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Romeo DJ, Le T, Massenburg BB, Wu M, Ng JJ, Salinero LK, Akarapimand P, Liao EC, Rudofker A, Taylor JA, Magee L. Columbia-Suicide Severity Rating Scale (C-SSRS) Reveals High Rates of Suicidality in 602 Patients With Cleft and Craniofacial Conditions. J Craniofac Surg 2024; 35:1444-1448. [PMID: 38842329 DOI: 10.1097/scs.0000000000010369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Little is known about rates of suicidal ideation and behavior among youth with cleft lip and/or palate (CLP) and other craniofacial conditions. METHODS Records of patients ages 6 and older who were administered the Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime Version during routine multidisciplinary cleft or craniofacial team visits between 2019 and 2023 were examined. Demographics information, C-SSRS data, and diagnoses were assessed with statistics including t tests, the Fisher exact test, and odds ratios. RESULTS A total of 1140 C-SSRS questionnaires across 602 (433 CLP and 169 craniofacial) patients with an average age of 11.2±3.7 years were included. Eighty-four (13.6%) patients endorsed lifetime suicidal ideation, 9 (1.5%) had at least one instance of suicidal behavior, 30 (5.0%) endorsed nonsuicidal self-injury, and 2 (0.3%) engaged in self-injurious behavior. Compared with CLP, those with other craniofacial conditions had similar odds of endorsing suicidal ideation and behavior ( P ≥0.05). Compared with those with isolated cleft palates, CLP had greater odds of endorsing suicidal ideation and behavior, though those differences were not significant ( P ≥0.05). Incidence of suicidality was unchanged before, during, and after the COVID-19 pandemic ( P ≥0.05). Dividing patients by sex or insurance type revealed no difference in suicidality ( P ≥0.05). CONCLUSION Patients with CLP and craniofacial conditions have a high incidence of suicidal ideation and behavior, though levels are similar between these groups. Suicidality in these patients was not negatively impacted by the COVID-19 pandemic. Early identification of safety risks and psychosocial challenges through regular screening can facilitate connection with appropriate clinical interventions.
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Affiliation(s)
- Dominic J Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Sadek J, Diaz-Piedra B, Saleh L, MacDonald L. A narrative review: suicide and suicidal behaviour in older adults. Front Psychiatry 2024; 15:1395462. [PMID: 38800059 PMCID: PMC11117711 DOI: 10.3389/fpsyt.2024.1395462] [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: 03/04/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.
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Affiliation(s)
- Joseph Sadek
- Professor, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Leah Saleh
- Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Luke MacDonald
- MD Candidate, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Butjosa A, Cruz D, Richart T, Terradas MR, Group CCAMH, Lacasa F. Rapid Response Unit for Children and Adolescents at Risk of Suicide: Promoting Therapeutic Linkage and Reducing the Risk of Relapse. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:72-82. [PMID: 38622005 PMCID: PMC11009870 DOI: 10.62641/aep.v52i2.1620] [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: 04/17/2024]
Abstract
INTRODUCTION The increase in suicidal behavior among adolescents under 17 years of age in Catalonia between 2019 and 2022 has gone from 473 to 1425 cases, which entails a new healthcare challenge. The objective of the article is to explain the procedure and intervention of the Rapid Response Unit (RRU) for children and adolescents at risk of suicide. The RRU is a multidisciplinary unit designed to prevent relapse and increase link-up to treatment. The cases attended in its 14 months of operation are described. METHODOLOGY 24 patients, 18 females and 6 males aged between 12 and 17 years, attended for the first time at the Child and Adolescent Health Centre of Cornellà for activation of the Suicide Risk Code (CRS) in hospital emergency departments during the period studied. RESULTS After the intervention, high suicidal risk decreased from 29.17% to 0%, medium risk decreased from 37.5% to 20.83% and low risk increased from 33.33% to 79.17%. In addition, there was only one new CRS activation in the 3 months following the first activation. In the RRU, care was intensive: 52.7% of cases with visits once a week and more than once a week in 24.9%. During the intervention months 100% of cases were linked and no interruptions occurred. CONCLUSIONS Rapid Response Unit (RRU) decreases the risk of recurrence of suicidal behavior and ensures therapeutic linkage.
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Affiliation(s)
- Anna Butjosa
- Child and Adolescent Mental Health Research Group, Sant Joan Research Institute de Déu, 08950 Esplugues de Llobregat, Spain
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopathogenesis and Treatment of Gray Mental Disorders (MERITT), Institute of Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Biomedical Research Networking Center in Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Daniel Cruz
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | - Teresa Richart
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | | | - CCAMH Group
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | - Fernando Lacasa
- Child and Adolescent Mental Health Research Group, Sant Joan Research Institute de Déu, 08950 Esplugues de Llobregat, Spain
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
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Rubenson MP, Gurtovenko K, Simmons SW, Thompson AD. Systematic Review: Patient Outcomes in Transdiagnostic Adolescent Partial Hospitalization Programs. J Am Acad Child Adolesc Psychiatry 2024; 63:136-153. [PMID: 37271333 DOI: 10.1016/j.jaac.2023.03.022] [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: 09/27/2022] [Revised: 03/02/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Partial hospitalization programs (PHPs) are designed to help stabilize patients with acute mental health problems and are considered more cost-effective than inpatient care for patients who do not require 24-hour monitoring. Many PHPs treat transdiagnostic adolescents to reduce suicidality, self-harm, and other high-risk behaviors; however, the effectiveness of such programs is unknown. We aimed to review the existing evidence for the effects of PHPs on adolescent mental health symptoms and functioning. METHOD We retrieved peer-reviewed evaluations of PHPs treating adolescents with a range of disorders that reported quantitative clinical outcomes. We followed PRISMA guidelines for systematic reviews and included studies published since 2000. RESULTS Fifteen studies of 10 PHPs in North America, Europe, Asia, and Australia met inclusion criteria, 5 of which used comparison groups. Most participants were White and female with depressive disorders. All studies found improvements in adolescents' functioning and mental health from admission to discharge; however, only 1 study tested PHP relative to other levels of care, and only 1 study included follow-up data. Dialectical behavior therapy (DBT) may be an effective theoretical orientation for PHP settings, but evidence is limited. CONCLUSION Evidence for effectiveness of PHPs relative to other models is limited. Currently available research suggests that many high-risk transdiagnostic adolescents tend to improve during PHP treatment; however, controlled studies with follow-up data are needed to determine whether partial hospitalization is effective and, if so, how effective, and whether treatment gains persist after discharge.
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Affiliation(s)
- Miriam P Rubenson
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington.
| | - Kyrill Gurtovenko
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Shannon W Simmons
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Alysha D Thompson
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
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Rahmani M, Silverman AL, Thompson A, Pumariega A. Youth Suicidality in the Context of Disasters. Curr Psychiatry Rep 2023; 25:587-602. [PMID: 37768444 DOI: 10.1007/s11920-023-01454-4] [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] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters. RECENT FINDINGS There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.
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Affiliation(s)
- Mariam Rahmani
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Andrew L Silverman
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andrew Thompson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andres Pumariega
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
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Kim H, Lee YJ, Jung SJ. Trends in Depressive Symptoms and Suicidality of South Korean Adolescents: Comparison of Expected and Observed Prevalence During the COVID-19 Pandemic. J Adolesc Health 2023; 73:79-87. [PMID: 37029047 PMCID: PMC10075317 DOI: 10.1016/j.jadohealth.2023.02.014] [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: 06/10/2022] [Revised: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Depressive symptoms and suicidality of adolescents during the COVID-19 pandemic are emerging public health issues. However, there is a lack of representative studies on adolescents' mental health that considers the preceding secular trends. METHODS This descriptive study used nationally representative cross-sectional data of Korean adolescents from the Korea Youth Risk Behavior Survey from 2005 to 2020 (N = 1,035,382). We utilized joinpoint regression analysis to explore the temporal prevalence trends of depressive symptoms, suicidal ideation, and suicide attempts. Based on the annual percentage change until 2019, the expected and actual prevalence in 2020 (N = 54,948) was compared to describe departures of prevalence from the trend line. These trends between sex, school level, ethnic status, and socioeconomic status were also compared. RESULTS Considering the recent increase in secular trends until 2019, the actual observed values in 2020 were lower than expected by 13% in depressive symptoms, 20% in suicidal ideation, and 40% in suicide attempts. The gap between sexes, school levels, ethnic status, and socioeconomic groups was similar or narrowed in 2020 compared to previous trends. DISCUSSION We observed a lower prevalence of depressive symptoms and suicidality among Korean adolescents than expected about 9 months from the beginning of the COVID-19 pandemic despite the recent increase in secular trends.
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Affiliation(s)
- Hyejin Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Yu Jin Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Jae Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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Liu J, Chai L, Zhu H, Han Z. COVID-19 impacts and adolescent suicide: The mediating roles of child abuse and mental health conditions. CHILD ABUSE & NEGLECT 2023; 138:106076. [PMID: 36764172 PMCID: PMC9894761 DOI: 10.1016/j.chiabu.2023.106076] [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: 10/13/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Considerable research has established the harmful impacts of the COVID-19 pandemic on children's and adolescents' health and well-being. However, the literature has been constrained by studies using less representative samples, hindering the generalization of the findings. OBJECTIVE This study aimed to investigate the associations of employment disruption and school closures during the pandemic with suicidal ideation and behavior in children and adolescents-and to consider the potential mediating effects of child psychological and physical abuse and subsequent mental health conditions. PARTICIPANTS AND SETTING This study used the Adolescent Behaviors and Experiences data (n = 4692) - a nationally representative survey administered by the CDC of the United States from January to June 2021. METHODS Logistic regression models were conducted to investigate the associations. A series of multiple mediation models were performed. RESULTS School closures directly reduced child psychological and physical abuse and suicidal ideation and behavior. Employment disruption did not directly predict suicidal ideation and behavior but primarily through child abuse. Mental health's mediation role was significant in the associations between child psychological abuse and suicidal ideation and behavior, but no evidence suggested the same mediating pattern for the physical abuse-suicidal ideation and behavior relationship. Within the covariates, sexual orientation was the most consistent and highest risk factor. CONCLUSIONS This study contributes to current knowledge on disaster impact, child abuse, and suicidal ideation and behavior, and it can also provide policy and intervention awareness for social workers.
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Affiliation(s)
- Jie Liu
- School of Political Science and Public Administration, Shandong University, Jinan, PR China; Institute of Public Safety Research (Center for Public Safety Strategy Research)
| | - Lei Chai
- Department of Sociology, University of Toronto, Toronto, Canada
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, PR China
| | - Ziqiang Han
- School of Political Science and Public Administration, Shandong University, Jinan, PR China; Center for Crisis Management Research, Tsinghua University; Institute of Public Safety Research (Center for Public Safety Strategy Research).
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Ali AM, Al-Dossary SA, Almarwani AM, Atout M, Al-Amer R, Alkhamees AA. The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event. Healthcare (Basel) 2023; 11:healthcare11060892. [PMID: 36981549 PMCID: PMC10048280 DOI: 10.3390/healthcare11060892] [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: 01/14/2023] [Revised: 02/18/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Saeed A Al-Dossary
- Department of Psychology, College of Education, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Abdulaziz Mofdy Almarwani
- Department of Psychiatric Nursing, College of Nursing, Taibah Univesity, Janadah Bin Umayyah Road, Tayba, Medina 42353, Saudi Arabia
| | - Maha Atout
- School of Nursing, Philadelphia University, Amman 19392, Jordan
| | - Rasmieh Al-Amer
- Faculty of Nursing, Isra University, Amman 11953, Jordan
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia
| | - Abdulmajeed A Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
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Zarowsky Z, Rashid T. Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19. INTERNATIONAL JOURNAL OF APPLIED POSITIVE PSYCHOLOGY 2022; 8:1-36. [PMID: 36196257 PMCID: PMC9523176 DOI: 10.1007/s41042-022-00078-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.
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Affiliation(s)
- Zachary Zarowsky
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trial, Toronto, ON M1C 1A4 Canada
| | - Tayyab Rashid
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trial, Toronto, ON M1C 1A4 Canada
- Centre for Wellbeing Science, Melbourne Graduate School of Education, Melbourne, Australia
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The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events. J Pers Med 2022; 12:jpm12050681. [PMID: 35629104 PMCID: PMC9144426 DOI: 10.3390/jpm12050681] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.
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