Posttraumatic Stress Disorder Symptomology Research Articles

The Impact of Psychological Capital and Workplace Social Support on Pediatric Oncology Nurses' Post Traumatic Stress Disorder (PTSD) Symptomology.

Introduction: Work-related post traumatic stress disorder (PTSD) can develop in nurses. Pediatric oncology nursing is a potentially high-risk subspecialty for PTSD secondary to the nature of the work. This study aimed to describe the prevalence of PTSD symptomology and explore relationships between nurse psychological capital, workplace social supports, and PTSD symptomology in pediatric oncology nurses. Methods: The study utilized a cross-sectional correlational survey design. Pediatric oncology nurses working in direct patient care in the United States completed a demographics questionnaire, Psychological Capital Questionnaire (PCQ), Coworker Support Scale, Supervisor Support Scale, and the Post traumatic Checklist for Diagnostic and Statistical Manual of Mental Disorders (PCL-5). Descriptive and inferential statistics, including logistic regression models, were used to analyze data. A cutoff score of ≥31 on the PCL-5 was used to determine the prevalence of PTSD symptomology. Results: The sample included 424 nurses. The prevalence of PTSD symptomology was 13.4%. Work setting (inpatient), decreased coworker and leadership social support, and psychological capital were independently associated with PTSD symptomology. After controlling for covariates, only psychological capital was associated with PTSD symptomology. For a 1 unit decrease in PCQ score, pediatric oncology nurses were 4.25 times more likely to have PTSD symptomology. Discussion: PTSD prevalence rates in pediatric oncology nurses are aligned with rates found in other nursing specialties. Nurse psychological capital may play a protective role against PTSD symptomology. Implications for Future Research: Findings support PTSD as a serious workplace concern for nurses. Workplace programs that foster nurses' psychological capabilities should be considered to protect against the development of PTSD symptomology.

Psychopathic traits predict the severity of post-traumatic stress in survivors of intimate partner abuse

Limited research exists exploring survivors' experiences in a relationship with a psychopathic abuser and their mental health following relationship dissolution. The present study examines the specific traits and patterns of abuse that have the most profound impact on survivors' mental health. Self-identified survivors of an intimate relationship with a psychopathic abuser (N = 454; Mage = 45.5) were recruited from intimate partner abuse support websites. They were assessed for abuse experiences, post-traumatic stress disorder (PTSD) symptomology, and the extent to which their abuser exhibited psychopathic traits via self-report questionnaires. Multiple regression analysis revealed that abusers' psychopathic traits were predictive of survivors' PTSD symptomology. Specifically, when controlling for the duration since last contact with the abuser and relationship length, interpersonal and affective traits, and experiences of versatile forms of abuse contributed to more severe PTSD symptoms. The present findings are consistent with an emerging body of research showing that abusers' emotional disconnection and predatory nature facilitate their ability to maintain an intimate relationship while engaging in a wide range of abuse resulting in widespread harm to survivors' mental health.

The impact of post-traumatic stress on quality of life and fatigue in women with Gulf War Illness

BackgroundGulf War Illness (GWI) is a chronic, multi-symptomatic disorder characterized by fatigue, muscle pain, cognitive problems, insomnia, rashes, and gastrointestinal issues affecting an estimated 30% of the ~ 750,000 returning military Veterans of the 1990–1991 Persian Gulf War. Female Veterans deployed to combat in this war report medical symptoms, like cognition and respiratory troubles, at twice the rate compared to non-deployed female Veterans of the same era. The heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. This is exacerbated by the presence of co-morbidities. Defining subgroups of the illness may help alleviate these complications. One clear grouping is along the lines of gender. Our aim is to determine if women with GWI can be further subdivided into distinct subgroups based on post-traumatic stress disorder (PTSD) symptom presentation.MethodsVeterans diagnosed with GWI (n = 35) and healthy sedentary controls (n = 35) were recruited through the Miami Veterans Affairs Medical Health Center. Symptoms were assessed via the RAND short form health survey, the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson trauma scale value and performing heteroscedastic t-tests across all measures.ResultsBased on the distinct differences found in PTSD symptomology regarding all health and trauma symptoms, two subgroups were derived within female GWI Veterans. Hierarchical regression models displayed the comorbid effects of GWI and PTSD, as both conditions had measurable impacts on quality of life and fatigue (ΔR2 = 0.08–0.672), with notable differences in mental and emotional measures. Overall, a cut point analysis indicated poorer quality of life and greater fatigue within all measures for women with GWI and PTSD symptoms in comparison to those women with GWI without PTSD symptoms and healthy controls.ConclusionsOur current findings support the understanding that comorbid symptoms of GWI and PTSD subsequently result in poorer quality of life and fatigue, along with establishing the possibility of varying clinical presentations.

Healthcare Workers and COVID-19-Related Moral Injury: An Interpersonally-Focused Approach Informed by PTSD.

The COVID-19 pandemic has resulted in a still-unfolding series of novel, potentially traumatic moral and ethical challenges that place many healthcare workers at risk of developing moral injury. Moral injury is a type of psychological response that may arise when one transgresses or witnesses another transgress deeply held moral values, or when one feels that an individual or institution that has a duty to provide care has failed to do so. Despite knowledge of this widespread exposure, to date, empirical data are scarce as to how to prevent and, where necessary, treat COVID-19-related moral injury in healthcare workers. Given the relation between moral injury and post-traumatic stress disorder (PTSD), we point here to social and interpersonal factors as critical moderators of PTSD symptomology and consider how this knowledge may translate to interventions for COVID-19-related moral injury. Specifically, we first review alterations in social cognitive functioning observed among individuals with PTSD that may give rise to interpersonal difficulties. Drawing on Nietlisbach and Maercker's 2009 work on interpersonal factors relevant to survivors of trauma with PTSD, we then review the role of perceived social support, social acknowledgment and social exclusion in relation to potential areas of targeted intervention for COVID-19-related moral injury in healthcare workers. Finally, building on existing literature (e.g., Phoenix Australia—Centre for Posttraumatic Mental Health and the Canadian Centre of Excellence—PTSD, 2020) we conclude with individual and organizational considerations to bolster against the development of moral injury in healthcare workers during the pandemic.

On the relation between mind wandering, PTSD symptomology, and self-control

Here we examined the association between mind wandering, post-traumatic stress disorder (PTSD) symptomology, and self-control. In a large undergraduate sample (N = 5,387), we assessed trait-levels of spontaneous and deliberate mind wandering, self-control, and PTSD symptomology. Results indicated that, while PTSD symptomology was uniquely positively associated with spontaneous mind wandering, it was negatively associated with deliberate mind wandering and self-control. These findings suggest that the mechanism(s) underlying everyday mind wandering may also underlie PTSD symptomology and traumatic intrusions. Moreover, the unique negative association between PTSD symptomatology and self-control suggests that PTSD is characterized not only by impairments in inhibiting unwanted thoughts (as indexed by mind wandering), but also by impairments in inhibiting other unwanted behaviors.

Associations Among Teacher Identification of Symptomology in the Classroom and Children’s Post-traumatic Stress Disorder Symptomology: Potential Influences of Caregiver History of Childhood Maltreatment

Associations Among Teacher Identification of Symptomology in the Classroom and Children’s Post-traumatic Stress Disorder Symptomology: Potential Influences of Caregiver History of Childhood Maltreatment

Investigating the experience of individuals with comorbid posttraumatic stress disorder and substance misuse attending a Seeking Safety group

PurposeThere is no specific recommended treatment for the co-morbid presentation of post-traumatic stress disorder (PTSD) and substance use disorder in the United Kingdom (UK). Seeking Safety (SS), a group-based treatment that targets symptoms of both disorder, has emerging evidence in the USA but lacks evidence from UK-based samples. The purpose of this study was to explore UK service users’ experience of attending SS and evaluate its impact on mental health symptomology and substance misuse.Design/methodology/approachA mixed method approach was used to evaluate the acceptability of SS for a small sample (n = 7) of adult users of a substance misuse service in the UK. Thematic analysis was used to explore their experiences, derived from individual semi-structured interviews. The authors also calculated the number of participants who achieved reliable and/or clinically significant change in mental health symptomology and substance misuse from data routinely collected by the service.FindingsSeven overarching themes emerged: strengthening the foundations of the self, the evocation and management of emotions, safety and validation provided relationally, readiness and commitment, content and delivery, Seeking Safety is Not an Island and ending. Most participants with data available both before and after the group made reliable (three out of four) and clinically significant (two out of three) change for depression and anxiety symptomology; however, this was less evident for PTSD symptomology with two out of three making reliable change and one out of three making clinically significant change.Originality/valueTo the best of the authors’ knowledge, this was the first study exploring the experiences of UK attendees of a SS group as an approach to treating comorbid PTSD and substance misuse.

Association between spatial working memory and Re-experiencing symptoms in PTSD

Background and objectivesFew studies have evaluated the link between working memory (WM) and post-traumatic stress disorder (PTSD). Further, it is unknown whether this relationship is accounted for by other relevant variables including negative affect, emotional dysregulation, or general non-WM-related cognitive control deficits, which are associated with PTSD. The purpose of this study was to determine the extent to which a computerized WM task could predict PTSD symptomology incrementally beyond the contribution of other relevant variables associated with PTSD. MethodsThirty veterans were eligible to complete emotional symptom questionnaires, a heart-rate variability measure, and computerized tasks (i.e., emotional Stroop and automated complex span tasks). A three-stage hierarchical regression was conducted with the PCL-5 total score and symptom clusters (i.e., re-experiencing, avoidance, hyperarousal, and negative cognition/mood) as the dependent variable. ResultsResults revealed that only the re-experiencing symptom cluster was significantly predicted by executive, verbal, and visuospatial WM tasks, which explained an additional 29.7% of the variance over and above other relevant variables. Most notably, the visuospatial task was the only WM task that significantly explained PCL-5 re-experiencing symptoms. LimitationsThis study was based on a small sample of veterans with PTSD and causality cannot be determined with this cross-sectional study. ConclusionsOverall, the results suggest that deficits in visuospatial WM are significantly associated with PTSD re-experiencing symptoms after controlling for other relevant variables. Further research should evaluate whether an intervention to improve visuospatial WM capacity can be implemented to reduce re-experiencing symptoms.

Lamotrigine for Treating Anger in Veterans With Posttraumatic Stress Disorder.

Lamotrigine is an antiepileptic drug that was Food and Drug Administration approved in 2003 for use in the maintenance treatment of bipolar I disorder to delay the time to recurrence of new mood episodes. The mechanism by which lamotrigine achieves its therapeutic effect in the treatment of bipolar disorder is unknown. Here, we report on 2 Veterans with combat-related posttraumatic stress disorder (PTSD) endorsing significant anger, aggression, and agitation, who were treated with selective serotonin reuptake inhibitors, but whose residual symptoms of anger and aggression were ultimately successfully managed with lamotrigine augmentation. The authors would like to make mental health providers aware of the impact that lamotrigine may have on PTSD symptomology, especially when used to treat anger and aggression in patients with PTSD.

Neural connectome prospectively encodes the risk of post-traumatic stress disorder (PTSD) symptom during the COVID-19 pandemic

BackgroundThe novel coronavirus (COVID-19) pandemic has affected humans worldwide and led to unprecedented stress and mortality. Detrimental effects of the pandemic on mental health, including risk of post-traumatic stress disorder (PTSD), have become an increasing concern. The identification of prospective neurobiological vulnerability markers for developing PTSD symptom during the pandemic is thus of high importance. MethodsBefore the COVID-19 outbreak (September 20, 2019–January 11, 2020), some healthy participants underwent resting-state functional connectivity MRI (rs-fcMRI) acquisition. We assessed the PTSD symptomology of these individuals during the peak of COVID-19 pandemic (February 21, 2020–February 28, 2020) in China. This pseudo-prospective cohort design allowed us to test whether the pre-pandemic neural connectome status could predict the risk of developing PTSD symptom during the pandemic. ResultsA total of 5.60% of participants (n = 42) were identified as being high-risk to develop PTSD symptom and 12.00% (n = 90) exhibited critical levels of PTSD symptoms during the COVID-19 pandemic. Pre-pandemic measures of functional connectivity (the neural connectome) prospectively classified those with heightened risk to develop PTSD symptom from matched controls (Accuracy = 76.19%, Sensitivity = 80.95%, Specificity = 71.43%). The trained classifier generalized to an independent sample. Continuous prediction models revealed that the same connectome could accurately predict the severity of PTSD symptoms within individuals (r2 = 0.31p<.0). ConclusionsThis study confirms COVID-19 break as a crucial stressor to bring risks developing PTSD symptom and demonstrates that brain functional markers can prospectively identify individuals at risk to develop PTSD symptom.

The Role of Posttraumatic Stress Symptoms and Negative Affect in Predicting Substantiated Intimate Partner Violence Incidents Among Military Personnel

Increasing rates of posttraumatic stress disorder (PTSD) in military populations during recent conflicts have sparked concerns regarding the incidence of other commonly associated problems, such as intimate partner violence (IPV). From a clinical perspective, it is important to understand patterns of PTSD symptomology that may indicate heightened risk for such aggression. To address this, among a longitudinal cohort of U.S. military personnel, we evaluated the association of PTSD symptom clusters and comorbid conditions as predictors of any subsequent Department of Defense Family Advocacy Program incidents of IPV meeting full definitional criteria for physical or psychological abuse. Results suggested that general symptoms of negative affect common in PTSD (e.g., anger/irritability, sleep disruption) and comorbid alcohol dependence were stronger predictors of IPV than trauma-specific PTSD symptomology (e.g., reexperiencing, hypervigilance). Clinical implications and recommendations for future research are discussed.

Is PTSD-Phenotype Associated with HPA-Axis Sensitivity?: The Endocannabinoid System in Modulating Stress Response in Rats.

Endocannabinoids play a role in adaptation to stress and regulate the release of glucocorticoids in stressed and unstressed conditions. We recently found that basal corticosterone pulsatility may significantly impact the vulnerability for developing post-traumatic-stress-disorder (PTSD), suggesting that the endocannabinoid system may contribute to its development. To examine this, we exposed rats to predator scent stress (PSS). Behavioral reactions were recorded seven days post-PSS. Cerebrospinal fluid (CSF) was collected from anesthetized rats shortly after PSS exposure to determine the levels of 2-arachidonoyl glycerol (2-AG) and anandamide (AEA). To correlate between endocannabinoids and corticosterone levels, rats were placed in metabolic cages for urine collection. To assess the levels of endocannabinoids in specific brain regions, rats’ brains were harvested one day after behavioral analysis for staining and fluorescence quantification. Moreover, 2-AG was elevated in the CSF of PTSD-phenotype rats as compared with other groups and was inversely correlated with corticosterone urinary secretion. Eight days post-PSS exposure, hippocampal and hypothalamic 2-AG levels and hippocampal AEA levels were significantly more reduced in the PTSD-phenotype group compared to other groups. We posit that maladaptation to stress, which is propagated by an abnormal activation of endocannabinoids, mediates the subsequent stress-induced behavioral disruption, which, later, reduces neuronal the expression of endocannabinoids, contributing to PTSD symptomology.

Tracking positive and negative affect in PTSD inpatients during a service dog intervention.

Though popular across many audiences, engagement with a service dog has undergone limited empirical evaluation as a complementary or alternative treatment for posttraumatic stress disorder (PTSD). The present study took advantage of a service dog training intervention underway in a Department of Veterans Affairs residential PTSD treatment program to perform a within-subjects comparison of a range of phenotypic markers. The present report considers negative and positive affect, assessed throughout the day, contrasting weeks when participants were or were not accompanied by their service dog. Fifty-four veterans were studied for 2-6 weeks. Negative and positive affect were sampled five times per day using items from the Positive and Negative Affect Schedule. Participants also wore a single-patch ECG/activity recorder and slept on beds recording sleep actigraphically. Linear mixed effects regression was employed to estimate the effect of the presence of service dog on momentary affect in the context of other presumable influences. Missing data were managed using methods applicable to random and nonrandom missingness. In this sample, the presence of a service dog was associated with reduced negative and increased positive affect, with both effects diminishing over time. Only negative affect was associated with time in residential treatment, and only positive affect was associated with concurrent heart rate, activity, and the interaction of activity and prior-night actigraphic sleep efficiency. These results concur with prior reports of reduced PTSD symptomology in association with the presence of a service dog, and with the distinct neurocircuitries underlying defensive and appetitive emotion and motivation. Limitations derive from the artificial environment and brief duration of study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of stress resilience and susceptibility on fear learning, anxiety, and alcohol intake

Post-traumatic stress disorder (PTSD) can develop after exposure to traumatic events and severely impacts the quality of life. PTSD is frequently comorbid with substance use disorders, with alcoholism being particularly common. However, not everyone who experiences trauma develops PTSD and the factors that render individuals susceptible or resilient to the effects of stress are unknown although gender appears to play an important role. Rodent models of stress exposure such as stress-enhanced fear learning (SEFL) recapitulate some aspects of PTSD symptomology, making them an invaluable tool for studying this disorder. This study examined whether exposure to a modified version of the SEFL procedure (4 footshocks instead of the standard 15 over 90 min) would reveal both susceptible and resilient subjects. Following stress exposure, distinct susceptible and resilient groups emerged that differed in fear learning and anxiety-related behavior as well as voluntary alcohol intake. Some aspects of stress susceptibility manifested differently in males compared to females, with susceptibility associated with increased alcohol intake in males and increased baseline anxiety in females.

The effect of time outdoors on veterans receiving treatment for PTSD.

Duration, frequency, and intensity of nature exposure link to different physical and psychological benefits. The present study aimed to determine how time outdoors affected military veterans' posttraumatic stress disorder (PTSD) symptomology during PTSD treatment. Hypotheses regarding time outdoors and the effect of program duration on PTSD symptoms were examined using multilevel models. The authors hypothesized that hours outdoors, both within- and between-persons, would predict reduced PTSD symptomology, program duration would predict reduced PTSD symptomology, and that hours outdoors and program duration would be significant when accounting for the other. The present study found that time outdoors correlated with participants' decreased PTSD symptomology: the more time participants spent outdoors, the greater the reduction in their PTSD symptoms. The effect of time outdoors was significant within-person, not between persons, suggesting that nature exposure may be used as an adjunct to traditional mental health treatment where exposure or dosage should be person-specific.

Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits

BackgroundIndividuals with Autism Spectrum Disorder (ASD) are known to be at increased risk of exposure to traumas such as maltreatment and abuse, however less is known about possible susceptibility towards the development of Posttraumatic Stress Disorder (PTSD) and associated risk factors. AimsThis study investigated the rates of trauma exposure and PTSD, and the role of cumulative trauma exposure and memory as risk factors for PTSD in adults who self-reported having received an ASD diagnosis, compared to a typically developing (TD) comparison group. MethodsQuestionnaires assessing self-reported frequency of trauma exposure (LEC), PTSD symptomology (PCL-S) and memory (EMQ- R and BRIEF-A) were completed online by 38 ASD adults and 44 TD adults. ResultsRates of trauma exposure and PTSD symptomatology were significantly higher in the ASD group, compared to the TD group, with deficits in working memory and everyday memory mediating this association. Interestingly, a cumulative effect of trauma exposure on PTSD symptom severity was only found in the ASD group. ConclusionsHigh rates of trauma and probable PTSD in ASD adults highlight the importance of routine screening. Cumulative trauma exposure and memory deficits may act to increase risk of PTSD in ASD; longitudinal research is called for.

Why Do Women Talk About It? Reasons for Disclosure of Sexual Victimization and Associated Symptomology.

Many sexual victimization survivors disclose their experience; however, there is limited research investigating why women disclose this experience and how reasons relate to psychopathology. The current online study aims to further understand the experiences of 142 female survivors (aged 18-29 years) by identifying their reason for disclosure and investigating how reasons relate to self-reported depression and post-traumatic stress disorder (PTSD) symptomology. Qualitative analyses identified two reasons: intentional and elicited disclosures. Hierarchical linear regressions revealed that elicited disclosures were associated with higher PTSD symptomology than intentional disclosures above and beyond relevant covariates, suggesting that disclosure reason is an important factor in the recovery process.

Examining Transdiagnostic Factors among Firefighters in Relation to Trauma Exposure, Probable PTSD, and Probable Alcohol Use Disorder

Objective Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters (N = 657) with probable PTSD-AUD (n = 27), probable PTSD-alone (n = 35), probable AUD-alone (n = 125), and trauma-exposure-only (n = 470). Methods: All firefighters completed a self-report, online questionnaire battery. Between group differences in anxiety sensitivity (AS), distress tolerance (DT), mindfulness, and emotional regulation difficulties (ERD) were assessed. It was hypothesized that firefighters with probable PTSD-AUD would endorse elevated AS and ERD, and reduced DT and mindfulness in comparison to all other diagnostic groups. Relationship status was included as a covariate in all comparisons. Results: Firefighters with probable PTSD-AUD endorsed elevated AS and ERD, and reduced DT and mindfulness in comparison to firefighters with trauma-exposure-only and probable AUD-alone. Firefighters with probable PTSD-AUD and probable PTSD-alone did not significantly differ. Conclusions: Given these findings, this line of inquiry has great potential to inform specialized, evidence-based mental health programming among firefighter populations, who represent a unique population susceptible to trauma-exposure, PTSD symptomology, and problematic alcohol use.

Mindfulness, sleep, and post-traumatic stress in long-haul truck drivers.

The high stress culture and demands associated with long-haul truck driving place truckers at risk for mental health and sleep disorders, and thereby, increased risk for accidents, injuries, and fatality. Hours-of-service regulations have proven insufficient as a stand-alone intervention to protect the welfare of long-haul truckers, impacting those working in the industry and those sharing our nation's roads. Interventions to increase mindfulness have been used across occupational and personal domains to improve sleep quality, mental health, awareness of the environment, and reaction time. The purpose of this study was to examine the relationships between sleep, mental health, health care utilization, and mindfulness in long-haul truck drivers in the United States. Participants (N = 140) were recruited to complete a web-based survey. Descriptive statistics, bivariate analysis, and regression analysis were used to examine variables of interest. Post-traumatic Stress Disorder (PTSD) symptomology and daytime sleepiness predicted mental health care utilization in the past year. Mindfulness was inversely correlated with PTSD symptomology, however in the full regression model, mindfulness failed to predict mental health care utilization. Occupational health professionals should utilize mindfulness screenings as an adjunctive component to traditional mental health screenings and refer drivers for advanced care as appropriate.

The Association Between Pain Trajectories With Posttraumatic Stress Disorder, Depression, and Disability During the Acute Posttrauma Period.

Exposure to a traumatic event is common among US adults, yet only a small fraction develops posttraumatic stress disorder (PTSD). Higher pain after a traumatic injury has been associated with higher PTSD symptoms and thus may be a risk factor. However, few studies have examined how pain during the period immediately after a trauma, referred to as the acute posttrauma period, relates later to PTSD outcomes. A sample of (n = 87) individuals who had experienced a traumatic injury assessed their pain through daily mobile assessments for the first month after injury. PTSD, depression, and functional impairment were assessed at the time of trauma and 1 and 3 months later. Using latent class growth analysis, three trajectories of pain were identified: low pain (41.3%), decreasing pain (43.7%), and high pain (14.9%). At baseline, the high-pain class reported higher levels of depression and functional impairment than did the low-pain group. From baseline to 3 months, the low-pain class experienced a reduction in PTSD, depression, and functional impairment, whereas the high-pain class experienced an increase in PTSD symptoms, persistent depression, and functional impairment. These results demonstrate that there are distinct trajectories of pain after a traumatic injury. Persistent elevated pain is associated with more severe psychopathology in the period immediately after a traumatic injury.