SARS control and psychological effects of quarantine, Toronto, Canada

As a transmissible infectious disease, severe acute respiratory syndrome (SARS) was successfully contained globally by instituting widespread quarantine measures. Although these measures were successful in terminating the outbreak in all areas of the world, the adverse effects of quarantine have not previously been determined in a systematic manner. In this hypothesis-generating study supported by a convenience sample drawn in close temporal proximity to the period of quarantine, we examined the psychological effects of quarantine on persons in Toronto, Canada. The 129 quarantined persons who responded to a Web-based survey exhibited a high prevalence of psychological distress. Symptoms of posttraumatic stress disorder (PTSD) and depression were observed in 28.9% and 31.2% of respondents, respectively. Longer durations of quarantine were associated with an increased prevalence of PTSD symptoms. Acquaintance with or direct exposure to someone with a diagnosis of SARS was also associated with PTSD and depressive symptoms.     

“非典”患者创伤后应激障碍追踪研究

目的追踪研究"非典"患者出院后3个月、12个月两个阶段创伤后应激障碍(PTSD)的发生,对有PTSD的"非典"患者进行心理干预并作干预后评价.方法采用经修订的事件影响量表(IES-R)、自编的应激源、认知问卷等量表对114名"非典"患者进行测试,并作相关统计分析.结果本调查30.7%的"非典"患者在事件结束后3个月被精神科医生确诊为PTSD,其中27人IES-R总分超过19分,闪入症状出现的频率较高;12个月后这些"非典"患者经1～4次电话心理干预后PTSD症状减轻.结论部分"非典"患者在事件结束后PTSD症状持续存在,临床应该持续评估其心理状态,并进行及时干预;电话心理干预有效,经干预后"非典"患者症状减轻明显.     

Cross-cultural adaptation of the Brazilian version of the Impact of Events Scale-Revised (IES-R)

The Impact of Events Scale-Revised (IES-R) is used to screen for post-traumatic stress disorder (PTSD). The aim of this study was to assess the cross-cultural adaptation of the IES-R. The scale was translated into Brazilian Portuguese and culturally adapted. Reliability and validity were evaluated in 45 individuals divided into three groups of 15 (without PTSD, with PTSD, and treated for PTSD). Reliability was evaluated using intraclass correlation coefficient - ICC and Cronbach's alfa. Discriminant validity was evaluated by comparing mean IES-R scores in the three groups. The area under the ROC curve (AUC) was evaluated to determine cut-offs with higher sensitivity (s) and specificity (e) using the clinical interview (DSM-IV) as reference. The IES-R showed good reliability (ICC = 1; alfa from 0.75 to 0.93). The mean IES-R scores (p < 0.05) and ROC curve had good discriminant validity for a cut-off of 5.6 (s = 0.80, e = 0.70 and AUC = 0.81). The Brazilian version of IES-R showed good properties and can be a useful screening tool for PTSD.     

社会支持及心理复原力与大学生创伤后应激障碍的关联

  目的  了解大学生创伤后应激障碍(post-traumatic stress disorder, PTSD)的发生特点,探讨心理复原力在社会支持与创伤后应激障碍间的作用。  方法  采用直接抽选法选取安徽、上海两地高校572名大学生, 采用一般特征调查表、创伤后应激障碍量表平民版(the PTSD Checklist-Civilian Version,PCL-C)、心理韧性量表(Psychological Resilience Scale,PRS)、社会支持评定量表(Social Support Rating Scale,SSRS)进行问卷调查。  结果  25.0%的大学生有一定程度PTSD症状,11.7%有较明显PTSD症状,PTSD的阳性检出率为36.7%。大学生有较明显PTSD的检出率男生高于女生,大三学生高于其他3个年级,差异均有统计学意义(χ2值分别为4.31,16.81,P值均＜0.05)。大学生社会支持得分为(33.79±4.83) 分,心理复原力得分为(92.17±13.39)分,PTSD得分为(35.50±11.39)分,各变量两两之间相关性均有统计学意义(r=-0.49~0.76,P值均 < 0.05);中介效应检验结果发现,社会支持既可以直接负向预测PTSD(直接效应为-0.35),又可以通过心理复原力间接影响PTSD(间接效应为-0.32)。  结论  大学生存在一定程度或者严重程度PTSD症状的比例较高,心理复原力在社会支持和大学生的PTSD间起中介作用,即社会支持既能直接负向预测PTSD,又可以通过提升个体的心理复原力间接影响PTSD。     

The association between discrimination and PTSD in African Americans: exploring the role of gender

ABSTRACT

Background: Research has demonstrated the adverse impact that discrimination has on physical and mental health. However, few studies have examined the association between discrimination and symptoms of posttraumatic stress disorder (PTSD). There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity.

Purpose: To examine the association between discrimination and PTSD among a cross-sectional sample largely comprising African American women, controlling for other psychosocial stressors (psychological distress, neighborhood safety, crime).

Methods: A sample of 806 participants was recruited from two low-income predominantly African American neighborhoods. Participants completed self-report measures of PTSD symptoms, perceived discrimination, perceived safety, and psychological distress. Information on neighborhood crime was obtained through data requested from the city. Multivariate linear regression models were estimated to assess adjusted relationships between PTSD symptoms and discrimination.

Results: Discrimination was significantly associated with PTSD symptoms with a small effect size, controlling for relevant sociodemographic variables. This association remained consistent after controlling for psychological distress, perceived safety, and total neighborhood crime. There was no evidence of a gender by discrimination interaction. Participants who experienced any discrimination were significantly more likely to screen positive for PTSD.

Conclusions: Discrimination may contribute to the disparate rates of PTSD experienced by African Americans. PTSD is associated with a range of negative consequences, including poorer physical health, mental health, and quality of life. These results suggest the importance of finding ways to promote resilience in this at-risk population.     

Psychological outcomes amongst family medicine healthcare professionals during COVID-19 outbreak: A cross-sectional study in Croatia

BackgroundHealthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown.ObjectivesTo assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes.MethodsA cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM.ResultsHCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact.ConclusionFamily physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.     

疫情应激对医护人员睡眠及情绪的影响调查

目的了解医务人员在重大公共卫生事件中的应激程度以及对发生创伤后应激障碍的预防提供数据支持和干预方向。方法采用网络随机抽样的原则,在疫情发生的两周内,收集258份医务人员和63份普通大众的有效问卷。调查内容包含一般人口学资料、IES-R(事件冲击量表)、PSQI(匹兹堡睡眠质量指数量表)、PHQ-9(9条目健康问卷)、GAD-7(7条目健康问卷)。结果医务人员在重大公共卫生事件中的IES-R量表得分显著高于普通大众(P<0.01),但一线医务人员和二线医务人员在得分上没有显著差异,管理岗位的医务人员得分最高,不同岗位间差异显著(F=3.931);且IES-R量表及其三个不同维度分别与睡眠情况、抑郁、焦虑显著相关(P<0.01);同时,医务人员的睡眠质量指数得分显著高于疫情期间的普通大众,也显著高于平时的医务人员群体(P<0.01)。结论医务人员在重大公共卫生事件时具有高应激性,由此带来睡眠问题突出,要注意调节情绪,预防创伤后应激障碍的发生。     

Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces

Objective

To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods

A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire‐12 (GHQ‐12), the post‐traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF‐36 questionnaire. The abridged questionnaire included the GHQ‐4, a 14 item PTSD checklist, five symptoms, and the item on self‐perception of health from the SF‐36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms.

Results

12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non‐downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury.

Conclusions

Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces.     

Hypertension and asthma: psychological aspects

Essential hypertensive and asthmatic patients, plus normal non-clinical controls, were compared on a number of psychological measures in order to identify the relationship between psychological distress, coping strategies and compliance behaviour. The hypothesised relationship between chronic clinical ailments and psychological distress was confirmed. The association between the presence of physical symptoms in the symptomatic condition, asthma, and greater psychological distress was also confirmed. The coping strategies adopted by the patients did not discriminate between the two clinical groups. Compliance with medication was negatively correlated with measures of psychological distress. Compliance with an appropriate healthy lifestyle was not correlated with medication compliance, although it too was negatively correlated with other measures of psychological distress.     

Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians.

OBJECTIVES: To assess the effects of interventions to prevent transmission of influenza and to increase employee compliance with influenza vaccination. DESIGN: The change in the proportion of hospitalized patients with laboratory-confirmed nosocomial influenza was observed over time and assessed using chi-square for trend analysis. The association between nosocomial influenza in patients and healthcare worker (HCW) compliance with vaccine was assessed by logistic regression. SETTING: A 600-bed, tertiary-care academic hospital. METHODS: After an outbreak of influenza A at this hospital in 1988, a mobile cart program was instituted with increased efforts to motivate employees to be vaccinated and furloughed when ill as well as new measures to prevent nosocomial spread. RESULTS: HCW vaccination rates increased from 4% in 1987-1988 to 67% in 1999-2000 (P < .0001). Proportions of nosocomially acquired influenza cases among employees or patients both declined significantly (P < .0001). Logistic regression analysis revealed a significant inverse association between HCW compliance with vaccination and the rate of nosocomial influenza among patients (P < .001). CONCLUSION: A mobile cart vaccination program and an increased emphasis on HCWs to receive the vaccine were associated with a significant increase in vaccine acceptance and a significant decrease in the rate of nosocomial influenza among patients.     

A cross-sectional study on posttraumatic impact among Qiang women in Maoxian County 1 year after the Wenchuan Earthquake, China

The authors sought to examine the posttraumatic impact among Qiang women aged 18 years or older in 2 villages of Maoxian county 1 year after the Wenchuan earthquake and determined the variables associated with mental health status and posttraumatic symptoms for further psychological interventions. They interviewed 270 Qiang women. Psychological health status was assessed using the Chinese Health Questionnaire (CHQ-12). Posttraumatic symptoms were assessed using the Impact of Event Scale-Revised (IES-R), Chinese version. The results showed that 141 (52.2%) of the participants had psychological problems. The widowed and those who witnessed casualty scored higher on the CHQ-12. Among those surveyed, 100 (37.0%) women's mean intrusion subscale scores were ≥2; for 71 (26.3%) women, the mean avoidance score was ≥2; and for 88 (32.6%), the mean hyperarousal score was ≥2. Also, 23 (8.5%) women had scores ≥2 on all the 3 subscales. Those who had no job, were injured, and had witnessed casualties scored higher on each subscale of the IES-R.     

Symptoms of Posttraumatic Stress,Depression, and Body Image Distress in Female Victims of Physical and Sexual Assault: Exploring Integrated Responses

While body image concerns and interpersonal violence exposure are significant issues for women, their interrelationship has rarely been explored. We examined the associations between severity of acute injuries, symptoms of posttraumatic stress disorder (PTSD), depression, and body image distress within a sample of predominantly African American victims of interpersonal violence (N = 73). Severity of body image distress was significantly associated with each outcome. Moreover, body image distress was a significant, unique predictor of depression but not PTSD severity. We recommend continued exploration of body image concerns to further integrated research on violence against women.     

Differences in the association of spirituality,forgiveness, PTSD and stress among social workers and social work students treating trauma survivors

ABSTRACT

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.     

江西省洪涝灾害后1149名受灾居民心理健康状况调查

目的了解江西地区洪涝灾区部分居民灾害后的心理健康状况及应激反应,为出台完善重大自然灾害心理干预预案提供依据。方法采用分层整群抽样方法,使用自编的一般情况调查表、症状自评量表(SCL-90)、事件影响量表-修订版(IES-R)对江西省南昌市西湖区和安义县15～70岁受灾居民进行调查。结果共调查1149人,受灾人群中有41.69%存在不同程度的心理问题,有15.06%的人可能存在某种明显的心理问题。受灾居民除躯体化及抑郁因子得分外与全国常模差异无统计学意义(P﹥0.05),焦虑、敌对等症状因子得分和总分、总均分均高于全国常模,差异有统计学意义(P﹤0.05);抑郁和敌对症状因子得分男女差异无统计学意义(P﹥0.05),男性受灾居民人际关系敏感因子得分较女性为低,而躯体化、强迫症状、焦虑、恐怖、偏执、精神病性及总分、总均分均高于女性受灾居民,差异有统计学意义(P﹤0.05);除人际关系敏感、敌对、偏执因子外(P﹥0.05),南昌地区受灾居民躯体化、强迫症状等因子及总分、总均分均高于安义县受灾居民,差异有统计学意义(P﹤0.05)。受灾居民创伤后应激症状阳性检出率为12.71%。不同性别受灾居民各应激反应症状因子及总分、总均分差异均无统计学意义(P﹥0.05);南昌地区受灾居民除闯入因子外,回避、高警觉性症状因子及总分、总均分均高于安义县受灾居民,差异有统计学意义(P﹤0.05)。结论极端恶劣天气对受灾居民的心理健康影响普遍而严重,尽早建立极端恶劣天气下心理干预机制十分必要。     

重症肝炎、肝衰竭患者疾病认知与心理痛苦状况的相关性

目的 观察重症肝炎、肝衰竭患者心理痛苦状况,分析患者疾病认知与心理痛苦的关系.方法 选取2019年3月～2020年4月海南省干部疗养院收治的63例重症肝炎、肝衰竭患者,设计一般资料调查问卷,询问患者基线资料情况,采用心理痛苦管理筛查工具(DT评分)评估患者并分为心理痛苦严重组和心理痛苦轻微组;评估并比较两组疾病认知,分...     

Posttraumatic Stress Symptoms and their Relationship to Drug and Alcohol use in an International Sample of Latino Immigrants

We identify the prevalence and correlates of posttraumatic stress (PTSD) symptoms and their relationship to alcohol and substance use disorders (AUD/SUD) among Latino immigrants in two countries. A screening battery assessing PTSD symptoms (PCL-C), alcohol use (AUDIT), drug abuse (DAST), and psychological measures was administered to 562 Latino immigrants recruited in clinics. We used logistical regression analyses to evaluate the relationship between PTSD symptoms and AUD/SUD. Prevalence of elevated PTSD symptoms was high (53.7 % in Boston, 47.9 % in Madrid and, 43.8 % in Barcelona). Screening positive for psychological measures was significantly correlated to screening positive on the PCL-C (p < 0.001). Significant gender differences in risk of AUD/SUD were moderated by PTSD symptoms. Presence of any PTSD symptoms predicted problems with benzodiazepine misuse. Given the high rates of co-morbidity between PTSD symptoms and AUD/SUD, we recommend early interventions for dual pathology for Latino immigrants with trauma history.     

山西省SARS康复者创伤后应激障碍分析

目的对山西省SARS康复者创伤后应激障碍(PTSD)的发生率及相关影响因素进行分析。方法采用自编的应激源-认知问卷、经修订的事件影响量表(IES-R)、领悟社会支持量表(PSSS)、简易应对方式问卷(SC-SQ)、自尊量表(SES)、艾森克个性问卷(EPQ)对117例SARS康复者进行测试,并作相关统计分析。结果PTSD发生率为55.1%;高反应者多为隔离受限、社会歧视明显以及习惯于采用消极应对方式者。结论山西省SARS康复者PTSD的发生率高,产生PTSD的主要影响因素是隔离受限、社会歧视和消极应对方式。     

The association of illness perceptions with depressive symptoms and general psychological distress in parents of an offspring with autism spectrum disorder

BackgroundRaising a child with an autism spectrum disorder (ASD) is a severe stressor and parents often present high levels of depression. Depression is associated with illness perceptions but this association has not been studied in parents of ASD offspring.ObjectiveWe aimed to assess the prevalence of psychological distress symptoms and their associations with illness perceptions in parents with an ASD offspring.MethodsIn 111 parents of ASD offspring we assessed depressive symptoms (PHQ-9), illness perceptions (B-IPQ) and general psychological distress (GHQ-28). Multiple linear and logistic regressions were used to assess their independent associations.ResultsThe prevalence of parental clinically significant depressive symptoms was 34.2%, while 55% presented clinically significant levels of general psychological distress. Younger parents and those with lower financial resources had greater psychological distress and more severe depressive symptoms. Parents felt that the condition impacted their lives and believed it would be chronic. Their beliefs about the consequences and the chronicity of the disorder were significant independent correlates of their psychological distress and depressive symptoms severity.ConclusionsThese findings indicate that a remarkable proportion of parents with an ASD offspring present clinically significant depressive symptoms, which were associated with illness perceptions relevant to the consequences and the chronicity of the disorder. Our data encourage psychotherapeutic interventions aiming to support parents to deal with the consequences and chronicity of their offspring's disorder, in order to reduce parental psychological distress.     

Combining a single session of prolonged exposure with physical activity in patients with PTSD: The effect of sequence

Adding physical activity may be a promising new strategy to augment the effectiveness of prolonged exposure (PE) therapy in post-traumatic stress disorder (PTSD). However, it is unknown whether it is more effective to provide the physical activities before or after PE for PTSD. Therefore, the current study examined the influence of the sequence in which physical activity and PE are applied, on the primary outcome measures of trauma-related distress and vividness. In this quasi-experimental study, a total of 93 patients with PTSD were allocated to two conditions: (1) PE followed by physical activity (N = 50) and (2) physical activity followed by PE (N = 43). The physical activity intervention consisted of a low to moderate intensive outside walk. The reduction in trauma-related distress and vividness from pre- to post-intervention was significantly stronger in the group that performed physical activity after a single PE session compared to the group performing physical activity prior to the PE session. However, the explorative results with regard to freezing symptoms and emotion regulation problems indicated that both sequence groups showed an equal decrease in symptoms over time. The current findings suggest that the sequence in which physical activity and PE sessions are performed, could matter. A stronger effect on distress and vividness was found when physical activity was added after, instead of before, one PE session. These results could further guide interventions for patients with PTSD by taking sequence into account when combining single physical activity and PE sessions in clinical practice.