Subthreshold PTSD Research Articles

Prevalence, Correlates, and Burden of Subthreshold PTSD in US Veterans.

Prevalence, Correlates, and Burden of Subthreshold PTSD in US Veterans.

Anxiety sensitivity and intolerance of uncertainty among veterans with subthreshold versus threshold PTSD.

Anxiety sensitivity and intolerance of uncertainty among veterans with subthreshold versus threshold PTSD.

Relationships of DSM-5 PTSD symptom clusters to suicidal ideation and death ideation in outpatient military veterans

Veterans with PTSD are at higher risk for suicide. This study examined the specific associations of PTSD symptom clusters with suicidal ideation (SI) and death ideation (DI), independently from depressive symptom clusters. Participants included 695 Israeli male outpatient military veterans (M = 25.35 years, SD = 5.65), divided into subsamples of probable PTSD (PTSD Checklist for DSM-5 [PCL-5] ≥ 33) and subthreshold PTSD scores (PCL-5 < 33). Data were extracted from medical chartsand self-report questionnaires. The main analyses included logistic regression to evaluate the associations between SI and DI (Brief Symptom Inventory, items 9 and 39) and PTSD symptom clusters (PCL-5), controlling for depressive symptom clusters (Beck Depression Inventory; cognitive-affective and somatization) in each subsample. The results showed that, for veterans with probable PTSD, the negative alterations in cognition and mood symptom cluster was positively correlated with SI and DI, while avoidance was negatively correlated with SI, independently from depressive symptoms clusters. In those with sub-syndromal PTSD, the re-experiencing cluster was positively correlated with DI, independently from the depressive symptom clusters. These findings highlight the importance of targeting PTSD components, such as negative alterations in cognition and mood symptoms experienced by veterans with PTSD, as part of suicide prevention efforts.

Efficacy of two brief trauma-focussed writing interventions in comparison to positive experiences writing: A randomized controlled trial

BackgroundThere is emerging literature regarding the efficacy of trauma-focussed writing therapies (TF-WTs) for posttraumatic stress. Such therapies have the potential to reduce posttraumatic stress symptoms (PTSS) in a brief time frame and can be delivered remotely. There remains a need for further research assessing the efficacy of different types of TF-WTs, as well comparing them to alternative control conditions not previously assessed. The present study assessed two TF-WTs that had differing writing instructions in comparison to an intervention that involved writing about positive experiences. MethodsAdult community participants (n = 83) with subthreshold or clinical PTSD symptoms were randomized to one of three conditions (two of which involved trauma-focussed writing, and the other involved writing about positive experiences). All conditions involved three weekly telehealth-delivered writing appointments. Outcomes were measured using the PTSD Checklist (PCL-5) and the Depression, Anxiety and Stress Scales (DASS-21), and were evaluated at baseline, one-week post-intervention, and five-weeks post-intervention. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR Protocol 12620001065987). ResultsThere was no evidence that the two TF-WTs were more efficacious in reducing PTSS or producing clinically meaningful change in comparison to positive experiences writing. Instead, a significant reduction from baseline to follow-up in PTSS, depression, anxiety and stress was observed in all three conditions. LimitationsThe results should be interpreted with consideration of the modest sample size and absence of longer-term follow-up. ConclusionsThree-session trauma-focussed writing delivered via telehealth may not be superior to writing about positive experiences.

Differential predictors of early- and delayed-onset post-traumatic stress disorder following physical injury: a two-year longitudinal study.

This study aimed to investigate the predictors of both early- and delayed-onset PTSD over a 2-year period following physical injuries. Patients were recruited from a trauma center at a university hospital in South Korea (June 2015 ~ January 2021). At baseline, 1142 patients underwent comprehensive assessments including socio-demographic, pre-trauma, trauma-related, and peri-trauma evaluations. Diagnoses of acute stress disorder (ASD) and subthreshold ASD were also determined using the Clinician-administered PTSD Scale (CAPS). Follow-up assessments at three months included diagnoses of PTSD and subthreshold PTSD using CAPS, and stressful life events (SLEs), with additional evaluations at 6, 12, and 24 months. The analyzed sample comprised 1014 patients followed up at least once after the baseline and 3-month evaluations. PTSD diagnoses were categorized into early-onset (within the first six months after trauma) and delayed-onset (more than six months after trauma). Logistic regression models identified predictors for each group. Early-onset and delayed-onset PTSD were diagnosed in 79 and 35 patients, respectively. Early-onset PTSD was predicted by previous psychiatric disorders, previous traumatic events, ASD and subthreshold ASD diagnoses, and higher anxiety levels. In contrast, delayed-onset PTSD was linked to higher education, higher injury severity, and subthreshold PTSD and SLEs at 3-month follow-up. Distinct predictors were found for early-onset and delayed-onset PTSD. The findings underscore the heterogeneous factors influencing the temporal development of PTSD post-trauma, and may provide valuable guidance for more targeted interventions and improved patient outcomes.

Posttraumatic stress symptoms, posttraumatic growth, and personality factors: A network analysis

BackgroundAfter experiencing a traumatic event, two possible outcomes are experiencing positive changes, such as posttraumatic growth (PTG), and/or experiencing distress in the form of posttraumatic stress symptoms (PTSS). These constructs are not mutually exclusive; those who experience PTSS may concurrently or at a later date likewise undergo PTG. Pretrauma factors, such as personality as measured by the Big Five Inventory (BFI), can interact with both PTSS and PTG. MethodsThe present study utilized Network theory to examine the interactions between PTSS, PTG, and personality in 1310 participants. Three networks were computed (PTSS, PTSS/BFI, PTSS/PTG/BFI). ResultsWithin the PTSS network, strong negative emotions emerged as the strongest influence on the network. Again, in the PTSS and BFI network, strong negative emotions exerted the strongest overall influence in addition to bridging the PTSS and personality domains. In the network with all variables of interest, the PTG domain of new possibilities was the strongest overall influence on the network. Specific relationships between constructs were identified. LimitationsLimitations of this study include the cross-sectional design and utilization of a sub-threshold PTSD, non-treatment seeking sample. ConclusionsOverall, nuanced relationships between variables of interest were identified, informing personalized treatment and furthers our understanding of both positive and negative responses to trauma. As the primary influence across two networks, the experience of strong negative emotions appears to be central to the subjective experience of PTSD. This may indicate a need to modify present treatments for PTSD, which conceptualize PTSD as a primarily fear-based disorder.

The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines.

Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.

Risk for PTSD symptom worsening during new PTSD treatment episode in a nationally representative sample of treatment-seeking U.S. veterans with subthreshold PTSD

Previous research has examined risk factors associated with poorer treatment outcomes for military Veterans with PTSD. However, work has not examined risk for symptom worsening among Veterans with subthreshold PTSD. The aim of this study was to examine demographic, psychiatric, physical health, and pre-treatment PTSD symptom clusters associated with clinically significant worsening of PTSD among a nationally representative sample of United States (U.S.) Veterans with subthreshold PTSD. Participants were Veterans (weighted N = 3162; unweighted N = 236) with subthreshold PTSD entering a new episode of treatment at U.S. Veterans Affairs PTSD specialty clinics during fiscal years 2018 and 2019. Data was collected as part of the Veterans Outcome Assessment, a yearly baseline and 3-month follow-up telephone survey. Analyses used weighted calculations to support the use of VOA data to draw inferences about all eligible Veterans, and binary logistic regression was used to examine risk factors for symptom worsening. Over 1/3 (37.7%) of Veterans with subthreshold PTSD experienced clinically significant symptom worsening from baseline to follow-up. Adjusted analyses revealed several risk factors for symptom worsening, including demographic (e.g., male sex, White race), psychiatric (personality and anxiety disorders), health care utilization (e.g., more primary care encounters in the previous year), physical health disability, and specific baseline PTSD symptom clusters (negative affect and anxious arousal). Findings suggest that Veterans with subthreshold symptoms seeking treatment for PTSD are at risk for symptom worsening, and highlight the importance of assessment, prevention, and treatment in targeting veterans with PTSD symptoms below the diagnostic threshold.

Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review.

ObjectiveTo examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging the gap between the traumatic exposure(s) and the clinical diagnosis.MethodsWe performed systematic searches of peer‐reviewed papers in English referenced in Pubmed, Embase, or PsycINFO and ascertained 34 prospective studies of PTSD symptom trajectories identified by latent class growth statistical modeling. Studies with delayed and low‐stable trajectories provided appropriate data for this study. We computed the difference between the delayed trajectory PTSD symptom sumscore and the low‐stable PTSD sumscore at the observed points in time after the traumatic event(s).ResultsIn 29 study populations, the latent class growth analyses displayed delayed trajectories, and in these, we identified 110 data points (% PTSD sumscore difference/months since traumatic exposure). The median PTSD symptom sumscore was 25% higher during the initial 6 months among individuals in the delayed trajectory compared to those in low‐stable trajectory. From this level, the difference widened and reached a plateau of 40–50% higher. The variation was large, and the baseline participation rate and loss to follow‐up were exceeding 25% in the majority of the studies. Heterogeneity of populations, measures, and analyses precluded formal meta‐analysis.ConclusionDelayed PTSD is preceded by PTSD symptoms during the first year in most cases. Still, few individuals may experience an asymptomatic delay. The results underpin the rationale for monitoring PTSD symptoms and may inform forensic assessments in that delayed PTSD without symptoms bridging the traumatic event is rare.

Identifying post-traumatic stress disorder in women of refugee background at a public antenatal clinic.

The aim of this study was to investigate symptomatology and diagnoses of PTSD and subthreshold PTSD and the screening properties of the Harvard Trauma Questionnaire (HTQ) within a sample of Dari-speaking women of refugee background receiving antenatal care. This cross-sectional study administered the HTQ to 52 Dari-speaking women at a public pregnancy clinic. The trauma module from the Structured Clinical Interview (SCID-5) was administered. Interview material was presented to an expert panel, blinded to the HTQ screening results, in order to achieve consensus diagnoses of PTSD using Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria. Three women (5.8%) met DSM-5 criteria for PTSD. Eleven women (21.15%) met criteria for subthreshold PTSD, defined as meeting two or three of the DSM-5 criteria domains. A comparison of HTQ cut-off scores was conducted and a score of ≥ 2.25 on the HTQ demonstrated excellent sensitivity 1.00 (95% CI 0.29-1.00) and specificity 0.76 (95% CI 0.61-0.87) in detecting PTSD; however, a wide confidence interval for sensitivity was found. A cut-off score of ≥ 2 provided the best balance of sensitivity 1.00 (95% CI 0.72-1.00) and specificity 0.80 (95% CI 0.65-0.91) when assessing for subthreshold PTSD. Screening for perinatal PTSD for women of refugee background is recommended, in order to identify those at risk of DSM diagnosis and also those women experiencing distressing PTSD symptomatology.

Post-traumatic Stress Disorder Among COVID-19 Survivors at 3-Month Follow-up After Hospital Discharge.

BackgroundPost-traumatic stress disorder (PTSD) is a severe but treatable mental disorder that develops after a life-threatening traumatic event. Coronavirus disease 19 (COVID-19) hospitalisation is a potentially traumatic experience, especially in severe cases. Furthermore, the unprecedented context of the severe acute respiratory syndrome coronavirus 2 pandemic, with daily media bombardment about COVID-19 mortality, may have amplified life-threatening perception also in patients with moderate infection. The aim of this study was to assess the prevalence and risk factors of PTSD at 3-month follow-up in patients hospitalised for COVID-19 infection.DesignIn this cohort follow-up study conducted in a large Italian academic COVID-19 hospital, 115 recruited survivors were contacted by telephone 3 months after discharge to home care. The Posttraumatic Stress Disorder Checklist for DSM-5 was administered. Multivariate logistic regression models were used to analyse risk factors for the development of PTSD.Key ResultsA total of 10.4% of the sample received a PCL-5-based diagnosis of PTSD. Other 8.6% of the sample received a diagnosis of subthreshold PTSD, which leads to significant levels of distress and impairment. Multivariate regression analysis indicated that previous psychiatric diagnosis (odds ratio (OR) = 6.3, 95% confidence interval (CI): 3.7–78.6, p < 0.001) and obesity (OR = 3.51, 95% CI: 1.4–857.9, p = 0.03) were risk factors for developing PTSD. Chronic pulmonary diseases approached significance as a risk factor (OR = 6.03, 95% CI: 1.0–37.1, p = 0.053). Male sex was a protective factor (OR=0.04, 95% CI: 0.0–0.041, p = 0.007).ConclusionsPTSD and subthreshold PTSD rates in patients hospitalised for COVID-19 are worrying. Female sex and pre-existing mental disorders are established risk factors for PTSD, while the prospective association with obesity needs further investigation. Clinicians treating COVID-19 should consider screening for PTSD at follow-up assessments in patients discharged from the hospital.

Written exposure therapy and app-delivered mindfulness-based meditation for PTSD and subthreshold PTSD in China: Design of a randomized controlled trial

BackgroundPosttraumatic stress disorder (PTSD) and subthreshold PTSD are still major global concerns, especially in developing areas short of mental health resources. Written exposure therapy (WET), a brief 5-session treatment, has been found to be effective in reducing PTSD symptoms, but no studies have examined it in an Eastern context. Mindfulness-based meditation mobile application may be a promising approach to reduce insomnia comorbid with PTSD. The current study aims to: 1) examine the effectiveness of WET for Chinese PTSD and subthreshold PTSD patients, and 2) examine the effectiveness of adding a mindfulness-based application (MBA) to WET for reducing comorbid insomnia. MethodsThe randomized controlled trial will enroll 150 adults with subthreshold/full PTSD and comorbid insomnia. Participants will be randomly assigned to written exposure therapy plus mindfulness-based application condition (WET + MBA, n = 50), written exposure therapy alone (WET, n = 50), or minimal contact control (MMC, n = 50). Clinical interview of the primary outcome (PTSD symptoms) will be administrated at baseline, posttreatment, 3- and 6- month follow-up, while self-reported PTSD symptoms and secondary outcomes (insomnia severity) will be administrated at baseline, every week and all follow-ups. DiscussionThis is the first study applying WET in Chinese PTSD patients, as well as examining a mindfulness-based mobile application as a treatment add-on for comorbid insomnia. Study findings will contribute to the knowledge of the effectiveness of WET and a mindfulness-based mobile application, and the development of a culture-adapted treatment protocol. Trial registrationChiCTR, ChiCTR2000034119. Registered 24 June 2020, http://www.chictr.org.cn/showproj.aspx?proj=55,467.

The power of appraisals in predicting PTSD symptom improvement following cognitive rehabilitation: A randomized clinical trial

BackgroundPatients with PTSD often voice concern over their perceived change in cognitive functioning. However, these negative appraisals do not always align with objective neuropsychological performance, yet are strongly predictive of PTSD symptom severity and self-reported functional impairment. MethodsThe present study involves a secondary analysis examining the role of appraisals of a subsample of 81 adults with full or subthreshold PTSD on treatment outcomes in a randomized controlled trial investigating the effectiveness of a cognitive rehabilitation treatment, Strategic Memory and Reasoning Training (n = 38), compared to a psychoeducation control arm, the Brain Health Workshop (n = 43). Neither condition addressed PTSD symptoms, focusing instead on cognitive skills training and psychoeducation about the brain. ResultsIntent-to-treat models showed statistically significant improvements for both groups on composite scores of executive functioning and memory. Additionally, both groups experienced clinically significant reductions in PTSD symptoms (assessed via the Clinician-Administered PTSD Interview) and the SMART group showed fewer negative appraisals about cognitive functioning following training. Change in appraisals of cognitive functioning was associated with change in PTSD as well as change in quality of life, with no differential associations based on group status. In contrast, neurocognitive test score changes were not associated with change in symptoms or functional outcomes. LimitationsWe did not collect data on other appraisals (e.g., self-efficacy), which could have further elucidated pathways of change. ConclusionsOur findings suggest that interventions that do not directly target PTSD symptoms can lead to PTSD symptom change via change in appraisals of functioning.

Is homelessness a traumatic event? Results from the 2019-2020 National Health and Resilience in Veterans Study.

Data from a nationally representative sample of 4,069 U.S. veterans in 2019-2020 were used to examine the prevalence of full and subthreshold PTSD in veterans with a history of homelessness; identify characteristics associated with PTSD; examine the proportion of veterans who reported homelessness as an index trauma event and screened positive for PTSD. Among veterans with a history of homelessness, lifetime prevalence of full and subthreshold PTSD was 33.0% and 32.0%; and past-month prevalence of full and subthreshold PTSD was 5.6% and 12.7%. These prevalence estimates were more than five times higher than nonhomeless veterans. Among veterans with a history of homelessness, 14.1% reported that homelessness was their "worst" traumatic event which was associated with a fivefold greater odds of current PTSD and nearly threefold greater odds of subthreshold PTSD even after adjustment for other trauma exposures. Veterans who have been homeless have extensive trauma histories and both events that occur during homelessness and the experience of homelessness itself may be traumatic and lead to PTSD, substantiating efforts to provide trauma-informed care for this population.

Crossover between diagnostic and empirical categorizations of full and subthreshold PTSD

Background: Most of the work on understanding subthreshold PTSD has focused on inconsistencies in defining subthreshold PTSD and how those inconsistencies impact prevalence rates. The present study distinguishes between full and subthreshold PTSD using empirical categorization and assesses the circumstances under which empirical categorization is discordant with full and subthreshold PTSD diagnoses. Methods: Using data from the NIDA CTN Women and Trauma Study (N = 353), we use a modernized adaptation of the Jacobson and Truax (1991) framework, assessing whether patients were above or below an empirical threshold on latent PTSD severity scores estimated under categorical confirmatory factor analysis; the empirical categorizations were then crossed with the diagnoses to form four diagnostic by empirical categorization groupings. Results: Compared to a reference group (full PTSD diagnosis and empirical categorization), patients who had a full PTSD diagnosis but a subthreshold empirical categorization had lower symptom endorsement rates on 15 PTSD symptoms, were more likely to be married, ethnic minorities with fewer lifetime traumas. Conversely, patients with a subthreshold PTSD diagnosis and a full PTSD empirical grouping looked similar to “Full/Fulls”, only differing on avoidance symptoms. Limitations: Alternative definitions of subthreshold PTSD and coding of symptom endorsement may impact results. The use of DSM-IV symptoms (though reconciled against overlapping symptoms from DSM-5) is also a key limitation. Conclusions: Empirical categorization can be a useful supplement to diagnosis in distinguishing subthreshold PTSD from full PTSD, using a methodology that could provide a platform for melding dimensional and categorical nosology approaches in the DSM.

Distinguishing Firefighters With Subthreshold PTSD From Firefighters With Probable PTSD or Low Symptoms

A substantial proportion of professional firefighters experience PTSD symptoms at levels high enough to qualify for a probable diagnosis. However, firefighters with subthreshold levels for clinical diagnosis may also experience significant difficulties. For this study, 164 professional firefighters completed measures assessing PTSD symptoms, job-related outcomes, and problems with substance use. Results indicated that firefighters with subthreshold levels of PTSD symptoms reported higher levels of job burnout compared to peers with fewer symptoms. Overall, study results suggest the importance of addressing the needs of firefighters who experience PTSD symptoms at levels below that of clinical diagnosis.

Practicing Counselors, Vicarious Trauma, and Subthreshold PTSD: Implications for Counselor Educators

Practicing Counselors, Vicarious Trauma, and Subthreshold PTSD: Implications for Counselor Educators

Nonlinear relations between post-traumatic stress symptoms and electrocortical reactivity during emotional face processing in combat-exposed veterans.

Combat-related post-traumatic stress symptoms (PTSS) are prevalent among recently deployed veterans, making identification of biomarkers of PTSS in this population a public health priority. Given the link between threat processing neurobiology and PTSS, the threat-related late positive potential (LPP), an ERP reflective of attentional processing sensitive to emotion and its regulation, may have utility as a cost-effective biomarker. Existing PTSS/threat-related LPP findings are mixed, possibly due to variability in PTSS across samples, but this has never been explicitly tested. To address this gap, LPP amplitudes to angry, fearful, and happy emotional face stimuli were recorded among 81 combat-exposed veterans at a VA hospital. A quadratic relationship between self-reported PTSS and LPP amplitude modulation by angry faces emerged such that greater PTSS was related to a decreased LPP response to angry faces among veterans with subthreshold PTSD and an enhanced LPP response to angry faces among veterans with probable PTSD. These results suggest that prior mixed findings may be due to variability in PTSS severity. In addition, exploratory moderation analysis revealed that PTSS was positively associated with late LPP modulation for veterans reporting low cognitive reappraisal use and negatively associated with late LPP modulation for veterans reporting high cognitive reappraisal use. All results were specific to the 1,000-3,000ms LPP time window. Thus, the functional nature of LPP modulation by direct threat cues may depend upon PTSS severity and/or related variables (e.g., cognitive reappraisal utilization).

Subthreshold PTSD and PTSD in a prospective-longitudinal cohort of military personnel: Potential targets for preventive interventions.

Prevention of PTSD requires identification of subpopulations contributing most to the population burden of PTSD. This study examines the relative contribution of subthreshold PTSD and probable PTSD on future PTSD in a representative military cohort. We analyze data on 3,457 U.S. National Guard members from the state of Ohio, assessed by telephone annually from 2008 to 2014. At each wave, participants were classified into one of three groups based on the PTSD Checklist: probable PTSD (DSM-IV-TR criteria), subthreshold PTSD (Criterion A1, at least one symptom in each cluster, symptom lasting longer than 30 days, and functional impairment), and no PTSD. We calculated the exposure rate, risk ratio (RR), and population attributable fraction (PAF) to determine the burden of future probable PTSD attributable to subthreshold PTSD compared to probable PTSD. The annualized prevalence of subthreshold PTSD and probable PTSD was respectively 11.9 and 5.0%. The RR for probable PTSD was twice as great among respondents with probable PTSD the prior interview than that of those with subthreshold PTSD (7.0 vs. 3.4); however, the PAF was considerably greater in participants with subthreshold PTSD the prior interview (PAF=35%; 95% confidence interval (CI)=26.0-42.9%) than in those with probable PTSD (PAF=28.0%; 95% CI=21.8-33.8%). Results were robust to changes in subthreshold PTSD definition. Subthreshold PTSD accounted for a substantial proportion of this population's future PTSD burden. Population-based preventive interventions, compared to an approach focused exclusively on cases of diagnosable PTSD, is likely to affect the greatest reduction in this population's future PTSD burden.

Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 - a cross-sectional study.

BackgroundNorway experienced two terror attacks on July 22, 2011. A car bomb exploded in the Oslo government district killing eight people. Shortly after, 69 adolescents gathered at a political youth camp were shot and killed at Utøya Island. First responders were exposed to multiple risk factors for the development of posttraumatic stress symptoms (PTSS).MethodsThis cross-sectional study investigated the degree of perceived peritraumatic strain among police officers, fire-fighters, and ambulance personnel, as well as the prevalence and predictors of PTSS. A questionnaire was completed by 89 ambulance personnel, 73 fire-fighters, and 76 police officers working close to the terror sites, 8–11 months after the event. PTSS were assessed using the PTSD Check List (PCL-S).ResultsMerging all groups, 68% reported to have witnessed injured/dead people, but only 5.7% reported this as very/extremely strainful. The PCL-S scores were low and not significantly different among the three professions (Median = 19-20, range 17-64). The prevalence of possible PTSD (cut-off > 50) was 1.3 %, and 2 % had scores indicating sub-threshold PTSD. Dissociation predicted higher PTSS-level in all groups (β 1.6-5.1), witnessing injured/dead among ambulance personnel (β 2.5) and feeling overwhelmed among police officers (β 1.2).ConclusionFirst responders were exposed to deaths, injuries, and destruction, but few reported this as highly stressful. The prevalence of possible PTSD was low in all occupational groups, and symptoms of dissociation were found to be the most important predictor.