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The discovery of the glymphatic system, crucial for cerebrospinal and interstitial fluid exchange, has enhanced our grasp of brain protein balance and its potential role in neurodegenerative disease prevention and therapy. Detecting early neurodegenerative shifts via noninvasive biomarkers could be key in identifying at-risk individuals for Alzheimer's disease (AD). Our research explores a diffusion tensor imaging (DTI) method that measures cortical mean diffusivity (cMD), potentially a more sensitive indicator of neurodegeneration than traditional macrostructural methods. We analyzed 67 post-traumatic stress disorder (PTSD)-diagnosed veterans from the Alzheimer's Disease Neuroimaging Initiative database. Participants underwent structural MRI, DTI, Aβ PET imaging, and cognitive testing. We focused on the DTI-ALPS technique to assess glymphatic function and its relation to cMD, cortical Aβ accumulation, and thickness, accounting for age and APOE ε4 allele variations. The cohort, all male with an average age of 68.1 (SD 3.4), showed a strong inverse correlation between DTI-ALPS and cMD in AD-affected regions, especially in the entorhinal, parahippocampal, and fusiform areas. Higher DTI-ALPS readings were consistently linked with greater cortical thickness, independent of Aβ deposits and genetic risk factors. Age and cMD emerged as inversely proportional predictors of DTI-ALPS, indicating a complex interaction with age. The study confirms a meaningful association between glymphatic efficiency and cMD in AD-sensitive zones, accentuating cortical microstructural alterations in PTSD. It positions DTI-ALPS as a viable biomarker for assessing glymphatic function in PTSD, implicating changes in DTI-ALPS as indicative of glymphatic impairment. • We explored the association between human glymphatic function, cMD, cortical Aβ deposition, and cortical thickness. • Significant associations were identified between glymphatic function and cMD in AD-susceptible brain regions. • Associations among DTI-ALPS, aging, and cortical thickness were noted. • We suggested the potential of DTI-ALPS as a biomarker of glymphatic function in PTSD. • Moreover, changes in DTI-ALPS occur in PTSD, possibly due to glymphatic system impairment. [ABSTRACT FROM AUTHOR]

While PTSD is commonly associated with multiple comorbidities, studies have yet to quantify the impact of these comorbidities on key clinical outcomes and HCRU. This study explored risks of emergency room (ER) visits, inpatient admissions (IA), suicidal ideation (SI), and treatment follow-up duration (FU), amongst PTSD patients with comorbid MDD and/or SUD. Using real-world data (RWD) generated by electronic health records accessed from the NeuroBlu database, a cohort of adolescent patients (12-17 yrs) was examined over a one-year study period following PTSD diagnosis. 5794 patients were included in the cohort. Compared to patients with only PTSD (n = 3061), those with comorbid MDD (n = 1820) had greater odds of ER (4.5 times), IA (1.6 times), and FU (4.3 times). Those with comorbid SUD (n = 653) had greater odds of IA (4.5 times), shorter FU (34 days), and lower odds of ER (0.5 times). Both comorbidities (n = 260) had greater odds of ER (3.8 times), IA (2.6 times), SI (3.6 times), and shorter FU (12 days). These RWD had a high proportion of missingness. Health records of patients who changed service providers could not be accounted for in this study. Both MDD and SUD substantially elevated the risk of HCRU and suicidal ideation for PTSD patients. • Limited literature studying the cumulative effects of major depressive disorder (MDD) and substance use disorder (SUD) on adolescents diagnosed with PTSD. • Comorbid MDD and SUD was respectively present in 31 % and 11 % of the 5794 adolescents diagnosed with PTSD. • Minimally, the odds of inpatient admission is at least 40 % higher in patients with comorbid MDD or SUD present, with the odds of patients with comorbid SUD being admitted to the hospital being 4.5 times higher than those with PTSD only. • Patients with both MDD and SUD were not observed to develop worse outcomes. • Screening for comorbid MDD and SUD may substantially improve prognosis of PTSD in adolescents. [ABSTRACT FROM AUTHOR]

The prevalence of trauma-related disorders, such as post-traumatic stress disorder (PTSD), as well as depressive or anxiety disorders, are significantly increased in refugees compared to the general population. This is due to the high risk of burdening and potentially traumatic experiences before, during and after their flight. However, the treatment options for these mental illnesses are significantly limited due to the legal uncertainties surrounding the asylum procedure as well as language and cultural barriers. In this study, a randomized controlled pilot trial was conducted to assess the effectiveness of self-applied audio-based mindfulness and guided imagery techniques for refugees with symptoms of post-traumatic stress disorder living in temporary accommodations. The symptom burden of PTSD, depression, and anxiety symptoms, as well as perceived stress and emotional state was assessed using the PC-PTSD-5, PHQ-4, Self-Assessment Manikin, and Stress Thermometer. N =32 refugees were included in the intervention study, n =24 participants completed the study. The audio-based mindfulness and guided imagery techniques were presented to n =17 refugees in the intervention group between T1 and T2 over 4 weeks; n =15 refugees from the waiting list control group received the audio-files 6 weeks after follow-up. Efficacy was evaluated using a mixed analysis of variance. There were no significant changes in the symptoms of post-traumatic stress disorder, depression and anxiety disorder. Moreover, no changes were observed in the level of perceived stress or emotional state. Only few participants used the exercises in self-administered application during the study period. This was mainly due to the stressors of the post-migratory phase, such as job search or worries about residence status. Due to the self-administered nature of the intervention, common factors, such as therapeutic alliance or expectations regarding the intervention's effectiveness, had minimal influence and did not contribute to the sustained use of the exercises. Additionally, regarding the life circumstances of refugees in temporary shelters, the intervention intensity may not have been sufficient to have a significant impact on the examined symptom burden. Small sample size and limited use of the exercises limit the reliability of the results. Clinical trial registration: https://drks.de/search/de/trial/DRKS00022862 Deutsches Register Klinischer Studien identifier, DRKS00022862. [ABSTRACT FROM AUTHOR]

Background: Home demolition is one of the issues that the Palestinian community faces as a result of Israeli procedures that can impact Palestinian mental health. This study aimed to measure the prevalence of Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and stress among Palestinian citizens whose homes were demolished. Materials and methods: A comparative cross-sectional design was adopted using a purposive sample of home demolished versus not home demolished Palestinian people. The Impact of Event Scale-Revised (IES-R) and the Depression and Anxiety Stress Scales (DASS) were used to assess the participants' levels of PTSD, depression, anxiety, and stress. The Statistical Package for the Social Sciences, Version 25, was applied to the statistical analysis. Results: This study showed that PTSD levels among people whose homes were demolished are significantly high, with a mean of 3.2, which could be indicative of a clinical concern. However, the PTSD level in the comparison group had no significance, with a mean of 1.48. Stress, depression, and anxiety levels were represented as 32.71, in their means, 32.61, and 32.08, respectively, among home-demolished people, compared to stress 18.46, depression 15.87, and anxiety 13.06 among the non home demolished group. Conclusions: This study is one of the few that sheds light on one of the disadvantaged groups who suffer from home demolition and the severe mental problems that affect them, including PTSD, stress, depression, and anxiety). Furthermore, many related risk factors were studied in this research. As a future recommendation, further research is needed in this field, especially among disadvantaged groups. Stakeholders need to take action to improve the health system in Palestine. [ABSTRACT FROM AUTHOR]

ObjectivesDesignMethodsResultsConclusionsTrauma and post‐traumatic stress are involved in the aetiology and maintenance of voice‐hearing. It has been proposed that trauma‐focused therapy (TFT) might affect voice‐hearing, but previous studies are limited and remain undecided.We aimed to investigate the effect of TFT on voice‐hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice‐hearing are related to changes in PTSD.This is an adjunct longitudinal ESM study of a sub‐group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting‐list control group.Voice‐hearing participants filled in 10 daily voice‐hearing‐related questionnaires for six consecutive days at baseline and post‐treatment at pseudo‐random times during the day. PTSD symptom severity was assessed at baseline and post‐treatment. Multilevel linear regression was used to test the effect of TFT on voice‐hearing and to analyse the relationship between changes in voice‐hearing and changes in PTSD.The intention‐to‐treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice‐hearing in the TFT group than in the waiting‐list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice‐hearing (p < .00001).Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions This study aimed to evaluate the validity and reliability of the adult self‐report and proxy version of the Trauma Screener‐Intellectual Disability (TS‐ID) in adults with mild intellectual disability or borderline intellectual functioning (MID‐BIF). An optimal cut‐off value was determined for the ratio of specificity to sensitivity for predicting the diagnosis of post‐traumatic stress disorder (PTSD).The TS‐ID was adapted from a Dutch Child and Adolescent Trauma Screener, for use with adults with MID‐BIF. Outcomes based on the TS‐ID were compared with the presence of PTSD, as classified using the Diagnostic Interview Trauma and Stressors–Intellectual Disability (Mevissen et al. 2018). The TS‐ID adult version was administered to 97 participants with MID‐BIF who lived in supported housing, whereas the TS‐ID proxy version was administered to 92 family members or professional caregivers.The TS‐ID adult version showed high internal consistency (Cronbach's α = .94) and excellent validity (AUC = .94) for distinguishing PTSD in adults with MID‐BIF. Optimal specificity and sensitivity was found at a cut‐off score of 18. Although the TS‐ID proxy version demonstrated excellent internal consistency (Cronbach's α = .93), it showed no validity in statistically distinguishing PTSD in adults with MID‐BIF.The TS‐ID showed favourable psychometric qualities as a screening instrument of PTSD in the case for people with MID‐BIF. [ABSTRACT FROM AUTHOR]

ABSTRACT With the introduction of the ICD‐11 diagnostic manual, the need for developing and validating new assessment instruments has become urgent. The International Trauma Questionnaire‐Child and Adolescent version (ITQ‐CA) assesses posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on the ICD‐11 diagnostic definition. This study examines the psychometric properties of the Danish version of the ITQ‐CA in a non‐clinical sample of 226 adolescents. Hierarchical multiple regression analyses were performed to study the effects of gender, age, trauma exposure, family dysfunction, and SDQ variables on PTSD and Disturbances in Self‐Organization (DSO). Results showed that 16 participants (7%) met the ITQ‐CA criteria for CPTSD and 11 (5.7%) for PTSD. The full model of gender, age, family dysfunction, trauma exposure, and SDQ variables was found to predict PTSD and DSO. The present study supports the validity of the Danish version of the ITQ‐CA and represents an important step of establishing and applying validated tools for assessing  PTSD and CPTSD in children and adolescents. The results also underscore the need for a broader trauma definition. Future research should examine the sensitivity of the ITQ‐CA. [ABSTRACT FROM AUTHOR]

Objective: Empowerment Self-Defense (ESD) is a sexual violence prevention approach backed by rigorous empirical research, yet its availability on college campuses is limited. This manuscript evaluates the feasibility and efficacy of an ESD program embedded within a university counseling center. Methods: Participants completed an 8-session ESD intervention and group counseling program. Results: Feasibility and acceptability of this program were demonstrated by excellent participant retention and supported by institutional buy-in and counselor involvement. Pre-post assessments demonstrated that participants reported significant reductions in posttraumatic stress symptoms, F (1, 56) = 22.46, p <.001 and improvements in both interpersonal self-efficacy, F (1, 56) = 88.81, p <.001, and self-defense self-efficacy, F (1, 56) = 100.20, p <.001. Conclusion: The findings support the use of ESD programming as part of college campus sexual violence efforts and provide a blueprint for administrators and college mental-health centers who wish to offer this effective program to the college students they serve. [ABSTRACT FROM AUTHOR]

High intensity (HI) binge drinking has emerged as a high-risk drinking phenotype in young adult drinkers, yet few studies have evaluated clinically meaningful correlates of HI binge drinking among young adults at risk for co-occurring psychopathologies, such as interpersonal trauma-exposed drinkers. The present study compared three groups (i.e., HI binge, standard binge, non-binge drinkers) of interpersonal trauma-exposed college student drinkers (N = 221) on alcohol and interpersonal trauma characteristics. Results of one-way ANOVAs indicated that the HI binge group endorsed significantly greater negative alcohol-related consequences relative to the other two groups. The HI binge group endorsed significantly greater enhancement motives compared to the non-binge group, and no group differences were detected for PTSD and interpersonal trauma characteristics. Individuals who engage in HI binge drinking may experience greater alcohol problems due to their use of alcohol to enhance positive mood. HI binge drinking does not differentiate individuals on the basis of interpersonal trauma experiences or related psychopathology. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neurorehabilitation in military populations is complicated by higher rates of PTSD and unique characteristics of military institutions. These factors can adversely impact the patient-therapist therapeutic alliance and engagement with the rehabilitation process leading to poorer outcomes. MDMA is a non-classical psychedelic with pro-social and fear regulating properties. MDMA-assisted therapy is being explored as a novel treatment for PTSD that potentially offers rapid symptom improvement and enhances therapeutic alliance. OBJECTIVE: A review of MDMA-assisted therapy for PTSD is provided in the context of neurorehabilitation in military populations. The molecular mechanism of MDMA is outlined and a novel application of MDMA for neurorehabilitation is proposed. METHODS: This is an expert review and synthesis of the literature. RESULTS: Results from late-stage clinical trials suggest MDMA-assisted therapy for PTSD would be of particular benefit for military populations with PTSD. The unique pro-social properties of MDMA could be leveraged to enhance the therapeutic alliance and patient engagement during neurorehabilitation. CONCLUSION: The unique qualities and benefits of MDMA and MDMA-assisted therapy for PTSD suggest relevant application in military personnel undergoing neurorehabilitation. There are many similarities in patient-therapist dynamics in PTSD treatment and neurorehabilitation. The properties of MDMA which enhance therapeutic alliance, downregulate fear, and increase cognitive flexibility would potentially benefit both military personnel with and without PTSD undergoing neurorehabilitation. [ABSTRACT FROM AUTHOR]

BACKGROUND: For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE: This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS: The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS: Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION: SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress. [ABSTRACT FROM AUTHOR]

The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community's location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables. [ABSTRACT FROM AUTHOR]

This research explores the relationship between post-traumatic stress disorder (PTSD), resulting from intense violence during the "Guardian of the Walls" operation in 2021, and economic decision-making. We surveyed civilians in Israel who experienced Gaza rocket attacks to understand the influence of PTSD on their financial decisions. The results revealed an interesting trend: PTSD sufferers showed a preference for immediate consumption over future savings and demonstrated a decrease in their willingness to take economic risks. These findings are significant because they offer insight into how trauma affects financial decisions, and crucial information for those helping PTSD sufferers—their relatives and therapists. It is essential for them to be aware of these tendencies to provide appropriate advice and assistance, helping the victims cope with their PTSD and make effective financial decisions in their daily lives. [ABSTRACT FROM AUTHOR]

The heterogeneity of posttraumatic stress disorder (PTSD) is an obstacle to both understanding and therapy, and this has prompted a search for internally homogeneous neuroradiological subgroups within the broad clinical diagnosis. We set out to do this using the individual differential structural covariance network (IDSCN). We constructed cortical thickness‐based IDSCN using T1‐weighted images of 89 individuals with PTSD (mean age 42.8 years, 60 female) and 89 demographically matched trauma‐exposed non‐PTSD (TENP) controls (mean age 43.1 years, 63 female). The IDSCN metric quantifies how the structural covariance edges in a patient differ from those in the controls. We examined the structural diversity of PTSD and variation among subtypes using a hierarchical clustering analysis. PTSD patients exhibited notable diversity in distinct structural covariance edges but mainly affecting three networks: default mode, ventral attention, and sensorimotor. These changes predicted individual PTSD symptom severity. We identified two neuroanatomical subtypes: the one with higher PTSD symptom severity showed lower structural covariance edges in the frontal cortex and between frontal, parietal, and occipital cortex—regions that are functionally implicated in selective attention, response selection, and learning tasks. Thus, deviations in structural covariance in large‐scale networks are common in PTSD but fall into two subtypes. This work sheds light on the neurobiological mechanisms underlying the clinical heterogeneity and may aid in personalized diagnosis and therapeutic interventions. [ABSTRACT FROM AUTHOR]

L'Enquête de Santé publique post-attentats du 13 novembre 2015 (ESPA 13 novembre) est une enquête épidémiologique réalisée par Santé publique France, dans le cadre du programme 13 novembre. Le première phase a été réalisée en 2016. Elle interroge les personnes civiles et les intervenants (professionnels et bénévoles) exposés aux attaques afin d'explorer l'impact post-traumatique des attentats sur leur santé ainsi que leur recours aux soins. L'enquête se présente sous la forme d'une série de questions fermées ainsi que de plusieurs questions ouvertes. Nous exposons ici l'analyse des réponses des civils, rédigées entre 8 et 12 mois après les attentats, à la question spécifique suivante : « Si vous avez des enfants, pouvez-vous nous dire si vous pensez que l'expérience que vous avez vécue a eu un effet sur eux, ou sur la relation avec eux ? Pouvez-vous nous expliquer ? ». Il s'agit de connaître l'impact des attentats sur les enfants des civils exposés et sur les relations parents–enfants, ce qui a été peu étudié dans le cadre d'attentats de masse. Nous avons procédé à une analyse thématique des réponses des civils à la question spécifique concernant leurs enfants, en constituant les thématiques générales par réduction de données. L'analyse thématique laisse apparaître quatre thèmes principaux qui concernent l'impact des attentats sur les relations parents–enfants, les changements vécus dans leur rôle de parent, les réactions des enfants et enfin, la manière dont ils ont tenté de protéger leurs enfants. Quelques mois après les attentats de novembre 2015, une partie des participants à l'enquête mettent en avant les changements psychiques qui se sont opérés chez eux : mal-être, peur du monde extérieur, inquiétude concernant la sécurité de leurs enfants. Ils relèvent d'existence de difficultés chez leurs enfants termes de stress, d'insécurité, de perturbations psychiques jusqu'à l'émergence de véritables troubles. S'ils ont tenté de mobiliser leur fonction de protection de multiples façons, une partie d'entre eux indiquent se sentir impuissant et avoir des difficultés à trouver des espaces de soins adaptés. Les enfants de leur côté peuvent également se montrer très protecteur avec leurs parents. Pour certains, cette inquiétude mutuelle a provoqué un resserrement des liens familiaux qui a pour fonction la réassurance du groupe. Santé publique France carried out a web-based epidemiological survey (ESPA 13 Novembre) between 8 and 12 months after the terrorist attacks of the 13 November 2015. This was done in order to explore the post-traumatic psychological impact of the attacks on the directly exposed civilians and responders as well as their use of healthcare services. The survey took the form of a series of closed-ended questions as well as several open-ended questions. We present here an analysis of the responses of civilians to the following specific question: "If you have children, can you tell us whether you think the experience you went through had an effect on them, or on your relationship with them? Can you explain?". To find out about the impact of the attacks on the children of exposed civilians and on parent–child relationships, something that has never been studied in the context of mass attacks. We carried out a thematic analysis of civilians' responses to this specific question, building up general themes by data reduction. The analyses revealed four main themes which relate to the impact of the exposure to terrorist attacks on parent-child relationships, the changes experienced in their role as parents, their children's reactions and, finally, the ways in which they tried to protect their children. The parents highlighted the psychological changes that operated in them, their unease, their fear of the outside world, and their concern for their children's safety. They discussed the consequences of the attacks on their children in terms of stress, insecurity, psychological disturbances, and even of the emergence of real disorders. The parents have tried to fulfil their protective role in a variety of ways, sometimes with a feeling of powerlessness reinforced for some by the difficulty of finding suitable care spaces. Attachment bonds have, for the most part, tightened in these families demonstrating their reassuring function within the group. It seems essential to care for children, and the family as a whole, alongside their parents, in order to re-establish secure attachment bonds which are a factor in resilience. [ABSTRACT FROM AUTHOR]

Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees. • Temporary residents had the least severe symptoms before treatment. • Danish citizens had a poorer HAM-D treatment outcome than temporary residents. • Overall, residence permit was a poor predictor of PTSD treatment outcome. [ABSTRACT FROM AUTHOR]

This preliminary study examines the link between war-related auditory (pseudo)hallucinations and symptoms of acute ICD-11 posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD) amidst ongoing conflict, with a specific focus on CPTSD. The research, which analyzed data from 2028 Israeli residents following the traumatic events of October 7, 2023, investigated the perception of non-existent sirens and their association with acute PTSD and CPTSD symptoms. The findings reveal that (pseudo)hallucinations were more prevalent among individuals with acute CPTSD symptoms compared to those with PTSD symptoms alone. Additionally, auditory (pseudo)hallucinations were significantly associated with a higher likelihood of CPTSD versus PTSD. These results were consistent for those directly and indirectly exposed individuals to the October 7 attack. Despite its cross-sectional nature, the study provides valuable insights into trauma-related auditory (pseudo)hallucinations in wartime contexts. [ABSTRACT FROM AUTHOR]

Background: Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma‐exposed children, identified factors that differentiate trauma‐exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit. Methods: Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change – a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post‐traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre‐intervention using self‐ and caregiver‐report. Parents self‐reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV. Results: Across caregiver‐ and child‐reports, 16%–17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology. Conclusions: Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention. [ABSTRACT FROM AUTHOR]

• Cognitive processing therapy is highly recommended in all PTSD treatment guidelines. • This paper reviews the scope of CPT and its effects on PTSD and comorbid disorders. • CPT with diverse populations and dissemination efforts are also described. This state of the science review provides an overview of the history and findings of cognitive processing therapy (CPT), one of the most recommended treatments for posttraumatic stress disorder, acute stress disorder, and comorbid conditions. After an introduction to CPT and the randomized controlled trials that have been conducted, the effects of CPT on comorbid conditions are reviewed, as well as new combination treatments. Cognitive mediators of change are described. Different formats for CPT that have been developed are described, as well as patient, therapy, and therapist factors in outcome; applicability across diverse populations; efforts to disseminate CPT; and ongoing studies into the future. [ABSTRACT FROM AUTHOR]

Although there are effective psychotherapies available for posttraumatic stress disorder (PTSD), brief treatments for PTSD are needed to expand the reach of treatment. Written exposure therapy (WET) is a brief treatment that has the potential to fill an important need in PTSD treatment and has a rapidly expanding evidence base to support its use. In this paper we provide information on how WET was developed, and we present proposed underlying mechanisms of the treatment and evidence supporting the underlying mechanism. The current evidence supporting WET for the treatment of PTSD is reviewed. The evidence indicates that WET is an efficacious and effective treatment approach for PTSD and is noninferior to more time-intensive evidence-based treatments for PTSD. The paper concludes with suggestions for expanding the evidence base of WET that is necessary for it to be considered a first-line treatment approach across clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Objective: Quantitative studies examining the occurrence of childbirth‐related posttraumatic stress disorder (CB‐PTSD) following severe perineal rupture are lacking. The objective of this population‐based study was to investigate the prospective associations between the degree of perineal tear during childbirth and CB‐PTSD symptoms, when adjusting for known covariates (maternal age, years of school education, premature birth, and parity). We hypothesized that women with different degrees of perineal tear will differ regarding (1) the level of CB‐PTSD symptoms at 8 weeks and 2 years postpartum and (2) the rate of change in CB‐PTSD symptoms from 8 weeks to 2 years postpartum. Method: Secondary data analysis from the Akershus Birth Cohort, a large population‐based prospective cohort study using self‐report questionnaires and hospital record data. Results: The degree of perineal tear was significantly associated with CB‐PTSD symptoms at 8 weeks and 2 years postpartum. However, the degree of perineal tear was not significantly associated with the change in CB‐PTSD symptoms over time. Similar patterns were found for both total CB‐PTSD symptoms as well as for avoidance and intrusion symptoms only. Conclusion: Results seem to support a dose–response model, suggesting that the higher the severity of the perineal tear, the higher the posttraumatic morbidity. [ABSTRACT FROM AUTHOR]

• VR Photsoscan environments were created in under 48 hours and were created between sessions. • High levels of satisfaction with VR Photoscan environment. • VR technology successfully implemented within a standard treatment protocol for PTSD. • Implemented within a routine community mental healthcare setting. • VR assisted with imaginal reliving, memory updating, and stimulus discrimination. Revisiting what happened during (or after) a traumatic event is an important part of the treatment process in trauma-focused cognitive therapy (TF-CT). However, clinicians may have difficulty helping patients to intentionally retrieve these memories in order to engage with their content. As such, clinical tools to support the access and delivery of imaginal exposure content within treatment may prove to be particularly useful for therapists. This case report introduces work undertaken with Mr. A, a 38-year-old male, who 2 years prior had experienced a city centre assault. Initial assessment revealed a PCL-5 score of 64 and he met DSM-5 criteria for posttraumatic stress disorder (PTSD). Mr. A received 10 sessions of TF-CT wherein the traditional imaginal exposure components were implemented via a newly developed virtual reality (VR) development workflow called "VR Photoscan." After 10 sessions, results showed PCL-5 scores decreased from 64 to 19 and Mr. A no longer met DSM-5 PTSD criteria. VR Photoscan was used during 4/10 sessions and included (1) reliving, (2) memory updating, and (3) stimulus discrimination activities. Mr. A also reported VR Photoscan as helpful regarding preparation for site visits. In conclusion, VR Photoscan technology provided a more visceral exposure experience which supported Mr. A to revisit the trauma memory. He reported high levels of satisfaction with the quality of the virtual environment and no issues using the VR technology. Produced with lower costs and shorter development times than typical computer-generated environments, VR Photoscan may be more easily implemented within routine care, although further research is required. [ABSTRACT FROM AUTHOR]

Objective: Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adults' access to and engagement with mental health care. These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stressful events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to the needs of older adults. Methods: From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for post-traumatic stress disorder, depression, or other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing the tracking of treatment initiation, engagement, completion, and clinical outcomes for all patients. Results: The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes. Conclusion: These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population. [ABSTRACT FROM AUTHOR]

AbstractMolecular studies identifying alterations associated with PTSD have predominantly focused on candidate genes or conducted genome-wide analyses, often encountering issues with replicability. This review aims to identify robust bi-directional epigenetic and microRNA (miRNA) regulators focusing on their functional impacts on post-traumatic stress disorder (PTSD) and their utility in clinical diagnosis, whilst examining knowledge gaps in the existing research. A systematic search was conducted across multiple databases, including Web of Science, Scopus, Global Health (CABI), and PubMed, augmented by grey literature, yielding 3465 potential articles. Ultimately, 92 studies met the inclusion criteria and were analysed to pinpoint significant epigenetic changes with clinically relevant potential in PTSD. The selected studies explored histone modifications, CpG sites, single nucleotide polymorphisms (SNPs), and miRNA biomarkers. Specifically, nine studies examined epigenetic markers, detailing the influence of methylation on chromatin accessibility at histone positions H3K4, H3K9, and H3K36 within a PTSD context. Seventy-three studies investigated DNA methylation, identifying 20 hypermethylated and five hypomethylated CpG islands consistently observed in PTSD participants. Nineteen studies linked 88 SNPs to PTSD, with only one SNP replicated within these studies. Furthermore, sixteen studies focused on miRNAs, with findings indicating 194 downregulated and 24 upregulated miRNAs were associated with PTSD. Although there are epigenetic mechanisms that are significantly affected by PTSD, a granular deconstruction of these mechanisms elucidates the need to incorporate more nuanced approaches to identifying the factors that contribute to PTSD. Technological advances in diagnostic tools are driving the need to integrate detailed participant characteristics, trauma type, genetic susceptibilities, and best practices for robust reporting. This comprehensive approach will be crucial for enhancing the translational potential of PTSD research for clinical application. [ABSTRACT FROM AUTHOR]

Large-scale genome-wide association studies (GWASs) have associated intronic variants in PDE4B, encoding cAMP-specific phosphodiesterase-4B (PDE4B), with increased risk for post-traumatic stress disorder (PTSD), as well as schizophrenia and substance use disorders that are often comorbid with it. However, the pathophysiological mechanisms of genetic risk involving PDE4B are poorly understood. To examine the effects of PDE4B variation on phenotypes with translational relevance to psychiatric disorders, we focused on PDE4B missense variant M220T, which is present in the human genome as rare coding variant rs775201287. When expressed in HEK-293 cells, PDE4B1-M220T exhibited an attenuated response to a forskolin-elicited increase in the intracellular cAMP concentration. In behavioral tests, homozygous Pde4bM220T male mice with a C57BL/6JJcl background exhibited increased reactivity to novel environments, startle hyperreactivity, prepulse inhibition deficits, altered cued fear conditioning, and enhanced spatial memory, accompanied by an increase in cAMP signaling pathway-regulated expression of BDNF in the hippocampus. In response to a traumatic event (10 tone-shock pairings), neuronal activity was decreased in the cortex but enhanced in the amygdala and hippocampus of Pde4bM220T mice. At 24 h post-trauma, Pde4bM220T mice exhibited increased startle hyperreactivity and decreased plasma corticosterone levels, similar to phenotypes exhibited by PTSD patients. Trauma-exposed Pde4bM220T mice also exhibited a slower decay in freezing at 15 and 30 d post-trauma, demonstrating enhanced persistence of traumatic memories, similar to that exhibited by PTSD patients. These findings provide substantive mouse model evidence linking PDE4B variation to PTSD-relevant phenotypes and thus highlight how genetic variation of PDE4B may contribute to PTSD risk. [ABSTRACT FROM AUTHOR]

Bisexual (i.e. those with attraction to multiple genders) women experience disparities in sexual violence and mental health outcomes, including PTSD, depression, and hazardous drinking, compared to lesbian and heterosexual women. Unique stigma due to bisexual identity (antibisexual stigma), negative reactions to sexual violence (SV) disclosure (e.g. victim blaming), and prior child sexual abuse (CSA) may all contribute to shame. We tested whether shame explained the associations of antibisexual stigma, negative reactions to SV disclosure, and CSA severity with PTSD symptoms, depression, and hazardous drinking among young bisexual women. Participants who self-identified as bisexual women, between the ages of 18–35, residing in the US were recruited via Amazon’s Mechanical Turk (MTurk) and completed online questionnaires. Women who reported SV since age 18 that they disclosed to someone were included in the current study, yielding a sample of 156 bisexual women (Mage = 25.7; 98.1% cisgender, 86.5% White). Path analysis with bias-corrected bootstrapping was conducted. There were significant direct effects of negative reactions on hazardous drinking and CSA on PTSD, and direct effects of shame on PTSD and depression symptoms. Shame explained the associations of antibisexual stigma, negative reactions, and CSA with PTSD symptoms, depression symptoms, and hazardous drinking. Shame may explain why stigmatizing experiences related to bisexual identity, sexual violence, and CSA history relate to distress among bisexual women. Shame is an important treatment target among bisexual survivors of SV. [ABSTRACT FROM AUTHOR]

Limited research exists regarding the impact of the Ukrainian War on mental distress among refugees or the presentation of post-traumatic stress disorder (PTSD) as a co-morbidity. This study analyzes the mental distress experienced by displaced Ukrainian refugees, including exposure to war-related trauma, PTSD, psychological distress based on socio-demographic factors, prevalence of concurrent mental illnesses, and associated risk factors. Ukrainian refugees in Israel were included in the study shortly after their arrival. Participants completed questionnaires on socio-demographic information, exposure to war-related events, presence of PTSD, depression, anxiety, and current life satisfaction. The 128 participants reported an average of 6.4 traumatic events (SD = 2.97). Among them, 69.5% (n = 89) met the criteria for probable PTSD, 36.7% (N = 47) for depression, and 53.1% (N = 68) for anxiety. The "comorbidity" cohort, consisting of refugees with PTSD and depression/anxiety or both, included 65 participants (53.3%), the "only PTSD" group was 24 participants (19.7%), and 33 (27%) had "no probability". Women and those who had left family members behind were 2.9 and 3.2 times more likely to experience comorbidity, respectively. Refugees with comorbidity reported higher distress and functional impairments compared to the "only PTSD" group, and lower life satisfaction than those with "no probability". This study highlights the significant traumatology experienced by Ukrainian refugees, with attention to the unique impact of comorbidity on functional and subjective well-being among refugees. Therefore, a comprehensive approach is necessary to appropriately diagnose and support refugees, considering the interconnected impact of PTSD, anxiety, and depression. [ABSTRACT FROM AUTHOR]

Gestational metabolic diseases adversely impact the health of pregnant persons and their offspring. Pregnant persons of color are impacted disproportionately by gestational metabolic disease, highlighting the need to identify additional risk factors contributing to racial-ethnic pregnancy-related health disparities. Trauma exposure and posttraumatic stress disorder (PTSD) are associated with increased risk for cardiometabolic disorders in nonpregnant persons, making them important factors to consider when identifying contributors to gestational metabolic morbidity and mortality health disparities. Here, we review current literature investigating trauma exposure and posttraumatic stress disorder as psychosocial risk factors for gestational metabolic disorders, inclusive of gestational diabetes, low birth weight and fetal growth restriction, gestational hypertension, and preeclampsia. We also discuss the physiological mechanisms by which trauma and PTSD may contribute to gestational metabolic disorders. Ultimately, understanding the biological underpinnings of how trauma and PTSD, which disproportionately impact people of color, influence risk for gestational metabolic dysfunction is critical to developing therapeutic interventions that reduce complications arising from gestational metabolic disease. Key Points Gestational metabolic diseases disproportionately impact the health of pregnant persons of color. Trauma and PTSD are associated with increased risk for cardiometabolic disorders in nonpregnant per. Trauma and PTSD impact physiological cardiometabolic mechanisms implicated in gestational metabolic. [ABSTRACT FROM AUTHOR]

Background: This study evaluated an online childbirth education course on childbirth self-efficacy and, subsequent birth related posttraumatic stress disorder (PTSD) symptoms and mother-infant relationship quality. Method: Three group (intervention, passive control, active control) parallel randomised controlled trial. Groups were assigned using computer generated random allocation. For the passive control group participants were instructed to carry on with whatever they were currently undertaking with their pregnancy, while the active control group were asked to read a booklet comprised of twelve birth stories. The purpose of the active control was to check if the act of having an activity to complete would influence outcomes. For the online course group (intervention) participants were asked to complete the online version of a birthing course designed by She Births®. One hundred and twenty-five women residing in Australia between 12 and 24 weeks pregnant were recruited online. Participants were asked to complete their required activity between 24 and 36 weeks pregnant. Childbirth self-efficacy scores were tested pre and post intervention (time one and time 2), PTSD symptoms and mother-infant relationship quality were tested at six weeks and six months postnatal. Results: There was no significant interaction by group for childbirth self-efficacy scores. Mean difference scores at time one (pre-intervention) and time two (post-intervention) for each group indicated a trend in the online group towards higher childbirth self-efficacy compared with the two control groups. The main effect of group on birth related PTSD scores was not statically significant at six weeks postnatal or at six months postnatal. The main effect of group on mother-infant relationship scores was not statically significant at six weeks postnatal or six months postnatal. Conclusions: Trends showed childbirth self-efficacy scores to be higher in the intervention group compared with the two control groups, demonstrating effectiveness for the intervention. Paradoxically, PTSD scores were higher in the intervention group compared with the two control groups and therefore also reported poorer mother-infant relationship quality. External factors may be more important than childbirth self-efficacy highlighting the need for a holistic approach that addresses systemic and socio-political influences to improve communication, autonomy, and respectful maternity care. Trial Registration: This trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry number: ACTRN12624000241538 on March 11, 2024. [ABSTRACT FROM AUTHOR]

Russia's aggression against Ukraine is undoubtedly a tragic event that will bring various, often difficult to predict, consequences at many levels of functioning. Certainly, the mental health of war victims faces many challenges. The mental health crisis that occurs during war is a public health problem.28 One of the main disorders that appear in people directly or indirectly related to war is PTSD. It arises as a result of experiencing extremely dangerous, terrifying events that go beyond one's ability to cope and is manifested by symptoms such as: obsessive, persistent re-experiencing of traumatic events, avoidance of factors causing a "return" to traumatic memories, excessive arousal and a sense of constant threats.8,10 Many factors influence the occurrence of PTSD. It is extremely important to look at the reasons that make it difficult to obtain support. mental health and improving the support system. Ukrainian children and youth deserve special attention here. A developing young society must face particularly great challenges, and it is their mental well-being that guarantees better development of the entire nation. Every effort must be made to ensure that citizens of a country at war receive adequate support. We have many methods of help, from basic emergency support, through a wide range of psychotherapy, to medications in the most severe cases. Additionally, the knowledge of the existence of a phenomenon such as post-traumatic growth may give hope and motivation to act to people in mental crisis struggling with symptoms of PTSD. However, the war continues and there will be more and more victims struggling with post-traumatic stress disorder (PTSD) and other mental health disorders. We cannot determine at this point how much damage this conflict will cause. However, it is worth acting now to prevent and limit the tragic consequences of the situation in which Ukraine finds itself. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) and depression are two major psychological disorders that affect the mental health of people living with HIV (PLWH). The occurrence of PTSD and depression may be linked to perceptions of parental rearing styles in childhood. However, little is known about the relationship between perceived parental rearing styles, and PTSD and depression in the PLWH population. This study investigated 300 PLWH and explored the relationship between perceived parental rearing style, social support, PTSD, and depression. The results indicated that perceived paternal and maternal warmth were negatively associated with PTSD. Perceived maternal warmth and overprotection were negatively associated with depression. Social support acted as a mediator between perceived parental warmth, PTSD, and depression. Therefore, it is necessary to focus on patients who feel they experienced a lack of parental warmth during childhood and provide psychological care and support, which may help reduce the risk of developing PTSD and depression. [ABSTRACT FROM AUTHOR]

Background: Dominant models of posttraumatic stress disorder (PTSD) implicate threat‐related attention biases in both the development and maintenance of posttraumatic stress symptoms. However, the ability to better understand and modify threat‐related attention biases in PTSD has been hampered by the low reliability of attention bias measures more generally. Methods: The current study adopts a new approach to calculate attention bias from a dot‐probe task, response‐based attention bias (RB‐AB) computation, in a sample of 689 individuals reporting significantly elevated PTSD symptoms who participated in a clinical trial of threat‐related attention bias modification training. Results: RB‐AB is a reliable strategy for deriving threat‐related attention bias scores that correlate with both PTSD severity and anxiety. On the other hand, scores from the traditional approach were unreliable and not associated with clinical symptoms. Attention training led to reductions in RB‐AB indices of attention bias, but not the traditional index, although attention bias training conditions did not appear to moderate these effects. Conclusions: Taken together, these findings support evidence that threat‐related attention biases may be a feature of PTSD and that RB‐AB computation is a more reliable and valid approach for studying reaction‐time‐based attentional processes. Using the RB‐AB approach to assess attention bias could allow us to better understand threat‐related attention biases in PTSD and to ultimately develop more precise interventions to reduce threat‐related attentional biases in PTSD and other disorders. [ABSTRACT FROM AUTHOR]

Although trauma-focused evidence-based psychotherapy (TF-EBP) is recommended for posttraumatic stress disorder (PTSD), rates of TF-EBP initiation among veterans is very low. Service delivery research has shown that other treatments are commonly provided to veterans diagnosed with PTSD, including stabilization treatments. As little is known about how veterans experience the transition to TF-EBP, we conducted a qualitative examination of veterans’ perspectives on transitions in PTSD treatment. We recruited a diverse sample of veterans (n = 30) who recently initiated TF-EBP to complete semi-structured qualitative interviews focusing on six domains (PTSD treatment options, cultural sensitivity of treatment, PTSD treatment selection, transition criteria, beliefs about stabilization treatment, treatment needs/preferences). Rapid qualitative analysis procedures were used to identify themes. Themes included: (1) wanting to learn about TF-EBP earlier; (2) perceived risks of transition; (3) relationships with non-TF-EBP providers as transition barriers; (4) high symptoms and poor interpersonal functioning as transition facilitators; (5) benefits of treatment planning and handoffs; (6) prior therapy best when aligned with TF-EBP; (7) socialization as a key benefit of prior therapy; and (8) medications supporting TF-EBP. Results highlight the importance of introducing TF-EBP early to veterans, establishing and communicating a comprehensive care plan, and anchoring stabilization treatment in TF-EBP concepts. [ABSTRACT FROM AUTHOR]

This article intends to explore the rational association connecting Kurt Vonnegut's encounter with Post-traumatic Stress Disorder and Post-traumatic Growth's impact on his narrative. Previous literature lean on linking the authors' spring of creativity to PTSD, it is a legitimate intent, for this study, to look at things differently attempting to verify the potential facet(s) of transformation. The centre focus of this paper is analyzing Vonnegut's healing process to explore PTG's affirmative connotations and how much serenity it can provide on the long term. In other words, we investigate if trauma narratives, trauma fiction in Slaughterhouse-five and Timequake, are vivid transcripts of the progressive healing process as a proof of PTG. [ABSTRACT FROM AUTHOR]

The effectiveness of psychotherapy for depression and posttraumatic stress disorder (PTSD) has been well-established in community samples but its effectiveness in carceral settings is less clear. The present systematic review thus sought to evaluate the effects of psychological therapies for PTSD and depression in incarcerated samples. We searched five databases from inception through January 2023, for eligible randomized controlled trials (RCTs). Two reviewers independently reviewed the study eligibility, extracted the data, assessed the intervention reporting, and evaluated the risk of bias. Eleven RCTs met inclusion criteria, five addressing treatment of PTSD, and six addressing treatment of depression. Interventions produced mixed findings with respect to symptom reduction relative to active controls, with a significant risk of methodological bias in virtually all studies. Of the interventions studied, interpersonal psychotherapy produced the most encouraging, though clearly still tentative results for the treatment of depression. Results highlight the need for increased methodological rigor and additional research to examine the effectiveness of interventions that have yielded positive results in community samples. [ABSTRACT FROM AUTHOR]

Prior studies show a heightened risk of child maltreatment during the COVID-19 pandemic because of financial difficulties and parenting stress, but little is known about what happened to the veteran families. This study aimed to examine the influences of the COVID-19 pandemic on veteran parents' harsh parenting – creating a potential for child maltreatment. Further, we explored the potential moderating effects of parental PTSD and parental role on the association between COVID-19 impacts and veteran harsh parenting. We recruited 509 veteran parents from Qualtrics online research panel and assessed the impacts of the COVID-19 pandemic (e.g., perceived threat, financial and psychological impacts) on the participants, parental PTSD, and parents' past year prevalence of corporal punishment and psychological aggression. We used Mplus 8.8 to build main models, two-way moderation models, and three-way moderation models. There was a significant association between COVID-19 pandemic impacts and harsh parenting (Corporal punishment: β = 0.09, p < 0.05; Psychological aggression: β = 0.10, p < 0.05), while parental PTSD was a significant moderator (Corporal punishment: β = 0.10, p < 0.05; Psychological aggression: β = 0.08, p < 0.05). Parents with higher levels of PTSD were more vulnerable to the negative influences of COVID-19 on their harsh parenting. However, the association between COVID-19 pandemic impacts and harsh parenting did not differ by parental role. Our study findings contribute to the current knowledge of veteran families during the COVID-19 pandemic and provide implications for both Veteran Affairs services and child protective services. Highlights: Veteran parents are especially vulnerable during the pandemic because their military experiences have already profoundly affected their behavioral health, such as PTSD. We examined the influences of the COVID-19 pandemic on veteran parents' harsh parenting. Veteran parents with higher levels of PTSD were more vulnerable to the negative influences of COVID-19 on their harsh parenting. Veteran fathers endorsed more corporal punishment than veteran mothers during the COVID-19 pandemic, but the association between COVID-19 pandemic impacts and harsh parenting did not differ by parental role. Research with a large survey data needs to be conducted to explain gender difference in harsh parenting during the pandemic. [ABSTRACT FROM AUTHOR]

Rationale: Family members of patients who die in an intensive care unit (ICU) are at heightened risk of post-traumatic stress disorder (PTSD) symptoms. Not all surrogates develop these symptoms and heterogeneity exists in PTSD symptom clusters. Objectives: The study tested a personality model of PTSD symptoms in bereaved family caregivers of ICU patients. It was hypothesized that family members endorsing higher levels of neurotic personality traits would report higher levels of PTSD symptom clusters and that these associations would be explained by tendencies to view the patient's death as unexpected and to cope by suppressing their emotions. Methods: Participants were family members of ICU patients at an urban, academic medical center who either died or were discharged to an inpatient hospice unit. Participants were contacted for participation at least six months after the patient's death. Participants completed measures of personality, emotion regulation, and PTSD symptoms. Data were analyzed using path analysis. Results: Approximately one-third (35%) of the sample of 162 caregivers endorsed at-risk levels of PTSD. Individuals reporting higher levels of neurotic personality traits reported more PTSD symptoms (r = 0.53, p < 0.001). Perceptions that the patient death was unexpected partially explained the association of neuroticism with the intrusive re-experiencing PTSD symptoms (B = 0.45, p = 0.031). In contrast, emotional suppression partially explained the association of neuroticism with avoidance (B = 0.70, p = 0.010) and hyperarousal symptom clusters (B = 0.37, p = 0.041). Conclusions: Family vulnerability to PTSD after an ICU death can be conceptualized based on neurotic personality traits. Tendencies to view the patient's death as unexpected may contribute to intrusive thoughts and memories of the ICU experience. Individuals may avoid reminders and remain at heightened levels of arousal when they suppress their emotional experiences. Key Message: Family members who experience the death of a loved one following ICU treatment are vulnerable to PTSD symptoms. These reactions to ICU-related losses may be shaped by family members' personalities, expectations, and emotion regulation styles. Understanding these characteristics could inform family screening and intervention efforts in the ICU. [ABSTRACT FROM AUTHOR]

Objective: Women of Color (WoC) experiencing intimate partner violence (IPV) have elevated rates of posttraumatic stress disorder (PTSD) and alcohol use and related harm (e.g., increased alcohol use and negative consequences). This secondary data analysis assessed the role of racial microaggressions in the association between PTSD and alcohol use and related harm among WoC experiencing IPV. Methods: Participants were 103 WoC currently experiencing IPV and using substances (Mage=40.39, 51.5% Black) who were recruited from the community and completed assessments of PTSD, racial microaggressions, and alcohol use and related harm. Results: Assumptions of Inferiority (e.g., intelligence; B = 1.44, SE = 0.90, 95% CI [0.10, 3.54]) and Environmental Microaggressions (e.g., portrayal in media; B = 1.88, SE = 1.03, 95% CI [0.28, 4.30]) explained the association between PTSD and alcohol use and related harm. Conclusions: Findings underscore the influence of specific microaggressions in the relation between PTSD and alcohol use and related harm among WoC experiencing IPV. [ABSTRACT FROM AUTHOR]

Objective: The present study examines the network structure and, using Bayesian network analysis, estimates the directional pathways among symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and levels of alcohol and cannabis use. Method: A sample of 1471 adults in the United States, who reported at least one potentially traumatic event, completed the PTSD Checklist (PCL-5), Patient Health Questionnaire (PHQ-9), and the Alcohol/Cannabis Use Disorders Identification Test (AUDIT/CUDIT). A regularized partial correlation network provided estimates of symptoms clusters and connections. Directional pathways within the network were then estimated using a directed acyclic graph (DAG). Results: Symptoms clustered in theoretically consistent ways. Risky behavior demonstrated the highest strength centrality and bridge strength. Neither alcohol nor cannabis use appeared central in the network, and DAG results suggested that MDD and PTSD symptoms are more likely to lead to substance use than the other way around. Conclusions: Results suggest that cannabis use is largely connected to alcohol use. Consistent with prior research, risky behavior appeared to be the primary bridge between substance use and PTSD. The direction of associations between substance use and psychological symptoms requires further attention. [ABSTRACT FROM AUTHOR]

Objective: To examine the co-occurrence of alcohol misuse and posttraumatic stress disorder (PTSD) and potential sources of coping (e.g., spirituality/religion) and clinically relevant variables among first responders (e.g., firefighters, law enforcement corrections officers, paramedics). Method: We assessed rates of independent and co-occurring alcohol misuse and PTSD among a national online sample of 320 first responders as well as the prevalence and salience of S/R, guilt, shame, moral injury, aspects of S/R, and treatment interest. Results: In our sample, 46.88% (n = 150) met criteria for comorbid alcohol misuse and probable PTSD and individuals with these comorbid conditions reported significantly greater negative religious coping, moral injury, and shame than all other diagnostic groups (i.e., independent alcohol misuse, independent PTSD, and neither). Correlations also revealed significant relationships between alcohol misuse and PTSD symptomatology with positive and negative religious coping, moral injury, shame, guilt, interest in treatment, and interest in spiritually integrated treatment. Conclusions: Findings highlight the high rates of independent and co-occurring alcohol misuse and PTSD among first responders as well as the salience of S/R in this population. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder is a prolonged stress and anxiety response that occurs after exposure to a traumatic event. Research shows that both parental and child posttraumatic stress symptoms (PTSS) are correlated but parental executive functions (EFs) could buffer this link. EFs refers to a group of high‐level cognitive processes that enable self‐regulation of thoughts and actions to achieve goal‐directed behaviours and can be of importance for both positive parenting interactions and effective coping skills for PTSS. Our study aimed to (1) examine the link between maternal and child PTSS and the moderating role of varying degrees of exposure to severe security threats context, and (2) to identify the moderating role of maternal EFs in this interaction, among families living in southern Israel. Our sample included 131 mothers in their second pregnancy and their firstborn children. Mothers performed computerised tasks to assess their EFs and they reported on their own and their child's PTSS. Results revealed a positive correlation between maternal PTSS and child PTSS. However, the link between maternal and child PTSS was moderated by maternal working memory updating abilities and threat context severity. Among mothers with lower updating capacities, the association between maternal and child symptoms was stronger under higher threat contexts; conversely, among mothers with higher maternal updating abilities, threat context did not modulate the link between maternal and child PTSS, suggesting a stress‐buffering effect. Our study contributes to the growing literature on the significant role of parental EFs in the context of parent‐child interactions. [ABSTRACT FROM AUTHOR]

This survey study aimed to contribute to the extensive debate on the dimensionality of the Posttraumatic Stress Disorder Checklist for the DSM‐5 (PCL‐5) questionnaire by examining the psychometric properties and construct validity of its Hungarian version and relying on the inspection of a conceptual network of related variables, that is, perceived stress, hostility, and resilience. Confirmatory factor analysis (CFA), exploratory structural equation modelling (ESEM) and path analysis were applied on data collected from 177 paramedics and 66 professionals from the social field (58.4% male; Mage = 43.5 ± 9.96 years). Despite the acceptable fit indices gained with CFA when testing the original four‐factor DSM‐5 model of PCL‐5, strong associations (r = 0.69–0.90) between subscales were found. Thus, ESEM was applied and as a result a new, three‐factor version of the DSM‐5 model of PCL‐5 was proposed due to significant crossloadings that was theoretically also supported. The Reexperiencing and Avoidance subscales were merged and named Difficulty with Assimilation of Experience (DAE). In the path analysis only two of the tested associations were not significant using the new factor structure, in which stress fully mediated the relationship between resilience and DAE, and resilience and Hyperarousal. Overall, the hypothesised pathways between variables fit the collected data well. (weighted least squares mean‐and variance‐adjusted χ2 = 503.750 (df = 270), comparative fit index = 0.948, Tucker–Lewis index = 0.939, root mean square error of approximation (90% confidence interval) = 0.064 (0.055–0.073), weighted root mean square residual = 1.024). Our analysis of the Hungarian version of PCL‐5 contributes to the testing of a DSM‐5‐based questionnaire measuring posttraumatic stress disorder symptomology. [ABSTRACT FROM AUTHOR]

Veteran and intimate partner perceptions of posttraumatic stress disorder (PTSD) may differ, and little is known about how agreement or disagreement on symptom severity is related to relationship satisfaction. Veterans and their partners (N = 199 couples) completed a baseline assessment for a clinical trial evaluating two couple‐based PTSD interventions. Veterans completed the PTSD Checklist for DSM‐5 (PCL‐5). Partners completed the collateral PCL‐5 (PCL‐5‐C), which asked them to rate the severity of the veteran's PTSD symptoms. Both partner and veteran completed the Couples Satisfaction Index (CSI‐32). Intraclass correlations (ICC) assessed agreement between PCL‐5 and PCL‐5‐C total and subscale scores, which was low for total PCL and for all subscales (ICC = 0.15–0.46). Actor‐Partner Interdependence Models (APIMs; actor‐only pattern) tested associations between relationship satisfaction and PTSD symptom severity (total PCL and subscales), and the magnitude and direction of difference between PCL‐5 and PCL‐5‐C (total and subscales). For veterans, more severe total PTSD and negative cognition/mood scores were associated with lower relationship satisfaction, and the direction of discrepancy for negative cognition/mood (i.e., higher veteran‐rated PTSD symptoms relative to partner's collateral report) was also associated with lower satisfaction. For partners, more severe collateral‐reported symptoms for total PTSD and all four subscales were associated with lower relationship satisfaction; further, a larger discrepancy between veterans' and partners' reports of total PTSD, negative cognition/mood, and hyperarousal were associated with lower satisfaction. These results suggest that partners may have different perceptions of PTSD symptoms, and support the potential of fostering a shared understanding of PTSD symptom severity in couples. [ABSTRACT FROM AUTHOR]

Written exposure therapy (WET) is a five-session exposure-based protocol for treating post-traumatic stress disorder (PTSD). The brevity and tolerability of WET present the potential to overcome barriers in implementing evidence-based therapy for PTSD within the Korean mental healthcare system. This study investigated the effectiveness of WET in Korean patients with PTSD through a waitlist-controlled trial (KCT0008112). A total of 57 patients with PTSD were allocated non-randomly to either WET (n = 27) or treatment-as-usual waitlist groups (n = 30). Both groups were followed up until the twenty-fourth week after the initial session. Primary outcomes assessed included PTSD symptoms, depressive symptoms, and general function. In the WET group, significant improvements were observed in PTSD symptoms, depressive symptoms, and general function compared to the control group. After the waiting period, the waitlist group also participated in WET, and exhibited significant improvement in all scores. The between- and within-group effect sizes were large. The dropout rate in both groups was 10.9%, and the mean satisfaction ratings were 28.24 ± 3.33 (range 22–32; scale range 8–32). The present study provides evidence of WET successfully reducing PTSD and depressive symptoms and improving general function among Korean patients with PTSD. Moreover, WET was well tolerated and received by Korean patients with PTSD. [ABSTRACT FROM AUTHOR]

Sometimes forensic psychologists are asked to determine whether the symptoms of PTSD presented by the plaintiff are genuine or feigned. To this end, they may use both symptom validity tests (SVTs) and performance validity tests (PVTs), but SVTs are used far more frequently in these assessments. Thus, we conducted a natural experiment and administered an SVT (i.e., the IOP-29) and a PVT (i.e., the IOP-M) to 76 individuals instructed to feign PTSD and to 34 controls who self-reported exposure to a devastating flood several months earlier. The results confirm the utility of both measures in detecting feigned PTSD. [ABSTRACT FROM AUTHOR]

Higher lifetime trauma exposure and increased peritraumatic dissociation (PD) are well-known predictors of Post-Traumatic Stress Disorder (PTSD) symptoms following new trauma (prospective PTSD symptoms). The interplay between those factors, however, is not well established. In this study, we aimed to assess whether PD mediates the influence of lifetime trauma exposure on prospective PTSD symptoms. A total of 387 adults visiting five emergency departments who had experienced a traumatic event within 72 hours completed baseline assessments on lifetime trauma exposure count and PD. PTSD symptoms were assessed 1 month later. Structural equation modeling was used to examine the mediation effect of PD in the relationship between lifetime trauma exposure count and 1-month PTSD symptoms. We found that PD mediated the association between lifetime trauma exposure count and 1-month PTSD symptoms, even after accounting for some confounders. However, the mediation was partial, accounting for 17.9% of the lifetime trauma exposure count's total effect. While this finding is significant, it also suggests that additional mechanisms beyond PD play a role in explaining the influence of higher lifetime trauma exposure on prospective PTSD symptoms. These findings provide valuable insights into the complex dynamics of PTSD development and call for further research to explore complementary factors and preventive strategies. [ABSTRACT FROM AUTHOR]

Background: Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting. Objective: The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability. Method: The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication. Results: Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability. Conclusion: The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain. [ABSTRACT FROM AUTHOR]

The impact of caregiving on caregivers' mental health is typically considered within the caregiver stress and burden literature; however, more recently, research has investigated the experience of post-traumatic stress symptoms (PTSS) in caregivers. As an emerging area of research, it is timely to conduct a scoping review to map the existing literature in relation to PTSS among adult caregivers of children and adults with neurodevelopmental disorders (NDD), neurocognitive disorders, and psychiatric disorders. The scoping review was conducted using Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and Arksey and O'Malley's five-stage methodology framework. Published and unpublished gray literature between 2005 and 2022 was included in the scoping review. Nine thousand one hundred and twenty-five studies were originally identified for screening and 22 studies were selected for inclusion in the final review. Trauma and PTSS experienced by NDD caregivers were related to news breaking, NDD diagnosis, and behavioral issues, whereas caregivers of individuals with psychosis reported aggression and violence as traumatic events. Studies showed that up to half of caregivers reported PTSS, although no conclusions could be drawn about prevalence rates. A wide variety of tools measuring PTSS were used across the 22 studies. Many symptoms of PTSS were reported by caregivers, and cognitive appraisals were associated with PTSS in caregivers. The findings highlight the importance of recognizing the impact of trauma in caregiver mental health and the potential value of using traumatic stress frameworks with these populations. Research should be expanded to establish prevalence rates and to examine the long-term impact of trauma on caregiving as caregivers and care recipients age. [ABSTRACT FROM AUTHOR]

Research has shown that complex post-traumatic stress disorder (cPTSD) differs from post-traumatic stress disorder (PTSD) on core symptoms relating to the individual's sense of self, and this has driven the need for treatment approaches to address these specific features of cPTSD. The COVID-19 pandemic has led to the increased use of digital-based interventions (DBIs) to treat mental illnesses, including trauma-related disorders. However, while evidence for the use of DBIs for PTSD has previously been synthesized, the current review is the first synthesis of research on the use of DBIs for cPTSD. A systematic search of Scopus, PsychINFO, and EBSCOhost was conducted, using search terms targeting "cPTSD" and "DBIs," to identify research on the use of DBIs to treat cPTSD symptoms. Ten papers were identified, which provided preliminary evidence for the efficacy of DBIs to reduce cPTSD symptoms. Further, DBIs were reported as acceptable by individuals with a history of complex trauma. The paper also provides insight into the therapeutic approaches adopted, digital modalities utilized, safety measures included, and whether/to what degree support was provided. While DBIs show promise for treating cPTSD, there is substantial room for advancement of the empirical evidence base for these approaches. Both clinical and research-based recommendations are provided separately. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to describe and synthesize the measures, methods, and key findings of published quantitative research examining the influence of child maltreatment (i.e., abuse and/or neglect) and adult trauma exposure on mental health symptoms among women Veterans. A systematic search from database inception to June 2023 generated 18,861 unique articles retrieved and independently screened for eligibility. A total of 21 articles met pre-established inclusion criteria: (a) quantitative data and results within a sample or subsample of U.S. women veterans, (b) published in a peer-reviewed journal, and (c) examining variables of interest simultaneously (i.e., child maltreatment, adult trauma exposure, mental health symptom) in quantitative analyses. Reviewed literature showed a lack of uniformity in measurement and methodologies to evaluate women veterans' lifetime trauma exposure in relation to mental health. Studies most frequently used self-report survey data to evaluate exposure to child maltreatment and/or adult trauma with convenience samples of women veterans (52.4%, n = 11) and examined depressive and/or posttraumatic stress symptomatology. Findings demonstrate the need for additional research attending to the interplay between child maltreatment and adult trauma exposures in relation to women veterans' mental health using comprehensive assessment, longitudinal methods, and understudied as well as more representative samples. [ABSTRACT FROM AUTHOR]