Posttraumatic Stress Disorder Checklist For DSM-5 Research Articles

PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public.

BackgroundWith widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated.ObjectiveWe aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach.MethodsWe examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users.ResultsDuring the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean −1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean −4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements.ConclusionsPTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement.

DSM-5 Posttraumatic Stress Disorder Symptoms in Nonclinical Samples of Chinese and Pakistani Trauma-Exposed Adults: Factor Structure and Invariance Across Culture.

The purpose of the current study was to examine the latent structure and cross-cultural measurement validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) posttraumatic stress disorder (PTSD) symptoms assessed by the PTSD Checklist for DSM-5. Participants comprised trauma-exposed Chinese and Pakistani undergraduate students (N = 495 and N = 186, respectively). Confirmatory factor analysis (CFA) indicated that a seven-factor hybrid model involving intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal factors provided good fit in both samples. This model fit significantly better than three alternative models including the DSM-5 four-factor model and six-factor anhedonia and externalizing behaviors models. The subsequent multigroup CFA showed that the best-fitting hybrid model demonstrated cross-cultural measurement invariance. Our findings provide further empirical support for the seven-factor PTSD hybrid model and its cross-cultural invariance, and have implications for understanding and application of DSM-5's PTSD symptoms.

The Relationship between Positive Memory Phenomenology and Alcohol Use among Trauma-Exposed Individuals

Background: Evidence links positive memory characteristics and hazardous alcohol use (HAU). Relevant to the current study, evidence also indicates that trauma-exposed individuals, especially those with posttraumatic stress disorder (PTSD) symptoms, report difficulties retrieving/accessing positive memories and report HAU. Objective: Considering this literature, we uniquely examined if and which positive memory characteristics were associated with HAU, and the potential mediating role of PTSD symptom severity in the examined relations. Methods: A sample of 126 trauma-exposed community participants seeking mental health treatment (Mage=34.97 years) completed measures of HAU (Alcohol Use Disorders Identification Test), positive memory characteristics (Memory Experiences Questionnaire–Short Form [MEQ-SF]), and PTSD severity (PTSD Checklist for DSM-5). We conducted 8 hierarchical multiple regressions; Step 1 examined effects of gender and Step 2 added a single MEQ-SF dimension (specificity, valence, emotional intensity, sensory details, vividness, accessibility, coherence, sharing). Results: In Steps 1 (β=.27) and 2 (βs from .27-.28), gender was associated with HAU. In Step 2, positive memory characteristics of specificity (β=.17), sensory details (β=.17), sharing (β=.23), and valence (β=-.19) were associated with greater HAU. PTSD severity mediated relations between sensory details (β=.09, p=.048), emotional intensity (β=.12, p=.011), and sharing (β=.09, p=.036), and the extent of HAU. Conclusions and implications: Results that specificity, greater sharing, more sensory details, and higher negative valence of positive memories were associated with greater HAU offer potential points of intervention.

PTSD Prevalence Rates of US Funeral Directors during the COVID-19 Pandemic

The COVID-19 pandemic has created physical and mental health concerns for funeral directors. Past literature notes that high job demands, occupational death exposure, and heightened numbers of funerals have negative impacts on the mental health of funeral workers. Additionally, previous studies have found prevalence rates of PTSD to be more than three times higher in funeral directors than the general population. The present study sought to evaluate PTSD rates of funeral directors in the United States during the COVID-19 pandemic given the increased job demands, high rates of burnout, and heightened death exposure they have faced. A convenience sample was used, and 10 participants completed an online survey containing the PTSD Checklist for DSM-5 (PCL-5) and questions regarding awareness of mental health resources. Findings indicate that 50% of participants met criteria for a provisional PTSD diagnosis (n = 5), and 30% of participants had little to no awareness of mental health resources for funeral directors (n = 3). The results highlight the need for increased research and awareness regarding the mental health of funeral directors, particularly during times of increased stress, and the need for mental health services for funeral workers.

Peace of mind: Promoting psychological growth and reducing the suffering of combat veterans

ABSTRACT The Peace of Mind (POM) program was designed to enable combat veterans in Israel to process their combat experience, address difficulties in the transition to civilian life and facilitate psychological growth as a result of their military experience. During the course of the program, 1068 participants were studied at four time points. Post-traumatic symptoms were measured using the PTSD checklist for DSM-5 (PCL-5), and post-traumatic growth (PTG) was measured using the Post Traumatic Growth Inventory (PTGI). Multilevel Modeling (MLM) was used to assess symptom and psychological trajectories for all participants and for those who began with and without PTSD symptoms, respectively. The results demonstrated that those who began the program with elevated PTSD symptoms experienced a significant reduction in PTSD symptoms following the completion of the intensive element of the program. Additionally, all participants demonstrated an increase in PTG following the intensive section of the program and this was maintained throughout follow-up. The findings indicate that the POM program is beneficial in relation to both positive and negative outcomes of traumatic military experiences though it is clear that the transition from combat to civilian life is more complex than the current measures identify and that further research needs to examine the distinct lifestyle and functional changes which occur following the program.

The more mindfulness practice, the more post-trauma stress symptoms? Trait mindfulness and PTSS during the COVID-19 pandemic.

Investigating the contributing factors of post-traumatic stress symptoms (PTSS) has always been an important topic in the field of traumatic psychology research. The current study explored the influences of pandemic/epidemic experiences, meditation experiences, and trait mindfulness on PTSS and the mediating role of emotional resilience during the COVID-19 pandemic. A total of 522 participants in Hubei province completed the Five Facet Mindfulness Questionnaire, the Adolescents’ Emotional Resilience Questionnaire, and the PTSD Checklist for DSM-5. The results showed that (1) participants who had family or friends diagnosed with COVID-19 scored higher on avoidance. (2) Participants who had family or friends had been diagnosed with SARS or H1N1 scored higher on PTSS. (3) Participants with meditation experience scored significantly higher on all dimensions of PTSS, other than avoidance. (4) The mediating role of recovering from negative emotions in the relationship between trait mindfulness and PTSS was significant (95%CI= [-0.212, -0.094]), while the generating positive emotion was not significant (95%CI= [-0.050, 0.071]). Individuals with pandemic/epidemic experience are more likely to have a high level of PTSS. Individuals who have meditation experience also express a higher level of PTSS, which may be a result of the quality of meditation. Trait mindfulness and the ability to recover from negative emotions were protective factors against PTSS.

Income and social support related with mental health during COVID-19 outbreak in China.

To investigate psychological response of Chinese public during the regular prevention and control of Corona Virus Disease 2019 (COVID-19), and explore the relationship among income loss, social support and mental health.Five hundred twenty-six participants were randomly selected by snowball sampling method. Chinese version of Perceived Psychological Stress Scale, Perceived Social Support Scale, self-rating anxiety scale, and the PTSD Checklist for DSM-5 were used to measure the levels of psychological stress, social support, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Demographic variables, income loss and income satisfaction during the outbreak period were also collected.The prevalence rate of anxiety, PTSD symptoms and stress problems were 19.8%, 23.8%, and 24.7% respectively. Multiple Regression Analysis illustrated that social support associated with stress, anxiety and PTSD after controlling demographic variables; for non-student samples, stress, anxiety, and PTSD were corelated with change in income and social support.During the regular prevention and control of COVID-19, social support might help reducing stress, anxiety, and PTSD symptoms. In addition to social support, change of income level was also an important factor for mental health. This study suggested the importance of maintaining a steady income after acute outbreak of COVID-19.

Examining the psychometric properties of the PCL-5 in a black community sample using item response theory

Black Americans are more likely to be exposed to certain types of traumatic events and experience posttraumatic stress disorder (PTSD) compared to other racial groups. Consequently, sound assessment of PTSD in this underserved and understudied population is necessary to develop and accurately answer research questions about etiology and intervention efficacy. However, the item-level psychometric properties of one of the most commonly used assessment tools, the PTSD Checklist for DSM-5 (PCL-5), has yet to be examined among Black Americans. To address this gap, we used item response theory (IRT) to assess item difficulty and discrimination in a sample of Black American adults (n = 307). We employed a graded response model with all 20 items of the PCL-5 loading on to a latent PTSD factor. At clinically significant levels of PTSD, the most discriminating items were flashbacks, inability to experience positive emotions, and nightmares and the least discriminating items were cued emotional distress, diminished interest, and hypervigilance. These results emphasize the importance of flashbacks, inability to experience positive emotions, and nightmares and deemphasize the importance of hypervigilance and sleep difficulties when assessing for clinically significant symptoms of PTSD in Black Americans. Treatment implications include a nuanced approach towards hypervigilance.

Cognitive-Behavioral Therapy (CBT) Is Applied in Post-Traumatic Stress Disorder (PTSD) of Chinese Shidu Parents Who Lost Their Only Child

Objective. The objective is to help Chinese Shidu parents who have lost their only child to relieve post-traumatic stress disorder. Methods. A qualitative phenomenology study using the hermeneutical phenomenological method was employed in a major metropolitan city in China. Participants were 46 parents who had lost their only child and suffered from post-traumatic stress disorder. Three major themes are: (1) to conduct semistructured in-depth interviews with 46 Shidu parents; (2) to develop and implement a psychological intervention program combining with group intervention and individual counseling based on cognitive-behavioral therapy; (3) to assess the effect of psychological intervention through PTSD Checklist for DSM-5 (PCL-5). Results. Those Shidu parents who lost their only child got great relief from PTSD. The Shidu parents got great relief and changed a lot after the intervention. They became active to participate in group counseling and willing to help others because they experienced the value and fun in the process. They rebuilt their attachment and looked forward to their future life. Conclusion. Cognitive-behavioral therapy can alleviate and even cure post-traumatic stress disorder in Shidu parents who have lost their only child.

Trauma-focused EMDR for Personality disorders among Outpatients (TEMPO): study protocol for a multi-centre, single-blind, randomized controlled trial

BackgroundExisting recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals’ adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored.MethodIn total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention.DiscussionIt is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses.Trial registrationNetherlands Trial Register NL9078. Registered on 31 November 2020

One Year after the Flood: Prevalence and Correlates of Post-Traumatic Stress Disorder among Residents in Fort McMurray.

Background: The 2020 Fort McMurray (FMM) and area flood caused more than $228 million in insured damage, affected over 1200 structures, and more than 13,000 people were evacuated. Objective: This study sought to determine the prevalence of post-traumatic stress disorder (PTSD)-like symptoms and the risk predictors among the population of FMM one year after the 2020 flooding. Methods: An online quantitative cross-sectional survey was distributed to residents of FMM via REDCap between 24 April to 2 June 2021 to collect sociodemographic, clinical, and flood-related information. The PTSD checklist for DSM-5 (PCL-C) was used to assess likely PTSD among respondents. Results: 186 of 249 respondents completed all essential self-assessment questionnaires in the analysis, yielding a response rate of 74.7%. The prevalence of likely PTSD was 39.6% (65). Respondents with a history of depression were more likely to develop PTSD symptoms (OR = 5.71; 95% CI: 1.68–19.36). Similarly, responders with limited and no family support after the disaster were more prone to report PTSD symptoms ((OR = 2.87; 95% CI: 1.02–8.05) and (OR = 2.87; 95% CI: 1.06–7.74), respectively). Conclusions: Our research indicated that history of depression and the need for mental health counseling significantly increased the risk of developing PTSD symptoms following flooding; family support is protective. Further studies are needed to explore the relations between the need to receive counseling and presenting with likely PTSD symptoms.

Psychometric properties of post-traumatic stress disorder (PTSD) checklist for DSM-5 in persons with serious mental illness

ABSTRACT Background PCL-5 is a self-report measure consisting of 20 items that are used to assess the symptoms of Post-Traumatic Stress Disorder (PTSD) according to the DSM-5. Objective This study evaluated the factor structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in people with serious mental illness. Method The sample in Study 1 included 536 participants with serious mental illness who were receiving supported employment services through community mental health agencies or supported housing programmes. Confirmatory factor analysis assessed the fit of six different models of PTSD. Results Results indicated that Armour’s Hybrid 7-factor model composed of re-experiencing, avoidance, dysphoria, dysphoric arousal, anxious arousal, negative affect, anhedonia, and externalizing behaviours demonstrated the best fit. Study 2 found support for convergent validity for PCL-5 among 132 participants who met criteria for PTSD. Conclusion Findings provide support for the psychometric properties of the PCL-5 and the conceptualization of the 7-factor hybrid model and the 4-factor DSM-5 model of PTSD among persons living with serious mental illness.

Post-traumatic stress disorder in patients with rheumatic disease during the COVID-19 outbreak: a cross-sectional case–control study in China

ObjectiveThe COVID-19 pandemic is not only a traumatic event, but a collective stressor unfolding over time, causing devastating implications for the mental health. This study aimed to shed light on...

Post Deployment Assessment & Treatment (PDAT) Inpatient Rehabilitation Program Improves Both Psychological Distress and Physical Pain Experience in Veterans w/ History of mTBI/Polytrauma Comorbidities

<h3>Research Objectives</h3> To evaluate the impact of a novel integrated interdisciplinary rehabilitation program on both psychological distress and physical pain (as well as striving to understand their relatedness) in Veterans with mTBI/polytrauma diagnoses and comorbidities including chronic pain after combat deployment. <h3>Design</h3> Before-and-after trial of a novel integrated and holistically-informed rehabilitation program for Veterans with complex polytrauma symptom presentations. <h3>Setting</h3> Interdisciplinary residential PDAT rehabilitation program within a VA hospital. <h3>Participants</h3> Participants were 21 males (mean age = 36, SD = 8.8) participating in the PDAT residential program. Mean number of deployments was 1.8 (SD = 1.0). All participants had history of mTBI. Common mental health comorbidities included trauma/stress-related disorders, mood disorders, sleep disorders, and problems with alcohol misuse. Most participants experienced chronic pain. Additional demographics will be detailed. <h3>Interventions</h3> Participants received intensive individual and group therapies from an integrated team emphasizing behavioral health, PM&R, CAM and other approaches with collective focus on pain, sleep, stress/anger management, mood, cognition, communication, and community reintegration. Inpatient treatment varied from 7 to 38 weeks in extreme cases. <h3>Main Outcome Measures</h3> Beck Depression Inventory-II and PTSD Checklist for DSM-5 are measures of depressive and PTSD symptomatology well-validated with Veterans. The Brief Pain Inventory measures aspects of pain including both severity and disabling impact on daily function. <h3>Results</h3> Results showed significant improvement of depression and PTSD symptoms after program participation (t = 5.38 and 7.32, respectively; both p <.001). Results also showed significantly reduced pain severity ratings (t = 2.47, p=.023), although interestingly, greater reductions were shown for impact of pain on daily function (t= 3.31; p=.003). Covariates and potential moderators will be further detailed. <h3>Conclusions</h3> Demonstrates significant benefit of PDAT inpatient rehabilitation program participation toward improvement of both psychological distress and comorbid physical pain. Findings can inform developing treatment approaches, particularly as expanded non-pharmacological treatment options for chronic pain are needed, and as studies increasingly provide support for integrated treatment of pain, mood/stress disorders, and sleep problems presenting comorbidly with mTBI. <h3>Author(s) Disclosures</h3> Nothing to Disclose.

Evidence-based posttraumatic stress disorder treatment in a community sample: Military-affiliated versus civilian patient outcomes.

Posttraumatic stress disorder (PTSD) is a significant mental health issue among military service members and veterans. Although the U.S. Department of Veterans Affairs (VA) provides crucial resources for behavioral health care, many veterans seek mental health services through community clinics. Previous research illustrates that military and veteran patients benefit less from evidence-based treatments (EBTs) for PTSD than civilians. However, most PTSD treatment outcome research on military and veteran populations is conducted in VA or military settings. Little is known about outcomes among military-affiliated patients in community settings. The primary aim of this study was to directly compare civilian versus military-affiliated patient outcomes on PTSD and depression symptoms using the PTSD Checklist for DSM-5 (PCL-5) and the nine-item Patient Health Questionnaire (PHQ-9) in a community setting. Participants (N = 502) included military-affiliated (veteran, Guard/Reservist, active duty) and civilian patients who engaged in cognitive processing therapy (CPT) or prolonged exposure (PE) for PTSD in community clinics. Both groups demonstrated significant reductions on the PCL-5, military-affiliated: d = -0.91, civilian: d = -1.18; and PHQ-9, military-affiliated: d = -0.65, civilian: d = -0.88, following treatment. However, military-affiliated patients demonstrated smaller posttreatment reductions on the PCL-5, Mdiff = 5.75, p = .003, and PHQ-9, Mdiff = 1.71, p = .011, compared to civilians. Results demonstrate that military-affiliated patients benefit from EBTs for PTSD, albeit to a lesser degree than civilians, even in community settings. These findings also highlight the importance of future research on improving EBTs for military personnel with PTSD.

Feasibility and Acceptability of Group-Facilitated Prolonged Exposure Therapy for PTSD in VA Residential Rehabilitation Treatment Programs

Prolonged Exposure therapy (PE) is a first-line treatment for posttraumatic stress disorder (PTSD); however, few VA patients receive this treatment. One of the barriers to PE receipt is that it is only available in an individual (one-on-one) format, whereas many VA mental health clinics provide the majority of their psychotherapy services in group format. In particular, PTSD residential rehabilitation treatment programs (RRTPs) offer most programming in group format. Consequently, strategies are needed to improve the scalability of PE by adapting it to fit the delivery setting. The current study was designed to pilot test a group-facilitated format of PE in RRTPs. Thirty-nine Veterans who were engaged in care in the PTSD RRTP at a Midwestern VA were recruited to participate in a Group-facilitated PE protocol. Participants engaged in twelve 90-minute sessions of Group PE over the course of 6 weeks, plus six 60-minute individual sessions for imaginal exposure. Group treatment followed the PE model and consisted of psychoeducation, treatment rationale, and in vivo exposure to reduce trauma-related avoidance and thereby improve PTSD symptoms. PTSD symptoms were measured via the PTSD Checklist for DSM-5 (PCL-5) and depression symptoms were measured via the Patient Health Questionnaire (PHQ-9) at baseline, endpoint (6 weeks), and at 2-month follow-up. Thirty-nine individuals initiated Group-facilitated PE and 34 completed treatment. The average number of group sessions attended was 11 out of 12. Acceptability ratings were high. Mean change (improvement) in the intent-to-treat sample at 2-month follow-up was 20.0 points on the PCL-5 (CI 18.1, 21.9; Cohen’s d = 1.1) and 4.8 points on the PHQ-9 (CI 4.1, 5.5, d = .8). These results suggest that adapted evidence-based interventions for PTSD can improve treatment access and efficiency for the RRTP setting. A group-based approach has the potential to improve the scalability of PTSD treatment by reducing required resources. A fully powered trial is now needed to test the effectiveness of Group-facilitated PE in the RRTP setting.

Posttraumatic Stress Disorder in US Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study.

Objective: The US military veteran population is changing rapidly, and contemporary data on the prevalence of DSM-5 posttraumatic stress disorder (PTSD) are lacking. The DSM-5 clarified PTSD Criterion A to delineate direct and indirect trauma exposures, but effects on the conditional probability of PTSD and functional impairment remain unknown. The objectives of this study were to provide contemporary estimates of PTSD prevalence and conditional probabilities in the US military veteran population, determine the likelihood of developing PTSD following direct versus indirect exposures to potentially traumatic events (PTEs), and examine the effects of direct and indirect PTEs and PTSD on functional impairment.Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), an online survey of a nationally representative sample of US military veterans conducted from November 2019 to March 2020 (median completion date: November 21, 2019). Trauma exposures were assessed with the Life Events Checklist-5 and PTSD with the PTSD Checklist for DSM-5.Results: The weighted prevalence of lifetime PTSD was 9.4% (95% CI, 8.5%-10.3%) and of past-month PTSD was 5.0% (95% CI, 4.3%-5.7%). Direct PTEs were associated with increased odds of lifetime (odds ratio [OR] = 1.36; 95% CI, 1.30-1.42) and past-month PTSD (OR = 1.38; 95% CI, 1.31-1.46), but indirect PTEs were not (lifetime OR = 1.01; 95% CI, 1.00-1.03; past-month OR = 0.99; 95% CI, 0.97-1.00). Both PTSD (unstandardized B = 6.11, SE = 0.35) and direct PTEs (unstandardized B = 0.13, SE = 0.04), but not indirect PTEs, were significantly associated with functional impairment after adjustment for demographic and psychiatric variables.Conclusions: The prevalence of lifetime PTSD in US military veterans (9.4%) is slightly higher than 2016 estimates (6.9%-8.1%). Direct and indirect PTEs are prevalent in US military veterans, with only direct PTEs associated with higher conditional probability of past-month PTSD and greater functional impairment.

Abstract P4-09-06: An investigation into the presence of posttraumatic stress disorder symptoms in breast cancer patients

Abstract The American Cancer Society (ACS) estimates that 284,200 new cases of breast cancer will be diagnosed in 2021. According to the Texas Cancer Registry (TCR) an estimated 18,277 of those new diagnoses of female breast cancer will be made in the state of Texas. Studies have found that between 5% and 35% of breast cancer patients in the United States will develop diagnosable posttraumatic stress disorder (PTSD) or significantly impairing PTSD symptoms. The goal of the study was to gather data related to the presence of PTSD symptoms in a sample of West Texas female breast cancer patients. The proposed study aimed to:. (1)Determine the prevalence of PTSD in a sample of female, West Texas breast cancer patients(2)Identify elements of a breast cancer diagnosis and breast cancer treatment that may contribute to, or exacerbate these PTSD symptoms. Our sample consistent of 78 female breast cancer patients collected from a university medical center-affiliated cancer center in the West Texas region. The PTSD Checklist for DSM-5 (PCL5) was used to determine if a participant met diagnostic criteria for PTSD or fulfilled diagnostic criteria for any of the four symptom clusters – intrusive symptoms, avoidance symptoms, negative symptoms, and hyperarousal symptoms. PCL5 scores were then compared to a range of demographic variables including age, marital status, educational level, menopausal status, tobacco and alcohol use, time since diagnosis, as well as treatment modalities used. Further, PCL5 scores were compared to Her2, ER, and PR status of the tumor as well as clinical stage. Patients meeting criteria for PTSD and those with significant symptoms in distinct symptom clusters The only multi-group categorical variable that showed a significant relationship was lifetime tobacco use (F(2,75) = 4.97, p = 0.009) which showed a relationship such that current smokers were found to have higher PCL5 scores that either participants that were past smokers or those that had never smoked. Further, menopausal status (pre-menopausal versus post-menopausal) did was found to be related to PCL5 scores such that pre-menopausal women were found to have significantly higher PCL5 scores than post-menopausal women (t(71) = 2.558, p = 0.42). Living arrangement (alone or with others) was similarly, significantly related to PCL5 scores such that women living with others were found to have higher PCL5 scores than those living alone (t(74) = -1.904, p = .002). Receiving chemotherapy treatment or not was similarly related to PCL5 scores such that those that underwent chemotherapy treatment were found to have higher PCL5 scores (t(76), = -2.381, p = .008). HER2 positive status was also found to be related to PCL5 scores, such that HER2 positive patients were found to have higher PCL5 scores than HER2 negative patients (t(74) = -2.429, p = .001). While other samples identified larger percentages of diagnosable PTSD, our sample did find a percentage of patients with diagnosable PTSD consistent with the lower end of estimated rates. This. suggests that our sample is similar in some ways to that used in the existing body of literature. Future research could expand the scope of this study by including focusing on the significant variables identified in the current study, as well as by including more factors that may be particularly relevant to the patient population of the West Texas region, such as measures of religiosity, individualism, or self-reliance. nPercentage of total sampleNo significant symptoms4962.82%Significant symptoms in one symptom cluster1316.66%Significant symptoms in two symptom clusters67.69%Significant symptoms in three symptoms clusters33.85%Significant symptoms in all four symptom clusters (met criteria for PTSD diagnosis)78.97%Total78100% Citation Format: Evan Thomas Guidry, Nusrat Jahan, Catherine Jones. An investigation into the presence of posttraumatic stress disorder symptoms in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-06.

Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder and Psychogenic Nonepileptic Seizures: A Case Study

Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown & Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown & Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.

Difficulties and Psychological Impact of the SARS-CoV-2 Pandemic in Patients with Systemic Lupus Erythematosus: A Nationwide Patient Association Study.

Objectives: We aimed to evaluate the difficulties encountered by systemic lupus erythematosus (SLE) patients during the early COVID-19 pandemic and to evaluate their impact on patient mental health. Methods: We conducted a nationwide survey including SLE patients from France, recruited by their treating specialist or through a patient association. The survey was administered online or in paper form between November 2020 and April 2021 and included questions aiming at evaluating the difficulties encountered during the early COVID-19 pandemic (March to August 2020). The impact on mental health was evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5). Results: 536 SLE patients (91.9% women) of mean age 50 (±14.1) years responded to the survey. The main reported difficulties were issues regarding access to medical care (n = 136, 25.4%) or hydroxychloroquine treatment (n = 98/389, 25.2%), the loss of employment (n = 85/349, 24.4%), and financial difficulties (n = 75/536, 11%). In 328 patients with complete mental health assessments, 161 (47.2%) screened positive for anxiety, 141 (41.2%) screened positive for depressive syndrome, and 128 (38.7%) screened positive for PTSD. The multivariate analysis showed that female sex (OR = 4.29 [95%CI: 1.39–13.24]), financial issues (OR = 2.57 [1.27–5.22]), and difficulties accessing medical care (OR = 2.15 [1.26–3.69]) or hydroxychloroquine treatment (OR = 1.90 [1.06–3.40]) were independently associated with a positive screening for PTSD. Conclusions: The COVID-19 pandemic resulted in a severe burden in SLE patients, including difficulties accessing care and treatment along with high psychological distress. Better understanding these difficulties will allow for better prevention and care in times of crisis.