Risk Factors For Posttraumatic Stress Disorder Symptoms Research Articles

Risk factors for PTSD symptoms following PICU admission for childhood septic shock.

ObjectivePaediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10-30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory response but the relationship between this and PTSD have not been clearly established. In this study we investigate associations between the inflammatory response, psychosocial risk factors, and PTS symptoms following PICU admission for septic shock.We investigate the outcomes for children aged > 3 years, discharged from one PICU following admission for septic shock between 2010 and 2017. The study was a retrospective analysis of PICU-specific PTS symptoms reported by parents at any time since discharge via the Trauma and Behavior Health screen. Demographics, pre-morbid health characteristics, and exposure to other traumatic events were assessed. Clinical characteristics and blood test results at admission and at 48 h were recorded from clinical records. Multiple linear regression was used to investigate relationships between PTS symptom scores and predictor variables.Data for 65 participants (48% male, median assessment age 8.0 years) was available. Median time since admission was 5.1 years. 30.8% children scored at risk of PTSD at any time since discharge Symptoms were significantly associated with acute CRP rise (p 0.03), other trauma exposures (p = 0.01), and female gender (p =0.04).PTS symptoms in children who have survived septic shock are prevalent. These findings support a possible contribution of acute inflammatory changes, cumulative traumatic exposure, and female gender in post-PICU PTSD development.

Fatigue as Mediator Factor in PTSD-Symptoms after Allogeneic Hematopoietic Stem Cell Transplantation.

Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a valid treatment for hematological oncological or metabolic diseases. Despite its therapeutic efficacy, it is an aggressive treatment that impacts negatively on quality of life (QoL) and may result in Post-Traumatic Stress Disorder (PTSD) symptoms. The aim of this study is to explore rates and risk factors for PTSD symptoms, and fatigue in post-HSCT patients with hematological malignancies. A total of 123 patients after HSCT were evaluated for PTSD symptoms, QoL and fatigue. PTSD symptoms were assessed with the Impact of Event Scale- Revised (IES-R), QoL was measured with Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) and fatigue symptoms were assessed with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). A total of 58.54% of the sample developed PTSD symptoms after transplant. Patients with PTSD symptoms reported significantly lower QoL total scores and significantly higher fatigue than those without PTSD symptoms (p < 0.001). The SEM analysis showed that worse QoL and fatigue affected PTSD symptomatology along different pathways. Fatigue was found as a major influencing factor of PTSD symptoms directly (β = 0.31 **), while QoL only through the mediation of fatigue at a lesser extent. (β = 0.33 *). Our findings indicate that QoL is a concurrent causative factor to the development of PTSD symptomatology through the mediating role of fatigue. Innovative interventions before transplantation to prevent PTSD symptoms should be investigated to improve survival and QoL in patients.

Posttraumatic stress disorder symptoms among Chinese college students following the COVID-19 outbreak.

This study examined the prevalence of posttraumatic stress disorder (PTSD) symptoms in college students 1 month after the lockdown of Wuhan to identify possible risk factors for PTSD symptoms in a cross-sectional study. Out of 10,502 who responded, 9,274 students impacted by the COVID-19 pandemic were included in our study. PTSD symptoms was evaluated by the Impact of Event Scale-revised (IES-R). Anxiety/depression symptoms were evaluated by the Kessler Psychological Distress Scale (K10). Personality traits, coping style, and social support were assessed by the Eysenck Personality Questionnaire-Revised Short Scale for Chinese (EPQ-RSC), the Simplified Coping Style Questionnaire (SCSQ), and the Social Support Rating Scale (SSRS). Logistic regression analysis was utilized to further explore risk factors for PTSD symptoms. More than 1 month after the COVID-19 outbreak, 13.1% of college students developed PTSD symptoms, indicating that COVID-19 associated stressful experiences were connected with PTSD symptoms. After the COVID-19 outbreak, subjects with symptomatologic PTSD symptoms were more likely to experience strained relationships with their family, to have close contact with COVID-19 patients and to drop out of college. The logistic regression model demonstrated the association factors of PTSD symptoms. Neuroticism, psychoticism and an avoidant coping style were associated with increased risk for PTSD symptoms, while an active coping style was protective against PTSD symptoms during this pandemic. The results showed that PTSD symptoms was prevalent in Chinese college students 1 month after the COVID-19 outbreak. Effective psychological support work should be carried out accordingly.

Alexithymia as a Mediator between Intimate Partner Violence and Post-Traumatic Stress Symptoms in Mothers of Children Disclosing Sexual Abuse.

The unveiling of child sexual abuse (CSA) can elicit symptoms of post-traumatic stress disorder (PTSD) in non-offending parents. The impact of disclosure is stronger for mothers who have already experienced interpersonal trauma, such as CSA or intimate partner violence (IPV). Alexithymia often serves as a coping mechanism in the aftermath of a trauma, as it creates a distance between oneself and distressing events. It could prevent individuals from resolving their trauma, be a risk factor for PTSD symptoms and compromise mothers' capacity to support their child. The objective of this study was to examine whether alexithymia mediated the relationship between the experiences of interpersonal violence (IPV and CSA) of mothers of sexually abused children, and mothers' PTSD symptoms following disclosure of their child's abuse. A sample of 158 mothers of sexually abused children completed questionnaires assessing CSA and IPV and the Toronto Alexithymia Scale, which measures the capacity to identify and express emotions. The Modified PTSD symptom Scale-Self-Report evaluated PTSD symptoms related to their child's disclosure of sexual abuse. Results of a mediation model revealed that alexithymia significantly mediated the relationship between IPV and PTSD symptoms. Mothers' CSA was directly associated with higher levels of PTSD following their child's disclosure of abuse, but the relationship was not mediated by alexithymia. Our findings highlight the importance of assessing mothers' history of interpersonal trauma and ability to recognize and identify emotions as well as the need to offer support and specific intervention programs to mothers.

PTSD Among Healthcare Workers During the COVID-19 Outbreak: A Study Raises Concern for Non-medical Staff in Low-Risk Areas.

Objective: To investigate the prevalence of sleep quality and post-traumatic stress disorder (PTSD) symptoms of healthcare workers (HCWs) and identify the determinants for PTSD symptoms among HCWs in high-risk and low-risk areas during the COVID-19 outbreak in China.Methods: The Pittsburgh Sleep Quality Index and the Impact of Event Scale were used to assess sleep quality and symptoms of PTSD of 421 Chinese HCWs, respectively, from January 30 to March 2, 2020. The influencing factors of PTSD symptoms were identified by univariate analysis and multiple regression.Results: The incidence of HCWs getting PTSD symptoms were 13.2%. HCWs from high-risk areas had significantly poorer sleep quality (p < 0.001). Poor sleep quality was the risk factor of PTSD symptoms for HCWs from high-risk (p = 0.018) and low-risk areas (p < 0.001). Furthermore, non-medical staff were found to be the risk factor for PTSD symptoms only in low-risk areas.Discussion: HCWs in Hubei had poorer sleep quality. Non-medical HCWs from low-risk areas were associated with more severe PTSD symptoms. Mental health programs should be considered for HCWs, especially those who are often overlooked.

A nine-month study on the course of COVID-19 related perceived post-traumatic stress disorder among Italian community-dwelling adults

The present study aimed to evaluate base rate estimates, course of, and psychopathology and personality risk factors for COVID-19-related post-traumatic stress disorder (PTSD) in community-dwelling adults during the pandemic. 203 participants from a sample of 811 Italian community-dwelling adults agreed to participate in a nine-month, three-wave (Wave 1: March 2020; Wave 2: June 2020; Wave 3: December 2020) longitudinal study. Participants in the longitudinal study did not differ from the cross-sectional original sample on age, gender, civil status, educational level, occupation, and Italian area of residence. At each wave, participants were administered the PTSD scale of the International Trauma Questionnaire (ITQ), DSM-5 measures of acute stress, dissociation, depression and anxiety, as well as a maladaptive personality domain measure at Wave 1. Participants were instructed to answer to the ITQ items based only on COVID-19 pandemic and related containment measures. The point prevalence estimates of COVID-19 related PTSD at each wave ranged from 11% to 13%; however, up to roughly 23% of our participants experienced clinically relevant PTSD features during nine months of the COVID-19 pandemic in Italy. Multiple logistic regression results showed that experiencing internalizing symptoms (i.e., mostly acute stress) and selected personality features (i.e., Negative Affectivity and Psychoticism) at Wave 1 represent risk factors for PTSD symptoms at later waves. These findings extend previous knowledge on COVID-19 related PTSD and support the need for preventive and treatment interventions for PTSD during the COVID-19 pandemic.

Post-Traumatic Stress Disorder (PTSD) Symptoms in Patients with Acute Myeloid Leukemia (AML)

Background: Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, experience a prolonged, isolating hospitalization, and endure substantial physical and psychological symptoms. Some patients with AML experience traumatic stress as a result of their diagnosis and illness course. As traumatic stress reactions can negatively impact patients' QOL, mood, and clinical outcomes, it is essential to understand the extent of this trauma, its clinical manifestations, and risk factors to inform targeted management strategies. Post-traumatic stress disorder (PTSD), characterized by experiencing a traumatic event, is a common stress related disorder in cancer populations. Despite the potential link between AML and PTSD, data are limited regarding risk and risk factors of PTSD symptoms in this population. Methods: We conducted a secondary analysis of 160 patients with high-risk AML hospitalized to receive intensive chemotherapy. We used the Post-Traumatic Stress Disorder Checklist-Civilian Version to assess PTSD symptoms at one month after diagnosis of AML. We used the Brief COPE, and Functional Assessment of Cancer Therapy-Leukemia at baseline and week-2 during hospitalization to assess coping and quality of life (QOL), respectively. We then used multivariate regression models to assess the relationship between PTSD symptoms at one month and patient baseline sociodemographic factors, coping, and QOL. Results: Twenty-eight percent of patients reported clinically significant PTSD symptoms, describing high rates of intrusion (92%), avoidance (100%), and hypervigilance (97%). Among those who did not have clinically significant PTSD symptoms, 27%, 26%, and 23% of patients reported clinically significant intrusion, avoidance, and hypervigilance symptoms, respectively. In adjusted analyses, higher baseline QOL (B= -.22, p= &amp;lt;.001) and less decline in QOL during hospitalization (B= -.17, p=.018) were associated with fewer PTSD symptoms. The use of approach-oriented coping (B= -.72; p= .018) was also associated with fewer PTSD symptoms, while the use of avoidant coping was not significantly associated with PTSD symptoms. Conclusion: A substantial proportion of patients with AML report clinically significant PTSD symptoms at one month after initiating intensive chemotherapy. These findings highlight the need to routinely screen, assess, and manage PTSD symptoms in all patients with AML. Patients' baseline QOL, coping strategies, and extent of QOL decline during hospitalization are important risk factors for PTSD symptoms, underscoring potential intervention targets in future studies to reduce the impact of PTSD in this population. Disclosures LeBlanc: Heron: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Medtronic: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Welvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; American Cancer Society: Research Funding; BMS: Research Funding; Duke University: Research Funding; NINR/NIH: Research Funding; Jazz Pharmaceuticals: Research Funding; UpToDate: Patents &amp; Royalties; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Consultancy, Honoraria, Research Funding, Speakers Bureau; CareVive: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Daiichi Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Flatiron: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Hobbs:Merck: Research Funding; Incyte: Research Funding; Celgene/BMS: Honoraria; Novartis: Honoraria; Jazz: Honoraria; Bayer: Research Funding; Constellation: Honoraria, Research Funding. Brunner:Novartis: Research Funding; AstraZeneca: Research Funding; Forty-Seven Inc: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding. Luger:Daiichi-Sankyo: Honoraria; Pfizer: Honoraria; Bristol-Myers Squibb: Honoraria; Acceleron: Honoraria; Agios: Honoraria; Loxo Oncology: Honoraria; Onconova: Research Funding; Kura: Research Funding; Hoffman La Roche: Research Funding; Ariad: Research Funding; Biosight: Research Funding. Bhatnagar:KITE: Membership on an entity's Board of Directors or advisory committees; KaryoPharm Therapuetics: Research Funding; Cell Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees.

A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps

Children and adolescents’ mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7–15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children’s post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children’s vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children’s prosocial behavior, just as mothers’ social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth’s mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.

The Association Between Physical and Mental Health and Face Mask Use During the COVID-19 Pandemic: A Comparison of Two Countries With Different Views and Practices.

BackgroundThe physical and mental health of citizens living in a country that encouraged face masks (China) and discouraged face masks (Poland) during the initial stage of the COVID-19 pandemic remained unknown. We conducted a cross-country study to compare the psychological impact of the COVID-19 pandemic on Poles and Chinese. This study aimed to compare the levels of psychological impact of pandemic and levels of anxiety and depression between China and Poland.MethodsThe survey collected information on demographic data, physical symptoms, contact history, and precautionary measures. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). The chi-squared test was used to analyze the differences in categorical variables between the two populations. Linear regression was used to calculate the bivariate associations between independents variables (e.g., physical symptoms and precautionary measures) and dependent variables (e.g., mental health outcomes).ResultsThis study included a total of 2,266 respondents from both countries (1,056 Poles and 1,210 Chinese). There were significantly less Polish respondents who wore face masks (Poles: 35.0%; Chinese: 96.8% p < 0.001). Significantly more Polish respondents reported physical symptoms resembling COVID-19 infection (p < 0.001), recent medical consultation (p < 0.01), recent COVID-19 testing (p < 0.001), and hospitalization (p < 0.01). Furthermore, Polish respondents had significantly higher levels of anxiety, depression and stress (p < 0.001) than Chinese. The mean IES-R scores of Poland and China were above the cut-off for post-traumatic stress disorder (PTSD) symptoms. Besides precautionary measures, unemployment, retirement, physical symptoms resembling COVID-19 infection, recent medical consultation or COVID-19 testing, and long daily duration of home confinement were risk factors for PTSD symptoms, anxiety, depression, or stress for Polish respondents.ConclusionUse of face masks at the community level may safeguard better physical and mental health during the COVID-19 pandemic. There is a need of health education with scientific information from Polish health authority on the proper use of face masks and reduce social stigma. This study was limited by the respondent sampling method that had compromised the representativeness of samples.

The impact of intimate partner violence on psychological well-being: Predictors of posttraumatic stress disorder and the mediating role of insecure attachment styles

Posttraumatic stress disorder (PTSD) symptoms have been linked to intimate partner violence (IPV). However, not all victims develop these problems. This study analyzed the effects of different types of IPV and of attachment styles on PTSD symptoms, and tested insecure attachment styles as mediators in the IPV-PTSD link in a sample of Portuguese women including victims and non-victims of IPV (n=209). Differences between women with versus women without IPV in PTSD symptoms and in attachment styles were also examined. Women who reported IPV also reported more PTSD symptoms and more attachment anxiety than those who reported no IPV. Psychological aggression, physical violence with injury, and attachment anxiety contributed significantly to PTSD symptoms, while less attachment dependency had a negative association with PTSD symptoms, after controlling for socio-demographic factors. Attachment anxiety and attachment dependency partially mediated the association between physical violence with injury and PTSD symptoms. This study shows the impact of IPV on mental health and stresses the role of attachment anxiety as a risk factor for PTSD symptoms, highlighting the need to design effective interventions that address this specific attachment pattern in psychotherapy to reduce PTSD symptoms among victims of IPV.

Sex differences in factors associated with post-traumatic stress disorder in acute type A aortic dissection patients

BackgroundEmergency surgery for acute type A aortic dissection (AAAD) is associated with a high risk for posttraumatic stress disorder (PTSD), and the risk factors for PTSD symptoms development in AAAD patients of different sexes remain unclear. ObjectiveTo identify the risk factors for PTSD symptoms separately in the females and males following AAAD. MethodsA sample population of 214 patients who had AAAD surgery was recruited. Patients’ sociodemographic and disease-specific data were collected during hospitalization. ResultsIn this study, PTSD symptoms was present in 22.1% of the male patients and 20.0% of the female patients (P = 0.739). For the male patients with AAAD, PTSD symptoms were significantly positively associated with HADS-D score (P = 0.029), while those with university education and above (P = 0.039), stronger subjective support (P = 0.010) and greater optimism (P = 0.001) had significantly lower possibility for the presence of PTSD symptoms. For the female patients with AAAD, support availability (P = 0.031) was significantly negatively associated with PTSD symptoms while HADS-D score (P = 0.033) was significantly positively associated with PTSD symptoms. ConclusionRisk factors for PTSD symptoms differ in male patients and female patients following AAAD.

Risk Factors for Post-Traumatic Stress Disorder Symptoms in Surrogate Decision-Makers of Patients with Chronic Critical Illness.

Chronically critically ill patients are often dependent on family members for surrogate decision-making, and these surrogates are at high risk for emotional distress. We hypothesized that patient- and surrogate-specific risk factors for surrogate post-traumatic stress disorder (PTSD) symptoms can be identified early in the course of chronic critical illness. To identify risk factors for PTSD symptoms in surrogate decision-makers of chronically critically ill patients. We performed a secondary analysis of the database from a multicenter randomized trial of a communication intervention for chronic critical illness patients and surrogates. Variables preselected for plausible mechanism for increasing PTSD symptoms and identifiable by Day 10 of mechanical ventilation were included in the analysis for association with surrogate PTSD symptoms at 90 days, as measured by the Impact of Events Score-Revised (IES-R). Patient factors included demographics, insurance status, baseline functional status, chronic comorbidities, illness severity, and presence of advance directive. Surrogate variables included demographics, education level and employment, religion, relationship to patient, and Hospital Anxiety and Depression Scale score measured at enrollment. Multivariable linear regression models were then constructed for 26 potential risk factors, including biologically or mechanistically plausible confounders for each, with IES-R score as the outcome. All models were adjusted for multiple respondents, using a mixed model, considering the patients as a random factor. Our analysis included 306 surrogates for 224 patients. A total of 49% of patients were female, and mean age was 59 years (95% confidence interval [CI], 56.4-60.7). A total of 71% of surrogates were female, and mean age was 51 years (95% CI, 49.3-52.4). After examining each potential risk factor in a separate multivariable model, only Day-10 surrogate Hospital Anxiety and Depression Scale score (β coefficient = 1.02; 95% CI, 0.73-1.30) and patient unresponsiveness (β coefficient = 8.39; 95% CI, 0.83-15.95) were associated with higher IES-R scores. Among surrogate decision-makers for chronically critically ill patients, high anxiety and depression scores and patient unresponsiveness on or near Day 10 of mechanical ventilation are risk factors for PTSD symptoms at 90 days.

Risk and protective factors of posttraumatic stress disorder among African American women living with HIV

ABSTRACTWe sought to examine risk and protective factors for Posttraumatic Stress Disorder (PTSD) among African American women living with HIV. This is a cross-sectional analysis of baseline data from a randomized trial of an HIV stigma reduction intervention. We examined data from two-hundred and thirty-nine African American women living with HIV. We examined whether age, marital status, level of education, internalized HIV-related stigma, and social support as potential protective and risk factors for PTSD symptoms using logistic regression. We analyzed bi-variate associations between each variable and PTSD symptoms, and constructed a multivariate logistic regression model adjusting for all variables. We found 67% reported clinically significant PTSD symptoms at baseline. Our results suggest that age, education, and internalized stigma were found to be associated with PTSD symptoms (p < 0.001), with older age and more education as protective factors and stigma as a risk factor for PTSD. Therefore, understanding this relationship may help improve assessment and treatment through evidence- based and trauma-informed strategies.

Examining the Prospective Relationship between Pre-Disaster Respiratory Sinus Arrhythmia and Post-Disaster Posttraumatic Stress Disorder Symptoms in Children.

Previous studies have examined the concurrent relationship between posttraumatic stress disorder (PTSD) and a range of psychophysiological variables, including respiratory sinus arrhythmia (RSA). However, there is a lack of research examining the prospective development of trauma symptomatology, and the directionality of the association between RSA level and PTSD has yet to be determined. The current study is the first prospective study to examine whether RSA level and RSA reactivity are risk factors for PTSD symptoms in children. Assessments were conducted both prior to (Time 1) and following (Time 2) a natural disaster (i.e., Hurricane Katrina). Participants were 36 children who were 3-6years-old during the Time 1 assessment. Structured diagnostic interviews were used to assess PTSD symptoms at both Time 1 and Time 2. RSA level during a neutral stimulus, RSA reactivity to emotional video stimuli (distress, joy, and trauma videos) and RSA reactivity to memory stimuli (remote happy memory, trauma memory, mother's recall of the trauma memory) were also collected at both time points. Time 1 RSA level during a neutral stimulus was a significant predictor of Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 neutral RSA level), such that lower RSA during a neutral condition was related to higher PTSD symptoms. Also, Time 1 RSA reactivity in response to memory (but not video) stimuli, in the form of relatively less vagal withdrawal, was a significant predictor of more Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 RSA reactivity). This unique prospective study provides evidence for level of RSA and RSA reactivity as pre-existing clinical markers of stress sensitivity that predict psychopathology following a trauma.

Racial/ethnic disparities in the risk of posttraumatic stress disorder symptoms among mothers of children diagnosed with cancer and Type-1 diabetes mellitus.

Research findings have indicated that mothers of children diagnosed with life-threatening illnesses can be at risk for posttraumatic stress disorder (PTSD) symptoms (PTSS), with African American mothers being especially vulnerable because of evidence suggesting higher rates of PTSD among both African Americans and women. Race/ethnicity, past trauma exposure and the interaction of these variables were evaluated as risk factors for PTSS, depression, and state and trait anxiety among African American and Caucasian mothers of chronically ill children. Mothers of children (N = 91) diagnosed with a life-threatening illness (i.e., cancer or Type-I diabetes mellitus [T1DM]) completed standardized measures and provided a salivary cortisol sample while attending medical appointments for their ill children. A MANCOVA revealed that mothers of children diagnosed with T1DM had higher cortisol levels than mothers of children with cancer. There was no racial or ethnic disparity in the risk of PTSS among the mothers. These findings suggest that mothers of children with T1DM may be vulnerable to stress reactions, as reflected by cortisol, a biological marker. Clinicians and researchers might consider illness-specific features when evaluating the risk of stress reactions among mothers of children with life-threatening illnesses. (PsycINFO Database Record

The traumatic experience of first-episode psychosis: A systematic review and meta-analysis

IntroductionA psychotic episode may be sufficiently traumatic to induce symptoms of post-traumatic stress disorder (PTSD), which could impact outcomes in first-episode psychosis (FEP). The objectives of this systematic review and meta-analysis were to estimate the prevalence of PTSD symptoms in relation to psychosis in FEP and to identify risk factors for the development of PTSD symptoms. MethodsWe searched electronic databases and conducted manual searching of reference lists and tables of contents to identify relevant studies. Quantitative studies were included if the population was experiencing FEP and if PTSD was measured in relation to psychosis. Prevalence of PTSD symptoms and diagnoses were meta-analyzed using a random effects model. Potential risk factors for PTSD symptoms were summarized qualitatively. ResultsThirteen studies were included. Eight studies assessed PTSD symptoms, three studies assessed full PTSD, and two studies assessed both. The pooled prevalence of PTSD symptoms was 42% (95% CI 30%–55%), and the pooled prevalence of a PTSD diagnosis was 30% (95% CI 21%–40%). Exploratory subgroup analyses suggest that prevalence may be higher in affective psychosis and inpatient samples. Evidence from included studies implicate depression and anxiety as potential risk factors for PTSD symptoms. ConclusionsApproximately one in two people experience PTSD symptoms and one in three experience full PTSD following a first psychotic episode. Evidence-based interventions to treat PTSD symptoms in the context of FEP are needed to address this burden and improve outcomes after the first psychotic episode. Further studies are needed to clarify the associated risk factors.

Sixteen-year follow-up of childhood avalanche survivors

BackgroundEvery year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on children's health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures.ObjectiveAmong childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood.MethodsChildhood survivors (aged 2–19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis.ResultsResponse rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F=5.96, p<0.05). When adjusted for age and sex, PTSD symptoms were associated with lower education (F=7.62, p<0.001), poor financial status (F=12.21, p<0.001), and unemployment and/or disability (F=3.04, p<0.05). In a multivariable regression model, when adjusting for age and sex, lack of social support (t=4.22, p<0.001) and traumatic reactions of caregivers (t=2.49, p<0.05) in the aftermath of the disaster independently predicted PTSD 16 years post-trauma.ConclusionsLingering PTSD symptoms after childhood exposure to a disaster may negatively influence socioeconomic development in adulthood. Strengthening children's support systems post-disaster may prevent the long-term sequelae of symptoms.Highlights of the articlePTSD symptoms following avalanche exposure during childhood were associated with poorer socioeconomic status in adulthood.Lack of social support and traumatic reactions of caregivers in the aftermath of avalanches predicted PTSD symptoms among childhood survivors 16 years later.Findings underscore the importance of strengthening children's support systems in the aftermath of disasters.

Racial discrimination, post-traumatic stress and prescription drug problems among Aboriginal Canadians.

1) To examine associations between racial discrimination and drug problems among urban-based Aboriginal adults; and 2) to determine whether these associations are best explained by symptoms of psychological stress, distress or post-traumatic stress disorder (PTSD). Data were collected through in-person surveys with a community-based sample of Aboriginal adults (N = 372) living in a mid-sized city in western Canada in 2010. Associations were examined using bootstrapped linear regression models adjusted for confounders, with continuous prescription and illicit drug problem scores as outcomes. Mediation was examined using the cross-products of coefficients method. More than 80% of Aboriginal adults had experienced racial discrimination in the past year, with the majority reporting high levels in that period. Past-year discrimination was a risk factor for PTSD symptoms and prescription drug problems in models adjusted for confounders and other forms of psychological trauma. In mediation models, PTSD symptoms explained the association between discrimination and prescription drug problems; psychological stress and distress did not. PTSD symptoms also explained this association when the covariance between mediators was controlled. The results also indicate that participation in Aboriginal cultural traditions was associated with increased discrimination. Most efforts to address Aboriginal health inequities in Canada have focused on the role Aboriginal people play in these disparities. The current findings combine with others to call for an expanded focus. Non-Aboriginal Canadians may also play a role in the health inequities observed. The findings of this study suggest efforts to reduce discrimination experienced by Aboriginal adults in cities may reduce PTSD symptomology and prescription drug problems in these populations.

Cognitive predictors and risk factors of PTSD following stillbirth: a short-term longitudinal study.

This short-term longitudinal study investigated cognitive predictors and risk factors of posttraumatic stress disorder (PTSD) in mothers following stillbirth. After a stillbirth at ≥ 24 weeks gestational age, 65 women completed structured clinical interviews and questionnaires assessing PTSD symptoms, cognitive predictors (appraisals, dysfunctional strategies), and risk factors (perceived social support, trauma history, obstetric history) at 3 and 6 months. PTSD symptoms decreased between 3 and 6 months (Cohen's d ranged .34-.52). Regression analyses also revealed a specific positive relationship between Rumination and concurrent frequency of PTSD symptoms (β = .45). Negative Self-View and Negative World-View related positively and Self-Blame related negatively to concurrent number of PTSD symptoms (β = .48, .44, -.45, respectively). Suppression and Distraction predicted a decrease and Numbing predicted an increase in time-lagged number of PTSD symptoms (β = -.33, -.28, .30, respectively). Risk factors for PTSD symptoms were younger age (β = -.25), lower income (β = -.29), fewer previous pregnancies (β = -.31), and poorer perceived social support (β = -.26). Interventions addressing negative appraisals, dysfunctional strategies, and social support are recommended for mothers with PTSD following stillbirth. Knowledge of cognitive predictors and risk factors of PTSD may inform the development of a screening instrument.

Effect of the interplay between trauma severity and trait neuroticism on posttraumatic stress disorder symptoms among adolescents exposed to a pipeline explosion.

BackgroundWhile numerous studies have explored relevant factors of posttraumatic stress disorder (PTSD) symptoms, there have been few joint investigations of trauma severity and trait neuroticism on the development of PTSD symptoms. This study aims to assess the involvement and interrelationship of trauma severity and neuroticism in the expression of PTSD symptoms among adolescents exposed to an accidental explosion.MethodsSix hundred and sixty-two adolescents were recruited from a junior middle school closest to the 2013 pipeline explosion site in China and were assessed using the Explosion Exposure Questionnaire, the NEO Five Factor Inventory-Neuroticism Subscale (FFI-N), and the PTSD Checklist-Civilian (PCL-C). A battery of hierarchical multiple regression analyses and two-way ANOVAs were performed to examine the effect of trauma severity and trait neuroticism on adolescent PTSD symptoms.ResultsEighty-seven adolescents (13.1%) showed PTSD symptoms after the pipeline explosion. Correlation analysis showed that all the factors of explosion exposure and trait neuroticism were positively associated with adolescent PTSD symptoms. Being male and younger was linked to lower risk for PTSD symptoms. The regression models identified explosion exposure and neuroticism as independent risk factors for PTSD symptoms, and the interactions between trait neuroticism and trauma exposure (personal casualty, degree of influence, total traumatic severity) were related to PTSD symptoms.ConclusionsThe results highlight the role of trauma exposure and trait neuroticism as risk factors for PTSD symptoms. Therefore, the combination of these two factors should be investigated in clinical settings due to an augmented risk for more severe PTSD symptoms.