Post-traumatic stress in children as a result of war: Strategies for psychological support

Background: Studies on mental health rates among primary school children are still limited, particularly related to psychological trauma and its relationship to other mental health challenges. Objective: The objective of this study was to 1) examine the prevalence of PTSD, depression, and anxiety symptoms in primary school children before the Covid-19 pandemic; 2) identify the relationship between PTSD, depression and anxiety symptoms; and 3) investigate potential gender differences in PTSD symptoms. Methods: This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in primary school children before the covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in this study. PTSD Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD), and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Results: Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms, and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model indicated that depressive symptoms were the only significant predictors of PTSD. In the second model, religion, family income, anxiety, and PTSD symptoms were significant predictors of depressive symptoms. In the third model, depressive symptoms were the sole significant predictors of anxiety. Conclusion: The study reveals that primary school children experience high levels of trauma, PTSD, depression, and anxiety, especially before the COVID-19 pandemic. During the early phases of the pandemic, these mental health issues have been largely neglected in Malaysia, with limited preventative and therapeutic interventions available. Future research should focus on documenting the prevalence of these issues in relation to the COVID-19 pandemic.

Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors. A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD. Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used. The presence (B=6.5, p=.03) and severity (B=6.3, p<.01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals. Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness. There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may differentially impact alternative PTSD treatments.

We know little about how change unfolds in depression symptoms during posttraumatic stress disorder (PTSD) treatment or how patient characteristics predict depression symptom change. This study examined critical transition points in depression symptoms during PTSD treatment, namely, depression sudden gains, which are rapid symptom improvements and transient depression spikes, which are transient depression worsenings. Social support, one of the strongest predictors of PTSD development, was examined as a predictor of depression symptom discontinuities. At pretreatment, 200 participants (76.6% female; 64.9% Caucasian; age M = 37.1, SD = 11.3 years) completed measures of PTSD severity (PTSD Symptom Scale-Self-Report), depression severity (Beck Depression Inventory), general social support (Inventory of Socially Supportive Behaviors; Social Support Questionnaire), and trauma-related social support (Social Reactions Questionnaire). During 10 weeks of prolonged exposure (PE) or sertraline, depression was assessed weekly. Overall, 18.0% of participants experienced a depression sudden gain, and 22.5% experienced a transient depression spike. The presence of a depression sudden gain predicted better treatment outcome, β = -4.82, SE = 1.17, p = .001, 95% CI [-6.79, -2.90]. Higher perceptions of negative trauma-related reactions, albeit modestly, were associated with experiencing a transient depression spike (r = .18, p = .01). There were no differences in rates of depression sudden gains or transient depression spikes between treatments. Encouragingly, rapid improvements in depression symptoms are beneficial for PTSD treatment outcome, but transient spikes in depressive symptoms do not strongly influence outcome. Understanding symptom discontinuities may help us to personalize current PTSD treatment options.

Clinical Characteristics and Health Service Use of Veterans With Comorbid Bipolar Disorder and PTSD

Back to table of contents Previous article Next article Professional NewsFull AccessMajor Study Will Assess 'What Works' in PTSD CareAaron LevinAaron LevinPublished Online:1 Apr 2011https://doi.org/10.1176/pn.46.7.psychnews_46_7_4_1AbstractThe Department of Defense and the Department of Veterans Affairs have received enormous funding from Congress for treating PTSD, but we can't view that as a bottomless pit," Navy Capt. Paul Hammer, M.C., said at the first meeting of an Institute of Medicine (IOM) panel that will study the current status of research and treatment of posttraumatic stress disorder (PTSD). "We have to learn to treat PTSD at a reasonable cost," said Hammer, an APA member and the new director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Doing that requires knowing more about the disorder, its causes, diagnosis, and treatment, so the Department of Defense (DoD) requested the IOM study. The panel is chaired by Sandro Galea, M.D., Dr.P.H., a professor and chair of the Department of Epidemiology in the Mailman School of Public Health at Columbia University. The request came three years after another report from the IOM noting that "significant gaps" existed in the evidence underlying nearly all treatments for PTSD (Psychiatric News, December 7, 2007). The earlier report said that only therapies that included some element of exposure to reminders of trauma—like prolonged exposure therapy, cognitive-behavioral therapy, or cognitive-processing therapy—were backed by sufficient evidence from clinical trials. "The 2007 PTSD report was simply an evaluation of the evidence on best practices for PTSD," said Galea. "Our mandate with this study is to understand what the best approach to screening, prevention, treatment, and rehabilitation for PTSD is and what DoD and the Department of Veterans Affairs [VA] should be doing about it." The panel will spend two years gathering information from the two federal departments "on programs and methods available for the prevention, screening, diagnosis, treatment, and rehabilitation of posttraumatic stress disorder," as well as study clinical trials of innovative treatments and services. The panel will then take another two years to evaluate the rates of success of each modality. The study could clarify how well current PTSD programs are working and identify gaps in assessment and treatment, said Hammer during the panel's initial meeting in late February. About 2.4 percent of the 2.2 million deployed service members have been diagnosed with PTSD, but depending on survey methodology, 10 percent to 17 percent of service members report some symptoms of PTSD, he noted. Several areas require special attention in any study of PTSD in military populations, Hammer pointed out.For example, "patterns of comorbidities are different in military populations, compared to the civilian sector," he said. Mild traumatic brain injury, pain, and substance abuse are common. In addition, combat troops less often report Category A ("horror") PTSD symptoms, because their military training and experience prepares them for battle. But they also have less access to protective factors due to their frequent re-exposure and the "tough-it-out" military culture, he said. National Guard and Reserve personnel are at even greater risk of PTSD and have less access to therapists skilled in PTSD care for military populations because they are dispersed geographically after they return from war zones. The armed forces have used several strategies to protect troops. Education and training begin at the start of military service. Increased screening and surveillance, interventions to manage combat stress in the field, and a full spectrum of available treatments in war zones and at home also serve as factors that may mitigate the likelihood or severity of PTSD. The Military Health System has increased behavioral health staffing from about 4,000 in 2007 to about 6,500 now, so fewer referrals for care go unfulfilled. Spending on PTSD care for the current cohort of veterans is likely to be high, and the true costs of treating them needed to be made clear, said Hammer. But more work needs to be done first. "Data are problematic on the effectiveness of current therapies," said Hammer. "We don't know what type of therapy is used or whether the therapist has made individual modifications. We don't have the ability to track measures over time." The executive director of the VA's National Center for PTSD (NCPTSD), Matthew Friedman, M.D., Ph.D., stressed that more should be done to monitor outcomes in clinical practice, expand the use of evidence-based therapies and clinical practice guidelines, and increase quality improvement and program evaluation efforts. The National Center for PTSD is a hub for research into the neuroscience of PTSD and its treatment, along with ways to move that research into the clinic. Basic research there now addresses mechanisms underlying the development of PTSD, as well as resilience, treatment effectiveness, and treatment resistance, Friedman told the IOM panel. The NCPTSD also provides PTSD-related assessment tools, training, treatment guides, and consultation services within the VA, he said. In addition, it provides information on PTSD and its treatment for outside clinicians and for the public via its Web site. The IOM study, when completed, will help guide future DoD and VA policies for screening, diagnosing, and treating service members and veterans. That can't come too soon, said Hammer. "We need to get it right and target well for what works," said Hammer.Information on the Institute of Medicine's "Assessment of Ongoing Efforts in the Treatment of PTSD" is posted at <www.iom.edu/Activities/Veterans/PTSDTreatment.aspx>. The Web site for the National Center for PTSD is <www.ptsd.va.gov>. ISSUES New Archived

Sustained Elevation of Serum Interleukin-6 and Relative Insensitivity to Hydrocortisone Differentiates Posttraumatic Stress Disorder with and Without Depression

Very few trials have investigated TFPIs for individuals with SMI and PTSD. Results from trials of TF-CBT are limited and inconclusive regarding its effectiveness on PTSD, or on psychotic symptoms or other symptoms of psychological distress. Only one trial evaluated EMDR and provided limited preliminary evidence favouring EMDR compared to waiting list. Comparing TF-CBT head-to-head with EMDR and brief psychoeducation respectively, showed no clear effect for either therapy. Both TF-CBT and EMDR do not appear to cause more (or less) adverse effects, compared to waiting list or usual care; these findings however, are mostly based on low to very low-quality evidence. Further larger scale trials are now needed to provide high-quality evidence to confirm or refute these preliminary findings, and to establish which intervention modalities and techniques are associated with improved outcomes, especially in the long term.

Although psychological trauma affects millions of Americans, few studies have examined treatment of posttraumatic stress disorder (PTSD) in real-world service environments. This study explored pharmacological treatment of PTSD among privately insured individuals. Data were from the MarketScan database, which compiles claims from private health insurance plans nationwide. Descriptive statistics and multivariate logistic regression were used to identify predictors of any use of a psychotropic medication and use of three medication classes: antidepressants, anxiolytics or sedative-hypnotics, and antipsychotics. Of 860,090 adult mental health care users in 2005, only 10,636 (1.2%) had a diagnosis of PTSD. Sixty percent of PTSD patients received any psychotropic medication: 74.3% of those received antidepressants, 73.7% received anxiolytics or sedative-hypnotics, and 21.3% received antipsychotics. Greater likelihood of any medication use was associated with greater use of mental health services and with several comorbid psychiatric disorders. Having a comorbid diagnosis of an indicated disorder was the most robust predictor of use of each of the three medication classes: major depressive disorder and dysthymia were most strongly associated with antidepressant use, schizophrenia and bipolar disorder were associated with antipsychotic use, and anxiety disorders were associated with use of anxiolytics or sedative-hypnotics. Psychotropic medications were frequently used in the treatment of PTSD among privately insured clients. Although use targeted specifically to PTSD and to comorbid disorders was common, substantial use appeared to be unrelated to diagnosis and may be targeted at specific symptoms rather than diagnosed illnesses. Further research is needed to determine symptom-specific responses to medications across diagnoses.

The Psychiatric Ramifications of Moral Injury Among Veterans

LGBTQIA + people experience trauma and posttraumatic stress disorder (PTSD) at higher rates than cisgender heterosexual people, in addition to experiencing minority stress. There remains a dearth of research on appropriate PTSD interventions and minority stress interventions for LGBTQIA + people. However, the scope of the literature on neither PTSD interventions nor minority stress interventions for LGBTQIA + adults has ever been reviewed. Furthermore, research on PTSD-focused and minority stress-focused interventions remains relatively siloed, despite the link between minority stress and PTSD symptoms. The proposed scoping review aims to: (1) describe the scope of the current literature, chart available data, and synthesize findings, (2) collate information on existing PTSD and minority stress interventions for LGBTQIA + adults, and (3) identify gaps in the literature and directions for future research. Research produced since 2000 on psychological, psychotherapeutic, and behavioral interventions for PTSD, minority stress, or both within the LGBTQIA + adult population will be reviewed. This protocol follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). The search yielded a total of 6818 results. Following deduplication, a total of 4945 results remained. Title/abstract screening will be followed by full-text review and data coding, charting, and mapping. This scoping review will be the first to describe the state of the literature and synthesize information on both PTSD and minority stress interventions for LGBTQIA + adults. Findings may also highlight promising interventions and treatment components. Information gleaned may inform future adaptations of existing interventions and development of new interventions for LGBTQIA + adults experiencing PTSD and/or minority stress. This paper discusses the planned steps for an ongoing scoping review. The scoping review will provide an overview of treatments for PTSD and for minority stress for LGBTQIA + adults. The online version contains supplementary material available at 10.1007/s44202-025-00355-2.

The article is related to the theoretical analysis of a child of primary school age who is experiencing a crisis of loss, namely the death of a loved one (one of the parents - the mother). The concepts of «grief», «loss crisis», «psychotrauma» and «post-traumatic stress disorder» were also analyzed. We also touched upon the issue of the type of loss crisis during the analysis. Primary school children have a specific emotional sphere for their development - we have considered this issue in more detail in a scientific article. The main reactions of the child to the loss of a loved one are also described. The death of a loved one has a certain individual imprint on the life of any person or child. Therefore, the impact of the death of a loved one on the present and future of the child was considered. Too often, relatives or guardians living with a child misbehave with a younger student, which also affects the child’s emotional state and has a significant impact on his or her personal development. In our work, this problem was also considered as the main cause of the development of a child of primary school age not only depression but also post-traumatic stress disorder, which is a serious intervention for the already vulnerable psyche of the child. Post-traumatic stress disorder (PTSD) in children of primary school age who survived the death of one of the parents – the mother – is considered. The article emphasizes that the emotional sphere in children and adolescents is particularly reactive, so mental trauma (loss crisis) affects them more than adults. However, it is necessary to take into account the smaller depth of feelings, the rapid change of mood in children, due to which psychogenic reactions in them are shorter. We also considered in the article the reasons for the development of post-traumatic stress disorder in children of primary school age. The scientific article considered post-traumatic stress disorder at the emotional, cognitive and behavioral levels in a child of primary school age who has lost a loved one. The article examines children of primary school age with post-traumatic stress disorder who have lost a loved one – the mother, the presence of a negative emotional state (malaise, low activity and poor depressed mood) and the results were confirmed by statistical processing.

Posttraumatic stress disorder in critical illness survivors: too many questions remain.

Accidental awareness under general anaesthesia: Incidence, risk factors, and psychological management

BackgroundPuerarin is a root extract of Pueraria lobate that can alleviate the behavioral disorders and could be therapy for post-traumatic stress disorder (PTSD). However, the underlying mechanism of puerarin in PTSD is unclear, so, we hypothesized that integration of its metabolomic and transcriptomic profiles in rat serum could help to identify the mechanisms of the protective action of puerarin.MethodsWe used the single prolonged stress procedure to establish a model of PTSD in rats and then subjected them to treatment with or without puerarin. Serum metabolomics and transcriptomics were analyzed by ultra-high-performance liquid chromatography-tandem mass spectrometry and mRNA sequencing. The differential metabolites were evaluated by multivariate analysis, and Bayes discriminant analysis and receiver operator characteristic (ROC) analysis were used to discover potential diagnostic or therapeutic biomarkers. Transcriptomic data were obtained from mRNA sequencing, and we identified the key target genes of puerarin in the treatment of PTSD by integrated analysis of bioinformatics, real-time reverse transcription-polymerase chain reaction (RT-PCR) and data mining. Finally, an integrative analysis of the different metabolites and differentially expressed genes was performed using MetaboAnalysis to investigate the possible molecular mechanisms.ResultsThe metabolomics analysis showed that 17 dysregulated metabolites in PTSD were reversed by puerarin treatment, and daidzein, 3-succinoylpyridine, 5-(2,5-dihydroxyhexyl) oxolan-2-one and elaidic acid were identified as potential biomarkers for the treatment and diagnosis of PTSD. Transcriptomics analysis showed that dysregulation of 99 genes in PTSD was reversed by puerarin treatment, and further revealed that CD36 molecule (CD36), HBS1-like translational GTPase (HBS1L), CD59 molecule (CD59) and dynein cytoplasmic 1 heavy chain 1 (DYNC1H1) were not only key targets for puerarin’s action in the treatment of PTSD but also potential biomarkers for the diagnosis and treatment of PTSD. Finally, integrated analysis of the metabolomic and transcriptomic data revealed that puerarin treatment for PTSD was mainly regulated by the metabolic pathways of one carbon pool by folate, synthesis and degradation of ketone bodies, and antigen processing and presentation.ConclusionsOur results are a new genetic insight into the mechanism of action of puerarin in PTSD treatment. We identified four metabolites and four genes that might be considered as novel biomarkers for the diagnosis and treatment of patients with PTSD.

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis