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Verstraeten BSE, Elgbeili G, Hyde A, King S, Olson DM. Maternal Mental Health after a Wildfire: Effects of Social Support in the Fort McMurray Wood Buffalo Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:710-718. [PMID: 33172310 PMCID: PMC8320544 DOI: 10.1177/0706743720970859] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Following disasters, perinatal women are vulnerable to developing post-traumatic stress disorder (PTSD)-like symptoms. Little is known about protective factors. We hypothesized that peritraumatic stress would predict PTSD-like symptoms in pregnant and postpartum women and would be moderated by social support and resilience. METHOD Women (n = 200) who experienced the 2016 Fort McMurray Wood Buffalo wildfire during or shortly before pregnancy completed the Peritraumatic Distress Inventory (PDI), Peritraumatic Dissociative Experiences Questionnaire, and the Impact of Event Scale-Revised for current PTSD-like symptoms. They also completed scales of social support (Social Support Questionnaire-Short Form) and resilience (Connor-Davidson Resilience Scale). RESULTS Greater peritraumatic distress (r = 0.56) and dissociative experiences (r = 0.56) correlated with more severe PTSD-like symptoms. Greater social support satisfaction was associated with less severe post-traumatic stress symptoms but only when peritraumatic distress was below average; at more severe levels of PDI, this psychosocial variable was not protective. CONCLUSIONS Maternal PTSD-like symptoms after a wildfire depend on peritraumatic distress and dissociation. Higher social support satisfaction buffers the association with peritraumatic distress, although not when peritraumatic reactions are severe. Early psychosocial interventions may protect perinatal women from PTSD-like symptoms after a wildfire.
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Affiliation(s)
| | - Guillaume Elgbeili
- 26632Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Ashley Hyde
- 12357Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne King
- Department of Psychiatry, 5620McGill University, Montréal, Québec, Canada
| | - David M Olson
- Department of Obstetrics & Gynecology, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Physiology, 3158University of Alberta, Edmonton, Alberta, Canada
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Thiel F, Berman Z, Dishy G, Chan S, Seth H, Tokala M, Pitman RK, Dekel S. Traumatic memories of childbirth relate to maternal postpartum posttraumatic stress disorder. J Anxiety Disord 2021; 77:102342. [PMID: 33276245 PMCID: PMC7856222 DOI: 10.1016/j.janxdis.2020.102342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
The trauma memory is a crucial feature of PTSD etiology and maintenance. Nonetheless, the nature of memories associated with childbirth-related posttraumatic stress disorder (CB-PTSD) requires explication. The present study, as part of a larger project on psychological outcomes of childbirth, utilized a multi-method approach to characterize childbirth memories in relation to CB-PTSD symptoms. We here assessed 413 women who completed self-report measures pertaining to CB-PTSD, postpartum depression, and childbirth memories. Additionally, a subset of 209 women provided written childbirth narratives, analyzed using Linguistic Inquiry and Word Count software. Women endorsing CB-PTSD symptoms on the PTSD-Checklist (PCL)-5 reported more incoherent childbirth memories with more emotional and sensory details, and more frequent involuntary recall and reliving of the memory. They also indicated the childbirth experience was more central to their identity. Written narratives in those with probable CB-PTSD were characterized by less (positive) affective processes, and more cognitive processes. We infer that childbirth memories in women who endorse symptoms of CB-PTSD in the early postpartum period resemble those described in the general PTSD literature. This suggests that childbirth may be experienced as traumatic and evoke a traumatic memory, implicated in symptom endorsement. Opportunities for therapeutic interventions modifying traumatic memories of childbirth in women at risk for CB-PTSD need to be investigated. Future research examining characteristics of traumatic childbirth memories is needed to advance our understanding of this overlooked postpartum condition.
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Affiliation(s)
- Freya Thiel
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Zohar Berman
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Gabriella Dishy
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Sabrina Chan
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Himani Seth
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Meghan Tokala
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
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Goral A, Greene T, Gelkopf M. Does sense of threat in civilians during an armed conflict predict subsequent depression symptoms? J Clin Psychol 2020; 76:1293-1303. [PMID: 32003909 DOI: 10.1002/jclp.22935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We aimed to assess whether peritraumatic threat experienced during a period of armed conflict predicted subsequent depression symptoms. METHOD Ninety-six Israeli civilians provided real-time reports of exposure to rocket warning sirens and subjective sense of threat, twice daily for 30 days, during the 2014 Israel-Gaza conflict. Depression symptoms were reported 2 months after the conflict. Mixed-effects models were used to estimate peritraumatic threat levels and peritraumatic threat reactivity (within-person elevations in threat following siren exposure). These were then assessed as predictors of depression symptoms at 2 months in an adjusted regression model. RESULTS Individual peritraumatic threat level, but not peritraumatic threat reactivity, was a significant predictor of 2 months depression symptoms, even after controlling for baseline depression symptoms. CONCLUSIONS The findings imply that in situations of ongoing exposure, screening for perceived levels of peritraumatic threat might be useful in identifying those at risk for developing subsequent depression symptoms.
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Affiliation(s)
- Aviva Goral
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Gelkopf M, Lapid Pickman L, Carlson EB, Greene T. The Dynamic Relations Among Peritraumatic Posttraumatic Stress Symptoms: An Experience Sampling Study During Wartime. J Trauma Stress 2019; 32:119-129. [PMID: 30720893 DOI: 10.1002/jts.22374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022]
Abstract
The associations among peritraumatic posttraumatic stress symptoms (P-PTSS) in the immediate aftermath of trauma exposure, including those in the posttraumatic stress disorder clusters of intrusions, avoidance, negative cognitions and mood (NCM), and arousal, might indicate mechanisms through which enduring PTSD develops. During a period of war, exposed participants (N = 181) were sent twice-daily questionnaires for 30 days via smartphone. We repeatedly assessed the predictive associations between the P-PTSS clusters over time. We performed a multilevel pathway analysis built of multiple triple sequence responses (6,221 cases) on each of the four P-PTSS clusters at a mean time lag of 12 hr (Model A) and 24 hr (Model B) for 181 participants, 85 of whom had been diagnosed with a serious mental illness. Arousal predicted intrusion in Models A and B, bA = 0.08, 95% CI [0.03, 0.12], p < .001 and bB = 0.03, 95% CI [0.00, 0.07], p = .051, respectively; and NCM in Models A and B, bA = 0.09, 95% CI [0.05, 0.12], p < .001 and bB = 0.06, 95% CI [0.03, 0.09], p < .001, respectively. Intrusion predicted arousal in Model B, bB = 0.05, 95% CI [0.01, 0.08], p = .010. NCM predicted arousal, bA = 0.10, 95% CI [0.05, 0.14], p < .001, and avoidance bA = 0.05, 95% CI [0.00, 0.11], p = .052, in Model A. Avoidance did not predict any other cluster. Arousal seemed to be acting as a hub, strengthening feedback loops to and from NCM and intrusion.
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Affiliation(s)
- Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Eve B Carlson
- National Center for PTSD and VA Palo Alto Health Care System, Dept. of Veterans Affairs, USA
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Bachem R, Levin Y, Solomon Z. Trajectories of attachment in older age: interpersonal trauma and its consequences. Attach Hum Dev 2018; 21:352-371. [PMID: 29865920 DOI: 10.1080/14616734.2018.1479871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Previous studies suggest that attachment insecurities may increase after trauma exposure, an effect documented only at a group level. This study explores the heterogeneity of changes over time and examines the associations of the nature of the traumatic event (interpersonal and nonpersonal), and its consequences (posttraumatic stress disorder [PTSD] and loneliness) with attachment trajectories. Two groups of Israeli veterans participated: 164 former prisoners-of-war and 185 combat veterans. Attachment was assessed at four points (1991-2015). Risk factors were evaluated in 1991. Using latent growth mixture modeling, trajectories of attachment insecurities were explored. Three avoidance trajectories (stability, decrease, inverse u-shaped) and two anxiety trajectories (stability, decrease) were identified. The inverse u-shaped avoidance trajectory was associated with captivity, humiliation, loneliness, and PTSD, and stable avoidance was associated with loneliness. Stable anxiety was associated with captivity and loneliness. Attachment insecurities can change during aging and persist decades after a trauma. Trauma-related risk factors are related to more deleterious trajectories.
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Affiliation(s)
- Rahel Bachem
- a I-Core Research Center for Mass Trauma , Tel Aviv University , Tel Aviv , Israel.,b Bob Shapell School of Social Work , Tel Aviv University , Tel Aviv , Israel
| | - Yafit Levin
- a I-Core Research Center for Mass Trauma , Tel Aviv University , Tel Aviv , Israel.,b Bob Shapell School of Social Work , Tel Aviv University , Tel Aviv , Israel
| | - Zahava Solomon
- a I-Core Research Center for Mass Trauma , Tel Aviv University , Tel Aviv , Israel.,b Bob Shapell School of Social Work , Tel Aviv University , Tel Aviv , Israel
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Maniates H, Stoop TB, Miller MW, Halberstadt L, Wolf EJ. Stress-Generative Effects of Posttraumatic Stress Disorder: Transactional Associations Between Posttraumatic Stress Disorder and Stressful Life Events in a Longitudinal Sample. J Trauma Stress 2018; 31:191-201. [PMID: 29630742 PMCID: PMC5906167 DOI: 10.1002/jts.22269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/17/2017] [Accepted: 12/26/2017] [Indexed: 11/06/2022]
Abstract
Longitudinal studies have demonstrated transactional associations between psychopathology and stressful life events (SLEs), such that psychopathology predicts the occurrence of new SLEs, and SLEs in turn predict increasing symptom severity. The association between posttraumatic stress disorder (PTSD), specifically, and stress generation remains unclear. This study used temporally sequenced data from 116 veterans (87.9% male) to examine whether PTSD symptoms predicted new onset SLEs, and if these SLEs were associated with subsequent PTSD severity. The SLEs were objectively rated, using a clinician-administered interview and consensus-rating approach, to assess the severity, frequency, and personal dependence (i.e., if the event was due to factors that were independent of or dependent on the individual) of new-onset SLEs. A series of mediation models were tested, and results provided evidence for moderated mediation whereby baseline PTSD severity robustly predicted personally dependent SLEs, B = 0.03, p = .006, and dependent SLEs predicted increases in follow-up PTSD symptom severity, B = -0.04, p = .003, among participants with relatively lower baseline PTSD severity. After we controlled for baseline PTSD severity, personality traits marked by low constraint (i.e., high impulsivity) were also associated with an increased number of dependent SLEs. Our results provide evidence for a stress-generative role of PTSD and highlight the importance of developing interventions aimed at reducing the occurrence of personally dependent stressors.
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Affiliation(s)
- Hannah Maniates
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Tawni B. Stoop
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Lisa Halberstadt
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Erika J. Wolf
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Dekel S, Stuebe C, Dishy G. Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors. Front Psychol 2017; 8:560. [PMID: 28443054 PMCID: PMC5387093 DOI: 10.3389/fpsyg.2017.00560] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Posttraumatic stress related with the childbirth experience of full-term delivery with health outcomes has been recently documented in a growing body of studies. The magnitude of this condition and the factors that might put a woman at risk for developing childbirth-related postpartum posttraumatic stress disorder (PP-PTSD) symptoms are not fully understood. Methods: In this systematic review of 36 articles representing quantitative studies of primarily community samples, we set to examine PP-PTSD prevalence rates and associated predictors with a focus on the role of prior PTSD and time since childbirth. Results: A significant minority of women endorsed PP-PTSD following successful birth. Acute PP-PTSD rates were between 4.6 and 6.3%, and endorsement of clinically significant PP-PTSD symptoms was identified in up to 16.8% of women in community samples of high quality studies. Negative subjective experience of childbirth emerged as the most important predictor. Endorsement of PTSD before childbirth contributed to PP-PTSD; nevertheless, women without PTSD also exhibited PP-PTSD, with acute rates at 4.6%, signifying a new PTSD onset in the postpartum period. Conclusion: Although the majority of women cope well, childbirth for some can be perceived as a highly stressful experience and even result in the development of PP-PTSD symptoms. More research is needed to understand postpartum adaption and childbirth-related posttraumatic stress outcomes.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical SchoolBoston, MA, USA.,Department of Psychiatry, Massachusetts General HospitalCharlestown, MA, USA
| | - Caren Stuebe
- Department of Psychiatry, Massachusetts General HospitalCharlestown, MA, USA
| | - Gabriella Dishy
- Department of Psychiatry, Massachusetts General HospitalCharlestown, MA, USA
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Fear extinction and memory reconsolidation as critical components in behavioral treatment for posttraumatic stress disorder and potential augmentation of these processes. Neurosci Lett 2017; 649:170-175. [PMID: 28065842 DOI: 10.1016/j.neulet.2017.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with alterations in critical brain regions such as the amygdala, hippocampus, and prefrontal cortex. This brief review has two objectives: (1) to discuss research examining extinction and reconsolidation processes as mechanisms in PTSD psychotherapy, and (2) present possibilities for augmenting extinction and reconsolidation within treatment through alterations to therapeutic interventions and novel approaches. A key component of many effective PTSD therapies is exposure, which involves intentional confrontation and processing of the traumatic memory. Our review suggests that extinction and reconsolidation processes underlie effective exposure-based treatment, but the neurobiological mechanisms of these processes in behavioral treatments for PTSD remains unclear. We argue that enhancing extinction and/or disrupting reconsolidation of a feared memory may improve the efficacy of existing treatments (e.g., increased change for limited/non-responders, faster/greater changes for responders), which can be done through multiple channels. Potential avenues for augmentation of the processes of extinction and reconsolidation in PTSD psychotherapies are reviewed, including behavioral modifications, pharmacotherapy agents, and the use of devices during therapy. We further suggest that investigations towards understanding the extent to which extinction and reconsolidation processes are necessary in effective PTSD psychotherapy is an important future direction for enhancing clinical care among PTSD populations.
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Andrade C, McCall WV, Youssef NA. Electroconvulsive therapy for post-traumatic stress disorder: efficacy, mechanisms and a hypothesis for new directions. Expert Rev Neurother 2016; 16:749-53. [DOI: 10.1080/14737175.2016.1179114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - W. Vaughn McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Nagy A. Youssef
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Mamon D, Solomon Z, Dekel S. Obsessive Compulsive Symptoms Predict Posttraumatic Growth: A Longitudinal Study. JOURNAL OF LOSS & TRAUMA 2016. [DOI: 10.1080/15325024.2015.1117931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Daria Mamon
- Department of Clinical Psychology, William James College, Newton, Massachusetts, USA
| | - Zahava Solomon
- School of Social Work, Tel Aviv University, Tel Aviv, Israel
- I-Core Research Center for Mass Trauma, Tel Aviv, Israel
| | - Sharon Dekel
- Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Dekel S, Hankin IT, Pratt JA, Hackler DR, Lanman ON. Posttraumatic Growth in Trauma Recollections of 9/11 Survivors: A Narrative Approach. JOURNAL OF LOSS & TRAUMA 2015. [DOI: 10.1080/15325024.2015.1108791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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