Positive Posttraumatic Stress Disorder Screen Research Articles

The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD

BackgroundPsychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in the literature examining PTSD in ACHD using the current DSM-5 criteria, while assessing patient characteristics and experiences with trauma-focused treatment. MethodsSurveys were offered to outpatients over a six-month enrollment period to be completed via QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo Social Support Scale (OSSS-3), Adverse Childhood Experiences (ACEs) survey, and the PTSD Checklist for DSM-5 (PCL-5). ResultsOf 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%), using a PCL-5 cutoff score of ≥ 31. A positive PTSD screen was associated with younger age, non-white race, presence of heart failure, lower New York Heart Association Functional Class, lower linear Quality of Life score, lower OSSS-3 score, an insecure caregiver relationship, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions was not associated with PTSD, although having undergone no cardiac surgeries until adulthood (≥ 18 years old) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14/48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. Eighteen patients (38%) reported currently having a mental health provider. Thirty patients (62%) had heard of at least one evidence-based trauma-informed therapy, and 14 (29%) had tried at least one. ConclusionsUsing the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few individuals with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.

Positive PTSD Screening and Its Health Correlates in Patients With HIV in Urban Primary Care Settings

Posttraumatic stress disorder (PTSD) is underdiagnosed and undertreated in primary care, especially among African American individuals. The current study assessed documentation rates of PTSD and clinical health correlates among 135 predominantly African American patients with HIV and positive PTSD screens in a primary care unit. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and a retrospective chart review of 135 patients with HIV were conducted. On the PCPTSD-5 (cut point of 3), approximately one half of patients (49.6%; n = 67) had probable PTSD; however, only 11.9% of patients ( n = 16) had a chart diagnosis of PTSD. A positive PTSD screen was associated with higher rates of depression and insomnia, but not anxiety, alcohol use, drug use, or pain in patients with HIV. Multi-morbidity of HIV, major depression, and positive PTSD screens was associated with increased risk for asthma, number of medical diagnoses, depression, insomnia, and anxiety. Findings highlight the need for trauma-informed care in primary care settings for people with PTSD and HIV. Larger samples are warranted to further explore health correlates of PTSD. [ Journal of Psychosocial Nursing and Mental Health Services, xx (xx), xx–xx.]

Diagnostic profiles and trauma history among treatment-seeking young adults with positive post-traumatic stress disorder screens: Findings and implications for public mental health care.

This study examined diagnostic profiles and trauma history among treatment-seeking young adults with positive PTSD screens in public mental health care. Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment-seeking young adults (aged 18-35) endorsed trauma exposure with a score of at least 45 on the DSM-IV PTSD Checklist, indicating probable PTSD. Young adults with positive PTSD screens were predominantly female, minority, and diagnosed with mood disorders. Of those with positive screens, only 15% had a chart diagnosis of PTSD; 17.3% (ages 18-24) versus 14.1% (ages 25-35). Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. Routine PTSD screening for young adults receiving public mental health care should be prioritized to address long-term impacts of trauma.

Post-traumatic stress disorder in a Canadian population of medical students, residents, and physicians

BACKGROUND: Physicians encounter stressors with potential long-term psychological consequences. However, a comprehensive picture of post-traumatic stress disorder (PTSD) prevalence and symptomatic work-related event occurrence across practice stages is lacking. OBJECTIVE: To evaluate PTSD prevalence and the occurrence of work-related symptomatic events among physicians and medical learners. METHODS: In 2017, we surveyed 3,036 physicians, residents, and students within the province of Saskatchewan, Canada. Participants completed the Life Events Checklist (LEC) for DSM 4 and the PTSD Checklist for DSM 4-Civilian version (PCL-C). They also reported work-related events that triggered PTSD-like symptoms. The prevalence of a positive PTSD screen (PCL-C ≥ 36) and the proportion identifying a symptomatic work event were determined. The t-test, Chi-square test, and multiple regression were used to evaluate associations between respondent characteristics and these outcomes. RESULTS: Among 565 respondents, 21.2% screened positively, with similarity across career stages. Thirty-nine percent reported a symptom-inducing work event, with many training-related. Although independent PTSD predictors were not identified, partnered residents and surgical residents were more likely to identify a work-related event. Internationally trained practicing physicians were less likely to identify an event. CONCLUSION: Both symptom-inducing work events and PTSD are frequent, broadly based concerns requiring better preventive strategies across career stages.

Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder.

Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms. Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores. Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point. Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.

Posttraumatic stress disorder and posttraumatic stress symptoms among adults with hemophilia A and B

BackgroundPersons with hemophilia may encounter various traumatic experiences related to their bleeding disorder throughout their lifetime. Little is known about the clinical impact of disease-related trauma on this population. ObjectivesTo explore the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms in adults with hemophilia A and B and characterize the traumatic experiences they report. MethodsAn online survey tool collecting data on participant characteristics and a validated questionnaire containing the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders 5 were distributed via Research Electronic Data Capture to adults with hemophilia A and B during their annual visit to their hemophilia treatment center. Participants were asked about traumatic experiences specific to their hemophilia prior to self-administering the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders 5 questionnaire. ResultsSurvey responses from 178 individuals across 3 hemophilia treatment centers were included in the analysis, representing a 70% response rate. One hundred one (56.7%) participants identified a hemophilia-related traumatic event, and 21 (11.8%) participants met criteria for a provisional diagnosis of PTSD. Multivariable analysis showed higher odds of a positive PTSD screen in participants with noninfectious (odds ratio [OR], 13.89; 95% CI, 2.23-86.62) and infectious comorbidities (OR, 11.18; 95% CI, 1.34-93.45) and in participants with >1 mental health comorbidity (OR, 10.07; 95% CI, 2.39-42.52). On the contrary, age >46 years (OR, 0.6; 95% CI, 0.01-0.62) and higher education (OR, 0.25; 95% CI, 0.07-0.88) reduced odds of PTSD. ConclusionPersons with hemophilia are at risk of developing PTSD and posttraumatic stress symptoms. These data support the need for trauma screening, psychosocial services in the bleeding disorders community, and provision of trauma-informed care by providers.

Feasibility and Utility of Posttraumatic Stress Disorder Screening Among Postpartum Patients at an Urban Safety-Net Institution.

Posttraumatic stress disorder (PTSD) is underdiagnosed peripartum. We administered a primary care screening tool and a pregnancy-related PTSD screening tool to postpartum patients presenting to our urban safety-net institution within 6 months of delivery, between August 2021 and February 2022. Our primary outcome was prevalence of positive PTSD screening results. Most patients (364/376, 96.8%) completed screening. Thirty (8.4%) had a positive score on at least one instrument, and seven of these 30 (23.3%) did not have a positive postpartum depression screening result. Among patients with a positive score, the majority (66.7%) obtained behavioral health follow-up. We found that routine PTSD screening for postpartum patients is feasible and identified patients at risk for PTSD. Obstetric practitioners should consider integrating PTSD screening into routine care.

Perceived discrimination and posttraumatic stress disorder among Venezuelan migrants in Colombia and the United States: The moderating effect of gender.

The primary aim of this study was to examine the association between perceived discrimination and posttraumatic stress disorder (PTSD) outcomes among recently arrived Venezuelan parents in Florida and Colombia. The secondary aim was to determine whether, given the existence of an association between perceived discrimination and PTSD, this association may have been moderated by gender or by country of relocation. This is the first study to examine perceived discrimination and PTSD in Venezuelan migrants. In October 2017, 647 Venezuelan migrant parents (62% female, average age 33) participated in an online survey in the United States (primarily Florida) and Colombia (Bogotá). The survey was cross-sectional and assessed mental health outcomes, perceived discrimination, and participant demographics. There was a significant positive association between discrimination and PTSD outcomes when controlling for age, college completion, marital status, and recency of arrival (β = .25, p < .001). Further, this relationship was moderated by gender, with the relationships of discrimination with PTSD symptom severity (β = .26, p < .001) and likelihood of a positive PTSD screen (OR = 1.07, 95% confidence interval [1.04, 1.09], p < .001) both reaching significance for women but not for men. Perceived discrimination is an important factor when considering mental health outcomes among Venezuelans in the United States and in Colombia. Further, our findings suggest the presence of gender differences in the relationship between discrimination and PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Does screening for PTSD lead to VA mental health care? Identifying the spectrum of initial VA screening actions.

Despite the active posttraumatic stress disorder (PTSD) screening program in Department of Veterans Affairs (VA) primary care clinics and the availability of empirically supported treatments for PTSD at VA, many veterans for whom screening suggests treatment may be indicated do not gain access to VA-based mental health care. To determine where we may be losing veterans to follow-up, we need to begin by identifying the initial action taken in response to a positive PTSD screen in primary care. Using VA administrative data and chart review, we identified the spectrum of initial actions taken after veterans screened positive for PTSD in VA primary care clinics nationwide between October 2017 and September 2018 (N = 41,570). We collapsed actions into those that could lead to VA-based mental health care (e.g., consult placed to a VA mental health clinic) versus not (e.g., veteran declined care), and then examined the association between these categories of actions and contextual- and individual-level variables. More than 61% of veterans with positive PTSD screens had evidence that an initial action toward VA-based mental health care was taken. Urban-dwelling and female veterans were significantly more likely to have evidence of these initial actions, whereas White and Vietnam-era veterans were significantly less likely to have this evidence. Our findings suggest that most veterans screening positive for PTSD in VA primary care clinics have evidence of initial actions taken toward VA-based mental health care; however, a substantial minority do not, making them unlikely to receive follow-up care. Findings highlight the potential benefit of targeted primary care-based access interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emergence of probable PTSD among U.S. veterans over the military-to-civilian transition.

Despite theorizing that posttraumatic stress disorder (PTSD) symptomatology may be exacerbated during the military-to-civilian transition, little research has delved into the trajectory of trauma-related symptomatology or the impact of diverse factors on timing of PTSD onset. To understand risk and protective factors for PTSD during the transition into civilian life, this study examined demographic, experiential, and psychosocial characteristics that may explain variation in PTSD symptoms and timing of onset. A nationwide sample representing 48,965 U.S. veterans separating from military service in fall 2016 responded to six Web-based surveys over 3 years. Assessments included PTSD symptoms, stress, warfare exposures, military sexual trauma, moral injury events, resilience, and social support. Multivariable models estimated covariates of positive PTSD screen or symptoms. Trauma exposure during military service was high at 59%. Probable PTSD was detected in 26% of the sample at baseline, with additional cases in each survey wave for an overall rate of 30%. Meeting criteria for probable PTSD covaried with current stress, female gender, and minority race/ethnicity; baseline psychological resilience and concurrent social support mitigated the risk. PTSD symptoms correlated positively with stress levels at current and previous time points. Social support was protective but only when contemporaneous with the PTSD symptoms. This study illustrates the need for ongoing social support for veterans coping with symptoms of PTSD, life stressors, and postmilitary trauma, suggesting a countervailing influence of psychological resilience and contemporaneous (but not historical) social support on symptom exacerbation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mental health among university employees during the COVID-19 pandemic: The role of previous life trauma and current posttraumatic stress symptoms.

Previous studies indicated that the coronavirus disease 2019 (COVID-19) pandemic has harmed the mental health of diverse samples. Adopting a trauma lens with a sample of university faculty and staff, this study examined risk conferred by previous exposure to traumatic life events (TLE) on pandemic-related mental health harm (MHH) and stress and the mediating influence of posttraumatic stress disorder (PTSD) symptoms. In Spring 2021, employees (N = 641) of a public university in the United States completed an online cross-sectional survey, including validated scales of TLE and PTSD and single-item measures of MHH and stress taken from published COVID-19 studies. A structural probit model was used to estimate: (a) direct effects of cumulative TLE on PTSD, MHH, and stress; and (b) indirect effects of cumulative TLE via PTSD adjusting for age. Gender was tested as a moderating influence. Nearly 36% of the sample reported positive PTSD screens along with high levels of MHH (22.5%) and stress (42.3%). Cumulative TLE was significantly and positively associated with MHH and stress. Both genders experienced a negative impact on mental health and stress either fully or partially through PTSD symptoms; however, the gender by trauma interaction term was not significant. As age decreased, PTSD and MHH increased. Results suggest that PTSD symptoms play a crucial role in the experience of MHH and stress during the pandemic for those who endured previous trauma. Implications for employer policies, public health messaging, and mental health services are explored. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personality traits and mental distress after COVID-19 testing. Prospective long-term analysis in a Viennese cohort.

Symptoms of mental stress are a hallmark of the COVID-19 pandemic. We hypothesized that just testing for COVID-19 could act as an effective stressor for persisting symptoms of mental distress including posttraumatic stress disorder. Our study aimed to determine whether personal beliefs on individual control and competence (locus of control, LoC) correlate with symptoms of mental distress and positive screening for post-traumatic stress disorder during a 9-month observational period. Between March and December 2021, we applied online versions of the Questionnaire on Competence and Control Expectations (FKK), the Depression, Anxiety, and Stress Score (DASS), the Short Screening Scale for DSM-IV Posttraumatic Stress Disorder (PTSD), and a medical history questionnaire for COVID-19 symptoms (visit 1). 48 hours after negative COVID-19 testing, DASS was repeated to address relief effects on mental distress (visit 2). Following 90 days (visit 3), development of mental distress was addressed by a combination of DASS and PTSD, while the possible long-term manifestation of PTSD was evaluated 9 months later (visit 4). At visit 1, 7.4 percent of the total sample (n = 867) demonstrated a positive screening for PTSD, while after nine months (at visit 4), 8.9 percent of the remaining sample (n = 204) had positive screening results. The mean age was 36.2 years; 60.8% were women, 39.2% men. In contrast to individuals with negative PTSD screening, these participants demonstrated a significantly different LoC personality profile. This was confirmed by the results of both DASS and the COVID-19 medical history questionnaire. Following testing for COVID-19, individuals with positive long-term PTSD screening present with significantly different personality traits than those w/o suggesting that self-confidence and effective control over one's own actions serve as a protective function against mental distress.

Supplemental Material for Characteristics of Recently Incarcerated Primary Care Patients With and Without a Positive Posttraumatic Stress Disorder Screening Upon Clinic Intake

Supplemental Material for Characteristics of Recently Incarcerated Primary Care Patients With and Without a Positive Posttraumatic Stress Disorder Screening Upon Clinic Intake

Characteristics of recently incarcerated primary care patients with and without a positive posttraumatic stress disorder screening upon clinic intake.

Posttraumatic stress disorder (PTSD) is prevalent among people who have been incarcerated. Here, we examined whether screening positive for PTSD was associated with other indicators of poor health, acute healthcare utilization, and poverty among primary care patients upon release from incarceration. We conducted a cross-sectional survey in a national network of primary care clinics serving people recently released from incarceration. Participants were 416 patients who completed the Primary Care PTSD screen (PC-PTSD) and other questions about mental and physical health, acute healthcare utilization, and economic status within 6 months of release. Screening positive for PTSD was associated with worse status across nearly all variables examined, including being more likely to report: poor/fair health (61.6% vs. 41.7%), current depressive symptoms (89.7% vs. 50.8%), lifetime depression diagnosis (63.3% vs. 35.3%), cannabis use since release (20.7% vs. 9.6%), homelessness (31.9% vs. 18.5%), having no cash on hand (56.3% vs. 39.0%) and severe food insecurity (29.3% vs. 18.2%; all ps < .01). Reporting recent suicidality (14.3% vs. 7.0%), alcohol use since release (30.2% vs. 20.0%), and emergency department utilization (20.4% vs. 12.2%) was also more likely (all ps ≤ .03). These trends were largely upheld when controlling for demographic characteristics and chronic physical health conditions using linear probability regression. Primary care patients recently released from incarceration have a need for wrap-around services that address health challenges and poverty. Patients with significant PTSD symptoms face even greater challenges. Identification and treatment of PTSD both during and after incarceration is warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence

Our study examines the association between Adverse Childhood Experience (ACE) exposure and posttraumatic stress disorder (PTSD) symptoms among survivors of violence. In this cross-sectional study, an ACE questionnaire and PTSD Checklist for DSM-5 (PCL-5) were completed by 147 participants ≤ 3 months after presenting to a Philadelphia, PA emergency department between 2014 and 2019 with a violent injury. This study treated ACEs, both separate and cumulative, as exposures and PTSD symptom severity as the outcome. Most participants (63.3%) met criteria for provisional PTSD, 90% reported experiencing ≥ 1 ACE, and 39% reported experiencing ≥ 6 ACEs. Specific ACEs were associated with increasing PCL-5 scores and increased risk for provisional PTSD. Additionally, as participants’ cumulative ACE scores increased, their PCL-5 scores worsened (b = 0.16; p < 0.05), and incremental ACE score increases predicted increased odds for a positive provisional PTSD screen. Results provide further evidence that ACEs exacerbate the development of PTSD in young survivors of violence. Future research should explore targeted interventions to treat PTSD among survivors of interpersonal violence.

121 Acute Stress Disorder and Post-traumatic Stress Disorder in the Outpatient Burn Population

IntroductionEarly screening and intervention for acute stress disorder (ASD), diagnosed within 30 days of the inciting trauma, and post-traumatic stress disorder (PTSD), diagnosed after 30 days, are quality metrics in burn care. However, a considerable knowledge gap remains surrounding these psychological conditions in the outpatient burn setting. In this study, we assessed the effectiveness of ASD and PTSD screening at an academic burn center and identified risk factors for their development.MethodsA retrospective cohort study of all patients treated at our ABA-verified burn center’s outpatient clinic, between July 2016 and August 2019, was undertaken. Adult patients with flame, flash, contact, or scald burns who were initially evaluated in the outpatient setting were included. ASD and PTSD were assessed using validated screening tools (ASDS and PCL-5, respectively). ASD/PTSD screening rate, screening tool appropriateness, and subsequent interventions were tracked, along with age, gender, % total body surface area (TBSA) burned, burn mechanism, operative intervention, psychiatric history, substance abuse history, and co-morbidities. Chi-square and Mann-Whitney U tests were used for univariate analysis of categorical and continuous variables, respectively.ResultsThe analysis included 2494 clinic encounters and 1147 unique patients. Patients were screened for ASD or PTSD at 94.8% of encounters. Median age was 36 years (range of 18 to 94 years), 57.6% of patients were male (n=661), and median TBSA burned was 1% (range of 0.1 to 12%). Among all screens, the appropriate screening tool was applied 88.5% of the time. For all encounters, positive screening rates for ASD and PTSD were 13.2% (n=286) and 14.6% (n=48), respectively. Risk factors for positive ASD screens included a history of substance abuse (OR 1.9, p=0.03) and history of psychiatric illness (OR 2.6, p=0.002). Similarly, risk factors for positive PTSD screens included a prior positive ASD screen (OR 9.5, p=0.001), a history of substance abuse (OR 2.1, p=0.04), and a history of psychiatric illness (OR 3.3, p=0.002). Age, gender, burn mechanism, TBSA burned, and need for operative intervention did not predict positive screens. The intervention rate for positive PTSD screens by referral, counseling, or medication, was only 7.9%.ConclusionsDemographics and burn severity do not appear to predict development of ASD or PTSD in the outpatient burn population. In contrast, a history of substance abuse or psychiatric illness warrant further attention. Despite consistent use of validated screening tools, these conditions remain under-treated in the outpatient setting, indicating a need for resource-expansion.

Mental health consequences of military sexual trauma: results from a national survey in the French military

BackgroundMilitary sexual trauma (MST) is a major public health concern, given its prevalence and mental health sequelae. This phenomenon is particularly prevalent among women in the US military, although more cases involve men given their overrepresentation. Little is known about MST and its consequences in other military settings, including in Europe.MethodsThis study draws from a national survey in the French military, including 1268 servicemen and 232 servicewomen. We conducted bivariate and multivariate analysis, using simple and multinomial logistic regressions to evaluate the associations between different forms of MST (repeated sexual comments alone/one form of sexual oppression (coercion, repeated verbal unwanted attention or assault)/ several sexual stressors) and symptoms of depression and of positive post-traumatic stress disorder (PTSD) screening scores.ResultsWomen were both more likely to experience MST and to experience more severe forms of MST than men. Women were also more likely than men to report mental health symptoms (31% versus 18% for symptoms of depression and 4.0% versus 1.8% for positive PTSD screening scores). Different forms of MST were associated with different levels of psychological distress. Women reporting repeated sexual comments alone had higher odds of depressive symptoms (OR=3.1 [1.7, 5.5]) relative to women with no MST. Likewise, the odds of depressive symptoms were 6.5 times higher among women and 8.0 times higher among men who experienced several sexual stressors relative to those who reported no MST. We also found higher relative risk of subthreshold PTSD screening scores among women reporting any form of sexual stressor, including sexual comments alone (RRR = 4.5 [2.8, 7.4]) and an elevenfold increase in the relative risk of positive PTSD screen scores (RRR = 11.3 [2.3, 55.6]) among women who experienced several sexual stressors relative to women with no MST.ConclusionMST is associated with mental health distress among service members in the French military, especially for women. The heightened risk of MST coupled with psychological sequelae call for preventive programs to reduce MST and for screening programs to provide adequate psychological support.

Posttraumatic stress and prenatal care adequacy among Black/African American women

Black/African American women with trauma histories experience a disproportionate burden of adverse perinatal outcomes. One mechanism for this association is inadequate prenatal care, as avoidant symptoms are a hallmark of posttraumatic stress disorder (PTSD). The objective of this study is to examine the association between PTSD symptoms and adequacy of prenatal care among Black/African American women. This retrospective cohort study included all pregnant women who self-identified as Black/African American and were referred to a hospital’s integrated mental health program between 2017-2021. All participants completed a PTSD Checklist -Civilian Version (PCL-C) as a part of an initial mental health evaluation. The EHR was reviewed to codify adequacy of prenatal care, which was assessed in three ways: late initiation of prenatal care (defined as gestational age at the first prenatal visit > 12 weeks), the ratio of no-show to attended prenatal visits, and the Adequacy of Prenatal Care Utilization (APNCU) Index. Bivariable analyses were performed. A propensity score for a positive PTSD screen was generated using confounders generated from a directed acyclic graph. This propensity score was included in multivariable models to control for imbalance across the exposure. Of the 111 women who met inclusion criteria, 57 (51%) screened positive on the PCL-C. Sample characteristics, stratified by a positive screen, are shown in Table 1. PCL-C score was associated with late initiation of prenatal care, the ratio of no-show to attended prenatal visits, and non-adequate prenatal care defined by the APNCU index (Table 2). The associations between late initiation of care and non-adequate APNCU index persisted in multivariable analyses. In this sample of pregnant Black/African American women with an identified mental health condition, PTSD symptoms were associated with inadequate prenatal care. The high prevalence of PTSD symptoms and the association with prenatal care emphasizes the importance of future research focused on trauma-related interventions for Black/African-American women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Internal entrapment and fearlessness about death as precipitants of suicidal thoughts and planning in the context of post-traumatic stress disorder.

The relationship between post-traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD). The cross-sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N=2690). Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past-month SI, and past-month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self-rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD. Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE.

Screening Children with a History of Maltreatment for PTSD in Frontline Social Care Organisations: An Explorative Study

Traumatic experiences during childhood are common and often lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). The primary aim of this study was to determine whether a well‐validated screening tool for PTSD administered in frontline services effectively identifies diagnosable PTSD in young people with a history of maltreatment. In total, 141 young people in community care settings were screened using three screening instruments (Child Revised Impact of Events Scale‐8; Generalised Anxiety Disorder‐2; Patient Health Questionnaire‐2). Participants described a range of adverse life events: 110 of the 141 participants reported at least one adverse life experience (mean number for the total sample was 2.8), with 44.2 per cent (n = 46) experiencing at least one form of interpersonal trauma; and 102 participants (72.3 per cent) screened positively for probable PTSD and subsequent mental health assessments confirmed this condition in 64.7 per cent of these participants. Further, 36.9 per cent (n = 52) and 46.8 per cent (n = 66) met the threshold for probable depression and anxiety, respectively. Three items were associated with positive PTSD screens: a history of being on the child protection register, previous mental health contact and interpersonal index trauma. Interpersonal traumas were also associated with higher risks of offending. It seems feasible to use screening measures effectively within frontline social care services if staff are provided with appropriate training and support to identify young people with PTSD who may benefit from evidence‐based mental health therapies.Key Practitioner Messages There is strong evidence of the link between childhood adversities and poor mental health, including PTSD. This study found that a short instrument can be embedded within social care services to screen children and young people for PTSD. It is important that frontline staff have the necessary training and tools to understand the effects of trauma and screen children's mental health in order to facilitate access to effective therapies at an early stage.