Ehring, T., Ehlers, A., Glucksman, E. (2006).
Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents. Behaviour Research & Therapy. 44(12):1699-716.
The present study investigated the extent to which theoretically derived cognitive variables predict PTSD, phobias and depression after motor vehicle accidents. The cognitive predictors were compared to a set of established, mainly non-cognitive predictors. In addition, we tested how disorder-specific the cognitive predictors are. Participants (n=101) were interviewed within a year after having been injured in a motor vehicle accident. Diagnoses of PTSD, travel phobias and depression, symptom severities and predictor variables were assessed with self-report questionnaires and structured interviews. In multiple regression analyses, the sets of cognitive variables derived from disorder-specific models explained significantly greater proportions of the variance of the symptom severities than the established predictors (PTSD 76% vs. 45%, depression 72% vs. 46% and phobia 66% vs. 40%), and than cognitive variables derived from the models of the other disorders. In addition, the majority of individual cognitive variables showed the expected pattern of differences between diagnostic groups. The results support the hypothesis that disorder-specific sets of cognitive factors contribute to the development and maintenance of PTSD, phobias and depression following traumatic events. [Adapted from Abstract].
Full article at Science Direct.
http://www.sciencedirect.com/.
December 2006

Rabe, S., Beauducel, A., Zollner, T., Maercker, A. and Karl, A. (2006).
Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident. Journal of Abnormal Psychology. 115, 687-698.
This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or sub-syndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and sub-syndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in non-traumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information. [Adapted from Abstract].
Journal of Abnormal Psychology. Full article at http://www.psychology.soton.ac.uk/.
November 2006

Deblinger, E., Mannarino, A. P., Cohen, J. A. and Steer, R. A. (2006).
A follow-up study of a multi-site, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry. 45, 1474-1484.
This study aimed to ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy (TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually abused would persist following treatment and to examine potential predictors of treatment outcome. A total of 183 children 8 to 14 years old and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. Mixed-model repeated analyses of covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. Children and caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month assessments as compared to participants assigned to CCT. [Adapted from Abstract].
Journal of the American Academy of Child and Adolescent Psychiatry (subscribers only).
http://www.jaacap.com.
November 2006

Rona, R.J., Hooper, R., Jones, M., Hull, L., Browne, T., Horn, O., Murphy, D., Hotopf, M. and Wessely, S. (2006).
Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study. British Medical Journal, 333, 979-980. A longitudinal cohort study of the UK armed forces assessed whether screening for mental disorder before the start of the 2003 Iraq war would have predicted subsequent mental disorders. 2873 personnel of the three services who completed an initial questionnaire in 2002 were asked to complete a second questionnaire between June 2004 and 2 March 2006. Outcome measures consisted positive and negative likelihood ratios, and positive and negative predictive value of first assessment compared with assessment two to three years later of post-traumatic stress disorder, health questionnaires and alcohol misuse for those deployed to the Iraq war. The positive likelihood ratio of post-traumatic stress disorder was high (13.1, 95% confidence interval 7.2 to 23.8), but the negative likelihood ratio was close to 1 (0.78, 0.67 to 0.91). The positive predictive values were low because of the low prevalence of PTSD in the period before the Iraq war. The positive likelihood ratios for the other psychological assessments varied between 2.7 and 5.6, and the negative likelihood ratios were slightly lower than for PTSD, indicating that these were not good candidates for screening. Results were the same for the analyses restricted to those who were deployed. It was concluded that screening for common mental disorders before deployment in this cohort would not have reduced subsequent morbidity or predicted post-traumatic stress disorder. [Adapted from Abstract]
Full article at British Medical Journal (subscribers only).
http://www.bmj.com/cgi/content/abstract/bmj.38985.610949.55v1.
November 2006

Davidson, J., Baldwin, D., Stein, D. J., Kuper, E., Benattia, I., Ahmed, S., Pedersen, R. and Musgnung, J. (2006).
Treatment of posttraumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Archives of General Psychiatry. 63,1158-65.
The study aimed to evaluate the efficacy of venlafaxine extended release (ER), a serotonin norepinephrine reuptake inhibitor, in PTSD in a 6-month, double-blind, placebo-controlled trial. Adult outpatients (N = 329) with a primary diagnosis of PTSD as defined in the DSM-IV, symptoms for 6 months or longer, and a Clinician-Administered Posttraumatic Stress Disorder Scale score of 60 or higher were randomly assigned to receive flexible doses of venlafaxine ER (37.5-300 mg/d) or placebo for 24 weeks. Mean changes from baseline in Clinician-Administered Posttraumatic Stress Disorder Scale total scores at end point were -51.7 for venlafaxine ER and -43.9 for placebo (P = .006). Improvement was significantly greater for the venlafaxine ER group than for the placebo group in cluster scores for reexperiencing and avoidance/numbing, but not for hyperarousal. Remission rates were 50.9% for venlafaxine ER and 37.5% for placebo. The venlafaxine ER group also showed significantly greater improvement at end point than the placebo group on all other reported outcome measures. In this study, venlafaxine ER was effective and well tolerated in short-term and continuation treatment of patients with PTSD. [Adapted from Abstract].
Full article at Archives of General Psychiatry (subscribers only).
http://archpsyc.ama-assn.org/cgi/content/full/63/10/1158.
October 2006

Kenardy, J. A., BSc, Spence, S. H. and Macleod, A. C. (2006)
Screening for Posttraumatic Stress Disorder in Children After Accidental Injury. Pediatrics: 118, 1002 - 1009.
The aim of this study was to examine the ability of the Child Trauma Screening Questionnaire (CTSQ) to predict children at risk of developing posttraumatic stress disorder symptoms 1 and 6 months after a traumatic accident. Participants were 135 children admitted to the hospital after a variety of accidents, including car- and bike-related accidents, falls and burns. The children completed the CTSQ and the Children's Impact of Events Scale (CIES) within 2 weeks of the accident, and the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Child Version, was conducted to assess full and subsyndromal posttraumatic stress disorder in the child 1 and 6 months after the accident. It was revealed that the CTSQ correctly identified 82% of children who demonstrated distressing posttraumatic stress disorder symptoms (9% of sample) 6 months after the accident. The CTSQ was also able to correctly screen out 74% of children who did not demonstrate such symptoms. Furthermore, the CTSQ outperformed the CIES.
Full article at Pediatrics (subscribers only).
http://pediatrics.aappublications.org.
September 2006

Dohrenwend, B. P., Turner, J. B., Turse, N. A., Adams, B. G., Koenen, K. C. and Marshall, R.
The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science, 313, 979-982.
In 1988, the National Vietnam Veterans Readjustment Study (NVVRS) of a representative sample of 1200 veterans estimated that 30.9% had developed posttraumatic stress disorder (PTSD) during their lifetimes and that 15.2% were currently suffering from PTSD. The study also found a strong dose-response relationship: As retrospective reports of combat exposure increased, PTSD occurrence increased. Skeptics have argued that these results are inflated by recall bias and other flaws. We used military records to construct a new exposure measure and to cross-check exposure reports in diagnoses of 260 NWRS veterans. We found little evidence of falsification, an even stronger dose-response relationship, and psychological costs that were lower than previously estimated but still substantial According to our fully adjusted PTSD rates, 18.7% of the veterans had developed war-related PTSD during their lifetimes and 9.1% were currently suffering from PTSD 11 to 12 years after the war; current PTSD was typically associated with moderate impairment.
Full article at Science (subscribers only).
http://www.sciencemag.org.
August 2006

Thienkrua W., Cardozo B.L., Chakkraband M.L., Guadamuz T.E., Pengjuntr W., Tantipiwatanaskul P., Sakornsatian S., Ekassawin S., Panyayong B., Varangrat A., Tappero J.W., Schreiber M. and van Griensven F. (2006)
Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. JAMA. 296(5):549-59.
The authors assessed trauma experiences and the prevalence of symptoms of PTSD and depression among children in tsunami-affected provinces in Thailand. Population-based mental health surveys were conducted among children aged 7 to 14 years in Phang Nga, Phuket, and Krabi provinces 2 and 9 months post-tsunami. 371 children participated in the first survey. In multivariate analysis of the first assessment, having had a delayed evacuation, having felt one's own or a family member's life to have been in danger, and having felt extreme panic or fear were significantly associated with PTSD symptoms. Older age and having felt that their own or a family member's life had been in danger were significantly associated with depression symptoms. In the follow-up survey rates of symptoms of PTSD and depression among these children did not decrease significantly over time. [Adapted from Abstract]
Full article at JAMA (subscribers only).
http://jama.ama-assn.org.
August 2006

van Griensven, F., M. L. Somchai Chakkraband, MD; Warunee Thienkrua, MSc; Wachira Pengjuntr, MD; Cardozo, B. L., Tantipiwatanaskul, P., Mock, P. A., Ekassawin, S., Varangrat, A., Gotway, C., Sabin, M. and Tappero, J. W. (2006)
Mental Health Problems Among Adults in Tsunami-Affected Areas in Southern Thailand. JAMA, 296:537-548.
The authors assessed the prevalence of symptoms of PTSD, anxiety, and depression among adults in areas affected by the tsunami in Thailand. A multistage, cluster, population-based mental health survey was conducted two months after the tsunami, of random samples of displaced (n = 371) and nondisplaced persons in Phang Nga province (n = 322) and nondisplaced persons in provinces of Krabi and Phuket (n = 368). In multivariate analysis, loss of livelihood was independently and significantly associated with symptoms of all three mental health outcomes (PTSD, anxiety and depression). A surveillance follow-up survey of the displaced (n = 371) and non-displaced (n = 322) persons in Phang Na was conducted nine months post- disaster, the rates of those reporting these symptoms decreased but were still elevated. [Adapted from Abstract]
Full article at JAMA (subscribers only).
http://jama.ama-assn.org.
August 2006

Barakat, L.P., Alderfer, M.A. and Kazak, A.E. (2006).
Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers. Journal of Pediatric Psychology. 31(4):413-9.
The study aimed to describe posttraumatic growth (PTG) following childhood cancer survival and its association with demographic and disease/treatment variables, perceived treatment severity and life threat, and posttraumatic stress symptoms (PTSS). Adolescent survivors of cancer (N = 150, ages 11-19), at least 1 year after treatment, and their mothers (N = 146) and fathers (N = 107) completed self-report measures of perceived treatment intensity, the PTSS and a semi-structured interview designed to identify posttraumatic responses and indicators of PTG. A majority of adolescents and their parents reported PTG. Greater perceived treatment severity and life threat, but not objective disease severity, was associated with PTG. PTG and PTSS were positively associated for the adolescent cancer survivors. Diagnosis after age 5 resulted in more perceived benefit and greater PTSS.[Adapted from Abstract]
Full article in the Journal of Pediatric Psychology (subscribers only).
http://jpepsy.oxfordjournals.org.
May 2006

Shalev, A. Y., Tuval, R., Frenkeil-Fishman, S., Hadar, H. and Eth, S. (2006).
Psychological Responses to Continuous Terror: A Study of Two Communities in Israel. American Journal of Psychiatry, 163, 659-666.
The authors evaluated psychological responses to continuous terror collecting data after 10 months of escalating hostilities against civilians in Israel. The study's participants were randomly selected adults living in two suburbs of Jerusalem, one frequently and directly exposed to acts of terrorism (N=167) and the other indirectly exposed (N=89). Directly and indirectly exposed groups reported comparable rates of PTSD and similar levels of symptoms. It was concluded that continuous terror created similar distress in proximal and remote communities. Exposure to discrete events was not a necessary mediator of terror threat. A subgroup of those exposed developed serious symptoms, whereas others were surprisingly resilient. [Adapted from Abstract].
Full article at American Journal of Psychiatry (subscribers only)
http://ajp.psychiatryonline.org.
April 2006

Solomon, Z., and Mikulincer, M. (2006).
Trajectories of PTSD: A 20 Year Longitudinal Study. American Journal of Psychiatry, 163, 659-666.
This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction in a 20 year longitudinal study. 214 veterans from the Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated at 1, 2, 3 and 20 years after the war. Veterans with combat stress reaction were more likely to endorse Post Traumatic Stress Disorder (PTSD) at all 4 points in time, their PTSD was more severe and they were at increased risk for exacerbation/reactivation. 23% of veterans without combat stress reaction reported delayed PTSD. These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. [Adapted from Abstract].
Full article at American Journal of Psychiatry (subscribers only)
http://ajp.psychiatryonline.org.
April 2006

Horn, O., Hull, L., Jones, M., Murphy, D., Browne, T., Fear, N. T., Hotopf, M., Rona, R. J., and Wessely, S. (2006).
Is There an Iraq War Syndrome? Comparison of the Health of UK Service Personnel after the Gulf and Iraq Wars.
Hotopf, M., Hull, L., Fear, N. T., Browne, T., Horn, O., Iversen, A., Jones, M., Murphy, D., Bland, D., Earnshaw, M., Greenberg, N., Hughes, J. H., Tate, A. R., Dandeker, C., Rona, R. and Wessely, S. (2006).
The Health of UK Military Personnel who were Deployed to the 2003 Iraq War: A Cohort Study.
Both: The Lancet, Volume 367, Issue 9524.
UK armed forces personnel who took part in the 1991 Gulf War experienced an increase in symptomatic ill health, colloquially known a "Gulf War Syndrome". These two studies suggest that there might not be an "Iraq War Syndrome". Male regular UK armed forces personnel deployed to Iraq during the 2003 war were compared with colleagues who were not deployed. The first of the two studies found that increases in common symptoms were slight, and that no pattern suggestive of a new syndrome was present. A second study found that deployment to Iraq had not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There was however evidence of a clinically and statistically significant effect on health in reservists. [Adapted from Abstract].
Full Article at Lancet (subscribers only)
http://www.sciencedirect.com.
March 2006

Hoge, C. W., Auchterlonie, J. L., Milliken, C.S. (2006).
Mental health problems, use of mental health services, and attrition from military service after returning from deployment in Iraq or Afghanistan. JAMA, 295, 1023-1032.
This study represents the first systematic analysis of mental health care utilisation among service members returning from deployment in Afghanistan, Iraq and other locations. A population based descriptive study of all Army Soldiers and Marines who completed the routine post-deployment health assessment between May 2003 and April 2004 was carried out. Health care utilization and occupational outcomes were measured for 1 year after deployment. The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations. Mental health problems were significantly associated with combat experiences, mental health care referral and utilization and attrition from military service. 35% of Iraq war veterans accessed mental health services in the year after returning home; 12% were diagnosed with a mental health problem. The results highlight the challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans. [Adapted from Abstract]
Full article at JAMA (subscribers only):
http://jama.ama-assn.org.
March 2006

Lindauer, R. J. L., Olff, M., van Meijel, E. P. M., Carlier, I. V. E. and Gersons, B. P. R. (2006).
Cortisol, learning, memory, and attention in relation to smaller hippocampal volume in police officers with posttraumatic stress disorder. Biological Psychiatry, 59, 171-177.
Posttraumatic stress disorder has been linked to hippocampal volume, memory and cortisol deficiencies. Having previously reported smaller hippocampi in police officers with PTSD, the authors went on and in this study examined changes in and associations between cortisol, learning, memory, attention and hippocampal volume in PTSD. In a case matched control study, 12 police officers with PTSD and 12 traumatized police officers without lifetime PTSD were examined with magnetic resonance imaging (for hippocampal volume), salivary cortisol tests, and neurocognitive assessments. Smaller hippocampi, higher cortisol levels and memory impairments were associated with PTSD but were not directly correlated with one another. It was concluded that memory impairments in PTSD did not seem to be a direct consequence of hippocampal size. [Adapted from Abstract]
Full article at Biological Psychiatry (subscribers only):
http://www.journals.elsevierhealth.com.
January 2006

Sabin, J. A., Zatzick, D. F., Jurkovich, G, Rivara, F. P. (2006).
Primary care utilization and detection of emotional distress after adolescent traumatic injury: Identifying an unmet need. Pediatrics, 117, 130-138.
Adolescent patients admitted to surgical units after injury frequently experience post traumatic stress symptoms. Post-discharge, trauma centres routinely rely on follow up care of this vulnerable population in the community by primary care providers. This was a prospective cohort study of traumatically injured adolescents admitted to a trauma centre. Adolescents were screened for mental health problems on the surgical ward and at 4 to 6 months post-injury. Primary care providers were also contacted at 4 to 6 months post-injury to assess follow-up care and the detection of emotional stress. On the ward almost 40% of adolescents reported no regular source of medical care. At follow-up 30% of adolescents were experiencing high posttraumatic stress symptom levels, 11% were experiencing depressive symptom levels and 17% had high levels of alcohol use. Primary care providers did not detect any new emotional distress or problem drinking during post injury visits. It was concluded that due to the substantial number of adolescents who developed mental health problems post-injury combined with almost 40% having reported no source of medical care, that trauma centres should make referrals to primary care providers and that awareness of and screening for emotional distress post-injury be routine components of post-injury care. [Adapted from Abstract]
Full article at Pediatrics (subscribers only):
http://pediatrics.aappublications.org.
January 2006

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