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Background Respectful care of bereaved parents after stillbirth plays a pivotal role in enabling the grieving process and reducing the traumatic impact of this life-changing event. Unfortunately, professionals and midwives, in particular, are often emotionally unprepared and frequently left alone when dealing with these stressful events. Aim The BLOSSoM (Burnout after perinatal LOSS in Midwifery) study aims to address the levels of professional burnout in Italian midwives and evaluate the psychological impact of bereavement care on professionals. Methods Web-based cross-sectional study, including socio-demographic questionnaire, survey on the knowledge of guidelines for stillbirth management and two psychometric tests: Maslach Burnout Inventory (MBI) and Impact of Event Scale - Revised (IES-R). Findings Of 445 female midwives, mean age 35.1 (SD 9.9), working years 11.2 (SD 10.2), 149 (33.4%) reported specific training on stillbirth and 420 (94.6%) highlighted the need for further training and support. Medium to high levels of burnout (Emotional Exhaustion) were present in 65 midwives (15.9%) with a high prevalence of Reduced Personal Accomplishment (292, 64.2%). ‘Communicating the diagnosis of death’ was considered the hardest task, followed by ‘assisting the meeting with the baby’; 109 midwives (24.5%) reported high IES-R scores (>30), suggesting symptoms of PTSD related to stillbirth events; a good level of knowledge of guidelines favoured Personal Accomplishment (OR 0.3 [0.1 – 0.6]). The number of stillbirths assisted by midwives was not associated with burnout levels. Conclusion Midwives are particularly at risk of developing professional burnout, as early as after five years of work, with a significant association with the psychological impact exerted by stressful events (stillbirth).

BACKGROUND: Posttraumatic stress disorder (PTSD) is prevalent in patients who have had a cardiac arrest and their partners. Accordingly, acute traumatic stress screening is recommended, but its association with later PTSD symptoms has never been addressed in postresuscitation settings.OBJECTIVE: The aim of this study was to examine whether acute traumatic stress is associated with PTSD symptoms in patients who have had a cardiac arrest and their partners.METHODS: This multicenter longitudinal study of 141 patients and 97 partners measures acute traumatic stress at 3 weeks and PTSD symptoms at 3 months and 1 year after resuscitation, using the Impact of Event Scale. Linear regression models were used to evaluate the association between severity of acute traumatic stress and PTSD symptoms and post hoc to explore effects of group (patients/partners), age, and sex on acute traumatic stress severity. We categorized Impact of Event Scale scores higher than 26 at 3 months and 1 year as clinical severe PTSD symptoms.RESULTS: Higher acute traumatic stress severity is significantly positively associated with higher PTSD symptom severity at 3 months (patients and partners: P < .001) and 1 year (patients and partners: P < .001) postresuscitation, with the strongest association for women compared with men (P = .03). Acute traumatic stress was higher in women compared with men across groups (P = .02). Clinical severe PTSD symptoms were present in 26% to 28% of patients and 45% to 48% of partners.CONCLUSION: Experiencing a cardiac arrest may elicit clinical severe PTSD symptoms in patients, but particularly in their partners. Screening patients and partners for acute traumatic stress postresuscitation is warranted to identify those at increased risk of long-term PTSD symptoms.

Objective To investigate the traumatic effects of the COVID-19 pandemic on middle-school students and their parents. Methods This epidemiological cross-sectional study was conducted with middle-school students in Denizli. A questionnaire consisting of the IES-R, CRIES-13 and a sociodemographic data form was delivered online. A total of 1059 participants who fully completed the questionnaire were included for analysis. Results The IES-R total and subdimension scores and the CRIES-13 scores were found to be significantly higher in families with an income level of ≤2,500 TL. The CRIES-13 scores of children were found to be significantly higher in divorced families. No statistically significant difference was determined between the IES-R total and subdimension scores of the parents who were healthcare workers and the CRIES-13 scale scores of their children. Conclusion A statistically significant, positive, moderate relationship was found between the IES-R scale total and subdimension scores of parents and the CRIES-13 scale scores of children. A low socioeconomic level was seen to increase the prevalence of anxiety in adults and adolescents. The children of divorced families were found to be at higher risk of PTSD. Successful management of mental health symptoms in parents will reflect positively on the mental health status of their children.

Background: Spontaneous Haemoperitoneum in Pregnancy (SHiP) is a rare, but life-threatening complication of pregnancy that occurs predominantly in the third trimester of pregnancy and is associated with adverse pregnancy outcomes. Recently the largest case series in literature was published describing 11 Dutch cases of SHiP in women with endometriosis. Purpose: To investigate experiences, psychological impact, and quality of life after SHiP. Methods: A mixed-methods study was performed in women with a history of SHiP and their partners, including all known cases in the Netherlands between 2007 to 2015. Semi-structured in-depth interviews were organized between 2016 and 2017 and analysed thematically with a framework approach. Participants were asked to complete questionnaires investigating the impact of the event (Impact of Event Scale) and Quality of Life (RAND-36). Results: Out of a total of 11 known cases, 7 women agreed for be individually interviewed. From these, all women described a freeze response at the moment of SHiP, combined with either an anxious reaction or a survival mode mind-set. All women received psychological help after SHiP. Still, the feeling of not being heard by the medical staff was present in all women. Other themes such as postpartum period, bonding with their child, effect on daily life, reviving the event, and future pregnancies were also identified in the interviews. In regard to their partners, 3 were interviewed, hence no saturation was achieved. Finally, the questionnaires showed lower Quality of Life and an impact score of ≥ 8/10. Conclusion: SHiP had a profound impact on women and their partners. Dedicated psychological help should be offered to all women after experiencing SHiP.

This study investigated the association between changes in sleep duration after disaster and post-traumatic stress disorder (PTSD) symptoms and the mediating role of resilience on the association.Data were collected from 2951 Korean adults who were victims of a natural disaster and did not have any mental or medical illnesses before the event. They completed a long-term survey on changes in life for disaster victims using computer-aided personal interviews. Changes in sleep duration before and one month after experiencing a disaster were assessed using a self-reported questionnaire. Resilience levels and PTSD symptoms were measured using the Brief Resilience Scale and the Impact of Event Scale - Revised, respectively, and more than 33 of the IES-R score items were defined as significant PTSD symptoms. Multivariate logistic regression was used to examine the associations between changes in sleep duration and PTSD symptoms. Additionally, mediating studies were conducted to identify the role of resilience on the association.Compared with participants without significant PTSD symptoms, those with PTSD symptoms were more likely to be older and female (group without significant PTSD symptom: mean age = 56.12 ± 18.70 years, female sex = 49.24%; group with significant PTSD symptoms: mean age = 60.88 ± 15.66 years, female sex = 59.52%). Compared with disaster victims without changes in sleep duration, those who had shorter sleep duration after disaster had a higher risk of significant PTSD symptoms (OR = 2.89, 95% Cl = 2.31-3.62, p 0.001). In the mediating study, resilience level significantly mediated the relationship between reduced sleep duration and PTSD symptoms (direct effect: β = 0.208, 95% Cl = 0.166-0.250, p 0.001; indirect effect: β = 0.007, 95% Cl = 0.002-0.011, p 0.001; total effect: β = 0.215, 95% Cl = 0.173-0.257, p 0.001).This study revealed that individuals with reduced sleep duration after disaster had a higher risk of PTSD symptoms, while those with increased sleep duration did not. In addition, mediating effects of resilience level on the relationship between reduced sleep duration and significant PTSD symptoms were observed.

Background Communication is key to understanding the emotional state of critical care patients. Objective To analyze the effectiveness of the communicative intervention known as CONECTEM, which incorporates basic communication skills and augmentative alternative communication, in improving pain, anxiety, and posttraumatic stress disorder symptoms in critical care patients transported by ambulance. Methods This study had a quasi-experimental design with intervention and control groups. It was carried out at 4 emergency medical centers in northern Spain. One of the centers served as the intervention unit, with the other 3 serving as control units. The nurses at the intervention center underwent training in CONECTEM. Pretest and posttest measurements were obtained using a visual analog scale to measure pain, the short-version State-Trait Anxiety Inventory to measure anxiety, and the Impact of Event Scale to measure posttraumatic stress disorder symptoms. Results In the comparative pretest-posttest analysis of the groups, significant differences were found in favor of the intervention group (Pillai multivariate, F2,110 = 57.973, P < .001). The intervention was associated with improvements in pain (mean visual analog scale score, 3.3 pretest vs 1.1 posttest; P < .001) and posttraumatic stress disorder symptoms (mean Impact of Event Scale score, 17.8 pretest vs 11.2 posttest; P < .001). Moreover, the percentage of patients whose anxiety improved was higher in the intervention group than in the control group (62% vs 4%, P < .001). Conclusion The communicative intervention CONECTEM was effective in improving psychoemotional state among critical care patients during medical transport.

Platyniuk O. B. Formation mechanisms of non-psychotic mental disorders in injured combatants as a basis of psychotherapy. Journal of Education, Health and Sport. 2020;10(12):359-364. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.12.035 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.12.035 https://zenodo.org/record/4741003 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 09.11.2020. Revised: 25.11.2020. Accepted: 29.12.2020. FORMATION MECHANISMS OF NON-PSYCHOTIC MENTAL DISORDERS IN INJURED COMBATANTS AS A BASIS OF PSYCHOTHERAPY O. B. Platyniuk Kharkiv National Medical University, Ukraine Abstract Today 16.2% of the world’s population suffers from the consequences of military conflicts. In 80% of people affected by hostilities, the consequences of combat trauma are non-psychotic mental disorders. According to the data obtained during the study, the following non-psychotic disorders were found in examined combatants: acute stress reaction (F43.0) in 36.2% of subjects, PTSD (F43.1) in 32.1%, prolonged depressive adjustment reaction (F43.21) in 11.3%, adjustment disorder with anxiety (F43.22) in 12.2%, depressive episode (F32.1, F32.2) in 8.2% of subjects. 145 male injured combatants aged 20 – 55 y. o. were examined at the Military Medical Clinical Center of the Northern Region. Methods: clinical psychopathological, clinical anamnestic, psychodiagnostic, catamnestic, statistical. According to the results of Clinically administered PTSD Scale (CAPS), clinically pronounced manifestations of PTSD were noted in examined combatants (frequency of PTSD symptoms: 33.9 ± 3.6 points, intensity: 32.2 ± 5.5 points, and total severity of symptoms: 67.1 ± 6.9 points). According to the Impact of Event Scale-Revised (IES-R) in the surveyed combatants, a high level of impact of the traumatic event was observed by scales of invasion (77.8% of surveyed), avoidance (62.9%) and physiological excitability (72.2%). Against the background of using the developed program there were a positive dynamics of mental state (86.9% of respondents), a decrease in anxiety (85.6%) and depression (82.2%), and a decrease level of PTSD symptoms by Impact of Event Scale (IES-R) (79.8%). Key words: combatants; injuries; non-psychotic mental disorders; psychotherapy; psychoeducation.

Recognized risk factors influencing the birth experience and subsequent poor mental health are not addressed among childbearing adolescents, especially minority teens. Our study purpose was to compare birth experiences of three adolescent groups by prevalence and influence of selected risk factors as moderated by racial/ethnic background. Using a birth rating scale and the Impact of Event Scale, birth perception and stress were examined among an equal number of Black, White, and Hispanic adolescents. Surveys completed at 72 hours postpartum showed Black adolescents most at risk for a negative birth experience. Contributing risk factors included depression, trauma, parity, and operative childbirth. Risk factors occur before and after birth; therefore, childbirth educators can promote a positive birth experience via perinatal assessments and interventions.

Purpose The aim of the study was: (1) to determine whether post-traumatic stress symptoms (PTSS) intensification in a spouse/partner is an essential predictor for PTSS intensification in the parents of children who were treated in the NICU during the neonatal period and (2) to indicate the relationship between psychological variables linked to stress intensification and coping styles with PTSS intensification. Design The research sample consisted of 41 couples of parents of infants aged between 3 and 11 months old, who had been treated in a NICU during the neonatal period. The Impact Event Scale – Revised was used to assess PTSS, the Perceived Stress Scale was applied to assess stress, and the Coping Inventory for Stressful Situations was used to measure the coping style. Data were analysed statistically using descriptive statistics, and hierarchical regression was performed to indicate PTSS predictors. Results PTSS intensification in men was 39.17 ± 17.17 points and in women it was 48.93 ± 18.97 points. The majority of the fathers (68.5%) and of the mothers (82.9%) scored more than 33 points in the IES-R scale, which suggests PTSD. Significant PTSS predictors in the fathers were: PTSS intensification in the partner, the level of perceived stress and emotion-oriented coping. Significant PTSS predictors in women were: avoidance-oriented style in stressful situations and PTSD intensification in the father. Conclusion Post-traumatic stress symptoms in a partner is a significant predictor for post-traumatic stress symptoms in the mothers and fathers of children previously treated in NICU. Practice implications Demonstrating a significant correlation between PTSS in a parent and their partner, as well as stress coping has crucial clinical implications both in terms of prevention and diagnosis.

Purpose As men nowadays often attend the delivery of their own child, they also have to go through the labor period. In this study, the condition of the expectant fathers attending labor was evaluated. Methods In 2016, fathers who went through labor with their partners in the University medical center of Mainz were interviewed within the first days after delivery and 6 months later. They received a “Fathers questionnaire” concerning their motivation, the valuation of their attendance, their emotions during labor, and concerning the service in the labor ward. Six months later, they also received the validated Impact of Event Scale questionnaire (IES-R). In total, 318 participants answered the “Fathers’ Questionnaire”, 226 the IES-R. Results Father’s attendance during labor was considered to be beneficial for fathers themselves (254, 79.8%), for the mother (272, 85.5%), for the newborn child (187, 58.8%), for the relationship (234, 73.6%). Only four could not see a purpose in their attendance. 73 men (23%) felt helpless, 47 (14.8%) were overwhelmed by the situation, 116 (36.5%) felt fear, 299 (94%) were happy to be present at birth, 27 (8.5%) felt traumatized by experiencing their partners in labor. According to the IES-R, none of the 226 men surveyed showed all symptoms of post-traumatic stress disorder. Conclusion Childbirth is related to positive and negative emotions. Positive emotions are predominant, but come along with negative feelings. In this survey, posttraumatic stress disorder did not occur among men after delivery. Nevertheless, fathers’ needs should be kept in view.

Background Women with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancers. We sought to estimate the prevalence of cancer-related distress and to identify predictors of distress in an international sample of unaffected women with a BRCA mutation. Methods Women with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the United States, Canada, the United Kingdom, Australia and from a national advocacy group. Using an online survey, we asked about cancer risk reduction options and screening, and we measured cancer-related distress using the Impact of Event Scale. Results Among 576 respondents, mean age was 40.8 years (SD = 8.1). On average 4.9 years after a positive test result, 16.3% of women reported moderate-to-severe cancer-related distress. Women who had undergone risk-reducing breast and ovarian surgery were less likely to have (moderate or severe) cancer-related distress compared to other women (22.0% versus 11.4%, P value = 0.007). Women recruited from the advocacy group were more likely to have cancer-related distress than other women (21.6% versus 5.3%, P value = 0.002). Conclusions Approximately 16% of women with a BRCA1 or BRCA2 mutation experience distress levels comparable to those of women after a cancer diagnosis. Distress was lower for women who had risk-reducing surgery.

Background Post-traumatic stress disorder (PTSD) frequently occurs in survivors of natural disasters, while symptom of depression is related mostly to interpersonal trauma. These conditions are highly correlated and strongly impact adolescent quality of life. This study aimed to explore the relationship among trauma exposure, PTSD symptoms, and/or depression symptoms in adolescent survivors of the 2013 Lushan (China) earthquake. Methods A cross-sectional survey of 2921 adolescents in the Longmenshan seismic fault zone was conducted three years after the Lushan earthquake. Participants were evaluated using the Earthquake Experience Scale, the Adolescent Self-rating Life Events Checklist (ASLEC), the Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-Rating Scale (KADS-6). Stepwise regression was used to explore relationships between trauma exposure and PTSD or depression symptoms. Results There was a strong correlation between PTSD and depression symptoms, with a 10.7% comorbidity. Earthquake-related exposure, negative life events, prior exposure to the 2008 Wenchuan (China) earthquake, and being left behind by parents all contributed to PTSD and depressive symptoms. Earthquake exposures contributed mainly to PTSD symptoms, while interpersonal traumas contributed mainly to depression symptoms. Conclusion PTSD and depression symptoms strongly correlate in adolescent survivors of the 2013 Lushan earthquake. The high comorbidity between PTSD and depression symptoms may reflect shared risk factors. Natural disasters are more likely to cause PTSD symptoms, while interpersonal traumas are more likely to cause depression symptoms.

We studied the short-term psychological effects of the COVID-19 crisis and the quarantine on 3550 adults from the Spanish population in a cross-sectional survey. Symptoms of anxiety, depression, and stress were analyzed using the 21-item version of the Depression Anxiety Stress Scale. Symptoms of posttraumatic stress disorder were analyzed using the Impact of Event Scale. Symptomatic scores of anxiety, depression, and stress were observed in 20% to 30% of respondents. Symptomatic scores indicating psychological stress were found in 47.5% of respondents. Similar to the findings of other multiple studies, confinement has been found to have significant emotional impact in the Spanish population.

Aim: While it is known that being mechanically restrained during hospitalization can, in severe cases, lead to PTSD in individuals with mental illness, less is known about why some develop posttraumatic stress reactions following restraint while others do not. This study examined whether the amount ofexposure to mechanical restraint and patients’ interpretations of the episodes’ centrality to their identity were related to symptoms of PTSD in individuals with schizophrenia. Methods: We asked 20 individuals to recall mechanical restraint episodes and rate them on centrality to identity. They also completed scales measuring symptoms of posttraumatic stress, depression, trauma history, and were rated on positive and negative symptoms. Objective information about thenumber of times they had been restrained was obtained through Danish health registries. Results: Amount of exposure to mechanical restraint was not significantly related to PTSD symptoms, potentially due to limitations of our small sample. However, interpreting episodes as more central toidentity was. This relationship remained significant when controlling for trauma history, positive symptoms, and depression. Conclusion: The results suggest that clinically significant levels of PTSD are common in this population,and that considering patients’ subjective interpretations of restraint episodes, and not merely the objective facts surrounding them is important for patients’ psychological adjustment. Aim While it is known that being mechanically restrained during hospitalization can, in severe cases, lead to PTSD in individuals with mental illness, less is known about why some develop posttraumatic stress reactions following restraint while others do not. This study examined whether the amount of exposure to mechanical restraint and patients' interpretations of the episodes' centrality to their identity were related to symptoms of PTSD in individuals with schizophrenia. Methods We asked 20 individuals to recall mechanical restraint episodes and rate them on centrality to identity. They also completed scales measuring symptoms of posttraumatic stress, depression, trauma history, and were rated on positive and negative symptoms. Objective information about the number of times they had been restrained was obtained through Danish health registries. Results Amount of exposure to mechanical restraint was not significantly related to PTSD symptoms, potentially due to limitations of our small sample. However, interpreting episodes as more central to identity was. This relationship remained significant when controlling for trauma history, positive symptoms, and depression. Conclusion The results suggest that clinically significant levels of PTSD are common in this population, and that considering patients' subjective interpretations of restraint episodes, and not merely the objective facts surrounding them is important for patients' psychological adjustment.

Purpose: This is a cross-sectional observational study that aims to evaluate the impact of the COVID-19 pandemic in pregnant women.Method: A form containing the validated Impact of Event Scale - Revised questionnaire was sent to the participants.Results: From the 106 participants, 13 had been contaminated by the Sars-Cov2 virus during the pregnancy. More than half of the women (51.89%) presented some degree of psychological impact, 20 participants were classified as having a mild impact, 6 with moderated impact and 29 with severe impact. The psychological impact was more prominent in women in their third gestational trimester, 36.07% of these women presented a severe impact, 4.92% a moderated impact and 14.75% a mild impact. The IES-R questionnaire had a mean score of 35.62 in the group of contaminated patients, indicating a higher psychological impact in comparison with the mean score of 26.76 in the group of patients who were not contaminated by the virus.Conclusion: It can be inferred that the pregnant women who were not contaminated by the Sars-Cov2 presented a lower psychological impact than those who were contaminated. In addition, patients with lower psychological impact did not miss their ultrasound exams. Furthermore, more than half of the women who participated in the study, whether they were contaminated or not, presented some degree of psychological impact.

Background: This study examines changes over time in post-traumatic stress disorder (PTSD) among children who survived the 2008 Wenchuan earthquake and the relevant predictive variables.Methods: A total of 203 children and adolescents were investigated 24 months after the earthquake, and 151 children and adolescents completed the 1-year follow-up study. Participants completed the Children's Revised Impact of Event Scale (CRIES-13), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Connor-Davidson Resilience Scale (CD-RISC). Hierarchical linear regression analysis was used to evaluate the predictors of changes in PTSD severity.Results: Eighty percent of the children still had some PTSD symptoms 2 years after the Wenchuan earthquake, and 66.25% of the children had symptoms that lasted 3 years. In the model predicting PTSD symptom severity, the loss of family members and child burial explained a significant 21.9% of the variance, and depression explained a significant 16.7% of the variance. In the model predicting changes in PTSD severity, the change scores for resilience and depression explained a significant 18.7% of the variance, and cognitive behavioral therapy (CBT) explained a significant 33.6% of the variance.Conclusions: PTSD symptoms in children and adolescents can persist for many years after trauma. In addition to using psychological interventions to improve PTSD symptoms, improvements in depression and resilience should also be considered.

Background As any traumatic event, avalanches could trigger psychological disorders on survivors. Our objectives were to determine the prevalence of post-traumatic stress disorder among avalanche survivors and to evaluate post-traumatic stress disorder risks factors as well as the impact on quality of life. Methods A multicentre study was conducted in victims included in the North Alpine Avalanche Registry from 2014 to 2018. Data were collected through a standard questionnaire during semi-directed phone interviews. The primary outcome was the total score on the Impact of Event Scale Revised. Secondary outcomes were the Mental Component Scale and the Physical Component Scale scores of the Short Form 12 questionnaire. Results During the study period, 132 of 211 victims survived. Among the 107 victims included, 55 (51.4%) phone interviews were obtained. Six patients (10.9, 95% CI 1.76–20.05) had an Impact of Event Scale Revised score ≥ 33 indicating a strong probability for post-traumatic stress disorder. Median Mental Component Scale score was 39.0 (IQR 30.5–46.3) for post-traumatic stress disorder patients and 40.1 (IQR 36.5–43.4) for non post-traumatic stress disorder (p = 0.76). Median Physical Component Scale score was 39.4 (37.2–44.3) for post-traumatic stress disorder patients and 44.2 (39.1–46.8) for non post-traumatic stress disorder (p = 0.39). No significant difference in the quality of life in both populations was observed, and no independent risk factors of post-traumatic stress disorder was identified. Conclusion Avalanche accidents may induce post-traumatic stress disorders among survivors in a comparable prevalence to the most traumatic event already studied. Early recognition and preventive measures should be set up in order to reduce the psychological burden in these victims. Trial registration NCT03936738.

Background Pediatric medical traumatic stress (PMTS) is a psychological and physiological response of children and their families to pain, serious illness, and invasive medical procedures. We aimed to apply the PMTS model to parents of newborns operated at birth for a congenital malformation and to identify clinical and sociodemographic risk factors associated with PMTS symptoms at 6 months. Methods We designed a cross-sectional study to assess PMTS symptoms (avoidance, arousal, reexperiencing) in parents of six months children operated on for a congenital anomaly, with the Italian version of the Impact of Event Scale – Revised (IES-R). Results One-hundred-seventy parents form the object of the study. Eighty-two parents (48.2%) fell over the clinical cut-off. Ventilatory time (p = 0.0001), length of hospital stay (p = 0.0001), associated anomalies (p = 0.0002), medical devices at discharge (p = 0.0001) and Bayley motor scale (p = 0.0002) were significantly correlated with IES-R Total and Subscale Scores. Multivariate linear regression showed length of hospital stay and number of associated anomalies as significant predictors of IES-R Scores. Conclusions Regardless the type of anomaly and sociodemographic factors, it is the clinical history of the child which seems to predict the severity of PMTS symptoms in this population of parents. PMTS represents a useful model to describe the psychological reactions of parents of newborns operated at birth for a congenital malformation. NICU and outpatient pediatric staff should be aware of risk factors to identify families who may request early multidisciplinary interventions since the first admission. Level of evidence Prognosis study, level II.

The Impact of Event Scale-Revised (IES-R) is a widely used self-report questionnaire used to assess symptoms of posttraumatic stress disorder (PTSD). Although the IES-R has been translated and validated in multiple languages, no previous version has employed the Arabic dialect commonly spoken in Syria. The present work aimed to assess the psychometric properties of a Syrian Arabic version of the IES-R. Syrian citizens (N = 288) living in refugee camps in Turkey were administered the Syrian Arabic IES-R as part of a humanitarian aid project focused on providing psychological assistance. The data were analyzed with respect to 10 previously published factor solutions. We found that the best-fitting model was a four-factor structure that included factors involving Avoidance-Numbing, Intrusion, Hyperarousal, and Sleep Disturbance. The model showed strong measurement invariance between male and female subsamples, allowing for meaningful comparisons of the factor means. Overall, the present findings support the validity of a new version of the IES-R, which can be used by both researchers and clinicians responding to the urgent need for psychological care for Syrian refugees fleeing war-related violence.

Aim To evaluate health-related quality of life, mental health and treatment-related stress responses in children with primary antibody deficiency and both their parents. Methods Children and their parents completed the standardised questionnaires Pediatric Quality of life Inventory, Strength and Difficulties Questionnaire and Impact of Event Scale. Parents also completed standardised questionnaires regarding their own mental health and quality of life. The results were compared to those of healthy children, kidney transplanted children and children in remission from acute lymphoblastic leukaemia. Results Children with primary antibody deficiency reported a poorer health-related quality of life compared to healthy children and children in remission from acute lymphoblastic leukaemia. They reported poorer mental health compared with healthy children. Mothers of children with primary antibody deficiency reported poorer mental health compared to mothers of healthy children but comparable to mothers of chronically ill children. Parents reported a similar quality of life as the general Norwegian population. Treatment with subcutaneous immunoglobulin infusions at home is generally well tolerated, but some report severe treatment-related stress. Conclusion Primary antibody deficiency has a significant impact on quality of life and mental health of affected children. Patients and parents with severe treatment-related stress should be identified and helped.

Objective: We aimed to conduct a comparative analysis of the psychological stress experienced by healthcare workers, frontline workers, and the general public and to assess the factors associated with psychological stress in each of these groups.Methods: We conducted an online survey targeting healthcare workers, frontline workers, and the general public. Psychological stress was assessed with the revised impact of event scale (IES-R). Univariable and multivariable logistic regression analyses were conducted.Results: We surveyed 1,336 participants (64.6% female; mean age, 36.6). The occupation group distribution of respondents was 50.7% healthcare workers, 27.2% frontline workers, and 22.1% general public. The healthcare (23.6 ± 15.8) and frontline (23.6 ± 17.8) workers had higher IES-R scores than the general public (15.3 ± 10.6; p < 0.01). Poor health perception and perception of infection avoidance were associated with psychological stress in the healthcare and frontline workers, but not in the general public.Conclusion: Both healthcare and frontline workers are suffering elevated psychological stress, compared to the general public, and this elevated stress may be related especially to their perceptions of their own health and infection risk. Interventions addressing these factors should be developed to alleviate psychological stress in these populations, and thus reduce their risk of mental illness pathogenesis.

Highlights • The psychological impact of COVID-19 crisis has remained stable during the lockdown. • Symptoms of frequent mental disorders were reported by 35-50% of participants. • Anxiety, depression and above all stress levels have risen from the COVID-19 outbreak. • Daily physical activity may be included as a complement to reduce symptomatology., Background Strict confinement and social distancing measures have been imposed due to the COVID-19 pandemic in many countries. The aim was to assess the temporal evolution of the psychological impact of the COVID-19 crisis and lockdown from two surveys, separated by one month, performed in Spain. Methods Symptoms of depression, anxiety and stress, and the psychological impact of the situation were longitudinally analyzed using the Depression Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale (IES) respectively. Results There was a total of 4,724 responses from both surveys. Symptomatic scores of anxiety, depression and stress were exhibited by 37.22%, 46.42% and 49.66% of the second survey respondents, showing a significant increase compared to the first survey (32.45%, 44.11% and 37.01%, respectively). There was no significant longitudinal change of the IES scores, with 48.30% of the second survey participants showing moderate to severe impact of the confinement. Constant news consumption about COVID-19 was found to be positively associated with symptomatic scores in the different scales, and daily physical activity to be negatively associated with DASS-21 scores. Conclusions Results indicated a temporal increase of anxiety, depression and stress scores during the COVID-19 lockdown. Factors such as age, consumption of information about COVID-19 and physical activity seem to have an important impact on the evolution of psychological symptoms.

Type 1 diabetes is a challenge for children, adolescents, and their families as it affects the quality of life and lifestyle of the whole family context. Diabetes onset and its chronic management could be therefore particularly related to post-traumatic stress disorder (PTSD), a group of persistent psychological and physiological symptoms due to a traumatic and severe event. The aim of this study was to assess the rate of PTSD in a group of pediatric patients with T1DM and to evaluate the relationship between parental trauma and quality of life. Forty-nine prepubertal children affected by T1DM and their families were consecutively enrolled in the study. Patients and parents were asked to complete two types of questionnaires: (1) The Impact of Event Scale (IES) questionnaire for the evaluation of PTSD. (2) The PedsQL™3.0 Diabetes Module questionnaire to measure diabetes-specific QOL in both children and their parents. Our data suggest that a clinical level of trauma is present in 66.7% of mothers and 65.5% of fathers of T1D children. Parents with medium or high IES Scores demonstrated lower levels of QoL. The results of this study show a high prevalence of acute post-traumatic stress symptoms in parents of prepubertal children with T1DM. This finding is consistent with data from adult diabetic patients. Our data demonstrated also a relation between parents’ level of traumatism and declared QoL scores. Indeed, our data confirm that the duration of diabetes negatively correlates with the QoL by both, parents and patients.

AIM: For those patients who suffer unfavourable outcome after survival of cardiac arrest, it is important to know whether this can be predicted at an early stage. Support can subsequently be provided. This study aimed to identify early prognostic factors of quality of life (QOL) and societal participation at one year post-cardiac arrest.METHODS: The design was a prospective longitudinal cohort study following cardiac arrest survivors up to one year. Prognostic personal, injury-related, function-related and subjective outcome factors were selected and entered into a hierarchical regression model to assess whether they were predictive of QOL and societal participation at one year post-cardiac arrest.RESULTS: Hundred and ten cardiac arrest survivors were included. Not having a partner, more functional limitations (at two weeks) and cognitive complaints were significantly predictive of lower physical QOL, while higher levels of anxiety and depression symptoms (at three months) were significant predictors of mental QOL. A neurological history and higher levels of anxiety and depression symptoms were significantly predictive of lower brain injury-specific QOL. Societal participation was only predicted by premorbid functioning.CONCLUSION: This study identified prognostic factors of QOL and societal participation one year after survival of cardiac arrest. Screening of these factors in early stages can identify those survivors with possibly unfavourable QOL at one year post cardiac arrest. For those survivors, preventive and targeted interventions may be offered.

Posttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors. Brief screening instruments are needed for clinical and research purposes. We evaluated internal consistency, external construct, and criterion validity of the Impact of Event Scale-6 (IES-6; 6 items) compared to the original Impact of Event Scale-Revised (IES-R; 22 items) and to the Clinician Administered PTSD Scale (CAPS) reference standard evaluation in ARDS survivors.This study is a secondary analysis from two independent multi-site, prospective studies of ARDS survivors. Measures of internal consistency, and external construct and criterion validity were evaluated.A total of 1001 ARDS survivors (51% female, 76% white, mean (SD) age 49 (14) years) were evaluated. The IES-6 demonstrated internal consistency over multiple time points up to 5 years after ARDS (Cronbach’s alpha = 0.86 to 0.91) and high correlation with the IES-R (0.96; 95% confidence interval (CI): 0.94 to 0.97). The IES-6 demonstrated stronger correlations with related constructs (e.g., anxiety and depression; |r| = 0.32 to 0.52) and weaker correlations with unrelated constructs (e.g., physical function and healthcare utilization measures (|r| = 0.02 to 0.27). Criterion validity evaluation with the CAPS diagnosis of PTSD in a subsample of 60 participants yielded an area under receiver operating characteristic curve (95% CI) of 0.93 (0.86, 1.00), with an IES-6 cutoff score of 1.75 yielding 0.88 sensitivity and 0.85 specificity.The IES-6 is reliable and valid for screening for PTSD in ARDS survivors and may be useful in clinical and research settings.

The present study showed that the frequency of post‐traumatic stress disorder was 9.3% at 1 month after bereavement among Japanese relatives of sudden death victims after an intervention. This frequency was minimal compared with previous reports., Aim To investigate the prospective frequency of post‐traumatic stress disorder (PTSD) among relatives of sudden death patients following provision of a pamphlet explaining the stages of the complicated grief process and self‐regulating techniques. Methods From May 2017 to February 2018, we prospectively and consecutively provided a pamphlet to relatives of out‐of‐hospital sudden cardiac arrest victims who failed to obtain spontaneous circulation. We investigated the psychiatric status of the bereaved relatives using the Impact of Event Scale – Revised (IES‐R). An IES‐R score over 24 was defined as PTSD. Results Fifty‐four relatives of the 54 dead patients (victims) provided permission of entry to this research. All subjects and victims were Japanese. Among them, 24 subjects had an IES‐R score of 0 and 5 (9.3%) had PTSD approximately 1 month after their bereavement. There were no relatives who received spontaneous psychiatric treatment. The IES‐R scores for non‐medical cardiac arrest, death inquests, and parent variables were significantly higher compared with medical cardiac arrest, no inquest, and no parent, respectively. The IES‐R scores in those who were a child of the victim were significantly lower than in those who were not. Conclusion The present study showed that the frequency of PTSD was 9.3% at 1 month following bereavement among Japanese relatives of sudden death victims after an intervention. This frequency was minimal compared with previous reports.

Background Previous studies showed that family carers (FCs) who engaged in formal ACP had fewer adverse outcomes in wellbeing compared with FCs who did not. The ACTION trial is the first multicentre randomized controlled trial of ACP in six European countries. This study will report on the effect of ACP on the wellbeing of bereaved FCs. Methods 451 questionnaires were sent to bereaved FCs 3 months after the patient participating in the trial had died; 163 were returned (response rate: 36.1%; N control= 93, N intervention= 70). Wellbeing was measured with the Hospital Anxiety and Depression Scale (HADS) and Impact Event Scale (IES). Results No significant differences were found in wellbeing of FCs between groups. The mean scores for the HADS show no significant differences between groups for anxiety (mean score control 7,09 vs. mean score intervention 8,29) and depression (mean score control 6,72 vs. mean score intervention 7,17). No significant differences are found between groups in the mean scores for the IES. Intrusion had a mean score of 21,27 for control vs. 21,38 for intervention; Avoidance had a mean score of 10,34 for control vs. 12,72 for intervention. Conclusion Despite previous evidence about improved outcomes for wellbeing in FCs in ACP programs, our ACP intervention did not show differences between groups. Possibly the non-response or cultural discrepancies between the different countries have a part in this. More research is needed to explain what mechanisms are present. This study is supported by a grant from the FWO (nr. G034717N).

Objectives This study aimed to determine the impact of the COVID-19 pandemic on the psychological, mental health and quality of life among Bangladeshi residents. Study design A purposive cross-sectional study of quality of life during the COVID-19 pandemic was performed. Methods Respondents completed a modified questionnaire that determined the Impact of Event Scale (IES), indicators of psychological distress impact, impact on government strategies, awareness and lifestyles, and impact on expectation of quality life change. A total of 465 (male = 330 and female = 135) respondents participated in this study. Results The overall mean age of respondents was 28.42 ± 7.07 years, and 63.4%, 44.1% and 50.3% were unmarried, were in the middle-income family group and had a masters or PhD qualification, respectively. The overall mean IES score of respondents was 80.89 ± 8.91, which reflects a stressful impact of the COVID-19 pandemic on physical and mental health problems. Only 27.75% of respondents had an IES score ≥75. More than half of respondents (57.8%) reported that they did not feel lonely and hopeless. In terms of preventative measures, the majority of the respondents (80.2%) reported that they did not wash their hands frequently with soap and sanitiser for at least 20 s to reduce spread of the virus. During the pandemic, more than half of the respondents (56.8%) claimed that they faced serious problems in education. Conclusions The ongoing COVID-19 pandemic has resulted in significant mental and physical health problems.

IntroductionChildren with traumatic brain injury (TBI) are at risk for post-traumatic stress disorder (PTSD). The vast majority of TBI are of mild severity (MTBI), however, they may develop persistent neurophysiological symptoms.ObjectivesThe purpose of this study was to investigate the incidence of PTSD in children with MTBI in Western Greece.MethodsA one-year prospective study was conducted at the Children Hospital of Patras. A total of 175 children aged 6-14 years screened for risk of PTSD at one-week and one-month post-injury, completing the Child Trauma Screening Questionnaire (CTSQ). The Children’s Revised Impact of Event Scale (CRIES 13) was administered to the parents, to inquire their assessment of PTSD in the children. Statistical analysis was performed with IBM SPSS v.22.0ResultsThere were 59 (33.7%) children (27.2% boys, 45.9% girls) whose screen result was at risk. At the rescreening one-month postinjury, 9.9% were still at risk. Parents assessed presence of PTSD in 19% of their children at one-week and in 3.9% at one-month post-injury. There was a positive correlation between parenting and child reporting on symptoms of PTSD in children. However, 23.4% mistakenly estimated their children did not experience stress while in fact they did and 24.2% mistakenly estimated the contrary.ConclusionsThe findings revealed the risk of PTSD even in mild TBI, justifying thus the screening to identify these children for intervention strategies. On the other hand, the rescreening demonstrated that not all at-risk children required intervention, since a natural remission in PTSD symptoms was observed one-month post-injury.

IntroductionDue to the Covid 19 pandemic, the Tunisian government has taken several measures, which had a psychological impact on adults and children.ObjectivesStudying the initial impact of the Covid 19 pandemic on Tunisian parents and children.MethodsOne week after the proclamation of sanitary lockdown in Tunisia, parents were invited to answer voluntarily an anonymous questionnaire posted on social media. The stress level of the parent was measured by the Impact Event Scale Revised (IES-R).ResultsThis questionnaire was answered by 138 parents.88% of them were mothers. Changes in working arrangements were made by 87.2% of fathers and 79.8% of mothers. Only 1% of parents did not teach their children about hygienic rules. Parents had a child aged 12 or less in 91% and aged more than 12 in 41.4%. Behavioral changes were reported in 60% for children aged 12 or younger (Graphic 1) and in 20% for those older than 12 (Graphic 2) The IES-R mean score was 28.9 ±18.The severity of the impact was associated with the female sex (p=0.04).We found a positive correlation between the IES-R score and the symptomatology of children with p=0.001 and r=0.518 when the age was superior to 12 and with pConclusionsThe Covid pandemic in Tunisia affected both parents and children. Psychological intervention is essential to help them get out of this crisis with less damage.

During the COVID-19 pandemic, along with others in Italy, oncological patients had to put their life on hold, adjusting to the new restrictions and complying to the precautionary measures, some of which affected their participation in treatment programs and medical check-ups/health screening tests. The aim of this contribution is to investigate the extent to which the COVID-19 lockdown affected the above-mentioned participation in health screening tests and treatment programs, as well as to study the prodromal levels of PTSD in oncological patients in Italy during the lockdown. A survey consisting of Impact of Event Scale Revised (IES-R), items related to the diagnosis of patients and items regarding treatment and screening tests was shared across several channels. Five-hundred forty-four patients answered the survey. Compared to the screening tests, treatment programs were less affected by COVID-19 restrictions, only 5% of participants had the treatment postponed or interrupted, for the screening tests this number exceeded 30%. The results of linear regression analysis show that overall the level of distress that oncological patients suffered from represents the probable diagnosis of PTSD, with patients who had to stop their regular screening tests showing a higher level of distress compared to those who continued screening (β = 10.78, SE = 1.85, t = 5.84, p = 0.00). These results indicate the need to provide psychological support for oncological patients during future emergency management of catastrophic events such as a pandemic. Citation Format: Mariam Chichua, Eleonora Brivio, Serena Oliveri, Paolo Guiddi, Gabriella Pravettoni. PTSD and levels of general anxiety in Italian oncological patients during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P40.

Which types of benefit finding in negative events central to identity lead to higher identity achievement? This study examined the relationships between the identity centrality of negative events, benefit finding, and identity achievement, with consideration of differences between benefit-finding domains. Participants included 245 undergraduates, who recalled a previous negative event and completed the Identity Scale, Centrality of Event Scale, and items regarding benefit finding. Path analysis showed that benefit finding regarding personal growth consistently correlated with identity achievement, while the effects of recognizing warmth in others were unstable depending on event category. The findings demonstrated the role of benefit finding regarding personal growth in promoting identity achievement and buffering the original adverse impact of negative events on identity.

Although most patients recover fully following mild traumatic brain injury (mTBI), a minority (15-25%) of all patients develop persistent post-traumatic complaints (PTC) that interfere with the resumption of previous activities. An early identification of patients who are at risk for PTC is currently performed by measuring the number of complaints in the acute phase. However, only part of this group will actually develop persisting complaints, stressing the need for studies on additional risk factors. This study aimed to compare this group of patients with many complaints with patients with few and no complaints to identify potential additional discriminating characteristics and to evaluate which of these factors have the most predictive value for being at risk. We evaluated coping style, presence of psychiatric history, injury characteristics, mood-related symptoms, and post-traumatic stress. We included 820 patients (Glasgow Coma Scale [GCS] score 13-15) admitted to three level-1 trauma centers as part of the UPFRONT-study. At 2 weeks after injury, 60% reported three or more complaints (PTC-high), 25% reported few complaints (PTC-low), and 15% reported no complaints (PTC-zero). Results showed that PTC-high consisted of more females (78% vs. 73% and 52%, p

Rationale: Millions of patients are diagnosed with pulmonary nodules every year. Increased distress may be a common harm, but methods of mitigating this distress are unclear.Objectives: We aimed to determine whether high-quality communication regarding the discovery of a pulmonary nodule is associated with a lower level of patient distress.Methods: We conducted a prospective, repeated-measures cohort study of 121 patients with newly reported, incidentally detected pulmonary nodules. The primary exposure was participant-reported quality of communication regarding the nodule. Secondary exposures included communication measures regarding participants’ values, preferences, and decision making. The main outcome was nodule-related distress measured using the Impact of Event Scale. We used adjusted generalized estimating equations to measure the association between nodule communication quality and at least mild distress.Measurements and Main Results: Most participants (57%) reported at least mild distress at lea...

Background: Although outcomes of critically ill patients with haematological malignancies (HMs) have been fully investigated in terms of organ failure and mortality, data are scarce on health-related quality of life (HRQOL) in this population. We aim to assess post-intensive care unit (ICU) burden and HRQOL of critically ill patients with HMs and to identify risk factors for quality-of-life (QOL) impairment. Results: In total, 1011 patients with HMs who required ICU admission in 17 ICUs in France and Belgium were included in the study; 278 and 117 patients were evaluated for QOL at 3 months and 1 year, respectively, after ICU discharge. HRQOL was determined by applying the interview form of the Short Form 36 (SF-36) questionnaire. Psychological distress symptoms were evaluated using the Hospital Anxiety Depression Score (HADS) and the Impact of Event Scale (IES). In-hospital mortality rates at 3 months and 1 year were, respectively, 39.1, 50.7 and 57.2%, respectively. At 3 months, median [IQR] physical and mental component summary scores (PCS and MCS) (SF-36) were 37 [28–46] and 51 [45–58], respectively. PCS was lower in ICU patients with HMs when compared to general ICU septic patients (52 [5–13], p = 0.00001). The median combined HAD score was 8 [5–13], and the median IES score was 8 [3–16]. However, recovery during the first year after ICU discharge was not consistent in all dimensions of HRQOL. Three months after ICU discharge, the maximum daily Sequential Organ Failure Assessment score and status of the underlying malignancy at ICU admission were significantly associated with MCS impairment (− 0.54 points [95% CI − 0.99; − 0.1], p = 0.018 and − 4.83 points [95% CI − 8.44; − 1.22], p = 0.009, respectively). Conclusion: HRQOL is strongly impaired in critically ill patients with HMs at 3 months and 1 year after ICU discharge. Organ failure and disease status are strongly associated with QOL. The kinetic evaluation of QOL at 3 months and 1 year offers the opportunity to focus on QOL aspects that may be improved by therapeutic interventions during the first year after ICU discharge., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. Methods All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach’s alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman’s rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. Results A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). Conclusion The final PSIT has good psychometric properties in adult trauma patients.

The death of a child can have significant emotional effects on doctors responsible for their care. Trainee doctors working in the paediatric intensive care unit (PICU) may be particularly vulnerable. The aim of this study was to examine the emotional impact of, and grief reactions to, a child's death in PICU trainee doctors, along with coping strategies they used.In a prospective, cross-sectional, observational study, qualitative and quantitative data were recorded on anonymised, written questionnaires. Grief severity was assessed using the Texas Revised Inventory of Grief. Emotional impact was assessed using the shortened Impact of Event Scale. The BriefCOPE tool was used to assess coping strategies. Qualitative data was analysed using conventional content analysis. Data are presented as median (inter-quartile range) or number (%).All invited trainee doctors (23 anaesthetists; 5 paediatricians) completed the questionnaire (age, 30 [29-34] yr; 13/28 [46%] female). Two (7%) doctors experienced severe grief (Texas Revised Inventory of Grief score39), with five (18%) doctors severely affected by the deaths as measured by the Impact of Event Scale. Qualitative analysis revealed prominent themes of sadness, helplessness, guilt, shock, and concern for the bereaved family. There was limited use of coping strategies. Speaking with another trainee doctor was the principal coping strategy. Requests for debriefing sessions, greater psychological support and follow-up with the patient's family were frequently suggested.Paediatric deaths evoke significant grief and emotional reactions in a subset of PICU trainee doctors. Trainee PICU doctors highlighted a lack of professional support and tailored debriefs.

Persistent post-concussion symptoms (PPCS) occur frequently after mild traumatic brain injury (mTBI). The identification of patients at risk for poor outcome remains challenging because valid prediction models are missing. The objectives of the current study were to assess the quality and clinical value of prediction models for PPCS and to develop a new model based on the synthesis of existing models and addition of complaints at the emergency department (ED). Patients with mTBI (Glasgow Coma Scale score 13-15) were recruited prospectively from three Dutch level I trauma centers between 2013 and 2015 in the UPFRONT study. PPCS were assessed using the Head Injury Severity Checklist at six months post-injury. Two prediction models (Stulemeijer 2008; Cnossen 2017) were examined for calibration and discrimination. The final model comprised variables of existing models with the addition of headache, nausea/vomiting, and neck pain at ED, using logistic regression and bootstrap validation.Overall, 591 patients (mean age 51years, 41% female) were included; PPCS developed in 241 (41%). Existing models performed poorly at external validation (area under the curve [AUC]: 0.57-0.64). The newly developed model included female sex (odds ratio [OR] 1.48, 95% confidence interval [CI] [1.01-2.18]), neck pain (OR 2.58, [1.39-4.78]), two-week post-concussion symptoms (OR 4.89, [3.19-7.49]) and two-week post-traumatic stress (OR 2.98, [1.88-4.73]) as significant predictors. Discrimination of this model was adequate (AUC after bootstrap validation: 0.75). Existing prediction models for PPCS perform poorly. A new model performs reasonably with predictive factors already discernible at ED warranting further external validation. Prediction research in mTBI should be improved by standardizing definitions and data collection and by using sound methodology.

Background Working as a paramedic carries the risk of witnessing events and personal experiences associated with emergency life-threatening circumstances that may result in symptoms associated with posttraumatic stress. This problem is well known but still underestimated. Objectives The specific study objectives were to 1) assess the influence of sociodemographic and occupational factors on posttraumatic stress disorder (PTSD) among paramedics, and 2) suggest preventive strategies in this population. Methods This prospective, descriptive study examined a sample of 100 paramedics who agreed to complete the Author Questionnaire comprising demographic questions and the Impact of Event Scale – Revised. Results The total prevalence of PTSD in the examined group was 40.0% (women = 64.3%, men = 36.1%). It was more frequently reported in paramedics working under an employer's contract than among those who were self-employed. It occurred less frequently in persons with more education. Other sociodemographic factors studied showed no significant impact. A statistically significant effect of exposure to certain types of traumatic events on the incidence of PTSD was found. There was no significant correlation between the prevalence of PTSD and the occurrence of problem situations in respondents' workplaces. Conclusions Polish paramedics who agreed to take part in the survey were shown to have a high rate of PTSD. Multi-center screening and early supportive management is recommended.

Background: Survivors of a cardiac arrest frequently have cognitive and emotional problems and their quality of life is at risk. We developed a brief nursing intervention to detect cognitive and emotional problems, provide information and support, promote self-management, and refer them to specialised care if necessary. This study examined its effectiveness.Methods: Multicentre randomised controlled trial with measurements at two weeks, three months and twelve months after cardiac arrest. 185 adult cardiac arrest survivors and 155 caregivers participated. Primary outcome measures were societal participation and quality of life of the survivors at one year. Secondary outcomes were the patient's cognitive functioning, emotional state, extended daily activities and return to work, and the caregiver's well-being. Data were analysed using 'intention to treat' linear mixed model analyses.Results: After one year, patients in the intervention group had a significantly better quality of life on SF-36 domains Role Emotional (estimated mean differences (EMD) = 16.38, p = 0.006), Mental Health (EMD = 6.87, p = 0.003) and General Health (EMD = 8.07, p = 0.010), but there was no significant difference with regard to societal participation. On the secondary outcome measures, survivors scored significantly better on overall emotional state (HADS total, EMD = -3.25, p = 0.002) and anxiety (HADS anxiety, EMD = -1.79, p = 0.001) at one year. Furthermore, at three months more people were back at work (50% versus 21%, p = 0.006). No significant differences were found for caregiver outcomes.Conclusion: The outcomes of cardiac arrest survivors can be improved by an intervention focused on detecting and managing the cognitive and emotional consequences of a cardiac arrest. Trial registration: Current controlled trials, ISRCTN74835019. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Background: Emergency room nurses were trained to provide a short-term psychological intervention in physically injured patients with Impact of Event Scale (IES) scores > 20. The aims were to study the effects of the psychological intervention relative to usual care (UC). Methods: In a randomized controlled trial, psychological distress, daily functioning and the personality traits optimism/pessimism were compared with patients who received the UC. The interventions were provided 1 - 3 months after discharge. Results: The IES scores were significantly reduced in both groups at 3 months (intervention: 41.1 - 28.6, P < 0.001 vs. UC: 35.4 - 26.2, P < 0.001), but not significantly different between groups. Baseline IES score was a significant predictor of IES scores at 3 (β = 0.4, P < 0.05) and 12 months (β = 0.3, P < 0.05), whereas overall daily functioning at 3 months predicted IES scores at 12 months (β = -0.5, P < 0.001). Patients receiving intervention became significantly more optimistic during the year, and had an increase in overall daily functioning from 3 to 12 months (P < 0.001). Patients declining intervention were more pessimistic and had lower daily functioning. Patients who talked with nurses with more training in psychological processing had a larger reduction in IES symptoms at 3 months (β = -0.3, P = 0.081). Conclusion: The nurse-led intervention had a significant effect on optimism and overall daily functioning. Nurses may become a low-cost option to perform short-term psychological interventions with physically injured hospitalized patients. J Clin Med Res. 2015;7(5):339-347 doi: http://dx.doi.org/10.14740/jocmr2082w

Objective This study aimed to estimate the prevalence and risk factors of probable posttraumatic stress disorder (PTSD) among adolescent survivors of the 2013 Lushan earthquake. Methods A cross-sectional survey was conducted in the Longmenshan thrust fault area at three years after the 2013 earthquake in Lushan, China. Most respondents (60.8%) had also been exposed to the 2008 Wenchuan earthquake. Probable PTSD was identified based on the Children's Revised Impact of Event Scale (CRIES-13), the Adolescent Self-Rating Life Events Checklist and Earthquake Experience Scale. Logistic regression was used to identify risk factors of probable PTSD. Results Probable PTSD prevalence was 14.1% among all respondents (n = 3851), 15.9% among those who had been exposed to the 2008 and 2013 earthquakes (n = 2342) and 11.3% among those who had experienced only the 2013 earthquake (n = 1509). Earthquake-related factors most strongly associated with probable PTSD were feeling scared of dying and exposure to the Wenchuan earthquake. The negative life event most strongly associated with probable PTSD was academic stress. Conclusion Among survivors of the 2013 Lushan earthquake, risk of probable PTSD was significantly higher if the person had also been exposed to the Wenchuan earthquake. Researchers and health care workers should pay more attention to adolescent earthquake survivors, especially those who experienced both the Wenchuan and Lushan earthquakes. Providing psychological care and preventing negative events may be effective measures for reducing PTSD after an earthquake.

Aim: This was a one-year follow-up of families referred to support services after the parents visited the emergency department due to intimate partner violence, substance abuse or a suicide attempt. Its aim was to evaluate the well-being of any children.Methods: Data on families identified a year earlier by the Amsterdam protocol were gathered from child protective services and parent and child self-reports in two Dutch regions from 2012-2015.Results: We included 399 children (52%) boys with a median age of eight years (range 1-18) in the study using child protective services data. Of the 101 families who participated in the first measurement, 67 responded one year after the parent's emergency department visit. The results showed that 20% of the children had no or minor problems, voluntary support services were involved in 60% of cases and child protective services were involved in 20%. Compared to their first assessment a year earlier, the children's psychosocial problems had not increased, but this could have been an underestimation due to selective responses.Conclusion: The Amsterdam protocol was valuable in referring families to voluntary support services, but given the ongoing problems in some families, professionals need to carefully monitor whether support services are sufficiently effective.

This study examined the severity of post-traumatic stress and depressive disorders in Longmenshan adolescents after the 2013 Lushan earthquake, as well as relationships among earthquake-related exposure, post-earthquake negative factors, previous exposure to the 2008 Wenchuan earthquake, and level of earthquake impact (city). A cross-sectional survey was conducted among adolescents in Lushan (n = 1416), Baoxing (n = 1102) and Tianquan (n = 1265) at 3 years after the Lushan earthquake. Respondents were evaluated using the Earthquake Experience Scale, the Adolescent Self-rating Life Events Checklist (ASLEC), the Children’s Revised Impact of Event Scale (CRIES-13), and the Depression Self-Rating Scale (KADS-6). High levels of post-traumatic stress and depression symptoms were found among adolescents in the most heavily affected cities, and these symptoms were more severe in respondents exposed to the 2008 earthquake. PTSD correlated most strongly with earthquake exposure, whereas depression correlated most strongly with psychosocial stressors following the event.

Background On September 27, 2012, at 3:43 pm, a hydrogen fluoride spill occurred in a manufacturing plant located at the 4th complex of the Gumi National Industrial Complex in Gumi City, South Korea. The present study aimed to evaluate the psychological effects of the hydrogen fluoride spill on the members of the community and to investigate their relationships with physical symptoms and changes in psychological effects occurring as time passed after the accident. Methods The 1st phase involved a survey of 1359 individuals that was conducted 1 month after the spill, and the 2nd phase involved a survey of 711 individuals that was conducted 7 months after the accident. The questionnaires included items for assessing demographic characteristics, hydrogen fluoride exposure level, physical symptoms, and psychological status. Physical symptoms were assessed to determine the persistence of irritations. Psychological status was assessed to investigate the impact of event level using the Impact of Event Scale – Revised Korean version (IES-R-K), and the anxiety level was assessed using the Beck Anxiety Inventory (BAI). Results As the hydrogen fluoride exposure level increased, the impact of event and anxiety levels increased significantly both 1 and 7 months after the accident (p

On 11 March 2011, Japan was struck by an earthquake measuring over 9·0 on the Richter magnitude scale, the strongest known to hit Japan and one of the top five largest earthquakes ever recorded in the world. The epicentre was 175 km (110 miles) east-north-east from the Fukushima Daiichi nuclear power plant, and within an hour a massive tsunami had inundated the site. This caused a serious nuclear accident, with an International Nuclear and Radiological Event Scale (INES) rating of Level 7 (the highest). Following the events at Fukushima, the nuclear industry in the UK responded quickly to review UK nuclear installations against seismic and flooding hazards. On 14 March 2011 the UK Secretary of State for Energy and Climate Change requested that Dr Mike Weightman, HM Chief Inspector of Nuclear Installations, examine the circumstances of the Fukushima accident to see what lessons could be learnt to enhance the safety of the UK nuclear industry. An Interim Report was published in the middle of May 201...

This paper provides a critical analysis of the International Nuclear and Radiological Event Scale (INES) and its use, both from an epistemic and an ethical perspective. As very few papers have been dedicated to this subject, our critical analysis is mainly based on the INES 2009 User's Manual and on technical information issued by different nuclear agencies. Our critical analysis leads to suggest several elements, which could contribute to the improvement of the INES scale and thereby to a better communication about nuclear events. First, we show that multiple criteria are used to assign an INES rating, which could lead to an insufficient differentiation between events. In order to avoid this issue, we suggest to clarify the criteria that are used to assess the level of the event. Then, we show that level 7 of the INES scale is ill-defined as it does not allow to properly take differences in severity between disasters into account. In this regard, we recommend to use an open scale instead. Moreover, we highlight the fact that INES is able to take into account neither events with long-term evolution nor events involving multiple initiators. In this respect, we suggest providing additional guidelines and reflecting about the data on which to rely, in order to assess an INES level. Furthermore, we reflect on who should be rating a nuclear event and we recommend that, for severe events, an independent and plural agency should be in charge. Finally, we show why INES appears to be insufficient for a global communication, and we suggest to complement the INES rating with additional information in parallel.

O artigo tem por objetivo rastrear sintomatologia de transtorno de estresse pós-traumático (TEPT) em profissionais que prestaram ajuda humanitária à população haitiana, após o terremoto de 2010. Estudo transversal. A sintomatologia de TEPT foi avaliada pela Escala Impacto do Evento - Revisada (IES-R). Os participantes foram 32 brasileiros (idade m = 37.58 +/- 7.01), 22 estadosunidenses (idade m = 33.67 +/- 8.03) e 12 equatorianos (idade m = 44.80 +/- 15.88) e não apresentaram sintomatologia de TEPT. A relação entre as variáveis experiência prévia em situação de desastre e escore total da IES-R [F(2) = 4.34, p = 0.017] bem como experiência prévia em situação de desastre e subescala intrusão [F(2) = 3.94, p = 0.024] foram significantes nos modelos de regressão linear. Experiência prévia se mostrou preditor significante para escore total da IES-R (p < 0,05). Os resultados demonstraram que vivências atuais podem ser potencializadas pelas memórias de experiências anteriores, aumentando a probabilidade de desenvolvimento de TEPT. Portanto, o cuidado com a saúde mental dos profissionais deve favorecer a precoce identificação do fator de risco experiência prévia, não permitindo que a iniciativa voluntária se sobreponha aos critérios seletivos e aos cuidados específicos. The scope of this article is to screen the symptoms of Post-Traumatic Stress Disorder (PTSD) among the professionals who provided humanitarian aid for the Haitian population after the 2010 earthquake. It involvess a cross-sectional study. The Impact of Event Scale - Revised (IES-R) was used for screening symptoms of PTSD. The participants included 32 Brazilians (mean age = 37.58 +/-7.01), 22 Americans (mean age =33.67 +/-8.03) and 12 Ecuadorians (mean age = 44.80 +/- 15.88). The professionals did not have PTSD symptoms. The relationship between prior experience variables in disaster situations and the total score of the IES-R (F (2) = 4.34, p = 0.017), as well as prior experience in disaster situations and the intrusion subscale (F (2) = 3.94, p = 0.024) were significant in linear regression models. The number of prior experiences was revealed as a significant predictor for the total score of IES (p < 0.05). The results showed that current experiences can be exacerbated by memories of prior experiences, increasing the likelihood of developing PTSD. Therefore the mental health care of the professionals should foster the early identification of prior experience risk factors, thereby not permitting voluntary initiative to transcend selective criteria and specific care.

Background Doctors are at particular risk of occupational needlestick injuries (NSI), and these may result in considerable acute anxiety and fear of disease transmission. Aims To measure the prevalence of post-traumatic stress disorder (PTSD) among trainee doctors who had experienced an NSI. Methods A questionnaire was distributed to trainee doctors starting work in a large university hospital in the UK. The survey gathered demographic information and experience of previous NSI and included questions designed to assess the presence of PTSD via the Impact of Event Scale (IES), a widely used screening tool for PTSD. The six-item version of this tool (IES-6) was used in this study. Results Among the 147 doctors who participated, 80 (54%) had sustained at least one NSI during their training and 77 of these completed the IES-6 survey. Of note, 38% of injuries (30/80) were not reported to the occupational health or emergency departments. Using a cut-off level of 10 in the IES-6, 12% (9/77) of the doctors who suffered NSI during their training showed evidence of PTSD. Since the prevalence of PTSD in the general population is estimated at 3%, the odds ratio of PTSD in doctors who had NSI was 4.28 (95% confidence interval: 2.16-8.47). Conclusions NSI injury is common among doctors in training. As 12% of doctors with experience of NSI had post-traumatic stress reactions, special attention should be paid to psychological impacts of NSIs. We would recommend further prospective studies.

OBJECTIVES Postpartum depressive symptoms (PDS) and acute stress reactions (ASR) after childbirth are frequently documented in mothers, but research is scarce in fathers. In a longitudinal path analysis, the interplay of depressive symptoms in pregnancy and the subjective childbirth experience of mothers and fathers are examined with regard to the development of PDS and ASR postpartum. STUDY DESIGN One hundred eighty nine expectant couples were recruited between August 2006 and September 2009. They completed the Edinburgh Postnatal Depression Scale (EPDS) in the last trimester of pregnancy. In the first week postpartum, they answered the Salmon's Item List (subjective birth experience), and four weeks after birth the EPDS and the Impact of Event Scale - revised (IES-r). The data were evaluated in a longitudinal path analysis. RESULTS Compared with fathers, mothers reported more depressive symptoms (pregnancy: p0.10), but moderately correlated four weeks after birth (r=0.387, p