Risk For Posttraumatic Stress Symptoms Research Articles

Unpacking the Links Between Community Violence, Delinquency, and Illicit Substance Use Among College Students: The Role of PTSS and Code of the Streets

ABSTRACT Community violence (CV) is a serious public health concern. To date, most of the existing research has focused on youth of color living in high-risk environments. The prior literature has shown that CV-exposed youth are at risk for post-traumatic stress symptoms (PTSS), delinquency, and substance use. CV has also been tied to beliefs about violence being an acceptable way of resolving conflict, referred to as the Code of the Streets (COS). It is unclear how the trajectories of other CV-exposed populations may differ from vulnerable youth, including college students who are in a developmental period associated with high-risk for violence exposure. The study objectives were therefore to: 1) examine the relations between CV and delinquency (i.e. gang involvement, arrest, weapon ownership) and illicit substance use, as well as 2) investigate whether there are indirect effects between CV and both delinquency and illicit substance use through PTSS and COS beliefs among college students. The sample included 547 students from two universities (M age = 20.31, SD = 2.08, Range = 18–28; 80.8% female; 57.8% White). CV was associated with delinquency and illicit substance use. COS beliefs had an indirect effect on the relation between CV and delinquency, but PTSS did not. Conversely, PTSS had an indirect effect on the link between CV and illicit substance use, but COS did not. College students are at risk for CV exposure and adverse outcomes. Interventions addressing PTSS and COS beliefs may be central to mitigating delinquent behaviors and illicit substance use in this population.

The impact of isolation on comorbidity of PTSD symptoms and depression: evidence from PTRP-5-6 in China.

The Omicron pandemic struck Shanghai, China, resulting in impairments of both physical and psychological health on those patients who were confirmed and transferred to the Fangcang shelters. The way of isolation led to high risk of posttraumatic stress symptoms (PTSS) and depressive symptoms among the patients in Fangcang shelters. We aim to estimate the prevalence and comorbidity of PTSS and depressive symptoms in patients from China's Fangcang shelters during the epidemic. Demographic information questionnaire, the posttraumatic stress disorder checklist for DSM-5 (PCL-5), and Patient Health Questionnaire (PHQ-9) were used in the study. The data were collected online via mobile phones during 10th April to 20th April, 2022, as part of our Psychological Trauma Recover Project-5-6 (PTRP-5-6), a longitudinal study focusing on individuals who have experienced trauma. A total of 336 subjects were included in the analysis. The results revealed (1) the prevalence of depressive symptoms, and PTSS were 30.1% (cut-off = 10) and 6% (cut-off = 33); (2) Multiple logistic regression showed that female (OR = 3.04, p < 0.05), suffering from dyspnea (OR = 5.83, p < 0.05) or gastrointestinal symptoms (OR = 6.38, p < 0.05) were risk factors for PTSS; higher education level (OR = 3.27, p < 0.05) and suffering from dizziness or headache (OR = 2.46, p < 0.05) were risk factors for depressive symptoms; (3)Respectively, 85% of the patients who reported PTSS also experienced depressive symptoms, 16.8% of the patients who reported depressive symptoms presented PTSS. In the context of COVID-19, the comorbidity rate of PTSS and depressive symptoms among patients in Fangcang shelters increased with the severity of depressive symptoms.

Consequences of Exposure to War Violence: Discriminating Those with Heightened Risk for Aggression from Those with Heightened Risk for Post-Traumatic Stress Symptoms.

Chronic exposure to ethnic-political and war violence has deleterious effects throughout childhood. Some youths exposed to war violence are more likely to act aggressively afterwards, and some are more likely to experience post-traumatic stress symptoms (PTS symptoms). However, the concordance of these two outcomes is not strong, and it is unclear what discriminates between those who are at more risk for one or the other. Drawing on prior research on desensitization and arousal and on recent social-cognitive theorizing about how high anxious arousal to violence can inhibit aggression, we hypothesized that those who characteristically experience higher anxious arousal when exposed to violence should display a lower increase in aggression after exposure to war violence but the same or a higher increase in PTS symptoms compared to those low in anxious arousal. To test this hypothesis, we analyzed data from our 4-wave longitudinal interview study of 1051 Israeli and Palestinian youths (ages at Wave 1 ranged from 8 to 14, and at Wave 4 from 15-22). We used the 4 waves of data on aggression, PTS symptoms, and exposure to war violence, along with additional data collected during Wave 4 on the anxious arousal participants experienced while watching a very violent film unrelated to war violence (N = 337). Longitudinal analyses revealed that exposure to war violence significantly increased both the risk of subsequent aggression and PTS symptoms. However, anxious arousal in response to seeing the unrelated violent film (measured from skin conductance and self-reports of anxiety) moderated the relation between exposure to war violence and subsequent psychological and behavioral outcomes. Those who experienced greater anxious arousal while watching the violent film showed a weaker positive relation between amount of exposure to war violence and aggression toward their peers but a stronger positive relation between amount of exposure to war violence and PTS symptoms.

A multi-country study of the associations between HIV vulnerability status, perception of COVID-19 related stigma and post-traumatic stress symptoms during the first wave of the pandemic

BackgroundThis study investigated the associations between COVID-19 related stigma and post-traumatic stress symptoms (PTSS); and the associations between PTSS and COVID-19 related stigma, HIV status, COVID-19 status and key HIV population status.MethodsThis was a secondary analysis of data of 12,355 study participants generated through an online survey that recruited adults from 152 countries between July and December 2020. The dependent variables were COVID-19-related stigma and PTSS. The independent variables were HIV status (positive/negative), transaction sex (yes/no), use of psychoactive drugs (yes/no), and vulnerability status (transaction sex workers, people who use psychoactive drugs, living with HIV, and COVID-19 status). The confounding variables were age, sex at birth (male/female), level of education, sexual minority individuals (yes/no) and country income level. Multivariable logistic regression analyses were conducted to determine associations between the dependent and independent variables after adjusting for confounders.ResultsThere were 835 (6.8%) participants who experienced COVID-19 related stigma during the pandemic and 3,824 (31.0%) participants reported PTSS. Respondents who were living with HIV (AOR: 1.979; 95%CI: 1.522–2.573), tested positive for COVID-19 (AOR: 3.369; 95%CI: 2.692–4.217), engaged in transactional sex (AOR: 1.428; 95%CI: 1.060–1.922) and used psychoactive drugs (AOR: 1.364; 95%CI: 1.053–1.767) had significantly higher odds of experiencing COVID-19 related stigma. Individuals with vulnerability status (AOR:4.610; 95%CI: 1.590-13.368) and who experienced COVID-19 related stigma (AOR: 2.218; 95%CI: 1.920–2.561) had significantly higher odds of PTSS.ConclusionIndividuals with vulnerability status may be at increased risk for COVID-19 related stigma. Key and vulnerable populations who were living with HIV and who experienced stigma may be at a higher risk of experiencing PTSS. Populations at risk for PTSS should be routinely screened and provided adequate support when they contract COVID-19 to reduce the risk for poor mental health during COVID-19 outbreaks and during future health crisis with similar magnitude as the COVID-19 pandemic.

Evaluation of psychiatric symptoms in patients diagnosed with fibromyalgia during COVID-19 pandemic: a cross-sectional study

Objectives: Our aim was to assess depression, anxiety, trauma symptoms and sleep problems in patients with fibromyalgia during the COVID-19 pandemic.Methods: This study was conducted face-to-face with 62 SARS-CoV-2 negative fibromyalgia patients. Sociodemographic and Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), the American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia 2010 were applied to the subjects. Results: Patient mean scores on the HAD Depression and HAD Anxiety scales were 8.42 ± 3.73 and 9.58 ± 3.86, respectively. The patients' PSQI and PCL-5 scores were 8.10 ± 3.49 and 33.90 ± 16.91, respectively. While the CAS score average was found to be 1.13 ± 2.79, the OCS score average was found to be 1.81 ± 2.27. The mean scores for the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), and Visual Analog Scale (VAS) were 9.90 ± 3.03, 7.84 ± 2.07 and 7.37 ± 1.81, respectively. Poor sleep quality was identified in 75.8% and a risk of post-traumatic stress symptoms in 16.1%. SSS scores were found to be higher in those at risk of depression than those without (U=265, p = 0.003). OCS (U=256, p = 0.007), SSS (U=203.5, p = 0.001), VAS (U=263.5, p = 0.012), PCL-5 (U=144, p = 0.001) scores were found to be higher in those at risk of anxiety than those without. Conclusions: It was observed that depression was a predictor of fibromyalgia symptom severity and anxiety was a predictor of obsession with coronavirus, fibromyalgia symptom severity, VAS, and post-traumatic stress symptoms.

Associations between COVID-19 Work-Related Stressors and Posttraumatic Stress Symptoms among Chinese Doctors and Nurses: Application of Stress-Coping Theory.

Healthcare workers are vulnerable to posttraumatic stress symptoms (PTSS) due to stressful work during the COVID-19 pandemic. This study aimed to investigate whether the associations between COVID-19 work-related stressors and PTSS would be mediated by maladaptive and adaptive coping strategies and moderated by perceived family support based on stress-coping theory. An anonymous online survey was conducted among 1449 doctors and nurses in five hospitals in China between October and November 2020 during the “post-outbreak” period. The prevalence of PTSS assessed by the Posttraumatic Symptom Scale Self-Report was 42%. Logistic regression analysis revealed that worries about being infected with COVID-19, perceived difficulties in family caregiving, coping strategies of rumination, catastrophizing, acceptance, and perceived family support were independently associated with PTSS. Furthermore, maladaptive and adaptive coping partially mediated the association between COVID-19 work-related stressors and PTSS.The results of multi-group analyses showed that perceived family support tended to intensify the associations between COVID-19 work-related stressors and adaptive coping and between adaptive coping and PTSS, whereas perceived family support attenuated the positive association between COVID-19 work-related stressors and PTSS. The findings suggest tailor-made health interventions with respect to alleviation of work-related stressors and coping skill training to reduce the risk of PTSS among healthcare workers, especially for those with lower perceived family support.

The stress before the storm: Psychological correlates of hurricane-related evacuation stressors on mothers and children.

Natural disasters, such as hurricanes, can contribute to the development of posttraumatic stress symptoms (PTSS), anxiety, and depression. Furthermore, mothers and children are especially vulnerable postdisasters. Despite the rise in the frequency of climate-related disasters and also the threat of disasters (e.g., storms that threaten but do not make landfall), little is known about how predisaster experiences are associated with mothers' and children's postdisaster psychological functioning. This study examined evacuation-related stressors as predictors of mothers' and youths' psychological functioning 3 months after Hurricane Irma. Mothers (N = 535; 33% ethnic/racial minorities) from South Florida counties most affected by Hurricane Irma completed an online survey that assessed evacuation-related stressors (both pre- and posthurricane), hurricane exposure (i.e., life threat, loss/disruption), and posthurricane social support and mental health symptomatology (i.e., PTSS, anxiety, depression). Mothers of children aged 7-17 years (n = 226) also reported on their child's psychological functioning. Using a risk and resilience model, evacuation stressors significantly predicted mothers' and youths' PTSS and symptoms of anxiety and depression, even after accounting for demographic factors, hurricane exposure, and availability of social support. Mothers of older children also reported significantly higher levels of PTSS, anxiety, and depression than mothers who only had young children (aged 6 or younger) at home. Evacuation experiences represent significant stressors that may put mothers and children at risk for PTSS and psychological distress. Resilience-building efforts should include efforts to better prepare families for prestorm evacuations, thereby reducing risk in mothers and youth and ultimately contributing to better psychosocial functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Conflict Appraisals and Trauma Symptoms in Children Exposed to Intimate Partner Violence.

Children exposed to intimate partner violence (IPV) are at risk for posttraumatic stress symptoms (PTSS) and alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning. The current study investigated children's threat and self-blame appraisals about parental conflict as potential mechanisms leading to these adverse outcomes. Parent-child relationships were also examined. The sample consisted of 119 10-year-olds and their mothers who were recruited from the community as part of a larger study of IPV. Children's reports of IPV directed at their mother in the past year were not associated with PTSS; however, IPV exposure was associated with attenuated cortisol output in response to a social stressor. IPV exposure was also associated with greater threat appraisals and poorer quality parent-child relationships. These results provide further evidence that witnessing IPV is threatening for children, has negative consequences for parent-child relationships, and can impact children's HPA axis functioning.

Risk of post-traumatic stress symptoms in hospitalized and non-hospitalized COVID-19 recovered patients. A cross-sectional study

High rates of post-traumatic stress disorder (PTSD) symptoms have been found among patients with more severe COVID-19-related symptoms, and hospitalization is generally recognized as a risk factor for developing PTSD. Furthermore, other personality characteristics may increase the risk of developing post-traumatic stress symptoms following a COVID-19 infection. This study aimed to assess personality traits, alexithymia, dissociation, anxiety, and depression in patients who have recovered from COVID-19 and the impact of these variables on the presence of post-traumatic stress symptoms. Five hundred and six participants completed a battery of standardized questionnaires. All the scales used in this study are valid and reliable measures of their respective constructs. Results showed that high levels of alexithymia, dissociation, anxiety, and depression statistically significantly predicted the three main clusters of PTSD symptoms (avoidance, intrusion, and hyperarousal) in individuals who have recovered from COVID-19. Furthermore, negative affectivity and psychoticism significantly predicted PTSD symptoms in our sample. Finally, individuals hospitalized by COVID-19 are more at risk of developing intrusion and hyperarousal symptoms than those who never needed hospital care. Our findings are a valuable contribution in identifying the main risk factors of psychological distress related to COVID-19 to address the long-term mental health needs of people who have experienced the disease.

Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review

In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

Gender differences in risk of posttraumatic stress symptoms after disaster among older people: Differential exposure or differential vulnerability?

BackgroundWomen have been observed to have a higher risk of developing posttraumatic stress symptoms (PTSS) after disaster compared to men. In a study of survivors of an earthquake, we sought to investigate: whether there was differential exposure to disaster-related trauma by gender; whether women and men have differential vulnerability to trauma; and what factors could explain the gender difference in PTSS. MethodsData from a cohort of community-dwelling older survivors of the 2011 Great East Japan Earthquake and Tsunami was used. Data were obtained before (2010) and 2.5-years after the disaster (n = 3,334). ResultsWomen suffered 1.6 times higher prevalence of PTSS than men (31.0% vs. 19.4%). Women were more likely to experience loss of relatives (29.2% vs. 23.2%), while men were more likely to report loss of friends (17.1% vs. 14.5%) and separation from work (7.5% vs. 4.6%). We did not find evidence for differential vulnerability to disaster-related trauma. Indeed, the gender gap in PTSS was larger among individuals who did not experience trauma. Women experienced greater deterioration of non-kin instrumental support, which significantly mediated the association between gender and PTSS. LimitationsWe have no information on PTSS prior to the earthquake. Nor do we have clinician diagnoses of PTSD. ConclusionsWomen experienced housing damages and loss of relatives more often than men, which explained ∼21% of the gender gap in PTSS after disaster. Women reported more non-kin support prior to the disaster, but they also experienced greater deterioration of it, which explained ∼21% of the gender gap.

Sex differences in the physical performance, physiological, and psycho-cognitive responses to military operational stress

ABSTRACT Combat roles are physically demanding and expose service personnel to operational stressors such as high levels of physical activity, restricted nutrient intake, sleep loss, psychological stress, and environmental extremes. Women have recently integrated into combat roles, but our knowledge of the physical, physiological, and psycho-cognitive responses to these operational stressors in women is limited. The aim of this narrative review was to evaluate the evidence for sex-specific physical, physiological, and psycho-cognitive responses to real, and simulated, military operational stress. Studies examining physical and cognitive performance, body composition, metabolism, hypothalamic-pituitary-gonadal axis, and psychological health outcomes were evaluated. These studies report that women expend less energy and lose less body mass and fat-free mass, but not fat mass, than men. Despite having similar physical performance decrements as men during operational stress, women experience greater physiological strain than men completing the same physical tasks, but this may be attributed to differences in fitness. From limited data, military operational stress suppresses hypothalamic-pituitary-gonadal, but not hypothalamic–pituitary–adrenal, axis function in both sexes. Men and women demonstrate different psychological and cognitive responses to operational stress, including disturbances in mood, with women having a higher risk of post-traumatic stress symptoms compared with men. Based on current evidence, separate strategies to maximize selection and combat training are not warranted until further data directly comparing men and women are available. However, targeted exercise training programmes may be advisable to offset the physical performance gap between sexes and optimize performance prior to inevitable declines caused by intense military operations.

Using a biopsychosocial approach to examine differences in post-traumatic stress symptoms between Arab and Jewish Israeli mothers following a child\u2019s traumatic medical event

BackgroundParents of children following traumatic medical events (TMEs) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents’ PTSS have been described in different cultures and societies. Parents from ethnic minority groups may be at particularly increased risk for PTSS following their child’s TME due to a host of sociocultural characteristics. Yet, differences in PTSS manifestation between ethnic groups following a child’s TME has rarely been studied.ObjectivesWe aimed to examine: (1) differences in PTSS between Israeli-Arab and Israeli-Jewish mothers, following a child’s TME, and (2) risk and protective factors affecting mother’s PTSS from a biopsychosocial approach.MethodsData were collected from medical files of children following TMEs, hospitalized in a Department of Pediatric Rehabilitation, between 2008 and 2018. The sample included 47 Israeli-Arab mothers and 47 matched Israeli-Jewish mothers. Mothers completed the psychosocial assessment tool (PAT) and the post-traumatic diagnostic scale (PDS).ResultsArab mothers perceived having more social support than their Jewish counterparts yet reported higher levels of PTSS compared to the Jewish mothers. Our prediction model indicated that Arab ethnicity and pre-trauma family problems predicted higher levels of PTSS among mothers of children following TMEs.ConclusionsDespite reporting higher social support, Arab mothers reported higher levels of PTSS, as compared to the Jewish mothers. Focusing on ethnic and cultural differences in the effects of a child’s TME may help improve our understanding of the mental-health needs of mothers from different minority groups and aid in developing appropriate health services and targeted interventions for this population.

PTSD and post-traumatic stress spectrum in the Italian Navy Operational Divers Group and corps of Coast Guard Divers employed in search and rescue activities in the Mediterranean refugees emergences and Costa Concordia shipwreck

Rescue personnel is at high risk for Post-traumatic Stress Disorder (PTSD) because of the possible repetitive exposition to “cruel details of traumatic events” (DSM-5). Literature reported PTSD rates in combat exposed veterans, although the Italian Navy military personnel has been frequently involved in no-war activities in most recent years, such as Search and Rescue (SAR) activities of civilians involved in catastrophic events. The study aimed at exploring the prevalence of PTSD and its impact on social and work functioning among divers of the Italian Navy employed in the SAR activities for the Costa Concordia shipwreck (2012), the collapsed control tower of the Genoa harbour (2013), and the “Mare Nostrum” and “Triton” immigrant emergency Operations in the Mediterranean Sea. The 85 Italian Navy and Coast Guard Divers on duty for these activities were involved in the study and forty fulfilled the assessments, including the: Impact Event Scale (IES-r), Trauma and Loss Spectrum Self-Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). In the three years before enrollment 77.5% of the sample (n = 31) performed at least one rescue operation, with full and partial DSM-5 PTSD rates being 7.5% and 22.5%, respectively. A correlation emerged between WSAS domains or total scores and TALS-SR score domains for PTSD. Rescue Navy personnel resulted to be at risk for post-traumatic stress symptoms, and these subthreshold PTSD manifestations appear to impact on functioning. Further studies are needed to better investigate PTSD risk and resilience factors in this particular group of workers.

Posttraumatic Stress Symptoms in Mothers and Fathers of Very Preterm Infants Over the First 2 Years.

Mothers and fathers of infants born very preterm (VPT) are at increased risk for posttraumatic stress symptoms (PTSSs), such as reexperiencing the event, persistent avoidance, or increased reactivity within the early months, compared with parents of term-born infants. This study aimed to assess PTSSs in mothers and fathers of VPT infants over the first 2 years of life, including changes over time and relationship with medical and social risk. A longitudinal, prospective, cohort study of PTSSs in parents of VPT infants. PTSS was assessed at term equivalent age (TEA) and 12 and 24 months using the Posttraumatic Stress Disorder Checklist Specific Version. Participants were 105 parents of 131 infants born at <30 weeks' gestational age with PTSS data at least once (92 mothers and/or 75 fathers). At TEA and 12 and 24 months, elevated PTSSs were reported by 36%, 22%, and 18% of mothers and 35%, 25%, and 19% of fathers, respectively. The mean symptom scores and rates of elevated PTSSs declined over time: mean (95% confidence interval) change in PTSS score per year = -1.52 (-2.33 to -0.72, p < 0.001). There was little evidence for difference in these patterns for mothers or fathers (interaction p = 0.46 [total score] and 0.71 [elevated category]) or that medical and social risk were associated with PTSSs over time. Although the rates of parents experiencing clinically elevated symptoms declined over time, it is concerning that one-fifth of mothers and fathers reported elevated PTSSs at 24 months. Further research is needed to identify factors associated with increased risk and resilience for PTSSs after VPT birth in mothers and fathers to provide effective and appropriate support.

Special Report: C-L Psychiatrists Provide Overview of Response to COVID-19 Pandemic and Patient Management

<i>Special Report</i>: C-L Psychiatrists Provide Overview of Response to COVID-19 Pandemic and Patient Management

Sexual Satisfaction in Spouses of Ex-POWs: The Role of PTSD Symptoms and Self-Differentiation

Spouses of former prisoners-of-war (ex-POWs) are at risk for posttraumatic stress symptoms (PTSS) and marital distress. This study assessed the implications of PTSS and self-differentiation for sexual satisfaction among 90 ex-POWs’ spouses and 75 matched combatants’ spouses from the 1973 Yom Kippur War. Standardized questionnaires were used. Ex-POWs’ spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.

The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: A randomised controlled trial (DRIP-study)

BackgroundCritical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial. ObjectivesThe objective of this study was to explore the effect of a diary authored by a close relative for a critically ill patient. MethodsThe study was a multicenter, block-randomised, single-blinded, controlled trial conducted at four medical-surgical ICUs at two university hospitals and two regional hospitals. Eligible for the study were patients ≥18 years of age, undergoing mechanical ventilation for ≥24 h, staying in the ICU ≥48 h, with a close relative ≥18 years of age. A total of 116 relatives and 75 patients consented to participate. Outcome measures were scores of posttraumatic stress symptoms, anxiety, depression, and health-related quality of life three months after ICU discharge. ResultsRelatives had 26.3% lower scores of posttraumatic stress in the diary group than in the control group (95% confidence interval: 4.8–% to 52.2%). Patients had 11.2% lower scores of posttraumatic stress symptoms in the diary group (95% confidence interval: −15.7% to 46.8%). There were no differences between groups in depression, anxiety, or health-related quality of life. ConclusionA diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically ill patients during their stay in the ICU.

Post traumatic stress symptoms in parents of children with cancer: A mediation model

Objective: Caregivers of pediatric cancer patients are at risk for posttraumatic stress symptoms (PTSS). Previous literature has identified caregiver illness uncertainty as a predictor of PTSS, yet little is known about the mechanism by which illness uncertainty may affect PTSS. Rumination, or perseverations about the cause and consequences of an event, has been related to posttraumtic stress disorder in other populations. However, limited research of this relationship exists for pediatric cancer caregivers. Further, no studies have evaluated rumination in relation to illness uncertainty. The current study examined rumination in relation to illness uncertainty and PTSS in caregivers with children actively receiving treatment for cancer. It was hypothesized that rumination would be related to illness uncertainty and would mediate the relationship between illness uncertainty and PTSS. Methods: Caregivers (N = 59) completed the Parent Perception of Uncertainty Scale, Ruminative Responses Scale, and the Impact of Event Scale-Revised. Results: illness uncertainty was identified as a significant predictor of rumination (B = 0.148, p = .015), and rumination was a significant predictor of PTSS (B = 1.83, p < .001). Biased-corrected bootstrap regression analysis revealed that rumination mediated the relationship between illness uncertainty and PTSS (R2 = 0.53, p < .001). Conclusions: Rumination was identified as a mediator between the relationship of illness uncertainty and PTSS. These findings underscore the importance of rumination in caregivers of children with cancer, as a potential construct for identifying caregivers at risk of PTSS, and as a possible mechanism for targeted intervention.

Interactive effects of traumatic brain injury and anxiety sensitivity on PTSD symptoms: A replication and extension in two clinical samples.

Traumatic brain injury is prevalent and linked with heightened risk for post-traumatic stress symptoms, yet little research has investigated the role of well-established cognitive-affective risk factors in explaining this association. The present study addressed this gap by evaluating if elevations in anxiety sensitivity global score and subscales (cognitive concerns, physical concerns, social concerns) potentiated the effects of traumatic brain injury history on post-traumatic stress symptoms in two clinical samples: trauma-exposed smokers (n = 256; study 1) and trauma-exposed treatment-seeking adults (n = 117; study 2). Both samples revealed a significant interaction such that traumatic brain injury was more strongly linked with post-traumatic stress symptoms among those with high anxiety sensitivity cognitive concerns. In addition, anxiety sensitivity cognitive concerns demonstrated a stronger relationship with post-traumatic stress symptoms among those with a traumatic brain injury history. Taken together, these results of both studies underscore the importance of anxiety sensitivity cognitive concerns in the association of traumatic brain injury and posttraumatic stress symptoms.