Evidence Of Posttraumatic Stress Disorder Research Articles

The Relationship Between Posttraumatic Stress Disorder and Alcohol Misuse and Smoking Among Aging Men Who Have Sex With Men: No Evidence of Exercise or Volunteering Impact.

To determine if the association between posttraumatic stress disorder (PTSD) and substance use (alcohol misuse or smoking tobacco) is mediated/moderated by exercise or volunteering among aging (≥40years) men who have sex with men (MSM), and if this mediation/moderation differs by HIV serostatus. Multicenter AIDS Cohort Study data were used. Three datasets with PTSD measured during different time periods (10/1/2017-3/31/2018, 898 men; 4/1/2018-9/30/2018, 890 men; 10/1/2018-3/31/2019, 895 men) were analyzed. Longitudinal mediation analyses estimated the mediation effect of exercise and volunteering on the outcomes. Nine percent of MSM had evidence of PTSD. There was no statistically significant mediation effect of exercise or volunteering regardless of substance use outcome. The odds of smoking at a future visit among MSM with PTSD were approximately double those of MSM without PTSD. Results did not differ by HIV serostatus. There is a particular need for effective smoking cessation interventions for aging MSM with PTSD.

Factors Associated with Post-Traumatic Stress Symptoms in Pregnant and Postpartum Women.

Background: Evidence of post-traumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic during the perinatal period and the associated risk factors are still limited. Thus, we aimed to investigate the PTSD symptoms associated with the COVID-19 pandemic in a large sample of both pregnant and postpartum women. Methods: A cross-sectional study was conducted on 3319 pregnant and up to 6-month postpartum women from Spain. An online survey was completed between June 2020 and January 2021. The assessment included measures of PTSD symptoms associated with COVID-19 (evaluated with 10 questions from the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), pandemic-related concerns and health background (assessed by the Coronavirus Perinatal Experiences-Impact Survey), and demographic characteristics. Results: We found that >40% of women suffered from symptoms of PTSD associated with the COVID-19 pandemic. Difficulty concentrating and irritability were the most common symptoms, showing marked alterations in arousal and reactivity associated with the traumatic event. Being younger, suffering from pandemic concerns and distress, changes due to the pandemic and previous mental health problems were risk factors associated with PTSD symptoms in perinatal women. In addition, whereas being an immigrant (non-Spanish) was a risk factor for pregnant women, having other children and financial problems were risk factors for postpartum women. COVID-19 infection did not appear to be a risk factor for symptoms of PTSD in perinatal women. Conclusions: The increased risk of PTSD in pregnant and postpartum women highlights the importance of early detection and treatment of PTSD for pregnant and postnatal women, both during and beyond the pandemic. Trial Registration: ClinicalTrials.gov Identifier (NCT04595123).

Battered woman syndrome and PTSD in women who kill their abusing partner: a study in medical jurisprudence

AimsThe aim of the study was to identify any symptoms or features of Battered Woman Syndrome (BWS) or Post-traumatic Stress Disorder (PTSD) that may be associated with, or explain, abused women killing their abuser; and the extent to which such identified symptoms or features have been deemed, or are potentially relevant, to past and now reformed partial defences to murder in English law. Hence two sub-studies were completed.MethodThe first sub-study identified mental symptoms of BWS or PTSD apparent in battered women who kill their abuser; achieved by identifying relevant research papers, through applying a ‘rapid review’ approach to three databases: PubMed, PsychInfo and PsychArticles. The second sub-study identified by legal research reported Court of Appeal (CA) judgments on women appealing their conviction of the murder of their abusive partner. It then analysed the legal approach taken towards evidence of the effects of abuse upon these women before and after relevant statutory law reform (although no CA cases were identified post-reform).ResultThe first sub-study identified and reviewed six symptoms or features, within three quantitative and three qualitative studies, that appeared to be associated with, or described by, abused women killing their abuser. These included helplessness, symptoms associated with PTSD, plus fear, isolation, experience of escalation of violence and cycle of violence. From the CA cases the perpetrators of killings that occurred prior to 04.10.2010 (the date of law reform) were usually successful in having their conviction overturned based upon diminished responsibility; but not provocation, because of the requirement of ‘sudden loss of self control’. ‘Loss of control’, which replaced provocation, appears highly likely to be capable of reducing murder to manslaughter based upon symptoms of BWS, or PTSD. However, the amended defence of diminished responsibility is likely to exclude evidence of BWS, but allow evidence of PTSD, because of its requirement of the defendant suffering from ‘a recognised medical condition’.ConclusionThis study demonstrated particular symptoms or features of BWS or PTSD associated with abused women killing their abusers plus their very different relevance to two partial defences to murder, pre and post law reform.

Impact of the COVID-19 pandemic on mental health and health-related quality of life among university students in Turkey.

The COVID-19 health crisis has reached pandemic scale spreading globally. The present study examines the COVID-19 pandemic’s impact on psychological and physical health-related quality of life (HRQOL) among university students in Turkey. A cross-sectional survey design was used for data collection. From May 11th to May 15th 2020, the study utilized snowball sampling techniques to gather data through an online survey. The pandemic’s psychological effects on participants were measured by the Impact of Event Scale-Revised. Depression, Anxiety and Stress Scale-21 and the 12-Item Short Form Health Survey assess related HRQOL were used to make mental health assessments. 1120 university students were contacted to complete the survey. Of these, a total of 1095 completed the survey, translating to a participation rate of 97.7%. Overall, 64.6%, 48.6% and 45.2%, and 34.5% of all participants self-reported symptomatic signs of depression, anxiety, stress and post-traumatic stress disorder (PTSD), respectively. Female gender and poor family relationships were identified as risk factors for probably PTSD, and symptoms of depression, anxiety, and stress as well. The mean scores of Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) were 66.99 ± 2.14 and 40.76 ± 2.31, respectively. Students suspected of a history with PTSD had considerably lower total scores for PCS-12 and MCS-12, when cross checked for similarity to those without such a history. The findings of this research suggest that evidence of PTSD, depression, anxiety, and stress is commonly apparent among university students during the period of the COVID-19 crisis. Prevention and intervention approaches to attenuate the psychosocial impact should be an integral component of crisis response during pandemic conditions.

Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New-Onset Depression Among Military Spouses.

Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member–spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new‐onset depression among military spouses. Over the 3‐year study period, 14.4% of these military spouses met the criteria for new‐onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new‐onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new‐onset depression in military spouses, which has implications for treatment provision.

Ten-Year Trend and Correlates of Reported Posttraumatic Stress Disorder among Young Male Veteran Suicide Decedents-Results from the National Violent Death Reporting System, 16 U.S. States, 2005-2014.

This study examined trends and correlates of reported post-traumatic stress disorder (PTSD) among young male Veteran suicide decedents, using data from the National Violent Death Reporting System from 2005-2014 on 1,362 male U.S. Veteran suicide decedents aged 18-34years. Prevalence of reported PTSD (i.e., diagnosis/symptoms) was determined by mental health diagnostic fields and narratives and examined by year. Demographic, incident, and precipitating circumstance characteristics correlated with reported PTSD were identified. One-hundred ninety-eight (15%) decedents had PTSD evidence. A 30-fold increase in reported PTSD prevalence occurred among decedents aged 25-34years; however, no increase was observed among younger decedents. Reported PTSD was associated with past deployments (odds ratio (OR): 14.5, 95% confidence interval (95% CI): 9.0-23.4); depression (OR: 1.8, 95% CI: 1.2-2.6); and divorce (OR: 1.7, 95% CI: 1.0-2.7). Recent crisis (OR: 0.6, 95% CI: 0.3-0.9) was inversely associated with reported PTSD. Reported PTSD prevalence substantially increased among Veteran suicide decedents aged 25-34years suggesting it is beginning to play a larger role in suicide for this group. Few correlated suicide risk factors were found, suggesting that if symptoms of PTSD are present, heightened vigilance by providers for suicide risk might be warranted, irrespective of evidence of other risk factors.

Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises.

Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises.

Effect of Post-Traumatic Stress Disorder on Cognitive Function and Covert Hepatic Encephalopathy Diagnosis in Cirrhotic Veterans.

In veterans, post-traumatic stress disorder (PTSD) is often associated with substance abuse, which in turn can lead to cirrhosis. Cirrhotic patients are prone to cognitive impairment, which is typically due to covert hepatic encephalopathy (CHE), but can also be affected by PTSD. The aim was to define the impact of PTSD on cognitive performance and the diagnosis of CHE in cirrhotic patients. Outpatient veterans with cirrhosis underwent two separate modalities for CHE cognitive testing [Psychometric Hepatic Encephalopathy Scale (PHES) and Inhibitory Control Test (ICT)]. ICT tests for inhibitory control and response inhibition, while PHES tests for attention and psychomotor speed. Comparisons were made between patients with/without PTSD. Multivariable logistic regression with CHE on PHES and CHE on ICT as dependent variables including prior OHE, demographics, PTSD and psychotropic medications was performed. Of 402 patients with cirrhosis, 88 had evidence of PTSD. Fifty-five of these were on psychoactive medications, 15 were undergoing psychotherapy, while no specific PTSD-related therapy was found in 28 patients. Cirrhotic patients with/without PTSD were statistically similar on demographics and cirrhosis severity, but cirrhotic subjects with PTSD had a higher frequency of alcoholic cirrhosis etiology and psychotropic drug use. PTSD cirrhosis had higher ICT lure and switching errors (NCT-B response), but on regression, there was no significant impact of PTSD on CHE diagnosis using either the ICT or PHES. Veterans with cirrhosis and PTSD have a higher frequency of psychotropic drug use and alcoholic cirrhosis etiology. CHE diagnosis using PHES or ICT is not affected by concomitant PTSD.

Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study

BackgroundMost women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.MethodsA Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.ResultsWomen who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2–5.6) and 2.9 (CI 95% 1.3–6.6), respectively.ConclusionHigh scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.

Psychological consequences of traumatic upper limb peripheral nerve injury: A systematic review

Introduction Traumatic upper limb peripheral nerve injuries significantly impact individuals’ function and ability to return to work. Patients with peripheral nerve injury experience ongoing psychological impairments for which they are not routinely treated. The aim of this review was to investigate the psychological consequences of traumatic upper limb peripheral nerve injury. Methods A systematic review of MEDLINE, Embase, PsycINFO, CINAHL, AMED, BNI, the Cochrane libraries and grey literature up to October 2015 was undertaken. Two reviewers independently assessed methodological quality in accordance with Cochrane Collaboration recommendations. Eligibility criteria comprised: adults or adolescents with traumatic upper limb peripheral nerve injury using any measurement of psychological well-being. Results Six studies ( n = 245) met the inclusion criteria. Methodological quality varied widely. Evidence of post-traumatic stress disorder at one month, which decreased over time, was reported in three studies. Two studies found a statistically significant correlation between the early presence of post-traumatic stress disorder and reduction in function at 12 or more months. Limited information was available on anxiety, depression and mental quality of life. Combined nerve injuries (in two studies) had significantly higher levels of post-traumatic stress disorder, at one month, compared to those with an isolated nerve injury. Conclusion There is some evidence of early post-traumatic stress disorder following traumatic upper limb peripheral nerve injury, which may have an impact on functional outcome. However, high-quality studies using prospective cohorts are required to further evaluate the psychological aspects associated with this traumatic injury.

About Edgar Derby: Trauma and Grief in the Unpublished Drafts of Kurt Vonnegut’s Slaughterhouse-Five

ABSTRACTIn this essay, I examine the unpublished drafts and false starts of Slaughterhouse-Five alongside Vonnegut’s notes and personal correspondences written between his return home from World War II and the publication of the novel in order to make the case that the novel is as much evidence of post-traumatic stress disorder as it is of a deep and prolonged grief. This grief is attached to a specific fellow prisoner-of-war who manifests in various incarnations in nearly all unpublished versions and early drafts of the novel. This individual is ultimately fictionalized in the character of Edgar Derby; however, many of his characteristics also prefigure the character of Billy Pilgrim.

Exposure to Armed Conflict and Prevalence of Posttraumatic Stress Symptoms Among Young Adults in Kashmir, India

In this study, the relationship between armed conflict and posttraumatic stress disorder (PTSD) symptoms was explored in a sample of young adults from Northern Kashmir in India. The sample included 797 college students. Exposure to conflict was assessed by the Exposure to Kashmir Conflict Checklist, made up of 16 different types of conflict-related events. PTSD symptoms were assessed through the PCL–C, a 17-item self-rating questionnaire typically used as a screening instrument. Nearly half of the respondents (49.81%) were found to be in the diagnosable range for PTSD. The nature and frequency of some of the conflict-related events emerged as risk factors associated with PTSD. Logistic regression analysis revealed that a family member being dead and missing, personally being threatened with death, witnessing distressful media portrayal of conflict, a feeling of living in the conflict, and a higher level of personal exposure to conflict emerged as risk factors associated with PTSD symptomatology. This study provides evidence of PTSD being prevalent among Kashmir youth and sheds light on the associated risk factors. The study highlights the trauma and distress that is inherent to the lives of the people of Kashmir and points to the urgent need for governmental and nongovernmental bodies to recognize, understand, and address the prevalent psychological morbidity in this understudied population.

Recognition of the neurobiological insults imposed by complex trauma and the implications for psychotherapeutic interventions.

Considerable research has been conducted on particular approaches to the psychotherapy of post-traumatic stress disorder (PTSD). However, the evidence indicates that modalities tested in randomised controlled trials (RCTs) are far from 100% applicable and effective and the RCT model itself is inadequate for evaluating treatments of conditions with complex presentations and frequently multiple comorbidities. Evidence at levels 2 and 3 cannot be ignored. Expert-led interventions consistent with the emerging understanding of affective neuroscience are needed and not the unthinking application of a dominant therapeutic paradigm with evidence for PTSD but not complex PTSD. The over-optimistic claims for the effectiveness of cognitive–behavioural therapy (CBT) and misrepresentation of other approaches do not best serve a group of patients greatly in need of help; excluding individuals with such disorders as untreatable or treatment-resistant when viable alternatives exist is not acceptable.

Post-traumatic stress disorder and post-traumatic growth in breast cancer patients--a systematic review.

Breast cancer (BC) is potentially a traumatic stressor which may be associated with negative outcomes, such as post-traumatic stress disorder (PTSD) or positive changes, such as post-traumatic growth (PTG). This study aims to identify the core issues of BC related PTSD, PTG and psychological distress by interrogating the literature in BC survivors. We have also highlighted issues related to the assessment, diagnosis and clinical management of PTSD and PTG. The authors systematically reviewed studies published from 1985 to 2014 pertaining to PTSD, psychological distress and PTG in BC survivors with particular attention paid to incidence rates and causative factors. Multiple studies intimated that women with BC have evidence of PTSD at the initial stages of diagnosis, whereas PTG develops once patients undergo treatment. Early diagnosis and treatment of PTSD/PTG is paramount from literature review but the previously mentioned relationship between PTSD and PTG in BC patients could not be verified. It is evident from the literature that a small percentage of BC patients experience PTSD, while the majority experience PTG after BC diagnosis and treatment. Future research should include prospective studies focusing on high-risk patients, causative factors and the development of psychological interventions.

Abstract T P363: A Pilot Study: Parents Show Evidence of PTSD while Children Display Anxiety following Childhood Stroke

Objectives: Post-traumatic stress disorder (PTSD) is commonly found in parents and child following life-threatening pediatric illness or injury including cancer, organ transplant, traumatic brain injury, and admission to the pediatric intensive care unit. It can be diagnosed months to years after the event. The prevalence and significance of PTSD in parents and children following a childhood stroke are unknown. We examine the emotional outcomes of a cohort of 33 parents and 10 children following recent stroke in the child. Methods: We prospectively enrolled children with stroke of ages 7-18 years and parents of children with stroke ages 0-18 years whose stroke occurred in 2013 or 2014. Parents were screened for PTSD using the PTSD checklist and children with stroke ≥ 7 years of age were screened with the University of California Los Angeles PTSD Reaction Index. Emotional outcome of the child was examined with the Behavior Assessment System for Children (BASC-2). Parents were surveyed on their child’s stroke outcome with the Recurrence and Recovery Questionnaire (RRQ). Results: Of the 33 parents (10 fathers, 23 mothers) 18 (55%) met one or more of the 3 PTSD criteria and 8 (24%) met all criteria for PTSD. Although not yet reaching significance, RRQ is higher in the group of parents with PTSD (RRQ M= 1.2, SD=1.4) compared to parents without PTSD (M=0.6, SD=1.0). The subsample of children enrolled ranged in age from 7 to 17 years old at time of stroke. Although preliminary, of the children who were surveyed none met criteria for PTSD while 2 of the 9 (22%) had clinically significant levels of anxiety. Conclusion: Preliminary findings reveal a rate of PTSD in parents of children with childhood stroke similar to that found in parents of other critically ill children. We did not yet detect PTSD in our small sample of children. However, emotional ratings revealed that over 20% experience anxiety. The children of parents with PTSD had higher RRQ scores reflecting increased disability which may be related to the parent’s PTSD. PTSD in parents of a child with stroke and children with anxiety following stroke could impede compliance with therapeutic interventions and, consequently, lead to poorer functional outcome in the child.

Bearing Witness: Midwives experiences of witnessing traumatic birth

Abstract Background traumatic birth is a phenomenon that has been identified in women's birthing experiences, yet there has been no primary research conducted into midwives experiences of witnessing traumatic birth. Traumatic stress from witnessing and working with traumatised clients has been identified in other caring professionals such as nurses, social workers and emergency department personnel. This includes evidence of posttraumatic stress disorder, secondary traumatic stress, vicarious traumatisation and compassion fatigue. A distinct gap in the literature about midwives experiences of witnessing traumatic birth and the effects of working with potentially traumatised women formed the basis for this research. Research design and method a descriptive qualitative study was used to explore midwives experiences of witnessing traumatic birth. The aim of this research was to enable midwives to describe their experiences and to determine if they are at risk of negative psychological sequalae similar to those in other caring professions. Ten currently or previously Registered Midwives with varying amounts of experience were interviewed, and transcripts of those interviews formed the raw data for the study. The data were independently thematically analysed by the two authors to identify common themes used to describe the experience of witnessing traumatic birth. Results ‘Stuck between two philosophies', ‘What could I have done differently', and ‘Feeling for the woman', emerged as the main themes from the research. The participants described their emotional distress from feeling ‘stuck' between wishing they could practice according to their midwifery philosophy, and the reality of working within a medical model of care. Feelings of responsibility for women and babies' outcomes, and repeatedly questioning what they could have done differently to prevent a traumatic birth was also reported. Feeling for the woman emerged as a major factor in midwives' experiences of witnessing traumatic birth. Conclusions as far as we can determine this is the first study to explicitly examine the phenomenon of midwives witnessing traumatic birth from the midwives point of view. While it was anticipated that midwives might describe being emotionally distressed by their experiences, the extent of their empathy and feelings of being stuck between two philosophies provide new knowledge into what affects midwives when working with birthing women. Further research into these areas is warranted. Better understanding of how witnessing traumatic birth impacts on midwives and what kind of support after these experiences is required to ensure midwives are equipped to cope when witnessing traumatic birth.

Plasma Concentrations of Endocannabinoids and Related Primary Fatty Acid Amides in Patients with Post-Traumatic Stress Disorder

BackgroundEndocannabinoids (ECs) and related N-acyl-ethanolamides (NAEs) play important roles in stress response regulation, anxiety and traumatic memories. In view of the evidence that circulating EC levels are elevated under acute mild stressful conditions in humans, we hypothesized that individuals with traumatic stress exposure and post-traumatic stress disorder (PTSD), an anxiety disorder characterized by the inappropriate persistence and uncontrolled retrieval of traumatic memories, show measurable alterations in plasma EC and NAE concentrations.MethodsWe determined plasma concentrations of the ECs anandamide (ANA) and 2-arachidonoylglycerol (2-AG) and the NAEs palmitoylethanolamide (PEA), oleoylethanolamide (OEA), stearoylethanolamine (SEA), and N-oleoyldopamine (OLDA) by HPLC-MS-MS in patients with PTSD (n = 10), trauma-exposed individuals without evidence of PTSD (n = 9) and in healthy control subjects (n = 29). PTSD was diagnosed according to DSM-IV criteria by administering the Clinician Administered PTSD Scale (CAPS), which also assesses traumatic events.ResultsIndividuals with PTSD showed significantly higher plasma concentrations of ANA (0.48±0.11 vs. 0.36±0.14 ng/ml, p = 0.01), 2-AG (8.93±3.20 vs. 6.26±2.10 ng/ml, p<0.01), OEA (5.90±2.10 vs. 3.88±1.85 ng/ml, p<0.01), SEA (2.70±3.37 vs. 0.83±0.47, ng/ml, p<0.05) and significantly lower plasma levels of OLDA (0.12±0.05 vs. 0.45±0.59 ng/ml, p<0.05) than healthy controls. Moreover, PTSD patients had higher 2-AG plasma levels (8.93±3.20 vs. 6.01±1.32 ng/ml, p = 0.03) and also higher plasma concentrations of PEA (4.06±1.87 vs. 2.63±1.34 ng/ml, p<0.05) than trauma-exposed individuals without evidence of PTSD. CAPS scores in trauma-exposed individuals with and without PTSD (n = 19) correlated positively with PEA (r = 0.55, p = 0.02) and negatively with OLDA plasma levels (r = −0.68, p<0.01). CAPS subscores for intrusions (r = −0.65, p<0.01), avoidance (r = −0.60, p<0.01) and hyperarousal (r = −0.66, p<0.01) were all negatively related to OLDA plasma concentrations.ConclusionsPTSD appears to be associated with changes in plasma EC/NAE concentrations. This may have pathophysiological and diagnostic consequences but will need to be reproduced in larger cohorts.

Life after near death: Long-term outcomes of emergency department thoracotomy survivors

BACKGROUND: Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors. METHODS: Review of our Level I trauma center registry (2000–2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist). RESULTS: After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening. CONCLUSION: Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the “futility” of EDT in our most severely injured patients. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.

Life after near death

Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors. Review of our Level I trauma center registry (2000-2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist). After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening. Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the "futility" of EDT in our most severely injured patients.

TREATMENT OF POSTTRAUMATIC STRESS DISORDER REDUCES SUICIDAL IDEATION

Suicide is a significant public health problem. Although various studies have found evidence of posttraumatic stress disorder (PTSD) as a risk factor for suicidal behaviors, no study has examined whether or not PTSD treatment decreases suicidal thoughts. This study aims to fill this gap in the literature by examining changes in suicidal ideation over the course of a randomized clinical trial, which compared two widely used treatments for PTSD-cognitive processing therapy (CPT) and prolonged exposure (PE). Data from 163 trial participants over five time points (pre- and posttreatment, 3 and 9 months posttreatment, and 5-10 years posttreatment) were examined using multilevel growth curve analyses to determine if reductions in PTSD symptoms during treatment were associated with reductions in suicidal ideation. Major depression diagnosis and hopelessness were controlled. Suicidal ideation decreased sharply during treatment with continued, but more subtle decreases, during the follow-up period. These decreases were associated with decreases in PTSD symptoms over the course of treatment. These associations were not accounted for by depression diagnoses at the start of the study or changes in hopelessness over the course of treatment. Two widely used, effective treatments for PTSD reduce suicidal ideation. CPT exhibited a larger influence on suicidal ideation than PE, although the magnitude of the difference was small in size. Inclusion of PTSD screening and treatment could enhance suicide prevention efforts.