Current Posttraumatic Stress Disorder Symptoms Research Articles

Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins

Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts. To investigate the association of current PTSD symptoms and PTSD diagnosis with OSA. This cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023. Symptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure. Obstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis. A total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found. This cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.

Traumatic Brain Injury and Posttraumatic Stress Disorder Are Associated with Physical Health Burden among Post-9/11 Women Veterans.

Background: Little research focuses on physical health outcomes of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) among post-9/11 women veterans (WVs). This study examined lifetime TBI, current PTSD, and their associations with biomarkers of cardiometabolic health, sleep, pain, and functional disability among post-9/11 WVs. Methods: WVs (n = 90) from the Translational Research Center for TBI and Stress Disorders longitudinal cohort study were included in this study. Gold standard clinician administered interviews assessed lifetime TBI (Boston Assessment of TBI-Lifetime) and current PTSD symptoms (Clinician-Administered PTSD Scale-IV). Objective measures of health included waist-hip ratio (WHR) and fasted blood biomarker (high density lipoprotein [HDL], low density lipoprotein [LDL], blood glucose, triglycerides) levels. Self-reported surveys assessed sleep, pain, and functional disability. Results: Just under two-thirds (58.9%) of WVs experienced a lifetime TBI, and just over half (53.3%) of this sample had a current PTSD diagnosis at the time of testing. Lifetime TBI was significantly associated with higher WHR, triglycerides levels, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.01 to 1.12). Current PTSD was significantly associated with higher WHR, lower HDL, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.009 to 1.19). PTSD was significantly associated with lower total functioning and each of its subdomains (βs = -0.58 to 0.63; ps = <0.001 to 0.02). Lifetime TBI was significantly associated with total functioning, mobility, and life/work (βs = -0.20 to 0.30; ps = <0.01 to 0.02). Conclusions: These findings highlight the importance of screening for lifetime TBI and cardiovascular disease for WVs and support transdiagnostic treatment approaches targeting physical health outcomes.

To Calm and to Commend: Veterans' Musical Preferences Anticipating End of Life.

Since World War 1, physicians have noted the calming effects of music for military personnel experiencing "shell shock," Post Traumatic Stress Disorder (PTSD), or stress. Researchers have documented that stress or PTSD-like symptoms re-emerge for veterans at the end of life, triggered by hospital-like settings, co-occurring conditions, and debilitation. Dying veterans also face integration of their service and combat experiences into summations of their lives. In response, there has been a national movement for bedside ceremonies, often with music, to honor veterans. The project elicited veterans' musical preferences for calming and for music for honor services, using non-hospitalized veterans as surrogates for veterans in hospice. Respondent-driven sampling protected confidentiality and likely resulted in participants being representative of US veterans in terms of ethnicity, gender, and military branch. Recruitment materials contained all elements of informed consent, with consent collected in the introduction to the online survey. The survey had embedded links to musical performances, as well as write-in musical choices, and allowed US veterans from the Army, Air Force, Marines, and Navy to note their preferences both for music that was calming and music to be used in honor ceremonies. Online queries also asked about stress during service, usual coping strategies for stress, and current or past symptoms of PTSD. Links to hot lines were provided. The study was approved by the University of Arizona Institutional Review Board. Listening to music was the most prevalent of the 20 coping mechanisms for stress in this sample of 30 veterans. Musical preferences were stable across age groups. For calming, music at resting heartbeat rhythms was chosen. Music from early adulthood or from the timelessness of the classics was selected most often. Modern music with lyrics has themes of duty, affirmation, gratitude, and relief. The nearly universal soothing effects of lullabies were recognized. For music for honor ceremonies, desires were often independent of the military branch. Patriotic songs, or songs recognizing multiple service branches, or with themes of peace and affirmation were more often chosen than music from a particular service branch. Listening to music is a frequent coping strategy for veterans. While themes representing classical music choices are readily available in anthologies, other music chosen by this sample is not; the veterans' preferred music is rarely found in compilations of popular, movie, and TV music. Hospice and hospital intakes that document and communicate veterans' musical preferences to music therapists and therapeutic musicians may better support service men and women. Further research may examine veterans' preference for live or recorded music at end of life given the importance of meaning-making and the presence of others documented in the literature.

Less is more: Smaller hippocampal subfield volumes predict greater improvements in posttraumatic stress disorder symptoms over 2 years.

Posttraumatic stress disorder (PTSD) is a heterogeneous disorder, and symptom severity varies over time. Neurobiological factors that predict PTSD symptoms and their chronicity remain unclear. This study investigated whether the volume of the hippocampus and its subfields, particularly cornu ammonis (CA) 1, CA3, and dentate gyrus, are associated with current PTSD symptoms and whether they predict PTSD symptom changes over 2 years. We examined clinical and structural magnetic resonance imaging measures from 252 trauma-exposed post-9/11 veterans (159 with Time 1 PTSD diagnosis) during assessments approximately 2 years apart. Automated hippocampal subfield segmentation was performed with FreeSurfer Version 7.1, producing 19 bilateral subfields. PTSD symptoms were measured at each assessment using the Clinician-Administered PTSD Scale-IV (CAPS). All models included total intracranial volume as a covariate. First, similar to previous reports, we showed that smaller overall hippocampal volume was associated with greater PTSD symptom severity at Time 1. Notably, when examining regions of interest (CA1, CA3, dentate gyrus), we found that smaller Time 1 hippocampal volumes in the bilateral CA1-body and CA2/3-body predicted decreased PTSD symptom severity at Time 2. These findings were not accounted for by combat exposure or treatment history. Additionally, both Time 1 CA1-body and CA2/3-body volume showed unique associations with changes in avoidance/numbing, but not with changes in reexperiencing or hyperarousal symptoms. This supports a more complex and nuanced relationship between hippocampal structure and PTSD symptoms, where during the posttrauma years bigger may not always mean better, and suggests that the CA1-body and CA2/3-body are important factors in the maintenance of PTSD symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population

BackgroundRace-related stress (RRS) is an unrecognized source of moral injury (MI)—or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined. MethodsBlack Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity. ResultsMIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (β = 0.10, p < 0.005). ConclusionsAll types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.

The Associations Between Gender Minority Stressors and PTSD Symptom Severity Among Trauma-Exposed Transgender and Gender Diverse Adults

ABSTRACT This study investigates associations between minority stressors, traumatic stressors, and post-traumatic stress disorder (PTSD) symptom severity in a sample of transgender and gender diverse (TGD) adults. We utilized surveys and clinical interview assessments to assess gender minority stress exposures and responses, and PTSD. Our sample (N = 43) includes adults who identified as a minoritized gender identity (i.e., 39.5% trans woman or woman, 25.6% trans man or man, 23.3% genderqueer or nonbinary, 11.6% other identity). All participants reported at least one traumatic event (i.e., life threat, serious injury, or sexual harm). The most common trauma events reported by the sample were sexual (39.5%) and physical violence (37.2%), with 40.9% of participants anchoring their symptoms to a discrimination-based event. PTSD symptom severity was positively correlated with both distal (r = 0.36, p = .017) and proximal minority stressors (r = 0.40, p < .01). Distal minority stress was a unique predictor of current PTSD symptom severity (b = 0.94, p = .017), however, this association was no longer significant when adjusting for proximal minority stress (b = 0.18, p = 0.046). This study suggests that minority stress, especially proximal minority stress, is associated with higher PTSD symptom severity among TGD adults.

Association of mild traumatic brain injury, post-traumatic stress disorder, and other comorbidities on photosensitivity.

Photosensitivity is common after mild traumatic brain injury. However, this study demonstrates that photosensitivity is also impacted by common comorbidities that often occur with mild traumatic brain injury. Understanding how physical and psychological traumas impact photosensitivity can help improve provider care to trauma survivors and guide novel therapeutic interventions. This study aimed to characterize the association between mild traumatic brain injury and common comorbidities on photosensitivity in post-9/11 veterans. Existing data from the Translational Research Center for TBI and Stress Disorders cohort study were analyzed including traumatic brain injury history and post-traumatic stress disorder clinical diagnostic interviews; sleep quality, anxiety, and depression symptoms self-report questionnaires; and photosensitivity severity self-report from the Neurobehavioral Symptom Inventory. Analysis of covariance and multiple ordinal regression models were used to assess associations between mild traumatic brain injury and common comorbidities with photosensitivity severity. Six hundred forty-one post-9/11 veterans were included in this study. An initial analysis showed that both mild traumatic brain injury and current post-traumatic stress disorder diagnosis were independently associated with higher photosensitivity ratings compared with veterans without either condition, with no interaction observed between these two conditions. Results of the ordinal regression models demonstrated positive associations between degree of photosensitivity and the number of mild traumatic brain injuries during military service and current post-traumatic stress disorder symptom severity, particularly hyperarousal symptoms, even when controlling for other factors. In addition, the degree of sleep disturbances and current anxiety symptoms were both positively associated with photosensitivity ratings, whereas depression symptoms, age, and sex were not. Repetitive mild traumatic brain injury, post-traumatic stress disorder, anxiety, and sleep disturbances were all found to significantly impact photosensitivity severity and are therefore important clinical factors that eye care providers should consider when managing veterans with a history of deployment-related trauma reporting photosensitivity symptoms.

Cohort Differences in PTSD Symptoms and Military Experiences: A Life Course Perspective.

There have been major changes in military service over the past 50 years. Most research on posttraumatic stress disorder (PTSD) among combat Veterans comes from help-seeking Vietnam and WWII cohorts; results from more recent cohort comparisons are mixed. The present study addressed these gaps by exploring cohort differences among Vietnam, Persian Gulf, and Post-9/11 combat Veterans from a life course perspective. We recruited community-dwelling combat and war zone Veterans (N = 167), primarily from Veterans' associations in Oregon from three cohorts: Vietnam, Persian Gulf, and Post-911. Online surveys assessed current PTSD symptoms, life course (demographics and cohort membership), and experiential variables (combat severity, appraisals of military service, homecoming, and social support). Cohorts were comparable in demographics and war experiences. Step one of a hierarchical regression found that PTSD symptoms were higher among Veterans of color and those with lower incomes, R2 = 0.37, p < .001. When cohort was added, Vietnam Veterans had higher symptoms than Post-9/11; income and race/ethnicity remained significant, ΔR2 = 0.01, p = .13. The final model added experiential variables, ΔR2 = 0.38, p < .001; cohort and income were no longer significant, although Veterans of color still reported higher symptoms. Those with more undesirable service appraisals and who sought social support had higher symptoms, while desirable appraisals were protective. From a life course perspective, the particular war zone that Veterans served in was less important than demographics and both service and postservice experiences, suggesting generalizability of risk and protective factors, as well as treatment modalities, across cohorts.

Exaggerated Peripheral and Systemic Vasoconstriction During Trauma Recall in Posttraumatic Stress Disorder: A Co-Twin Control Study

BackgroundIndividuals with posttraumatic stress disorder (PTSD) face an increased risk of cardiovascular disease, but the mechanisms linking PTSD to cardiovascular disease remain incompletely understood. We used a co-twin control study design to test the hypothesis that individuals with PTSD exhibit augmented peripheral and systemic vasoconstriction during a personalized trauma recall task. MethodsIn 179 older male twins from the Vietnam Era Twin Registry, lifetime history of PTSD and current (last month) PTSD symptoms were assessed. Participants listened to neutral and personalized trauma scripts while peripheral vascular tone (Peripheral Arterial Tone ratio) and systemic vascular tone (e.g., total vascular conductance) were measured. Linear mixed-effect models were used to assess the within-pair relationship between PTSD and vascular tone indices. ResultsThe mean age of participants was 68 years, and 19% had a history of PTSD. For the Peripheral Arterial Tone ratio analysis, 32 twins were discordant for a history of PTSD, and 46 were discordant for current PTSD symptoms. Compared with their brothers without PTSD, during trauma recall, participants with a history of PTSD had greater increases in peripheral (β = −1.01, 95% CI [−1.72, −0.30]) and systemic (total vascular conductance: β = −1.12, 95% CI [−1.97, −0.27]) vasoconstriction after adjusting for cardiovascular risk factors. Associations persisted after adjusting for antidepressant medication use and heart rate and blood pressure during the tasks. Analysis of current PTSD symptom severity showed consistent results. ConclusionsPTSD is associated with exaggerated peripheral and systemic vasoconstrictor responses to traumatic stress reminders, which may contribute to elevated risk of cardiovascular disease.

Abstract 12776: Sustained Impact of Peripartum Cardiomyopathy on Mental Health Disorders and Quality of Life

Introduction: Mental health diagnoses such as depression, post-traumatic stress disorder (PTSD), and anxiety are common after acute cardiovascular events. Peripartum cardiomyopathy (PPCM) affects women near the end of pregnancy or in the near post-partum period and occurs during a period of heightened psychosocial stress. There is limited data on the prevalence of mental health diagnoses after the acute PPCM event. Methods: Patients with self-identified PPCM enrolled in the online PPCM Registry (PPCM-R at ppcmr.org) and completed validated surveys for depression (Patient Health Questionnaire - 9, PHQ-9), anxiety (Generalized Anxiety Disorder -7, GAD-7), PTSD ( Posttraumatic Stress Disorder Checklist- Civilian, PCL-C) and quality of life (Rand SF-36). Patients were recruited on PPCM support groups, social media, and physician referral. Results: After 4 months, 103 patients enrolled and 55 (54%) completed the mental health and QOL surveys. Mean age was 32.3 (SD 4.7) and median time since diagnosis was 4.2 years (IQR 1.7, 10.4 years). Mean (SD) PHQ-9 score was 8.1 (7.3) and 27% had a score (≥10) indicating moderate or severe depressive symptoms. Mean (SD) GAD-7 score was 7.3 (6.7) and 36% of participants had scores (≥10) consistent with moderate or severe anxiety symptoms. Mean (SD) PCL-C score was 20.7 (19.3) and 33% screened positive for PTSD. Overall, 30% of participants reported that QOL was ‘fair’ or ‘poor’ with lower domain scores for physical function, emotional function, energy/fatigue and general health compared to the general population. Characteristics of participants stratified by mental health symptom severity and QOL scores are presented in the Table. Conclusions: Half (51%) of participants had at least one mental health screening tool which indicated current moderate or severe symptoms of depression, anxiety or PTSD. These findings confirm a significant burden of mental health symptoms in this PPCM survivor cohort.

Effects of prenatal exposure to the 1944–45 Dutch famine and glucocorticoid receptor polymorphisms on later life PTSD susceptibility

ABSTRACT Background: Exposure to adversity in utero is thought to increase susceptibility to develop posttraumatic stress disorder (PTSD) following later life trauma, due to neurobiological programming effects during critical developmental periods. It remains unknown whether effects of prenatal adversity on PTSD susceptibility are modulated by genetic variations in neurobiological pathways implicated in PTSD susceptibility. Objective: We investigated whether genetic variation in the glucocorticoid receptor (GR) modulated effects of prenatal famine exposure on late adulthood PTSD symptom severity after trauma exposure in childhood and mid-to-late adulthood. Method: We included N = 439 term-born singleton adults (mean age: 72 years, 54.2% women) from the Dutch Famine Birth Cohort, born around the time of the Dutch Famine of 1944/1945, divided into exposure and control groups based on timing of the famine during gestation. Participants filled out self-report questionnaires on childhood (Childhood Trauma Questionnaire) and mid-to-late adulthood (Life Events Checklist for DSM-5) trauma, and current PTSD symptom severity (PTSD Checklist for DSM-5). GR haplotypes were determined from four functional GR single nucleotide polymorphisms (ER22/23EK, N363S, BclI and exon 9β) in previously collected DNA. Linear regression analyses were performed to investigate associations of GR haplotype and prenatal famine exposure in conjunction with later life trauma on PTSD symptom severity. Results: We observed a significant three-way interaction between the GR Bcll haplotype, famine exposure during early gestation, and adulthood trauma exposure on PTSD symptom severity in late adulthood. Only participants exposed to famine during early gestation without the GR Bcll haplotype showed a significantly stronger positive association between adulthood trauma and PTSD symptom severity than non-exposed participants, indicating increased PTSD susceptibility. Conclusions: Our results illustrate the importance of integrated approaches considering genetics and environmental contexts throughout various life periods, including the rarely investigated prenatal environment, to elucidate how PTSD susceptibility evolves throughout life. HIGHLIGHTS Adversity during pregnancy is thought to increase offspring’s PTSD risk following later life trauma, but exact neurobiological mechanisms underlying this process remain unknown. We found that effects of prenatal famine exposure on PTSD symptom severity were influenced by genetic variation in the glucocorticoid receptor, which signals effects of the stress hormone cortisol. Integrated approaches considering genetics and environmental contexts throughout both early and later life are important to understand how PTSD risk evolves throughout life.

0666 Need a novel method to reduce anger after combat? Treat sleep apnea

Abstract Introduction Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. Methods The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1,263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Results Multiple regression model results revealed that PTSD symptoms (β = 0.517, p &amp;lt; .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p &amp;lt; .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for associations between PTSD and pain interference with anger. Conclusion Treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Support (if any) This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Psychological Health/Traumatic Brain Injury Research Program Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award/W81XWH-18-PH/TBIRP-LIMBIC and with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED

WHEN REPRODUCTION IS NO LONGER AUTONOMOUS: FEELING RESPECTED BY MATERNITY CARE PROVIDERS MODERATES THE ASSOCIATION BETWEEN AUTONOMY IN DECISION MAKING AND BIRTH-RELATED PTSD SYMPTOMS IN A COMMUNITY SAMPLE OF POSTPARTUM BLACK WOMEN

ABSTRACT Black individuals are at particularly high risk for birth-related posttraumatic stress disorder (PTSD) symptoms, in part due to a lack of opportunity to lead maternity care decisions. Maternal care providers need evidence-based ways to reduce pregnant persons’ risk for birth-related PTSD symptoms despite reduced autonomy in decision making resulting from heightened restrictions on reproductive rights. We investigated whether a potential relation between autonomy in decision making and birth-related PTSD symptoms would be moderated by being mistreated or feeling respected by maternity care providers in a community sample of Black women (N = 52; Mage = 28.2 years, SDage = 5.7 years) seeking maternity care at a public hospital in the southeastern United States. At six weeks postpartum, participants completed measures assessing autonomy in decision making, current birth-related PTSD symptoms, number of mistreatment events, and feelings of respect from providers during pregnancy, childbirth, and the postpartum period. Autonomy in decision making was negatively correlated with birth-related PTSD symptoms, r=−.43, p < .01. An interaction between autonomy in decision making and mistreatment by providers was trending toward significance, B=−.23, SE=.14, p = .10. Autonomy in decision making and feeling respected by maternity care provider interacted to predict birth-related PTSD symptoms, B = .05, SE=.01, p < .01. Feeling respected by providers may buffer against the negative effects of lack of autonomy in decision making on birth-related PTSD symptoms, highlighting the importance of providers’ ability to convey respect to pregnant patients when they cannot lead care decisions.

Differing associations of depersonalization with physiological response during rest and breath-focused mindfulness in a trauma-exposed female population

BackgroundDissociative and posttraumatic stress disorder (PTSD) symptoms are commonly co-occurring responses to psychological trauma. Yet, these two groups of symptoms appear to be related to diverging patterns of physiological response. To date, few studies have examined how specific dissociative symptoms, namely, depersonalization and derealization, relate to skin conductance response (SCR), a marker of autonomic function, within the context of PTSD symptoms. We examined associations among depersonalization, derealization, and SCR during two conditions – resting control and breath-focused mindfulness – in the context of current PTSD symptoms. MethodsSixty-eight trauma-exposed women (82.4% Black; Mage = 42.5, SDage = 12.1) were recruited from the community for a breath-focused mindfulness study. SCR data were collected during alternating resting control and breath-focused mindfulness conditions. Moderation analyses were conducted to examine relations among dissociative symptoms, SCR, and PTSD for these different conditions. ResultsModeration analyses revealed that depersonalization was linked to lower SCR during resting control, B = 0.0005, SE = 0.0002, p = .006, in participants low-to-moderate PTSD symptoms; however, depersonalization was associated with higher SCR during breath-focused mindfulness, B = −0.0006, SE = 0.0003, p = .029, in individuals with similar levels of PTSD symptoms. No significant interaction between derealization and PTSD symptoms on SCR was observed. ConclusionsDepersonalization symptoms may associate with physiological withdrawal during rest, but greater physiological arousal during effortful emotion regulation in individuals with low-to moderate levels of PTSD, which has significant implications for barriers to treatment engagement as well as treatment selection in this population.

Childhood Trauma and PTSD Symptoms: Disentangling the Roles of Emotion Regulation and Distress Tolerance.

Research documents that a history of childhood trauma increases risk for post-traumatic stress disorder (PTSD), greater emotion regulation difficulties (ERD), and reduced distress tolerance (DT). Independent lines of research implicate ERD and DT as transdiagnostic risk factors and link them to PTSD. To elucidate how such mechanisms may influence the etiology, maintenance, and treatment of PTSD, the current study investigates the distinct mediating roles of emotion regulation and DT, exploring which explains a larger indirect effect from childhood trauma to PTSD symptom severity. Participants (N = 385, aged 18-48) who endorsed a history of childhood trauma provided retrospective report of cumulative childhood trauma exposure, and of current ERD, DT, and PTSD symptom severity. Single and dual mediation analyses were used to assess indirect effects through ERD and DT in the relation between cumulative childhood trauma exposure and current PTSD symptom severity. ERD and DT were significantly and inversely related. Higher current self-ratings of PTSD symptom severity were explained by cumulative childhood trauma through ERD (B = 0.93, p < 0.001) and DT (B = 0.50, p < 0.05). The full model explained 36% of the variance in PTSD symptom severity. Current findings provide preliminary evidence of DT and emotion regulation (with specific facets identified) as distinct mechanisms in the development of PTSD. Of clinical relevance, current findings support post-trauma processing theories that contend individuals' recovery requires accepting and learning to modulate trauma-related emotional states. Implications for methods of treatment and prevention are discussed.

Adolescent Post-traumatic Stress Disorder as a Mediator Between Childhood Negative Life Event Types and Depression

The aim of the current research was to understand how subtypes of childhood negative life events (NLEs) contribute to adolescent post-traumatic stress disorder (PTSD) symptoms and depression, as well as the mediating effects of PTSD symptoms in the relationship of stress of NLEs and depression. The sample included 447 Chinese young people from 12 to 24. The participants were asked to report subtypes of their experienced childhood NLEs as well as past and current stress intensity of the NLEs. Then their current PTSD and depression symptoms were measured. Results found that among the past stress of NLEs, such as family violence or abuse had a significant impact on depression symptoms. Among the current stress of NLEs, such as death of family member or friend and serious illness or injuries had significant impacts on depression. Moreover, PTSD symptoms had partial mediating effect in the relationship between the past stress of NLEs and adolescent depression, and full mediating effect in the relationship between the current stress of NLEs and adolescent depression. These results suggested that the impacts of childhood NLEs on adolescent PTSD and depression are multi-dimentional. Future intervention of adolescent PTSD and depression should take the expousre experieces of specific types of NLEs into consideration.

Relationship between Experience of Antepartum Intervention and Posttraumatic Stress Symptoms Following Childbirth: A Prospective Study

Background: Childbirth is an important event in a woman’s life. Adverse childbirth experiences may lead to negative psychological reactions and disturb the mother’s mental health during the postpartum period. Objective: This prospective study aimed to assess the relationship between experiences of antepartum intervention and post-traumatic stress symptoms in mothers following childbirth. Methods: The study sample comprised 176 Iranian women, who were under assessment for 8 weeks postpartum. Current Post-Traumatic Stress Disorder symptoms (PTSD) were assessed through the Impact of Events Scale-Revised (IES-R) questionnaire. Data were analyzed using SPSS software (Version 19.0), and the adjusted odds ratios (ODs) were estimated by binary logistic regression. Results: Based on the obtained results, 38.3% (N = 62) of the women appeared to be at risk of developing PTSD symptoms. The mean ± SD score of PTSD symptoms was obtained at 22.51 ± 12.04 (0-65). The results showed that women in the PTSD group underwent more obstetric interventions (P = 0.002) and experienced more childbirth pain (P = 0.048), compared to women without PTSD, during childbirth. Insertion of sublingual or vaginal prostaglandin tablets, experiencing episiotomy incision, perineal/labial/vaginal sutures, and artificial rupture of amniotic membranes correlated significantly with PTSD symptoms (P &lt; 0.05). The results of binary logistic regression analysis confirmed that the rate of obstetric interventions was the significant predictor of PTSD after childbirth (OD = 1.284; P = 0.008). Conclusion: The findings of the present study indicate that the enhanced understanding of healthcare providers of obstetric intervention consequences may prevent postpartum PTSD through the provision of physiological delivery and supportive care during labor.

Putting the pieces together to understand anger in combat veterans and service members: Psychological and physical contributors

Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C–V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1263 C–V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for the association between PTSD and anger, in addition to the association between pain interference and anger. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C–V/SM. Additionally, treating OSA may be a novel way to reduce anger in C–V/SM who have PTSD and/or pain interference.

Mental health among older Bhutanese with a refugee life experience: A mixed-methods latent class analysis study.

There are disparities in the mental health of refugee populations compared to individuals who have not experienced forced migration. It is important to identify individuals with a refugee life experience who are most in need of mental health care and prioritize their engagement in services. The objectives of this convergent mixed-methods study are to quantitatively identify the association between exposure to pre- and postresettlement traumas and stressors and mental health among older adults with a refugee life experience, qualitatively identify typologies of narratives of forced migration, and integrate findings to provide a more comprehensive understanding of the relationship between trauma and symptoms of posttraumatic stress disorder (PTSD). Study participants were Bhutanese with a refugee life experience living in a metropolitan area in New England (United States). We used quantitative surveys to identify exposures to traumas and symptoms of PTSD. We used latent class analysis to identify subgroups of trauma exposure and association with symptoms of PTSD. A subset of individuals participated in qualitative interviews. Narrative thematic analysis was used to explore typologies of life history narratives. Quantitatively, we identified four classes of patterns of trauma exposure throughout the refugee life trajectory. These classes were associated with current symptoms of PTSD. Qualitatively, we identified four narrative types that indicate participants interpreted and made sense of their life trajectories in a variety of ways. Integration of findings indicate that caution is needed in identifying individuals in need of mental health services and the best approach for interventions that promote psychosocial well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).