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One in 25 patients experience PTSD following childbirth. Risk factors include unplanned cesarean delivery, operative vaginal delivery, obstetric emergencies such as cord prolapse, neonatal intensive care admission, previous trauma, and severe physical complications. Early recognition of PTSD is imperative. It can have a significant impact on the health of both the birthing parent and the infant. It is associated with difficulty in bonding with the infant, breast-feeding, or engaging in postnatal care. A multidisciplinary approach between obstetricians, psychiatrists, and other mental health providers is recommended for management. Treatment may involve eye movement desensitization and reprocessing, cognitive behavioral therapy, and pharmacotherapy. It is reasonable to perform cesarean delivery for maternal request in patients who are well informed of the risks, benefits, and alternatives.
Traumatic experiences can trigger post-traumatic stress disorder (PTSD) and influence one’s future perspective, which can change over time with the sense of control.
Aims
We measured changes in predictions about the future among individuals who experienced a traumatic event, with or without PTSD, according to their sense of control, and its relationship with post-traumatic change (post-traumatic stress symptom severity, well-being and coping strategies).
Method
Eighty-one exposed individuals (who experienced the 2015 Paris terrorist attacks), some with PTSD, and 71 non-exposed controls (who had not experienced the attacks) were asked to estimate the probable future occurrence of 20 controllable and 20 uncontrollable events, 7–18 and 31–43 months after the attacks. Repeated-measures analysis of variance and correlations were performed to measure inter-group differences in outcomes and relationships with post-traumatic change.
Results
Exposed participants with PTSD and without PTSD estimated uncontrollable future events to be more likely over time. Uncontrollable predictions were related to increases in post-traumatic stress symptom severity for individuals without PTSD. Uncontrollable predictions were not correlated with well-being or coping in exposed individuals.
Conclusions
Over time, exposed individuals provide increasingly high probability ratings for the future occurrence of uncontrollable events, a tendency associated with an increase in post-traumatic stress symptom severity in exposed individuals without PTSD. This may reflect potential delayed PTSD symptoms over time in individuals who did not initially develop PTSD following the attacks. The range of the measurements and the use of a self-constructed questionnaire limit the internal validity of the results.
High rates of trauma exposure among patients with severe mental illness (SMI) in Botswana highlight the need for appropriate interventions. Culturally adapted interventions have been reported to be more acceptable, effective and feasible. This study aimed to culturally adapt the Brief Relaxation, Education and Trauma Healing (BREATHE), a brief psychological intervention to treat post-traumatic stress disorder (PTSD) among people with SMI in Botswana. The cultural adaptation process followed the steps outlined by previous research. They included a community assessment to identify needs, selecting an appropriate intervention and consultations with experts and stakeholders. Individual interviews and focus groups were conducted with patients living with SMI and mental health professionals, respectively, to inform domains of the intervention to be adapted. BREATHE was adapted to be culturally congruent to Botswana by following the ecological validity model framework and using data from the interviews. Examples of the adaptation include language that was translated to Setswana, and spoken English and the content that was revised to reflect the traumatic experiences and demographics of the Botswana population. The study underscores the utility of using evidence-based frameworks to culturally adapt interventions. The adaptation process resulted in a culturally relevant BREATHE for patients with comorbid PTSD and SMI in Botswana.
Post-traumatic stress disorder (PTSD) and hypertension are highly prevalent among Veterans. Cognitive dispersion, indicating within-person variability across neuropsychological measures at one time point, is associated with increased risk of dementia. We examined interactive effects of PTSD symptom severity and hypertension on cognitive dispersion among older Veterans.
Methods:
We included 128 Vietnam-era Veterans from the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI) with a history of PTSD. Regression models examined interactions between PTSD symptom severity and hypertension on cognitive dispersion (defined as the intraindividual standard deviation across eight cognitive measures) adjusting for demographics and comorbid vascular risk factors.
Results:
There was an interaction between PTSD symptom severity and hypertension on cognitive dispersion (p = .026) but not on mean cognitive performance (p = .543). Greater PTSD symptom severity was associated with higher cognitive dispersion among those with hypertension (p = .002), but not among those without hypertension (p = .531). Results remained similar after adjusting for mean cognitive performance.
Conclusions:
Findings suggest, among older Veterans with PTSD, those with both hypertension and more severe PTSD symptoms may be at greater risk for cognitive difficulties. Further, cognitive dispersion may be a useful marker of subtle cognitive difficulties. Future research should examine these associations longitudinally and in a diverse sample.
Economic variables such as socioeconomic status and debt are linked with an increased risk of a range of mental health problems and appear to increase the risk of developing of post-traumatic stress disorder (PTSD). Previous research has shown that people living in more deprived areas have more severe symptoms of depression and anxiety after treatment in England’s NHS Talking Therapies services. However, no research has examined if there is a relationship between neighbourhood deprivation and outcomes for PTSD specifically. This study was an audit of existing data from a single NHS Talking Therapies service. The postcodes of 138 service users who had received psychological therapy for PTSD were used to link data from the English Indices of Deprivation. This was analysed with the PCL-5 measure of PTSD symptoms pre- and post-treatment. There was no significant association between neighbourhood deprivation measures on risk of drop-out from therapy for PTSD, number of sessions received or PTSD symptom severity at the start of treatment. However, post-treatment PCL-5 scores were significantly more severe for those living in highly deprived neighbourhoods, with lower estimated income and greater health and disability. There was also a non-significant trend for the same pattern based on employment and crime rates. There was no impact of access to housing and services or living environment. Those living in more deprived neighbourhoods experienced less of a reduction in PTSD symptoms after treatment from NHS Talking Therapies services. Given the small sample size in a single city, this finding needs to be replicated with a larger sample.
Key learning aims
(1) Previous literature has shown that socioeconomic deprivation increases the risk of a range of mental health problems.
(2) Existing research suggests that economic variables such as income and employment are associated with greater incidence of PTSD.
(3) In the current study, those living in more deprived areas experienced less of a reduction in PTSD symptoms following psychological therapy through NHS Talking Therapies.
(4) The relatively poorer treatment outcomes in the current study are not explained by differences in baseline PTSD severity or drop-out rates, which were not significantly different comparing patients from different socioeconomic strata.
Post-traumatic stress disorder (PTSD) is a mental health condition caused by the dysregulation or overgeneralization of memories related to traumatic events. Investigating the interplay between explicit narrative and implicit emotional memory contributes to a better understanding of the mechanisms underlying PTSD.
Methods
This case–control study focused on two groups: unmedicated patients with PTSD and a trauma-exposed control (TEC) group who did not develop PTSD. Experiments included real-time measurements of blood oxygenation changes using functional near-infrared spectroscopy during trauma narration and processing of emotional and linguistic data through natural language processing (NLP).
Results
Real-time fNIRS monitoring showed that PTSD patients (mean [SD] Oxy-Hb activation, 0.153 [0.084], 95% CI 0.124 to 0.182) had significantly higher brain activity in the left anterior medial prefrontal cortex (L-amPFC) within 10 s after expressing negative emotional words compared with the control group (0.047 [0.026], 95% CI 0.038 to 0.056; p < 0.001). In the control group, there was a significant time-series correlation between the use of negative emotional memory words and activation of the L-amPFC (latency 3.82 s, slope = 0.0067, peak value = 0.184, difference = 0.273; Spearman’s r = 0.727, p < 0.001). In contrast, the left anterior cingulate prefrontal cortex of PTSD patients remained in a state of high activation (peak value = 0.153, difference = 0.084) with no apparent latency period.
Conclusions
PTSD patients display overactivity in pathways associated with rapid emotional responses and diminished regulation in cognitive processing areas. Interventions targeting these pathways may alleviate symptoms of PTSD.
The post-traumatic stress disorder (PTSD) diagnosis encompasses heterogeneous presentations, many of the diagnostic criteria are not trauma-related and almost all PTSD symptoms are common to several psychiatric diagnoses. Flashbacks are the only symptom unique to PSTD. However, the absence of a consensus definition of flashbacks means that this term means different things to different people, causing misunderstanding and miscommunication, and presumably affecting treatment. This Refreshment discusses how flashbacks are defined in DSM-5-TR and ICD-11 (essentially, as reliving/re-experiencing when awake) and briefly describes the dual representation theory's account of flashbacks. In discussing what flashbacks are and are not, it aims to promote improved understanding, assessment and diagnosis of PTSDs.
This study aimed to investigate the psychological impact of the Turkey 2023 earthquakes on preschool-aged children and to compare them with those with other life-threatening traumas. Thirty-four preschool children who experienced earthquakes on February 6, 2023, and applied to our outpatient clinic in the following 3 months, and 37 other trauma-experienced preschool children were included in this cross-sectional study. Preschool Age Psychiatric Assessment/Post-Traumatic Stress sections were conducted. Parents were asked to complete the Pediatric Emotional Distress Scale and the Child Behavior Checklist for Ages 1.5–5 to evaluate stress-related reactions alongside psychiatric problems of children. The results showed that acute stress disorder and post-traumatic stress disorder (PTSD) were more common in the earthquake-experienced group than in the other trauma-experienced group (Fisher’s exact test, 52.9% vs. 8.1%, p < 0.001 and 38.2% vs. 8.1%, p = 0.004, respectively). Migration after the earthquake had no additional impact on trauma-related psychiatric outcomes, either ASD or PTSD (p = .153, and p = 0.106, respectively); whereas sleep problems predicted PTSD (OR = 1.26, β = 0.42, p = 0.036) in the earthquake-experienced group. Our study provides implications for understanding the psychological impact of earthquakes and risk factors for PTSD among preschool children.
Childhood maltreatment (CM) significantly increases the risk of developing post-traumatic stress disorder (PTSD) for which the prevalence in Europe is higher than initially assumed. While the high economic burden of PTSD is well-documented, little is known about the health care cost differences between individuals with PTSD-CM and those without PTSD in Germany. This study aimed to determine the excess health care and absenteeism costs associated with PTSD-CM in Germany.
Methods
Baseline data from a multi-center randomized controlled trial on individuals with PTSD-CM (n = 361) were combined with data from individuals without PTSD (n = 4760). Entropy balancing was used to balance the data sets with regard to sociodemographic characteristics. Six-month excess health care costs from a societal perspective were calculated for 2022, using two-part models with logit specification for the first part and a generalized linear model for the second part.
Results
The total six-month excess costs associated with PTSD-CM were €8864 (95% CI: €6855 to €10,873) per person. Of this, the excess health care costs accounted for €4647 (95% CI €3296 to €5997) and the excess costs of absenteeism for €4217 (95% CI: €3121 to €5314). Individuals with mild to moderate PTSD symptoms incurred total excess costs of €6038 (95% CI: €3879 to €8197), while those with severe to extreme symptoms faced €11,433 (95% CI: €8220 to €14,646).
Conclusions
Excess health care and absenteeism costs associated with PTSD-CM were substantial, with absenteeism accounting for roughly half of the total excess costs.
This chapter provides a review for post-traumatic stress disorder (PTSD). It starts by presenting the epidemiological data as well as the risk factors in the development of PTSD. It then defines the diagnosis of PTSD, by using both DSM-5 and ICD-11 criteria, and provides a clinical approach on how to clarify differential diagnoses and comorbidities. It then reviews the pathophysiology and pathogenesis of PTSD by looking at neuroanatomic, neuroendocrine, neurochemical, and genetic changes in brain neural networks. It concludes by presenting the current evidence-based options for the treatment and management of PTSD that include psychotherapy and pharmacotherapy.
A history of psychologically traumatic experiences can impact health outcomes for pregnant people and their infants. The perception and prevalence of traumatic experiences during pregnancy may differ by geographical region. To better understand trends in how and what kinds of psychological trauma are assessed globally, we conducted a secondary analysis on a larger systematic review examining psychological trauma measurement in pregnancy. Through a systematic literature review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, completed between July 2021 and September 2023 using Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, PsycInfo and Cochrane, we identified 576 research studies assessing psychological trauma during pregnancy that were conducted across nine geopolitical regions. Most of these studies took place in North America, followed by sub-Saharan Africa, Europe, Asia, the Middle East or Northern Africa, Oceania, South America, and Central America. The fewest number of studies was conducted across multiple regions. We found that most studies measuring psychological trauma in pregnancy across the nine geopolitical regions assessed interpersonal trauma, and the fewest number of studies assessed healthcare trauma. Moreover, for each type of psychological trauma assessed, the greatest number of studies was conducted in North America. We also found that Central America, Oceania, sub-Saharan Africa, Asia, Middle East or Northern Africa, Europe, and studies conducted across multiple regions had one-third or more studies that only used in-house assessments, rather than previously validated assessments of psychological trauma. The results of this review emphasize the need for regionally specific and culturally appropriate measures of psychological trauma for pregnant people, which prioritize the types of psychological trauma that are most common in a given region. Newly developed measures can be used for screening and treatment of patients using trauma-informed obstetric care.
History of prior mental disorder, particularly post-traumatic stress disorder (PTSD), increases risk for PTSD following subsequent trauma exposure. However, limited research has examined differences associated with specific prior mental disorders among people with PTSD.
Aims
The current study examined whether different prior mental disorders were associated with meaningful differences among individuals presenting to a specialist service for severe earthquake-related distress following the Canterbury earthquakes (N = 177).
Method
Two sets of comparisons were made: between participants with no history of prior disorder and participants with history of any prior disorder; and between participants with history of prior PTSD and those with history of other prior disorders. Comparisons were made in relation to sociodemographic factors, earthquake exposure, peri-traumatic distress, life events and current psychological functioning.
Results
Participants with any prior mental disorder had more current disorders than those with no prior disorder. Among participants with history of any prior disorder, those with prior PTSD reported more life events in the past 5 years than those with other prior disorders.
Conclusions
Findings suggest a history of any prior mental disorder contributes to increased clinical complexity, but not increased PTSD severity, among people with PTSD seeking treatment. Although post-disaster screening efforts should include those with prior mental disorders, it should also be recognised that those with no prior disorders are also at risk of developing equally severe PTSD.
Little is known about the prevalence of post-traumatic stress disorder (PTSD) in emerging adults living with HIV in low-income countries.
Aims
Determine prevalence of trauma exposure, prevalence of probable PTSD and conditional prevalence of probable PTSD for different traumatic events; and better understand the experiences of individuals with HIV and PTSD.
Method
This mixed method study used secondary data from a cross-sectional survey of people (N = 222) aged 18 to 29 living with HIV in Zimbabwe and primary qualitative data collection. The PTSD Checklist for DSM-5 (PCL-5) and the Life Events Checklist for DSM-5 (LEC-5) were used to measure PTSD and exposure to traumatic events, both translated to Shona. In-depth interviews (n = 8) with participants who met the criteria for probable PTSD were analysed using thematic analysis.
Results
In all, 68.3% [95% CI (61.4–74.1)] of participants reported exposure to at least one traumatic event. The observed prevalence of probable PTSD was 8.6% [95% CI (5.2–13.0)], most observed following exposure to fire or explosion 29.0% [95% CI (13.0–45.0)] and sexual assault 27.8% [95% CI (7.2–48.7)]. Probable PTSD was also more prevalent following multiple exposure to trauma; four and six events, N = 4 (21%) [95% CI (5.1–8.8)] each, two and three events N = 3 (15.7%) [95% CI (5.9–9.2)] each, and five events N = 1 (5.4%) [95% CI (7.5–9.6)]. Qualitative results indicated that HIV stigma exacerbated psychological distress from trauma.
Conclusions
Despite trauma exposure being common, prevalence of probable PTSD was not high, but was higher in those with multiple exposures. Participants described coping strategies, including social support and religious thinking.
The mental health of paramedics is critical for disaster response in order to provide rapid and effective interventions. This study aimed to determine the prevalence of post-traumatic stress disorder (PTSD) and related individual and occupational factors in Turkish paramedics during the eleventh month of the COVID-19 pandemic.
Methods
The “Sociodemographic Information Form,” “Life Events Checklist,” and “Post-Traumatic Stress Disorder Checklist” were used to collect data from 440 randomly selected paramedics in this cross-sectional study.
Results
The prevalence of PTSD was 59.8% in the 11th month of the COVID-19 pandemic. Multiple regression analysis revealed that approximately 25% of the total PTSD score could be independently explained by paramedics’ general health situation and sociodemographic characteristics; 27% by crisis management skills, long working hours, a lack of equipment, and intensive work; and 40% by past traumatic experiences due to difficult life events during their professional practice, such as responding to gunshot wounds, becoming a victim of a gunshot attack, or sexual assault (P < 0.05).
Conclusions
Integrating a mental health monitoring system into the health and safety program, providing paramedics with supervision and psychological assistance, and engaging them in disaster preparedness planning would be beneficial.
Among those with common mental health disorders (e.g. mood, anxiety, and stress disorders), comorbidity of substance and other addictive disorders is prevalent. To simplify the seemingly complex relationships underlying such comorbidity, methods that include multiple measures to distill which specific addictions are uniquely associated with specific mental health disorders rather than due to the co-occurrence of other related addictions or mental health disorders can be used.
Methods
In a general population sample of Jewish adults in Israel (N = 4002), network analysis methods were used to create partial correlation networks of continuous measures of problematic substance (non-medical use of alcohol, tobacco, cannabis, and prescription sedatives, stimulants, and opioid painkillers) and behavioral (gambling, electronic gaming, sexual behavior, pornography, internet, social media, and smartphone) addictions and common mental health problems (depression, anxiety, and post-traumatic stress disorder [PTSD]), adjusted for all variables in the model.
Results
Strongest associations were observed within these clusters: (1) PTSD, anxiety, and depression; (2) problematic substance use and gambling; (3) technology-based addictive behaviors; and (4) problematic sexual behavior and pornography. In terms of comorbidity, the strongest unique associations were observed for PTSD and problematic technology-based behaviors (social media, smartphone), and sedatives and stimulants use; depression and problematic technology-based behaviors (gaming, internet) and sedatives and cannabis use; and anxiety and problematic smartphone use.
Conclusions
Network analysis isolated unique relationships underlying the observed comorbidity between common mental health problems and addictions, such as associations between mental health problems and technology-based behaviors, which is informative for more focused interventions.
Although natural hazards (e.g., tropical cyclones, earthquakes) disproportionately affect developing countries, most research on their mental health impact has been conducted in high-income countries. We aimed to summarize prevalences of mental disorders in Global South populations (classified according to the United Nations Human Development Index) affected by natural hazards.
Methods
To identify eligible studies for this meta-analysis, we searched MEDLINE, PsycINFO and Web of Science up to February 13, 2024, for observational studies with a cross-sectional or longitudinal design that reported on at least 100 adult survivors of natural hazards in a Global South population and assessed mental disorders with a validated instrument at least 1 month after onset of the hazard. Main outcomes were the short- and long-term prevalence estimates of mental disorders. The project was registered on the International Prospective Register of Systematic Reviews (CRD42023396622).
Results
We included 77 reports of 75 cross-sectional studies (six included a non-exposed control group) comprising 82,400 individuals. We found high prevalence estimates for post-traumatic stress disorder (PTSD) in the general population (26.0% [95% CI 18.5–36.3]; I2 = 99.0%) and depression (21.7% [95% CI 10.5–39.6]; I2 = 99.2%) during the first year following the event, with similar prevalences observed thereafter (i.e., 26.0% and 23.4%, respectively). Results were similar for regions with vs. without recent armed conflict. In displaced samples, the estimated prevalence for PTSD was 46.5% (95% CI 39.0–54.2; k = 6; I2 = 93.3). We furthermore found higher symptom severity in exposed, versus unexposed, individuals. Data on other disorders were scarce, apart from short-term prevalence estimates of generalised anxiety disorder (15.9% [95% CI 4.7–42.0]; I2 = 99.4).
Conclusions
Global South populations exposed to natural hazards report a substantial burden of mental disease. These findings require further attention and action in terms of implementation of mental health policies and low-threshold interventions in the Global South in the aftermath of natural hazards. However, to accurately quantify the true extent of this public health challenge, we need more rigorous, well-designed epidemiological studies across diverse regions. This will enable informed decision making and resource allocation for those in need.
Well documented in the lives of people with intellectual disability are greatly increased occurrences of adverse life events, exposure to abuse (emotional, physical, sexual), neglect, exploitation, victimisation, and hate crimes, in contrast to the general population. Shockingly, abuse has been reported in developmental service systems at even higher rates and in specialist treatment units such as Winterbourne View and Whorlton Hall. People with intellectual disability also experience trauma associated with physical restraint to manage behaviours that challenge services, negative consequences of psychotropic medication, greater exposure to painful medical procedures consequent to health issues, particularly in early and late stages of life and greater than typical discontinuities in care related to hospital admissions, respite, and staff turnover in group and institutional living. The evidence to support medication treatment in post-traumatic stress disorder is reviewed.
The pharmacologic treatment of post-traumatic stress disorder attempts to alleviate the symptoms associated with the condition including anxiety, depression, and sleep disturbances. SSRIs are first-line medications and SNRIs such as venlafaxine are also effective, especially in instances where there has been a suboptimal response to SSRIs. There are quite a few options for nonpharmacologic therapy in older adults. Outcomes are best in those who participate in both pharmacologic and nonpharmacologic treatments. Some of the best outcomes are seen with cognitive behavioral therapy combined with pharmacotherapy. Follow-up for those with post-traumatic stress disorder should involve regular visits with a provider to assess response to treatment. Rating scales such as the PTSD Checklist 5 can be quite helpful in objectively assessing the severity and nature of symptoms over time. The prognosis varies widely among individuals and some patients may experience significant improvement or even full remission of symptoms over time.
Humanitarian migrants are at increased risk of post-traumatic stress disorder (PTSD) and elevated psychological distress. However, men and women often report varying degrees of stress and experience different challenges during migration. While studies have explored PTSD, psychological distress, gender, and resettlement stressors, they have not explored the interplay between these factors. This study aims to address that gap by investigating gender disparities in PTSD and psychological distress among humanitarian migrants in Australia, with a focus on the moderating role of socioeconomic factors.
Methods
This study used data from five waves of the Building a New Life in Australia (BNLA) survey, a longitudinal study of 2,399 humanitarian migrants who arrived in Australia in 2013. PTSD and psychological distress were measured using the PTSD-8 and Kessler-6 (K6) scales, respectively. We conducted generalised linear mixed-effect logistic regression analyses stratified by gender.
Results
Female humanitarian migrants exhibited a significantly higher prevalence of PTSD and psychological distress than males over five years of resettlement in Australia. Women facing financial hardship, unemployment, or residing in short-term housing reported greater levels of PTSD and distress compared to men.
Conclusions
Women facing financial hardship, inadequate housing, and unemployment exhibit higher rates of PTSD and psychological distress, underscoring the significant impact of socioeconomic factors. Addressing these challenges at both individual and systemic levels is essential for promoting well-being and managing mental health among female humanitarian migrants.
In this issue of BJPsych Advances Siddaway explores the challenges of assessing and treating post-traumatic stress disorder (PTSD) and complex PTSD. In this commentary I reflect on those challenges, not least of which is the need for a thorough understanding of different approaches to diagnoses. The very concept of diagnostic classification systems can be problematic, but when used sensitively they can aid communication, assessment and treatment. The relatively new diagnosis of complex PTSD may serve as a more accurate and more useful description of some psychological difficulties, leading to better treatment decisions. Good assessment, leading to accurate diagnosis, useful formulation and effective treatment takes time, and adequate resources should be allocated. Professionals can help patients to make well-informed choices about treatment options and they should offer evidence-based treatments without unnecessary delay.