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Dissociative behaviours and hallucinations are often reported in trauma-exposed people with schizophrenia spectrum disorders and post-traumatic stress disorder (PTSD). Auditory hallucinations are the most commonly reported type of hallucination, but often co-occur with experiences in other sensory modalities. The phenomenology and the neurobiological systems involved in visual experiences are not well characterised. Are these experiences similar in nature, content or severity among people with schizophrenia and/or PTSD? What are the neurobiological bases of these visual experiences and what is the role of dissociative behaviours in the formation of these experiences? A study by Wearne and colleagues in BJPsych Open aimed to characterise these phenomenological systems in groups of people with PTSD, schizophrenia or both (schizophrenia + PTSD).
Trauma exposure can cause post-traumatic stress symptoms (PTSS), and persistently experiencing PTSS may lead to the development of post-traumatic stress disorder (PTSD). Research has shown that PTSS that emerged within days of trauma was a robust predictor of PTSD development.
To investigate patterns of early stress responses to trauma and their associations with development of PTSD.
We recruited 247 civilian trauma survivors from a local hospital emergency department. The PTSD Checklist for DSM-5 (PCL-5) and Acute Stress Disorder Scale (ASDS) were completed within 2 weeks after the traumatic event. Additionally, 3 months post-trauma 146 of these participants completed a PTSD diagnostic interview using the Clinician Administered PTSD Scale for DSM-5.
We first used latent profile analysis on four symptom clusters of the PCL-5 and the dissociation symptom cluster of the ASDS and determined that a four-profile model (‘severe symptoms’, ‘moderate symptoms’, ‘mild symptoms’, ‘minimal symptoms’) was optimal based on multiple fit indices. Gender was found to be predictive of profile membership. We then found a significant association between subgroup membership and PTSD diagnosis (χ2(3) = 11.85, P < 0.01, Cramer's V = 0.263). Post hoc analysis revealed that this association was driven by participants in the ‘severe symptoms’ profile, who had a greater likelihood of developing PTSD.
These findings fill the knowledge gap of identifying possible subgroups of individuals based on their PTSS severity during the early post-trauma period and investigating the relationship between subgroup membership and PTSD development, which have important implications for clinical practice.
Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease.
Materials and methods:
A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale – Revised.
The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder.
Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.
The high trauma load and prevalence of mental distress in unaccompanied refugee minors (URMs) who resettle in Western (European) countries is well documented. However, the lack of studies investigating the potentially most vulnerable population, URMs who are currently on the move in transit countries such as Libya, is alarming.
To document the mental health of URMs detained in Libya and the possible associations with trauma, flight and daily hardships.
In total n = 99 (94.9% male; n = 93) URMs participated in this cross-sectional study conducted in four detention centres near the Libyan capital Tripoli. Data were collected via standardised questionnaires in an interview format and analysed using structured equation modelling.
Participants reported high rates of trauma, especially within Libya itself. Reports of daily hardships in detention ranged between 40 and 95% for basic needs and between 27 and 80% for social needs. Higher social needs were associated with increased anxiety symptoms (β = 0.59; P = 0.028) and increased pre-migration (β = 0.10; P = 0.061) and peri-migration trauma (β = 0.16; P = 0.017) with symptoms of depression. Similarly, higher levels of pre-migration trauma were associated with higher post-traumatic stress disorder levels (β = 0.17; P = 0.010).
The rates of daily hardships and traumatic events are higher compared with those recorded for URMs living in asylum centres in Europe. The emotional, social and cognitive development of detained URMs is severely threatened in both the short and long term. This paper outlines some of the most detrimental effects of migration policies on URMs transiting through Libya.
Studies reporting that highly intelligent individuals have more mental health disorders often have sampling bias, no or inadequate control groups, or insufficient sample size. We addressed these caveats by examining the difference in the prevalence of mental health disorders between individuals with high and average general intelligence (g-factor) in the UK Biobank.
Participants with g-factor scores standardized relative to the same-age UK population, were divided into two groups: a high g-factor group (g-factor 2 SD above the UK mean; N = 16,137) and an average g-factor group (g-factor within 2 SD of the UK mean; N = 236,273). Using self-report questionnaires and medical diagnoses, we examined group differences in the prevalence of 32 phenotypes, including mental health disorders, trauma, allergies, and other traits.
High and average g-factor groups differed across 15/32 phenotypes and did not depend on sex and/or age. Individuals with high g-factors had less general anxiety (odds ratio [OR] = 0.69, 95% CI [0.64;0.74]) and post-traumatic stress disorder (PTSD; OR = 0.67, 95 %CI [0.61;0.74]), were less neurotic (β = −0.12, 95% CI [−0.15;−0.10]), less socially isolated (OR = 0.85, 95% CI [0.80;0.90]), and were less likely to have experienced childhood stressors and abuse, adulthood stressors, or catastrophic trauma (OR = 0.69–0.90). However, they generally had more allergies (e.g., eczema; OR = 1.13–1.33).
The present study provides robust evidence that highly intelligent individuals do not have more mental health disorders than the average population. High intelligence even appears as a protective factor for general anxiety and PTSD.
People suffering from chronic dissociation often experience stress and detachment during self-perception. We tested 18 people with dissociative disorders not otherwise specified (DDNOS; compared with a matched sample of 18 healthy controls) undergoing a stress-inducing facial mirror confrontation paradigm, and measured acute dissociation and frontal electroencephalography (measured with a four-channel system) per experimental condition (e.g. confrontation with negative cognition). Linear mixed models indicated a significant group×time×condition effect, with DDNOS group depicting less electroencephalography power than healthy controls at the beginning of mirror confrontation combined with negative and positive cognition. This discrepancy – most prominent in the negative condition – diminished in the second minute. Correlational analyses depicted a positive association between initial electroencephalography power and acute dissociation in the DDNOS group. These preliminary findings may indicate altered neural processing in DDNOS, but require further investigation with more precise electroencephalography measures.
Yazidis in the Kurdistan Region of Iraq have been exposed to recurrent traumatic experiences associated with genocide and gender-based violence (GBV). In 2014, ISIS perpetrated another genocide against the Yazidi community of Sinjar. Women and girls were held captive, raped and beaten. Many have been forced into displacement. Rates of post-traumatic stress disorder (PTSD) and suicide are high. Limited research has evaluated interventions delivered to this population.
This review explores how the global evidence on psychosocial interventions for female survivors of conflict-related sexual violence applies to the context of the female Yazidi population. We used a realist review to explore mechanisms underpinning complex psychosocial interventions delivered to internally displaced, conflict-affected females. Findings were cross-referenced with eight realist, semi-structured interviews with stakeholders who deliver interventions to female Yazidis in the Kurdistan Region of Iraq. Interviews also allowed us to explore the impact of COVID-19 on effectiveness of interventions.
Seven mechanisms underpinned positive mental health outcomes (reduced PTSD, depression, anxiety, suicidal ideation): safe spaces, a strong therapeutic relationship, social connection, mental health literacy, cultural-competency, gender-matching and empowerment. Interviews confirmed relevance and applicability of mechanisms to the displaced female Yazidi population. Interviews also reported increased PTSD, depression, suicide and flashbacks since the start of the COVID-19 pandemic, with significant disruptions to interventions.
COVID-19 is just one of many challenges in the implementation and delivery of interventions. Responding to the mental health needs of female Yazidis exposed to chronic collective violence requires recognition of their sociocultural context and everyday experiences.
During stressful experiences the endocrine and brain systems involved have distinct neurochemical processes which enhance the power of the memory. Post-traumatic stress disorder is due not only to psychological factors, but neurochemical and evolutionary ones as well. It is valuable for people who have experienced stressful life events to realize that the power these memories have is not entirely psychological. It is in a deeply developed neural pathway created and preserved in the brain in a resilient fashion. Understanding that this is not a question primarily of “getting over It,” but rather “learning to live with it” may help. Stress has many effects on the brain and the body. Bolstering your physical reserves with physical activity, effective sleep, and a healthy diet enhances the ability to deal with stress. The experience of stress involves not only the brain, but also the body’s cardiovascular system and other parts. It is best if the work of dealing with stressful factors is accomplished early, before the achlyievement of great age. Several strategies can help to deal with stress: restful sleep, meditation, diet, cognitive and physical exercise, and avoidance of toxins.
This commentary conveys appreciation for a recent review of the rates of complex post-traumatic stress disorder (CPTSD) among refugees, describes the relevance of CPTSD to the refugee experience and discusses implications for assessment and treatment, the effective development of which requires collaboration among researchers, clinicians and individuals with lived experience.
Post-traumatic growth (PTG) refers to beneficial psychological change following trauma.
This study explores the sociodemographic, health and deployment-related factors associated with PTG in serving/ex-serving UK armed forces personnel deployed to military operations in Iraq or Afghanistan.
Multinomial logistic regression analyses were applied to retrospective questionnaire data collected 2014–2016, stratified by gender. PTG scores were split into tertiles of no/very low PTG, low PTG and moderate/large PTG.
A total of 1447/4610 male personnel (30.8%) and 198/570 female personnel (34.8%) reported moderate/large PTG. Male personnel were more likely to report moderate/large PTG compared with no/very low PTG if they reported a greater belief of being in serious danger (relative risk ratio (RRR) 2.47, 95% CI 1.68–3.64), were a reservist (RRR 2.37, 95% CI 1.80–3.11), reported good/excellent general health (fair/poor general health: RRR 0.33, 95% CI 0.24–0.46), a greater number of combat experiences, less alcohol use, better mental health, were of lower rank or were younger. Female personnel were more likely to report moderate/large PTG if they were single (in a relationship: RRR 0.40, 95% CI 0.22–0.74), had left military service (RRR 2.34, 95% CI 1.31–4.17), reported better mental health (common mental disorder: RRR 0.37, 95% CI 0.17–0.84), were a reservist, reported a greater number of combat experiences or were younger. Post-traumatic stress disorder had a curvilinear relationship with PTG.
A moderate/large degree of PTG among the UK armed forces is associated with mostly positive health experiences, except for post-traumatic stress disorder.
Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a knowledge gap on how this may affect refugees’ health and health care needs.
Herein, we investigate the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health and highly prevalent in refugees.
Included were 712 adult Syrian refugees and asylum seekers in Lebanon and Denmark arriving no more than 12 months prior to inclusion. The Harvard Trauma Questionnaire was used to assess PTSD and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analysis were carried out.
The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%) and long-distance migration was associated with a 9 percentage point (95% CI [-1; 19]) increase in the prevalence of PTSD among newly arrived Syrian refugees and asylum-seekers.
In the present study the prevalence of PTSD increased after long-distance migration which may support considering “long-distance migration” in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. This is a first step in examining the health effects of migration on refugee health.
Adults diagnosed with Borderline Personality Disorder (BPD) likely have a history of psychological trauma. There has been research about the connection between Complex Post-Traumatic Stress Disorder (c-PTSD) and BPD.
This paper provides a review of the relationship between complex trauma and key features of BPD.
Review of the literature from 2015 to present, using search engines such as Pubmed and Google Shoolar, using the following keywords: borderline personality disorder, complex post-traumatic stress disorder, trauma
Traumatic victimisation and compromised primary caregiving relationships have been hypothesized to be key aetiological factors in the subsequent development of BPD. c-PTSD was defined as a syndrome with symptoms of emotional dysregulation, dissociation somatisation and poor self-esteem, with distorted cognition about relationships, following traumatic interpersonal abuse. It was proposed as an alternative for understanding and treating people who had suffered prolonged and severe interpersonal trauma, many of whom were diagnosed with BPD. Although, the boundaries between c-PTSD and BPD remain vague. Currently, the main difference is the assumption that symptoms of c-PTSD are sequelae of exposure to traumatic stress, which is not inherent in the current DSM-5 definition of BPD. Furthermore, to date, the neurochemistry and neurostructural changes seen in c-PTSD, BPD and PTSD do not clearly differentiate the three conditions.
BPD and PTSD are relatively distinct with regard to the precise qualitative definitions of their diagnostic features, but nevertheless have substantial potential overlap in their symptom criteria.
Nurses may be particularly at risk of violence exposure at work which can cause psychological trauma and even develop post-traumatic stress disorder (PTSD), which is a serious mental health disorder.
The aim of this study was to determine the prevalence of PTSD among nurses in psychiatry and emergency departments and to identify the factors associated with it.
This was a cross-sectional, descriptive and analytical study. It concerned 60 nurses working in the psychiatry (35 nurses) and emergency (25 nurses) departments of the Hedi Chaker and Habib Borguiba University Hospital in Sfax. The screening of PTSD was carried out by the « post-traumatic stress evaluation questionnaire » (PTSQ).
Direct trauma exposure was reported by 93% of participants, of which 48.3% experienced the act of violence more than 4 times. According to the PTSQ, 48.3% of the nurses had PTSD with a mean score of 50.93. Hyper-arousal was the most frequently observed outcome in victims (85%), followed by re-experience (83%) and avoidance (80%) symptoms. The presence of PTSD was correlated with female gender (p=0.002), the young age of the nurse (p=0.04), and the absence of peri-traumatic reactions (p=0.001).
Our study shows that PTSD is a pathology frequently encountered in psychiatric and emergency nurses. Hence the need to put in place strategies against violence in hospitals and to apply them rigorously in order to better manage this phenomenon and manage its repercussions on health workers .
Post-traumatic stress disorder (PTSD) occurs in 4% of all pregnancies during the postnatal period. This prevalence can increase in high-risk groups reaching a mean prevalence of 18%. Some risk factors are significantly associated with the development or exacerbation of postnatal PTSD, including prenatal depression and anxiety, pre-pregnancy history of psychiatric disorders, history of sexual trauma, intimate partner violence, emergency childbirth, distressing events during childbirth and psychosocial attributes. Maternal postnatal PTSD is highly associated with the difficulties in mother-infant bond and the postpartum depression. Evidence shows significant links between psychological, traumatic and birth-related risk factors as well as the perceived social support and PTSD following childbirth. The City Birth Trauma Scale can be recommended as a universal instrument for diagnosis of postnatal PTSD.
Wissam El-Hage reports personal fees from Air Liquide, EISAI, Janssen, Lundbeck, Otsuka, UCB and Chugai.
First responders to disasters are at risk of developing post-traumatic stress disorder (PTSD). The trajectories of post-traumatic stress symptom severity differ among individuals, even if they are exposed to similar events. These trajectories have not yet been reported in non-Western first responders.
We aimed to explore post-traumatic stress symptom severity trajectories and their risk factors in first responders to the 2011 Great East Japan Earthquake (GEJE)— a historically large earthquake that resulted in a tsunami and a nuclear disaster.
56 388 Japan Ground Self-Defense Force (JGSDF) personnel dispatched to the GEJE were enrolled in this seven-year longitudinal cohort study. PTSD symptom severity was measured using the Impact of Event Scale-Revised (IES-R). Trajectories were identified using latent growth mixture models (LGMM). Nine potential risk factors for the symptom severity trajectories were analyzed using multinomial logistic regression.
Five symptom severity trajectories were identified: “resilient” (54.7%), “recovery” (24.5%), “incomplete recovery” (10.7%), “late-onset” (5.7%), and “chronic” (4.3%). The main risk factors for the four non-resilient trajectories were older age, personal disaster experiences, and working conditions. These working conditions included duties involving body recovery or radiation exposure risk, longer deployment length, later or no post-deployment leave, and longer post-deployment overtime.
The majority of first responders to GEJE were resilient and developed few or no PTSD symptoms. A substantial minority experienced late-onset and chronic symptom severity trajectories. The identified risk factors can inform policies for prevention, early detection, and intervention in individuals at risk of developing symptomatic trajectories.
Resilience is a multidimensional construct. Despite being quoted as protective against mental disorders, it remains largely unexplored in our context.
We attempted to explore the role of resilience in the development of various psychiatric symptoms as depression, anxiety and post-traumatic stress disorder following trauma in clinical population in a psychiatry outpatient of a university hospital.
We interviewed one hundred patients who sought treatment in psychiatry outpatient in a university hospital in Kathmandu, Nepal. We collected sociodemographic and trauma related information using semi-structured interview format. Other instruments used were the World Health Organization Composite International Diagnostic Interview version 2.1 for trauma categorization, the Post-Traumatic Stress Disorder Checklist-Civilian version to measure the post-traumatic stress disorder symptoms, and the 25-item Hopkins Symptom Checklist-25 to assess the level of depression and anxiety symptoms. We used Nepali adapted resilience scale derived from the original Wagnild and Young Resilience scale to measure resilience. We explored the associations between resilience scores and the scores on depression, anxiety and posttraumatic stress disorder using bivariate and multivariate analysis.
Resilience had negative correlations with depression, anxiety, and post-traumatic stress disorder symptoms after adjusting for other variables such as gender, marital status, employment status, socioeconomic status and trauma types which were observed to have significant association in the bivariate analysis.
There was inverse correlation between resilience scores and depression, anxiety, and post-traumatic stress symptoms. Resilience should be considered in studies involving trauma population.
Neuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD.
To complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research.
A PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging).
A final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1).
Neuroimaging Findings in TBI-related PTSD.
Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus.
Additional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related
There is mixed evidence regarding the direction of a potential association between post-traumatic stress disorder (PTSD) and suicide mortality.
This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality.
Retrospective study that included all US Department of Veterans Affairs (VA) patients with a PTSD diagnosis and at least one symptom severity assessment using the PTSD Checklist (PCL) between 1 October 1999 and 31 December 2018 (n = 754 197). We performed multivariable proportional hazards regression models using exposure groups defined by level of PTSD symptom severity to estimate suicide mortality rates. For patients with multiple PCL scores, we performed additional models using exposure groups defined by level of change in PTSD symptom severity. We assessed suicide mortality using the VA/Department of Defense Mortality Data Repository.
Any level of PTSD symptoms above the minimum threshold for symptomatic remission (i.e. PCL score >18) was associated with double the suicide mortality rate at 1 month after assessment. This relationship decreased over time but patients with moderate to high symptoms continued to have elevated suicide rates. Worsening PTSD symptoms were associated with a 25% higher long-term suicide mortality rate. Among patients with improved PTSD symptoms, those with symptomatic remission had a substantial and sustained reduction in the suicide rate compared with those without symptomatic remission (HR = 0.56; 95% CI 0.37–0.88).
Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit.
This study aimed to investigate the effects of disaster trauma, disaster conflict, and economic loss on posttraumatic stress disorder (PTSD), and to verify the moderating effect of personal and community resilience in these relationships. The data of 1914 people, aged 20 or above, who had experienced natural disasters (earthquake, typhoon, flooding) were used.
Hayes’s (2013) PROCESS macro (Model 1) was conducted to verify the moderation effect of personal and community resilience between PTSD and disaster trauma, disaster conflict, and economic loss.
Disaster trauma, disaster conflict, and economic loss were found to be positively related to PTSD. Personal and community resilience were negatively related to PTSD. Resilience had a moderating effect on the relationship between disaster trauma, economic loss, and PTSD. However, there was no moderating effect on the relationship between disaster conflict and PTSD. Community resilience had a moderating effect on the relationship between economic loss and PTSD. However, there was no moderating effect on the relationship between disaster trauma, disaster conflict, and PTSD.
The results suggest that personal and community resilience could be used for prevention and therapeutic interventions for disaster victims who experience PTSD.
Despite its potential scalability, little is known about the outcomes of internet-based cognitive behaviour therapy (iCBT) for post-traumatic stress disorder (PTSD) when it is provided with minimal guidance from a clinician.
To evaluate the outcomes of minimally guided iCBT for PTSD in a randomised control trial (RCT, Study 1) and in an open trial in routine community care (Study 2).
A RCT compared the iCBT course (n=21) to a waitlist control (WLC, n=19) among participants diagnosed with PTSD. The iCBT group was followed up 3 months post-treatment. In Study 2, treatment outcomes were evaluated among 117 adults in routine community care. PTSD symptom severity was the primary outcome in both studies, with psychological distress and co-morbid anxiety and depressive symptoms providing secondary outcomes.
iCBT participants in both studies experienced significant reductions in PTSD symptom severity from pre- to post-treatment treatment (within-group Hedges’ g=.72–1.02), with RCT findings showing maintenance of gains at 3-month follow-up. The WLC group in the RCT also significantly improved, but Study 1 was under-powered and the medium between-group effect favouring iCBT did not reach significance (g=0.64; 95% CI, –0.10–1.38).
This research provides preliminary support for the utility of iCBT for PTSD when provided with minimal clinician guidance. Future studies are needed to clarify the effect of differing levels of clinician support on PTSD iCBT outcomes, as well as exploring how best to integrate iCBT into large-scale, routine clinical care of PTSD.