Full Posttraumatic Stress Disorder Research Articles

Associations between Posttraumatic Stress Disorder and Diabetes in Vietnam-Era Women Veterans in the HealthViEWS Study.

Background: Posttraumatic stress disorder (PTSD) is associated with incident diabetes. However, past studies have often included predominantly male samples, despite important sex and gender differences in diabetes. To address this limitation, this study examined the association between PTSD and diabetes in older Veteran women, a population with a high burden of PTSD. Materials and Methods: Data were collected from 4,105 women (Mage = 67.4 years), participating in the Health of Vietnam-Era Veteran Women's Study (HealthViEWS; Department of Veterans Affairs Cooperative Studies Program #579). Participants completed self-report measures of demographics, health conditions, and health behaviors. Information on military service was obtained through service records. A structured clinical interview was conducted by telephone to assess current and lifetime PTSD and other mental health disorders. Weighted descriptive and logistic regression analyses were used to examine associations between PTSD and diabetes. Results: The prevalence of diabetes was 28.4% among women with current full PTSD compared to 23.4%, 17.6%, and 17.5% for current subthreshold, remitted, and no PTSD. In unadjusted analyses, women with current full and subthreshold PTSD were 1.87 [1.49; 2.33] and 1.44 [1.11; 1.85] times more likely to have diabetes compared to women with no PTSD. Remitted PTSD was not associated with increased odds of diabetes. Effects were attenuated but remained significant after adjustment for relevant covariates. Conclusions: Vietnam-era women with current PTSD, including subthreshold symptoms, had a greater likelihood of diabetes compared to women without PTSD. These findings suggest that women with PTSD may benefit from increased diabetes prevention efforts.

Clinical relevance of subthreshold PTSD versus full criteria PTSD following traumatic brain injury in U.S. service members and veterans

BackgroundThe purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). MethodsParticipants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). ResultsThere was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e., MTBI: Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). LimitationsLimitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. ConclusionPTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself.

Factors Related to Post-traumatic Stress Disorder Symptoms Among Intensive Care Unit Nurses

PurposeTo identify the factors affecting the post-traumatic stress disorder (PTSD) symptoms of intensive care unit (ICU) nurses. The variables include event experiences, cognitive flexibility, and co-worker support. MethodsA survey was conducted among 153 ICU nurses working in a general hospital or an advanced general hospital. The questionnaire was completed between October and December 2018, and 153 copies were used for the final analysis. Data were analyzed using multiple linear regression to determine the factors associated with PTSD symptoms among ICU nurses. ResultsThe level of PTSD symptoms of ICU nurses was 1.20±0.82 out of 4. Full PTSD, signified by a total score of 25 or more, was reported by 45.1% of the study's 153 participants. The significant influencing factors of PTSD symptoms among ICU nurses were the “experience of traumatic events”, “trusted alliance”, which is a sub-area of “coworker support,” and both “control” and “alternative”, which are sub-areas of “cognitive flexibility.” The explanatory power (49.8%) was statistically significant. ConclusionThese results suggest that a program to enhance the cognitive flexibility and coworker support of ICU nurses needs to be developed to reduce the PTSD symptoms of ICU nurses.

Differences in predictive factors for post-traumatic stress disorder encompassing partial PTSD and full PTSD: a cross-sectional study among individuals exposed to the November 13, 2015 Paris attacks.

When faced with a surge of physically injured individuals, especially following a traumatic event like an attack, frontline practitioners prioritize early triage. Detecting potential psychological injuries soon after such events remains challenging. Some individuals might develop post-traumatic stress disorder (PTSD) according to DSM-V criteria. Others may exhibit PTSD symptoms without meeting full diagnostic criteria, termed partial or sub-syndromal PTSD, a less-explored area in literature. This study aims to identify predictive factors for both full and partial PTSD. In a cohort of victims of the 2015 Paris attacks, multinomial logistic regressions explored predictive factors for partial or full PTSD status 8 to 18 months post-attacks. Analyses considered pre, peri, and posttraumatic factors chosen from literature review and univariate analysis within each group. Within the cohort, 50 individuals showed no signs of PTSD, 35 experienced partial PTSD, and 30 presented with full PTSD. After logistic regression, risk factors associated with full PTSD included a history of trauma (OR = 1.30, CI [1.02-1.66], p < 0.05), the intensity of peri-traumatic physical reactions (OR = 1.22, CI [1.09-1.36], p < 0.001), the difficulties in suppressing intrusive thoughts (OR = 1.11, CI [1.02-1.21], p < 0.013). Only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD (OR = 1.13, [CI 1.02-1.24], p < 0.001). This study revealed that a history of trauma, the intensity of peri-traumatic physical reactions (e.g., tachycardia, trembling, flushes, numbness.), and the difficulties in suppressing intrusive thoughts constitute risk factors for the development of full PTSD. Moreover, the study identified that only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD. These findings seem to underscore the significance of peri-traumatic experiences in influencing the development of post-traumatic stress symptoms. This study emphasizes the significance of examining peri-traumatic reactions in PTSD development, suggesting its potential as a straightforward screening tool for post-traumatic stress disorder. It also underscores the influence of prior traumatic experiences, before de novo traumatization, in shaping vulnerability to PTSD and illuminates the crucial role of compromised control of intrusive thoughts that could perpetuate PTSD.

The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials

Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. None.

Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks

BackgroundTerrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors.MethodsData were collected from a web-based survey of civilians 8–12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation.ResultsAmong the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were “did not feel the need”, “it was not the right time to talk about it”, and “not offered”. For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims.ConclusionThe organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.

An empirical investigation of definitions of subthreshold posttraumatic stress disorder.

Subthreshold posttraumatic stress disorder (PTSD) has long been recognized as an important construct that identifies a subgroup of individuals who report significant PTSD symptoms and associated disability but do not endorse enough symptoms to meet the criteria for a full PTSD diagnosis. Different investigators have defined subthreshold PTSD in various ways, making it difficult to interpret findings across studies. To address this problem, we systematically compared individuals who met criteria for nine different subthreshold PTSD definitions with individuals diagnosed with either full PTSD or no PTSD (i.e., failed to meet the criteria for a subthreshold definition) with respect to prevalence and associated clinical outcomes of interest. Participants were 1,082 veterans enrolled in the Veterans After DischargeLongitudinalRegistry. PTSD and subthreshold PTSD diagnostic status were determined using the Structured Clinical Interview for DSM-5 (SCID-5) and validated self-report instruments were used to assess clinical outcomes. Across outcomes, subthreshold definitions generally identified a group of participants that was distinguishable from participants in both the PTSD and no PTSD groups, rs = .02-.47. We discuss the benefits and drawbacks of various subthreshold definitions and highlight the need for additional work evaluating these definitions across additional outcomes and samples. In the interim, we propose a working case definition of subthreshold PTSD as meeting any three of the four DSM-5 symptom criteria (i.e., Criteria B, C, D, and E) along with Criterion A and Criteria F-H. The results suggest subthreshold PTSD is a clinically meaningful construct.

Mental health impact of the catastrophic 2023 earthquake on Turkish youth: psychological distress amidst humanitarian crisis

On February 6, 2023, Türkiye was struck by a devastating earthquake with a magnitude of 7.8, a natural disaster of enormous destruction. As a result, many citizens succumbed to mortality, suffered immense physical and psychosocial harm, and the properties of the survivors suffered severe damage. Adolescents and the youth sector in particular are at an increased risk of developing psychiatric disorders1. Hence, policymakers and stakeholders need to pay attention to this understudied sector to prevent and manage health care issues associated with the recent earthquakes. Because of their rapid appearance, ferocity, and devastation, earthquakes exert unequivocal stress events2. Previous studies have demonstrated that posttraumatic stress disorder (PTSD) is frequently linked to earthquakes, which have a significant psychological influence on individuals and hinder their early return to normal activities while prolonging unpleasant emotions3. Moreover, prior traumatic encounters and childhood abuse have a significant impact on the mental health of adolescent survivors3. Recalling fear, triggering memories, or experiencing panic and anxiety is one of the most notable effects of the possibility and persistence of PTSD. These symptoms have a rapid impact on mental health and, according to studies and personal experience, are associated with the initiation and risk of developing PTSD3. In addition, this disorder comprises mood disorders, such as dysthymia and anxiety, with the diagnosis being connected to the existence of PTSD following the earthquake3. The majority of adolescent survivors’ experience intrusive flashbacks and posttrauma ruminations, also known as event-related ruminations, which result from the shaking of beliefs after excruciating occurrences2. Adolescents may experience varying levels of trauma following the earthquake, with one of the most significant elements influencing the intensity being the loss of family members and the damage of homes, which causes a dramatic change in their lives2,3. Adolescent trauma survivors are thought to focus more on the negative aspects of traumatic cues as a result of automatic ruminations that reduce an individual’s ability to avoid them. The most recent earthquake in Türkiye since 1939 had the largest recorded magnitude, and it damaged an area of around 400 km24. The chronicity of adolescent survivors’ mental health and quality of life are impacted by postearthquake difficulties including eviction, destroyed homes, or injuries. These variables are more likely to be subjected to harsher conditions in the aftermath of the traumatic event3. According to a study, those who have experienced partial or full PTSD symptoms for 2 years may continue to experience them for the following 10 years5. The Turkish government faces a serious task in constructing a suitable plan to aid the afflicted youth alongside heal those affected and develop a prosperous generation. In response to the rising prevalence of adolescent mental health issues, the World Health Organization (WHO) is assisting the Turkish government through its regional concept of operations, working in partnership with the Turkish Ministry of Health to provide mental health services throughout all impacted areas4. It is advised to conduct a structured examination of adolescent psychological distress symptoms. This may be achieved by interviewing teenagers, preferably without their parents present to prevent emotional bias and distress disguise. This mediates a secure clinical setting in which to discuss their traumatic experience to receive appropriate care6. Moreover, following the early emergency comeback, children and caregivers will warrant additional specialized trauma healing interventions that will be crucial in assisting youth in maintaining their well-being while also being impacted by the risk and protective factors that came with the Türkiye earthquake7. Offering extensive training for mental health professionals is highly advised, so that the symptoms of PTSD and other disorders are revealed more rapidly, and hence managed more sufficiently6. Not only should face-to-face therapy be offered, but also eHealth methods should be adopted to expand the range of benefited adolescents throughout all regions of Türkiye6. There is a need to break the stigma surrounding mental health, that acts as a barrier preventing individuals from seeking help. Moreover, community and political engagement and improvement of disaster management goals accountability and identifying gaps are essential steps. Through sustained research identification of predictors may help formulate postdisaster relief and rehabilitation efforts to further reduce the psychological distress in such a humanitarian crisis. Ethical approval Not applicable. Sources of funding The authors have not received any financial support for this manuscript. Author’s contribution O.U.: conceptualization, project administration, writing—review and designing. H.A.: reviewing the first draft and revising. J.W.: reviewing and editing. All authors approved the final manuscript and submission. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Abubakar Nazir. Guarantor Abubakar Nazir. Data availability statement Not applicable.

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials.

Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas. To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas. We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy. Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' g = 1.09; 95% CI 0.70-1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74-1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only). The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.

Ten-Year Follow-Up of Earthquake Survivors

Objective: Few earthquake survivor studies extend follow-up beyond 2 years, leaving the long-term course of earthquake-related posttraumatic stress disorder (PTSD) unknown. This 10-year survey re-assessed the 1999 İzmit, Turkey, earthquake survivors. Methods: İzmit earthquake survivors (N = 198), previously assessed for PTSD/partial PTSD at 1–3 months and 18–20 months post-earthquake, were evaluated 10 years post-event from January 2009 through December 2010. A PTSD self-test (Turkish translation) used DSM-IV criteria to characterize full PTSD, “stringent partial PTSD,” “lenient partial PTSD,” or non-PTSD based on symptom type/amount. Results: Full PTSD prevalence decreased from 37% at 1–3 months post-earthquake to 15% at 18–20 months (P < .001), remaining relatively stable (12%) at 10 years (P = .38). Stringent and lenient partial PTSD decreased between 1–3 months and 18–20 months (from 9% to 3% and from 24% to 12%, respectively; P < .001), remaining stable at 10 years (5% and 9%, respectively; P = .43 and P = .89). PTSD was more prevalent at 1–3 months among those who had a close acquaintance harmed, had been evacuated for long periods (> 1 week), or had more children; this was not observed at 10 years (P = .007–.017). Avoidance symptoms 1–3 months post-earthquake were the best predictor for full PTSD at 10 years (P < .001). Delayed-onset PTSD was observed in only 2% of participants. Conclusions: Full and partial PTSD decreased over the first 2 years post-trauma, but remained stable at 10 years, suggesting PTSD symptoms at around 2 years remain stable at 10 years. Background characteristics did not predict PTSD long-term course, but avoidance level did. Delayed-onset PTSD was relatively rare.

Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a "platinum" standard for diagnosis?

Symptom counts as the basis for Post-Traumatic Stress Disorder(PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the "equal weight" assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom. Baseline structured interview data from Project Harmony (N=2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data. One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis. Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM.

Improving care for SUD patients with complex trauma-relationships between childhood trauma, dissociation, and suicidal behavior in female patients with PTSD and SUD.

Posttraumatic disorders are among the most frequent co-occurring diagnoses in patients with substance use disorders (SUD). Individuals with this dual diagnosis often present with special treatment needs, especially after childhood traumatic experiences (CT). Along with posttraumatic stress disorder (PTSD) and dissociative symptoms, suicidal behaviors belong to the clinical challenges in this group of patients and may influence the course and outcome of SUD treatment. Therefore, a better understanding of the relationships between different forms of CT, psychopathology and suicidal behaviors seems to be important to tailor adequate concepts of care. We examined 343 female patients with SUD and Posttraumatic stress disorder (PTSD). All patients completed the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale-Taxon (DES-T) and the Structured Clinical Interview Axis I Disorders (SCID-I). To determine relationships between different symptoms with potential importance for concepts of treatment, we conducted analyses of moderated mediation for different models. We examined the direct and indirect effects of associations between the type of CT, dissociation and suicidal behavior, as well as the moderation effect of PTSD. All participants met DSM-criteria for either full PTSD (75.2%) or subsyndromal PTSD (24.8%). Almost all (94.5%) received at least one substance dependence diagnosis and the remaining 5.5% met substance abuse criteria. Most participants (93.3%) reported at least one type of childhood trauma. In all models, dissociation was a risk factor for suicidal ideation (SI) and for suicide attempts (SA). In both, participants with subsyndromal PTSD and participants with full PTSD, dissociation mediated the relationship between childhood sexual abuse and SI as well as SA. Moreover, we report direct effects between different childhood traumas and SI and SA. Furthermore, emotional abuse was a significant predictor of dissociation. In our sample of female patients with SUD and co-occurring PTSD, dissociation significantly increased suicidal behavior and served as a mediator of the relationship between childhood sexual abuse and suicidal behavior. Our findings underline the need to include interventions to address dissociative symptoms and other more complex consequences of childhood trauma into concepts of care for patients with SUD.

A systematic examination of cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight in relation to posttraumatic stress disorder symptoms among trauma exposed patients with early nonaffective psychosis.

Previous research has shown that emotion dysregulation after trauma is associated with increased posttraumatic stress disorder (PTSD) severity. However, it remains unclear how different dimensions of emotion dysregulation and cognitive insight may interact to predict Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) PTSD symptoms in early psychosis. The present study systematically examines cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight in relation to DSM-5 PTSD symptoms among trauma-exposed patients with early nonaffective psychosis. A total of 150 outpatients with early nonaffective psychosis were screened for trauma exposure on the Stressful Life Events Questionnaire. Participants (N = 79; 52.6%) who met the DSM-5 Criterion A subsequently completed the PTSD Checklist for DSM-5, Cognitive Emotion Regulation Questionnaire, Difficulties With Emotion Regulation Questionnaire, and Beck Cognitive Insight Scale. Severity of psychotic and depressive symptoms were rated on the Brief Psychiatric Rating Scale. Multivariate regression models adjusting for age, gender, psychotic and depressive symptoms revealed that PTSD symptom clusters were associated with more maladaptive cognitive emotion regulation strategies (catastrophic thinking, rumination, and other blame) and less adaptive cognitive emotion regulation strategies (cognitive reappraisal and planning; Cohen's f² = 1.50-3.17). Further moderation analyses revealed a negative interaction between global emotion dysregulation and self-reflection on intrusive symptoms such that for patients with low self-reflectivity, global emotion dysregulation was associated with increased severity of intrusive symptoms (f² = 0.96). Our findings suggest that addressing emotion dysregulation and cognitive insight may improve intrusive symptoms, and this may prevent the development of full PTSD in patients with early nonaffective psychosis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of hormonal contraceptives on sex differences in fear conditioning and fear extinction in PTSD.

Sex differences in the neurobiological mechanisms involved in fear conditioning and extinction have been suggested to contribute to differential vulnerability for the development of posttraumatic stress disorder (PTSD) in women compared with men. Reproductive hormones, such as estradiol, have been shown to facilitate fear conditioning and extinction learning and may explain some of these differences. However, the effect of commonly used hormonal contraceptives on the neurobiological mechanisms of fear conditioning and extinction is poorly understood. A laboratory study was conducted in trauma-exposed men and women with and without full or partial PTSD to examine effects of sex and use of hormonal birth control on fear conditioning, fear extinction learning, and extinction retention. Participants underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS−) with shock. Extinction learning occurred 72 h later, and extinction retention was tested 1 wk after extinction. Women on hormonal contraceptives (HCs) demonstrated enhanced acquisition of fear conditioning and enhanced extinction of fear as compared with women off hormonal birth control and men. While clinical implications have yet to be determined, these results suggest that hormonal contraceptives may facilitate learning during both fear acquisition and extinction. Understanding the impact of sex and hormones on fear conditioning and extinction processes may lead to new insights into the pathophysiology of PTSD and result in advancements in treatment that may vary by sex.

"It leaves me very skeptical" messaging in marketing prolonged exposure and cognitive processing therapy to veterans with PTSD.

Direct-to-consumer marketing has the potential to increase demand for specific treatments, but little is known about how to best market evidence-based psychotherapies to veterans with posttraumatic stress disorder (PTSD). The objective of this study was to gain an understanding of marketing messages that may impact veteran demand for prolonged exposure (PE) and cognitive processing therapy (CPT). Veterans (n = 31) with full or subthreshold PTSD participated in semistructured interviews that queried attitudes about PTSD and recovery, current knowledge of PE and CPT, and reactions to existing educational materials. A 2-stage qualitative coding and analytic strategy was used to identify primary themes related to the marketing of PE and CPT. Veterans viewed the treatments' effectiveness as their primary selling point but questioned the credibility of improvement descriptions that didn't fit with their experiences or beliefs about PTSD. Participants had difficulties distinguishing CPT from non-trauma-focused approaches in which they had previously participated, leading to skepticism about promised treatment effects and decreased interest. Without targeting, women veterans assumed information regarding PTSD treatment options applied only to men. Examination of the impact of a direct-to-consumer marketing campaign including these messages on PE and CPT demand is needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effect of Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome at Long-Term Follow-Up.

ObjectivePsychological consequences of myocardial infarction (MI) are substantial, as 4% of all MI patients develop posttraumatic stress disorder (PTSD) and 12% clinically relevant posttraumatic stress symptoms (PTSS). The study investigated the course and development within 12 months of MI-induced PTSS to gain novel insights in potentially delayed response to early trauma-focused counseling aimed at preventing the incidence of MI-induced PTSS.MethodsIn the MI-SPRINT two-group randomized controlled trial, 190 MI-patients were randomly allocated to receive a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 12-month follow-up.Results12-month follow-up of outcomes were available for 106 (55.8%) of 190 participants: In the entire sample, one patient (0·5%, 1/190) who received trauma-focused counseling developed full PTSD. There was no significant difference between trauma-focused counseling and stress counseling regarding total score of interviewer-rated PTSS (p > 0.05). The only group difference emerged in terms of more severe hyperarousal symptoms in the trauma-focused counseling group in the ITT analysis, but not in the completer analysis.ConclusionsNo benefits were found for trauma-focused counseling after 12 months when compared with an active control intervention. PTSD prevalence in the present study was low highlighting a potential beneficial effect of both interventions. Further studies are needed to determine the most accurate approach of counseling.

Suicidal ideation, post-traumatic stress disorder, and depression in traumatic spinal cord injury: What resilience tells us

Objective Identification of unmet psychiatric needs, protective and risk factors for suicide are crucial for people with traumatic spinal cord injury (SCI). In this study, we aimed to explore depression, post-traumatic stress disorder (PTSD) status (non-PTSD, partial-PTSD, full-PTSD), resilience, suicidal ideation (SI) and to examine predictors and clinical correlates of current SI in traumatic SCI. Method Sixty-three individuals with traumatic SCI who were at least 3 months post-injury were included in the study. The participants were evaluated in terms of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), depression, SI, and resilience using the PCL-5, the Patient Health Questionnaire-9, the Brief Resilience Scale, and sociodemographic measures. Results 33% of our sample (n = 21) had SI over the past two weeks. 71.4% of the patients with SI (n = 15) had depression. A total of 52.4% of the patients with SI (n = 11) were diagnosed with full PTSD. Resilience was found to be significantly lower in individuals with depression and individuals with SI. While depression predicted SI in traumatic SCI, resilience stands as a protective factor against SI. Conclusion SI is quite common in individuals with traumatic SCI and is accompanied by substantial psychiatric comorbidities such as depression and PTSD. Along with depression and PTSD, resilience – which has protective and predictive values and is inversely associated with SI – constitutes a significant psychotherapeutic intervention and screening area.

The effect of stillbirth and late termination of pregnancy on the emergence of post-traumatic symptoms among attending medical personnel

The purpose of this paper was to assess the impact and the post-traumatic potential of late termination of pregnancy (TOP) and stillbirth on medical staff and characterise personal attributes that modulate these possible outcomes. Fifty-one participants involved in the treatment of women undergoing late TOPs and stillbirths answered questionnaires including demographics, Neuroticism subscale of the Big Five Inventory (BFI), Life Orientation Test-Revised (LOT-R), Posttraumatic Diagnostic Scale (PDS), Brief Symptom Inventory (BSI-18) and questions regarding exposure to stillbirths and late TOPs. None of the participants met the full post-traumatic stress disorder (PTSD) criteria. A correlation with a marginal significance was found between the number of TOP's/stillbirths attended during the past year and traumatic symptoms. Neuroticism moderated the association between presence in TOP's/stillbirths and post-traumatic symptoms among those who attended this event over the past month. According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP’s/stillbirths. Impact Statement What is already known on this subject ? There is a very little research on the ways in which medical personnel respond to Stillbirths, late miscarriages and terminations of pregnancy (TOP) of their patients and on the possible effect of their personality traits in this response. What do the results of this study add ? According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP’s/stillbirths. What are the implications of these findings for clinical practice and/or further research ? Further studies are warranted to better assess the impact of exposure to traumatic events in general and on the effect of late TOP and stillbirths in particular, on medical personnel and to identify interventions that may prevent posttraumatic symptoms among staff members when they happen.

Exercise to Reduce Posttraumatic Stress Disorder Symptoms in Veterans.

Physical exercise offers benefits for treating psychological disorders, particularly depression. Exercise is associated with reduction of posttraumatic stress disorder (PTSD) symptoms in civilians. Given the comorbidities and unique trauma experiences of the veteran population, the current work aims to estimate the effect of exercise on PTSD symptoms in veteran samples. A systematic review identified 6 single-arm studies and 3 randomized controlled trials (RCTs) using exercise as an interventional treatment among veteran samples with full or subsyndromal PTSD. Most single-arm studies used yoga-based interventions, whereas RCTs showed more variety and included yoga, aerobic activity, and resistance exercises. Data synthesis of study results revealed a medium standardized mean difference for the single-arm trials (Hedges g, -0.60, P = .03) and a small-to-medium standardized mean difference for the RCTs (Hedges g, -0.40, P = .06). Single-arm studies were all rated at serious risk of bias. Only 1 RCT was rated at high risk of bias, although the remaining RCTs showed some concern of elevated bias. There is preliminary evidence that exercise may be a useful treatment option for PTSD symptom reduction in veterans. Our review also highlights the need for additional high-quality randomized trials to confirm the benefits of exercise for PTSD symptom reduction in veterans.

Brain Responses to a Self-Compassion Induction in Trauma Survivors With and Without Post-traumatic Stress Disorder.

Self-compassion (SC) is a mechanism of symptom improvement in post-traumatic stress disorder (PTSD), however, the underlying neurobiological processes are not well understood. High levels of self-compassion are associated with reduced activation of the threat response system. Physiological threat responses to trauma reminders and increased arousal are key symptoms which are maintained by negative appraisals of the self and self-blame. Moreover, PTSD has been consistently associated with functional changes implicated in the brain’s saliency and the default mode networks. In this paper, we explore how trauma exposed individuals respond to a validated self-compassion exercise. We distinguish three groups using the PTSD checklist; those with full PTSD, those without PTSD, and those with subsyndromal PTSD. Subsyndromal PTSD is a clinically relevant subgroup in which individuals meet the criteria for reexperiencing along with one of either avoidance or hyperarousal. We use electroencephalography (EEG) alpha-asymmetry and EEG microstate analysis to characterize brain activity time series during the self-compassion exercise in the three groups. We contextualize our results with concurrently recorded autonomic measures of physiological arousal (heart rate and skin conductance), parasympathetic activation (heart rate variability) and self-reported changes in state mood and self-perception. We find that in all three groups directing self-compassion toward oneself activates the negative self and elicits a threat response during the SC exercise and that individuals with subsyndromal PTSD who have high levels of hyperarousal have the highest threat response. We find impaired activation of the EEG microstate associated with the saliency, attention and self-referential processing brain networks, distinguishes the three PTSD groups. Our findings provide evidence for potential neural biomarkers for quantitatively differentiating PTSD subgroups.