Acute Stress Reaction Symptoms Research Articles

Early Identification of Post-Traumatic Stress Disorder in Trauma Patients: Development of a Multivariable Risk Prediction Model.

The purpose of this study was to build a risk prediction model to identify trauma patients at the time of injury who are at high risk for post-traumatic stress disorder (PTSD) 1year later. Patients 18+ with operative orthopedic trauma injuries were enrolled in prospective social determinants of health cohort. Data were collected through initial surveys, medical records at time of injury, and 1-year follow-up phone screenings. Univariate analysis examined associations between factors and PTSD at 1 year. The best fit multivariable logistic regression model led to a novel PTSD risk prediction tool based on weights assigned similar to the Charlson index methods. Of 329 enrolled patients, 87 (26%) completed follow-up surveys; 58% screened positive for chronic PTSD. The best fit model predicting PTSD included age, insurance, violent mechanism, and 2 acute stress screening questions (AUC .89). Using these parameters, the maximum possible TIPPS index was 19. Those with PTSD at 1year had a mean TIPPS index of 12.9 ± 4.0, compared to 5.9 ± 4.2 for those who did not (P < .001). Traumatic injury often leads to PTSD, which can be predicted by a novel risk score incorporating age, insurance status, violent injury mechanism, and acute stress reaction symptoms. Stability in life and relationships with primary care physicians may be protective of PTSD. Diagnostic level II.

Caring for Critically Ill Children Experiencing Traumatic Stress.

Traumatic stress occurs in children when their coping mechanisms are overwhelmed by exposure to traumatic events or situations. Estimates indicate that as many as 80% of ill and injured children experience traumatic stress after such exposure. Critically ill or injured children are especially at risk for the development of traumatic stress, including acute stress reaction and posttraumatic stress disorder. To explore the phenomenon of traumatic stress disorders in critically ill or injured children to assist bedside nurses in decreasing the severity of short- and long-term consequences in this patient population. This article presents types of traumatic stress, risk factors for the development of traumatic stress, clinical findings in children and adolescents, and nursing strategies for preventing and managing traumatic stress in pediatric patients. Critical care and acute care nurses are in an excellent position to assess children for symptoms of acute stress reaction and posttraumatic stress disorder during or after a stay in the intensive care unit, to implement strategies to prevent or ease the symptoms of acute stress reaction and posttraumatic stress disorder, and to make appropriate referrals for children and their families after exposure to traumatic stressors.

COVID-19 outbreak–related psychological distress among healthcare trainees: a cross-sectional study in China

ObjectivesThe COVID-19 outbreak has caused enormous strain on healthcare systems, and healthcare trainees, which comprise the future healthcare workforce, may be a vulnerable group. It is essential to assess the...

Post-traumatic stress disorder risk and witnessing team members in acute psychological stress during combat.

Occupational groups operating in dangerous environments may witness the development of acute stress reaction (ASR) in team members. Witnessing ASR in team members may increase the risk of developing subsequent post-traumatic stress disorder (PTSD) symptoms. To describe ASR symptoms that individuals witness, assess the relationship between witnessing a team member exhibiting ASR symptoms and an individual's own PTSD symptoms, and describe common intervention responses by peers. Cross-sectional, anonymous surveys were conducted with US soldiers who were previously deployed (sample 1; n = 176) and currently deployed sample 2; n = 497). Surveys assessed combat experiences, PTSD (PTSD Checklist-5), ASR exposure and intervention responses. Analyses included frequencies and binary logistic regression. Witnessing at least one ASR symptom during a combat-related event was reported by 51.7% in sample 1 and 42.4% in sample 2; the most commonly observed symptoms were being unable to function or being detached. Controlling for combat experiences, high levels of witnessing a team member exhibit ASR symptoms was associated with increased risk of subthreshold PTSD or PTSD in sample 1 (odds ratio (OR) = 8.69, 95% CI 2.29-42.60) and approached significance in sample 2 (OR = 1.67, 95% CI 0.98-2.81). Common intervention responses included providing a directive or yelling; many also reported being unsure how to respond. Witnessing team members who exhibit ASR symptoms appears to be associated with screening positive for subthreshold PTSD or PTSD. Results suggest the need for further research into how to prepare individuals to manage ASR in team members and to examine ASR in other high-risk occupations.

Witnessing Acute Stress Reaction in Team Members: The Moderating Effect of Peer-Based Training.

Individuals who witness team members exhibiting symptoms of an acute stress reaction (ASR) in the middle of a high-stress operational event may be negatively affected; ASR-related training may moderate this impact. In the present study, 560 Israeli soldiers were surveyed about ASR exposure, posttraumatic stress disorder (PTSD) symptoms, public stigma, and whether they had received ASR-related training. This training, called YaHaLOM, is a Hebrew acronym that outlines steps for managing ASR in team members. Controlling for combat exposure, greater exposure to ASR symptoms was associated with more overall PTSD symptoms, PTSD cluster symptoms, and public stigma. YaHaLOM training buffered these relationships for PTSD, intrusion and avoidance symptoms, and public stigma. The findings suggest that such training may help teams in high-risk occupations better manage ASR exposure.

Psychological distress among health professional students during the COVID-19 outbreak.

Due to the drastic surge of COVID-19 patients, many countries are considering or already graduating health professional students early to aid professional resources. We aimed to assess outbreak-related psychological distress and symptoms of acute stress reaction (ASR) in health professional students and to characterize individuals with potential need for interventions. We conducted a prospective cohort study of 1442 health professional students at Sichuan University, China. At baseline (October 2019), participants were assessed for childhood adversity, stressful life events, internet addiction, and family functioning. Using multivariable logistic regression, we examined associations of the above exposures with subsequent psychological distress and ASR in response to the outbreak. Three hundred and eighty-four (26.63%) participants demonstrated clinically significant psychological distress, while 160 (11.10%) met the criterion for a probable ASR. Individuals who scored high on both childhood adversity and stressful life event experiences during the past year were at increased risks of both distress (ORs 2.00-2.66) and probable ASR (ORs 2.23-3.10), respectively. Moreover, internet addiction was associated with elevated risks of distress (OR 2.05, 95% CI 1.60-2.64) and probable ASR (OR 2.15, 95% CI 1.50-3.10). By contrast, good family functioning was associated with decreased risks of distress (OR 0.43, 95% CI 0.33-0.55) and probable ASR (OR 0.48, 95% CI 0.33-0.69). All associations were independent of baseline psychological distress. Our findings suggest that COVID-19 related psychological distress and high symptoms burden of ASR are common among health professional students. Extended family and professional support should be considered for vulnerable individuals during these unprecedented times.

Early psychological intervention following the 2014 Nepal snowstorm

The following is a case study of the blizzard of October 2014, an Israeli rescue team, the Special Mental Health Team (SMHT) of the Israeli Defense Forces Medical Corps, was sent to the disaster area to rescue Israeli trekkers. The SMHT intervention was provided immediately following the traumatic events with the purpose of lowering stress-related symptoms, shortening recovery time and reducing post-traumatic stress disorder symptoms that could occur in the future. Forty Israeli trekkers were assessed by SMHT: 75 % (n = 30) had mild acute stress reaction (ASR) symptoms and 25 % (n = 10) had severe acute stress disorder (ASD) symptoms. All participating trekkers receiving the intervention as a way to alleviate symptoms reported no symptoms of ASR and ASD following the intervention. Trekkers with mild ASR reported full recovery after 1 week and trekkers with ASD reported full recovery after 3 months. This case study describes the psychological intervention conducted by SMHT for the surviving trekkers following the blizzard and aims to extend the knowledge base of mental health intervention at the early phases of disaster. A research study should be conducted to develop a measurement tool capable of evaluating the effect of a short-term intervention conducted in the field.

Screening for Postpartal Depression with Edinburgh Postnatal Depression Scale in Home Visits to New Mothers in Sarajevo Canton

Introduction Postpartum depression is a non-psychotic depressive episode occurring in postpartum period or continuing from pregnancy. Prevalence of PPD is about 12% in general population. The most dangerous consequences of PPD are mother’s suicide and infanticide. Aims Assess symptoms of PPD in the first month after delivery at regular home visits to new mothers using Edinburgh Postnatal Depression Scale (EPDS) and symptoms of acute stress reaction using Impact of Events Scale revised (IES-R). Determine correlation between EPDS and IES-R scores. Determine risk factors for PPD comparing results of EPDS scale and socio-demographic questionnaire. Methods Study included 50 women, ages between 21 and 42 who gave birth less than a month prior to assessment. Instruments used for this study were: EPDS, IES-R and socio-demographic questionnaire specifically designed for this study. Results 16% of women had EPDS scores indicating possible PPD, 16% had clinically insignificant symptoms, while 4% had clinically significant symptoms of postpartum PTSD. A significant correlation between EPDS and IES-R score was determined. These variables showed statistically significant influence on EPDS score:, age of mother at first pregnancy, education, work status, smoking during pregnancy and Caesarean section. All women who had EPDS indicating possible PPD had 3 or more risk factor for PPD. Conclusions The results indicate considerable presence of PPD in women in Sarajevo Canton, and the need for screening for PPD and timely interventions that can prevent possible complications some of which can be serious.

Early post-traumatic stress disorder in relation to acute stress reaction: An ICD-10 study among help seekers following an earthquake

Disaster research related to earthquakes has almost exclusively dealt with their long-term psychosocial impact; besides, diagnoses were previously based only on DSM criteria. Therefore, it is pertinent to assess stress-related reactions of earthquake victims during the early post-disaster period through the application of ICD-10 criteria. For the first 3 weeks following an earthquake, 102 help-seekers were assessed based on a checklist of sociodemographic variables and a semi-structured interview for the detection of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) according to ICD-10. Forty-four subjects (43%) fulfilled the ICD-10 criteria for PTSD; all but one of them had suffered ASR. Moreover, among a series of potential predictors for PTSD, ASR was found to be the only significant one; this indicates a definite association between ASR and early development of PTSD. Logistic regression to predict group membership (PTSD/no PTSD) based on specific ASR symptoms showed that accelerated heart rate and feelings of derealization were the only significant predictors for early PTSD. Individuals who fulfill the ICD-10 diagnostic criteria for ASR following an earthquake are at high risk for subsequent occurrence of early PTSD. Increased heart rate and feelings of derealization within the first 48 h after the traumatic event appear to be the principal factors associated with the development of early PTSD. In addition to their potential value for timely prevention and treatment, these findings raise important nosological issues pertaining to the current diagnostic classification of stress-related disorders (ICD-10 versus DSM-IV).

The Impact of Major Trauma: Quality-of-Life Outcomes Are Worse in Women than in Men, Independent of Mechanism and Injury Severity

The importance of gender differences in quality of life and psychologic morbidity after major trauma is a newly recognized focus of trauma outcomes research. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL), and psychologic sequelae such as depression and early symptoms of acute stress reaction (SASR). The specific objectives of the present report are to examine gender differences in QoL outcomes and the early incidence of combined depression and SASR after injury, controlling for injury severity, specific body area injured, and mechanism. Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. QoL outcome after trauma was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies scale. SASR was assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. Women (n = 313) were significantly more likely to have poor QoL outcomes at follow-up than men (n = 735) (women vs. men: 12-month follow-up odds ratio [OR] = 2.2, p < 0.001; 18-month follow-up OR = 2.0, p < 0.001). Quality of Well-being scores at each of the 6-, 12-, and 18-month follow-up time points were markedly and significantly lower in women compared with men, independent of injury severity, serious and moderate injury status, lower extremity injury, intentional or unintentional injury type, and blunt or penetrating injury. Women were also significantly more likely to develop early combined depression and SASR at discharge (OR = 1.7, p < 0.01) and to have continuous depression throughout the 18-month follow-up period (OR = 2.3, p < 0.001). These analyses provide further important and more detailed evidence that women are at risk of worse QoL outcomes and early psychologic morbidity after major trauma than men, independent of mechanism and injury severity. A better understanding of the impact of major trauma in men and women will be an important component of efforts to improve trauma care and long-term outcome in mature trauma systems.

Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men.

The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to examine gender differences in prolonged PTSD (L-PTSD) and to assess the impact of PTSD by gender on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included the following: age 18 years and older; admission Glasgow Coma Scale score of 12 or greater; and length of stay greater than 24 hours. QoL was measured after injury using the Quality of Well-being (QWB) scale, a sensitive index to the well end of the functioning continuum (range: 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-, 12-, and 18-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. PTSD (L-PTSD) was diagnosed if full or partial (F + P) or full (F) PTSD Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were present at all follow-up time points. PTSD (L-PTSD) (F + P) was diagnosed in 35% (221 of 627) of patients at follow-up. PTSD (L-PTSD) (F) was present in 32% (153 of 627). Women were at significantly higher risk of PTSD (F + P) (odds ratio = 2.4, p = 0.001) and PTSD (F) (odds ratio = 2.8, p = 0.001) than men. The association of gender with PTSD was independent of mechanism and injury event-related factors such as perceived threat to life. In multivariate logistic regression, female gender, perceived threat to life, and SASR were strongly and independently associated with PTSD risk. Women were also at risk for worse QWB outcomes; beginning at discharge through the 18-month follow-up, women had significantly lower QWB scores at each follow-up time than men, regardless of prolonged PTSD status. These results provide important new evidence that high rates of PTSD persist in the long-term aftermath of major trauma. The association of gender with PTSD was independent of mechanism and injury event-related factors such as perceived threat to life. Within categories of specific mechanism of injury and injury event-related factors, women were at significantly higher risk of prolonged PTSD onset. Prolonged PTSD was associated with significantly reduced quality of life in both men and women, with markedly worse QWB outcomes in women regardless of prolonged PTSD status.

Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome.

The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess the impact on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow-up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in women (39%) than in men (29%) and in younger low-income patients. Other major risk factors were penetrating trauma (OR, 2.3; p < 0.001) and assaults (OR, 1.5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month follow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 months, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001). These results provide new and provocative evidence that perceived threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome and QoL.

The importance of gender on outcome after major trauma: functional and psychologic outcomes in women versus men.

Outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population. Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in women compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs. 0.6685, p < 0.0001) and 18-month (0.646 vs. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4, p < 0.05). These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors. Women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences in short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.