Posttraumatic Stress Related Symptoms Research Articles

A guided single session intervention to reduce intrusive memories of work-related trauma: a randomised controlled trial with healthcare workers in the COVID-19 pandemic

Abstract Background Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic. Methods Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint). Results The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0–3), control Mdn = 5.0 (IQR = 1–17); p < 0.0001, IRR = 0.30; 95% CI = 0.17–0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition. Conclusions This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma. Trial registration 2020–07-06, ClinicalTrials.gov identifier: NCT04460014.

The potential beneficial effect of sleep deprivation following traumatic events to preventing PTSD: Review of current insight regarding sleep, memory, and trauma resonating with ancient rituals-Àìsùn Oku (African) and Tsuya (Japanese).

Sleep figures in numerous ancient texts, for example, Epic of Gilgamesh, and has been a focus for countless mystical and philosophical texts. Even in the present century, sleep remains one of the most complex behaviors whose function still remains to be further explored. Current hypotheses suggest that among other functions, sleep contributes to memory processes. Memory is a core topic of study in post-traumatic stress disorder (PTSD) and other stress-related phenomena. It is widely accepted that sleep plays a major role in the consolidation of newly encoded hippocampus-dependent memories to pre-existing knowledge networks. Conversely, sleep deprivation disrupts consolidation and impairs memory retrieval. Along this line, sleep deprivation following a potentially traumatic event may interfere with the consolidation of event-related memories and, thereby, may reduce long-term post-traumatic stress-related symptoms. This review consolidates clinical and animal studies on the relationships between sleep, sleep deprivation, memory processes, and trauma exposure while introducing new contemporary insights into an ancient African tribal ritual (Àìsùn Oku) and Japanese ceremony ritual (Tsuya). We propose that these findings, focusing specifically on the effects of sleep deprivation in the immediate aftermath of traumatic events, may be explored as a possible therapeutic measure. Along with a summary of the field questions on whether sleep is performed "to remember" or "to forget" we lay the rationale for using sleep deprivation as a clinical tool. A tool that may partially prevent the long-term persistence of these traumatic events' memory and thereby, at least partly, attenuating the development of PTSD.

Editorial on Psychological distress in the Greek general population during the first COVID-19 lockdown.

This editorial discusses a study by Karaivazoglou and colleagues, where the authors investigated anxiety, depressive, post-traumatic stress-related symptoms and coronavirus disease 2019 (COVID-19)-related beliefs in the Greek population during the first COVID-19 lockdown, via an anonymous online survey.

Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement

Background/ObjectiveDeath in intensive care units (ICUs) may increase bereaved family members’ risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care.MethodIn this longitudinal observational study, 319 family members of deceased ICU patients were consecutively recruited from medical ICUs from two Taiwanese medical centers. PTSD symptoms were assessed at 1, 3, 6, and 13 months post-loss using the Impact of Event Scale-Revised (IES-R). Family satisfaction with end-of-life care in ICUs was assessed at 1 month post-loss. End-of-life care received in ICUs was documented over the patient’s ICU stay. Predictors for developing clinically significant PTSD symptoms (IES-R score ≥ 33) were identified by multivariate logistic regression with generalized estimating equation modeling.ResultsThe prevalence of clinically significant PTSD symptoms decreased significantly over time (from 11.0% at 1 month to 1.6% at 13 months post-loss). Longer ICU stays (adjusted odds ratio [95% confidence interval] = 1.036 [1.006, 1.066]), financial insufficiency (3.166 [1.159, 8.647]), and reported use of pain medications (3.408 [1.230, 9.441]) by family members were associated with a higher likelihood of clinically significant PTSD symptoms among family members during bereavement. Stronger perceived social support (0.937 [0.911, 0.965]) and having a Do-Not-Resuscitate (DNR) order issued before the patient’s death (0.073 [0.011, 0.490]) were associated with a lower likelihood of clinically significant PTSD symptoms. No significant association was observed for family members’ satisfaction with end-of-life care (0.988 [0.944, 1.034]) or decision-making in ICUs (0.980 [0.944, 1.018]).ConclusionsThe likelihood of clinically significant PTSD symptoms among family members decreased significantly over the first bereavement year and was lower when a DNR order was issued before death. Enhancing social support and facilitating a DNR order may reduce the trauma of ICU death of a beloved for family members at risk for developing clinically significant PTSD symptoms.

Help-Seeking Behavior in Survivors of Intimate Partner Violence: Toward an Integrated Behavioral Model of Individual Factors.

This study examined individual behavioral predictors of help-seeking using the frameworks of the Andersen model and the theory of planned behavior in a sample of help-seeking female survivors of intimate partner violence (IPV). In-person interviews were conducted with 372 women (Mage = 34.41 years, 66% African American). Results indicated that variables suggested by the Andersen model, including age, depression, psychological aggression, and posttraumatic stress-related arousal symptoms, were significant predictors of help-seeking. Variables suggested by the theory of planned behavior, including perceived helpfulness of resource and perceived controllability of the violence, were also significantly related to help-seeking. However, a combined model including variables from both theoretical approaches accounted for the most variance in help-seeking behavior. Overall, results suggest that these models are useful conceptualizations of help-seeking in an IPV population and that it is important to consider personal characteristics, need-based variables, and cognitive factors in outreach efforts.

Impact of Proactive Nurse Participation in ICU Family Conferences: A Mixed-Method Study.

To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. Mixed-method design with a qualitative study embedded in a single-center randomized study. Twelve-bed medical-surgical ICU in a 460-bed tertiary hospital. One family member for each consecutive patient who received more than 48 hours of mechanical ventilation in the ICU. Planned proactive participation of a nurse in family conferences led by a physician. In the control group, conferences were led by a physician without a nurse. Of the 172 eligible family members, 100 (60.2%) were randomized; among them, 88 underwent semistructured interviews at ICU discharge and 86 completed the Peritraumatic Dissociative Experiences Questionnaire at ICU discharge and then the Hospital Anxiety Depression Questionnaire and the Impact of Event Scale (for posttraumatic stress-related symptoms) 3 months later. The intervention and control groups were not significantly different regarding the prevalence of posttraumatic stress-related symptoms (52.3 vs 50%, respectively; p = 0.83). Anxiety and depression subscale scores were significantly lower in the intervention group. The qualitative data indicated that the families valued the principle of the conference itself. Perceptions of nurse participation clustered into four main themes: trust that ICU teamwork was effective (50/88; 56.8%), trust that care was centered on the patient (33/88; 37.5%), trust in effective dissemination of information (15/88; 17%), and trust that every effort was made to relieve anxiety in family members (12/88; 13.6%). Families valued the conferences themselves and valued the proactive participation of a nurse. These positive perceptions were associated with significant anxiety or depression subscale scores but not with changes in posttraumatic stress-related symptoms.

Caregiver strain and posttraumatic stress symptoms of informal caregivers of intensive care unit survivors.

Many intensive care unit survivors (ICU) are confronted with undesirable and long-lasting impairments in physical, cognitive, and mental health, but not only patients are at risk of developing this post-intensive care syndrome (PICS). Family members can experience symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). This cluster of complications is called PICS-family. To describe the level of caregiver strain and posttraumatic stress-related symptoms in relatives of ICU survivors. We conducted a cohort study in a general hospital between July 2010 and May 2014. Relatives of ICU survivors, mechanically ventilated for > 48 h in the ICU, were asked to complete a questionnaire 3 months after discharge from critical care. Symptoms of PTSD and caregiving concerns were assessed using the Trauma Screening Questionnaire and the Caregiver Strain Index (CSI). A total of 94 relatives visiting our post-ICU clinic completed the questionnaires. Twenty-one percent of the caregivers had a CSI score of 7 or more, indicating high levels of strain. Six percent had CSI scores indicating severe strain (CSI > 10). PTSD-related symptoms were seen in 21% of the caregivers. The mean time spent on caregiving was 10 h (interquartile range 6-17 h) per week. This study shows that relatives of ICU survivors could experience strain 3 months after hospital discharge and are at risk of developing PTSD-related symptoms. This complements existing data that relatives are at risk of psychological symptoms. Knowledge can lead to improvements and means to prevent these symptoms. (PsycINFO Database Record

CAESAR: a new tool to assess relatives' experience of dying and death in the ICU.

To develop an instrument designed specifically to assess the experience of relatives of patients who die in the intensive care unit (ICU). The instrument was developed using a mixed methodology and validated in a prospective multicentre study. Relatives of patients who died in 41 ICUs completed the questionnaire by telephone 21days after the death, then completed the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Inventory of Complicated Grief after 3, 6, and 12months. A total of 600 relatives were included, 475 in the main cohort and 125 in the reliability cohort. The 15-item questionnaire, named CAESAR, covered the patient's preferences and values, interactions with/around the patient and family satisfaction. We defined three groups based on CAESAR score tertiles: lowest (≤59, n=107, 25.9%), middle (n=185, 44.8%) and highest (≥69, n=121, 29.3%). Factorial analysis showed a single dimension. Cronbach's alpha in the main and reliability cohorts was 0.88 (0.85-0.90) and 0.85 (0.79-0.89), respectively. Compared to a high CAESAR score, a low CAESAR score was associated with greater risks of anxiety and depression at 3months [1.29 (1.13-1.46), p=0.001], post-traumatic stress-related symptoms at 3 [1.34 (1.17-1.53), p<0.001], 6 [OR=1.24 (1.06-1.44), p=0.008] and 12 [OR=1.26 (1.06-1.50), p=0.01] months and complicated grief at 6 [OR=1.40 (1.20-1.63), p<0.001] and 12months [OR=1.27 (1.06-1.52), p=0.01]. The CAESAR score 21days after death in the ICU is strongly associated with post-ICU burden in the bereaved relatives. The CAESAR score should prove a useful primary endpoint in trials of interventions to improve relatives' well-being.

The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update.

Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate holistic care for both the patient and the family. Family interaction can significantly impact on the experience of critical illness, notwithstanding the challenge of meeting families' needs for many clinicians in the intensive care unit (ICU). Family needs have been extensively researched; however, a previous Joanna Briggs Institute (JBI) systematic review was the first published systematic review recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care setting. Since its publication in 2011, additional research findings have been published and it was deemed appropriate to update the original systematic review. This systematic review aims to establish recent best practice in addressing the needs of family members with a relative or loved one admitted to an adult critical care unit. Studies that included family members (including children) of adult patients in an ICU were considered for inclusion in this review. Patients with any clinical condition, length of stay or outcome were included. This review considered interventions that addressed the five previously identified categories of family needs: support - support groups, training in coping strategies and journal or diary writing; assurance - face-to-face meetings and participation in ward rounds; proximity - changes to visitation policies; information - staff and/or family education, handouts and brochures and the use of technology (e.g. SMS messages); and comfort - changes to the ICU physical environment. This review considered any randomized controlled trials (RCTs) that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult ICU. In the absence of RCTs, other research designs such as quasi-experimental, as well as pre- and post-studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients. This review considered studies that evaluated outcomes with a validated tool that measured information comprehension, coping mechanisms, anxiety, depression, stress and satisfaction. An extensive search of the major databases was conducted. Databases searched included PubMed, CINAHL, psycINFO, Health source, Web of Science, EMBASE, the Cochrane Library and Database of Abstracts of Reviews of Effects. The original search of this review included published and unpublished studies and articles in English from 1980 to 2010. The updated search identified articles for inclusion from 2010 to 2014. Quantitative articles selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Data was extracted from the articles included in this review using standardized data extraction tools from the JBI Meta Analysis of Statistics Assessment and Review Instrument package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented as a narrative summary. Originally, 14 studies and one dissertation met the inclusion criteria and were included in the review. Of these, 12 were quasi-experimental studies and three were prospective randomized trials. In this current update, 14 new articles were identified for inclusion - one RCT, 10 quasi-experimental studies and three observational studies. The settings were in ICUs in Sweden, USA, United Kingdom, the Netherlands, France, Hong Kong, Saudi Arabia and Iran. The evidence identified from all studies in the review includes the use of support groups for family members of patients admitted to an ICU, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs, use of a diary, changes in the physical environment and open or more flexible visiting hours. This current update of the original review makes several reiterative and new recommendations for clinical practice to address family needs of patients admitted to a critical care unit; however, the need for significant further research in this area is again highlighted. Future intervention studies focusing on family needs could include the use of technology such as DVDs (Digital Versatile Discs) and SMS (Short Message Service) for informing families and interventions specifically designed to improve family comfort. Communication interventions help promote family involvement in their loved one's care and facilitate their decision-making capacity, as well as improving clinician and family interaction, family comprehension of their loved one's condition and also reduce the development of post-traumatic stress-related symptoms (Grade A). Family satisfaction may be increased with the provision of comfortable physical environments with noise reduction measures (Grade B). More rigorous high-quality studies investigating interventions to meet the needs of family with a relative in ICU are needed. The majority of included studies in this updated review focused on family satisfaction wherein more robust data on family needs would better inform health professionals in their practice.

The association between post-traumatic stress-related symptoms, resilience, current stress and past exposure to violence: a cross sectional study of the survival of Quechua women in the aftermath of the Peruvian armed conflict.

BackgroundThe long lasting resilience of individuals and communities affected by mass violence has not been given equal prominence as their suffering. This has often led to psychosocial interventions in post-conflict zones being unresponsive to local realities and ill-equipped to foster local strengths. Responding to the renewed interest in resilience in the field of violence and health, this study examines the resilience and post-traumatic responses of Indigenous Quechua women in the aftermath of the political violence in Peru (1980–2000).MethodsA cross-sectional study examined the relationship between resilience, post-traumatic responses, exposure to violence during the conflict and current life stress on 151 Quechua women participants. Purposive and convenience sampling strategies were used for recruitment in Ayacucho, the area most exposed to violence. The study instruments were translated to Quechua and Spanish and cross-culturally validated. Data was analyzed using hierarchical regression analysis. A locally informed trauma questionnaire of local idioms of distress was also included in the analysis.FindingsSixty percent of women (n = 91) were recruited from Ayacucho city and the rest from three rural villages; the mean age was 45 years old. Despite high levels of exposure to violence, only 9.3% of the sample presented a level of symptoms that indicated possible PTSD. Resilience did not contribute to the overall variance of post-traumatic stress related symptoms, which was predicted by past exposure to violence, current life stress, age, and schooling (R2 = .421). Resilience contributed instead to the variance of avoidance symptoms (Stand β = −.198, t = −2.595, p = 0.010) while not for re-experiencing or arousal symptoms.ConclusionsThese findings identified some of the pathways in which resilience and post-traumatic responses interrelate in the aftermath of violence; yet, they also point to the complexity of their relationship, which is not fully explained by linear associations, requiring further examination. Age and gender-sensitive health care is considered critical almost fifteen years after the end of the conflict. The notable resilience of Quechua women—despite exposure to a continuum of violence and social inequalities—also calls for enhanced recognition of women not only as victims of violence but also as complex social actors in the reconstruction of post-conflict societies.

Impact of an intensive care unit diary on psychological distress in patients and relatives*

To assess the impact of an intensive care unit diary on the psychological well-being of patients and relatives 3 and 12 months after intensive care unit discharge. Prospective single-center study with an intervention period between two control periods. Medical-surgical intensive care unit in a 460-bed tertiary hospital. Consecutive patients from May 2008 to November 2009 and their relatives. Study inclusion occurred after the fourth day in the intensive care unit. A diary written by both the patient's relatives and the intensive care unit staff. Patients and relatives completed the Hospital Anxiety and Depression Scale and Peritraumatic Dissociative Experiences Questionnaire 3 months after intensive care unit discharge, and completed the Impact of Events Scale assessing posttraumatic stress-related symptoms 12 months after intensive care unit discharge. Of the 378 patients admitted during the study period, 143 were included (48 in the prediary period, 49 in the diary period, and 46 in the postdiary period). In relatives, severe posttraumatic stress-related symptoms after 12 months varied significantly across periods (prediary 80%, diary 31.7%, postdiary 67.6%; p<.0001). Similar results were obtained in the posttraumatic stress-related symptom score after 12 months in the surviving patients (prediary 34.6 ± 15.9, diary 21 ± 12.2, and postdiary 29.8 ± 15.9; p = .02). The intensive care unit diary significantly affected posttraumatic stress-related symptoms in relatives and surviving patients 12 months after intensive care unit discharge.

Outcomes and moderators of a preventive schoolbased mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial

We aimed to examine outcomes, moderators and mediators of a preventive school-based mental health intervention implemented by paraprofessionals in a war-affected setting in northern Sri Lanka. A cluster randomized trial was employed. Subsequent to screening 1,370 children in randomly selected schools, 399 children were assigned to an intervention (n=199) or waitlist control condition (n=200). The intervention consisted of 15 manualized sessions over 5 weeks of cognitive behavioral techniques and creative expressive elements. Assessments took place before, 1 week after, and 3 months after the intervention. Primary outcomes included post-traumatic stress disorder (PTSD), depressive, and anxiety symptoms. No main effects on primary outcomes were identified. A main effect in favor of intervention for conduct problems was observed. This effect was stronger for younger children. Furthermore, we found intervention benefits for specific subgroups. Stronger effects were found for boys with regard to PTSD and anxiety symptoms, and for younger children on pro-social behavior. Moreover, we found stronger intervention effects on PTSD, anxiety, and function impairment for children experiencing lower levels of current war-related stressors. Girls in the intervention condition showed smaller reductions on PTSD symptoms than waitlisted girls. We conclude that preventive school-based psychosocial interventions in volatile areas characterized by ongoing war-related stressors may effectively improve indicators of psychological wellbeing and posttraumatic stress-related symptoms in some children. However, they may undermine natural recovery for others. Further research is necessary to examine how gender, age and current war-related experiences contribute to differential intervention effects.

A Teacher-Delivered Intervention for Adolescents Exposed to Ongoing and Intense Traumatic War-Related Stress: A Quasi-Randomized Controlled Study

For the past 8 years, the residents of Sderot-a town in southern Israel-have been exposed to ongoing and intense war-related threat due to daily rocket attacks and mortar shelling from the adjacent Gaza region. This study first evaluates the prevalence of posttraumatic symptomatology in a sample of seventh- and eighth-grade students, and then assesses the efficacy of a universal teacher-delivered skill-oriented and present-focused intervention in preventing and reducing adolescents' posttraumatic stress-related symptoms. In a quasi-randomized controlled trial, 154 seventh- and eighth-grade students with significant levels of war-related exposure were assigned to participate in either a manualized active 16-session intervention (Extended Enhancing Resiliency Amongst Students Experiencing Stress, ERASE-Stress) or a waiting-list control group. They were assessed using self-report measures before and after the intervention on posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety. At baseline, 43.5% were found to have a likely diagnosis of posttraumatic stress disorder. A month after the intervention ended, students in the active intervention showed statistically significant reduction on all outcome measures compared with those in the waiting-list control group. Extended ERASE-Stress-a universal teacher-delivered skill-oriented program not targeting traumatic memories and involving trained and supervised homeroom teachers-may help students suffering from significant war-related posttraumatic symptoms reduce their level of symptomatology and can serve as an important and effective component of a community mental health policy for communities affected by chronic trauma, such as war and terrorism.

Memories and post-traumatic stress-related symptoms in older, post-cardiac surgery patients: substudy of an RCT

The majority of ICU survivors display little evidence of severe psychological sequelae. However, there is evidence of post-traumatic stress disorder (PTSD)-related symptoms such as anxiety, depression, panic attacks, distressing memories and flashbacks within the first 3 months post ICU discharge [1,2]. This substudy of the DEXCOM trial 3 (randomised controlled trial of neurobehavioural effects of dexmedetomidine or morphine for sedation and analgesia in patients 60 years or older, undergoing coronary artery bypass grafting and/or valve replacement) aims to explore any negative memories of the ICU and development of PTSD-related symptoms between treatment groups of patients at high risk of developing delirium.

Efficacy of Telehealth Treatments for Posttraumatic Stress-Related Symptoms: A Meta-Analysis

This meta-analysis summarizes the findings of outcome research on the degree to which telehealth treatments reduce posttraumatic stress disorder (PTSD)-related symptoms. In a search of the literature, 13 studies were identified for inclusion in the meta-analysis and were coded for relevant variables. A total of 725 participants were included. Results indicate that telehealth treatments are associated with significant pre- to postreduction in PTSD symptoms (d = 0.99, 95% confidence interval [CI]: 0.87–1.11, p < .001), and result in superior treatment effects relative to a wait-list comparison condition (d = 1.01, 95% CI: 0.76–1.26, p < .001). However, no significant findings were obtained for telehealth intervention relative to a supportive counseling telehealth comparison condition (d = 0.11, 95% CI: − 0.38 to 0.60, p = .67), and telehealth intervention produced an inferior outcome relative to a face-to-face intervention (d = − 0.68, 95% CI: − 0.39 to − 0.98, p < .001). Findings for depression symptom severity outcome were generally consistent with those for PTSD outcome. Telehealth interventions produced a significant within-group effect size (d = 0.98, 95% CI: 0.86 to 1.10, p < .001) and superior effect relative to wait-list comparison condition (d = 0.80, 95% CI: 0.56–1.05, p < .001). Relative to face-to-face interventions, telehealth treatments produced comparable depression outcome effects (d = 0.13, 95% CI: − 0.55 to 0.28, p = .53). Taken together, these findings support the use of telehealth treatments for individuals with PTSD-related symptoms.

Stress-related symptoms and positive emotions after a myocardial infarction: a longitudinal analysis

Background There is a controversy as to whether the diagnostic umbrella of post-traumatic stress reactions is directly applicable to serious health conditions like myocardial infarction (MI).Objective The principal objective of this study was to examine longitudinally the prevalence of posttraumatic stress-related symptoms, throughout three measurement periods, for patients who had suffered a first MI. In addition to the analysis of symptoms related to stress and general distress, the presence of and temporary evolution of positive emotions and optimism in these patients was also evaluated.Design A longitudinal study with three periods of evaluation after the MI (Time 1 (T1): 48–72 hours, Time 2 (T2): 5 months, and Time 3 (T3): 13 months).Results In T1 few symptoms related to the stressful event were found. The probable prevalence of PTSD was 8–11% at 5 months after the MI and 0–3% 13 months after the event. With regard to subjective severity of the infarction, although in the first instance patients did not regard the event as excessively traumatic, in the periods T2 and T3 this perception increased significantly [F (2, 32)=20.00; p=0.0001]. At all times during the measurement period the mean positive affect was significantly greater than the negative affect.Conclusions As the results show, the probable prevalence of PTSD, as well as the severity of different symptom clusters, is low at all times of the evaluation. The diagnostic implications of these findings are discussed as well as the uses and abuses of diagnostic labels to characterize the psychological experiences lived through after a potentially life-threatening health problem.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online.

Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension.

Aim: To investigate the association of uncontrolled hypertension with psychological factors associated with high cardiovascular morbidity and mortality (type D personality, depression, posttraumatic stress-related symptoms). Methods: 205 consecutive outpatient hypertensives completed three questionnaires evaluating Type D personality (DS 16), post traumatic symptoms (revised Impact of Events Scale), symptoms of anxiety, hostility, depression and obsessive-compulsive traits (subscales of the Symptom Checklist). Uncontrolled hypertension was diagnosed when clinic sitting blood pressure was above 140/90 mmHg (130/80 in the presence of diabetes or nephropathy), despite reported adherence to treatment with at least three antihypertensive medications, including a diuretic. Results: Uncontrolled hypertension (39%), was predicted by lower scores at Symptom Checklist obsessive-compulsive subscale and higher number of post traumatic avoidance symptoms, older age, diabetes, higher systolic pressure at first visit and longstanding hypertension. Type D personality correlated with depression, hostility, anxiety, compulsiveness, history of malignancy, and older age, but not with uncontrolled hypertension. Conclusions: Uncontrolled hypertension is associated with low obsessionality and avoidance symptoms, which reduce compliance to treatment. On the contrary, type D personality is not correlated with uncontrolled hypertension, as it includes compulsiveness, which improves compliance. A multidisciplinary approach to the hypertensive patient is mandatory to establish if the psychological profile affects compliance.

Chronic thought suppression and posttraumatic symptoms: Data from the Madrid March 11, 2004 terrorist attack

Although a considerable number of people either witnessed directly or in the mass media the traumatic scenes of the terrorist attack that took place on March 11th, 2004 in Madrid, only a fraction of Madrid citizens developed posttraumatic symptoms. In this study, posttraumatic stress-related symptoms, degree of exposure, coping strategies related to the attack, and chronic attempts to avoid intrusive thoughts (i.e., thought suppression) were assessed in a general population Madrid sample ( N = 503) 2–3 weeks after the attacks. Our results showed that participants with higher scores in chronic thought suppression exhibited higher levels of PTSD symptoms. Higher scores in chronic thought suppression also correlated positively with the use of avoidant coping strategies after the attacks. We discuss the possible common roots of avoidance of intrusive thoughts and avoidant coping strategies and the implications of this relationship for the emergence of stress-related symptoms as well as for public health policies.

School‐based intervention for prevention and treatment of elementary‐students' terror‐related distress in Israel: A quasi‐randomized controlled trial

A school-based intervention for preventing and reducing children's posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety due to exposure to terrorism was evaluated. In a quasi-randomized controlled trial, elementary school students were randomly assigned to an eight-session structured program, "Overshadowing the Threat of Terrorism" or to a waiting list control comparison group. Two months postintervention, the study group reported significant improvement on all measures. The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- (PTSD-) related symptoms in children repeatedly exposed to terrorist attacks and propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism.

One-year follow-up of patients with mild traumatic brain injury: Occurrence of post-traumatic stress-related symptoms at follow-up and serum levels of cortisol, S-100B and neuron-specific enolase in acute phase

Objective: To investigate serum levels of cortisol (a biochemical marker of stress), S-100B and neuron-specific enolase (two biochemical markers of brain tissue injury), in acute phase in mild traumatic brain injury patients and the occurrence of post-traumatic stress-related symptoms 1 year after the trauma.Methods: Blood samples were taken in patients (n = 88) on admission and ∼7 hours later for analysis. Occurrence of post-traumatic stress-related symptoms was assessed for 69 patients using items from the Impact of Event Scale questionnaire (IES) at follow-up at 15 ± 4 months after the injury.Results: Serum levels of cortisol were more increased in the first sample (cortisol/1, 628.9 ± 308.9 nmol L−1) than in the second blood sample (cortisol/2, 398.2 ± 219.4 nmol L−1). The difference between these samples was statistically significant (p < 0.001). Altogether 12 patients (17%) showed post-traumatic stress related symptoms at the time of the follow-up. Stepwise forward logistic regression analysis of symptoms and serum concentrations of markers revealed that only S-100B in the second sample was statistically significantly (p < 0.05) associated to symptoms (three symptoms of the avoidance sub-set of IES).Conclusion: A major increase in serum concentrations of cortisol indicates that high stress levels were reached by the patients, in particular shortly (∼3 hours) after the trauma. The association between the occurrence of post-traumatic stress related symptoms and serum levels of S-100B (generally considered as a biochemical marker of brain injury) seem to reflect the complexity of interactions between brain tissue injury and the ensemble of stress reactions.