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Clair KS, Bean-Mayberry B, Schweizer CA, Chanfreau C, Jackson L, Than CT, Finley EP, Hamilton A, Farmer MM. Factors Associated with Delayed Care Among Women Veterans Actively Engaged in Primary Care. J Womens Health (Larchmt) 2024; 33:604-612. [PMID: 38386795 DOI: 10.1089/jwh.2023.0227] [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] [Indexed: 02/24/2024] Open
Abstract
Background: Delaying needed medical care contributes to greater health risks and higher long-term medical costs. Women Veterans with complex medical and mental health needs face increased barriers to timely care access. Objectives: In a sample of women Veterans with recent engagement in Veterans Administration (VA) primary care, we aimed to compare characteristics of women Veterans who delayed care in the past 6 months with those who did not and examine factors associated with self-reported delayed care. Our study aims to inform interventions focused on eliminating health care access disparities among women Veterans. Materials and Methods: An innovation to improve women Veterans' engagement and retention in evidence-based health care for cardiovascular (CV) risk reduction (CV Toolkit) was implemented across five primary care sites within the VA. Women Veterans who were exposed to at least one CV Toolkit component participated in a mailed survey (n = 253). We used multivariate logistic regression to model factors associated with delaying care, including trust in VA providers, positive mental health screening (i.e., positive screen for either depression or anxiety), traumatic experience, self-rated health, and age. Results: Women with any mental health symptoms (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.23-4.74) and women who had experienced a traumatic event (OR 2.61, 95%CI: 1.11-6.14) were significantly more likely to report delaying care. Conclusions: Our study identified high rates of delayed care-over one-third of respondents-among women Veterans with recent primary care engagement. Mental health symptoms were the most common reported reason for delay among those who delayed care. Clinical Trial registration: NCT02991534.
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Affiliation(s)
- Kimberly S Clair
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Bevanne Bean-Mayberry
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - C Amanda Schweizer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - LaShawnta Jackson
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Claire T Than
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Erin P Finley
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Alison Hamilton
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Melissa M Farmer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Wasmuth S, Rattray NA, Cheng P, Crow S, Myers J, Burns DS, Myers LJ, Hook B, Lustig A, Perkins AJ, Cheatham AJ, Bravata DM. A developmental formative evaluation of a pilot participatory music program for veterans with housing insecurity. BMC Public Health 2023; 23:1583. [PMID: 37596545 PMCID: PMC10439562 DOI: 10.1186/s12889-023-16427-8] [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: 09/09/2022] [Accepted: 07/31/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Interventions are needed to improve well-being and promote community reintegration among Veterans with housing insecurity. The objective was to conduct a developmental formative evaluation of a participatory music program. METHODS This single-site, pilot study implemented a participatory music program at a U.S. Department of Veterans Affairs (VA) Homeless Domiciliary that included one-hour sessions (group music instruction and ensemble playing), 3 times per week for 3 months. Intervention development was guided by the Model of Human Occupation (MOHO). Evaluation was guided by the MOHO and the Consolidated Framework for Implementation Evaluation (CFIR). Qualitative data were collected via semi-structured interviews from participants and non-participants, and were analyzed using an interdisciplinary, constant comparison qualitative analysis technique. RESULTS Sixteen program participants and 8 non-participants were enrolled, age range 26-59 (mean 41; standard deviation, 11) years; 75% were White. The sample for this study (N = 12) included five participants and seven non-participants. Semi-structured interview responses produced three salient themes illuminating Veterans' perspectives: (1) key characteristics of the intervention (the relative advantage of the participatory program over other problem-focused programs; the importance of a supportive, encouraging teaching; the group setting; the role of music); (2) the therapeutic power of the program (based on it being enjoyable; and serving as an escape from preoccupations); and (3) the context and culture (which included Veterans supporting each other and the Domiciliary setting). CONCLUSIONS Veterans described the benefits of a participatory music intervention compared to problem-based groups, which included enjoyment, skill acquisition facilitating pride, escape, reconnecting with their identity prior to current problems, and experiencing positive aspects of Veteran culture such as mutual support and discipline. These data support ongoing research about participatory music programs to support Veterans with housing insecurity.
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Affiliation(s)
- Sally Wasmuth
- Department of Occupational Therapy, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA
- HSR&D Center for Health Information and Communication (CHIC), United States Department of Veteran Affairs, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anthropology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Phillip Cheng
- School of Medicine, Indiana University, IN, Indianapolis, USA
| | - Shannon Crow
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA
| | - Jennifer Myers
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA
- HSR&D Center for Health Information and Communication (CHIC), United States Department of Veteran Affairs, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Debra S Burns
- Department of Music and Arts Technology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Laura J Myers
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA
- HSR&D Center for Health Information and Communication (CHIC), United States Department of Veteran Affairs, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brittany Hook
- United States Department of Veteran Affairs, Domiciliary Care for Homeless Veterans Program (DCHV), IN, Indianapolis, USA
| | - Anne Lustig
- United States Department of Veteran Affairs, Domiciliary Care for Homeless Veterans Program (DCHV), IN, Indianapolis, USA
| | - Anthony J Perkins
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ariel J Cheatham
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA
- HSR&D Center for Health Information and Communication (CHIC), United States Department of Veteran Affairs, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Dawn M Bravata
- Department of Veteran Affairs, Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), United States, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, IN, 46202, Indianapolis, USA.
- HSR&D Center for Health Information and Communication (CHIC), United States Department of Veteran Affairs, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Indianapolis, IN, USA.
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Smith-MacDonald L, Jones C, Brown MRG, Dunleavy RS, VanderLaan A, Kaneva Z, Hamilton T, Burback L, Vermetten E, Brémault-Phillips S. Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5415. [PMID: 37048029 PMCID: PMC10094650 DOI: 10.3390/ijerph20075415] [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: 01/20/2023] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Exposure to trauma and potentially morally injurious events may lead to moral injury (MI). The link between MI and posttraumatic stress disorder (PTSD) may have particularly relevant implications for treatment-resistant PTSD (TR-PTSD). Multi-modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR), a technology-assisted exposure-based trauma therapy that has been used in the treatment of PTSD, may also be an acceptable modality for patients in the treatment of TR-PTSD and MI. This proof-of-concept study aimed to investigate (1) whether MI co-occurs in military members (MMs) and veterans with TR-PTSD, and (2) the perspectives of MMs and veterans with TR-PTSD utilizing 3MDR for MI. METHODS This study employed a mixed-methods clinical trial. Military Members and veterans participated in this study (N = 11) through self-reported questionnaires, video recordings of treatment sessions, and semi-structured interviews post-session and post-intervention, with longitudinal follow-up to 6 months. RESULTS MI scores correlated with self-reported measures of mental health symptoms related to PTSD. The thematic analysis revealed three emergent themes: (1) Realities of War, (2) Wrestling Scruples, and (3) Moral Sensemaking. CONCLUSION MI was highly correlated with TR-PTSD and themes regarding MI. This result, while preliminary, allows for the postulation that MI may be contributing to the continuation of PTSD symptoms in TR-PTSD, and that 3MDR may be an acceptable modality for addressing these symptoms in MMs and veterans.
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Affiliation(s)
- Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
- St. Stephen’s College, Edmonton, AB T6G 2J6, Canada
| | - Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Matthew R. G. Brown
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2S4, Canada
| | | | - Annelies VanderLaan
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Zornitsa Kaneva
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Tristin Hamilton
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Lisa Burback
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
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Rosing T, Malka M, Brafman D, Fisher PW. A qualitative study of equine-assisted therapy for Israeli military and police veterans with PTSD-impact on self-regulation, bonding and hope. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5074-e5082. [PMID: 35852225 DOI: 10.1111/hsc.13922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/09/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Equine-assisted therapy (EAT) is an increasingly popular form of treatment for people suffering from post-traumatic stress disorder (PTSD) who, for one reason or another, find psychotherapy and other traditional treatment approaches unsuitable or unhelpful. However, the concomitant growth of research in the field is yet to engage with key factors relating to EAT; specifically, there are few studies considering the phenomenological perspective of patients, and the embodied knowledge deriving from the lived experience of PTSD patients who participated in EAT-based intervention programmes. Based on a qualitative-phenomenological study, interviews were conducted with 12 PTSD patients who had completed an EAT-based intervention programme. From these, three main themes characterising the meanings they gave to participation in an EAT-based treatment programme were identified: the ability to relax (self-regulation); establishing a relationship (bonding) and transformation and hope for the future. The findings of this study point to a process whereby participation in an EAT-based treatment programme facilitates the ability to cope with PTSD symptoms in a way that bridges the patient's emotional, social and spiritual-existential dimensions. The findings suggest that EAT can contribute to the healing process of veterans suffering from PTSD.
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Affiliation(s)
- Thom Rosing
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Menny Malka
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Dorit Brafman
- School of Social Work, Ariel University, Hamada, Ariel, Israel
- Therapeutic riding and Canine Institute (ngo), Derech Halord Tel Mond, Tel Mond, Israel
| | - Prudence W Fisher
- Clinical Psychiatric Social Work (in Psychiatry), Columbia University, New York City, New York, USA
- New York State Psychiatric Institute, New York City, New York, USA
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5
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Houle SA, Vincent C, Jetly R, Ashbaugh AR. Patterns of distress associated with exposure to potentially morally injurious events among Canadian Armed Forces service members and Veterans: A multi-method analysis. J Clin Psychol 2021; 77:2668-2693. [PMID: 34224575 DOI: 10.1002/jclp.23205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/27/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study describes patterns of distress associated with exposure to potentially morally injurious experiences (PMIEs) in a Canadian military sample. METHOD Thematic analysis was performed on interviews from PMIE-exposed military members and Veterans. Participants also completed structured diagnostic interviews, and measures of trauma exposure and psychopathology. Multiple regression examined associations among these variables. Information on pharmacological treatment and past diagnoses are reported. RESULTS Eight qualitative themes were identified: changes in moral attitudes, increased sensitivity and reactivity to moral situations, loss of trust, disruptions in identity, disruptions in spirituality, disruptions in interpersonal relatedness, rumination, and internalizing and externalizing emotions and behaviors. Self-report data revealed that degree of PMIE exposure was meaningfully associated with posttraumatic stress disorder. CONCLUSION Qualitative but not quantitative findings supported existing models of moral injury (MI). Additional research is needed to examine the impact of PMIE type on mental health, and to test basic assumptions of MI theory.
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Affiliation(s)
| | - Colin Vincent
- Operational Stress Injury Clinic, Royal Ottawa Health Care Group, Ottawa, Canada
| | - Rakesh Jetly
- The Royal's Institute of Mental Health Research, Ottawa, Canada
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Milan S, Dáu ALBT. The Role of Trauma in Mothers' COVID-19 Vaccine Beliefs and Intentions. J Pediatr Psychol 2021; 46:526-535. [PMID: 33970252 PMCID: PMC8135971 DOI: 10.1093/jpepsy/jsab043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Research on COVID-19 vaccine beliefs has focused primarily on adults' intentions to vaccinate themselves; however, many parents will also face decisions about vaccinating their children. In this study, we examine how maternal posttraumatic stress disorder (PTSD) and trauma history relate to mothers' beliefs and intentions about the COVID-19 vaccine for themselves and their children. METHODS A total of 240 mothers with a mental health history participating in a parenting study answered online survey questions via Prolific. Questions assessed: (a) trauma indictors (past diagnosis, current symptoms, and lifetime exposure to events); (b) vaccine measures (intentions for self and child, COVID-19 vaccine confidence, general vaccine perceived safety, reasoning about vaccine intentions, sources of influence on intentions); and (c) possible explanatory variables (institutional distrust, negative worldviews). ANCOVAs and regression analyses were used. RESULTS When compared with mothers with other mental health diagnoses, mothers with a PTSD history had significantly less confidence in the COVID-19 vaccine and less intent to get the vaccine for themselves or their child. These effects were explained by greater institutional distrust (i.e., significant indirect effects). Mothers with a previous PTSD diagnosis also expressed different reasons for vaccine hesitancy (e.g., less belief in science) and ascribed less influence to healthcare and governmental sources in vaccine decision-making. CONCLUSION Findings highlight the potential utility of a trauma-informed approach in efforts to reduce COVID-19 vaccine hesitancy. For mothers with a history of PTSD, addressing institutional distrust, including towards the healthcare industry, may be an important element to consider in the content, delivery, and mode of vaccine messaging.
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Affiliation(s)
- Stephanie Milan
- Department of Psychological Sciences, University of Connecticut
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7
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Friedmann F, Santangelo P, Ebner-Priemer U, Hill H, Neubauer AB, Rausch S, Steil R, Müller-Engelmann M, Kleindienst N, Bohus M, Fydrich T, Priebe K. Life within a limited radius: Investigating activity space in women with a history of child abuse using global positioning system tracking. PLoS One 2020; 15:e0232666. [PMID: 32392213 PMCID: PMC7213734 DOI: 10.1371/journal.pone.0232666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Early experiences of childhood sexual or physical abuse are often associated with functional impairments, reduced well-being and interpersonal problems in adulthood. Prior studies have addressed whether the traumatic experience itself or adult psychopathology is linked to these limitations. To approach this question, individuals with posttraumatic stress disorder (PTSD) and healthy individuals with and without a history of child abuse were investigated. We used global positioning system (GPS) tracking to study temporal and spatial limitations in the participants’ real-life activity space over the course of one week. The sample consisted of 228 female participants: 150 women with PTSD and emotional instability with a history of child abuse, 35 mentally healthy women with a history of child abuse (healthy trauma controls, HTC) and 43 mentally healthy women without any traumatic experiences in their past (healthy controls, HC). Both traumatized groups—i.e. the PTSD and the HTC group—had smaller movement radii than the HC group on the weekends, but neither spent significantly less time away from home than HC. Some differences between PTSD and HC in movement radius seem to be related to correlates of PTSD psychopathology, like depression and physical health. Yet group differences between HTC and HC in movement radius remained even when contextual and individual health variables were included in the model, indicating specific effects of traumatic experiences on activity space. Experiences of child abuse could limit activity space later in life, regardless of whether PTSD develops.
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Affiliation(s)
| | | | | | - Holger Hill
- Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas B. Neubauer
- DIPF | Leibniz Institute for Research and Information in Education, Frankfurt, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | | | | | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
- McLean Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Kathlen Priebe
- Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, Berlin, Germany
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8
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Media Exposure and General Trust as Predictors of Post-traumatic Stress Disorder: Ten Years after the 5.12 Wenchuan Earthquake in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112386. [PMID: 30373271 PMCID: PMC6266127 DOI: 10.3390/ijerph15112386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 01/23/2023]
Abstract
There is a paucity of literature on the roles of media exposure, general trust, and their interactions in long-term post-traumatic stress disorder (PTSD) symptoms after a natural disaster. Trying to address this knowledge gap, our study aimed to (a) investigate whether exposure to media coverage during the traumatic event and general trust directly affected adult survivors’ long-term PTSD symptoms 10 years after the 5.12 Wenchuan earthquake, and (b) to identify the potential differential pattern of the influence of media exposure on PTSD symptoms for adult survivors with various levels of general trust. Using cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We assessed PTSD symptoms, media exposure, general trust, demographic characteristics, socioeconomic status, and earthquake exposure. Data were analyzed descriptively and with Tobit regression analyses. Reversed relationships between general trust and PTSD were verified, whereas no direct links were found between media exposure and PTSD. Interaction tests revealed that media exposure alleviated PTSD for high-trust survivors, but aggravated PTSD for low-trust survivors. These results suggest that general trust building should be considered in post-disaster construction activities.
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Carey LB, Hodgson TJ. Chaplaincy, Spiritual Care and Moral Injury: Considerations Regarding Screening and Treatment. Front Psychiatry 2018; 9:619. [PMID: 30568605 PMCID: PMC6290645 DOI: 10.3389/fpsyt.2018.00619] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/02/2018] [Indexed: 01/20/2023] Open
Abstract
Moral injury is a complex trauma related syndrome involving a correlation of biological, psychological, social, and spiritual symptoms that can have substantial impact upon health and well-being. This paper argues for a holistic bio-psycho-social-spiritual approach to moral injury, by including chaplaincy in the screening and treatment of moral injury among actively serving military members and retired veterans. As part of the moral injury treatment process, and in alignment with the World Health Organization's Spiritual Intervention Codings, a new technique is proposed, "Pastoral Narrative Disclosure" (PND), as a guide for chaplains and others trained in spiritual care to assist those suffering from moral injury.
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Affiliation(s)
- Lindsay B Carey
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Timothy J Hodgson
- Department of Religious Studies, School of Historical and Philosophical Enquiry, University of Queensland, St. Lucia, QLD, Australia
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