Posttraumatic Stress Disorder Symptom Severity Research Articles

Do childhood experiences influence associations between posttraumatic stress disorder symptoms and positive autobiographical memories among military veteran students? An exploratory study

ABSTRACT Background Evidence links posttraumatic stress disorder (PTSD) symptoms and features of positive autobiographical memories (accessibility, vividness, coherence, sharing, emotional intensity, distancing). There is a knowledge gap on how adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) may influence these relationships. Objectives The current study explored whether the number ACEs or BCEs moderated associations between PTSD symptom severity and features of positive autobiographical memories. Design and Methods The sample included 124 student military veterans who had experienced a trauma (M age = 33.90; 77.4% male; 75.0% White). Results Path analyses showed more PTSD symptom severity was significantly associated with less positive autobiographical memory vividness (β = −0.26, p = .019, R2 = 0.06). Further, the number of ACEs moderated the relationship between PTSD symptom severity and positive autobiographical memory accessibility (β = −0.25, p = .023, R2 = 0.10) and vividness (β = −0.20, p = .024, R2 = 0.10). Among individuals with more ACEs (1 SD above the mean) compared to those with fewer ACEs (1 SD below the mean), less accessibility and vividness of positive autobiographical memories was associated with greater PTSD symptom severity. The number of BCEs was not a significant moderator. Conclusions Positive memory-based interventions may be particularly useful to address PTSD symptoms among military veterans with a history of childhood adversity.

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia.

Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia. This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire. The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001). The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

A Pilot Study of a Trauma Resiliency Protocol for Law Enforcement Officers With Posttraumatic Stress Disorder Symptoms.

The aim of the study is to test the efficacy of the 22ZERO Trauma Resiliency Protocol (TR-P) on posttraumatic stress disorder (PTSD) symptom severity among current and former law enforcement officers. The study used a retrospective, pre/post intervention design to test the effects of the TR-P on measures of self-reported symptom severity. One hundred twenty-eight current and former law enforcement officers were exposed to the TR-P treatment. All participants were administered the PTSD Checklist for DSM-5 PTSD Checklist and other psychological assessments before and after exposure. Participants experienced a significant reduction in symptom severity, suggesting that exposure to the TR-P reduced the effects of PTSD in this sample of law enforcement officers. The 22ZERO TR-P may be an efficacious mechanism for reducing PTSD symptom severity among current and former law enforcement officers. It should be tested using a randomized trial and a longer follow-up period.

Salivary inflammatory biomarkers as a predictor of post-traumatic stress disorder and depressive symptom severity in trauma patients: A prospective study

BackgroundAlthough post-traumatic stress disorder (PTSD) and depression screening are recommended for traumatic injury patients, routine screening is still uncommon. Salivary inflammatory biomarkers have biological plausibility and potential feasibility and acceptability for screening. This study tested prospective associations between several salivary inflammatory biomarkers (proinflammatory cytokines interleukin-1β, interleukin-6, tumor necrosis factor-α; and C-reactive protein), collected during hospitalization and PTSD and depressive symptoms at 5-month follow-up. MethodsAdult traumatic injury patients (N = 696) at a major urban Level 1 trauma center provided salivary samples and completed PTSD and depressive symptom measures during days 0–13 of inpatient hospitalization. At 5-month follow-up, 368 patients (77 % male, 23 % female) completed the Clinician-Administered PTSD Scale for DSM-IV and the Self-rated Inventory of Depressive Symptomatology. Analyses focused on a latent inflammatory cytokine factor and C-reactive protein at baseline predicting 5-month PTSD and depression symptom outcomes and included baseline symptom levels as covariates. ResultsA latent factor representing proinflammatory cytokines was not related to 5-month PTSD or depressive symptom severity. Higher salivary CRP was related to greater PTSD symptom severity (β = .10, p = .03) at 5-month follow-up and more severity in the following depressive symptoms: changes in weight and appetite, bodily complaints, and constipation/diarrhea (β’s from .14 to .16, p’s from .004 −.03). ConclusionIn a primarily Latine and Black trauma patient sample, salivary CRP measured after traumatic injury was related to greater PTSD symptom severity and severity in several depressive symptom clusters. Our preliminary findings suggest that salivary or systemic CRP may be useful to include in models predicting post-trauma psychopathology.

Trauma exposure across the lifespan among individuals engaged in treatment with medication for opioid use disorder: differences by gender, PTSD status, and chronic pain

BackgroundThere is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain.MethodsA cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind–body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression.ResultsParticipants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%).ConclusionThe study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment.Trial registrationNCT04082637.

Deep brain stimulation of the amygdala for treatment-resistant combat post-traumatic stress disorder: Long-term results

Deep brain stimulation (DBS) holds promise for neuropsychiatric conditions where imbalance in network activity contributes to symptoms. Treatment-resistant Combat post-traumatic stress disorder (TR-PTSD) is a highly morbid condition and 50% of PTSD sufferers fail to recover despite psychotherapy or pharmacotherapy. Reminder-triggered symptoms may arise from inadequate top-down ventromedial prefrontal cortex (vmPFC) control of amygdala reactivity. Here, we report long-term data on two TR-PTSD participants from an investigation utilizing high-frequency amygdala DBS. The two combat veterans were implanted bilaterally with quadripolar electrodes targeting the basolateral amygdala. Following a randomized staggered onset, patients received stimulation with adjustments based on PTSD symptom severity for four years while psychiatric and neuropsychiatric symptoms, neuropsychological performance, and electroencephalography were systematically monitored. Evaluation of vmPFC-Amygdala network engagement was assessed with 18FDG positron emission tomography (PET). CAPS-IV scores varied over time, but improved 55% from 119 at baseline to 53 at 4-year study endpoint in participant 1; and 44%, from 68 to 38 in participant 2. Thereafter, during 5 and 1.5 years of subsequent clinical care respectively, long-term bilateral amygdala DBS was associated with additional, clinically significant symptomatic and functional improvement. There were no serious stimulation-related adverse psychiatric, neuropsychiatric, neuropsychological, neurological, or neurosurgical effects. In one subject, symptomatic improvement was associated with an intensity-dependent reduction in amygdala theta frequency power. In our two participants, FDG-PET findings were inconclusive regarding the hypothesized mechanism of suppression of amygdala hyperactivity. Our findings encourage further research to confirm and extend our preliminary observations.

Subtypes of childhood maltreatment and posttraumatic stress disorder symptoms in an adult trauma sample: The mechanistic role of sleep.

Childhood maltreatment is indisputably linked to adverse mental health outcomes, including an increased risk to develop posttraumatic stress disorder (PTSD) in adulthood. The role of childhood maltreatment in the context of recovery from a trauma later in adulthood is not well understood. A variable related to both childhood maltreatment and PTSD symptoms, and a potential link between the two, is sleep. The current study aimed to understand how sleep disturbances may play a mechanistic role in the effect of subtypes of childhood maltreatment on PTSD symptom severity in an adult trauma sample. 160 adults (90 women; Mage = 33.73, SD = 10.86) were recruited from the emergency department at a Level-1 trauma center in southeastern Wisconsin after experiencing a traumatic injury. Experiences of childhood maltreatment and sleep were self-reported at 2-week and 3-month posttrauma, respectively. PTSD symptoms were clinically assessed 6 months later. Sleep disturbances 3-month posttrauma mediated the effect of emotional abuse, physical neglect, and emotional neglect on PTSD symptom 6 months after the traumatic injury. The effect of sexual and physical abuse on PTSD symptoms was not significantly mediated by sleep disturbances. These findings highlight the differential impact of subtypes of childhood maltreatment on PTSD symptoms, the mechanistic role of sleep, and the need to consider early life adversity when assessing adult posttrauma experiences. These results also suggest that interventions aimed at improving sleep quality might improve PTSD symptoms in those who have experienced childhood maltreatment and a subsequent traumatic injury in adulthood. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neural and psychological correlates of post-traumatic stress symptoms in a community adult sample.

A multitude of factors are associated with the symptoms of post-traumatic stress disorder. However, establishing which predictors are most strongly associated with post-traumatic stress disorder symptoms is complicated because few studies are able to consider multiple factors simultaneously across the biopsychosocial domains that are implicated by existing theoretical models. Further, post-traumatic stress disorder is heterogeneous, and studies using case-control designs may obscure which factors relate uniquely to symptom dimensions. Here we used Bayesian variable selection to identify the most important predictors for overall post-traumatic stress disorder symptoms and individual symptom dimensions in a community sample of 569 adults (18 to 85yr of age). Candidate predictors were selected from previously established risk factors relevant for post-traumatic stress disorder and included psychological measures, behavioral measures, and resting state functional connectivity among brain regions. In a follow-up analysis, we compared results controlling for current depression symptoms in order to examine specificity. Poor sleep quality and dimensions of temperament and impulsivity were consistently associated with greater post-traumatic stress disorder symptom severity. In addition to self-report measures, brain functional connectivity among regions commonly ascribed to the default mode network, central executive network, and salience network explained the unique variability of post-traumatic stress disorder symptoms. This study demonstrates the unique contributions of psychological measures and neural substrates to post-traumatic stress disorder symptoms.

Blunted Brachial Blood Flow Velocity Recovery to Acute Mental Stress in Young Women with PTSD Compared to Controls

Introduction: Post-traumatic stress disorder (PTSD) is a debilitating mental illness associated with increased cardiovascular disease (CVD) risk, a major cause of death among women in the United States. Women are twice as likely as men to develop PTSD after trauma exposure, and cardiovascular reactivity to stress is a known risk factor for CVD. Therefore, our aim was to investigate if young women diagnosed with PTSD will present with impaired hemodynamic responses to acute stress compared to controls. We hypothesized that women with PTSD will have high blood pressure (BP), heart rate (HR) and blood flow velocity (BFV) response to a mental stress protocol, and a blunted recovery. Methods: We recruited for this study ten young women with PTSD and nine trauma-exposed women without PTSD (controls) between the ages of 18 to 40 years. We collected data in a single laboratory visit after informed consent and PTSD symptoms severity questionnaire. After demographics and resting hemodynamics, we continuously measured HR using a three-lead EKG, beat-to-beat BP using finger plethysmography and continuous brachial BFV using Doppler ultrasound. A Doppler audio translator was used to transfer the doppler signal in our data analysis software for simultaneous recording of all hemodynamics variables. All variables were recorded during 5 min of supine rest, 5 min of mental stress (via mental arithmetic) and 5 min of recovery. The response and recovery to stress was analyzed using an analysis of covariance with timepoint as within factor and PTSD diagnosis as between-factor. Results: Women with a clinical diagnosis of PTSD had a mean age of 27±10 years and body mass index (BMI) of 30.1±2.9 kg/m2. Controls (trauma-exposed women without PTSD) had a mean age of 26±7 years and body mass index (BMI) of 24± 2.1 kg/m2. Resting seated BP and HR were not different between the groups. The slopes of the overall changes in BFV from baseline to mental stress to recovery were different between young women with PTSD and controls (timepoint*group, P= 0.057) when controlling for PTSD symptoms severity. Specifically, although mental stress elicited similar increases in BFV in women with PTSD (Δ0.80±1.8 cm/sec) and in controls [Δ0.45±1.2 cm/sec, P= 0.44 (timepoint*group)], BFV recovery from stress was impaired in PTSD (Δ0.64±1.3 cm/sec), but not in controls [Δ-2.20±0.84 cm/sec, P= 0.047 (timepoint*group)]. BP and HR reactivity to mental stress and recovery were not different between the groups (P&gt;0.05). Conclusion: The current pilot study revealed that PTSD is associated with blunted recovery from acute mental stress, suggesting early impairment of vascular function in these women at a young age. Young pre-menopausal women are overlooked in prevention strategies and health policies targeting populations at-risk for CVD; with the rising prevalence of trauma exposure in young women, evidence is pointing to a parallel increase in CVD risk. K01HL161027 and UMN CTSI UL1TR002494 No Disclosure. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Symptom Severity and Beat-to-Beat Blood Pressure Variability in Patients with Post-Traumatic Stress Disorder (PTSD)

Individuals with post-traumatic stress disorder (PTSD) have an elevated risk of developing cardiovascular disease. Emerging research suggests that blood pressure variability (BPV) may serve as an early indicator for increased cardiovascular disease risk. However, the relationship between post-traumatic stress symptom severity and symptom clusters, and comorbid conditions such as depression, with BPV is unclear. Purpose: The primary objective of this study was to investigate the relationship between the severity of PTSD and depression symptoms, PTSD symptom clusters, and beat-to-beat blood pressure variability (BPV) in a sample of individuals diagnosed with PTSD. We hypothesized that participants with greater PTSD symptom severity would have increased BPV. Methods: Twenty participants (mean age = 46 ± 10 yr; 70% males; 75% African American) with diagnosed PTSD were enrolled. PTSD severity and symptom clusters were assessed via the PTSD Checklist (PCL-5) and depression symptoms were assessed via Beck's Depression Inventory (BDI). Beat-to-beat blood pressure was recorded via finger photoplethysmography for a five-minute duration. BPV indices were calculated as the coeffcient of variation (CV), standard deviation (SD), and average real variability (ARV) for systolic, diastolic, and mean blood pressure. Pearson correlations were conducted to evaluate the association between symptoms and BPV outcomes. Participants were also categorized into two groups based on symptom severity. Independent t-tests were used to compare those with mild to moderate symptoms (n = 7) relative to participants with severe and extreme PTSD symptoms (n = 13). Results: PTSD symptom severity was significantly correlated with depression symptoms (r = 0.83, p &lt; 0.001). However, there were no significant correlations between BPV measures and either PTSD or depression symptoms. We did observe moderate non-significant correlations between the PTSD intrusive symptom cluster and diastolic and mean blood pressure CV (r = 0.33 and r = 0.29, p &gt; 0.05). Similar moderate correlations were observed between depression symptoms and diastolic and mean blood pressure CV (r = 0.31 and r = 0.29, p &gt; 0.05). No significant differences were observed between the two symptom severity groups in terms of systolic, diastolic, and mean blood pressure for CV, SD, and ARV (systolic CV 0.61 ± 0.17 vs. 0.62 ± 0.17 %, p &gt; 0.05, diastolic CV, 0.70 ± 0.06 vs. 0.72 ± 0.16 %, p &gt; 0.05, and mean blood pressure CV 0.63 ± 0.09 vs. 0.65 ± 0.15 %, p &gt; 0.05 for mild to moderate and severe to extreme PTSD symptoms, respectively). Conclusions: Contrary to our hypothesis, those with greater PTSD symptom severity did not have significantly greater BPV. In summary, our data demonstrate that higher PTSD symptoms are not associated with beat-to-beat BPV; however, the moderate correlations suggest that larger studies are needed to determine if PTSD intrusive symptoms and depression symptoms, are related beat-to-beat BPV indices. VA Merit I01-CX001065, and DOD PR210574. M. McGranahan is supported by NIDDK training grant TL1DK129502 and U2CDK129501. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Estradiol Levels are Differentially Associated with Arterial Stiffness in Trauma-Exposed Premenopausal Women with and without PTSD

Introduction: Cardiovascular disease (CVD) remains the leading cause of death for females in the United States. Although premenopausal females are typically thought to be protected from CVD, available data supports growing CVD risk in females before menopause by virtue of PTSD. Arterial stiffness is a well-known risk factor for CVD and estradiol (E2) in premenopausal females is known to promote good vascular function. Therefore, the purpose of the present study was to investigate the effects of E2 on arterial compliance in young trauma-exposed females with and without a PTSD diagnosis. We hypothesized that E2 levels will be negatively associated with arterial stiffness in women with PTSD. Methods: Sixty-eight trauma-exposed females (27 ± 7.4 years, 26.5 ± 5 kg/m2) from diverse backgrounds with (PTSD+, n=37) and without (PTSD-, n=31) a diagnosis of PTSD were included in this analysis. We collected blood samples to quantify plasma estrogen (E2) levels and assessed pulse wave velocity (PWV) using applanation tonometry. PWV is a non-invasive technique used to measure the speed at which blood travels from the aorta to the femoral artery using a tonometer that is placed over the carotid artery while a blood pressure cuff is placed over the femoral artery. PTSD symptom severity was assessed using the PTSD checklist for DSM 5 and blood samples were analyzed for total E2 using the quantitative sandwich enzyme immunoassay technique (ELISA). We used Pearson correlations and multiple linear regression to determine associations between E2 and PWV in the entire sample and in each group. Given our previous findings on sleep effciency and vascular function, we controlled for sleep effciency in the current analysis. Sleep effciency was objectively measured as the relative time (%) spent asleep while in bed, using wrist actigraphy for seven days. Results: Our analysis revealed an overall weak correlation between E2 and PWV (r=-0.028, p=0.024). However, when we examined each group, we found no association between E2 levels and PWV (r=-0.01, p=0.95) in the PTSD+ group. In contrast, in the PTSD- group, we found a strong association between E2 levels and PWV (r=-0.51, p=0.004). Furthermore, we conducted a multiple linear regression in the PTSD- group to detect the predictive value of E2 levels on PWV, controlling for sleep effciency, age, BMI, blood pressure, and PCL5. The model was significant (R2=0.65, adjusted R2=0.56, p&lt;0.001) with estradiol (β=-0.24, p=0.005) and diastolic blood pressure (β=-0.059, p&lt;0.001) as the strongest predictors. Thus, for every unit increase in E2 level, PWV decreased by 0.24 in the PTSD- group. Conclusion: Our analysis revealed that although E2 levels were negatively associated with PWV in young trauma-exposed females without PTSD, it was not the case in those with a PTSD diagnosis. These findings suggest that PTSD disrupts the association between E2 and arterial compliance in young females. K01HL161027 and UMN CTSI UL1TR002494 no disclosure. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Plasma Levels of Estradiol and Progesterone are Positively Associated with IL-1α and IL-1Ra in Young Women with PTSD

Introduction: Post-traumatic stress disorder (PTSD) is independently associated with greater cardiovascular disease (CVD) risk. Prior studies have reported higher inflammation as a possible underlying mechanism. Premenopausal females are typically thought to be protected from CVD due to estradiol (E2) and available data supports growing CVD risk in females before menopause by virtue of having PTSD. Given that E2 and progesterone (P4) have been shown to have a broad range of both pro- and anti-inflammatory effects, the purpose of our study was to investigate whether plasma levels of E2 and P4 are associated with subclinical inflammation in young women with PTSD. We hypothesized that E2 and P4 will be negatively associated with IL-1α, IL-1Ra, and IL-6. Methods: Seventy-five otherwise healthy young women (age, 28±7 years; BMI, 26.7±6 kg/m2) with a prior clinical diagnosis of PTSD (PTSD+, n=39) and without a PTSD diagnosis (PTSD-, n=36) were included in this study. We collected blood plasma samples to quantify E2 and P4 and inflammatory biomarkers Interleukin-1α (IL-1α), Interleukin-1 receptor antagonist (IL-1Ra) and Interleukin-6 (IL-6). Total plasma levels of E2 and P4 were measured using the quantitative sandwich enzyme immunoassay technique (ELISA). The inflammatory biomarkers were quantified using a Luminex assay. Participants were also asked to complete a self-administered PTSD checklist for DSM-5 (PCL5) to assess the severity of PTSD symptoms. We ran Pearson correlations between the sex hormones and the inflammatory biomarkers stratified by PTSD diagnosis. Results: We found a positive correlation between E2 levels and IL-1α (r=0.39, p=0.018), E2 and IL-1Ra (r=0.35, p=0.030), P4 and IL-1α (r=0.45, p=0.005), and P4 and IL-1Ra (r=0.27, p=0.101) in the PTSD+ group. In contrast, in the PTSD- group, there was no correlation between E2 and IL-1α (r=0.05, p=0.77), E2 and IL-1Ra (r=-0.06, p=0.73), P4 and IL-1α (r=-0.04, p=0.83) and P4 and IL-1Ra (r=0.07, p=0.68). Conclusion: Our analysis revealed that in young women with a clinical diagnosis of PTSD, E2 and P4 levels in the blood are positively associated with an increased IL-1α and IL-1Ra but not in young trauma-exposed women without PTSD. These findings suggest that in young women with PTSD, E2 and P4 might have a paradoxical effect on inflammation such that E2 and P4 promote the release of both pro-inflammatory (i.e. IL-1α) and anti-inflammatory (i.e. IL-1Ra) cytokines. Conversely, an increase in subclinical inflammation could lead to an increase in E2 and P4 levels, which in turn would promote the release of anti-inflammatory cytokines in order to inhibit the inflammatory response. K01HL161027 and UMN CTSI UL1TR002494 No Disclosure. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

0925 A Multilevel Time-lagged Mediation of Nightmare and PTSD Symptom Severity Across Time in a Combined Treatment

0925 A Multilevel Time-lagged Mediation of Nightmare and PTSD Symptom Severity Across Time in a Combined Treatment

Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity.

Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder- and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs =.285-.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.

Alone on the frontline: The first report of PTSD prevalence and risk in de-occupied Ukrainian villages.

The ongoing Russian invasion of Ukraine marks a critical juncture in a series of events posing severe threat to the health of Ukrainian citizens. While recent reports reveal higher rates of PTSD in Ukrainian refugees following Russia's invasion - data for Ukrainians remaining at the warfront is inherently difficult to access. A primarily elderly demographic, Ukrainians in previously Russian-occupied areas near the front (UPROANF) are at particular risk. Data was sourced from screening questionnaires administered between March 2022 and July 2023 by mobile health clinics providing services to UPROANF. Previously occupied villages in Eastern and Southern Ukraine. UPROANF attending clinics completed voluntary self-report surveys reporting demographics, prior health diagnoses, and PTSD symptom severity (n = 450; Meanage = 53.66; 72.0% female). Participants were exposed to Russian occupation of Ukrainian villages. The PTSD Checklist for the DSM-V (PCL-5) with recommended diagnostic threshold (i.e. 31) was utilized to assess PTSD prevalence and symptom severity. ANCOVA was used to examine hypothesized positive associations between (1) HTN and (2) loneliness and PTSD symptoms (cumulative and by symptom cluster). Between 47.8% and 51.33% screened positive for PTSD. Though cumulative PTSD symptoms did not differ based on HTN diagnostic status, those with HTN reported significantly higher PTSD re-experiencing symptoms (b = 1.25, SE = 0.60, p = .046). Loneliness was significantly associated with more severe cumulative PTSD symptoms (b = 1.29, SE = 0.31, p < .001), re-experiencing (b = 0.47, SE = 0.12, p < .001), avoidance (b = .18, SE = 0.08, p = .038), and hypervigilance (b = 0.29, SE = 0.13, p = .036). PTSD prevalence was higher than other war-exposed populations. Findings highlight the urgent mental health burden among UPROANF, emphasizing the need for integrated care models addressing both trauma and physical health. Given the significance of loneliness as a risk factor, findings suggest the potential for group-based, mind-body interventions to holistically address the physical, mental, and social needs of this highly traumatized, underserved population.

The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation.

The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts. We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored. 134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being. Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers.

Pathway from Childhood Maltreatment to Perceived Parental Competence and Intimate Partner Violence Among Expecting Fathers: The Role of PTSD Symptoms

ABSTRACT Men who have a history of childhood maltreatment may be at risk of experiencing significant challenges during the transition to parenthood, which might be explained by the presence of post-traumatic stress disorder (PTSD) symptoms. Using a nonclinical community sample of 230 expecting fathers, the aims of the current study were as follows (1) to investigate, during the prenatal period, associations between childhood maltreatment and perceived parental competence as well as between childhood maltreatment and intimate partner violence, and (2) to evaluate whether PTSD symptoms contributed to explaining these associations. A structural equation model showed that the severity of childhood maltreatment predicted more severe PTSD symptoms, which in turn predicted higher levels of intimate partner violence as well as a lower perceived parental competence. No direct associations between childhood maltreatment and both perceived parental competence and intimate partner violence were observed. Implications for interventions and future research are discussed.

Graph theory-based analysis reveals neural anatomical network alterations in chronic post-traumatic stress disorder

Abstract Multimodal imaging using network connectivity techniques shows promise for investigating neuropathology influencing Post-Traumatic Stress Disorder (PTSD) symptom maintenance and course. We recruited World Trade Center (WTC) responders who continued to suffer from chronic PTSD into a diffusion tensor neuroimaging protocol (n=100), along with nine unexposed controls without PTSD from other sources. Using a graph theory approach to probe network alterations in brain diffusion images, we calculated weighted characteristics path length as a surrogate marker for the effective neuroanatomical distance between anatomical nodes. The sample (N=109; 47 with chronic PTSD) was in their mid-fifties, and the majority were male. Responders were matched in terms of cognitive performance, occupation, and demographics. The anatomical connectivity graph was constructed for each participant using deterministic diffusion tractography. We identified a significant difference in weighted Characteristic Path Length (wCPL) between trauma-exposed WTC responders (Cohen’s d = 0.42, P&amp;lt;0.001) that was highest in people with PTSD, and not explained by WTC exposure severity or duration. We also found that wCPL was associated with PTSD symptom severity in responders with PTSD. In the largest study to date to examine the relationship between chronic PTSD and anatomy, we examined the anatomical topography of neural connections and found that wCPL differed between the PTSD+ and PTSD- diagnostic categories.

Posttraumatic cognitions about the self are associated with depression symptoms in veterans endorsing a history of assaultive military sexual trauma.

Depressive symptoms are a commonly observed yet understudied mental health sequalae of military sexual trauma (MST). Prior research supports the relationship between negative posttraumatic cognitions (NPCs) and the onset and course of trauma symptoms more broadly. We hypothesized that NPCs would be associated with depression symptoms in veterans endorsing a history of MST, specifically assaultive type MST. Our clinical sample included veterans presenting for treatment related to assaultive MST (N = 158; 70.9% female, 65.2% White, 27.8% Black). Participants completed self-report measures of posttraumatic stress disorder (PTSD), depression, and NPCs during intake at a Veteran's Affairs specialty trauma clinic. Linear regressions were used to analyze the association between NPCs and depression symptoms controlling for PTSD symptom severity. PTSD severity and NPCs about the self were significantly associated with depression symptoms, explaining 46% of the variance severity, F(4, 153) = 33.16, R² = .46, p < .001. These findings newly demonstrate a relationship between NPCs about the self and depression in veterans with a history of MST. Clinicians may benefit from incorporating cognitive interventions into preexisting depression treatments to directly address NPCs in this population. Future study is needed to determine how these results may extend to other forms of MST or trauma types. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of veteran attendance in an intimate partner violence intervention.

This study examined session attendance data from 2,754 veterans who participated in a national implementation of a trauma-informed intimate partner violence intervention, Strength at Home, across the Veterans Affairs Healthcare System. Potential correlates of attendance were demographic characteristics, posttraumatic stress disorder (PTSD) symptom severity, alcohol use, court involvement, current military involvement, and intervention modality (in-person vs. virtual). Given the trauma-informed nature of the intervention, it was expected that trauma-relevant risk factors, specifically PTSD symptom severity and racial minority status, would be less strongly associated with attendance than barriers related to other demographic variables and higher alcohol use, intervention modality, and court involvement. Results indicated that age, education level, employment status, retirement status, PTSD symptom severity, alcohol use, and court involvement were associated with session attendance in the expected direction at the bivariate level. Only education level, employment status, retirement status, alcohol use, and court involvement emerged as unique predictors of attendance such that more educated, employed, retired, and court-mandated veterans with less alcohol use attended more sessions. These findings suggest the importance of a trauma-informed, coordinated community response to intimate partner violence intervention and integration of motivational components surrounding problematic alcohol use to enhance compliance and mitigate barriers to attendance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).