Longitudinal analysis of the relationship between PTSD symptom clusters, cigarette use, and physical health-related quality of life

Purpose

Posttraumatic stress disorder (PTSD) symptoms, particularly numbing and hyperarousal symptoms, are related to poor physical health-related quality of life (HRQoL). Tobacco dependence is also associated with poor HRQoL, and individuals with PTSD may smoke at higher rates than the general population. Our study aimed to examine the impact of quitting smoking and changes in PTSD symptoms over time on changes in physical HRQoL.

Methods

The study used archival data from enrollees (N = 943) in a smoking cessation clinical trial for veterans with PTSD (VA Cooperative study #519).

Results

Two of the physical HRQoL domains were sensitive to changes in PTSD symptoms over time: General Health and Vitality.

Conclusions

Our findings suggest that particular physical HRQoL domains may be subject to improvement if PTSD symptoms decrease over time.     

Preliminary Evidence for a Classroom Based Psychosocial Intervention for Disaster Exposed Children with Posttraumatic Stress Symptomatology

Background

In 2004, a firework factory in a residential area of a large Danish city exploded. The children at the local school were screened for symptoms of posttraumatic stress disorder (PTSD) 16 months and 3½ years after the incident. A large proportion of the children still suffered from a substantial number of symptoms 3½ years after the incident. Thus, a treatment program designed to target PTSD symptoms in trauma-exposed children was established.

Objectives

The first aim of this study was to provide preliminary evidence that a classroom-based psychosocial intervention program for children with posttraumatic stress would be associated with reductions in symptoms. The second aim was to evaluate the usefulness of the Darryl, a cartoon-based PTSD screening instrument.

Methods

One hundred and eight children participated in the treatment program, all of whom fulfilled at least two out of the three DSM-IV PTSD symptom clusters. The children were screened for PTSD symptoms at baseline and 1 month after treatment using Darryl.

Results

There was a statistically significant reduction in PTSD symptoms from pre-treatment to post-treatment. Furthermore, a logistic regression analysis revealed that being female, being young, and having a high PTSD score at baseline predicted a probable PTSD diagnosis post-treatment.

Conclusion

The present study provides preliminary evidence of feasibility and that the treatment program described may help to alleviate PTSD symptoms children with chronic PTSD symptoms. Furthermore, the results indicated that the Darryl instrument is a useful screening tool for assessing PTSD symptoms in this sample of children.     

Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study

Background

Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

Methods

This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups.

Results

The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

Conclusion

Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

     

Anxiety after a fall in elderly subjects and subsequent risk of developing post traumatic stress disorder at two months. A pilot study

Background

The psychological burden suffered by elderly subjects after a fall adds to rehabilitation difficulties. We hypothesised that Post Traumatic Stress Disorder (PTSD) may be at the root of these psychological post-fall problems. The immediate psychological state was examined after 2 months post-fall in order to determine the prevalence of anxiety and PTSD and their possible correlates.

Method

A single centre prospective survey including elderly subjects referred to an emergency department (ED) after a fall with a 2-month follow-up.

Results

30.5% of patients showed a significant level of anxiety after their fall and (26%) showed evidence supporting the presence of PTSD at 2-months. Immediate anxiety, ability to re-establish upright posture and a history of repeated falls were significant predictors of PTSD at 2-months.

Conclusion

persistent psychological problems post fall may be related to PTSD which is significantly correlated to immediate anxiety. This study can be seen as a first step in patient characterisation, and predicts who may benefit from which of the various approaches of rehabilitation.     

Protective Factors Based Model for Screening for Posttraumatic Distress in Adolescents

Background

There is growing application of school-based screening to identify post-traumatic distress in students following exposure to trauma. The consensus method is based on self-report questionnaires that assess posttraumatic symptoms, functional impairment, depression or anxiety.

Objective

The current research explored the possibility of using a model, based on the assessment of protective factors, as a screening method for identifying youth who may suffer from posttraumatic distress and need professional help in the aftermath of war.

Method

Participants were 482 Israeli high-school students who were exposed to ongoing missile attacks during Operation Cast Lead in Gaza in 2008. The data collected included symptom scales and three protective factor scales assessing perceived self-efficacy, cognitive-emotion regulation and flexibility in the use of various coping strategies.

Results

The results showed that all three protective factors were significant predictors of symptom severity. The protective-factor-based model utilized logistic regression and receiver operating characteristics analysis. The model correctly classified 84 % of adolescents presenting with probable post traumatic stress disorder, identifying them as distressed. Cross-validation was conducted to assess the stability and reliability of the model, which were found to be acceptable.

Conclusion

The protective factors based model could be important as a part of preliminary triage before referral for intervention and for identification of distressed adolescents. School based screening which focuses on assessing protective factors may facilitate cooperation by both adolescent students and the education system.     

Untangling Psychiatric Comorbidity in Young Children Who Experienced Single,Repeated, or Hurricane Katrina Traumatic Events

Background

In individuals with posttraumatic stress disorder (PTSD), 70–90 % have at least one comorbid non-PTSD disorder.

Objective

This study tested several hypotheses to untangle comorbidity issues. Following McMillen et al. (Compr Psychiatry 43(6):478–485, 2002), we hypothesized that few non-PTSD disorders would arise following traumatic events in children with substantial PTSD symptoms. Second, Repeated Events victims would show more internalizing and externalizing problems compared to Single Event and Hurricane Katrina victims. Third, we aimed to replicate in young children the finding from older populations that exposure to multiple events, not the type of event, would predict severity of symptoms. These results would inform speculations that repeated and prolonged traumas produce greater symptom complexity.

Methods

Children 3–6 years of age were recruited for three types of trauma: Single (n = 62), Hurricane Katrina (n = 85), and Repeated Events (n = 137), and assessed with caregiver reports from a diagnostic interview.

Results

Overall, 95 % of children who developed new non-PTSD disorders following traumas also had substantial PTSD symptoms. The Katrina and Repeated Events groups showed more diagnoses of oppositional defiant disorder compared to the Single Event group, but groups did not differ on PTSD, depression, anxiety, or attention-deficit/hyperactivity disorder. Cumulative number of events was the only significant predictor of PTSD symptoms, while type of trauma and total occurrences of traumas did not predict additional variance.

Conclusion

These data provide empirical support for targeting interventions on PTSD following traumas and disasters. The homogeneity of outcomes across types of traumas provides little empirical support for speculations that repeated and prolonged traumas produce greater symptom complexity.

     

Analysis of occupational stress in a high fashion clothing factory with upper limb biomechanical overload

Purpose

To study job stress and upper limb biomechanical overload due to repetitive and forceful manual activities in a factory producing high fashion clothing.

Methods

A total of 518 workers (433 women and 85 men) were investigated to determine anxiety, occupational stress (using the Italian version of the Karasek Job Content Questionnaire) and perception of symptoms (using the Italian version of the Somatization scale of Symptom Checklist SCL-90). Biomechanical overload was analyzed using the OCRA Check list.

Results

Biomechanical assessment did not reveal high-risk jobs, except for cutting. Although the perception of anxiety and job insecurity was within the normal range, all the workers showed a high level of job strain (correlated with the perception of symptoms) due to very low decision latitude.

Conclusion

Occupational stress resulted partially in line with biomechanical risk factors; however, the perception of low decision latitude seems to play a major role in determining job strain. Interactions between physical and psychological factors cannot be demonstrated. Anyway, simultaneous long-term monitoring of occupational stress features and biomechanical overload could guide workplace interventions aimed at reducing the risk of adverse health effects.     

Job-related stress in psychiatric nurses in Japan caring for elderly patients with dementia

Objectives

We investigated the specificity and structures of job-related stress in psychiatric dementia nurses (PDNs) caring for elderly patients with serious behavioral and psychological symptoms of dementia who required substantial assistance with activities of daily living, in order to obtain fundamental knowledge toward providing mental health care for these nurses.

Methods

Subjects were 244 nurses [63 PDNs and 181 other psychiatric nurses (OPNs)]

Results

Analysis of covariance to examine the specificity of job-related stress in PDNs revealed physical workload and work environment to be more significant stressors, and irritability and anxiety to be more significant stress reactions in PDNs than in OPNs. An examination of PDNs’ job-related stress structures established in a structural equation model with two stress reactions confirmed as specific outcomes for PDNs revealed a significant positive influence of work environment on irritability; utilization of techniques for anxiety and physical workload influenced both stress reactions.

Conclusions

Our findings highlight the importance of reducing physical workload and environment and establishing a structure for nursing techniques in psychiatric dementia wards to improve the mental health of PDNs.     

Depression and anxiety symptoms in bronchiectasis: associations with health-related quality of life

Background and purpose

Bronchiectasis causes pulmonary infections and loss of lung function, resulting in chronic respiratory symptoms and worsening health-related quality of life. The aims of this study were to measure symptoms of depression and anxiety in a sample of patients with bronchiectasis and evaluate their relationship to health outcomes and health-related quality of life.

Methods

This cross-sectional study included adolescents and adults with bronchiectasis. Patients completed the hospital anxiety and depression scale and the St. George respiratory questionnaire. Health outcome data, including clinical, radiological and spirometric values, were recorded from medical charts.

Results

Ninety-three participants with bronchiectasis of any aetiology were recruited: 20 % had elevated depression-related scores and 38 % had elevated anxiety-related scores. Increased symptoms of depression and anxiety were significantly associated with age; anxiety was associated with more frequent exacerbations. Regression analyses indicated that after controlling for demographic (gender and age) and clinical variables (exacerbations frequency, daily sputum, aetiology and spirometry), both depression and anxiety symptoms predicted significantly worse health-related quality of life. In comparison with other predictors, psychological symptoms explained the largest amount of variance in health-related quality of life.

Conclusions

Symptoms of depression and anxiety were significant predictors of health-related quality of life in patients with bronchiectasis, independently of respiratory involvement, gender, age or other variables.     

Temperamental correlates of trauma symptoms in firemen,policemen and soldiers

Objectives

The main goal of the research was to assess temperamental determinants of trauma symptoms in firemen, policemen and soldiers. The temperament traits which were considered were those postulated by the Regulative Theory of Temperament (briskness, perseveration, sensory sensitivity, emotional reactivity, endurance and activity).

Material and Methods

A cross-sectional study was run on non-clinical samples. The participants were 417 men, White-Caucasian only: 284 firemen (aged 21–55), 58 policemen (aged 22–45), and 75 soldiers (aged 21–42). Temperament was assessed using the Formal Characteristics of Behavior — Temperament Inventory. Intensity of trauma symptoms was assessed with the PTSD-Factorial Version Inventory, a quantitative measure of trauma-related symptoms. The respondents were examined in their place of work. The study included only men reporting at least 1 traumatic event during the year before the trauma diagnosis.

Results

Emotional reactivity had a significant positive effect on the intensity of trauma symptoms only in the group of firemen. Emotional reactivity accounted for 16% of the variance of trauma intensity symptoms in this occupational group. Negative significant effect on trauma symptoms was found for briskness only in the soldiers group (briskness explained 20% trauma intensity variance in this group).

Conclusions

Emotional reactivity was conducive to the increased trauma symptoms intensity in firemen, whereas briskness tended to reduce symptoms intensity only in the group of soldiers.     

Prison employment and post‐traumatic stress disorder: Risk and protective factors

Objectives

To examine the prevalence of Post‐Traumatic Stress Disorder (PTSD) in a sample of prison employees, investigate risk factors, and explore protective factors for PTSD.

Methods

We surveyed 355 Washington State Department of Corrections employees. The survey included the PTSD checklist for the DSM‐5 (PCL‐5), the Critical Incident History Questionnaire, and the Work Environment Inventory.

Results

We found 19% of the sample met the criteria for diagnosable PTSD. Several risk factors were associated with a higher PCL‐5 score, including exposure to critical incidents, and having greater ambiguity in the job role. Being happy with job assignments and having positive relationships with supervisors and coworkers were associated with decreased PCL‐5 score.

Conclusions

Prison employees have a PTSD rate equivalent to Iraq and Afghanistan war veterans and higher than police officers, suggesting the importance of developing programs for promoting resilience to stress, incorporating the knowledge gained on risk, and protective factors.

     

Mental health and health-related quality of life of Chinese college students who were the victims of dating violence

Purpose

The aim of the study is to evaluate the mental health and health-related quality of life (HRQOL) of Chinese college students who were the victims of dating violence.

Methods

Six hundred and fifty-two subjects were included in the data analysis. Subjects completed a structured questionnaire containing the Woman Abuse Screening tool, the Hospital Anxiety and Depression Scale, the 10-item version of the Perceived Stress Scale (PSS-10) and the World Health Organization Quality of Life-BREF Instrument (WHOQOL-BREF).

Results

Analysis by independent t test suggested that victims of dating violence had more severe depressive, anxiety and stress symptoms and poorer HRQOL than non-victims. Multiple linear regression models found that more severe dating violence victimization was associated with more severe depressive, anxiety and stress symptoms. The mediation analysis found that after simultaneously controlling for the degree of depressive, anxiety and stress symptoms, the direct effect between dating violence severity and HRQOL, as measured by overall HRQOL and the global health, physical and environment domains of the WHOQOL-BREF, was statistically insignificant, supporting a full-mediation model. The relationship between dating violence severity and the social domain of HRQOL was partially mediated by the degree of depressive, anxiety and stress symptoms.

Conclusion

Victims of dating violence had poorer mental health and HRQOL than non-victims. The study findings affirm the importance of assessing depressive, anxiety and stress symptoms in victims and the need to improve their depressive, anxiety and stress symptoms to diminish the negative effects of dating violence, which are apparent in their HRQOL.

     

Psychometric study of depression,anxiety and stress among university students

Aim

Depression, anxiety and stress are phenomena observed across world, especially in developing countries. This research explores a relationship between depression, anxiety, and stress, and socio-demographic characteristics of university students.

Subject and methods

For this purpose, depression, anxiety and stress scale (DASS–21) was used for data collection along with socio-demographic variables. The data were collected from 361 students of various academic disciplines and degree programs through self-reported questionnaire.

Results

The findings reveal that male students had more depression, stress, and anxiety in comparison to female students. There were no significant differences in depression, anxiety and stress on the basis of family type. In addition, there was significant difference in the perception of depression, anxiety, and stress on the basis of their residential status and parents’ education.

Conclusions

This study concludes that male students were more depressed, stressed and anxious as compared to female students. Furthermore, symptoms of depression, anxiety and stress were the same among students with nuclear and joint family living systems. Parental education was associated with students’ depression, anxiety and stress. Students with educated parents had fewer symptoms of stress, anxiety and depression.

     

The association between post-traumatic stress disorder symptoms and the quality of life among Wenchuan earthquake survivors: the role of social support as a moderator

Objective

To examine the role of the three types of social support as possible moderating factors between post-traumatic stress disorder (PTSD) and its relationship to two domains of the quality of life (QOL).

Methods

A cross-sectional survey was done in a local area near the epicenter of the severe earthquake in Wenchuan. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the standard Chinese 12-item Short Form (SF-12v2), and the Social Support Rating Scale (SSRS) were used to interview a total of 2,080 earthquake survivors in the one-year follow-up period. Multiple regressions were performed to evaluate the moderating role of social support on the relationship between PTSD and QOL.

Results

Among survivors one-year after the Wenchuan earthquake, being a woman (p < 0.01), having a lower level of education (p < 0.01), having a lower level of income (p < 0.01), having a worse housing status (p < 0.05) and having a higher level of exposure (p < 0.05) were risk factors for a poorer QOL (?R ² = 0.063). PTSD symptoms negatively influenced the QOL (?R ² = 0.145), while social support positively influenced the QOL (?R ² = 0.016). However, the interaction between social support and PTSD weakened the negative effect of PTSD on the QOL (?R ² = 0.012). Subjective support and support availability moderated the association between PTSD and the QOL (?R ² = 0.010).

Conclusion

Subjective support and support availability are more useful strategies to improve the QOL of the earthquake survivors with PTSD symptoms.     

Prospectively assessed posttraumatic stress disorder and associated physical activity

Objectives

We examined the association of physical activity with prospectively assessed posttraumatic stress disorder (PTSD) symptoms in a military cohort.

Methods

Using baseline and follow-up questionnaire data from a large prospective study of U.S. service members, we applied multivariable logistic regression to examine the adjusted odds of new-onset and persistent PTSD symptoms associated with light/moderate physical activity, vigorous physical activity, and strength training at follow-up.

Results

Of the 38,883 participants, 89.4% reported engaging in at least 30 minutes of physical activity per week. At follow-up, those who reported proportionately less physical activity were more likely to screen positive for PTSD. Vigorous physical activity had the most consistent relationship with PTSD. Those who reported at least 20 minutes of vigorous physical activity twice weekly had significantly decreased odds for new-onset (odds ratio [OR] = 0.58, 95% confidence interval [CI] 0.49, 0.70) and persistent (OR=0.59, 95% CI 0.42, 0.83) PTSD symptoms.

Conclusions

Engagement in physical activity, especially vigorous activity, is significantly associated with decreased odds of PTSD symptoms among U.S. service members. While further longitudinal research is necessary, a physical activity component may be valuable to PTSD treatment and prevention programs.Recent military operations in Iraq and Afghanistan have been characterized by sustained ground combat, persistent risk, and multiple protracted deployments. Increased psychological symptom reporting has engendered heightened concern for the postdeployment mental health of service members and, in particular, the public health burden of posttraumatic stress disorder (PTSD).^1–4 A previous study using data from all U.S. service branches identified new-onset self-reported PTSD symptoms in 7.6%–8.7% of deployers who reported combat exposures, 1.4%–2.1% of deployers who did not report combat exposures, and 2.3%–3.0% of nondeployers.⁴PTSD is associated with poor physical health as well as negative health behaviors, such as tobacco use and problem alcohol drinking.^5–11 The extent to which behavioral correlates of PTSD mitigate or mediate PTSD symptoms and associated morbidities is currently under investigation.¹² While research has focused on adverse health behaviors, the relationship between positive health behaviors (e.g., physical activity) and PTSD has not been fully explored.Studies of depression and anxiety have pointed to the mental health benefits of physical activity, and researchers have postulated a number of mechanisms by which physical activity may modulate mood and the stress response.^13–19 While previous research indicates that physical activity may mitigate PTSD and related symptoms, other studies indicate that exercise habits of PTSD patients may be substandard.^20–23 In a retrospective study among Brazilians, physical activity levels decreased after the onset of PTSD.²⁴ These previous studies, however, were limited by small sample sizes, retrospective designs, and an inability to control for possible confounders.^20,22–25 The purpose of this study was to investigate new-onset, resolution, and persistence of PTSD symptoms in relation to type and quantity of physical activity in a large, population-based cohort of U.S. military service members.     

Posttraumatic stress disorders in the Nanai after pollution of the Amur River: ethnocultural analysis

Objectives

Chemical pollution of the Amur River has seriously damaged traditions and caused posttraumatic stress disorder (PTSD) among the Nanai, the indigenous people living along this river. This study was performed to clarify the ethnographic characteristics of PTSD in this unique population.

Methods

The study group consisted of 75 male and 112 female randomly selected volunteers. PTSD severity measured using scores of the Impact of Event Scale – Revised (Total-I) and Clinical-Administered PTSD Scale (Total-C) was estimated according to demographic and ethnocultural backgrounds, clinical status, and ethnopsychological attitudes toward the Amur River.

Results

The differences in averages of Total-I and Total-C were not always the same in the groups divided by ethnographic information. Logistic regression analysis with a dependent variable, possibly without PTSD (Total-I <34 and Total-C <40)/possibly with PTSD (either Total-I ≥34 or Total-C ≥40), and categorical independent variables using ethnographic information extracted a low score when ‘priority values’ and ‘the Amur River for me is’ was “profession” and a high score when ‘dominant role in spousal relationship’ was “self,” when ‘predominant forms of response in stressful situations’ was “try to organize,” when ‘preferred method of medical treatment’ was specific for the Nanai, when “rely on something mystical” was manifested, and when the Amur River was believed to be “sacred”.

Conclusion

Those with a pragmatic attitude were less likely to have PTSD. However, those who were required to make decisions within close relationships and were intimate with the Nanai tradition and the Amur River had increased likelihood of PTSD.     

Training Teachers to Build Resilience in Children in the Aftermath of War: A Cluster Randomized Trial

Background

There is growing interest in school-based interventions for building resilience in children facing trauma and adversity. Recent studies focus on teacher training as an effective way to enhance resilience in their students, and emphasize the need for additional evidence-based practice.

Objective

The aim of this study was to evaluate the effectiveness of a short-term resilience-building teacher intervention on reducing post-traumatic distress in students in the context of exposure to recurrent rocket attacks in Israel.

Methods

A quasi-experimental, cluster randomized design employing intervention and wait-list control groups was implemented with students from grades four-six (N = 563) in four schools in Acre in the aftermath of the Second Lebanon War. We assessed the students’ trauma exposure, posttraumatic symptoms and anxiety before and after the intervention or the wait-list condition.

Results

There was a significantly (p < 0.001) greater decrease of posttraumatic symptoms and anxiety levels among the students whose teachers participated in the intervention group as compared to students whose teachers were in the wait-list control group. A multiple regression model showed that this greater decrease in posttraumatic symptoms and anxiety levels was statistically significant after controlling for demographic variables, trauma exposure and past trauma history.

Conclusion

The results of this study show that the training of teachers alone in building resilience can effectively lower post-traumatic distress and anxiety in their students. The empowerment of teachers and by building upon their expertise and experience are crucial for creating sustainability in school-based interventions.     

Short and longer-term psychological consequences of Operation Cast Lead: documentation from a mental health program in the Gaza Strip

Background

There is growing recognition of the psychological impact of adversity associated with armed conflict on exposed civilian populations. Yet there is a paucity of evidence on the value of mental health programs in these contexts, and of the chronology of psychological sequelae, especially in prolonged conflicts with repeated cycles of extreme violence. Here, we describe changes in the psychological profile of new patients in a mental health program after the military offensive Cast Lead, in the context of the prolonged armed conflict involving the Gaza Strip.

Methods

This study analyses routinely collected program data from a Médecins Sans Frontières mental health program in the Gaza Strip spanning 2007?C2011. Data consist of socio-demographic as well as clinical baseline and follow-up data on new patients entering the program. Comparisons were made through Chi square and Fisher??s exact tests, univariate and multivariate logistic and linear regression.

Results

PTSD, depression and other anxiety disorders were the most frequent psychopathologies, with 21% having multiple diagnoses. With a median of nine sessions, clinical improvement was recorded for 83% (1122/1357), and more common for those with separation anxiety, acute and posttraumatic disorders as principal diagnosis (855/1005), compared to depression (141/183, p<0.01). Noted changes proximal to Operation Cast Lead were: a doubling in patient case load with a broader socio-economic background, shorter interval from an identified traumatic event to seeking care, and a rise in diagnoses of acute and posttraumatic stress disorders. Sustained changes included: high case load, more distal triggering events, and increase in diagnoses of other anxiety disorders (especially for children 15 years and younger) and depression (especially for patients 16 years and older).

Conclusion

Evolving changes in patient volume, diagnoses and recall period to triggering events suggest a lengthy and durable effect of an intensified exposure to violence in a context of prolonged conflict. Our findings suggest that mental health related humanitarian relief in protracted conflicts might need to prepare for an increase in patients with changing profiles over an extended period following an acute flare-up in violence.     

The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services

Purpose

Previous studies showed that older persons with vision loss generally reported low levels of health-related quality of life, although study outcomes with respect to feelings of anxiety and social support were inconsistent. The objective of this study was to examine the impact of low vision on health-related quality of life, including feelings of anxiety and social support, among community-living older adults seeking vision rehabilitation services.

Methods

Differences of activities of daily living (Groningen Activity Restriction Scale??GARS), symptoms of depression and feelings of anxiety (Hospital Anxiety and Depression Scales??HADS) and social support (Social Support Scale Interactions??SSL12-I) between 148 older persons ??57?years with low vision and a reference population (N?=?4,792) including eight patient groups with different chronic conditions were tested with Student??s t tests.

Results

Older persons with vision loss reported poorer levels of functioning with respect to activities of daily living, symptoms of depression and feelings of anxiety as compared to the general older population as well as compared to older patients with different chronic conditions. In contrast, older persons with vision loss reported higher levels of social support.

Conclusions

Vision loss has a substantial impact on activities of daily living, symptoms of depression and feelings of anxiety. Professionals working at vision rehabilitation services may improve their quality of care as they take such information into account in their intervention work.