Posttraumatic Stress Disorder Checklist-Civilian Version Research Articles

Poor sleep quality contributes to occurrence of posttraumatic stress disorder in trauma patients

To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder (PTSD) in trauma patients. We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October, 2021 to November, 2022, and 226 of the participants completed the PTSD survey and assessment. The patients' sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index (PSQI), and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring; the PTSD Checklist-Civilian Version (PCL-C) was used to detect the occurrence of PTSD during the follow-up. The detection rate of PTSD in the patients was 19.47% at 1 month and 17.61% at 3 months after trauma. The patients who developed PTSD had poorer sleep quality before the trauma, as shown by significantly higher PSQI scale scores (P < 0.001), than those without PTSD, and they showed a sleep abnormality rate as high as 72.73% prior to PTSD onset. Within 7 days after admission, the patients developing PTSD had lower sleep quality scores with more frequent night awakenings (P < 0.05). A 1 month and 3 months after trauma, the patients with PTSD had significantly higher PSQI scores than those without PTSD (P < 0.05). PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.

Clinical relevance of subthreshold PTSD versus full criteria PTSD following traumatic brain injury in U.S. service members and veterans

BackgroundThe purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). MethodsParticipants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). ResultsThere was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e., MTBI: Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). LimitationsLimitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. ConclusionPTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself.

Bereavement during lockdown: the potential impact of COVID-19 restrictions on grief and post-traumatic stress disorder in a Turkish-Muslim population

ABSTRACT The current study examined whether disruption to performing Islamic death rituals could be linked to core bereavement and post-traumatic stress disorder (PTSD) symptoms in Turkish-Muslim individuals who lost their close relatives to COVID-19. Participants (n = 52) completed a Demographic Information and Bereavement Experience (DIBEF) form with items probing demographics, attendance to rituals, receiving social support, and perceived disruption to bereavement via COVID-19 restrictions. The Core Bereavement Items (CBI) and the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) were used to measure symptomatology. The results showed that 92.3% of the participants did not receive condolence visitors, 98.1% failed to say goodbye, and 78.8% could not practice their religious duties. Importantly, perceived disruption score was significantly linked to the CBI (but not PCL-C) scores. The potential role of perceived disruption to bereavement in aggravating the grief response is discussed in relation to the dual process model of coping with bereavement.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China.

Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma. To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors. A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson ResilienceScale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively.Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist. The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (β=0.052,95% CI=0.342,5.409, P<0.05), education background (β=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (β=0.106,95% CI=1.385,4.317, P<0.001), empathy (β=0.057,95% CI=0.312,4.374, P<0.05), and resilience (β=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level. Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

Mitigating Psychological Problems Associated with the 2023 Wildfires in Alberta and Nova Scotia: Six-Week Outcomes from the Text4Hope Program

Background: In 2023, wildfires led to widespread destruction of property and displacement of residents in Alberta and Nova Scotia, Canada. Previous research suggests that wildfires increase the psychological burden of impacted communities, necessitating population-level interventions. Cognitive Behavioural Therapy (CBT)-based text message interventions, Text4HopeAB and Text4HopeNS, were launched in Alberta and Nova Scotia, respectively, during the 2023 wildfire season to support the mental health of impacted individuals. Objectives: The study examines the effectiveness of Text4HopeNS and Text4HopeAB in alleviating psychological symptoms and improving wellbeing among subscribers. Methods: The study involved longitudinal and naturalistic controlled trial designs. The longitudinal study comprised subscribers who completed program surveys at baseline and six weeks post-enrolment, while the naturalistic controlled study compared psychological symptoms in subscribers who had received daily supportive text messages for six weeks (intervention group) and new subscribers who had enrolled in the program during the same period but had not yet received any text messages (control group). The severity of low resilience, poor mental wellbeing, likely Major Depressive Disorder (MDD), likely Generalized Anxiety Disorder (GAD), likely Post-Traumatic Stress Disorder (PTSD), and suicidal ideation were measured on the Brief Resilience Scale (BRS), the World Health Organization-5 Wellbeing Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) scale, PTSD Checklist–Civilian Version (PCL-C), and the ninth question on the PHQ-9, respectively. The paired and independent sample t-tests were employed in data analysis. Results: The results from the longitudinal study indicated a significant reduction in the mean scores on the PHQ-9 (−12.3%), GAD-7 (−14.8%), and the PCL-C (−5.8%), and an increase in the mean score on the WHO-5, but not on the BRS, from baseline to six weeks. In the naturalistic controlled study, the intervention group had a significantly lower mean score on the PHQ-9 (−30.1%), GAD-7 (−29.4%), PCL-C (−17.5%), and the ninth question on the PHQ-9 (−60.0%) which measures the intensity of suicidal ideation, and an increase in the mean score on the WHO-5 (+24.7%), but not on the BRS, from baseline to six weeks compared to the control group. Conclusions: The results of this study suggests that the Text4Hope program is an effective intervention for mitigating psychological symptoms in subscribers during wildfires. This CBT-based text messaging program can be adapted to provide effective support for individuals’ mental health, especially in the context of traumatic events and adverse experiences such as those induced by climate change. Policymakers and mental health professionals should consider these findings when shaping strategies for future disaster response efforts, emphasizing the value of scalable and culturally sensitive mental health interventions.

Gratitude, optimism, and satisfaction with life and patient-reported outcomes in patients undergoing hematopoietic stem cell transplantation.

Associations between positive psychological well-being (PPWB) and patient-reported outcomes (PROs, e.g., quality of life [QOL]) have yet to be studied extensively in patients with hematologic malignancies who are allogeneic hematopoietic stem cell transplant (HSCT) survivors, despite substantial evidence that PPWB impacts PROs of other medical populations. We conducted a secondary analysis of cross-sectional data examining the association of PPWB and PROs at day 100 post-transplant among 158 allogeneic HSCT recipients. Optimism, gratitude, life satisfaction, and PROs (i.e., QOL, anxiety, depression, and PTSD symptoms) were assessed using the Life Orientation Test-Revised, Gratitude Questionnaire, Satisfaction with Life Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, Hospital Anxiety and Depression Scale, and Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, respectively. We used linear and multivariate regressions for all analyses and controlled for patient factors. Optimism was associated with better QOL (β=1.46; p<0.001) and lower levels of anxiety (β=-0.28; p<0.001), depression (β=-0.31; p<0.001), and PTSD (β=-0.58; p<0.001). Gratitude was associated with better QOL (β=1.11; p<0.001) and lower levels of anxiety (β=-0.21; p=0.001), depression (β=-0.14; p=0.021), and PTSD (β=-0.32; p=0.032). Finally, satisfaction with life was associated with better QOL (β=1.26; p<0.001) and lower levels of anxiety (β=-0.18; p<0.001), depression (β=-0.21; p<0.001), and PTSD (β=-0.49; p<0.001). Optimism, gratitude, and satisfaction with life were all associated with better QOL and lower levels of psychological distress in allogeneic HSCT survivors. These data support studies to harness PPWB as a therapeutic intervention for this population throughout HSCT recovery.

Expressive suppression moderates the relationship between PTSD from COVID-19 and somatization and validation of the Arabic version of Patient Health Questionnaire-15 (PHQ-15).

Lebanese adults have been crippled for years by several crises, including the lately COVID-19 pandemic. These massive civilian traumas have increased the risk of post-traumatic stress disorder (PTSD) in this population. Extensive literature pointed to the association between PTSD and somatization; however, the nature of this relationship remains unknown. We sought to contribute further to work in this area by testing the moderating role of emotion regulation in the relationship between COVID-19- related PTSD and somatization. As a secondary objective, we aimed to examine the psychometric properties of an Arabic translation of the somatization measure Patient Health Questionnaire-15 (PHQ-15) in terms of factorial validity and internal consistency before its use in the present study. This cross-sectional study was conducted between September and October 2021. A total of 403 Lebanese adults residing in Lebanon were recruited. Eligible participants received an online link to the survey. The Patient Health Questionnaire-15 was used to assess somatization, PTSD Checklist-Civilian Version for PTSD and Emotion Regulation Questionnaire for emotion regulation. The results of the exploratory factor analysis (EFA) revealed a three-factor solution explaining 48.79% of the common variance. Confirmatory Factor Analysis results of the three-factor model obtained in the EFA indicated a good fit with a significant CFI of 0.98, TLI 0.98 and a GFI of .97, a RMSEA of .04 [90% CI .01, .06]. Higher PTSD symptoms were associated with somatization. In addition, we found that one specific ER component, i.e. expressive suppression, significantly moderated the relationship between PTSD from the COVID pandemic and somatization. In particular, the interaction PTSD from the COVID-19 pandemic by expressive suppression was significantly associated with somatization; at low, medium and high levels of expressive suppression, higher PTSD from the COVID-19 pandemic was significantly associated with higher somatization scores. As for our secondary objective, findings revealed that the Arabic version of the PHQ-15 exhibited good psychometric properties. In particular, the scale yielded a three-factor structure, and good internal consistency (Cronbach's alpha = 0.87). The moderating role of expressive suppression on the link between PTSD and somatization presents a novel finding in the field of trauma. Additionally, making a psychometrically sound Arabic version of the PHQ-15 available is a valuable addition to the literature.

Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan

Objective: This study examined the levels of Post-Traumatic Stress Disorder (PTSD) in pediatric cancer caregivers and the impact of spirituality on PTSD in Pakistan. Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Oncology, Shaukat Khanum Memorial Cancer Hospital &amp; Research Centre, Peshawar, Northwest General Hospital &amp; Research Centre, Peshawar in Khyber Pakhtunkhwa (KPK), Pakistan Institute of Medical Sciences, Islamabad and Quaid-e-Azam International Hospital in Islamabad, Pakistan from January 2023 to March 2023.Methods: The study comprised 153 Caregivers of pediatric cancer patients aged One month –12 Years using convenience sampling. The PTSD Checklist-Civilian Version (PCL-C) and Caregiver's Spirituality Scale (CSS-10) were used to collect data. Results: Results of the study found that 81 caregivers (52.94%) had high PTSD, and 96 (62.74%) had high spirituality. Females reported higher PTSD and spirituality than guys. Graduates have more PTSD and spirituality than illiterates and matriculate. PTSD and spirituality had a negative Pearson's Correlation Coefficient. Conclusion: The study emphasizes spirituality as a caregiver's mental health protector. Healthcare practitioners caring for pediatric cancer patients can use the findings to lessen PTSD symptoms by targeting caregivers' spiritual needs. Convenience sampling and self-report measurements decrease generalizability. Future study is needed to investigate the association between PTSD and spirituality in caregivers of pediatric cancer patients.How to cite this: Bashir N, Ain Q, Karim N, Niazi H, Khan MI, Asghar AK. Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan. Life and Science. 2024; 5(1): 33-40. doi: http://doi.org/10.37185/LnS.1.1.440

Prevalence and network structure of post-traumatic stress symptoms and their association with suicidality among Chinese mental health professionals immediately following the end of China’s Dynamic Zero-COVID Policy: a national survey

Studies on post-traumatic stress symptoms (PTSS) among mental health professionals (MHPs) are limited, particularly since restrictions due to coronavirus disease (COVID-19) have been lifted such as the recent termination of China’s Dynamic Zero-COVID Policy. The current study filled this gap by exploring the prevalence, correlates, and network structure of PTSS as well as its association with suicidality from a network analysis perspective. A cross-sectional, national survey was conducted using a convenience sampling method on MHPs between January 22 and February 10, 2023. PTSS were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian version, while suicidality was assessed using standardized questions related to ideation, plans, and attempts. Univariate and multivariate analyses examined correlates of PTSS. Network analysis explored the structure of PTSS and suicidality. The centrality index of “Expected influence” was used to identify the most central symptoms in the network, reflecting the relative importance of each node in the network. The “flow” function was adopted to identify specific symptoms that were directly associated with suicidality. A total of 10,647 MHPs were included. The overall rates of PTSS and suicidality were 6.7% (n = 715; 95% CI = 6.2–7.2%) and 7.7% (n = 821; 95% CI = 7.2–8.2%), respectively. Being married (OR = 1.523; P < 0.001), quarantine experience (OR = 1.288; P < 0.001), suicidality (OR = 3.750; P < 0.001) and more severe depressive symptoms (OR = 1.229; P < 0.001) were correlates of more PTSS. Additionally, higher economic status (e.g., good vs. poor: OR = 0.324; P = 0.001) and health status (e.g., good vs. poor: OR = 0.456; P < 0.001) were correlates of reduced PTSS. PCL6 (“Avoiding thoughts”; EI = 1.189), PCL7 (“Avoiding reminders”; EI = 1.157), and PCL11 (“Feeling emotionally numb”; EI = 1.074) had the highest centrality, while PCL12 (“Negative belief”), PCL 16 (“Hypervigilance”) and PCL 14 (“Irritability”) had the strongest direct, positive associations with suicidality. A high prevalence of lingering PTSS was found among MHPs immediately after China’s “Dynamic Zero-COVID Policy” was terminated. Avoidance and hyper-arousal symptoms should be monitored among at-risk MHPs after the COVID-19 pandemic and serve as potential targets for the prevention and treatment of PTSS in this population.

Mild Traumatic Brain Injury in the Maturing Brain: An Investigation of Symptoms and Cognitive Performance in Soldiers Returning From Afghanistan and Iraq.

The majority of traumatic brain injuries (TBIs) are classified as mild and occur in young individuals. The course of recovery varies but can result in chronic or troubling outcomes. The impact of age on TBI outcomes in young adults before complete brain maturation is not well studied. In this study, we compared the effects of mild TBI on cognitive performance and self-reported TBI symptoms and posttraumatic stress disorder (PTSD) in 903 soldiers in 3 different age groups: 24 years or younger, 25 to 27 years, and 28 to 40 years. The soldiers had returned from war zones in Iraq and were screened for TBI within a few days of return. Cognitive performance was measured with the Automated Neuropsychological Assessment Metrics of Military TBI Version 4 (ANAM4). Symptoms associated with mild TBI were self-reported on the Neurobehavioral Symptom Inventory, and the PTSD Checklist-Civilian Version (PCL-C). Soldiers with TBI in every age group had significantly higher prevalence of most symptoms than those with no TBI. Soldiers with TBI also reported more chronic pain sites, regardless of age. Soldiers aged 28 to 40 years with TBI had the lowest cognitive performance scores (ANAM) across several subtests, both unadjusted and adjusted. The Global Deficit Score was significantly higher for soldiers aged 28 to 40 years and 25 to 27 years with TBI than for soldiers younger than 24 years with no TBI. After adjusting for PTSD symptoms, education, and number of lifetime TBIs, the overall test battery mean for soldiers aged 28 to 40 years with TBI was significantly lower than for soldiers younger than 24 years with no TBI. Soldiers with mild TBI in the younger age group show more symptoms associated to frontal lobe function while soldiers in the older group suffer more cognitive impairment. This may warrant further study as it may indicate a propensity to later cognitive decline among soldiers who were older at the time of injury.

Associations of TNF-RII rs1061622 With Post-Traumatic Stress Disorder and Their Interplays on Serum Lipids Levels in Adolescents.

To verify effects of rs1061622 at tumor necrosis factor-α receptor II (TNF-RII) gene (TNF-RII) on post-traumatic stress disorder (PTSD) and its interactive effects with PTSD on serum lipids levels in adolescents. PTSD was measured by PTSD Checklist-Civilian Version (PCL-C) in 699 adolescent survivors at 6 months after Wenchuan earthquake in China. A polymerase chain reaction and restriction fragment length polymorphism assay were utilized for TNF-RII rs1061622 genotyping followed by verification using DNA sequencing. Serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol were tested using routine methods. G (deoxyguanine) allele carriers had higher PCL-C scores than TT (deoxythymidine) homozygotes in female subjects. Female adolescents had higher PCL-C scores than male subjects in TT homozygotes. Predictors of PTSD prevalence and severity were different between G allele carriers and TT homozygotes. Subjects with PTSD had lower TG, TG/HDL-C, TC/HDL-C, and higher HDL-C than adolescents without PTSD in male G allele carriers. G allele carriers had higher TG/HDL-C and TC/HDL-C than TT homozygotes in male adolescents without PTSD, and lower TG and TG/HDL-C in male PTSD patients. G allele carriers had higher TG than TT homozygotes only in female adolescents without PTSD. These results suggest reciprocal actions of TNF-RII rs1061622 with other factors on PTSD severity, interplays of TNF-RII rs1061622 with PTSD on serum lipid levels, and novel treatment strategies for PTSD and comorbidities of PTSD with hyperlipidemia among adolescents with different genetic backgrounds of TNF-RII rs1061622 after experiencing traumatic events.

Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder.

Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms. Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores. Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point. Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.

Assessment of post-traumatic stress disorder (PTSD) in elderly survivors of the Wenchuan earthquake: A cross-sectional study.

Post-traumatic stress disorder (PTSD) is a prevalent condition characterized by prolonged psychological distress following traumatic events encompassing serious health threats, domestic abuse, and natural disasters. The onset and persistence of PTSD can be attributed to advanced age. This study aimed to explore the occurrence and influencing factors of enduring post-traumatic stress disorder (PTSD) in survivors aged 60 years and over in the main area of the 2008 Wenchuan earthquake 10 years after the disaster. Data were collected using a multistage sampling method from individuals aged 60 years and older living in the main impacted areas of Wenchuan 10 years after the Wenchuan earthquake. The PTSD Checklist-Civilian Version (PCL-C) was used to evaluate PTSD symptoms. We evaluated participants based on their PTSD symptoms: those exhibiting and those without. The latter group was four times the size of the former and was matched based on gender and age (within±2 years). Conditional logistic regression was used to discern the risk factors. Out of the total, 56 participants were recognized as having probable PTSD as per the PCL-C checklist, leading to a rate of 9.4% (56/588). The univariate conditional logistic regression values showed that playing Mahjong/poker (odds ratio (OR)=0.394, 95% confidence interval (CI)=0.171-0.911) and displacement (OR=0.446, 95% CI=0.220-0.907) were protective factors for the long-term mental health of survivors in the hard-hit areas, while the presence of a 2-week illness (OR=3.605, 95% CI=1.751-7.424), possessing insurance (OR=0.250, 95% CI=0.072-0.864), suffering from a chronic ailment (OR=3.132, 95% CI=1.2-8.174), and having an injured family member (OR=2.26, 95% CI = 1.136-4.496) emerged as risk factors for PTSD symptoms. Multivariate analysis indicated that the absence of insurance and prevalence of 2-week illness correlated with increased PTSD symptoms. Ten years after the Wenchuan earthquake, the prevalence of probable PTSD remained significantly high in the elderly population. The major risk factors were the absence of insurance and the occurrence of a 2-week illness. Policymakers should incorporate these findings when devising strategies for aging societies.

Early predictors of chronic posttraumatic stress disorder symptom trajectories in U.S. Army soldiers deployed to the Iraq war zone.

The course of posttraumatic stress disorder (PTSD) symptoms varies among veterans of war zones, but sources of variation in long-term symptom course remain poorly understood. Modeling of symptom growth trajectories facilitates the understanding of predictors of individual outcomes over time. Although growth mixture modeling (GMM) has been applied to military populations, few studies have incorporated both predeployment and follow-up measurements over an extended time. In this prospective study, 1,087 U.S. Army soldiers with varying military occupational specialties and geographic locations were assessed before and after deployment to the Iraq war zone, with long-term follow-up assessment occurring at least 5 years after return from deployment. The primary outcome variable was the PTSD Checklist-Civilian Version summary score. GMM yielded four latent profiles, characterized as primarily asymptomatic (n = 194, 17.8%); postdeployment worsening symptoms (n = 84, 7.7%); mild symptoms (n = 320, 29.4%); and preexisting, with a chronic postdeployment elevation of symptoms (n = 489, 45.0%). Regression models comparing the primarily asymptomatic class to the symptomatic classes revealed that chronic symptom classes were associated with higher degrees of stress exposure, less predeployment social support, military reservist or veteran status at the most recent assessment, and poorer predeployment visual memory, ORs = 0.98-2.90. PTSD symptom course varies considerably over time after military deployment and is associated with potentially modifiable biopsychosocial factors that occur early in its course in addition to exposures and military status.

Translation, adaptation, and initial evaluation of a guided self-help intervention to reduce psychological distress among nurses during COVID-19 in China.

This study aimed to reduce the unprecedented and intense psychological distress that nurses were forced to experience during the COVID-19 pandemic. A Chinese version of the World Health Organization's Self-Help Plus (SH+) intervention guide was adapted and tested among nurses. The objective of this study was to translate and adapt the SH+ guideline into the Chinese version and to test its feasibility in reducing psychological distress among nurses during COVID-19. A staged approach comprising translation, adaptations, initial evaluation by pilot implementation, and a qualitative process evaluation was conducted in two hospitals in Xi'an, China. The translation of the Chinese version was authorized by the World Health Organization. We adapted SH+ for use among clinical nurses working during the pandemic in China through a qualitative process evaluation, which was guided by the descriptive phenomenological study design. The outcomes of the pilot included psychological distress, psychological flexibility, depressive and anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms, and subjective psychological wellbeing, which were assessed using the Kessler 6 symptom checklist, the Comprehensive Assessment of ACT Process (CompACT), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), the PTSD Checklist-Civilian Version (PCL-C), and the Index of Wellbeing (IWB), respectively. The SH+ materials, including audio-recorded sessions and an accompanying illustrated manual, were translated into Chinese and adapted in line with feedback from the nurses. An uncontrolled pilot study (n = 28) for 5 weeks showed a statistically significant reduction of psychological distress (mean difference in Kessler 6 score, -2.74; 95% CI [-3.71, -1.78]; p < 0.001). We also found improvements in psychological flexibility (mean difference in CompACT score, 6.89; 95% CI [-12.35, -4.47]; p < 0.001), subjective psychological wellbeing (mean difference in IWB score, 0.86; 95% CI [0.07, 1.65]; p < 0.05), and depressive symptoms (mean difference in PHQ-9 score, -1.52; 95% CI [-2.78, -0.26]; p < 0.05). The process evaluation showed that nurses found the SH+ program very useful but difficult to adhere to. We found that the translated Chinese version of SH+ was applicable and feasible in the Chinese cultural context. There was a potential effect of adapted SH + in reducing nurses' psychological distress during COVID-19 and suggested the value of exploring strategies to increase adherence to the program.

Feasibility of Virtual Reality Exposure Therapy in the Treatment of Danish Veterans with Post-Traumatic Stress Disorder: A Mixed Method Pilot Study.

The BraveMind virtual reality exposure therapy (VRET) has been developed and has shown efficacy for U.S. service members and veterans. As the first study to date, the present study examined the feasibility of BraveMind VRET for non-U.S. military veterans. Moreover, the study sought to explore in-depth the participants' experiences with BraveMind VRET. Nine Danish veterans with post-traumatic stress disorder (PTSD) after deployment to Afghanistan participated in the study. PTSD, depression, and quality of life were assessed at pretreatment, post-treatment, and 3-month followup. The treatment consisted of 10 BraveMind VRET sessions. Semistructured interviews with treatment completers were conducted post-treatment to ascertain views about the treatment, in general, and the BraveMind VR system in particular. Thematic qualitative analysis was conducted at the semantic level using an inductive approach. There were significant reductions in pre- to post-treatment self-reported PTSD and significant improvements in quality of life. Treatment gains were maintained at 3-month followup. Pre- to post-treatment Cohen's d effect sizes were large for self-reported PTSD (PTSD Checklist-Civilian Version [PCL-C]: d = 1.55). Qualitative results indicated that the virtual environment of the BraveMind VR system does not entirely map the reality of Danish soldiers in Afghanistan. However, this was not experienced as a hindering factor in therapy. Findings indicate that BraveMind VRET is an acceptable, safe, and effective treatment for Danish veterans with PTSD. The qualitative results emphasize the importance of a strong therapeutic alliance, as VRET is experienced as more emotional straining than regular trauma-focused therapy.

Posttraumatic stress disorder among sexual harassment victims: the role of social support, resilience, and religious coping

Female students are still at risk of experiencing sexual harassment, which can lead to posttraumatic stress disorder (PTSD). This study investigated the impact of social support on PTSD female students who have been sexually harassed, as mediated by the resilience and religious coping. Out of a total of 1,439 female students who filed online self-reports, 170 female students reported being sexually harassed by lecturers, male students, and administrative officers. The PTSD checklist–civilian version (PCL-C), Multidimensional scale of perceived social support, brief resilience scale, and brief religious coping scale (RCOPE) were used to collect data. Partial least squares (PLS) modeling was used to test the developed hypothesis. This study found that social support, resilience, and religious coping all had an impact on PTSD. Furthermore, social support has an indirect effect on PTSD through resilience and religious coping. Because resilience and coping are mediators in recovering PTSD and that both can be intervened and modified, a training program specifically designed to improve both is needed to overcome the PTSD symptoms experienced by sexual harassment victims.

Relationship Between Perceived Violence and Post-traumatic Stress Disorder in Infertile Women: A Case-Control Study

Background: Infertility disrupts the life of infertile couples and causes violence against women. Women who experience violence must deal with the painful memories of that stressful event. Those who go through events beyond normal experience may develop post-traumatic stress disorder (PTSD). Objectives: The present study aimed to determine the relationship between perceived violence and PTSD in infertile women. Methods: This case-control study was conducted on 148 infertile women with PTSD and 148 infertile women without PTSD who had attended Milad Infertility Treatment Center in Mashhad, Iran. A score above 50 from the PTSD checklist-civilian version (PCL-C) was considered for the diagnosis of PTSD, and the mean score of violence was compared between the groups of subjects with and without PTSD. Results: The results showed a significant relationship between PTSD and violence against infertile women (P &lt; 0.001). The mean violence score was 59.22 ± 7.31 in subjects with PTSD and 41.10 ± 13.33 in the group of subjects without PTSD. Moreover, the risk of violence was 1.11 times higher in subjects with PTSD than in the healthy group (OR = 1.11, CI 95%: 1.08 - 1.14). Conclusions: The results of this study showed that the risk of violence was higher in subjects with PTSD than in women without this disorder. Therefore, necessary measures must be taken to help infertile women affected by violence.

Changes in Posttraumatic Stress Disorder Symptoms With Integrative Psychotherapy for Functional Neurological Symptom Disorder.

Patients with functional neurological symptom disorder (FNSD) report high rates of traumatization and have high levels of posttraumatic stress disorder (PTSD) symptoms. Psychotherapy is a mainstay of treatment for persons with FNSD. In this study, the investigators explored changes in PTSD symptoms and health-related quality of life after psychotherapy among persons with FNSD and examined factors contributing to these changes. Data were prospectively collected for patients with FNSD attending a specialist outpatient psychotherapy service in the United Kingdom (N=210) as part of an ongoing routine service evaluation. Pre- and posttherapy questionnaires included self-report measures of PTSD symptoms (Posttraumatic Stress Disorder Checklist-Civilian version), depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (General Anxiety Disorder-7 scale), somatic symptoms (Patient Health Questionnaire-15), health-related quality of life (Short-Form Health Survey-36), and social functioning (Work and Social Adjustment Scale). Independent contributions to psychotherapy-related changes in PTSD symptoms and health-related quality of life were explored through multivariate analyses. All outcome measures revealed improvements after psychotherapy (p<0.001). Psychotherapy-related changes in depression and somatic symptoms and employment status at baseline explained 51% of the variance in PTSD symptom changes. Changes in PTSD symptoms, depressive symptoms, and somatic symptoms made independent contributions to improvements in health-related quality of life (R2=0.54). Improvements were unrelated to FNSD subtype (dissociative seizures or other FNSD), age, marital status, or number of sessions attended. Reductions in self-reported PTSD, depressive, anxiety, and somatic symptoms, as well as improved health-related quality of life, were observed among patients who received one or more sessions of psychotherapy. Randomized controlled trials of psychotherapy for patients with FNSD are warranted.

The impact of post-traumatic stress on the clinical outcome in a cohort of patients with knee osteoarthritis and knee arthroplasty: A prospective study

BackgroundKnee osteoarthritis (KOA) is one of the most common musculoskeletal disorders and commonly occurs in older adults, predominantly female populations. Both populations have intimate links with trauma-related stress. Therefore, we intended to evaluate the prevalence of post-traumatic stress disorder (PTSD), which arises from KOA and determine its effects on the postoperative results in patients undergoing total knee arthroplasty (TKA). MethodsThe patients who fulfilled the diagnosis of KOA from February 2018 to October 2020 were interviewed. Patients were interviewed by a senior psychiatrist about evaluating their overall experience during their most difficult or stressful situations. KOA patients who underwent TKA were further analyzed to investigate whether PTSD influences the postoperative results. The PTSD Checklist–Civilian Version (PCL-C) and Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index were used to assess PTS symptoms and clinical outcomes after TKA, respectively. Results212 KOA patients completed this study with a mean follow-up of 16.7 months (7–36 months). The mean age was 62.5 ± 12.3 years, and 53.3% (113/212) were women. 64.6% of the sample (137/212) underwent TKA to relieve the symptoms of KOA. Patients with either PTS or PTSD tended to be younger (P < 0.05), female (P < 0.05) and undergo TKA (P < 0.05) than their counterparts. WOMAC-pain (P < 0.05), WOMAC-stiffness (P < 0.05), and WOMAC-physical function (P < 0.05) both before TKA and 6 months after TKA in the PTSD group is significantly higher compared to their counterparts. Logistic regression analysis showed that a history of OA-inducing trauma (adjusted OR = 2.0, 95% CI = 1.7–2.3, P = 0.003), posttraumatic KOA (adjusted OR = 1.7, 95% CI = 1.4–2.0, P < 0.001), and invasive treatment (adjusted OR = 2.0, 95% CI = 1.7–2.3, P = 0.032), were significantly associated with PTSD in KOA patients. ConclusionsPatients with KOA, especially those undergoing TKA, are associated with PTS symptoms and PTSD, indicating the need to evaluate it and offer care for them.