Posttraumatic Stress Disorder Symptom Scores Research Articles

Treatment of Posttraumatic Stress Disorder in Postwar Kosovar Adolescents Using Mind-Body Skills Groups

To determine whether participation in a mind-body skills group program based on psychological self-care, mind-body techniques, and self-expression decreases symptoms of posttraumatic stress disorder (PTSD). Eighty-two adolescents meeting criteria for PTSD according to the Harvard Trauma Questionnaire (which corresponds with 16 of the 17 diagnostic criteria for PTSD in DSM-IV) were randomly assigned to a 12-session mind-body group program or a wait-list control group. The program was conducted by high school teachers in consultation with psychiatrists and psychologists and included meditation, guided imagery, and breathing techniques; self-expression through words, drawings, and movement; autogenic training and biofeedback; and genograms. Changes in PTSD symptoms were measured using the Harvard Trauma Questionnaire. The study was conducted from September 2004 to May 2005 by The Center for Mind-Body Medicine at a high school in the Suhareka region of Kosovo. Students in the immediate intervention group had significantly lower PTSD symptom scores following the intervention than those in the wait-list control group (F = 29.8, df = 1,76; p < .001). Preintervention and postintervention scores (mean [SD]) for the intervention group were 2.5 (0.3) and 2.0 (0.3), respectively, and for the control group, 2.5 (0.3) and 2.4 (0.4), respectively. The decreased PTSD symptom scores were maintained in the initial intervention group at 3-month follow-up. After the wait-list control group received the intervention, there was a significant decrease (p < .001) in PTSD symptom scores compared to the preintervention scores. Mind-body skills groups can reduce PTSD symptoms in war-traumatized high school students and can be effectively led by trained and supervised schoolteachers.

Relationship between PTSD symptomatology and nicotine dependence severity in crime victims

Smoking rates are higher and cessation rates are lower among individuals with posttraumatic stress disorder (PTSD) compared to the general population, thus understanding the relationship between PTSD and nicotine dependence is important. In a sample of 213 participants with a crime-related trauma (109 with PTSD), the relationship between PTSD status, smoking status (smoker vs. non-smoker), substance abuse diagnosis (SUD), PTSD symptoms, and sex was assessed. SUD diagnosis was significantly related to smoking status, but PTSD symptomatology and sex were not. Among smokers (n=117), increased nicotine dependence severity was associated with being male and with increased level of PTSD avoidance symptoms. Correlations indicated that PTSD avoidance and hyperarousal symptom clusters and total PTSD symptom scores were significantly related to nicotine dependence severity in males, while PTSD symptomatology in general did not correlate with dependence severity for females. The results suggest that level of PTSD symptomatology, particularly avoidance symptoms, may be important targets for smoking cessation treatment among male smokers who have experienced a traumatic event.

The Relationship of Post-traumatic Stress Disorder and Depression to Antiretroviral Medication Adherence in Persons with HIV

In HIV/AIDS, symptoms of depression or post-traumatic stress may interfere with important self-care behaviors such as the ability to adhere to one's medical treatment regimen. However, these problems may frequently go undetected in HIV care settings. The present study used brief self-report screening measures of depression and post-traumatic stress disorder (PTSD) in the HIV/AIDS care settings to examine (1) frequency of positive screens for these diagnoses; (2) the degree to which those with a positive screen were prescribed antidepressant treatment; and (3) the association of continuous PTSD and depression symptom scores, and categorical (screening positive or negative) PTSD and depression screening status, to each other and to ART adherence as assessed by the Medication Event Monitoring System, regardless of antidepressant treatment. Participants were 164 HIV-infected individuals who took part in a multisite adherence intervention study in HIV treatment settings in Massachusetts. Available data from 5 time points was used, yielding 444 data points. Participants screened positive for PTSD at 20% of visits, and depression at 22% of visits. At visits when participants screened positive for both depression and PTSD, 53.6% of the time they were on an antidepressant. Those who screened positive for PTSD were more likely to also screen positive for depression. In multiple regression analyses that included both continuous and dichotomous PTSD and depression and controlled for shared variance due to clustering of multiple observations, only depression contributed significant unique variance, suggesting the primary role of depression and the secondary role of PTSD in poor adherence in individuals with HIV.

Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis: a nomogram

ObjectiveTo determine to what extent patients who have survived abdominal sepsis suffer from symptoms of posttraumatic stress disorder (PTSD) and depression, and to identify potential risk factors for PTSD symptoms.Design and settingPTSD and depression symptoms were measured using the Impact of Events Scale–Revised (IES-R), the Post-Traumatic Symptom Scale 10 (PTSS-10) and the Beck Depression Inventory II (BDI-II).Patients and participantsA total of 135 peritonitis patients were eligible for this study, of whom 107 (80%) patients completed the questionnaire. The median APACHE-II score was 14 (range 12–16), and 89% were admitted to the ICU.Measurements and resultsThe proportion of patients with “moderate” PTSD symptom scores was 28% (95% CI 20–37), whilst 10% (95% CI 6–17) of patients had “high” PTSD symptom scores. Only 5% (95% CI 2–12) of the patients expressed severe depression symptoms. Factors associated with increased PTSD symptoms in a multivariate ordinal regression model were younger age (0.74 per 10 years older, p = 0.082), length of ICU stay (OR = 1.4 per doubling of duration, p = 0.003) and having some (OR = 4.9, p = 0.06) or many (OR = 55.5, p < 0.001) traumatic memories of the ICU or hospital stay.ConclusionAs many as 38% of patients after abdominal sepsis report elevated levels of PTSD symptoms on at least one of the questionnaires. Our nomogram may assist in identifying patients at increased risk for developing symptoms of PTSD.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-007-0941-3) contains supplementary material, which is available to authorized users.

Predictors of Enduring PTSD After an Industrial Disaster

Back to table of contents Previous article Next article LetterFull AccessLetterPhilippe J. Birmes M.D., Ph.D.Laetitia Daubisse M.D.Alain Brunet Ph.D.Philippe J. Birmes M.D., Ph.D.Search for more papers by this authorLaetitia Daubisse M.D.Search for more papers by this authorAlain Brunet Ph.D.Search for more papers by this authorPublished Online:1 Jan 2008https://doi.org/10.1176/ps.2008.59.1.116AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Predictors of Enduring PTSD After an Industrial DisasterTo the Editor: Only a few studies have examined the long-term effects (more than one year) of mass trauma on victimized communities ( 1 , 2 ). On September 21, 2001, a petrochemical plant exploded in the city of Toulouse, France. Victims were surveyed by using self-report questionnaires that assessed peritraumatic distress and dissociation and acute stress. A hierarchical multiple regression conducted with survey data gathered six months after the explosion indicated that all three constructs explained unique variance, accounting for 62% of the variance in symptoms of posttraumatic stress disorder (PTSD) ( 3 ). Here we report the results of a follow-up survey conducted 15 months after the explosion. The survey used the same predictors plus a measure of depression. Five to ten weeks after the explosion, 892 potential study participants were sent self-report questionnaires to assess symptoms of acute stress (Stanford Acute Stress Reaction Questionnaire) and depression (Beck Depression Inventory). The 391 persons who responded were sent another self-report questionnaire six months after the explosion. The second survey retrospectively assessed peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire) and distress (Peritraumatic Distress Inventory) as well as current PTSD symptoms (Posttraumatic Stress Disorder Checklist). Fifteen months after the explosion, the 200 participants who responded to the second survey were sent the same questionnaire assessing PTSD symptoms, and 129 persons responded to this third survey.To analyze the relationship between predictors and PTSD symptoms at 15 months, we computed Pearson correlations. Strong correlations with PTSD symptoms were found for peritraumatic dissociation (r=.50, p<.01), peritraumatic distress (r=.58, p<.01), acute stress symptoms (r=.71, p<.01), and depression symptoms (r=.61, p<.01). We computed a hierarchical multiple linear regression with PTSD symptom score as the dependent variable. Peritraumatic dissociation was entered first, followed by peritraumatic distress in the second step, symptoms of acute stress in the third step, and symptoms of depression in the fourth step. The model accounted for 59% of the variance in PTSD symptoms. All of our predictors were strongly correlated with persistent PTSD symptoms 15 months after exposure. The number of dropouts and retrospective ratings of the peritraumatic responses should be acknowledged as potentially limiting the generalizability of these results. However, the study found that peritraumatic dissociation and distress, acute stress, and depression were related to the development and persistence of PTSD symptoms after an industrial disaster. Loss of control and helplessness-anger, measured with the Peritraumatic Distress Inventory, were strong predictors of posttraumatic stress one year after the World Trade Center disaster ( 4 ). Acknowledgments and disclosuresThe authors report no competing interests.Dr. Birmes is affiliated with the Traumatic Stress Laboratory, Young Unit 2511, Toulouse III University, and the University Hospital of Toulouse, Toulouse, France. Dr. Daubisse is with Mixed Research Unit S558, National Institute of Health and Medical Research (INSERM), and Toulouse III University. Dr. Brunet is with Douglas Hospital Research Center and McGill University, Montreal.

Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers

Tens of thousands of the estimated 250,000 child soldiers worldwide are abused or have been abused during the last decade in Africa's Great Lakes Region. In the process of rebuilding the war-torn societies, it is important to understand how psychological trauma may shape the former child soldiers' ability to reconcile. To investigate the association of posttraumatic stress disorder (PTSD) symptoms and openness to reconciliation and feelings of revenge in former Ugandan and Congolese child soldiers. Cross-sectional field study of 169 former child soldiers (aged 11-18 years) in rehabilitation centers in Uganda and the Democratic Republic of the Congo, conducted in 2005. Potentially traumatic war-related experiences assessed via a sample-specific events scale; PTSD symptoms assessed using the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI), with a score of 35 or higher indicating clinically important PTSD symptoms; and openness to reconciliation and feelings of revenge assessed via structured questionnaires. Children participating in this study were a mean of 15.3 years old. These former child soldiers reported that they had been (violently) recruited by armed forces at a young age (mean [SD], 12.1 [2] years), had served a mean of 38 months (SD, 24 months), and had been demobilized a mean of 2.3 months before data collection (SD, 2.4 months). The children were exposed to a high level of potentially traumatic events (mean [SD], 11.1 [2.99]). The most commonly reported traumatic experiences were having witnessed shooting (92.9%), having witnessed someone wounded (89.9%), and having been seriously beaten (84%). A total of 54.4% reported having killed someone, and 27.8% reported that they were forced to engage in sexual contact. Of the 169 interviewed, 59 (34.9%; 95% confidence interval, 34.4%-35.4%) had a PTSD symptom score higher than 35. Children who showed more PTSD symptoms had significantly less openness to reconciliation (rho= -0.34, P < .001) and more feelings of revenge (rho= 0.29, P < .001). PTSD symptoms are associated with less openness to reconciliation and more feelings of revenge among former Ugandan and Congolese child soldiers. The effect of psychological trauma should be considered when these children are rehabilitated and reintegrated into civilian society.

Screening for Complicated Grief Among Project Liberty Service Recipients 18 Months After September 11, 2001

Screening for Complicated Grief Among Project Liberty Service Recipients 18 Months After September 11, 2001

The Traumatic Impact of the September 11, 2001, Terrorist Attacks and the Potential Protection of Optimism

This study examined the impact of the September 11 terrorist attacks on graduate and undergraduate students and the role of optimism in posttraumatic distress. A sample of 457 students who attended courses at three schools of social work (Nevada, Pennsylvania, and Washington) participated in the study. A quarter of them had a known person as an immediate victim of the attacks. Multivariate analysis showed that posttraumatic stress disorder symptom scores were positively related to personal loss and two types of previous trauma reactivated by the attacks, and levels of initial negative emotional response. Optimism and its interaction with personal loss were inversely associated with posttraumatic stress disorder symptom scores.

Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers

Little is known about posttraumatic stress disorder (PTSD) among pathological gamblers (PGs), even though the two disorders share several clinical characteristics. We examined the relationship between pathological gambling and PTSD on measures of gambling disorder severity, experience of specific traumas, psychiatric symptoms, impulsivity, and dissociation. A total of 149 treatment-seeking PGs were surveyed. Participants were divided into two groups on the basis of their score on the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993). Thirty-four percent (n = 51) reported a high frequency of PTSD symptoms. Participants who had high scores reported greater lifetime gambling severity, psychiatric symptom severity, impulsivity, and dissociation than participants who had low PTSD symptom scores. These findings point to a need for more assessment and research about PTSD in PGs.

Relationship of Quality of Life and Perceived Control With Posttraumatic Stress Disorder Symptoms 3 to 6 Months After Myocardial Infarction

This study examined whether psychological variables were associated with posttraumatic stress disorder (PTSD) symptoms 3 to 6 months after myocardial infarction. The sample included 52 patients with myocardial infarction. A structured interview was used to obtain information about PTSD symptoms, quality of life, and ratings of perceived control, danger, and predictability, as well as information about stressful events that occurred during hospitalization. Four patients (7.7%) met criteria for the diagnosis of PTSD. Elevated PTSD scores were associated with poorer quality of life (r = -0.32 to -0.79). Lower perceived control was associated with higher PTSD symptom scores (r = -0.30 to -0.52). Finally, PTSD scores were significantly correlated with the number of times patients were readmitted to the hospital (r = 0.35-0.57). Approximately 8% of patients experienced PTSD 3 to 6 months following MI. Increasing levels of PTSD symptoms were correlated with poorer quality of life. Perceived lack of control during the MI and multiple hospitalizations may be related to the severity of PTSD symptoms.

Post-traumatic stress disorder and anxiety symptoms in children exposed to the 1999 Greek earthquake.

Five months after the Athens earthquake of September 1999, 178 children from three districts of Athens at increasing distances from the epicenter were administered questionnaires to identify symptoms of post-traumatic stress disorder (PTSD), anxiety and the extent of personal threat experienced. It was found that PTSD and anxiety symptoms were significantly related to proximity to the epicenter, exposure to threat and female gender. Age did not have a significant main effect on either anxiety or PTSD symptoms, but there were significant interactions between age and the other main variables. In the region closest to the epicenter, the youngest children reported the highest PTSD and anxiety symptom scores, but in the group furthest from the epicenter the older children reported the highest PTSD and anxiety symptom scores. These findings were discussed in relation to direct and media-imparted exposure to the earthquake.

Time does not heal all wounds: quality of life and psychological distress of people who survived the holocaust as children 55 years later.

The present study assessed posttraumatic stress disorder (PTSD) symptoms, psychological distress, and subjective quality of life (QoL) in a group of 43 child Holocaust survivors and a community sample of 44 persons who had not personally experienced the Holocaust. The participants were administered the PTSD-Scale, the SCL-90, and the WHOQOL-Bref. Results showed that the child survivors had higher PTSD symptom scores, higher depression, anxiety, somatization, and anger-hostility scores; and lower physical, psychological, and social QoL than did the comparison group. The findings suggest that the psychological consequences of being a child during the Holocaust can be long lasting.

Violence Exposure, Posttraumatic Stress, and Personality in Juvenile Delinquents

To assess posttraumatic stress and its relationship to comorbid psychopathology, violence exposure, and personality traits in Russian male juvenile delinquents. Posttraumatic stress and comorbid psychopathology were assessed by a semistructured psychiatric interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version) in 370 delinquent youths during winter-spring of 1999. In addition, violence exposure, personality, and psychopathology were assessed by self-reports. Most delinquents reported some degree of posttraumatic stress: 156 subjects (42%) fulfilled partial criteria and 87 (25%) fulfilled full DSM-IV criteria for posttraumatic stress disorder (PTSD). Violence-related experiences (witnessing and victimization) were the most common types of trauma. Higher levels of posttraumatic stress were accompanied by higher rates of comorbid psychopathology, with the most striking differences occurring between the groups with full versus partial PTSD criteria. Violence exposure was related to temperamental behavior activation (novelty seeking), whereas PTSD symptom scores were predominantly related to behavior inhibition and poor coping (high harm avoidance and low self-directedness). Similar to findings from American samples, Russian juvenile delinquents represent a severely traumatized population, mainly due to high levels of violence exposure. Those with full PTSD are the most severely traumatized and have highest rates of psychopathology, as compared to those with no or partial PTSD, and they require the most clinical attention and rehabilitation. Both exposure to violence and levels of posttraumatic stress are related to personality traits, which influence degree of exposure and individual perception of stress. The latter should be considered in individualized approaches to rehabilitation.

Posttraumatic Stress Two Years after the Oklahoma City Bombing in Youths Geographically Distant from the Explosion

This article describes Posttraumatic Stress Disorder (PTSD) symptomatology in 69 sixth-grade youths who resided within 100 miles of Oklahoma City at the time of the 1995 bombing of the Alfred P. Murrah Federal Building. These youths neither had any direct physical exposure nor personally knew anyone killed or injured in the explosion. A survey conducted two years after the bombing assessed exposure, PTSD symptoms, and functioning. PTSD symptom frequency was measured with the Impact of Event Scale--Revised. Our BCD criteria for defining PTSD caseness was modeled after DSM-IV B, C, and D criteria requiring one reexperiencing, three avoidance/numbing, and two arousal symptoms for diagnosis. Those who met our BCD criteria had significantly higher PTSD symptom scores than those who did not. Both increased mean PTSD symptom score and meeting our caseness definition were associated with increased functioning difficulties. Media exposure and indirect interpersonal exposure (having a friend who knew someone killed or injured) were significant predictors of symptomatology. These findings suggest that children geographically distant from disaster who have not directly experienced an interpersonal loss report PTSD symptoms and functional impairment associated with increased media exposure and indirect loss.