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van Zuiden M, Engel S, Karchoud JF, Wise TJ, Sijbrandij M, Mouthaan J, Olff M, van de Schoot R. Sex-differential PTSD symptom trajectories across one year following suspected serious injury. Eur J Psychotraumatol 2022; 13:2031593. [PMID: 35186216 PMCID: PMC8856115 DOI: 10.1080/20008198.2022.2031593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recent years have shown an increased application of prospective trajectory-oriented approaches to posttraumatic stress disorder (PTSD). Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD symptom trajectories have not yet been extensively studied. OBJECTIVE To perform an in-depth investigation of differences in PTSD symptom trajectories across one-year post-trauma between men and women, by interpreting the general trends of trajectories observed in sex-disaggregated samples, and comparing within-trajectory symptom course and prevalence rates. METHOD We included N = 554 participants (62.5% men, 37.5% women) from a multi-centre prospective cohort of emergency department patients with suspected severe injury. PTSD symptom severity was assessed at 1, 3, 6, and 12 months post-trauma, using the Clinician-Administered PTSD Scale for DSM-IV. Latent growth mixture modelling on longitudinal PTSD symptoms was performed within the sex-disaggregated whole samples. Bayesian modelling with informative priors was applied for reliable model estimation, considering the imbalanced prevalence of the expected latent trajectories. RESULTS In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable, but resilient women had higher symptoms than resilient men. Sex differences in prevalence rates were observed for the recovery (higher in women) and delayed onset (higher in men) trajectories. Model fit for the sex-disaggregated samples was better than for the whole sample, indicating preferred application of sex-disaggregation. Analyses within the whole sample led to biased estimates of overall and sex-specific trajectory prevalence rates. CONCLUSIONS Sex-disaggregated trajectory analyses revealed limited sex differences in PTSD symptom trajectories within one-year post-trauma in terms of general trends, courses and prevalence rates. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.
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Affiliation(s)
- Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jeanet F Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Thomas J Wise
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology; Amsterdam Public Health Research Institute, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Joanne Mouthaan
- Department of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, AK Leiden, Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands & Arq National Psychotrauma Centre, Amsterdam, The Netherlands
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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da Silva JAM, Siegmund G, Bredemeier J. Crisis interventions in online psychological counseling. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2016; 37:171-82. [PMID: 26689385 DOI: 10.1590/2237-6089-2014-0026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/22/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The world's population is often assailed by crises of various orders. Disasters caused by nature and by humans themselves also impact on people's mental health. Psychological crises, such as suicide attempts, represent a growing problem in mental health. When faced with such scenarios, specific strategies of crisis intervention are both appropriate and necessary. OBJECTIVE To conduct a systematic review of the literature dealing with online psychological crisis intervention, describing and discussing their operational design, specific characteristics and applications. METHOD A systematic review of literature indexed on the PubMed, PsycINFO, and SciELO databases identified by searches conducted from January to June of 2014. RESULTS The searches identified 17 empirical studies about online crisis interventions which were reviewed. Three crisis contexts emerged: 1) disasters, 2) risk/prevention of suicide, and 3) trauma. Eleven different intervention programs were described and the predominant treatment approach was cognitive behavioral therapy. The results showed that research into online psychological crisis intervention has been conducted in several different countries, especially the Netherlands and Australia, and that the users of these tools benefit from them. CONCLUSION Online crisis interventions have been developed and researched in many countries around the world. In Brazil, there is still a lack of investment and research in this area.
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Affiliation(s)
| | - Gerson Siegmund
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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3
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Zwingmann J, Hagelschuer P, Langenmair E, Bode G, Herget G, Südkamp NP, Hammer T. Lower Health-Related Quality of Life in Polytrauma Patients: Long-Term Follow-Up After Over 5 Years. Medicine (Baltimore) 2016; 95:e3515. [PMID: 27175646 PMCID: PMC4902488 DOI: 10.1097/md.0000000000003515] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Although trauma-associated mortality has fallen in recent decades, and medical care has continued to improve in many fields, the quality of life after experiencing polytrauma has attracted little attention in the literature. This group of patients suffer from persisting physical disabilities. Moreover, they experience long-term social, emotional, and psychological effects that limit/lower considerably their quality of life.We analyzed retrospective data on 147 polytraumatized patients by administering written questionnaires and conducting face-to-face interviews 6 ± 0.8 years after the trauma in consideration of the following validated scores: Glasgow Outcome Scale, European Quality of Life Score, Short Form-36, Trauma Outcome Profile, and Beck Depressions Inventory II.Our analysis of these results reveals that polytraumatized patients suffer from persistent pain and functional disabilities after >5 years. We also observed changes in their socioeconomic situation, as well as psychological after-effects.The rehabilitation of this particular group of patients should not only address their physical disabilities. The psychological after-effects of trauma must be acknowledged and addressed for an even longer period of time.
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Affiliation(s)
- Jörn Zwingmann
- From the Department of Orthopaedic and Trauma Surgery, University of Freiburg Medical Center, Freiburg, Germany
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4
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Mouthaan J, Sijbrandij M, Reitsma JB, Luitse JSK, Goslings JC, Gersons BPR, Olff M. The role of early pharmacotherapy in the development of posttraumatic stress disorder symptoms after traumatic injury: an observational cohort study in consecutive patients. Gen Hosp Psychiatry 2015; 37:230-5. [PMID: 25805128 DOI: 10.1016/j.genhosppsych.2015.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Pharmacological intervention during traumatic memory consolidation has been suggested to prevent posttraumatic stress disorder (PTSD). The aim of this study was to examine the association between prescription of early pharmacotherapy and the risk of developing PTSD symptoms following traumatic injury. METHOD The use of opiate analgesics, beta-adrenergic blockers, corticosteroids and benzodiazepines within 48 h postinjury was documented based on hospital charts for 629 Level 1 trauma center patients. PTSD symptoms were assessed using structured clinical interviews. Primary outcome was 6-week PTSD symptoms. Secondary outcomes were PTSD diagnoses at 6 weeks and during 1 year posttrauma. RESULTS Linear regression analyses showed that opiate administration within 48 h was negatively associated with PTSD symptoms at 6 weeks (β=-0.14, P=.009) after controlling for demographic and injury-related characteristics and concurrent pharmacotherapy. Fewer patients with opiates had a PTSD diagnosis at 6 weeks (P=.047) and during 1 year posttrauma (P=.013) than patients with none of the specified pharmacotherapies. Low prescription frequency of beta-blockers (3.8%), corticosteroids (2.2%) and benzodiazepines (7.8%) precluded further examination of their role in the development of PTSD symptoms because of limited statistical power. CONCLUSIONS This study suggests a possible beneficial influence of opiate administration within 48 h posttrauma on the development of PTSD symptoms. Future studies may evaluate the effectiveness of inhospital opiate analgesics compared to placebo in preventing PTSD and may focus on the mechanisms underlying the effect of opiates in preventing PTSD.
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Affiliation(s)
- Joanne Mouthaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Department of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
| | - Marit Sijbrandij
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - Johannes B Reitsma
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Jan S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Berthold P R Gersons
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, The Netherlands.
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, The Netherlands.
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5
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Bolton AJ, Dorstyn DS. Telepsychology for Posttraumatic Stress Disorder: A systematic review. J Telemed Telecare 2015; 21:254-67. [DOI: 10.1177/1357633x15571996] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/16/2022]
Abstract
Summary The effectiveness of psychological services provided remotely, telepsychology, for the management of Posttraumatic Stress Disorder (PTSD) was evaluated. Eleven studies ( n = 472 participants) were identified from electronic database searches. Study quality was assessed, with studies characterised by small and underpowered samples. Effect sizes and associated confidence intervals (CIs) were calculated to determine the direction and magnitude of treatment change. Short-term treatment gains were reported for internet and video-based interventions. This included significant medium to large improvements ( d range = 0.66–3.22) in cognitive and behavioural symptoms of depression, generalised anxiety and posttraumatic stress. However, the equivalence of telepsychology and face-to-face psychotherapy could not be determined, with few comparative studies available. Both treatment gains and deterioration were noted 1 to 6 months following treatment cessation, although this was based on limited follow-up data. Further larger scale and longitudinal research will help to ascertain the minimum requirements for the management and treatment of PTSD in a technology-supported environment.
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Affiliation(s)
- AJ Bolton
- School of Psychology, University of Adelaide, Adelaide, South Australia 5005
| | - DS Dorstyn
- School of Psychology, University of Adelaide, Adelaide, South Australia 5005
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6
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Abstract
The field of mobile health ("m-Health") is evolving rapidly and there is an explosive growth of psychological tools on the market. Exciting high-tech developments may identify symptoms, help individuals manage their own mental health, encourage help seeking, and provide both preventive and therapeutic interventions. This development has the potential to be an efficient cost-effective approach reducing waiting lists and serving a considerable portion of people globally ("g-Health"). However, few of the mobile applications (apps) have been rigorously evaluated. There is little information on how valid screening and assessment tools are, which of the mobile intervention apps are effective, or how well mobile apps compare to face-to-face treatments. But how feasible is rigorous scientific evaluation with the rising demands from policy makers, business partners, and users for their quick release? In this paper, developments in m-Health tools-targeting screening, assessment, prevention, and treatment-are reviewed with examples from the field of trauma and posttraumatic stress disorder. The academic challenges in developing and evaluating m-Health tools are being addressed. Evidence-based guidance is needed on appropriate research designs that may overcome some of the public and ethical challenges (e.g., equity, availability) and the market-driven wish to have mobile apps in the "App Store" yesterday rather than tomorrow.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands;
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Abend R, Dan O, Maoz K, Raz S, Bar-Haim Y. Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety. J Behav Ther Exp Psychiatry 2014; 45:447-53. [PMID: 24978117 DOI: 10.1016/j.jbtep.2014.06.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/24/2014] [Accepted: 06/06/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Assessment of state anxiety is frequently required in clinical and research settings, but its measurement using standard multi-item inventories entails practical challenges. Such inventories are increasingly complemented by paper-and-pencil, single-item visual analog scales measuring state anxiety (VAS-A), which allow rapid assessment of current anxiety states. Computerized versions of VAS-A offer additional advantages, including facilitated and accurate data collection and analysis, and applicability to computer-based protocols. Here, we establish the psychometric properties of a computerized VAS-A. METHODS Experiment 1 assessed the reliability, convergent validity, and discriminant validity of the computerized VAS-A in a non-selected sample. Experiment 2 assessed its sensitivity to increase in state anxiety following social stress induction, in participants with high levels of social anxiety. RESULTS Experiment 1 demonstrated the computerized VAS-A's test-retest reliability (r = .44, p < .001); convergent validity with the State-Trait Anxiety Inventory's state subscale (STAI-State; r = .60, p < .001); and discriminant validity as indicated by significantly lower correlations between VAS-A and different psychological measures relative to the correlation between VAS-A and STAI-State. Experiment 2 demonstrated the VAS-A's sensitivity to changes in state anxiety via a significant pre- to during-stressor rise in VAS-A scores (F(1,48) = 25.13, p < .001). LIMITATIONS Set-order administration of measures, absence of clinically-anxious population, and gender-unbalanced samples. CONCLUSIONS The adequate psychometric characteristics, combined with simple and rapid administration, make the computerized VAS-A a valuable self-rating tool for state anxiety. It may prove particularly useful for clinical and research settings where multi-item inventories are less applicable, including computer-based treatment and assessment protocols. The VAS-A is freely available: http://people.socsci.tau.ac.il/mu/anxietytrauma/visual-analog-scale/.
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Affiliation(s)
- Rany Abend
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel.
| | - Orrie Dan
- Department of Psychology, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Israel
| | - Keren Maoz
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
| | - Sivan Raz
- Department of Psychology, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel
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8
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The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms. Psychoneuroendocrinology 2014; 45:179-86. [PMID: 24845188 DOI: 10.1016/j.psyneuen.2014.04.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Decreased activation of the hypothalamus-pituitary-adrenal (HPA) axis in response to stress is suspected to be a vulnerability factor for posttraumatic stress disorder (PTSD). Previous studies showed inconsistent findings regarding the role of cortisol in predicting PTSD. In addition, no prospective studies have examined the role of dehydroepiandrosterone (DHEA), or its sulfate form DHEAS, and the cortisol-to-DHEA(S) ratio in predicting PTSD. In this study, we tested whether acute plasma cortisol, DHEAS and the cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks and 6 months post-trauma. METHODS Blood samples of 397 adult level-1 trauma center patients, taken at the trauma resuscitation room within hours after the injury, were analyzed for cortisol and DHEAS levels. PTSD symptoms were assessed at 6 weeks and 6 months post-trauma with the Clinician Administered PTSD Scale. RESULTS Multivariate linear regression analyses showed that lower cortisol predicted PTSD symptoms at both 6 weeks and 6 months, controlling for age, gender, time of blood sampling, injury, trauma history, and admission to intensive care. Higher DHEAS and a smaller cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks, but not after controlling for the same variables, and not at 6 months. CONCLUSIONS Our study provides important new evidence on the crucial role of the HPA-axis in response to trauma by showing that acute cortisol and DHEAS levels predict PTSD symptoms in survivors of recent trauma.
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9
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Mouthaan J, Sijbrandij M, Reitsma JB, Gersons BPR, Olff M. Comparing screening instruments to predict posttraumatic stress disorder. PLoS One 2014; 9:e97183. [PMID: 24816642 PMCID: PMC4016271 DOI: 10.1371/journal.pone.0097183] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Following traumatic exposure, a proportion of trauma victims develops posttraumatic stress disorder (PTSD). Early PTSD risk screening requires sensitive instruments to identify everyone at risk for developing PTSD in need of diagnostic follow-up. AIMS This study compares the accuracy of the 4-item SPAN, 10-item Trauma Screening Questionnaire (TSQ) and 22-item Impact of Event Scale-Revised (IES-R) in predicting chronic PTSD at a minimum sensitivity of 80%. METHOD Injury patients admitted to a level-I trauma centre (N = 311) completed the instruments at a median of 23 days and were clinically assessed for PTSD at 6 months. Areas under the curve and specificities at 80% sensitivity were compared between instruments. RESULTS Areas under the curve in all instruments were adequate (SPAN: 0.83; TSQ: 0.82; IES-R: 0.83) with no significant differences. At 80% sensitivity, specificities were 64% for SPAN, 59% for TSQ and 72% for IES-R. CONCLUSION The SPAN, TSQ and IES-R show similar accuracy in early detection of individuals at risk for PTSD, despite differences in number of items. The modest specificities and low positive predictive values found for all instruments could lead to relatively many false positive cases, when applied in clinical practice.
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Affiliation(s)
- Joanne Mouthaan
- Department of Psychiatry, Centre for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Clinical Psychology, VU University, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Johannes B. Reitsma
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Berthold P. R. Gersons
- Department of Psychiatry, Centre for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Centre, Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Centre for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Centre, Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
- * E-mail:
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Mouthaan J, Sijbrandij M, de Vries GJ, Reitsma JB, van de Schoot R, Goslings JC, Luitse JSK, Bakker FC, Gersons BPR, Olff M. Internet-based early intervention to prevent posttraumatic stress disorder in injury patients: randomized controlled trial. J Med Internet Res 2013; 15:e165. [PMID: 23942480 PMCID: PMC3742408 DOI: 10.2196/jmir.2460] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/03/2013] [Accepted: 06/10/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. OBJECTIVE To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients. METHODS Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale-Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented. RESULTS The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001). CONCLUSIONS Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).
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Affiliation(s)
- Joanne Mouthaan
- Center for Anxiety Disorders, Research Group Psychotrauma, Department of Psychiatry, Academic Medical Center, Amsterdam, Netherlands.
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Marsac ML, Kohser KL, Winston FK, Kenardy J, March S, Kassam-Adams N. Using a web-based game to prevent posttraumatic stress in children following medical events: design of a randomized controlled trial. Eur J Psychotraumatol 2013; 4:21311. [PMID: 23898396 PMCID: PMC3725541 DOI: 10.3402/ejpt.v4i0.21311] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/25/2013] [Accepted: 06/26/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medical events including acute illness and injury are among the most common potentially traumatic experiences for children. Despite the scope of the problem, only limited resources are available for prevention of posttraumatic stress symptoms (PTSS) after pediatric medical events. Web-based programs provide a low-cost, accessible means to reach a wide range of families and show promise in related areas of child mental health. OBJECTIVES To describe the design of a randomized controlled trial that will evaluate feasibility and estimate preliminary efficacy of Coping Coach, a web-based preventive intervention to prevent or reduce PTSS after acute pediatric medical events. METHOD Seventy children and their parents will be randomly assigned to either an intervention or a waitlist control condition. Inclusion criteria require that children are aged 8-12 years, have experienced a medical event, have access to Internet and telephone, and have sufficient competency in the English language to complete measures and understand the intervention. Participants will complete baseline measures and will then be randomized to the intervention or waitlist control condition. Children in the intervention condition will complete module 1 (Feelings Identification) in the hospital and will be instructed on how to complete modules 2 (Appraisals) and 3 (Avoidance) online. Follow-up assessments will be conducted via telephone at 6, 12, and 18 weeks after the baseline assessment. Following the 12-week assessment, children in the waitlist control condition will receive instructions for completing the intervention. RESULTS Primary study outcomes include data on intervention feasibility and outcomes (child appraisals, coping, PTSS and health-related quality of life). DISCUSSION Results will provide data on the feasibility of the implementation of the Coping Coach intervention and study procedures as well as estimations of efficacy to determine sample size for a larger study. Potential strengths and limitations of this design are discussed.
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Affiliation(s)
- Meghan L. Marsac
- Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen L. Kohser
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Flaura K. Winston
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of General Pediatrics and Leonard David Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Justin Kenardy
- Schools of Medicine and Psychology, University of Queensland, Brisbane, Australia
| | - Sonja March
- Department of School of Psychology, Counselling and Community, University of Southern Queensland, Toowoomba, Australia
| | - Nancy Kassam-Adams
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
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12
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Vermetten E, Olff M. Psychotraumatology in the Netherlands. Eur J Psychotraumatol 2013; 4:20832. [PMID: 23671764 PMCID: PMC3644061 DOI: 10.3402/ejpt.v4i0.20832] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 03/17/2013] [Accepted: 03/17/2013] [Indexed: 12/04/2022] Open
Abstract
The contribution to psychotrauma literature from Dutch authors has a long tradition. The relatively high lifetime prevalence of trauma and posttraumatic stress disorder (PTSD) is not unique for the Netherlands and does not fully explain the interest in trauma and its consequences. In this overview of psychotraumatology in the Netherlands, we will discuss some of the key events and processes that contribute to the current interest. We outlined the historical basis and development of the field in the Netherlands, including the impact of World War II, the effects of major man-made or natural disasters, engagement in military conflicts, as well as smaller scale traumatic events like sexual abuse and traffic accidents. The liberal and open culture may have reduced stigma to trauma, while other sociocultural aspects may have contributed to increased prevalence. Finally, we describe Dutch psychotraumatology today and how history and culture have shaped the current scientific basis.
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Affiliation(s)
- Eric Vermetten
- Military Mental Health Research Center, Ministery of Defence, Utrecht, The Netherlands
- Department of Psychiatry, University Medical Center, Utrecht, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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13
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Olff M. Bonding after trauma: on the role of social support and the oxytocin system in traumatic stress. Eur J Psychotraumatol 2012; 3:EJPT-3-18597. [PMID: 22893838 PMCID: PMC3402118 DOI: 10.3402/ejpt.v3i0.18597] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper outlines the state of affairs in psychobiological research on psychotrauma and PTSD with a focus on the role of the oxytocin system in traumatic stress. With a high prevalence of trauma and PTSD in the Netherlands, new preventive and therapeutic interventions are needed. The focus is on the role of social support and bonding in coming to grips with psychological trauma, about the oxytocin system as a basis for reducing the stress response and creating a feeling of bonding, about binding words to painful emotions in psychotherapy, and about the bonds between researchers and clinicians.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam & Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Mouthaan J, Sijbrandij M, Reitsma JB, Gersons BPR, Olff M. Internet-based prevention of posttraumatic stress symptoms in injured trauma patients: design of a randomized controlled trial. Eur J Psychotraumatol 2011; 2:EJPT-2-8294. [PMID: 22893814 PMCID: PMC3402131 DOI: 10.3402/ejpt.v2i0.8294] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/14/2011] [Accepted: 09/29/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Injured trauma victims are at risk of developing Posttraumatic Stress Disorder (PTSD) and other post-trauma psychopathology. So far, interventions using cognitive behavioral techniques (CBT) have proven most efficacious in treating early PTSD in highly symptomatic individuals. No early intervention for the prevention of PTSD for all victims has yet proven effective. In the acute psychosocial care for trauma victims, there is a clear need for easily applicable, accessible, cost-efficient early interventions. OBJECTIVE To describe the design of a randomized controlled trial (RCT) evaluating the effectiveness of a brief Internet-based early intervention that incorporates CBT techniques with the aim of reducing acute psychological distress and preventing long-term PTSD symptoms in injured trauma victims. METHOD In a two armed RCT, 300 injured trauma victims from two Level-1 trauma centers in Amsterdam, the Netherlands, will be assigned to an intervention or a control group. Inclusion criteria are: being 18 years of age or older, having experienced a traumatic event according to the diagnostic criteria of the DSM-IV and understanding the Dutch language. The intervention group will be given access to the intervention's website (www.traumatips.nl), and are specifically requested to login within the first month postinjury. The primary clinical study outcome is PTSD symptom severity. Secondary outcomes include symptoms of depression and anxiety, quality of life, and social support. In addition, a cost-effectiveness analysis of the intervention will be performed. Data are collected at one week post-injury, prior to first login (baseline), and at 1, 3, 6 and 12 months. Analyses will be on an intention-to-treat basis. DISCUSSION The results will provide more insight into the effects of preventive interventions in general, and Internet-based early interventions specifically, on acute stress reactions and PTSD, in an injured population, during the acute phase after trauma. We will discuss possible strengths and limitations.
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Affiliation(s)
- Joanne Mouthaan
- Department of Psychiatry, Academic Medical Center, Center for Anxiety Disorders, Research Group Psychotrauma, Amsterdam, the Netherlands
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