Significant Posttraumatic Stress Disorder Symptomatology Research Articles

Behavioral and neurocognitive factors distinguishing post-traumatic stress comorbidity in substance use disorders

Significant trauma histories and post-traumatic stress disorder (PTSD) are common in persons with substance use disorders (SUD) and often associate with increased SUD severity and poorer response to SUD treatment. As such, this sub-population has been associated with unique risk factors and treatment needs. Understanding the distinct etiological profile of persons with co-occurring SUD and PTSD is therefore crucial for advancing our knowledge of underlying mechanisms and the development of precision treatments. To this end, we employed supervised machine learning algorithms to interrogate the responses of 160 participants with SUD on the multidimensional NIDA Phenotyping Assessment Battery. Significant PTSD symptomatology was correctly predicted in 75% of participants (sensitivity: 80%; specificity: 72.22%) using a classification-based model based on anxiety and depressive symptoms, perseverative thinking styles, and interoceptive awareness. A regression-based machine learning model also utilized similar predictors, but failed to accurately predict severity of PTSD symptoms. These data indicate that even in a population already characterized by elevated negative affect (individuals with SUD), especially severe negative affect was predictive of PTSD symptomatology. In a follow-up analysis of a subset of 102 participants who also completed neurocognitive tasks, comorbidity status was correctly predicted in 86.67% of participants (sensitivity: 91.67%; specificity: 66.67%) based on depressive symptoms and fear-related attentional bias. However, a regression-based analysis did not identify fear-related attentional bias as a splitting factor, but instead split and categorized the sample based on indices of aggression, metacognition, distress tolerance, and interoceptive awareness. These data indicate that within a population of individuals with SUD, aberrations in tolerating and regulating aversive internal experiences may also characterize those with significant trauma histories, akin to findings in persons with anxiety without SUD. The results also highlight the need for further research on PTSD-SUD comorbidity that includes additional comparison groups (i.e., persons with only PTSD), captures additional comorbid diagnoses that may influence the PTSD-SUD relationship, examines additional types of SUDs (e.g., alcohol use disorder), and differentiates between subtypes of PTSD.

4417 Association between Brain Volumes and Posttraumatic Stress Disorder in Intensive Care Unit Survivors

OBJECTIVES/GOALS: To explore the severity of posttraumatic stress disorder (PTSD) symptoms in association with hippocampal and amygdala volumes in ICU survivors. We hypothesize that the severity of posttraumatic stress symptoms in ICU survivors is associated with lower volumes of both the hippocampus and amygdala. METHODS/STUDY POPULATION: Secondary analysis of the VISIONS study, a prospective sub-study of the BRAIN-ICU cohort, which included survivors of critical illness. Patients were screened for preexisting PTSD before discharge. The PTSD Checklist Specific (PCL-S) was used at 3 and 12 months to evaluate the ICU as a traumatic experience. A score of >30, indicated significant symptoms of PTSD. A Philips Achieva 3T MRI scanner was used to scan patients at both discharge and 3-month follow-up. To compare median brain volumes at discharge and 3 months for those with and without significant PTSD symptomatology (PCL-S ≥30) at 3 and 12 months, we used a Kruskal-Wallis (KW) equality-of-populations rank test. RESULTS/ANTICIPATED RESULTS: The median age for our sample was 58.5 (52.6, 63.7). One-third of the sample was female, and 90% were Caucasian. Fifty-seven percent of individuals (N = 12) had at least one prior mental health diagnosis, with two having a prior history of PTSD. One third of individuals experienced delirium during their critical illness. At 3-month follow up, there were three patients with PTSD symptomatology and one at 12-month follow up. Median brain volumes (hippocampus or amygdala) did not differ between individuals with or without PTSD symptomatology at either 3 or 12 months (p-values for all tests >0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Although our study did not reveal significant differences in brain volumes between PTSD patients and non-PTSD patients, sample size is a major limitation and larger scale studies should be undertaken to elucidate possible neurobiological markers of PTSD in ICU survivors. CONFLICT OF INTEREST DESCRIPTION: Dr. Wilson would like to acknowledge salary support from the Vanderbilt Faculty Research Scholars Program (1KL2TR002245), HL111111 and GM120484. Drs. Ely and Jackson as well as Mrs. Kiehl all receive funding for their time working on this investigation from AG035117 and HL111111. Dr. Ely would additionally like to acknowledge salary support from the Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC). Dr. Ely will also disclose additional funding for his time from AG027472 and having received honoraria from Orion and Hospira for CME activity; he does not hold stock or consultant relationships with those companies. The authors would like to acknowledge the following: this work was conducted in part using the resources of the Center for Computational Imaging at Vanderbilt University Institute of Imaging Science and the Advanced Computing Center for Research and Education at Vanderbilt University, Nashville, TN, and study data were collected and managed using REDCap electronic data capture tools hosted at Vanderbilt University.

Sex differences in global and local connectivity of adolescent posttraumatic stress disorder symptoms.

Sex differences in youth's posttraumatic stress disorder (PTSD) symptomatology have not been well studied. Based on a recently burgeoning theory of psychopathology networks, this study conducted sex comparisons of global and local connectivity of PTSD symptoms in a sample of 868 disaster-exposed adolescents (57.0% girls; a mean age of 13.4±0.8years) with significant PTSD symptomatology evaluated by the UCLA PTSD Reaction Index for DSM-IV. The results revealed that global connectivity was stronger in girls' network than in boys', and individual symptoms' connectivity and its rankings differed by sex. Intrusive recollections, flashbacks, avoiding activities/people, and detachment were the most strongly connected symptoms in girls, whereas flashbacks, physiological cue reactivity, diminished interest, and foreshortened future were the most strongly connected symptoms in boys. Several symptoms were identified as featuring large connectivity differences across sex. These findings provide novel insights into sex differential risk and features of youth's PTSD symptomatology. Sex differences reflected in the co-occurrence of PTSD symptoms may merit more consideration in research and clinical practice.

Prediction of Posttraumatic Stress Disorder From Peritraumatic Dissociation and Distress Among Men and Women Victims of Violent Crimes

ABSTRACTThis prospective study evaluated the main and interactive effects of peritraumatic reactions with gender on posttraumatic stress disorder (PTSD) onset, independently of known risk factors. Further, 111 adult victims of violent crime completed the Structured Clinical Interview, the Modified PTSD Symptom Scale, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Hierarchical regressions and chi-square tests were conducted for continuous and categorical measures of PTSD. Extremely elevated scores of peritraumatic dissociation (PD) and peritraumatic distress (PDI) were obtained for both sexes. Greater PDI and PD were related to more PTSD symptoms. No significant interaction effects with gender emerged. These results remained when acute stress disorder was controlled for. Analyses on categorical data produced similar results. Victims of violent crimes recall severe peritraumatic reactions. The more severe these are, the more likely they are to develop significant PTSD symptomatology in the months that follow.

Nature and correlates of post-traumatic stress symptomatology in lung transplant recipients

The burden of post-traumatic stress disorder (PTSD) symptoms may be associated with worse outcomes after transplantation. Little is known about the prevalence and correlates of PTSD symptoms in lung transplant recipients. We conducted a cross-sectional study of lung transplant recipients between April 2008 and February 2010 at a single center. The PTSD Checklist was used to determine the burden of PTSD symptomatology (total score) and percent of subjects with a provisional PTSD diagnosis (validated algorithms). We assessed the relationship between PTSD symptom burden and patient characteristics with multivariable logistic modeling. We enrolled 210 subjects (response rate 91%). Most patients were female (50%), and Caucasian (89%). The median age was 59 (interquartile range [IQR] 48 to 63) years and the median time between transplant and follow-up was 2.4 (IQR 0.7 to 5.3) years. Clinically significant PTSD symptomatology was observed in 12.6% (8.4% to 17.9%) of subjects. Subjects were more likely to endorse symptoms of re-experiencing (29.5%) and arousal (33.8%) than avoidant symptoms (18.4%). Multivariable linear regression showed higher PTSD symptom scores among recipients who were: younger (p < 0.001); without private insurance (p = 0.001); exposed to trauma (p < 0.001); or diagnosed with bronchiolitis obliterans syndrome (p = 0.005). Overall prevalence of PTSD (12.6%) in our study was two times higher than the general population. Patient characteristics found to be associated with an increased burden of PTSD symptoms may be useful to consider in future interventions designed to reduce this comorbidity.

Risk factors for PTSD after Typhoon Morakot among elderly people in Taiwanese aboriginal communities

This study aimed to investigate the risk factors associated with post-traumatic stress disorder (PTSD) symptoms in a mid- and old-age population who experienced Typhoon Morakot in Taiwan. One hundred and twenty people, who were mostly Taiwanese aboriginal people aged 55 years and above, were invited to participate in this study. PTSD symptoms were assessed using the PTSD Symptom Scale (PSS-I). Information regarding demographic characteristics, relocation, personal injury, family death, property damage, and self-perceived health was collected. 29.2% of study participants presented significant PTSD symptomatology during the previous month. Development of PTSD symptomatology after the disaster was significantly associated with being female (OR 3.63, 95% CI = 1.11-11.88), experiencing relocation (OR 5.64, 95% CI = 1.60-19.88), and having poorer self-perceived health (OR 4.24, 95% CI = 1.53-11.78) after controlling for age, education, personal injury, family death, and property damage. Further, by adding depression into the analysis, we found the risk factors were being female (OR 4.66, 95% CI = 1.16-18.80), experiencing relocation (OR 27.91, 95% CI = 3.74-229.80), family death (OR 67.62, 95% CI = 2.85-1063.68), and poorer self-perceived health (OR 28.69, 95% CI = 4.52-182.06). Nearly 30% of the elderly people studied who experienced Typhoon Morakot developed significant PTSD symptomatology. The risk factors for PTSD symptoms were female gender, poorer self-perceived health, relocation, family death, and depression. The elderly people who were relocated by governmental programs were more likely to develop PTSD symptomatology after experiencing trauma. Resettlement and rehabilitation programs after a disaster need to be more concerned with their psychological effects on victims.

Risky business: Trauma exposure and rate of posttraumatic stress disorder in African American children and adolescents

Demographics, parental risk factors, and experiencing interpersonal trauma (domestic violence, community violence, and physical and sexual abuse) are related to childhood posttraumatic stress disorder (PTSD). Little is known about these factors and the risk of PTSD in African American children. This study examined associations between PTSD symptoms and gender, age, parent mental illness, parent substance abuse, and interpersonal trauma in African American children. Participants were 257 children and adolescents, ages 8-17 years (M = 11.7, SD = 2.5), who received outpatient mental health treatment. Being female and witnessing domestic violence was associated with more PTSD symptoms. Exposure to community violence and physical abuse increased the odds of clinically significant PTSD symptomatology by more than 2 times. The rate of PTSD (16%) was lower in the current study than in other same-age study populations (25%-40%). Risk factors and identification strategies for PTSD are discussed.

Exploring Posttraumatic Outcomes as a Function of Childhood Sexual Abuse

There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results showed that 95% of the participants experienced clinically significant post-traumatic stress disorder symptomatology related to their childhood sexual abuse. In conjunction with these high levels of negative symptoms, the population evidenced posttraumatic growth levels that were comparable to other trauma samples. This research has clinical relevance in terms of adding to the knowledge base on sexual abuse and the usefulness of this knowledge in therapeutic interventions and relationships.

Posttraumatic Stress Disorder and Male-Perpetrated Intimate Partner Violence

ALTHOUGH THE RELATIONSHIP BETWEEN POSTTRAUmatic stress disorder (PTSD) and aggression is generally well established within the literature, research investigating the relationship between PTSD and male-perpetrated intimate partner violence (IPV) has only begun to emerge. Preliminary findings suggest a link between trauma exposure, PTSD symptomatology, and maleperpetrated IPV, which may have important clinical implications for batterer intervention programs. To the extent that IPV associated with PTSD has an etiology distinct from non–PTSD-related IPV, prevention and intervention programs may need to be tailored to address the potentially unique IPV risk factors among men with PTSD. Because of the lack of research on the association of PTSD and IPV perpetrated by women, this Commentary will focus on male-perpetrated IPV. Most US studies examining the relationship between PTSD and male-perpetrated IPV have been conducted with male veterans. Findings from these studies indicate that male veterans with greater PTSD symptomatology often self-report higher levels of anger, hostility, aggressiveness, anger reactivity, and IPV perpetration than veterans without significant PTSD symptomatology. The association between PTSD and IPV perpetration has also been found among civilian men. Rosenbaum and Leisring found that civilian male batterers referred to a group batterers treatment program who met diagnostic criteria for PTSD based on the PTSD Checklist-Civilian Version self-reported greater generalized aggressivity and significantly higher rates of IPV perpetration on the Conflict Tactics Scale than civilian male batterers without PTSD. In a study examining IPV rates within a nonclinical civilian male sample recruited from a college campus, Jakupcak and Tull reported similar findings, with higher self-reported rates of IPV perpetration, trait and internal anger, and hostility found among civilian men with PTSD symptomatology compared with civilian men without PTSD symptoms. Prior research investigating the relationship between PTSD and aggression has often included PTSD as a single construct. However, findings from a 3-wave longitudinal study examining the course of PTSD symptoms over a 12-month period in young adults who experienced community violence highlight the importance of considering how the 3 PTSD symptom clusters differentially change over time, influence other PTSD symptoms, and affect behavior, including aggression. Although debate exists as to the nature and number of factors, PTSD is currently characterized by 3 distinct symptom clusters consisting of (1) reexperiencing symptoms (eg, nightmares, flashbacks); (2) avoidance symptoms (eg, avoidance of trauma-related stimuli); and (3) hyperarousal symptoms (eg, hypervigilance, exaggerated startle response). These 3 symptom clusters have been examined as they relate to aggressive behavior. Overall, hyperarousal symptoms appear to play an especially prominent role in the initiation of aggressive behavior. For example, in a study examining the association between aggression and each of the 3 PTSD symptom clusters among male Vietnam veterans participating in a larger multisite psychophysiological project on PTSD, Taft et al found hyperarousal symptoms to have the strongest positive relationship with aggressive behavior in comparison with the other 2 PTSD symptom clusters. Additionally, the authors found that hyperarousal symptoms were both directly related to aggression and indirectly associated with aggression through alcohol problems, as measured by the CAGE questionnaire for assessing alcoholism. Conversely, findings from the same study show that reexperiencing symptoms may not directly influence aggressive behavior, but may indirectly affect aggression via their positive relationship on physiological reactivity (ie, heart rate and skin conductance) to trauma cues and negative affect on alcohol problems. Mixed findings exist regarding the role of PTSD avoidance symptoms and subsequent aggressive behavior. A study comparing male Vietnam veterans seeking inpatient PTSD treatment with a mixed diagnostic group of male inpatient Vietnam veterans without PTSD found a positive relationship between avoidance/numbing symptoms and aggression when assessing PTSD symptom clusters using the brief Mississippi Scale for Combat-Related PTSD. However, additional evidence from the study by Taft et al suggests a potential negative association between avoidance/numbing

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). We recruited 400 patients (mean age 60 +/- 12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.

Chronic Posttraumatic Stress Disorder After Facial Injury: A 1-year Prospective Cohort Study

This study examined the prevalence, severity, and predictors of persistent traumatic stress symptoms in socioeconomically disadvantaged adults after orofacial injury. A 1-year prospective study of 336 socioeconomically disadvantaged adults treated for orofacial injury at a Level I trauma center was conducted. Univariate analyses were performed on early measures of injury characteristics, prior trauma exposure, coping resources, and psychosocial functioning to select potential predictors of 1-year posttraumatic stress disorder (PTSD) scores; independence of variable contribution was then evaluated in multiple regression analyses. A substantial number of patients (23%) continued to experience significant PTSD symptomatology at 12 months. Predictors of PTSD symptoms at 12 months included current and lifetime mental health and social service needs, lifetime social service use, prior trauma exposure, sum of stressful life events in the year preceding injury, patient report of pain severity and inadequate social support at 10 days postdischarge, and PTSD scores at 1 month. One-month PTSD symptoms, unmet social service need, and need for more instrumental and emotional support were independent predictors of 12-month PTSD outcomes. Limitations include loss to follow up, use of self-report measures, and the possibility of additional traumatization in the follow-up year influencing symptom levels. Many socioeconomically disadvantaged adults manifest negative psychological outcomes even 1 year after an orofacial injury. Poor social support and unmet social service needs immediately after the injury, as well as high PTSD symptoms at 1 month postinjury, are strongly associated with the risk of developing chronic PTSD. The surgical management of orofacial injuries in disadvantaged individuals should integrate case management that addresses psychosocial sequelae and patient service needs.

LIFE EVENT ATTRIBUTIONS AS A POTENTIAL SOURCE OF VULNERABILITY FOLLOWING EXPOSURE TO A TRAUMATIC EVENT

Attributions for traumatic events have been identified as a potential source of vulnerability for posttraumatic stress disorder (PTSD) following exposure to a traumatic event. In this study, 516 undergraduates were screened for traumatic exposure and the development of significant symptoms of posttraumatic stress. Twenty-nine individuals with significant symptoms of PTSD and 29 similarly trauma-exposed individuals without significant PTSD symptomatology wrote narratives of three types of life events (pleasant, unpleasant, and traumatic) and provided attributions for those events. Trained judges who were unaware of participants' symptom status rated the attributions along the following dimensions: internal-external, global-specific, and stable-unstable. PTSD participants offered more global and stable attributions for life events generally. The relationship between attributions for actual life events and PTSD was not trauma specific, suggesting that these attributional tendencies which are associated with heightened distress following trauma may be fairly pervasive. Etiological implications and directions for future research are presented and discussed.

Post-traumatic stress disorder caused in mentally disordered offenders by the committing of a serious violent or sexual offence

The aim of the study was to measure in a sample of mentally disordered offenders the frequency of post-traumatic stress disorder (PTSD) symptoms related to the committing of an offence and to consider what factors might be contributory to the onset and maintenance of these symptoms. The study was the first to investigate the incidence of PTSD in a primarily mentally ill population. A sample of 37 mentally disordered offenders was assessed for PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R; American Psychiatric Association, 1987) and the Impact of Events Scale (IES; Horowitz, Wilner and Alvarez, 1979). Of this sample, 33% met diagnostic criteria for PTSD and 54% had significant PTSD symptomatology as indexed by the IES. The IES scores were greater in those who had committed violent offences than in those who had committed sexual offences, and in those who had an affective diagnosis. Frequency of PTSD symptoms was greater in those offenders who now felt regret for their actions. The high frequency of PTSD symptoms in this population may serve as a significant stressor and may exacerbate co-morbid psychiatric illness and contribute to poor treatment response and relapse. Many mental illnesses are exacerbated by stress and the presence of untreated PTSD symptoms may serve to prevent treatment gains for the primary mental disorder. If risk of future dangerous-ness is associated with unstable mental state, as is often the case in a mentally disordered population, then the development of PTSD post-offence may serve to prolong or increase risk of harm to both self and others.

Post-Traumatic Stress Disorder Symptoms in United Nations Peacekeepers: An Examination of Factor Structure in Peacekeepers with and without Chronic Pain

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.

Posttraumatic stress in children following acute physical injury.

To prospectively assess the presence of posttraumatic stress disorder (PTSD) in children hospitalized following acute physical injury. The focus was identification of the incidence of PTSD, PTSD symptoms, and exploration of factors associated with development of PTSD symptoms and disorder. Forty children ages 8-17 were interviewed approximately 1 month following a serious injury and assessed for PTSD, pretrauma behavior problems, levels of peritraumatic fear, and posttraumatic thought suppression. Twenty-two and a half percent of participants met DSM-IV diagnostic criteria for PTSD; 47.5% met criteria for at least two of the three PTSD symptom clusters. Greater thought suppression was associated with increased symptoms of PTSD, as were the child's peritraumatic fear response and pretrauma internalizing behaviors. Results suggest that many children who have been hospitalized for physical trauma may be experiencing clinically significant PTSD symptomatology and may benefit from psychological as well as medical intervention.

PTSD Substance abuse comorbidity and treatment utilization

The present study investigates the prevalence of posttraumatic stress disorder (PTSD) among a sample of treatment-seeking substance abusers and examines the relationship between PTSD comorbidity and rates of inpatient substance abuse treatment. Eightyfour patients (48 male and 36 female) admitted for detoxification at a private hospital were administered self-report measures of lifetime stressor events, PTSD symptomatology, and prior treatment history. Approximately one quarter of the sample was found to present with significant PTSD symptomatology. Women were more likely than men to have been physically and sexually abused, and women reported experiencing a greater number of traumatic events. Consequently, more women than men were classified as having possible PTSD. With respect to inpatient substance abuse treatment admission rates, the PTSD group reported a greater number of hospitalizations than their non-PTSD counterparts. Implications of these findings for routine trauma screening and more effective treatment for substance abusers with concomitant PTSD are highlighted.