Posttraumatic Stress Symptoms Research Articles

Self-compassion as a protective factor against post-traumatic stress symptoms induced by adverse childhood experiences: A cross-sectional study among Japan air self-defense force new recruits

Adverse childhood experiences (ACEs) may result in long-term mental health complications, including post-traumatic stress disorder (PTSD). ACEs are known to be more frequent among military personnel, despite their need to maintain their mental health to accomplish their missions. Self-compassion, or treating oneself with kindness and understanding, can mitigate the psychological effects of adversity but is also affected by adversity. This cross-sectional study aimed to identify the complex relationships between ACEs, self-compassion, and PTSD symptoms among 752 new recruits of the Japan Air Self-Defense Force, of whom 537 with ACEs completed the PTSD Checklist for DSM-5. Hierarchical multiple regression analysis was used to examine the independent effect of self-compassion, measured using the Self-Compassion Scale, on PTSD symptoms. Mediation effect analysis with self-compassion as a mediator was conducted on the relationship between ACEs and PTSD symptoms. We confirmed high levels of ACEs among our participants compared to a healthy population of a previous study, and approximately 6% presented PTSD symptoms above a threshold. Self-compassion was significantly negatively associated with PTSD symptoms (β = −.22, 95% confidence interval [CI], −.34 to −.11). Mediation effect analysis revealed that self-compassion partially mediated the relationship between ACEs and PTSD symptoms, explaining 6.9% of this effect, and ACEs were negatively associated with self-compassion (β = −.13, 95% CI, −.22 to −.04). These findings suggested that self-compassion is a protective factor against PTSD symptoms, whereas ACEs can decrease self-compassion. Further research should explore educational interventions to enhance self-compassion among individuals with ACEs to mitigate PTSD symptoms.

Intimate Partner Violence and Mental Distress, Post-Traumatic Stress Symptoms and Life Satisfaction in Colombian Women.

Intimate partner violence (IPV) against women is a major global public health and human rights issue, with significant consequences for women's health and well-being. This study aimed to determine the relevance of IPV on women's mental distress, post-traumatic stress symptoms and life satisfaction, and to examine whether age, education, socioeconomic status, social support and self-esteem are associated with mental health and well-being. The sample consisted of 255 women aged 18 to 71 living in Colombia who were assessed using six self-reported questionnaires. Hierarchical multiple regression analyses showed that more IPV was associated with women's increased mental distress, post-traumatic stress symptoms and decreased life satisfaction. Although self-esteem and, to a lesser extent, social support were important predictors of women's mental distress and well-being, psychological IPV was the main predictor of women's post-traumatic stress symptoms, followed by lower self-esteem and younger age. The most important predictor of women's mental distress was lower self-esteem, followed by more psychological IPV and lower social support. The main predictor of women's life satisfaction was high self-esteem, followed by high social support, less psychological IPV and higher age and education. It is concluded that IPV, especially psychological IPV, is a serious threat to women's mental health and well-being, while high self-esteem and, to a lesser extent, high social support are associated with better mental health and well-being.

COVID-19 Personal Experiences and Posttraumatic Stress in National Guard Service Members.

The National Guard (NG) was an important component of the U.S. emergency response for the coronavirus (COVID-19) pandemic. Understanding how the personal COVID-19 experiences of NG members may be associated with posttraumatic stress symptoms (PTSS) and disorder (PTSD) can inform approaches to identifying and sustaining service members' mental health. We surveyed 3,993 NG service members (75% Army; 79% enlisted; 33% 30-39 years old; 81% male) during the pandemic. Forty-six percent of participants were activated in response to COVID-19. Surveys were administered between August and December 2020. We defined personal COVID-19 experiences as having COVID-19, a family member(s) having COVID-19, and/or having a close relationship with someone who died from COVID-19. In addition, using a 4-item form of the PTSD Checklist for DSM-5 (PCL-5), current posttraumatic stress symptoms (PTSS) and probable PTSD were assessed. Linear and logistic regression analyses were conducted to examine the relationship of COVID-19 experiences to PTSS and probable PTSD, respectively. Approximately 32% of participants reported at least one personal COVID-19 experience. Univariable linear regression analyses indicated that NG service members who had a personal COVID-19 experience reported more PTSS than those with no personal experience (B = 0.53, SE = 0.12, P < .001). After adjusting for demographics and service-related characteristics, having a personal COVID-19 experience continued to be associated with higher PTSS (B = 0.48, SE = 0.12, P < .001). When examining the relationships of distinct types of personal COVID-19 experiences to PTSS and PTSD together in multivariable models, those who had a close relationship with someone who died from COVID-19 had higher levels of PTSS (B = 1.31, SE = 0.22, P < .001) and were almost 3 times more likely to have PTSD (OR = 2.94[95%CI = 1.93-4.47], P < .001). Personal COVID-19 experiences are associated with increased PTSS and PTSD risk in NG service members. Such knowledge may aid in selection of service members for activation and identifying those in need of care.

Patterns of Intimate Partner Violence Among Veterans: A Latent Class Analysis.

The majority of intimate partner violence (IPV) research is unidirectional, focusing on IPV use (i.e., perpetration) or experience (i.e., victimization). However, when IPV use and experience data are simultaneously included in analyses, bidirectional IPV often emerges as a common IPV pattern. The objective of this study was to examine patterns of IPV use and experience, risk factors that may be associated with these patterns, and potential gender differences within a sample of post-9/11 Veterans. This study included a national sample of post-9/11 Veterans (N = 1,150; 50.3% women) who completed self-report measures at two timepoints. We performed a latent class analysis (LCA) to determine the appropriate number of IPV classes, conducted sensitivity analyses, and examined factors potentially associated with IPV class membership. We identified three distinct classes of IPV: Low to no IPV, Bidirectional Psychological IPV, and Bidirectional Multiform IPV. Men and women reported similar rates of IPV use and experience, and there were no gender differences in the LCA model. However, race and ethnicity, employment status, children in the household, marital status, child abuse or witnessing family violence, lifetime physical assault, posttraumatic stress symptoms, and binge drinking were differentially associated with class membership. This study extends existing knowledge on patterns of IPV among Veterans and factors associated with these patterns. Bidirectional IPV was the most common IPV pattern, underscoring the importance of examining IPV use and experience concurrently within research and clinical samples, and developing comprehensive IPV screening and treatment strategies that incorporate bidirectional IPV in work to advance relationship health and safety among Veterans.

Attachment, emotion regulation, and their roles in refugee post-traumatic stress and post-migration living difficulties

ABSTRACT Background: Upon arrival in the host country, refugees and asylum seekers (RAS) experience a range of post-migration living difficulties (PMLD), which are often linked to psychological symptoms such as post-traumatic stress (PTS). Initial research suggests that attachment insecurity partly explains the association between PMLD and psychological symptoms in RAS. However, the mechanisms through which attachment insecurity may act as a mediator are not well understood, though emotion dysregulation is one of the potential candidates. Objectives: This study investigated (1) whether attachment insecurity (i.e. anxiety and avoidance) mediate the association between PMLD and PTS, and (2) whether this mediation model can be extended to emotion dysregulation. Methods: 134 treatment-seeking RAS living in Switzerland completed questionnaires assessing PMLD, attachment insecurity, emotion dysregulation, and PTS. Two models were tested: (1) a parallel mediation analysis with attachment anxiety and avoidance as mediators, and (2) a serial mediation analysis with attachment anxiety as the first and emotion dysregulation as the second mediator. Results: First, PMLD was indirectly associated with PTS through attachment anxiety but not avoidance. Second, the association between PMLD and PTS was further explained by a pathway through attachment anxiety and emotion dysregulation. Conclusions: Although this study is limited by its cross-sectional design, we identified attachment anxiety and emotion dysregulation as potential mechanisms explaining how PMLD affects symptoms of PTS in RAS. Systematically assessing attachment style and addressing emotion regulation may therefore help improve treatment of refugee and asylum-seeking patients.

Role of distress tolerance, meaning in life and social support in the relationship between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among Nigerian cancer patients

We examined the moderating roles of distress tolerance, meaning in life, and social support in the relationship between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) among cancer patients. Participants included 301 cancer outpatients randomly selected from the oncology unit of a tertiary healthcare institution in Nigeria (female = 60.1%%; age range = 21 to 85 years, mean age = 52.30 years, SD = 12.64 years). They completed self-report measures on distress tolerance, meaning in life, social support, posttraumatic stress symptoms (PTSS), and PTG. Following series of moderation analysis using Hayes PROCESS macro for SPSS Model 1, results showed that higher PTSS was associated with lower PTG at low and moderate, but not at high levels of distress tolerance. Moreover, meaning in life and social support moderators the PTSS and PTG relationship for higher PTG. Therefore, intervention programmes to promote PTG among cancer patients should consider meaning in life, and social support for their protective potentials in improving positive posttraumatic outcome and recovery with distress tolerance.

Discrimination, Traumatic Stress, and Coping Among Muslim International Students

ABSTRACT There are a significant number of Muslim international students in the United States. Little is known about these students’ experiences and mental health. This study examined the relationships among discrimination, posttraumatic stress, religious coping, and social connectedness. The sample consisted of 133 Muslim international students, with 50% reported being women and the average age being 27. The results showed that discrimination predicted post-traumatic stress symptoms above and beyond general stress, and that less social connectedness to the United States was associated with more perceived discrimination and trauma reactions. Individuals with more visible markers, like wearing a hijab, reported more experiences of discrimination, and women reported more post-traumatic stress symptoms than men. The results highlight the importance for counseling professionals to assess for trauma, discrimination, and post-traumatic stress symptoms when working with Muslim international students. Recommendations for intervention and support for these students are provided.

Post-Traumatic Stress Disorder (PTSD) in Trauma Patients.

Post-traumatic stress disorder (PTSD) was first introduced as a diagnosis by the American Psychiatric Association in 1980. This diagnosis, included in the 3rd edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III), was to be considered after someone was exposed to a traumatic event "outside the range of usual human experience and would be markedly distressing to almost anyone." Since then, trauma survivors have been identified as being at risk for the development of post-traumatic stress symptom (PTSS) and post-traumatic stress disorder (PTSD). Despite the recognition of this fact, the screening, recognition, and diagnosis of PTSD in these at-risk populations are inconsistent. In the following review, which is designed for the clinician who is unfamiliar with PTSD and its recognition, diagnosis, and treatment, we introduce the problem in the trauma patient and define its scope. In addition, we discuss the diagnosis of PTSD in trauma patients, special considerations relating to these patient populations, treatment options, and explore future directions for how best to define, study, recognize, and treat this challenging and potentially devastating condition.

The dissemination and implementation of trauma-focused cognitive behavioural therapy for children and adolescents in seven European countries

BackgroundThere is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as “trauma-focused cognitive behavioural therapy” (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries.MethodsFor this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden).ResultsCommon modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe.ConclusionsThe results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.

The Mediating Role of Posttraumatic Stress Symptoms in the Relationship between Adult Attachment and Quality of Life.

There is evidence that anxiety and avoidance toward close relationships (i.e., insecure attachment orientations), as well as posttraumatic stress symptoms (PTSSs), are linked to a poor quality of life. The current study aimed to investigate the potential mediating effects of PTSSs on the associations between insecure attachment orientations and domains of quality of life. A convenience sample of 497 adults (375 females, 75.5%), ranging in age between 18 and 65 years old (M = 32.48, SD = 13.26), was recruited. Participants were administered self-report instruments assessing attachment anxiety and avoidance, PTSSs, and domains of quality of life, including physical health, psychological status, social relationships, and environment. A series of mediation analyses were performed to test the mediating role of PTSSs in the relationships between attachment orientations and domains of quality of life. Results showed that attachment anxiety was related to decreased levels of quality of life in all domains, and that their associations were mediated by PTSSs. Also, attachment avoidance was related to a worse quality of psychological status and social relationships, and PTSSs were a significant mediating variable in these associations. Prevention programs and clinical interventions focused on promoting effective strategies for managing distress might be critical in reducing the impact of distressing events on the quality of life of individuals with insecure attachment.

Initial Witnessing on Future Witnessing: A Mediation Analysis of Chronic Community Violence, Post-Traumatic Stress, and Delinquency in Urban, African American Youth.

Witnessing community violence can predict negative mental health outcomes for youth such as post-traumatic stress symptoms and delinquent behavior. Such outcomes differ by gender. Variables that predict witnessing community violence in youth are less understood. This study aims to explore potential pathways between initial witnessing and continued witnessing for early adolescents. The relationship between witnessing as a predictor and witnessing as an outcome is hypothesized to be mediated by both post-traumatic stress and delinquency and moderated by gender. A sample of 153 African American, sixth-grade students (M= 11.65, 59% female) in high crime, high poverty areas completed self-report surveys at baseline, 12 and 24 months. Moderated serial mediation was used to assess longitudinal associations. For the full model, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. Gender moderated several paths. For girls, witnessing at Time 1 was predictive of high post-traumatic stress (aggregate) at Time 2 and high delinquency at Time 3. For girls, witnessing at Time 1 also was predictive of higher hyperarousal and higher intrusion subscale symptoms than other symptoms at Time 2. Analyses also indicated that hyperarousal at Time 2 significantly predicted witnessing at Time 3 for girls only. Lastly, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. For boys, no analyses indicated witnessing at Time 1 as a significant predictor. Results contribute to our understanding of the trajectory of witnessing community violence and the roles both post-traumatic stress subscales and delinquency play in that trajectory, especially among girls.

Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial.

Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning. This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression. A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes. BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes. ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination

ABSTRACT Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals. Objective: This article addresses this problem in a study of Ukrainian war refugees’ experiences with post-migration discrimination and powerlessness (loss of control). Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty. Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty. Conclusions: Understanding the effect of post-migration experiences on war refugees’ mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

Longitudinal relationship between posttraumatic cognitions and internalising symptoms in children and adolescents

ABSTRACT Background: Little is known about the naturalistic course of posttraumatic cognitions (PTCs) after exposure to a potentially traumatic event (PTE) in children and adolescents. Moreover, previous studies on the longitudinal associations of PTCs with internalising symptoms yielded mixed results. Objective: To explore the naturalistic courses and longitudinal associations of dysfunctional PTCs and functional PTCs with posttraumatic stress symptoms (PTSS), depression, and anxiety. Method: A total of 115 children and adolescents, aged 7–15 years, were assessed within 1 month, 3 months, and 6 months after exposure to an acute accidental PTE. Repeated measures analyses of variance were conducted to capture the naturalistic courses of PTCs and internalising symptoms. Cross-lagged panel analyses were applied to explore the longitudinal relationship between dysfunctional and functional PTCs, along with their longitudinal associations with PTSS, depression, and anxiety. Results: Dysfunctional PTCs and internalising symptoms decreased, whereas functional PTCs increased over time. Dysfunctional and functional PTCs were moderately inversely related, but no significant cross-lagged paths emerged among them. Dysfunctional PTCs were moderately to strongly associated with internalising symptoms, while functional PTCs were weakly to moderately inversely associated with internalising symptoms. Initial PTSS predicted later dysfunctional PTCs (β = .31, p < .05), but not vice versa. Conclusions: Dysfunctional PTCs, functional PTCs, and internalising symptoms were entangled over time. Our findings support the cognitive scar model with initial PTSS predicting later dysfunctional PTCs. Future research complementing between-subject with within-subject analyses could offer additional insights into the longitudinal relationship between dysfunctional PTCs, functional PTCs, and psychological symptoms.

Effects of skin-to-skin contact on mental health outcomes in the parents of full-term newborns: A systematic review and meta-analysis of randomized clinical trials

BackgroundThe postpartum period can be emotionally challenging for parents, with documented levels of anxiety, stress, and depression. While the benefits of skin-to-skin contact (SSC) are well-known, its impact on the mental health of parents of full-term newborns has been less studied. Objective: We aimed to assess the effects of SSC in mental health outcomes in the parents of full-term newborns. MethodsIn this systematic review, a comprehensive search was conducted to identify randomized clinical trials (RCTs) comparing SSC versus no SSC and assessing mental health outcomes. Meta-analyses were performed whenever possible, and the GRADE approach was used to rate the certainty of evidence. ResultsWe included 9 RCTs with 1201 participants. Regarding the risk of bias, the most affected domains were selective reporting, blinding, and allocation concealment. Regarding parental anxiety, SSC may reduce it at short-term, while it is unsure its effect at mid-term and it may not have any effect at long-term. Regarding Psychological stress, SSC may not have an impact at mid- and long-term. Regarding delivery-related post-traumatic stress symptoms, SSC may not have an impact at short-, mid-, and long-term. Regarding depressive symptoms, the evidence is uncertain at short- and mid-term. LimitationsFor the assessed outcomes, certainty of the evidence was low or very low. ConclusionSSC may reduce parental anxiety at short-term, while it may not have an impact in psychological stress and delivery-related post-traumatic stress symptoms. Moreover, the evidence is uncertain regarding its effect in long-term anxiety and depressive symptoms.

Autistic children and their parents in the context of war: Preliminary findings.

While existing literature on the intersection of trauma and autism is limited, emerging evidence suggests heightened vulnerability of autistic children to the psychological consequences of traumatic events, including an elevated risk of developing posttraumatic stress disorder (PTSD). Additionally, parents of autistic children often experience elevated levels of negative emotional states, compared to parents of typically developing children. This study investigates the impact of terrorism and war on autistic and non-autistic children and their parents, presenting preliminary results from the initial data collection phase of a year-long longitudinal investigation of the experience of autistic children and their parents following Hamas' 7 October 2023 attack on Israel. Data gathered within 30days of the initial attack reveal that both autistic and non-autistic children exhibited clinically significant post-traumatic stress symptoms, with autistic children demonstrating a more pronounced manifestation. Moreover, parents of autistic children reported significantly higher levels of depression, anxiety, and stress in the aftermath of the events, compared to an independent cohort of parents of autistic children assessed prior to the crisis. These results underscore the heightened susceptibility of autistic children to post-traumatic stress and the unique challenges confronted by their parents during times of conflict. The study highlights the imperative for tailored support services for autistic children and their families amidst traumatic incidents and stresses the need for further research in comparable contexts globally.

Stress responses of infants and mothers to a still-face paradigm after traumatic childbirth

IntroductionOne-third of women experience childbirth as traumatic and some develop symptoms of childbirth-related posttraumatic stress symptoms (CB-PTSS). Whether CB-PTSS negatively impact on physiological and psychological stress responses in mothers and their offspring and whether they are associated with mother-infant synchrony is not clear. This study aimed to investigate stress responses of (1) mothers with CB-PTSS, (2) of their infant, and (3) the physiological mother-child-synchrony at six months postpartum. MethodPsychophysiological (cortisol and vagal tone) and psychological stress responses of mothers and infant’s (n=31 dyads) from the Swiss TrAumatic biRth Trial (NCT03576586) were assessed during a face-to-face still-face paradigm (FFSF-R). ResultsThere was a significant time effect in maternal stress responses for salivary cortisol, vagal tone, and for maternal subjective stress. As expected, mothers’ subjective stress increased during the stress task and mothers vagal tone changed during the first stressful period but not during the second, whereas cortisol unexpectedly decreased over the FFSF-R. Infant negative mood increased over the experiment, but there were no physiological changes. However, a significant interaction effect for mother-infant synchrony during the second reunion period of the FFSF-R was found. ConclusionAlthough mothers and their infants were subjectively stressed, they showed only limited physiological stress responses.

Between mourning and hope: A mixed-methods study of ambiguous loss and posttraumatic stress symptoms among partners of Israel defence force veterans.

Spouses of military combatants often experience adverse outcomes, including posttraumatic stress symptoms (PTSS) in the event of ambiguous loss (AL). AL refers to an uncertain situation regarding a person's status as alive or as cognitively present. The former ambiguity is categorized by the term physical AL (PAL), which refers to the continued psychological presence of a person, despite their physical absence. The latter ambiguity, categorized by the term psychological AL or ambiguous presence, refers to when a person is emotionally absent, despite their physical presence. Though AL has been widely researched, there are still gaps around the AL-posttraumatic stress disorder (PTSD) relationship, especially regarding dyadic variables that can moderate this relationship. Also, most of the AL military-related studies are qualitative, with only a few that combine qualitative and quantitative research methods. We address these gaps in an innovative mixed-methods study examining the emotional experience of Israeli veterans' spouses with a focus on the relationship between AL, PTSS, and dyadic adjustment (DA). The study included 63 participants, all spouses of Israeli veterans. We used self-report questionnaires (AL, Dyadic Adjustment Scale, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition) and a semistructured narrative interview. Our results revealed positive correlations between AL-PTSS and PAL-PTSS. Also, an interaction effect was found in which the lower the DA level, the stronger the PAL-PTSS correlation. Conversely, the higher the DA level, the stronger the ambiguous presence-PTSS correlation. Qualitative findings identified themes in the experience of these situations, including uncertainty and ambivalence. Our qualitative and quantitative results combined suggest that the way military couples deal with AL may be an important emotional experience requiring specific attention from mental health professionals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic Stress Disorder in Children: A Narrative Review

Method: This narrative review summarizes research from the years 2019-2024 on posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in children. Results: This research suggests that prevalence rates have been highly variable as a function of the stress experienced, for example, post-surgery (15%), following exposure to war (28%) and following head injury (34%). The negative effects have included cognitive dysfunction, aggression and other behavioral difficulties and the comorbidities include sleep disorders, somatic symptoms and depression. Predictors/risk factors have been the primary focus in this literature and have included parent risk factors including exposure to intimate partner violence, sexual and emotional abuse. Sensory modulation and cognitive processes have been implicated as, for example, negative attention bias and subjective threat. Injuries and hospitalizations have been predictors as has been exposure to explosions and earthquakes. The most frequently studied intervention has been cognitive behavioral therapy which has consistently reduced the symptoms of PTSD. Potential underlying biological mechanisms have included parent PTSD, pregnancy inflammation, and autonomic dysregulation including low cortisol and heartrate, although reduced cortical thickness (volume) in several areas of the brain has been the most frequently studied potential mechanism. Discussion: The studies in this review highlight the prevalence and severity of posttraumatic stress disorder in children. However, they have been primarily based on mixed-age child and adolescent samples and the results have varied by the type of stress experienced and the severity of the stress.

Predicting Parental Post-Traumatic Stress Symptoms Following their Child's Stay in a Pediatric Intensive Care Unit, Prior to Discharge.

Objective: Develop an inpatient predictive model of parental post-traumatic stress (PTS) following their child's care in the Pediatric Intensive Care Unit (PICU). Design: Prospective observational cohort. Setting: Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICUs. Subjects: Parents of patients admitted to the PICU. Interventions: None. Measurements and Main Results: Preadmission and admission data from 169 parents of 129 children who completed follow up screening for parental post-traumatic stress symptoms at 3-9 months post PICU discharge were utilized to develop a predictive model estimating the risk of parental PTS 3-9 months after hospital discharge. The parent cohort was predominantly female (63%), partnered (75%), and working (70%). Child median age was 3 years (IQR 0.36-9.04), and more than half had chronic illnesses (56%) or previous ICU admissions (64%). Thirty-five percent (60/169) of parents met criteria for PTS (>9 on the Post-traumatic Stress Disorder Symptom Scale-Interview). The machine learning model (XGBoost) predicted subjects with parental PTS with 76.7% accuracy, had a sensitivity of 0.83 (95% CI 0.586, 0.964), a specificity of 0.72 (95% CI 0.506, 0.879), a precision of 0.682 (95% CI 0.451, 0.861) and number needed to evaluate of 1.47 (95% CI 1.16, 1.98). The area under the receiver operating curve was 0.78 (95% CI 0.64, 0.92). The most important predictive pre-admission and admission variables were determined using the Local Interpretable Model-Agnostic Explanation, which identified seven variables used 100% of the time. Composite variables of parental history of mental illness and traumatic experiences were most important. Conclusion: A machine learning model using parent risk factors predicted subsequent PTS at 3-9 months following their child's PICU discharge with an accuracy of 76.7% and number needed to evaluate of 1.47. This performance is sufficient to identify parents who are at risk during hospitalization, making inpatient and acute post admission mitigation initiatives possible.