Predictors Of Posttraumatic Stress Disorder Research Articles

Post-traumatic stress disorder among individuals with traumatic spinal cord injury in Nepal: a cross-sectional study.

Cross-sectional study OBJECTIVES: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.

Posttraumatic stress disorder, secondary traumatic stress, and burnout in frontline workers in homelessness services: risk and protective factors

ABSTRACT People experiencing homelessness (PEH) frequently have multiple and complex needs that may contribute to interpersonal difficulties that affect their relationships with services. As a result, professionals working in frontline homelessness services are frequently exposed to primary trauma (e.g. workplace aggression, crisis situations) and secondary trauma (e.g. hearing about service users’ traumatic experiences). This cross-sectional study explored organizational and individual factors in relation to three related but distinct facets of work-related distress: posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), and burnout. A sample of 139 frontline workers in UK homelessness services completed an inventory of 15 possible distressing workplace experiences and four psychometric questionnaires. Results clearly evidence that frontline workers are exposed to high levels of potentially traumatic incidents at work and that this is associated with significant distress, with 23% of the sample meeting the threshold for PTSD diagnosis. Hierarchical multiple regression analyses identified trauma exposure and the use of “maladaptive” cognitive coping strategies as strong predictors of PTSD and STS, while organizational culture and compassion satisfaction were protective against burnout. These findings have important service implications, and recommendations are made regarding trauma- and psychologically informed approaches that organizations can implement to effectively support their employees.

PTSD and depression in adult burn patients three months postburn: The contribution of psychosocial factors

ObjectiveBurn injuries can be traumatic and increase the risk of posttraumatic stress disorder (PTSD) and major depression (MDD). The current study examined the incremental contribution of established predictors of PTSD and theory-derived cognitive predictors to PTSD and depression early after burn. MethodsParticipants were 118 adult burn patients consecutively admitted to the largest burn center in Taiwan who completed a baseline assessment, of which 101 (85.6%) were reassessed 3-month post-burn. ResultsThree months after the burn, 17.8% and 17.8% of participants met probable DSM-5 PTSD and MDD, respectively. The rates rose to 24.8% and 31.7% using a cut-off of 28 on the Posttraumatic Diagnostic Scale for DSM–5 and 10 on the Patient Health Questionnaire-9, respectively. After controlling for potential confounders, the model with established predictors uniquely explained 26.0% and 16.5% of the variance of PTSD and depressive symptoms 3-month post-burn, respectively. The model with theory-derived cognitive predictors uniquely explained 17.4% and 14.4% of the variance, respectively. Posttrauma social support and thought suppression remained significant predictors of both outcomes. ConclusionA sizeable subset of burn patients suffer from PTSD and depression early after burn. Social and cognitive factors are implicated in the development and recovery of post-burn psychopathology.

The other side of COVID-19: A cross-sectional study on mental health in a sample of Italian nurses during the second wave.

The COVID-19 pandemic has led to a drastic increase in the workload of healthcare professionals, particularly nurses, with serious consequences for their psychological well-being. Our study aimed to identify demographic and work-related factors, as well as clinical predictors of post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD), in nurses employed during the COVID-19 pandemic. We carried out a cross-sectional study between December 2020 and April 2021 on nurses employed during the COVID-19 second wave (October - December 2020). We evaluated PTSD and GAD using two validated questionnaires: i) the Impact of Event Scale - Revised (IES-R); and ii) General Anxiety Disorder -7 (GAD-7). Overall, 400 nurses, whose mean age was 34.3 years (SD ± 11.7), were included in the study. Most were female (78.5%), unmarried (58.5%) and employed in the central (61.5%) regions of Italy. A total of 56.8% of all participants had clinical predictors of PTSD, recording a median IES-R score (IQR) of 37.0 (22.0, 51.0) (range 1-84; cut-off >33 for PTSD). Furthermore, 50% of respondents reported moderate-to-severe symptoms consistent with GAD, recording a median GAD-7 score (IQR) of 9.5 (6.0,14.0) (range 0-21; cut-off >10 for GAD). Multivariable analysis showed that moderate-to-severe GAD (aOR = 4.54, 95% CI: 2.93 - 7.05), being employed in the critical care area (aOR = 1.74, 95% CI: 1.01 - 3.00) and being female (aOR= 1.88, 95% CI: 1.09 - 3.22) were significantly associated with the presence of clinical predictors of PTSD. The levels of PTSD symptoms and anxiety among nurses were high during the pandemic. PTSD and GAD represent a public health problem that should be addressed in the post-pandemic period. Healthcare organizations need to activate specific support and rehabilitation networks and programs for healthcare professionals employed during the COVID-19 pandemic.

Maternal, but not paternal, ratings of child preinjury functioning predict child posttraumatic stress.

Pretrauma internalizing and externalizing behaviors have been found to predict posttraumatic stress disorder (PTSD) symptoms (PTSS) in children following injury. However, child in-hospital self-report of pretrauma symptoms may be impacted by their injury and associated medical care (e.g., sedation/pain medications). Parental report of child pretrauma risk factors may be easier to capture; however, mothers and fathers differ in the extent to which they report, and agree on, internalizing versus externalizing behaviors in their child. The present study examined the differential utility of maternal versus paternal ratings of child preinjury internalizing, externalizing, and prosocial behaviors in predicting child PTSS 3- and 6-months postinjury. Eighty-four children were recruited from an emergency department after emergency medical services transport following injury, along with their parent(s). Dyadic (one parent and a child) analyses revealed that maternal reports of internalizing behaviors were significantly associated with child PTSS 3 months, F(5, 64) = 9.48, p < .001; ß = .44, p = .01, and 6 months, F(5, 48) = 5.57, p < .001; ß = .42, p = .03, postinjury. Paternal reports were not associated with child PTSS at either time point. In a subsample of triads (mother-father-child), mothers' and fathers' reports were only moderately correlated (rs = .30-.53), and neither maternal nor paternal ratings individually predicted child PTSS when both parents' reports were included in the model. Exploratory analyses revealed that family conflict and maternal initial PTSS moderated the relationship between maternal ratings of internalizing behaviors and child 3-month PTSS. Results suggest that maternal reports of child preinjury internalizing behaviors should be considered as predictors of later child PTSS development. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The traumatic impact of the COVID-19 pandemic: the possible role of rumination and uncertainty.

The COVID-19 pandemic has caused some traumatic injuries to individuals due to the isolation, loneliness, and uncertainty it has created. Ruminative thoughts and uncertain situations are known to affect trauma. It aimed to evaluate the traumatic effect of the pandemic based on the ruminative thoughts and intolerance of uncertainty in the study. The sample for the descriptive and cross-sectional study consisted of 402 participants. Data were collected by using the questionnaire form, the Post Traumatic Stress Disorder Scale (PTSD), the Ruminative Reactions Scale (RRS), and the Intolerance of Uncertainty Scale (IUS). A positive correlation was discovered between the PTSD mean scores of the study participants and their RRS and IUS scores (p < .05). Furthermore, RRS (β = 0.280) was identified as a variable that primarily affected PTSD (p < .05). It was concluded that both ruminative thoughts and intolerance of uncertainty were predictors of post-traumatic stress disorder in the COVID-19 pandemic. Considering the possible effects of the pandemic, it is recommended to reduce the intolerance to uncertainty, to rework the ruminative thought content with appropriate and effective methods, and to create some programs for gaining problem-solving skills.

Using machine learning algorithm to predict the risk of post-traumatic stress disorder among firefighters in Changsha.

Firefighters are prone to suffer from psychological trauma and post-traumatic stress disorder (PTSD) in the workplace, and have a poor prognosis after PTSD. Reliable models for predicting PTSD allow for effective identification and intervention for patients with early PTSD. By collecting the psychological traits, psychological states and work situations of firefighters, this study aims to develop a machine learning algorithm with the aim of effectively and accurately identifying the onset of PTSD in firefighters, as well as detecting some important predictors of PTSD onset. This study conducted a cross-sectional survey through convenient sampling of firefighters from 20 fire brigades in Changsha, which were evenly distributed across 6 districts and Changsha County, with a total of 628 firefighters. We used the synthetic minority oversampling technique (SMOTE) to process data sets and used grid search to finish the parameter tuning. The predictive capability of several commonly used machine learning models was compared by 5-fold cross-validation and using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, precision, recall, and F1 score. The random forest model achieved good performance in predicting PTSD with an average AUC score at 0.790. The mean accuracy of the model was 90.1%, with an F1 score of 0.945. The three most important predictors were perseverance, forced thinking, and reflective deep thinking, with weights of 0.165, 0.158, and 0.152, respectively. The next most important predictors were employment time, psychological power, and optimism. PTSD onset prediction model for Changsha firefighters constructed by random forest has strong predictive ability, and both psychological characteristics and work situation can be used as predictors of PTSD onset risk for firefighters. In the next step of the study, validation using other large datasets is needed to ensure that the predictive models can be used in clinical setting.

Polygenic risk for mental disorders as predictors of posttraumatic stress disorder after mild traumatic brain injury

Many patients with mild traumatic brain injury (mTBI) are at risk for mental health problems such as posttraumatic stress disorder (PTSD). The objective of this study was to determine whether the polygenic risk for PTSD (or for related mental health disorders or traits including major depressive disorder [MDD] and neuroticism [NEU]) was associated with an increased likelihood of PTSD in the aftermath of mTBI. We used data from individuals of European ancestry with mTBI enrolled in TRACK-TBI (n = 714), a prospective longitudinal study of level 1 trauma center patients. One hundred and sixteen mTBI patients (16.3%) had probable PTSD (PCL-5 score ≥33) at 6 months post-injury. We used summary statistics from recent GWAS studies of PTSD, MDD, and NEU to generate polygenic risk scores (PRS) for individuals in our sample. A multivariable model that included age, sex, pre-injury history of mental disorder, and cause of injury explained 7% of the variance in the PTSD outcome; the addition of the PTSD-PRS (and five ancestral principal components) significantly increased the variance explained to 11%. The adjusted odds of PTSD in the uppermost PTSD-PRS quintile was nearly four times higher (aOR = 3.71, 95% CI 1.80–7.65) than in the lowest PTSD-PRS quintile. There was no evidence of a statistically significant interaction between PTSD-PRS and prior history of mental disorder, indicating that PTSD-PRS had similar predictive utility among those with and without pre-injury psychiatric illness. When added to the model, neither MDD-PRS nor NEU-PRS were significantly associated with the PTSD outcome. These findings show that the risk for PTSD in the context of mTBI is, in part, genetically influenced. They also raise the possibility that an individual’s PRS could be clinically actionable if used—possibly with other non-genetic predictors—to signal the need for enhanced follow-up and early intervention; this precision medicine approach needs to be prospectively studied.

Persian version of the support and control in birth questionnaire among Iranian women.

Lack of perceived support and control during labor and childbirth is known as an important predictor of post-traumatic stress disorder following childbirth. However, there is no standard scale to measure perceived support and control for Iranian women. This study determined the validity and reliability of the support and control in birth questionnaire for Iranian women. Support and control in the birth questionnaire were translated into Persian by the forward and backward translation method in 2019. Among a total of 102 healthcare centers in Tabriz, 50 urban and 10 rural centers were selected randomly. Then, 660 women with vaginal childbirth during the postpartum period were extracted by each center and selected randomly. The validity of the Persian version was evaluated in terms of face, content, and construct validity. Internal consistency and reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Exploratory and confirmatory factor analyses were used for evaluating the construct validity of the tool. Cronbach's alpha coefficient (0.95) and intraclass correlation coefficient (0.99) were acceptable. In an exploratory analysis, three factors were extracted and these three factors explained 63.1% of the total variance. Items 14 and 17 were removed from the Persian version due to low factor loading and impact factor values. Confirmatory factor analysis supported the three factors extracted in the exploratory analysis. Confirmatory factor analysis showed suitable indexes of fitness for 31 items. Persian version of the support and control in the birth questionnaire is a valid and reliable tool for the Iranian women population.

Predictors of PTSD and Psychological Distress Symptoms of Ukraine Civilians During war.

War may raise the level of distress and post-traumatic stress disorder (PTSD). The study explores the extent to which 4 factors determine levels of PTSD and distress symptoms of Ukraine civilians (without developing PTSD) during the current war. The data were collected via a Ukrainian internet panel company. 1001 participants responded to a structured online questionnaire. Path analysis was conducted to identify predictive indicators of PTSD scores. PTSD symptoms positively correlated with respondents' level of exposure to the war and their sense of danger, and negatively correlated with well-being, family income, and age. Females scored higher on PTSD symptoms. Path analysis showed that higher exposure to war and higher sense of danger increase PTSD and distress symptoms, whereas higher well-being, higher individual resilience, and being a man, as well as older age decrease their level. Despite the strong effects of the coping suppressing factors, most respondents did not reach the critical level of PTSD or distress symptoms. At least 4 positive and negative factors account for people's coping with stressful experiences: previous traumatic experiences, individual level of pathology, personality attributes, and socio-demographic characteristics. The balance of these factors protects most people from PTSD symptoms despite their being affected by war traumas.

Post-Traumatic Stress Disorder among Emergency Medical Technicians and its Relationship with Occupational Stress and Depression: Post-Corona Screening, Zanjan, 2022.

Emergency medical technicians (EMTs) are at risk of developing post-traumatic stress disorder (PTSD) as a result of seeing painful events involving suspected COVID-19 patients and being concerned about potentially infecting themselves and their families. Therefore, screening for these disorders is essential in the post-Corona era. This study aimed to investigate the prevalence of PTSD among EMTs and its relationship with occupational stress and depression when dealing with patients with suspected COVID-19. This cross-sectional study was conducted on EMTs at Zanjan University of Medical Sciences using a convenience sampling method. Data were collected using a demographic information questionnaire, PTSD checklist, occupational stress questionnaire, and the Goldberg depression scale. The data were analyzed using SPSS software. Statistical tests such as Pearson correlation and logistic regression analysis were used to evaluate the data. 205 EMTs participated in this cross-sectional study. The mean and standard deviation of PTSD was 37.13±12.93 (17-85), and according to the cut-off (45), the prevalence of PTSD was 30.7%. There was a direct and significant association between the total PTSD and depression scores (r=0.435, p=0.001). Some occupational stress domains, such as demand (r=0.306, p=0.001), colleague support (r=0.149, p=0.033), and communication (r=0.293, p=0.001) had a significant association with PTSD. The domains of sadness in depression (OR=1.074, p=0.027) and demands in occupational stress (OR=1.872, p=0.029) were the most important predictors of PTSD. Among demographic variables, employment status was the most important protective factor for PTSD (OR=0.378, p=0.038). PTSD affected one-third of EMTs, and it had a significant relationship with various dimensions of depression and occupational stress. Due to the chronic nature of these diseases, policymakers are advised to prioritize psychological screening of EMTs as part of the post-Corona policy.

SIGH, what's in a name? An examination of the factor structure and criterion validity of the (Structured Interview Guide for the) Hamilton Anxiety scale (SIGH-A) in a sample of African American adults with co-occurring trauma experience and heavy alcohol use.

The Hamilton Anxiety Inventory (HAM-A) is one of the oldest and most commonly used anxiety rating scales in clinical research. Despite its ubiquity, no studies have examined the scale's underlying factor structure and criterion validity among Black and African American adults with psychopathology (Mage = 42.25, SD = 11.44). Therefore, we estimated a confirmatory factor analysis of the commercially available Structured Interview Guide for the Hamilton Anxiety scale (SIGH-A; Williams, 1996) among African American adults (n = 88; 43% female) with co-occurring heavy alcohol use and trauma-related symptoms. Next, we examined the criterion validity of its Psychic and Somatic factors and overall anxiety severity score from participants who completed a single screening session (i.e., cross-sectional analysis) for a larger study. Results indicated that a two-factor solution provided an adequate fit to the data. Regression analyses indicated that the total SIGH-A score, but not its subscales, significantly predicted posttraumatic stress disorder (PTSD) severity. Neither the SIGH-A subscales nor total scores were significant predictors of alcohol consumption. The current findings suggest that the SIGH-A factor structure among African American adults with alcohol and trauma-related conditions is similar to previous reports that have tested largely White samples but highlight potential shortcomings when its subscales are used independently. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The virtue of religious faith and its relationship to posttraumatic stress disorder in victims of torture: the unique outcomes of men and women

ABSTRACT Three aspects of religious faith: faith-as-faithfulness; faith-as-trust; and faith-as-experience were examined in the lives of torture survivors with Posttraumatic Stress Disorder (PTSD). The Fetzer Scale items: Positive and Negative Religious Coping (PRC & NRC), Religious Practices (RP), and Daily Spiritual Experiences (DSE) were applied to a sample of 111 asylees. While none of the correlational hypotheses from the total sample showed a significant association between the variables of PRC, RP, and DSE to PTSD, a post hoc gender analyses revealed significant posttraumatic responses between women and men. Men showed a positive and significant association between PTSD, PRC and NRC, and women, a significant, negative association between Religious Social Support and PTSD. A multiple regression analysis investigated whether NRC, RP and DSE would predict significant variance with PTSD. Only NRC was shown to be a unique, significant predictor of PTSD above and beyond any beneficial effects of Religious Social Support (RSS).

Narcissistic and psychopathic traits in romantic partners predict post-traumatic stress disorder symptomology: Evidence for unique impact in a large sample

This study investigated whether partner psychopathy and narcissism predicted posttraumatic stress disorder (PTSD) symptoms. Participants (N = 1294) involved in romantic relationships with individuals they perceived to have high narcissistic or psychopathic traits completed the Informant Five Factor Narcissism Inventory, the Modified Self-Report Psychopathy Scale and the PTSD Checklist for DSM-5 to assess partner traits and their own PTSD symptoms. The study also accounted for the impact of previous abuse history such as childhood abuse, manipulative behaviors associated with these partner traits such as love-bombing, gaslighting, stonewalling, jealousy induction, relationship status and duration, and the presence of physical abuse.Multiple linear regressions revealed that grandiose and vulnerable narcissism were significant predictors of PTSD symptomology for those who had already left the romantic relationship, even when previous abuse, physical abuse, manipulative tactics and abuse frequency were accounted for. Partner grandiose narcissism was the strongest predictor of PTSD and was more predictive than abuse frequency, childhood abuse or physical abuse for those who had left the relationship. Partner grandiose narcissism was the strongest predictor for most PTSD symptom clusters. Partner traits explained the most variance in PTSD intrusion and avoidance symptoms. Love bombing and jealousy induction were significant but weaker predictors of PTSD, and partially mediated the effect of grandiose narcissism on PTSD, although the direct effect of grandiose narcissism on PTSD was stronger than this mediation. For individuals who stayed in the relationship, only psychopathy, abuse frequency and childhood abuse remained significant predictors. This is the first study to establish that narcissistic partner traits are associated with posttraumatic symptomology.

Psychic trauma and mental characteristics of patients with multiple sclerosis as predictors of post-traumatic stress disorder and targets for psychotherapy

The article describes the psychological characteristics of the personality of patients with multiple sclerosis (MS), which can be identified as the main targets of psychotherapy for comorbid post-traumatic stress disorder (PTSD). A total of 127 patients with MS were examined, of which 61 patients had symptoms of PTSD that developed in connection with the underlying disease. The control group included 67 MS patients resistant to stress. To assess the structure of personality and psyche, Ammon’s I-structural test was used (G. Ammon, 1976, adaptation by Yu. Ya. Tupitsin, V. V. Bocharov, T. V. Alkhazova, E. V. Brodskaya, 1998). To determine the level of resilience, which is defined as the patient’s ability to navigate in a crisis situation and get out of stress with minimal damage to mental and physical health, D.A. Leontiev (D.A. Leontiev, E.I. Rasskazova, 2006).As a result of the study, it was revealed that patients of the main group have significantly lower scores on all scales of the resilience questionnaire («involvement», «control», «risk acceptance»). At the same time, patients with PTSD are characterized by a higher level of destructive and deficient manifestations of selffunctions on the Ammon scale, in contrast to patients in the control group. Decreased characteristics of hardiness, the predominance of deficient and destructive personality structures are predictors of the onset of post-traumatic stress disorder in patients with MS. The revealed psychological phenomena should be the targets of psychoprophylactic and psychotherapeutic influence in complex programs for the treatment and rehabilitation of these patients.

Predictors of undocumented PTSD in persons using public mental health services

Individuals diagnosed with serious mental illness (SMI) have greater trauma exposure and are at increased risk for posttraumatic stress disorder (PTSD). However, PTSD is rarely documented in their clinical records. This study investigated the predictors of PTSD documentation among 776 clients with SMI receiving public mental health services, who had probable PTSD as indicated by a PTSD Checklist score of at least 45. Only 5.3% of clients had PTSD listed as a primary diagnosis, and 8.4% had PTSD as a secondary diagnosis, with a total 13.7% documentation rate. PTSD documentation rate was highest for clients with major depression (18.8%) compared to those with schizophrenia (4.1%) or bipolar disorder (6.3%). Factors that predicted a lower likelihood of having a chart diagnosis of PTSD included being diagnosed with schizophrenia/schizoaffective disorder or bipolar disorder. Factors that predicted a higher likelihood of having a chart diagnosis of PTSD included being of non-white race, being female, and experiencing eight or more types of traumatic events. Findings highlight the need for PTSD screening and trauma informed care for clients with SMI receiving public mental health services.

Understanding the disparate PTSD prevalence for U.S. and Mexico via social comparison effect types that inform perception of trauma difficulty.

The United States (U.S.) and Mexico have vastly different lifetime prevalence of posttraumatic stress disorder (PTSD), despite similarly high rates of trauma exposure. To explain this disparate prevalence, we created the Perception of Trauma Difficulty Assessment Tool (PTDAT) to identify four social comparison effect types that inform perception of trauma difficulty (i.e., Upward Assimilation Effect, Downward Assimilation Effect, Downward Contrast Effect, Upward Contrast Effect) to determine whether there was a dominant effect type associated with respondents' perception of coping with trauma difficulty for a sample of U.S. Americans and Mexicans. We identified sociodemographic characteristics and the degree of trauma exposure that associated with PTSD, PTSD symptom severity, and functional impairment for each effect type. This was a cross-sectional study of a sample of 898 U.S. Americans and 902 Mexicans. A chi-square test determined whether there was a dominant effect type for each national group. For each effect type, multiple regression analyses identified predictors of PTSD, PTSD symptom severity, and functional impairment. For U.S. Americans, trauma exposure was a predictor for PTSD for effect type Upward Contrast Effect, when respondents contrasted from an excellent appraisal of most people by making a poor self-appraisal. For Mexicans, all effect types had predictors for PTSD, with trauma exposure being a predictor for all. These preliminary findings provide support to consider patients' social context as it informs their perception of their capacity to cope, which may maintain PTSD. Future research is needed to determine whether perceptions of trauma difficulty are stable over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic.

Background:Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19.Methods:This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experiences caring for patients with COVID-19, and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma screening tool. The online survey was completed by 1833 HCWs. Univariate and multivariate logistic regression analyses were used to identify independent predictors of PTSD.Results:The mean age of the participants was 32.7±7.0 years; 81.9% were physicians, and 56.5% were female. The rates of COVID-19 history in the respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD (49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) (P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a nonphysician HCW, fear of spreading coronavirus to family, female sex, and a history of having COVID-19.Conclusions:HCWs were at risk for impairment in mental well-being in the era of COVID-19, with a significant number experiencing PTSD as well as suicidal ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit and are female, should be monitored regularly for PTSD.

Machine learning prediction of posttraumatic stress disorder trajectories following traumatic injury: Identification and validation in two independent samples.

Due to its heterogeneity, the prediction of posttraumatic stress disorder (PTSD) development after traumtic injury is difficult. Recent machine learning approaches have yielded insight into predicting PTSD symptom trajectories. Using data collected within 1 month of traumatic injury, we applied eXtreme Gradient Boosting (XGB) to classify admitted and discharged patients (hospitalized, n = 192; nonhospitalized, n = 214), recruited from a Level 1 trauma center, according to PTSD symptom trajectories. Trajectories were identified using latent class mixed models on PCL-5 scores collected at baseline, 1-3 months posttrauma, and 6 months posttrauma. In both samples, nonremitting, remitting, and resilient PTSD symptom trajectories were identified. In the admitted patient sample, a unique delayed trajectory emerged. Machine learning classifiers (i.e., XGB) were developed and tested on the admitted patient sample and externally validated on the discharged sample with biological and clinical self-report baseline variables as predictors. For external validation sets, prediction was fair for nonremitting versus other trajectories, areas under the curve (AUC = .70); good for nonremitting versus resilient trajectories, AUCs = .73-.76; and prediction failed for nonremitting versus remitting trajectories, AUCs = .46-.48. However, poor precision (< .57) across all models suggests limited generalizability of nonremitting symptom trajectory prediction from admitted to discharged patient samples. Consistency in symptom trajectory identification across samples supports prior studies on the stability of PTSD symptom trajectories following trauma exposure; however, continued work and replication with larger samples are warranted to understand overlapping and unique predictive features of PTSD in different traumatic injury populations.

PTSD Risk Factors and Acute Pain Intensity Predict Length of Hospital Stay in Youth after Unintentional Injury.

Background: Many hospitals have adopted screening tools to assess risk for posttraumatic stress disorder (PTSD) after pediatric unintentional injury in accordance with American College of Surgeons recommendations. The Screening Tool for Early Predictors of PTSD (STEPP) is a measure initially developed to identify youth and parents at high risk for meeting diagnostic criteria for PTSD after injury. Acute pain during hospitalization has also been examined as a potential predictor of maladaptive outcomes after injury, including PTSD. We investigated in a retrospective cohort study whether the STEPP, as well as acute pain intensity during hospitalization, would predict maladaptive outcomes during the peri-trauma in addition to the post-trauma period, specifically length of hospitalization. Methods: A total of 1123 youths aged 8–17 (61% male) and their parents were included. Patients and parents were administered the STEPP for clinical reasons while hospitalized. Acute pain intensity and length of stay were collected through retrospective chart review. Results: Adjusting for demographics and injury severity, child but not parent STEPP total predicted length of stay. Acute pain intensity, child threat to life appraisal, and child pulse rate predicted length of stay. Conclusions: Acute pain intensity and child PTSD risk factors, most notably child threat to life appraisal, predicted hospitalization length above and beyond multiple factors, including injury severity. Pain intensity and child appraisals may not only serve as early warning signs for maladaptive outcomes after injury but also indicate a more difficult trajectory during hospitalization. Additional assessment and treatment of these factors may be critical while youth are hospitalized. Utilizing psychology services to support youth and integrating trauma-informed care practices during hospitalization may support improved outcomes for youth experiencing unintentional injury.