Onset Of Posttraumatic Stress Disorder Research Articles

Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first two years after Hurricane Katrina

Hurricane Katrina was the most devastating natural disaster to hit the United States in the past 75 years. The authors conducted interviews of 810 persons who were representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina. The prevalence of posttraumatic stress disorder (PTSD) since Hurricane Katrina was 22.5%. The determinants of PTSD were female gender, experience of hurricane-related financial loss, postdisaster stressors, low social support, and postdisaster traumatic events. Kaplan-Meier survival curves suggest that exposure to both hurricane-related traumatic events and to financial and social stressors influenced the duration of PTSD symptoms. Postdisaster interventions that aim to improve manipulable stressors after these events may influence the onset and course of PTSD.

Evaluation of Physical Activity Habits in Patients with Posttraumatic Stress Disorder

OBJECTIVEIn this study, we present data from a survey that aimed to assess the physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder.METHODFifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37±12 years, and the mean time between diagnosis and follow-up was 3.6±4.2 years.RESULTSSubstantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation.DISCUSSIONSeveral studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits.CONCLUSIONOur findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.

Trauma and Post-Traumatic Stress Disorder Among Homeless Adults in Sydney

International studies indicate high prevalence rates of post-traumatic stress disorder within homeless populations. In Australia, studies indicate high rates of trauma among homeless adults, yet post-traumatic stress disorder has not been investigated in homeless Australian adults. The primary aim of this project was to determine the prevalence of post-traumatic stress disorder among homeless adults in Sydney. Further, another aim of the study was to determine whether the onset of post-traumatic stress disorder preceded the first episode of homelessness or was a consequence of homelessness. The sample consisted of 70 homeless men and women aged 18-73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted with each participant. Lifetime prevalence of post-traumatic stress disorder was determined via the Composite International Diagnostic Interview. The majority of the sample had experienced at least one traumatic event in their lifetime (98%). Indeed, the mean number of traumas per person was six. The 12 month prevalence of post-traumatic stress disorder was higher among homeless adults in Sydney in comparison to the Australian general population (41% vs 1.5%). But 79% of the sample had a lifetime prevalence of post-traumatic stress. In 59% of cases, the onset of post-traumatic stress disorder preceded the age of the first reported homeless episode. Homeless adults in Sydney frequently experience trauma and post-traumatic stress disorder. The study found that trauma and post-traumatic stress disorder more often precede homelessness, but re-victimization is common. These findings highlight the high mental health needs among homeless people and have implications for services for homeless people.

Posttraumatic Stress Disorder and Psychiatric Comorbidity Among Detained Youths

Most youth in detention have 1 or more psychiatric disorders (1). Posttraumatic stress disorder (PTSD) is one of the more prevalent disorders in detention, affecting at least 1 in 10 youth (2–4). One of the more debilitating aspects of PTSD is its tendency to co-occur with other psychiatric disorders (5–7). In a community sample, Giaconia and colleagues (8) found that nearly four-fifths of those with lifetime PTSD also had one or more additional disorders. Studies of detained adolescent males in Russia (9) and detained adolescent females in Australia (10) found that all of the detainees with PTSD had at least 1 comorbid disorder. It is unclear if PTSD increases the vulnerability to other disorders or if there are common genetic or environmental factors underlying the disorders (5,11). Researchers agree, however, that comorbid disorders have an adverse impact on the prognosis and treatment of individuals with PTSD. Youth with PTSD and comorbid disorders have significantly more behavioral and health problems and more impaired interpersonal relationships than those without comorbid disorders (5). Effective treatment planning for detained youth with PTSD requires epidemiologic data on patterns of prevalence and comorbidity. Yet, to our knowledge, no epidemiologic study of detainees in the US has examined PTSD and comorbid psychiatric disorders. In this paper, we administered standardized diagnostic measures to a large, stratified random sample of detained youth to: (a) compare the prevalence of psychiatric disorders among juvenile detainees with and without PTSD and (b) examine the prevalence of PTSD among youth with and without other psychiatric disorders.

Clinical and sociodemographic variables associated with the onset of posttraumatic stress disorder in road traffic accidents

Our objective was to identify variables related to the onset of acute posttraumatic stress disorder (PTSD) after a road traffic accident. We evaluated 60 victims of a motor vehicle accident (MVA) in 2004 at 2 months postaccident. Thirty of them had developed PTSD; the other 30 had not developed PTSD. Clinical data, physical injuries, and sociodemographic characteristics were determined in 60 victims. The Davidson Trauma Scale (DTS) and a Structured Clinical Interview for DSM-IV (SCID) were used to evaluate PTSD occurrence. PTSD scores assessed by DTS and SCID at 2 months were significantly and positively associated with female sex, severe physical injuries, perceived social deprivation, and loss of job activity due to the accident. Female sex, severe physical injury, perceived social deprivation, and sick leave were related to the diagnosis of PTSD 2 months after the accident.

The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears.

There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic "bull's eye" disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology.

The Prevalence of Posttraumatic Stress Disorder Among Children and Adolescents Affected by Tsunami Disaster in Tamil Nadu

The Asian earthquake and subsequent tsunami of December 2004, one of the largest natural disasters in recent history, resulted in the deaths of over 250,000 people and massive destruction in 8 countries. As with any disaster, children are at risk for developing short- and long-term psychological consequences, including posttraumatic stress disorder (PTSD). One area particularly affected by this disaster was southern India. Five hundred twenty-three juvenile survivors of the tsunami were studied to determine the prevalence of PTSD. The survey was conducted in 2 waves. Interviews were conducted by postgraduate psychiatric social work students, proficient in the local language of Tamil and trained in PTSD-related data collection. The Impact of Event Scale-8 items Tamil Version and Child Behaviour Checklist Post-traumatic Stress Disorder-Tamil Revised Version, with age-specific measures and validated for the local culture and language, were used for the study. Our study revealed a prevalence of 70.7% for acute PTSD and 10.9% for delayed onset PTSD. PTSD was more prevalent among girls and more severe among adolescents exposed to loss of life or property. These results indicate that PTSD is widely prevalent among the survivors of the tsunami, reinforcing the need to develop an effective, culturally sensitive outreach therapy strategy for them.

Changing the Face of Abu Ghraib through Mental Health Intervention: U.S. Army Mental Health Team Conducts Debriefing with Military Policemen and Iraqi Detainees

A critical incident stress debriefing (CISD) was conducted with two U.S. Army military police officers (MPs) and 11 Iraqi detainees who experienced the untimely death of a detainee. The CISD was conducted by a psychiatrist and a psychologist, who used the seven-step debriefing model created by Jeffrey Mitchell in 1983. A primary goal of CISD is to diminish the impact of a traumatic event and ultimately to prevent the onset of post-traumatic stress disorder. An unexpected finding was that the debriefing provided an opportunity for the MPs and detainees to clear preconceived notions about each other, enhancing mutual collaboration. The purpose of this article is to describe how a mental health team used a CISD as an intervention in treating MPs and detainees who experienced a common tragic event.

Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: A 6-month follow-up study

Background Psychiatric disorders in HIV/AIDS are common, emerging soon after diagnosis or during the subsequent course of illness. However, there are few prospective studies on the rates of psychiatric disorders in HIV/AIDS, particularly in the context of the developing world. Methods Sixty-five patients with recently diagnosed HIV were interviewed on presentation to a hospital-based HIV clinic and then 6 months later. On both interviews, the patients were assessed using the MINI International Neuropsychiatric Interview, the Carver Brief COPE, and the Sheehan Disability Scale. Exposure to negative life events and risk behaviors was also evaluated. Results The overall prevalence of psychiatric disorders in the follow-up period remained high (56% of patients had at least one psychiatric disorder at baseline, and 48% of patients had at least one psychiatric disorder at 6 months). Depression and posttraumatic stress disorder (PTSD) were the most prevalent disorders at both baseline (34.9% and 14.8%) and follow-up (26% and 20%), respectively. More than half of all patients with depression at baseline improved (16 of 29; 55.1%). However, there was a new onset of both depression (4 of 49; 8.1%) and PTSD (12 of 17; 70.5%) on follow-up. In univariate analysis, depression on follow-up was significantly associated with: (a) disability in work/social/family functioning, (b) greater number of negative life events, and (c) a decline in CD4 lymphocyte count. Univariate analysis also revealed that a diagnosis of PTSD on follow-up was significantly associated with (a) a longer duration of infection and (b) baseline disability in work/social/family functioning. However, in multivariate analysis, only disability scores predicted the diagnoses of major depression and PTSD on follow-up assessment. Persistence of risky sexual behaviour was also noted, with a significantly higher number of participants reporting nonuse of condom on follow-up. There appeared to be a shift from maladaptive coping behaviors to more adaptive coping behaviors over the 6-month period. Conclusion The rate of psychiatric disorders in HIV/AIDS patients was consistent over time. These findings emphasize the importance of regular evaluation for psychiatric disorders in HIV/AIDS patients, not only at the commencement of treatment but also during subsequent follow-up visits.

Epidemiology of trauma, post-traumatic stress disorder (PTSD) and co-morbid disorders in Chile

In this study we examined the prevalence rates of post-traumatic stress disorder (PTSD), types of trauma most often associated with PTSD, the co-morbidity of PTSD with other lifetime psychiatric disorders, which disorders preceded PTSD, and gender differences in PTSD and trauma exposure in a representative sample of Chileans. The DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule (DIS) and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview (CIDI) were administered to a representative sample of 2390 persons aged 15 to over 64 years in three cities in Chile. The lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among persons exposed to trauma, rape was most strongly associated with PTSD. Onset of PTSD significantly increased the risk of developing each of the 10 other tested disorders. Among those exposed to trauma, women were significantly more likely to develop PTSD, after controlling for assaultive violence. This study highlights the importance of investigating the prevalence of PTSD, patterns of co-morbidity of PTSD, and gender differences in PTSD in non-English-speaking countries.

Common Mental Health Correlates of Domestic Violence

This article is a review of the research literature on mental health correlates of domestic violence, with an emphasis on posttraumatic stress disorder (PTSD). It was done to develop clues, symptoms, and indicators so that practitioners in mental health or criminal justice could become alert to indicators of the onset and severity of depression, anxiety disorders, substance abuse, and/or PTSD among battered women.

Changes in the Psychiatric Landscape

Changes in the Psychiatric Landscape

L'état de stress post-traumatique chez l'enfant

Post-traumatic stress disorder (PTSD) is the main psychopathological outcome following exposure to major events (natural disasters, war, terrorist bombing, rape…) which threaten life or integrity of the subject or where one witnesses the dead of others. It is the most frequent complication of sexual or physical abuse. Contrary to generally accepted ideas, child PTSD is a frequent, long lasting and potentially serious illness. Young age is not a protection. Typical clinical form is closed to those observed in veterans of Viet Nam, with developmental particularities and characteristics according to the type of Trauma. It is well-established that exposure to the traumatic event and its characteristics are the first determining factor in PTSD onset. There are as yet few systematic studies on long-term outcome of child Trauma and PTSD, particularly studies on infants and very young children or prospective studies. Disorders may become chronic in half of the cases, last until adulthood, get complicated with onset of other mental disorders, particularly depressive, behaviour or personality disorders. Psychosocial complications also put a strain on prognosis. PTSD treatments for children are not yet enough validated. PTSD treatments, mainly psychotherapies, show the interest of Trauma-focused therapies, and to take the family into account. Studies are still necessary to complete our knowledge.

Delayed-onset PTSD: A prospective study of injury survivors

Background Recent studies have indicated that delayed-onset posttraumatic stress disorder (PTSD) (i.e., the development of PTSD more than 6 months posttrauma) is generally characterised by subsyndromal diagnoses within the first 6 months. This study sought to examine the relationship between sub-clinical levels of PTSD symptoms at 3 months posttrauma and delayed onset PTSD at 12 months in a large sample of traumatic injury survivors. Methods Three hundred and one consecutively admitted injury survivors were assessed at 3 and 12 months posttrauma. PTSD was diagnosed according to DSM-IV criteria, while partial and subsyndromal diagnoses were based on recent definitions developed by Mylle and Maes [Mylle, J., Maes, M., 2004. Partial posttraumatic stress disorder revisited. J. Affect. Disord. 78, 37–48]. Results Eight percent of participants was diagnosed with 3-month PTSD while 10% was diagnosed with 12-month PTSD. Nearly half (47%) of 12-month PTSD cases were of delayed onset. The majority of those with delayed-onset were diagnosed with partial or subsyndromal PTSD at 3 months. Ten percent of delayed onset cases did not meet partial or subsyndromal criteria. Limitations As symptoms were not assessed at 6 months (the DSM cut-off for delayed PTSD), it could not be conclusively determined that delayed-onset cases had not developed PTSD between 3 and 6 months posttrauma. Conclusion A considerable proportion of 12-month PTSD diagnoses was delayed in onset. While most demonstrated 3-month morbidity in the form of partial and subsyndromal diagnoses, a minority did not. Thus, clinicians should consider subthreshold diagnoses as potential risk factors for delayed-onset PTSD. Future research is required to identify factors that may predict delayed-onset PTSD in trauma survivors without evidence of prior PTSD pathology.

A Twin Registry Study of the Relationship Between Posttraumatic Stress Disorder and Nicotine Dependence in Men

Recent studies indicate a strong association between posttraumatic stress disorder (PTSD) and nicotine dependence (ND). However, the explanation for the association remains unclear. To test competing explanations for the association between PTSD and ND. Analysis of data on 6744 members of the Vietnam Era Twin Registry, a national registry of all male-male twin pairs who served in the military during the Vietnam era interviewed in 1991-1992. Risk of PTSD and ND using the Diagnostic Interview Schedule for the DSM-III-R. The prevalence of ND was elevated among trauma-exposed individuals (52.0%) and those with PTSD (71.7%) compared with unexposed individuals (40.5%). This association was significant for ND and for trauma without PTSD (odds ratio, 1.31; 95% confidence interval [CI], 1.18-1.45) and for PTSD (odds ratio, 2.34; 95% CI, 1.92-2.84) and was not entirely explained by shared risk factors. Shared genetic effects explained 63% of the PTSD-ND association; the remaining covariance was explained by individual-specific environmental effects. Using survival analysis with time-dependent covariates, ND was associated with a substantially increased risk of PTSD among trauma-exposed men (hazard ratio, 1.98; 95% CI, 1.61-2.42). Trauma (hazard ratio, 1.49; 95% CI, 1.35-1.64) and PTSD (hazard ratio, 1.36; 95% CI, 1.14-1.61) were less strongly but significantly associated with increased risk of ND onset after controlling for shared risk factors. Most of the PTSD-ND association is explained by shared genetic effects. However, there is a substantial, robust PTSD-ND association not explained by shared risk factors. Multiple explanations for the association were supported; however, the strongest association was consistent with preexisting ND increasing the risk of PTSD onset. These data suggest that male veterans with a history of ND may be at increased risk for PTSD. Further research on the biological mechanisms underlying PTSD-ND comorbidity is needed.

Trauma Exposure, Posttraumatic Stress, and Psychiatric Comorbidity in Female Juvenile Offenders

To document the rate of posttraumatic stress disorder (PTSD) in female juvenile offenders and its relationship to trauma history, comorbid diagnoses, attributional style, and family functioning. The psychological profiles and trauma histories of 100 incarcerated female juvenile offenders (ages 13.5-19 years) were assessed using a semistructured interview. Two self-report measures were used to assess family functioning and attributional style. High rates of PTSD were reported by offenders (37%), with sexual abuse the precipitant in 70% of cases. Offenders with PTSD had significantly more comorbid diagnoses than those without (PTSD = 5.4, no PTSD = 3.1, p < .001). The majority (73%) of comorbid diagnoses appeared concurrently with or after PTSD onset. The presence of four or more psychiatric diagnoses (OR = 14.48, p < .001) and a history of sexual abuse (OR = 7.91, p < .001) were independently associated with a diagnosis of PTSD among female juvenile offenders. These results suggest a link among trauma, PTSD, and the development of further psychopathology in female juvenile offenders. This link highlights the importance of comprehensive diagnosis and treatment of this and other comorbid disorders to ensure the effectiveness of interventions designed to treat antisocial behavior.

Delayed Onset of Posttraumatic Stress Disorder Among Male Combat Veterans: A Case Series

Objective Authors investigated the nature of delayed-onset posttraumatic stress disorder (PTSD) among combat veterans. Methods PTSD, along with cognitive and emotional functioning, was assessed in a case series of elderly Australian war veterans. Results Fifteen elderly male subjects consecutively referred to an outpatient psychiatric clinic were identified as having PTSD with significantly delayed onset. In most cases, the onset of PTSD symptoms was associated with unrelated medical complaints, psychosocial stress, and/or mild cognitive impairment. Conclusions Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma. Authors investigated the nature of delayed-onset posttraumatic stress disorder (PTSD) among combat veterans. PTSD, along with cognitive and emotional functioning, was assessed in a case series of elderly Australian war veterans. Fifteen elderly male subjects consecutively referred to an outpatient psychiatric clinic were identified as having PTSD with significantly delayed onset. In most cases, the onset of PTSD symptoms was associated with unrelated medical complaints, psychosocial stress, and/or mild cognitive impairment. Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma.

Delayed Onset of Posttraumatic Stress Disorder Among Male Combat Veterans: A Case Series

Authors investigated the nature of delayed-onset posttraumatic stress disorder (PTSD) among combat veterans. PTSD, along with cognitive and emotional functioning, was assessed in a case series of elderly Australian war veterans. Fifteen elderly male subjects consecutively referred to an outpatient psychiatric clinic were identified as having PTSD with significantly delayed onset. In most cases, the onset of PTSD symptoms was associated with unrelated medical complaints, psychosocial stress, and/or mild cognitive impairment. Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma.

Sertraline in the Treatment of Co‐occurring Alcohol Dependence and Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) frequently co-occurs with alcohol use disorders. This study investigated the use of sertraline, a serotonin reuptake inhibitor, in treating co-occurring symptoms of alcohol dependence and PTSD. A total of 94 individuals with current alcohol dependence and PTSD were randomly assigned to receive sertraline (150 mg/day) or placebo for 12 weeks. Post hoc cluster analysis of baseline characteristics was used to define subgroups of participants. There was a significant decrease in alcohol use during the trial in both the sertraline and the placebo groups. Cluster analysis revealed significant medication group by cluster interactions for alcohol-related outcomes. Sertraline-treated participants with less severe alcohol dependence and early-onset PTSD had significantly fewer drinks per drinking day (p < 0.001). For participants with more severe alcohol dependence and later onset PTSD, the placebo group had significantly greater decreases in drinks per drinking day (p < 0.01) and average number of drinks consumed per day (p < 0.05). There may be subtypes of alcohol-dependent individuals who respond differently to serotonin reuptake inhibitor treatment. Further investigation of differential responders may lead to improvements in the pharmacological treatment of co-occurring alcohol dependence and PTSD.

Smaller hippocampal volume in patients with recent-onset posttraumatic stress disorder

Previous structural magnetic resonance (MR) research in patients with posttraumatic stress disorder (PTSD) has found smaller hippocampal volumes in patients compared with control subjects. These studies have mostly involved subjects who have had PTSD for a number of years, such as war veterans or adult survivors of childhood abuse. Patients with recent-onset PTSD have rarely been investigated. To our knowledge only one other study has investigated such a group. The aim of this study was to compare hippocampal volumes of patients with recent onset PTSD and nontrauma-exposed control subjects. Fifteen patients with PTSD, recruited from an accident and emergency department, were compared with 11, non-trauma-exposed, healthy control subjects. Patients underwent a structural MR scan soon after trauma (mean time = 158 +/- 41 days). Entire brain volumes, voxel size 1 x 1 x 1 mm, were acquired for each subject. Point counting and stereology were used to measure the hippocampal and amygdala volume of each subject. Right-sided hippocampal volume was significantly smaller in PTSD patients than control subjects after controlling for effects of whole brain volume and age. Neither left nor total hippocampal volume were significantly smaller in the PTSD group after correction. Whole brain volume was also found to be significantly smaller in patients. There were no differences in amygdala or white matter volumes between patients and control subjects. This result replicates previous findings of smaller hippocampal volumes in PTSD patients, but in an underinvestigated population, suggesting that either smaller hippocampal volume is a predisposing factor in the development of PTSD or that damage occurs within months of trauma, rather than a number of years. Either of these two hypotheses have significant implications for the treatment of PTSD. For instance, if it could be shown that screening for hippocampal volume may, in some cases, predict those likely to develop clinical PTSD.