Particularly Posttraumatic Stress Disorder Research Articles

Mediating effects of insomnia and resilience on COVID-19-related post-traumatic stress disorder and quality of life in adolescents

The coronavirus disease-2019 (COVID-19) pandemic has impaired the quality of life (QoL) for many due to its extensive impacts. However, few studies have addressed the specific impact of COVID-19 on the mental health of adolescents, particularly post-traumatic stress disorder (PTSD). This study considered the impact of COVID-19-related PTSD on the QoL of adolescents in China, the mediating effects of insomnia, and the moderating effects of resilience. Participants included 50,666 adolescents aged 12–18 years selected using a comprehensive sampling method. We performed data collection from January 8th to January 18th, 2023, using the Children’s Revised Impact of Event Scale, Pittsburgh Sleep Quality Index, Ten-item Connor-Davidson Resilience Scale, and Screening for and Promotion of Health-related QoL in Children and Adolescents Questionnaire for data collection. Male adolescents exhibited significantly lower levels of PTSD and insomnia compared to females and scored significantly higher in psychological resilience and overall QoL. Insomnia played a mediating role between PTSD and QoL. Psychological resilience moderated the impact of COVID-19-related stress on adolescents’ QoL through its influence on insomnia. PTSD resulting from the COVID-19 pandemic affects the QoL of adolescents through the presence of insomnia. Psychological resilience plays a moderating role in this process. Cultivating psychological resilience in adolescents can effectively enhance their ability to cope with the impacts of sudden public events.

The association between negative war-related beliefs and probable PTSD and complex PTSD among Ukrainians during the 2022 Russian invasion

The ongoing Ukraine-Russia war triggered significant mental health consequences, particularly posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). A population study with 1895 Ukrainians explored the association between negative war-related beliefs and risk for PTSD and CPTSD. Negative war-related beliefs were shown to be significantly linked to increased risks for PTSD and more so for CPTSD. Interventions that address negative war-related beliefs could mitigate the mental health impact of war.

Leveraging interindividual variability in threat conditioning of inbred mice to model trait anxiety.

Trait anxiety is a major risk factor for stress-induced and anxiety disorders in humans. However, animal models accounting for the interindividual variability in stress vulnerability are largely lacking. Moreover, the pervasive bias of using mostly male animals in preclinical studies poorly reflects the increased prevalence of psychiatric disorders in women. Using the threat imminence continuum theory, we designed and validated an auditory aversive conditioning-based pipeline in both female and male mice. We operationalised trait anxiety by harnessing the naturally occurring variability of defensive freezing responses combined with a model-based clustering strategy. While sustained freezing during prolonged retrieval sessions was identified as an anxiety-endophenotype biomarker in both sexes, females were consistently associated with an increased freezing response. RNA-sequencing of CeA, BLA, ACC, and BNST revealed massive differences in phasic and sustained responders' transcriptomes, correlating with transcriptomic signatures of psychiatric disorders, particularly post-traumatic stress disorder (PTSD). Moreover, we detected significant alterations in the excitation/inhibition balance of principal neurons in the lateral amygdala. These findings provide compelling evidence that trait anxiety in inbred mice can be leveraged to develop translationally relevant preclinical models to investigate mechanisms of stress susceptibility in a sex-specific manner.

Investigating the Potential Double-Edged Score of Immigration-Related Stress, Discrimination, and Mental Health Access.

Prior work has suggested that discrimination and immigration-related stress may impede mental health care seeking and utilization among Latinx populations. These effects may be more nuanced as both discrimination and immigration-related stress may increase symptomology, particularly post-traumatic stress disorder (PTSD) and depression. Both symptoms may, in turn, prompt attempts to seek care. The current study examined the direct effects of discrimination and immigration-related stress on care access, as well as potentially indirect effects with PTSD and depression symptoms as mediators. Interviews and online surveys were completed with 234 Latinx residents of the Midwest, assessing everyday discrimination, discrimination in healthcare, PTSD symptoms, depression symptoms, current mental health utilization, and previous unsuccessful attempts to seek care. Direct effects of discrimination and immigration-related stress were largely unrelated to care access variables. Discrimination in healthcare settings predicted both unsuccessful attempts to seek care and current use, but this effect was positive. The indirect effect was largely supported, but only for PTSD symptoms and not depression. Results indicate that further investigation is necessary to understand the direct effects of discrimination on care access. Further, discrimination and immigration-related stress may indirectly prompt attempts to seek mental health care.

Comorbid trajectories of posttraumatic stress disorder symptoms and depressive symptoms in a 10-year cohort of Chinese Wenchuan earthquake survivors: Course, predictors, and consequences.

Survivors may suffer mental health problems following disasters, particularly posttraumatic stress disorder (PTSD) and depressive symptoms. However, few studies have explored longitudinal processes of co-occurring PTSD and depressive symptoms among adolescent survivors and their associated predictors and consequences. The present study examines the codevelopment of both symptoms postearthquake using a 10-year cohort. A total of 1,357 senior high school students reported PTSD and depressive symptoms at 6, 12, 18, and 24 months after the 2008 Wenchuan earthquake. Self-report measures were also used to evaluate earthquake exposure, negative life events, social support, and trait resilience. At the 10-year follow-up (T10y), 799 participants reported their quality of life (QoL) online and 744 of them provided available data. A parallel-process latent class growth analysis was used to identify trajectories. Multinominal logistic and linear regressions were used, respectively, to analyze the predictors and consequences of these trajectories. Three comorbid trajectories were found: a resilient group (56.7%), a vulnerable group (33.3%), and a chronic high-risk group (9.9%). Gender, injury/missing/killed of family members, witnessing of traumatic sciences, negative life events, social support, and trait resilience were significant predictors of vulnerable and chronic high-risk groups. Finally, adolescents in these two groups were more likely to experience poorer QoL in adulthood. The results highlight the heterogeneity of depression-PTSD comorbidities among adolescent survivors. They also emphasize PTSD-depression symptoms predictors and their adverse impacts on life outcomes in adulthood. Individualized interventions should be provided for adolescents affected by natural disasters, especially those in the vulnerable and higher risk groups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Post-traumatic stress disorder and post-traumatic stress symptoms in patients with systemic autoimmune diseases during the COVID-19 pandemic.

The COVID-19 outbreak led to an increase in mental disorders, particularly post-traumatic stress disorder (PTSD), in the general population and especially in high-risk populations such as patients with rheumatologic conditions. Although these latters are considered vulnerable to developing PTSD, few specific data have been particularly reported in the framework of the pandemic. The aim of the present study was to investigate PTSD and post-traumatic stress symptoms (PTSS) in a sample of patients with systemic autoimmune disease (SAD), followed in the framework of a prospective observational study during the pandemic. The PERMAS project is a prospective observational study including patients with SAD and involving the Rheumatology and the Psychiatric Clinics of the Azienda Ospedaliero Universitaria Pisana (AOUP, Pisa, Italy) and the Institute of Management of the Scuola Superiore Sant'Anna (Pisa, Italy). The assessments included: a data-sheet for sociodemographic and clinical characteristics; the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), for PTSD and PTSS; the 36-item Short Form Survey (SF-36) to assess quality of life. The total sample consisted of 252 patients with SAD, including 131 with connective tissue disease, 101 with arthritis and 20 with systemic vasculitis. The diagnostic groups differed significantly in age (p<0.001), gender (p<0.001), prevalence of full-blown and partial PTSD (p=0.001), and other psychopathologic variables. Connective tissue disease and SF-36 were significantly associated with the TALS-SR scores in both univariate (p<0.001) and multivariate (p<0.025; p<0.001) analyses. Patients with SAD, and, in particular, patients with connective tissue diseases reported an increased risk of developing stress-related psychopathological symptoms, indicating the need for special psychological monitoring of this high-risk group.

Assessment of Post-Traumatic Stress Disorder in Patients Who Recovered from COVID-19

Background: It is essential to address psychological health, particularly post-traumatic stress disorder (PTSD), among patients who have recovered from COVID-19. The negative impacts on the psychological health of an individual have negative impacts on health-related quality of life. The authors aimed to assess PTSD in patients recovered from COVID-19, and COVID-19-related comorbidities. Methodology: The present study was conducted as an observational cross-sectional study on patients diagnosed with COVID-19 who were discharged from Gandhi Medical College and Hamidia Hospital, both in Bhopal, India, and returning to follow-up at the medicine/psychiatry outpatient department within 6 months after discharge, during the study period of 20 months. Detailed history regarding sociodemographic variables, previous medical history, comorbidities associated with COVID-19 (e.g., mucormycosis, etc.) were noted. PTSD was assessed using the PTSD Symptom Scale (PSS). Results: A total of 120 cases, who recovered from COVID-19 infection and sought care at the authors’ centre, were included in this study, with mean age of 37.520±12.756 years. Mean PTSD score was 3.350±1.528, and PTSD was noted in 85% cases. Of these, 83.3% cases had mild, and 1.7% cases had moderate PTSD. The authors observed no significant association of sociodemographic variables with PTSD on univariate as well as multivariate analysis (p&gt;0.05). Conclusions: Though the wave of COVID-19 pandemic has subsided, the long-term morbidities, particularly due to the impact on psychological health, are still persistent. PTSD is a common consequence following recovery from COVID-19 infection. Thus, mental health services must be provided to patients recovered from COVID-19 infection, mainly targeted at prevention of PTSD.

Decision-making for concurrent reward and threat is differentially modulated by trauma exposure and PTSD symptom severity

Trauma exposure, particularly interpersonal violence (IPV) traumas, are significant risk factors for development of mental health disorders, particularly posttraumatic stress disorder (PTSD). Studies attempting to disentangle mechanisms by which trauma confers risk and maintenance of PTSD have often investigated threat or reward learning in isolation. However, real-world decision-making often involves navigating concurrent and conflicting probabilities for threat and reward. We sought to understand how threat and reward learning interact to impact decision-making, and how these processes are modulated by trauma exposure and PTSD symptom severity. 429 adult participants with a range of trauma exposure and symptom severities completed an online version of the two stage Markov task, where participants make a series of decisions towards the goal of obtaining a reward, that embedded an intermediate threat or neutral image along the sequence of decisions to be made. This task design afforded the possibility to differentiate between threat avoidance vs diminished reward learning in the presence of threat, and whether these two processes reflect model-based vs model-free decision-making. Results demonstrated that trauma exposure severity, particularly IPV exposure, was associated with impairment in model-based learning for reward independent of threat, as well as with model-based threat avoidance. PTSD symptom severity was associated with diminished model-based learning for reward in the presence of threat, consistent with a threat-induced impairment in cognitively-demanding strategies for reward learning, but no evidence of heightened threat avoidance. These results highlight the complex interactions between threat and reward learning as a function of trauma exposure and PTSD symptom severity. Findings have potential implications for treatment augmentation and suggest a need for continued research.

Efficiency of a psychiatric support for PTSD on a cohort of relatives of patients hospitalized in intensive care unit during the French lockdown – the OLAF (Opération Liaison et Aide aux Familles in French) dispositive

IntroductionHaving a family member admitted in Intensive Care Unit (ICU) can cause a severe psychological stress, and various psychological disorders gathered into the notion of Post intensive care syndrome-family (PICS-F). In this way, Family-centered care in ICU represents the aim of international accepted recommendations focusing on a partnership approach to health care decision-making between the family and health care provider to prevent PICS-F. During the first SARS-CoV-2 linked lockdown, social restrictions impaired the right application of these recommendations, increasing risk of PICS-F, particularly Post-Traumatic Stress Disorder (PTSD).ObjectivesThe main objective was to compare the PTSD prevalence at 6 months in a group of relatives including during OLAF implementation with a control group in a cohort of ICU-patient relatives.MethodsConsidering this, the psychiatric team and the ICU team of the Toulouse University, France, proposed the creation of a temporary device called OLAF (Opération de Liaison et d’Aide aux Familles in French), aiming to bring a psychological phone support to ICU-patient relatives. Besides this operational approach we designed a research approach that aimed to investigate the impact of OLAF device on PICS-F.ResultsWe noted that 12 participants (11.5 %) presented a PTSD at 6 months without statistically significant differences between the groups (p=0.8). Considering that OLAF group presented higher PDI (Peritraumatric Distress Inventory) score at screening we also considered a mediation model suggesting that OLAF could have played a role to diminish the PCL-5 score as a covariable. In the multinomial logistic regression analysis, we found that the only factor associated with the PTSD diagnosis was the level of Anxiety and Depression Signs measured with HADS (Hospital Anxiety and Depression Scale) at screening (OR= 1.2, p&lt;0.001).ConclusionsWe found no difference in PTSD prevalence according to OLAF intervention. Nevertheless, our result suggested that the intervention could have play a role in reducing PTSD by acting on anxiety and peri traumatic distress in a mediated model. We found that anxiety score could serve as a risk marker to predict PTSD and should probably be precociously screened and treated in this population.Disclosure of InterestNone Declared

OP0197 POST-TRAUMATIC STRESS DISORDER AND SYMPTOMS IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES DURING THE COVID-19 PANDEMIC: PRELIMINARY RESULTS FROM THE PERMAS STUDY

BackgroundThe COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people’s everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders.ObjectivesTo assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy.MethodsPERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum- Self Report (TALS-SR) and the Impact of Event Scale- Revised (IES-R), aimed to assess symptomatological PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic.ResultsA total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females; 112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defined by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with significant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031).ConclusionThe present findings point out high prevalence rates of symptomatological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.

Collective Trauma and Mental Health in Adolescents: A Retrospective Cohort Study of the Effects of Retraumatization.

In the wake of the massive Canadian wildfire of May 2016 in the area of Fort McMurray Alberta, we observed increased rates of mental health problems, particularly post-traumatic stress disorder (PTSD), in school-aged adolescents (ages 11–19). Surprisingly, we did not see these rates decline over the 3.5-year follow-up period. Additionally, our research suggested that the impact of this mass incident resulted in other unanticipated effects, including the finding that children who were not present for and relatively unaffected by the wildfire showed a similar PTSD symptom profile to children more directly involved, suggesting some degree of spillover or stress contagion. A potential explanation for these high rates in individuals who were not present could be undiagnosed retraumatization in some of the students. To investigate this possibility, we compared two groups of students: those who reported the wildfire as their most significant trauma (n = 740) and those who had their most significant trauma prior to the wildfire (n = 295). Those with significant pre-existing trauma had significantly higher rates of both depression and PTSD symptoms, although, unexpectedly the groups exhibited no differences in anxiety level. Taken together, this evidence suggests retraumatization is both longer-lasting and more widespread than might be predicted on a case-by-case basis, suggesting the need to reconceptualize the role of past trauma history in present symptomatology. These findings point to the need to recognize that crises instigated by natural disasters are mass phenomena which expose those involved to numerous unanticipated risks. New trauma-informed treatment approaches are required that incorporate sensitivity to the collective impact of mass crises, and recognize the risk of poorer long-term mental health outcomes for those who experienced trauma in the past.

Prevalence, Demographic, and Clinical Correlates of Likely PTSD in Subscribers of Text4Hope during the COVID-19 Pandemic.

Background: During the COVID-19 pandemic, people may experience increased risk of adverse mental health, particularly post-traumatic stress disorder (PTSD). Methods: A survey measured stress, anxiety, depression, and PTSD symptoms in Text4Hope subscribers using the Perceived Stress Scale, Generalized Anxiety Disorder 7-Item Scale, Patient Health Questionnaire-9, and PTSD Checklist for DSM-5 Part 3, respectively. A Chi-square test and multivariate logistic regression were employed. Results: Most respondents were 41–60 years old (49.5%), Caucasian (83.3%), with post-secondary education (92.1%), employed (70.3%), married/cohabiting/partnered (64.9%), and homeowners (71.7%). Likely PTSD was reported in 46.8% of the respondents. Those who were afraid to contract the coronavirus had a history of depression before the pandemic, and those who received counselling during the pandemic exhibited a high prevalence of likely PTSD (OR (1.7 to 2.2)). Significant lower odds of likely PTSD were observed among subscribers who received absolute support from family/friends. Conclusions: This paper presents findings on the prevalence of likely PTSD and identified vulnerable groups during the COVID-19 pandemic. Our results support the proposal that public health advice should incorporate mental health wellness campaigns aiming to reduce the psychological impact of pandemics.

Post-Traumatic Stress Reactions in Caregivers of Children and Adolescents/Young Adults with Severe Diseases: A Systematic Review of Risk and Protective Factors.

Severe illnesses in children and adolescents/young adults (AYAs) may represent a complex burden for patients and their caregivers, including a wide range of mental disorders, particularly post-traumatic stress disorder (PTSD). Few events are as potentially traumatizing as having a son or a daughter diagnosed with a severe, life-threatening, or disabling disease. The presence of PTSD symptoms in caregivers may compromise their efficacy as caregivers and negatively affect the child’s well-being. This systematic review aims at outlining potential risk and protective factors for the development of PTSD symptoms in caregivers of children and AYAs affected by severe acute or chronic illnesses. Thirty-one studies on caregivers of children and AYAs affected by severe, acute, or chronic diseases were included. Socio-demographic and socio-economic characteristics, illness-related distress, psychiatric symptoms, support, and coping styles were found as potential risk/protective factors across studies. It is crucial to consider risk factors affecting caregivers of severely ill young patients, in order to plan focused interventions aimed at preventing an adverse clinical outcome in caregivers and at enhancing caregivers’ coping skills, in order to ultimately improve their quality of life.

Implicit Associations of Nonsuicidal Self-Injury with Relief in Posttraumatic Stress and Depressive Disorders*

Objective Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were associated with unique self-reported NSSI motives. Given well-established limitations of assessing motives via self-report measures, the present study sought to extend this line of research by using a novel laboratory measure of the implicit NSSI-relief association to examine NSSI emotional relief motives. Method A subset of participants from our previous study (N = 109) completed diagnostic interviews and the laboratory-based DSH-Relief Implicit Association Test (IAT). Results Findings indicated that individuals with lifetime PTSD evidenced stronger NSSI-relief associations than those without PTSD. Further, this main effect was qualified by a PTSD by depressive disorder interaction, such that stronger NSSI-relief associations were found among individuals with lifetime PTSD but no lifetime depressive disorder than among individuals without a history of either PTSD or a depressive disorder. Conclusions Results highlight the importance of investigating NSSI motives associated with different symptom profiles using a multi-method approach.

Gene Therapy in Erectile Dysfunction: Dead or Alive?

Mental disorders are frequently related to sexual dysfunction (SD) but scant data are still available on trauma-related disorders, particularly post-traumatic stress disorder (PTSD).To evaluate the relationships between SD and PTSD in 2009 L'Aquila (Italy) earthquake young adult survivors, with particular attention to gender differences.Five hundred twelve high-school senior students were assessed 21 months after exposure by the following: Trauma and Loss Spectrum–Self-Report (TALS-SR), for post-traumatic spectrum symptoms; Mood Spectrum–Self-Report (MOODS-SR) lifetime version, for mood spectrum symptoms (including SD-related symptoms). Descriptive and inferential statistics were adopted.TALS-SR and MOODS-SR scores were analyzed to evaluate PTSD- and SD-related symptoms.Around 6.5% of subjects reported SD-related symptoms with males showing higher rates than females in each symptom, with a statistically significant difference in item n = 154 (…less sexually active). Survivors with symptomatological PTSD reported rates up to 10%, with higher ratio of endorsing at least one SD-related symptom than with NO-PTSD. Significantly higher total MOODS-SR SD-related symptom scores emerged in survivors with symptomatological PTSD than in those with NO-PTSD, and a 2-way ANOVA showed a significant main effect of symptomatological PTSD and gender and gender × PTSD interaction.SD-related symptoms are reported among young adult survivors to earthquake exposure and the number of symptoms is related to PTSD, particularly in males, suggesting the need for accurate evaluation.Strengths are the large sample of young adult survivors to a massive natural disaster; the long-time frame from exposure corroborating the role of PTSD; the assessment of symptoms specifically occurring after exposure. Limitations are as follows: the lack of a specific scale for SD; the self-report instruments other than clinical interviews, that may be less accurate; the lack of information on the presence of somatic illness and other mental disorders; the lack of a control group; the young age of the sample because of the lifetime sexual experiences of the subjects, in addition to the lack of a comparison measure of sexual functioning before the earthquake.Our results highlight relevant rates of SD-related symptoms in young adults exposed to the L'Aquila earthquake, particularly males and subjects with PTSD, suggesting SD may represent a specific male gender–related somatic complaint. Our results highlight the need for accurate investigation of SD in such population to improve clinical management and appropriate treatment.Carmassi C, Dell'Oste V, Pedrinelli V, et al. Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective. J Sex Med 2020;17:1770–1778.

Is Sexual Dysfunction in Young Adult Survivors to the L‘Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective

BackgroundMental disorders are frequently related to sexual dysfunction (SD) but scant data are still available on trauma-related disorders, particularly post-traumatic stress disorder (PTSD). AimTo evaluate the relationships between SD and PTSD in 2009 L'Aquila (Italy) earthquake young adult survivors, with particular attention to gender differences. MethodsFive hundred twelve high-school senior students were assessed 21 months after exposure by the following: Trauma and Loss Spectrum–Self-Report (TALS-SR), for post-traumatic spectrum symptoms; Mood Spectrum–Self-Report (MOODS-SR) lifetime version, for mood spectrum symptoms (including SD-related symptoms). Descriptive and inferential statistics were adopted. OutcomesTALS-SR and MOODS-SR scores were analyzed to evaluate PTSD- and SD-related symptoms. ResultsAround 6.5% of subjects reported SD-related symptoms with males showing higher rates than females in each symptom, with a statistically significant difference in item n = 154 (…less sexually active). Survivors with symptomatological PTSD reported rates up to 10%, with higher ratio of endorsing at least one SD-related symptom than with NO-PTSD. Significantly higher total MOODS-SR SD-related symptom scores emerged in survivors with symptomatological PTSD than in those with NO-PTSD, and a 2-way ANOVA showed a significant main effect of symptomatological PTSD and gender and gender × PTSD interaction. Clinical ImplicationsSD-related symptoms are reported among young adult survivors to earthquake exposure and the number of symptoms is related to PTSD, particularly in males, suggesting the need for accurate evaluation. Strengths & LimitationsStrengths are the large sample of young adult survivors to a massive natural disaster; the long-time frame from exposure corroborating the role of PTSD; the assessment of symptoms specifically occurring after exposure. Limitations are as follows: the lack of a specific scale for SD; the self-report instruments other than clinical interviews, that may be less accurate; the lack of information on the presence of somatic illness and other mental disorders; the lack of a control group; the young age of the sample because of the lifetime sexual experiences of the subjects, in addition to the lack of a comparison measure of sexual functioning before the earthquake. ConclusionsOur results highlight relevant rates of SD-related symptoms in young adults exposed to the L'Aquila earthquake, particularly males and subjects with PTSD, suggesting SD may represent a specific male gender–related somatic complaint. Our results highlight the need for accurate investigation of SD in such population to improve clinical management and appropriate treatment.Carmassi C, Dell'Oste V, Pedrinelli V, et al. Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective. J Sex Med 2020;17:1770–1778.

Assessment of Primary School Teachers' Knowledge Towards Post-Traumatic Stress Disorder among Pupils In Mosul City

Background: Teachers’ knowledge towards childhood mental health disorders at schools located in regions which were exposed to armed conflict, traumatic events and wars should be given the highest priority, not only for pupils’ mental health, but also as an important perspective for education. Therefore, teachers' knowledge must be adequately assessed about common childhood mental health disorders, particularly posttraumatic stress disorder (PTSD). Objectives: The study aimed to assess teachers' knowledge towards post-traumatic stress disorder (PTSD) among pupils at primary schools in Mosul city. Materials and Method: A descriptive study was conducted for the period from 1st December 2018 to 30th May 2019. The study included (520) primary schools inside Mosul which is the second largest city in Iraq. A probability sampling (simple random technique) was used, the sample consisted of (60) teachers who were teaching in primary schools inside Mosul city. Data were collected through the utilization of constructed questionnaire after validity and reliability of it were estimated. Reliability of the questionnaire was estimated through a pilot study and the validity was determined through(15) experts related to the field of study. All data were collected by means of interview technique. Data were analyzed through use of descriptive and inferential statistical analysis procedures using SPSS Version-23. Results: The findings of current study indicates that the level of teachers’ knowledge towards post-traumatic stress disorder (PTSD) was low. Conclusion: The study concludes that there is a considerable lack in teachers' knowledge in regard to posttraumatic stress disorder (PTSD).

Más Allá De Las Barreras: Competency and Practice Considerations in Language, Cultural, and Social Issues When Delivering Group CPT to Hispanic Immigrants

ABSTRACTHigh rates of underassessed trauma and psychiatric disorders, particularly post-traumatic stress disorder (PTSD) have been reported among Hispanic immigrants, especially as related to immigration trauma. Multiple studies have shown group cognitive processing therapy (CPT) to be an effective evidence-based practice (EBP) for treatment of PTSD across a number of clinical populations. To date, however, no studies have examined important competency and practice issues in linguistic, cultural, and ethical areas that group CPT providers should consider when delivering group CPT to Hispanic immigrants. This article aims to outline these and provide future directions for research.

Prevalence of Posttraumatic Stress Disorder among Children and Adolescents following Road Traffic Accidents: A Meta-Analysis.

Children and adolescents are among the most vulnerable road users, and road traffic accidents (RTAs) can lead to not only physical injuries but also adverse psychological outcomes, particularly posttraumatic stress disorder (PTSD). However, estimates of the prevalence of PTSD among children and adolescents following RTAs varied considerably across studies. Therefore, this study aimed to estimate the pooled prevalence of PTSD among this population. A systematic search for literature was performed in the electronic databases of PubMed, Web of Science, PsycINFO, and Embase. Heterogeneity was assessed using the Cochran's chi-square test and quantified by the I2 value. Meta-regression analyses were carried out to identify the effects of some potential moderators on the overall heterogeneity. Subgroup analyses were performed to estimate the pooled prevalence of PTSD according to some sample characteristics. Eleven eligible studies with a total of 1532 children and adolescents who were involved in RTAs were included. The overall heterogeneity (I2 = 89.7, P < 0.001) was high across the eligible studies, and the pooled prevalence of PTSD was 19.95% (95% confidence interval, 13.63% to 27.09%) by a random-effects model. No significant moderators of the overall heterogeneity were identified using meta-regression analyses. Subgroup analyses showed that the pooled prevalence of PTSD differed significantly according to the study location and gender (P < 0.05). One-fifth of children and adolescents developed PTSD in the aftermath of RTAs, indicating the need for regular assessment of PTSD and timely and effective psychological interventions among this population. Furthermore, more population-based studies with a large sample size are warranted. The protocol was registered in the PROSPERO database (No. CRD42018087941).

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. This study is registered as PROSPERO CRD42013003889. The National Institute for Health Research Health Technology Assessment programme.