Acute Posttraumatic Stress Disorder Research Articles

Preparing Trainees to Rebound from Surgical Complications.

In this review, we aim to summarize the impact of surgical complications and adverse events on surgeons, including psychiatric illnesses. We evaluate current programs to develop trainee well-being and investigate research within the field of urology. Surgical complications and adverse events affect all surgeons, including surgical trainees. Research estimates that 80% of healthcare professionals have been involved in an event that affected them emotionally. These events can affect physicians in many ways, ranging from negatively impacting their quality of life to leading to psychiatric disorders such as acute stress reactions and post-traumatic stress disorder. Unfortunately, there is no standardized preparation to equip trainees to manage and rebound from the profound emotional impact of surgical complications. Data in this realm is insufficient, especially in urology, and we need more research in order to better evaluate emotional implications of complications on trainees and how we can prepare trainees to handle them.

Spirituality in the line of duty: Perspectives from first responders with acute posttraumatic stress disorder and alcohol use disorder.

Spirituality/religion is clinically relevant to patients experiencing posttraumatic stress disorder (PTSD) and/or alcohol use disorder (AUD). Despite the comorbidity of PTSD and AUD among first responders (i.e., firefighters, law enforcement, paramedics, corrections officers), relatively little research has investigated the lived experience of first responders with PTSD and AUD as it related to spirituality and religion. As such, 12 (100% cisgender men, 91.7% White/European American) first responder psychiatric patients with comorbid PTSD and AUD were recruited from a psychiatric program serving first responders in the Northeast. Participants completed a semistructured interview, and transcripts were coded and thematically analyzed. The following themes and subthemes were identified: spiritual/religious distress (subthemes: abandonment, progressive deterioration of moral certainty, and loss of faith/doubt), spiritual/religious coping (subthemes: supporting sobriety and coping with PTSD), spirituality/religion in treatment, spirituality as distinct from religion, and spirituality and first responder culture. Findings highlight the need for additional research examining the role of spirituality/religion at the intersection of PTSD and AUD among first responders as well as the development of spiritually integrated treatment for this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reliability of Anxiety Stress Irritability Behavioral Changes (Asib) – Neuro Psychosomatic Scale in the Post - Covid 19 Population

The Corona Virus Disease (COVID-19) has lead to universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, also called as “coronaphobia”, has generated a plethora of psychiatric problems all over the society. Disease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. The ASIB neuro psychosomatic scale for post COVID - 19 patients is basically designed to evaluate the level of neuro psychosomatic impairments caused by COVID – 19.

Age differences in acute stress and PTSD symptoms during the 2023 Israel-Hamas war: Preliminary findings

Traumatic exposure can result in acute stress symptoms in the immediate aftermath and post-traumatic stress disorder (PTSD) symptoms that persist beyond the initial weeks. Both short-term and long-term reactions require research and clinical attention. There is considerable evidence for age differences in PTSD, and older adults frequently present lower rates of PTSD compared to young adults. Much less is known concerning age differences in acute reaction or the extent to which age differences in PTSD are affected by age differences in acute stress. The current study examined acute stress and PTSD symptoms among young and older adult Israelis during the 2023 Israel-Hamas war. A web-based sample of 428 participants (mean age = 48.36 ± 16.29) completed retrospective accounts of pre-war psychological distress and acute stress in the first week of the war and further reported current PTSD symptoms. Rates of elevated levels of acute stress symptoms and probable PTSD were significantly higher among young adults (24.8% and 42.8%, respectively) compared to their older counterparts (3.7% and 13.7%, respectively). Age differences in probable PTSD remained significant even after controlling for other demographics, traumatic exposure, pre-war psychological distress, and acute stress symptoms. These preliminary findings further attest to the impressive resilience manifested by older adults during wartime. Moreover, as age differences in probable PTSD were not fully explained by acute reactions, unique mechanisms may be mobilized by older adults to cope with warfare trauma in the short- and long term.

Promising Effect of the Children in Disaster: Evaluation and Recovery Intervention on Trauma Symptoms and Quality of Life for Children and Adolescents: A Controlled Study.

The Children in Disaster: Evaluation and Recovery (CIDER) program in Korea was developed to treat children and adolescents exposed to trauma. This study aimed to demonstrate the effectiveness of the CIDER through a comparison with controls. A total of 85 participants consisted of the intervention group (n=41) and control group (n=44). We assessed the changes in trauma-related symptoms, depression, anxiety, and improvements in quality of life before and after the intervention. In total, bullying and school violence (44.7%) were the most common trauma, followed by sexual abuse (17.6%). Acute stress disorder and post-traumatic stress disorder (PTSD) accounted for 41.2%, and attention-deficit/hyperactivity disorder (ADHD) and developmental disorder were the most common comorbidities (51.8%). The symptoms of trauma, depression, anxiety, and quality of life improved significantly in the intervention group, while the control group did not show significant changes. Compared with the control group, the CIDER improved symptoms and quality of life in children and adolescents who had experienced trauma. The CIDER program was practical and easy to apply, even for different ages, types of traumas, and comorbidities.

Increased risk of acute stress disorder and post-traumatic stress disorder in children and adolescents with autism spectrum disorder: a nation-wide cohort study in Taiwan.

Children and adolescents with autism spectrum disorder (ASD) may be particularly vulnerable to the impact of traumatic events, yet the association between ASD and the risk of developing acute stress disorder and post-traumatic stress disorder (PTSD) remains uncertain. This study aims to investigate this association, addressing the gap in large-scale evidence on the subject. Conducted as a retrospective and matched cohort study, data was sourced from the National Health Insurance Research Database (NHIRD) in Taiwan, spanning from January 1, 2000, to December 31, 2015. The study included patients aged 18 years or under newly diagnosed with ASD (n=15,200) and compared them with a matched control group (n=45,600). The Cox proportional regression model was employed to assess the risk of acute stress disorder and PTSD. Over the 15-year follow-up period, a total of 132 participants developed either acute stress disorder or PTSD. Among them, 105 cases (0.691% or 64.90 per 100,000 person-years) were in the ASD group, while 27 cases (0.059% or 5.38 per 100,000 person-years) were in the control group. The adjusted hazard ratio for the ASD group was significantly higher compared to the control group (25.661 with 95% CI = 15.913-41.232; P < .001). This study provides compelling evidence that individuals with ASD face an elevated risk of developing acute stress disorder and PTSD. The findings underscore the importance of clinicians recognizing and addressing this vulnerability in ASD individuals exposed to traumatic events. This emphasizes the need for heightened attention to the risk of PTSD and acute stress disorder in the ASD population.

Prevalence and predictors of post-traumatic stress disorder in road traffic accidents

trauma-related disorders following a road accident have both a health and an economic impact. we conducted a prospective study to determine the prevalence of these disorders, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. a total of sixty-ten subjects were included in this study. The prevalence of acute stress disorder was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Changes in attachment dimensions during the treatment of acute post-traumatic stress disorder in sexually assaulted Brazilian women.

Attachment patterns are established during early childhood; however, extreme experiences throughout life may change this structure, either toward attachment security or insecurity. We analyzed changes in attachment dimensions in women with acute post-traumatic stress disorder (PTSD) following sexual assault, that were randomized to a 14-week treatment with either the medication sertraline or Interpersonal Psychotherapy. Seventy-four adult women who presented significant reduction in PTSD symptoms across the trial responded to the Revised Adult Attachment Scale at baseline, on week 8 of treatment, and at the end of the trial, on week 14. We fitted a generalized linear model to explain the attachment anxiety and avoidance scores at baseline. A generalized linear mixed model investigated how attachment dimensions changed over time. Socioeconomic data, treatment type, history of childhood trauma, and PTSD severity over the 14-week period were the considered covariates. At baseline, attachment anxiety was associated with a history of early trauma. Attachment anxiety remained stable during the follow-up. Attachment avoidance, on the other hand, significantly increased from baseline to week 14. Higher avoidance was observed in patients with higher total PTSD scores and on the cluster of hyperarousal symptoms. Races other than White (black, mixed-race, or Asian) and younger age were associated with higher attachment avoidance. Contrary to our expectations, attachment avoidance increased during follow-up, indicating changes in the interpersonal realm beyond the symptoms of PTSD.

Early identification and influencing factors of post-traumatic stress disorder in high-stress rescue workers

Objective: To explore the risk intensity and related influencing factors of post-traumatic stress disorder (PTSD) among high-stress rescue workers, and to provide effective tools for the risk assessment of PTSD in military rescue workers. Method: From June to August 2022, cluster sampling was used to select the high-stress rescue personnel of an Army department as the survey subjects. The acute Stress reaction (ASD) scale and PTSD checklist were used to evaluate the risk of PTSD in military rescue personnel. Multivariate logistic regression were used to analyze the influencing factors of PTSD. Results: The age of 4 460 subjects was (24.38±4.072) years old, including 4 396 males (98.6%). The positive rate of initial screening for ASD was 2.85% (127/4 460). The positive rate of PTSD was 0.67% (30/4 460). Multivariate logistic regression model analysis showed that female, older age, recent trauma exposure history, passive smoking and alcohol consumption were at higher risk of ASD, the values of OR (95%CI) were 4.183 (1.819-9.618), 6.278 (1.363-28.912), 3.094 (1.500-6.379), 2.059 (1.298-3.267) and 2.607 (1.614-4.211), respectively; Lower education level was associated with lower risk of ASD, OR (95%CI) was 0.593 (0.359-0.978); People who are older, thinner, have a history of mental illness, and drink alcohol were at higher risk for PTSD, the values of OR (95%CI) were 20.144 (2.459-165.043), 10.287 (2.218-47.700), 91.104 (8.592-965.980) and 2.866 (1.144-7.180), respectively. Conclusion: Gender, age, education level, passive smoking, alcohol consumption, past history of mental illness and body mass index may be related to the potential risk of PTSD in rescue workers,passive smoking, alcohol consumption, and weight controlling should be focused on to reduce potential risks of PTSD.

Post-Traumatic Stress Disorder As Reflected On Cara Hoffman Be Safe I Love You Novel

The aims of this research are to identify the types of Post – Traumatic Stress Disorder as well as to find out the impacts caused by Post – Traumatic Stress Disorder that are contained in Be Safe I Love You novel. In this research the writer applied qualitative descriptive methods and theory by Sigmund Freud to analyse the phases of Post – Traumatic Stress Disorder in the novel Be Safe I Love You. The result shows that there are types and impacts of post-traumatic stress disorder contain in Cara Hoffman's Be Safe I Love You novel base on Sigmund Freud's theory, the writer find that there are two types of post-traumatic stress disorder, namely acute stress disorder and post-traumatic stress disorder without complications. Uncomplicated post-traumatic stress disorder is the most dominant type of post-traumatic stress disorder find in the novel. There are 4 effects of post-traumatic stress disorder find in the novel, namely hallucinations, mood swings, irritability, insomnia.&#x0D;

The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma.

Sleep reactivity is a predisposition to sleep disturbance during environmental perturbations, pharmacological challenges, or stressful life events. Consequently, individuals with highly reactive sleep systems are prone to insomnia disorder after a stressor, engendering risk of psychopathology and potentially impeding recovery from traumatic stress. Thus, there is tremendous value in ameliorating sleep reactivity to foster a sleep system that is robust to stress exposure, ultimately preventing insomnia and its downstream consequences. We reviewed prospective evidence forsleep reactivity as a predisposition to insomnia since our last review on the topic in 2017. We also reviewed studies investigating pre-trauma sleep reactivity as a predictor of adverse post-traumatic sequelae, and clinical trials that reported the effect of behavioural treatments for insomnia on mitigating sleep reactivity. Most studies measured sleep reactivity via self-report using the Ford Insomnia Response to Stress Test (FIRST), demonstrating high scores on this scale reliably indicate a sleep system with a lower capacity to tolerate stress. Nascent evidence suggests elevated sleep reactivity prior to trauma increases the risk of negative posttraumatic outcomes, namely acute stress disorder, depression, and post-traumatic stress disorder. Lastly, sleep reactivity appears most responsive to behavioural insomnia interventions when delivered early during the acute phase of insomnia. Overall, the literature strongly supports sleep reactivity as a premorbid vulnerability to incident acute insomnia disorder when faced with an array of biopsychosocial stressors. The FIRST identifies individuals at risk of insomnia a priori, thereby guiding early interventions toward this vulnerable population to prevent insomnia and promote resilience to adversity.

Post-traumatic stress disorder in doctors: Origins, approach and Eye Movement Desensitisation and Reprocessing therapy

Navigating a high-stakes clinical environment, medical doctors tend to consider trauma and adverse workplace events as 'part of their job'. This often leads to delays in help-seeking in doctors who develop acute traumatic stress symptoms (ATSS), post-traumatic stress disorder (PTSD) and their comorbidities. This article outlines the prevalence of acute traumatic stress and PTSD in this population and summarises the emerging evidence base for Eye Movement Desensitisation and Reprocessing (EMDR) early-intervention protocols of this population. Doctors have higher prevalence rates of ATSS and PTSD than the general public. Eye Movement Desensitisation and Reprocessing therapy's early-intervention protocols for recent, prolonged and ongoing traumatic stress have the potential to be a widely acceptable, timely and cost-effective intervention for doctors and other healthcare workers (HCWs), as highlighted in the emerging evidence base, which has grown considerably in response to the impact of the COVID pandemic on HCWs' mental health. These evidence-based interventions could potentially be routinely offered to doctors and other HCWs within 1month of an adverse workplace experience to reduce ATSS, PTSD and other comorbidities.

Appearance of extrapyramidal symptoms in adolescent psychiatry patients during COVID-19 infection.

Since the start of the pandemic, there has been an increase in the incidence of psychiatric morbidity among those infected with coronavirus disease 2019 (COVID-19) and those indirectly affected by COVID-19. There has been a considerable increase in the number of individuals with such psychiatric conditions as depression, acute stress disorders, anxiety, and posttraumatic stress disorder (PTSD). About one-third of patients with COVID-19 are reported to have developed short and long-term neuropsychiatric conditions such as delirium, agitation, altered consciousness, hypoxic encephalopathy encephalitis, dysexecutive syndrome, cerebrovascular complications (e.g., stroke), hypoxic encephalopathy, convulsions, neuromuscular dysfunction, demyelinating processes, or parkinsonism through several pathophysiological mechanisms. Nevertheless, as the pandemic progressed, data on neuropsychiatric manifestations implied that the pathologic capacity of COVID-19 and its association with the onset and/or exacerbation of psychiatric morbidity indicate that COVID-19 is potentially related to neuropsychiatric involvement. Patients with existing mental disorders under psychotropic treatment exposed to the COVID-19 infection have been represented by an increased risk of worsened psychiatric symptoms and expanded drug side effects. The present study aimed to describe five pediatric patients with various psychiatric illness that experienced COVID-19 infection and had potentially associated neuropsychiatric involvement, such as exacerbation of underlying psychiatric symptoms and extrapyramidal side effects. To the best of our knowledge, the present study is the first to describe adolescents with COVID-19 infection that presented with a series of manifestations in the form of an increase in extrapyramidalsymptoms(EPS)during exacerbation of underlying psychiatric disease.

P822 The negative impact of mental health comorbidity in children and young adults with inflammatory bowel disease: a UK population-based cohort study

Abstract Background Whilst the high burden of mental health comorbidity in people with inflammatory bowel disease (IBD) is now being recognised, less is known about the additional impacts of having concurrent IBD and a mental health condition, especially in children and young adults. Methods We conducted a retrospective, observational study using a large UK primary care dataset (Optimum Patient Care Research Database). Children and young adults (aged 5-25 years) diagnosed with IBD prior to 2015 were identified and grouped into those with and without prevalent mental health conditions (any of depression, anxiety, eating disorders, body image disorder, attention-deficit disorder, behavioural disorders, adjustment disorder, acute stress disorder, schizophrenia, bipolar disorder or post-traumatic stress disorder). The following outcomes were compared over 5 years in the two groups; quality-of-life indicators (bowel symptoms [abdominal pain, discomfort or bloating, diarrhoea], systemic symptoms [fatigue, sleep problems, weight-loss, underweight, growth retardation], emotional function [low mood, substance abuse, deliberate self-harm, suicidal attempt or parasuicide] and social function [absence from school, absence from work, unemployment]), IBD-specific therapy interventions (diet [nutritional supplements], medications [oral and rectal 5-aminosalicylic acid and steroids, antimetabolites and tumour necrosis factor inhibitors] and surgery [abdominal and stoma formation]), and healthcare utilisation (primary care interactions and hospital admissions). Adjustment for confounders was performed using Cox regression for non-recurring outcomes (e.g. stoma formation), and negative binomial or Poisson regression for outcomes with recurring events (e.g. primary care interactions). Results 1,943 individuals with IBD were identified. 295 of these had a prevalent mental health condition. Mental health comorbidity was associated with increased bowel symptoms (adjusted Incident Rate Ratio [aIRR] 1.82; 95% Confidence Interval [CI] 1.33, 2.52), sleep disturbance (adjusted Hazard Ratio [aHR] 1.63; 95% CI 1.02, 2.62), substance abuse (aHR 3.63; 95% CI 1.69, 7.78), primary care interactions (aIRR 1.33; 95% CI 1.12, 1.58) and hospital admissions (aIRR 1.87; 95% CI 1.29, 2.75) (Figure 1). In those &amp;gt;18 years old, mental health comorbidity was associated with increased time off work (aHR 1.55; 95% CI 1.21, 1.99) (Figure 1). Conclusion Mental health comorbidity in children and young adults with IBD is associated with increased IBD symptoms, healthcare utilisation and time off work. Given the impact of mental health comorbidity, it is crucial those affected are monitored and receive appropriate mental health support as part of their multidisciplinary care.

ПОСТСТРЕССОВЫЕ РЕАКЦИИ И РАССТРОЙСТВА У УЧАСТНИКОВ ВОЙНЫ В АРЦАХЕ / POST-STRESS REACTIONS AND DISORDERS AMONG THE PARTICIPANTS OF THE WAR IN ARTSAKH

Relevance: Psychological trauma and stress-related disorders represent the primary challenges in modern psychiatry, notably acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). In the context of contemporary fifth-generation warfare, combat trauma assumes particular signifi-cance, evident in the nature of resulting mental disorders. The aim: To examine the main forms of psychopathological disorders among 44-day Artsakh war participants. Material, methods: A total of 104 war veterans aged 18-50 were examined using clinical-psychopathological, laboratory, instrumental, and psychological methods, including the SCL-90-R, Mississippi PTSD scale, and Shmishek Personality Scale. Results: Among the participants, 77 individuals (74%) exhibited ASD, while 27 individuals (26%) displayed depressive and psychotic disorders, etc. Additionally, 39 participants (37.5%) showed signs of PTSD in its earliest stages of pathological development. The most prevalent personali-ty accentuation type observed was the exalted type (69 individuals, 66.3%). %). The statistical analy-sis unveiled significant differences in the expression of factors measured by the SCL-90-R, Mississippi-an, and Shmishek questionnaires. These differences were dependent on the combatants' age, type of military engagement, and the timing of hospital admission. Discussion: All forms of psychopathological disorders stemmed from an unique combat trauma, which, in this case, is characterized by its "invisibility, inaccessibility of the source of trauma, its reali-ty, and tangibility." The boundaries between post-trauma clinical manifestations are amorphous, overlapping, and do not correspond to the chronological criteria outlined in the ICD and DSM. Combat trauma acts as a catalyst for all post-trauma disorders. Conclusion: The atypical nature of trauma undermines the conventional criteria for PTSD and ASD. Chronological criteria fail to align with clinical realities, revealing challenges in distinguishing between ASD and PTSD. The findings suggest the existence of peritraumatic stress disorders, which encompass all post-trauma conditions.

A Retrospective Study on Sexual Assault - Abuse Cases

Objective: In this study; it is aimed to analyze the sexual attack-abuse cases that occurred in Bolu province and were judged by the High Criminal Court. &#x0D; Methods: A total of 148 cases of sexual assault - abuse decided by the Bolu High Criminal Court between 2007 and 2016 were analyzed retrospectively.&#x0D; Results: This study included 148 cases: 131 (88.5%) cases were female and 17 (11.5%) were male. The mean age was 18.6 ± 11.6 (min:4, max:83). The highest number of cases was in the 13-15 age group (n=52, 35.2%). Sexual abuse most frequently occurred through vaginal penetration (n=72: 48.6%). The most common psychiatric diagnosis was acute stress disorder (n:12, 10.8%) and post-traumatic stress disorder (n:12, 10.8%). Physical violence was found to be statistically effective (p = 0.008) in the occurrence of mental disorders after the event. The victim recognized 81.8% of the attacker.&#x0D; Conclusion: We think that more effective sexual attack-abuse prevention strategies can be developed at the national level by determining the risk factors of sexual assault-abuse in our country through wider research to be conducted across the country.

CE: Pain and Mental Health Symptoms After Traumatic Orthopedic Injury

This article highlights the need to screen survivors of traumatic orthopedic injuries for postinjury symptoms associated with stressor-related disorders such as acute stress disorder and posttraumatic stress disorder, including pain, sleep disturbances, anxiety, and depression. The authors discuss the presentation of these postinjury symptoms, the instruments used to screen for each, the various pharmacological and nonpharmacological treatments, and the nursing implications for managing postinjury symptoms in traumatic orthopedic injury survivors.

PTSD Risk Factors and Acute Pain Intensity Predict Length of Hospital Stay in Youth after Unintentional Injury.

Background: Many hospitals have adopted screening tools to assess risk for posttraumatic stress disorder (PTSD) after pediatric unintentional injury in accordance with American College of Surgeons recommendations. The Screening Tool for Early Predictors of PTSD (STEPP) is a measure initially developed to identify youth and parents at high risk for meeting diagnostic criteria for PTSD after injury. Acute pain during hospitalization has also been examined as a potential predictor of maladaptive outcomes after injury, including PTSD. We investigated in a retrospective cohort study whether the STEPP, as well as acute pain intensity during hospitalization, would predict maladaptive outcomes during the peri-trauma in addition to the post-trauma period, specifically length of hospitalization. Methods: A total of 1123 youths aged 8–17 (61% male) and their parents were included. Patients and parents were administered the STEPP for clinical reasons while hospitalized. Acute pain intensity and length of stay were collected through retrospective chart review. Results: Adjusting for demographics and injury severity, child but not parent STEPP total predicted length of stay. Acute pain intensity, child threat to life appraisal, and child pulse rate predicted length of stay. Conclusions: Acute pain intensity and child PTSD risk factors, most notably child threat to life appraisal, predicted hospitalization length above and beyond multiple factors, including injury severity. Pain intensity and child appraisals may not only serve as early warning signs for maladaptive outcomes after injury but also indicate a more difficult trajectory during hospitalization. Additional assessment and treatment of these factors may be critical while youth are hospitalized. Utilizing psychology services to support youth and integrating trauma-informed care practices during hospitalization may support improved outcomes for youth experiencing unintentional injury.

Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co-twin control study.

Post-traumatic stress disorder (PTSD) has been associated with cardiovascular disease (CVD), but the mechanisms remain unclear. Autonomic dysfunction, associated with higher CVD risk, may be triggered by acute PTSD symptoms. We hypothesized that a laboratory-based trauma reminder challenge, which induces acute PTSD symptoms, provokes autonomic dysfunction in a cohort of veteran twins. We investigated PTSD-associated real-time physiologic changes with a simulation of traumatic experiences in which the twins listened to audio recordings of a one-minute neutral script followed by a one-minute trauma script. We examined two heart rate variability metrics: deceleration capacity (DC) and logarithmic low frequency (log-LF) power from beat-to-beat intervals extracted from ambulatory electrocardiograms. We assessed longitudinal PTSD status with a structured clinical interview and the severity with the PTSD Symptoms Scale. We used linear mixed-effects models to examine twin dyads and account for cardiovascular and behavioral risk factors. We examined 238 male Veteran twins (age 68 ± 3 years old, 4% black). PTSD status and acute PTSD symptom severity were not associated with DC or log-LF measured during the neutral session, but were significantly associated with lower DC and log-LF during the traumatic script listening session. Long-standing PTSD was associated with a 0.38 (95% confidence interval, -0.83,-0.08) and 0.79 (-1.30,-0.29) standardized unit lower DC and log-LF, respectively, compared to no history of PTSD. Traumatic reminders in patients with PTSD lead to real-time autonomic dysregulation and suggest a potential causal mechanism for increased CVD risk, based on the well-known relationships between autonomic dysfunction and CVD mortality.

Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness.

Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness. PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences. Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences. Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.