Journal of traumatic stress最新文献

Clinicians have expressed concerns that symptoms may worsen during evidence-based treatments for posttraumatic stress disorder (PTSD), such as cognitive processing therapy (CPT). The current study examined rates of symptom exacerbation in two samples undergoing massed CPT: veterans (N = 499) and community members (N = 69). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was administered throughout treatment in both samples, and exacerbation was calculated based on changes from one assessment point to the next during treatment. Clinically reliable exacerbation, defined as a PCL-5 score increase greater than 8.83 points in consecutive measurements taken throughout treatment, was observed at least once in 27.3% of veterans and 21.7% of community members during treatment. Only 1.4% of veterans and 5.8% of community members reported reliably elevated symptoms from baseline at the end of treatment. The findings suggest low rates of clinically meaningful exacerbation during massed CPT, highlighting its utility across diverse populations and treatment formats. These results can inform clinician-patient discussions, alleviate concerns about worsening symptoms, and assuage clinician concerns about symptom exacerbation during CPT.

There are 43,400,000 refugees worldwide; half are children. To address this global public health crisis, there is a need to integrate refugee youth voices into the study of risk and resilience following forced migration. We aimed to disentangle linguistic elements of refugee youths' trauma narratives and identify biopsychosocial correlates of traumatic stress. Participants were 68 youth aged 7-17 years who resettled as refugees of Syria (M_age = 12.85) and provided trauma narratives while electrodermal activity (EDA) was recorded. A mixed-methods analytic approach combined narrative data analyzed using the Linguistic Inquiry and Word Count (LIWC) tool with psychophysiology and self-reported anxiety symptoms. In total, 61.8% of participants mentioned violence and loss in pre-resettlement narratives. Post-resettlement narratives frequently described discrimination and bullying in schools and neighborhoods. Exploratory LIWC analyses revealed social references and perception as the top semantic categories in narratives. Two-tailed Spearman correlations indicated a significant association between anxiety severity and social-related language, r = .40, and home-related language, r = .37, ps < .001. We also observed significant associations between social anxiety and space-related language, r = .36, p < .001, and baseline tonic EDA and death-related language frequency, r = -.38, p < .001. Effects did not survive correction for multiple comparisons. The design and preliminary data lay the groundwork for further understanding the qualitative stressors of youth pre- and post-resettlement but require replication in better-powered samples. Understanding the impact of civilian war trauma, forced displacement, and post-resettlement stress can inform intervention development, targeted treatment, and policy.

The aim of this study was to investigate the prevalence of prolonged grief disorder (PGD) in children and adolescents who experienced parental loss in the 2023 Turkey earthquake and to identify factors predicting the development of PGD. The study was designed as a prospective, longitudinal observational study. The final sample consisted of 147 children and adolescents. The Prolonged Grief Assessment-Child Version (PGA-C) was used to assess the severity of prolonged grief and normative grief symptoms. The Revised Child Anxiety and Depression Scale-Child Version was used to assess the severity of major depressive disorder (MDD) symptoms, and the Children's Revised Impact of Event Scale was used to assess the severity of posttraumatic stress disorder (PTSD) symptoms. Data collection took place in two phases: The first phase occurred between June 16, 2023, and July 20, 2023, and the second phase was conducted between November 10, 2023, and November 20, 2023. The PGA-C was utilized in the latter assessment to evaluate the prevalence and severity of PGD. Nine months after the earthquake, 19.7% of participants met the diagnostic criteria for PGD. Multivariate regression analyses showed that the severity of MDD symptoms predicted PGD, OR = 1.14, p = .024, whereas both normative grief, B = 0.35, p = .005, and MDD symptom severity, B = 0.42, p = .028, significantly predicted PGD symptom severity. These findings suggest that early identification and treatment of MDD during bereavement may help mitigate the risk of later PGD development.

The traumatic loss of a loved one is among the most common traumatic events worldwide and represents a public mental health concern. This study assessed the lifetime prevalence of such losses in a nationally representative sample of Icelandic adults. Among traumatically bereaved individuals in this sample (N = 1,002; 56.4% women, 43.6% men), a hierarchical structural equation model was used to examine loss-related, personal, interpersonal, and emotion regulation factors associated with psychological distress. The overall prevalence of exposure to traumatic loss was high (56.7%). Significant risk factors identified for psychological distress included being a woman, β = .084; a history of multiple losses; β = .090; and higher levels of anger control difficulties, β = .459. Conversely, older age, β = -.076; higher levels of educational attainment, β = -.100; more financial security, β = -.218; and higher social support, β = -.253, were identified as protective factors. These findings underscore the burden of traumatic loss and point to potential targets for mental health prevention efforts among bereaved individuals.

The network approach to posttraumatic stress disorder (PTSD) has rapidly developed in recent years, driven by a growing number of empirical studies employing psychometric network analyses to investigate the structure of associations among PTSD symptoms. In this paper, we provide an overview of network psychometrics and consider the role of these analyses within the network approach to PTSD. Adopting a recently proposed workflow for conducting network psychometric analyses, we identify and address issues that researchers using network psychometrics to study PTSD are likely to confront. We conclude with a consideration of work beyond network psychometrics that will be critical in translating the growing body of empirical network studies into meaningful advances in the field's understanding of the causal systems underlying PTSD.

The COVID-19 pandemic has significantly impacted global physical, mental, and public health and disproportionately affected refugee youth. Novel stressors, like a global pandemic, may compound previous stress and trauma exposure. We aimed to test the "challenge model of resilience" (i.e., moderate exposure to adversity may confer resilience to future stressors) and assess COVID-19-related stress severity in youth resettled in the United States as refugees of Syria (N = 66, M_age = 12.72 years). We recruited youth aged 10-17 years who had been previously screened for trauma exposure and conducted virtual assessments on COVID-19-related stress, posttraumatic stress symptoms, and anxiety symptoms between March 2021 and March 2022. An ANCOVA adjusted for age, posttraumatic stress, and anxiety indicated a significant dose-response effect of trauma on current COVID-19-related stress, F(2, 58) = 6.67, p = .002, h² = .19. Youth exposed to high doses of adversity reported more distress than those exposed to low-to-moderate, p = .007, and no-to-minimal, p = .006, doses. Although youth exposed to low-to-moderate doses reported slightly less distress than those who reported no-to-minimal exposure, post hoc comparisons indicated that this contrast was nonsignificant. Our findings partially support the challenge model of resilience; however, the small size and homogeneity of the sample preclude generalization to other cohorts of stress-exposed youth. Regular screening for traumatic life events in youth could prompt early intervention to mitigate longer-term impacts. Increased integration of positive health-promoting programs in schools and communities that teach stress coping strategies could confer resilience to youth regardless of exposure level.

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and PTSD Checklist for DSM-5 (PCL-5) have demonstrated high levels of diagnostic accuracy and strong psychometric properties across various samples and settings. However, the impact of age on these measures has been underinvestigated. This is problematic, as without accurate measurement, older adults with posttraumatic stress disorder (PTSD) may be vulnerable to misdiagnosis and inappropriate treatment planning. This study examined the diagnostic accuracy of these measures in older (≥ 65 years; n = 192) versus younger (< 65 years; n = 188) veterans to determine whether precision in identifying PTSD was equally strong between groups in a sample of veterans receiving primary care services in a U.S. Department of Veterans Affairs setting. Results indicated that, despite a lower PTSD prevalence among older veterans (9.3% vs. 25.5%), the PC-PTSD-5 performed better among older veterans, AUC = .960, 95% CI [.928, .992], than younger veterans, AUC = .897, 95% CI [.846, .949], z = 2.04, p = .042. A PC-PTSD-5 cutoff score of 4 was optimal for both groups. PCL-5 performance was excellent for both older, AUC = .925, 95% CI [.880, .970], and younger veterans, AUC = .894, 95% CI [.847, .942], z = 0.92, p = .358. Although different optimal cutoff scores were found for older (36) versus younger (34) veterans, these cutoffs were not significantly different from each other or the standard cutoff (33), McNemar tests ps = .125-1.00. Both measures maintain their robust psychometric properties in veterans across the lifespan.

A key conceptual issue in the resilience literature centers on whether the presence of resilience in one domain corresponds to positive adaptation in other areas. The present studies investigated whether an individual's likelihood of demonstrating resilience in their trajectory of depressive symptoms would be associated with positive adjustment in psychological, functional, and health-related domains following exposure to spinal cord injury, bereavement, and heart attack. In each study, we utilized growth mixture and robust linear mixed-effects modeling to examine the associations between depression-based trajectories and multiple domains of positive adjustment. Results from all three studies indicated that, on average, individuals who exhibited trajectories of resilience in relation to depressive symptoms concurrently experienced better quality of life, perceived manageability, self-esteem, cognition, and body mass index (BMI). Further, a higher probability of belonging to the resilient trajectory class was linked to higher quality of life, B = 33.78, 95% CI [24.31, 42.91]; perceived manageability, B = 3.44, 95% CI [1.54, 5.21]; cognitive functioning, B = 2.30, 95% CI [1.32, 3.27]; and healthier BMI, B = -1.02, 95% CI [-1.89, -0.17]. Together, these findings illustrate that it is possible to utilize symptoms of depression to predict patterns of resilience across several clinically meaningful domains.

As of June 2023, there are more than 4,380,000 internally displaced people in Ethiopia due to conflict, drought, and social tension. This study examined the traumatic experiences of internally displaced people (IDPs) in the Wag-Hemra Zone of the Amhara Region of Ethiopia and the coping mechanisms utilized to overcome the impacts of their forced displacement. An exploratory qualitative design was used to guide the study. A purposive sampling technique was applied to select 12 IDPs from the Weleh IDP camp in Sekota town. A semistructured interview guide was developed, tested, and used to collect data through in-depth interviews that lasted for an average of 35 min. Interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis was performed using Nvivo14 qualitative software. Two major themes and six subthemes emerged from the analysis. Under the first theme, traumatic experiences, subthemes included escaping death and a traumatic journey, experiencing and witnessing violence and suffering, and loss and separation. Under the second theme, coping mechanisms, subthemes included religion and spirituality, optimism and positivity, and social support. The study highlighted the grave mental health implications of conflict and forced displacement that participants experienced and the dire need for urgent mental health interventions in Ethiopia's conflict-torn region. Mental health efforts should focus on enhancing social capital, leveraging spirituality, and promoting the communal culture to foster resilience and buffer the effects of traumatic events among IDPs.

Childhood maltreatment is recognized as a risk factor for cognitive decline in adulthood. However, the mechanisms underlying this association, particularly the role of systemic inflammation, remain understudied. To address this gap, this study investigated the indirect effects of inflammation on the associations between childhood maltreatment and both episodic memory (EM) and executive functioning (EF) performance 10 years after inflammatory measurement in older adults. We selected 590 participants (M_age = 65.5 years) from the Midlife in the United States Study based on available childhood maltreatment, inflammation, and composite cognitive data. Spearman's rank correlations were calculated to test associations among childhood maltreatment, cognition, and inflammation. The results informed follow-up analyses testing the indirect effects of inflammation on the associations between childhood maltreatment and cognition. Correlations demonstrated that inflammation was associated with overall childhood maltreatment as well as with specific domains of childhood maltreatment (i.e., physical abuse, sexual abuse, emotional abuse, and physical neglect), ps = .002-.010. Inflammation was negatively associated with EF, p = .001, and EM, p = .028. Follow-up analyses revealed significant indirect pathways linking overall childhood maltreatment, β = -.0088, SE = 0.0058, 95% CI [-0.0223, -0.00000], to EM performance through inflammation, but no specific domain of maltreatment drove this association. The results suggest that inflammation may help explain links between childhood maltreatment exposure and EM deficits in adulthood. These results elucidate the importance of evaluating childhood maltreatment as a risk factor for later-life cognitive decline, particularly within the context of heightened inflammatory biomarkers.