Discrete Traumatic Event Research Articles

5-Year Arthroscopy-Free Survivorship and Outcomes of Adolescents Undergoing Primary Hip Arthroscopy: A Comparison Between Traumatic and Atraumatic Injuries

Background: There is a paucity of literature evaluating the outcomes of adolescent patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with a discrete traumatic event related to an injury. Purpose: (1) To evaluate 5-year outcomes of adolescents undergoing hip arthroscopy for FAIS with traumatic injuries (TIs) and (2) to compare the traumatic group with a propensity-matched control group of patients with atraumatic injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for all adolescent patients (<18 years) undergoing primary hip arthroscopy for FAIS with a TI between November 2008 and March 2015. Patients were included if they had preoperative and minimum 5-year follow-up outcomes for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. The Patient Acceptable Symptom State (PASS), minimum clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOIT) were also calculated for both groups. Adolescents with TI were propensity matched in a 1:2 ratio according to age at surgery, sex, and body mass index (BMI) to a control group of adolescents who reported atraumatic hip symptoms (AHSs). Survivorship was defined as having no secondary surgery on the ipsilateral hip. Results: A total of 31 patients (32 hips) with TI, out of 39 total patients (40 hips) (80%), were included with a mean follow-up time of 72.2 ± 24.1 months and age of 15.8 ± 1.3 years. The TI group demonstrated significant improvement in all patient-reported outcomes (PROs) (P < .001) and demonstrated high rates of MCID (78.3%) and PASS (91.3%) for the mHHS. When compared with a propensity-matched control group of 64 AHS hips (57 patients), the TI group demonstrated similar rates of improvement in all PROs, as well as rates of achieving the MCID, PASS, and MOIT for all PROs; however, the TI group demonstrated significantly higher revision rates compared with controls (28.1% vs 6.3%; P = .008). Conclusion: Adolescent patients with TIs undergoing hip arthroscopy demonstrated favorable outcomes for all PROs (P < .001) and achieved high rates of MCID (78.3%) and PASS (91.3%) for the mHHS. When compared with a propensity-matched control group of adolescents with atraumatic injuries undergoing hip arthroscopy, they achieved similar levels of improvement, postoperative scores, and clinical benefit thresholds; however, reoperation rates were higher in the TI group compared with controls.

Commentary on the special issue on disproportionate exposure to trauma: Disrupting single stories, broadening the aperture, and embracing the trauma socioexposome in research with minoritized individuals.

The theory-driven studies in this special issue of the Journal of Traumatic Stress illustrate the opportunities and inherent methodological complexities that arise in traumatic stress studies when scholars consider the unique social-ecological contexts and exposure histories of minoritized individuals. Moreover, the included articles challenge the field's paradigmatic preoccupation with maladaptive individual trauma responses and invite researchers to shift their attention to the role played by a range of environmental adversities. This commentary is organized around three key recommendations regarding what is needed to enhance future research and treatment among trauma-exposed minoritized populations: (a) disrupt single scientific stories about trauma risk, detection, protection, and resilience; (b) embrace the complexity of the trauma socioexposome; and (c) expand capacity to assess, research, and mitigate syndemic risk. The present commentary describes how these key points are highlighted and underscored in the articles in this special issue, arriving at the conclusion that, more than ever, scholars and clinicians need lenses and methods that can help in assessing and treating the whole person and community from a biopsychosocial perspective when racism contibutes to a complex trauma socioexposome rather than perpetuating scientific and clinical models based only on single stories of isolated individuals confronted by discrete traumatic events.

Posttraumatic Distress and Treatment Barriers Among Former Gang Members: Implications for Improving Access to Traumatic Stress Resources in Marginalized Populations.

Limited research has examined the links among violent victimization, mental health, and service utilization among gang-involved individuals. This mixed-methods preliminary study examined narratives of psychiatric distress, current psychiatric morbidity, and mental health treatment experiences among a sample of former gang members (N = 32; M age = 44.4 years, 87.5% male; 56.3% Hispanic or Latino, 31.3% African American). Participants completed online questionnaires to assess trauma exposure and current psychiatric symptoms as well as a semistructured interview to examine histories of psychiatric distress and mental health treatment. Participants reported exposure to an average of 10.2 discrete traumatic events (range: 3-21). On average, participants reported exposure to five to six community violence-related events, ranging from never or one time up to monthly and weekly exposure. Participants generally described histories of depression, anxiety, posttraumatic stress disorder (PTSD), and substance abuse, although a thematic analysis revealed PTSD symptoms predominated the psychiatric distress described, including symptoms related to intrusions, avoidance, negative alterations in cognitions and mood, and alterations in arousal. Grounded theory analysis revealed barriers to traditional models of mental health treatment included self-isolation, gang rules, and social stigma, especially in the context of interpersonal disconnect with providers. Given conditions of limited resources to access treatment, participants engaged in peer support services, which may have reduced their psychiatric distress to currently low levels. Implications for understanding these notable findings of recovery and resilience for some individuals and building trauma-informed communities that improve access to traumatic stress resources for marginalized populations are discussed.

Does a Traumatic Etiology of Hip Pain Influence Hip Arthroscopy Outcomes?

To determine whether patients who reported a discrete traumatic event precipitating the onset of femoroacetabular impingement syndrome (FAIS) reported similar patient-reported outcomes for the modified Harris Hip Score (mHHS) and the Non-Arthritic Hip Score (NAHS) following hip arthroscopy as patients with atraumatic hip pain associated with FAIS alone. A retrospective comparative therapeutic investigation of a prospectively collected database of cases performed by a single surgeon from 2010 to 2015 identified a group of patients who developed FAIS after a discrete traumatic event. This group was compared 1:2 with a body mass index and age-matched group of primary hip arthroscopies with atraumatic hip pain attributed to FAIS. Preoperative mHHS and NAHS were obtained and compared with those at 2-year follow-up. Clinical failure at 2years was defined as any further ipsilateral hip surgery including revision arthroscopy and conversion to arthroplasty. In the traumatic etiology group, the mean mHHS and NAHS improved from 49.6 to 82.7 (P < .001) and from 46.9 to 84.0 (P < .001), respectively. The mean mHHS and NAHS in the atraumatic group improved from 51.5 to 85.82 (P < .001) and from 49.3 to 85.2 (P < .001), respectively. Survivorship at 2years was 81.1% for traumatic etiology and 88.3% for atraumatic etiology; adjusted proportional hazards regression analysis demonstrated a difference in survivorship that was not statistically significant between the traumatic and atraumatic cohorts (hazard ratio 1.8, 95% confidence interval 0.8-4.0). The findings of this study demonstrate that patients presenting with FAIS and history of a traumatic hip injury can expect to experience similar good outcomes at 2years following primary hip arthroscopy as compared with patients with atraumatic FAIS. Level III (Therapeutic) retrospective comparative study.

Initial validation of an instrument to evaluate early trauma: The EARLY Scale

IntroductionIdentification of traumatic events in childhood and adolescence are truly relevant to understand how these situations affects to adult's psychopathology. ObjectiveThis study presents a scale to identify both continuous and discrete traumatic events happening in family, school, or between equals, below the age of 18. MethodAn initial questionnaire was designed and then submitted to a process of analysis, which led to a reformulation of the items. The instrument was applied in a sample of 522 psychiatric outpatients from different populations of Galicia. ResultsThe results show a high reliability of the instrument, which is divided into three sections. The first part of the test (EARLY-G) is related to traumatic events happening in different contexts. The second part (EARLY-FP) includes indicators of healthy care by the main caretakers, which is structured as a single factor. The third (EARLY-FN), includes adverse relational situations within the family. In this third section 7 factors have been identified: Emotional neglect, Overprotection, Physical abuse, Witnessing problems at home, Role reversal, High demand and Emotional abuse. ConclusionsThe questionnaire seems to be reliable and valid.

Alternative Intensive Therapy for PTSD

Alternative Intensive Therapy for PTSD

Sexual motivation and anxiety-like behaviors of male rats after exposure to a trauma followed by situational reminders

Experiencing a traumatic event can produce long-lasting impairments in affective and social behaviors. In humans, psychopathologies associated with exposure to a single traumatic event often are associated with varying degrees of sexual dysfunction. Similarly, in rats, exposure to a trauma results in long-lasting changes in social behaviors. The current investigation examined if the sexual and affective behaviors of male rats were impacted by exposure to a discrete traumatic event that was followed days later by reminders of the event. The initial trauma combined exposure to a foot shock and predator odor, followed 3 and 7 days later by reminders of the trauma in the absence of either stressor. A day after the final reminder, traumatized rats exhibited decreased sexual motivation indicated by prolonged mount and intromission latencies, although ejaculation latencies and post-ejaculatory intervals remained unchanged. Traumatized rats also exhibited marked increases in anxiety-like behavior in a novel environment as evidenced by longer latencies to begin feeding, decreased movement and ambulation, and fewer entries into the center of an open field. Taken together, the results of the current study suggest that exposure to a single traumatic event, followed by reminders of the event, affected the motivation of male rats to interact with a receptive female and increased their anxiety-like behaviors. Moreover, because posttraumatic stress disorder can arise from exposure to a single traumatic event and is associated with recurrent and intrusive thoughts related to the trauma, the current findings have implications for our understanding of this disorder.

Outcomes After Arthroscopic Repair of Type-II SLAP Lesions

To our knowledge, there has been no prospective study on the results of arthroscopic repair of superior labrum-biceps anchor complex (SLAP) tears with use of modern techniques. The purpose of the present study was to prospectively evaluate the minimum two-year results for patients with type-II SLAP tears that were treated with arthroscopic suture anchor fixation. Forty-seven patients with symptomatic type-II SLAP tears were evaluated preoperatively and at least two years postoperatively with use of the American Shoulder and Elbow Surgeons (ASES) and L'Insalata outcomes instruments and physical examination. The study group included thirty-nine male and eight female patients with a mean age of thirty-six years; thirty-four of the forty-seven patients were athletes. Patients with rotator cuff tears requiring repair or concomitant shoulder instability were excluded. At an average of 2.7 years, the median ASES and L'Insalata scores were 97 and 93, respectively, compared with baseline scores of 62 and 65 (p < 0.05). The median patient-reported satisfaction rating was 9 (of 10); forty-one patients (87%) rated the outcome as good or excellent. The median patient-reported satisfaction rating was significantly higher for patients with a discrete traumatic etiology than for those with an atraumatic etiology (9 compared with 7); however, there was no significant difference between these groups in terms of the ASES or L'Insalata outcome scores. Overall, twenty-five (74%) of the thirty-four athletes were able to return to their preinjury level of competition, whereas eleven (92%) of the twelve athletes who reported a discrete traumatic event were able to return to their previous level of competition. There were five complications, including four cases of refractory postoperative stiffness. Our findings indicate that favorable outcomes can be anticipated in the majority of patients after arthroscopic SLAP lesion repair. While only three of four patients overall may be capable of returning fully to their previous level of competition, patients with a distinct traumatic etiology have a greater likelihood of a successful return to sports.

Resilience and Thriving: Issues, Models, and Linkages

This article addresses distinctions underlying concepts of resilience and thriving and issues in conceptualizing thriving. Thriving (physical or psychological) may reflect decreased reactivity to subsequent stressors, faster recovery from subsequent stressors, or a consistently higher level of functioning. Psychological thriving may reflect gains in skill, knowledge, confidence, or a sense of security in personal relationships. Psychological thriving resembles other instances of growth. It probably does not depend on the occurrence of a discrete traumatic event or longer term trauma, though such events may elicit it. An important question is why some people thrive, whereas others are impaired, given the same event. A potential answer rests on the idea that differences in confidence and mastery are self‐perpetuating and self‐intensifying. This idea suggests a number of variables whose role in thriving is worth closer study, including personality variables such as optimism, contextual variables such as social support, and situational variables such as the coping reactions elicited by the adverse event.

Resilience and Thriving: Issues, Models, and Linkages

This article addresses distinctions underlying concepts of resilience and thriving and issues in conceptualizing thriving. Thriving (physical or psychological) may reflect decreased reactivity to subsequent stressors, faster recovery from subsequent stressors, or a consistently higher level of functioning. Psychological thriving may reflect gains in skill, knowledge, confidence, or a sense of security in personal relationships. Psychological thriving resembles other instances of growth. It probably does not depend on the occurrence of a discrete traumatic event or longer term trauma, though such events may elicit it. An important question is why some people thrive, whereas others are impaired, given the same event. A potential answer rests on the idea that differences in confidence and mastery are self-perpetuating and self-intensifying. This idea suggests a number of variables whose role in thriving is worth closer study, including personality variables such as optimism, contextual variables such as social support, and situational variables such as the coping reactions elicited by the adverse event.

Prevalence and Characteristics of Trauma and Posttraumatic Stress Disorder in a Southwestern American Indian Community

High rates of violence and trauma in many American Indian communities have been reported. The authors investigated the relationship between both the frequency and type of traumatic events and the prevalence of posttraumatic stress disorder (PTSD) in a Southwestern American Indian tribe. A structured psychiatric interview and the Traumatic Events Booklet were administered to a subset of 247 tribal members from an overall study population of 582. Subjects were recruited from the community on the basis of membership in pedigrees, and not by convenience. DSM-III-R diagnoses were assigned by consensus after the interviews were evaluated blindly by independent raters. The prevalence of lifetime PTSD was 21.9% (N = 54), and 81.4% of the subjects (N = 201) had experienced at least one traumatic event apiece. The most predictive factor for lifetime PTSD among women was the experience of physical assault, and for men the most predictive factors were a history of combat and having experienced more than 10 traumatic events. In this Southwestern American Indian community, the prevalences of lifetime PTSD and of exposure to a traumatic event were higher than in the general U.S. population. However, the nearly 4:1 ratio of subjects who reported at least one traumatic event to those with PTSD diagnoses is similar to findings from studies of non-Indians. Individuals with a history of multiple traumatic events (66.0%, N = 163) had a significantly higher risk of developing PTSD. Chronic and multiple trauma did not preclude the identification of acute and discrete traumatic events that resulted in PTSD.

Validation of a multimethod assessment of posttraumatic stress disorders in Vietnam veterans.

Veterans Administration Medical Center, Jackson, Mississippi andUniversity of Mississippi Medical CenterThere appears to be a high incidence of posttraumatic stress disorders (PTSD)in Vietnam veterans. Yet there is little information available on the reliability andvalidity of any approach to the assessment of these combat-related stress disorders.The present study was designed to determine if responses to the presentation ofmild combat stimuli would distinguish the following three carefully matchedgroups of veterans: (a) those with an exclusive diagnosis of PTSD, (b) inpatientson a psychiatry ward who clearly do not have PTSD, and (c) Vietnam veteranswith combat experience who are currently well adjusted. Behavioral, physiolog-ical, and self-report measures of anxiety obtained through this laboratory-basedassessment clearly distinguished the PTSD veterans from the remaining two crit-ical comparison groups. The utility of this tripartite assessment approach for thereliable identification of PTSD secondary to combat is discussed. Future researchdirections are presented.Posttraumatic stress disorders (PTSD) aredenned as the maladaptive emotional re-sponse that an individual may experience fol-lowing a discrete traumatic event. The dis-order is characterized by persistently high lev-els of anxiety, intrusive recollections of theevent through nightmares or flashbacks, ex-aggerated startle responses, severe sleep dis-turbances, avoidance of close interpersonalcontact, depression and guilt, constricted af-fect, and impairment of memory and con-centration abilities (cf. Diagnostic and Sta-tistical Manual of Mental Disorders—DSM-III; American Psychiatric Association, 1980).Traumatic events that can lead to a stressdisorder include vehicular accidents, naturaldisasters, rape, and combat. Many Vietnamveterans were exposed to severely traumaticevents during combat, and in addition ex-perienced considerable hostility and lack ofsupport upon return home. As a result, atleast 24% of Vietnam veterans surveyed re-

Validation of a multimethod assessment of posttraumatic stress disorders in Vietnam veterans.

Veterans Administration Medical Center, Jackson, Mississippi andUniversity of Mississippi Medical CenterThere appears to be a high incidence of posttraumatic stress disorders (PTSD)in Vietnam veterans. Yet there is little information available on the reliability andvalidity of any approach to the assessment of these combat-related stress disorders.The present study was designed to determine if responses to the presentation ofmild combat stimuli would distinguish the following three carefully matchedgroups of veterans: (a) those with an exclusive diagnosis of PTSD, (b) inpatientson a psychiatry ward who clearly do not have PTSD, and (c) Vietnam veteranswith combat experience who are currently well adjusted. Behavioral, physiolog-ical, and self-report measures of anxiety obtained through this laboratory-basedassessment clearly distinguished the PTSD veterans from the remaining two crit-ical comparison groups. The utility of this tripartite assessment approach for thereliable identification of PTSD secondary to combat is discussed. Future researchdirections are presented.Posttraumatic stress disorders (PTSD) aredenned as the maladaptive emotional re-sponse that an individual may experience fol-lowing a discrete traumatic event. The dis-order is characterized by persistently high lev-els of anxiety, intrusive recollections of theevent through nightmares or flashbacks, ex-aggerated startle responses, severe sleep dis-turbances, avoidance of close interpersonalcontact, depression and guilt, constricted af-fect, and impairment of memory and con-centration abilities (cf. Diagnostic and Sta-tistical Manual of Mental Disorders—DSM-III; American Psychiatric Association, 1980).Traumatic events that can lead to a stressdisorder include vehicular accidents, naturaldisasters, rape, and combat. Many Vietnamveterans were exposed to severely traumaticevents during combat, and in addition ex-perienced considerable hostility and lack ofsupport upon return home. As a result, atleast 24% of Vietnam veterans surveyed re-