma exposure. Resilience to prior trauma may be a protective factor for physical health during subsequent stressors, including the COVID-19 pandemic. METHODS Using data from 528 US adults in a longitudinal cohort study, we examined psychological resilience to lifetime potentially traumatic events early in the pandemic and the risk of COVID-19 infection and somatic symptoms across 2 years of follow-up. Resilience was defined as level of psychological functioning relative to lifetime trauma burden, assessed in August 2020. Outcomes included COVID-19 infection and symptom severity, long COVID, and somatic symptoms assessed every 6 months for 24 months. Using regression models, we examined associations between resilience and each outcome adjusting for covariates. RESULTS Higher psychological resilience to trauma was associated with a lower likelihood of COVID-19 infection over time, with one standard deviation higher resilience score associated with a 31% lower likelihood of COVID-19 infection, adjusting for sociodemographics and vaccination status. Furthermore, higher resilience was associated with lower levels of somatic symptoms during the pandemic, adjusting for COVID-19 infection and long COVID status. In contrast, resilience was not associated with COVID-19 disease severity or long COVID. CONCLUSIONS Psychological resilience to prior trauma is associated with lower risk of COVID-19 infection and lower somatic symptoms during the pandemic. Promoting psychological resilience to trauma may benefit not only mental but also physical health.
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Affiliation(s)
- Kristen Nishimi
- Mental Health Service, San Francisco Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Jeri Tan
- Mental Health Service, San Francisco Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Arielle Scoglio
- Department of Natural and Applied Sciences, Bentley University
- Department of Epidemiology, Harvard TH Chan School of Public Health
| | - Karmel W Choi
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital
- Psychiatric & Neurodevelopment Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital
| | - D. Parker Kelley
- Mental Health Service, San Francisco Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Aoife O’Donovan
- Mental Health Service, San Francisco Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
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22
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Yin Y, Han S, Guan J, Wang D, Wang H, Yuan TF, Yang Y. Posttraumatic stress disorder symptoms among healthcare workers during the Omicron era. Front Psychiatry 2023; 14:1140511. [PMID: 37293404 PMCID: PMC10244510 DOI: 10.3389/fpsyt.2023.1140511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Background The COVID-19 pandemic has caused significant psychological stress among healthcare workers. This study aimed to clarify the factors that influenced health workers' posttraumatic stress disorder (PTSD) symptoms. Method A total of 443 healthcare workers from eight Mental Health Centers in Shandong were recruited to attend an online survey. Participants completed self-evaluation measures of exposure to the COVID-19 environment and PTSD symptoms, as well as measures of potential protective factors such as euthymia and perceived social support. Results About 45.37% of healthcare workers had severe symptoms of PTSD symptoms. Healthcare workers with more serious PTSD symptoms were significantly related to higher exposure to COVID-19 (r = 0.177, p < 0.001), as well as lower levels of euthymia (r = -0.287, p < 0.001) and perceived social support (r = -0.236, p < 0.001). The structural equation model (SEM) further revealed that the impact of exposure to COVID-19 on PTSD symptoms was partially mediated by euthymia, and moderated by perceived social support, especially from others (e.g., friends, leaders, relatives and colleagues). Conclusion These findings suggested that improving the state of euthymia, getting social support from others could alleviate PTSD symptoms among healthcare workers during the COVID-19.
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Affiliation(s)
- YuanYuan Yin
- Shandong Mental Health Center, Jinan, Shandong, China
- Wenzhou Medical University, School of Mental Health, Wenzhou, Zhejiang, China
| | - Sizhu Han
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoqiong Guan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - DuanWei Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - HaiRong Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Ying Yang
- Shandong Mental Health Center, Jinan, Shandong, China
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23
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Persistent physical symptoms after COVID-19 infection and the risk of Somatic Symptom Disorder. J Psychosom Res 2023; 166:111172. [PMID: 36736191 PMCID: PMC9876030 DOI: 10.1016/j.jpsychores.2023.111172] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Evidence shows that many patients with COVID-19 present persistent symptoms after the acute infection. Some patients may be at a high risk of developing Somatic Symptom Disorder (SSD), in which persistent symptoms are accompanied by excessive and disproportionate health-related thoughts, feelings and behaviors regarding these symptoms. This study assessed the frequency of persistent physical symptoms and SSD and their associated factors in patients with confirmed COVID-19. METHODS We conducted a longitudinal retrospective study after the first two French lockdowns at the Lille University Hospital (France), including all patients with confirmed COVID-19. Persistent physical symptoms and excessive preoccupations for these symptoms were measured 8 to 10 months after the onset of COVID-19. The combination of the Patient Health Questionnaire-15 and the Somatic Symptom Disorder-B Criteria Scale was used to identify the individuals likely to present with SSD. Two linear regression models were performed to identify sociodemographic and medical risk factors of SSD. RESULTS Among the 377 patients with a laboratory-confirmed diagnosis, 220 (58.4%) completed the questionnaires. Sixty-five percent of the 220 included patients required hospitalization, 53.6% presented at least one persistent physical symptom and 10.4% were considered to present SSD. Female sex, older age, infection during the second wave and having probable PTSD were significantly associated with the severity of SSD and SSD was associated with a significantly higher healthcare use. CONCLUSIONS The identification of SSD should encourage clinicians to move beyond the artificial somatic/psychiatric dualism and contribute to a better alliance based on multi-disciplinary care.
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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Gori A, Topino E, Musetti A. The Relationship among Anxiety, Worry, Perceived Stress, Defense Mechanisms, and High Levels of Post-Traumatic Stress Symptoms: A Discriminant Analytic Approach. J Pers Med 2023; 13:jpm13020237. [PMID: 36836471 PMCID: PMC9966516 DOI: 10.3390/jpm13020237] [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: 09/29/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a pathological condition that may lead to a significant deterioration in the quality of life over time. Therefore, the study of the elements that can characterize the disorder could be considered of great clinical interest and relevance. The aim of the present research was to empirically discriminate the influence of perceived stress, state anxiety, worry, and defense mechanisms (mature, neurotic, and immature) at different levels of post-traumatic stress symptoms. A sample of 1250 participants (69.5% women, 30.5% men; Mage = 34.52, SD = 11.857) completed an online survey including the Impact of Event Scale-Revised, Ten-Item Perceived Stress Scale, Penn State Worry Questionnaire, Forty Item Defense Style Questionnaire, and State-Trait Anxiety Inventory-Form X3. Data were analysed by implementing MANOVA and discriminant analysis. Results showed significant differences in the levels of perceived stress, state anxiety, and worry, as well as neurotic and immature defenses based on the levels of post-traumatic stress symptoms: F(12,2484) = 85.682, p < 0.001; Wilk's Λ = 0.430. Furthermore, these variables discriminate significant accuracy between participants who reported a mild psychological impact and those with a probable presence of PTSD, with perceived stress, which was found to be the best predictor. Classification results indicated that the original grouped cases were classified with 86.3% overall accuracy. Such findings may provide useful insight for clinical practice.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Firenze, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
- Correspondence:
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Borgo Carissimi 10, 43121 Parma, Italy
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Haller H, Mitzinger D, Cramer H. The integration of yoga breathing techniques in cognitive behavioral therapy for post-traumatic stress disorder: A pragmatic randomized controlled trial. Front Psychiatry 2023; 14:1101046. [PMID: 37139325 PMCID: PMC10150115 DOI: 10.3389/fpsyt.2023.1101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction In trauma-focused Cognitive Behavioral Therapy (TF-CBT), stabilization techniques are used before confrontation ones to increase stress/affect tolerance and thus effectiveness of CBT. This study investigated the effects of pranayama, meditative yoga breathing and breath holding techniques, as a complimentary stabilization technique in patients with post-traumatic stress disorder (PTSD). Methods Seventy-four PTSD-patients (84% female, 44.2 ± 13 years) were randomized to receive either pranayama at the beginning of each TF-CBT session or TF-CBT alone. The primary outcome was self-reported PTSD severity after 10 sessions of TF-CBT. Secondary outcomes included quality of life, social participation, anxiety, depression, distress tolerance, emotion regulation, body awareness, breath-holding duration, acute emotional reaction to stress, and adverse events (AEs). Intention-to-treat (ITT) and exploratory per-protocol (PP) analyses of covariance with 95% confidence intervals (CI) were performed. Results ITT analyses revealed no significant differences on primary or secondary outcomes, except for breath-holding duration in favor of pranayama-assisted TF-CBT (20.81 s, 95%CI = 13.05|28.60). PP analyses of 31 patients without AEs during pranayama revealed significantly lower PTSD severity (-5.41, 95%CI = -10.17|-0.64) and higher mental quality of life (4.89, 95%CI = 1.38|8.41) than controls. In contrast, patients with AEs during pranayama breath holding reported significantly higher PTSD severity (12.39, 95%CI = 5.08|19.71) than controls. Concurrent somatoform disorders were found to be a significant moderator of change in PTSD severity (p = 0.029). Conclusion In PTSD patients without concurrent somatoform disorders, the integration of pranayama into TF-CBT might reduce post-traumatic symptoms and increase mental quality of life more efficiently than TF-CBT alone. The results remain preliminary until they can be replicated by ITT analyses. Clinical trial registration ClinicalTrials.gov, identifier NCT03748121.
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Affiliation(s)
- Heidemarie Haller
- Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Heidemarie Haller,
| | - Dietmar Mitzinger
- Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Insititute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Bosch Health Campus, Stuttgart, Germany
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Cerebral Blood Flow in Predator Stress-Resilient and -Susceptible Rats and Mechanisms of Resilience. Int J Mol Sci 2022; 23:ijms232314729. [PMID: 36499055 PMCID: PMC9738343 DOI: 10.3390/ijms232314729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Stress-induced conditions are associated with impaired cerebral blood flow (CBF) and increased risk of dementia and stroke. However, these conditions do not develop in resilient humans and animals. Here the effects of predator stress (PS, cat urine scent, ten days) on CBF and mechanisms of CBF regulation were compared in PS-susceptible (PSs) and PS-resilient (PSr) rats. Fourteen days post-stress, the rats were segregated into PSs and PSr groups based on a behavior-related anxiety index (AI). CBF and its endothelium-dependent changes were measured in the parietal cortex by laser Doppler flowmetry. The major findings are: (1) PS susceptibility was associated with reduced basal CBF and endothelial dysfunction. In PSr rats, the basal CBF was higher, and endothelial dysfunction was attenuated. (2) CBF was inversely correlated with the AI of PS-exposed rats. (3) Endothelial dysfunction was associated with a decrease in eNOS mRNA in PSs rats compared to the PSr and control rats. (4) Brain dopamine was reduced in PSs rats and increased in PSr rats. (5) Plasma corticosterone of PSs was reduced compared to PSr and control rats. (6) A hypercoagulation state was present in PSs rats but not in PSr rats. Thus, potential stress resilience mechanisms that are protective for CBF were identified.
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Claudius M, Shino EN, Job S, Hofmann D, Thalmayer AG. Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14323. [PMID: 36361207 PMCID: PMC9657148 DOI: 10.3390/ijerph192114323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, "it keeps on coming back"; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress.
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Affiliation(s)
- Milena Claudius
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
- Department of Psychology and Professional Counseling, Webster University Geneva, 1293 Bellevue, Switzerland
| | - Elizabeth N. Shino
- Department of Psychology and Social Work, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek 10026, Namibia
| | - Sylvanus Job
- Department of Humanities and Arts, Faculty of Education & Human Sciences, University of Namibia, Windhoek 10026, Namibia
| | - Daniel Hofmann
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Amber Gayle Thalmayer
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland
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Weil ZM, White B, Whitehead B, Karelina K. The role of the stress system in recovery after traumatic brain injury: A tribute to Bruce S. McEwen. Neurobiol Stress 2022; 19:100467. [PMID: 35720260 PMCID: PMC9201063 DOI: 10.1016/j.ynstr.2022.100467] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Traumatic brain injury (TBI) represents a major public health concern. Although the majority of individuals that suffer mild-moderate TBI recover relatively quickly, a substantial subset of individuals experiences prolonged and debilitating symptoms. An exacerbated response to physiological and psychological stressors after TBI may mediate poor functional recovery. Individuals with TBI can suffer from poor stress tolerance, impairments in the ability to evaluate stressors, and poor initiation (and cessation) of neuroendocrine stress responses, all of which can exacerbate TBI-mediated dysfunction. Here, we pay tribute to the pioneering neuroendocrinologist Dr. Bruce McEwen by discussing the ways in which his work on stress physiology and allostatic loading impacts the TBI patient population both before and after their injuries. Specifically, we will discuss the modulatory role of hypothalamic-pituitary-adrenal axis responses immediately after TBI and later in recovery. We will also consider the impact of stressors and stress responses in promoting post-concussive syndrome and post-traumatic stress disorders, two common sequelae of TBI. Finally, we will explore the role of early life stressors, prior to brain injuries, as modulators of injury outcomes.
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30
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Putica A, O’Donnell ML, Felmingham KL. Prolonged Exposure Therapy in the Treatment of Functional Neurological Disorder and Posttraumatic Stress Disorder. Clin Case Stud 2022. [DOI: 10.1177/15346501221098458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional neurological disorder (FND) symptoms resemble neurological symptoms but are unexplained by disease or injury to the body. Psychological trauma and posttraumatic stress disorder (PTSD) are prevalent among patients with FND. This is a case report of a 64-year-old female who began treatment 2 years after developing PTSD, generalised anxiety disorder, major depressive disorder and agoraphobia following a physical assault. She subsequently developed FND approximately 18 months later. Her FND symptomology was characterised by aphasia and paraplegia. These symptoms usually lasted for a period of hours to days and usually occurred on a weekly basis. She had not previously engaged in psychological therapy due to limited insight into the relationship between her psychological and physiological symptomology. She was treated with Prolonged Exposure for PTSD (PE), and by the last session, she no longer met the diagnostic criteria for either FND or PTSD disorder. PE successfully treated both PTSD and FND. Theoretical understandings of the mechanisms underpinning this improvement are discussed.
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Affiliation(s)
- Andrea Putica
- Phoenix Australia Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Meaghan L. O’Donnell
- Phoenix Australia Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Kim L. Felmingham
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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31
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Mavragani A, Sveen J, Cernvall M, Arnberg FK. Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial. J Med Internet Res 2022; 24:e31419. [PMID: 35353052 PMCID: PMC9008528 DOI: 10.2196/31419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Self-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach-an app for managing trauma-related distress-are inconsistent. OBJECTIVE This study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach. METHODS Adults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test. RESULTS Intention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories). CONCLUSIONS Using PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922.
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Affiliation(s)
| | - Josefin Sveen
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Filip K Arnberg
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Soumoff AA, Clark NG, Spinks EA, Kemezis PA, Raiciulescu S, Driscoll MY, Kim SY, Benedek DM, Choi KH. Somatic Symptom Severity, Not Injury Severity, Predicts Probable Posttraumatic Stress Disorder and Major Depressive Disorder in Wounded Service Members. J Trauma Stress 2022; 35:210-221. [PMID: 34374129 DOI: 10.1002/jts.22722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022]
Abstract
Although previous studies have reported an association between patient-reported somatic symptom severity and the development of posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) in injured military service members (SMs), conclusions from other studies regarding the association between clinician-determined injury severity and PTSD or MDD remain unclear. The present study investigated whether somatic symptoms or injury severity predict the development of probable PTSD or MDD in wounded SMs medically evacuated from combat areas. Data including SM demographic characteristics, clinician-determined injury severity (i.e., Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] values), and self-report assessments of PTSD (PTSD Checklist-Civilian Version), MDD (Patient Health Questionnaire [PHQ]-9), and somatic symptoms (PHQ-15) were analyzed. A total of 2,217 SMs completed at least one self-assessment between 2003 and 2014, with 425 having completed assessments at each assessment period (AP), conducted 1-75 (AP1), 76-165 (AP2), and 166-255 (AP3) days postinjury. Between AP1 and AP3, the rates of probable PTSD and MDD increased from 3.0% to 11.7% and from 2.8% to 9.2%, respectively. Somatic symptom severity at AP1 predicted probable PTSD and MDD at all three APs, odds ratios (ORs) = 3.5-11.5; however, ISS values did not predict probable PTSD or MDD at any AP, ORs = 0.6-0.9. This suggests that the initial severity of self-reported somatic symptoms rather than clinician-determined injury severity predicts the development of probable PTSD and MDD in wounded SMs.
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Affiliation(s)
- Alyssa A Soumoff
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA
| | - Neil G Clark
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Elizabeth A Spinks
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Patricia A Kemezis
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, Maryland, USA
| | - Mercedes Y Driscoll
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA
| | - Sharon Y Kim
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - David M Benedek
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - Kwang H Choi
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
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33
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Qian J, Wang W, Sun S, Liu L, Sun Y, Yu X. Interventions to reduce post-traumatic stress disorder symptoms in health care professionals from 2011 to 2021: a scoping review. BMJ Open 2022; 12:e058214. [PMID: 35058271 PMCID: PMC8783816 DOI: 10.1136/bmjopen-2021-058214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This scoping review aimed to describe available interventions for decreasing (post-traumatic stress disorder) PTSD symptoms among healthcare professionals in hospital care. METHOD A scoping review was conducted following Arksey and O'Malley's framework. PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest were searched for original research published in English from 2011 to 2021, on 8 July 2021. We included studies that described interventions that focused on reducing the PTSD symptoms of healthcare professionals. A narrative synthesis was adopted to synthesise the data. RESULTS A total of eight studies out of 2558 articles were identified. Six used a quantitative study design and two adopted qualitative methods. cognitive behavioural therapy and mindfulness-based interventions were the most commonly adopted. Most studies used a combination of different intervention strategies. Trauma-related knowledge, emotion regulation and relaxation skill training, and psychological support from peers and psychologists were three core intervention components. The duration ranged from 2 weeks to 6 months. Healthcare professionals who participated in training programmes reported both positive experiences and suggestions for the improvement of PTSD-reducing interventions in their qualitative feedback. CONCLUSIONS The scoping review provides a practical summary of the intervention characteristics for reducing the PTSD symptoms of healthcare professionals. Hospitals and managers could use the overview of interventions to assist healthcare professionals with PTSD symptoms. More research investigating the effects of PTSD symptom-reducing interventions for healthcare professionals with appropriate follow-up assessments is needed in the future.
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Affiliation(s)
- Jialu Qian
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Weihong Wang
- Department of Obstetrics, Ninghai Maternal and Child Health Hospital, Ningbo, China
| | - Shiwen Sun
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Lu Liu
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Yaping Sun
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyan Yu
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
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34
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Peñuela-O'Brien E, Wan MW, Edge D, Berry K. Health professionals' experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review. Transcult Psychiatry 2022; 60:176-198. [PMID: 34986056 PMCID: PMC10074763 DOI: 10.1177/13634615211067360] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.
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Affiliation(s)
- E Peñuela-O'Brien
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| | - M W Wan
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester
| | - D Edge
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| | - K Berry
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
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35
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Qing X, Xu YL, Liu H, Liu XS. The influence of anesthesia and surgery on fear extinction. Neurosci Lett 2022; 766:136347. [PMID: 34808271 DOI: 10.1016/j.neulet.2021.136347] [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: 05/07/2021] [Revised: 08/29/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Accumulating evidence has demonstrated significant clinical post-traumatic stress disorder (PTSD) symptoms after anesthesia or surgery. Fear extinction dysfunction is a notable feature of PTSD. Although anesthetics and surgery profoundly affect memory processes, their designated effects on fear extinction have not been dissertated. Previous studies have suggested that innate immune system activation disrupts fear extinction, and surgery has been shown to increase the inflammatory response. Thus, in the current study, we examined the effects of propofol, sevoflurane, dexmedetomidine and surgery on fear extinction in adolescent mice, and further tested whether dexmedetomidine could reverse the injury effect of surgery on fear extinction through its anti-inflammatory effects. Our results showed that propofol (200 mg/kg) impaired the acquisition and recall of cued fear extinction, and surgery disrupted cued fear extinction acquisition/recall and consolidation. In contrast to cued fear extinction, contextual fear extinction was not affected by propofol or surgery. Moreover, dexmedetomidine prevented surgery-induced impairment of cued extinction acquisition and recall but not consolidation. Finally, TNF-α and IL-6 levels in the ventromedial prefrontal cortex were not necessary for the dexmedetomidine treatment effect of surgery-induced fear extinction dysfunction. The study results showed that propofol and surgery selective impaired the cued fear extinction stage in adolescent mice, and dexmedetomidine may unleash a protective effect in preventing postoperative PTSD.
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Affiliation(s)
- Xin Qing
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, China
| | - Yuan-Ling Xu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, China
| | - Hu Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, China.
| | - Xue-Sheng Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, China.
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36
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Avishai-Cohen H, Zerach G. Exposure to Potentially Traumatic Events, Posttraumatic Stress Symptoms, Pain Catastrophizing, and Functional Somatic Symptoms Among Individuals With Varied Somatic Symptoms: A Moderated Mediation Model. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP76-NP103. [PMID: 32326819 DOI: 10.1177/0886260520912587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The relationships between exposure to potentially traumatic events (PTEs), as well as posttraumatic stress symptoms (PTSS) and somatic syndromes, have recently been exemplified. Exposure to PTEs can also set in motion complex psychological processes such as pain catastrophizing that is associated with PTSS and somatic syndromes. However, the specific moderating role of pain catastrophizing in these links remains relatively unexamined. The present study aims to assess a moderated mediation model in which catastrophizing will moderate the indirect effect of exposure to PTEs on the number of somatic symptoms and chronic pain severity via PTSS, among individuals with somatic syndromes. A volunteers' sample of 175 Israeli adults with varied somatic symptoms responded to online validated self-report questionnaires in a cross-sectional designed study. Participants' self-reported PTSS rates (57.1%) were high. PTSS and pain catastrophizing, but not exposure to PTEs, were related to chronic pain severity. Interestingly, a moderated mediation analysis indicated that the indirect effect of catastrophizing in the relation between exposure to PTEs and the number of somatic symptoms via PTSS existed only among those with high levels of catastrophizing. The present study highlights the assumption that functional somatic syndromes (FSS) have much in common. Our findings support a moderated mediation model that begins with exposure to PTEs that leads to PTSS, which in turn increase the number of somatic symptoms. Higher levels of pain catastrophizing might attenuate this indirect link by affecting the interpretation of PTSS and create a vulnerability to more somatic symptoms. Thus, changes in cognitive-sensory processing in the form of catastrophic thinking can affect psychobiological processes and heighten sensitivity to stimuli arising in the body and should be considered as possible target for future research and psychological interventions.
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37
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Oroian BA, Ciobica A, Timofte D, Stefanescu C, Serban IL. New Metabolic, Digestive, and Oxidative Stress-Related Manifestations Associated with Posttraumatic Stress Disorder. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5599265. [PMID: 34966477 PMCID: PMC8712172 DOI: 10.1155/2021/5599265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/29/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) represents a pressing and generally invalidating syndrome that is triggered by a terrifying or stressful experience, relying on recurrently reliving the traumatic event feelings associated to it, which is subsequently linked to ongoing activations of stress-related neurobiological pathways and is often associated with neurodegeneration. In this paper, we examine what lies beneath this disorder, reviewing evidence that connects PTSD with a wide array of mechanisms and its intertwined pathways that can lead to the decompensation of different pathologies, such as cardiovascular disease, gastrointestinal ailments, autoimmune disorders, and endocrine diseases. Also, the significance of the oxidative stress in this frame of reference is debated. Thus, knowing and identifying the main features of the distressing experience, the circumstances around it, as well as the neuropsychological and emotional characteristics of people prone to develop PTSD after going through disturbing incidents can offer an opportunity to anticipate the development of potential destructive consequences in several psychological dimensions: cognitive, affective, relational, behavioral, and somatic. We can also observe more closely the intricate connections of the disorder to other pathologies and their underlying mechanisms such as inflammation, oxidative stress, bacterial overgrowth syndrome, irritable bowel syndrome, metabolic disorders, oxytocin, and cortisol in order to understand it better and to optimize the course of treatment and its management. The complex foundation PTSD possesses is supported by the existing clinical, preclinical, and experimental data encompassed in the current review. Different biological systems and processes such as the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, oxidative stress, inflammation, and microbiome suffer modifications and changes when it comes to PTSD; that is why targeted therapies exert tremendous alleviations of symptoms in patients diagnosed with this disorder. Therefore, this implies that PTSD is not restricted to the psychiatric domain and should be viewed as a systemic condition.
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Affiliation(s)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, B dul Carol I No. 11 Iasi, Romania
| | - Daniel Timofte
- “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Cristinel Stefanescu
- “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Ionela Lăcrămioara Serban
- “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
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38
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Evaluating symptom endorsement typographies of trauma-exposed veterans on the Personality Assessment Inventory (PAI): A latent profile analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00486-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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39
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Maroti D, Ljótsson B, Lumley MA, Schubiner H, Hallberg H, Olsson PÅ, Johansson R. Emotional Processing and Its Association to Somatic Symptom Change in Emotional Awareness and Expression Therapy for Somatic Symptom Disorder: A Preliminary Mediation Investigation. Front Psychol 2021; 12:712518. [PMID: 34690868 PMCID: PMC8528965 DOI: 10.3389/fpsyg.2021.712518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to investigate emotional processing as a potential mediator in therapist-guided, internet-based Emotional Awareness and Expression Therapy (I-EAET) for somatic symptom disorder, using data from a previously published pilot study. Methods: Participants (N = 52) engaged in a 9-week I-EAET treatment. Before treatment and each week during treatment (i.e., 10 weekly measurements), emotional processing was assessed with the Emotional Processing Scale-25 (EPS-25), which contains five subscales, and somatic symptoms were assessed with the Patient Health Questionnaire-15 (PHQ-15). Results: Mediation analyses using linear mixed models showed that two EPS-25 subscales—Signs of Unprocessed Emotions and Impoverished Emotional Experience—were uniquely associated with somatic symptom reduction. The proportion of the mediated effect was 0.49, indicating that about half of the total association of the PHQ-15 with symptoms was accounted for by the two EPS-25 subscales. Conclusion: This preliminary mediation analysis suggests that improved emotional processing is associated with change in somatic symptoms in I-EAET. However, randomized controlled and comparison trials are needed to establish that I-EAET creates the change in emotional processing and that such changes are specific to I-EAET.
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Affiliation(s)
- Daniel Maroti
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, United States
| | - Henrik Hallberg
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per-Åke Olsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robert Johansson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
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Abstract
Posttraumatic stress disorder (PTSD) is a complex mental disorder afflicting approximately 7% of the population. The diverse number of traumatic events and the wide array of symptom combinations leading to PTSD diagnosis contribute substantial heterogeneity to studies of the disorder. Genomic and complimentary-omic investigations have rapidly increased our understanding of the heritable risk for PTSD. In this review, we emphasize the contributions of genome-wide association, epigenome-wide association, transcriptomic, and neuroimaging studies to our understanding of PTSD etiology. We also discuss the shared risk between PTSD and other complex traits derived from studies of causal inference, co-expression, and brain morphological similarities. The investigations completed so far converge on stark contrasts in PTSD risk between sexes, partially attributed to sex-specific prevalence of traumatic experiences with high conditional risk of PTSD. To further understand PTSD biology, future studies should focus on detecting risk for PTSD while accounting for substantial cohort-level heterogeneity (e.g. civilian v. combat-exposed PTSD cases or PTSD risk among cases exposed to specific traumas), expanding ancestral diversity among study cohorts, and remaining cognizant of how these data influence social stigma associated with certain traumatic events among underrepresented minorities and/or high-risk populations.
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Affiliation(s)
- Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
- Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Frank R Wendt
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
- Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
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41
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Littman AJ, Bratman GN, Lehavot K, Engel CC, Fortney JC, Peterson A, Jones A, Klassen C, Brandon J, Frumkin H. Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA. BMJ Open 2021; 11:e051885. [PMID: 34556516 PMCID: PMC8461737 DOI: 10.1136/bmjopen-2021-051885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD). DESIGN AND SETTING A pilot randomised controlled trial conducted in the US Pacific Northwest. PARTICIPANTS Veterans with PTSD due to any cause. INTERVENTIONS Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13). PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and postintervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up. RESULTS Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group. CONCLUSIONS This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes. TRIAL REGISTRATION NUMBER NCT03997344.
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Affiliation(s)
- Alyson J Littman
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Seattle, Washington, USA
| | - Keren Lehavot
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Charles C Engel
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C Fortney
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexander Peterson
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Alex Jones
- Outdoors for All, Seattle, Washington, USA
| | - Carolyn Klassen
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Howard Frumkin
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
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Schneider KE, Tomko C, Nestadt DF, Silberzahn BE, White RH, Sherman SG. Conceptualizing overdose trauma: The relationships between experiencing and witnessing overdoses with PTSD symptoms among street-recruited female sex workers in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:102859. [PMID: 32712164 PMCID: PMC7854789 DOI: 10.1016/j.drugpo.2020.102859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The opioid crisis has rendered witnessing and experiencing overdoses a common occurrence, especially among marginalized and drug using populations, including female sex workers (FSW). Such exposures may confer psychological trauma that has gone unrecognized. We explored relationships between experiencing and witnessing overdoses and PTSD symptomology to understand the traumatic nature of these experiences. METHODS Data were from FSW (N = 380) in Baltimore City, Maryland, who reported whether they had witnessed/experienced any overdoses in the past 6 months ("overdose traumas") and PTSD symptoms (PCL-5). We tested for associations between overdose traumas and PTSD diagnoses/symptomology in bivariate logistic regression models and multivariate models, adjusting for sociodemographic, experiences of violence, and drug use characteristics. RESULTS In our sample, 35.3% witnessed a fatal overdose, 51.9% witnessed a non-fatal overdose, and 28.3% experienced an overdose in the past 6 months. More than half (52.4%) met criteria for PTSD. Most endorsed symptoms within each PTSD domain: 63.2% for intrusive, 58.4% for avoidance, 66.1% for cognition/mood, and 64.7% for arousal/reactivity symptoms. Experiencing an overdose was associated with meeting PTSD criteria and symptoms in all domains in bivariate models. Witnessing an overdose was associated with PTSD diagnoses and intrusive and arousal/reactivity symptoms in bivariate models. Adjusting for sociodemographic characteristics and drug use, experiencing an overdose was associated with intrusive and cognition/mood symptoms, while neither trauma remained associated with PTSD diagnoses. CONCLUSIONS Traumas related to overdose, coined "overdose traumas" appear to be extremely psychologically traumatic, though the relationships vary by type and symptom. Programs should be cognizant of psychological trauma to address the full spectrum of overdose harms. Existing measures of PTSD do not accurately represent the effects of overdose traumas in populations like FSW due to the structural barriers to avoiding locations/situations where overdoses may occur and the overlap between symptoms, drug effects, and adaptive responses to homelessness.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Bradley E Silberzahn
- Department of Sociology, The University of Texas at Austin, 305 E. 23rd St., Austin, TX 78712, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Borho A, Morawa E, Schmitt GM, Erim Y. Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study. BMC Public Health 2021; 21:896. [PMID: 33975567 PMCID: PMC8114491 DOI: 10.1186/s12889-021-10731-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany. METHODS This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)). RESULTS Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied. CONCLUSIONS The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.
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Affiliation(s)
- Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Mumford EA, Liu W, Taylor BG, Ramey S. Profiles of US Law Enforcement Officers' Diagnosed Health Conditions: Results From a Probability-Based Sample of Officers. J Occup Environ Med 2021; 63:422-431. [PMID: 33560070 DOI: 10.1097/jom.0000000000002162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess comorbidity across five common health conditions. METHODS Surveys were collected from a probability-based sample of US law enforcement officers, and latent class models estimated for hypertension (HTN), high blood cholesterol (LDL), diabetes (DM), a gastrointestinal disorder (GI), and sleep apnea (SA). RESULTS The majority of officers (69.4%) were classified in a Healthy profile. One in four officers (23.7%) were classified in a LDL-HTN-DM profile. About 7% of officers were classified in a GI-SA-HTN profile. Age, sex, body mass index (BMI), exercise, and working a rotating shift assignment distinguished class membership. CONCLUSION Most officers reported good health. Law enforcement administrative or clinical assessments using readily accessible measures might be informative in identifying risk categories of need for more targeted prevention and treatment support.
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Affiliation(s)
- Elizabeth A Mumford
- National Opinion Research Center at the University of Chicago, Bethesda, Maryland (Dr Mumford, Dr Liu, Dr Taylor); University of Iowa, Iowa City, Iowa (Dr Ramey)
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Jowett S, Shevlin M, Hyland P, Karatzias T. Posttraumatic Stress Disorder and Persistent Somatic Symptoms During the COVID-19 Pandemic: The Role of Sense of Threat. Psychosom Med 2021; 83:338-344. [PMID: 33818055 DOI: 10.1097/psy.0000000000000890] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Persistent somatic symptoms, such as pain and fatigue, have been referred to as somatization. Somatization is commonly associated with histories of trauma and posttraumatic stress disorder (PTSD). Although previous research has demonstrated that PTSD can predict somatic problems, there has been no examination of this at the level of PTSD symptom clusters and multidimensional assessment of somatic symptoms. We examined the association between the three International Classification of Disease (11th Edition) PTSD symptom clusters (reexperiencing in the here and now, avoidance, and sense of threat), measured in relation to the COVID-19 pandemic as the stressor, and somatic symptoms while statistically adjusting for confounding variables. METHODS Participants were a nationally representative sample of 1041 adults from the general population of the Republic of Ireland. Physical health problems across the domains of pain, gastrointestinal, cardiopulmonary, and fatigue were assessed by the Patient Health Questionnaire, and PTSD symptoms were assessed using the International Trauma Questionnaire. RESULTS Sense of threat was associated with the presence of pain (β = 0.254), fatigue (β = 0.332), gastrointestinal (β = 0.234), and cardiovascular symptoms (β = 0.239). Avoidance was associated with pain (β = 0.347). Reexperiencing was not associated with any physical health variable. CONCLUSIONS In the context of COVID-19, the sense of threat symptoms in PTSD is most strongly related to somatic problems. Findings suggest that interventions addressing sense of threat symptoms might provide relief from somatization.
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Affiliation(s)
- Sally Jowett
- From the West London NHS Trust (Jowett), London, United Kingdom; Ulster University, School of Psychology (Shevlin), Derry, Northern Ireland; Department of Psychology (Hyland), Maynooth University, Kildare; Centre for Global Health, Trinity College Dublin (Hyland), Dublin, Ireland; School of Health and Social Care, Edinburgh Napier University (Karatzias); and NHS Lothian, Rivers Centre for Traumatic Stress (Karatzias), Edinburgh, United Kingdom
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Vallejo-Martín M, Sánchez Sancha A, Canto JM. Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094806. [PMID: 33946312 PMCID: PMC8125581 DOI: 10.3390/ijerph18094806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the present systematic review was to identify and examine studies from the last fifteen years on the relationship between the impact of traumatic experiences and PTSD psychopathology in refugee women. Twelve studies were included, from which the overall results approved this relation. In addition, six of these studies show that exposure to sexual trauma in refugee women is associated with the high odds of being at risk for PTSD. These findings suggest that gender-related traumatic experiences can explain the high rate of PTSD in refugee women and highlight the unmet need for psychosocial health care in this population.
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Affiliation(s)
- Macarena Vallejo-Martín
- Department of Social Psychology, Social Work, Social Anthropology and East Asia Studies, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
- Correspondence:
| | - Ana Sánchez Sancha
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
| | - Jesús M. Canto
- Department of Social Psychology, Social Work, Social Anthropology and East Asia Studies, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
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Nazarian A, Negus SS, Martin TJ. Factors mediating pain-related risk for opioid use disorder. Neuropharmacology 2021; 186:108476. [PMID: 33524407 PMCID: PMC7954943 DOI: 10.1016/j.neuropharm.2021.108476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/03/2020] [Accepted: 01/23/2021] [Indexed: 12/23/2022]
Abstract
Pain is a complex experience with far-reaching organismal influences ranging from biological factors to those that are psychological and social. Such influences can serve as pain-related risk factors that represent susceptibilities to opioid use disorder. This review evaluates various pain-related risk factors to form a consensus on those that facilitate opioid abuse. Epidemiological findings represent a high degree of co-occurrence between chronic pain and opioid use disorder that is, in part, driven by an increase in the availability of opioid analgesics and the diversion of their use in a non-medical context. Brain imaging studies in individuals with chronic pain that use/abuse opioids suggest abuse-related mechanisms that are rooted within mesocorticolimbic processing. Preclinical studies suggest that pain states have a limited impact on increasing the rewarding effects of opioids. Indeed, many findings indicate a reduction in the rewarding and reinforcing effects of opioids during pain states. An increase in opioid use may be facilitated by an increase in the availability of opioids and a decrease in access to non-opioid reinforcers that require mobility or social interaction. Moreover, chronic pain and substance abuse conditions are known to impair cognitive function, resulting in deficits in attention and decision making that may promote opioid abuse. A better understanding of pain-related risk factors can improve our knowledge in the development of OUD in persons with pain conditions and can help identify appropriate treatment strategies. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'.
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Affiliation(s)
- Arbi Nazarian
- Department of Pharmaceutical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA.
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Thomas J Martin
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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Costello CM, Walters ME. Integrating Resiliency Into Neurobiologically-Focused Mental Health Counseling Through Mindfulness. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2021. [DOI: 10.1080/15401383.2021.1892558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Corinna M. Costello
- The Family Institute at Northwestern University, Evanston, Illinios, USA
- Northwestern University, Evanston, USA
| | - Mary E. Walters
- The Family Institute at Northwestern University, Evanston, Illinios, USA
- Northwestern University, Evanston, USA
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Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder. J Psychiatr Res 2021; 134:113-120. [PMID: 33383494 DOI: 10.1016/j.jpsychires.2020.12.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.
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Manukhina EB, Tseilikman VE, Komelkova MV, Lapshin MS, Goryacheva AV, Kondashevskaya MV, Mkhitarov VA, Lazuko SS, Tseilikman OB, Sarapultsev AP, Dmitrieva YA, Strizhikov VK, Kuzhel OP, Downey HF. Сardiac injury in rats with experimental posttraumatic stress disorder and mechanisms of its limitation in experimental posttraumatic stress disorder-resistant rats. J Appl Physiol (1985) 2021; 130:759-771. [PMID: 33411642 DOI: 10.1152/japplphysiol.00694.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Traumatic stress causes posttraumatic stress disorder (PTSD). PTSD is associated with cardiovascular diseases and risk of sudden cardiac death in some subjects. We compared effects of predator stress (PS, cat urine scent, 10 days) on mechanisms of cardiac injury and protection in experimental PTSD-vulnerable (PTSD) and -resistant (PTSDr) rats. Fourteen days post-stress, rats were evaluated with an elevated plus-maze test, and assigned to PTSD and PTSDr groups according to an anxiety index calculated from the test results. Cardiac injury was evaluated by: 1) exercise tolerance; 2) ECG; 3) myocardial histomorphology; 4) oxidative stress; 5) pro- and anti-inflammatory cytokines. Myocardial heat shock protein 70 (HSP70) was also measured. Experimental PTSD developed in 40% of rats exposed to PS. Exercise tolerance of PTSD rats was 25% less than control rats and 21% less than PTSDr rats. ECG QRS, QT, and OTc intervals were significantly longer in PTSD rats than in control and PTSDr rats. Only cardiomyocytes of PTSD rats had histomorphological signs of metabolic and hypoxic injury and impaired contractility. Oxidative stress markers were higher in PTSD than in PTSDr rats. Pro-inflammatory IL-6 was higher in PTSD rats than in control and PTSDr rats, and anti-inflammatory IL-4 was lower in PTSD than in control and PTSDr rats. Myocardial HSP70 was lower in PTSD rats than in PTSDr and control rats. Our conclusion was that rats with PTSD developed multiple signs of cardiac injury. PTSDr rats were resistant also to cardiac injury. Factors that limit cardiac damage in PS rats include reduced inflammation and oxidative stress and increased protective HSP70.NEW & NOTEWORTHY For the first time, rats exposed to stress were segregated into experimental PTSD (ePTSD)-susceptible and ePTSD-resistant rats. Cardiac injury, ECG changes, and impaired exercise tolerance were more pronounced in ePTSD-susceptible rats. Resistance to ePTSD was associated with decreased inflammation and oxidative stress and with increased protective heat shock protein 70. Results may help identify individuals at high risk of PTSD and also provide a foundation for developing preventive and therapeutic means to restrict PTSD-associated cardiac morbidity.
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Affiliation(s)
- Eugenia B Manukhina
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,Laboratory for Regulatory Mechanisms of Stress and Adaptation, Institute of General Pathology and Pathophysiology, Moscow, Russian Federation.,Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Vadim E Tseilikman
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Maria V Komelkova
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Maxim S Lapshin
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Anna V Goryacheva
- Laboratory for Regulatory Mechanisms of Stress and Adaptation, Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
| | - Marina V Kondashevskaya
- Laboratory for Immunomorphology of Inflammation, Research Institute of Human Morphology, Moscow, Russian Federation
| | - Vladimir A Mkhitarov
- Laboratory for Immunomorphology of Inflammation, Research Institute of Human Morphology, Moscow, Russian Federation
| | - Svetlana S Lazuko
- Department of Normal Physiology, Vitebsk State Medical University, Vitebsk, Republic of Belarus
| | - Olga B Tseilikman
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,School of Basic Medicine, Chelyabinsk State University, Chelyabinsk, Russian Federation
| | - Alexey P Sarapultsev
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,Laboratory of Immunopathophysiology, Institute of Immunology and Physiology of RAS, Ekaterinburg, Russian Federation
| | - Yulia A Dmitrieva
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Viktor K Strizhikov
- Department of Morphology and Histology, South Ural State Agricultural University, Troitsk, Russian Federation
| | - Olga P Kuzhel
- Department of Normal Physiology, Vitebsk State Medical University, Vitebsk, Republic of Belarus
| | - H Fred Downey
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
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