Posttraumatic Stress Disorder Severity Research Articles

Posttraumatic Stress Symptoms After Stroke: The Effects of Anatomy and Coping Style.

Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke. Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients. Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08-21.34]; P<0.01) compared with low-anxious and repressive coping styles, after adjusting for age, education, stroke severity, brain atrophy, and depression. In our cohort, PTSD was a common sequela among stroke survivors. We suggest that risk factors for PTSD development include stroke severity, white matter damage, and premorbid coping styles. Early identification of at-risk patients is key to effective treatment.

Prevalence of Anxiety, Depression, and Post-Traumatic Stress Disorder Among Amputees Attending Jaipur Foot Trust Artificial Limb Centre in Kenya

Background: Amputees have been noted to present various psychiatric disorders including anxiety, body image disturbances, depression, and Post-Traumatic Stress Disorder (PTSD). However, there is limited data available on the prevalence of anxiety, depression, and PTSD among amputees in Kenya despite the high incidences of amputations in Kenyan hospitals. This study aimed at finding out the prevalence of anxiety, depression, and post-traumatic stress disorder among amputees attending the Jaipur Foot Trust Centre in Kenya. Method: This study took a cross-sectional descriptive study design. One hundred and forty-one patients attending the Jaipur Foot Trust were recruited to participate in the study after giving informed consent using a non-probability purposive sampling method. A socio-demographic questionnaire was used to collect socio-demographic characteristics. The Patient Health Questionnaire (PHQ-9) was used to assess the patient's depression. The Generalized Anxiety Disorder (GAD-7) scale was used to assess the patient's anxiety level and The Impact of Event Scale (IES-R) was used to assess the severity of post-traumatic stress disorder (PTSD). Data analysis was done using Statistical Package for Social Science (SPSS) version 23. Results: Findings from this study showed high rates of psychiatric morbidity where two-thirds of the patients reported PTSD (65%) with more than three-quarters of patients being diagnosed with depression (89.4%) and anxiety (91.5%). Also, there was a significant correlation between depression, anxiety, and PTSD, such that participants who had higher scores on anxiety and depression had significantly higher PTSD scores. Conclusion: Anxiety, Depression, and PTSD are very common psychological reactions in patients who have undergone amputation. The researchers expected that some of the sociodemographic factors and some amputation-related characteristics would have a relation with psychiatric comorbidity. However, the findings of this study did not show any such relationship except the relation between anxiety, depression, and PTSD. Early psychological assessment and interventions after amputations will help alleviate psychological distress.

MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD

IntroductionEating disorders (EDs) and posttraumatic stress disorder (PTSD) are highly comorbid, yet there are no proven integrative treatment modalities for ED-PTSD. In clinical trials, MDMA-assisted therapy (MDMA-AT) has shown marked success in the treatment of PTSD and may be promising for ED-PTSD. MethodsNinety individuals with severe PTSD received treatment in a double-blind, placebo-controlled pivotal trial of MDMA-AT. In addition to the primary (Clinician-Administered PTSD Scale) and secondary (Sheehan Disability Scale) outcome measures, the Eating Attitudes Test 26 (EAT-26) was administered for pre-specified exploratory purposes at baseline and at study termination. ResultsThe study sample consisted of 58 females (placebo = 31, MDMA = 27) and 31 males (placebo = 12, MDMA = 19) (n = 89). Seven participants discontinued prior to study termination. At baseline, 13 (15%) of the 89 individuals with PTSD had total EAT-26 scores in the clinical range (≥20), and 28 (31.5%) had total EAT-26 scores in the high-risk range (≥11) despite the absence of active purging or low weight. In completers (n = 82), there was a significant reduction in total EAT-26 scores in the total group of PTSD participants following MDMA-AT versus placebo (p = .03). There were also significant reductions in total EAT-26 scores in women with high EAT-26 scores ≥11 and ≥ 20 following MDMA-AT versus placebo (p = .0012 and p = .0478, respectively). ConclusionsED psychopathology is common in individuals with PTSD even in the absence of EDs with active purging and low weight. MDMA-AT significantly reduced ED symptoms compared to therapy with placebo among participants with severe PTSD. MDMA-AT for ED-PTSD appears promising and requires further study.

Postdeployment Treatment Gap: Symptoms and Treatment Utilization Among Returning National Guard Soldiers.

This study evaluated rates of psychiatric symptoms and mental health treatment utilization among National Guard service members during the post-deployment period. National Guard service members (n=311) completed surveys assessing demographics, beliefs about mental health treatment, emotion regulation strategies, and psychiatric symptoms. Mental health treatment utilization was assessed at 6-month follow-up. Post-deployment, 41.2% of the sample had psychiatric symptoms above the clinical cut-off for at least one symptom measure. This proportion increased at follow-up (53.5%). Alcohol use disorder (AUD) symptoms showed the largest increase (d=0.66), although symptoms of depression and posttraumatic stress disorder (PTSD) also showed small magnitude increases. Among those with elevated symptoms post-deployment (n=128), only 27.8% received mental health treatment at follow-up. Severity of depression, anxiety, and PTSD were higher among those who utilized treatment. The post-deployment period is a vulnerable one. Continued efforts to understand and address barriers to treatment for this population are warranted.

Nurse Adaptability and Post-traumatic Stress Disorder Symptoms During the COVID-19 Pandemic: The Effects of Family and Perceived Organizational Support.

ObjectiveTo examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units.BackgroundProximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports—i.e., family and organizational support—moderated the relationship between nurse adaptability and COVID-related PTSD symptoms.MethodsA sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N = 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms.ResultsAdaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r = 0.51 and 0.56, respectively, p < 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r = −0.43, p < 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r = −0.30, p < 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for.ConclusionFindings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis.

Characteristics of Posttraumatic Nightmares and Their Relationship to PTSD Severity Among Combat Veterans With PTSD and Hazardous Alcohol Use.

Although nightmares are known to predict the clinical course of posttraumatic stress disorder (PTSD), research on the relationship between specific nightmare characteristics and PTSD severity is sparse. This study conducted a secondary analysis to explore how five nightmare characteristics are cross-sectionally related to PTSD severity in 76 combat veterans with PTSD and at-risk alcohol use. Consistent with emotional processing theory, we hypothesized that more replicative, threatening, realistic, and easily recalled nightmares would be associated with more severe PTSD, whereas those with greater symbolism would predict lower PTSD severity. Nightmares narratives were audio-recorded and rated by multiple coders. Multiple analyses of variance explored the relationship between nightmare characteristics and PTSD clinical indicators. Most nightmares were realistic, easily recalled, and involved significant threat. Greater realism and replication were associated with greater PTSD severity. Realistic and replicative nightmares may be markers of more severe PTSD and may indicate that less emotional processing of the trauma has occurred.

The Costs and Health Benefits of Expanded Access to MDMA-assisted Therapy for Chronic and Severe PTSD in the USA: A Modeling Study

Background and ObjectiveIntensive psychotherapy assisted with 3,4-methylenedioxymethamphetamine (MDMA-AT) was shown in Phase 3 clinical trials to substantially reduce post-traumatic stress disorder (PTSD) symptoms compared to psychotherapy with placebo. This study estimates potential costs, health benefits, and net savings of expanding access to MDMA-AT to eligible US patients with chronic and severe PTSD.MethodsUsing a decision-analytic model, we compared the costs, deaths averted, and quality-adjusted life years (QALYs) gained of three, 10-year MDMA-AT coverage targets (25%, 50%, and 75%) compared to providing standard of care to the same number of eligible patients with chronic and severe PTSD. We used a payer perspective and discounted costs (in US$) and QALYs to 2020. We conducted one-way, scenario, and probabilistic sensitivity analyses and calculated the net monetary value of MDMA-AT using a cost-effectiveness threshold of $100,000 per QALY gained.ResultsExpanding access to MDMA-AT to 25–75% of eligible patients is projected to avert 43,618–106,932 deaths and gain 3.3–8.2 million QALYs. All three treatment targets are dominant or cost-saving compared to standard of care. Our sensitivity analyses found that accounting for parameter uncertainty and changes in various assumptions did not alter the main finding—MDMA-AT is dominant compared to standard of care.ConclusionExpanding access to MDMA-AT to patients with chronic and severe PTSD will provide substantial health and financial benefits. The precise magnitude is uncertain and will depend on the number of eligible patients and other inputs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40261-022-01122-0.

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...

Neuroticism and PTSD symptoms: Gender moderates the mediating effect of peritraumatic emotions and dissociation.

Gender differences in posttraumatic stress disorder (PTSD) prevalence and severity are well established; there is also growing evidence that men and women develop PTSD symptoms differently. This article aims to examine gender differences in the relationship between PTSD symptoms and personality traits according to the Five Factor model (FFM), based on the data from different studies conducted in Poland. The meta-analysis method and path analyses were conducted on the data from seven studies, including 1,182 women and 1,150 men. Five studies were carried out among motor vehicle accident survivors, one from fire and flood victims. All of the studies had a cross-sectional design. All FFM traits were significantly related to PTSD symptoms. Neuroticism showed the strongest relationship. Further analyses revealed a moderated mediation of this relationship: It was stronger for men and mediated by peritraumatic emotions and dissociation for women. The results indicate that PTSD development is mediated by peritraumatic factors, but this mediation is moderated by gender. Men with higher Neuroticism are at particular risk of developing PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Special Report: Stress and Distress During Pregnancy—How to Protect Both Mother and Child

Special Report: Stress and Distress During Pregnancy—How to Protect Both Mother and Child

Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.

OBJECTIVES:Symptoms of posttraumatic stress disorder (PTSD) are common among surrogate decision makers of patients with chronic critical illness (CCI). PTSD symptoms can be categorized into clusters including intrusion, avoidance, and hyperarousal, each of which has been associated with distinct outcomes and treatment responses. Our objective was to determine which symptom cluster was predominant among surrogates of patients with CCI.DESIGN:Secondary analysis of data from a clinical trial of a communication intervention.SETTING:The original trial was conducted in medical intensive care units at three tertiary-care centers and one community hospital.PATIENTS:Patients with CCI (≥7 d of mechanical ventilation and not expected to die or to be weaned from the ventilator in the subsequent 72 hr) and their surrogates.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Surrogate PTSD symptoms were measured 90 days after onset of patient CCI using the Impact of Events Scale-Revised (IES-R). The IES-R includes a total score (range, 0–88, higher scores indicate severe symptoms) as well as three subscales that assess intrusion, avoidance, and hyperarousal (range of intrusion and avoidance scores 0–32 and range of hyperarousal score 0–24). Intrusion symptoms were most severe (mean score, 10.3; 95% CI, 9.3–11.2), followed by avoidance (mean score, 8.0; 95% CI, 7.2–8.8). Hyperarousal symptoms were lowest (mean score, 5.1; 95% CI, 4.5–5.7). In a multivariable linear regression model, we found that surrogates of patients who died had higher odds of intrusion (β, 5.52; p < 0.0001) and avoidance (β, 3.29; p = 0.001) symptoms than surrogates of patients who lived, even after adjusting for baseline symptoms of anxiety and depression. Patient death was not associated with hyperarousal symptoms.CONCLUSIONS:Intrusive thoughts are the most severe PTSD symptom in surrogates of patients experiencing CCI, with intensified symptoms among surrogates of patients who died. These results have the potential to inform tailored treatment strategies to reduce PTSD symptoms in this population.

Posttraumatic stress disorder symptom severity modulates avoidance of positive emotions among trauma-exposed military veterans in the community.

Theoretical and empirical evidence links emotional avoidance to the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. However, few studies have tested whether these findings extend to positive emotional avoidance. Addressing this important gap in the literature, the current study examined the moderating role of PTSD symptom severity in the relation between positive emotional intensity and positive emotional avoidance. Participants were 465 trauma-exposed veterans recruited from the community (Mage = 38.00, 71.6% male, 69.5% White). The interaction between positive emotional intensity and PTSD symptom severity on positive emotional avoidance was significant. Analysis of simple slopes revealed that positive emotional intensity was significantly positively associated with positive emotional avoidance when participants endorsed high, but not low, levels of PTSD symptom severity. Veterans with more severe PTSD symptoms may utilize avoidance strategies in the context of intense positive emotions. These findings may suggest the potential need for addressing positive emotional avoidance in interventions to reduce PTSD symptom severity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Immediate Mental Health Effects of the 2020 Artsakh War on Armenians: A Cross-Sectional Study

Background: While previous studies show the long-term and transgenerational effects of war on mental health, immediate effects on mental health are relatively understudied. The 44-day 2020 Artsakh War (September 27-November 10, 2020) resulted in an estimated 5,000 Armenian casualties, displacement of half the Artsakh population, and ongoing captivity of Armenian prisoners of war. This is the first study post-war to quantify depression, anxiety, and post-traumatic stress disorder (PTSD) levels among the Armenian population. Methods: We conducted a cross-sectional study from February 3-May 31, 2021. Using Google Forms, we implemented a 75-item survey, including depression (PHQ-9), anxiety (GAD-7), and PTSD (PCL-5) questionnaires. We used six binary (yes/no) questions to define direct-exposure (DE) and no direct exposure (NDE) groups. We used independent samples t-tests to compare mean scores between groups. Results: There were 825 participants from 32 countries, 48% from the United States and 33% from Armenia and Artsakh. All participants from Artsakh (100%), 89.2% from Armenia, and 46.6% from the United States were directly exposed to the war. The DE (n=529) group exhibited significantly higher PHQ-9 (p=0.0001), GAD-7 (p=&lt;0.0001), and PCL-5 (p=0.0001) mean scores, than the NDE (n=296) group. Those who sustained a physical injury (n=20) had the highest average clinically relevant PTSD score (mean=39.5, SD=24). Conclusion: Our results suggest an association between direct exposure to war in Artsakh and increased depression, anxiety, and PTSD severity, suggesting an immediate need for mental health resources. Those who lost a loved one, had a loved one get injured, and had a loved one participate in the 2020 Artsakh War had higher PHQ-9, GAD-7, and PCL-5 mean scores relative to those who did not. Implications of this study include the development of targeted evidence-based psychotherapeutic methods based on specific direct exposure factors.

A Case Study of Prolonged Exposure for Posttraumatic Stress Disorder With a Latino Male with Polysubstance Use, Severe Depression, and Anger in a Residential Substance Use Treatment Program

Substance use disorders and post-traumatic stress disorder (PTSD) often co-occur, along with depression and anger. Despite evidence that Prolonged Exposure Therapy is effective for individuals with co-occurring PTSD and SUD when PE is implemented alongside SUD treatment, clinicians have been reluctant to offer PE or other trauma-focused therapies to individuals with co-occurring PTSD and SUD because of the belief that increased emotional distress would be counter-therapeutic for individuals in early recovery. A widely held explanation for the high degree of comorbidity is that individuals with PTSD use substances to reduce or avoid painful and disturbing PTSD symptoms. This case study describes the implementation and outcome of PE therapy with a 32-year-old man who had been admitted to a residential substance use treatment program for Latino males. The client had a long history of polysubstance use and severe PTSD. The client was homeless and reported significant depressive and anger symptoms. Assessment of PTSD revealed that he was using heroin and cocaine to avoid painful memories of a traumatic event that had occurred several years prior to his admission to this treatment program. Because the client reported using these substances to reduce emotional distress, PE was chosen as the PTSD intervention. During PE Therapy the client reported no thoughts or urges to use substances and at discharge from residential treatment he reported no problems with PTSD or depression. The client maintained all gains at 1-year follow-up, when he also reported that he was working full time and had remained abstinent since he completed treatment.

Relationship between Socio-Demographic Factors and Posttraumatic Stress Disorder: A Cross Sectional Study among Civilian Participants' Hostilities in Ukraine.

Background: Even though there is an extensive body of literature on posttraumatic stress disorder (PTSD) in individuals who have experienced armed conflict, there are still many grey areas, especially in relation to civilian participants in hostilities. This article evaluates how socio-demographic factors and the interactions between them have influenced PTSD among civilians involved in the recent war in Ukraine. Methods: This cross-sectional study included a convenience sample of 314 adults, 74 women, and 235 men. The mean age was 34.08 years. We used the Posttraumatic Stress Disorder (PTSD) Checklist–Civilian Version (PCL-C). Results: Our findings show that predictors of posttraumatic stress are loss of a loved one, place of residence, gender, continuation of education, and health insurance. We demonstrated that PTSD produced by the loss of a loved one as a result of war is determined by participation in the education system, whatever the level of education. The literature emphasises the importance of social support, e.g., from the family. We demonstrated that having children is associated with a risk of more severe PTSD, causing serious mental strain among participants of hostilities. We discovered that material security lowers PTSD, but only among people who have no children. Conclusions: PTSD is the result of not only the violence and damage caused by war but also of other stressful circumstances associated with the social and financial conditions of life. Further research needs to focus on identifying modifiable risk factors and protective factors that could be embraced by intervention strategies. Our findings can inform the goals behind therapeutic support for civilian participants of hostilities, and implications for social work. Social work professionals are encouraged to engage in direct questioning and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education. Trauma-affected people need to be given opportunities to build up their strengths and increase their psychological resources towards well-being. Social security (health insurance, savings, material security) should be taken into account when working with people affected by PTSD.

Updated cost-effectiveness of MDMA-assisted therapy for the treatment of posttraumatic stress disorder in the United States: Findings from a phase 3 trial.

Severe posttraumatic stress disorder (PTSD) is a prevalent and debilitating condition in the United States. and globally. Using pooled efficacy data from six phase 2 trials, therapy using 3,4-methylenedioxymethamphetamine (MDMA) appeared cost-saving from a payer's perspective. This study updates the cost-effectiveness analysis of this novel therapy using data from a new phase 3 trial, including the incremental cost-effectiveness of the more intensive phase 3 regimen compared with the shorter phase 2 regimen. We adapted a previously-published Markov model to portray the costs and health benefits of providing MDMA-assisted therapy (MDMA-AT) to patients with chronic, severe, or extreme PTSD in a recent phase 3 trial, compared with standard care. Inputs were based on trial results and published literature. The trial treated 90 patients with a clinician administered PTSD scale (CAPS-5) total severity score of 35 or greater at baseline, and duration of PTSD symptoms of 6 months or longer. The primary outcome was assessed 8 weeks after the final experimental session. Patients received three 90-minute preparatory psychotherapy sessions, three 8-hour active MDMA or placebo sessions, and nine 90-minute integrative psychotherapy sessions. Our model calculates the per-patient cost of MDMA-AT, net all-cause medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We reported results from the U.S. health care payer's perspective for multiple analytic time horizons, (base-case is 30 years), and conducted extensive sensitivity analyses. Costs and QALYs were discounted by 3% annually. Costs were adjusted to 2020 U.S. dollars according to the medical component of the U.S. Bureau of Labor Statistics' Consumer Price Index (CPI). MDMA-AT as conducted in the phase 3 trial costs $11,537 per patient. Compared to standard of care for 1,000 patients, MDMA-AT generates discounted net health care savings of $132.9 million over 30 years, accruing 4,856 QALYs, and averting 61.4 premature deaths. MDMA-AT breaks even on cost at 3.8 years while delivering 887 QALYs. A third MDMA session generates additional medical savings and health benefits compared with a two-session regimen. Hypothetically assuming no savings in health care costs, MDMA-AT has an ICER of $2,384 per QALY gained. MDMA-AT provided to patients with severe or extreme chronic PTSD is cost-saving from a payer's perspective, while delivering substantial clinical benefit.

Phycological debriefing in acute traumatic events: Evidence synthesis.

Stressful life situations can generate chronic symptomatology, so it is of great concern to analyze preventive strategies. Psychological debriefing is an intervention for acute trauma, which verbalizes perceptions, thoughts, and emotions experienced during a recent traumatic event. The evidence surrounding its efficacy is controversial. This article discusses the efficacy of psychological debriefing based on systematic reviews and clinical practice guidelines. In all, nine systematic reviews were included. Only one of them found that psychological debriefing effectively decreased psychological stress, while the remaining eight found no significant effects for outcomes such stress, depressive and anxious symptoms, or development and severity of post-traumatic stress disorder. Moreover, two clinical trials found that the intervention had a significantly deleterious effect. Another study found a worsening in the symptomatology associated with the event. Of the eight clinical practice guidelines incorporated, none recommended psychological debriefing as an intervention for acute trauma. Some phenomena could explain the lack of success of the intervention in the scientific evidence. The bioethical conditions related to the traumatic scenario hinder its research, and its lack of standardization makes its evaluation in clinical trials problematic. Other variables such as ethnicity, personality, culture, gender, and history of traumatic experiences have been little considered in research. Nevertheless, the intervention may hinder the adequate processing of traumatic memory and emotions. Current evidence is consistent in not recommending psychological debriefing as an intervention for acute trauma, so its management should avoid it. It is suggested to promote research on preventive interventions to develop chronic traumatic symptomatology.

Families With Violence Exposure and the Intergenerational Transmission of Somatization.

Introduction:Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology.MethodsThis paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age.ResultsMaternal PTSD severity was significantly associated with increased maternal somatization severity (p = 0.031). Maternal somatization severity during the child's early childhood predicted both maternal report of child somatization (p = 0.011) as well as child thought problems (p = 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization.ConclusionThe results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent–child relationship. The authors conclude with a discussion of implications for parent–infant and early childhood intervention.

Worse sleep, worsening post-traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID-19 pandemic.

SummaryThe coronavirus disease 2019 (COVID‐19) pandemic is a global health crisis with the potential to elicit and worsen psychiatric symptoms, particularly post‐traumatic stress disorder (PTSD) symptoms. Identifying modifiable protective factors is critical for preventing and treating PTSD symptoms both during and following the COVID‐19 pandemic. The present study examined associations of self‐reported sleep quality and anticipatory threat appraisals of the pandemic with PTSD symptoms 6 months later in a sample enriched for pre‐pandemic trauma exposure and PTSD. The sample included 590 adults (mean age 38.2 years) who completed a baseline survey in August/September 2020 and follow‐up survey in March/April 2021. The sample was recruited from a pool of participants interested in a prior study about traumatic stress. Participants self‐reported sleep quality and pandemic‐related anticipatory threat appraisals at baseline. PTSD symptoms were assessed at baseline and follow‐up. Baseline sleep quality was associated with PTSD symptoms at follow‐up controlling for baseline PTSD symptoms (B = −2.49, p = 0.001). Perceived anticipatory threat of the pandemic moderated this association such that worse sleep quality was related to more severe PTSD symptoms at follow‐up for participants with higher (B = −4.07, p < 0.001) but not lower (B = −0.43, p = 0.679) anticipatory threat about the COVID‐19 pandemic. These findings suggest that poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those individuals who perceived the pandemic as threatening for their future. Treatments that address sleep problems may be beneficial for reducing trauma‐related symptoms during and following the global health crisis.

Associations among clinical variables and anger differ by early life adversity among post-9/11 veterans.

Maladaptive anger and aggression are common in US military veterans and increase risk for impaired social relationships and functioning, justice-involvement and violence. Early life (before age 18) adversity predisposes veterans to later life psychopathology, though the link to increased later life anger is unclear. We analysed cross-sectional data of 158 post-9/11 veterans from the Translational Research Center for Traumatic Brain Injury and Stress Disorders study with and without a history of early life adversity (ns = 109 and 49, respectively). We explored the relationship among major clinical variables and current veteran anger (Dimensions of Anger Reactions) and whether the associations with these variables differed among participants with and without a history of retrospective self-reported early life adversity (Childhood Trauma Questionnaire). In the overall sample, posttraumatic stress disorder (PTSD) and depression severities had the strongest associations with current veteran anger (βs = 0.261 and 0.263; p-values = 0.0022 and 0.0103, respectively). In the subsample without early life adversity, only PTSD severity was significantly associated with anger (β = 0.577, p = 0.0004). In the early life adversity subsample, this strong association weakened and was no longer significant (β = 0.168, p = 0.1007); instead, anxiety and depression severities showed moderate associations with anger (βs = 0.243 and 0.287, p-values = 0.0274 and 0.0130, respectively). Findings suggest that clinicians should screen veterans with history of early life adversity for depression and anxiety when anger is present.