Hyperarousal Symptoms Research Articles

Dissociation and psychopathology in Kenyan survivors of a terrorist bombing.

Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology. A sample of 278 disaster-affected Kenyans was assessed 8 to 10 months after the 1998 terrorist bombing of the US Embassy in Nairobi for a study of trauma-related psychopathology and dissociation in the context of personality and culture. Instruments of assessment were the Diagnostic Interview Schedule, the Dissociative Experiences Scale, and the Temperament and Character Inventory. Dissociation appeared to represent a largely nonpathological response to the disaster experience that reflected personality variables and a cultural context. These findings suggest that dissociation encountered in disaster-exposed groups in this cultural setting does not necessarily represent psychopathology, but attention to dissociative responses might help clinicians identify and provide interventions for individuals experiencing distressing intrusive and hyperarousal symptoms.

Post-traumatic Stress Disorder Experienced by Said and Safeya in Ghassan Kanafani’s Aid Ila Haifa Based on The Perspective of Gerald C. Davison

This study aims to determine the form, reveal the causes, and understand the impact of PTSD on Said and Safeya on individuals, families, and society in the novel Aid Ila Haifa. Data was collected using reading and note-taking techniques and analyzed descriptively qualitativelythat focusing on the problem of PTSD with a literary psychology approach. The primary data source used is Ghassan Kanafani’s Aid Ila Haifa. This study was using the theory of abnormal psychology by Gerald C. Davison. This study reveals that the form of PTSD included in re-experiencing symptoms are crying, overlapping memories, and a faster heart rate. Included in the avoidance symptoms are denying the traumatic event and keeping their mouth shut over the whereabouts of their child. Meanwhile, hyperarousal symptoms include sudden outbursts of anger, excessive anxiety, and feeling panicked. The cause is a conflict environment and the loss of a son. The impact of PTSD experienced by Said and Safeya on individuals is prolonged sadness, trapped in fear, and loss of zest for life. The impact on the family is a cold attitude. Meanwhile, the impact on society is Said's attitude which forbids his son from joining the front for the defense of the state.

Randomized clinical trial of capnometry-assisted respiratory training in veterans with posttraumatic stress disorder hyperarousal.

To investigate whether capnometry-assisted antihyperventilation respiratory training, successful in treating panic, and sleep hygiene instructions would reduce posttraumatic stress disorder (PTSD) hyperarousal symptoms in U.S. military veterans. We conducted a parallel, nonblinded clinical trial and randomized 80 veterans with PTSD hyperarousal into treatment or wait list. Primary treatment outcomes from baseline to 1st follow-up were analyzed using mixed modeling. Baseline physiological measures were compared between the PTSD hyperarousal group and a no-PTSD group (n = 68). Baseline respiration rate but not partial-pressure of end-tidal carbon dioxide (PCO₂) was higher in the PTSD hyperarousal group than in the no-PTSD group during 3 min of quiet sitting, indicating no difference in baseline hyperventilation. There was no significant effect of the intervention on PTSD hyperarousal symptoms or hyperventilation compared to wait list, but treatment did lower respiratory rate. This intervention did not reduce PTSD hyperarousal symptoms, perhaps due to differences between underlying mechanisms of PTSD hyperarousal and panic disorder or to differences between veteran and civilian populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention.

Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.

Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study.

Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.

Coping styles and mental health outcomes of community members affected by black summer 2019-20 bushfires in Australia.

The aim of this study was to investigate coping styles, posttraumatic stress, and mental health symptoms among a sample of community members affected by 2019-20 Australian bushfires. Using a convenience sampling approach, an online survey was used to assess a range of coping strategies, posttraumatic stress and symptoms of depression, anxiety, and stress among the affected community members of Black Summer bushfires. The results revealed that study participants reported moderate symptoms of depression and stress, and severe levels of anxiety. Additionally, participants reported use of both approach and avoidance coping strategies following the bushfire event as well as experiencing symptoms of posttraumatic stress, such as having intrusive thoughts and symptoms of avoidance and hyperarousal. Despite the durability of many individuals, others remain affected by the event and there is evidence there may be longer term mental health consequences of the bushfires for some people. Given these findings, it is imperative that mental health services be readily available for people in the bushfire-affected areas. Mental health nurses have an important role to play in supporting individuals affected by disasters. Awareness of the short- and long-term impacts of disasters on the mental health of people is paramount for mental health nurses.

Effect of the COVID-19 Pandemic on Resilience Among Chinese Adolescents and Its Influential Factors: A Longitudinal Study.

The current study assessed the effect of the coronavirus disease 2019 (COVID-19) pandemic on resilience among Chinese adolescents and explored its influential factors. A total of 2,359 students were recruited from three middle schools through cluster randomization in Chengdu. Data were collected before and after home confinement due to the COVID-19 pandemic. Resilience, family function, and effect of the pandemic were measured using subscales of the Chinese Positive Youth Development Scale, Chinese Family Assessment Instrument, and Children's Revised Impact of Event Scale. Paired samples t test showed resilience decreased significantly after confinement. According to stepwise multiple linear regression, basal resilience, family dysfunction, higher frequencies of hyperarousal symptoms of posttraumatic stress, increased electronic device use, and relationship with caregivers were independent influential factors of resilience. COVID-19 negatively affected adolescents' resilience; therefore, stakeholders need to focus on improving resilience in this population to mitigate mental health impacts of acute stressful events. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 31-37.].

Skin conductance response to trauma interview as a candidate biomarker of trauma and related psychopathology in youth resettled as refugees

ABSTRACT Background: Posttraumatic stress symptoms (PTSS) include a constellation of physical and emotional profiles that youth exposed to trauma may experience. An estimated 20% of youth are exposed to trauma, and in refugee populations, up to 54% experience posttraumatic stress. Given the physical and mental health consequences associated with trauma exposure and subsequent psychopathology, identifying biomarkers of symptom severity is a top research priority. Objective: Previous research in adults found that skin conductance responses to trauma interview predicted current and future PTSS. We extended this method to refugee youth exposed to civilian war trauma and forced migration, to examine associations between PTSS and skin conductance in this uniquely vulnerable child and adolescent population. Methods: 86 refugee youth ages 7–17 years completed a trauma interview and assessment of self-reported PTSS. The mobile eSense app on a iPad was used to obtain continuous recordings of skin conductance level (SCL) during a trauma interview (trauma SCL). Skin conductance response (SCR) was calculated by subtracting the baseline SCL from the maximum amplitude of the trauma SCL. Results: SCL during trauma was significantly greater than baseline SCL, Trauma exposure was significantly associated with SCR to trauma interview, R2 = .084, p = .042. SCR to trauma interview was positively correlated with reexperiencing (R2 = .127, p = .028), and hyperarousal symptoms (R 2 = .123, p = .048). Conclusions: The present study provides evidence for feasibility of SCR to trauma interview as a candidate biomarker of PTSS in youth. This is the first study to look at SCR to trauma interview in youth resettled as refugees and is part of the limited but growing body of research to look at biomarkers in refugee cohorts more broadly. As the number of forcibly displaced persons surges, early detection and prevention of trauma-related psychology is becoming more important than ever. HIGHLIGHTS Using the mobile eSense app, we demonstrate that skin conductance is measurable in a variety of research settings and that skin conductance response may be a biological indicator of trauma and related psychopathology – namely re-experiencing symptoms – in youth resettled as refugees.

Investigating Psychological Differences Between Nurses and Other Health Care Workers From the Asia-Pacific Region During the Early Phase of COVID-19: Machine Learning Approach.

BackgroundAs the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region.ObjectiveThis study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers.MethodsExploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree–based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers.ResultsNurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states.ConclusionsNurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree–based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.

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

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

Recent Traumatic Episode Protocol EMDR Applied Online for COVID-19-Related Symptoms of Turkish Health Care Workers Diagnosed with COVID-19-Related PTSD: A Pilot Study.

This study investigates the effect of the online Eye Movement Desensitization and Reprocessing Recent Traumatic Episode Protocol on posttraumatic stress disorder, anxiety, depression, and burnout symptoms in healthcare workers diagnosed with pandemic-related post-traumatic stress disorder. The study included healthcare workers who applied to psychiatry outpatient clinics due to the psychiatric symptoms that developed related to the pandemic and who were diagnosed with post-traumatic stress disorder. The Beck Anxiety Inventory, Impact of Event Scale-Revised to evaluate the symptoms of post-traumatic stress disorder (avoidance, intrusion, and hyperarousal), Maslach Burnout Inventory, and Beck Depression Inventory were used for the assessment. The tests were administered 3 times (pre-treatment, post-treatment, and at 1-month follow-up). This study included 14 healthcare workers diagnosed with post-traumatic stress disorder; 2 (14.3%) physicians, 2 (14.3%) nurses, 4 (28.6%) other-healthcare workers/medical staff, and 6 (42.8%) other healthcare workers/non-medical staff. There was a significant decrease in Impact of Event Scale-Revised total score, the intrusion and hyper-arousal sub-scores between T1 and T2 (P = .018; P = .005; P = .0005, respectively) and between T1 and T3 (P < .001; P < .001; P < .001, respectively), but there was no difference between T2 and T3 (P = .89). A significant difference was found in repeated measurements of both Beck Depression Inventory [P < .001] and Beck Anxiety Inventory [P < .001] scores. There was a significant difference in emotional exhaustion, one of the subscales of Maslach Burnout Inventory (P = .09). However, there was no significant difference in depersonalization (P = .48) and personal accomplishment (P = .66). Recent Traumatic Episode Protocol appears to be capable of reducing symptoms of anxiety, depression, intrusion, and hyperarousal symptoms of post-traumatic stress disorder and emotional exhaustion when symptoms that developed are related to the pandemic in healthcare workers.

Alterations of Resting-State Locus Coeruleus Functional Connectivity After Transdermal Trigeminal Electrical Neuromodulation in Insomnia.

BackgroundTransdermal trigeminal electrical neuromodulation (TTEN) is a novel treatment modality that is known for noradrenergic modulation through the trigeminal nerve and locus coeruleus (LC). This study aimed to demonstrate the alterations of LC functional connectivity (FC) in patients with insomnia after a 4-week TTEN.MethodsThe Cefaly device targeting the ophthalmic division of the trigeminal nerve was applied to a total of 12 patients with insomnia to monitor for the effects of TTEN. All the patients went through a 4-week daily 20 min TTEN sessions before bedtime. Baseline and post-TTEN demographic data, polysomnography (PSG) parameters, and insomnia severity index (ISI) were attained. Data from pre- and post-intervention resting-state functional magnetic resonance imaging (MRI) were collected. LC FC differences were measured between the pre-and post-TTEN groups through seed-to-voxel analysis. Correlation analyses were conducted between LC FC changes after TTEN, ISI score changes, and PSG parameter changes.ResultsThere was a significantly decreased LC FC with occipital and temporal cortices after a 4-week TTEN. However, there was no significant correlation between LC FC, ISI score changes, and PSG parameter changes.ConclusionBy targeting hyperarousal symptoms of insomnia, TTEN can be a promising intervention that can modulate LC FC in patients with insomnia patients. The data presented in the study are from a study exploring the effect of TTEN on insomnia (www.clinicaltrials.gov, NCT04838067).

Drug-facilitated sexual assault, impaired trauma memory, and implications for mental health treatment

ABSTRACT Background Sexual assault (SA) is a highly prevalent global public health problem and a robust predictor of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and suicidality. A large percentage are drug or alcohol facilitated (DFSA), impairing trauma memory and affecting the application of evidence-based treatments. Despite these problems, few have investigated DFSA-specific mental health (MH) needs. Objective Goals of this study were (1) to identify psychological sequelae characterizing DFSA towards explaining why symptoms have been treatment-refractory, comparing survivors with involuntary substance ingestion (forced, covert: DFSA-I), voluntary ingestion (DFSA-V), and non-DFSA; and (2) to determine how impaired trauma memory relates to the development of PTSD and depression symptoms. Method Data from a retrospective chart review of 74 adults receiving SA MH services at an outpatient trauma center are presented. The sample includes a 2-year cohort seen acutely at an urban rape treatment center. The study is one of the first to examine therapy records beyond case studies for DFSA. Logistic, Poisson, and negative binomial regression analyses of quantitative data and qualitative thematic analysis of trauma cognitions and treatment foci were conducted. Results DFSA-V had five times greater odds of SUD, and notable substance-related self-blame compared to DFSA-I. DFSA-I had prominent relationship distress and self-blame for missing danger of perpetrator drugging. Survivors with impaired trauma memory had significantly fewer hyper-arousal and overall PTSD symptoms, and specifically less hypervigilance. No differences were found in re-experiencing symptoms. Conclusion Impaired trauma memory is common in DFSA and is associated with fewer baseline hyper-arousal and overall PTS. Despite this, DFSA issues including re-experiencing symptoms that are particularly distressing without the ability to cognitively connect the intrusions contribute to increased treatment needs. Impaired memory limits the application of evidence-based treatments, and collectively these findings call for the development of trauma-specific treatment protocols to enhance recovery for DFSA survivors. HIGHLIGHTS Survivors of drug-facilitated sexual assault have prominent PTSD including reexperiencing, though trauma memory may not be encoded. • Those absent trauma memory have less hyperarousal, but DFSA complications explain why it is treatment refractory and inform treatment development.

Six-year changes of posttraumatic stress symptoms and depressive symptoms among Chinese earthquake survivors: A network analysis

BackgroundThe risk factors of Posttraumatic Stress Symptoms (PTSS) and depressive symptoms have been well-established, but whether the network structure of their symptoms changes over time remains unclear. This study aims to examine the six-year changes of network structure of PTSS and depressive symptoms among Wenchuan earthquake adult survivors in China. MethodsIn this pooled cross-sectional study, respondents were sampled from the same population at each of the five waves (N = 1343, 1205, 1177, 1376, and 1339). The network structure of them was investigated using network analyses. ResultsThe study shows network connections stable across waves were the positive connections between hyperarousal and intrusions, hyperarousal and somatic symptoms, and two dimensions of positive effects. Stable negative connections were those between depressed affects and positive effects, avoidance and depressed affects, avoidance with interpersonal symptoms and avoidance with somatic symptoms. Across waves, fearful emotion consistently was the strongest bridge symptom connecting with PTSS symptoms. However, for PTSS the strongest bridge symptom varied across time as it was avoidance in wave 1 but were hyperarousal in other four waves. LimitationsThis study was based on a pooled cross-sectional survey, which inhibits conclusions regarding causal influences between symptoms at the individual patient level. ConclusionsThe network structure of PTSS and depressive symptoms was partly stable, yet also varied across survey waves. Core symptom clusters for PTSS and depressive symptoms were avoidance and depressed affect, respectively. The central role of these clusters in PTSS and depressive symptoms has important implications to future psychiatric programs.

Do expectations of recovery improve risk assessment for people with whiplash-associated disorders? Secondary analysis of a prospective cohort study

BackgroundWhipPredict, which includes prognostic factors of pain-related disability, age and hyperarousal symptoms, was developed and validated for prediction of outcome in people with whiplash associated disorders (WAD). Patient expectations of recovery was not an included factor, though is known to mediate outcomes. The aim of this study was to determine whether the addition of expectations of recovery could improve the accuracy of WhipPredict.MethodsTwo hundred twenty-eight participants with acute WAD completed questionnaires (WhipPredict and expectations of recovery) at baseline. Health outcomes (neck disability index (NDI) and Global Perceived Recovery (GPR)) were assessed at 6- and 12-months post injury. Cut-off points for expectations of recovery predictive of both full recovery (NDI ≤10 % , GPR ≥ 4) and poor outcome (NDI ≥30 % , GPR ≤ − 3) were determined, and multivariate logistic regression analyses were used to compare models with and without this variable.ResultsExpectations of recovery improved or maintained the accuracy of predictions of poor outcome (6-months: sensitivity 78 to 83%, specificity maintained at 79.5%; 12-months: sensitivity maintained at 80%, specificity 69 to 73%). The sensitivity of predictions of full recovery improved (6-months: 68 to 76%; 12-months: 57 to 81%), though specificity did not change appreciably at 6 months (80 to 81%) and declined at 12 (83 to 76%). ROC curves indicated a larger and more consistent improvement in model performance when expectations of recovery were added to the pathway predictive of full recovery.ConclusionsThe addition of expectations of recovery may improve the accuracy of WhipPredict, though further validation is required.

Ketamine sex- and dose-dependently mitigates behavioral sequelae induced by a predator-based psychosocial stress model of post-traumatic stress disorder

Current pharmacotherapy for post-traumatic stress disorder (PTSD), a debilitating psychiatric condition that develops in a subset of traumatized individuals, is inadequate. Over the past two decades, numerous studies have shown that ketamine, a non-competitive NMDA receptor antagonist, exerts rapid antidepressant effects in both humans and rodents, but the anxiolytic profile of ketamine, as well as its ability to treat PTSD-related symptoms, is still unclear. Thus, we examined the ability of a single administration of ketamine to prevent the onset of PTSD-like sequelae in a chronic psychosocial stress model of PTSD. Adult male and female Sprague-Dawley rats were exposed to a cat on two occasions, in combination with chronic social instability. Immediately following the cat exposure on Day 1, rats were given intraperitoneal injections of 10 mg/kg or 15 mg/kg ketamine or vehicle; control rats were injected with vehicle. Three weeks after the second cat exposure, we assessed symptoms of hyperarousal and anxiety-like behavior in the rats. In males, chronic stress led to greater anxiety on the elevated plus maze and in the open field; in females, chronic stress resulted in an exaggerated startle response and greater anxiety in the open field. These effects were most effectively prevented by the administration of 10 mg/kg ketamine. These findings demonstrate that ketamine can prophylactically prevent the onset of PTSD-like behaviors in males and females. Their sex-dependent nature is consistent with previous preclinical research and highlights the need for future research to examine their neurobiological basis.

122 PTSD Symptom Clusters as Predictors of Pain Interference in Burn Survivors

IntroductionIndividuals who experience burns are at higher risk of developing post-traumatic stress disorder (PTSD) and chronic pain. There exists a synergistic relationship between PTSD and chronic pain in burn survivors. Theories exist about how aspects of each condition may perpetuate one another, or share underlying mechanisms. Both of these conditions are of relevance to pain-related disability. We sought to examine the role of individual PTSD symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two PTSD symptom clusters, pain intensity, and other covariates (burn size, hospital length of stay, age and gender).MethodsData were analyzed from the Burn Model System National Database. Inclusion criteria required participants to have a moderate to severe burn injury that required surgery for wound closure. Patient-reported outcome data: PTSD Checklist - Civilian, PROMIS-Pain Interference Short Form 4a, and a 0-10 average Pain Intensity item were analyzed at 6-months after injury. Hierarchical linear regression models were fit to examine the impact of PTSD symptom clusters on pain interference over and above that of pain intensity, and standardized betas were calculated (B).ResultsA total of 439 adult participants had complete responses on the measures of interest (e.g. PTSD symptoms, PROMIS-Pain Interference, and Pain Intensity) and were included in the analysis. Mean age, percent total body surface area burned, and hospital length of stay were 47 years, 18%, and 27 days, respectively. 69% were male and 82% were Caucasian. Results of a linear regression found that hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) PTSD symptom clusters were each significant predictors of pain-related disability, even when accounting for pain intensity (B = .64, p < .001). The covariates age, gender, days until discharge, and TBSA were all nonsignificant. The model accounted for 61% of the variance associated with pain-related disability.ConclusionsResults highlight the importance of the emotional numbing and hyperarousal PTSD symptom clusters in explaining pain interference. Future evaluations parsing out the longitudinal relationships (i.e., beyond 6-months postburn) between PTSD symptom clusters, pain intensity, and pain interference, as well as evaluating other underlying mechanisms, are warranted.

A sudden and unexpected death of a spouse and the severity of symptoms of complicated grief and Post-Traumatic Stress Disorder

Introduction: The death of a spouse is one of the most stressful events in life. A better understanding of the factors leading to difficulties in adaptation to the situation of loss in widowed people seems to be important. The main goal of the presented study is to verify the role of the circumstances of the loss of a spouse (a sudden and unexpected death) with respect to severity of the symptoms of complicated grief and post-traumatic stress disorders.&#x0D; Method: Fifty five widowed people participated in the study (27 of them indicated that their spouse's death occurred suddenly and unexpectedly, in the case of 28 people the loss had been anticipated). The time elapsed since death ranged from six months to 2.5 years. To measure the severity of complicated grief, the Complicated Grief Inventory by Prigerson et al. (in the Polish adaptation by Ludwikowska-Świeboda and Lachowska) was used. In order to assess the severity of symptoms of post-traumatic stress disorder (intrusion, avoidance and hyperarousal), the Impact of Event Scale — Revised by Weiss and Marmar (in the Polish adaptation by Juczyński and Ogińska-Bulik) was used. To determine the circumstances of the spouse's death, a self-authored demographic data questionnaire was used.&#x0D; Results: As expected, the experience of a sudden and unexpected death is a significant predictor of the severity of complicated grief. Detailed analyses revealed that widowed people who experienced a sudden and unexpected death of their spouse are significantly more likely to be preoccupied with thinking about the deceased, experience shock and disbelief, and feel distanced from those who are important to them (compared to people who experienced an anticipated loss). They may also have a greater tendency to avoid stimuli reminding them of the deceased, experience more discomfort when recalling the deceased, and have difficulty trusting other people since their loss. A sudden and unexpected death is also a significant predictor of the severity of hyperarousal symptoms.&#x0D; Conclusions: Widowed people who view their spouse's death as sudden and unexpected are at a greater risk of a disruption of the grief process.

Pandemic Exposure, Post-traumatic Stress Disorder, Conflict Behaviors, and Online Aggressive Behaviors Among College Students During the COVID-19 Pandemic: Examining the Moderating Role of Gender.

The COVID-19 pandemic impacts people’s mental health and behaviors, but the influence mechanism between pandemic exposure, conflict behaviors, and online aggressive behaviors during the COVID-19 outbreak remains unclear. This study will address this gap. Data were collected from 1,153 college students in an online survey that included an pandemic experiences scale, a post-traumatic stress disorder (PTSD) scale, a conflict behaviors scale, and an online aggressive behaviors scale. Structural equation modeling and multi-group comparisons were used to analyze the data. Pandemic exposure positively predicted conflict and online aggressive behaviors through hyperarousal symptoms, and negatively predicted these behaviors through intrusive symptoms. The mediating roles of avoidance and negative alterations in cognition and mood symptoms in the relations between pandemic exposure and conflict behaviors and online aggressive behaviors were non-significant. Among male students, pandemic exposure directly predicted conflict and online aggressive behaviors, but for female students, pandemic exposure indirectly influenced these behaviors through intrusive and hyperarousal symptoms. The intrusive and hyperarousal symptoms play mediating roles in the relations between pandemic exposure and conflict behaviors and online aggressive behaviors. Gender plays a moderating role in the above mediating mechanism.

Threat Responsivity Predicts Posttraumatic Stress Disorder Hyperarousal Symptoms in Children after Hurricane Florence.

Following a traumatic event, posttraumatic stress disorder (PTSD) symptoms are common. Considerable research has identified a relationship between physiological responses during fear learning and PTSD. Adults with PTSD display atypical physiological responses, such as increased skin conductance responses (SCR) to threatening cues during fear learning (Orr et al., 2000). However, little research has examined these responses in childhood when fear learning first emerges. We hypothesized that greater threat responsivity in early acquisition during fear conditioning before Hurricane Florence would predict PTSD symptoms in a sample of young children following the hurricane. The final sample included 58 children in North Carolina who completed fear learning before Hurricane Florence—a potentially traumatic event. After the hurricane, we assessed severity of hurricane impact and PTSD symptoms. We found that threat responsivity as measured by differential SCR during fear learning before the hurricane predicted PTSD hyperarousal symptoms and that hurricane impact predicted PTSD symptoms following the disaster. This exploratory work suggests that prospective associations between threat responsivity and PTSD symptoms observed in adulthood may be replicated in early childhood. Results are discussed in the context of the current COVID-19 crisis.