Posttraumatic Stress Disorder Symptom Severity Research Articles

Endocannabinoid dysregulation and PTSD in urban adolescents: Associations with anandamide concentrations and FAAH genotype.

The endocannabinoid system, which regulates fear- and anxiety-related behaviors, is dysregulated in adults with posttraumatic stress disorder (PTSD), as indicated by higher circulating anandamide (AEA) concentrations. The C385A (rs324420) polymorphism in the fatty acid amide hydrolase (FAAH) gene, which catabolizes AEA, is linked to higher AEA concentrations and greater PTSD symptoms in adults. Given that adolescence is a critical period during which trauma and psychiatric disorders emerge, understanding this relationship in youth is essential. This study examines PTSD symptoms, AEA concentrations, and FAAH genotype in a diverse adolescent sample. This study included 102 Detroit-area adolescents (M ± SD = 13.33 ± 2.21 years, 54.9% female) and their parents/guardians. The sample consisted of 40.2% White Non-Hispanic, 34.3% Black Non-Hispanic, 6.9% White Hispanic, 4.9% Asian/Pacific Islander, and 12.7% Biracial adolescents. Trauma exposure and PTSD symptoms were assessed using the UCLA PTSD Reaction Index for DSM-5. Plasma concentrations of AEA were measured by liquid chromatography-tandem mass spectrometry, and FAAH genotype was determined from saliva samples and high-throughput screening. The majority (90%) of adolescents reported trauma exposure, and 20% met PTSD criteria. Higher AEA concentrations were associated with more severe PTSD symptoms (p = 0.009), especially hyperarousal. The FAAH A-allele (present in 52.5% of participants) was associated with higher AEA concentrations (2.11 ± 0.69 pmol/ml, p = 0.013) and greater PTSD severity (22.65 ± 15.931, p = 0.027), particularly those with the reexperiencing cluster, compared to the CC genotype (1.79 ± 0.66 pmol/ml and 15.87 ±+ 13.043, respectively). Elevated AEA concentrations and the FAAH A-allele were associated with greater PTSD symptom severity in urban adolescents. These findings suggest endocannabinoid dysregulation may play a role in adolescent PTSD, highlighting the need for further research and targeted interventions.

Nursing as an earthquake survivor: A qualitative study on nurses traumatized by the Kahramanmaraş earthquake in Turkey.

Nurses' critical input and firsthand disaster management experience are vital to healthcare quality. This study aims to comprehend nurses' experiences during and after the earthquakes, their coping mechanisms for posttraumatic stress disorder (PTSD), and the consequent effects on their profession, given the nurses' crucial role in disaster response. A descriptive qualitative study using semistructured interviews was conducted between April and May 2024. Fifteen nurses were selected using criterion and snowball sampling methods from those working as earthquake survivor nurses in the affected areas. The COREQ guidelines for reporting qualitative research were followed. Five main themes were: emotional reactions/physical difficulties, career and motivation, PTSD and well-being, suggestions, and work performance. The results highlighted the significant psychological and professional challenges that nurses encounter, including the effects of severe PTSD symptoms, coping strategies, and the influence on their capacity to deliver care. Nurses dealing with earthquakes face unique challenges that test their resilience on all levels. Learning from their experiences and coping mechanisms can help healthcare systems support these frontline workers better. Investing in disaster preparedness and mental health resources for nurses is crucial for their well-being and the overall strength of the healthcare system during crises. Effectively managing workloads and rest periods can reduce physical fatigue and prevent burnout. Shift rotations and adequate staffing levels are necessary. Access to psychological mental health support is vital for nurses to recover from the psychological effects of disasters. Regular disaster preparedness training is imperative for physical safety and psychological resilience. Robust support systems, including safe accommodation and peer support groups, are crucial for nurses in disaster response.

The Psychological Health of Iranian Citizens Protesting the Actions of Their Country's Morality Police: La santé psychologique des citoyens iraniens qui manifestent contre les actions de la police des mœurs de leur pays.

To determine the mental health of Iranian citizens protesting the actions of their country's Morality Police. Street protests across Iran were met with violent suppression that included security forces reportedly targeting protestors' eyes. A group of 63 Iranian protestors (58.7% female; mean age 32.0 [SD = 9.43] years, from all socio-economic classes) who had been part of street protests against the regime's morality police, was recruited by convenience sampling between May and August 2023 by journalists working underground in Iran. The study was conducted in Farsi by telephone (n = 60) and in-person (n = 3). Demographic and psychometric data were collected, the latter including symptoms of posttraumatic stress disorder (PTSD; Impact of Events Scale-Revised) and depression (Beck Depression Inventory-Revised), in Farsi-validated scales. Between-group comparisons were undertaken with one-way ANOVA and post-hoc Tukey comparisons. Significance was set at P < 0.05. The protestors comprised three groups: not wounded (n = 27: 59.26% female, mean age 34.44 [SD = 12.11] years), non-eye wound (n = 23; 60.87% female, mean age 32.61 [SD = 5.89] years) and eye-wound (n = 13; 53.85% female, mean age 27.54 [SD = 6.58] years). The eye wound group (blinded in one or both eyes) had less severe intrusion symptoms of PTSD (P = 0.048) and depression (P = 0.0001) than the non-eye wound group. The not wounded group had less severe symptoms of depression than the non-eye wound group (P = 0.003). Every protestor who had lost sight regarded their actions, notwithstanding their physical consequences, in a positive psychological light. Contrary to our a-prior hypothesis, Iranian protestors blinded in one or both eyes were faring better psychologically than protestors with non-eye wounds. Possible reasons for this included higher rates of psychological treatment and social support in the eye-wound group compared to the other two groups post-injury and the nascent development of posttraumatic growth.

I Belong: Gender and Sexuality Minoritized Students' Positive Perceptions of Campus Climate Protect Against PTSD Following Sexual Assault.

Sexual assault is a widespread problem among institutions of higher education. Students whose gender and/or sexuality are minoritized (GSM; non-cisgender and/or non-heterosexual) are especially vulnerable to experiencing sexual assault and its negative consequences, including post-traumatic stress disorder (PTSD). A sense of belonging within the campus community can protect victims of sexual assault from negative psychological outcomes; however, no study to date has examined whether this aspect of a positive campus climate protects GSM victims, in particular, from developing more severe PTSD symptoms after sexual assault. We hypothesized that GSM victims would experience more severe PTSD symptoms than non-GSM victims after experiencing sexual assault and that their perceptions of campus climate would moderate this relationship. All undergraduate students from a public liberal arts college on the East Coast were asked to participate in an online survey about their history of sexual assault and emotional well-being. Of those who completed the survey, approximately 18% reported a history of sexual assault (N = 146). GSM victims of sexual assault reported more severe PTSD symptoms than non-GSM victims; however, a significant interaction showed that PTSD symptoms were similar for GSM and non-GSM victims with high ratings of campus climate. Thus, positive perceptions of campus climate protected GSM students from experiencing more severe PTSD symptoms. These findings inform administrative efforts by suggesting the need for more inclusive support resources (i.e., crisis centers and orientation materials), curricula, and community spaces for GSM students.

Impact of the February 6, 2023, Turkey earthquake on post-traumatic stress disorder, internet addiction and insomnia: A cross-sectional study.

After earthquakes, individuals may increase their internet usage to cope with post-traumatic stress symptoms, potentially leading to internet addiction and sleep disturbances. This study aims to determine the levels of post-traumatic stress disorder (PTSD), internet addiction and insomnia in earthquake survivors 1 year after the event and to explore the relationships between these variables. This cross-sectional descriptive study was conducted between April and June 2024 through face-to-face interviews with 554 individuals who survived the February 6, 2023 earthquake in Turkey, 1 year after the event. Data were collected using the PTSD Checklist for DSM-5 (PCL-5), the Young Internet Addiction Test-Short Form (YIAT-SF) and the Insomnia Severity Index (ISI). A statistically significant moderate positive correlation was found between PCL-5, YIAT-SF and ISI based on the Pearson correlation test (r = .32 and .44, respectively; p < .05). According to the logistic regression analysis, experiencing physical injury during the earthquake and the loss of first-degree relatives were found to predict the severity of PTSD symptoms (p = .04, OR = 2.44, 95% CI [1.04, 5.65]; p < .001, OR = 1.98, 95% CI [1.26, 3.06], respectively). Additionally, the YIAT-SF and ISI variables were found to be statistically significant predictors of PTSD symptom severity (p < .001, OR = 1.04, 95% CI [1.01, 1.07]; p < .001, OR = 1.18, 95% CI [1.12, 1.23], respectively). It is concluded that the severity of PTSD symptoms in earthquake survivors is associated with the severity levels of insomnia and internet addiction. Additionally, it is determined that experiencing injury or loss of a loved one during the earthquake may increase the severity of PTSD symptoms. To protect earthquake survivors from the risk of PTSD, it may be necessary to provide psychosocial support focussed on positive coping strategies for internet addiction and insomnia.

Mental Health and Substance Use Among Black Women Attending STD Clinics in Baltimore: The Role of Overt and Subtle Discrimination.

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013-2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

The effect of trauma-focused therapy on voice-hearing: An experience sampling study.

We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD. This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group. Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD. The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = -0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001). Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

Specific symptom change associated with ecological momentary assessments of intrusive trauma memories

As the global prevalence of exposure to traumatic events rises, there is a growing need for accessible and scalable treatments for trauma-related disorders like posttraumatic stress disorder (PTSD). Intrusive reexperiencing symptoms, such as trauma-related intrusive memories (TR-IMs), are central to PTSD and a target of gold-standard treatments that are effective but resource-intensive. This study examined whether completing a brief ecological momentary assessment (EMA) protocol assessing the occurrence and phenomenology of TR-IMs was associated with decreases in intrusion symptom severity. Trauma-exposed adults (N = 139) experiencing at least 2 TR-IMs per week related to a DSM-5 criterion A traumatic event completed a 2-week EMA protocol. During this period, they reported on 18 sensory-perceptual and affective qualities of their TR-IMs three times per day and on posttraumatic stress symptom severity at day’s end. Longitudinal symptom measurements were entered into linear mixed-effects models to test the effect of Time on symptom severity. Over the 2-week protocol, intrusion symptom severity decreased, while other symptom cluster scores did not change. Within the intrusion symptoms, this effect was specific to TR-IMs and emotional reactivity to trauma reminders, and was not moderated by survey completion rate, total PTSD symptom severity, ongoing treatment, or time since trauma. This study was quasi-experimental and lacked a control group, therefore no definitive conclusions about clinical utility can be made. Nonetheless, these findings provide preliminary proof-of-principle and warrant future clinical trials assessing the clinical efficacy of EMAs of intrusive trauma memories as a scalable treatment option targeting intrusive memory symptoms.

Is Sharing One’s Personal Story of Victimization Preferred? Incarcerated Women’s Perspectives on Group Treatment for Sexual Trauma

Treatment preferences are an important part of evidence-based practice and have been shown to affect treatment outcomes. In this two-part study, incarcerated women were asked about their preferences for two versions of a trauma-focused group treatment: one that requires sharing their personal memory of sexual victimization (Sharing Required) and one that does not (Sharing Not Required). Study 1 enrolled 88 non-treatment seeking women who evaluated the treatments based on descriptions of the groups. Study 2 was a partially randomized patient preference trial with 85 treatment-seeking women who either agreed to be randomly assigned to one of the two therapy groups or declined randomization and instead were directly assigned to their preferred therapy. Participants in Study 1 evaluated the Sharing Not Required condition more favorably (p &lt; 0.001, Cohen’s d = 0.39). However, the results were affected by PTSD symptom severity as those above the clinical cutoff for probable PTSD evaluated both group treatments more favorably than those below the cutoff (ps &lt; 0.05, Cohen’s ds ≥ 0.46). Study 2 found no significant difference between the proportion of participants who chose Sharing Required, Sharing Not Required, or had no personal preference, and the results did not differ by PTSD symptom severity (ps ≥ 0.70). Outcomes suggest that a variety of forms of trauma-focused therapy may be acceptable to incarcerated women, including those that involve personal narration of trauma memories and those that do not.

Exploring Immersive Multimodal Virtual Reality Training, Affective States, and Ecological Validity in Healthy Firefighters: Quasi-Experimental Study.

Firefighters face stressful life-threatening events requiring fast decision-making. To better prepare for those situations, training is paramount, but errors in real-life training can be harmful. Virtual reality (VR) simulations provide the desired realism while enabling practice in a secure and controlled environment. Firefighters' affective states are also crucial as they are a higher-risk group. To assess the impact on affective states of 2 simulated immersive experiences in a sample of healthy firefighters (before, during, and after the simulation), we pursued a multivariate approach comprising cognitive performance, situational awareness, depression, anxiety, stress, number of previous adverse events experienced, posttraumatic stress disorder (PTSD) severity, and emotions. The efficacy and ecological validity of an innovative VR haptic system were also tested, exploring its impact on performance. In collaboration with the Portuguese National Fire Service School, we exposed 22 healthy firefighters to 2 immersive scenarios using the FLAIM Trainer VR system (neutral and arousing scenarios) while recording physiological data in a quasi-experimental study. Baseline cognitive performance, depression, anxiety, stress, number of adverse events, and severity of PTSD symptoms were evaluated. Positive and negative affective states were measured before, between, and after each scenario. Situational awareness, sense of presence, ecological validity, engagement, and negative effects resulting from VR immersion were tested. Baseline positive affect score was high (mean 32.4, SD 7.2) and increased after the VR tasks (partial η2=0.52; Greenhouse-Geisser F1.82,32.78=19.73; P<.001). Contrarily, mean negative affect score remained low (range 11.0-11.9) throughout the study (partial η2=0.02; Greenhouse-Geisser F2.13,38.4=0.39; P=.69). Participants' feedback on the VR sense of presence was also positive, reporting a high sense of physical space (mean score 3.9, SD 0.8), ecological validity (mean score 3.8, SD 0.6), and engagement (mean score 3.8, SD 0.6). Engagement was related to the number of previously experienced adverse events (r=0.49; P=.02) and positive affect (after the last VR task; r=0.55; P=.02). Conversely, participants reported few negative effects (mean score 1.7, SD 0.6). The negative effects correlated positively with negative affect (after the last VR task; r=0.53; P=.03); and avoidance (r=0.73; P<.001), a PTSD symptom, controlling for relevant baseline variables. Performance related to situational awareness was positive (mean 46.4, SD 34.5), although no relation was found to metacognitively perceived situational awareness (r=-0.12; P=.59). We show that VR is an effective alternative to in-person training as it was considered ecologically valid and engaging while promoting positive emotions, with few negative repercussions. This corroborates the use of VR to test firefighters' performance and situational awareness. Further research is needed to ascertain that firefighters with PTSD symptomatology are not negatively affected by VR. This study favors the use of VR training and provides new insights on its emotional and cognitive impact on the trainee.

Towards accurate screening and prevention for PTSD (2-ASAP): protocol of a longitudinal prospective cohort study

BackgroundEffective preventive interventions for PTSD rely on early identification of individuals at risk for developing PTSD. To establish early post-trauma who are at risk, there is a need for accurate prognostic risk screening instruments for PTSD that can be widely implemented in recently trauma-exposed adults. Achieving such accuracy and generalizability requires external validation of machine learning classification models. The current 2-ASAP cohort study will perform external validation on both full and minimal feature sets of supervised machine learning classification models assessing individual risk to follow an adverse PTSD symptom trajectory over the course of 1 year. We will derive these models from the TraumaTIPS cohort, separately for men and women.MethodThe 2-ASAP longitudinal cohort will include N = 863 adults (N = 436 females, N = 427 males) who were recently exposed to acute civilian trauma. We will include civilian victims of accidents, crime and calamities at Victim Support Netherlands; and who were presented for medical evaluation of (suspected) traumatic injuries by emergency transportation to the emergency department. The baseline assessment within 2 months post-trauma will include self-report questionnaires on demographic, medical and traumatic event characteristics; potential risk and protective factors for PTSD; PTSD symptom severity and other adverse outcomes; and current best-practice PTSD screening instruments. Participants will be followed at 3, 6, 9, and 12 months post-trauma, assessing PTSD symptom severity and other adverse outcomes via self-report questionnaires.DiscussionThe ultimate goal of our study is to improve accurate screening and prevention for PTSD in recently trauma-exposed civilians. To enable future large-scale implementation, we will use self-report data to inform the prognostic models; and we will derive a minimal feature set of the classification models. This can be transformed into a short online screening instrument that is user-friendly for recently trauma-exposed adults to fill in. The eventual short online screening instrument will classify early post-trauma which adults are at risk for developing PTSD. Those at risk can be targeted and may subsequently benefit from preventive interventions, aiming to reduce PTSD and relatedly improve psychological, functional and economic outcomes.

Intrinsic functional connectivity of right dorsolateral prefrontal cortex and hippocampus subregions relates to emotional and sensory-perceptual properties of intrusive trauma memories.

Trauma-related intrusive memories (TR-IMs), unwanted and vivid, are core symptoms of posttraumatic stress disorder (PTSD). Prior research links voluntary TR-IM suppression to inhibitory control of the right dorsolateral prefrontal cortex (dlPFC) over the hippocampus (HPC). However, the potential relevance of tonic resting-state inhibition has not been examined, nor has the functional differentiation of the anterior and posterior hippocampus (aHPC/HPC). This study examined relationships of TR-IM frequency and properties with resting-state negative coupling between the right dlPFC and right aHPC/pHPC in trauma-exposed individuals with PTSD symptoms. Participants (N=109; 88 female) completed two weeks of ecological momentary assessments capturing TR-IM frequency and properties (intrusiveness, emotional intensity, vividness, visual properties, and reliving). Using 3T resting-state magnetic resonance imaging, participant-specific 4-mm spheres were placed at the right dlPFC voxel most anticorrelated with the right aHPC and pHPC. Quasi-Poisson and linear mixed-effects models assessed relationships of TR-IM frequency and properties with right dlPFC-right aHPC and pHPC anticorrelation. TR-IM emotional intensity was positively associated with right dlPFC-aHPC connectivity, while vividness and visual properties were linked to right dlPFC-pHPC connectivity. No significant associations were found between TR-IM frequency, intrusiveness, or reliving, and anticorrelation with either HPC subregion. This study provides novel insights into the neural correlates of TR-IMs, highlighting the relevance of intrinsic negative coupling between the right dlPFC and aHPC/pHPC to their emotional impact and perceptual properties. Further research on inhibitory mechanisms in this circuit could improve understanding of component processes of intrusive reexperiencing, a severe and treatment-refractory PTSD symptom.

The Association between Post-Traumatic Stress Disorder and Problematic Alcohol and Cannabis Use in a Multi-Ethnic Cohort in The Netherlands: The HELIUS Study.

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background.

Effect of Obstructive Sleep Disorder Treatment on Posttraumatic Stress Disorder Symptoms: A Literature Review.

To explore whether continuous positive airway pressure (CPAP) adherence among adult patients with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) affects the PTSD Checklist (PCL), a validated tool that measures severity of PTSD symptoms. Studies focusing on PTSD and OSA were searched in PubMed and CINAHL databases. Inclusion and exclusion criteria were applied, decreasing the article yield to nine. All articles chosen focused on the adult population and were conducted in North America. The literature review yielded eight observational cohort studies and one descriptive study. Seven studies were conducted with Veterans and all studies used the PCL tool. Three themes were identified: (a) Trauma and OSA, (b) OSA and PTSD Symptoms, and (c) CPAP Therapy and PTSD Symptoms. An area of further study is assessing how CPAP adherence might affect improvement in PTSD symptoms and how adherence can be improved. OSA is correlated with more severe PTSD symptoms, but CPAP use is associated with improvement in PTSD symptoms. The literature reviewed found PCL scores improved up to 10 points within 3 months of CPAP use. These findings highlight the importance of collaboration between mental health and sleep medicine professionals and opportunity for further study in this area. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Traumatised youth harbour feelings of revenge: investigating the association between PTSD symptomatology, vengeance, and willingness to forgive among the Congolese adolescent refugees in Uganda

ABSTRACT Background: Prolonged conflicts in the Democratic Republic of Congo (DRC) have caused widespread psychological trauma among civilians leading to maladaptive coping strategies across generations. Despite this occurrence, empirical studies on the prevalence of trauma and its impact on attitudes towards revenge and forgiveness, particularly among the youth, are scarce. This study aims to clarify the relationship between Post Traumatic Stress Disorder (PTSD) symptom severity and the desires for forgiveness and revenge among Congolese adolescents residing in Uganda. Methods: We analysed data from 269 adolescent refugees from the DRC living in the Nakivale refugee settlement in Southwestern Uganda. The assessment included exposure to war-related traumatic events and the MINI-KID for DSM-V PTSD symptom severity. The Heartland Forgiveness and Vengeance Scales measured willingness to forgive and feelings of vengeance. Results: Exposure to war-related traumatic events was notably high in our sample, with severe deprivation of food (260 [97%]), exposure to armed combat (249 [93%]), witnessing bombing, burning, or destruction of houses (245 [91%]), disappearance of family members (239 [89%]), and seeing dead bodies (236 [88%]). PTSD symptom severity was negatively associated with willingness to forgive (b = −0.48; 95% CI −0.71–−0.25; p < .001) and positively associated with vengeance (b = 0.18; 95% CI 0.04–0.32; p = .011). Conclusion: PTSD symptom severity reduces the willingness to forgive and increases the desire for vengeance among adolescent refugees. Mental health clinicians and policymakers should consider addressing maladaptive coping behaviours related to feelings of revenge and unwillingness to forgive in their support strategies for refugees.

Discrepancies in perceptions of PTSD symptoms among veteran couples: Links to poorer relationship and individual functioning.

Veteran and intimate partner perceptions of posttraumatic stress disorder (PTSD) may differ, and little is known about how agreement or disagreement on symptom severity is related to relationship satisfaction. Veterans and their partners (N = 199 couples) completed a baseline assessment for a clinical trial evaluating two couple-based PTSD interventions. Veterans completed the PTSD Checklist for DSM-5 (PCL-5). Partners completed the collateral PCL-5 (PCL-5-C), which asked them to rate the severity of the veteran's PTSD symptoms. Both partner and veteran completed the Couples Satisfaction Index (CSI-32). Intraclass correlations (ICC) assessed agreement between PCL-5 and PCL-5-C total and subscale scores, which was low for total PCL and for all subscales (ICC = 0.15-0.46). Actor-Partner Interdependence Models (APIMs; actor-only pattern) tested associations between relationship satisfaction and PTSD symptom severity (total PCL and subscales), and the magnitude and direction of difference between PCL-5 and PCL-5-C (total and subscales). For veterans, more severetotal PTSD and negative cognition/mood scores were associated with lower relationship satisfaction, and the direction of discrepancy for negative cognition/mood (i.e., higher veteran-rated PTSD symptoms relative to partner's collateral report) was also associated with lower satisfaction. For partners, more severe collateral-reported symptoms for total PTSD and all four subscales were associated with lower relationship satisfaction; further, a larger discrepancy between veterans' and partners' reports of total PTSD, negative cognition/mood, and hyperarousal were associated with lower satisfaction. These results suggest that partners may have different perceptions of PTSD symptoms, and support the potential of fostering a shared understanding of PTSD symptom severity in couples.

Prevalence and co-occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low- and middle-income countries: a cross-sectional study.

Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co-occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co-occurrence of MSDs among ageing PWH remains limited, particularly in low- and middle-income countries (LMICs). We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co-occurrence of unhealthy alcohol use (AUDIT-C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ-9 ≥10), anxiety (GAD-7 ≥10) and post-traumatic stress disorder (PTSD) (PCL-5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio-demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use. Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men. Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.

Impact of patient death on physicians’ mental health

IntroductionPhysicians often encounter stressful situations that can impact their mental well-being. The death of a patient represents one of the most difficult situations in routine medical practice. Literature notably lacks comprehensive studies into physicians’ personal experiences with patients’ deaths. However, it does underscore heightened levels of sorrow, guilt, and stress stemming from the passing of terminally ill patients. As a majority of studies in this realm adopt qualitative methodologies, there is merit in supplementing existing research with a quantitative approach that employs validated psychometric scales. Furthermore, the study of phenomena associated with stress, particularly the perceived professional support by physicians in stressful events, can contribute to the implementation of preventive measures to help physicians cope. ObjectiveOur study aims to measure the traumatic impact on resident and intern physicians at national university hospitals following the death of patients, as well as to assess the perceived level of professional support among these physicians. Materials and methodsWe conducted a nationwide cross-sectional, descriptive, and analytical study. Participants included interns and residents from various specialties (medical, surgical and laboratory) at national university hospitals in Morocco. Assessing the traumatic impact of patients’ death on doctors was conducted using two psychometric scales: the Peri-Traumatic Distress Inventory (PDI) and the Revised Impact of Event Scale (IES-R). Additionally, we used the Perceived Professional Social Support Scale (QSSP-P) to evaluate how supportive the professional environment was towards these doctors. All scales utilized in the study are validated in the French language. ResultsThe study included 96 participants, with 67.7% being female. The average age was 26.8 years, ranging from 23 to 39 years. The majority of participants managed more than nine patients simultaneously (58.3%) while 41.7% were scheduled for more than six 24h shifts per month. During their training, over 64.6% of interns and residents faced more than ten patients’ death incidents, and 68.8% considered their first patient death as the most traumatizing. Half of the physicians evaluated the patients’ care as moderately appropriate, with 46.9% believing that the incident could have been prevented. Notably, 70.8% of interns and residents involved in patient care experienced self-blame and attributed a share of responsibility to themselves for the patient's demise. The majority of participants, 82.3%, exhibited peri-traumatic distress with a PDI score exceeding 15. Among the studied factors, only the perceived responsibility and a management system centered on a single physician (rather than a team) demonstrated a noteworthy correlation with PDI scores. The mean score on the IES-R scale was 25.6, with almost half of the sample (54.2%) reporting moderate to severe PTSD symptoms. The severity of these symptoms was significantly correlated with higher age, high number of patient's deaths experienced and the physician's perceived sense of responsibility. Participants in our study were more satisfied with support from colleagues compared to support functions (paramedical staff, administrative officials) or superiors. Moreover, only colleagues’ support was statistically significantly associated with low scores on the traumatic impact scales. ConclusionPhysicians maintain a unique relationship and therapeutic alliance with their patients. Therefore, the death of a patient can have a significant psychological impact on the physician. This study allowed us to objectively measure this psychological impact and evaluate professional support. The results of these studies encourage further exploration of the issue and the implementation of measures to reduce this psychological impact.

Dissociative Subtype of Posttraumatic Stress Disorder and its Correlates Among Treatment-Seeking Refugees

ABSTRACT The dissociative subtype of posttraumatic stress disorder (PTSD-DS) denotes a severe type of PTSD associated with complex trauma exposure and psychiatric comorbidity. Refugees may be at heightened risk of developing PTSD-DS, but research is lacking. This cross-sectional study aimed to examine PTSD-DS and its demographic, trauma-related, and clinical correlates among a convenience sample of refugee patients over 18 years old who were diagnosed with PTSD according to DSM-5. PTSD-DS (Clinician-Administered PTSD Scale for DSM-5), trauma exposure (Life Events Checklist for DSM-5) and general psychopathology (Brief Symptom Inventory) were assessed at intake. T-tests, chi-square tests, and logistical regression analysis were conducted. The final sample consisted of 552 participants (177 (32.1%) women; 375 (67.9%) men; average age 40.0 years (SD = 11.2)) who originated from 63 countries. Of those, 158 (28.6%) met criteria for PTSD-DS. Participants with PTSD-DS scored significantly higher on PTSD symptom severity (t(550)=-5.270, p < .001), number of traumatic event types (t(456)=-3.499, p < .001), and exposure to sexual assault (χ(1) = 6.471, p = .01) than those without PTSD-DS. The odds of having PTSD-DS increased by 14.1% with exposure to each additional traumatic event type (OR = 1.141, CI 0.033–1.260). In conclusion, around 29% of adult treatment-seeking refugees with PTSD met the criteria for PTSD-DS. Those exposed to multiple traumatic event types including sexual assault, regardless of sex, were especially at risk. Having PTSD-DS was associated with more severe PTSD. Prioritizing trauma-focused treatment for those with PTSD-DS is recommended.

Resilience as a protective factor in the development of post-traumatic stress disorder in patients hospitalised for COVID-19

Introduction and objective: Both the illness itself and hospitalisation due to COVID-19 are potentially traumatic experiences, especially when the course of the disease is severe. Resilience has been identified as a crucial factor in the process of successfully coping with traumatic events and may protect against the development of symptoms of post-traumatic stress disorder. The aim of this study was to determine the role of resilience in the prevention of post-traumatic stress disorder symptoms in patients requiring hospitalisation due to COVID-19. Materials and methods: A total of 138 patients (59 women, 79 men; mean age: 52.34 years; standard deviation, SD = 12.46) hospitalised at the University Hospital in Krakow were included in the study, which was conducted 7–8 months after their COVID-19 diagnosis. The PTSD Checklist for DSM-5 (PCL-5) and the Resilience Measurement Scale (SPP-25) were administered, and stepwise multiple regression analysis was used in the predictive models. Results: A total of 31 participants (22.5%) met the criteria for probable post-traumatic stress disorder symptoms. The study participants were characterised by a moderate level of resilience (5th sten), with women exhibiting lower levels than men. Higher levels of resilience were associated with lower severity of PTSD symptoms. A significant predictor of post-traumatic stress disorder symptoms was “Tolerance for failure and treating life as a challenge”. Conclusions: Resilience has an impact on the severity of symptoms of post-traumatic stress disorder. Specifically, the dimension of “Tolerance” within resilience appears to be an important protective factor against post-traumatic stress disorder symptoms after hospitalisation for COVID-19. Patients hospitalised with severe course of COVID-19 exhibit a moderate level of resilience, with men demonstrating higher resilience levels than women.