Persistent Posttraumatic Stress Disorder Research Articles

A prediction model for differential resilience to the effects of combat-related stressors in US army soldiers.

To develop a composite score for differential resilience to effects of combat-related stressors (CRS) on persistent DSM-IV post-traumatic stress disorder (PTSD) among US Army combat arms soldiers using survey data collected before deployment. A sample of n=2542 US Army combat arms soldiers completed a survey shortly before deployment to Afghanistan and then again two to three and 8-9months after redeployment. Retrospective self-reports were obtained about CRS. Precision treatment methods were used to determine whether differential resilience to persistent PTSD in the follow-up surveys could be developed from pre-deployment survey data in a 60% training sample and validated in a 40% test sample. 40.8% of respondents experienced high CRS and 5.4% developed persistent PTSD. Significant test sample heterogeneity was found in resilience (t=2.1, p=0.032), with average treatment effect (ATE) of high CRS in the 20% least resilient soldiers of 17.1% (SE=5.5%) compared to ATE=3.8% (SE=1.2%) in the remaining 80%. The most important predictors involved recent and lifetime pre-deployment distress disorders. A reliable pre-deployment resilience score can be constructed to predict variation in the effects of high CRS on persistent PTSD among combat arms soldiers. Such a score could be used to target preventive interventions to reduce PTSD or other resilience-related outcomes.

Stimulation of an entorhinal-hippocampal extinction circuit facilitates fear extinction in a post-traumatic stress disorder model.

Effective psychotherapy of post-traumatic stress disorder (PTSD) remains challenging due to the fragile nature of fear extinction, for which ventral hippocampal CA1 (vCA1) region is considered as a central hub. However, neither the core pathway nor the cellular mechanisms involved in implementing extinction are known. Here, we unveil a direct pathway, where layer 2a fan cells in the lateral entorhinal cortex (LEC) target parvalbumin-expressing interneurons (PV-INs) in the vCA1 region to propel low gamma-band synchronization of the LEC-vCA1 activity during extinction learning. Bidirectional manipulations of either hippocampal PV-INs or LEC fan cells sufficed fear extinction. Gamma entrainment of vCA1 by deep brain stimulation (DBS) or noninvasive transcranial alternating current stimulation (tACS) of LEC persistently enhanced the PV-IN activity in vCA1, thereby promoting fear extinction. These results demonstrate that the LEC-vCA1 pathway forms a top-down motif to empower low gamma-band oscillations that facilitate fear extinction. Finally, application of low gamma DBS and tACS to a mouse model with persistent PTSD showed potent efficacy, suggesting that the dedicated LEC-vCA1 pathway can be stimulated for therapy to remove traumatic memory trace.

Prazosin Treatment of Sleep Problems in Youth with PTSD

Post traumatic stress disorder (PTSD) is a condition characterized by reexperiencing symptoms, persistent avoidance, negative alterations in cognition and mood, and changes in arousal and reactivity in response to a traumatic event (American Psychiatric Association, 2013). The pathophysiology of PTSD is not fully understood but likely related to dysregulation of fear‐processing. Currently, the gold standard of treatment is trauma‐focused cognitive behavioral therapy (TF‐CBT). SSRIs are the only FDA‐approved pharmacologic treatments for PTSD in adults and there are no FDA approved medications to treat pediatric PTSD. Unlike studies in adults, double‐blinded randomized control trials (RCTs) did not show any efficacy for SSRIs in pediatric patients diagnosed with PTSD (Hudson et al., 2021). While estimates of pediatric PTSD prevalence varies, the prevalence of PTSD at age 18 is 7.8% (Rolling et al., 2023). Sleep disturbances such as insomnia, night‐time awakenings, and nightmares often persist despite treatment with TF‐CBT or SSRIs. Left untreated, sleep disturbances are predictive of PTSD persistence and comorbid psychiatric complications (Rolling et al., 2023). There is evidence supporting the use of the medication prazosin in alleviating pediatric PTSD sleep disturbances including nightmares and insomnia. Anywhere from 20–80% of children with PTSD report nightmares compared to a prevalence of 10–20% in the general pediatric population (Kovachy et al., 2013). There is a growing need for pharmacologic therapy given the paucity of providers trained in TF‐CBT and a need for symptomatic management. In this review, we will examine sleep disturbances in pediatric PTSD patients and discuss the feasibility of prazosin as an adjunct treatment option.

Interplay among attention, appraisal, and memory bias in provisional posttraumatic stress disorder: Exploring the combined cognitive biases hypothesis.

Both theoretical and empirical studies suggest that negative cognitive biases significantly influence the onset and persistence of posttraumatic stress disorder (PTSD) symptoms. However, the interplay among these cognitive biases and their conjoint contribution to the long-term trajectory of posttraumatic stress symptoms remains underexplored. This study delves into the interplay among attention, appraisal, and memory biases within a provisional PTSD population and evaluates the predictive effects of two integrative models (weakest link, additive approach) on posttraumatic stress symptoms reported 2 months later. Sixty Chinese participants (Mage = 20.17, SDage = 2.11) with provisional PTSD undertook the scrambled sentences test (appraisal bias) with their eye movements recorded (attention bias) and then the free recall task (memory bias). Posttraumatic stress symptom was assessed at baseline and 2-month follow-up. Selective attention bias toward negative words was positively associated with the negative appraisal of scrambled sentences, which subsequently showed a strong association with negative memory bias. Regarding the progression of posttraumatic stress symptoms, the additive approach was found to be a more reliable predictor of self-reported posttraumatic stress symptoms at 2 months than the weak link approach. This study provides initial evidence supporting the combined cognitive biases hypothesis in provisional PTSD. It also underscores potential avenues to enhance cognitive bias modification techniques. Replication of these findings in broader clinical samples is essential. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans

Posttraumatic stress disorder (PTSD) symptom reduction is linked with lower risk of incident type 2 diabetes (T2D), but little is known about the association between PTSD and comorbid T2D outcomes. Whether PTSD is a modifiable risk factor for adverse T2D outcomes is unknown. To determine whether patients with PTSD who improved and no longer met diagnostic criteria for PTSD had a lower risk of adverse T2D outcomes compared with patients with persistent PTSD. This retrospective cohort study used deidentified data from US Veterans Health Administration (VHA) historical medical records (from October 1, 2011, to September 30, 2022) to create a cohort of patients aged 18 to 80 years with comorbid PTSD and T2D. Data analysis was performed from March 1 to June 1, 2024. Diagnoses of PTSD and T2D. The main outcomes were insulin initiation, poor glycemic control, any microvascular complication, and all-cause mortality. Improvement of PTSD was defined as no longer meeting PTSD diagnostic criteria, per a PTSD Checklist score of less than 33. Entropy balancing controlled for confounding. Survival and competing risk models estimated the association between meeting PTSD criteria and T2D outcomes. Subgroup analyses examined variation by age, sex, race, PTSD severity, and comorbid depression status. The study cohort included 10 002 veterans. More than half of patients (65.3%) were aged older than 50 years and most (87.2%) were men. Patients identified as Black (31.6%), White (62.7%), or other race (5.7%). Before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 vs 24.4 per 1000 person-years), poor glycemic control (137.1 vs 133.7 per 1000 person-years), any microvascular complication (108.4 vs 104.8 per 1000 person-years), and all-cause mortality (11.2 vs 11.0 per 1000 person-years) compared with patients with persistent PTSD. After controlling for confounding, no longer meeting PTSD criteria was associated with a lower risk of microvascular complications (hazard ratio [HR], 0.92 [95% CI, 0.85-0.99]). Among veterans aged 18 to 49 years, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.69 [95% CI, 0.53-0.88]) and all-cause mortality (HR, 0.39 [95% CI, 0.19-0.83]). Among patients without depression, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.73 [95% CI, 0.55-0.97]). The findings of this cohort study of patients with comorbid PTSD and T2D suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-VHA health care settings.

Longitudinal changes in the PTSD symptom network following trauma-focused treatment in military populations: Identifying central symptoms and the role of military sexual trauma

Posttraumatic stress disorder (PTSD) is a debilitating condition affecting military populations, with a higher prevalence compared to the general population. Despite the development of first-line trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), a significant proportion of patients continue to experience persistent PTSD symptoms following treatment. This study utilized network analysis to explore the PTSD symptom network's dynamics pre- and post- trauma-focused treatment and investigated the role of military sexual trauma (MST) history in shaping the network. Network analysis is a novel approach that can guide treatment target areas. The sample was comprised of 1648 service members and veterans who participated in a two-week intensive PTSD treatment program, which included completion of evidenced-based individual therapy as well as skill-building focused group therapy. PTSD severity was assessed using the PTSD Checklist for DSM-5 at baseline and post-treatment. Network analyses revealed strong connections within symptom clusters, with negative emotions emerging as one of the most central symptoms. Interestingly, the symptom network's overall structure remained stable following treatment, whereas global strength significantly increased. MST history did not significantly impact the network's structure or its change relative to treatment. Future research should further examine whether targeting negative emotions optimizes PTSD treatment outcomes for military populations.

Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms

Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average “large” effect size improvement, d = 1.49). Significant and “moderate-to-large” main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62–1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.

Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury?

Objective A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions. Method This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms. Results A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time. Conclusions Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.

Fatigue and Mental Illness Symptoms in Long COVID: Protocol for a Prospective Cohort Multicenter Observational Study.

The aftermath of the COVID-19 pandemic continues to affect millions worldwide, resulting in persisting postvirus complaints and impacting peoples' quality of life. Long COVID, characterized by lingering symptoms like fatigue and mental illness, can extend beyond a few months, necessitating further research to understand its implications. This study aims to quantify the degree of physical and psychological fatigue in patients following COVID-19 infection and examine its correlation with mental health disorders. Using a consecutive nonrandom sampling technique, we will conduct a prospective cohort multicenter observational study in 5 Portuguese hospitals. Symptomatic adult patients with previous COVID-19 attending follow-up consultations will be enrolled. We will include patients who had mild, moderate, and severe acute disease. We will assess clinical outcomes related to COVID-19, including the type of respiratory support such as high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. The exclusion criteria will include previous severe psychiatric disorders confirmed by a psychiatrist; refusal or inability to respond to the questionnaire; concomitant neurological disorder; persistent fatigue symptoms during the 6 months before infection; and the need for invasive mechanical ventilation during COVID-19 infection due to a high prevalence of postintensive care syndrome. Our primary outcome is the prevalence of fatigue in patients with post-COVID-19 depression and/or anxiety, as measured by the Chalder Fatigue Scale (CFQ-11) and the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes will include an assessment of health-related quality of life via the EQ-5D questionnaire and an exploration of the prevalence of symptoms of posttraumatic stress disorder (PTSD) using the 14-item Posttraumatic Stress Scale (PTSS-14). We will also examine the association between mental health symptoms and the severity of acute COVID-19. The post-COVID-19 data will be collected at least 6 months after the positive test and no longer than 9 months during the clinical appointment. We expect our multicenter study on patients post COVID-19 to reveal a significant link between mental illness symptoms and both physical and psychological fatigue. Patients with heightened depression and anxiety may report increased levels of fatigue. Additionally, we expect to find persistent PTSD symptoms in a subset of participants, indicating the enduring psychological impact of the virus. This study may underscore the need for integrated care addressing physical and mental health in patients post COVID-19. The observed connections emphasize the importance of considering mental well-being for long-term health outcomes. Despite study limitations, our findings contribute valuable insights for future treatment strategies and highlight the necessity for comprehensive mental health support in post-COVID-19 care. This research provides valuable insights into the mental health implications of COVID-19 and its impact on post-COVID-19 fatigue and the overall well-being of affected individuals. ClinicalTrials.gov NCT05323318; https://clinicaltrials.gov/study/NCT05323318. DERR1-10.2196/51820.

The war in Ukraine and the dynamics of PTSD and depression in Poles aged 50+

Introduction and objective: Older Poles are a group particularly exposed to mental health disturbances in connection with the war in Ukraine. The aim of this research was to determine the severity and dynamics of post-traumatic stress disorder (PTSD), depression and somatic symptoms in the first year of the war in Ukraine, the relationship between PTSD and depression and sociodemographic factors, as well as to identify factors that increase the risk of PTSD and depression persisting a year after Russia’s aggression against Ukraine. Materials and methods: People aged ≥50 years (N = 116) were included in the study. The respondents were asked to complete the questionnaires twice, i.e. taking into account 2022 (beginning of war) and 2023 (a year after the outbreak). The International Trauma Questionnaire (ITQ), Patient Health Questionnaire (PHQ-9) and 8 items from the Patient Health Questionnaire – Somatic Symptoms (PHQ-15) were used. Results: In 2022, nearly 40% of respondents presented with PTSD, and over 60% showed depressed mood. In 2023, the number of people meeting the criteria for PTSD and depression decreased. Women showed higher levels of PTSD and depression. Higher levels of PTSD symptoms were observed among people with higher education. A greater decrease in the severity of PTSD was found among those declaring involvement in providing help for Ukraine. Older age and a higher baseline ITQ or PHQ-9 score favoured the persistence of PTSD and depression in 2023. Conclusions: Factors contributing to poor mental health other than the war itself may include the negative effects of the COVID-19 pandemic, current socioeconomic changes and past traumas.

Use of substances to cope predicts posttraumatic stress disorder symptom persistence: Investigating patterns of interactions between symptoms and its maintaining mechanisms.

Posttraumatic stress disorder (PTSD) remains a growing public health challenge across the globe and is associated with negative and persistent long-term consequences. The last decades of research have identified different mechanisms associated with the development and persistence of PTSD, including maladaptive coping strategies, cognitive and experiential avoidance, and positive and negative metacognitions. Despite these advances, little is known about how these different processes interact with specific PTSD symptoms, and how they influence each other over time at the within-person level. Leveraging a large (N > 1,800) longitudinal data set representative of the Norwegian population during the COVID-19 pandemic, this preregistered study investigated these symptom-process interactions over four assessment waves spanning an 8-month period. Our panel graphical vector autoregressive network model revealed the dominating role of substance use to cope in predicting higher levels of PTSD symptoms over time and increases in PTSD symptomatology within more proximal time windows (i.e., within 6 weeks). Threat monitoring was associated with increased suicidal ideation, while threat monitoring itself was increasing upon decreased avoidance behavior, greater presence of negative metacognitions, and higher use of substances to cope. Our findings speak to the importance of attending to different coping strategies, particularly the use of substances as a coping behavior in efforts to prevent PTSD chronicity upon symptom onset. We outline future directions for research efforts to better understand the complex interactions and temporal pathways leading up to the development and maintenance of PTSD symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comorbid Prolonged Grief, PTSD, and Depression Trajectories for Bereaved Family Surrogates

Family surrogates of patients who die in an intensive care unit (ICU) are at risk of cooccurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depressive disorder during bereavement, but symptom trajectories are often explored individually. To simultaneously examine and determine co-occurrence of PGD, PTSD, and depressive symptom trajectories. This cohort study was conducted in ICUs of 2 Taiwanese medical centers from January 2018 to March 2020, with follow-up through July 2022. Participants included surrogates responsible for decision-making who provided data 6 to 24 months after the death of their loved one. Data were analyzed from August to December 2022. PGD was assessed with the 11 grief symptom items of the PG-13; PTSD, the Impact of Event Scale-Revised; and depressive symptoms, the depression subscale of the Hospital Anxiety and Depression Scale at 6, 13, 18, and 24 months after the death. Latent growth mixture modeling was conducted to identify distinct trajectories, and joint latent class analysis was used to assess joint patterns of trajectories. A total of 303 participants were included, with most younger than 56 years (207 participants [68.3%]), female (177 participants [58.4%]), and married (228 participants [75.2%]), and their relationship with the patient was mostly spouse (88 participants [29.0%]) or adult child (166 participants [54.8%]). Three trajectories were identified each for PGD, PTSD, and depressive symptoms. A resilience trajectory was predominant across PGD (253 participants [83.5%]), PTSD (250 participants [82.5%]), and depressive (200 participants [66.0%]) symptoms. Second most common was a recovery trajectory identified for PGD (36 participants [11.9%]) and PTSD (41 participants [13.5%]) symptoms, while for depressive symptoms, a moderate trajectory (72 participants [23.8%]) signified persistent moderate distress. A chronic trajectory characterized by persistently high distress was identified for PGD (14 participants [4.6%]) and depressive (31 participants [10.2%]) symptoms, whereas a unique delayed-onset trajectory (12 participants [4.0%]) was identified for PTSD symptoms. Most family surrogates (228 participants [75.2%]) experienced cooccurring PGD, PTSD, and depressive symptom trajectories, but multiple patterns were discordant. Symptom trajectories cooccurred in joint patterns: resilient (247 participants [81.5%]), recovered (43 participants [14.1%]), and distressed (14 participants [4.5%]). These patterns were characterized by high conditional probabilities for the resilience (PGD, 0.999; PTSD, 0.999; depressive, 0.804), recovery (PGD, 0.854; PTSD, 0.890; depressive, 0.588), and chronic (PGD, 0.921; PTSD, 0.789; depressive, 0.980) symptom trajectories. In this cohort study, grief-related psychological symptoms evolved in complex ways during ICU bereavement, as characterized by heterogeneous trajectories. Some ICU bereaved surrogates experienced persistent elevated PGD, PTSD, and depressive symptoms individually or conjointly, underscoring the importance of early screening to identify this population at high risk of comorbid psychological distress trajectories.

Long-term socio-psychological disaster impact after 8 years: Relationships between the persistent impact of the Fukushima disaster and individuals’ media and community connectedness

Residents of Fukushima Prefecture continue to face trauma after Japan's 2011 nuclear disaster. While there remains a substantial presence of posttraumatic stress disorder (PTSD) in the prefecture, and the majority of literature tends to view PTSD as an individual psychological disease that can be ameliorated; there is little understanding about how individuals experiencing PTSD influence their communities over time. The present research employs Barton's collective stress theory and Ball-Rokeach et al.'s communication infrastructure theory to examine multilevel effects of individual-level trauma and offers a new term, long-term socio-psychological disaster impact (LTSDI). LTSDI modifies pre-existing notions of persistent PTSD to a neutral understanding of experiences of symptomology and various levels of individuals’ impacts on their communities. Survey research conducted in Fukushima eight years after the disaster and analyses employing structural equation modeling found individuals experiencing LTSDI can positively contribute to their communities through community connectedness, a measure of interpersonal storytelling, collective efficacy, and civic participation. Implications of the study are discussed.

Oxytocin and Vasopressin Blood Levels in People with Post-Traumatic Stress Disorder.

The neuroendocrine system and the hypothalamic-pituitary-adrenal axis are among the possible neurobiological factors that may be involved in the emergence and persistence of post-traumatic stress disorder. Here, we determined the levels of vasopressin and oxytocin in the peripheral blood of people with post-traumatic stress disorder, investigating their correlation with post-traumatic stress disorder symptoms. The study included patients with post-traumatic stress disorder according to the Diagnostic and Statistical Manual of Mental Disorders Version 4 and healthy controls. People who accepted to participate in the study, who did not have any additional diseases, who had the ability to understand the questionnaires, and who did not use medications during the 3 months preceding the study onset were enrolled. The levels of vasopressin and oxytocin were measured using the enzyme-linked immunosorbent assay. Twenty-eight subjects with post-traumatic stress disorder and 19 healthy controls were included. The 2 groups were not significantly different in terms of oxytocin blood levels (P = .481). However, subjects with post-traumatic stress disorder had a significantly lower vasopressin level than controls (P < .001). We found no significant correlations of trauma duration and scale scores with oxytocin or vasopressin levels. The findings of this study show that blood vasopressin may play a role in post-traumatic stress disorder. Prospective studies based on a larger number of participants are warranted to clarify how neuromodulators may affect the pathogenesis of post-traumatic stress disorder.

Post traumatic stress disorder in African American men exposed to violent trauma

Research has shown strong association between exposures to violence resulting in post traumatic stress symptoms. Despite the high lifetime prevalence of post traumatic stress disorder (PTSD) and exposure to violence among African American men, research outcomes are limited and inconsistent. African American youth who live in low-income urban areas routinely face various contextual specific risks factors that leave them susceptible to loss and trauma in their lifetime resulting in persistent PTSD over time. Personas of resilience found in African American men exposed to chronic violence often mask trauma symptoms raising concerns on the evaluation of PTSD symptomology among African American men as well as the process of resilience and coping methods within this population. Limitations to research include convenience sampling limited to specific cities and exclusion of incarcerated African American men. In addition, there is a lack of longitudinal studies detailing the physiological and psychological course of PTSD and rates of recovery in African Americans. Health care systems and providers must be equipped, informed, and prepared to responding to mental health needs of African American men. The understanding of the expression and presence of PTSD among African American men will result in improvements of healthcare professionals' ability to evaluate, diagnose, and provide treatment for PTSD among this group whose symptoms of trauma may be misinterpreted or overlooked.

Assessment of post-traumatic stress disorder (PTSD) in elderly survivors of the Wenchuan earthquake: A cross-sectional study.

Post-traumatic stress disorder (PTSD) is a prevalent condition characterized by prolonged psychological distress following traumatic events encompassing serious health threats, domestic abuse, and natural disasters. The onset and persistence of PTSD can be attributed to advanced age. This study aimed to explore the occurrence and influencing factors of enduring post-traumatic stress disorder (PTSD) in survivors aged 60 years and over in the main area of the 2008 Wenchuan earthquake 10 years after the disaster. Data were collected using a multistage sampling method from individuals aged 60 years and older living in the main impacted areas of Wenchuan 10 years after the Wenchuan earthquake. The PTSD Checklist-Civilian Version (PCL-C) was used to evaluate PTSD symptoms. We evaluated participants based on their PTSD symptoms: those exhibiting and those without. The latter group was four times the size of the former and was matched based on gender and age (within±2 years). Conditional logistic regression was used to discern the risk factors. Out of the total, 56 participants were recognized as having probable PTSD as per the PCL-C checklist, leading to a rate of 9.4% (56/588). The univariate conditional logistic regression values showed that playing Mahjong/poker (odds ratio (OR)=0.394, 95% confidence interval (CI)=0.171-0.911) and displacement (OR=0.446, 95% CI=0.220-0.907) were protective factors for the long-term mental health of survivors in the hard-hit areas, while the presence of a 2-week illness (OR=3.605, 95% CI=1.751-7.424), possessing insurance (OR=0.250, 95% CI=0.072-0.864), suffering from a chronic ailment (OR=3.132, 95% CI=1.2-8.174), and having an injured family member (OR=2.26, 95% CI = 1.136-4.496) emerged as risk factors for PTSD symptoms. Multivariate analysis indicated that the absence of insurance and prevalence of 2-week illness correlated with increased PTSD symptoms. Ten years after the Wenchuan earthquake, the prevalence of probable PTSD remained significantly high in the elderly population. The major risk factors were the absence of insurance and the occurrence of a 2-week illness. Policymakers should incorporate these findings when devising strategies for aging societies.

Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial

Purpose To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. Materials and methods Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. Results Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. Conclusions Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma. IMPLICATIONS FOR REHABILITATION After hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns. Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers. We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia. The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.

Persistence of post-traumatic stress disorder in Chinese Shidu parents is associated with combined gray and white matter abnormalities

Post-traumatic stress disorder (PTSD) is one of the most common mental health disorders among Shidu parents. Identification of gray and white matter differences between persistence of PTSD (P-PTSD) and remission of PTSD (R-PTSD) is crucial to determine their prognosis. A total of 37 Shidu parents with PTSD were followed for five years. Surface-based morphometry and diffusion tensor imaging were carried out to analyze the differences in gray and white matter between P-PTSD and R-PTSD. Finally, 30 patients with PTSD were enrolled, including 12 with P-PTSD and 18 with R-PTSD. Compared with patients with R-PTSD, patients with P-PTSD exhibited lower fractional anisotropy (FA) in Cluster 1 (including body of the corpus callosum, superior longitudinal fasciculus, corticospinal tract) and Cluster 2 (including inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, splenium of the corpus callosum) in the left cerebral hemisphere and higher cortical thickness in the right lateral occipital cortex (LOC). In patients with P-PTSD, FA values of Cluster 2 were negatively correlated with cortical thickness of the right LOC. These results suggest that among Shidu parents, differences were observed in gray and white matter between P-PTSD and R-PTSD. Moreover, some certain gray and white matter abnormalities were often present simultaneously in P-PTSD.

Cerebral cortical thinning in brain regions involved in emotional regulation relates to persistent symptoms in subjects with posttraumatic stress disorder

A considerable proportion of individuals exposed to trauma experience chronic and persistent posttraumatic stress disorder (PTSD). However, the specific brain and clinical features that render trauma-exposed individuals more susceptible to enduring symptoms remain elusive. This study investigated 112 trauma-exposed participants who had been diagnosed with PTSD and 112 demographically-matched healthy controls. Trauma-exposed participants were classified into those with current PTSD (persistent PTSD, n = 78) and those without (remitted PTSD, n = 34). Cortical thickness analysis was performed to discern group-specific brain structural characteristics. Coping strategies and resilience levels, assessed as clinical attributes, were compared across the groups. The persistent PTSD group displayed cortical thinning in the superior frontal cortex (SFC), insula, superior temporal cortex, dorsolateral prefrontal cortex, superior parietal cortex, and precuneus, relative to the remitted PTSD and control groups. Cortical thinning in the SFC was associated with increased utilization of maladaptive coping strategies, while diminished thickness in the insula correlated with lower resilience levels among trauma-exposed individuals. These findings imply that cortical thinning in brain regions related to coping strategy and resilience plays a vital role in the persistence of PTSD symptoms.

Mental health impact of the catastrophic 2023 earthquake on Turkish youth: psychological distress amidst humanitarian crisis

On February 6, 2023, Türkiye was struck by a devastating earthquake with a magnitude of 7.8, a natural disaster of enormous destruction. As a result, many citizens succumbed to mortality, suffered immense physical and psychosocial harm, and the properties of the survivors suffered severe damage. Adolescents and the youth sector in particular are at an increased risk of developing psychiatric disorders1. Hence, policymakers and stakeholders need to pay attention to this understudied sector to prevent and manage health care issues associated with the recent earthquakes. Because of their rapid appearance, ferocity, and devastation, earthquakes exert unequivocal stress events2. Previous studies have demonstrated that posttraumatic stress disorder (PTSD) is frequently linked to earthquakes, which have a significant psychological influence on individuals and hinder their early return to normal activities while prolonging unpleasant emotions3. Moreover, prior traumatic encounters and childhood abuse have a significant impact on the mental health of adolescent survivors3. Recalling fear, triggering memories, or experiencing panic and anxiety is one of the most notable effects of the possibility and persistence of PTSD. These symptoms have a rapid impact on mental health and, according to studies and personal experience, are associated with the initiation and risk of developing PTSD3. In addition, this disorder comprises mood disorders, such as dysthymia and anxiety, with the diagnosis being connected to the existence of PTSD following the earthquake3. The majority of adolescent survivors’ experience intrusive flashbacks and posttrauma ruminations, also known as event-related ruminations, which result from the shaking of beliefs after excruciating occurrences2. Adolescents may experience varying levels of trauma following the earthquake, with one of the most significant elements influencing the intensity being the loss of family members and the damage of homes, which causes a dramatic change in their lives2,3. Adolescent trauma survivors are thought to focus more on the negative aspects of traumatic cues as a result of automatic ruminations that reduce an individual’s ability to avoid them. The most recent earthquake in Türkiye since 1939 had the largest recorded magnitude, and it damaged an area of around 400 km24. The chronicity of adolescent survivors’ mental health and quality of life are impacted by postearthquake difficulties including eviction, destroyed homes, or injuries. These variables are more likely to be subjected to harsher conditions in the aftermath of the traumatic event3. According to a study, those who have experienced partial or full PTSD symptoms for 2 years may continue to experience them for the following 10 years5. The Turkish government faces a serious task in constructing a suitable plan to aid the afflicted youth alongside heal those affected and develop a prosperous generation. In response to the rising prevalence of adolescent mental health issues, the World Health Organization (WHO) is assisting the Turkish government through its regional concept of operations, working in partnership with the Turkish Ministry of Health to provide mental health services throughout all impacted areas4. It is advised to conduct a structured examination of adolescent psychological distress symptoms. This may be achieved by interviewing teenagers, preferably without their parents present to prevent emotional bias and distress disguise. This mediates a secure clinical setting in which to discuss their traumatic experience to receive appropriate care6. Moreover, following the early emergency comeback, children and caregivers will warrant additional specialized trauma healing interventions that will be crucial in assisting youth in maintaining their well-being while also being impacted by the risk and protective factors that came with the Türkiye earthquake7. Offering extensive training for mental health professionals is highly advised, so that the symptoms of PTSD and other disorders are revealed more rapidly, and hence managed more sufficiently6. Not only should face-to-face therapy be offered, but also eHealth methods should be adopted to expand the range of benefited adolescents throughout all regions of Türkiye6. There is a need to break the stigma surrounding mental health, that acts as a barrier preventing individuals from seeking help. Moreover, community and political engagement and improvement of disaster management goals accountability and identifying gaps are essential steps. Through sustained research identification of predictors may help formulate postdisaster relief and rehabilitation efforts to further reduce the psychological distress in such a humanitarian crisis. Ethical approval Not applicable. Sources of funding The authors have not received any financial support for this manuscript. Author’s contribution O.U.: conceptualization, project administration, writing—review and designing. H.A.: reviewing the first draft and revising. J.W.: reviewing and editing. All authors approved the final manuscript and submission. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Abubakar Nazir. Guarantor Abubakar Nazir. Data availability statement Not applicable.