Long-term Psychological Symptoms Research Articles

Subclinical, long-term psychological symptoms following sport-related concussion: are athletes more depressed than we think?

ABSTRACT Introduction In adolescent and collegiate athletes with sport-related concussion (SRC), we sought to evaluate the prevalence and predictors of long-term psychological symptoms. Methods A cohort study was conducted of athletes 12–24-year-old diagnosed with SRC between November 2017 and April 2022. Athletes/proxies were interviewed on psychological symptoms (i.e. anger, anxiety, depression, and stress). Participants who scored ≥75th percentile on one or more PROMIS (Patient-Reported Outcomes Measurement System) measures were operationalized to have subclinical, long-term psychological symptoms. Uni/multivariable regressions were used. Results Of 96 participants (60.4% male), the average age was 16.6 ± 2.6 years. The median time from concussion to interview was 286 days (IQR: 247–420). A total of 36.5% athletes demonstrated subclinical, long-term psychological symptoms. Univariate logistic regression revealed significant predictors of these symptoms: history of psychiatric disorder (OR = 7.42 95% CI 1.37,40.09), substance use (OR = 4.65 95% CI 1.15,18.81), new medical diagnosis since concussion (OR = 3.43 95% CI 1.27,9.26), amnesia (OR = 3.42 95% CI 1.02,11.41), other orthopedic injuries since concussion (OR = 3.11 95% CI 1.18,8.21), age (OR = 1.24 95% CI 1.03,1.48), days to return-to-play (OR = 1.02 95% CI 1.00,1.03), and psychiatric medication use (OR = 0.19 95% CI 0.05,0.74). Multivariable model revealed significant predictors: orthopedic injuries (OR = 5.17 95% CI 1.12,24.00) and return-to-play (OR = 1.02 95% CI 1.00,1.04). Conclusions Approximately one in three athletes endorsed long-term psychological symptoms. Predictors of these symptoms included orthopedic injuries and delayed RTP.

Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study

ObjectiveTo compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors. DesignProspective, multicentre observational cohort study. SettingFour tertiary medical-surgical ICUs in Australia. ParticipantsIntubated and non-intubated adult ICU survivors. Main outcome measuresPrimary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire. ResultsOf the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66–3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53–3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions. ConclusionsNearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.

Development of a checklist of short-term and long-term psychological symptoms associated with ketamine use.

BackgroundKetamine is an increasingly popular drug of abuse in China but there is currently no method for classifying the psychological effects of ketamine in individuals with ketamine dependence.AimDevelop a scale that characterizes the acute and long-term psychological effects of ketamine use among persons with ketamine dependence.MethodsWe developed a preliminary symptom checklist with 35 dichotomous (‘yes’ or ‘no’) items about subjective feelings immediately after ketamine use and about perceived long-term effects of ketamine use that was administered to 187 inpatients with ketamine dependence recruited from two large hospitals in Guangzhou, China. Exploratory factor analysis (EFA) was conducted on a randomly selected half of thesample to reduce the items and to identify underlying constructs. Confirmatory factor analysis (CFA) was conducted on the second half of the sample to assess the robustness of the identified factor structure.ResultsAmong the 35 symptoms, the most-reported acute effects were ‘floating or circling’ (94%), ‘euphoric when listening to rousing music’ (86%), and ‘feeling excited, talkative, and full of energy’ (67%). The mostreported long-term symptoms were ‘memory impairment’ (93%), ‘personality changes’ (86%), and ‘slowed reactions’ (81%). EFA resulted in a final 22-item scale best modelled by a four-factor model: two factors representing chronic symptoms (social withdrawal and sleep disturbances), one about acute psychoticlike symptoms, and one that combined acute drug-related euphoria and longer-term decreased libido. CFA showed that these 4 factors accounted for 50% of the total variance of the final 22-item scale and that the model fit was fair (Goodness of Fit Index, GIF=83.3%; Root Mean Square Error of Approximation, RMSEA=0.072).ConclusionA four-factor model including social withdrawal, sleep disturbance, psychotic-like symptoms, and euphoria at the time of drug use provides a fair description of the short-term and long-term psychological symptoms associated with ketamine use. Future work on the 22-item version of the scale with larger samples is needed to confirm the validity of this 4-factor structure, to assess the scale’s test-retest reliability, and to determine whether or not it can be useful in the differential diagnosis and monitoring of treatment of individuals with ketamine dependence.

Peri-Traumatic Dissociation, Post-Traumatic Negative Beliefs, and Poor Social Support As Predictors of Long-Term Psychological Symptoms Following a Natural Disaster

본 연구는 자연재난 생존자들의 장기적인 외상 후 스트레스증상, 불안증상 및 우울증상을 예측하는데 있어 인구통계학적 및 심리사회적 변인들의 역할을 검토하기 위하여 수행되었다. 강원도 P군에 거주하는 집중호우 피해 주민 148명을 대상으로 재난 발생 2년 4개월 후에 그들의 인구통계학적 특징, 외상 후 스트레스증상, 불안증상, 우울증상, 과거 외상 노출, 외상 당시의 고통과 해리, 외상 후의 부정적 신념 및 사회적 지지 부족에 관한 자료를 수집하였다. 위계적 중다회귀분석 결과, 외상 후 스트레스증상에 대한 유의한 예측요인으로는 외상 당시의 해리, 외상 후 부정적 신념 및 연령, 그리고 불안증상에 대한 유의한 예측요인으로는 외상 후 부정적 신념, 외상 당시의 해리, 외상 후의 사회적 지지 부족 및 배우자와의 동거 여부로 밝혀졌다. 우울증상에 대한 유의한 예측요인들은 외상 후의 부정적 신념, 배우자와의 동거 여부, 사회경제적 지위, 외상 당시의 해리 및 연령이었다. 이 결과들은 자연재난 생존자들의 장기적인 심리적 후유증을 예측하고 예방하는데 있어 연령, 배우자와의 동거 여부 및 사회경제적 지위 뿐 아니라, 외상 당시 및 외상 이후의 다양한 심리사회변인들이 중요한 역할을 할 가능성을 시사한다. 끝으로, 본 연구의 의의와 제한점들에 관해 논의하였다.

Long-term effects of sulfur mustard on civilians’ mental health 20 years after exposure (The Sardasht-Iran Cohort Study)

BackgroundSulfur mustard (SM) is an alkylating agent that induces short and long term toxicity on various organs. The aim of this study was to assess the long-term psychological symptoms among samples of exposed to sulfur mustard gas compared with unexposed civilians 20 years after exposure.MethodsThis historical cohort study was conducted on 495 civilians of Sardasht and Rabat in two age matched groups, including 367 sulfur mustard exposed participants from Sardasht and 128 unexposed subjects from Rabat. Psychological symptoms was assessed using the Symptom Check List-90 Revised (SCL-90-R) including measures of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism providing three global distress indices namely: Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Index (PSDI). Comparison was made between exposed and unexposed civilians.ResultsThere were significant differences in somatization (P = 0.002), obsessive-compulsive (P = 0.031), depression (P = 0.007), anxiety (P = 0.042), and hostility (P = 0.002), between the exposed and unexposed groups. In addition there were significant differences between two groups concerning the GSI (P = 0.045) and the PSDI (P < 0.001). The differences between two groups in other subscales were not significant.ConclusionsThe findings from this study showed that civilians who exposed to sulfur mustard gas were suffering from a number of psychological symptoms even 20 years after exposure. Providing mental health services and more resource allocation for this community are highly recommended.

Parental physical and psychological aggression: Psychological symptoms in young adults

Objective The purpose of the present study was to evaluate the relationship between various levels of parent-child physical violence and psychological symptoms reported by college students, while controlling for demographic variables, severity and frequency of violence, and co-occurrence of parental psychological aggression. Method Participants included 298 college students ranging in age from 18 to 27 years. Participants completed a demographic information form, the Brief Symptom Inventory (BSI), and the Parent-Child Conflict Tactics Scale (CTSPC). Results Results of analysis of variance and multivariate analysis of variance indicated that individuals in the child physical abuse group obtained higher BSI scores compared to individuals in the corporal punishment and no violence groups. Few differences were observed between mild and severe corporal punishment groups. Multiple regression analyses indicated that when frequency of corporal punishment, child physical abuse, and psychological aggression, along with demographic variables, were considered simultaneously, psychological aggression was the most unique predictor of BSI scores. Conclusions The findings suggest that severe forms of physical violence were associated with long-term psychological symptoms. When demographic variables and the frequency of several parent aggression variables were considered simultaneously, however, psychological aggression was most predictive of psychological outcome. These findings suggest that messages communicated to a child via psychological aggression may be more important in contributing to psychological outcome than the actual occurrence of physical violence toward the child. Practice implications The current study supports the premise that severe physical aggression experienced in childhood is associated with serious psychological consequences in adulthood. In contrast, individuals who experienced less severe forms of parent-child violence, such as corporal aggression, exhibited similar symptom levels to those reporting no parent-child violence. When severe physical aggression, corporal aggression, and psychological aggression were considered simultaneously, however, psychological aggression emerged as the most unique predictor of psychological outcome. Researchers and clinicians who work with adults reporting childhood histories of severe parent-child violence should be aware of the importance of parent-child psychological aggression in contributing to psychological outcome.

Intra‐operative awareness in children and post‐traumatic stress disorder*

Adults who experience intra-operative awareness can develop disturbing long-lasting after-effects, such as daytime anxiety, sleep disturbances, nightmares, flashbacks and, in the worst case, a post-traumatic stress disorder (PTSD). It is unknown whether intra-operative awareness has a similar psychological impact in children. We designed the present study in order to evaluate the incidence of psychological symptoms in children who had either confirmed or possible intra-operative awareness. Attempts were made to locate 11 children who had been identified in a previous study, approximately 1 year following their experience. A PTSD questionnaire was administered to the children and their parents in order to detect any long-term or short-term psychological symptoms (the 1-month postoperative data were evaluated retrospectively). Factors believed to be associated with PTSD, such as intra-operative perceptions, the children's temperament and cognitive strategies, and the parents' coping strategies, were also analysed. Seven children were successfully located and interviewed and no short or long-term psychological symptoms were identified. None of them offered negative appraisals of the traumatic event and none had displayed dysfunctional behaviour or cognitive strategies. Thus, none of them had developed a PTSD syndrome. In contrast with what has been reported in adults, these children claimed not to have experienced major pain, terror or helplessness during their surgery. Despite the small sample size, the results of the present study suggest that children suffer less psychological sequelae than adults following intra-operative awareness. This may be due to the fact that the children reported less frightening intra-operative sensations as compared with the adults, and had less understanding of the anaesthesia procedure, and this may have influenced their appraisal of their awareness and protected them from the full impact of this potentially traumatic experience.

Psychological debriefing is a waste of time.

People who experience serious traumatic events may become distressed and are at risk of developing psychological illness. Because of the perceived need to ease the distress and to prevent chronicity, various forms of psychological therapy have been deployed. One such therapy is psychological debriefing. Some claim that it is helpful, others claim it may not do any good but at least it does no harm, but still others claim that it increases the risk of people developing long-term psychological symptoms following a traumatic event. Statutory agencies, charities and commercial organisations offer their services to victims following traumatic events. Fearing litigation, some companies require their employees to undergo debriefing following certain incidents. But is psychological debriefing the right treatment? Is it cost-effective? And what of the concerns that it may lead to long-term problems? Could litigation be joined because of exposure to psychological debriefing? We asked two experts who have published widely on the subject – Professor Simon Wessely and Professor Martin Deahl – to debate the proposition that psychological debriefing is a waste of time.