Levels Of Posttraumatic Stress Disorder Symptoms Research Articles

Factors related to Post-traumatic Stress Disorder Symptoms among Intensive Care Unit Nurses

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

Racial discrimination increases the risk for nonremitting posttraumatic stress disorder symptoms in traumatically injured Black individuals living in the United States.

Traumatic, life-threatening events are experienced commonly among the general U.S. population, yet Black individuals in the United States (i.e., Black Americans) exhibit higher prevalence rates of posttraumatic stress disorder (PTSD) and more severe symptoms than other populations. Although empirical research has noted a range of symptom patterns that follow traumatic injury, minimal work has examined the role of racial discrimination in relation to PTSD symptom trajectories. The current study assessed racial discrimination and PTSD symptom trajectories at 6 months postinjury across two separate samples of traumatically injured Black Americans (i.e. emergency department (ED)-discharged and hospitalized). Identified PTSD symptom trajectories largely reflect those previously reported (i.e., ED: nonremitting, moderate, remitting, and resilient; hospitalized: nonremitting, delayed, and resilient), although the resilient trajectory was less represented than expected given past research (ED: 55.8%, n = 62; hospitalized: 46.9%, n = 38). Finally, higher racial discrimination was associated with nonremitting, ED: relative risk ratio (RR) = 1.32, hospitalized: RR = 1.23; moderate, ED: RR = 1.18; and delayed, hospitalized: RR = 1.26, PTSD symptom trajectories. Overall, the current findings not only emphasize the inimical effects of racial discrimination but also demonstrate the unique ways in which race-related negative events can impact PTSD symptom levels and recovery across time.

Classifications of Trauma Exposure and Their Associations With 3-Year Follow-up Psychological Symptoms Among Korean Victims of Disaster: A Latent Class Analysis.

This study aimed to classify patterns of trauma exposure among disaster victims using latent class analysis (LCA) and to examine group differences in post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms over 3 years. Data were obtained from a 3-year panel survey of Korean disaster victims (male = 461, female = 513) who responded to four types of trauma experiences: threatened death, injury or disease, witnessing injury or death, and loss of family or relatives in 2017. The LCA yielded three classes: the low-threat (66.1%), life-threat (29.4%), and multi-threat (4.5%) groups. One-way analysis of variance showed that the multi-threat group had the highest levels of PTSD, depressive, and anxiety symptoms in 2017, 2018, and 2019. Post-traumatic stress disorder symptoms significantly decreased between 2017 and 2018 in the life-threat and multi-threat groups. However, there were no differences between 2018 and 2019 in any groups. These results highlight the importance of early intervention during the proximal period after trauma, particularly in individuals exposed to multiple types of traumatic experiences.

Social support in relation to posttraumatic stress disorder symptoms among patients with violent versus nonviolent injury.

Violent injuries have become increasingly more common in the United States. Individuals experiencing violent injury are at increased risk for the development of posttraumatic stress disorder (PTSD) as compared to those experiencing nonviolent injury. Social support is touted as a protective factor against various psychiatric symptoms (i.e., PTSD), though little is known about the relation between PTSD symptoms and social support in traumatic injury populations. The aims of the present paper were twofold: (1) examine the prevalence of PTSD as a function of injury type (2) explore differences in levels of social support as a function of injury type and (3) explore the association between injury type and later PTSD symptoms as moderated by baseline social support. Participants were 553 adults from a level-one trauma center in the Southeast United States who experienced a violent injury or nonviolent injury and completed measures of social support at baseline as well as PTSD symptoms at the 30-day follow-up timepoint. The study utilized data from both the baseline timepoint (i.e., upon admission to the trauma surgery unit), as well as a 30-day follow-up timepoint. Results demonstrated that those endorsing nonviolent injury reported lower levels of social support and PTSD symptoms. Social support predicted later PTSD symptoms until injury type was included as a covariate in the model. Social support did not moderate the relationship between injury type and later PTSD symptoms. Findings highlight the interrelatedness of key risk variables (i.e., injury type) with protective factors in influencing the trajectory of psychopathology postinjury. Violence intervention and interruption programs may have the capacity to fill patient needs when social support networks are insufficient. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring false negatives in self-reported trauma exposure status.

Trauma exposure is often assessed using checklists such as the Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013b). When participants endorse multiple events, respondents are asked to identify a single, worst event (i.e., index event). Recent work indicates that the "worst event" method leads to a concerning number of false negatives. The purpose of the current study was to replicate previous findings of false negatives and extend them by examining characteristics associated with false negatives, such as trauma type, means of exposure, recency of trauma, and posttraumatic stress disorder (PTSD) symptom severity. Adults (n = 476) provided data on trauma history assessed using a revised version of the LEC-5 that asked participants to provide follow-up information for each traumatic event endorsed. Participants also provided demographic data and completed the PTSD Checklist for DSM-5. Results: Two hundred thirty-four participants (49.16%) reported a worst event that met the DSM-5 definition of Criterion A trauma ("primary Criterion A" group). However, of the 242 participants who did not, 138 participants (57.02%, or 28.99% of the total sample) reported a secondary event that did meet Criterion A ("secondary Criterion A" group). The secondary Criterion A group most commonly reported serious life-threatening illnesses/injuries and "other" stressful life experiences as their index trauma that did not fulfill Criterion A. Participants in the primary and secondary Criterion A groups reported similar levels of PTSD symptoms. No differences were observed in means of exposure and recency of index trauma between the Criterion A groups. Findings raise questions regarding the efficiency and accuracy of the worst event method to determine trauma exposure status via self-report. Researchers should consider alternative methods for assessing trauma exposure rather than relying on the worst event scoring method. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The war in Ukraine and the dynamics of PTSD and depression in Poles aged 50+

Introduction and objective: Older Poles are a group particularly exposed to mental health disturbances in connection with the war in Ukraine. The aim of this research was to determine the severity and dynamics of post-traumatic stress disorder (PTSD), depression and somatic symptoms in the first year of the war in Ukraine, the relationship between PTSD and depression and sociodemographic factors, as well as to identify factors that increase the risk of PTSD and depression persisting a year after Russia’s aggression against Ukraine. Materials and methods: People aged ≥50 years (N = 116) were included in the study. The respondents were asked to complete the questionnaires twice, i.e. taking into account 2022 (beginning of war) and 2023 (a year after the outbreak). The International Trauma Questionnaire (ITQ), Patient Health Questionnaire (PHQ-9) and 8 items from the Patient Health Questionnaire – Somatic Symptoms (PHQ-15) were used. Results: In 2022, nearly 40% of respondents presented with PTSD, and over 60% showed depressed mood. In 2023, the number of people meeting the criteria for PTSD and depression decreased. Women showed higher levels of PTSD and depression. Higher levels of PTSD symptoms were observed among people with higher education. A greater decrease in the severity of PTSD was found among those declaring involvement in providing help for Ukraine. Older age and a higher baseline ITQ or PHQ-9 score favoured the persistence of PTSD and depression in 2023. Conclusions: Factors contributing to poor mental health other than the war itself may include the negative effects of the COVID-19 pandemic, current socioeconomic changes and past traumas.

Longitudinal associations among experiences of sexual assault, posttraumatic stress disorder symptoms, and heavy drinking in young adults.

Prior research with young adults has demonstrated clear associations between experiences of sexual assault, symptoms of posttraumatic stress disorder (PTSD), and alcohol use, but most studies have been cross-sectional or have not considered multiple theoretical pathways to understand these associations. Using six waves of data from a longitudinal cohort sample of 1,719 young adults, we examined associations among experiences of past-year sexual assault (i.e., rape, unwanted sexual touching, and physical intimidation in a sexual way), PTSD symptoms, and the frequency of binge drinking over time, allowing for the exploration of symptom-induced, interpersonal risk, and substance-induced pathways for male and female participants. For both male, βs = 2.84 to 6.55, and female participants, βs = 2.96 to 10.1, higher prior levels of PTSD symptoms were associated with larger increases in binge drinking over time. For female participants, higher prior levels of sexual assault were associated with larger increases in PTSD symptoms over time, βs = 3.48 to 4.25, whereas for male participants, higher prior levels of past-year binge drinking were associated with decreases in PTSD symptoms over time, βs = -2.75 to -0.53. Continued efforts are needed to prevent sexual assault among young adults and address PTSD symptoms among those who experience sexual assault. Interventions that target binge drinking are also needed for individuals who experience PTSD symptoms, especially young adults, to address potentially hazardous drinking before problems escalate and become chronic.

The relationship between discrimination, alcohol use severity, and PTSD symptoms among Latinx heavy drinkers

IntroductionDiscrimination is linked to alcohol use severity among Latinx adults, who also show high prevalence rates of PTSD compared to non-Latinx adults. We know little about whether PTSD symptoms affects the relationship between discrimination and alcohol use severity. We hypothesized that the association between discrimination and alcohol use severity might differ by level of PTSD symptom severity. MethodsThis is a secondary cross-sectional analysis of data collected at baseline from a completed randomized clinical trial testing the relative efficacy of a culturally adapted motivational interview designed to address discrimination and drinking behavior against an unadapted motivational interview for Latinx adults. Eligible participants screened positive for the NIAAA Single Alcohol Screening Question for heavy drinking days, identified as Latinx, and were 18–65 years old. We assessed the Everyday Discrimination Scale, Primary Care PC-PTSD screener, Alcohol Use Disorder Identification Test, and the Short Acculturation Scale for Hispanics. The study analyzed the main and interactive effects of discrimination and PTSD symptoms on alcohol use severity, while controlling for age, sex, household income, and acculturation. ResultsAfter controlling for covariates in model 2, the interaction of discrimination and PTSD symptoms was significantly related to alcohol use severity. Simple slopes analysis indicated that discrimination was positively related to alcohol use severity among those with high (1 SD above the mean) but not low (1 SD below the mean) levels of PTSD symptoms. ConclusionsEvidence suggests that the experiences of discrimination were associated with alcohol use severity among those who reported more PTSD symptoms. Specifically, discrimination may have a stronger effect on alcohol use severity among Latinx adults who report more PTSD symptoms. Screening Latinx adults for heavy drinking days, discrimination, and PTSD symptoms is clinically important. Culturally adapted alcohol interventions that target discrimination may be particularly effective for Latinx individuals with more PTSD symptoms.

Is a Criterion A trauma necessary to elicit posttraumatic stress symptoms?

ObjectiveThe posttraumatic stress disorder (PTSD) diagnosis has undergone substantial revision since its first appearance in the DSM-III. Much of the controversy surrounds the definition of trauma, or Criterion A. Our study sought to evaluate the DSM-5-TR's Criterion A and severity of PTSD symptoms in college students. MethodParticipants were 1500 college students who completed an online questionnaire about mental health symptoms. Responses to the Criterion A assessment were double coded by researchers to determine if the DSM-5-TR's Criterion A was met. Interpersonal agreement between raters was high (kappa = .81). Participants were compared across groups based on their PTSD Criterion A status: (1) DSM-Congruent, (2) DSM-Incongruent, (3) DSM-Ambiguous, and (4) Denied Trauma, using analysis of variance and multiple regression. ResultsParticipants who reported a trauma that was coded as Criterion A by researchers had the highest levels of PTSD symptoms, even after controlling for perceived stress, depression, anxiety, and gender (p < .001). Comparing across groups, the DSM-Congruent Criterion A group had significantly higher overall PTSS than those in the DSM-Incongruent Criterion A group and also significantly higher hyperarousal symptoms. However, the DSM-Congruent Criterion A group did not differ from the DSM-Ambiguous trauma group on any PTSD symptom cluster. ConclusionsThe lack of significant differences in scores between individuals with DSM- Congruent, DSM-Incongruent, and DSM-Ambiguous traumas provides evidence about the subjective nature of trauma and how college-age individuals interpret their symptoms of PTSD. Clinical implications are discussed.

Use of substances to cope predicts posttraumatic stress disorder symptom persistence: Investigating patterns of interactions between symptoms and its maintaining mechanisms.

Posttraumatic stress disorder (PTSD) remains a growing public health challenge across the globe and is associated with negative and persistent long-term consequences. The last decades of research have identified different mechanisms associated with the development and persistence of PTSD, including maladaptive coping strategies, cognitive and experiential avoidance, and positive and negative metacognitions. Despite these advances, little is known about how these different processes interact with specific PTSD symptoms, and how they influence each other over time at the within-person level. Leveraging a large (N > 1,800) longitudinal data set representative of the Norwegian population during the COVID-19 pandemic, this preregistered study investigated these symptom-process interactions over four assessment waves spanning an 8-month period. Our panel graphical vector autoregressive network model revealed the dominating role of substance use to cope in predicting higher levels of PTSD symptoms over time and increases in PTSD symptomatology within more proximal time windows (i.e., within 6 weeks). Threat monitoring was associated with increased suicidal ideation, while threat monitoring itself was increasing upon decreased avoidance behavior, greater presence of negative metacognitions, and higher use of substances to cope. Our findings speak to the importance of attending to different coping strategies, particularly the use of substances as a coping behavior in efforts to prevent PTSD chronicity upon symptom onset. We outline future directions for research efforts to better understand the complex interactions and temporal pathways leading up to the development and maintenance of PTSD symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BackgroundAdolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.MethodsWe analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes’ procedures (2008).ResultsImmature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.ConclusionsMaladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Prospective associations between psychological factors, potentially morally injurious events, and psychiatric symptoms among Israeli combatants: The roles of ethical leadership and ethical preparation.

Exposure to potentially morally injurious events (PMIEs) during military service is known to be associated with psychiatric symptoms. However, antecedents and outcomes of exposure to PMIEs have only been studied in cross-sectional or retrospective-designed studies. In this prospective study, we examined associations between preenlistment characteristics, predeployment psychological factors, exposure to PMIEs, posttraumatic stress disorder (PTSD), and psychiatric symptoms, and the moderating roles of ethical leadership and ethical preparation, among combatants. A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements. Participants' characteristics were assessed via semistructured interviews and validated self-report measures between 2019 and 2021. Above and beyond preenlistment personal characteristics and psychiatric symptoms, predeployment psychological flexibility predicted higher levels of exposure to PMIEs-Other and Betrayal, and combat exposure predicted higher levels of exposure to PMIEs-Self, Other, and betrayal. Moreover, PMIEs-Betrayal predicted higher levels of PTSD and psychiatric symptoms, and ethical preparation predicted lower PTSD and psychiatric symptoms. Importantly, among combatants who reported high levels of ethical preparation and leadership, the association between exposure to PMIEs and PTSD and psychiatric symptoms following deployment dissolved. This is the first prospective study of antecedents and outcomes of exposure to PMIEs among active-duty combatants. Clinicians treating combatants should be aware of the putative role of psychological flexibility for exposure to PMIEs, as well as the promising mitigating role of ethical leadership and preparation for moral injury and psychopathological outcomes among combatants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The contribution of childhood adversity and potentially traumatic events during military service to PTSD and complex PTSD symptoms among Israeli women veterans.

Adverse childhood experiences (ACEs) and exposure to potentially traumatic events (PTEs) during military service are associated with mental health problems. However, knowledge about relative contributions of these factors to non-U.S. women combat veterans' posttraumatic sequelae is sparse. This study examines associations between ACEs, combat exposure (CES), military sexual trauma (MST), potentially morally injurious events (PMIEs), posttraumatic stress disorder (PTSD), and complex PTSD (CPTSD) symptoms among women veterans. A volunteer sample of Israeli women combat veterans (n = 885) and noncombat veterans (n = 728) responded to self-report questionnaires in a cross-sectional design study. Combat veterans reported higher total average ACEs and were more likely to experience three or more ACEs and specific ACEs of physical abuse and emotional neglect, as compared to noncombat veterans. Combat veterans also reported higher levels of CES, PMIEs, higher prevalence of MST, and higher levels of PTSD symptoms, but not CPTSD symptoms, as compared to noncombat veterans. Importantly, ACEs, CES, MST-assault, and PMIEs of betrayal predicted PTSD symptoms, while only ACEs and PMIEs of betrayal predicted CPTSD symptoms. This study emphasized the relatively high exposure to PTEs and PTSD symptoms of women combat veterans as compared to noncombat veterans. Our findings also confirm prior studies demonstrating associations between ACEs, CES, MST, and mental health problems. Importantly, we demonstrated the unique contribution of betrayal-based PMIEs and the differential associations of PTEs with PTSD and CPTSD symptoms among combat veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care.

To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design. Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout. N =1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions. The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.

Birth related PTSD and its association with the mother-infant relationship: A meta-analysis

ObjectiveThere is a growing body of research showing that birth related posttraumatic stress disorder (PTSD) symptoms may impact the mother-infant relationship. The present study assessed the strength of the association between birth related PTSD symptoms and the mother-infant relationship. MethodA total of twelve studies (5,572 participants) were included based on database searches using PubMed, EBSCO and ProQuest. ResultsThe findings showed that greater levels of birth related PTSD symptoms were associated with poorer mother-infant relationship, r = −0.36, 95% CI: [−0.43 - −0.28], random effects model. The outcomes appeared to be heterogeneous (Q(11) = 81.63, p <.001, tau2 = 0.0123, I2 = 80.73%), despite all outcomes being in the same direction as the overall outcome. ConclusionsThe results indicated that birth related PTSD symptoms are negatively associated with the mother-infant relationship. Further investigation into the prevention of birth related trauma is suggested. Improving birthing experiences for mothers is likely to contribute to improved infant mental health, thereby reducing overall social and economic costs.

Long-lasting effects of World War II trauma on PTSD symptoms and embodiment levels in a national sample of Poles

The main aim of this study was to investigate the long-lasting influences of World War II (WWII) trauma in a national sample of Poles, based on Danieli’s (1998) survivors’ post-trauma adaptational styles (fighter, numb, victim) and their link with current post-traumatic stress disorder (PTSD) symptoms and embodiment level among participants. We also sought to investigate whether the level of knowledge about WWII trauma among ancestors could moderate that association. The study was conducted among a representative sample of 1598 adult Poles obtained from an external company. Participants filled out the Danieli Inventory of Multigenerational Legacies of Trauma, the knowledge about traumatic World War II experiences in the family questionnaire, the Posttraumatic Diagnostic Scale-5, and the Experience of Embodiment Scale. We observed a positive relationship between all survivors’ post-trauma adaptational styles and current levels of PTSD symptoms among participants. In addition, PTSD level mediated the relationships between those adaptational styles and embodiment intensity; that mediation was additionally moderated by a lack of knowledge about WWII trauma among ancestors in our participants. Our study adds to the literature on intergenerational trauma by highlighting the importance of evaluating embodiment in understanding the mechanisms of trauma transmission. Furthermore, it highlights the moderating effect of knowledge of family history in this mechanism and the need to share family histories with subsequent generations.

Acceptability of a smartphone-based intervention targeting anxiety sensitivity among women receiving emergency care after sexual assault: A pilot uncontrolled trial.

Anxiety sensitivity (AS), defined as the fear of anxious arousal, is a promising therapeutic target to reduce posttraumatic stress disorder (PTSD) symptom development after trauma exposure. Computerized AS interventions have been shown to be acceptable to individuals with PTSD symptoms and effective in achieving symptom reduction; however, to our knowledge, no research has examined AS interventions initiated in the immediate aftermath of trauma. We evaluated the feasibility, acceptability, and credibility of a brief (i.e., ∼75 min of psychoeducation, ∼2 hr of ecological momentary intervention) smartphone-based AS intervention in a pilot study. Participants were 12 women who presented for emergency care after sexual assault with high levels of peritraumatic PTSD symptoms. Most women who started the intervention completed the majority of it and reported using the techniques provided. Results indicated that participants perceived the intervention as logical and believed it would help in reducing their symptoms. Qualitative feedback was mostly positive but also indicated concern regarding intervention length. Although not the purpose of the study, results indicated medium-to-large, statistically significant decreases in AS, g = 0.74, and PTSD symptoms, g = 1.20. Overall, these preliminary findings suggest that this novel smartphone-based intervention targeting AS was feasible, acceptable, and credible in this small sample of women receiving emergency care following sexual assault. Treatment outcome data must be considered in the context of natural recovery; however, these promising preliminary feasibility, acceptability, and credibility data support continuing to pilot the feasibility and potential efficacy of the intervention to reduce AS and prolonged PTSD symptoms.

Impact of the COVID-19 Pandemic on U.S. Women's Mental Health.

Background: Women are more likely than men to be diagnosed with depression and anxiety with rates increasing since the COVID-19 pandemic. This study sought to understand how women's intersecting identities, personal strengths, and COVID-19-related stressors were associated with their anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms early in the pandemic. Methods: During May-June 2020, American women (N = 398) recruited via MTurk completed an online questionnaire assessing mental health (PTSD, anxiety, and depression), demographic characteristics, personal strengths (coping, hope, social support), and experiences with COVID-19-specific stressors. Results: Women who had a child younger than 18 years of age, lived in rural or urban areas (compared with suburban), and identified as sexual minority reported increased levels of PTSD, depression, and anxiety symptoms. Social support and hope (Agency) were associated with fewer mental health symptoms. Engagement in maladaptive coping and greater perception of COVID-19 threat and perceived stress was associated with more PTSD, depression, and anxiety symptoms. COVID-19-related illness events and difficulty accessing living essentials were associated with increased anxiety symptoms. COVID-19-related disruption to living and income were associated with increased PTSD symptoms. Loneliness was associated with increased anxiety and depression symptoms. Conclusions: Results of this study can inform prevention and intervention efforts to address depression and anxiety among women with intersecting identities during times of stress. Specifically, supporting the development of women's resilience and adaptive coping and intervening to address maladaptive coping strategies, such as drinking, provide paths to supporting women's mental health.

Burnout following moral injury and dehumanization: A study of distress among Italian medical staff during the first COVID-19 pandemic period.

Italy was the first country outside Asia to deal with the early phase of the COVID-19 pandemic, and health care facilities and medical staff were not fully prepared. Research worldwide has documented the enormous effect of the COVID-19 pandemic on health care providers' mental health, including experiences of dehumanization, but less work has focused on factors which may influence the development of these outcomes in response to COVID-19-related stress. This study examined the association of dehumanization, self-efficacy, and alienation to burnout, depression, and PTSD among medical staff. Potential moderators included moral injury, professional role, COVID workload, and work in a critical care unit (CCU). Participants were recruited through the Internet. The sample consisted of 270 medical staff members who completed a self-report survey online. Instruments included: Human Traits Attribution Scale for dehumanization; NYP-Queens Survey-Self-Efficacy Subscale for self-efficacy; Moral Injury Events Scale for moral injury; Alienation Scale for alienation; PTSD-8 for posttraumatic stress disorder; Patient Health Questionnaire-9 for depression; and a single item for burnout. The analytic plan included ANOVAs, zero-order correlations, logistic regression analyses, multiple linear regression models, and parallel mediation. Results show that dehumanization was associated with higher levels of burnout, PTSD, and depressive symptoms and effects were consistent across professional role and work context. Dehumanization was significantly associated with PTSD symptoms only among those who had increased COVID-19-related caseloads. Moral injury was positively associated with dehumanization, displayed an independent association with all 3 mental health outcomes, over and above dehumanization, and tended to exacerbate the effects of dehumanization. The effect sizes across analyses were small to medium. This research confirms that the COVID-19 pandemic stressed Italian medical staff in a way not documented in the prepandemic literature. There is a need to support staff in their complex relationships and communication with patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Everyday life experiences for evaluating post-traumatic stress disorder symptoms

ABSTRACT Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms. Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796). Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms. Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = −.427 to −.224, 95% confidence intervals [−.543 to −.359, −.310 to −.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = −.285 to −.096, 95% confidence intervals [−.379 to −.189, −.190 to −.003], p values < .05). Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.