Severe Posttraumatic Stress Research Articles

Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy

Severe posttraumatic stress symptoms (PTSS) are connected to a variety of health-related and interpersonal problems, among them are the insecure attachment orientations. However, psychotherapy seems to improve not only PTSS but also attachment insecurities. In a large multicenter, randomized clinical trial, the attachment characteristics and PTSS of 85 adolescents and young adults (aged 14–21 years) with clinically relevant abuse-related PTSS were assessed at study entry, at the end of treatment, and 3 months after the end of treatment. Participants were randomized either to a developmentally adapted cognitive processing therapy (D-CPT) or to a wait-list with treatment advice (WL/TA). The purpose of the study was to analyze the association between PTSS and attachment at study entry as well as changes in attachment during the trial. We found that attachment-related avoidance (AR avoidance) was positively associated with PTSS from both self-reports and clinician ratings, whereas attachment-related anxiety (AR anxiety) was only related to self-reported PTSS (Pearson correlation coefficients between 0.37 and 0.46). Changes in AR anxiety occurred in both conditions at some point during the study (baseline to 3-month follow-up effect size was d = 0.60 for D-CPT and d = 0.44 for WL/TA) whereas for AR avoidance, only participants in D-CPT improved significantly (baseline to 3-month follow-up effect size was d = 0.75). The results indicate that PTSS and attachment are connected. Positive changes in attachment insecurities brought about by trauma-focused psychotherapy seem possible.Trial registration: German Clinical Trials Register (DRKS); Germanctr.de; identifier: DRKS00004787; date of registration: 18 March 2013.

Factors distinguishing veterans participating in supported education services from veterans on campus: Evidence supporting modifiable intervention targets.

The purpose of this study was to identify specific and modifiable supported education (SEd) service needs for the veteran population. To do so, we compared veterans participating in SEd services to other veterans on campus with respect to service-related challenges, community reintegration, and academic-related challenges. Identifying independent factors that distinguish veterans receiving SEd services from other veterans on campus may help operationalize interventions that target the unique challenges in this vulnerable population. This study used an exploratory cross-sectional design. We used logistic regression on 410 veterans attending college. Models tested whether sociodemographic characteristics (e.g., age), service-related challenges (e.g., combat exposure), academic-related challenges (e.g., academic self-efficacy), and aspects of community reintegration (e.g., employment status) distinguished veterans receiving SEd services (n = 94) from veterans on campus (n = 316). Veterans who reported (a) more severe combat exposure, (b) more severe posttraumatic stress disorder (PTSD) symptoms, (c) service-related mild traumatic brain injury (mTBI), (d) lower levels of academic self-efficacy, and (e) no paid employment were more likely to participate in SEd services. This study established several factors that distinguished veterans receiving SEd services from veterans on campus. Findings indicate that SEd education services for veterans should: (a) apply principles of trauma-informed care, (b) mitigate the influence of PTSD and/or mTBI upon academic success and community reintegration, (c) promote academic self-efficacy, and (d) integrate principles of supported employment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Acute Posttraumatic Symptoms Are Associated With Multimodal Neuroimaging Structural Covariance Patterns: A Possible Role for the Neural Substrates of Visual Processing in Posttraumatic Stress Disorder

BackgroundAlthough aspects of brain morphology have been associated with chronic posttraumatic stress disorder (PTSD), limited work has investigated multimodal patterns in brain morphology that are linked to acute posttraumatic stress severity. In the present study, we utilized multimodal magnetic resonance imaging to investigate if structural covariance networks (SCNs) assessed acutely following trauma were linked to acute posttraumatic stress severity. MethodsStructural magnetic resonance imaging data were collected around 1 month after civilian trauma exposure in 78 participants. Multimodal magnetic resonance imaging data fusion was completed to identify combinations of SCNs, termed structural covariance profiles (SCPs), related to acute posttraumatic stress severity collected at 1 month. Analyses assessed the relationship between participant SCP loadings, acute posttraumatic stress severity, the change in posttraumatic stress severity from 1 to 12 months, and depressive symptoms. ResultsWe identified an SCP that reflected greater gray matter properties of the anterior temporal lobe, fusiform face area, and visual cortex (i.e., the ventral visual stream) that varied curvilinearly with acute posttraumatic stress severity and the change in PTSD symptom severity from 1 to 12 months. The SCP was not associated with depressive symptoms. ConclusionsWe identified combinations of multimodal SCNs that are related to variability in PTSD symptoms in the early aftermath of trauma. The identified SCNs may reflect patterns of neuroanatomical organization that provide unique insight into acute posttraumatic stress. Furthermore, these multimodal SCNs may be potential candidates for neural markers of susceptibility to both acute posttraumatic stress and the future development of PTSD.

Early versus Late Profiles of Inflammatory Cytokines after Mild Traumatic Brain Injury and Their Association with Neuropsychological Outcomes.

Despite pre-clinical evidence for the role of inflammation in traumatic brain injury (TBI), there is limited data on inflammatory biomarkers in mild TBI (mTBI). In this study, we describe the profile of plasma inflammatory cytokines and explore associations between these cytokines and neuropsychological outcomes after mTBI. Patients with mTBI with negative computed tomography and orthopedic injury (OI) controls without mTBI were prospectively recruited from emergency rooms at three trauma centers. Plasma inflammatory cytokine levels were measured from venous whole-blood samples that were collected at enrollment (within 24 h of injury) and at 6 months after injury. Neuropsychological tests were performed at 1 week, 1 month, 3 months, and 6 months after the injury. Multivariate regression analysis was performed to identify associations between inflammatory cytokines and neuropsychological outcomes. A total of 53 mTBI and 24 OI controls were included in this study. The majority of patients were male (62.3%), and injured in motor vehicle accidents (37.7%). Plasma interleukin (IL)-2 (p = 0.01) and IL-6 (p = 0.01) within 24 h post-injury were significantly higher for mTBI patients compared with OI controls. Elevated plasma IL-2 at 24 h was associated with more severe 1-week post-concussive symptoms (p = 0.001). At 6 months, elevated plasma IL-10 was associated with greater depression scores (p = 0.004) and more severe post-traumatic stress disorder (PTSD) symptoms (p = 0.001). Plasma cytokine levels (within 24 h and at 6 months post-injury) were significantly associated with early and late post-concussive symptoms, PTSD, and depression scores after mTBI. These results highlight the potential role of inflammation in the pathophysiology of post-traumatic symptoms after mTBI.

Multi-voxel pattern analysis of amygdala functional connectivity at rest predicts variability in posttraumatic stress severity.

IntroductionResting state functional magnetic resonance imaging (rsfMRI) studies demonstrate that individuals with posttraumatic stress disorder (PTSD) exhibit atypical functional connectivity (FC) between the amygdala, involved in the generation of emotion, and regions responsible for emotional appraisal (e.g., insula, orbitofrontal cortex [OFC]) and regulation (prefrontal cortex [PFC], anterior cingulate cortex). Consequently, atypical amygdala FC within an emotional processing and regulation network may be a defining feature of PTSD, although altered FC does not seem constrained to one brain region. Instead, altered amygdala FC involves a large, distributed brain network in those with PTSD. The present study used a machine‐learning data‐driven approach, multi‐voxel pattern analysis (MVPA), to predict PTSD severity based on whole‐brain patterns of amygdala FC.MethodsTrauma‐exposed adults (N = 90) completed the PTSD Checklist‐Civilian Version to assess symptoms and a 5‐min rsfMRI. Whole‐brain FC values to bilateral amygdala were extracted and used in a relevance vector regression analysis with a leave‐one‐out approach for cross‐validation with permutation testing (1,000) to obtain significance values.ResultsResults demonstrated that amygdala FC predicted PCL‐C scores with statistically significant accuracy (r = .46, p = .001; mean sum of squares = 130.46, p = .001; R 2 = 0.21, p = .001). Prediction was based on whole‐brain amygdala FC, although regions that informed prediction (top 10%) included the OFC, amygdala, and dorsolateral PFC.ConclusionFindings demonstrate the utility of MVPA based on amygdala FC to predict individual severity of PTSD symptoms and that amygdala FC within a fear acquisition and regulation network contributed to accurate prediction.

Adverse Childhood Experiences and Mental Health among Women Experiencing Intimate Partner Violence

This study described the frequency of different adverse childhood experience (ACE) types described by women with recent IPV and examined the effects of each ACE type on women’s mental health. Over 70% of women reported parental separation or divorce, over 40% reported childhood sexual assault, and around 40% had a mother who was treated violently. Childhood physical abuse and sexual assault were associated with more severe posttraumatic stress disorder or depressive symptoms. Comprehensive interventions that address not only the effects of IPV but also the enduring effects of ACEs are needed to promote mental health for survivors of IPV.

Network Functional-Connectivity Patterns as Indication for Posttraumatic Stress Severity in Exposed Adolescents

Network Functional-Connectivity Patterns as Indication for Posttraumatic Stress Severity in Exposed Adolescents

Post-traumatic stress disorder in a population of 2008 Wenchuan earthquake survivors with disabilities: the role of environmental barriers

Purpose Earthquake survivors whose physical injuries result in disability may be at increased risk for prolonged and severe post-traumatic stress disorder. We estimated the prevalence of post-traumatic stress disorder, functional limitations, and environmental barriers in 289 survivors with disabilities induced by the 2008 Wenchuan earthquake eight years after the disaster. We also investigated the relationship of post-traumatic stress disorder symptom severity with function, considering a mediating role of environmental barriers. Methods Post-traumatic stress disorder was measured with post-traumatic stress disorder checklist-civilian version. Physical and mental functioning was assessed with Medical Outcomes Short Form-36 and perceived environmental barriers were evaluated with Nottwil Environmental Factors Inventory-Short Form. Path analysis was employed to examine the relationship of exposures, post-traumatic stress disorder symptom severity, environmental barriers, and physical and mental function. Results Prevalence of probable post-traumatic stress disorder was 18.68% (95% CI: 14.19–23.18%). Earthquake survivors with lower physical and mental functioning perceived more environmental barriers, and those who perceived more barriers demonstrated more severe post-traumatic stress disorder symptoms, confirming a mediating role of environmental barriers. Conclusions Long-term community-based health services for earthquake survivors with disabilities should combine both mental and physical rehabilitation and focus on creating disability-inclusive environments. Implications for rehabilitation Earthquake survivors whose physical injuries result in permanent disability may experience two different types of psychological trauma. The first originates from the initial psychological impact of the disaster and their injuries and the second arises from the added difficulty of coping with environmental barriers given the limitations imposed by their impairments. Even years after the disaster, prevalence of post-traumatic stress disorder is likely high in earthquake survivors with acquired musculoskeletal or neurological impairments and needs to be considered in the rehabilitation process. Physical and mental functioning, as well as environmental barriers, are important intervention targets to reduce post-traumatic stress disorder symptoms. Long-term community-based health services for earthquake survivors with disabilities are needed that combine both mental health and physical rehabilitation components with advocating for disability-inclusive environments.

Trauma exposure and stress-related disorders in African-American women with diabetes mellitus.

ObjectiveThe purpose of the study was to assess demographic features, rates of trauma exposure, prevalence of post‐traumatic stress and depressive symptoms in a group of urban, low‐income, African‐American women with type 1 or type 2 diabetes mellitus.Research Design and MethodsWe conducted a survey of (n = 290) low‐income, African‐American women seeking care in the diabetes clinic of an urban hospital and collected data on the demographic characteristics, childhood and nonchildhood abuse trauma exposure, and the severity of post‐traumatic stress and depressive symptoms using the Post‐traumatic Stress Disorder (PTSD) Symptom Scale (PSS) and the Beck Depression Inventory (BDI). In a subset of women with type 2 diabetes (n = 96), we assessed haemoglobin A1c to examine the relationship between psychopathology and glycaemic control.ResultsOf the overall sample, 61.7% reported exposure to trauma in their lifetime, and 30.4% and 29.3% had current PTSD and MDD, respectively. Exposure to both childhood and nonchildhood abuse trauma was associated with an increased PTSD and depressive symptom severity (P's < .05). PTSD diagnosis, but not depression, was associated with increased haemoglobin A1c (P = .002).ConclusionsThese data document high levels of trauma exposure, PTSD and depressive symptoms in diabetic African‐American women treated in a specialty clinic of an urban hospital setting. Furthermore, these data indicate that the presence of PTSD is negatively associated with glycaemic control.

Bir ÇEMATEM kliniğinde yatan ergen hastalarda madde kullanım eğilimleri, psikososyal travmalar, psikiyatrik komorbiditeler ve cinsiyet farklılıkları

Objective: The aim of the present study was to determine sociodemographic and clinical characteristics, substance use patterns, psychosocial traumas, and gender differences among adolescent inpatients at an addiction treatment center. Method: Participants were 105 adolescents consecutively admitted and hospitalized at the Children and Adolescent Alcohol and Drug Dependency Research Treatment and Training Center of Bakirkoy Prof Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery between February and December 2017. Kiddie-Schedule for Affective Disorders and Schizophrenia, present and lifetime version, Hamilton Anxiety and Depression Rating Scales, Conners-Wells’ Adolescent Self-Report Scale, Adolescent Dissociative Experiences Scale, Childhood Trauma Questionnaire, Addiction Profile Index-Practitioner Form, and Inventory of Parents and Peer Attachment were administered to all participants. Results: Of all cases, 31.4% were girls. Criminal history, a diagnosis of conduct disorder, substance use in the family, emotional abuse, and heroin use were frequently revealed. Among the girls, the substance use period was shorter and ecstasy use, traumatic experiences, diagnosis of post-traumatic stress disorder (PTSD) and severity of comorbidities were prominent; among the boys, synthetic cannabinoid use was more prevalent. While synthetic cannabinoid and alcohol use were frequent among the cases with a diagnosis of attention deficit hyperactivity disorder, heroin use was prominent among cases with depression diagnosis and ecstasy use among cases with PTSD. Conclusion: Among children and adolescents, substance use trends, childhood traumatic experiences, and severity of comorbidities may differ according to gender. It is important to take these differences into consideration in the treatment process.

ПСИХОЛОГИЧЕСКИЕ ПОСЛЕДСТВИЯ ВЛИЯНИЯ СТРЕССОРОВ ВЫСОКОЙ ИНТЕНСИВНОСТИ РАЗНОГО ТИПА

The article is devoted to the study of delayed (post-traumatic) stress caused by different types of stressful situations (death of a loved one, life-threatening diseases, traffic accidents, situations of physical and emotional violence) during early adulthood, the analysis of specific psychological markers of its intensity. The study involved 509 people (232 men and 277 women) aged 17 to 35 years (Me = 21; SD = 4,3). Methods: Posttraumatic Stress Disorder Checklist (PCL-5) in the Russian-language adaptation by N. V. Tarabrina and co-authors for the diagnosis of stressful events and their psychological consequences; the list of stress situations contained in the Life Events Checklist (LEC-5) for DSM-5; the Symptom Check List-90-r-Revised (SCL-90-R) technique in the Russian-language adaptation by N. V. Tarabrina and co-authors was used to evaluate psychopathological symptoms. It has been shown that the most severe in intensity posttraumatic stress causes situations that pose a threat to the physical and psychological well-being of a person at the same time (violence and life-threatening disease). Taking into account the level of mental trauma and the type of stressor, an analysis of a number of features of psychopathological symptoms was carried out. The results of the study made it possible to identify markers of severe post-traumatic stress, which were indicators of violation of contact with reality, expressed in distancing a person from the surrounding reality, distrust of the world, suspicion, phobic anxiety.

A cross-sectional study to assess the psychosocial impact of COVID-19 pandemic on health-care workers at a tertiary care hospital in India

Introduction: Corona virus disease 2019 (COVID-19) has been declared a notified disaster and public health emergency of international concern. Health-care workers (HCWs) who are involved in the care of these COVID patients are at additional risk of developing mental illness themselves due to direct exposure associated with the disease in them leading to this study.Aim: This study aims to assess the psychosocial impact of COVID-19 pandemic on HCW using Screening Questionnaire for Disaster Mental Health (SQD).Materials and Methods: A cross-sectional study was done on 112 HCW in SMS Hospital, Jaipur from June 1, 2020, to June 15, 2020. SQD was used to assess the magnitude of posttraumatic stress disorder and depression in these HCWs who were directly involved in care of COVID-19 patients at some point of time and had no previous history of mental illness.Results: 5.67% HCW were suffering from severe posttraumatic stress disorder and similar 5.67% had severe depression due to COVID-19. Results analyzed by t-test found that, overall, HCWs were mildly affected by COVID-19 in terms of posttraumatic stress disorder (mean value 2.16; 95% confidence interval [CI] = 1.80–2.53, P = 0.000) and depression (mean value 1.27; 95% CI = 0.97–1.57, P = 0.000) as per SQD scale.Conclusion: The study highlighted that the majority of the HCW were slightly affected by corona pandemic in terms of posttraumatic stress disorder and depression but as corona is still persisting, the need of constant vigilance for its psychosocial impact on them continues.The following core competencies are addressed in this article: Medical knowledge, Professionalism, Practice-based learning and improvement, Systems-based practice.

Interpersonal violence and mental health outcomes following disaster.

Disasters pose a documented risk to mental health, with a range of peri- and post-disaster factors (both pre-existing and disaster-precipitated) linked to adverse outcomes. Among these, increasing empirical attention is being paid to the relation between disasters and violence. This study examined self-reported experiences of assault or violence victimisation among communities affected by high, medium, and low disaster severity following the 2009 bushfires in Victoria, Australia. The association between violence, mental health outcomes and alcohol misuse was also investigated. Participants were 1016 adults from high-, medium- and low-affected communities, 3-4 years after an Australian bushfire disaster. Rates of reported violence were compared by areas of bushfire-affectedness. Logistic regression models were applied separately to men and women to assess the experience of violence in predicting general and fire-related post-traumatic stress disorder, depression and alcohol misuse. Reports of experiencing violence were significantly higher among high bushfire-affected compared with low bushfire-affected regions. Analyses indicated the significant relationship between disaster-affectedness and violence was observed for women only, with rates of 1.0, 0 and 7.4% in low, medium and high bushfire-affected areas, respectively. Among women living in high bushfire-affected areas, negative change to income was associated with an increased likelihood of experiencing violence (odds ratio, 4.68). For women, post-disaster violence was associated with more severe post-traumatic stress disorder and depression symptoms. Women residing within high bushfire-affected communities experienced the highest levels of violence. These post-disaster experiences of violence are associated with post-disaster changes to income and with post-traumatic stress disorder and depression symptoms among women. These findings have critical implications for the assessment of, and interventions for, women experiencing or at risk of violence post-disaster.

Baseline Resilience and Posttraumatic Symptoms in Dyads of Neurocritical Patients and Their Informal Caregivers: A Prospective Dyadic Analysis

Admission to a neuroscience intensive care unit (Neuro-ICU) is sudden and often traumatic for both patients and their informal caregivers. No prior studies have assessed prospectively risk and resiliency factors for chronic posttraumatic symptoms, as well as the potential interdependence between patients' and caregivers' symptoms over time. To analyze the impact of baseline resiliency factors on symptoms of posttraumatic stress (PTS) longitudinally in dyads of patients admitted to the Neuro-ICU and their primary family caregivers. We recruited dyads (M= 108) of patients admitted to the Neuro-ICU (total N=102) and their family caregivers (total N=103). Dyads completed self-report assessments of PTS and resiliency factors (mindfulness and coping) at baseline in the Neuro-ICU. PTS was measured again at 3- and 6-month follow-up. Clinically significant PTS symptoms were high at baseline in both patients (20%) and caregivers (16%) and remained high through 6 months (25% in patients; 14% in caregivers). Actor-partner interdependence modeling demonstrated that severity of PTS symptoms was predictive of PTS symptoms at subsequent time points (P<0.001). High baseline mindfulness and coping predicted less severe PTS symptoms in patients and caregivers (P<0.001) at all time points. Own degree of PTS symptoms at 3 months predicted worse PTS symptoms in one's partner at 6 months, for both patients and caregivers (P= 0.02). Findings highlight the need to prioritize assessment and treatment of PTS in Neuro-ICU patients and their informal caregivers through a dyadic approach.

Postconcussive, posttraumatic stress and depressive symptoms in recently deployed U.S. Army soldiers with traumatic brain injury.

Prior studies raise questions about whether persistent postconcussive symptoms (PCS) are differentiable from mental health sequelae of traumatic brain injury (TBI). To investigate whether PCS represented a distinct symptom domain, we evaluated the structure of post-concussive and psychological symptoms using data from The Army STARRS Pre/Post Deployment Study, a panel survey of three U.S. Army Brigade Combat Teams that deployed to Afghanistan. Data from 1229 participants who sustained probable TBI during deployment completed ratings of past-30-day post-concussive, posttraumatic stress, and depressive symptoms three months after their return. Exploratory factor analysis (EFA; n = 300) and confirmatory factor analysis (CFA; n = 929) of symptom ratings were performed in independent subsamples. EFA suggested a model with 3 correlated factors resembling PCS, posttraumatic stress, and depression. CFA confirmed adequate fit of the 3-factor model (CFI = .964, RMSEA = .073 [.070, .075]), contingent upon allowing theoretically defensible cross-loadings. Bifactor CFA indicated that variance in all symptoms was explained by a general factor (λ = .36-.93), but also provided evidence of domain factors defined by (a) reexperiencing/hyperarousal, (b) cognitive/somatic symptoms, and (c) depressed mood/anhedonia. Soldiers with more severe TBI had higher cognitive/somatic scores, whereas soldiers with more deployment stress had higher general and reexperiencing/hyperarousal scores. Thus, variance in PCS is attributable to both a specific cognitive/somatic symptom factor and a general factor that also explains variance in posttraumatic stress and depression. Measurement of specific domains representing cognitive/somatic symptoms, reexperiencing/hyperarousal, and depressed mood/anhedonia may help clarify the relative severity of PCS, posttraumatic stress, and depression among individuals with recent TBI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs.

Traumatized refugees with comorbid pain report more severe posttraumatic stress disorder (PTSD), respond less well to PTSD-focused treatments and exhibit greater disability. A mutually maintaining relationship may exist between pain and PTSD, that may be partly accounted for by depression, but no prior studies have tested this assumption in traumatized refugees. Self-report measures of pain, PTSD, depression, disability, pain catastrophizing (PC) and trauma-related beliefs (TRBs) were administered to 197 refugees referred to the Danish Institute Against Torture (DIGNITY) prior to treatment. The contribution of pain, depression, PC, and TRBs to the overall variance in PTSD severity was examined. We also examined whether the relationship between pain and PTSD was mediated by PC and TRBs, after controlling for depression. Depression, pain severity, PC and TRBs together accounted for 66% of the overall variance in PTSD, with depression being the primary contributor (57%). In univariate tests, both PC and TRBs significantly mediated the relationship between pain interference/severity and PTSD. However, after controlling for depression only PC mediated this relationship. Negative beliefs about pain and the trauma made small, but additive contributions to the relationship between pain and PTSD severity, after controlling for depression. Longitudinal studies with refugees, involving tests of more complex mutual maintenance models, are warranted. After controlling for symptoms of depression, pain catastrophizing and negative trauma-related beliefs partly mediated the relationship between pain and PTSD in tortured refugees. The results suggest that all three variables are important in a mutual mediation model of pain and PTSD, and as targets for treatment, in traumatized refugees.

New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

SummaryBackgroundExisting WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population.MethodsIn this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously.FindingsWe estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8–25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3–16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9–5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0–6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations.InterpretationThe burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden.FundingWHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.

Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea: a retrospective, nonrandomized controlled study

BackgroundSleep disorders frequently occur in posttraumatic stress disorder (PTSD) patients. Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD. Another sleep disorder, obstructive sleep apnea (OSA), also occurs frequently in PTSD, and emerging research indicates OSA fuels chronic insomnia. Scant research has investigated the impact of OSA treatment on insomnia outcomes (Insomnia Severity Index, ISI) in trauma survivors.MethodsOSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review. Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes [autobilevel (ABPAP); adaptive servo-ventilation (ASV)], which were subsequently prescribed. PAP use measured by objective data downloads divided the sample into three groups: compliant regular users (C-RU): n = 68; subthreshold users (SC-RU): n = 12; and noncompliant users (NC-MU): n = 16. The average follow-up was 11.89 ± 12.22 months. Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.ResultsThe C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group (P = 0.019). Insomnia severity significantly decreased in all three groups with large effects (C-RU, P = 0.001; SC-RU, P = 0.027; NC-MU, P = 0.007). Hours of weekly PAP use and insomnia severity were inversely correlated (P = 0.001, r = − 0.321). However, residual insomnia symptoms based on established ISI cut-offs were quite common, even among the C-RU group. Post hoc analysis showed that several categories of sedating medications reported at baseline (hypnotics, anti-epileptic, opiates) as well as actual use of any sedating medication (prescription or nonprescription) were associated with smaller insomnia improvements than those in patients not using any sedating agents.ConclusionsIn a retrospective, nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms, advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users. However, residual insomnia symptoms persisted, indicating that PAP therapy provides only limited treatment. RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes, and their potential impact on posttraumatic stress symptoms. Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.

Examining emotion relief motives as a facilitator of the transition from suicidal thought to first suicide attempt among active duty soldiers.

Cross-sectional and retrospective studies indicate that a primary motive for suicidal behavior among United States soldiers is the desire to alleviate or reduce emotional distress. This is also the aim of psychological services designed to prevent suicidal behavior. The prospective association of emotion relief (and other) motives with future suicidal behavior has yet to be examined, however. In a high-risk sample of 97 active duty soldiers presenting for an emergency behavioral health appointment, suicide motives were examined and compared between those with and without a history of suicide attempts. Results indicated that soldiers with a history of suicide attempts reported significantly more emotion relief (i.e., reducing or avoiding negative emotional states) and feeling generation (i.e., creating positive emotional states) motives. Feeling generation motives were positively correlated with severity of suicide ideation, hopelessness, depression, and posttraumatic stress, especially among those with a prior suicide attempt. Among soldiers with no previous suicide attempts, emotion relief motives were associated with significantly increased risk for suicide attempt during the 6-month follow-up assessment. Among soldiers with a prior attempt, emotion relief motives were not associated with later suicide attempts. Results provide preliminary evidence suggesting the desire to reduce or avoid negative emotional states may facilitate the emergence of a first suicide attempt among treatment-seeking Soldiers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Is Psychedelic Medicine on the Horizon?

Is Psychedelic Medicine on the Horizon?