Posttraumatic Research Articles

Clinical potential of epigenetic and microRNA biomarkers in PTSD.

Molecular studies identifying alterations associated with PTSD have predominantly focused on candidate genes or conducted genome-wide analyses, often encountering issues with replicability. This review aims to identify robust bi-directional epigenetic and microRNA (miRNA) regulators focusing on their functional impacts on post-traumatic stress disorder (PTSD) and their utility in clinical diagnosis, whilst examining knowledge gaps in the existing research. A systematic search was conducted across multiple databases, including Web of Science, Scopus, Global Health (CABI), and PubMed, augmented by grey literature, yielding 3465 potential articles. Ultimately, 92 studies met the inclusion criteria and were analysed to pinpoint significant epigenetic changes with clinically relevant potential in PTSD. The selected studies explored histone modifications, CpG sites, single nucleotide polymorphisms (SNPs), and miRNA biomarkers. Specifically, nine studies examined epigenetic markers, detailing the influence of methylation on chromatin accessibility at histone positions H3K4, H3K9, and H3K36 within a PTSD context. Seventy-three studies investigated DNA methylation, identifying 20 hypermethylated and five hypomethylated CpG islands consistently observed in PTSD participants. Nineteen studies linked 88 SNPs to PTSD, with only one SNP replicated within these studies. Furthermore, sixteen studies focused on miRNAs, with findings indicating 194 downregulated and 24 upregulated miRNAs were associated with PTSD. Although there are epigenetic mechanisms that are significantly affected by PTSD, a granular deconstruction of these mechanisms elucidates the need to incorporate more nuanced approaches to identifying the factors that contribute to PTSD. Technological advances in diagnostic tools are driving the need to integrate detailed participant characteristics, trauma type, genetic susceptibilities, and best practices for robust reporting. This comprehensive approach will be crucial for enhancing the translational potential of PTSD research for clinical application.

Characteristics of incident benzodiazepine recipients among US veterans with posttraumatic stress disorder

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose While benzodiazepine prescribing among veterans with posttraumatic stress disorder (PTSD) declined substantially in the Veterans Health Administration over the past decade, little is known about current incident prescribing. Our objective was therefore to describe patient, provider, facility, and prescribing characteristics among veterans with PTSD who were incident benzodiazepine recipients in 2022 and contrast these to the characteristics for incident recipients in 2012. Methods This retrospective observational study included all veterans with PTSD who received an incident benzodiazepine prescription during calendar year 2022 and separately for 2012. The distribution of patient, provider, facility, and benzodiazepine prescribing characteristics was contrasted between years. Stratified subanalyses were conducted by potential non-PTSD benzodiazepine indication, including anxiety and sleep disorders. Results A total of 28,310 (6.6%) incident benzodiazepine recipients were identified in 2012, which decreased to 16,776 (1.9%) incident recipients in 2022. The proportion of initial prescriptions written for a days’ supply of 30 or more days decreased from 75.6% to 51.7%, and the proportion who received a second prescription within 6 months decreased from 68.7% to 53.5%. The proportion of patients with diagnoses for potential benzodiazepine indications also increased, including for generalized anxiety disorder (15.1% increase), obsessive compulsive disorders (0.6% increase), panic disorder (6.7% increase), and sleep disorders (22.9% increase). Conclusion As incident benzodiazepine prescribing among veterans with PTSD decreased over the past decade, so did the volume of drug dispensed and duration of therapy, while the prevalence of documented prescriptions for non-PTSD indications increased.

Impacts of early life adversity on the neurocircuitry of emotional memory in children.

Similar to adults with posttraumatic stress disorder, children with early life adversity show bias in memory for negative emotional stimuli. However, it is not well understood how childhood adversity impacts mechanisms underlying emotional memory. N = 56 children (8-14 years, 48% female) reported on adverse experiences including potentially traumatic events and underwent fMRI while attending to emotionally pleasant, neutral, or negative images. Post-scan, participants completed a cued recall test to assess memory for these images. Emotional difference-in-memory (DM) scores were computed by subtracting negative or positive from neutral recall performance. All children showed enhancing effects of emotion on recall, with no effect of trauma load. However, children with less trauma showed a larger emotional DM for both positive and negative stimuli when amygdala or anterior hippocampal activity was higher. In contrast, highly trauma-exposed children demonstrated a lower emotional DM with greater amygdala or hippocampal activity. This suggested that alternative neural mechanisms might support emotional enhancement of encoding in children with greater trauma load. Whole-brain analyses revealed that right fusiform activity during encoding positively correlated with both trauma load and successful later recall of positive images. Therefore, highly trauma-exposed children may use alternative, potentially adaptive neural pathways via the ventral visual stream to encode positive emotional events.

Protocol for remote Tai Chi and wellness for PTSD and pain in veterans

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is a debilitating psychological disorder that is associated with a host of psychosocial and health ailments, including chronic pain. Although evidence-based psychological therapies are recommended as first-line PTSD treatments, a large proportion of individuals either drop out and/or do not achieve a therapeutic response. PTSD is increasingly recognized as a systemic disorder that impacts both physical and mental health, and mind-body approaches, such as Tai Chi, have shown promise. However, to date there have been no randomized clinical trials examining Tai Chi as a treatment for PTSD. Objective: To conduct a fully remote two-phased study designed to adapt, refine, and standardize two group treatments, Tai Chi and a Wellness comparison, for Veterans diagnosed with PTSD and chronic pain. Method: We deploy the project in two phases. In Phase One, we adapt both interventions for delivery via a videoconferencing platform. We then pilot the interventions in a ‘dry run’ with non-random assignment of 12 participants to Tai Chi or a Wellness comparison group. In Phase Two, we randomize 36 participants to one of the two group interventions. The feasibility and acceptability of the two remotely delivered interventions and assessment protocols are evaluated. Conclusions: This is the first study to our knowledge to evaluate the feasibility, acceptability, adherence, and participant burden of the Tai Chi and Wellness comparison interventions for PTSD and chronic pain in Veterans. This information will facilitate the development of a future large, randomized control trial to evaluate the efficacy of Tai Chi to address PTSD and chronic pain in Veterans.

Prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) after acute myocardial infarction: a systematic review and meta-analysis

Abstract Background There is increasing recognition that patients experience a greater risk of mental illnesses after an acute myocardial infarction (AMI), with the former being linked to worse post-AMI outcomes. However, the prevalence of these conditions is largely unknown as most studies focus on depression and few on other illnesses such as anxiety and post-traumatic stress disorder (PTSD). Additionally, existing studies mostly involved diagnoses of mental illnesses through patient-reported questionnaires which may carry subjectivity (1). Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence and risk factors of developing depression, anxiety and PTSD after an AMI with the inclusion of only studies with official diagnoses of the mental illnesses. Methods Searches in MEDLINE, EMBASE, and PsycINFO up to January 23, 2023, identified 25 qualifying studies that examined the risk of depression, anxiety and PTSD after AMI, with case definitions based strictly on psychiatrist-administered structured interviews according to the Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria. Meta-analyses of proportions using random-effects models estimated the pooled prevalence of each outcome at the <3-month and >3-month time-points. Heterogeneity was tested using I-squared statistics, if significant heterogeneity was found, subgroup analyses and meta-regression analyses were performed to identify the source of heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and Risk of Bias 2 (RoB2) Tool, and publication bias using the funnel plot and verified by the Egger’s and Begg’s tests. Results A total of 25 studies were included in the meta-analysis. The pooled prevalence of depression post-AMI (20 studies) was 16.70% (95% CI: 12.40%; 22.11%), with pooled prevalence <3-month and >3-month post-AMI at 19.46% (95% CI: 15.47%; 24.19%) and 14.87% (95% CI: 9.55%; 22.43%) respectively. Pooled prevalence of anxiety (7 studies) and PTSD (3 studies) were 11.96% (95% CI: 6.15; 21.96%) and 10.26% (95% CI:5.49;18.36%) respectively. Subgroup analysis showed that the pooled prevalence of both depression and anxiety are significantly higher in the female gender, in those with hypertension, diabetes or hyperlipidemia, and in smokers, while the pooled prevalence of depression is higher in unmarried than married individuals and in patients with a history of depression. Meta regression indicates that history of depression is a significant predictor of prevalence of depression (p= 0.0035, regression coefficient 1.54). Conclusion The prevalence of mental illnesses is high after AMI. Risk factors identified included female gender, hypertension, diabetes, hyperlipidemia, smoking, depression history, as well as one’s social set-up. These findings highlight the importance of screening at-risk patients and early intervention to improve long-term outcomes after AMI.Forest plot of depression prevalenceSubgroup analysis for depression

Pandemic-related PTSD and associated risk factors in the general adult population in the Netherlands

Abstract Introduction The COVID-19 pandemic introduced widespread stressors and shocking events, impacting mental well-being. Understanding posttraumatic stress disorder (PTSD) prevalence during the pandemic is crucial, yet existing studies on this topic vary widely in methodological quality. This study aims to fill this gap using a large-scale national survey study to examine PTSD prevalence during the pandemic and compare pandemic-related and traditional shocking events. Methods This study uses data from the Dutch Public Health Monitor Adults and Elderly 2022, consisting of 365,000 Dutch adults representative for the general adult population. Pandemic-related and traditional events were assessed and anchored to a screening instrument for PTSD: the Dutch version of the PCL-5. Results Two-thirds of participants reported experiencing a shocking event during the pandemic. Exposure to pandemic-related events was reported more frequently than traditional events. Overall probable PTSD prevalence due to these events was 2.4%, evenly split between pandemic-related and traditional events. Among exposed individuals, probable PTSD prevalence was 3.7%. This was higher for traditional than for pandemic-related events. Risk factors for developing probable PTSD after exposure to an event during the pandemic were younger age, financial difficulties, loneliness, low resilience and experiencing multiple events. Discussion Exposure to shocking events during the pandemic influenced the prevalence of probable PTSD. Despite the lower relative impact of pandemic-related shocking events compared to traditional events, exposure to pandemic-related shocking events accounted for the same amount of probable PTSD cases in the Dutch general population as 5 common traditional events. This emphasizes the need to address mental health consequences of prolonged crises and the demand for healthcare, and the importance of mitigation strategies based on risk and protective factors. Key messages • Exposure to pandemic-related events accounted for approximately the same amount of probable PTSD cases as 5 frequently occurring traditional events. • Despite pandemic-related events being reported more frequently, traditional events were associated with a relatively higher prevalence of PTSD.

Long-term mental health impairments in survivors of critical illness

Abstract Background Survivors of critical illness frequently suffer from long-term disabilities, including physical, cognitive, and mental impairments (post-intensive care syndrome). However, long-term studies are scarce and healthcare services for critical illness survivors are limited, not only in Germany. Therefore, we followed-up on anxiety, depression, and post-traumatic stress disorder (PTSD) during post-intensive care unit (ICU) rehabilitation and up to 1 year after critical illness onset. Methods Patients at Schoen Clinic Bad Aibling in Germany were eligible for this prospective cohort study after receiving ≥5 days of mechanical ventilation. The Hospital Anxiety and Depression Scale (HADS; subcategory score ≥8) was conducted after ICU discharge (V1), at discharge from inpatient rehabilitation (V2) and 1 year after critical illness onset (V3). The Impact of Event Scale-6 (score ≥1.75) was conducted to assess PTSD at V3. Multiple logistic regressions were performed. Results We included 250 patients (62±14 years, 34% female, median stay on ICU 55 days, median duration of rehabilitation 65 days). 10% died before V3. Anxiety decreased during rehabilitation (effect size r = 0.35, p<.001), but increased again until V3 (r = 0.42, p<.001). At V3, 54% suffered from anxiety. Depression also decreased during rehabilitation (r = 0.46, p<.001), and increased again until V3 (r = 0.39, p<.001). At V3, 44% showed depressive symptoms and 38% suffered from PTSD. COVID-19 diagnosis was associated with increased anxiety (p<.001), depression (p=.068), and PTSD at V3 (p=.028), compared to non-COVID-19 patients. Furthermore, longer duration of mechanical ventilation was associated with increased anxiety (p=.041) and depression (p=.019) at V3. Conclusions Mental health impairments frequently occur in critical illness survivors, and they seem to worsen after rehabilitation. As these impairments can significantly impact daily functioning and quality of life, tailored healthcare services are urgently needed. Key messages • Anxiety, depression, and PTSD are frequent in critical illness survivors, even 1 year after critical disease onset. This calls for tailored healthcare services. • Patients with COVID-19 and longer mechanical ventilation suffer from more severe mental health impairments.

Predicting PTSD among labour ward staff: The role of burnout, intent to leave, and emotional support

Abstract Background Healthcare professionals in delivery rooms frequently encounter stressful situations. Following an examination of how midwives coped and functioned during the unfamiliar and chaotic period of the Covid-19 pandemic, it is crucial to understand their challenges and the support they receive to enhance well-being and patient care. This study aimed to examine the relationship between burnout, intentions to leave, and PTSD (Post-Traumatic Stress Disorder) symptoms among healthcare professionals, and to identify predictors of PTSD. Methods We employed a mixed-methods design, consisting of a survey of 196 midwives and gynecologists assessing burnout, intentions to leave, exposure to negative work experiences, and PTSD. Additionally, we conducted 15 semi-structured interviews and 13 interviews with labour ward head nurses. Results Most participants experienced difficult events in the delivery room or multiple such events, reporting insufficient emotional support. The main themes identified were stress, fear, anxiety, and frustration. Burnout and a lack of emotional support were significant predictors of PTSD symptoms, with participants highlighting the need for more support to manage complex situations. Discussion Addressing burnout through prevention and intervention programs is essential. Emotional support plays a crucial role in mitigating PTSD symptoms, enhancing resilience and well-being among midwives and gynecologists. Implications for Nursing Management: Understanding the psychological impact of stressful situations on healthcare professionals is crucial for guiding policies and interventions aimed at maintaining staff psychological well-being. Midwives’ managers can leverage this research to identify actions that improve staff resilience and cohesion during crises. Strengthening the resilience of health teams is pivotal in providing optimal health services. Key messages • Burnout and insufficient emotional support are key predictors of PTSD among healthcare workers in labour wards. • Enhancing support and resilience for midwives and gynecologists is crucial for their well-being and patient care.

The influence of post-traumatic stress on the intention to leave among Korean child welfare workers

Abstract Background and aims Previous research have highlighted the challenges faced by social workers who are exposed to traumatic events, such as client violence, and vicarious traumas. These experiences often lead social workers to leave their agencies. However, it is commonly assumed that child welfare workers are immune to such experiences as they primarily work with non-violent children. This study aims to investigate whether post-traumatic stress among Korean child welfare workers influences their intention to leave, and whether peer support and organizational culture mediate this relationship. Methods A total of 246 participants were recruited in 2021 through purposive sampling. Due to the ongoing Covid-19 pandemic, a self-administered online survey method was employed. Only workers who reported direct and/or indirect traumatic experiences at their workplaces were included in the final analysis. Structural equation modeling was utilized to examine the relationships among variables in this study. Results While organizational culture had a partial mediating effect in the relationship between post-traumatic stress and intention to leave, peer support did not show a significant effect. This suggests that fostering a supportive organizational climate may be crucial in reducing work-related stress, including post-traumatic stress. It also highlights the need for social work administrators to actively promote such climates to prevent turnover within the child welfare workforce. Discussion and conclusions The findings of this study suggests that child welfare organizations can take proactive measures to address this issue. Creating a supportive organizational culture that fosters resilience and provides resources for coping with post-traumatic stress is crucial. Organizations may explore additional strategies for reducing workforce turnover, which will have negative effects on their clients and organizations as well. Key messages • Fostering a supportive organizational climate may be crucial in reducing work-related stress, including post-traumatic stress. • Child welfare organizations may explore additional strategies for reducing workforce turnover, which will have negative effects on their clients and organizations as well.

The impact of childhood abuse on future military sexual assault and PTSD symptomology in Australian veterans.

The trauma most commonly associated with the military is combat-related trauma. It is increasingly recognised that childhood sexual and physical abuse and military sexual assault may influence or exacerbate posttraumatic stress disorder (PTSD) when military members are exposed to combat. The study aimed to determine whether a history of childhood sexual and physical abuse would increase the likelihood of military sexual assault (MSA) and determine whether a history of sexual abuse (childhood or military) impacted the incidence and severity of post-trauma sequelae compared to veterans without this history. A retrospective correlational analysis was performed on baseline data collected from clinical case records of a cohort of 134 Australian veterans with PTSD who had attended an outpatient Military Service Trauma Recovery Day Programme between October 2020 and May 2022. Almost half (48.5%) of veterans reported a history of abuse. Prevalence rates of military sexual abuse, child sexual abuse and child physical abuse were 14.9%, 13.4% and 23.1% respectively. The relationship between those who experienced childhood abuse and those who experienced military sexual abuse was not significant. No significant differences were observed between those who experienced any sexual abuse and those who did not on intake scores of psychological symptoms. This is the first Australian study to investigate the prevalence of childhood abuse and military sexual abuse and its impact on PTSD and associated psychopathology in a sample of veterans seeking mental health treatment. No additional risks of experiencing military sexual assault were found for those who had survived childhood sexual abuse.

Neurocognitive Intraindividual Variability in Veterans with Mild Traumatic Brain Injury History and Posttraumatic Stress Disorder.

Veterans with a history of blast-related mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) may be at risk for greater cognitive concerns and worse functional outcomes compared to those with either condition in isolation. However, traditional neuropsychological assessment approaches have yielded equivocal results in these populations. The present study examined an alternative method for detecting subtle cognitive inefficiencies: neurocognitive intraindividual variability (IIV), a measure of within-person performance consistency. Participants were 79 male Veterans with a history of blast-related mTBI and current PTSD (mTBI/PTSD group; n = 54) or neither diagnosis (controls; n = 25). Mean T-scores and IIV scores were calculated from neuropsychological measures of attention and speed of information processing (A/SoP) as well as executive functioning (EF). Global IIV was significantly higher in the mTBI/PTSD group compared to controls (p = .047, Cohen's d = 0.49). At the domain level, larger effect sizes were observed for EF IIV (Cohen's d = 0.46) compared to A/SoP IIV (d = 0.32), although neither were statistically significant. Within the mTBI/PTSD group, higher Global IIV was associated with worse self-reported executive dysfunction, psychological quality of life, and cognitive post-concussive symptoms; at the domain level, these clinical outcomes were generally associated with greater A/SoP IIV (but not EF IIV). Findings extend previous investigations of neurocognitive IIV in individuals with a history of mTBI across PTSD status. Among Veterans with a history of mTBI and comorbid PTSD, neurocognitive variability may be a better indicator of self-reported cognitive inefficiencies and Veteran experience of daily cognitive functioning than mean neuropsychological performances.

Covid-19 and mental health hospitalizations in Italy. Results from a multicenter longitudinal cohort

Abstract Background The impact of Covid-19 pandemic on mental health (MH) is still being assessed. The aim of this study was to evaluate the impact of Covid-19 on ordinary hospital admissions for psychiatric disorders in Italy. Methods The multicenter project “Covid-19 and mental health” (CoMeH), coordinated by the National Institute for Health, Migration and Poverty, enrolled an open cohort of subjects resident in three large areas of Italy (2018-2021) aged 10 + (N = 5,159,363), and followed-up until 2021. The study outcome was the first ordinary admission with a psychiatric disorder as main diagnosis (FMHA). Citizenship and deprivation level (DL) are the socioeconomic factor considered. Different groups of diagnosis were used to characterize the hospitalizations. The impact of Covid-19 on FMHAs was evaluated by interrupted time series (ITS) analysis, pre (until February 2020) and post (from March 2020) the outbreak of pandemic, using a step-change model. Results 11,171 FMHAs were observed. Patients hospitalized with a MH diagnosis were younger compared to the study population; the distributions by sex, deprivation level and citizenship were similar. A decrease of incidence of FMHAs was found after the outbreak of the pandemic, overall and for all group of diagnoses, except for post-traumatic stress disorders (PTSD). A reduction in adjusted FMHA rates after the onset of Covid-19 (RR 0.80[0.72-0.90]) were observed through multivariate ITS. The oldest patients had the lowest probabilities of FMHAs in pre Covid-19 and experienced the highest reduction in post-Covid19. PTSD presented trend in countertendency compared with the other diagnosis, with an immediate effect of Covid-19 increasing FMHAs (+97%), followed by a post-outbreak return to the pre-pandemic levels, below the counterfactual line. Conclusions Covid-19 pandemic determined a general reduction of admissions for psychiatric disorders. A significant impact was observed among the eldest (decrease) and for PTSD (increase). Key messages • Covid-19 pandemic determined a reduction of admissions for psychiatric disorders. • Older people were mostly affected. No significant socioeconomic impact was observed.

Mental health trajectories among Syrian refugees in Norway: A longitudinal cohort study

Abstract Background Refugees encounter various risk factors that can affect their mental health throughout the migration process. However, while most studies focus on mental health challenges at the time of resettlement, only a few explore these changes over an extended period. This study aims to explore changes in mental health among Syrian refugees in Norway and to identify influencing factors. Methods This is a prospective cohort study using data from CHART and Integration for Health studies, which followed Syrian refugees granted settlement in Norway. Data collection took place in Lebanon between 2017-2018 (baseline), and at one- and four-years post-arrival in Norway. Assessments for anxiety/depression and post-traumatic stress disorder (PTSD) were conducted using the Hopkins Symptom Checklist (HSCL-10) and the Harvard Trauma Questionnaire, respectively. Mixed-effects logistic regression analyzed temporal changes, with results presented as odds ratio (OR) with 95% confidence intervals (CI). The study also explored the effect modification of outcomes by the following baseline factors: age, gender, education. Results A total of 132 participants were included in all three data collection points. There was a decrease in the proportion of participants reporting anxiety/depression (from 30% to 28%, OR 0.1, 95% CI 0.1 - 0.2) four years post-settlement. The proportion of participants reporting PTSD symptoms decreased one year after settlement (from 4% to 3%, OR 0.3, 95% CI 0.1 - 0.7), but increased to 4% four years after arrival, showing no improvement from baseline (OR 0.8, 95% CI 0.4 - 2.0). No interactions were observed between changes over time and baseline variables. Conclusions After four years in Norway, Syrian refugees reported improvement in anxiety/depression, but PTSD symptoms worsened. This highlights the need for ongoing support that extends beyond the initial phases of resettlement. Key messages • Refugees face various risk factors that affect their mental health throughout the migration process. • Ongoing mental health support for refugees is essential, beyond the initial resettlement phase.

Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States

Abstract Objectives The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States. Methods Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients. Results TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better. Conclusions We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.

Incidence and predictors of neuropsychiatric manifestations following a traumatic brain injury at referral hospitals in Dodoma, Tanzania: A protocol of a prospective longitudinal observational study.

Traumatic Brain Injury (TBI) is any injury to the brain resulting from an external force leading to complications. TBI affects 27-69 million people yearly, with high incidence in low- and middle-income countries (LMICs), mainly attributed to motor traffic accidents. Within three to six months following moderate-to-severe TBI, the relative risk of any psychiatric disorder is significantly higher than in the general population. Post-TBI neuropsychiatric disorders include depression with a prevalence of up to 53%, apathy up to 72%, Posttraumatic stress disorder (26%), anxiety (9%), manic symptoms (5-9%) and psychosis (3 to 8%). This study aims to determine the incidence and predictors of post-TBI neuropsychiatric manifestations among patients admitted at Referral hospitals in Dodoma. This is a prospective longitudinal observational study in which patients admitted with moderate to severe TBI will be recruited. Patients will be followed for six months, the diagnostic MINI International Neuropsychiatric Interview (MINI) tool will be used to assess TBI, and the severity and progression of symptoms will be evaluated using PHQ-9 for depressive symptoms, GAD-7 for anxiety symptoms, PCL-5 for Posttraumatic Stress Disorders (PTSD), MoCA for cognitive assessment, AES for apathy and YMRS for manic symptoms at one, three and six months. Logistic regression will be analysed to determine the association between predictors and neuropsychiatric outcomes. Given the dearth of understanding of the burden of neuropsychiatric complications and associated outcomes in sub-Saharan Africa, the study will shed light on the incidence and factors contributing to post-TBI neuropsychiatric complications and, thus, provide a platform for further research and design of necessary interventional programs for the population at risk.

5.Y.1. Refugees and mental health

Abstract Research suggests an elevated risk of mental health conditions (depression, posttraumatic stress disorder, anxiety) among refugees, due to exposure to trauma, displacement, and the challenges of adapting to new environments. Children and adolescents with refugee background face additional challenges, including family disruptions, education interruptions, and uncertain futures. However, the data are heterogeneous and more detailed data are needed. To address this gap, we present data on refugee’s mental health and resilience. First, data on resilience and mental health from Germany are presented. These data are adjusted for demographics and suggest that in case data are adjusted to the living situation in the host country the migrant status is less relevant. The second study presents the mental health of refugee adolescents and children in Greece. The third study presents results based on a Portuguese prospective cohort study Perinatal Health in Migrants: Barriers, Incentives, and Outcomes (baMBINO). This study investigates postpartum depression among refugee women in Portugal highlighting the need for access to care. Last, a systematic review and meta-analysis provides data on depression, anxiety and stress of 62,522 refugees from more than 30 countries. This data suggests that life experiences are critical for refugees’ mental health. Based on the presentations the audience will be engaged in discussion on how to better early prevent mental health conditions in refugees. Key messages • Mental health of refugees is a Public Health challenge. • Pre- and post migration experiences impact refugees and migrants mental health conditions.

Refugee mental health - systematic review and meta-analysis

Abstract Background Mental health conditions of forcibly displaced persons are unknown as the characteristics of the population change over the years. This study aims to estimate the prevalence rates of mental health conditions among refugees (depression, anxiety and posttraumatic stress). Methods We conducted a systematic review using MEDLINE (Ovid), Embase, Web of Science Core Collection (Clarivate), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), and PTSDPubs (ProQuest) published between 1994-2022. We set up clear eligibility criteria and developed a data extraction sheet. The risk of bias of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Heterogeneity was assessed using I² statistics. Results The search yielded 4,381 records, of which 171 were included in the full-text review. 54 studies were included in the final review. These 54 studies comprised of 62,522 forcibly displaced populations (49.22% males, 50.78% females). Pooled prevalence rates for anxiety, depression, and PTSD were 36.3% (95% CI 30.0-43.2), 35.9% (95% CI 31.9-41.3), and 35.4% (95% CI 29.0-42.4) respectively. Conclusions The prevalence of PTSD, depression and anxiety is significant among forcibly displaced persons. Screening for mental health conditions among these populations might prove beneficial to prevent more severe mental health conditions through the implementation of early intervention strategies.

Depression, posttraumatic stress of migrants and refugees in Germany – a cross -sectional study

Abstract Background Research shows associations between migration status and mental health conditions (e.g., depression). Yet, few representative data on migrants’ health are available. We aim to provide representative data on depression, and posttraumatic stress (PTSD) among migrants in a representative sample in Northwestern Germany. Methods We conducted a longitudinal study with two measurement points using a standardized assessment instrument in a representative sample of 18-65 years olds in Germany. Here we report on the baseline data. To assess socio-demographic characteristics (gender, age, marital status employment status, household income and migration status) we developed a standardized instrument. To assess depression, we used the Patient Health Questionnaire (PHQ-9), to assess PTSD we used the Harvard Trauma Questionnaire (HTQ-5). To investigate associations of migrant status with depression, and PTSD we estimated linear regression models. Results The analytical sample for this study includes n = 437 (male: n = 181, female: n = 256) individuals (age: M = 44.48, range: 18-65). In the total sample 15.1% (n = 66) showed symptoms of depression, and 6.5% showed PTSD (n = 26). Depression was more frequent in migrants than in non-migrants (22.1% vs. 13.4%, p = 0.043; 66.7). Crude linear regression models showed statistically significant associations between migration status and depression (B = 1.998, 95% CI: 0.831; 3.165, p < 0.001), and PTSD (B = 0.204, 95% CI: 0.085; 0.333, p = 0.002). However, models adjusted for gender, age, marital status employment status, household income and migration status suggested significant associations between migration status and PTSD (B = 0.136, 95% CI: 0.009; 0.263, p = 0.036), but not for depression. Conclusions Longitudinal data are needed to better understand trajectories between mental health conditions, PTSD and migration status. Living situation after the migration is of critical importance for mental health of migrants.

Prevalence of postpartum post-traumatic stress disorder and associated factors among postnatal mothers in West Arsi zone, South West Ethiopia, 2024: a community-based cross-sectional study

BackgroundUp to one-third of women globally experience giving birth as traumatic, which can lead to postpartum post-traumatic stress disorder. Postpartum post-traumatic stress disorders have significant health consequences for the mother, child, and other family members. Although it has tragic health impacts, little is known about this problem in the study area.ObjectivesThe study aimed to assess the prevalence of postpartum posttraumatic stress disorder and associated factors among postnatal mothers.MethodsA community-based cross-sectional study was employed among 635 mothers in the first year after childbirth by using simple random sampling techniques from March 20 to April 20, 2024 in West Arsi zone, Ethiopia. Face-to-face interviewers administered structured questionnaires that were used to collect the data. The collected data were cleaned, coded, and entered into Epidata and exported to Statistical Package for Social Sciences for further analysis. Both bivariate and multivariable analyses were done by using binary logistic regression.ResultOut of 635, 624 postnatal mothers participated in the study, for a response rate of 98.27%. The prevalence of postpartum post-traumatic stress disorder was 21.60% (95% CI: 18.40%, 24.87%). Primiparous mothers (AOR = 2.26, 95% CI: 1.38, 3.70), have no antenatal care follow-up (AOR = 2.48, 95% CI: 1.47, 4.20), cesarean section delivery (AOR = 2.86, 95% CI: 1.50, 5.61), instrumental delivery (AOR = 3.06, 95% CI: 1.75, 5.34), maternal morbidity (AOR = 2.94, 95% CI: 1.71, 5.05), and postpartum intimate partner violence (AOR = 7.43, 95% CI: 4.53, 12.20) were the identified factors.Conclusion and recommendationAs identified, one out of five mothers had postpartum posttraumatic stress disorder. Thus, healthcare providers should focus on identified factors like cesarean section and instrumental deliveries while counseling, as this enhances the mothers’ psychological readiness. In addition, the West Arsi Zonal Health Office should develop effective strategies to alleviate the problem by focusing on the identified factors.

Young North African migrants in Europe: exploring their health and the adequacy of health services

Abstract Background Over five million people from North Africa (NA) lived in Europe in 2019, including youth characterized by intense trans-border mobility, precarious living conditions and high-risk behaviours such as prostitution and illegal activities. This population challenges health professionals and institutions ability to deliver medical care and health information remains scarce. This scoping review aims to better understand NA adolescents and young adult (aged 12-25) health status, access to and use of healthcare. Methods Following the Arksey and ÓMalley process and based on the Population-Concept-Context framework, we searched the CINAHL, Cochrane, Embase, PubMed, PsycINFO and Web of Science databases for peer-reviewed articles and non-index reports. We systematically tracked references. Results Initial search returned 5319 articles of which we included 13 (2 Spanish, 2 French, 3 German). All reported about observational studies. Nine of 13 papers included males only and 11 focused exclusively on unaccompanied minors. They reported about physical health conditions related to poverty such as dental caries, iron deficiency and dermatological conditions (n = 5) or infectious diseases, notably tuberculosis (n = 7). Trauma-related mental health conditions were frequently reported (n = 7), including post-traumatic stress disorder and alcohol, cannabis or benzodiazepines harmful use with frequent overlapping presentations. Three studies discussed multi-pronged barriers to healthcare, emphasizing the importance of transcultural approaches and attention to social factors. Conclusions Embedded into multiple factors of vulnerability, poor physical and mental health is commonly associated with young NA migrants. Evidence is limited in scope and quality notably about females and young adults. There is an important gap about optimal strategies to deliver tailored health services, notably to respond to complex mental health needs. Key messages • The complex health needs and barriers to care of young NA migrants in Europe are not adequately documented, understood, and addressed. • Particular attention should be paid to trauma-related mental health conditions.