Long-term Psychological Outcomes Research Articles

Subjective effectiveness of ibogaine treatment for problematic opioid consumption: Short- and long-term outcomes and current psychological functioning.

Background and aimsVery few studies have reported the effectiveness of ibogaine as a treatment for chronic opioid use. Therefore, this study evaluated the acute subjective effects of ibogaine, outcomes on problematic opioid consumption, and the long-term associations with psychological functioning.MethodsUsing online data collection, 88 patients who received ibogaine treatment in Mexico between 2012 and 2015 completed our survey.ResultsMost participants (72%) had used opioids for at least 4 years and 69% reported daily use. Most (80%) indicated that ibogaine eliminated or drastically reduced withdrawal symptoms. Fifty percent reported that ibogaine reduced opioid craving, some (25%) reporting a reduction in craving lasting at least 3 months. Thirty percent of participants reported never using opioids again following ibogaine treatment. And over one half (54%) of these abstainers had been abstinent for at least 1 year, with 31% abstinent for at least 2 years. At the time of survey, 41% of all participants reported sustained abstinence (>6 months). Although 70% of the total sample reported a relapse following treatment, 48% reported decreased use from pretreatment levels and an additional 11% eventually achieved abstinence. Treatment responders had the lowest rates of depressive and anxious symptoms, the highest levels of subjective well-being and rated their ibogaine treatment as more spiritually meaningful compared with treatment non-responders.ConclusionThe results suggest that ibogaine is associated with reductions in opioid use, including complete abstinence, and has long-term positive psychological outcomes. Future research should investigate the efficacy of ibogaine treatment using rigorous longitudinal and controlled designs.

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional’s and patient’s perspectives: research protocol for a national multicentre mixed-methods prospective cohort study

IntroductionLiving donation accounts for over one-third of all kidney transplants taking place in the UK.1 The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney...

Psychosocial and behavioral impact of breast cancer risk assessed by testing for common risk variants: protocol of a prospective study

BackgroundThe ‘common variant, common disease’ model predicts that a significant component of hereditary breast cancer unexplained by pathogenic variants in moderate or high-penetrance genes is due to the cumulative effect of common risk variants in DNA (polygenic risk). Assessing a woman’s breast cancer risk by testing for common risk variants can provide useful information for women who would otherwise receive uninformative results by traditional monogenic testing. Despite increasing support for the utility of common risk variants in hereditary breast cancer, research findings have not yet been integrated into clinical practice. Translational research is therefore critical to ensure results are effectively communicated, and that women do not experience undue adverse psychological outcomes.MethodsIn this prospective study, 400 women with a personal and/or high risk family history of breast cancer will be recruited from six familial cancer centers (FCCs) in Australia. Eligible women will be invited to attend a FCC and receive their personal polygenic risk result for breast cancer. Genetic health professionals participating in the study will receive training on the return of polygenic risk information and a training manual and visual aids will be developed to facilitate patient communication. Participants will complete up to three self-administered questionnaires over a 12-months period to assess the short-and long-term psychological and behavioral outcomes of receiving or not receiving their personal polygenic risk result.DiscussionThis is the world’s first study to assess the psychological and behavioral impact of offering polygenic risk information to women from families at high risk of breast cancer. Findings from this research will provide the basis for the development of a new service model to provide polygenic risk information in familial cancer clinics.Trial registrationThe study was retrospectively registered on 27th April 2017 with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12617000594325; clinical trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372743).

Palliative Care Needs Assessment in the Neuro-ICU: Effect on Family.

Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds. Between March and October, 2015, surveys were mailed to family members of patients discharged from the neuro-ICU. Nearly half of surveys (n=91, 48.1%) were returned at a median of 4.7months. At the time of survey completion, mean Modified rankin scale score (mRS) of neuro-ICU patients was 3.1 (SD 2). Overall ratings of quality of care were relatively high (82.2 on a 0-100 scale) with 32% of family members meeting screening criteria for depressive syndrome. The primary outcome measuring family satisfaction, consisting of eight items from the Family Satisfaction in the ICU questionnaire, did not differ significantly between families of patients from either ICU service nor did family ratings of depression (PHQ-8) and post-traumatic stress (PCL-17). Among families of patients discharged from the neuro-ICU, the daily use of a palliative care needs checklist had no measurable effect on family satisfaction scores or long-term psychological outcomes. Further research is needed to identify optimal interventions to meet the palliative care needs specific to family members of patients treated in the neuro-ICU.

Using humor and boosting emotions: An affect-based study of managerial humor, employees’ emotions and psychological capital

Evidence from emerging scholarly investigations consistently points to managerial humor as fruitful new grounds to expand management knowledge and practice. In light of this, the present study examined managerial humor as an affective event at work that has short-term emotional and long-term psychological outcomes for employees. To test this empirically, we recruited a sample of 2498 Australian employees to participate in a field experience sampling study. We also considered the potential moderating effect of leader–member exchange on the humor–emotions relationship. Findings provide initial support for managerial humor as an affective event such that when employees perceived their manager’s humor as positive they reported experiencing positive emotions, and vice versa. Importantly, employees with high-quality relationships with their managers responded to their manager’s humor use with a greater number of positive emotions and fewer negative emotions than did employees with low-quality relationships with their managers. We argue that humor is an event that managers must responsibly manage in order to produce positive emotional experiences for employees and support healthy emotion regulation at work. We also discuss the conditions under which it is advisable for managers to use humor with employees, and suggest future research directions to develop this growing field of inquiry.

What Do We Know About Psychological Outcomes of Lymphoma in Adults?

Abstract. The goal of this review is to present the results of research on the influence of lymphoma on patients’ emotional status and cognitive functioning. A literature search was conducted to identify articles in English that investigated short- and long-term psychological outcomes of lymphoma and lymphoma treatment. Studies published prior to July 2016 were located by an electronic search using relevant databases such as ScienceDirect and PubMed. The search terms used included both medical subject headings and keywords such as “Hodgkin lymphoma,” “non-Hodgkin lymphoma,” “therapy,” “treatment,” “malignant,” “psychology,” “cognitive function,” “emotion,” “psychological adaptation,” “depression,” and “anxiety.” The retrieved publications were independently evaluated by two reviewers. Articles were selected based on the applicable titles and abstracts. The lists of eligible publications were compared and disagreements were resolved by discussion. Of the 1,418 articles identified in the search, we chose 39 publications, which in our opinion could be interesting or useful for psychologists. Studies show that lymphoma and its treatment lead to severe distress. Thirty-six percent of patients manifest symptoms of anxiety and depression, which are most often associated with the so-called “B-symptoms,” which mark poor prognosis or with side effects of chemotherapy such as nausea or vomiting. Reports also indicate that lymphoma patients may develop mild to severe cognitive decline. Its manifestations may range from benign problems with attention, thinking, and memory to severe cognitive impairment, that is, subcortical dementia. The etiology of intellectual deterioration in lymphoma has not been well described yet, but it may be related to the disease process or to the treatment. Additionally, literature demonstrates that lymphoma may lead to adverse changes in patient’s professional life such as resignation or early retirement.

Psychological Outcomes in Parents of Critically Ill Hospitalized Children

Parents of children in pediatric intensive care units (PICUs) are subjected to significant psychological stress. The purpose of this study was to determine the prevalence of, and factors associated with anxiety, depressive symptoms and decisional conflict in parents of children hospitalized in the PICU. The study employed a descriptive, cross-sectional design to investigate the psychological status of 118 parents of 91 children (74 mothers and 44 fathers) admitted to the PICU, using measures of anxiety (STAI), depression (CES-D), and decisional conflict (DCS). Using hospital data and self-administered questionnaires, information on child and parent characteristics and psychological outcomes were collected. Objective measures of parental sleep also were examined using actigraphy and sleep diaries. The research findings indicated that 24% of parents achieved scores characteristic of severe anxiety. Proportions of parents with symptoms indicative of major depression and significant decisional conflict were 51% and 26% respectively. For all psychological outcomes, higher levels of social support were protective. Inconsistency in sleep schedule and sleep location affected psychological outcomes and are possible targets for future interventions. Given evidence that parents of children admitted to the PICU are at risk for developing post-traumatic stress symptoms, future studies should examine the effects of hospitalization on long-term parental psychological outcomes. Screening for those at risk and implementing interventions to promote coping strategies and reduce decisional conflict may be beneficial. Pediatric nurses have a critical role in assessing parents' psychological distress and promoting family health during a child's hospitalization.

Combat amputees' health-related quality of life and psychological outcomes: A brief report from the wounded warrior recovery project.

This study extends what is known about long-term health-related quality of life (HrQoL) and other psychosocial outcomes (i.e., depression, posttraumatic stress disorder [PTSD]) among US military combat amputees serving in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. A total of 63 combat amputees were identified from the Wounded Warrior Recovery Project, a study assessing long-term self-reported HrQoL and psychological outcomes among those wounded during military service. Another 477 service members from the Wounded Warrior Recovery Project were identified as a comparison group (i.e., nonamputees with moderate to severe extremity injuries). After adjusting for age, time since injury, overall injury severity, and traumatic brain injury, amputees had poorer functional HrQoL than those in the nonamputee comparison group overall and in the specific area related to performance of usual activities, and, to some degree, chronic and acute symptoms, and mobility/self-care. On the other hand, depression and PTSD symptoms were not different for the two groups. Results suggest that when assessed over 5 years postinjury, on average, amputees have unique physical and functional limitations, yet do not report greater depression or PTSD symptoms than others seriously injured in combat. It may be that state-of-the-art integrated amputee care that includes support networks and emphasis on adjustment and psychological health may increase successful coping and adjustment, at least to a level that is on par with other types of serious combat injury. Epidemiologic/prognostic study, level III.

Long-term psychological outcomes of flood survivors of hard-hit areas of the 1998 Dongting Lake flood in China: Prevalence and risk factors

BackgroundAlthough numerous studies have indicated that exposure to natural disasters may increase survivors’ risk of post-traumatic stress disorder (PTSD) and anxiety, studies focusing on the long-term psychological outcomes of flood survivors are limited. Thus, this study aimed to estimate the prevalence of PTSD and anxiety among flood survivors 17 years after the 1998 Dongting Lake flood and to identify the risk factors for PTSD and anxiety.MethodsThis cross-sectional study was conducted in December 2015, 17 years after the 1998 Dongting Lake flood. Survivors in hard-hit areas of the flood disaster were enrolled in this study using a stratified, systematic random sampling method. Well qualified investigators conducted face-to-face interviews with participants using the PTSD Checklist-Civilian version, the Zung Self-Rating Anxiety Scale, the Chinese version of the Social Support Rating Scale and the Revised Eysenck Personality Questionnaire-Short Scale for Chinese to assess PTSD, anxiety, social support and personality traits, respectively. Logistic regression analyses were used to identify factors associated with PTSD and anxiety.ResultsA total of 325 participants were recruited in this study, and the prevalence of PTSD and anxiety was 9.5% and 9.2%, respectively. Multivariable logistic regression analyses indicated that female sex, experiencing at least three flood-related stressors, having a low level of social support, and having the trait of emotional instability were risk factors for long-term adverse psychological outcomes among flood survivors after the disaster.ConclusionsPTSD and anxiety were common long-term adverse psychological outcomes among flood survivors. Early and effective psychological interventions for flood survivors are needed to prevent the development of PTSD and anxiety in the long run after a flood, especially for individuals who are female, experience at least three flood-related stressors, have a low level of social support and have the trait of emotional instability.

Revival after Ebola: multidisciplinary assessment at 1 year, prospect and follow-up study of surviving patients from Ebola in Guinea (PostEboGui cohort)

Ebola virus disease (EVD) epidemic that spread in West Africa from the end of 2013 to early 2016 has reached more people than all past epidemics. Beyond care management of acute phase ill patients and measures for the control of the epidemic, the outcome of Ebola survivors became an important question as their number increased and raised new issues. A multidisciplinary prospective cohort of survivors in Guinea has been launched by IRD UMI 233 and Donka National Hospital, Conakry, Guinea, to assess the long-term clinical, psychological, sociological, immunological, and viral outcomes potentially related to EVD. This paper describes PostEboGui Programme, constraints and changes to the initial proposal, participants, first results, and new issues, 1 year after its start, in a descriptive and critical view. We started also to work on ethical aspects in the context of epidemics and of mass interventions with a risk of overinvestigation of patients.

Post-traumatic cognitions as a mediator of the relationship between sense of coherence and post-traumatic stress disorder after motor vehicle accidents

ObjectiveIndividuals who experience a motor vehicle accident (MVA) are at increased risk for psychological problems, particularly post-traumatic stress disorder (PTSD). Among a wide range of pre-trauma cognitions, the sense of coherence (SOC) is considered as a good predictor of effective post-traumatic adaptation. However, the mechanism underlying the relationship between this resilience factor and the intensity of PTSD so far has not been fully explored. There arises the question of whether SOC protects only from the development of PTSD symptoms in the early post-traumatic period, or also from further development of the symptoms over time. Furthermore, has SOC an impact on PTSD directly, or through a third explanatory variable? This longitudinal study offers a contribution to the discussion. In searching for a potential mediator, the model of trauma-related beliefs was taken into consideration. MethodData were drawn from 289 MVA survivors. The first measurement took place one to six months after the injury; the second was taken a year later. The mediation hypotheses were tested using structural equation modelling. The path analysis method was carried out using LISREL 8.72. ResultsA path analytic modelling approach showed that SOC predicted the subsequent intensity of PTSD over and above what could be predicted from the initial symptom levels; however, the relationship was mediated by negative post-traumatic cognitions. Among them, only negative cognitions about self played a statistically significant mediating role. ConclusionsOur findings highlight the inverse relationship between SOC and later PTSD symptoms, mediated by post-traumatic cognitions. The set of negative cognitions about self, strongly related to other post-traumatic appraisals, plays the most influential mediating role. This confirms the suggestion, found in the current literature, that negative cognitions about self may have some hierarchical preference that drives other belief systems. Moreover, our findings present SOC as a resilience factor that provides added value in predicting the long-term psychological outcomes of trauma. It protects against PTSD symptoms development and escalation over time through a specific cognitive mechanism. In consequence, changes in cognitions seem to constitute one of the basic mechanisms of the development and maintenance of PTSD symptoms. This fully supports the decision to include post-traumatic negative cognitions and alteration in mood in the diagnosis of PTSD in DSM-5.

Health-Related Quality of Life and Psychological Distress in Patients With Early-Stage Hepatocellular Carcinoma After Hepatic Resection or Transplantation.

The aim of our study was to compare the post-operative health-related quality of life in patients with small hepatocellular carcinoma (HCC; within the Milan criteria) after liver resection or liver transplantation. From August 2000 to December 2010, 207 patients were diagnosed with early HCC within the Milan criteria. We divided these patients into 2 groups according to their curative schedule: the liver transplantation group (n= 95) and the liver resection group (n= 110). We compared the baseline characteristics of these 2 groups of patients, after which we focused on comparing the post-operative health-related quality of life (HRQOL) and psychological outcome in these 2 groups. The demographics of the patients in the 2 groups were similar, and there were no significant differences except for higher family income in the transplantation group (P= .002).With long-term follow-up, there were no significant differences in the 8 domains of the HRQOL and the 9 domains of the psychological outcome measure between the 2 groups. Both the transplantation and resection groups exhibited good outcomes in both HRQOL and psychological outcome measures. Several years after operation, early-stage HCC patients who underwent liver transplantation or resection had similar long-term HRQOL and psychological outcomes.

Long-Term Follow-Up of Transgender Women After Secondary Intestinal Vaginoplasty.

Intestinal vaginoplasty with a sigmoid colon or ileal segment is an established surgical technique for vaginal reconstruction. Little has been reported on long-term (functional) outcome and postoperative quality of life. To assess the surgical and long-term psychological outcomes of secondary intestinal vaginoplasty performed from 1970 through 2000 in transgender women. Transgender women who underwent intestinal vaginoplasty from 1970 through 2000 were identified from our hospital registry. Demographics, surgical characteristics, complications, and reoperations were recorded. Traceable women were invited to fill out a set of questionnaires (quality-of-life questionnaire, Female Sexual Function Index, Amsterdam Hyperactive Pelvic Floor Scale for Women, Female Genital Self-Imaging Scale, and self-evaluation of vaginoplasty questionnaire) and attend the outpatient clinic for physical, endoscopic, and histologic examination of the neovagina. Primary outcomes were complications, reoperations, self-perceived quality of life, and functional and esthetic self-evaluation. Twenty-four transgender women were identified who underwent intestinal vaginoplasty as a secondary procedure from 1970 through 2000. There were no intraoperative complications. Three intestinal neovaginas were surgically removed because of postoperative complications. Nineteen women (79%) underwent at least one genital reoperation, most commonly introitus plasty (n= 13, 54%). Five women were deceased at time of analysis. Nine women consented to partake in the study (median age= 58 years, range= 50-73; median postoperative time= 29.6 years, range= 17.2-34.3). They were generally satisfied with life and scored 5.9 of 7 on a subjective happiness scale. Neovaginal functionality was rated as 7.3 and appearance as 7.4 of10. In our institution, intestinal vaginoplasty before 2000 was always performed as a revision procedure after a previous vaginoplasty had failed. Although surgical corrections were frequently necessary, women reported satisfaction with the surgical outcome and with life in general.

A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury.

To examine mortality, psychological impact, coping strategies, and cognitive appraisals in a cohort of individuals with spinal cord injury from 12 weeks postinjury to >21 years post-hospital discharge. This longitudinal, multiple-wave panel study accounted for 50.6% of Kennedy et al.'s (2000) original cohort. Twenty-two participants consented to take part in the current study, and data were collected from the COPE, Beck Depression Inventory, Functional Independence Measure, and a new measure of appraisal: Appraisals of DisAbility: Primary and Secondary Scale (ADAPSS). A further 22 individuals were deceased, giving a total sample of 44 for examining longitudinal factors in relation to mortality. The 22 deceased individuals were found to have significantly higher depression and anxiety at Week 12 than the 22 individuals who participated in the current study. There were significant increases in use of "positive" coping strategies and significant decreases in "negative" strategies. A significant regression model found coping strategies at Week 12 predicted 37% of variance in depression at 21-plus years. Depression and coping strategies at Week 12 were found to predict variance in cognitive appraisals at 21 years. The findings suggest that psychological factors, such as depression, and aspects of coping strategies may contribute to premature mortality. Further research is needed to develop interventions that focus on protective psychological factors to reduce mortality risk following SCI. Coping strategies in the early stages of rehabilitation are an important predictor of both long-term psychological outcomes and appraisals, and this has clinical implications for psychological aspects of rehabilitation.

Psychological disorders after coronary artery by-pass surgery: a one-year prospective study

Coronary artery by-pass surgery (CABG) is often followed by anxiety and depression that require early identification in order to provide adequate psychological support. The predictive role of tests administered soon after CABG on long-term psychological outcomes has been only incompletely explored. AIM, DESIGN AND METHODS: Aim of this study was to assess post-operative and 12-month persistence of psychological disorders by means of the Minnesota Multiphasic Personality Inventory (MMPI-2) and the depression and state and trait anxiety scales of the Cognitive Behavioural Assessment (CBA-2.0) in 118 male patients admitted to cardiac rehabilitation after CABG. Early after CABG we observed a high prevalence of depression (11.8% by MMPI-2 and 12.7% by CBA) and state anxiety (23.5%). At 1-year the MMPI-2 scale D indicated stable mean score and high scores at entry were predictive of persistent depression. Conversely the CBA-2.0 scale QD score significantly decreased (from 3.86 +/- 3.19 to 2.91 +/- 3.45, p = 0.017). Also ST1 state anxiety significantly decreased (from 35.17 +/- 6.95 to 32.55 +/- 6.72, p = 0.003) whereas ST2 trait anxiety was stable. We found no association between psychometric results and ventricular function, number of grafts or time since diagnosis of coronary artery disease. State anxiety and depression by CBA significantly decreased 1-year after CABG; conversely trait anxiety and depression, investigated by MMPI-2, a more specific personality questionnaire, were stable. High scores for the depression in the scale D of MMPI-2 early after CABG seem to be predictive of the persistence of the disorder at 1-year.

Factors associated with long-term functional and psychological outcomes in persons with moderate to severe traumatic brain injury.

To examine factors impacting long-term functional and psychological outcomes in persons with moderate-severe traumatic brain injury. A prospective cross-sectional study (n = 103) assessed the long-term (up to 5 years) impact of traumatic brain injury on participants' current activity and restriction in participation using validated questionnaires. Participants' median age was 49.5 years (interquartile range (IQR) 20.4-23.8), the majority were male (77%), and 49% had some form of previous rehabilitation. The common causes of traumatic brain injury were falls (42%) and motor vehicle accidents (27%). Traumatic brain injury-related symptoms were: pain/headache (47%), dizziness (36%), bladder/bowel impairment (34%), and sensory-perceptual deficits (34%). Participants reported minimal change in their physical function and cognition (Functional Assessment Measure: motor (median 102, IQR 93-111) and cognition (median 89, IQR 78-95)). Participants were well-adjusted to community-living; however, they reported high levels of depression. Factors significantly associated with poorer current level of functioning/well-being included: older age (≥ 60 years), presence of traumatic brain injury-related symptoms, a lack of previous rehabilitation and those classified in "severe disability categories" at admission. Caregivers reported high levels of strain and burden (55%). Cognitive and psychosocial problems are more commonly reported than physical disability in the longer-term. A greater focus on participation and ageing with disability in these persons is needed.

The long-term neurodevelopmental and psychological outcomes of gastroschisis: A cohort study

ObjectivesPrevious gastroschisis specific neurodevelopmental studies have focused on the first 3years of life. The aim of this study was to assess the intellectual, behavioral and neurological outcomes of older children and adolescents born with gastroschisis. Study designOf 99 gastroschisis survivors born in Western Australia, 1992 to 2005, and who were at least 5years old, 42 agreed to take part in this study. The study assessed: intellectual ability, with age appropriate Wechsler intelligence scales; neurological status; hearing; vision; behavioral status with the Strengths and Difficulties Questionnaire (SDQ); and parenting style with the Parenting Relationship Questionnaire (PRQ). All results were compared to normative means. ResultsMedian age at follow-up was 10years (range 5–17). No child had evidence of cerebral palsy or hearing loss; 1 child had amblyopia. Psychometric tests were completed in 39 children: mean full scale IQ was 98.2 (standard deviation [SD] 10.7); the working memory index was the only subscale to show a significant decrease from the normative mean (mean 95.5, SD 12.4, p=0.038). The mean SDQ behavioral scores were significantly lower for 3 of 5 domains and the Total Difficulties score. PRQ scores were significantly abnormal for 4 of 7 domains: Communication, Discipline, Satisfaction with School and Relational Frustration. ConclusionsOverall intellectual abilities were within a normal range. The decrease in working memory index and the behavioral and parenting relationship impairments could be an effect of perinatal factors, gastroschisis management and complications or the complexity of the socio-economic environment.

Personality, self-perceptions, and daily variability in perceived usefulness among older adults.

Age-based self-stereotyping is associated with a variety of long-term physical health and psychological well-being outcomes for older people. However, little is known about how older individuals' day-to-day experiences of functional limitations may be related to concurrent self-appraisals on dimensions representing negative age stereotypes. We examined how distal personality traits and global self-perceptions of aging at baseline affect processing of daily experiences relevant to age-based self-stereotyping over time. Data from the 100-day Internet-based Personal Understanding of Life and Social Experiences (PULSE) study (N = 98, age = 52 - 88) were used to examine the link between personality and self-perceptions of aging to differences in 2 age stereotype-relevant daily experiences: cognitive limitations and variation in usefulness. Multilevel random coefficient models suggested that personality and self-perceptions of aging were associated with the level of usefulness and the frequency of reporting trouble concentrating during the study period. Daily experiences of trouble concentrating were significantly associated with lower perceived usefulness on that day, and conscientiousness moderated this relationship. By linking personality and global self-perceptions to daily experiences, our findings contribute toward understanding self-stereotyping processes by which personality and perceptions may affect long-term outcomes.

"The flames engulfed us from all sides and the air roared" - A systematic diagnostic evaluation of the survivors of the "Hamburg Firestorm" of 1943

In an interdisciplinary research project at Hamburg University, psychoanalysts and historians investigated the long-term psychological effects of World War II bombing attacks during the "Hamburger Feuersturm" (Operation Gomorrha) in 1943. The paper looks at the experiences from that time and the different modalities of how they were processed and compares them with the mental repercussions today. Evaluation of completely transcribed interviews with 31 female and 29 male contemporary witnesses (at the time of the firestorm between 3 and 27 years old) using "systematic diagnostic assessment."A matrix of the rated diagnostic characteristics was subjected to factor analysis and scales of severity were established in order to calculate correlation coefficients and to determine the degree of interdependence of the diagnostic characteristics. The primary experience of those interviewed was being bombed out of their homes, often with a complete loss of all personal belongings. In particular, the sight of dead bodies has remained in their thoughts to this day. The persistent psychological consequences include anxiety, nightmares, and an aversion to certain noises and smells that continue to be associated with the firestorm. The initial experiences after the war proved to be crucial to their subsequent well-being. Discussions of their dreadful experience remained mostly rare, but when they did occur, they were beneficial to their overcoming the associated trauma. We successfully quantified the essential qualitative information. Long-term psychological outcome appears to depend not only on the severity and circumstances of the - often traumatic - experiences during the war. The individual experiences in the years after the war held an important sway over subsequent well-being to the present day.

Long-term outcomes after severe shock.

Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P < 0.001), whereas mental health scores were similar to population norms. Nineteen percent of the patients had symptoms of depression, 39% had symptoms of anxiety, and 8% had symptoms of posttraumatic stress disorder. Thirty-six percent were disabled, and 17% were working full-time. Early survivors of severe shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.