Life-threatening Experiences Research Articles

Meaning in life (but not life satisfaction) moderates the effects of battlefield experiences on suicidal ideation and anxiety.

Although research has been conducted in the last decade distinguishing between meaning in life and life satisfaction, no research has examined whether their potential moderating role in mental health problems is distinct. Among military personnel, mental health is paramount, and suicide is one of the leading causes of death. Data were collected to determine the potential moderating effects of meaning in life and/or life satisfaction of battlefield experiences on depression, anxiety, and thoughts about death (including suicidal ideation). Data were collected on 851 total military personnel, spanning two distinct survey administrations, who reported at least one combat deployment. Findings suggest that meaning in life has a significant moderating effect on the impact of life-threatening experiences on anxiety and thoughts about death (including suicidal ideation), but no moderating effect on depression. Life satisfaction had no significant moderating role for any mental health outcome. This research suggests that meaning in life is a significant buffer against certain negative mental health outcomes stemming from life-threatening experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparative physiology and morphology of BLA-projecting NBM/SI cholinergic neurons in mouse and macaque.

Cholinergic projection neurons of the nucleus basalis and substantia innominata (NBM/SI) densely innervate the basolateral amygdala (BLA) and have been shown to contribute to the encoding of fundamental and life-threatening experiences. Given the vital importance of these circuits in the acquisition and retention of memories that are essential for survival in a changing environment, it is not surprising that the basic anatomical organization of the NBM/SI is well conserved across animal classes as diverse as teleost and mammal. What is not known is the extent to which the physiology and morphology of NBM/SI neurons have also been conserved. To address this issue, we made patch-clamp recordings from NBM/SI neurons in ex vivo slices of two widely divergent mammalian species, mouse and rhesus macaque, focusing our efforts on cholinergic neurons that project to the BLA. We then reconstructed most of these recorded neurons post hoc to characterize neuronal morphology. We found that rhesus macaque BLA-projecting cholinergic neurons were both more intrinsically excitable and less morphologically compact than their mouse homologs. Combining measurements of 18 physiological features and 13 morphological features, we illustrate the extent of the separation. Although macaque and mouse neurons both exhibited considerable within-group diversity and overlapped with each other on multiple individual metrics, a combined morpho-electric analysis demonstrates that they form two distinct neuronal classes. Given the shared purpose of the circuits in which these neurons participate, this finding raises questions about (and offers constraints on) how these distinct classes result in similar behavior.

Trauma-informed palliative care for humanitarian crises

Abstract Healthcare triage during humanitarian crises requires attention to saving lives and prevention of suffering at end of life. The prevalence of life-threatening experiences during humanitarian crises needs a trauma-informed palliative care approach, attending to the trauma-related psychosocial needs of patients, caregivers, and health care providers to support healing. This commentary includes research and practice literature that builds on and complements themes from an International Psychosocial Oncology Society Palliative Care Special Interest Group initiative. During humanitarian crises, palliative care experts contribute to mobilizing and training host country health care providers and volunteers who reciprocally promote cultural sensitivity for patients and their caregivers in all aspects of death and dying. Future directions require assessing how best to integrate trauma-informed principles into early and later responses to humanitarian crises. Culturally sensitive research partnerships with patients and caregivers must account for hierarchy and flexibility in research design and knowledge construction.

Shaping the perception of flood risk among residents of riverbank informal settlements in Kathmandu

The aim of the study is to investigate how riverbank informal settlement residents in Kathmandu perceive flood risk. The way they perceive flood risk influences their response to flood impacts and their adaptation measures. Their responses and initiatives to reduce flood risk are important because they are less likely to receive support from the government as they are considered illegal residents. Studies on perceptions of hazard risk in informal settlements are rare. This study contributes to fill this gap. The study explores factors influencing the flood risk perception through 40 semi-structured interviews from three riverbank informal settlements situated along the Bagmati River, the largest river running through Kathmandu. Thematic analysis of the interviews identified various factors influencing perception of flood risk. The study reveals that flood risk perception among informal settlement residents is shaped by flood impacts such as life-threatening experiences, property damage, and effects on health and livelihood, along with residents’ awareness of flooding dynamics and realisation of vulnerabilities due to their socio-economic conditions. Furthermore, a sense of solidarity among residents fosters bonding social capital, influencing their flood risk perception. The findings benefit various stakeholders by providing guidance for collaboration with informal settlement residents to work towards flood risk reduction. The results underscore the need for governments to view informal settlements not solely as illegal entities, but as areas facing substantial challenges from flood impacts and taking appropriate measures to address these challenges.

Rescue treatment with add-on efgartigimod in a patient with impending myasthenic crisis: a case report

Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating muscle weakness. Severe patients may develop life-threatening respiratory failure and experience crisis. Plasma exchange or intravenous immunoglobulin (IVIg) is the first-line treatment option for myasthenia crisis, but some patients still poorly respond to them. Here, we first reported a generalized MG patient from China who was in a state of impending myasthenic crisis and did not respond effectively to IVIg but was successfully rescued by add-on efgartigimod. Especially, we also detected meaningful changes in T-cell and B-cell subsets after efgartigimod, promoting a potential role of efgartigimod in re-establishing immune homeostasis.

Development and Validation of a Machine Learning Prediction Model of Posttraumatic Stress Disorder After Military Deployment

Military deployment involves significant risk for life-threatening experiences that can lead to posttraumatic stress disorder (PTSD). Accurate predeployment prediction of PTSD risk may facilitate the development of targeted intervention strategies to enhance resilience. To develop and validate a machine learning (ML) model to predict postdeployment PTSD. This diagnostic/prognostic study included 4771 soldiers from 3 US Army brigade combat teams who completed assessments between January 9, 2012, and May 1, 2014. Predeployment assessments occurred 1 to 2 months before deployment to Afghanistan, and follow-up assessments occurred approximately 3 and 9 months post deployment. Machine learning models to predict postdeployment PTSD were developed in the first 2 recruited cohorts using as many as 801 predeployment predictors from comprehensive self-report assessments. In the development phase, cross-validated performance metrics and predictor parsimony were considered to select an optimal model. Next, the selected model's performance was evaluated with area under the receiver operating characteristics curve and expected calibration error in a temporally and geographically distinct cohort. Data analyses were performed from August 1 to November 30, 2022. Posttraumatic stress disorder diagnosis was assessed by clinically calibrated self-report measures. Participants were weighted in all analyses to address potential biases related to cohort selection and follow-up nonresponse. This study included 4771 participants (mean [SD] age, 26.9 [6.2] years), 4440 (94.7%) of whom were men. In terms of race and ethnicity, 144 participants (2.8%) identified as American Indian or Alaska Native, 242 (4.8%) as Asian, 556 (13.3%) as Black or African American, 885 (18.3%) as Hispanic, 106 (2.1%) as Native Hawaiian or other Pacific Islander, 3474 (72.2%) as White, and 430 (8.9%) as other or unknown race or ethnicity; participants could identify as of more than 1 race or ethnicity. A total of 746 participants (15.4%) met PTSD criteria post deployment. In the development phase, models had comparable performance (log loss range, 0.372-0.375; area under the curve range, 0.75-0.76). A gradient-boosting machine with 58 core predictors was selected over an elastic net with 196 predictors and a stacked ensemble of ML models with 801 predictors. In the independent test cohort, the gradient-boosting machine had an area under the curve of 0.74 (95% CI, 0.71-0.77) and low expected calibration error of 0.032 (95% CI, 0.020-0.046). Approximately one-third of participants with the highest risk accounted for 62.4% (95% CI, 56.5%-67.9%) of the PTSD cases. Core predictors cut across 17 distinct domains: stressful experiences, social network, substance use, childhood or adolescence, unit experiences, health, injuries, irritability or anger, personality, emotional problems, resilience, treatment, anxiety, attention or concentration, family history, mood, and religion. In this diagnostic/prognostic study of US Army soldiers, an ML model was developed to predict postdeployment PTSD risk with self-reported information collected before deployment. The optimal model showed good performance in a temporally and geographically distinct validation sample. These results indicate that predeployment stratification of PTSD risk is feasible and may facilitate the development of targeted prevention and early intervention strategies.

Climate change and extreme weather disasters: evacuation stress is associated with youths' somatic complaints.

Climate-change has brought about more frequent extreme-weather events (e.g., hurricanes, floods, and wildfires) that may require families to evacuate, without knowing precisely where and when the potential disaster will strike. Recent research indicates that evacuation is stressful for families and is associated with psychological distress. Yet, little is known about the potential impact of evacuation stressors on child health. After Hurricane Irma, which led to a mass evacuation in Florida, we examined whether evacuation stressors and hurricane exposure were uniquely associated with youth somatic complaints, and whether youth psychological distress (i.e., symptoms of posttraumatic stress, anxiety, and depression) served as a potential mediating pathway between evacuation stressors, hurricane experiences, and somatic complaints. Three months after Irma, 226 mothers of youth aged 7-17 years (N=226; M age = 9.76 years; 52% boys; 31% Hispanic) living in the five southernmost Florida counties reported on evacuation stressors, hurricane-related life threat and loss/disruption, and their child's psychological distress and somatic complaints using standardized measures. Structural equation modeling revealed a good model fit (χ2 = 32.24, p = 0.003, CFI = 0.96, RMSEA = 0.08, SRMR = 0.04). Even controlling for life-threatening hurricane experiences (β = 0.26) and hurricane loss and disruption (β = 0.26), greater evacuation stressors were associated with greater symptoms of youth psychological distress (β = 0.34; p's < 0.001), and greater psychological distress was associated with more somatic complaints (β = 0.67; p < 0.001). Indirect effects revealed that evacuation stressors (p < 0.001), actual life-threatening events (p < 0.01), and loss and disruption (p < 0.01) were all uniquely and indirectly associated with youths' somatic complaints via youth psychological distress. Findings suggest that even coping with the threat of a disaster may be sufficient to prompt psychological and physical health symptoms in youth. Due in part to climate change, threats of disaster occur much more often than actual disaster exposure, especially for areas that are prone to hurricanes or wildfires. Preparing youth and families residing in vulnerable areas for potential disaster evacuation or sheltering-in-place appears critical. Encouraging families to develop Disaster Plans and teaching stress management skills may reduce both youth distress and somatic health problems.

Gambaran Risiko Post-Traumatic Stress Disorder (PTSD) pada Penyintas COVID-19 di Rumah Sakit Universitas Andalas

Introduction. The COVID-19 pandemic has a negative impact on life where sufferers can experience emotional problems such as despair, deep sadness, helplessness, anxiety, and depressive symptoms. Especially in hospitalized COVID-19 survivors, there are sequelae in the form of anxiety, depression, and Post-traumatic Stress Disorder (PTSD). PTSD experienced by COVID-19 survivors will affect the patient’s quality of life in the future. This study aimed to assess the risk of PTSD in COVID-19 survivors who had been hospitalized at Andalas University Hospital. Methods. A cross-sectional descriptive study was conducted among COVID-19 survivors aged ≥15 years who had been hospitalized at Andalas University Hospital. Samples were selected by using total sampling method with inclusion criteria included experiencing mild, severe, or critical clinical symptoms during COVID-19 infection, being discharged from Andalas University Hospital for six months or more, and willing to participate in the study by signing an informed consent. Samples who have met the inclusion criteria completed the Bahasa Indonesia version of PCL-5 (PTSD Checklist for DSM-5) questionnaire which has been tested for its validity and reliability. Respondents were categorized as having PTSD risk if the questionnaire results showed a score of ≥23. The collected data were subsequently analyzed using univariate analysis. Results. A total of 75 respondents were included in the study, of which 9.3% (7) were found to be potentially or at risk of PTSD. The group of respondents who were at risk of PTSD was mostly comprised of females, and all of them experienced the four PTSD symptoms (intrusion/re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal). The most common trigger that causes PTSD among respondents was the experience of a previous life-threatening traumatic event (71.43%). In addition, the most frequent clinical symptoms of COVID-19 in the PTSD risk group were severe clinical symptoms (71.43%). Conclusions. COVID-19 survivors who have the potential to experience PTSD are predominantly female survivors with severe clinical symptoms, experiencing all four PTSD symptoms, and having a traumatic life-threatening experience during COVID-19 hospitalization.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study.

Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

ВПЛИВ ТРАВМУВАЛЬНОГО ДОСВІДУ ЗАГРОЗИ ЖИТТЯ НА ОСОБИСТІСНИЙ РОЗВИТОК УКРАЇНЦІВ

Background. Theoretical and empirical data confirm that war-trauma' situations associated with parameters of post-traumatic stress disorder (PTSD) and adjustment disorders (AD) negatively affect personality development The purpose of the study is to present evidence of the psychological mechanisms of the effect of war-trauma on the personality development of Ukrainians during the war. Methods. Mississippi scale, Keane et al.; Inventory - Schmieschek, Adaptability, Agaev et al., Values-in-action, Seligman et al.; Big Five Locator, Howard et al. Results. As to the MS, the sample was divided into two polar groups of Ukrainians. One - 128 (56,9 %) participants after the war-trauma' exposure, remain adjusted, which indicates the evolutionary resourcefulness of their personality development. Another - 97 (43.1 %) has signs of unadjusted - AD and PTSD - due to a life-threatening traumatic experience (36,9 % vs. 6,2 %). The Adaptability-data confirmed statistically significant differences (by t-test) between thеsе polar groups, especially in such components as neuropsychological stability and moral normativity (t = 7,945, &amp; t = 8,743, p = 0,000). Significantly more often in the pre-traumatic period, there are differences in character accentuations as potential RA / PTSD risk factors in the two groups (t-test): anxious, excitable, emotional, dysthymic, cyclothymic, stuckic. In the post-trauma, there are other differences in the tendencies to increase accentuations in: dysthymic, stuckic, anxious, excitable, demonstrative, pedantic types. Correlation analysis confirmed that the "top-five" personality traits (Big Five) ак reliable predictors for positive sociocultural personality development in well-adjusted individuals. In the polar group, v. v the "bottom-five" traits - neuroticism, social maladjustment, high emotionality, depression, deviations in behavior are predictors of traumatic personality development. It was established: the higher the level of adjustment disorders, the lower the level of manifestation of such positive values as "wisdom", "courage", "justice", but there is a positive relationship between PTSD / AD indicators and the values "mildness" and "transcendence" (by F-Fisher, all p = 0,000 level). Conclusions. The PTSD, personality-related problems of Ukrainians in the post-trauma period are easier to overcome, the shorter the exposure to the severe war-trauma and the sooner the life-threatening traumatic experience is identified by psychologists.

Morally injurious combat events as an indirect risk factor for postconcussive symptoms among veterans: The mediating role of posttraumatic stress.

Psychosocial factors, including combat-related distress (e.g., posttraumatic stress disorder [PTSD]), contribute to postconcussive symptoms (PCS) among veterans with mild traumatic brain injury (mTBI). However, research on risk factors for PCS has focused solely on life-threatening combat experiences, neglecting the morally injurious dimension of combat-related trauma and associated implications for treatment. Morally injurious events (MIEs) are associated with PTSD symptoms among veterans, a robust risk factor of PCS. Nonetheless, the interplay between MIEs, PTSD symptoms, and PCS remains poorly understood. We sought to investigate MIEs as an indirect risk factor for PCS among Veterans with mTBI. This cross-sectional study of 145 veterans with mTBI used path analysis to investigate whether PTSD symptoms mediated the relationship between MIEs (transgressions and betrayals) and PCS (mood-behavioral, vestibular-sensory, and cognitive domains) among 145 veterans with mTBI. We used the Moral Injury Event Scale, PTSD Checklist-Civilian Version, and Neurobehavioral Symptom Inventory to measure MIEs, PTSD, and PCS, respectively. Perceived transgressions were indirectly associated with mood-behavioral (β = .21, p = .005), vestibular-sensory (β = .17, p = .005), and cognitive PCS (β = .20, p = .005), as mediated by PTSD. Greater transgressions were associated with more severe PTSD (β = .27, p = .003), and greater PTSD was associated with more severe mood-behavioral (β = .79, p < .001), vestibular-sensory (β = .64, p < .001), and cognitive PCS (β = .73, p < .001). Betrayals were not indirectly associated with PCS. Findings offer preliminary support for responses to MIEs being a modifiable risk factor for PCS among veterans. Interventions designed to foster veterans' recovery by targeting the unique emotions and beliefs associated with MIEs may be indicated. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Impact of Just and Unjust War Events on Mental Health Need and Utilization within U.S. Service Members

Background: Soldiers are resilient to just war events, such as killing enemy combatants and life-threatening experiences, but these same soldiers appear to struggle with unjust war events, such as killing a noncombatant or being unable to help civilian women and children in need. This study is the first to examine how just and unjust war experiences are associated with clinical health service outcomes. Methods: Two samples of soldiers in different stages of readjustment from deployment were drawn from a longitudinal, survey-based study of a US Army brigade. Measures included items related to combat events, mental health utilization, perceived mental health need, PTSD, depression, and functional impairment. Results: After controlling for other kinds of combat events, just war events (i.e., life-threatening events and killing enemy combatants) predicted outcomes in soldiers who are less than three months post-deployment, but only predicted 2 of 26 outcomes in soldiers one year post deployment. In contrast, unjust war events were found to be robust predictors of short-term and long-term outcomes related to mental health need and utilization, even after controlling for exposure to other combat events. Conclusions: The results extend previous longitudinal research that suggests that exposure to unjust war events carry a heavier long-term mental health burden than other types of events. Additionally, Soldiers exposed to unjust war events had an unmet need for care one year post deployment that was not directly tied to PTSD or depression. The results question the emphasis on life-threat within mental health pathogenesis models.

Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia.

Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, -0.18; P&lt;.001; depression symptoms: β, -0.42; P&lt;.001; PTSD symptoms: β, -0.60; P&lt;.001) and better QoL (β, 2.00; P&lt;.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P&lt;.001 for all) and worse QoL (β, -4.27; P&lt;.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.

Traumatic experiences of the Great East Japan Earthquake and postpartum depressive symptoms: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

BackgroundNatural disasters can have serious mental health consequences. We aimed to examine the long-term effects of the 2011 Great East Japan Earthquake (GEJE) on postpartum depressive symptoms (PDS). MethodsThe Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study recruited pregnant women in Miyagi Prefecture from 2013 to 2016. Data from 11,403 participants were used in this study. Women were asked about their traumatic experiences of the GEJE with questions addressing threat, witness, and loss. PDS were defined as Edinburgh Postnatal Depression Scale score ≥9 at 1 month after delivery. Multiple logistic regression analyses were conducted to examine the associations of different traumatic experiences of the GEJE and number of traumatic experiences with PDS, after adjustment for age, parity, feelings toward pregnancy, education, income, social isolation, house damage caused by the GEJE, and survey year. ResultsAbout two-fifths of women had at least one traumatic experience of the GEJE. The prevalence of PDS at 1 month after delivery was 13.3 %. Life-threatening experience and witnessing another person's actual or threatened death were associated with PDS: the odds ratios (ORs) were 1.40 (95 % confidence interval [CI], 1.24–1.59) and 1.28 (95 % CI, 1.08–1.53), respectively. Loss of close person was not associated with PDS: the OR was 1.13 (95 % CI, 0.99–1.30). Larger number of traumatic experiences of the GEJE was associated with increased risk of PDS (p for trend <0.001). LimitationsPDS was self-reported. ConclusionsTraumatic experiences of the GEJE prior to pregnancy were associated with increased risks of PDS.

War, immigration and COVID-19: The experience of Afghan immigrants to Iran Amid the pandemic.

IntroductionAfghanistan's domestic upheaval following the Taliban's invasion leads to massive displacement of its population. The number of Afghan refugees in Iran has dramatically increased since the Taliban's takeover of Afghanistan in August 2021. Multiple pre-and post-migratory traumatic experiences affect immigrants' physical, psychological, social, and economic wellbeing. The coronavirus outbreak, considered a traumatic experience in human life in the 21st century, added to their problems in Iran and exposed them to new challenges. This qualitative study aimed to investigate their experiences early before, during, and after immigration and the pandemic's challenges to their lives in Iran.MethodsIn the present qualitative study, ten Afghan residents living in Iran who immigrated to Iran legally or illegally since the summer of 2021 and the last year after the second Taliban invasion were selected via purposive sampling. A semi-structured interview was applied to gather the data, and the data were analyzed through Braun and Clarke's thematic analysis method.ResultsTen male participants with a mean age of 26 y/o were interviewed. Their residence in Iran was between 20 days and 8 months. Four main themes were extracted. The first theme, the Tsunami of suffering, represents a disruption of the normal flow of life. Six subthemes, including loss, being near death, insecurity, sudden hopelessness, leaving the country involuntarily, and reluctance to explore underlying emotions, are included in this category. The second one, Lost in space, describes the participant's attempt to leave Afghanistan following the extensive losses and violent death threats. Their experiences are categorized into four subthemes: the miserable trip, encountering death, life-threatening experiences, and being physically and verbally abused. The third theme, with its five subthemes, try to demonstrate the participants' experiences after getting to their destination in Iran. The last one, Challenges of the COVID-19 explained the experience of Taliban return, war trauma, running away, and living as a refugee or immigrant coincided with the COVID pandemic.DiscussionOur interviewees explained multiple and successive traumatic experiences of war, migration, and the pandemic. The central clinical features of survivors are fears of losing control, being overwhelmed, and inability to cope. They felt abandoned because not only lost their family support in their homeland but could not also receive support in Iran due to the pandemic-related social distancing and isolation. They were dissociated and emotionally numb when describing their experience, which is a hallmark of experiencing severe, unprocessed traumas.ConclusionGaining a better understanding of Afghan refugees lived experiences may help provide them with better social and health care support. Proper mental and physical healthcare support and de-stigmatization programs may reduce the impact of multiple traumas on their wellbeing.

Traumatic Experiences of Women Living with HIV/AIDS in Ghana

Background: Trauma faced by women infected with HIV and AIDS poses great challenge to the coordinated fight against HIV and AIDS. Traumatising events impacting people living with HIV and AIDS, most notably women, impede diagnosis, prevention and treatment efforts.Methods: The study set out to investigate the lifethreatening experiences of thirty-eight women living with HIV and AIDS in the Lower Manya Krobo District of the Eastern Region, Ghana. The study used focus-groups as method of data collection. The data was analysed through theme identification and grouping, along with selection of relevant quotes.Results: The study revealed five major lifethreatening experiences of the women: disclosure, mental ill-health, isolation, stigmatisation and financial challenges. The study concluded that women living with HIV and AIDS suffer enormous psychological burden of the pandemic in addition to physical challenges. However, it is the social burden of the pandemic that contributes significantly tothe eventual death of the victims rather than the disease itself.Conclusion: Consequently, HIV and AIDS education campaign should be intensified using a variety of media, targeting those social issues identified in this research as part of the efforts to fight the disease.

The anterior cingulate cortex and its role in controlling contextual fear memory to predatory threats

Predator exposure is a life-threatening experience and elicits learned fear responses to the context in which the predator was encountered. The anterior cingulate area (ACA) occupies a pivotal position in a cortical network responsive to predatory threats, and it exerts a critical role in processing fear memory. The experiments were made in mice and revealed that the ACA is involved in both the acquisition and expression of contextual fear to predatory threat. Overall, the ACA can provide predictive relationships between the context and the predator threat and influences fear memory acquisition through projections to the basolateral amygdala and perirhinal region and the expression of contextual fear through projections to the dorsolateral periaqueductal gray. Our results expand previous studies based on classical fear conditioning and open interesting perspectives for understanding how the ACA is involved in processing contextual fear memory to ethologic threatening conditions that entrain specific medial hypothalamic fear circuits.

Epigenetic Approach to PTSD: In the Aspects of Rat Models.

Posttraumatic stress disorder (PTSD) is a stress-related mental disorder and develops after exposure to life-threatening traumatic experiences. The risk factors of PTSD included genetic factors; alterations in hypothalamic–pituitary–adrenal (HPA) axis; neurotrophic, serotonergic, dopaminergic, and catecholaminergic systems; and a variety of environmental factors, such as war, accident, natural disaster, pandemic, physical, or sexual abuse, that cause stress or trauma in individuals. To be able to understand the molecular background of PTSD, rodent animal models are widely used by researchers. When looking for a solution for PTSD, it is important to consider preexisting genetic risk factors and physiological, molecular, and biochemical processes caused by trauma that may cause susceptibility to this disorder. In studies, it is reported that epigenetic mechanisms play important roles in the biological response affected by environmental factors, as well as the task of programming cell identity. In this article, we provided an overview of the role of epigenetic modifications in understanding the biology of PTSD. We also summarized the data from animal studies and their importance during the investigation of PTSD. This study shed light on the epigenetic background of stress and PTSD.

Prevalence and Associated Factors of Common Mental Disorders Among Adult Residents in Silte Zone, Southern Ethiopia.

Introduction:Mental health problems appear to be increasing in importance in Africa. Mental and substance use disorders were the leading cause of yearly lived with disability in Sub-Saharan Africa. Evidence from previous studies shows considerable variation in the prevalence of these disorders. The most acceptable explanation for this wide variation is likely to be the fact that socio cultural factors are major determinants of mental disorders. Therefore a mental disorder has to be understood in a specific setting to develop effective and tailored interventions.Objective:The objective of this study was to determine the prevalence and associated factors of common mental disorders among adult residents in Silte Zone, southern EthiopiaMethods:Community based cross-sectional study was conducted in the study area. A total of 1178 adults were selected by using a three-stage systematic sampling technique. The Self-Reporting Questionnaire (SRQ-20) was used to determine the prevalence of common mental disorders. Data were analyzed by using SPSS version 20. Both bivariate and multiple logistic regression analyses were employed to identify factors associated with common mental disorders.Results:The prevalence of common mental disorders among adults found to be 39.7%. Increased age (OR = 1.114; 95% CI = 1.095, 1.134), being female (OR = 9.421; 95% CI = 5.947, 14.926), poor social support (OR = 1.987; 95% CI = 1.358, 2.907) and having life threatening experience (OR = 2.162; 95% CI = 1.825, 2.562) were significantly associated with common mental disorders.Conclusion:In the study, the magnitude of common mental disorders remains high in the study area. Increased age, being female, poor social support and having life-threatening experience were significantly associated with common mental disorders.

An Interaction Effect of Life-Threatening Experience, Self-Efficacy, and Financial Resources on Quality of Life Among Chinese Middle-Aged and Older Women

The current study explores the interaction effect of adversities and self-efficacy at baseline on quality of life (QoL) at follow-up among middle-aged and older Chinese women. 531 women were interviewed in 2008 and 226 of them were re-interviewed a year later using Quality of Life Ladder (QoLL), General Self-Efficacy Scale (GSE), List of Threatening Experiences (LTE), Somatic Complaint Scale, and self-rated health. Respondents’ mean age at baseline was 55.7 (SD = 4.7, range: 50–78). Over a year’s time, respondents had a decline in quality of life and self-rated health (p < .001), experienced more life-threatening events (p < .05) and somatic complaints. The hierarchical multiple regression model, employed in the study, identifies three predictors of future quality of life after adding the interaction term ‘Previous LTE × Previous GSE × Previous household income’ — previous quality of life (β = .492, p < .001), previous LTE (β = -.292, p < .001), and the interaction term (β = .221, p < .05). This model explains 34.1% of the variance of future quality of life (Adjusted R2 = .341, p < .001). The findings suggests that respondents’ good self-appraisal of coping resources could moderate the impact of adversities on their future quality of life. Interventions for promoting positive psychological growth among middle-aged and older adults should cover four domains, i.e. event-related factors, environmental factors, personal factors, and cognitive and coping responses. Traditional Chinese wisdom emphasizes the importance of understanding the bad (‘Yin’—the shady side) and the good (‘Yang’—the sunny side) aspect of life events. Future research may explore the Yin Yang perspective on life-threatening experiences and its applications in cross-cultural quality of life studies in the era of globalization.