Search

Background: Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers. Methods: Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being. Results: High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect. Conclusions: The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) holds promise for neuropsychiatric conditions where imbalance in network activity contributes to symptoms. Treatment-resistant Combat post-traumatic stress disorder (TR-PTSD) is a highly morbid condition and 50% of PTSD sufferers fail to recover despite psychotherapy or pharmacotherapy. Reminder-triggered symptoms may arise from inadequate top-down ventromedial prefrontal cortex (vmPFC) control of amygdala reactivity. Here, we report long-term data on two TR-PTSD participants from an investigation utilizing high-frequency amygdala DBS. The two combat veterans were implanted bilaterally with quadripolar electrodes targeting the basolateral amygdala. Following a randomized staggered onset, patients received stimulation with adjustments based on PTSD symptom severity for four years while psychiatric and neuropsychiatric symptoms, neuropsychological performance, and electroencephalography were systematically monitored. Evaluation of vmPFC-Amygdala network engagement was assessed with 18FDG positron emission tomography (PET). CAPS-IV scores varied over time, but improved 55% from 119 at baseline to 53 at 4-year study endpoint in participant 1; and 44%, from 68 to 38 in participant 2. Thereafter, during 5 and 1.5 years of subsequent clinical care respectively, long-term bilateral amygdala DBS was associated with additional, clinically significant symptomatic and functional improvement. There were no serious stimulation-related adverse psychiatric, neuropsychiatric, neuropsychological, neurological, or neurosurgical effects. In one subject, symptomatic improvement was associated with an intensity-dependent reduction in amygdala theta frequency power. In out two participants, FDG-PET findings were inconclusive regarding the hypothesized mechanism of suppression of amygdala hyperactivity. Our findings encourage further research to confirm and extend our preliminary observations.

Wigner predicted that when the Coulomb interactions between electrons become much stronger than their kinetic energy, electrons crystallize into a closely packed lattice1. A variety of two-dimensional systems have shown evidence for Wigner crystals2-11 (WCs). However, a spontaneously formed classical or quantum WC has never been directly visualized. Neither the identification of the WC symmetry nor direct investigation of its melting has been accomplished. Here we use high-resolution scanning tunnelling microscopy measurements to directly image a magnetic-field-induced electron WC in Bernal-stacked bilayer graphene and examine its structural properties as a function of electron density, magnetic field and temperature. At high fields and the lowest temperature, we observe a triangular lattice electron WC in the lowest Landau level. The WC possesses the expected lattice constant and is robust between filling factor ν ≈ 0.13 and ν ≈ 0.38 except near fillings where it competes with fractional quantum Hall states. Increasing the density or temperature results in the melting of the WC into a liquid phase that is isotropic but has a modulated structure characterized by the Bragg wavevector of the WC. At low magnetic fields, the WC unexpectedly transitions into an anisotropic stripe phase, which has been commonly anticipated to form in higher Landau levels. Analysis of individual lattice sites shows signatures that may be related to the quantum zero-point motion of electrons in the WC lattice.

INTRODUCTION: This study examined the prevalence and correlates of probable mental health disorders, including psychological distress, somatization, depression, anxiety, phobic anxiety (PHO), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and insomnia among Chinese primary health care (PHC) physicians and nurses amid the post-pandemic period in 2022. METHOD: Region-stratified sampling was conducted to recruit a national sample of 4,246 respondents from 31 July 2022 to 12 August 2022. A total of 692 primary healthcare institutions were identified in 30 provincial-level administrative regions of China. An online questionnaire was used for assessing probable mental health disorders using Symptoms Checklist-90-Revised (SCL-90-R) and PTSD Checklist for DSM-5 (PCL-5), and sleeping problems using Insomnia Severity Index (ISI). Data on demographics and work were also collected. Bivariate analysis and multiple logistic regression were conducted to identify significant correlates of probable mental health disorders. RESULTS: A total of 4,246 valid questionnaires were identified. Results showed that relative to the prevalence of probable mental health disorders among health care workers at the early stage of the pandemic in China, there was an overall decreased prevalence except for somatization, PHO, and OCD among the current PHC physicians and nurses. Multiple logistic regressions showed that significant risk factors of common probable mental health disorders, namely psychological distress, SOM, DEP, ANX, PHO, OCD, PTSD, and insomnia, were female gender, multimorbidity, history of psychiatric disorders, quarantine experience, never asking anyone for help, and overtime work. CONCLUSION: Attention should be given to preexisting psychiatric and multimorbid conditions, social support, and work-related stressors. Regular assessment and psychological interventions are needed to enhance the mental health of PHC professionals even after public health crisis.

BACKGROUND: Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. METHODS: The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. RESULTS: At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. CONCLUSION: PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.

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]

While there is extensive empirical support and clinical guidance for the treatment of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) individually, less is known about treating the comorbid presentation of both conditions.The purpose of this review article is to provide information on the mental health treatment needs of service members (SMs) engaged in traumatic brain injury (TBI) rehabilitation. It also aims to offer a framework for an integrated treatment approach to address the cognitive and psychological health needs of warfighters.We review the prevalence and outcomes associated with comorbid TBI and PTSD and present relevant access to care considerations. Additionally, we identify an integrated approach to TBI treatment which takes psychological trauma into consideration. We introduce a trauma-informed care (TIC) model with specified diagnostic and treatment considerations for the service member and veteran (SM/V) communities. TIC is a strengths-based framework that raises the system-wide awareness of treatment facilities to the impact of psychological trauma on behavioral health.A comprehensive diagnostic approach is recommended with considerations for symptom etiology. Clinical considerations derived from available guidelines are identified to meet critical treatment needs for SM/Vs presenting for TBI treatment with a remote history of mTBI and psychological trauma or known PTSD. Clinical practice guidelines are used to inform an integrated TBI treatment model and maximize rehabilitation efforts for warfighters.Given the prevalence of comorbid TBI and PTSD among SM/Vs and its impact on outcomes, this review presents the integration of appropriate diagnostics and treatment practices, including the incorporation of CPGs into TBI rehabilitation. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusionTo explore the differences in mental health symptom profiles, trauma profiles, childhood trauma and comorbidities in patients with PTSD and those without PTSD.A cross-sectional study was carried out on 110 adult patients with trauma backgrounds attending a mental health outpatient clinic in Southern Oslo, Norway. In addition to self- report questionnaires, several standardized validated diagnostic tools were used to assess mental disorders. Multiple linear regression models were used to assess the association between trauma history, the mental health symptom profile of the patients, and PTSD diagnosis. Bivariate logistic regression was used to examine if childhood trauma/adversities were associated with PTSD.Patients diagnosed with PTSD had significantly higher rates of comorbid major depressive disorder, panic disorder, agoraphobia disorder, and social phobia compared to those without PTSD. We also found a positive association between PTSD diagnosis and all the different mental health symptoms domains of the Symptom Checklist-90-Revised instrument. When adjusted for age, gender, education, smoking habits, immigration, relationship, and employment status, these associations persisted with varying effects. We did not find any association between PTSD and childhood trauma/adversities, however, sexual abuse trended towards an association.Adult trauma patients with PTSD may have more comorbid disorders and mental health symptoms. Childhood trauma may be less critical for the PTSD diagnosis in this group. In clinical practice, personalized treatment plans addressing both the symptom burden and its comorbidities may be beneficial. [ABSTRACT FROM AUTHOR]

Researchers have identified university students and military personnel as highly susceptible to the stress and emotional challenges imposed by the Coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to compare the psychological impact of COVID-19 on soldiers and students based on risk factors identified in self reports. We recruited 258 students (male: female = 58: 204, average age = 19.73 ± 1.52 years) and 194 active soldiers (male: female = 172: 22, average age = 24.88 ± 4.11 years) from northern Taiwan. Analysis was performed on demographic data, history of COVID-19 infection, vaccinations, and the subjective psychological impact of the pandemic, as well as their current (within one month) anxiety levels, depression level, and symptoms of post-traumatic stress disorder (PTSD). Descriptive statistics and linear regression analysis models were used to compare soldier vs. student status and male vs. female. Overall, roughly 54% of the subjects had been infected by COVID-19 at least once, and the psychological impact of the pandemic was more pronounced in the infected group. The students reported more pronounced symptoms of PTSD (elevated anxiety and depression levels) than did the soldiers. All regression models other than those associated with age and sex revealed that the link between COVID-19 infection and the symptoms of PTSD was more salient among soldiers and males than among students and females. It appears that the psychological impact of COVID-19 is underreported by soldiers. These findings indirectly support previous research indicating that soldiers are less likely than students to disclose emotions related to trauma, indicating the need for psychological support for military personnel. [ABSTRACT FROM AUTHOR]

Background: Horizontal violence can cause serious mental health problems for nurses, particularly anxiety, depression, and post-traumatic stress disorder. However, the intrinsic linkage mechanism between mental symptoms of anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence is unclear. This study aims to elucidate the characteristics of anxiety, depression, and post-traumatic stress disorder networks among nurses with horizontal violence exposure. Methods: Data for this cross-sectional study were obtained from the baseline portion of a short longitudinal survey conducted at four tertiary hospitals in Shandong Province, China. A total of 510 nurses with horizontal violence exposure completed the General Information Scale, the Negative Acts Questionnaire, the Seven-item Generalized Anxiety Disorder Scale, the Nine-item Patient Health Questionnaire, and the Four-item SPAN. The network model was constructed using network analysis. The expected influence and the bridge expected influence of nodes were calculated. The stability and accuracy of the network were estimated. Results: The results show that A4 (Trouble relaxing) and P1 (Startle) had the highest expected influence in the network. D9 (Suicidality ideation) and A5 (Restlessness) were the key bridge symptoms. Conclusions: "Trouble relaxing", "Startle", "Suicidality ideation", and "Restlessness" are all mental symptoms that need to be urgently improved the most in nurses exposed to horizontal violence. Nursing administrators and policymakers should implement mental health intervention programs for these symptoms as early as possible to maximize nurses' mental health. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged mental health professionals in many unexpected ways. Research completed in the years following the pandemic suggests that individuals around the globe have experienced significant mental health difficulties since the start of the pandemic, including posttraumatic stress disorder (PTSD) and complicated grief. Much of this research has examined the general population or medical personnel specifically and has neglected to turn attention to mental health professionals who have been on the frontlines of treating these mental health difficulties. This study fills this gap in the literature by examining mental health professionals' reactions during the early stages of the pandemic. Sixty-nine mental health professionals completed questionnaires examining trauma, grief, and resilience during the COVID-19 pandemic. Results indicated that 48% of participants met criteria for a provisional diagnosis of posttraumatic stress disorder (PTSD) and 7% were experiencing severe grief. Those who first began using virtual platforms during the pandemic reported less grief and fewer PTSD symptoms. Those with children reported more resilience. Further, resilience mediated the relationship between having children and grief. Resilience and PTSD symptoms independently predicted grief responses. The results suggest the COVID-19 pandemic had profound effects on mental healthcare providers during the early stages of the pandemic. [ABSTRACT FROM AUTHOR]

This study investigated the mediating role of perceived stress in long-term development of posttraumatic stress symptoms (PTSS) and emotional distress among local government officials over seven years after the Wenchuan earthquake in China. Moreover, how dysfunctional coping would impact the relationship between perceived stress and PTSS or emotional distress was examined. Data were collected one year (T1) and seven years (T2) after the earthquake. Trauma experience, PTSS, and emotional distress were measured at one year. PTSS and emotional distress were re-assessed at seven years together with perceived stress and dysfunctional coping (i.e., behavioral disengagement, denial, self-distraction, self-blame, substance use, and venting). Mediation analyses were conducted to examine the mediating role of perceived stress. Moderated mediation analyses were performed to test the moderation effect of dysfunctional coping. Perceived stress fully mediated the association of T1 emotional distress with its' T2 scores (indirect effect: B = 0.10, SE = 0.04, β = 0.11, 95% CI [0.02, 0.18]), while did not mediate the association of T1 PTSS with T2 PTSS (indirect effect: B = 0.04, SE = 0.03, β = 0.04, 95% CI [−0.02, 0.10]). Compared to a low frequency use of dysfunctional coping strategies (ps = 0.148–0.326), the detrimental effects of perceived stress on PTSS and emotional distress were stronger at higher levels of dysfunctional coping strategies (ps < 0.001). This study highlights the importance of paying attention to the adverse impacts of perceived stress and dysfunctional coping on long-term mental health outcomes among local government officials after disasters. [ABSTRACT FROM AUTHOR]

Few studies have addressed the influence of mass stressors in the context of couple relationships; therefore, understanding how unique constraints and stressors related to the COVID-19 pandemic influenced mental health distress and, in turn, loss in couple relationships is valuable. Because resource loss has been defined as the primary agent of stress, examining factors that may have shaped the degree of resource loss incurred during the pandemic will be vital. Previous research implies that early life adversity may be a form of resource loss and is linked to poorer mental health and relational outcomes in adulthood. Additionally, the stress sensitization hypothesis posits that childhood adversity may prime individuals to have a lower threshold for later life stress. As such, this study was designed to examine how family of origin stress (reported at the outset of pandemic related shutdowns in the US in April 2020) associated with posttraumatic stress (PTSS) 3 months later (July 2020) to, in turn, predict variation in resource losses associated with the COVID-19 pandemic reported 3 months later (October 2020) in 535 cisgender, heterosexual couples. Findings showed that individual's higher family of origin stress predicted higher levels of their own PTSS at wave 2, and higher PTSS at wave 2 predicted higher levels of couples' shared resource loss at wave 3. Additionally, family of origin stress is associated with higher levels of couples' shared experience of loss via higher levels of their own PTSS. [ABSTRACT FROM AUTHOR]

The increasing number of population-level stressors globally has raised concerns over their mental health consequences on young people. Few studies, however, have examined such factors in population-based youth samples, particularly with consideration of how different stressor types could affect mental health via their impacts on specific world assumptions. As part of a household-based epidemiological study, 766 young people (aged 15–25 years) participated in this study from June 2021 to 2022. We examined how negative world assumptions, assessed using the World Assumption Scale (WAS), and the subdomains of benevolence, meaningfulness, and self-worth, would mediate the impact of stressors on symptom expression. Stressors included population-level stressful events, such as those related to social unrest (TEs) and the COVID-19 pandemic (PEs), as well as personal stressful life events (SLEs) and adverse childhood experiences (ACEs). Meanwhile, symptoms included depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Results showed that negative meaningfulness assumptions significantly mediated the effect of social unrest–related TEs on PTSD symptoms, while benevolence and self-worth mediated the effect of ACEs on depressive and anxiety symptoms. COVID-19 PEs and SLEs showed no significant association with world assumptions. Higher overall negative world assumptions were also significantly associated with poorer functioning and health-related quality of life. The findings suggest that world assumptions play specific mediating roles between different types of external stressors and symptom outcomes, with population-level human-induced stressors and childhood adversity playing more determining roles. These observations provide opportunities for designing interventions targeting negative world assumptions. [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]

This study sought to test the distinctiveness of symptoms of prolonged grief disorder (PGD) from posttraumatic stress disorder (PTSD) and depression. Confirmatory factor analysis (CFA) and target exploratory factor analysis (EFA), were used to test the distinctiveness of PGD from PTSD and depression symptoms in a large sample of adults bereaved for at least six months (N = 1917). Identified factors were explored in relation to demographic (i.e., age, gender) and loss-related (i.e., time since bereavement, nature of death, relationship to deceased, age of deceased, and frequency of contact with deceased) correlates. The CFA model provided a good fit to the data, while the target EFA provided a slightly improved fit. All items loading strongly and significantly onto their respectively factors, and the IGQ items had few significant cross-factor loadings. All demographic and loss-related variables (except for death of a sibling and death from other causes) were associated with each of the factors, however, these associations were strongest for the PGD factor. Participants were recruited using a non-probability sampling method and were from a relatively affluent Western nation. Findings from the current study demonstrate that PGD reflects an empirically distinguishable albeit related disorder to PTSD and depression in a sample of bereaved adults. The identification of correlates common to PGD, PTSD, and depression, as well as those unique to PGD, affords a comprehensive understanding of the risk factors associated with bereavement-related psychopathology. • Uses target EFA to test distinctiveness of symptoms of PGD, PTSD and depression. • Three factor target EFA provided slightly better fit to data than three-factor CFA. • ICD-11 PGD, PTSD, and depression are strongly correlated albeit distinct constructs. • Associations between demographic and loss-related variables strongest for the PGD factor. [ABSTRACT FROM AUTHOR]

Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events. Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis. In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD. DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability. • In our sample of 17,505 trauma exposed participants, 13 % had PTSD and 42 % had distressing memories without PTSD. • Distressing memories represent an intermediate state between well-being and post-traumatic stress disorder. • Distressing memories are transdiagnostic psychiatric symptoms useful in identifying psychiatric vulnerability. [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]

ABSTRACT Background Methods Results Conclusion On 6 February, 2023, Turkey experienced a disaster resulting from two major earthquakes. The elderly population stands out as one of the most vulnerable and least adaptable. This study aims to identify the quality of life (QOL) and post‐traumatic stress disorder (PTSD) symptoms among elderly earthquake survivors in Turkey.This research was conducted between 1 October, 2023 and 15 December, 2023 as a cross‐sectional design. During the data collection process, survey questions prepared by the researchers (29 questions) and the Elderly Quality of Life Scale (OPQOL‐Bref) and the Impact of Events Scale (IES‐R) were used.Three hundred and eighty‐four elderly people participated in the study. PTSD was more common in those diagnosed with chronic diseases after the earthquake, in those who had a drug‐free period after the earthquake, in those who smoked and quit smoking, and in those who started psychiatric medication after the earthquake. Post‐traumatic stress was seen more frequently in those with low QOL scores and in those who had a longer period of not using medication after the earthquake. It was observed that QOL was better in married people, high school graduates, those with average income levels, those who did not have chronic diseases before and after the earthquake, those who did not have a drug‐free period after the earthquake, those who were physically active, and those who did not use psychiatric medication after the earthquake.Chronic disease diagnosis post‐earthquake, drug‐free periods, smoking habits, and psychiatric medication usage were identified as influential factors in PTSD occurrence. Additionally, the study shed light on the profound effect of earthquake‐related experiences, such as house damage, injuries, deaths in first‐degree relatives, displacement, and changes in living conditions, on PTSD prevalence. [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]

In 1926, Freud famously conjectured that the human ego defense of repression against an internal instinctual threat evolved from the animal motor defense of flight from an external predatory threat. Studies over the past 50 years mainly in rodents have investigated the neurobiology of the fight-or-flight reflex to external threats, which activates the emergency alarm system in the dorsal periaqueductal gray (dPAG), the malfunction of which appears likely in panic and post-traumatic stress disorders, but perhaps also in some "nonemergent" conditions like social anxiety and "hysterical" conversion disorder. Computational neuroscience studies in mice by Reis and colleagues have revealed unprecedented insights into the dPAG-related neural mechanisms underlying these evolutionarily honed emergency vertebrate defensive functions (e.g., explore, risk assessment, escape, freeze). A psychoanalytic interpretation of the Reis studies demonstrates that Freud's 1926 conjecture is confirmed, and that internal instinctual threats alone can also set off the dPAG emergency alarm system, which is regulated by 5-HT1A and CRF-1 receptors. Consistent with current psychoanalytic and neurobiologic theories of panic, several other of the primitive components of the dPAG alarm system may also have relevance for understanding of the unconscious determinants of impaired object relationships (e.g., avoidance distance). These dPAG findings reveal (1) a process of "evolution in situ," whereby a more sophisticated dPAG ego defense is seen evolving out of a more primitive dPAG motor defense, (2) a dPAG location for the phylogenetically ancient kernel of Freud's Ego and Id, and (3) a Conscious Id theory that has been conclusively invalidated. [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]

Background: Anxiety disorders (ADs) are a complex group of mental disorders and majorly contribute to the global health-related burden. Symptoms and clinical management differ widely depending on the specific diagnosis. There is a need for new, more effective pharmacological treatments for these patients as many patients do not respond to treatment and treatment is not available for several types of AD. The increased interest in the potential effects of cannabidiol (CBD) on symptoms of AD has led to several preclinical and clinical studies that suggest that CBD may be effective in some patients with AD. However, it remains unclear whether and how CBD can be used in the clinical management of ADs due to a lack of sufficiently robust clinical evidence. Comparative evaluation: This narrative review provides a critical analysis of the current state of the art for ADs and summarizes six recently completed and 22 currently ongoing clinical trials investigating the effects of CBD on ADs or anxiety. The aim was to examine whether the ongoing trials are likely to provide the necessary solid evidence, or whether new studies with more robust design parameters can help to overcome the prevailing lack of solid clinical data for this CBD indication. Most of the trials reviewed are considered exploratory and do not focus on specific types of clinical anxiety or ADs as the primary condition studied. Participant numbers, CBD dose, treatment duration, and CBD formulation vary widely among the studies, and all but two are single-center studies. Conclusion: For an effective clinical management of ADs using CBD, there is a need for sufficiently powered and appropriately designed clinical trials (RCT, multicenter, defined doses and exposure monitoring, robust primary outcomes) investigating the effect of CBD in specific ADs, such as social anxiety disorder and panic disorder, or in post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Background: Psychological repercussions resulting from coronavirus disease 2019 (COVID-19) have been encountered, such as anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD). The study aimed to assess the frequency and severity of PTSD, depression, and anxiety in a sample of Egyptian patients with COVID-19 infection and analyze potential risk factors. The current study is a descriptive cross-sectional, hospital-based study, conducted from August 2020 to June 2021. The sample was selected from patients diagnosed with COVID-19 infection at Ain Shams University hospitals (outpatient clinics and inpatient units). Patients underwent a COVID severity criteria scoring system, structured clinical interview for DSM-IV (SCID-I), PTSD checklist–Civilian Version (PCLC), Beck depression inventory, and Taylor's manifest anxiety scale. Results: PTSD was observed in 79.29% of the study sample, 61.43% had depression, and 18.57% had anxiety. The severity of COVID-19 infection was significantly associated with PTSD severity mean scores (P value = 0.027). Furthermore, a significant relationship was observed between the severity of depression and COVID-19 infection severity (P value = 0.028). The number of comorbid medical risk factors demonstrated significance to PTSD severity (P value = 0.014). Conclusion: A significant portion of the study's patients experienced psychiatric consequences following COVID-19 infection, with 79.29% developing PTSD, 61.43% suffering from depression, and 18.57% experiencing anxiety. Various factors, such as the presence of chronic medical illnesses and the number of co-morbid medical risk factors, were observed to contribute to these psychiatric outcomes. Therefore, comprehensive psychiatric assessment and management in COVID-19 patients especially with severe forms of the disease and hospitalized patients are mandatory. [ABSTRACT FROM AUTHOR]

We examined the moderating roles of distress tolerance, meaning in life, and social support in the relationship between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) among cancer patients. Participants included 301 cancer outpatients randomly selected from the oncology unit of a tertiary healthcare institution in Nigeria (female = 60.1%%; age range = 21 to 85 years, mean age = 52.30 years, SD = 12.64 years). They completed self-report measures on distress tolerance, meaning in life, social support, posttraumatic stress symptoms (PTSS), and PTG. Following series of moderation analysis using Hayes PROCESS macro for SPSS Model 1, results showed that higher PTSS was associated with lower PTG at low and moderate, but not at high levels of distress tolerance. Moreover, meaning in life and social support moderators the PTSS and PTG relationship for higher PTG. Therefore, intervention programmes to promote PTG among cancer patients should consider meaning in life, and social support for their protective potentials in improving positive posttraumatic outcome and recovery with distress tolerance. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Post‐traumatic stress disorder (PTSD) is a mental health disorder resulting from exposure to traumatic events, manifesting in various debilitating symptoms. Despite available treatments, many individuals experience inadequate response or significant side effects. Previous reviews suggest promising outcomes with MDMA‐assisted psychotherapy (MDMA‐AT), but limitations prompt the need for a comprehensive evaluation.We searched various online databases and registries such as MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov to retrieve RCTs that fit our inclusion criteria. We performed meta‐analyses using Review Manager by applying a random‐effects model. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and standard mean difference (SMD), respectively.Nine studies with a total of 297 participants with PTSD were included in our meta‐analysis. The control group consisted of inactive doses of MDMA (25–40 mg) or placebo. Our meta‐analysis showed that MDMA‐AT led to a significant reduction in the Clinician‐Administered PTSD Scale for DSM‐5 (CAPS‐5) severity scores as compared to the control group (SMD −1.10, 95% CI: −1.62 to −0.59). More patients in the MDMA‐AT group exhibited significant response (RR 1.59, 95% CI: 1.22, 2.08) and remission (RR 2.32, 95% CI: 1.47 to 3.66) as compared to patients in the control group. There was no significant difference regarding the incidence of ≥1 treatment‐emergent adverse events (TEAE), ≥1 severe TEAE, and suicidal ideation between the two groups.MDMA‐AT demonstrates significant efficacy in improving PTSD symptoms, enhancing both response and remission rates in individuals with chronic, treatment‐resistant PTSD, while maintaining a favorable safety profile. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of this study is to investigate the factors related to post‐traumatic stress disorder (PTSD), depression and anxiety mental disorders, as well as the quality of life of Syrian refugees and to examine the relationships between mental health disorders and the quality of life of Syrian refugees. Data were collected via face‐to‐face surveys with 613 adult Syrian refugees in an urban setting. Brislin's methodology was used for translating scale items, involving initial translation, back‐translation and review by another professional translator. The study utilised the PTSD Scale, Beck Anxiety Scale, Depression Scale and Quality of Life Scale (QOLS). Descriptive, correlational and multivariate regression analysis were applied. Findings of correlational analysis indicate that PTSD levels among Syrian refugees are significantly related to gender, income level and employment. Depression levels are significantly associated with trauma history, healthcare service use, marital status and employment. Anxiety levels are significantly related to gender, trauma history, healthcare service use, employment and income. According to the findings of the regression analyses, the relationships between depression, quality of life and PTSD are complex. Meanwhile, anxiety decreases quality of life and increases PTSD. Quality of life moderates the relationship between depression and PTSD, as well as between anxiety and PTSD. The study concludes that the mental disorder levels of Syrian refugees, in terms of PTSD, depression and anxiety, are linked to their socio‐demographic characteristics. These results highlight the importance of social, economic and cultural factors, healthcare and social services and the socio‐demographic characteristics of the region where refugees have settled after displacement. [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]

Acute traumatic event exposure is a direct cause of post-traumatic stress disorder (PTSD). Amygdala is suggested to be associated with the development of PTSD. In our previous findings, different activation patterns of GABAergic neurons and glutamatergic neurons in early or late stages after stress were found. However, the neural plastic mechanism underlying the role of basolateral amygdala (BLA) in post-traumatic stress disorder remains unclear. Therefore, this study mainly aimed at investigating time-dependent morphologic and electrophysiological changes in BLA during the development of PTSD. We used single prolonged stress (SPS) procedure to establish PTSD model of rats. The rats showed no alterations in anxiety behavior as well as in dendritic spine density or synaptic transmission in BLA 1 day after SPS. However, 10 days after SPS, rats showed enhancement of anxiety behavior, and spine density and frequency of miniature excitatory and inhibitory postsynaptic currents in BLA. Our results suggested that after traumatic stress, BLA displayed delayed increase in both spinogenesis and synaptic transmission, which seemed to facilitate the development of PTSD. [ABSTRACT FROM AUTHOR]

Background: The construct of “moral injury” is used widely in the research literature and media to broadly describe the impact of events involving perceived violations of one’s sense of right and wrong (herein referred to as “potentially morally injurious events” [PMIEs]). Summary: In this theoretical review, we provided a brief overview of the “moral injury” construct and its limitations including the lack of consensus-drawn boundaries and operational definitions to guide hypothesis-driven research. We discussed whether this construct can be reliably distinguished from established psychiatric diagnoses and psychological constructs and the inherent challenges in separating or classifying the impact of high-magnitude stressful life events that likely form the majority of PMIEs. Assessments that purportedly measure “moral injury” are reviewed and limitations are discussed such as shared measurement variance with established psychological instruments. Key Messages: We identified conceptual strategies for investigating behavioral and neurobiological features of PMIEs that could be used to inform the field of traumatic stress. We concluded that the construct of “moral injury” may provide an interpretive framework for positing why someone may be beset by guilt, shame, and/or rage whereas existing psychiatric diagnoses such as post-traumatic stress disorder and depression provide comprehensive descriptions regarding what someone might experience following extremely stressful events. We proposed directions to better clarify the boundaries of “moral injury” versus established psychiatric categories that could be used to enhance the conceptualization and assessment of this construct. [ABSTRACT FROM AUTHOR]

Background: The high psychological burden of rape, together with complications such as pregnancy and chronic conditions, is associated with an increase in mental disorders. Social cognitive theory (SCT) is an important health theory that views behavior as dynamic and influenced by environmental, behavioral and individual factors. The aim of the present research is to determine the effect of an educational intervention on post-traumatic stress disorder and social cognitive theory constructs in women who have experienced sexual assault. Methods/design: This study is randomized, double-blind clinical trial research that will be conducted on 40 women with experience of sexual. In this research, by the intervention program based on social cognitive theory include" awareness, self-efficacy, outcome expectations and environment. Written consent will be obtained from the participants to participate in the research. Participants in the intervention group will be taught about health, hygiene, psychology and stress reduction methods in group or individual sessions according to their preference in 6 sessions of 60 min each, one session per week. A post-test will be conducted for both groups. Discussion: This study provides comprehensive data on the effect of providing an educational intervention using the social cognition Theory. Social cognitive theory focuses on how patterns of behavior are learned and how they function in interaction between the individual and the environment. It seems that the use of this theory in designing the content of educational interventions can be useful and practical. Trial registration: The trial is prospectively recorded at the IRCT registry (Trial ID: IRCT20230926059526N1. Date recorded: 18/10/2023. [ABSTRACT FROM AUTHOR]

Background: Individuals who have experienced severe traumatic events are estimated to have a post-traumatic stress disorder (PTSD) prevalence rate ranging from 10 to 50%, while those not affected by trauma exposure are often considered to possess psychological resilience. However, the neural mechanisms underlying the development of PTSD, especially resilience after trauma, remain unclear. This study aims to investigate changes of cortical morphometric similarity network (MSN) in PTSD and trauma-exposed healthy individuals (TEHI), as well as the associated molecular alterations in gene expression, providing potential targets for the prevention and intervention of PTSD. Methods: We recruited PTSD patients and TEHI who had experienced severe earthquakes, and healthy controls who had not experienced earthquakes. We identified alterations in the whole-brain MSN changes in PTSD and TEHI, and established associations between these changes and brain-wide gene expression patterns from the Allen Human Brain Atlas microarray dataset using partial least squares regression. Results: At the neuroimaging level, we found not only trauma-susceptible changes in TEHI same as those in PTSD, but also unique neurobiological alterations to counteract the deleterious impact of severe trauma. We identified 1444 and 2214 genes transcriptionally related to MSN changes in PTSD and TEHI, respectively. Functional enrichment analysis of weighted gene expression for PTSD and TEHI revealed distinct enrichments in Gene Ontology biological processes and Kyoto Encyclopedia of Genes and Genomes pathways. Furthermore, gene expression profiles of astrocytes, excitatory neurons, and microglial cells are highly related to MSN abnormalities in PTSD. Conclusions: The formation of resilience may be by an active compensatory process of the brain. The combination of macroscopic neuroimaging changes and microscopic human brain transcriptomics could offer a more direct and in-depth understanding of the pathogenesis of PTSD and psychological resilience, shedding light on new targets for the prevention and treatment of PTSD. [ABSTRACT FROM AUTHOR]

Life review therapy is a form of psychotherapy framework which involves the guided reflection of life events throughout a patient's life journey. Patients are encouraged to actively recall and analyze important life events, both negative and positive. Through this process, patients may be able to come to terms with, or even resolve negative events such as conflicts and regrets. The aim of this study is to gain an understanding of the current knowledge of the use of life review therapy in older adults, and to identify areas for future research. A systematic literature search was conducted across CINAHL, Medline, PsycInfo, Embase and Scopus. Papers were screened and selected using predetermined inclusion and exclusion criteria using Covidence and exported into Excel. Data analysis was conducted to synthesise thematic analyses. One hundred and thirty‐one articles from 1974 to 2023 were included in this study and were used to develop four themes: life satisfaction and self‐esteem, depression and depressive symptoms, institutional care and cognitive decline, and post‐traumatic stress disorder (PTSD) and trauma. Life review has some benefit in older adults in certain groups and situations, although the extent and duration of effectiveness of this benefit is unclear. Life review unlikely improves self‐esteem. However, in the short term, life review appears to improve life satisfaction, depression or depressive symptoms, and PTSD symptoms in the elderly. Life review may be a useful therapeutic tool for older adults with cognitive decline for as long as the intervention continues. Areas for future research are explored. [ABSTRACT FROM AUTHOR]

Background Aim Method Results Conclusion Effective eating disorder (ED) treatments are drastically needed for patients with experiences of sustained and prolonged emotional, physical and sexual childhood maltreatment (CM) that often results in post‐traumatic sequelae such as severe, complex posttraumatic stress disorder (cPTSD). EDs with comorbid cPTSD (cPTSD‐ED) have protracted treatment courses and poorer prognoses.To summarise the knowledge base on cPTSD‐ED with specific emphasis on disturbances in self‐organisation (DSO) in relation to therapeutic alliance (TA) processes.Expert opinions based on current relevant literature are critically examined.Preliminary insights on change and alliance processes suggest that neglecting to address emotional‐relational processes in the conceptualisation and treatment of cPTSD‐ED impedes treatment progress.We hypothesise that the DSO construct inherent in cPTSD‐ED calls for a focus on TA processes in addition to traditional ED treatment elements such as nutritional rehabilitation and behaviour change, and regardless of ED treatment provided. More process research on a larger scale is urgently called for. [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]

Background: A better understanding of the relationships between insomnia and anxiety, mood, eating, and alcohol-use disorders is needed given its prevalence among young adults. Supervised machine learning provides the ability to evaluate which mental disorder is most associated with heightened insomnia among U.S. college students. Combined with Bayesian network analysis, probable directional relationships between insomnia and interacting symptoms may be illuminated. Methods: The current exploratory analyses utilized a national sample of college students across 26 U.S. colleges and universities collected during population-level screening before entering a randomized controlled trial. We used a 4-step statistical approach: (1) at the disorder level, an elastic net regularization model examined the relative importance of the association between insomnia and 7 mental disorders (major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, post-traumatic stress disorder, anorexia nervosa, and alcohol use disorder); (2) This model was evaluated within a hold-out sample. (3) at the symptom level, a completed partially directed acyclic graph (CPDAG) was computed via a Bayesian hill-climbing algorithm to estimate potential directionality among insomnia and its most associated disorder [based on SHAP (SHapley Additive exPlanations) values)]; (4) the CPDAG was then tested for generalizability by assessing (in)equality within a hold-out sample using structural hamming distance (SHD). Results: Of 31,285 participants, 20,597 were women (65.8%); mean (standard deviation) age was 22.96 (4.52) years. The elastic net model demonstrated clinical significance in predicting insomnia severity in the training sample [R2 =.44 (.01); RMSE = 5.00 (0.08)], with comparable performance in the hold-out sample (R2 =.33; RMSE = 5.47). SHAP values indicated that the presence of any mental disorder was associated with higher insomnia scores, with major depressive disorder as the most important disorder associated with heightened insomnia (mean |SHAP|= 3.18). The training CPDAG and hold-out CPDAG (SHD = 7) suggested depression symptoms presupposed insomnia with depressed mood, fatigue, and self-esteem as key parent nodes. Conclusion: These findings provide insights into the associations between insomnia and mental disorders among college students and warrant further investigation into the potential direction of causality between insomnia and depression. Trial registration: Trial was registered on the National Institute of Health RePORTER website (R01MH115128 || 23/08/2018). [ABSTRACT FROM AUTHOR]

Attentional bias and deficits in attentional control are associated with posttraumatic stress disorder (PTSD) symptoms. Attention control training (ACT) may address these factors. We reviewed randomized controlled trials (RCTs) of ACT for PTSD to address unanswered questions about ACT's effectiveness, tolerability, and implementation. Studies were included if they were an RCT that used an adult sample, recruited participants with a PTSD diagnosis, and had ACT as at least one treatment arm. The PTSD Trials Standardized Data Repository (PTSD‐Repository) and additional databases were searched to identify PTSD RCTs published through May 2024. Seven studies met the inclusion criteria (N = 407). The effect size for ACT versus a comparison condition on PTSD symptoms was large, but the confidence interval (CI) overlapped with 0, g = 0.75, 95% CI [‐0.63, 2.12]. The same pattern was observed for attention bias variability, g = 1.04, 95% CI [‐0.90, 2.98]. There was a significant within‐group effect of ACT on self‐reported PTSD symptoms, g = ‐1.43, 95% CI [‐2.83, ‐0.03]. Risk of bias varied, with high risk of bias being primarily due to bias in the measurement of the outcome. These effects should be interpreted cautiously given the significant heterogeneity and wide confidence intervals observed. It remains unclear for whom and under what conditions ACT may be most effective. Future studies should move beyond response time measures, employ an inactive comparator, and examine the mechanism of action to determine whether ACT could be a viable intervention for PTSD. [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 document explores the impact of warfare on cardiovascular health, emphasizing the devastating effects it has on individuals, families, communities, and the environment. It discusses how the use of various weapons in warfare can lead to significant human casualties and long-term health implications. Both civilians and veterans are at a higher risk of cardiovascular diseases and related risk factors due to war-related stressors and traumatic injuries. The document also highlights the long-term effects of wartime stress on mental and physical health. The authors advocate for global efforts to de-escalate armed conflicts and prioritize the health of affected populations through comprehensive healthcare systems and peace-building initiatives. [Extracted from the article]

Objective: The relationship between post-traumatic stress disorder (PTSD) and autoimmune thyroid disease (AITD) needs further evaluation. This study employs Mendelian randomization (MR) to investigate the causal correlations of PTSD with autoimmune thyroiditis (AIT) and Graves' disease (GD). Methods: Datasets for PTSD, AIT, and GD were obtained from FinnGen. The exposure-outcome causal relationship was assessed using inverse variance weighted, MR-Egger, and weighted median. Horizontal pleiotropy was evaluated through the MR-Egger intercept, heterogeneity was examined using Cochran's Q test, and robustness was assessed via leave-one-out sensitivity analysis. Results: MR analysis indicated no significant causal relationship between PTSD and AIT (OR 0.920, 95% CI 0.832 to 1.017, p = 0.103), but a potential increase in the risk of GD associated with PTSD (OR 1.056, 95% CI 1.008 to 1.105, p = 0.021). MR-Egger intercept showed no horizontal pleiotropy (p > 0.05), and Cochran's Q showed no heterogeneity (p > 0.05). Sensitivity analysis suggested the MR results were robust. Conclusions: Evidence of an MR association between genetic liability to PTSD and an increased risk of GD were provided, but no evidence of association between PTSD and AIT. The findings indicate that individuals with PTSD may have an increased likelihood of developing GD, underscoring the importance of further research to comprehend the intricate interplay between PTSD and thyroid disorders. [ABSTRACT FROM AUTHOR]

Background: Chronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post‐traumatic stress disorder (PTSD), but the implications for treatment are unknown. Objective(s): To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interference, awake bruxism and sleep bruxism would decrease after evidence‐based trauma‐focused treatment and that this decrease would be maintained at the 6‐month follow‐up. Methods: Individuals referred for PTSD treatment were assessed for chronic painful TMD (temporomandibular disorder pain screener), pain intensity, pain interference (Graded Chronic Pain Scale 2.0), awake bruxism and sleep bruxism (oral behaviours checklist) pre‐, post‐treatment and at the 6‐month follow‐up. Hypotheses were tested using the Friedman test, followed by a post hoc Wilcoxon signed‐rank test. Effect sizes (Cohen's r) are reported. Barely any pain interference was reported, therefore these outcomes were not analysed. Results: In individuals with chronic painful TMD (n = 98), pain intensity, awake bruxism and sleep bruxism decreased across the three time points. Post hoc tests showed that chronic painful TMD (r = 0.59), pain intensity (r = 0.28), awake bruxism (r = 0.51) and sleep bruxism (r = 0.35) decreased between pre‐ and post‐treatment. Between pre‐treatment and the 6‐month follow‐up, chronic painful TMD (r = 0.58), awake bruxism (r = 0.30) and sleep bruxism (r = 0.39) decreased as well. Conclusion: The results provide preliminary support for a trauma‐sensitive approach for patients with chronic painful TMD and PTSD and suggest that trauma‐focused treatment may be beneficial for chronic painful TMD, awake bruxism and sleep bruxism in patients with PTSD and chronic painful TMD. [ABSTRACT FROM AUTHOR]

Objective: Chronic pain (CP) is independently associated with substance use disorders (SUD) and posttraumatic stress disorder (PTSD). However, little is known about factors associated with CP among patients with co-occurring PTSD and SUD. Patterns of hospital resource usage should also be explored further. Methods: Using the 2019 National Inpatient Sample (NIS), we identified 216,125 hospital discharges with co-occurring diagnoses of PTSD and SUD in 2019 and examined their association with CP. Multivariable logistic regression models were used to identify factors associated with an increased likelihood of CP in this cohort. Results: Among those with co-occurring PTSD and SUD (N = 216,125), 35,450 had associated CP, a prevalence of 164.02 cases per 1,000 discharges (95% CI [160.54, 167.52]). Individuals aged 55–64 with co-occurring PTSD and SUD were approximately 7.2 times more likely to experience CP, compared to those aged 16–24 (OR = 7.2; 95% CI [6.09, 8.60]). Being in the CP group was associated with 50% increased odds of insomnia and obesity (OR = 1.5; 95% CI [1.12, 2.03] and OR = 1.5; 95% CI [1.38, 1.55], respectively), 30% increased odds of anxiety (OR = 1.3; 95% CI [1.24, 1.38]), 20% increased odds of attention deficit disorder (ADD;OR = 1.2; 95% CI [1.12, 1.38]) and 10% increased odds of depression (OR = 1.1; 95% CI [1.01, 1.14]). Compared with females, being male was associated with slightly decreased odds of CP (OR = 0.9; 95% CI [0.84, 0.94]). Conclusions: Among hospitalized Americans with co-occurring PTSD and SUD, advanced age, being female, and the presence other mental health disorders were associated with an increased risk of CP. Providers treating co-occurring PTSD/SUD should evaluate for and consider evidence-based management of CP if present. [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]

Millions of critically ill patients are discharged from intensive care units (ICUs) every year. These ICU survivors may suffer from a condition known as post-intensive care syndrome (PICS) which includes a wide range of cognitive, psychological, and physical impairments. This article will provide an extensive review of PICS. ICU survivors may experience cognitive deficits in memory and attention, with a slow-down of mental processing and problem-solving. From psychological perspectives, depression, anxiety, and post-traumatic stress disorder are the most common issues suffered after ICU discharge. These psycho-cognitive impairments might be coupled with ICU-acquired weakness (polyneuropathy and/or myopathy), further reducing the quality of life, the ability to return to work, and other daily activities. The burden of ICU survivors extends to families too, leading to the so-called PICS-family (or PICS-F), which entails the psychological impairments suffered by the family and, in particular, by the caregiver of the ICU survivor. The development of PICS (and PICS-F) is likely multifactorial, and both patient- and ICU-related factors may influence it. Whilst the prevention of PICS is complex, it is important to identify the patients at higher risk of PICS, and clinicians should be aware of the tools available for diagnosis. Stakeholders should implement strategies to achieve PICS prevention and to support its effective treatment during the recovery phase with dedicated pathways and supporting care. [ABSTRACT FROM AUTHOR]

Depression and posttraumatic stress disorder are two common mental disorders after negative life events. This study was conducted to evaluate the depression and posttraumatic stress levels of pregnant women after the large-scale earthquakes that occurred in Turkey in 2023. The study was carried out with 395 pregnant women who visited maternity outpatient clinics of a public hospital in a province in southern Turkey. The data were collected with the Beck Depression Inventory (BDI) and the Post-Traumatic Stress Disorder Checklist – Civilian Version (PCL-C). Descriptive statistics, the independent-samples t-test, and the Pearson correlation test were used in the analyses of the data. Among all participants, 3.8 percent had a likely depression risk, and 31.9 percent exhibited posttraumatic stress disorder symptoms. A statistically significant relationship was found between the earthquake exposure of the participants and their BDI and PCL-C total scores (p <.05). The BDI scores of the participants also had statistically significant relationships to their PCL-C scores (p <.05). In this study, it was discerned that posttraumatic stress disorder symptoms were prevalent among pregnant women in the post-earthquake period. Psychological support is needed to improve the mental health of the pregnant women after earthquakes. [ABSTRACT FROM AUTHOR]

Posttraumatic growth (PTG) is a possible common reaction to exposure to potentially traumatic events (PTEs) during military service. However, knowledge about correlates of PTG among female combat veterans is sparse. This study examines associations between combat exposure, posttraumatic stress symptoms (PTSS), general self‐efficacy (GSE), and PTG among Israeli female veterans. This is a cross‐sectional studyA volunteer sample of female Israeli combat veterans (n = 616) and non‐combat veterans (n = 484) responded to self‐report questionnaires. Combat veterans reported higher levels of combat exposure, PTSS, GSE, and PTG, as compared to non‐combat veterans. Among combat veterans, combat exposure and GSE were associated with greater PTG. Importantly, PTSS and GSE mediated the link between combat exposure and PTG. The study's findings are among the first to report about possible psychological growth outcomes among Israeli combat veterans. Clinicians treating female veterans coping with combat trauma should be aware of the heterogeneity of reactions to military service challenges and the importance of enhancing veterans' GSE to facilitate PTG. [ABSTRACT FROM AUTHOR]