Journal of traumatic stress最新文献

Combat deployments are stressful life events that confer risk for posttraumatic stress disorder (PTSD) in veterans. Typically, PTSD is conceptualized as being caused by traumatic experiences, leading research to focus predominantly on events while excluding other contributors, such as personality features. Narcissism may contribute to the deleterious effects of trauma exposure because of vulnerabilities in the sense of self, as demonstrated in research on narcissism and the development and maintenance of PTSD in civilians. However, the strength of the association between pathological narcissism features and PTSD has yet to be examined in a veteran sample. The present study sought to address this gap by comparing how narcissism contributes to variance in PTSD symptoms relative to the contribution of combat experience. In a sample of veterans deployed in support of recent operations in Afghanistan and Iraq (N = 179), regression analysis showed that higher pathological narcissism features accounted for variance beyond combat experience alone in PTSD symptoms, ∆R² = .13, p < .001. When dimensions of narcissism were examined as separate predictors of PTSD, vulnerable, β = .45, p < .001, but not grandiose, β = −.09, p = .293, features had a significant effect on PTSD. Our results align with recent work demonstrating that personality pathology is an important factor in the study of PTSD in veterans. Further research incorporating a larger variety of variables related to personality functioning, personality traits, and life events is needed to understand the role of pathological narcissism features in the development of PTSD.

Posttraumatic stress disorder (PTSD) commonly co-occurs with other disorders. Although there are several evidence-based treatments available for PTSD and co-occurring disorders, including cognitive processing therapy (CPT), prolonged exposure (PE), acceptance and commitment therapy (ACT), and the unified protocol for transdiagnostic treatment of emotional disorders (UP), limited findings clarify the use of baseline symptom data to help providers and patients choose among treatments. To address this, the current study examined baseline symptoms and treatment trajectories among 90 veterans and veteran family members with probable PTSD (based on PCL-5) receiving either trauma-focused (CPT, PE) or transdiagnostic (ACT, UP) treatment via telehealth, with the aim of assisting providers in recognizing patterns to inform data-driven treatment selection. Overall, there was no difference in the likelihood of clinically meaningful improvement in PTSD symptoms between transdiagnostic and trauma-focused treatments, relative risk (RR) = 0.92, 95% confidence interval (CI) [0.63, 1.34]. When stratified by probable substance use disorder (SUD) and major depressive disorder (MDD) status, the results revealed a pattern suggesting that transdiagnostic treatment may be more effective for reducing PTSD symptoms among individuals with probable co-occurring SUD and MDD, RR = 1.50, 95% CI [0.27, 8.34], whereas trauma-focused treatment may be more effective for those without probable co-occurring SUD or MDD, RR = 0.56, 95% CI [0.31, 1.00]. Studies with larger samples and randomization are needed to confirm patterns. This work could be extended by comparing outcomes from other treatments and by assessing functional outcomes such as posttraumatic growth and quality of life.

Evidence describing the association between sleep quality and trauma-focused therapy is mixed. This secondary analysis of a primary care sample examined whether (a) baseline sleep quality moderated posttraumatic stress disorder (PTSD) symptom severity over time across groups receiving different doses of cognitive processing therapy (CPT) and (b) sleep quality improved over time with CPT. Participants were 227 adults who screened positive for PTSD and were participating in a clinical trial comparing two models of PTSD treatment delivery in primary care. The Pittsburgh Sleep Quality Index (PSQI) and PTSD Checklist for DSM-5 (PCL-5) were used to assess sleep disturbance and PTSD symptom severity, respectively. Multiple linear regression was used to assess whether baseline PSQI scores moderated 12-month PCL-5 scores across CPT dosage groups (0 sessions: 51.1%, 1–7 sessions: 31.7%; ≥ 8 sessions [adequate dose]: 17.2%) and whether PSQI scores differed by group at 12-month follow-up. Post hoc analyses examined changes in PCL-5 sleep disturbance items. Baseline sleep disturbance did not moderate the effect of CPT on PTSD severity among participants with an adequate CPT dose, p > .112. Sleep quality improved with adequate dose, B  = -2.63, SE = 0.75, p < .001. Differences in change scores across groups for PCL-5 Item 2, F(2, 435) = 11.34, and Item 20, H(2) = 32.04, indicated that participants with an adequate CPT dose had greater reductions in trauma-related sleep symptoms than those who received 0–7 sessions, ps < .001. Residual post-CPT sleep impairment despite adequate PTSD improvement warrants further interventions.

Kagee, A., Bantjes, J., Saal, W., & Sterley, A. (2022). Predicting posttraumatic stress disorder caseness using the PTSD Checklist for DSM-5 among patients receiving care for HIV. Journal of Traumatic Stress, 35(1), 13–21. https://doi.org/10.1002/jts.22654

In Table 3, the confidence interval for Sensitivity should be [80.2, 93.7].

Race-based traumatic stress (RBTS) is a psychological response to racial discrimination among individuals with marginalized racial/ethnic identities, but the literature about how different forms of racial discrimination contribute to RBTS is lacking. We compared the effects of major, everyday, and vicarious racial discrimination on RBTS and evaluated the associations between ethnic–racial identity (ERI) and RBTS. Analyses used cross-sectional survey data from Black, Asian, and Latine young adults (N = 1,342, M_age = 25.9 years) collected in 2022. Demographic variables; major, everyday, and vicarious racial discrimination; ERI commitment and exploration; and RBTS were assessed. Hierarchical multiple regression was used to identify correlates of RBTS. Everyday, β = .37, p < .001; vicarious, β = .16, p < .001; and major racial discrimination, β = .16, p = .004, predicted RBTS. Neither ERI commitment nor ERI exploration was significantly associated with RBTS. Race did not moderate the associations between major, everyday, or vicarious discrimination and RBTS, highlighting that Black, Asian, and Latine young adults appear to be equally at risk. As most vicarious racial discrimination and RBTS research has focused on Black samples, we expand the literature by including Latine and Asian young adults. Our observation that vicarious racial discrimination was a similarly strong predictor of RBTS compared to everyday and major racial discrimination underscores the importance of its inclusion in research focused on discrimination and mental health. Taken together, clinical assessment should focus on questions related to diverse experiences of racial discrimination for individuals with marginalized racial identities.

Posttraumatic growth (PTG) is characterized as the experience of positive psychological change following exposure to traumatic stress. However, studies examining the association between posttraumatic stress disorder (PTSD) symptoms and PTG have demonstrated mixed results. Further, although higher levels of social support have been shown to predict higher ratings of PTG, there are limited longitudinal findings regarding how interpersonal functioning may affect the association between PTSD symptoms and PTG. In this study, we examined interpersonal functioning in romantic relationships and friendships as mediators of the relation between PTSD symptom severity and PTG and examined potential sex differences among these associations. Participants were 1,427 veterans who completed self-report questionnaires across three time points. A parallel mediation analysis indicated that romantic relationship, β = −.01, 95% CI [−.03, −.001], and friendship, β = −.02, 95% CI [−.04, −.001], functioning were both indirectly associated with PTG in the full sample. Moreover, sex-stratified models indicated that romantic relationship functioning was a significant mediator for male veterans, β = −.02, 95% CI [−.05, −.01], whereas friendship functioning was a significant mediator for female veterans, β = −.04, 95% CI [−.08, −.01]. Together, these findings suggest that interpersonal functioning is an important factor in PTG, and targeting romantic relationship and friendship functioning in the context of trauma-focused treatment may be valuable and can help build a pathway from PTSD symptoms to PTG among female and male veterans.

The outbreak of the Israel–Hamas war on October 7, 2023, has presented unprecedented challenges to older adults’ mental health, including increased posttraumatic stress, anxiety, and depression. The current study examined potential war- and age-related factors associated with probable posttraumatic stress disorder (PTSD), clinical depression (probable depression), and generalized anxiety disorder (probable anxiety) among older adults during the ongoing war. Moreover, due to the continued threat of death, we examined whether death anxiety is an additional contributing factor to older adults’ probable PTSD, depression, and anxiety. Data were collected January–March 2024 from 554 community-dwelling older adults (M_age = 73.90 years, SD = 7.35, range: 61–96 years) who completed online scales assessing sociodemographic variables, war exposure (distance from the Gaza Strip, exposure to terror attacks/blasts), and age-related constructs (assistance in daily activities [ADL], cognitive decline, physical illnesses, death anxiety). Increased ADL was associated with probable depression, B = 0.62, OR = 1.87, and anxiety, B = 0.42, OR = 1.53, and cognitive decline was associated with probable depression, B = 1.52, OR = 4.56. Older adults with high levels of death anxiety were almost 3 times as likely to meet the criteria for probable PTSD, B = 1.05, OR = 2.85, and more than 1.5 as likely to meet the criteria for probable depression, B = 0.54, OR = 1.71, and anxiety, B = 0.50, OR = 1.65. The importance of death anxiety as a potential risk factor for negative psychological outcomes among older adults during war is discussed.

Problematic anger affects up to 30% of individuals who have experienced trauma. Digital mental health approaches, such as ecological momentary assessment (EMA) delivered via smartphone and wearable devices (i.e., wearables), hold significant potential for the development of novel digital technology treatments. The objective of this cohort study was to examine the acceptability, feasibility, and outcomes from 10 days of usage of a digital mental health tool combining EMA and wearable use among trauma-exposed adults with problematic anger. We used mixed methods to examine feasibility and acceptability and explored quantitative changes in mental health symptoms among participants over the study period (N = 98, 80.4% women, M_age = 38 years). Quantitative and qualitative data revealed that regular EMA combined with a wearable was feasible and acceptable in the sample. We observed reductions in problem anger, p < .001, repeated-measures d (d_RM) = -0.81, 95% CI [-1.04, -0.59]; and posttraumatic stress disorder symptoms, p = .025, d_RM = -0.26, 95% CI [-0.55, -0.03], over the 10 days of monitoring. Qualitative findings suggest that by regularly “checking in” on anger symptoms, participants improved their self-awareness and ability to self-manage their mood. These findings provide valuable learnings for building future personalized digital mental health tools.

Individuals exposed to disasters are at high risk of developing mental health conditions, yet the availability of mental health practitioners is often limited. The aim of this scoping review was to examine the quality of the evidence for psychosocial interventions that can be delivered by non–mental health workers in the context of disasters. Searches were performed in PsycInfo, EMBASE, Family & Society Studies Worldwide, CINAHL, Global Health, PubMed, and SCOPUS, from inception through to November 2024, to identify studies of relevance. Only studies investigating psychosocial interventions that could be delivered by non–mental health clinicians in a non–hospital or clinic setting were included. In total, 69 primary intervention studies examining 27 universal interventions and 10 indicated interventions were identified. Studies were rated on quality and risk of bias, and GRADE was used to rank the evidence for each intervention. For universal interventions, no study had an evidence rating above “very low” to support confidence in a significant impact on clinical outcomes. For indicated interventions, Problem Management Plus (PM+) and Self-Help Plus (SH+) had an evidence rating of “high” in the postdisaster context, and Skills for Life Adjustment and Resilience (SOLAR) had a “low” evidence rating; the remaining interventions were given “very low” ratings. Despite the high number of psychosocial interventions that target postdisaster distress, very few have been tested using rigorous methodologies with large samples. Future research should include methodologies that test interventions at scale and recognize the impacts of compounding disasters.

The processing of positive memories technique (PPMT) entails detailed narration and processing of specific positive autobiographical memories (AM) and has shown promise in improving posttraumatic stress disorder (PTSD) symptoms. We examined whether participants receiving PPMT reported decreases in PTSD and depressive symptom severity, negative affect levels/reactivity, posttrauma cognitions, and positive emotion dysregulation, as well as increases in positive affect levels/reactivity and the number of retrieved positive AMs across four PPMT sessions. Individuals (N = 70) recruited from the community completed surveys at baseline (pre-PPMT), each PPMT session, and after completing all four PPMT sessions. Multilevel linear growth models indicated session-to-session decreases in PTSD severity, β = −.17, p < .001; depressive symptom severity, β = −.13, p < .001; negative affect levels, β = −.13, p < .001; positive affect reactivity, β = −.14, p = .014; and posttrauma cognitions, β = −.12, p < .001; and session-to-session increases in negative affect reactivity, β = .18, p = .001. Paired-samples t tests indicated decreases in retrieved positive AMs, d = 0.40, p = .001, including specific positive AMs, and negative AMs, d = 0.23, p = .022, and increases in retrieved overgeneral positive AMs, d = −0.38, p = .002, from baseline to postintervention. Thus, PPMT may help decrease PTSD and depression severity, negative affect, posttrauma cognitions, and negative AM recall tendencies. Clinicians may need to incorporate additional skills into the PPMT framework to improve positive affect processes that can be sustained over time.