Higher Posttraumatic Stress Disorder Symptoms Research Articles

The experience of aging before one's time during the coronavirus pandemic among war veterans in Israel

Subjective age, the personal sense of how old one feels, is an important concomitant of posttraumatic outcomes in the second half of life. The present study aims to disentangle the interrelationships between posttraumatic stress disorder symptoms (PTSS) and subjective age, during the COVID-19 pandemic, among a sample of Israeli older adults who are veterans of the 1973 Yom Kippur War. Participants were interviewed in 2015 (T1; N = 259; mean age = 65.23, SD = 5.32) and in 2020, during the COVID-19 outbreak in Israel (T2). We assessed subjective age, PTSS, fear of COVID-19, self-rated health, and COVID-19 related accelerated subjective aging. A cross-lagged path analysis showed that while higher PTSS at T1 were associated with an increase in subjective age from T1 to T2, subjective age at T1 was not associated with PTSS at T2. PTSS at T1, but not subjective age, were associated with higher COVID-19 related accelerated subjective aging at T2. Older adults with continued PTSS due to past traumas, might be susceptible to the stressors of COVID-19 expressed in the personal subjective experience of having aged quickly in a short period of time. Our findings also suggest that in the context of stress and trauma, subjective age is more appropriately conceived as an outcome variable rather than a predictor of PTSS.

Posttraumatic stress disorder symptoms and timing of menopause and gynecological surgery in the Nurses' Health Study II

BackgroundEarlier menopause, either natural or through gynecologic surgeries, has been associated with various negative health sequelae. While posttraumatic stress disorder (PTSD) has been linked to dysregulated biological processes, including reproductive system changes that could alter menopausal timing, little work has examined whether trauma and PTSD are associated with greater risk of early cessation of menses. MethodsData are from 46,639 women in the Nurses' Health Study II, a prospective cohort study of women followed for up to 26 years. Lifetime trauma and PTSD symptoms were assessed with the Brief Trauma Questionnaire and a PTSD symptom screener in 2008. Age at cessation of menses and reason for cessation of menses (i.e., natural menopause, gynecologic surgery including hysterectomy and/or bilateral salpingo-oophorectomy [BSO]) were assessed. Cox proportional hazards models estimated hazards ratios (HR) of cessation of menses (separately for naturally or surgically) associated with trauma alone or PTSD symptoms, relative to no trauma, adjusting for covariates. ResultsTrauma/PTSD status was associated with earlier cessation of menses due to surgery, but not natural menopause. Women with trauma exposure, low, and high PTSD symptoms had higher hazard of cessation of menses due to surgery relative to those with no trauma exposure (HRtrauma = 1.16, 95%CI 1.07–1.26; HRlow PTSD = 1.25, 95%CI 1.15–1.36; HRhigh PTSD = 1.29, 95%CI 1.17–1.42). Trauma exposure and PTSD symptoms were associated with similarly increased risk of hysterectomy and BSO surgeries. ConclusionsWomen who experienced trauma and PTSD may be at elevated risk for common gynecological surgeries premenopausally, potentially due to increased clinical indications or gynecological conditions.

Results of the Kigali Imbereheza Project: A 2-Arm Individually Randomized Trial of TI-CBT Enhanced to Address ART Adherence and Mental Health for Rwandan Youth Living With HIV.

Adolescents living with HIV have elevated mental distress and suboptimal antiretroviral therapy (ART) adherence. Two urban clinics in Kigali, Rwanda. A 2-arm individual randomized controlled trial compared Trauma-Informed Cognitive Behavioral Therapy enhanced to address HIV (TI-CBTe) with usual care (time-matched, long-standing, unstructured support groups) with 356 12- to 21-year-old (M = 16.78) Rwandans living with HIV. TI-CBTe included 6 group-based 2-hour sessions led by trained and supervised 21- to 25-year-old Rwandans living with HIV. Participants reported their ART adherence, depression/anxiety, and Post-Traumatic Stress Disorder symptoms at baseline, 6, 12, and 18 months. ART adherence was relatively high at baseline, and youth reported elevated rates of depression/anxiety and trauma symptoms. There were no differential treatment effects on adherence, but depression/anxiety improved over time. Youth with lower depression/anxiety at baseline seemed to benefit more from TI-CBTe than usual care, whereas women with high baseline distress seemed to benefit more from usual care. Youth were less likely to score in high Post-Traumatic Stress Disorder symptom categories at the follow-up, with no differential treatment effects. TI-CBTe did not outperform usual care on ART adherence, possibly reflecting relatively high adherence at baseline, simplified medication regimens over time, a strong comparison condition, or because youth assigned to TI-CBTe returned to their support groups after the intervention. TI-CBTe was more effective for youth with lower depression/anxiety symptoms, whereas youth with high distress benefitted more from the support groups. TI-CBTe was feasible and acceptable, and young adults living with HIV were able to deliver a mental health intervention with fidelity. The powerful nature of the comparison group, ongoing support groups, points to the potential value of locally crafted interventions in low-resource settings.

Relationships among uncertainty, post-traumatic stress disorder symptoms, and quality of life in non-muscle-invasive bladder cancer survivors.

The aim of this study was to examine relationships among uncertainty, PTSD symptoms (PTSS), and quality of life (QOL) in non-muscle-invasive bladder cancer (NMIBC) survivors. Eligible NMIBC survivors were identified through the North Carolina CentralCancer Registry, and 398 survivors participated in a mailed survey that measured survivor's outcomes (uncertainty, PTSS, and QOL). Structural equation modeling was used to examine the mediating effect of uncertainty and PTSS on the association between personal characteristics and QOL in NMIBC survivors. NMIBC survivors experienced cancer-related uncertainty; higher uncertainty was associated with male, lower income, lack of cure, and lower cognition-ability. Uncertainty was significantly and negatively associated with QOL. In addition, PTSS completely mediated the effect of uncertainty on QOL, and higher PTSS had a strong association with poorer QOL. Additionally, comorbidities, cognition-general concerns, uncertainty, and PTSS had strong negative effects on QOL. This study has identified modifiable psychosocial factors which affect QOL in NMIBC survivors. The study findings can be used in the development of interventions to improve QOL for NMIBC survivors.

Perceived Discrimination as a Moderator between Living Difficulties and Psychological Distress among Asylum Seekers from Darfur

Abstract Migration inevitably involves difficulties. These difficulties are more pronounced for refugees and asylum seekers, who also often suffer discrimination. In this study, we examined the impact of living difficulties on the psychological wellbeing of Darfuri asylum seekers in Israel. Based on the stress process theory, we hypothesized that perceived discrimination mediates the relationship between living difficulties and psychological distress, post-traumatic stress disorder (PTSD), and psychological quality of life. The sample consisted of 300 Darfuri asylum seekers aged 19 or older. Measures included post-migration living difficulties, perceived discrimination, psychological distress, PTSD, psychological quality of life, and demographic factors. The results show that greater living difficulties were associated with lower psychological quality of life, higher PTSD symptoms, and increased psychological distress. As hypothesized, perceived discrimination fully mediated the relation between living difficulties and psychological quality of life and PTSD symptoms. Additionally, perceived discrimination partly mediated the relation between living difficulties and psychological distress. Our findings support the stress process theory and the role of society in stressful situations. It also indicates that by reducing perceived discrimination, psychological wellbeing can be improved.

The impact of neurotoxicant exposures on posttraumatic stress disorder trajectories: The Ft. Devens Gulf War Veterans Cohort.

Gulf War veterans (GWVs) were exposed to neurotoxicants, including sarin nerve gas, anti–nerve agent pills, pesticides, oil well fires, and fumes from unvented tent heaters, all of which have been associated with subsequent adverse health. Posttraumatic stress disorder (PTSD) symptoms have also been associated with GW deployment; however, associations between exposures and PTSD symptoms have not been investigated. We assessed PTSD symptom trajectories and associations with neurotoxicant exposures in Ft. Devens Cohort (FDC) veterans (N = 259) who endorsed trauma exposure during deployment and completed the PTSD Checklist at three follow‐ups (1992–1993, 1997–1998, 2013–2017). Results indicate that among veterans with more severe initial PTSD symptoms, symptoms remained significantly higher across follow‐ups, Bs = −1.489–1.028, whereas among those with low initial PTSD symptoms, symptom severity increased significantly over time, Bs = 1.043–10.304. Additionally, neurotoxicant exposure was associated with a significant increase in PTSD symptoms, Bs = −1.870–9.003. Significant interactions between time and exposures were observed for PTSD symptom clusters, suggesting that among participants with high initial PTSD symptom, unexposed veterans experienced symptom alleviation, whereas exposed veterans’ PTSD symptoms remained high. In GWVs with low initial PTSD symptoms, both unexposed and exposed veterans experienced PTSD symptom exacerbations over time; however, this occurred at a faster rate among exposed veterans. These findings suggest that in the years following deployment, GWVs who were exposed to both traumatic events and neurotoxicants may experience more severe and chronic PTSD symptoms than those without neurotoxicant exposures.

The role of depression in the maintenance of gains after a prolonged exposure intensive outpatient program for posttraumatic stress disorder.

Intensive outpatient programs (IOPs) for trauma-focused therapy, such as prolonged exposure (PE), have the potential to deliver highly effective treatment, quickly and with minimal dropout. Identifying factors that predict maintenance of gains after treatment can help triage individuals who may need additional services. Growth mixture modeling (GMM) was used to identify classes of posttraumatic stress disorder (PTSD) and depression symptom trajectories across the year following a 2-week IOP, delivering daily PE for PTSD for post-9/11 Veterans. Predictors of trajectories were examined. Three classes of trajectories best-fit the data for PTSD and depression symptoms. Two classes made up the majority of the sample (85%) and both maintained significantly reduced PTSD symptoms across the year following therapy. For a minority of the sample (14.6%), PTSD symptoms rebounded after treatment. These individuals were highly likely to be categorized in the persistent depression class. IOP-delivered PE is effective, and gains are largely maintained. The minority of patients who do not maintain their gains as robustly are likely to report persistent depressive symptoms in treatment and higher PTSD symptoms on a self-report measure.

Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders

ABSTRACT 74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; M age = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).

Marfatia Award Abstracts

Background:Few studies across the globe have evaluated the adverse mental health consequences of COVID-19, in patients who suffered from COVID-19 infection. However, a comparative study of persons who suffered from COVID-19 and those who witnessed the COVID-19 infection in their 1 st degree relative/s is lacking.Aims & Objectives:This study aims to compare the psychiatric morbidity in persons who suffered from COVID-19 infections, and those who witnessed the illness in one of their first degree relative/s.Methods:In this cross-sectional online survey, 2964 adult participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Fear of COVID-19 Scale (FCS-19), Brief Resilient Coping Scale (BRCS), The Brief Resilience Scale (BRS) and a self-designed questionnaire to evaluate Neuropsychiatric issues.Results-Mean PHQ-9, GAD-7 and FCS-19 were significantly higher in those who themselves suffered from COVID-19 as compared to those who witnessed the infection in their 1 st degree relative (7.41 ± 7.09 vs 6.56 ± 6.15; p<0.0001; 5.58 ± 6.59 vs 5.10 ± 5.97;p=0.001;11.32±6.45 vs 10.48±6.12; p=0.001 respectively). However, BRS coping score was not significantly different between both the groups. Overall, about 1/3 rd of the participants who developed COVID-19 infection had depression and one-third had anxiety disorders. One-fifth of the participants reported high fear, PTSD and OCD symptoms, while 1/6 th reported other neuropsychiatric manifestations.Conclusion:Patients who suffered from COVID-19 had higher prevalence of PHQ-9, GAD-7 and FCS-19 as compared to those to witnessed COVID-19 in relatives but with similar BRCS.

Personal experience, posttraumatic symptomatology, and meaning in life during the first months of the COVID-19 pandemic

BackgroundThe traumatic subjective distress and personal meaning in life were examined in the context of the first months of the COVID-19 pandemic sanitary crisis and home lockdown. Method: A total of 543 participants answered an online survey that included questions about the individual characteristics of the pandemic experience, the Impact of Event Scale-Revised, and the Personal Meaning Profile-Brief. Results: Nearly all of life impaired areas, having the suspicion of being ill with COVID-19, having lost a close person to this virus, and having been accompanied during the lockdown were experiences associated with higher PTSD symptoms. Posttraumatic symptomatology was inversely correlated with areas of meaning in life. Lastly, a higher number of affected areas and a negative subjective lockdown circumstance explained greater total PTSD symptoms. Conclusion: Specific pandemic experiences and lockdown circumstances affected the presence of posttraumatic symptoms. The personal meaning of life seems to be involved in the process of less adverse traumatic consequences.

Post-traumatic stress disorder in healthcare workers of emergency departments during the pandemic: A cross-sectional study.

Emergency departments (EDs) were the first application center for Covid-19 patients, as in almost all diseases. For this reason, a serious mental burden has arisen for ED workers. This study was conducted to determine the possible rate of Posttraumatic Stress Disorder (PTSD) and factors that may be associated with PTSD symptom severity in physicians and nurses working in EDs. This cross-sectional study was conducted with a total of 783 participants, including 406 physicians and 377 nurses working in EDs. The PTSD Checklist for DSM-5; Depression, Anxiety and Stress Scale-21; and a structured questionnaire on sociodemographic and work-related characteristics were administered to the participants. The probable PTSD rate in the total sample was found to be 19.2%. The rate of probable PTSD in physicians (22.9%) was significantly higher than in nurses (15.1%). However, PTSD symptom total scores and PTSD symptom clusters were higher in physicians than in nurses, but there was no difference between the two groups in terms of depression, anxiety and stress levels. High anxiety level, being diagnosed with COVID-19, high depression level, female gender, and having additional chronic disease were predictors of high PTSD symptom severity in physicians. For nurses, high anxiety level, being diagnosed with COVID-19, working with 24-h shifts, high depression level, low work experience (years), low monthly income and having additional chronic disease were the predictors of high PTSD symptom severity. The results of our study showed that both profession groups are at risk for PTSD, and contrary to the existing literature, this rate may be higher in physicians than in nurses. HCWs in the EDs needed protective and supportive mental health models in terms of PTSD.

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.

Social Interaction Within a Trauma-Exposed Population During the Early Phase of COVID-19

The novel coronavirus (COVID-19) has led to significant stressors and shifts in social life, yet social interactions experienced by people with trauma exposure during the COVID pandemic is largely unknown. This study assessed the frequency of interactions, social support given and received, and prosocial behavior using online survey methods (N = 1049). We examined differences in experiences across three groups: no trauma exposure, trauma-exposed with low PTSD symptoms, and trauma-exposed with high PTSD symptoms. We also explored correlations between social interactions and PTSD symptom clusters. Results indicated significant differences across groups and the high PTSD group reported stronger associations between social interaction variables and symptom clusters, on average.

PTSD Symptoms and Sleep Quality of COVID-19 Patients During Hospitalization: An Observational Study from Two Centers.

BackgroundThe outbreak of COVID-19 has developed into a pandemic. Data are required that specifically address the psychological consequences in COVID-19 confirmed patients. This study mainly aimed to examine posttraumatic stress disorder (PTSD) symptoms and sleep quality among COVID-19 confirmed patients during hospitalization.MethodsAn observational study was conducted in two designated hospitals in Wuhan, China. Data were collected from 190 patients hospitalized with laboratory-confirmed COVID-19 infection between February 10, 2020 and March 13, 2020.ResultsThe mean age of the 190 confirmed patients was 55.7 years (SD = 13.7), of which 96 (50.5%) were female and 88 (46.3%) had family members or acquaintances infected with COVID-19. Lymphocytopenia was presented in 62 (32.6%) patients and 25 (13.2%) patients showed oxygen desaturation. The prevalence of high PTSD symptoms was 22.6% among the 190 patients. The median time from symptom onset to first medical visit and hospitalization was 2 days (IQR, 1–5) and 16 days (IQR, 10–27), respectively. Patients’ PTSD symptoms were positively related to the time from symptom onset to first medical visit (r = 0.156, p < 0.05) and hospitalization (r = 0.181, p < 0.01). There were significant correlations between sleep quality and PTSD symptoms (r = 0.312–0.547, p < 0.01).ConclusionThe prevalence of high PTSD symptoms was 22.6% among hospitalized COVID-19 patients. Early diagnosis and treatment of COVID-19 symptoms are beneficial to infected patients both physically and psychologically. With the recovery of physical symptoms, psychological intervention is desired to promote the trauma recovery in COVID-19 patients.

Attachment and social support mediate associations between polyvictimization and psychological distress in early Uganda and Kenya adolescents

BackgroundThere is strong evidence that the experience of several potentially traumatic events (polyvictimization) is a risk factor for posttraumatic stress disorder (PTSD) and psychological distress among adolescents. The identification of the variables that influence the link between polyvictimization and PTSD and other psychiatric symptoms is warranted. ObjectiveWe analyzed the associations between polyvictimization, PTSD symptoms (PTSS) and psychiatric symptoms in Kenya and Uganda adolescents, and explored the mediating roles of attachment orientations and perceived social support in the associations between polyvictimization, PTSS and psychiatric symptoms among adolescents from lower-middle-income countries (LALMIC). Participants and settingA sample of 481 Kenyan adolescents (M = 16.28; SD = 1.878) and a sample of 408 Uganda adolescents (M = 15.95; SD = 1.377) completed validated self-report questionnaires. MethodsSerial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). ResultsPolyvictimization was related to higher PTSS and psychiatric symptoms. Importantly, polyvictimization was significantly linked to high attachment anxiety, which was linked with low perceived social support, which in turn was linked with high PTSS levels and psychiatric symptoms. ConclusionsHigh levels of attachment anxiety might be connected with lack of perceived social support, which might be seen as a possible psychological distress mechanism subsequent to exposure to polyvictimization in adolescence from LALMIC.

Distinguishing Among Symptoms of Posttraumatic Stress Disorder, Complex Posttraumatic Stress Disorder, and Borderline Personality Disorder in a Community Sample of Women.

The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the ICD-11 in 2018. Debates are still ongoing in the scientific community regarding the conceptual distinction between CPTSD symptoms and those of comorbid PTSD and borderline personality disorder (BPD). The present study aimed to determine whether (a) patterns of symptoms reported by women in a community sample would reveal a CPTSD profile distinct from PTSD and BPD profiles and (b) the resulting profiles could be compared on measures of cumulative childhood trauma exposure, dissociation, and life satisfaction. Women who reported at least one potentially traumatic experience (N = 438) completed questionnaires assessing PTSD, CPTSD, and BPD symptoms. We performed latent profile analyses testing seven models, with the five-profile model emerging as the most appropriate solution. The profiles were characterized as "high PTSD symptoms" (12.0%), "high CPTSD symptoms" (7.6%), "high BPD symptoms" (9.9%), "high CPTSD and BPD symptoms" (3.8%), and "low symptoms" (66.7%). Group comparisons revealed that the profiles characterized by high CPTSD symptoms, high BPD symptoms, and high CPTSD and BPD symptoms tended to include participants with higher levels of cumulative childhood trauma exposure and symptoms of dissociation and lower ratings of life satisfaction compared to the profiles characterized by high PTSD symptoms and low symptoms, ds = 0.55-1.06. These findings support the distinction between ICD-11 CPTSD symptoms and those of PTSD and BPD, promoting an integrative approach to understanding trauma sequelae, diagnosis, and treatment.

A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms.

To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. ClinicalTrials.gov NCT02655354.

Posttraumatic Stress Disorder Symptom Trajectories in ICU Family Caregivers.

Prospective cohort study. The medical ICU at a tertiary-care center in the United States. Adult patients experiencing acute cardiorespiratory failure (defined as requiring at least one of the following: 1) vasopressors, 2) noninvasive positive pressure ventilation, 3) high-flow nasal cannula, or 4) mechanical ventilation) were enrolled in a pair with their primary family caregivers. Participants were enrolled within the first 48 hours of ICU admission. Family caregiver posttraumatic stress disorder symptoms were measured using the Impact of Events Scale-Revised at four time points: at enrollment, shortly after ICU discharge, and at 3 and 6 months after ICU discharge. The data were examined using latent class growth analysis to identify posttraumatic stress disorder symptom trajectories. Two distinct symptom trajectories were identified: a persistently high trajectory, characterized by high posttraumatic stress disorder symptoms at initial assessment, which remained elevated over time, and a persistently low trajectory, characterized by low posttraumatic stress disorder symptoms at initial assessment, which remained low over time. Approximately two-thirds of caregivers belonged to the persistently high trajectory, and one-third of caregivers belonged to the persistently low trajectory. Using latent class growth analysis to measure 6-month ICU family caregiver posttraumatic stress disorder symptom trajectories, we identified two distinct trajectories (persistently low and persistently high). A larger cohort study is warranted to further delineate posttraumatic stress disorder trajectories in this population, with the ultimate goal of targeting high-risk caregivers for interventions to reduce psychologic distress and improve long-term caregiver outcomes.

Maladaptive schema modes as the predictor of post-traumatic stress disorder among trauma survivors.

To study the relationship between dysfunctional schema modes and post-traumatic stress disorder among trauma survivors. The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from March to August 2019, and comprised patients of traumatic brain injury and orthopaedic trauma. Data was collected using Schema Mode Inventory and the Clinician Administered Post-Traumatic Stress Disorder Scale version 5. Data was analysed using SPSS 23. Of the 281 patients, 203(72.2%) were males, 78(27.8%) were females, and 157 (55.9%) were aged 18-40 years. Besides, 137(48.8%) had orthopaedic trauma, 96(34.2%) traumatic brain injuries, and 48(17%) had multiple injuries. Post-traumatic stress disorder symptoms and dysfunctional schema modes were higher in patients with moderate injuries with a mean of 42.14±7.36. Intentionally injured patients 42.70±6.92 and female trauma survivors 42.05±8.26 had more symptoms. Maladaptive schema mode could lead to post-traumatic stress disorder symptoms among trauma survivors with history of orthopaedic injury, traumatic brain injury and multiple injuries.

Investigating Relationships Among Distress Tolerance, PTSD Symptom Severity, and Alcohol Use

Exposure to trauma (particularly interpersonal trauma), post-traumatic stress disorder (PTSD) symptoms, and low distress tolerance (DT; the ability to tolerate negative internal states), are all related to risk for alcohol use disorders (AUD). The aim of this study was to examine the main and interactive effects of PTSD symptom severity and DT in relation to current (past 30-day) alcohol consumption and binge drinking among emerging adult men and women with a history of sexual/physical assault. Participants were 572 undergraduate students (66% women) with a history of physical/sexual assault endorsing past month alcohol use. Participants completed the Distress Tolerance Scale (DTS), the PTSD Checklist for DSM-V (PCL-5), and an abbreviated Timeline Followback Questionnaire (TLFB), which assessed past 30-day total alcohol consumption (i.e., total number of drinks) and binge drinking frequency (i.e., 5+ drinks [4+ for women]). Negative binomial regression analyses revealed that male sex, higher trauma load (i.e., total number of trauma categories endorsed), and higher PTSD symptom severity were associated with both higher number of total drinks and higher frequency of binge drinking episodes. However, DT was not associated with either alcohol outcome when PTSD symptom severity was entered in the models. The interaction of PTSD symptom severity and DT was not significantly associated with total alcohol consumption or binge drinking. These results highlight the importance of investigating the unique contributions of PTSD symptoms and DT (as well as other transdiagnostic cognitive-affective constructs) in the onset and maintenance of AUD.