Posttraumatic Outcomes Research Articles

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.

Relations between trauma-based subgroups and posttrauma health outcomes: A latent class analysis.

In trauma research, it is common for researchers to characterize participants as either "trauma exposed" or "not trauma exposed" regardless of nuanced differences of the potentially traumatic event (PTE). To our knowledge, no study has simultaneously examined differences across both PTEs and exposure types. Using latent class analysis, we investigated latent homogeneous subgroups of individuals following experiences of 16 PTEs via three exposure types (i.e., direct, indirect, and/or occupational). We further examined class differences regarding posttraumatic stress disorder (PTSD) symptom clusters, event centrality, depression, and anxiety. Our sample included 2,663 participants (Mage = 22.33; 56.0% female). Results indicated four latent subgroups: (a) occupational trauma (OT), (b) direct interpersonal trauma (DIT), (c) indirect trauma (IT), and (d) low trauma exposure (LTE). Individuals in the OT class reported the highest levels of all symptoms except for PTSD avoidance and event centrality (which were highest in the DIT class), and individuals in the LTE class reported the lowest levels of all symptoms. Several nuanced between-class differences were found regarding posttrauma outcomes. Findings further support the notion that dichotomizing participants as "trauma exposed" or "not trauma exposed" is overly simplistic and ignores important variability in trauma research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

BackgroundThe aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay.Materials and methodsAn observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database.ResultsAmong 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals.ConclusionThis study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

The role of rumination and metamemory beliefs in posttraumatic growth and posttraumatic stress

The risk of developing posttraumatic stress symptoms following exposure to traumatic events is well documented, however, emerging research also lends support to the potential development of growth in some people. Rumination and memory have been identified as important factors in post-trauma outcomes, yet, current research in this area is limited, particularly in the context of a multidimensional view of rumination (i.e., intrusive and deliberate rumination) and metamemory beliefs. This study explored the association between rumination styles, beliefs about memory, and posttraumatic stress symptoms and posttraumatic growth. Participants (N = 151) who experienced a traumatic event completed relevant measures online. Path analysis showed that intrusive rumination was significantly related to higher levels of posttraumatic stress symptoms (β = 0.19, p < 0.01), while deliberate rumination was related to higher levels of both posttraumatic growth (β = .52, p < 0.001) and posttraumatic stress symptoms (β = 0.15, p < 0.05). Additionally, negative beliefs about memory were significantly related to higher posttraumatic stress symptoms (β = 0.48, p < 0.001). No significant associations were found for positive beliefs about memory. The findings suggest that rumination may be understood as multidimensional, incorporating both adaptive and maladaptive processes. Further, the present study contributes to the limited literature concerning metamemory beliefs and may provide an increased understanding of factors contributing to stress or growth.

Assessing shared psychological constructs as risk factors in comorbid PTSD-AUD combat-exposed male veterans

ABSTRACT PTSD and AUD are frequently comorbid post-trauma outcomes. Much remains unknown about shared risk factors as PTSD and AUD work tends to be conducted in isolation. We examined how self-report measures of distress tolerance (DT), experiential avoidance (EA), and drinking motives (DM) differed across diagnostic groups in white, male combat-exposed veterans (n = 77). A MANOVA indicated a significant difference in constructs by group, F (5, 210) = 4.7, p = <.001. Follow-up ANOVAs indicated DM subscales (Coping: F (3,82) = 21.3; Social: F (3,82) = 13.1; Enhancement: F (3,82) = 10.4; ps = <.001) and EA (F (3,73) = 7.8, p < .001) differed by groups but not DT. Post hoc comparisons indicated that mean scores of the comorbid and AUD-only groups were significantly higher than controls for all DM subscales (all ps < .01). EA scores were significantly higher for the comorbid as compared to control (p < .001) and PTS-only (p = .007) groups. Findings support shared psychological factors in a comorbid PTSD-AUD population.

Impact of neighborhood disadvantage on posttrauma outcomes after sexual assault.

In the United States, 8,000,000 people seek emergency care for traumatic injury annually. Motor vehicle collisions (MVCs) and sexual assault are two common sources of trauma, with evidence that reduced neighborhood-level socioeconomic characteristics increase posttraumatic pain and stress after an MVC. We evaluated whether neighborhood disadvantage was also associated with physical and mental posttrauma outcomes after sexual assault in a sample of adult women (N = 656) who presented for emergency care at facilities in the United States following sexual assault and were followed for 1 year. Neighborhood characteristics were assessed via the Area Deprivation Index, and self-reported pain, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms were collected at 6 weeks posttrauma. Adjusted log-binomial regression models examined the association between each clinical outcome and neighborhood disadvantage. Women in more disadvantaged neighborhoods were more likely to be non-White and have lower annual incomes. At 6 weeks posttrauma, the prevalence of clinically significant pain, anxiety, and depressive symptoms more than doubled from baseline (41.7% vs.18.8%,62.4% vs.23.9%, and 55.2% vs.22.7%, respectively); 40.7% of women also reported PTSD symptoms. Black, Hispanic, and lower-income participants were more likely to report pre- and postassault pain, anxiety, and depression. After adjusting for race, ethnicity, and income, no significant association existed between neighborhood disadvantage and any outcome, ps =.197 -.859. Although neighborhood disadvantage was not associated with posttrauma outcomes, these findings highlight the need for continued research in diverse populations at high risk of adverse physical and mental health symptoms following sexual assault.

Exploring the differential effects of psychological resilience and social support in mitigating post-traumatic psychiatric symptoms: real-world network analysis of front-line rescuers.

Although both psychological resilience and social support are widely believed to be effective in alleviating post-traumatic psychiatric symptoms in individuals with traumatic events, there has been a lack of comparative analysis of their intervention effects on different post-traumatic psychiatric symptoms. Furthermore, previous studies have mostly failed to control for potential confounding effects caused by different traumatic events. We used the novel network analysis approach to examine the differential moderating effects of psychological resilience and social support on post-traumatic psychiatric symptoms, controlling for the confounding effects of traumatic events. We recruited 264 front-line rescuers who experienced the same traumatic event. Quantified edge weights and bridge expected influence (BEI) were applied to compare the alleviating effects of psychological resilience and social support. Our study revealed distinct correlations in a sample of front-line rescuers: social support negatively correlates more with psychosomatic symptoms, notably fatigue in depressive networks and sleep disturbance in post-traumatic stress disorder (PTSD) networks, whereas psychological resilience shows fewer such correlations. Quantitative analysis using BEI indicated that psychological resilience more effectively suppresses depressive and anxiety symptom networks, whereas social support more significantly inhibits PTSD symptom networks. The current study represents the first attempt to examine the differential effects of psychological resilience and social support on post-traumatic outcomes in real-world emergency rescuers, controlling for the confounding effect of traumatic events. Our results can act as the theoretical reference for future precise and efficient post-trauma psychological interventions.

How meaning in life and vitality are associated with posttrauma outcomes: A systematic review.

When confronted with a traumatic event, people may suffer from adverse posttraumatic outcomes, such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD). Positive psychology research has shown that meaning in life and vitality are potentially correlated protective factors against negative developments following trauma exposure that can lead to PTSD or CPTSD. This systematic review aimed to synthesize global empirical research findings, emphasizing the impact of meaning in life and vitality on both PTSD and CPTSD. A search of empirical studies was performed within the Embase, Scopus, and Web of Science core collection databases, as well as PsycInfo, using the PRISMA checklist. A total of 29 studies were included after a systematic exclusion process. The collective findings from 22 studies examining meaning in life and five studies focusing on vitality revealed a consistent negative association with symptoms of PTSD. No study that explored the associations among meaning in life, vitality, and CPTSD was found. In contrast to vitality, meaning in life has been extensively studied in relation to traumatic stress worldwide, and few discrepancies in results were found. This systematic review identified the need to intensify scientific efforts in capitalizing on meaning in life as a possible target for psychological interventions, especially for trauma survivors globally, and to consider vitality as a protective factor that needs more empirical attention in relation to posttraumatic stress. Furthermore, there is a need for studies that encompass diverse target samples and employ longitudinal study design to examine the associations between protective factors and CPTSD.

EFFECT OF GENDER ON 28-DAY SURVIVAL RATES AND TRANSFUSION VOLUME IN SEVERE TRAUMA PATIENTS: A MULTICENTER OBSERVATIONAL STUDY.

Background: This study clarified the relationship between sex with survival and transfusion volume in severe trauma cases. Methods: A multicenter, collaborative post hoc analysis of patients with trauma in Japan was conducted. Patients aged ≥18 years with severe trauma indicated by an Injury Severity Score (ISS) of 16 or higher were enrolled. Patients were matched and analyzed by gender based on propensity score with factors determined at the time of injury. Subgroup analysis was performed on patients younger than 50 years and older than 50 years. The significance level was defined as P < 0.05. Results: The 1,189 patients included in this registry were divided into adjusted groups of 226 male and female patients each. In the main analysis, 28-day survival rates in females were significantly higher than those in males ( P = 0.046). In the subgroup analyses, there was no statistically significant prognostic effect of gender. Secondary outcomes, including transfusion volume, showed no significant gender-based variations. Logistic regression analyses consistently demonstrated that female sex was a significant favorable prognostic factor in all ages. This was true for the over-50 group on subgroup analysis, but no significant gender-prognosis relationship was identified in the under-50 age group. High ISSs were associated with poorer outcomes across all age groups. Conclusion: In severe trauma, survival at 28 days was significantly lower in males. However, this trend was not observed in patients aged <50 years. Factors other than sex hormones may be responsible for differences in posttraumatic outcomes by gender.

Psychological scars of genocide: a systematic review of post-traumatic outcomes in Kurdish Anfal survivors

The Anfal genocide, including the infamous Halabja chemical attack, has imprinted deep scars on the Kurdish community in Iraq that lasted for decades. Despite significant historical documentation, the enduring psychological impact on survivors is less examined. This systematic review synthesizes existing research to address this gap. Adhering to the PRISMA guidelines, this review systematically searched databases for scholarly articles examining the mental health of Kurdish survivors following the 1988 Anfal genocide, with a focus on PTSD, depression, and anxiety. Of the initial 201 articles identified, seven met the inclusion criteria. These studies were subjected to a thorough data extraction and qualitative synthesis, and their quality was appraised using the Mixed Methods Appraisal Tool (MMAT). The selected studies encompassed a combined sample of 760 participants, ranging in age from 7 to 92 years. The findings revealed high prevalence rates of PTSD, particularly in children, with a prevalence rate of 87%. In adults, PTSD and depression prevalence rates in unselected samples were estimated at 86.2% and 49%, respectively. Qualitative findings from survivors reveal a complex interplay of depression, intrusive memories, and societal isolation, compounded by poverty and discrimination, with health concerns like respiratory and ocular problems further exacerbating psychological distress. However, non-representative samples and absence of control groups limit result generalization. The literature reviewed indicates substantial psychological distress among the Anfal genocide survivors, underscoring an urgent need for targeted mental health interventions. Future research needs representative samples and validated tools for precise prevalence assessment and comprehensive impact understanding.

Spatiotemporal dynamics of hippocampal-cortical networks underlying the unique phenomenological properties of trauma-related intrusive memories

Trauma-related intrusive memories (TR-IMs) possess unique phenomenological properties that contribute to adverse post-traumatic outcomes, positioning them as critical intervention targets. However, transdiagnostic treatments for TR-IMs are scarce, as their underlying mechanisms have been investigated separate from their unique phenomenological properties. Extant models of more general episodic memory highlight dynamic hippocampal-cortical interactions that vary along the anterior-posterior axis of the hippocampus (HPC) to support different cognitive-affective and sensory-perceptual features of memory. Extending this work into the unique properties of TR-IMs, we conducted a study of eighty-four trauma-exposed adults who completed daily ecological momentary assessments of TR-IM properties followed by resting-state functional magnetic resonance imaging (rs-fMRI). Spatiotemporal dynamics of anterior and posterior hippocampal (a/pHPC)-cortical networks were assessed using co-activation pattern analysis to investigate their associations with different properties of TR-IMs. Emotional intensity of TR-IMs was inversely associated with the frequency and persistence of an aHPC-default mode network co-activation pattern. Conversely, sensory features of TR-IMs were associated with more frequent co-activation of the HPC with sensory cortices and the ventral attention network, and the reliving of TR-IMs in the “here-and-now” was associated with more persistent co-activation of the pHPC and the visual cortex. Notably, no associations were found between HPC-cortical network dynamics and conventional symptom measures, including TR-IM frequency or retrospective recall, underscoring the utility of ecological assessments of memory properties in identifying their neural substrates. These findings provide novel insights into the neural correlates of the unique features of TR-IMs that are critical for the development of individualized, transdiagnostic treatments for this pervasive, difficult-to-treat symptom.

Association between microbiome and the development of adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure

Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biological mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition after trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether the gut microbiomes of trauma-exposed emergency department patients who develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms. We performed metagenomic analysis on stool samples (n = 51) from a subset of adults enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA) study. Two-, eight- and twelve-week post-trauma outcomes for post-traumatic stress disorder (PTSD) (PTSD checklist for DSM-5), normalized depression scores (PROMIS Depression Short Form 8b) and somatic symptom counts were collected. Generalized linear models were created for each outcome using microbial abundances and relevant demographics. Mixed-effect random forest machine learning models were used to identify associations between APNS outcomes and microbial features and encoded metabolic pathways from stool metagenomics. Microbial species, including Flavonifractor plautii, Ruminococcus gnavus and, Bifidobacterium species, which are prevalent commensal gut microbes, were found to be important in predicting worse APNS outcomes from microbial abundance data. Notably, through APNS outcome modeling using microbial metabolic pathways, worse APNS outcomes were highly predicted by decreased L-arginine related pathway genes and increased citrulline and ornithine pathways. Common commensal microbial species are enriched in individuals who develop APNS. More notably, we identified a biological mechanism through which the gut microbiome reduces global arginine bioavailability, a metabolic change that has also been demonstrated in the plasma of patients with PTSD.

PTSD, depression, and suicidality among survivors of childhood sexual trauma (CST), military sexual trauma (MST), and sexual revictimization (CST + MST).

Research to date has not examined how childhood sexual trauma (CST) followed by sexual trauma during military service (MST) relates to posttraumatic stress disorder (PTSD), depression, and suicidality among women and men. Given the strong association between MST in particular, and these serious posttraumatic outcomes, the current study sought to address this gap. The current study compared the mental health concerns of 268 treatment-seeking veterans who were survivors of CST, MST, or both (CST + MST). We hypothesized that MST would be associated with greater severity of symptoms compared with CST and that those who experienced sexual revictimization (CST + MST) would report more severe symptoms than veterans who experienced CST or MST alone. Veteran men presented with significantly higher suicidality but not higher PTSD or depression scores than women. Controlling for gender, MST survivors had significantly higher PTSD and depression symptom severity scores, but not suicidality, than CST survivors. PTSD, depression, and suicidality scores were significantly higher for the CST + MST group than for CST only survivors, but did not significantly differ from survivors of MST alone. Findings support the more severe clinical impact of CST + MST-specific sexual revictimization compared with CST-only among military men and women, but also suggest that MST alone can have negative consequences similar to revictimization. While results point to the need to consider context and trauma history in future trauma research and clinical applications, they should be interpreted in light of our sample demographics, which were representative of the southwest U.S. veteran population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Judgments of Event Centrality as Predictors of Post-Traumatic Growth and Post-Traumatic Stress after Infidelity: The Moderating Effect of Relationship Form

Infidelity, a betrayal within a romantic partnership, often violates a person’s core beliefs about themselves and their significant other and can influence the degree to which a person can feel safe in romantic relationships. Infidelity can also increase exposure to sexually transmitted diseases that can compromise physical and mental health. Therefore, infidelity can be judged as central to one’s identity and potentially traumatic, possibly triggering outcomes similar to other DSM-5 Criterion A traumas. The current research examines the contribution of centrality perceptions to the development of PTG and PTS post-infidelity. Bivariate regressions examined the relationships between the judged centrality of infidelity and PTG and PTS, respectively. Exploratory analyses considered the moderating role of relationship form (i.e., casually dating, exclusively dating, and engaged/married) on those relationships. In a sample of 177 adults, greater judgments of the centrality of infidelity were associated with both PTG and PTS. Results demonstrated a significant moderating effect of relationship form on the relationship between the centrality of infidelity and PTG but not between the centrality of infidelity and PTS. Moderation results demonstrated that if infidelity is considered central in a casually dating relationship, it is more strongly related to PTG than in other relationship forms. Considering infidelity as central may generate both beneficial and problematic post-traumatic outcomes. However, an early infidelity experience may provide increased opportunities for engagement in different behaviors in the future (e.g., selecting a different partner, setting different relational boundaries), which, in turn, may be more conducive to growth.

Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial

IntroductionEnhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes. MethodologyA randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes. ResultsBaseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001). ConclusionOur study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.

Trauma-Related Shame Mediates the Associations Between Self-Blame, Bisexual Minority Stress, and Rape-Related PTSD Symptoms.

Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18-35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.

The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma.

Sleep reactivity is a predisposition to sleep disturbance during environmental perturbations, pharmacological challenges, or stressful life events. Consequently, individuals with highly reactive sleep systems are prone to insomnia disorder after a stressor, engendering risk of psychopathology and potentially impeding recovery from traumatic stress. Thus, there is tremendous value in ameliorating sleep reactivity to foster a sleep system that is robust to stress exposure, ultimately preventing insomnia and its downstream consequences. We reviewed prospective evidence forsleep reactivity as a predisposition to insomnia since our last review on the topic in 2017. We also reviewed studies investigating pre-trauma sleep reactivity as a predictor of adverse post-traumatic sequelae, and clinical trials that reported the effect of behavioural treatments for insomnia on mitigating sleep reactivity. Most studies measured sleep reactivity via self-report using the Ford Insomnia Response to Stress Test (FIRST), demonstrating high scores on this scale reliably indicate a sleep system with a lower capacity to tolerate stress. Nascent evidence suggests elevated sleep reactivity prior to trauma increases the risk of negative posttraumatic outcomes, namely acute stress disorder, depression, and post-traumatic stress disorder. Lastly, sleep reactivity appears most responsive to behavioural insomnia interventions when delivered early during the acute phase of insomnia. Overall, the literature strongly supports sleep reactivity as a premorbid vulnerability to incident acute insomnia disorder when faced with an array of biopsychosocial stressors. The FIRST identifies individuals at risk of insomnia a priori, thereby guiding early interventions toward this vulnerable population to prevent insomnia and promote resilience to adversity.

Management Strategies for Geriatric Maxillofacial Fractures

Geriatric maxillofacial trauma has become an increasingly pressing clinical issue in Taiwan because of increased life expectancy. The purposes of this study were to investigate the anthropometric changes and the posttrauma outcomes in the aging population and to optimize the management strategies for geriatric facial fractures. From 2015 to 2020, a total of 30 patients 65 years or older were identified to have suffered from maxillofacial fractures and presented at the emergency department of the Chang Gung Memorial Hospital (CGMH). These patients were categorized into group III, representing the elderly group. Two other groups (group I, age 18-40 years; group II, age 41-64 years) of patients were categorized based on their age. After applying propensity score matching to reduce bias caused by a large case number difference, patient demographics, anthropometric data, and management methods were compared and analyzed. Among 30 patients 65 years or older who met the inclusion criteria, the mean age of the matched group III was 77.31 ± 14.87 years, and the mean number of retained teeth was 11.77 (range, 3-20 teeth). The elderly patients had a significantly lower number of retained teeth (group I vs group II vs group III, 27.3 vs 25.23 vs 11.77; P < 0.001). Anthropometric data showed that facial bone structure degenerated significantly with advancing age. Outcome analysis demonstrated that falls accounted for 43.3% of injury mechanisms in the elderly group, followed by motorcycle accidents (30%) and car accidents (23.3%). Nineteen elderly patients (63%) received nonsurgical management. On the other hand, 86.7% of cases in the other 2 age groups underwent surgery. The average numbers of total hospital and intensive care unit stays in group III patients were 16.9 (range, 3-49 days) and 4.57 (range, 0-47 days), which was significantly longer than the other 2 age groups. Our results suggested that not only surgery is feasible for elderly patients with facial fractures, but an acceptable result is often obtainable. However, an eventful course, including extended hospital/intensive care unit stays and an increased risk of associated injuries and complications, may be expected.

Epigenetic aging and PTSD outcomes in the immediate aftermath of trauma.

Psychological trauma exposure and posttraumatic stress disorder (PTSD) have been associated with advanced epigenetic age. However, whether epigenetic aging measured at the time of trauma predicts the subsequent development of PTSD outcomes is unknown. Moreover, the neural substrates underlying posttraumatic outcomes associated with epigenetic aging are unclear. We examined a multi-ancestry cohort of women and men (n = 289) who presented to the emergency department (ED) after trauma. Blood DNA was collected at ED presentation, and EPIC DNA methylation arrays were used to assess four widely used metrics of epigenetic aging (HorvathAge, HannumAge, PhenoAge, and GrimAge). PTSD symptoms were evaluated longitudinally at the time of ED presentation and over the ensuing 6 months. Structural and functional neuroimaging was performed 2 weeks after trauma. After covariate adjustment and correction for multiple comparisons, advanced ED GrimAge predicted increased risk for 6-month probable PTSD diagnosis. Secondary analyses suggested that the prediction of PTSD by GrimAge was driven by worse trajectories for intrusive memories and nightmares. Advanced ED GrimAge was also associated with reduced volume of the whole amygdala and specific amygdala subregions, including the cortico-amygdaloid transition and the cortical and accessory basal nuclei. Our findings shed new light on the relation between biological aging and trauma-related phenotypes, suggesting that GrimAge measured at the time of trauma predicts PTSD trajectories and is associated with relevant brain alterations. Furthering these findings has the potential to enhance early prevention and treatment of posttraumatic psychiatric sequelae.

Revisiting the Factor Structure of the Centrality of Event Scale.

Traumatic experiences that become self-defining impact posttraumatic outcomes, yet exact mechanisms are currently being studied. Recent research has used the Centrality of Event Scale (CES). However, the factor structure of the CES has been in question. We analyzed archival data (N = 318) split into homogenous groups of participants to examine whether the factor structure of the CES differed based on event type (bereavement vs. sexual assault) or by levels of PTSD (meeting clinical cut off score vs. group of lowest scorers). Exploratory factor analyses with subsequent confirmatory analyses revealed a single factor model in the bereavement group, sexual assault group, and the low PTSD group. A three-factor model emerged in the high PTSD group, with the factors' themes matching previous findings. Event centrality appears to be a universal theme when people endure and process a diversity of adverse events. These distinct factors may illuminate pathways in the clinical syndrome.