Pre-existing diabetes mellitus is associated with an increased risk for high PTSD symptom levels. Results of a prospective population-based study.

Does prior exposure to interpersonal violence increase risk of PTSD following subsequent exposure?

PurposeExamine to what extent adults affected by recent potentially traumatic events (PTE) with different PTSD-symptom levels are more at risk for post-event loneliness than non-affected adults are in the same study period.MethodsWe extracted data from the Dutch longitudinal LISS panel to measure pre-event loneliness (2011) and post-event loneliness (2013 and 2014), pre-event mental health problems (2011), PTE and PTSD symptoms (2012). This panel is based on a traditional random sample drawn from the population register by Statistics Netherlands.ResultsResults of the multinomial logistic regression analyses showed that affected adults with high levels of PTSD symptoms were more at risk for high levels of post-event loneliness than affected adults with very low PTSD-symptom levels and non-affected adults, while controlling for pre-event loneliness, pre-event mental health problems and demographics. However, affected adults with very low levels of PTSD symptoms compared to non-affected adults were less at risk for medium and high levels of post-event loneliness while controlling for the same variables. Yet, pre-event loneliness appeared to be the strongest independent predictor of loneliness at later stages: more than 80% with high pre-event levels had high post-event levels at both follow-ups.ConclusionsRemarkably, potentially traumatic events have depending on PTSD-symptom levels both negative and positive effects on post-event loneliness in favor of affected adults with very low PTSD symptoms levels. However, post-event levels at later stages are predominantly determined by pre-event loneliness levels.

ObjectivePsychological trauma is a well-known risk factor for the onset of persistent somatic symptoms (PSS). In contrast, little is known on the relation between potentially traumatic events (PTEs) and the severity of PSS, and on the protective effect of social support. We aimed to: (i) determine whether childhood, adulthood and recent PTEs are associated with burden of PSS over four years of follow-up; (ii) examine associations of multiple and cumulative (in childhood and adulthood) exposure to PTEs with burden of PSS; and (iii) determine whether social support modifies these associations. MethodsLongitudinal data of 322 patients with PSS were analyzed. PTEs (Life Events Questionnaire) and social support (Social Support Scale) were assessed at baseline. Burden of PSS was measured in terms of symptom severity (PHQ-15) and physical functioning (RAND-36 PCS) at six repeated measurements over a four-year interval. Associations were analyzed using longitudinal mixed model analysis. ResultsPatients with multiple childhood PTEs reported higher burden of PSS over four-year time. Adulthood PTEs were associated with burden of PSS in patients with, but not in patients without childhood PTEs. Recent PTEs were not associated with burden over time. Social support did not modify any of the associations. ConclusionsPTEs are associated with higher burden of PSS over time, in addition to the well-known association with the onset of PSS. PTEs in early life and cumulative exposure to PTEs in childhood and adulthood are associated with higher burden over time in patients with PSS. Social support did not attenuate the associations.

Background: Potentially traumatic events (PTEs) are unfortunately common experiences among children and adolescents. Approximately one quarter of US children are exposed to a PTE before the age of four, with rates increasing to 60% by 16 years of age (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010; Copeland, Keeler, Angold, & Costello, 2007). Exposure to PTEs during childhood is associated with a wide range of negative emotional, behavioral, and physical health consequences over the life course (Anda et al., 2006; Felitti et al., 1998; Gilbert et al., 2009; Shonkoff et al., 2012). Emerging research suggests that childhood trauma may also increase susceptibility to the development of chronic pain in adolescence and adulthood (Boey & Goh, 2001; Davis, Luecken, & Zautra, 2005; Larsson & Sund, 2007; Liakopoulou-Kairis et al., 2002; Mulvaney, Lambert, Garber, & Walker, 2006). However, most investigations of the link between childhood trauma and chronic pain have focused on adults with history of maltreatment. As a result, the contribution of other PTEs to the development of chronic pain among children and adolescents is poorly understood. Additionally, prior research has largely emphasized the prevalence of comorbid chronic pain and posttraumatic stress disorder (PTSD) diagnoses, rather than closely examining the associations between specific posttraumatic stress symptoms (PTSS), pain severity, and functional impairment. As such, much remains unknown regarding the interplay between exposure to PTEs, PTSS, and chronic pain in youth. Aims: The current study aimed to investigate the relationships between quantity and timing of PTEs, pain severity, and pain-related functional impairment among children with amplified musculoskeletal pain syndromes (AMPS). Additionally, this investigation examined the relationships between indices of PTSD symptomatology (i.e., overall symptom severity and symptom clusters) and pain. Finally, this study explored whether potential associations between childhood trauma and pain outcomes were moderated by anxiety, depression, PTSS, and family functioning. Methods: This study employed a cross-sectional design. Participants included 76 children ages 8-17 years (M = 14.08, SD = 2.14) diagnosed with AMPS and their caregivers presenting to the CHOP Center for Amplified Musculoskeletal Pain Syndromes. Participants completed assessments of childhood trauma history, family functioning, and child anxiety, depression, and PTSS online within two weeks before or after their initial consultation appointment. Medical records were reviewed to obtain information about demographic characteristics, pain severity, and pain-related functional disability from measures administered as part of routine clinical care. Results: While total quantity of PTEs was not associated with pain, PTEs reported during the first five years of life significantly predicted pain-related disability. This relationship varied as a function of both child depression and perceptions of family functioning, such that children who endorsed higher current depression and family functioning exhibited the strongest relationship between early trauma and disability. Total PTSS severity and specific symptom clusters were not associated with pain outcomes and did not moderate the relationship between early childhood PTEs and pain-related disability. Conclusions: Early childhood may be a sensitive period for the effects of PTEs on risk for functional disability in youth with AMPS. Additional research utilizing prospective and longitudinal designs is needed to better understand the biopsychosocial mechanisms underlying the relationship between early childhood trauma and pediatric chronic pain.

ObjectiveThe aim of this study was to explore perceived posttraumatic growth (PTG) and its associations with potentially traumatic events (PTEs), dispositional optimism, perceived social support, posttraumatic stress disorder (PTSD) symptoms, and satisfaction with life (SWL) among adolescent refugees and asylum seekers.MethodA cross-sectional design was employed including 111 refugees, aged 12–17, that were recruited from asylum seeker centres throughout the Netherlands. Measurements included the revised Posttraumatic Growth Inventory for Children, Children's Impact of Event Scale, Multidimensional Scale of Perceived Social Support, The Life Orientation Test, and the Satisfaction with Life Scale.ResultsParticipants reported mean PTG scores (20.2) indicating an average response of some perceived change, while reporting high levels of PTSD symptoms (30.6). PTG and PTSD symptoms were not related with each other (r=0.07, p=0.50). PTG was positively associated with dispositional optimism (r=0.41, p<0.01) and social support (r=0.43, p<0.01). A hierarchical regression analysis demonstrated that dispositional optimism (β=0.33; p<0.05) and social support (β=0.27; p<0.05) positively predicted PTG, explaining 22% of the PTG variance above demographic variables and PTEs. PTG was also positively related with SWL (r=0.37, p<0.01).ConclusionsPerceived PTG and PTSD symptoms appear to be independent constructs, which co-occur in adolescent refugees and asylum seekers. The relationship between PTG and mental health remains inconclusive; PTG was positively related to SWL and not associated with PTSD symptoms. Longitudinal research is required to determine causality between PTG and mental health in this refugee population confronted with many traumatic experiences and challenging migration tasks.

Resilience can be evidenced when an exposure to potentially traumatic event (PTE) has no negative impact on behavior. This study explored the effects of exposure to PTE applying a longitudinal design with 592 children (mean age 4 years) followed across three years. Children who had experienced a PTE and those who had not, were compared over time. Behavioral difficulties and prosocial behaviour for children experiencing PTE did not differ from those who had not experienced a PTE suggesting resilience among the exposed children. PTE in itself seems to carry minimal risk for symptoms of behaviour difficulties among preschool children.

Increased white matter connectivity in traumatized children with attention deficit hyperactivity disorder

Analyzing the relationships among psychosocial variables associated with resilience

Longitudinal interplay between posttraumatic stress symptoms and coping self-efficacy: A four-wave prospective study

The extent to which recent potentially traumatic events (PTEs) hinder the recovery from pre-existing mental health problems is largely unknown. The same applies to the extent to which non-recovery from pre-existing mental health problems increases the risk of posttraumatic stress disorder (PTSD). The aim of the present study is to gain insight in these effects. Data were extracted from six annual surveys of the Dutch population-based Victims in Modern Society (VICTIMS) study. Of the adult respondents who participated in two subsequent surveys (labeled T1 and T2, n = 6942), those with severe anxiety and depression symptoms (ADS) at T1 (n = 487) were selected. We distinguished respondents exposed to PTEs (PTE-group, n = 162) and not exposed to PTEs (comparison group, n = 325) between T1 and T2. We applied five indicators of recovery [based on the Reliable Change Index (RCI), degrees of symptom reduction, and the cut-off score at T2]. Differences in the recovery from ADS and probable PTSD at T2 were examined using multivariate logistic regression. The PTE group less often recovered from severe ADS between T1 and T2 than the comparison group according to all five indicators of recovery, while controlling for 11 different variables (0.40 ≤ adjusted OR's ≤ 0.66). Those in the PTE group who did not recover, considerably more often suffered from probable PTSD at T2 (63%-82%) than those who did recover (0%-29%; 8.96 ≤ adjusted OR ≤ 26.33). Recent potentially traumatic events hinder the recovery from pre-existing anxiety and depression symptomatology and thereby increase the risk of probable PTSD.

ObjectivesLittle is known about the 12-month prevalence of potentially traumatic events (PTEs) and to what extent the type of PTE is a risk factor for post-event lack of social support. In addition, it is largely unknown if pre-event mental health problems and loneliness, and demographics are risk factors for a lack of support. Aim of the present prospective study is to fill these gaps in evidence-based knowledge.MethodsA survey was conducted among a large random sample of the Dutch adult population (i.e. the longitudinal LISS panel) in March-April 2018, and linked with pre-event mental health and loneliness data from surveys conducted in 2016 (n = 5,879). We distinguished four forms of perceived social support: emotional and esteem support, and social recognition and general disapproval.ResultsLoss of a significant other and/or colleague (28%) was the most prevalent 12-month PTE. The 12-month prevalence of violence, accidents and/or, and theft-related events was 13%. Multivariate logistic regression analyses revealed no differences in lack of emotional and esteem support, or in lack of recognition across non-death PTEs and death-related PTEs. However, victims of threat and physical (sexual) violence more often faced disapproval than those affected by burglary and accidents. Results furthermore showed that pre-event mental health problems, pre-event loneliness and stress during the PTE were important independent predictors of forms of support and acknowledgment. Affected individuals with a non-Western background more often lacked support and acknowledgment.ConclusionsMany adults are confronted with a PTE during a year. In general, pre-event factors and stress during the event are better predictors of a perceived lack of support and acknowledgment than type of event. Early screening programs should especially assess pre-event mental health and loneliness, besides levels of stress during the event, to identify affected people who are at risk for a lack of social support and acknowledgment.

Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care settings. The Positive Outcomes for Orphans study used a 2-stage, cluster-randomized sampling design to identify 1,357 institution-dwelling and 1,480 family-dwelling orphaned and separated children in 5 low- and middle-income countries (LMICs) in sub-Saharan Africa and Asia. We used the Life Events Checklist developed by the National Center for Posttraumatic Stress Disorder to examine self-reported PTEs among 2,235 OSC ages 10-13 at baseline. We estimated prevalence and incidence during 36-months of follow-up and compared the risk of PTEs across care settings. Data collection began between May 2006 and February 2008, depending on the site. Lifetime prevalence by age 13 of any PTE, excluding loss of a parent, was 91.0% (95% confidence interval (CI) = 85.6, 94.5) in institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0) in family-dwelling OSC; annual incidence of any PTE was lower in institution-dwelling (23.6% [95% CI = 19.4, 28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1, 32.2]). More than half of children in institutions (50.3% [95% CI = 42.5, 58.0]) and in family-based care (54.0% [95% CI = 50.2, 57.7]) had experienced physical or sexual abuse by age 13. Annual incidence of physical or sexual abuse was lower in institution-dwelling (12.9% [95% CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95% CI = 17.7, 21.3]), indicating statistically lower risk in institution-dwelling OSC (risk difference = 6.5% [95% CI = 1.4, 11.7]). Prevalence and incidence of PTEs were high among OSC, but contrary to common assumptions, OSC living in institutions did not report more PTEs or more abuse than OSC living with families. Current efforts to reduce the number of institution-dwelling OSC may not reduce incidence of PTEs in this vulnerable population. Protection of children from PTEs should be a primary consideration, regardless of the care setting.

We present the data of the first six annual surveys of the large prospective population-based Dutch VICTIMS-study that started in 2018. Each survey systematically examines exposure to potential traumatic events in the past 12 months, including time of event and amount of stress during the event. Furthermore, each survey assesses anxiety and depression symptomatology, lack of social support, physical, mental, work, partner/family, religious, legal, administrative and financial problems, and problem-related services use. Among the by potentially traumatic events (PTEs) affected respondents, current PTSD-symptomatology, social acknowledgement, events-related contacts with various professional, and coping self-efficacy related to the (most stressful) PTE in the past 12 months was examined.This multi-wave study is conducted using the Dutch Longitudinal Internet studies for the Social Sciences panel (LISS panel) that is based on a large traditional probability sample of the Dutch population (16+). People cannot register themselves as a panel member which minimizes the risks of selection bias. Panel members receive a financial compensation for each completed questionnaire, which has a positive effect on the response rate. Households that would otherwise be unable to participate are provided with a simple, remotely managed computer and internet connection. The set-up of the LISS panel in 2007 was funded by the Dutch Research Council and is managed by Centerdata, a non-profit institute housed at the campus of Tilburg University (The Netherlands). The number of invited (adult) panel members for the VICTIM-study varies between 6119 and 7096 across the years, and the response rate varies between 82.4 % and 87.9 %.The data of the VICTIMS-study can efficiently be linked with archived data of all other (past or future) studies conducted with the LISS panel, such as the annual Core studies on Health and Personality, and the 300+ Assembled studies conducted with the LISS panel. This offers unique opportunities for researchers to address numerous research questions related to potential traumatic and stressful life-events.

Background: Posttraumatic stress disorder (PTSD) is a serious and debilitating condition among military veterans. Exposure to potentially traumatic events (PTEs) may lead to PTSD and PTE sensitivity may be influenced by the personality trait neuroticism. Objective: The current investigation aims to test whether exposure to PTEs during deployment is associated with changes in PTSD symptoms, and whether individual levels of neuroticism are related to resilience or sensitivity to such exposures. Methods: The study sample included 701 Danish soldiers deployed to Afghanistan in 2009. PTSD symptoms were measured pre-, peri- and post-deployment (T1-T3) with the PTSD Checklist-Civilian Version. PTSD symptom load was modelled in a mixed linear model along with an extensive list of covariates. Interactions between time, exposure, and neuroticism were tested in order to assess whether neuroticism moderated the effect of PTEs upon PTSD symptoms. Results: On average, PTSD symptoms decreased from T1 through T3. Factors associated with higher PTSD symptom levels included number of past trauma, neuroticism, and low age at deployment. Interaction analyses showed that individuals with low and medium neuroticism levels displayed no significant change in PTSD symptoms, and individuals with high neuroticism displayed a significant decrease in PTSD symptoms. These changes were consistent across levels of perceived exposure to danger and combat and witnessing the consequences of war. Conclusions: Results indicate that low levels of neuroticism appear to be related to resilience. Individuals with high levels of neuroticism displayed elevated PTSD symptoms across all time points, but contrary to expectations, they reported a significant decrease in PTSD symptoms from pre- to post-deployment.

Cross-lagged associations between posttraumatic stress symptoms and coping self-efficacy in long-term recovery: A four-wave comparative study