High Risk For Posttraumatic Stress Disorder Research Articles

Prevalence of trauma exposure and PTSD symptoms among the Icelandic population: gender and regional differences.

The primary aim of this cross-sectional study was to provide descriptive data about the lifetime prevalence of trauma exposure with a particular focus on sexual violence and natural disasters and to assess the prevalence of symptoms of post-traumatic stress disorder (PTSD) in the Icelandic population. In addition, the aim was to investigate whether PTSD symptoms, trauma types and prevalence differed by gender and geographical location. A representative sample of the population between the ages of 18 and 80 years was randomly selected from the Icelandic National Registrar. The study included a total of 1766 participants consisting of 930 (52.7%) women and 836 (47.3%) men, with an overall mean age of 49.9 years (standard deviation 16.1). Participants were contacted by phone and asked questions from the Lifetime Events Checklist (LEC-5) to assess lifetime exposure to traumatic events. Individuals who had experienced traumatic events completed the PTSD Checklist for DSM-5 (PCL-5) to assess PTSD symptoms. Exposure to trauma is common among the Icelandic population, with 84.3% of the participants experiencing at least one kind of trauma. Of those exposed to trauma, 10.5% fulfilled criteria indicating a higher risk of PTSD. The prevalence of sexual violence and other unwanted sexual experiences was relatively high (16.2% and 24.4%, respectively) compared with other national studies. Women were almost four times more likely than men to have been exposed to sexual violence (24.9% vs 6.4%), and were more likely to have been exposed to other unwanted sexual experience (35.1% vs 12.4%, respectively). Exposure to natural disasters is frequent but with great geographical variation. This study highlights the high prevalence of trauma in Iceland, revealing significant gender disparities in sexual violence and geographical variations in natural disaster exposure.

Prediction of post-traumatic stress disorder in family members of ICU patients: a machine learning approach.

Post-traumatic stress disorder (PTSD) can affect family members of patients admitted to the intensive care unit (ICU). Easily accessible patient's and relative's information may help develop accurate risk stratification tools to direct relatives at higher risk of PTSD toward appropriate management. PTSD was measured 90days after ICU discharge using validated instruments (Impact of Event Scale and Impact of Event Scale-Revised) in 2374 family members. Various supervised machine learning approaches were used to predict PTSD in family members and evaluated on an independent held-out test dataset. To better understand variables' contributions to PTSD predicted probability, we used machine learning interpretability methods on the best predictive algorithm. Non-linear ensemble learning tree-based methods showed better predictive performances (Random Forest-area under curve, AUC = 0.73 [0.68-0.77] and XGBoost-AUC = 0.73 [0.69-0.78]) than regularized linear models, kernel-based models, or deep learning models. In the best performing algorithm, most important features that positively contributed to PTSD's predicted probability were all non-modifiable factors, namely, lower patient's age, longer duration of ICU stay, relative's female sex, lower relative's age, relative being a spouse/child, and patient's death in ICU. A sensitivity analysis in bereaved relatives did not alter the algorithm's predictive performance. We propose a machine learning-based approach to predict PTSD in relatives of ICU patients at an individual level. In this model, PTSD is mostly influenced by non-modifiable factors.

Bayesian Network Models for PTSD Screening in Veterans

The prediction of posttraumatic stress disorder (PTSD) has gained a lot of interest in clinical studies. Identifying patients with a high risk of PTSD can guide mental healthcare workers when making treatment decisions. The main goal of this paper is to propose several Bayesian network (BN) models to assess the probability that a veteran has PTSD when first visiting a U.S. Department of Veteran Affairs (VA) facility seeking medical care. The current practice is to use a five-question test called PC-PTSD-5. We aim to use the PC-PTSD-5 test, which is currently administered to most incoming new patients, and demographic information, military service history, and medical history. We construct a Bayes information criterion score-based BN, a group L2-regularized BN (GL2-regularized BN), and a naïve Bayes BN to assess the probability that a patient has PTSD. The GL2-regularized BN is a new method for constructing a BN motivated by some of the challenges of analyzing this data set. A secondary goal is to identify which features are important in predicting PTSD. We discover that the following features help compute the probability of PTSD: PC-PTSD-5, service-connected flag, combat flag, agent orange flag, military sexual trauma flag, traumatic brain injury, and age. History: Accepted by Ram Ramesh, Area Editor for Data Science & Machine Learning. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2021.0174 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2021.0174 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .

Post-traumatic Stress Disorder and Its Associated Risk Factors Among Emergency Healthcare Workers: A Saudi Cross-Sectional Analytical Study.

Post-traumatic stress disorder (PTSD) is a psychiatric disease characterized by exposure to threatened death or serious injury and directly experiencing or witnessing the event. Many healthcare professionals have had PTSD, but emergency physicians may be particularly susceptible. To our knowledge, no study has been performed in Saudi Arabia to identify the prevalence and associated risk factors of PTSD among emergency staff. This study aims to determine the prevalence and risk factors of post-traumatic stress disorder (PTSD) among emergency healthcare workers (HCWs) in Saudi Arabia. A cross-sectional analytical study will be conducted in emergency departments around Saudi Arabia in all regions. The study population will include healthcare workers in emergency departments who work and presently live in Saudi Arabia. The survey was divided into two sections. The first section focuses on the emergency personnel's demographic data; the second concentrates on screening for post-traumatic stress disorder using the PTSD checklist for DSM-5 (PCL-5). Our population included 519 emergency healthcare staff, including males (51.4%) and females (48.6%). Most emergency HCWs worked in the Ministry of Health Hospitals (58%). The highest diagnosed psychological disorders among emergency staff were anxiety (19.3%) and mood disorders (10.2%). The prevalence of PTSD among emergency workers in Saudi Arabia was 14.1%. The prevalence of PTSD was significantly higher among emergency HCWs who had chronic diseases, emergency workers with anxiety or mood disorders, emergency staff who were using psychiatric medication (p<0.001), and those with psychotic disorders (p=0.002). The prevalence of PTSD among emergency healthcare workers in Saudi Arabia is estimated to be 14.1%, and pre-existing mental illnesses are associated with a higher risk of PTSD.

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.

Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark.

Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement. We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults). Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth. Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.

Low Resilience Was a Risk Factor of Mental Health Problems during the COVID-19 Pandemic but Not in Individuals Exposed to COVID-19: A Cohort Study in Spanish Adult General Population.

The aim is to analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults. a longitudinal cohort study was carried out. Resilience was measured with the CD-RISC. Mental health problems that were assessed included: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms. we found statistically significant differences between groups and resilience scores in MDE [F (3; 48.40) = 19.55], GAD [F (3; 19.63) = 6.45] and STB [F (3; 111.74) = 31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 were not at higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95% CI) = -3.25 (-3.969 to -2.54)], but not for individuals with COVID-19. in the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, and not in the population with COVID-19.

Low resilience as risk factor of mental disorders during COVID-19 pandemic: A cohort study

Abstract Background To analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults. Methods A longitudinal cohort study was carried out. Resilience was measured pre/post-pandemic with the CD-RISC. Mental health problems assessed were: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms. Results We found statistically significant differences between groups and resilience scores in MDE [F (3;48.40)=19.55], GAD [F(3;19.63)=6.45] and STB [F(3;111.74)=31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB, respectively. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 did not have a significantly higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95%CI)= -3.25(-3.969 to -2.54)], but not for individuals with COVID-19. Conclusions In the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, but not in the population with COVID-19. Key messages • Resilience was a buffer of mental health problems in general population, but not in those exposed to COVID-19. • Those with low resilience were at 21-fold risk of mental health problems before and during the first year of pandemic.

A cross-sectional study on the mental health of patients with COVID-19 1year after discharge in Huanggang, China.

ObjectiveThis study is aimed to investigate the mental health status of COVID-19 survivors 1 year after discharge from hospital and reveal the related risk factors.MethodsFrom April 11 to May 11, 2021, 566 COVID-19 survivors in Huanggang city were recruited through their primary doctors. A total of 535 participants (94.5%) admitted to participate in the survey and completed the questionnaires. Five scales were applied including 7-Items Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, Impact of Event Scale-Revised, Pittsburgh Sleep Quality Index, and Fatigue Scale-14. The chi-square and the Fisher’s exact test were used to evaluate the classification data, multivariate logistic regression was used to explore the related factors of sleep quality, fatigue, anxiety, depression, and post-traumatic stress disorder (PTSD).ResultsOne year after being discharged, of the 535 COVID-19 survivors, 252 (47.1%) had poor sleep quality; 157 (29.3%) had the symptoms of fatigue; 84 (15.7%),112 (20.9%), and 130 (24.3%) suffered from symptoms of anxiety, depression, and PTSD, respectively. The logistic regression analysis showed that history of chronic disease was risk factor for poor sleep quality (OR 2.501; 95% CI, 1.618–3.866), fatigue (OR 3.284; 95% CI 2.143–5.033), PTSD (OR 2.323; 95% CI 1.431–3.773) and depression (OR 1.950; 95% CI 1.106–3.436) in COVID-19 survivors. Smoking contributed to the poor sleep quality (OR 2.005; 95% CI 1.044–3.850), anxiety (OR 4.491; 95% CI 2.276–8.861) and depression (OR 5.459; 95% CI 2.651–11.239) in survivors. Drinking influenced fatigue (OR 2.783; 95% CI 1.331–5.819) and PTSD (OR 4.419; 95% CI 1.990–9.814) in survivors. Compared with college-educated survivors, survivors with high school education were at higher risk for poor sleep quality (OR 1.828; 95% CI 1.050–3.181) and PTSD (OR 2.521; 95% CI 1.316–4.830), and survivors with junior high school education were at higher risk for PTSD (OR 2.078; 95% CI 1.039–4.155). Compared with overweight survivors (BMI ≥ 23.0), survivors with normal BMI (18.5–22.9) (OR 0.600; 95% CI 0.405–0.889) were at lower risk for fatigue. While being housewife (OR 0.390; 95% CI 0.189–0.803) was protective factor for fatigue and having more family members was protective factor for PTSD (OR 0.404 95% CI 0.250–0.653) in survivors.ConclusionsOne year after infection, poor sleep quality, fatigue, anxiety, depression, and PTSD, still existed in a relatively high proportion of COVID-19 survivors. Chronic disease history was an independent risk factor for poor sleep quality, fatigue, depression, and PTSD. Participants with low education levels were more likely to have mental problems than the others. We should focus on the long-term psychological impact of COVID-19 on survivors, and the government should apply appropriate mental health services to offer psychiatric support.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00406-022-01484-8.

Posttraumatic stress disorder and related factors among nurses working during the COVID-19 pandemic.

AimTo analyse the prevalence of posttraumatic stress disorder (PTSD) and examine its related factors among nurses who worked during the coronavirus disease 2019 (COVID‐19) pandemic in Daegu, South Korea.BackgroundNurses are a high‐risk population for PTSD, especially during the COVID‐19 pandemic. This study was conducted to identify the nursing work environmental factors that should be addressed to reduce PTSD.MethodsUsing a cross‐sectional design, 365 nurses were enrolled. Their characteristics (intrapersonal, interpersonal, organizational, and COVID‐19‐related) and PTSD Checklist‐5 scores were analysed.ResultsThe average PTSD score was 14.98 ± 15.94, and 16.5% of the participants had a high risk of PTSD. Nurses were more likely to have PTSD if they were married (odds ratio = 3.02, p = .013) and when nurse managers' abilities, leadership, and support of nurses were low (odds ratio = 3.81, p < .001).ConclusionsThe nursing work environment was found to be associated with PTSD. Therefore, interventions are necessary to increase nurse managers' abilities, leadership, and support for nurses to reduce the risk of PTSD among nurses.Implications for Nursing ManagementEffective professional and social support and interventions to improve nurse managers' abilities, leadership, and support of nurses are needed to reduce PTSD.

Post-Traumatic Stress Disorder among Children Involved in Traffic Accidents and Their Parents in Japan.

Children who survive traffic accidents, and their parents, may develop post-traumatic stress disorder (PTSD) or related symptoms (depression or anxiety), which can hinder the children's development and the parents' ability to provide effective care. In Japan, the PTSD incidence rate after traffic accidents and its related factors remain unclarified. The participants were 79 children and 104 parents. The children were aged 3-18 years when injured. From August through December 2015, participants completed a self-reported questionnaire survey that comprised the 15-item Post-traumatic Stress Symptoms for Children and the Japanese version of the Impact of Event Scale-Revised. The children's Injury Severity Score (ISS) was also obtained from their medical records. Correlation analysis, analysis of variance, and multiple regression analysis were conducted. Among the children and parents, 10.1% and 22.1%, respectively, were deemed to be at high risk of PTSD. Their stress scores were significantly positively correlated with each other and negatively correlated with the children's age at the time of the accident. Parents who witnessed their children's accidents and those whose children were hospitalized were more stressed. Neither the children's nor the parents' risk for PTSD was associated with ISS or the amount of time since the accident. A system that simultaneously works with children and parents to support both parties' psychological recovery is required. To ensure psychological care post-injury, it is necessary to evaluate PTSD risk, regardless of injury severity. Implementing preventive and early interventions can prove more valuable than awaiting natural recovery.

Erectile dysfunction among patients and health care providers during COVID-19 pandemic: A systematic review.

COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected as well. We performed a systematic review of the published articles about the change in EF among patients and health care providers during the COVID-19 pandemic. We searched PubMed and Cochrane databases for English literature using a combination of medical subject headings (MeSH) terms and keywords. We extracted data of erectile dysfunction (ED) rate, international index of erectile function (IIEF), changes related to exposure to the pandemic (Primary objectives), and factors affecting these differences (Secondary objectives). Twenty articles were included in the screening phase. Only 3 articles were eligible for primary objectives, and 2 articles were included for the secondary objective. Three articles revealed an increase in ED cases and a reduction in IIEF-5 scores during the pandemic. Rates of ED have ranged from 32% to 87% of the study populations. Anxiety, depression, and post-traumatic stress disorder (PTSD) were associated with increased ED rates. We conclude that the COVID-19 pandemic is associated with increased rates of ED. Anxiety and depression augment this increase. Health care providers are at higher risk for PTSD, which increases the risk of ED.

Post-Traumatic Stress Disorder in People with Visual Impairment Compared with the General Population.

Background: People with a visual impairment appear to have an increased risk of experiencing potentially traumatizing life events and possibly also subsequently developing post-traumatic stress disorder (PTSD). This study investigated the point prevalence of PTSD in people with a visual impairment compared with the general population of Norway and examined factors associated with PTSD among people with a visual impairment. Methods: A telephone-based survey was administered to a probability sample of 1216 adults with a visual impairment. Of these, 736 (61% response rate) participated. A probability sample from the general population served as a reference (n = 1792, 36% response rate). PTSD was measured with the PTSD Checklist for the DSM-5 (PCL-5), based on the currently most bothersome event reported from the Life Events Checklist for DSM-5 (LEC-5). We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Results: The prevalence of PTSD was higher among people with a visual impairment than in the general population, both for men (9.0% vs. 3.8%) and women (13.9% vs. 8.5%). The prevalence rates of PTSD from the illness or injury that had caused the vision loss (men 3.9%, women 2.2%) accounted for a considerable part of the difference between the populations. For women, PTSD related to sexual assaults also contributed significantly to a higher PTSD prevalence in the visually impaired versus the general population (5.2% vs. 2.2%), while for men there were no other event categories which resulted in significant differences. Among people with a visual impairment, the higher risk of PTSD was associated with lower age, female gender, having acquired the vision loss, and having other impairments in addition to the vision loss. Conclusion: The higher prevalence of PTSD in people with a visual impairment suggests that vulnerability to mental health problems is associated with serious life events. The higher incidence than in the general population is partly due to the illness or injury that had led to the vision loss and partly due to people with vision loss appearing to be more vulnerable through exposure to other types of potentially traumatizing events, such as sexual abuse.

The Mental Health of Long-Term Evacuees outside Fukushima Prefecture after the Great East Japan Earthquake.

Ten years after the Great East Japan Earthquake, thousands of residents of Fukushima Prefecture were still living as evacuees. Among them, unignorable numbers of people were living outside of the prefecture. A survey was conducted with evacuees to Ibaraki, the neighboring prefecture of Fukushima, to investigate their medium- to long-term mental care needs. A questionnaire was sent to 1,470 households that had been living in Fukushima on March 11, 2011, and who were evacuated to Ibaraki by October 2016. Binary logistic regression analyses were performed to identify risk factors for major depressive disorder, post-traumatic stress disorder (PTSD), and suicidal ideation. Of the participants, 16.5% had a high risk for major depressive disorder, 39.0% exhibited a high risk for PTSD, and 19.7% indicated suicidal ideation. "Own injuries and illnesses" and "Worries about the hometown" were risk factors for major depressive disorder, PTSD, and suicidal ideation. "Not receiving compensation for damages" was a risk factor common to major depressive disorder and suicidal ideation. There is a high possibility that many people who have evacuated to other prefectures might still be suffering from psychological symptoms after the disaster. Worries about their hometowns were highly related to their mental disorders.

Posttraumatic Stress Disorder Symptoms 2 Months After Vaginal Delivery.

To assess the prevalence of posttraumatic stress disorder (PTSD) symptoms and identify characteristics associated with it 2 months after singleton vaginal delivery at or near term. We conducted an ancillary cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial in 15 French hospitals in 2015-2016. Women who had singleton vaginal delivery after 35 weeks of gestation were enrolled. After randomization, characteristics of labor and delivery were prospectively collected and paid special attention to postpartum blood loss. Posttraumatic stress disorder profile and provisional diagnosis were assessed 2 months after childbirth by two self-administered questionnaires: the IES-R (Impact of Event Scale-Revised) and the TES (Traumatic Event Scale). Associations between potential risk factors and PTSD symptoms were analyzed by multivariable logistic or linear regression modeling, depending on the type of dependent variable. Questionnaires were returned by 2,740 of 3,891 women for the IES-R and 2,785 of 3,891 women for the TES (70.4% and 71.6% response rate). The prevalence of PTSD symptoms was 4.9% (95% CI 4.1-5.8%; 137/2,785) with the TES, and the prevalence of PTSD provisional diagnosis was 1.6% (95% CI 1.2-2.1%; 44/2,740), with the IES-R and 0.4% (95% CI 0.2-0.8%; 9/2,080) with the TES. Characteristics associated with a higher risk of PTSD in multivariable analysis were vulnerability factors - notably migrant status and history of psychiatric disorder (adjusted odds ratio [aOR] 2.7 95% CI 1.4-5.2) - and obstetric factors - notably induced labor (aOR 1.5 95% CI 1.0-2.2), being labor longer than 6 hours (aOR 1.7 95% CI 1.1-2.5), postpartum hemorrhage of 1,000 mL or more (aOR 2.0 95% CI 1.0-4.2), and bad memories of delivery at day 2 postpartum (aOR 4.5 95% CI 2.4-8.3) as assessed with the IES-R. Results were similar with the TES. Approximately 1 of 20 women with vaginal delivery have PTSD symptoms at 2 months postpartum. History of psychiatric disorder, postpartum hemorrhage, and bad memories of deliveries at day 2 were the main factors associated with a PTSD profile.

Somatic distress, mental health and psychological resilience among cancer patients during the Covid-19 pandemic

We aimed to investigate the somatic distress and psychological symptoms levels of cancer patients, and analyze the influencing factors on somatic distress during COVID-19 pandemic. This cross-sectional study included 216 eligible cancer patients. The Patient Health Questionnaire-15, Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5, The Depression, Anxiety and Stress Scale-21, the Brief Resilience Scale, the Stressful Life Events List due to Pandemic were administered to the participants. The moderate to severe somatic distress rate was % 38 and probable PTSD rate was 20.4%. Depression, anxiety and stress symptoms were 36.1%, 49.1% and 45.4%, respectively, from mild to extremely severe. There were substantial association between somatic symptoms severity and high PTSD, anxiety, depression, and stress symptoms levels. Low education, high anxiety levels, high experience stressful life events, and low psychological resilience predicted high somatic distress. This study demonstrates the high risk of somatic distress, PTSD, depression, anxiety and stress in patients with cancer during the pandemic. In addition, somatic distress may indicate high levels of psychological symptoms, high experience stressful life events, and low psychological resilience. It underscores the need to assess psychological status during the pandemic, especially those with high level somatic symptoms.

Dreams and Nightmares during the First and Second Wave of the COVID-19 Infection: A Longitudinal Study

Recent literature shows that the Coronovirus-19 (COVID-19) pandemic has provoked significant changes in dreaming. The current study intends to provide an update about dream variable changes during the second wave of COVID-19. A total of 611 participants completed a web survey from December 2020 to January 2021. Statistical comparisons showed that subjects had lower dream-recall frequency, nightmare frequency, lucid-dream frequency, emotional intensity, and nightmare distress during the second than the first wave of the pandemic. Dreams had a higher negative tone during the second than first wave. We revealed significant differences concerning post-traumatic growth, sleep-related post-traumatic stress disorder (PTSD) symptoms and sleep measures between groups obtained as a function of the changes in the oneiric frequency between the first and second waves. We also found significant correlations between qualitative/emotional dream features and COVID-19-related factors (job change, forced quarantine, having COVID-19 infected relatives/friends, or asking for mental health help). Overall, we found that the second wave affected fewer quantitative features of dream activity and there was less emotional intensity. Moreover, we confirmed the relationship between nightmares and the high risk of PTSD when subjects were grouped as a function of the increasing/decreasing frequency. Finally, our findings are partly coherent with the continuity hypothesis between oneiric and waking experiences.

206 Development and Validation of a Simple Clinical Prediction Tool to Identify Individuals in the Emergency Department at High Risk of Posttraumatic Stress Disorder After Motor Vehicle Collision

Approximately 4 million individuals are seen in US EDs after motor vehicle collision (MVC) each year. The overwhelming majority (>90%) are discharged to home after evaluation. Posttraumatic stress disorder (PTSD) is a relatively common sequelae in this population, occurring in ∼15-30% of individuals discharged to home from the ED. No ED-based or ED-initiated secondary preventive interventions are routinely available to prevent PTSD among those at high risk. The development of such interventions has been hampered by the lack of a simple clinical prediction tool that can be used in the ED to risk stratify individuals for PTSD risk. We sought to develop and validate such a tool. ED patients 18-75 years old were recruited at 28 ED sites. Candidate predictive baseline characteristics assessed (n=265) spanned 11 risk factor domains, including sociodemographic characteristics, lifetime trauma, pre-trauma stressors and psychological distress, pre-trauma mental and physical health, MVC characteristics, peritraumatic symptoms, personality, and social support. PTSD was defined by a PCL-5 score ≥ 38 at 3-month follow-up. Inverse missing probability weighting was used to balance baseline characteristics with full cohort (eg, 20% without 3-month follow-up). Lasso logistic regression with nested binary variables for identified influential factors was used to develop the predictive tool in the derivation sample (19 ED sites in 13 states, n=1282). Application of tool in the validation sample (11 different ED sites in 6 states, n=286) was used to assess generalizability. In derivation and validation samples (n=1570, 68% female, 33% non-Hispanic White, mean age 36), 26% met criteria for 3-month PTSD. A simple 8-item tool had AUC=0.83 with excellent calibration in the derivation cohort, and AUC=0.76 with continued excellent calibration in the validation cohort. (The tool also had AUC=0.78 and excellent calibration in a separate non-MVC sample.) At thresholds of .3 and .4, the tool had sensitivity/specificity of 69%/80% and 58%/85%, respectively. The most important predictors were anxiety sensitivity, pre-MVC depressive and distress symptoms, and peritraumatic psychophysiological symptoms. A simple 8 question tool can be used in the ED to help identify those at high risk of PTSD. This tool may be useful in clinical trials testing secondary preventive interventions for PTSD.

Risk of PTSD Due to the COVID-19 Pandemic Among Patients in Opioid Substitution Treatment.

Background: The impact of the COVID-19 pandemic on the mental health of patients suffering from addictive disorders is of major concern. This study aimed to explore the presence and potential increase in post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety since the beginning of the pandemic for patients in opioid substitution therapy (OST).Methods: This cross-sectional survey study evaluated a clinical sample of patients in OST (N = 123). Symptoms of post-traumatic stress disorder (PTSD) due to the COVID-19 pandemic were assessed by an adapted version of the impact of event scale (IES-R), resulting in two subgroups of low and high risk for PTSD. The depression, anxiety, and stress scale (DASS-21) was applied to collect data on the respective symptoms, and changes since the onset of the pandemic were reported on separate scales. Sociodemographic and COVID-19 related factors, as well as data on craving, consumption patterns, concomitant use, and the drug market were further assessed.Results: A binary logistic regression analysis confirmed the impact of self-perceived higher burden by psychological and economic factors on the elevated risk for PTSD due to the pandemic. The high-risk PTSD group also showed higher levels of depression, anxiety and stress, as well as a more pronounced deterioration in these symptoms since the pandemic. While reported levels of craving did not differ between the two groups, the high-risk PTSD group indicated a significantly higher increase in craving since the crisis, when compared to the low-risk group.Discussion: Our findings demonstrate elevated levels of clinical symptoms among patients in OST, with more than a quarter of patients found at risk for PTSD due to the COVID-19 pandemic. Furthermore, about 30–50% of our patients reported concerning levels of depression, anxiety, or stress. Special attention should be drawn to these findings, and potential deterioration of the situation should be addressed by health care facilities. Particularly, psychological, and financial burden due to the crisis were identified as factors increasing the risk for PTSD. These factors can easily be evaluated during routine anamneses, and might be a valuable source of information, when special attention is needed.

Problematic Internet Use Was Associated With Psychological Problems Among University Students During COVID-19 Outbreak in China.

Background: As the coronavirus disease 2019 (COVID-19) pandemic progressed globally, school closures and home quarantine may cause an increase in problematic Internet use among students in universities. Such a traumatic stress event may also contribute to the development of posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms. This study aimed to evaluate the prevalence of PTSD, depressive, and anxiety symptoms as well as the predictive role of problematic Internet use in the above-mentioned psychological problems in university students.Methods: A cross-sectional study was conducted through an online survey of 8,879 students in China between April 20 and April 26, 2020. The presence of PTSD, depressive, and anxiety symptoms and problematic Internet use were evaluated using PTSD Checklist for DSM-5, the Center for Epidemiologic Studies Depression 9-item scale, the generalized anxiety disorder 7-item scale, and the Young diagnostic questionnaire, respectively. Sociodemographic information and the knowledge, attitude, and practice (KAP) toward COVID-19 data were also collected.Results: A total of 4,834 (54.4%) participants were female, and 7,564 (85.2%) were undergraduate students. A total of 615 students (6.9%) reported PTSD symptoms; 5.2% (465) and 10.1% (896) reported moderate to severe depressive and anxiety symptoms, respectively. The problematic Internet use was significantly associated with higher risk of PTSD, depressive, and anxiety symptoms (odds ratio 2.662 [95% CI, 2.239–3.165], odds ratio 4.582 [95% CI, 3.753–5.611], odds ratio 3.251 [95% CI, 2.814–3.757], respectively; all P < 0.001). Lower attitude and practice scores also contributed to the risk of depressive, anxiety, and PTSD symptoms (P < 0.05).Conclusions: Psychological problems should be paid more attention, and problematic Internet use may be a predictor when screening high-risk students for psychological problems. Our results will aid in timely psychological screening, which is meaningful in the prevention and intervention of psychological problems.