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Posttraumatic stress disorder in general intensive care unit survivors: a systematic reviewThe objective of the study was to summarize and review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD and the impact of post-ICU PTSD on health-related quality of life (HRQOL). The authors conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO and a hand-search of 13 journals.
Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained "clinically significant" PTSD symptoms was 22% (n=1104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n=93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL
The prevalence of PTSD in ICU survivors is high and negatively impacts survivors' HRQOL. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients' needs for early intervention.
Dimitry S. Davydow, Jeneen M. Gifford, Sanjay V. Desai, Dale M. Needham, O. Joseph Bienvenu
Full article in General Hospital Psychiatry (subscribers only).
http://www.ghpjournal.com/
July 2008
Can emotion-focused coping help explain the link between posttraumatic stress disorder severity and triggers for substance use in young adults?High rates of posttraumatic stress disorder (PTSD) have been reported among people seeking treatment for substance use disorders, although few studies have examined the relationship between PTSD and substance use in young drug users. This study compared levels of substance use, coping styles, and high-risk triggers for substance use among young adults with substance use disorder, with or without comorbid PTSD. Young people with current substance use disorder and PTSD reported significantly higher levels of substance use in negative situations, as well as emotion-focused coping, compared to the current substance use disorder-only group. Severity of PTSD was a significant predictor of negative situational drug use, and emotion-focused coping was found to mediate this relationship.
Petra K. Staiger, Fritha Melville, Leanne Hides, Nicolas Kambouropoulos, Dan I. Lubman
Full article in Journal of Substance Abuse Treatment (subscribers only).
http://www.journalofsubstanceabusetreatment.com/
July 2008
Test of a single-item posttraumatic stress disorder screener in a military primary care settingPosttraumatic stress disorder (PTSD) is prevalent in primary care, frequently goes undetected and can be highly debilitating when untreated. Therefor the authors assessed the operating characteristics of a single-item PTSD screener (SIPS) for primary care and compared it to a commonly used four-item primary care PTSD screener (PC-PTSD). A total of 3234 patients from three Washington, DC, area military primary care clinics completed the SIPS. Independent, blinded assessments using a structured diagnostic PTSD interview were completed in 213 of these patients. The SIPS yielded a reasonable range of likelihood ratios, suggesting capacity to discriminate between low- and high-probability PTSD patients. A single, user-friendly primary care PTSD screening question with three response options, failed to offer sound test characteristics for PTSD screening. Ways of improving SIPS performance are discussed.
Kristie L. Gore, Charles C. Engel, Michael C. Freed, Xian Liu, David W. Armstrong
Full article in General Hospital Psychiatry (subscribers only).
http://www.ghpjournal.com/
July 2008
Prevalence of Secondary Traumatic Stress Among Emergency NursesThe purpose of this study is to investigate the prevalence of Secondary Traumatic Stress (STS) in emergency nurses. Authors used an exploratory comparative design, with 67 emergency nurses from three general community hospitals in California. Survey instruments included a demographic tool and the STS Survey (STSS). The nurses were most likely to have Arousal symptoms (irritability reported by 54% of nurses), followed by Avoidance symptoms (avoidance of patients 52%), and Intrusion symptoms (intrusive thoughts about patients 46%). The majority of nurses (85%) reported at least one symptom in the past week. Utilizing Bride's algorithm to identify STS, 15% of nurses met no criteria, while 33% met all. Nurse participation in stress management activities was associated with less prevalence of STS symptoms.
The high prevalence of STS in the sample indicates that potentially large numbers of emergency nurses may be experiencing the negative effects of STS. Symptoms may contribute to emotional exhaustion and job separation of emergency nurses.
Elvira Dominguez-Gomez, Dana N. Rutledge
Full article in Journal of Emergency Nursing (subscribers only).
http://www.jenonline.org/
July 2008
Abnormal recruitment of working memory updating networks during maintenance of trauma-neutral information in post-traumatic stress disorderPost-traumatic stress disorder (PTSD) is characterised by disturbances in concentration and memory, symptoms which are a source of further distress for patients. Related to this, abnormalities in underlying working memory (WM) systems have been identified. In this study, a functional magnetic resonance imaging (fMRI) in 13 patients with severe PTSD was performed and matched with non-traumatized Controls, during performance of visuo-verbal tasks that involved either maintenance or continual updating of word stimuli in WM. The PTSD group failed to show differential activation during WM updating, and instead appeared to show abnormal recruitment of WM updating network regions during WM maintenance. These regions included the bilateral dorsolateral prefrontal cortex (DLPFC) and the inferior parietal lobe (IPL). Several other regions were significantly more activated in Controls than in PTSD during WM updating, including the hippocampus, the anterior cingulate (AC), and the brainstem pons, key regions that are consistently implicated in the neurobiology of PTSD. These findings suggest compensatory recruitment of networks in PTSD normally only deployed during updating of WM and may reflect PTSD patients' difficulty engaging with their day-to-day environment.
Kathryn A. Moores, C. Richard Clark, Alexander C. McFarlane, Greg C. Brown, Aina Puce, D. James Taylor
Full article in Psychiatry Research: Neuroimaging (subscribers only).
http://www.psyn-journal.com/
July 2008
Narrative Exposure Therapy for the Treatment of Traumatized Children and Adolescents (KidNET): From Neurocognitive Theory to Field InterventionMany children in war-affected and refugee populations have experienced multiple traumatic exposures, and high rates of psychologic disorders, especially posttraumatic stress disorder (PTSD), were found. Intervention strategies require pragmatic and effective approaches to treatment. The article describes the rationale for and the use of narrative exposure therapy in children (KidNET). KidNET is a short-term treatment for PTSD based on a neurocognitive theory of traumatic memory. Early treatment trials, including randomized controlled studies, show promising results for the treatment of children and adolescents who have PTSD living in war-affected countries and refugee communities.
Frank Neuner, Claudia Catani, Martina Ruf, Elisabeth Schauer, Maggie Schauer, Thomas Elbert
Full article in Child and Adolescent Psychiatric Clinics of North America, July 2008 (Vol. 17, Issue 3, Pages 641-664) (subscribers only).
http://www.childpsych.theclinics.com/
July 2008
Quantitative testing of pain perception in subjects with PTSD - Implications for the mechanism of the coexistence between PTSD and chronic painPost-traumatic stress disorder (PTSD) often co-occurs with chronic pain. Neither the underlying mechanism of this comorbidity nor the nature of pain perception among subjects with PTSD is well defined. This study is a systematic and quantitative evaluation of pain perception and chronic pain in subjects with PTSD. The study group consisted of 32 outpatients with combat- and terror-related PTSD, 29 outpatients with anxiety disorder and 20 healthy controls. Subjects with PTSD exhibited higher rates of chronic pain, more intense chronic pain and more painful body regions compared with the other two groups. PTSD severity correlated with chronic pain severity. Thresholds of subjects with PTSD were significantly higher than those of subjects with anxiety and healthy controls, but they perceived suprathreshold stimuli as being much more intense than the other two groups. These results suggest that subjects with PTSD exhibit an intense and widespread chronic pain and a unique sensory profile of hyposensitivity to pain accompanied by hyper-reactivity to suprathreshold noxious stimuli.
Ruth Defrin, Karni Ginzburg, Zahava Solomon, Efrat Polad, Miki Bloch, Mirella Govezensky, Shaul Schreiber
Full article in Pain - 31 August 2008 (Vol. 138, Issue 2, Pages 450-459) (subscribers only).
http://www.painjournalonline.com/
July 2008
The Relation of Post-Traumatic Stress Symptoms to Depression and Pain in Patients With Accident-Related Chronic PainThis study highlights the impact of symptoms of PTSD on levels of depression, disability, and pain in patients with pain secondary to physical injury. The results suggest that pain rehabilitation programs provide directed interventions for PTSD symptoms among this population to improve pain treatment outcomes The study used structural equation modeling to examine 3 models that assess these relations in a sample of chronic pain patients with accident-related pain. Subjects were assessed for pain experience, depressive symptoms, anxiety, PTSD symptoms, pain disability, and relevant demographic variables. Pearson correlations indicated that symptoms of depression were significantly related to more severe pain, disability, and PTSD symptoms. PTSD symptoms were significantly associated with higher disability. The model of best fit indicated that after controlling for the influence of anxiety on the dependent measures, PTSD symptoms have a direct influence on severity of depressive symptoms, whereas depressive symptoms have a direct influence on pain intensity and an indirect impact on pain intensity by way of their effect on disability. These data point to the importance of unresolved PTSD symptoms in contributing to the level of depression, pain, and disability exhibited by chronic pain patients and highlight the need to consider directed and primary treatment of PTSD in pain rehabilitation programs.
Randy S. Roth, Michael E. Geisser, Rachel Bates
Full article in The Journal of Pain - July 2008 (Vol. 9, Issue 7, Pages 588-596)(subscribers only).
http://www.jpain.org/
July 2008
Is anxiety sensitivity a predictor of PTSD in children and adolescents?Anxiety sensitivity (AS) is the fear of the physical symptoms of anxiety and related symptoms. Longitudinal studies support AS as a vulnerability factor for development of anxiety disorders. This study aimed to investigate AS as a vulnerability factor in the development of childhood posttraumatic stress disorder (PTSD) following traumatic experiences.
The authors included 81 children aged 8-15 years who experienced the 1999 earthquake in Bolu, Turkey. The earthquake survivors were compared to a randomized group of matched controls 5 years after the earthquake. Both the subject and control groups were administered the Childhood Anxiety Sensitivity Index (CASI), State and Trait Anxiety Inventory for Children (STAI-C), and Child Depression Inventory (CDI). PTSD symptoms were assessed using the Child Posttraumatic Stress Reaction Index (CPTS-RI). Subjects and controls did not differ significantly in CASI, STAI-C, or CDI scores. Multiple regression analysis showed that both trait anxiety and CASI scores predicted CPTS-RI scores of the subjects; the prediction by CASI scores was over and above the effect of trait anxiety. The results support the hypothesis that AS may be a constitutional factor, which might increase the risk of PTSD following traumatic experiences.
Emine Zinnur Kiliç, Cengiz Kiliç, Savas Yilmaz
Full article in Journal of Psychosomatic Research - July 2008 (Vol. 65, Issue 1, Pages 81-86)(subscribers only).
http://www.jpsychores.com/
July 2008
The link between childhood trauma and depression: Insights from HPA axis studies in humansChildhood trauma is a potent risk factor for developing depression in adulthood, particularly in response to additional stress. The authors summarize results from a series of clinical studies suggesting that childhood trauma in humans is associated with sensitization of the neuroendocrine stress response, glucocorticoid resistance, increased central corticotropin-releasing factor (CRF) activity, immune activation, and reduced hippocampal volume, closely paralleling several of the neuroendocrine features of depression. Neuroendocrine changes secondary to early-life stress likely reflect risk to develop depression in response to stress, potentially due to failure of a connected neural circuitry implicated in emotional, neuroendocrine and autonomic control to compensate in response to challenge. Not all of depression is related to childhood trauma and results suggest the existence of biologically distinguishable subtypes of depression as a function of childhood trauma that are also responsive to differential treatment. Other risk factors, such as female gender and genetic dispositions, interfere with components of the stress response and further increase vulnerability for depression. This evidence demonstrates that psychoneuroendocrine research may promote optimized clinical care and help prevent the adverse outcomes of childhood trauma.
Christine Heim, D. Jeffrey Newport, Tanja Mletzko, Andrew H. Miller, Charles B. Nemeroff
Full article in Psychoneuroendocrinology - July 2008 (Vol. 33, Issue 6, Pages 693-710) (subscribers only).
http://www.psyneuen-journal.com/
July 2008
School-Based Prevention Programs for Refugee ChildrenRefugee families tend to underutilize mental health services, so schools have a key mediation role in helping refugee children adapt to their host country and may become the main access point to prevention and treatment services for mental health problems. Many obstacles hamper the development of school-based prevention programs. Despite these difficulties, a review of existing school-based prevention programs points to a number of promising initiatives that are described in this article. More interdisciplinary work is needed to develop and evaluate rigorously joint school-based education and mental health initiatives that can respond to the diverse needs of refugee children.
Cécile Rousseau, Jaswant Guzder
Full article in Child and Adolescent Psychiatric Clinics of North America - July 2008 (Vol. 17, Issue 3, Pages 533-549) (subscribers only).
http://www.childpsych.theclinics.com/
July 2008
Self-reported combat stress indicators among troops deployed to Iraq and Afghanistan: an epidemiological studyEvident mental health needs among combat veterans after their return from combat have been described, whereas available data describing the mental health status of military personnel during deployment are few. Data were collected from personnel systematically selected from current combat regions participating in a rest and recuperation program in Doha, Qatar. Overall, 40 620 troops completed a clinic screening form between October 2003 and January 2005. Distinct temporal trends found in reported combat stress and monthly mortality rates were noted. These data support previous reports of higher mental health problems among troops in Iraq as compared with troops in Afghanistan and lower health care-seeking behavior overall.
Mark S. Riddle, John W. Sanders, James J. Jones, Schuyler C. Webb
Full article in Comprehensive Psychiatry July 2008 (Vol. 49, Issue 4, Pages 340-345) (subscribers only).
http://www.comppsychjournal.com/
July 2008
A short DSM-IV screening scale to detect posttraumatic stress disorder after a natural disaster in a Chinese populationThe objective of the study was to construct a short screening scale for posttraumatic stress disorder (PTSD). Data from a previous study on PTSD among flood victims in 1998 and 1999 in Hunan, China were used, which was a representative population sample of 27,267 subjects. Multistage sampling was used to select the subjects from the flood areas and PTSD was ascertained with the Diagnostic and Statistical Manual of Mental Disorders: 4th Edition (DSM-IV). The short screening scale developed in this study is highly valid, reliable, and predictable. It is an efficient tool to screen PTSD in epidemiological and clinical studies.
Aizhong Liu, Hongzhuan Tan, Jia Zhou, Shuoqi Li, Tubao Yang, Xuemin Tang, Zhenqiu Sun, Xin Yang, Chengqiu Wu, Shi Wu Wen
Full article in Psychiatry Research - 30 June 2008 (Vol. 159, Issue 3, Pages 376-381) (subscribers only).
http://www.psy-journal.com/
July 2008
Post-traumatic stress disorder is not over-represented in a sample population of migraine patientsObjective of the authors was to evaluate the prevalence of PTSD among migraine patients and to assess its relation to migraine severity.
They evaluated 92 consecutive patients fulfilling the international headache society criteria for migraine using the Clinician Administered PTSD Scale (CAPS), and headache severity scales (HIT-6 and MIDAS). Migraine patients do not suffer from PTSD more than the general population. When they do suffer from PTSD they report high levels of disability.
Gal Ifergane, Dan Buskila, Nino Simiseshvely, Alan Jotkowitz, Zeev Kaplan, Hagit Cohen
Full article in European Journal of Internal Medicine - 19 June 2008, article in press (subscribers only).
http://www.ejinme.com/
June 2008
Clinicians' understanding of International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnostic criteria: F62.0 enduring personality change after catastrophic experienceInternational Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has included a diagnostic category of "enduring personality change after catastrophic experience" (EPCACE). Preliminary investigation suggests that there is considerable endorsement in principle for this new category among experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. Criticisms leveled at EPCACE raised issues that question the reliability, validity, and clinical utility of this diagnostic category. In ICD-10, there are 2 sets of documents describing EPCACE criteria. This study examines how clinicians described the symptoms that conform to or exceed the criteria of EPCACE that they observed in their clients. A qualitative approach from social phenomenology and applied policy research perspectives was used to gather the views and experiences of clinicians. Twenty-four clinicians working in the area of torture and refugee trauma, war trauma, and sexual assault trauma were interviewed in depth.
Using the CDDG, clinicians were able to typify the characteristic symptom criteria of EPCACE. This study contributes to the descriptive validity of EPCACE. It demonstrates the utility of a qualitative approach to descriptive validation of diagnostic criteria.
Ruth O. Beltran, Gwynnyth M. Llewellyn, Derrick Silove
Full article in Comprehensive Psychiatry - 16 June 2008, articles in press (subscribers only).
http://www.comppsychjournal.com/
June 2008
Broken Laws, Broken Lives
The international organisation "Physicians for Human rights" recently has published a report on 11 detainees from Guantanomo Bay, Iraq and Afghanistan. The report provides medical evidence of torture by US Personell and its impact. None of the 11 men were ever charged with any crime. There is no longer any doubt as to whether the current administration of the US has committed war crimes. The only question is whether those who ordered the use of torture will be held to account. The executive summary of this report is online available for ESTSS members (PDF 889kB). Please enter your ESTSS members username and password when prompted 
. For the full report register at http://brokenlives.info.
GMS (German Medical Science) Psycho-Social-Medicine (p-s-m) is an open access e-journal, which publishes articles from the whole area of psychosocial research in medicine. It is edited on an interdisciplinary level by ten German scientific societies from the areas of behavioral medicine, medical psychology and sociology, psychiatry, psychosomatic medicine, and psychotherapy. P-s-m offers all scientists from the field of psychosocial medicine the possibility to publish their research online. Only high-ranking and quality reviewed articles are accepted for publication. All accepted articles are published in English. They are available online for anyone interested: immediately, permanently and free of charge at http://www.egms.de/ »»
The ESTSS thanks Stevan E. Hobfoll for permission to share the following articles, published in Psychiatry: Interpersonal & Biological Processes, volume: 70, Issue 4, 2007, pp. 283-315
Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence
Stevan E. Hobfoll, Patricia Watson, Carl C. Bell, Richard A. Bryant, Melissa J. Brymer, Matthew J. Friedmann, Merle Friedmann, Berthold P. R. Gersons, Joop t. V. M de Jong, Christopher M. Layne, Shira Maguen, Yuval Neria, Ann E. Norwood, Robert S. Pynoos, Dori Reissmann, Josef I. Ruzeck, Arieh Y. Shalev, Zahava Solomon, Alan M. Steinberg and Robert J. Ursano
The article "Five Essential elements of Immediate and Mid-term Mass Trauma Intervention" is a key paper for mental health professionals, policy makers, decision makers, and others who are involved in crisis-management and preparations to cope with large scale traumatic events and disasters. Stevan E Hobfoll and all the famous co-authors have produced something that has been missing for a long time. They have provided evidence regarding various actions of support and counselling in situations of massive trauma, affecting many people and communities.
To create evidence in a field in which a lot of experiments have been performed and experience gained, but without direct research evidence for psychosocial interventions, demands a theoretical framework. The authors have provided a solution, which comprises an extrapolation of knowledge from related fields of research and a consensus from researchers and practitioners in the fields of trauma and disaster recovery. The authors also decided to identify foci that are best supported by the literature as promoting stress-resistant and resilient outcomes following exposure to extreme stress.
As a result, five evidence informed elements have been defined. These elements are empirically supported and should be used to guide and inform intervention and prevention efforts in the early to mid-term stages. The elements are:
- a sense of safety
- calming
- a sense of self- and community efficacy
- connectedness
- hope
Each of these elements is broadly supported with empirical data and research results. The elements apply to all levels of interventions and they will help in the process of setting policy and designing intervention strategies. They broaden primary and secondary prevention possibilities, inform psychological first aid and community support and consider much more than just effective clinical interventions for survivors who develop PTSD. By doing so a large number of individuals could be accessed.
The authors believe that there are many ways to operationalize these principles and that they should be applied in careful designs, that must be appropriate for the local culture, location and type of trauma. The authors argue for the need to research and test interventions with these elements. Finally they argue for modesty regarding the potential for interventions to have a long-term impact on symptomatology. They warn against overestimation of the effects and state that these principles will not lead to a one-treatment-fits-all approach.
The paper represents a challenge for all professions within the disaster-field and serves to encourage a discussion on standards and procedures for helping victims of large scale events. This is started by the ten accompanying commentaries listed below.
John A. Fairbanks and Ellen T. Gerrity - "Making Trauma Intervention Principles Public Policy" [113kB}
Fran H. Norris and Susan P. Stevens - "Community Resilience and the Principles of Mass Trauma Intervention" [143kB]
Beverly Raphael - "The Human Touch and Mass Catastrophe" [154kB].
Lars Weisæth, Grete Dyb and Trond Heir - "Disaster Medicine and Mental Health: Who, How, When for International and National Disasters" [138kB]..
David M. Benedek and Carol S. Fullerton - "Translating Five Essential Elements into Programs and Practice" [119kB]..
Patricia A. Resick - "Whose Role Is It Any Way?" [116kB].
Michael Blumenfield - "The March Toward Evidence Based Criteria for Mass Trauma Intervention" [107kB].
Farris Tuma - "Mass Trauma Intervention: A Case for Integrating Principles of Behavioral Health with Intervention to Restore Physical Safety, order and Infrastructure" [127kB].
Norman Jones, Neil Greenberg and Simon Wessely - "No Plans Survive First Contact with the Enemy: Flexibility and Improvisation in Disaster Mental Health" [120kB].
Brian W. Flynn - "A Sound Blueprint for Building Stronger Home" [133kB].
All commentaries appreciate the outstanding quality of the article, they value the large number of authors, their honesty about the limits of the evidence base and the promotion of the idea to open access to intervention for more individuals, who are not patients but affected people, who are in need of help. Nevertheless each commentary raises a number of questions, critical remarks and concerns, which are thoughtfully discussed using research evidence and experience.
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