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Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack. 于特岛恐怖袭击事件八年后,失去亲人的父母和兄弟姐妹的躯体症状和失眠。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-01-12 DOI: 10.1080/20008066.2023.2300585
Erik-Edwin Leonard Nordström, Riittakerttu Kaltiala, Pål Kristensen, Jens C Thimm

Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.

背景:长期悲伤症状(PGS)和创伤后应激症状(PTSS)的水平可能很高,在恐怖丧亲后的许多年都是如此,但有关躯体健康的知识却很少。恐怖主义是一项严重的公共卫生挑战,增加对长期躯体症状和失眠的了解对于制定恐怖主义丧亲后的后续干预措施至关重要:研究恐怖主义丧亲的父母和兄弟姐妹中躯体症状和失眠的发生率及其与 PGS、PTSS 和功能障碍的关系:一项横断面定量研究纳入了122名2011年挪威于特岛恐怖袭击事件中的丧亲者。样本包括88名父母和34名兄弟姐妹,年龄均在19岁及以上(男=49.7岁,女=13.8岁,59.8%为女性)。参与者在袭击发生 8 年后填写了调查问卷,评估躯体症状(儿童躯体症状量表)和失眠(卑尔根失眠量表),以及 PGS(复杂悲伤量表)、PTSS(事件影响量表-修订版)和功能障碍(工作和社会适应量表):疲劳是最常报告的躯体症状(88% 的女性和 65% 的男性)。据统计,女性报告的躯体症状明显多于男性。总计有 68% 的丧亲者的失眠评分超过了临界值。在失眠方面,性别差异没有统计学意义。女性性别、入侵和唤醒与躯体症状有关。躯体症状与失眠有关。躯体症状、回避和过度唤醒与功能障碍有关:结论:许多失去亲人的父母和兄弟姐妹在恐怖袭击发生八年后报告了躯体症状和失眠。躯体症状与功能障碍有关。创伤性丧亲后的长期跟踪和支持应重点关注躯体症状和失眠。
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引用次数: 0
The role of interoception in reducing trauma-associated distress: a feasibility study. 互感在减少与创伤有关的痛苦中的作用:一项可行性研究。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-01-30 DOI: 10.1080/20008066.2024.2306747
Daria Shatrova, Pablo F Cáncer, Jose Manuel Caperos

Background: Altered interoception plays an important role in chronic stress and posttraumatic stress disorder. The aim of this study was to evaluate the feasibility of a Trauma Sensitive Yoga (TSY) intervention for improving emotional distress and psychological discomfort in women living under circumstances of social and gender vulnerability. We assessed the effect of the treatment on the interoceptive mechanisms, and whether the psychological improvements were mediated by the changes in these mechanisms.Methods: The study involved a sample of 62 women who attended public community centres dedicated to supporting women victims of gender-based violence or who were socially and economically disadvantaged because of their gender. Participants underwent a six-week TSY programme. We evaluated dropout rate, adherence, and intervention satisfaction. We measured emotional distress, psychological discomfort, interoceptive mechanisms, and two nonequivalent dependent variables to enhance internal validity. We compared pre-post differences using paired samples t-test and a structural equation model (SEM) analysis was performed to compare the changes in the outcomes with the changes in the nonequivalent dependent variables. Mediation models were adjusted to evaluate the role of changes in interoception on outcome changes.Results: Fourteen (23%) women dropped out, mainly after the first intervention session. Intervention adherence (mean attendance 5.3 over 6 sessions) and acceptability were high (mean satisfaction 3.4 over 4). We observed post-intervention improvements in anxiety, depression, psychological discomfort, body responsiveness, and interoceptive awareness. The changes in the outcomes were larger than the changes in the nonequivalent dependent variables. Additionally, we found that the changes in body responsiveness partially mediated the change in anxiety and psychological discomfort but not in depression.Conclusions: TSY could be an interesting therapeutic approach for women experiencing chronic posttraumatic stress symptomatology. Our findings underscore the role of interoceptive mechanisms in traumatic stress and emphasize the importance of addressing these aspects.

背景:截觉改变在慢性压力和创伤后应激障碍中起着重要作用。本研究旨在评估创伤敏感瑜伽(TSY)干预对改善生活在社会和性别弱势环境中的女性的情绪困扰和心理不适的可行性。我们评估了治疗对感知间机制的影响,以及心理改善是否由这些机制的变化促成:研究对象为 62 名妇女,她们都曾在专门为性别暴力受害妇女或因其性别而在社会和经济上处于弱势地位的妇女提供支持的公共社区中心就读。参与者参加了为期六周的 TSY 计划。我们对辍学率、坚持率和干预满意度进行了评估。我们测量了情绪困扰、心理不适、感知机制和两个非等效因变量,以提高内部有效性。我们使用配对样本 t 检验比较了前后的差异,并进行了结构方程模型(SEM)分析,以比较结果的变化与非等效因变量的变化。对中介模型进行了调整,以评估内感知的变化对结果变化的作用:14名妇女(23%)退出了干预,主要是在第一次干预之后。干预的依从性(6 个疗程的平均出席率为 5.3)和可接受性都很高(4 个疗程的平均满意度为 3.4)。我们观察到,干预后焦虑、抑郁、心理不适、身体反应能力和内感知意识都有所改善。结果的变化大于非等效因变量的变化。此外,我们还发现,身体反应能力的变化在一定程度上促进了焦虑和心理不适的变化,但对抑郁没有影响:TSY可以作为一种有趣的治疗方法,用于治疗女性的慢性创伤后应激症状。我们的研究结果强调了创伤应激中感受机制的作用,并强调了解决这些问题的重要性。
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引用次数: 0
Heightened response to positive facial cues as a potential marker of resilience following childhood adversity. 对积极面部暗示的反应增强是童年逆境后复原力的潜在标志。
IF 5 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-02-06 DOI: 10.1080/20008066.2024.2309783
Mattia I Gerin, Essi Viding, Louise Neil, Diana J N Armbruster-Genc, Ze Freeman, Molly Sharp, Harriet Phillips, Eamon J McCrory

Background: Childhood maltreatment profoundly influences social and emotional development, increasing psychiatric risk. Alterations in the implicit processing of threat-related cues following early abuse and neglect represent a marker of mental health vulnerability. Less is known about how early adversity influences the perception of positive social cues, despite their central role in establishing and maintaining social interactions and their association with better mental health outcomes.Methods: The sample consisted of 42 children and adolescents with substantiated childhood maltreatment experiences and 32 peers (mean age 13.3), matched on age, pubertal status, gender, socioeconomic status, ethnicity, and cognitive ability. A computerised experimental task assessed the perceived emotional intensity of positive (happy) and negative (fearful) facial expressions. Mental health symptoms were measured via self- and parental reports, and perceived social support was self-reported.Results: The experience of abuse and neglect was associated with heightened perceived intensity of positive facial cues. Cross-sectional post-hoc moderation and mediation analyses, employing a model-building approach, revealed that in maltreatment-exposed participants: (i) their increased response to positive facial cues was associated with lower symptoms; (ii) the presence of social support accounted for their heightened perceived intensity of positive facial cues; (iii) the presence of social support putatively contributed to lower symptoms by increasing the perceived intensity of positive facial cues. No group differences in perceived intensity of negative expressions were observed.Conclusions: These findings provide fresh insight into how positive faces are processed following maltreatment experience in childhood. Maltreatment experience was found to be associated with heightened perceived intensity of happy faces, which in turn was associated with better mental health and greater levels of social support. This suggests that heightened saliency of positive emotions acts protectively in children with maltreatment experience.

背景:童年时期的虐待行为会严重影响儿童的社交和情感发育,从而增加患精神病的风险。早期遭受虐待和忽视后,对威胁相关线索的内隐处理发生了改变,这是精神健康易受攻击的一个标志。早期逆境如何影响对积极社交线索的感知,尽管这些线索在建立和维持社会交往中起着核心作用,而且与更好的心理健康结果有关,但人们对此知之甚少:样本包括 42 名有确凿童年虐待经历的儿童和青少年以及 32 名同龄人(平均年龄 13.3 岁),他们的年龄、青春期状况、性别、社会经济地位、种族和认知能力均匹配。一项计算机化的实验任务评估了积极(快乐)和消极(恐惧)面部表情的感知情绪强度。心理健康症状通过自我报告和父母报告进行测量,感知到的社会支持通过自我报告进行测量:结果:虐待和忽视的经历与积极面部暗示的感知强度增加有关。采用建立模型的方法进行的横截面事后调节和中介分析表明,遭受虐待的参与者:(i) 对积极面部暗示的反应增强与症状减轻有关;(ii) 社会支持的存在是他们对积极面部暗示感知强度增强的原因;(iii) 社会支持的存在通过增强对积极面部暗示的感知强度,可能有助于减轻症状。在消极表情的感知强度方面没有观察到任何群体差异:这些研究结果为我们提供了新的视角,让我们了解在童年时期遭受虐待后,正面表情是如何被处理的。研究发现,虐待经历与快乐面孔的感知强度增加有关,而快乐面孔的感知强度增加又与更好的心理健康和更高的社会支持水平有关。这表明,积极情绪的显著性增强对有虐待经历的儿童具有保护作用。
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引用次数: 0
The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic. 在 COVID-19 大流行期间,精神伤害和精神痛苦对医护人员创伤后应激障碍症状的独立和综合影响。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-02-09 DOI: 10.1080/20008066.2023.2299661
Andrea M D'Alessandro-Lowe, Herry Patel, Bethany Easterbrook, Kim Ritchie, Andrea Brown, Yuanxin Xue, Mauda Karram, Heather Millman, Emily Sullo, Mina Pichtikova, Andrew Nicholson, Alex Heber, Ann Malain, Charlene O'Connor, Hygge Schielke, Sarah Rodrigues, Fardous Hosseiny, Randi E McCabe, Ruth A Lanius, Margaret C McKinnon

Background: Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic.Methods: HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the sample when controlling for sex, age, depression, anxiety, stress, and childhood adversity.Results: A structural equation model independently regressing both MI and MD onto PTSD accounted for 74.4% of the variance in PTSD symptoms. Here, MI was strongly and significantly associated with PTSD symptoms (β = .412, p < .0001) to a higher degree than MD (β = .187, p < .0001), after controlling for age, sex, depression, anxiety, stress and childhood adversity. A model regressing a combined MD and MI construct onto PTSD predicted approximately 87% of the variance in PTSD symptoms (r2 = .87, p < .0001), with MD/MI strongly and significantly associated with PTSD (β = .813, p < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity.Conclusion: Our results support a relation between MI and PTSD among HCWs and suggest that a combined MD and MI construct is most strongly associated with PTSD symptoms. Further research is needed better understand the mechanisms through which MD/MI are associated with PTSD.

背景:在 COVID-19 大流行期间,全球各地的医护人员(HCWs)都报告了创伤后应激障碍(PTSD)症状。道德伤害(MI)在军事人群中与创伤后应激障碍有关,但在医疗保健环境中却没有得到很好的研究。道德压力(MD)是一个相关的概念,它可以加深医护人员对道德伤害及其与创伤后应激障碍之间关系的理解。方法:2021 年 2 月至 12 月期间,医护人员参与了一项在线调查,调查问题涉及社会人口统计学、心理健康和创伤史(如 MI、MD、创伤后应激障碍、分离、抑郁、焦虑、压力、童年逆境)。在控制性别、年龄、抑郁、焦虑、压力和童年逆境的情况下,采用结构方程模型分析了创伤后应激障碍(MI)和精神分裂症(MD)对样本中创伤后应激障碍症状(包括解离)的独立和综合影响:将 MI 和 MD 独立回归到创伤后应激障碍的结构方程模型占创伤后应激障碍症状变异的 74.4%。其中,MI 与创伤后应激障碍症状有明显的密切关系(β = .412,p β = .187,p r2 = .87,p β = .813,p 结论:我们的研究结果表明,MI 与创伤后应激障碍症状有明显的密切关系:我们的研究结果支持多元智能与创伤后应激障碍之间的关系,并表明 MD 和多元智能的组合与创伤后应激障碍症状的关系最为密切。我们需要进一步开展研究,以便更好地了解 MD/MI 与创伤后应激障碍之间的关联机制。
{"title":"The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic.","authors":"Andrea M D'Alessandro-Lowe, Herry Patel, Bethany Easterbrook, Kim Ritchie, Andrea Brown, Yuanxin Xue, Mauda Karram, Heather Millman, Emily Sullo, Mina Pichtikova, Andrew Nicholson, Alex Heber, Ann Malain, Charlene O'Connor, Hygge Schielke, Sarah Rodrigues, Fardous Hosseiny, Randi E McCabe, Ruth A Lanius, Margaret C McKinnon","doi":"10.1080/20008066.2023.2299661","DOIUrl":"10.1080/20008066.2023.2299661","url":null,"abstract":"<p><p><b>Background:</b> Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic.<b>Methods:</b> HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the sample when controlling for sex, age, depression, anxiety, stress, and childhood adversity.<b>Results:</b> A structural equation model independently regressing both MI and MD onto PTSD accounted for 74.4% of the variance in PTSD symptoms. Here, MI was strongly and significantly associated with PTSD symptoms (<i>β</i> = .412, <i>p</i> < .0001) to a higher degree than MD (<i>β</i> = .187, <i>p</i> < .0001), after controlling for age, sex, depression, anxiety, stress and childhood adversity. A model regressing a combined MD and MI construct onto PTSD predicted approximately 87% of the variance in PTSD symptoms (<i>r</i><sup>2</sup> = .87, <i>p</i> < .0001), with MD/MI strongly and significantly associated with PTSD (<i>β</i> = .813, <i>p</i> < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity.<b>Conclusion:</b> Our results support a relation between MI and PTSD among HCWs and suggest that a combined MD and MI construct is most strongly associated with PTSD symptoms. Further research is needed better understand the mechanisms through which MD/MI are associated with PTSD.</p>","PeriodicalId":12055,"journal":{"name":"European Journal of Psychotraumatology","volume":"15 1","pages":"2299661"},"PeriodicalIF":4.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10860446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Childbirth as a traumatic event for attendant fathers. 分娩对随行父亲来说是一个创伤性事件。
IF 5 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-04-29 DOI: 10.1080/20008066.2024.2338671
Anna Golubitsky, Carolyn Weiniger, Yaron Sela, Daniella Mouadeb, Sara Freedman

Background: Negative reactions such as post-traumatic stress disorder (PTSD) following childbirth have been increasingly reported in mothers, particularly following objectively and subjectively difficult childbirth experiences. A small body of research has examined fathers' reactions to childbirth, with mixed results.Objective: The study aimed to further these studies, investigating whether objective and subjective aspects of fathers' participation in childbirth were related to levels of PTSD and fear of childbirth symptoms, in the first year following childbirth.Method: In total, 224 fathers whose partners had given birth within the previous 12 months answered online questionnaires that examined participation in childbirth, subjective appraisals, levels of fear of childbirth, and PTSD symptoms. Data were analysed using structural equation modelling, examining both direct and indirect effects.Results: Approximately 6% of fathers reported symptoms consistent with probable PTSD. Negative cognitions mediated the path between an emergency caesarean and PTSD. Fear of childbirth was related to emergency caesareans and lack of information from the medical team.Conclusions: Future studies should examine the level of fathers' participation, their subjective appraisal of childbirth, and fear of childbirth, when assessing fathers' reactions to childbirth.

背景:越来越多的报道称,母亲在分娩后会出现创伤后应激障碍(PTSD)等不良反应,尤其是在客观和主观上经历了难产之后。有一小部分研究探讨了父亲对分娩的反应,结果不一:本研究旨在进一步推动这些研究,调查父亲参与分娩的客观和主观方面是否与产后第一年的创伤后应激障碍水平和分娩恐惧症状有关:共有 224 名父亲的伴侣在过去 12 个月内生育过孩子,他们回答了在线问卷,问卷调查了父亲参与分娩的情况、主观评价、对分娩的恐惧程度以及创伤后应激障碍症状。我们使用结构方程模型对数据进行了分析,研究了直接和间接效应:结果:约有 6% 的父亲报告了可能患有创伤后应激障碍的症状。负面认知在紧急剖腹产和创伤后应激障碍之间起到了中介作用。对分娩的恐惧与紧急剖腹产和缺乏医疗团队的信息有关:未来的研究在评估父亲对分娩的反应时,应考察父亲的参与程度、他们对分娩的主观评价以及对分娩的恐惧。
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引用次数: 0
Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness. COVID-19 危重病幸存者抑郁症和创伤后应激障碍症状的发生、并发和持续情况。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-06-17 DOI: 10.1080/20008066.2024.2363654
Guillem Navarra-Ventura, Marta Godoy-González, Gemma Gomà, Mercè Jodar, Leonardo Sarlabous, Verónica Santos-Pulpón, Alba Xifra-Porxas, Candelaria de Haro, Oriol Roca, Lluís Blanch, Josefina López-Aguilar, Sol Fernández-Gonzalo

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.

背景:入住重症监护病房(ICU)和进行有创机械通气(IMV)与心理压力和创伤有关。COVID-19 大流行带来了一系列额外的长期压力和创伤体验。然而,人们对合并抑郁症和创伤后应激障碍(PTSD)知之甚少:研究 COVID-19 危重症幸存者中具有临床意义的抑郁症和创伤后应激障碍症状的发生、并发和持续情况及其预测因素:方法:单中心前瞻性观察研究,对象为入住重症监护室≥24小时的COVID-19成年幸存者。使用医院焦虑和抑郁量表的抑郁分量表和戴维森创伤量表对重症监护室出院后1个月和12个月的患者进行评估。分析了患有和未患有IMV的患者在抑郁症和创伤后应激障碍的独立症状和合并症状方面的差异,以及这些精神障碍症状发生和持续的预测因素:89名患者(42名IMV患者)完成了1个月的随访,71名患者(34名IMV患者)完成了12个月的随访。出院一个月后,29.2%的患者出现抑郁症状,36%的患者出现创伤后应激障碍症状;一年后,这两个数字分别为32.4%和31%。抑郁症状和创伤后应激障碍症状并存的患者约占所有症状病例的一半。IMV患者出现孤立的创伤后应激障碍症状的频率更高(p≤.014)。IMV需求与这两种精神障碍中任何一种症状在一个月内的发生率(OR = 6.098,p = .005)和12个月内的持续率(OR = 3.271,p = .030)相关:结论:在我们的 COVID-19 危重症幸存者队列中,合并抑郁症状和创伤后应激障碍症状的发生率很高。对 IMV 的需求预示着这些精神障碍症状的短期发生和长期存在,尤其是创伤后应激障碍症状。呼吸困难在IMV与重症监护室后精神障碍之间的关联中的具体作用值得进一步研究:试验注册:ClinicalTrials.gov identifier:试验注册:ClinicalTrials.gov 标识符:NCT04422444。
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引用次数: 0
Torture and its sequelae among prostituted women in the United States. 美国卖淫妇女遭受的酷刑及其后遗症。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-10-01 DOI: 10.1080/20008066.2024.2404307
Melissa Farley, M Alexis Kennedy

Background: Extreme violence and psychological abuse have been extensively documented and are pervasive in prostitution. Survivors of prostitution report high levels of posttraumatic stress disorder, dissociation, depression, and self-loathing. These are the same sequelae reported by torture survivors.Objective: Severe forms of violence have been categorized as torture by experts. The authors note that torture is commonly suffered during prostitution and should be appropriately named.Method: Using standardized measures and including a new measure of torture, we interviewed 45 women in the United States about their torture experiences in prostitution and their symptoms of PTSD, dissociation, childhood trauma, health status and somatic symptoms. The interviewees had exited prostitution and were in supportive programmes.Results: Formerly prostituted interviewees reported acts of physical, sexual, and psychological torture, including strangulation, rape, beatings, restriction of movement, denial of privacy, sleep, or food, and being forced to witness the torture of others. The 45 women had high levels of PTSD and dissociation. They endorsed needs for individual counselling, substance abuse treatment, and other medical care.Conclusions: A recognition of the physical, sexual, and psychological torture experienced in prostitution would strengthen psychological and medical interventions for survivors. Naming specific acts of prostitution as torture will reduce the survivor's shame and self-blame. Holistic treatment includes medical and psychological interventions and peer support, as seen in torture rehabilitation programmes for survivors of state-sponsored torture. This research supports the perspective that private or non-state-sponsored torture against women and marginalized populations should be clinically and legally understood in the same way as state-sponsored torture.

背景:极端暴力和心理虐待已被广泛记录在案,并在卖淫活动中普遍存在。据卖淫幸存者报告,他们患有严重的创伤后应激障碍、解离症、抑郁症和自我厌恶。这些与酷刑幸存者报告的后遗症相同:专家将严重的暴力形式归类为酷刑。作者指出,酷刑通常是在卖淫过程中遭受的,因此应予以适当命名:我们采用标准化的测量方法,包括一种新的酷刑测量方法,对美国的 45 名妇女进行了访谈,了解她们在卖淫过程中遭受酷刑的经历,以及她们的创伤后应激障碍、解离、童年创伤、健康状况和躯体症状。受访者已退出卖淫业,并参加了支持性项目:结果:曾经卖淫的受访者报告了遭受身体、性和心理折磨的经历,包括勒颈、强奸、殴打、限制行动、剥夺隐私、睡眠或食物,以及被迫目睹他人遭受折磨。这 45 名妇女患有严重的创伤后应激障碍和分离症。她们表示需要个人咨询、药物滥用治疗和其他医疗护理:结论:认识到卖淫过程中经历的身体、性和心理折磨将加强对幸存者的心理和医疗干预。将具体的卖淫行为称为酷刑将减少幸存者的羞耻感和自责感。整体治疗包括医疗和心理干预以及同伴支持,这在针对国家支持的酷刑幸存者的酷刑康复计划中可见一斑。这项研究支持这样一种观点,即针对妇女和边缘化人群的私人或非国家支持的酷刑应与国家支持的酷刑一样得到临床和法律上的理解。
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引用次数: 0
High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination. 乌克兰战争难民中创伤后应激障碍的高发率:对不确定性的不容忍、失控和随后的歧视所起的作用。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-10-02 DOI: 10.1080/20008066.2024.2394296
Michał Bilewicz, Maria Babińska, Anna Gromova

Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals.Objective: This article addresses this problem in a study of Ukrainian war refugees' experiences with post-migration discrimination and powerlessness (loss of control).Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty.Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty.Conclusions: Understanding the effect of post-migration experiences on war refugees' mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

背景:众所周知,对不确定性的不容忍是创伤事件后出现创伤后应激症状的一个预测因素。与此同时,对于不确定性的不容忍是否会放大其他不利生活事件对创伤后应激障碍症状的影响,人们还相对缺乏了解:本文通过研究乌克兰战争难民在移民后遭受歧视和无能为力(失去控制)的经历来解决这一问题:4972名来自乌克兰的被迫移民(90.2%为女性,男性=40.4,女性=12.5)参加了研究,他们填写了创伤后应激障碍-8量表、移民后歧视和失控经历测量表以及对不确定性的不容忍度测量表:几乎一半的受访者(47.5%)可能患有创伤后应激障碍。回归分析证实,与战争有关的经历、对不确定性的不容忍、移民后的失控和歧视经历是自我报告的创伤后应激障碍症状的重要预测因素。此外,对不确定性的不容忍弱化了歧视经历和控制权丧失对自我报告的创伤后应激障碍症状的影响,因此,移民后不利经历对不确定性不容忍度高的人的影响更为明显:了解移民后经历对战争难民心理健康的影响对于制定更好的文化适应政策和为被迫移民营造有利环境至关重要。
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引用次数: 0
Fostering trust - a qualitative outcome study of psychodynamic group and individual psychotherapy for refugees with PTSD. 培养信任--针对创伤后应激障碍难民的心理动力学小组和个人心理治疗的定性结果研究。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-10-21 DOI: 10.1080/20008066.2024.2413736
Sebastian Zinfandel, Martin Svensson

Background: Refugees and asylum-seekers have an elevated risk of mental health issues, such as depression and posttraumatic stress. Qualitative outcome studies can contribute by offering insight into patients' experiences of what they find beneficial and how they undergo the process of recovery. This study aligns with the small body of qualitative research focusing on refugees' perspectives of psychotherapeutic treatment for PTSD.Objective: This study investigates and compares the treatment experiences of refugees with posttraumatic stress disorder (PTSD) in psychoanalytic group therapy (PAGT) and individual psychodynamic therapy (PDT) within an outpatient context in Sweden.Method: 10 former patients were interviewed using a semi-structured interview schedule. Data were analysed and interpreted according to the principles of grounded theory.Results: The findings reveal distinct categories for each treatment modality, being reborn for PDT and building a home for PAGT. Being reborn involved persistent intrapersonal change and lasting improvement in posttraumatic symptoms. Building a home involved a sense of belonging, support and temporary relief from posttraumatic symptoms. Participants from both treatment modalities underscored the significance of cultivating trust in therapeutic relationships.Conclusions: The study emphasises the necessity for tailored therapeutic approaches, contributing valuable insights to the limited research on effective mental health interventions for this population.

背景:难民和寻求庇护者罹患抑郁症和创伤后应激反应等心理健康问题的风险较高。定性结果研究可以帮助我们深入了解患者的经历,让我们了解他们认为哪些治疗是有益的,以及他们是如何经历康复过程的。本研究与关注难民对创伤后应激障碍心理治疗的看法的少量定性研究相一致:本研究调查并比较了瑞典门诊患者中患有创伤后应激障碍(PTSD)的难民在精神分析小组疗法(PAGT)和个人心理动力学疗法(PDT)中的治疗经历:方法:采用半结构化访谈表对 10 名前患者进行了访谈。根据基础理论的原则对数据进行分析和解释:研究结果表明,每种治疗方式都有不同的类别,PDT 属于 "重生",PAGT 属于 "建立家园"。重生涉及持续的人际变化和创伤后症状的持久改善。建立家园涉及归属感、支持和创伤后症状的暂时缓解。两种治疗模式的参与者都强调了在治疗关系中培养信任的重要性:这项研究强调了采取有针对性的治疗方法的必要性,为针对这类人群的有效心理健康干预措施的有限研究提供了有价值的见解。
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引用次数: 0
Moral injury appraisals and posttraumatic stress symptoms in trauma-exposed police officers: a latent class analysis. 受创伤警官的道德伤害评价和创伤后应激症状:潜类分析。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-06-21 DOI: 10.1080/20008066.2024.2365030
Nora Mooren, Simone M de la Rie, Paul A Boelen

Background: Police officers encounter various potentially traumatic events (PTEs) and may be compelled to engage in actions that contradict their moral codes. Consequently, they are at risk to develop symptoms of Posttraumatic Stress Disorder (PTSD), but also moral stress or moral injury (MI). To date, MI in police officers has received limited attention.Objective: The present study sought to identify classes of MI appraisals and PTSD symptoms among police officers exposed to PTEs, while also investigating potential clinical differences between these classes.Method: For this study, 421 trauma-exposed police officers were assessed on demographics and several clinical measurements including MI appraisals (self-directed and other-directed), PTSD severity, and general psychopathology. Latent class and regression analyses were conducted to examine the presence of different classes among trauma-exposed police officers and class differentiation in terms of demographics, general psychopathology, PTSD severity, mistrust, guilt, self-punishment, and feelings of worthlessness.Results: The following five classes were identified: (1) a 'Low MI, high PTSD class' (28%), (2) a 'High MI, low PTSD class' (11%), (3) a 'High MI, high PTSD class' (17%), (4) a 'Low MI, low PTSD class' (16%), and (5) a 'High MI-other, high PTSD class' (27%). There were significant differences between the classes in terms of age, general psychopathology, PTSD severity, mistrust, guilt, and self-punishment but no differences for gender and feelings of worthlessness.Conclusion: In conclusion, we identified five classes, each exhibiting unique patterns of cognitive MI appraisals and PTSD symptoms. This underscores the criticality of measuring and identifying MI in this particular group, as it allows for tailored treatment interventions.

背景:警察会遇到各种潜在的创伤事件(PTEs),并可能被迫采取与其道德准则相悖的行动。因此,他们有可能出现创伤后应激障碍(PTSD)症状,也有可能出现道德压力或道德伤害(MI)。迄今为止,人们对警察道德伤害的关注还很有限:本研究旨在确定遭受创伤后应激障碍(PTEs)的警察中的精神创伤评估类别和创伤后应激障碍症状,同时调查这些类别之间的潜在临床差异:本研究对 421 名受到创伤的警察进行了人口统计学和多项临床测量评估,包括 MI 评估(自我导向和他人导向)、创伤后应激障碍严重程度和一般心理病理学。通过潜类分析和回归分析,研究了受创伤警察中是否存在不同的类别,以及在人口统计学、一般心理病理学、创伤后应激障碍严重程度、不信任、内疚、自我惩罚和无价值感等方面的类别区分:结果:确定了以下五个等级:(1)"低 MI、高创伤后应激障碍等级"(28%);(2)"高 MI、低创伤后应激障碍等级"(11%);(3)"高 MI、高创伤后应激障碍等级"(17%);(4)"低 MI、低创伤后应激障碍等级"(16%);以及(5)"高 MI-其他、高创伤后应激障碍等级"(27%)。在年龄、一般精神病理学、创伤后应激障碍严重程度、不信任、内疚感和自我惩罚方面,各等级之间存在明显差异,但在性别和无价值感方面没有差异:总之,我们确定了五个等级,每个等级都表现出独特的认知多元评价模式和创伤后应激障碍症状。这强调了测量和识别创伤后应激障碍这一特殊群体的多元智能的重要性,因为这有助于采取有针对性的治疗干预措施。
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引用次数: 0
期刊
European Journal of Psychotraumatology
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