Occurrence Of Posttraumatic Stress Disorder Research Articles

Analysis of treatment methods for victims of torture in Kenya and East Africa Region.

In this article, a comparative study of multisensory trauma processing (MTP) and conventional treatment (CT) on victims of torture/trauma (VOTs) for Kenyan citizens and refugees from East African Region has been undertaken. Kenyan VOTs were selected from the rosters of People Against Torture (PAT) and Release Political Prisoners (RPP). Refugee VOTs were selected from the United Nations High Commission for Refugees (UNHCR) and Urban Refugee Program implemented by GOAL, Kenya. Participants were randomly assigned to the two (MTP and CT) conditions, and the Stress State Inventory (SSI) scores were used to measure changes in posttraumatic stress disorder (PTSD) symptoms. Data values for 34 Kenyan and 35 refugee VOTs were recorded and analyzed. The study confirms the occurrence of PTSD in both samples. The results revealed that PTSD prevalence was 56% among Kenyan and 77% among refugee VOTs. Both treatments reduced SSI scores and PTSD symptoms in the participants. The study provides preliminary evidence that MT...

Status of Oral Ulcerative Mucositis and Biomarkers to Monitor Posttraumatic Stress Disorder Effects in Breast Cancer Patients

This study was designed to assess oral ulcerative mucositis, C-reactive protein, blood pressure, heart rate and thyroid function in breast cancer patients in relation to the occurrence of posttraumatic stress disorder (PTSD). A total of 120 female breast cancer patients and women 100 healthy subjects were enrolled in this study. PTSD status was assessed by questionnaire. Before and after treatment (modified radical mastectomy and chemotherapy), serum samples were collected and measured for levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) and high-sensitivity C-reactive protein (hs-CRP) by ELISA. Oral ulcerative mucositis was evaluated by the number and duration of oral ulcers and the degree of pain. Breast cancer patients experienced long-term PTSD and had elevated serum T3 and T4 levels. Patients experienced more severe pain and longer duration of oral ulcers compared with the healthy group. Oral ulcers were significantly associated with PTSD score in terms of the number of ulcers (p=0.0025), the degree of pain (p<0.0001) and the duration of ulcers (p<0.0001). These findings support that thyroid function is altered in breast cancer patients with PTSD. Elevation of T3 and T4 and oral ulcerative mucositis might be indicative of the emotional status of breast cancer patients.

Paranoia and post-traumatic stress disorder in the months after a physical assault: a longitudinal study examining shared and differential predictors

Being physically assaulted is known to increase the risk of the occurrence of post-traumatic stress disorder (PTSD) symptoms but it may also skew judgements about the intentions of other people. The objectives of the study were to assess paranoia and PTSD after an assault and to test whether theory-derived cognitive factors predicted the persistence of these problems. At 4 weeks after hospital attendance due to an assault, 106 people were assessed on multiple symptom measures (including virtual reality) and cognitive factors from models of paranoia and PTSD. The symptom measures were repeated 3 and 6 months later. Factor analysis indicated that paranoia and PTSD were distinct experiences, though positively correlated. At 4 weeks, 33% of participants met diagnostic criteria for PTSD, falling to 16% at follow-up. Of the group at the first assessment, 80% reported that since the assault they were excessively fearful of other people, which over time fell to 66%. Almost all the cognitive factors (including information-processing style during the trauma, mental defeat, qualities of unwanted memories, self-blame, negative thoughts about self, worry, safety behaviours, anomalous internal experiences and cognitive inflexibility) predicted later paranoia and PTSD, but there was little evidence of differential prediction. Paranoia after an assault may be common and distinguishable from PTSD but predicted by a strikingly similar range of factors.

Prediction of Trauma-Related Disorders

In the month following a motor vehicle accident, the rate of posttraumatic stress disorder (PTSD) and other trauma-related disorders (ie, mood, other anxiety disorders, and substance use disorders) may reach 30%.1 From a clinical perspective, there is an unmet need to develop screening tools that can help identify individuals at risk of developing such disorders. The Peritraumatic Distress Inventory (PDI) is a 13-item self-report measure—validated in several languages—that has been shown in several studies to predict the development of posttraumatic stress symptoms or disorder.2–4 In a prospective study of 79 motor vehicle accident victims, Nishi et al5 proposed an optimum cutoff point of 23 for the PDI to predict acute PTSD 1 month after the accident. However, to this day, the measure has not been used to predict the full spectrum of trauma-related disorders. The aim of this study was to fill that gap. Method. The study, approved by an independent ethics committee, included 211 subjects consecutively hospitalized in a Trauma Center following a motor vehicle accident from January 2003 to July 2006. The PDI was administered within 5 days of admission after written informed consent was obtained. Six weeks after the accident, the patients underwent a semistructured PTSD diagnostic interview6 as well as the Mood, Anxiety, and Substance Use Disorders sections of a structured psychiatric interview7 by trained psychiatrists. Partial PTSD as described by Blanchard et al8 was also screened for. Subjects with a history of posttraumatic amnesia were excluded. Nineteen subjects were lost at the 6-week follow-up and therefore dropped from the analyses. Results. The final cohort consisted of 192 subjects, 137 adult men and 55 women. The mean age of subjects was 35.14 years (SD = 15.39). Injury severity was classified as mild (10%), moderate (49%), or severe (41%). In the final cohort, 154 subjects fulfilled DSM-IV-TR criteria A1 and A2 for trauma exposure. The mean PDI total score was 15.68 (SD = 8.71). At the follow-up, 66 patients fulfilled criteria for partial (n = 31) or full (n = 35) PTSD, 19 for major depressive disorder, 10 for at least 1 anxiety disorder, and 3 for a psychoactive substance disorder. No association was found between injury severity and PTSD (χ2 = 0.96, df = 1, NS). The PDI score was, however, significantly associated with an increased risk of acute PTSD (χ2 = 5.15, df = 1, P = .02). According to the occurrence of traumatic events, receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.7 (Figure 1). The optimum predictive cutoff point of the PDI was a score of 14 (sensitivity 68%, specificity 61%). On the one hand, 90% of the victims with a PDI score > 28 developed PTSD or partial PTSD at follow-up. On the other hand, 90% of those with a score < 7 did not develop PTSD. In order to detect PTSD or partial PTSD 6 weeks later, we propose a cutoff score of 14 (PTSD: sensitivity 84% and specificity 47%, AUC 0.6; partial PTSD: sensitivity 73% and specificity 60%, AUC 0.7). Figure 1 Receiver Operating Characteristic (ROC) Curve for Occurrence of PTSD and PDI Scorea The PDI could be a useful tool for screening individuals at risk of developing trauma-related disorders. We recommend that trauma survivors with a PDI score 28 would need immediate care and follow-up. Finally, for those with a score of 7 through 28, we propose a checkup after a few weeks.

Victimization and PTSD in an Indian youth sample from Pune City

Background: Indian adolescents are presumably exposed to a range of potentially traumatizing and negative life events. However, the knowledge on this area is relatively sparse. The present study aims to investigate the prevalence of exposure to potentially traumatizing and negative life events and the occurrence of Posttraumatic Stress Disorder (PTSD) among a specific sample of Indian adolescents. Method: A sample of 411 Indian 9th graders, (M = 14.15 years) from two private schools in Pune City answered a questionnaire about 1) socio-demographical background and 2) the direct or indirect exposure to 20 specific, potentially traumatizing and negative life events. Also, they filled out Part IV of the Harvard Trauma Questionnaire (HTQ-IV) to assess their level of PTSD-symptoms. Results: 70% of the females and 85% of the males had been exposed to or witnessed at least one traumatizing or negative life event. The mean number of experienced events was 2.5. The most common events were: death of someone close, traffic accidents, serious illness, witnessing the injury or killing of others, and coming close to being injured or killed. The prevalence of PTSD was 10%. Males reported higher direct as well as indirect exposure than females to all events, while no significant gender difference was found in the prevalence of PTSD. Living in a single-parent household meant increased risk of developing PTSD. Conclusion: Exposure to potentially traumatizing events was comparable to that seen in similar studies in Western European youth samples. Prevalence of PTSD was also in the same range. This may be attributable to a number of protective factors associated with the specific sample. Males were exposed to more potentially traumatizing events than females, but contradictory to most other studies, no gender difference in prevalence of PTSD was seen. These differences in comparison to earlier studies might reflect cultural and national circumstances that distinguish this Indian sample from Western European countries previously investigated.

Neuroticism and post-traumatic stress disorder: a prospective investigation

Neuroticism has been consistently correlated with the post-traumatic stress disorder (PTSD) response to traumatic events. Interpretation of these findings is limited by the retrospective nature of these findings: neuroticism was measured after the trauma had occurred. The prospective association of neuroticism with PTSD has not been examined (the relationship of neuroticism with PTSD symptoms was examined in a few prospective studies). We evaluate prospectively the relationship of neuroticism, measured at baseline, with the cumulative occurrence of PTSD during the subsequent 10 years, using data from a longitudinal epidemiological study of young adults. A sample of 1007 young adults randomly selected from the membership of a large health maintenance organization in southeast Michigan was assessed at baseline and followed up at 3, 5 and 10 years later. We conducted a series of multinomial logistic regressions to estimate the relative risk (RR) of exposure to trauma and PTSD by neuroticism at baseline, adjusting for history of major depression (n = 990). During the 10-year follow-up, 50.2% of the sample experienced traumatic events and 5.2% developed PTSD. Neuroticism score at baseline increased significantly the RR of PTSD response to trauma. Additional analysis revealed that, among persons with history of major depression at baseline, RR for PTSD associated with neuroticism was equal to the null value of 1, but was increased significantly among those with no history of major depression. The results confirm the role of neuroticism as diathesis in the PTSD response to traumatic experiences.

Wie traumatisiert sind die Kinder des 2. Weltkrieges? Der Zusammenhang von Alter bei Flucht und Vertreibung und aktuellen posttraumatischen Belastungssymptomen

Traumatic events experienced in childhood can be reactivated in older age. The present study investigates the relation of age during flight and forced displacement within World War II (WWII; 2-7 years, 8-13 years, 14-20 years) and the current occurrence of posttraumatic stress disorder (PTSD). Traumatic events and current posttraumatic stress symptoms were assessed by the Harvard Trauma Questionnaire and the Impact of Event Scale-revised. Mean age of participants (N=169) was 73.76 years (SD=4.18). The eldest group reported most war-related traumatic events. In each age group a one-week-prevalence for a full PTSD of 10-11% was found. The prevalence for both full and subthreshold PTSD was higher for the age group 14-20 years (60.5%) compared to the younger age groups (33-35%). People, who experienced WWII as adolescents, show a dose-response-effect indicated by a higher prevalence for subthreshold PTSD.

PTSD and depression following armed robbery: Patterns of appearance and impact on absenteeism and use of health care services

Armed robbery is a sudden, life-threatening event affecting the victims' mental health. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in this population have rarely been studied. The objectives of the study were to assess the occurrence of PTSD and MDD in victims of armed robbery, and to evaluate occupational functioning and use of health care services. Eighty-six convenience store employees, victims of armed robbery, were evaluated within days after the robbery, and 1 and 3 months after. A validated diagnostic interview (SCID-I) was used. Data about sick leave, absenteeism, and use of health care services were collected. The total number of individuals who had PTSD, MDD, or both at any time during the 3 months following the robbery was 1 (2%), 4 (6%), and 5 (8%), respectively, showing that comorbid PTSD-MDD is as frequent as or even more frequent than either disorder in isolation. Individuals with PTSD (with or without comorbid MDD) reported more absenteeism (η(2) (p) = .25) and more medical visits (η(2) (p) = .12) following the robbery. Clinicians and management resources personnel must be alert to the possibility that both PTSD and MDD, either alone or comorbid, can develop in victims of armed robbery.

Behavioral Studies and Genetic Alterations in Corticotropin-Releasing Hormone (CRH) Neurocircuitry: Insights into Human Psychiatric Disorders.

To maintain well-being, all organisms require the ability to re-establish homeostasis in the presence of adverse physiological or psychological experiences. The regulation of the hypothalamic-pituitary adrenal (HPA) axis during stress is important in preventing maladaptive responses that may increase susceptibility to affective disorders. Corticotropin-releasing hormone (CRH) is a central stress hormone in the HPA axis pathway and has been implicated in stress-induced psychiatric disorders, reproductive and cardiac function, as well as energy metabolism. In the context of psychiatric disorders, CRH dysfunction is associated with the occurrence of post-traumatic stress disorder, major depression, anorexia nervosa, and anxiety disorders. Here, we review the synthesis, molecular signaling and regulation, as well as synaptic activity of CRH. We go on to summarize studies of altered CRH signaling in mutant animal models. This assembled data demonstrate an important role for CRH in neuroendocrine, autonomic, and behavioral correlates of adaptation and maladaptation. Next, we present findings regarding human genetic polymorphisms in CRH pathway genes that are associated with stress and psychiatric disorders. Finally, we discuss a role for regulators of CRH activity as potential sites for therapeutic intervention aimed at treating maladaptive behaviors associated with stress.

L’état de stress post-traumatique comme conséquence de l’interaction entre une susceptibilité génétique individuelle, un évènement traumatogène et un contexte social

Resume Introduction Un etat de stress post-traumatique (ESPT) ne s’installe jamais par hasard : l’intrication de facteurs de risque intrinseques (individuels) et extrinseques (evenement traumatique) temoigne d’un support genetique interactif au trouble. Toute situation dramatique peut etre le lieu d’un trauma, non necessairement, mais en lien avec la maniere dont l’individu a investi l’evenement. Parmi les sujets confrontes a la meme situation stressante, seuls quelques uns souffriront d’un ESPT. Pour ces derniers, la thematique des repetitions est tres differente d’un sujet a un autre, venant temoigner de la singularite de l’evenement vecu pour chacun d’entre eux. Comme temoignage d’une interaction entre l’homme et son environnement, le stress est une reaction biologique aspecifique de l’organisme, mais reaction declenchee par un ressenti subjectif. L’ESPT en tant que diagnostic causalement attribue s’integre parfaitement dans le modele interactif gene × environnement. Revue de la litterature Les sujets presentant le genotype S/S codant pour le transporteur de la serotonine declenchent un ESPT pour un niveau d’exposition traumatique moindre que leurs homologues L/L. Mais l’interaction entre le genome et son environnement est plus complexe qu’une simple implication : une association de facteurs environnementaux intervient. Considerant la voie dopaminergique, l’allele A1 codant pour le recepteur dopaminergique de type 2 est associe a une comorbidite severe de l’ESPT avec presence de troubles somatiques, d’anxiete, d’alteration sociale et de depression. S’interessant a la neuromodulation noradrenergique, une interaction entre le polymorphisme du gene GABRA2 et la survenue d’un ESPT est decrite tandis qu’une interaction entre le nombre d’evenements traumatiques et le polymorphisme Val(158)Met du gene codant pour la catecholamine-o-methyltransferase a egalement ete retrouvee. Au niveau neuroendocrinien, le gene codant pour la proteine FKBPR, co-chaperonne de la hsp90 qui lie le recepteur aux glucocorticoides, a ete etudie selon quatre polymorphismes qui interviennent comme cofacteur en interaction avec l’origine ethnique et les experiences stressantes. Ce polymorphisme mono-nucleotidique interagit avec la severite de traumatismes infantiles pour predire le niveau d’ESPT ulterieur retrouve a l’âge adulte, ce dernier etant secondaire a un autre evenement de vie traumatisant. Discussion Aucune etude neurobiologique n’a pour l’instant decrit de marqueur biologique qui destinerait a priori et immanquablement un sujet a structurer un ESPT en reaction a une situation de stress. Differemment, l’etude psychopathologique retrouve a posteriori que tel sujet a necessairement construit un syndrome de repetition traumatique en fonction de la concordance de donnees signifiantes relatives a son histoire. L’evenement vient frapper un refoulement ou une impasse biographique anterieure et dont la thematique interroge les fondamentaux de la culture humaine dans son emancipation d’avec la nature. Une proposition therapeutique constitue alors par excellence un facteur environnemental lequel peut etre ou protecteur ou deletere. La prise en charge aigue par la technique du debriefing anglophone est discutee alors que la technique francophone est toujours en cours d’evaluation. Bien que ces donnees restent a confirmer, les benzodiazepines paraissent deleteres en post-immediat alors que l’usage de propranolol serait protecteur. A la phase chronique, la prise en charge pharmacologique n’est pas consensuelle meme si les ISRS et les IRSNa sont regulierement prescrits. S’eloignant de la pharmacopee pour rejoindre une perspective psychotherapique a l’orientation dynamique et interactive, ce qui a fait trauma n’est pas simplement l’evenement stressant en temps que tel, mais sa rencontre avec l’homme qui se trouvait la, pret a accueillir ce trauma et qui ne s’en detache plus. La reparation du sujet psychotraumatise ne peut simplement s’etablir sur un statut passif de victime stressee, statut qui nuirait a la reflexion et a la reconstruction. Alors que la confrontation a la mort s’apparentait a l’insense, le sujet interrogera les determinants psychotraumatiques de son histoire biographique pour y reinscrire son evenement dramatique au sein d’une quete singuliere de sens. Une telle restructuration se construit via l’intersubjectivite de la relation clinique, laquelle intervient au sein d’un contexte social. L’ESPT est une pathologie qui interagit avec le contexte societal : d’une part, le trauma s’etablit via la remise en cause brutale de valeurs sociales qui semblaient immuables et, d’autre part, le concept clinique et nosographique d’ESPT est changeant avec l’evolution des societes. Conclusion Un ESPT ne survient jamais par hasard, les conditions de possibilite du trauma sont etablies par des determinants genetiques et psychologiques s’integrant de facon interactive au cœur d’un contexte social. Apres l’inflation d’un interet psychotraumatique dans les publications internationales depuis les annees 1980, une lutte contre la survictimisation semble desormais s’installer. L’evolution des techniques de genetique et de neuro-imagerie est en cours de supplanter les etudes psychometriques en termes de fiabilite et de validite : peut-etre faut-il voir dans cette evolution sociale les changements de demain concernant la clinique de l’ESPT et son traitement.

Comparison of subjective cognitive complaints with neuropsychological tests in individuals with mild vs more severe traumatic brain injuries

Primary objective: The aim of this study was to examine the complex inter-relationship between subjective reports of cognitive impairments and neuropsychological performances in compensation-seeking individuals with traumatic brain injury (TBI) of differing severities. Specifically, this study examined: (a) the participants’ neuropsychological test scores and self-reported ratings according to TBI severity; (b) whether there was a predictive relationship between self-report and cognitive test scores; and (c) the influence of emotional functioning on self-reported cognitive functioning.Research design: A multi-group comparative research design was employed.Methods and procedure: An outpatient sample of 61 patients with TBIs using neuropsychological testing, RNBI (Ruff Neurobehavioral Inventory) and clinical interviews.Main outcomes and results: The mild TBI group exhibited greater attentional impairments, while the moderate-to-severe group exhibited greater memory and learning impairments on neuropsychological tests. The mild group reported more cognitive symptoms than their more severely damaged counterparts. The mild TBI participants reported significantly more symptoms of post-traumatic stress disorder (PTSD).Conclusions: Individuals with moderate-to-severe TBI were more accurate when reporting their memory and learning difficulties, whereas individuals with mild TBI were more accurate when reporting attentional difficulties. It is likely that the occurrence of PTSD worsens the outcome of a mild TBI. There likely is a cumulative effect between the PTSD symptoms and the emotional residuals in the mild TBI population.

PTSD, depression and anxiety among former abductees in Northern Uganda

BackgroundThe population in Northern Uganda has been exposed to extreme levels of traumatic stress and thousands abducted forcibly became rebel combatants.MethodsUsing structured interviews, the prevalence and severity of posttraumatic stress disorder (PTSD), depression and anxiety was assessed in 72 former abducted adults, 62 of them being former child soldiers.ResultsAs retrospective reports of exposure to traumatic stress increased, anxiety and PTSD occurrence increased (r = .45). 49% of respondents were diagnosed with PTSD, 70% presented with symptoms of depression, and 59% with those of anxiety. In a multiple linear regression analysis four factors could best explain the development of PTSD symptoms: male respondents (sex) living in an IDP-Camp (location) with a kinship murdered in the war (family members killed in the war) and having experienced a high number of traumatic events (number of traumatic events) were more likely to develop symptoms of PTSD than others. In disagreement to a simple dose-response-effect though, we also observed a negative correlation between the time spent with the rebels and the PTSD symptom level.ConclusionsFormer abductees continue to suffer from severe mental ill-health. Adaptation to the living condition of rebels, however, may lower trauma-related mental suffering.

Bio-socio-demographic factors associated with post-traumatic stress disorder in a sample of postpartum Brazilian women

Post-traumatic stress disorder (PTSD) is common among women. In the postpartum period, the prevalence is between 1% and 6%. The present study investigated PTSD in a sample of 400 Brazilian women between 2 and 26weeks postpartum using the Mini-International Neuropsychiatric Interview and found a frequency of 5.3%. The factors associated with the occurrence of PTSD were low purchasing power, a history of psychiatric disorders, clinical disease, and the infant having experienced some complication.

(P2-50) Surviving a Severe Train Crash

BackgroundPrevious disaster studies mainly focused on analyzing the experience from a psychological or psychiatric perspective. The occurrence of post-traumatic stress disorder also has been the central issue when studying survivors of train crashes. Research concerning being involved in train crashes is scarce.ObjectiveThe aim of this study was to explore the experience of surviving a severe train crash.MethodsIn 2004, a severe train crash occurred in the south of Sweden. Approximately 78 passengers were on the train. All of them were injured, and two of the passengers died. Fourteen of the survivors agreed to be interviewed five years after the crash. The interviews were narrative, transcribed verbatim, and analyzed using a phenomenological-hermeneutical method. First, a naive reading of the text, later, a structural analysis, and finally a comprehensive understanding in which the other phases were considered and discussed with relevant literature.ResultsThe preliminary results show a naive understanding of being in the pre-crash, crash and post-crash phases. Four themes were recognized: (1) life is going on like being on a railway track; (2) the train derails, so do I; (3) back on track again; and (4) life goes on in a new track. The results will be elaborated and discussed together with the comprehensive understanding.ConclusionsSurviving a severe train crash changes life immediately as well as five years later.

Post-traumatic stress disorder in children. Overview and case study

Post-traumatic stress disorder (PTSD) is a severe psychological trauma which results in an emotional suffering and a significant impairment in social area of functioning, revealing an intricate clinic summary which proves to be a tackling challenge concerning the therapeutic response. Among the general population PTSD is commonly associated with the highest rate in the use of medical and other professional services which makes it one of the most costly mental disorders. Widespread scientific recognition of PTSD occurrence in children was only recently gained. Studies indicate that there is a series of traumatic circumstances with a high potential of inducing PTSD in children: witnessing the murder or any other violent aggression against a parent. In this article the authors' approach on PTSD in children starts with the overall data followed by an in depth presentation and analysis of a clinical case, in which a child was diagnosed with PTSD, following her witnessing the severe physical injury of her father.

A longitudinal investigation of posttraumatic stress disorder in patients with ovarian cancer

Introduction Exposure to the aggressive and life-threatening nature of ovarian cancer and its treatment is potentially traumatic. However, little is known about the occurrence of posttraumatic stress disorder (PTSD) in these patients. Methods A total of 121 women newly diagnosed with ovarian cancer were recruited into a prospective longitudinal study of the course of PTSD and the factors that predict its development and persistence. Between 82 and 111 were assessed at each of the four time points subsequent to their diagnosis, and 63 women provided complete data from the beginning of chemotherapy treatment, midtreatment, end of treatment and 3-months follow-up on PTSD. Results Between 36% and 45% of the total sample experienced PTSD at some point, with a nonsignificant but progressive increase in prevalence over time. Of those women with complete data, only 30% never experienced PTSD at any time. Most of the women were intermittent cases of PTSD (57%, n=36), while 13% ( n=8) were persistent cases. Younger women were at higher risk of experiencing PTSD. Discussion The prevalence of women newly diagnosed with ovarian cancer with persistent PTSD is relatively low (13%); however, our findings highlight that the trajectory of the illness and its associated stressors may constitute an enormous challenge and may be perceived as traumatic and stressful for most of the women in our sample at least once. Repetitive screening for PTSD and the provision of psychological treatments could ameliorate PTSD symptoms.

Alexithymia and posttraumatic stress: subscales and symptom clusters

This study examined the relationship between the emotion-regulating factor alexithymia and the occurrence of posttraumatic stress disorder (PTSD) after critical incidents in a nonclinical sample of 136 nurses and ambulance personnel working in military facilities. The results showed that alexythima accounts for variance in PTSD symptoms. Breaking PTSD into its 4 symptom clusters, alexithymia was found to predict numbing and hyperarousal symptoms but not avoidance or reexperiencing symptoms. Finally, the rarely investigated, but clinically relevant, distinctive subdimensions of alexithymia were examined in relation to the 4 PTSD clusters. The difficulty identifying feelings subscale contributed most to the numbing and hyperarousal PTSD subscales. Clinical implications and future research directions are discussed.

Investigation of Posttraumatic Stress Disorder in Children After Animal-Induced Injury in China

Dogs are important members of many families in many countries. However, posttraumatic stress disorder (PTSD) in children after animal attacks has always been underestimated, and a more-detailed study of PTSD in children after animal attacks is needed. The charts and follow-up data for 358 children after animal-induced injuries were reviewed. Family Apgar Scale assessment and PTSD screening were performed at emergency department admission. On week 1 after the emergency department admission, the patient underwent evaluation for acute stress disorder (ASD) diagnosis, by using the Child Acute Stress Questionnaire. PTSD screening and interim history-taking were performed 3 months after the emergency department admission, by telephone or in face-to-face interviews, by using the Clinician-Administered PTSD Scale for Children and Adolescents. P values of <.05 were considered significant. A total of 19 patients developed PTSD, including 10 patients with severe injuries, 8 patients with moderate injuries, and 1 patient with a mild injury (chi(2)=48.104; P=.000). No significant differences in PTSD occurrence according to gender and age were observed. Family Apgar Scale scores were not significantly related to PTSD (P=.781). ASD and PTSD symptom severity scores were significantly associated (r=0.51; P < .005). Child victims of severe animal attacks should be considered at risk for the development of PTSD, family support was not correlated with posttraumatic stress symptoms in school-aged children after animal attacks, and ASD seems to be an early predictive indicator of PTSD.

Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study

Long-term outcome of traumatic experiences among war-exposed civilians living in their home country has been seldom documented. The present study examined change in posttraumatic stress disorder (PTSD) frequency and perceived physical and mental health in a cohort of Kosovar Albanians over 6 years (2001-2007). Of 996 Albanian Kosovar civilians included in the 2001 survey, 551 subjects (55.3%) were recalled and interviewed in 2007. Diagnoses of PTSD and major depressive episode were assessed using the Mini International Neuropsychiatric Interview. Subjective physical and mental health were investigated using the Medical Outcomes Study 36-Item Short-Form (SF-36). A list of traumatic events adapted from the Harvard Trauma Questionnaire and other stressful life events was also considered. Posttraumatic stress disorder was significantly less frequent in 2007 than in 2001 (14.5% vs. 23.2%, p < 0.001). For 18.0, 5.3 and 9.3% of participants, PTSD remitted, persisted and developed over the 6-year follow-up period, respectively. Ill health without having access to medical care and major changes in responsibilities at work were associated with both persistence and new occurrence of PTSD. While the SF-36 mental component summary score significantly improved (mean change +4.5, p < 0.001), the physical component summary score did not change between 2001 and 2007, after adjustment for age (mean change -0.8, p = 0.14). Results point at the importance of economic and health system reconstruction programs with respect to public health in post-conflict countries.

Prediction of posttraumatic stress disorder among adults in flood district

BackgroundFlood is one of the most common and severe forms of natural disasters. Posttraumatic stress disorder (PTSD) is a common disorder among victims of various disasters including flood. Early prediction for PTSD could benefit the prevention and treatment of PTSD. This study aimed to establish a prediction model for the occurrence of PTSD among adults in flood districts.MethodsA cross-sectional survey was carried out in 2000 among individuals who were affected by the 1998 floods in Hunan, China. Multi-stage sampling was used to select subjects from the flood-affected areas. Data was collected through face-to-face interviews using a questionnaire. PTSD was diagnosed according to DSM-IV criteria. Study subjects were randomly divided into two groups: group 1 was used to establish the prediction model and group 2 was used to validate the model. We first used the logistic regression analysis to select predictive variables and then established a risk score predictive model. The validity of model was evaluated by using the model in group 2 and in all subjects. The area under the receiver operation characteristic (ROC) curve was calculated to evaluate the accuracy of the prediction model.ResultsA total of 2336 (9.2%) subjects were diagnosed as probable PTSD-positive individuals among a total of 25,478 study subjects. Seven independent predictive factors (age, gender, education, type of flood, severity of flood, flood experience, and the mental status before flood) were identified as key variables in a risk score model. The area under the ROC curve for the model was 0.853 in the validation data. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of this risk score model were 84.0%, 72.2%, 23.4%, and 97.8%, respectively, at a cut-off value of 67.5 in the validation data.ConclusionsA simple risk score model can be used to predict PTSD among victims of flood.