Primary Care Posttraumatic Stress Disorder Research Articles

Nutrition Factors Are Associated with Post-Traumatic Stress Disorder in Immigrant and Canadian-Born Adults: Findings from the Canadian Longitudinal Study on Aging

Abstract Objectives To examine associations between post-traumatic stress disorder (PTSD) and nutrition factors among Canadian-born and immigrant adults. Methods The sample included participants of the Canadian Longitudinal Study on Aging (CLSA) (n = 27,211; 45–85 years) categorized by ethnicity (native white, native minority, immigrant white, and immigrant minority). PTSD was measured using the Primary Care PTSD tool. Nutrition factors included nutrition status indicators (anthropometrics, body fat %, handgrip strength, nutrition risk, sarcopenia, bone mineral density, and iron deficiency anemia) and dietary intakes (fiber, pulses and nuts, fat, omega-3 fatty acids, fruits and vegetables, fruit juice, calcium/vitamin D, salty snacks, pastries, and chocolate bars). Covariates included socioeconomic and health-related variables. Binary logistic regression analysis was conducted. Results Compared to white Canadians born in Canada, immigrant minority groups had a higher likelihood of PTSD (OR = 1.47, 95% CI 1.14–1.90, P < 0.001). Nutrition factors associated with PTSD included high nutrition risk (OR = 1.60, CI 1.41–1.80, P < 0.001), intakes of pulses and nuts (≥ one source; ORs 1.50–1.16, P's-< 0.05), pastries or chocolate (≥ 2/3 of a standard bar) (ORs = 1.35–1.37, P's < 0.05), and fiber (2–3 sources daily; OR = 0.83, CI 0.69–1.00, P < 0.05), as well as high waist-to-height ratio (OR = 0.91, CI 0.69–0.97, P < 0.05). Other factors included income (<C$100,000/yr; ORs 1.39–2.58, P's < 0.001), being widowed, divorced, or separated (OR = 1.35, CI 1.10–1.65, P < 0.05), having multiple chronic conditions (ORs = 1.76–3.34, P's < 0.001), experiencing chronic pain (OR = 1.64, P < 0.001), and smoking (OR = 1.22, P < 0.001). Conclusions Many nutrition-related factors contribute to PTSD in mid-age and older adults suggesting that targeted nutrition interventions within comprehensive programming will likely help prevent or manage PTSD. Funding Sources MITACS and Fulbright Canada.

0581 Characteristics of US Women Veterans with Sleep Apnea: Results of a National Survey of VA Healthcare Users

Abstract Introduction Sleep apnea (SA) is the most commonly diagnosed sleep disorder among patients in the US Veterans Administration (VA). The dramatic rise in women receiving VA care makes it essential to understand the presentation and treatment of SA in women Veterans. We performed a nationwide survey about sleep among US women Veterans and compared characteristics of respondents with and without a self-reported history of SA diagnosis and treatment. Methods A survey was mailed to a random sample of 4000 women VA healthcare users. The survey included demographics, Insomnia Severity Index (ISI), Patient Health Questionnaire-4 (PHQ-4 depression/anxiety), Primary Care-Post-Traumatic Stress Disorder (PC-PTSD), RLS symptom presence, SA symptoms (snore loudly, observed breathing pauses), diagnosis of SA, and use of PAP therapy (APAP, BPAP, CPAP). We compared women with and without SA, and (among those with SA) women who did and did not use PAP, using Chi-square and t-tests. Results 1,498 completed surveys were returned (mean age 51.6 years, range 18-105 years, 62% non-Hispanic White). 200 respondents (13.4%) reported diagnosed SA. Women with SA were older (p<.001), likely to be employed (p=.013), more likely to snore loudly (p<.001) and to have breathing pauses while asleep (p<.001). They also had higher ISI (p<.001), were more like to report RLS (p<.001) nightmares (p=.027), and had higher PHQ-4 (p<.001) and PC-PTSD (p<.001) scores. Among women with SA, 130 (65%) used PAP. Loud snorers (p<.001) and those with observed breathing pauses were more likely to use PAP (p<.001). Conclusion One in 7 women who receive VA care report diagnosed SA. Women with SA had more mental health symptoms and comorbid sleep problems. Most reported using PAP therapy, although the amount of use is unknown. Those with SA symptoms were more likely to use PAP. Future work is needed to understand barriers to diagnosis and treatment of SA among women Veterans. Support Funding: VA Quality Enhancement Research Initiative RRP12-189 (Martin); NIH/NHLBI K24 HL143055 (Martin).

From Tear to Fear: Posttraumatic Stress Disorder in Patients With Acute Type A Aortic Dissection.

BackgroundAcute type A aortic dissection presents with abrupt onset of pain that requires emergency surgery. However, minimal research exists on posttraumatic stress disorder (PTSD) in survivors. We aimed to quantify the prevalence and describe characteristics of PTSD in patients following dissection.Methods and ResultsA total of 295 adult survivors of surgical dissection with an email on file were administered a cross‐sectional online survey about their dissection experience; 137 returned questionnaires, and 129 (94%) responded to the 4‐item Primary Care PTSD portion of the survey that was part of a larger lifestyle survey designed to study survivors of aortic dissection and surgery. In addition to the PTSD screening, it inquired about current sexual activity, exercise habits, and employment within the preceding 30 days. At a median of 6.8 years (quartile 1=2.6, quartile 3=8.9 years) after dissection, 23% of patients (30/129) screened positive for PTSD, with 44% (57/129) stating that within the past month they felt constantly on guard or watchful or were easily startled. Of those who screened positive and matched to their electronic medical record (n=27), only 2 (7.4%) had been tested and clinically diagnosed with PTSD. Patients who screened positive for PTSD were more likely to report limited current sexual activity than those who did not (odds ratio, 5.3; 95% CI, 1.9–15 [P=0.0006]).ConclusionsPTSD is an important mental health consideration in aortic dissection survivors. Physicians should screen these patients for PTSD at follow‐up visits to identify those who test positive and refer them for further testing and treatment, such as trauma‐focused psychotherapy or medication.

The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans' Perinatal Outcomes Following Separation From Military Service.

Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period.

Symptom burden in patients with cancer who are experiencing unplanned hospitalization

Inpatient supportive care programs often target patients with advanced solid tumors. To the authors' knowledge, few studies to date have characterized symptom burden in hospitalized patients with potentially curable cancers. The objective of the current study was to compare symptom burden, palliative care consultation, and readmission rates in hospitalized patients by cancer type and treatment intent. The authors conducted a single-center study of hospitalized patients with cancer between 2014 and 2017. They assessed physical symptoms using the Edmonton Symptom Assessment System and psychological distress using the Patient Health Questionnaire-4 and the Primary Care PTSD (Posttraumatic Stress Disorder) Screen. Multivariate linear regression models were used to assess symptom burden, logistic regression was used to assess palliative care use, and competing risk regression was used to compare 90-day readmission risk. A total of 1549 patients were enrolled and surveyed. The majority of patients reported moderate to severe fatigue, poor well-being, and drowsiness with no significant differences noted by cancer type and treatment intent. Compared with other groups, patients with incurable solid cancer reported higher physical symptoms (beta coefficient [B], 4.73; P<.01) and symptoms of depression (B, 0.44; P<.01) and anxiety (B, 0.39; P<.01), but no difference in posttraumatic stress disorder. Among patients in the top quartile symptom burden according to the Edmonton Symptom Assessment System, the palliative care service was consulted in 14.7%, 7.9%, 25.0%, and 49.6%, respectively, of patients with potentially curable hematologic, potentially curable solid, incurable hematologic, and incurable solid cancers (P<.001). Compared with patients with potentially curable solid cancer, patients in each group experienced a higher risk of readmission within 90days. Hospitalized patients with cancer experience substantial physical and psychological symptoms. Palliative care rarely is consulted for highly symptomatic patients with potentially curable cancers. Supportive care interventions should target the needs of symptomatic patients regardless of treatment intent.

778 Association of Demographic and Burn-related Factors to PTSD Pre-screen Survey Results Among Burn Patients

Abstract Introduction A burn injury can be a traumatic experience and many patients suffer physical, social, and psychological consequences. Stress disorders, including posttraumatic stress disorder (PTSD), have been reported to occur after burn injury in 18%-33% of cases, but knowledge about the predictors of PTSD in burn patients is still lacking. The objective of our study is to evaluate the demographic and burn-related factors in these patients associated with screening positive or negative to be at high risk for PTSD. Methods All patients who met the inclusion/exclusion criteria were administered the 4-item Primary Care Post-Traumatic Stress Disorder screen (PC-PTSD) survey, and subsequently their charts were reviewed. High risk of PTSD was defined as a “yes” answer to three or more survey questions. Variables collected on each subject included gender, date of birth, age at time of burn, date of burn, race, ethnicity, insurance category, TBSA, burn location, and whether surgery was required for the burn. Wilcoxon rank sum test with continuity correction was used to compare patients with a positive screen to those without one. Fisher’s Exact Test for Count Data was used to analyze the associations of gender and need for surgery to the positive or negative screening test results. Results Among the 121 patients who met inclusion criteria and had burn mechanism documented, 15 were excluded due to missing information or unclear burn mechanism. Among the 121 patients, 55 (45.5%) screened positive and 66 screened negative. The mean (median) TBSA percentage for the patients screening negative was 4.79 (3.0) and 11.35 (4.5) for the patients who screened positive (P=0.02). 51.8% of females had a positive screening test compared to 40% males (Fisher’s exact P=0.206). Of the patients requiring surgery, 49% of the patients had a positive screening test, compared to only 40% who did not require surgery (Fisher’s exact P = 0.365). Conclusions In analyzing these survey results it was clear that burn patients with a higher TBSA are significantly more likely to develop PTSD than those will a smaller TBSA, with the mean TBSA for patients developing PTSD being 11.35%. Probable association was found between developing PTSD and female gender. The need for surgery was also correlated with a slight increase in PTSD, though this was not statistically significant. More research is necessary to determine other factors in burn patients that may be associated with PTSD. Applicability of Research to Practice All patients with burns should be screened for PTSD, but particularly those with greater than 11% TBSA. Resources should be given to burn patients at discharge to follow up on the results of their PTSD screening.

The scales of recovery: Balancing posttraumatic stress with resilience in the violently injured.

Community violence remains a clinical concern for urban hospitals nationwide; however, research on resilience and posttraumatic growth (PTG) among survivors of violent injury is lacking. This study intends to assess survivors of violent injury for resilience and PTG to better inform mental health interventions. Adults who presented with nonaccidental penetrating trauma to an urban level 1 trauma center and were at least 1 month, but no more than 12 months, from treatment were eligible. Participants completed the Connor-Davidson Resiliency Scale, Posttraumatic Growth Inventory (PTGI), Primary Care Posttraumatic Stress Disorder screen, and a community violence exposure screen. Additional demographic, injury, and treatment factors were collected from medical record. A total of 88 patients participated. The mean resiliency score was 83.2, with 71.1% scoring higher than the general population and 96.4% scoring higher than the reported scores of those seeking treatment for posttraumatic stress disorder (PTSD). Participants demonstrated a mean PTGI score of 78 (SD, 20.4) with 92.4% scoring above the significant growth threshold of 45. In addition, 60.5% of patients screened positive for significant PTSD symptoms, approximately eight times higher than general population. Exposure to other traumatic events was high; an overwhelming 94% of participants stated that they have had a family member or a close friend killed, and 42% had personally witnessed a homicide. Higher resilience scores correlated with PTGI scores (p < 0.001) and lower PTSD screen (p = 0.02). Victims of violent injury experience a myriad of traumatic events yet are highly resilient and exhibit traits of growth across multiple domains. Resiliency can coexist with posttraumatic stress symptoms. Practitioners should assess for resiliency and PTG in addition to PTSD. Further investigation is needed to clarify the relational balance between resilience and posttraumatic stress. Epidemiological study type, Level II.

The psychological impact of COVID-19 on the families of first-line rescuers.

Under the COVID-19 epidemic, the families of front-line rescue workers are under unusual pressure. We aim to understand the extent of their psychological distress in this epidemic and whether they have received sufficient support. Thus targeted to provide support for them and indirectly reduce the concerns of the rescue workers. From February 27 to March 1, 2020, we used the scales of Perceived Stress Scale, 10-items Connor-Davidson Resilience Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-2, and primary care-posttraumatic stress disorder (PTSD) to evaluate the mental health level of the family members of front-line rescue workers online. Six hundred and seventy one family members voluntarily filled out the questionnaire after reading the purpose of the study. A total of 671 family members of front-line rescue workers participated in the survey, including 194 husbands/wives, 52 parents, 49 children, 76 brothers and sisters, and 300 other relationships. Among them, 55% of the family members reported sleep problems, 49.0% of the family members had mild, and above anxiety symptoms, 12.2% of the family members reported clinically significant depression symptoms, and 10.4% of the family members may have PTSD, 8.3% of family members had thoughts of self-injury or suicide. The feeling of stress was positively correlated with anxiety and depression, but there was no significant correlation between psychological elasticity and various symptoms. Family members who are more worried about the safety, physical condition and living security of front-line rescue workers are more likely to report symptoms such as sleep disorders, anxiety, and depression. Family members' first-line rescue has a significant impact on their daily life, raising children and supporting the elderly, which is also related to the occurrence of mental and psychological symptoms. During the period of front-line support, they received support from the units or organizations of the first-line workers, mainly including telephone greetings and daily necessities. The top three concerns about the information of the epidemic were the time of the end of the epidemic, the time of the return of the family and the progress of COVID-19's treatment. After the end of the epidemic, what they most want to do is to pay more attention to and accompany their families, family gatherings, and do more exercise. The psychological impact of this epidemic on the families of front-line rescue workers is mainly sleep problems and anxiety. The psychological intervention of family members should mainly start from the relief of stress and increase of material and spiritual support.

Psychosocial factors and medication adherence among recipients of vascularized composite allografts.

Objectives:Psychosocial factors are important predictors of medication adherence, and subsequently graft survival, in solid organ transplantation. Early experiences suggest this may also be the case in vascularized composite allotransplantation.Methods:Using validated tools, we surveyed upper extremity transplant recipients at two centers to assess depression (Patient Health Questionnaire-9), personality (Ten-Item Personality Inventory), anxiety (Generalized Anxiety Disorder 7-Item Scale), post-traumatic stress disorder (Primary Care Post-Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), and social support (Multidimensional Scale of Perceived Social Support). Medication adherence among vascularized composite allotransplantation recipients at two centers was assessed by a member of the clinical research team using the recipients’ medical records.Results:Medication adherence was reported for 12 vascularized composite allotransplantation recipients, and 9 vascularized composite allotransplantation recipients completed psychosocial assessments. Most recipients were believed to be adherent to their immunosuppression, however, three recipients were believed to be non-adherent and a member of the clinical team had discussed non-adherence at least once with five recipients. Results from the psychosocial assessment (n = 9) indicated that eight participants had high levels of social support, and eight demonstrated high levels of conscientiousness which have been associated with better medication adherence in solid organ transplantation. However, three participants demonstrated mild anxiety, two demonstrated minimal symptoms of depression, and one demonstrated post-traumatic stress disorder which have been associated with worse medication adherence in solid organ transplantation.Conclusion:These findings lay the groundwork for future assessments of the role psychosocial factors play in facilitating medication adherence and broader transplant outcomes.

Post-traumatic stress disorder and subthreshold post-traumatic stress disorder in recent male asylum seekers: An expected but overlooked "European" epidemic.

The literature shows an increased risk for post-traumatic stress disorder (PTSD) among illegal migrants. We aimed to estimate the prevalence of PTSD, subthreshold PTSD, the degree of disability, and differences in sociodemographic and anamnestic characteristics associated with these clinical conditions in a sample of newly arrived migrants. Two hundred male asylum seekers from West sub-Saharan Africa were evaluated for traumatic life events, PTSD symptoms, and disability through the Life Events Checklist for DSM-5 (LEC-5), the Primary Care PTSD Screen, the PTSD Checklist for DSM-5, and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The current prevalence of PTSD and subthreshold PTSD was 9.5% and 12.0%, respectively. PTSD and subthreshold PTSD subgroups presented higher WHODAS 2.0 scores and LEC-5 events, an over-representation of individuals with childhood adversities and an excess of premigration psychiatric contacts unrelated to PTSD spectrum disorders and peri-migration offences. Witnessing a traumatic event and disability in understanding and communication predicted both the presence of PTSD symptoms and PTSD status. PTSD spectrum disorders should be considered among the clinical emergencies associated with asylum seeker condition, and targeted interventions also involving the host citizens should be predisposed.

Pilot of a screening, brief intervention and referral to treatment process for symptoms of trauma among primary care patients.

For populations with high rates of trauma exposure yet low behavioural health service use, identifying and addressing trauma in the primary care setting could improve health outcomes, reduce disability and increase the efficiency of health system resources. To assess the acceptability and feasibility of a screening, brief intervention and referral to treatment (SBIRT) process for trauma and symptoms of posttraumatic stress disorder (PTSD) among American Indian and Alaska Native people. We also examine the short-term effects on service utilization and the screening accuracy of the Primary Care Posttraumatic Stress Disorder Screen. Cross-sectional pilot in two tribal primary care settings. Surveys and interviews measured acceptability among patients and providers. Health service utilization was used to examine impact. Structured clinical interview and a functional disability measure were used to assess screening accuracy. Over 90% of patient participants (N = 99) reported the screening time was acceptable, the questions were easily understood, the right staff were involved and the process satisfactory. Ninety-nine percent would recommend the process. Participants screening positive had higher behavioural health utilization in the 3 months after the process than those screening negative. The Primary Care Posttraumatic Stress Disorder Screen was 100% sensitive to detect current PTSD with 51% specificity. Providers and administrators reported satisfaction with the process. The SBIRT process shows promise for identifying and addressing trauma in primary care settings. Future research should explore site specific factors, cost analyses and utility compared to other behavioural health screenings.

Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries

The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. A GSW sustained from January 1, 2008, through December 31, 2017. Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. This study's results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.

An Internet-Based Therapeutic Tool for American Indian/Alaska Native Adults With Posttraumatic Stress Disorder: User Testing and Developmental Feasibility Study.

BackgroundPosttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native populations. Primary care clinics are often the first point of contact for American Indian and Alaska Natives seeking health care and are feasible locations for trauma-focused interventions.ObjectiveWeb-based therapeutic interventions have the potential to reduce PTSD symptoms by offering psychoeducation and symptom self-management tools. We investigated the feasibility of a culturally adapted Web-based therapeutic intervention in two American Indian and Alaska Native–serving primary care sites. We developed and tested a self-guided Web-based therapeutic intervention aimed at improving knowledge and awareness of, and provision of guidance, support, and symptom-management for, PTSD symptoms.MethodsA community-based participatory research process was used to refine adaptations to the veteran’s administration’s PTSD Coach Online, to develop new content, and to guide and interpret the results of the feasibility pilot. This process resulted in a 16-guide intervention “Health is Our Tradition: Balance and Harmony after Trauma” website. The feasibility pilot included 24 American Indian and Alaska Natives aged 18 years and older who scored positive on a primary care PTSD screener. Enrolled participants completed a demographic questionnaire, an experience with technology questionnaire, and baseline behavioral health measures. Once measures were complete, research staff described weekly text messages, minimum study expectations for website use, and demonstrated how to use the website. Feasibility measures included self-reported website use, ratings of satisfaction and perceived effectiveness, and website metrics. Feasibility of obtaining measures for an effectiveness trial was also assessed to include behavioral health symptoms and service utilization through self-report instruments and electronic health record queries. Self-reported measures were collected at enrollment and at 6 and 12 weeks post enrollment. Electronic health records were collected from 12 months before study enrollment to 3 months following study enrollment. Changes between enrollment and follow-up were examined with paired t tests, analysis of variance or logistic regression, or the Wilcoxon signed rank test for nonnormally distributed data.ResultsThe culturally adapted website and associated text message reminders were perceived as satisfactory and effective by participants with no differences by age or gender. The majority of participants (86%, 19/24) reported use of the website at 6 weeks and nearly all (91%, 20/22) at 12 weeks. At 6 weeks, 55% (12/22) of participants reported using the website at the recommended intensity (at least three times weekly), dropping to 36% (8/22) at 12 weeks. Participant use of modules varied from 8% (2/24) to 100% (24/24), with guide completion rates being greater for guides that were only psychoeducational in nature compared with guides that were interactive. There were no significant changes in patterns of diagnoses, screening, medications, or service utilization during exposure to the website.Conclusions“Health is Our Tradition: Balance and Harmony after Trauma” shows promise for an effectiveness pilot.

CROSS-SECTIONAL ASSOCIATION OF FALLS AND POST-TRAUMATIC STRESS IN CANADIANS ACROSS LEVELS OF FRAILTY

Frail older adults are vulnerable to stressors and are more likely to experience adverse outcomes. Post-traumatic stress is common in older adults, and can be related to common adverse outcomes, such as falls. We examined whether falls are associated with post-traumatic stress in middle-aged and older Canadians, by levels of frailty. We conducted cross-sectional analysis of the baseline assessment of the Canadian Longitudinal Study on Aging’s tracking cohort, comprising 21,241 individuals, aged 45 to 85 years. We constructed a 60-item frailty index (FI) and defined post-traumatic stress using the primary care post-traumatic stress disorder four-item tool (score 3 as the cut-point). Logistic regressions with post-traumatic stress as the dependent variable and at least one fall in the past year as the independent variable, were adjusted for socio-demographic variables and stratified according to FI 0.1 groups. Prevalence of post-traumatic stress and falls was of 6.5% and 5.0%, respectively for the whole sample. Among those who did not fall prevalence of post-traumatic stress ranged across frailty levels from 3.2% (FI<0.1) to 24.5% (FI≥0.3). Among those who fell, post-traumatic stress ranged from 3.4% (FI<0.1) to 36.9% (FI≥0.3). Falls were not significantly associated with post-traumatic stress among people who had an FI<0.3, but among those with an FI≥0.3 the odds ratio for having post-traumatic stress for those who fell was 2.25 (95% CI 1.2-4.23, p=0.011) compared to non-fallers. In conclusion, high levels of frailty can impact how a stressor, such as a fall, can be associated with an adverse psychological outcome.

Short-Term Music Therapy Attention and Arousal Regulation Treatment (SMAART) for Prisoners with Posttraumatic Stress Disorder: A Feasibility Study

ABSTRACTHyperarousal and attention problems as a result of posttraumatic stress disorder (PTSD) are being recognized as a risk for offense recidivism. Short-term Music therapy Attention and Arousal Regulation Treatment (SMAART) was designed as a first step intervention to address responsivity and treatment needs of prisoners who were not eligible for or unwilling to undergo eye movement desensitization and reprocessing (EMDR) therapy. This article describes a pilot study of the manualized SMAART protocol in a Penitentiary Psychiatric Center (PPC) and whether there is an increase of focused and sustained attention and a decline of arousal symptoms in prisoners suffering from PTSD, attributable to SMAART. A single case baseline-treatment-design with pre- and post-assessment (N = 13) was used. PTSD prevalence and severity were assessed using the Primary Care-PTSD screen and the PTSD Symptom Scale Interview. Selective and sustained attention was assessed using the Bourdon–Wiersma dot cancellation test. The results show a promising decline of arousal symptoms as well as improved selective and sustained attention levels in the subjects. Also, after the SMAART intervention, five participants no longer met the threshold for a PTSD diagnosis. The results show that the SMAART protocol could be implemented in the PPC-setting. Although the clinical results of the manualized SMAART protocol suggest improvement, this is a small feasibility study so the results must be interpreted with care. Suggestions for future research are offered.

Patterns and correlates of racial/ethnic disparities in posttraumatic stress disorder screening among recently separated veterans

BackgroundDespite the high prevalence of posttraumatic stress disorder (PTSD) among military veterans, there is a lack of knowledge about racial/ethnic differences. The current study describes patterns and correlates of PTSD screening across race/ethnicity and gender in a sample of 9420 veterans recently separated from the military. Veterans who identified as White (n = 6222), Hispanic/Latinx (n = 1313), Black (n = 1027), Asian/Hawaiian/Pacific Islander (n = 420) and multiracial (n = 438) were included. MethodTrauma exposure and PTSD were assessed with the Primary Care PTSD Screen for DSM-5. Contextual factors examined included the intensity of ongoing stressful events, perceived social support, and sociodemographic variables (e.g., income). Weighted analyses were conducted to account for differential sample response rates. Regression analyses examining correlates of racial/ethnic differences in PTSD screening were stratified by gender. ResultsAmong men and women, positive PTSD screening rates were significantly elevated among Black, multiracial, and Hispanic/Latinx veterans compared with White veterans. Sociodemographics, trauma exposure, stress and social support accounted for elevated positive screening rates among all racial/ethnic groups except Black men and multiracial women. ConclusionsFindings suggest that Black, Hispanic/Latinx and multiracial veterans may be at higher risk for PTSD shortly following separation from the military. Contextual factors examined explain the excess risk among some, but not all, subgroups. Further specifying disparities in PTSD diagnostic rates and risk factors will enable targeted and tailored intervention among veteran subgroups.

Use of alcohol as a sleep aid, unhealthy drinking behaviors, and sleeping pill use among women veterans

ObjectivesSleep complaints, such as insomnia and sleep disturbances caused by posttraumatic stress disorder (PTSD), are more common among women veterans than nonveteran women. Alcohol use among some women may be partially motivated by the desire to improve sleep. This study evaluated rates of alcohol use as a sleep aid among women veterans and explored the relationship between alcohol use to aid sleep and drinking frequency and sleeping pill use. Design and settingNational cross-sectional population-based residential mail survey on sleep and other symptoms. ParticipantsRandom sample of women veteran VA users who completed a postal survey (N = 1533). InterventionsNone. MeasurementsThe survey included demographics, Insomnia Severity Index, Primary Care PTSD screen, and items on alcohol use frequency (days/week), use of prescription or over-the-counter sleep medications, and use of alcohol as a sleep aid (yes/no for each item) over the past month. ResultsA total of 14.3% of respondents endorsed using alcohol to aid sleep. Logistic regression models showed more severe insomnia (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.01-1.06) and PTSD (OR = 2.11; 95% CI: 1.49-2.97) were associated with increased odds of using alcohol to aid sleep. Alcohol use to aid sleep was associated with increased odds of daily drinking (OR = 8.46; 95% CI: 4.00-17.87) and prescription (OR = 1.79; 95% CI: 1.34-2.38) and over-the-counter sleep aid use (OR = 1.54; 95% CI: 1.12-2.11). ConclusionsInsomnia and PTSD may increase risk for using alcohol as a sleep aid, which may increase risk for unhealthy drinking and for mixing alcohol with sleep medications. Findings highlight the need for alcohol use screening in the context of insomnia and for delivery of cognitive-behavioral therapy for insomnia to women veterans with insomnia.

Randomized, Double-Blind Study of Fixed-Dose Intranasal Esketamine Plus Oral Antidepressant vs. Active Control in Treatment-Resistant Depression

Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years.4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses.The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77.A clinical interview was not used to validated diagnostic findings.The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.

Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children

BackgroundEffective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years. Methods4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses. ResultsThe mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77. LimitationsA clinical interview was not used to validated diagnostic findings. ConclusionsThe reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.

Validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in Eritrean refugees living in Ethiopia

BackgroundDepression is among the top mental health problems with a major contribution to the global burden of disease. This study aimed at identifying the latent factor structure and construct validity...