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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 Medicine 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
Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms. 针对有创伤后应激症状的青少年开展以创伤为重点的互联网和移动干预的可行性。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-03 DOI: 10.1080/20008066.2024.2364469
Christina Schulte, Cedric Sachser, Rita Rosner, David Daniel Ebert, Anna-Carlotta Zarski

Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

背景:许多患有创伤后应激症状(PTSS)的青少年得不到循证治疗。基于互联网和移动设备的干预(IMI)包含以创伤为重点的循证内容,可以弥补这一不足,但这方面的研究还很少。因此,我们研究了针对患有 PTSS 的青少年的以创伤为重点的 IMI 的可行性:在一项单臂非随机前瞻性概念验证研究中,32 名年龄在 15-21 岁、患有临床相关的 PTSS(CATS ≥ 21)的青少年在治疗师的指导下接受了以创伤为重点的 IMI,其中包括通过网络浏览器访问的电子健康平台上的 9 个疗程。我们采用了一个可行性框架,对招募能力、样本特征、数据收集、满意度、可接受性、研究管理能力、安全性以及 IMI 对 PTSS 严重程度和相关结果的疗效进行了评估。在干预前、干预中、干预后和3个月随访时进行自评,在基线和干预后进行临床医生评定:结果:样本主要由有人际创伤和较高创伤后应激障碍水平的年轻女性组成(CATS,M = 31.63,SD = 7.64)。参与者认为 IMI 课程有用且易于理解,而创伤处理的可行性则被认为是困难的。约三分之一的参与者(31%)完成了 IMI 的八个核心环节。研究完成者分析表明,在治疗后[t(21) = 4.27; p d = 0.88]和随访[t(18) = 3.83; p = .001; d = 0.84],自我评定的创伤后应激障碍严重程度和临床医生评定的创伤后应激障碍严重程度[t(21) = 4.52; p d = 0.93]均有显著降低,且影响较大。意向治疗分析表明,在治疗后和随访期间,创伤后应激障碍严重程度显著降低,且效应大小较大(d = -0.97--1.02)。所有参与者都经历了至少一次负面影响,最常见的是不愉快记忆的重现(n = 17/22,77%):结论:这项研究覆盖了负担沉重的年轻人。IMI在实用性和可理解性方面都得到了认可,但许多年轻人并没有完成所有疗程。除了在随后的随机对照试验中评估 IMI 的疗效外,还需要探索提高青少年对以创伤为重点的 IMI 坚持率的策略。
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引用次数: 0
Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder. 创伤性失落:区分创伤后应激障碍和长期悲伤障碍的潜在风险因素的系统性回顾。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-18 DOI: 10.1080/20008066.2024.2371762
Philipp Jann, Jessica Netzer, Tobias Hecker

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

背景:当创伤事件和损失以创伤性损失的形式交织在一起时,这些事件可能会引发创伤后应激障碍和病态悲伤:本系统性综述研究了哪些特征可区分创伤后应激障碍和病态悲伤,或与这两种障碍的并发症相关:方法:使用 Medline、PubMed、APA PsycInfo 和 Web of Science 进行系统性文献检索,结果有 46 项研究符合纳入标准。在这些研究中,创伤后应激障碍和病态悲伤分别使用了 17 种和 16 种不同的有效工具进行评估。在质量评估中,12 项研究被评为一般,30 项研究被评为高于一般,4 项研究被评为优秀。所调查的风险因素被分为 19 个上位群组,并采用叙事综合法进行处理:与创伤后应激障碍症状相比,与逝者的关系、心理健康问题和宗教信仰似乎与病态悲伤症状特别相关。社会支持和社会情感是创伤后应激障碍和病态悲伤的重要相关因素和潜在风险因素。所纳入的研究主要采用横断面设计:结论:病态悲伤和创伤后应激障碍之间似乎存在区别因素。结论:病态悲伤和创伤后应激障碍之间的区别因素似乎是存在的,但应考虑到所纳入研究的异质性和研究领域的局限性。目前缺乏以下研究:(1)采用纵向研究设计;(2)在创伤性失落发生后尽早开始数据收集;(3)采用标准化的最新测量工具;(4)在分析中纳入合并症。为了在创伤性失能后进行更准确的(急性)筛查、预后和干预,迫切需要开展进一步的研究。
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引用次数: 0
Childhood trauma is linked to epigenetic age deceleration in young adults with previous youth residential care placements. 童年创伤与曾有青少年寄宿照料经历的青少年的表观遗传年龄减速有关。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-25 DOI: 10.1080/20008066.2024.2379144
Maria Meier, Sina Kantelhardt, Laura Gurri, Christina Stadler, Marc Schmid, Vera Clemens, Aoife O'Donovan, Cyril Boonmann, David Bürgin, Eva Unternaehrer

Background: Early adversity increases the risk for mental and physical disorders as well as premature death. Epigenetic processes, and altered epigenetic aging in particular, might mediate these effects. While the literature that examined links between early adversity and epigenetic aging is growing, results have been heterogeneous.Objective: In the current work, we explored the link between early adversity and epigenetic aging in a sample of formerly out-of-home placed young adults.Method: A total of N = 117 young adults (32% women, age mean = 26.3 years, SD = 3.6 years) with previous youth residential care placements completed the Childhood Trauma Questionnaire (CTQ) and the Life Events Checklist (LEC-R) and provided blood samples for the analysis of DNA methylation using the Illumina Infinium MethylationEPIC BeadChip Microarray. Epigenetic age was estimated using Hovarth's and Hannum's epigenetic clocks. Furthermore, Hovarth's and Hannum's epigenetic age residuals were calculated as a proxy of epigenetic aging by regressing epigenetic age on chronological age. The statistical analysis plan was preregistered (https://osf.io/b9ev8).Results: Childhood trauma (CTQ) was negatively associated with Hannum's epigenetic age residuals, β = -.23, p = .004 when controlling for sex, BMI, smoking status and proportional white blood cell type estimates. This association was driven by experiences of physical neglect, β = -.25, p = .001. Lifetime trauma exposure (LEC-R) was not a significant predictor of epigenetic age residuals.Conclusion: Childhood trauma, and physical neglect in particular, was associated with decelerated epigenetic aging in our sample. More studies focusing on formerly institutionalized at-risk populations are needed to better understand which factors affect stress-related adaptations following traumatic experiences.

背景:早期逆境会增加精神和身体失调以及过早死亡的风险。表观遗传过程,尤其是表观遗传衰老的改变,可能会介导这些影响。虽然研究早期逆境与表观遗传衰老之间联系的文献越来越多,但结果却不尽相同:在目前的研究中,我们以曾经被安置在家庭外的年轻人为样本,探讨了早期逆境与表观遗传衰老之间的联系:共有 N = 117 名曾被安置在青少年寄宿机构的青壮年(32% 为女性,平均年龄 = 26.3 岁,SD = 3.6 岁)填写了童年创伤问卷(CTQ)和生活事件核对表(LEC-R),并提供了血液样本,以便使用 Illumina Infinium MethylationEPIC BeadChip 芯片分析 DNA 甲基化。表观遗传年龄是使用 Hovarth 和 Hannum 的表观遗传时钟估算的。此外,通过将表观遗传年龄与年代年龄进行回归,计算出 Hovarth 和 Hannum 的表观遗传年龄残差,作为表观遗传衰老的替代指标。统计分析计划已预先登记(https://osf.io/b9ev8):结果:在控制性别、体重指数、吸烟状况和白细胞类型比例估计值的情况下,童年创伤(CTQ)与汉纳姆表观遗传年龄残差呈负相关,β = -.23, p = .004。这种关联由身体被忽视的经历驱动,β = -.25, p = .001。终生创伤暴露(LEC-R)对表观遗传年龄残差的预测作用不显著:结论:在我们的样本中,童年创伤,尤其是身体忽视,与表观遗传衰老减速有关。为了更好地了解哪些因素会影响创伤经历后与压力相关的适应性,需要对曾被机构收容的高危人群进行更多的研究。
{"title":"Childhood trauma is linked to epigenetic age deceleration in young adults with previous youth residential care placements.","authors":"Maria Meier, Sina Kantelhardt, Laura Gurri, Christina Stadler, Marc Schmid, Vera Clemens, Aoife O'Donovan, Cyril Boonmann, David Bürgin, Eva Unternaehrer","doi":"10.1080/20008066.2024.2379144","DOIUrl":"10.1080/20008066.2024.2379144","url":null,"abstract":"<p><p><b>Background:</b> Early adversity increases the risk for mental and physical disorders as well as premature death. Epigenetic processes, and altered epigenetic aging in particular, might mediate these effects. While the literature that examined links between early adversity and epigenetic aging is growing, results have been heterogeneous.<b>Objective:</b> In the current work, we explored the link between early adversity and epigenetic aging in a sample of formerly out-of-home placed young adults.<b>Method:</b> A total of <i>N </i>= 117 young adults (32% women, age <i>mean </i>= 26.3 years, <i>SD </i>= 3.6 years) with previous youth residential care placements completed the Childhood Trauma Questionnaire (CTQ) and the Life Events Checklist (LEC-R) and provided blood samples for the analysis of DNA methylation using the Illumina Infinium MethylationEPIC BeadChip Microarray. Epigenetic age was estimated using Hovarth's and Hannum's epigenetic clocks. Furthermore, Hovarth's and Hannum's epigenetic age residuals were calculated as a proxy of epigenetic aging by regressing epigenetic age on chronological age. The statistical analysis plan was preregistered (https://osf.io/b9ev8).<b>Results:</b> Childhood trauma (CTQ) was negatively associated with Hannum's epigenetic age residuals, <i>β </i>= -.23, <i>p</i> = .004 when controlling for sex, BMI, smoking status and proportional white blood cell type estimates. This association was driven by experiences of physical neglect, <i>β </i>= -.25, <i>p</i> = .001. Lifetime trauma exposure (LEC-R) was not a significant predictor of epigenetic age residuals.<b>Conclusion:</b> Childhood trauma, and physical neglect in particular, was associated with decelerated epigenetic aging in our sample. More studies focusing on formerly institutionalized at-risk populations are needed to better understand which factors affect stress-related adaptations following traumatic experiences.</p>","PeriodicalId":12055,"journal":{"name":"European Journal of Psychotraumatology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11275517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758013","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 Medicine 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
Defining military sexual trauma: establishing parameters and perspectives. 界定军队性创伤:确定参数和观点。
IF 4.2 2区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-08-16 DOI: 10.1080/20008066.2024.2390759
Charlotte Herriott, Gavin Campbell, Lauren Godier-McBard, Abigail Wood, Dominic Murphy

Background: The term military sexual trauma [MST] is increasingly used to describe instances of sexual harassment/assault that occur between serving personnel during military service. However, in the absence of a clear universal definition, MST is an increasingly contested term, with confusion about its scope, application to differing jurisdictions and implications for responses and treatment.Objective: This editorial provides a universal definition of MST, decoupled from any national system or framework.Method: Drawing on existing international evidence about the nature and impact of MST.Results and Conclusion: We argue that MST terminology provides a unique framing which recognises the institutional nature of MST victimisation and situates the context, behaviours, and impact on a continuum of violence.

背景:军队性创伤(MST)一词越来越多地被用来描述服役期间现役军人之间发生的性骚扰/性侵犯事件。然而,由于缺乏一个明确的通用定义,MST 成为一个越来越有争议的术语,其范围、在不同司法管辖区的应用以及对应对和治疗的影响都存在混乱:这篇社论提供了一个与任何国家制度或框架脱钩的关于 "强暴性暴力 "的通用定义:方法:借鉴现有的国际证据来说明 MST 的性质和影响:结果与结论:我们认为,"强暴性和性暴力 "这一术语提供了一个独特的框架,承认了强暴性和性暴力受害的制度性质,并将其背景、行为和影响置于暴力的连续统一体中。
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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
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
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
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European Journal of Psychotraumatology
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