Levels Of Posttraumatic Stress Disorder Research Articles

Increased psychological distress among individuals with spinal cord injury is associated with central neuropathic pain rather than the injury characteristics

Cross-sectional study. Central neuropathic pain (CNP) is common after spinal cord injury (SCI). The psychological impact of CNP is not clear. Previous studies reported depression and pain catastrophizing among patients with SCI and CNP; however, the lack of control groups prevented discerning whether these were attributed to CNP or to the SCI itself. The aim was to examine the psychological distress among individuals with SCI with and without CNP and controls to evaluate its impact and possible source. Outpatient clinic of a large rehabilitation center. Individuals with SCI and CNP (n = 27) and without CNP (n = 23), and able-bodied controls (n = 20) participated. Data collection included sociodemographics, SCI characteristics, and level of post-traumatic stress disorder (PTSD), anxiety, stress, depression, and pain catastrophizing. The sensory, affective, and cognitive dimensions of CNP were analyzed. Individuals with SCI and CNP exhibited elevated levels of PTSD, anxiety, stress, depression, and pain catastrophizing compared to the two control groups, which presented similar levels. The psychological variables among the CNP group correlated positively only with the affective dimension of CNP. Neither CNP nor the psychological variables correlated with SCI characteristics. Irrespective of CNP intensity, the affective dimension (suffering) is associated with increased psychological distress. Perhaps individual differences in the response to SCI and/or individual traits rather than the mere exposure to SCI may have a role in the emergence of CNP and psychological distress/mood dysfunction. Rehabilitation programs should prioritize stress management and prevention among individuals with SCI and CNP.

Sleep Mediates the Association Between PTSD Symptoms and Chronic Pain in Youth

Symptoms of post-traumatic stress disorder (PTSS) and chronic pain have been shown to co-occur at high rates in adolescents and this co-occurrence is linked to worse pain and quality of life. Sleep disturbance has been posited as a mechanism underlying this co-occurrence in conceptual models of mutual maintenance. This study examined the mediating role of sleep in the relationship between PTSS and pain in youth (aged 10–17 years) with chronic pain. Ninety-seven participants completed measures of PTSS, pain (intensity and interference), anxiety symptoms, and sleep quality, in addition to demographic characteristics. Mediation models were conducted. Findings revealed that, over and above the influence of associated demographic characteristics (age, race) and anxiety symptoms, sleep quality partially mediated the relationships between PTSS and pain intensity and interference for youth with chronic pain. Specifically, higher levels of PTSS was linked to higher levels of pain intensity and pain interference, and these relationships were partially explained by poor sleep quality. Findings highlight the potential mechanistic role of sleep in explaining the co-occurrence of chronic pain and PTSS and suggest sleep might be an important target in future interventions. PerspectiveConsistent with the pediatric model of mutual maintenance in PTSS and chronic pain, poor sleep quality was found to underlie this co-occurrence in youth.

Dangers on the road: A longitudinal examination of passenger-initiated violence against bus drivers.

This study examined the impact of workplace violence against 109 bus drivers over a 1-year span. Workplace violence is related to both psychological and work-related consequences. Our findings showed that bus drivers experienced a wide range of violence at work and the psychological consequences were devastating: Half of the participants met the diagnostic criteria for acute stress disorder within the first month following the index event. Majority of them experienced at least moderate levels of post-traumatic stress disorder (PTSD) problems over the 1-year span. About 9.3% of participants showed a delayed onset of PTSD 6months after. Furthermore, counter-supportive behaviours and reexposure to violence played important roles in the maintenance of PTSD symptoms over time. Even though PTSD symptoms per se did not relate to bus driver's confidence in coping with aggressive passengers, the immediate post-traumatic reaction-symptoms of acute stress disorder-showed a significant long-term negative effect on bus drivers' confidence in dealing with aggressive passengers 12months after. This study provided empirical evidence of the changing nature of PTSD symptoms over time among bus drivers.

Posttraumatic Stress Disorder and Emotion-Focused Coping Among Disaster Mental Health Counselors

The authors surveyed 235 disaster mental health counselors (DMHCs) for levels of posttraumatic stress disorder (PTSD) symptom severity. A correlational design was used to examine the roles of adult attachment security, emotion regulation, and mindfulness in predicting PTSD symptoms among this group. Each of the 3 predictors was negatively correlated with PTSD symptom severity, and data supported a mediating role for emotion regulation. Results may inform DMHCs, other counselors, and individuals who train or deploy DMHCs.

The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review.

BackgroundObstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression.MethodsWe searched on PubMed, PsychoInfo and Embase. Studies were included with primary data on anxiety and/or depression postpartum in women with childbirth fear who had requested an ECS. After full-text evaluation of 65 papers and quality analysis of four papers, three papers were included. Of one paper additional and yet unpublished data were provided. Studies varied in outcome measures, hence no meta-analysis was performed.ResultsWomen who requested an ECS had higher antepartum depression and anxiety levels but no different postpartum depression levels than women who delivered vaginally. One study of good quality examined the effect of vaginal delivery in women preferring ECS: These women had significantly higher symptom levels of post-traumatic stress disorder (PTSD) and depression than women with normal vaginal delivery.ConclusionsThe prospect of an ECS does not lower antepartum anxiety and/or depression levels in women requesting an ECS. If women resolutely persist in wishing an ECS despite adequate counselling and/or psychiatric treatment, the risk of developing depressive and PTSD symptoms in case of vaginal delivery should be taken into account, and an ECS may be considered as a valid alternative.

A controlled trial of trauma-focused therapy versus problem-solving in Islamic children affected by civil conflict and disaster in Aceh, Indonesia.

To evaluate the relative efficacies of trauma-focused cognitive behavior therapy and problem-solving therapy in treating post-traumatic stress disorder in children affected by civil conflict in Aceh, Indonesia. A controlled trial of children with post-traumatic stress disorder ( N = 64) randomized children to either five individual weekly sessions of trauma-focused cognitive behavior therapy or problem-solving therapy provided by lay-counselors who were provided with brief training. Children were assessed by blind independent assessors at pretreatment, posttreatment and 3-month follow-up on post-traumatic stress disorder, depression and anger, as well as caregiver ratings of the child's post-traumatic stress disorder levels. Intent-to-treat analyses indicated no significant linear time × treatment condition interaction effects for post-traumatic stress disorder at follow-up ( t(129.05) = -0.55, p = 0.58), indicating the two conditions did not differ. Across both conditions, there were significant reductions in post-traumatic stress disorder on self-reported ( t(131.26) = -9.26, p < 0.001) and caregiver-reported ( t(170.65) = 3.53, p = 0.001) measures and anger ( t(127.66) = -7.14, p < 0.001). Across both conditions, there was a large effect size for self-reported post-traumatic stress disorder (cognitive behavior therapy: 3.73, 95% confidence interval = [2.75, 3.97]; problem-solving: 2.68, 95% confidence interval = [2.07, 3.29]). These findings suggest that trauma-focused cognitive behavior therapy and problem-solving approaches are comparably successful in reducing post-traumatic stress disorder and anger in treating mental health in children in a post-conflict setting. This pattern may reflect the benefits of non-specific therapy effects or gains associated with trauma-focused or problem-solving approaches.

Frontal EEG asymmetry during symptom provocation predicts subjective responses to intrusions in survivors with and without PTSD.

Studies suggest that frontal alpha asymmetry is closely linked to psychological adjustment following stressful experiences, such that more left-sided frontal activation during symptom provocation might predict lower levels of posttraumatic stress disorder (PTSD). Here, we tested whether frontal asymmetry at rest and during exposure to neutral, positive, negative, and trauma-related images would be associated with PTSD, and particularly with characteristic reexperiencing symptoms. Symptoms were assessed in trauma victims with (n = 24) and without PTSD (n = 15), using both retrospective measures and 1-week ambulatory assessments with a diary and a smartphone. While resting frontal asymmetry was unrelated to all retrospective measures, left-sided activation in response to the negative picture correlated with lower levels of psychopathology. Left-sided activation in the trauma-related picture condition was more specifically associated with less emotionally intense intrusions and responses to viewing the picture, even when corrected for other symptoms of psychopathology. These effects tended to increase when participants with possible overreporting tendencies were removed from the analyses. Moreover, trauma victims without PTSD (i.e., relatively more resilient individuals) displayed higher left-sided frontal activation in response to the negative picture, also when compared with a third group of healthy, trauma-free individuals (n = 15). Our findings suggest that state-dependent changes in frontal asymmetry could serve as a biological marker of PTSD symptoms and could eventually be used for diagnostic purposes or as a target for neuromodulation interventions. Future studies should establish whether this marker can serve as an early predictor of psychopathology in recently traumatized individuals.

Maternal support following childhood sexual abuse: Links to parent-reported children’s outcomes

Maternal support is touted to play a critical role in predicting children’s symptom trajectories following sexual abuse disclosure. Yet, a recent meta-analysis indicates that this widely held belief may actually have limited empirical support. The lack of correspondence between maternal support and children’s symptoms may be the result of the limitations of the prior literature including the use of maternal support measures with inadequate psychometric properties. The aim of the present study was to utilize the only published measure with sufficient psychometrics properties, the Maternal Self-Report Support Questionnaire (MSSQ; Smith et al., 2010), to determine the relationships between maternal support and demographic and family characteristics, parent-reported children’s symptoms, and aspects of the traumatic event in a treatment-seeking sample. The sample included 252 treatment-seeking children (M=8.86, SD=3.85; 67.5% female, 59.5% White) and their mothers, who completed the MSSQ and other measures at pre-treatment. Mothers of older children, White children, and mothers with greater educational attainment reported higher levels of Emotional Support. Single mothers were more likely to report higher levels of Blame/Doubt than married mothers. Characteristics of the traumatic event, such as sexual abuse duration and number of sexual abuse incidents were negatively correlated with Emotional Support. Maternal support was related to relatively few of children’s symptoms and was not associated with levels of posttraumatic stress disorder (PTSD) symptoms. Although several demographic and family characteristics may be related to maternal support, it is a relatively weak predictor of children’s outcomes.

Correlates of posttraumatic stress disorder in adults with congenital heart disease.

The aims of this study were to compare the level of posttraumatic stress disorder between adults with and without congenital heart disease, and to examine the correlates of posttraumatic stress disorder (e.g., sociodemographics). Cross-sectional. Two university-affiliated heart hospitals in Tehran, Iran. A sample of 347 adults with congenital heart disease aged 18-64 years (52% women), and 353 adults without congenital heart disease matched by sex and age (±2 years) was recruited. The PTSD Scale: Self-report version was used to assess the diagnosis and severity of posttraumatic stress disorder. Hierarchical multivariate logistic regression analyses were performed to explore correlates of likely posttraumatic stress disorder diagnosis among each group of participants. The posttraumatic stress disorder in the patients was comparable to those of the control group, except for increased arousal (P = .027) which was scored higher among the patients. Over 52% of adults with congenital heart disease met the criteria for a likely posttraumatic stress disorder diagnosis compared with 48% of adults without congenital heart disease. The regression analyses among patients revealed that elevated depressive symptoms (OR = 1.27) and a positive history of cardiac surgery (OR = 2.02) were significantly associated with posttraumatic stress disorder. The model could explain 29% of the variance in posttraumatic stress disorder. The high and comparable prevalence of posttraumatic stress disorder among patients and nonpatients highlight the significance of the context in which adults with congenital heart disease may face other/additional stressors than disease-related ones, an issue that clinicians need also take into account. Furthermore, the association of posttraumatic stress disorder with elevated depressive symptoms warrant a comprehensive psychological assessment and management of adults with congenital heart disease, in particular among those with a history of invasive procedures.

A Systems Science Approach to Understanding Polytrauma and Blast-Related Injury: Bayesian Network Model of Data From a Survey of the Florida National Guard.

We sought to further define the epidemiology of the complex, multiple injuries collectively known as polytrauma/blast-related injury (PT/BRI). Using a systems science approach, we performed Bayesian network modeling to find the most accurate representation of the complex system of PT/BRI and identify key variables for understanding the subsequent effects of blast exposure in a sample of Florida National Guard members (1,443 deployed to Operation Enduring Freedom/Operation Iraqi Freedom and 1,655 not deployed) who completed an online survey during the period from 2009 to 2010. We found that postdeployment symptoms reported as present at the time of the survey were largely independent of deployment per se. Blast exposure, not mild traumatic brain injury (TBI), acted as the primary military deployment-related driver of PT/BRI symptoms. Blast exposure was indirectly linked to mild TBI via other deployment-related traumas and was a significant risk for a high level of posttraumatic stress disorder (PTSD) arousal symptoms. PTSD arousal symptoms and tinnitus were directly dependent upon blast exposure, with both acting as bridge symptoms to other postdeployment mental health and physical symptoms, respectively. Neurobehavioral or postconcussion-like symptoms had no significant dependence relationship with mild TBI, but they were synergistic with blast exposure in influencing PTSD arousal symptoms. A replication of this analysis using a larger PT/BRI database is warranted.

The relationship of predeployment child-focused preparedness to reintegration attitudes and PTSD symptoms in military fathers with young children.

Research shows that lower negative reintegration attitudes relate to lower levels of posttraumatic stress disorder (PTSD) among service members. Furthermore, mission preparedness has been shown to buffer the effects of combat exposure on PTSD development. The current study aims to extend the preparedness for deployment research into the family domain by examining the effect of predeployment child-focused preparedness on military fathers’ reintegration attitudes and PTSD symptoms. Correlations were conducted to examine the relationship between predeployment child-focused preparedness, reintegration attitudes, and PTSD symptoms among military fathers with young children (N = 30). Findings indicate that preparing one’s young children prior to deployment is positively related to fathers’ less negative reintegration attitudes following the deployment. Additionally, participants who engaged in predeployment child-focused preparation were significantly less likely to meet the clinical cut-off for PTSD compared to those who did not engage in any preparation for their young children. Implications for the potential positive impact of predeployment child-focused preparation on the family system are discussed, particularly as a buffer against PTSD among reintegrating service members.

Psychological consequences of traumatic upper limb peripheral nerve injury: A systematic review

Introduction Traumatic upper limb peripheral nerve injuries significantly impact individuals’ function and ability to return to work. Patients with peripheral nerve injury experience ongoing psychological impairments for which they are not routinely treated. The aim of this review was to investigate the psychological consequences of traumatic upper limb peripheral nerve injury. Methods A systematic review of MEDLINE, Embase, PsycINFO, CINAHL, AMED, BNI, the Cochrane libraries and grey literature up to October 2015 was undertaken. Two reviewers independently assessed methodological quality in accordance with Cochrane Collaboration recommendations. Eligibility criteria comprised: adults or adolescents with traumatic upper limb peripheral nerve injury using any measurement of psychological well-being. Results Six studies ( n = 245) met the inclusion criteria. Methodological quality varied widely. Evidence of post-traumatic stress disorder at one month, which decreased over time, was reported in three studies. Two studies found a statistically significant correlation between the early presence of post-traumatic stress disorder and reduction in function at 12 or more months. Limited information was available on anxiety, depression and mental quality of life. Combined nerve injuries (in two studies) had significantly higher levels of post-traumatic stress disorder, at one month, compared to those with an isolated nerve injury. Conclusion There is some evidence of early post-traumatic stress disorder following traumatic upper limb peripheral nerve injury, which may have an impact on functional outcome. However, high-quality studies using prospective cohorts are required to further evaluate the psychological aspects associated with this traumatic injury.

Existential Anxiety Among Adolescents Exposed to Disaster: Linkages Among Level of Exposure, PTSD, and Depression Symptoms.

Exposure to natural disasters can be highly traumatic and have a detrimental effect on youth mental health by threatening the satisfaction of basic human needs and goals. Recent research in adults suggests that exposure to disasters may exacerbate existential anxiety about the meaning of life. The current study expands this investigation to adolescents, who may be particularly vulnerable to the negative effects of disaster. Data came from 325 adolescents (mean age = 15.05 years, SD = 1.05) residing in the Greater New Orleans area who were exposed to Hurricanes Katrina and/or Gustav. Existential anxiety concerns were highly prevalent in the sample and were associated with elevated levels of posttraumatic stress disorder (R2 = .09) and depression symptoms (R2 = .13). Consistent with theoretical predictions, disaster exposure levels moderated the association between facets of existential anxiety and mental health symptoms. Findings highlight the salience of existential concerns in disaster exposed youth, and provide evidence that exposure to traumatic stress may strengthen their association with mental health problems.

Perceptions of Individual and Family Functioning Among Deployed Female National Guard Members.

Females currently make up 15% of U.S. military service members. Minimal attention has been paid to families of female National Guard members who have been deployed and their subsequent reintegration challenges. This cross-sectional Internet-based survey of female members of four National Guard units compared those who were and were not deployed. Instruments, guided by the variables of the Family Resilience Model, measured individual, family, and deployment-related factors. Bivariate analysis and ordinal logistic regression were done to assess differences between the groups. Of the 239 National Guard members surveyed, deployed women (n = 164) had significantly higher levels of posttraumatic stress disorder (PTSD; p < .001) and lower coping skills (p = .003) than non-deployed women (n = 75). Perceptions of overall family functioning were higher among deployed when compared with never deployed women. Results indicate community interventions that focus on strengthening coping skills of female Guard members would be useful for this population.

The emotional impact of national music on young and older adults differing in posttraumatic stress disorder symptoms

ABSTRACTIn spite of previous evidence regarding the function of national songs as a contextual stimulus, their effect on the emotional state of older adults living with different levels of posttraumatic stress disorder (PTSD) symptoms has not be been examined. Following the 2014 Israel–Gaza conflict, we examined the emotional effects of listening to happy national songs (songs of Independence Day) and sad national songs (Memorial Day songs) on young (N = 144, mean age = 29.4) and older adults (N = 132, mean age = 68.5). Respondents were exposed to happy or sad national songs, and completed measures of exposure to missile attacks, related PTSD symptoms, and positive and negative emotions. Sad national songs were related to higher negative affect among young adults who were lower on PTSD symptoms, but not among their older counterparts. In contrast, sad national songs were related to higher negative affect among older adults who were higher on PTSD symptoms, but not among their young counterparts. These findings support the strength and vulnerability model, as they demonstrate that relative to young adults, older adults are generally more capable to withstand negative stimuli, yet are more sensitive to negative stimuli when they suffer from chronic vulnerability, as in the case of higher level of PTSD symptoms.

Caregiver strain following critical care discharge: An exploratory evaluation

ObjectiveThe objective of this exploratory evaluation was to understand the impact of critical care survivorship on caregivers. DesignFamily members who attended a quality improvement initiative within our critical care unit were asked to complete 4 questionnaires. SettingThe setting for this study was a 20-bedded mixed critical care unit in a large teaching hospital in Scotland. Data were collected as a part of an evaluation of a quality improvement initiative. ParticipantsThirty-six carers completed the questionnaire set. Measurements and main resultsA total of 53% of caregivers suffered significant strain. Poor quality of life in the patient was significantly associated with higher caregiver strain (P= .006). Anxiety was present in 69% of caregivers. Depression was present in 56% of caregivers, with a significant association between carer strain and depression (P< .001).Those caregivers who were defined as being strained also had significantly higher Insomnia Severity Index scores than those without carers strain (P= .007). ConclusionThis evaluation has demonstrated that there is a significant burden for caregivers of critical care survivors. Furthermore, they reported high levels of posttraumatic stress disorder, anxiety, depression, and insomnia. Future work on rehabilitation from critical care should focus on the inclusion of caregivers.

Acceptance and Commitment Therapy for Posttraumatic Stress Disorder in Early Psychosis: A Case Series

Persons with psychosis often report high levels of posttraumatic stress disorder (PTSD) symptoms, which render them more vulnerable to relapse, symptom exacerbation, and reduced well-being. However, less is known about how to adequately accommodate the needs of persons recovering from a first episode of psychosis, presenting with PTSD. Further, the existing evidence-based interventions for PTSD seem less equipped to deal with serious mental disorder and comorbid conditions. This study aimed to assess the efficacy, acceptability, and safety of Acceptance and Commitment Therapy (ACT) for persons suffering from PTSD with comorbid trauma and psychosis. Three consecutively referred participants meeting ICD-10 criteria for PTSD and a first-episode nonaffective psychotic disorder were treated in an outpatient service within a case-series analysis. A manual-guided ACT intervention of 12 sessions showed clinically relevant improvement on self-report measures of PTSD symptoms and emotional distress. These initial findings are promising and appear to justify a more controlled evaluation of this brief intervention.

Are Inmates With Military Backgrounds “Army Strong?”

We use data from the Survey of Inmates in State and Federal Correctional Facilities 2004 to examine the relationship between prior military service and misbehavior for a nationally representative sample of incarcerated inmates. Our regression analyses, based on 18,185 respondents across 326 prisons, suggest that inmates with military backgrounds tend to fare better than others across 12 negative prison outcomes. In contrast, we do not find much support for the argument—implied by violentization and other theories—that inmates with military backgrounds fare worse than others, with the exception of high levels of post-traumatic stress disorder (PTSD) and violent victimization. Supplementary analyses also show conditional patterns based on exposure to combat as well as honorable versus dishonorable discharge.

PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War

The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.

The effect of childhood emotional maltreatment on romantic relationships in young adulthood: A double mediation model involving self-criticism and attachment.

Despite growing recognition of the importance of childhood emotional maltreatment (CEM) on the development of psychopathology, very few studies have addressed its impact on adult romantic relationship functioning, particularly among otherwise relatively well-functioning individuals. In an attempt to further elucidate the mechanism underlying the negative impact of CEM on romantic relationships, we tested an integrative mediational model linking CEM to romantic relationships through the impact of CEM on the development of self-criticism and adult attachment. Recent work in this context suggests that while self-criticism concerns broad cognitive-affective schemas related to achievement and failure, attachment avoidance assesses the expression of these broad schemas in close relationships (Luyten & Blatt, 2011; Sibley & Overall, 2008, 2010). This hypothesized mediational model was examined in a sample of young adult undergraduates (N = 99, 85 female), using structural equation modeling. The mediational model was in large part supported. Attachment avoidance, but not attachment anxiety, fully accounted for the mediating role of self-criticism in the relationship between CEM and romantic relationship satisfaction, even when controlling for the potential role of concurrent levels of posttraumatic stress disorder severity. Understanding the long-term psychological dynamics related to CEM and identifying mediating vulnerability factors-self-criticism and attachment avoidance-might have implications for both the assessment and treatment of individuals with a history of CEM, particularly as effective interventions to address self-criticism and attachment issues are available. (PsycINFO Database Record