Higher Posttraumatic Stress Disorder Research Articles

501 Maternal PTSD and Child Brain Function During Implicit Emotion Regulation

OBJECTIVES/GOALS: Maternal mental health, such as post-traumatic stress disorder (PTSD), is closely linked to child mental health. PTSD in mothers is associated with their children’s emotional responses. We examined associations between maternal PTSD and child brain function during emotion regulation. METHODS/STUDY POPULATION: Eight children ages 10-12 years, whose mothers had trauma histories, performed the Emotional N-Back task during functional MRI scanning. Mothers and children each reported on their trauma exposure and PTSD symptom severity. BOLD response to fearful faces during the Emotional N-Back was extracted from two specific brain regions of interest, amygdala and anterior cingulate cortex. These regions are involved in emotional response and attentional control, which are processes intrinsic to emotion regulation. An independent samples t-test was conducted on children’s BOLD response to fearful faces, with maternal PTSD symptom severity (high, low) as the independent variable. A parallel analysis was conducted with child PTSD symptom severity (high, low) as the independent variable. RESULTS/ANTICIPATED RESULTS: We found a main effect of maternal PTSD within brain regions of relevance to implicit emotion regulation. Compared to children whose mothers reported low PTSD symptom severity (n=4), children whose mothers reported high PTSD symptom severity (n=4) showed greater responsiveness to fearful faces in anterior cingulate cortex (t=2.04, p=.09,d=1.44) and amygdala (t=2.44, p=.05, d=1.72) at trending significance. A parallel analysis with child PTSD symptom severity showed no differences in brain function by this factor (ps=.55-.61). DISCUSSION/SIGNIFICANCE: Our pilot study is the first, to our knowledge, to examine associations between maternal PTSD and brain function during emotion regulation in their children. This study lays a foundation for future work; our goal is to explore dysfunction in emotion regulation neurocircuitry as one mechanism linking maternal PTSD to their children’s mental health.

Posttraumatische Belastungsstörung bei Kindern und Jugendlichen: Ergebnisse einer Querschnittsstudie zu Auswirkungen der neu formulierten Diagnosen PTBS und kPTBS in der ICD-11

ZusammenfassungHintergrundDie in der ICD-11 enger gefassten Kriterien der posttraumatischen Belastungsstörung (PTBS) und die Einführung der komplexen PTBS (kPTBS) mit zusätzlichen Schwierigkeiten in der Selbstorganisation und -regulation (SSO) können deutliche Auswirkungen auf die Diagnosehäufigkeit haben. In der vorliegenden Studie wurde untersucht, aufgrund welcher ICD-11-Cluster Kinder und Jugendliche die Diagnose verfehlen und ob Bezugspersonen Veränderungen im SSO-Bereich eher auf den Entwicklungsstand oder das traumatische Ereignis attribuieren und wie diese Attributionen wiederum mit der Symptomschwere zusammenhängen.MethodenN = 88 deutschsprachige Kinder und Jugendliche (Alter: 7–17) mit traumatischen Ereignissen sowie N = 79 Bezugspersonen wurden zwischen September 2019 und November 2020 zur (k)PTBS-Symptomschwere (CATS-2) und der Attribution der SSO-Symptome (Fragebogen für Bezugspersonen) befragt.ErgebnisseDie ICD-11-Kriterien (CATS‑2 und eine entwicklungsangepasste Version) ergaben geringere Häufigkeitsraten der PTBS als DSM‑5 und ICD-10. Am seltensten wurden die ICD-11-Cluster „Wiedererleben“ und „Übererregung“ erfüllt. Veränderungen der SSO-Symptome wurden vorwiegend als ereignisbedingt eingeschätzt. Diese Attribution hing mit höherer PTBS- und SSO-Symptomschwere im Fremdbericht zusammen. Die entwicklungsbedingte Attribution hing mit einer höheren SSO-, jedoch nicht PTBS-Symptomschwere im Fremdbericht zusammen.DiskussionIm Rahmen der Diagnostik und bei der Überarbeitung von Diagnoseinstrumenten für ICD-11-(k)PTBS sollten auch entwicklungsspezifische Symptomausprägungen berücksichtigt werden. Eine Herausforderung stellt die Abgrenzung von Veränderungen im SSO-Bereich als „traumabezogen“ gegenüber „entwicklungsbedingt“ dar und erfordert mehrere Informationsquellen.

PTSD, depression, and treatment outcomes: A latent profile analysis among active duty personnel in a residential PTSD program

Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist–Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction ps < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (ps < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (ps < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment.

Healthcare Workers’ General Health and Its Relation with Anxiety, Anger, and Posttraumatic Stress Disorder during COVID-19 Outbreak in Southeast Iran

Background. Healthcare workers during the COVID-19 pandemic played an effective role in providing preventive and curative measures. Scientific evidence confirmed that the outbreak of this disease has caused numerous psychological problems such as pre- and posttraumatic stress disorder (PTSD), anxiety, depression, and anger at a global level. This study is aimed at investigating the general health of healthcare workers and its relationship with anxiety, anger, and posttraumatic stress disorder during the outbreak of COVID-19. Methods. This research was a cross-sectional study conducted on 455 healthcare workers of four teaching hospitals in Kerman, southeast of Iran. The convenience sampling method was used. The research tools included the 12-Item General Health Questionnaire (GHQ-12), the Impact of Event Scale-Revised (IES-R), the trait anxiety section of State-Trait Anxiety Inventory (STAI), and the trait anger section of Trait-State Anger Expression Inventory 2 (STAXI-2). Data analysis was done in IBM SPSS Statistics version 25 and using Pearson’s correlation tests, independent t-test, ANOVA, and multivariate linear regression. Results. 28.1% (n=128) of the participants had mental health disorders. The mean score of anxiety was 43.99±9.24 which was at moderate to high level of anxiety. The mean score of anger was 18.65±5.72 which was at the moderate level. The mean score of PTSD was 34.77±15.24 which was less than the midpoint of the questionnaire, i.e., the score of 44. The results of the multiple linear regression model that showed anxiety, anger, gender, and hospital were predictors of mental health (P&lt;0.05). Conclusion. The results of the present study showed that about a quarter of the healthcare workers faced with the COVID-19 pandemic had mental health disorders and suffered from moderate to high anxiety, moderate anger, and PTSD. It was also observed in this study that there was a weak to moderate significant correlation between general health and anxiety, anger, and PTSD in healthcare workers. So, healthcare workers need a lot of social and psychological support.

Relationships between job stress, post-traumatic stress and musculoskeletal symptoms in firefighters and the role of job burnout and depression mediators: a bayesian network model

IntroductionJob stress, post-traumatic stress disorder (PTSD), and negative psychological outcomes in firefighters can be caused, or aggravated, by their work. These mental disorders can impart musculoskeletal symptoms. This study aimed to investigate relationships between musculoskeletal and psychological disorders in a population of firefighters using a Bayesian network model.MethodsThis cross-sectional study, conducted in 2022, included 2339 firefighters who completed questionnaires during their rest periods. The questionnaires comprised of demographical information, the Occupational Stress Questionnaire-HSE, the PTSD Checklist, Maslach Burnout Inventory, Center for Epidemiologic Studies - Depression scale (CES-D), and Nordic Musculoskeletal Questionnaire. GeNIe academic software was used to analyze the Bayesian network.ResultsHigh job stress and high PTSD each increased the probability of musculoskeletal symptoms by 34%. When combined, high job stress and high PTSD increased the probability of musculoskeletal symptoms by 37%. Among the mediator’s burnout and depression, depression had the highest association with musculoskeletal symptoms.ConclusionsJob stress and PTSD can increase musculoskeletal symptoms and are influenced by psychological mediators (like burnout and depression). Adopting preventive and therapeutic measures to mitigate job stress and PTSD, mitigate and rehabilitate WMSD, and manage associated mediators are critical for the mental and physical health of firefighters.

Effectiveness of art therapy in reducing post-traumatic stress disorder symptoms and the propensity to quit journalism among journalists covering banditry activities in Nigeria

The goal of this study was to examine the efficacy of art therapy in the treatment of Post Traumatic Stress Disorder (PTSD) and the propensity to quit journalism among Nigerian journalists covering banditry attacks. The researchers utilized a quasi-experiment as the design for the study and sampled 327 journalists. The result of the study showed that at baseline, journalists reported high PTSD symptoms and a propensity to quit journalism, but after the intervention, journalists who received the art therapy intervention reported a significant drop in their PTSD symptoms and the propensity to quit the pen profession. This suggests that art therapy is a cost-effective way of treating PTSD among journalists covering dangerous assignments and reducing high labour turnover in the profession.

Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan

Objective: This study examined the levels of Post-Traumatic Stress Disorder (PTSD) in pediatric cancer caregivers and the impact of spirituality on PTSD in Pakistan. Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Oncology, Shaukat Khanum Memorial Cancer Hospital &amp; Research Centre, Peshawar, Northwest General Hospital &amp; Research Centre, Peshawar in Khyber Pakhtunkhwa (KPK), Pakistan Institute of Medical Sciences, Islamabad and Quaid-e-Azam International Hospital in Islamabad, Pakistan from January 2023 to March 2023.Methods: The study comprised 153 Caregivers of pediatric cancer patients aged One month –12 Years using convenience sampling. The PTSD Checklist-Civilian Version (PCL-C) and Caregiver's Spirituality Scale (CSS-10) were used to collect data. Results: Results of the study found that 81 caregivers (52.94%) had high PTSD, and 96 (62.74%) had high spirituality. Females reported higher PTSD and spirituality than guys. Graduates have more PTSD and spirituality than illiterates and matriculate. PTSD and spirituality had a negative Pearson's Correlation Coefficient. Conclusion: The study emphasizes spirituality as a caregiver's mental health protector. Healthcare practitioners caring for pediatric cancer patients can use the findings to lessen PTSD symptoms by targeting caregivers' spiritual needs. Convenience sampling and self-report measurements decrease generalizability. Future study is needed to investigate the association between PTSD and spirituality in caregivers of pediatric cancer patients.How to cite this: Bashir N, Ain Q, Karim N, Niazi H, Khan MI, Asghar AK. Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan. Life and Science. 2024; 5(1): 33-40. doi: http://doi.org/10.37185/LnS.1.1.440

Post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic: Analysis of the HERO Registry

Little is known about the mental health consequences of the COVID-19 pandemic in healthcare workers (HCWs). Past literature has shown that chronic strain caused by pandemics can adversely impact a variety of mental health outcomes in HCWs. There is growing recognition of the risk of stress and loss of resilience to HCWs during the COVID-19 pandemic, although the risk of post-traumatic stress disorder (PTSD) symptoms in HCWs during the COVID-19 pandemic remains poorly understood. We wanted to understand the relationship between the COVID-19 pandemic and the risk of PTDS symptoms in HCWs during the COVID-19 pandemic. We surveyed 2038 health care workers enrolled in the Healthcare Worker Exposure Response &amp; Outcomes (HERO) study, which is a large standardized national registry of health care workers. Participants answered questions about demographics, COVID-19 exposure, job burnout, and PTSD symptoms. We characterize the burden of PTSD symptoms among HCWs, and determined the association between high PTSD symptoms and race, gender, professional role, work setting, and geographic region using multivariable regression. In a fully adjusted model, we found that older HCWs were less likely to report high PTSD symptoms compared with younger HCWs. Additionally, we found that physicians were less likely to report high PTSD symptoms compared with nurses. These data add to the growing literature on increased risks of mental health challenges to healthcare workers during the COVID-19 pandemic.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder.

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.

High Lifetime Blast Exposure Using the Blast Exposure Threshold Survey Is Associated With Worse Warfighter Brain Health Following Mild Traumatic Brain Injury.

The purpose of this study was to extend previous research by examining the relationship between lifetime blast exposure and neurobehavioral functioning after mild TBI (MTBI) by (a) using a comprehensive measure of lifetime blast exposure, and (b) controlling for the influence of post-traumatic stress disorder (PTSD). Participants were 103 United States service members and veterans (SMVs) with a medically documented diagnosis of MTBI, recruited from three military treatment facilities (74.8%) and community-based recruitment initiatives (25.2%, e.g., social media, flyers). Participants completed a battery of neurobehavioral measures 12 or more months post-injury (Neurobehavioral Symptom Inventory, PTSD-Checklist PCLC, TBI-Quality of Life), including the Blast Exposure Threshold Survey (BETS). The sample was classified into two lifetime blast exposure (LBE) groups: High (n = 57) and Low (n = 46) LBE. In addition, the sample was classified into four LBE/PTSD subgroups: High PTSD/High LBE (n = 38); High PTSD/Low LBE (n = 19); Low PTSD/High LBE (n = 19); and Low PTSD/Low LBE (n = 27). The High LBE group had consistently worse scores on all neurobehavioral measures compared with the Low LBE group. When controlling for the influence of PTSD (using ANCOVA), however, only a handful of group differences remained. When comparing measures across the four LBE/PTSD subgroups, in the absence of clinically meaningful PTSD symptoms (i.e., Low PTSD), participants with High LBE had worse scores on the majority of neurobehavioral measures (e.g., post-concussion symptoms, sleep, fatigue). When examining the total number of clinically elevated measures, the High LBE subgroup consistently had a greater number of clinically elevated scores compared with the Low LBE subgroup for the majority of comparisons (i.e., four to 15 or more elevated symptoms). In contrast, in the presence of clinically meaningful PTSD symptoms (i.e., High PTSD), there were no differences between High versus Low LBE subgroups for all measures. When examining the total number of clinically elevated measures, however, there were meaningful differences between High versus Low LBE subgroups for those comparisons that included a high number of clinically elevated scores (i.e., six to 10 or more), but not for a low number of clinically elevated scores (i.e., one to five or more). High LBE, as quantified using a more comprehensive measure than utilized in past research (i.e., BETS), was associated with worse overall neurobehavioral functioning after MTBI. This study extends existing literature showing that lifetime blast exposure, that is largely subconcussive, may negatively impact warfighter brain health and readiness beyond diagnosable brain injury.

Effect of traumatic experiences and future threats on executive functioning and verbal fluency amongst Farsi-Dari speaking immigrants, refugees, and asylum seekers

BackgroundImpairments in executive functioning associated with posttraumatic stress disorder (PTSD) may impact the capacity of refugees and asylum seekers. AimsTo examine the association between executive functioning and PTSD with and without prominent future-focused threat (FFT) intrusions at rest and after threat priming. Method66 Farsi and Dari-speaking asylum-seekers, refugees, and immigrants were recruited into 3 groups: High PTSD & FFT Symptoms; High PTS Symptoms; Low PTSD & FFT symptoms. The Category Fluency Test (animals; food; flora) in Farsi was administered at baseline and after two counter-balanced future- and past-focused threat narrative tasks. Results: Higher PTSD and FFT symptom scores was associated with reduced verbal fluency [correct words (PTS p < 0.001; FFT p < 0.007), clustered words (PTS, p < 0.004; FFT p < 0.009) and clusters (PTS p < 0.017; FFT p < 0.009)]. The PTSD group retrieved fewer correct words (17.6, p < 0.009) using fewer clusters (p < 0.008) than the low-symptom group at baseline. It was only after exposure to the narrative task that the FFT group displayed comparable impairment. ConclusionsA subset of displaced persons with future threat symptoms exhibit cognitive impairment when asked to recount narrative details. Future threat may limit capacity to engage in cognitively demanding activities, such as participating in Refugee Status Determination.

The Association between Early Life Trauma and Veteran Reintegration to Civilian Life

The rate of early life trauma (ELT) is higher among military service members than civilians. While ELT is associated with higher post-traumatic stress disorder following deployment, it is unknown whether other reintegration difficulties are associated with various types of ELT. The present study investigated the relationship between ELT and reintegration difficulties among veterans. Additionally, the influence of the desire to escape ELT as enlistment motivation on this relationship was examined. Data were obtained from 257 veterans between the ages of 20 and 76 years who served in the U.S. Armed Forces during the Global War on Terrorism. Results revealed a significant positive relationship between emotional abuse, sexual abuse, physical abuse, and physical neglect with veterans’ reintegration difficulties. Additionally, enlisting as motivation to escape ELT significantly influenced the relationship between emotional abuse and physical neglect with intimate relationship problems and career challenges, respectively. These findings help facilitate our understanding of factors contributing to reintegration difficulties. In particular, information about the individual history of veterans’ ELT and their enlistment motivation can be used by social workers and other mental health care professionals to successfully assist veterans with the transition to civilian life.

Early Aftermath of February 6 Earthquakes in Turkey: PTSD, PTG, and Resilience

On February 6, 2023, earthquakes with magnitudes of 7.7 and 7.6 on the Richter scale struck Turkey, impacting eleven cities within Turkey and adjacent parts of Syria. This study investigates the immediate aftermath (50 days after the disaster) effects of these earthquakes on survivors. The primary focus is on posttraumatic stress disorder (PTSD) and post-traumatic growth (PTG), coupled with an exploration of the explanatory roles played by resilience, intolerance to uncertainty, and anxiety. For data collection, the study employs instruments such as the PTSD Checklist for DSM-5, Beck Anxiety Inventory, Brief Resilience Scale, PTG Inventory, and Intolerance to Uncertainty Scale. For the analysis, PTSD groups were formed (categorized using cutoff scores based on PTSD severity [69% high PTSD, 31% low PTSD]) and subjected to t-tests. In addition, multiple regression analysis is utilized to assess whether anxiety, resilience, and intolerance to uncertainty account for variations in PTSD and PTG. The findings revealed that the high PTSD group exhibited higher levels of anxiety, PTG, and intolerance to uncertainty, while displaying lower age and resilience in comparison to the low PTSD group. Moreover, the study found that intolerance to uncertainty (specifically in the inhibitory anxiety subscale), anxiety, and age significantly contributed to explaining PTSD. For PTG, the predictors were intolerance to uncertainty (inhibitory anxiety subscale), resilience, and age. This study underscores the significance of anxiety, resilience, and intolerance to uncertainty in comprehending PTG and PTSD. While PTSD was perceived as a negative aftermath of trauma, PTG was seen as a positive facet.

Therapist-assisted online psychological therapies differing in trauma focus for post-traumatic stress disorder (STOP-PTSD): a UK-based, single-blind, randomised controlled trial

Many patients are currently unable to access psychological treatments for post-traumatic stress disorder (PTSD), and it is unclear which types of therapist-assisted internet-based treatments work best. We aimed to investigate whether a novel internet-delivered cognitive therapy for PTSD (iCT-PTSD), which implements all procedures of a first-line, trauma-focused intervention recommended by the UK National Institute for Health and Care Excellence (NICE) for PTSD, is superior to internet-delivered stress management therapy for PTSD (iStress-PTSD), a comprehensive cognitive behavioural treatment programme focusing on a wide range of coping skills. We did a single-blind, randomised controlled trial in three locations in the UK. Participants (≥18 years) were recruited from UK National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) services or by self-referral and met DSM-5 criteria for PTSD to single or multiple events. Participants were randomly allocated by a computer programme (3:3:1) to iCT-PTSD, iStress-PTSD, or a 3-month waiting list with usual NHS care, after which patients who still met PTSD criteria were randomly allocated (1:1) to iCT-PTSD or iStress-PTSD. Randomisation was stratified by location, duration of PTSD (<18 months or ≥18 months), and severity of PTSD symptoms (high vs low). iCT-PTSD and iStress-PTSD were delivered online with therapist support by messages and short weekly phone calls over the first 12 weeks (weekly treatment phase), and three phone calls over the next 3 months (booster phase). The primary outcome was the severity of PTSD symptoms at 13 weeks after random assignment, measured by self-report on the PTSD Checklist for DSM-5 (PCL-5), and analysed by intention-to-treat. Safety was assessed in all participants who started treatment. Process analyses investigated acceptability and compliance with treatment, and candidate moderators and mediators of outcome. The trial was prospectively registered with the ISRCTN registry, ISRCTN16806208. Of the 217 participants, 158 (73%) self-reported as female, 57 (26%) as male, and two (1%) as other; 170 (78%) were White British, 20 (9%) were other White, six (3%) were Asian, ten (5%) were Black, eight (4%) had a mixed ethnic background, and three (1%) had other ethnic backgrounds. Mean age was 36·36 years (SD 12·11; range 18-71 years). 52 (24%) participants met self-reported criteria for ICD-11 complex PTSD. Fewer than 10% of participants dropped out of each treatment group. iCT-PTSD was superior to iStress-PTSD in reducing PTSD symptoms, showing an adjusted difference on the PCL-5 of -4·92 (95% CI -8·92 to -0·92; p=0·016; standardised effect size d=0·38 [0·07 to 0·69]) for immediate allocations and -5·82 (-9·59 to -2·04; p=0·0027; d=0·44 [0·15 to 0·72]) for all treatment allocations. Both treatments were superior to the waiting list for PCL-5 at 13 weeks (d=1·67 [1·23 to 2·10] for iCT-PTSD and 1·29 [0·85 to 1·72] for iStress-PTSD). The advantages in outcome for iCT-PTSD were greater for participants with high dissociation or complex PTSD symptoms, and mediation analyses showed both treatments worked by changing negative meanings of the trauma, unhelpful coping, and flashback memories. No serious adverse events were reported. Trauma-focused iCT-PTSD is effective and acceptable to patients with PTSD, and superior to a non-trauma-focused cognitive behavioural stress management therapy, suggesting that iCT-PTSD is an effective way of delivering the contents of CT-PTSD, one of the NICE-recommended first-line treatments for PTSD, while reducing therapist time compared with face-to-face therapy. Wellcome Trust, UK National Institute for Health and Care Research Oxford Health Biomedical Research Centre.

Traumatic stress symptoms and PTSD risk in children served by Children's Advocacy Centers.

Children who experience maltreatment are at high risk for posttraumatic stress disorder (PTSD). Children's Advocacy Centers (CACs) can facilitate access to treatment following maltreatment allegations. We describe PTSD symptoms and intervention decision-making for children served by CACs. Children served by CACs in a single state were screened for PTSD symptoms using a structured mental health screening/referral protocol. CAC staff used an electronic form that provided guidance for decision-making. We examined descriptive statistics for PTSD symptoms and risk and tested associations between child characteristics and symptoms. We described CAC staff's delivery of brief interventions and referral decisions and tested associations with child characteristics and symptoms. Two thousand and three hundred fifty children completed screening between 2018 and 2020. Almost half (45.5%) exhibited traumatic stress symptoms suggesting high probability of PTSD at the time of their CAC visit. Children who identified as female or transgender male and older children were more likely to be at high risk for PTSD. Brief interventions were delivered to 66% of children, and most were referred to evidence-based trauma treatment (53.1%) or community mental health services (39.0%). Categorization as moderate or high PTSD risk was associated with a higher likelihood of brief intervention delivery and referral to trauma treatment. Many children served by CACs are likely to meet criteria for PTSD at their initial visit. CAC staff demonstrated the ability to deliver brief interventions and make referrals to mental health treatment. Use of structured screening/referral protocols may improve early identification and treatment access for children experiencing PTSD symptoms.

ASSOCIATION OF HIGH BLOOD PRESSURE WITH POST-TRAUMATIC STRESS DISORDER IN UKRAINIAN WOMEN SEEKING ASYLUM IN POLAND: A PILOT STUDY

Objective: Post-traumatic stress disorder (PTSD) and its components have been associated with hypertension, particularly in military servants, war veterans and more recently in populations exposed to chronic violence. However, to our knowledge, this association has not been investigated in refugees. The objective of this study was to explore the potential association between high blood pressure and PTSD in Ukrainian women seeking asylum in Poland. Design and method: From September to December 2022, 55 Ukrainian women refugees were enrolled in dormitories from Sopot (Poland). Blood pressure (BP) was measured using validated oscillometric devices. Hypertension was defined as systolic BP &gt; = 140 mmHg, diastolic BP &gt; = 90 mmHg or being on antihypertensive treatment. Relevant demographic and clinical data were obtained. Furthermore, subjects filled validated questionnaires for depression, stress and anxiety (DASS) and post-traumatic stress disorder (PTSD) (PCL-5). Subjects with and without hypertension were compared for both general and psychological characteristics. Results: Thirty out of 55 subjects were found to be hypertensive. Compared to subjects with normal BP in absence of drugs (mean BP: 117.8/75.6 mmHg, n = 25), hypertensive subjects (mean BP: 138.1/85.8 mmHg, n = 30) were older (57.2 ± 11.1 vs. 39.1 ± 0.8 years, p &lt; 0.00001) and had a higher BMI (29.0 ± 5.4 vs. 23.8 ± 4.4 kg/m2, p = 0.003). Furthermore, despite a similar personal situation (socio-economic background, direct exposure to war, time since arrival in Poland, with or without children/relatives), hypertensive subjects were more often feeling unsafe at the time of examination (4-items scale, p = 0.001) and scored higher for PTSD score (24.9 ± 17.0 vs. 16.3 ± 12.9, p = 0.038), particularly regarding intrusion (cluster B, p = 0.039) and hyper-arousal (cluster E, p = 0.002) dimensions, but not for DASS score (22.4 ± 14.2 vs. 17.2 ± 11.5, p = 0.14). Conclusions: This preliminary analysis is consistent with an association between high BP and both feeling of being unsafe and PTSD score in Ukrainian women refugees. Our results need confirmation using 24-hour BP monitoring and in a larger sample. In the absence of difference in personal background and exposure to war, these associations may reflect underlying differences in expression of emotions and coping abilities, as previously shown in other populations exposed to violence or with difficult-to-treat hypertension.

Exposure to combat experiences: PTSD, somatization and aggression amongst combat and non-combat veterans.

To this date, the prevalence of posttraumatic stress disorder (PTSD) and associated psychological symptom profiles amongst non-combatant community-based veterans in Israel has not been studied. Data were analysed from a web-based survey of veterans via a market research platform during September 2021 and included 522 non-combat (e.g. intelligence, office-based or education corps) veterans and 534 combat (e.g. front-line infantry) veterans. The survey assessed PTSD, depression, anxiety and somatic symptoms in addition to the prevalence of self-reported aggression. A two-way multivariate analysis of covariance indicated that higher PTSD and somatic symptoms were prevalent for those exposed to combat experiences even when not in a combatant role. A logistic regression indicated that of those who did not self-define as aggressive prior to service, those exposed to combat were three times more likely to be aggressive following their service than veterans not exposed to combat. This effect was not demonstrated for combat soldiers compared to non-combat soldiers. Results indicate that mental health outreach would be better targeted towards those who have been exposed to combat-type experiences during their service even in non-combat units. The current study highlights the effect of combat exposure on secondary PTSD symptoms; aggression and somatization.

Latent class analysis of post-traumatic stress disorder symptoms following exposure to Hurricane Ike

BackgroundThere is substantial heterogeneity in how people react to potentially traumatic events (PTEs). Although some literature has explored this heterogeneity, there are only a few studies identifying factors associated with it within the disaster literature. ObjectiveThe current investigation identified latent classes of post-traumatic stress disorder (PTSD) symptoms and differences between these classes after exposure to Hurricane Ike. MethodsAdults living in Galveston and Chambers County, Texas, (n = 658) completed a battery of measures during an interview conducted two to five months after Hurricane Ike. Latent class analysis (LCA) was performed to identify latent classes of PTSD symptoms. Additionally, gender, age, racial or ethnic minority status, depression severity, anxiety severity, quality of life, perceived need for services, and disaster exposure were examined to explore class differences. ResultsLCA supported a 3-class model with low (n = 407, 61.9%), moderate (n = 191, 29.0%), and high PTSD symptoms (n = 60, 9.1%). Women appeared most at-risk for a moderate-severity presentation as compared to a low-severity presentation. Further, racial or ethnic minority groups appeared most at-risk for a high-severity presentation as compared to a moderate-severity presentation. Overall, the high symptom class had the poorest well-being, the most perceived need for services, and the highest exposure to the disaster, followed by the moderate symptom class, and finally the low symptom class. ConclusionsPTSD symptom classes appeared to be differentiated primarily by overall severity as well as important psychological, contextual, and demographic dimensions.

Depression, PTSD, and suicidal ideation among ex-ultra-Orthodox individuals in Israel

ABSTRACT Introduction: Disaffiliating from an ultra-Orthodox society is complex and challenging. The process includes dealing with culture shock, traumatic experiences, education gaps, and disconnection from familiar surroundings. Thus, ex-ultra-Orthodox individuals (ex-ULTOIs) may face loneliness, lack of belongingness, and loss of meaning, which may relate to high psychological distress such as depression and suicide ideation. In the present study, we sought to shed light on the distress of ex-ULTOIs in Israel and to understand the disaffiliation-related characteristics that may relate to their distress levels. Method: The sample comprised 755 participants, aged 19–54, who left their ultra-Orthodox Jewish lifestyle and communities. Participants completed self-report questionnaires tapping depression, anxiety, posttraumatic stress disorder (PTSD) symptoms, suicide ideation and behaviour, as well as demographics and disaffiliation-related characteristics. Results: Nearly half of the sample (N = 332, 45.9%) reported symptom intensity meeting the current criteria for major depressive disorder. Moreover, 46.7% reported symptoms meeting PTSD criteria, and 34.5% reported having suicidal ideations in the past year. Hierarchical regression analyses revealed that the intensity of past negative life events, the nature of motives for disaffiliation, and the longer duration of the disaffiliation process contributed to the severity of distress. Conclusions: The study's findings reveal that ex-ULTOIs suffer from high mental pain levels, particularly depression, PTSD, and suicidal risk. Importantly, experiencing disaffiliation as traumatic and longer durations of the process may facilitate greater mental pain and distress symptoms. These findings emphasize that ex-ULTOIs must be continually assessed, especially when their disaffiliation processes are experienced as traumatic.

Posttraumatic stress as a moderator of the association between HPA-axis functioning and alcohol use disorder among a community sample of women currently experiencing intimate partner violence.

Women experiencing intimate partner violence (IPV) experience a heightened prevalence of alcohol use disorder (AUD). Hypothalamic-pituitary-adrenal (HPA)-axis functioning has been associated with increased risk for AUD in other populations, including individuals with posttraumatic stress disorder (PTSD) symptoms. The goal of the present study was to determine whether PTSD symptom severity exacerbates the relationship between HPA-axis functioning and AUD. Participants were 151 community women who had experienced physical or sexual IPV in the past 30 days by their current male partners and used any amount of alcohol or drugs. A two-phase emotion induction protocol was utilized: Neutral mood induction followed by randomly assigned negative, positive, or neutral emotion induction. Saliva cortisol samples were obtained immediately following the neutral mood induction (baseline HPA-axis functioning), 20 min following the individualized emotion induction script (HPA-axis reactivity), and 40 min post the emotionally evocative cue (HPA-axis recovery). Findings revealed that PTSD symptom severity moderated the relations between baseline HPA-axis functioning and HPA-axis recovery and log odds of meeting criteria for AUD. Specifically, baseline HPA-axis functioning was positively associated with log odds of meeting criteria for AUD at high (but not low) PTSD symptom severity, whereas HPA-axis recovery was negatively associated with log odds of meeting criteria for AUD at high (but not low) PTSD symptom severity. Results contribute to our understanding of the biological processes involved in the etiology and maintenance of AUD among women experiencing IPV-specifically the prominent role of PTSD symptom severity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).