Posttraumatic Stress Disorder Reactions Research Articles

Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis

BackgroundFirefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea. MethodsA total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership. ResultsThe LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities. LimitationsThe cross-sectional design and usage of self-reported questionnaires are limitations of this study. ConclusionsThe severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.

American Veterans in the Era of COVID-19: Reactions to the Pandemic, Posttraumatic Stress Disorder, and Substance Use Behaviors.

The COVID-19 pandemic may have a compounding effect on the substance use of American veterans with posttraumatic stress disorder (PTSD). This study investigated the relationship between PTSD and current reactions to COVID-19 on alcohol and cannabis use among veterans who completed a survey 1 month prior to the pandemic in the USA and a 6-month follow-up survey. We hypothesized that veterans with PTSD would experience more negative reactions to COVID-19 and increased alcohol and cannabis use behaviors over those without PTSD. Veterans with PTSD prior to the pandemic, relative to those without, endorsed poorer reactions, greater frequency of alcohol use, and greater cannabis initiation and use during the pandemic. Veterans with PTSD may use substances to manage COVID-related stress. Clinicians may see an increase in substance use among this group during and after the pandemic and may need to implement specific behavioral interventions to mitigate the negative effects of COVID-19.

Parental PTSD and psychological reactions during the COVID-19 pandemic among offspring of Holocaust survivors.

Previous evidence suggests heightened sensitivity to life-threatening challenges among offspring of Holocaust survivors (OHS). Therefore, this study examined the psychological reactions of aging OHS during the COVID-19 pandemic. A convenience sample (N = 297, mean age = 66.85) of North American Jews rated posttraumatic stress disorder (PTSD) symptoms for their parents and for themselves. They further rated their psychological distress, COVID-19-related worries, loneliness, and social support. Respondents were divided into four groups: OHS with two parents with probable PTSD, with one such parent, with no such parent, and comparisons whose parents did not undergo the Holocaust. OHS with two parents with PTSD reported the highest levels of PTSD symptoms. Controlling for respondents' own PTSD, OHS with two parents with PTSD reported higher psychological distress relative to comparisons. Moreover, OHS with parental PTSD reported higher loneliness relative to OHS without parental PTSD or comparisons. The groups did not differ in COVID-19-related worries or social support. The distress experienced by OHS with parental PTSD seems more general, and is possibly related to the multiple coalescing crises that occurred since the pandemic began, rather than to the health risk associated directly with COVID-19. Moreover, while OHS acknowledge having good social support, some of them nevertheless feel lonely. This possibly reflects unique interpersonal difficulties characteristic in Holocaust survivor families. These findings suggest that OHS with parental PTSD (especially when both parents had symptoms) represent a group of older adults who are relatively susceptible to negative psychological effects of the current pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the development of PTSD symptoms in individuals who witness acute stress reaction on the battlefield.

Adler et al describe an innovative perspective on battlefield posttraumatic stress disorder (PTSD) symptoms in response to an acute stress reaction (ASR), tracking not the individual experiencing ASR, but rather the service members who witness another team member experiencing an ASR. PTSD symptoms, reactions, observations and responses in the witness are assessed.

Changes in geographic clustering of post-traumatic stress disorder and post-traumatic growth seven years after an earthquake in Cauquenes, Chile

Recent findings indicate that both disruptive Post-Traumatic Stress Disorder (PTSD) and healthy Post-Traumatic Growth (PTG) responses have some spatial distribution depending on where they are measured and the different degrees of exposure that people may have to a critical event (e.g., earthquake). Less is known about how these responses change as a function of space and time after these events. The objective of this study was to enter deeper into this relationship analysing how PTSD and PTG responses vary in their spatial distribution 6 and 7 years after an earthquake (such as the one that occurred on 27 February, 2010 in Cauquenes City, Chile). Spatial analyses based on Geographic Information Systems (GIS) were performed to detect global and local geographic clustering. Investigating 171 (2016) and 106 (2017) randomly selected adults from Cauquenes, we demonstrated that 7 years after the event only 4 variables were spatially clustered, i.e. personal mental strength, interpersonal relations, new possibilities and appreciation of life), all of them PTG dimensions; This result contrasted with the situation the previous year (2016), when 7 variables were clustered (total PTG, spiritual change, new possibilities, appreciation of life, PTSD symptoms, PTSD reactions and PTSD in total). The spatial identifications found could facilitate the comparison of mental health conditions in populations and the impact of recovery programmes in communities exposed to disasters.

Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.

Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

Environmental Considerations for Trauma‐Responsive Juvenile and Family Courts: A Review of the Literature with Recommendations for Practice

AbstractJuvenile and family courts serve some of our most vulnerable populations, many of whom have experienced some traumatic event. People suffering with posttraumatic stress disorder (PTSD) are known to be more sensitive to environmental stimuli, and many of the environmental conditions within courts can be challenging for those suffering traumatic stress. Trauma‐responsive practices help foster conditions of healing, which can benefit both the court user and those who work within the court. Research reviewed in this article demonstrates the likelihood of negative behavioral and emotional responses to specific environmental factors for people suffering PTSD and other stress reactions, and offers recommendations to minimize environmental stressors.

Parental Factors Associated with Child Post-traumatic Stress Following Injury: A Consideration of Intervention Targets.

Post-traumatic stress disorder (PTSD) symptoms are relatively common following pediatric traumatic injury and are related to poor long-term child outcomes. However, due to concerns regarding the efficacy of early child preventive interventions, and difficulty intervening with injured and medicated children soon after the event, it is not feasible to provide early psychological interventions to children exposed to traumatic injury. Parental PTSD symptoms and reactions to the child’s traumatic injury impact child outcomes and provide potential targets for early intervention to reduce child symptom development without involving the child. The authors conducted a review of the literature using Psycinfo and Pubmed research databases (publication years = 1990–2017) and identified 65 published studies relevant to the topic of the review. The present review considers parent factors [parenting styles, parental post-traumatic pathology (PTS), adaptive and maladaptive coping strategies, and communication regarding the traumatic injury] and their impact on child PTS. We focus specifically on factors amenable to intervention. We further review moderators of these relationships (e.g., child age and gender, parent gender) and conclude that it is unlikely that a one-size-fits-all approach to treatment will be successful. Rather, it is necessary to consider the age and gender of parent child dyads in designing and providing targeted interventions to families following the traumatic injury of a child.

Diagnosing Post Traumatic Stress Disorder: Using a Physiological Computing Method and Apparatus

Background: Post traumatic stress disorder (PTSD) is typically diagnosed using self-reports and physician interviews and observations. For example, the US military has used the Warrior Administered Retrospective Causality Assessment Tool (WARCAT), which is a self-report method for diagnostics. Methods: To help correct for associated deficiencies in self-reports, we utilized a computerized dual-task method and central nervous system (CNS) monitoring of reactions by participants who viewed troubling scenes. Results: We found evidence to support unreported PTSD reactions to these incidents. Furthermore, we used a computerized technique to induce cognitive load to distract participants from the purpose of the assessment to gain more accurate assessments. Conclusion: We conclude that using a computer apparatus is more effective in diagnosing PTSD than psychological instrumentation.

Prevalence and prognosis of stress disorders: a review of the epidemiologic literature.

Given the ubiquity of traumatic events, it is not surprising that posttraumatic stress disorder (PTSD) – a common diagnosis following one of these experiences – is characterized as conferring a large burden for individuals and society. Although there is recognition of the importance of PTSD diagnoses throughout psychiatry, the literature on other diagnoses one may receive following a stressful or traumatic event is scant. This review summarizes the literature on stress disorders (classified according to the International Classification of Diseases, 10th Edition [ICD-10]), including acute stress reaction, PTSD, adjustment disorder and unspecified stress reactions. This review focuses on the literature related to common psychiatric and somatic consequences of these disorders. The prevalence and incidence of each disorder are described. A review of epidemiologic studies on comorbid mental health conditions, including depression, anxiety and substance abuse, is included, as well as a review of epidemiologic studies on somatic outcomes, including cancer, cardiovascular disease and gastrointestinal disorders. Finally, the current literature on all-cause mortality and suicide following stress disorder diagnoses is reviewed. Stress disorders are a critical public health issue with potentially deleterious outcomes that have a significant impact on those living with these disorders, the health care system and society. It is only through an awareness of the impact of stress disorders that appropriate resources can be allocated to prevention and treatment. Future research should expand the work done to date beyond the examination of PTSD, so that the field may obtain a more complete picture of the impact all stress disorders have on the many people living with these diagnoses.

Coping with Accident Reactions (CARE) early intervention programme for preventing traumatic stress reactions in young injured children: study protocol for two randomised controlled trials.

BackgroundAccidental injury represents the most common type of traumatic event experienced by children under the age of 6 years. Around 10–30 % of young injured children will go on to develop post-traumatic stress disorder (PTSD) and other co-morbid conditions. Parents of injured children are also at risk of PTSD, and this is associated with short- and long-term consequences for their children’s physical and psychological recovery. Despite the significance of this problem, to date, the mental health needs of injured young children have been neglected. One reason for this is due to the uncertainty and considerable debate around how to best provide early psychological intervention to traumatised children and adults. To address these gaps, researchers and psychologists in Australia and Switzerland have developed the Coping with Accident Reactions (CARE) programme, which is a two-session early intervention designed to prevent persistent PTSD reactions in young injured children screened as ‘at risk’. Two separate international studies are being conducted to evaluate the effectiveness and feasibility of this programme.Methods/designThe study design for the two proposed studies will employ a randomised controlled trial design and children (aged 1–6 years) who are screened as at risk for PTSD 1 week after an unintentional injury, and their parents will be randomised to either (1) CARE intervention or (2) treatment as usual. Assessment will be completed at baseline (2 weeks) and 3 and 6 months post-injury.DiscussionThis international collaboration provides an excellent opportunity to test the benefit of screening and providing early intervention to young children in two different countries and settings. It is expected that outcomes from this research will lead to significant original contributions to the scientific evidence base and clinical treatment and recovery of very young injured children.Trial registrationThe Australian study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) on 26 March 2014. The Swiss study was registered with ClinicalTrials.gov (NCT02088814) on 12 March 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1490-2) contains supplementary material, which is available to authorized users.

Exploring the interrelationship between alexithymia, defense style, emotional suppression, homicide-related posttraumatic stress disorder and psychiatric co-morbidity

This study investigated the interrelationship between alexithymia, defense style, emotional suppression, posttraumatic stress disorder (PTSD) following homicide and psychiatric co-morbidity. One hundred and fifty male homicide perpetrators and 156 male perpetrators of non-violent crime completed the Posttraumatic Stress Diagnostic Scale (except for non-violent perpetrators), the General Health Questionnaire-28, the Defense Styles Questionnaire, the Courtauld Emotional Control Scale and the Toronto Alexithymia Scale-20. The results showed that 44% of homicide perpetrators met the criteria for PTSD. No significant differences were found between groups in alexithymia, defense style and psychiatric co-morbidity. Homicide perpetrators suppressed depression significantly more than the non-violent group. PLS analyses showed that alexithymia was significantly correlated with defense style. Defense styles were significantly correlated with emotional suppression which, in turn, was associated with homicide-related PTSD and psychiatric co-morbidity. To conclude, perpetrators can experience PTSD reactions following the act of homicide. The severity of these reactions and other psychological problems were related to difficulty getting in touch with distressing emotions, the defenses they used to protect themselves psychologically and the way they suppressed their emotion.

Pathways involving traumatic losses, worry about family, adult separation anxiety and posttraumatic stress symptoms amongst refugees from West Papua

There is some evidence that adult separation anxiety disorder (ASAD) symptoms are closely associated with posttraumatic stress disorder (PTSD) amongst refugees exposed to traumatic events (TEs), but the pathways involved remain to be elucidated. A recent study suggests that separation anxiety disorder precedes and predicts onset of PTSD. We examined a path model testing whether ASAD symptoms and worry about family mediated the path from traumatic losses to PTSD symptoms amongst 230 refugees from West Papua. Culturally adapted measures were applied to assess TE exposure and symptoms of ASAD and PTSD. A structural equation model indicated that ASAD symptoms played an important role in mediating the effects of traumatic losses and worry about family in the pathway to PTSD symptoms. Although based on cross-sectional data, our findings suggest that ASAD symptoms may play a role in the path from traumatic losses to PTSD amongst refugees. We propose an evolutionary model in which the ASAD and PTSD reactions represent complementary survival responses designed to protect the individual and close attachments from external threats.

Developmental trauma and its correlates: a study of Chinese children with repeated familial physical and sexual abuse in Hong Kong.

The present study examined the relevance of the developmental trauma disorder (DTD) framework (van der Kolk, ) in Hong Kong Chinese children with repeated familial physical and/or sexual abuse. Self-reports of (a) key dimensions of DTD including emotion regulation, attribution and perceptions in self and relationships, belief in future victimization, behavioral difficulties, and self-esteem; and (b) attachment styles and posttraumatic stress disorder (PTSD) reactions were obtained from children aged 9-15 years in clinical and school settings. Children were categorized into an abused trauma group (n = 82), a nonabused trauma group (n = 83), and a no-trauma control group (n = 201). The findings indicated that the DTD framework was applicable to abused children who showed a lower level of attachment security (Cohen's d from 0.50-0.61) and a higher level of PTSD reactions (Cohen's d = 0.71) than the comparison groups. After adding attachment security and emotion dysregulation to the model, there were no longer significant group differences in most of the variables.

Early Interventions Following Exposure to Traumatic Events: Implications for Practice From Recent Research

It is has been argued that early interventions for individuals, groups or others affected by traumatic events should not be routinely offered as there is the danger of causing more harm. The notion of “watchful waiting” has been espoused in clinical guidelines for the assessment and treatment of posttraumatic stress disorder (PTSD). Instead, a more proactive early intervention is suggested for potentially traumatic events that have the potential to lead to high psychic distress, PTSD, or complicated grief reactions for a significant number of those affected. This involves providing strategies tailored to the needs of these individuals and families and not providing conventional individual therapeutic interventions. Early intervention is wise as recent research has demonstrated that early misconceptions and negative appraisals about one's own reactions to a trauma can be significant in the development and maintenance of posttraumatic reactions and early intervention may help in forming adequate appraisals, thus counteracting misunderstandings and misperceptions. Adopting a “watchful waiting” approach with individuals and families has the potential to hinder and impede their longer-term coping responses. Recent advances, especially in the field of memory research, have implications for early interventions. We present recent findings, which make the case for early interventions following exposure to traumatic events.

Risk indicators for post-traumatic stress disorder in adolescents exposed to the 5.12 Wenchuan earthquake in China

In Chinese adolescents exposed to the Wenchuan earthquake, we used the Children's Revised Impact of Event Scale (CRIES) as the screening tool, and Post-traumatic Cognitions Inventory (PTCI) and the Social Support Rating Scale (SSRS) were used to assess the cognitive status and their social supports, to evaluate the prevalence and the predictors variables of post-traumatic stress disorder (PTSD) after the Wenchuan earthquake in China, which occurred on 12 May 2008. Subjects with a CRIES score greater than 30 were interviewed and assessed using the DSM-IV criteria for PTSD diagnosis by a trained psychiatrist with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Lifetime version (Kiddie-SADS-L). We found the overall prevalence of PTSD was 2.5% in 3208 adolescents from the surrounding areas of the epicentre 6 months after the earthquake. Risk factors for post-traumatic stress symptoms are as follows: being female, being buried/injured during the earthquake, having parents who were severely injured, having classmate(s) who died, having a house destroyed, and witnessing someone buried/wounded/dying during the earthquake. Individuals with better social support had significantly lower scores on the CRIES. There were significant differences in cognitive style between individuals at low risk for PTSD (CRIES < 30) and those at high risk for PTSD (CRIES ≥ 30). Post-traumatic cognition emerged as an important factor that was associated with PTSD reactions in children. Social support can lessen the impact of a natural disaster by affecting post-traumatic cognition.

Sexual Violence, Posttraumatic Stress Disorder, and the Pelvic Examination: How Do Beliefs About the Safety, Necessity, and Utility of the Examination Influence Patient Experiences?

Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted. This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions. A total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey. Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment. Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.

Post Traumatic Stress Disorder in Police and Military Personnel: Assessment and Treatment Methods from Psychophysiology and Neuroscience—Essential Preliminary Information

Abstract This article presents the clinical approach developed by a Canadian biofeedback practitioner for the assessment and treatment of police and military clients, especially those with post traumatic stress disorder (PTSD). The author conducted a clinical practice for more than 25 years primarily with male police and military clients. He examines the impact on treatment effectiveness of a number of factors, such as how police and military clients differ from civilian populations, the definition of trauma in this population, Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV) diagnostic criteria, the assessment of post-traumatic stress disorder, risks and coping factors, consequences of PTSD, DSM-IV conundrums, epidemiology, and other reactions to traumatic events.

Post-Traumatic Stress Disorder in Older People

Research into post-traumatic stress disorder (PTSD) among older people is in its ascendancy. Several reviews have been published to capture the main arguments of the studies from 1994 to 2000. This article aims to review published studies from 2000 onwards on PTSD among older people. These studies show that following their exposure to different types of traumas, older people have been shown to develop PTSD symptoms, a range of psychiatric comorbidity and cognitive and biological changes. On the whole, PTSD reactions do not vary across age groups, although this finding is not entirely conclusive. There seems to be evidence demonstrating ethnic differences in terms of PTSD reactions. Despite some anecdotal evidence, research has not focused on evaluating therapeutic interventions for older people with PTSD.

Identifying potential predictors of traumatic reactions to psychotic episodes

The experience of a psychotic episode can sometimes lead to post-traumatic stress disorder (PTSD) symptoms. The objective of the research was to identify candidate predictors of such negative reactions for future prospective study. We examined six predictors identified from the PTSD and psychosis literatures in a retrospective study: a history of previous trauma, a history of previous episodes of psychosis, perceived helplessness and uncontrollability at the time of the index psychotic episode, the content of persecutory delusions at episode and the perceived presence of crisis support after the psychotic episode. The design was a cross-sectional self-report and interview study of people with recently remitted symptoms of psychosis. 36 individuals with delusions and hallucinations that had remitted in the past year were assessed for the presence of PTSD symptoms in reaction to their most recent psychotic episode. Measures of the potential predictors were also taken at this point and associations with PTSD symptoms tested. 61% of the individuals with remitted positive symptoms had a reaction to their psychotic episode that was potentially severe enough to receive a PTSD diagnosis. Higher levels of PTSD symptoms were associated with all six predictors tested. The study provides further evidence that negative reactions to psychotic episodes are relatively common. Clinicians may wish to assess for such symptoms. The study extended these findings by identifying a number of candidate psychological predictors of PTSD reactions such as perceptions of uncontrollability and absence of support. Prospective longitudinal studies are required to test the causal significance of these factors. More broadly, the findings indicate that traumatic stress in response to intra-psychic events such as delusions can be understood in similar ways to traumatic stress arising from physical traumas such as disasters.