Acute psychological reactions in assault victims of non-domestic violence: peritraumatic dissociation, post-traumatic stress disorder, anxiety and depression

The aims of this study were to investigate acute and subacute post-traumatic reactions in victims of physical non-domestic violence. A Norwegian sample of 138 physically assaulted victims was interviewed and a questionnaire was completed. The following areas were examined: the frequency and intensity of acute and subacute psychological reactions such as peritraumatic dissociation (PD), post-traumatic stress disorder (PTSD) and anxiety and depression; the relationship between several psychological reactions; the relationship between psychological reactions and level of physical injury, perceived life threat, and potential of severe physical injury, and the relationship between psychological reactions and socio-demographic variables. The following distress reactions were measured retrospectively: PD, PTSD, and anxiety and depression. Thirty-three per cent of the victims scored as probable PTSD cases according to the Post Traumatic Symptoms Scale 10 (PTSS-10); the corresponding Impact of Event Scale-15 (IES-15) score identified prevalence of 34% respectively. Forty-four per cent scored as cases with probable anxiety and depression, according to the Hopkins Symptom Check List 25 (HSCL-25). Severity of perceived threat predicted higher scores on all measures of psychological reactions. There were no statistically significant differences between acute and subacute groups on PD, PTSS-10, IES-15, IES-22 and HSCL-25 according to measured means (and standard deviations) and occurrence of probable cases and risk level cases. The results showed no connection between severity of physical injury and caseness. The acute psychological impairment that results from assault violence may have a deleterious effect on the mental health of victims.     

Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence

BACKGROUND: Victims of violent assault experience diverse post-event emotional problems such as post-traumatic stress disorder (PTSD), and they may have multiple emotional problems. The aim of the present study was to evaluate the prevalence and predictors of PTSD in a longitudinal design. METHODS: The levels of physical injury, perceived life threat, prior experience of violence, peritraumatic dissociation (PD), acute PTSD, perceived self-efficacy and perceived social support are considered possible predictors. This study had a single group (N = 70), longitudinal design with three repeated measures over a period of 12 months. Questionnaires used were: Impact of Event Scale-15 and 22 (IES-15 and 22), Post-Traumatic Symptom Scale-10 (PTSS-10), Peritraumatic Dissociation (PD) 7-item self-report measure, Social Provisions Scale (SPS) and Generalized Self-Efficacy scale (GSE). RESULTS: Results showed a high prevalence and severity of PTSD on all outcomes, for instance 31% scored as probable PTSD-cases and 14% as risk level cases by IES-15 at T3. Either injury severity or prior experience of being a victim of violence predicted PTSD in this study. Early PTSD predicted subsequent PTSD, and perceived life threat was a predictor of PD. Furthermore, lack of perceived social support was a predictor of PTSD symptoms at T3. In addition, low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1. CONCLUSIONS: Our results showed that experience of non-domestic violence may cause serious chronic emotional problems, and therefore it is important to be aware of early symptoms indicating needs for special follow-ups.     

Post-traumatic stress disorder in the forensic psychiatric setting

The objective was to assess the prevalence of post-traumatic stress disorder (PTSD) in offenders who undergo forensic psychiatric evaluation (FPE), compare differences with regard to the prevalence of PTSD between immigrants and Swedes, compare psychiatric comorbidity and offenses between PTSD and non-PTSD patients, and compare various instruments and questionnaires when assessing the level of PTSD symptoms. Twenty-five immigrants and 25 Swedes were studied consecutively. The Clinician-Administered PTSD Scale (CAPS), Impact of Event Scale-22 (IES), Post-traumatic Symptom Scale (PTSS-10), and Structured Clinical Interview for DSM-IV (SCID)-PTSD were administered. In the immigrant group, 60 percent had PTSD, compared with 12 percent of the Swedes. Subjects with PTSD scored higher on IES-22 and PTSS-10 than those without PTSD. Considering the number of sexual and violent offenses together, the proportion of these types of offenses was higher in the PTSD group than in the non-PTSD group.     

Mental disorder in limb reconstruction: Prevalence,associations and impact on work disability

ObjectiveThis cross-sectional survey aimed to assess the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and drug and alcohol dependence in a limb reconstruction population and examine associations with demographic and functional variables.MethodsAs part of routine clinical care, data were collected from 566 patients attending a tertiary referral centre for limb reconstruction between April 2012 and February 2016. Depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and drug dependence were measured using standardised self-report screening tools.Results173 patients (30.6% CI 26.7–34.4) screened positive for at least one of the mental disorders assessed. 110 (19.4% CI 16.2–22.7) met criteria for probable major depression; 112 (19.9% CI 16.6–23.2) patients met criteria for probable generalised anxiety disorder; and 41 (7.6% CI 5.3–9.8) patients met criteria for probable PTSD. The prevalence of probable alcohol dependence and probable drug dependence was 1.6% (CI 0.6–2.7) and 4.5% (CI 2.7–6.3), respectively. Patients who screened positive for depression, anxiety and PTSD reported significantly higher levels of pain, fatigue, and functional impairment. Depression and anxiety were independently associated with work disability after adjustment for covariates (OR 1.98 (CI 1.08–3.62) and OR 1.83 (CI 1.04–3.23), respectively).ConclusionThe high prevalence and adverse associations of probable mental disorder in limb reconstruction attest to the need for routine psychological assessment and support. Integrated screening and management of mental disorder in this population may have a positive impact on patients' emotional, physical and occupational rehabilitation. A randomised controlled trial is needed to test this hypothesis.     

Posttraumatic stress disorder and psychiatric co-morbidity: symptoms in a random sample of female Bosnian refugees.

OBJECTIVES: This study investigated psychological symptoms in Bosnian women 3-4 years after their arrival in Sweden. SUBJECTS AND METHODS: A simple random sample of 163 Bosnian women aged 19-59 was drawn from the Swedish populations register in 1996. The control group consisted of 392 Swedish-born women. Data were collected in face-to-face interviews. The Hopkins Symptom Checklist 25 (HSCL-25) and the Posttraumatic Symptom Scale (PTSS-10) were used to measure psychological symptoms of depression, anxiety, psychological distress, and posttraumatic stress disorder (PTSD). Unconditional logistic regression was used to estimate odds ratios (OR) for psychological symptoms after adjustment for age, country of birth, education, marital status, economic difficulties, social network, and feeling secure. RESULTS: The prevalence of symptoms of PTSD was 28.3% among the Bosnian women. Bosnian women had significantly higher risks of symptoms of depression, anxiety, and psychological distress than Swedish-born women. For depression the odds ratio was 9.50 among Bosnian women. CONCLUSION: Psychiatric community interventions need to target Bosnian refugee women. Awareness among health-care workers who encounter these women in a clinical setting should be improved.     

Post-traumatic stress, depression, and anxiety in patients with injury-related chronic pain: A pilot study

Aim

To investigate, in patients with injury-related chronic pain, pain intensity, levels of post-traumatic stress, anxiety and depressions.

Methods

One hundred and sixty patients aged 17–62 years, admitted for assessment to the Pain Rehabilitation Clinic at the Umeå University Hospital, Umeå Sweden, for chronic pain caused by an injury, answered a set of questionnaires to assess post-traumatic stress (Impact of Event Scale [IES]), pain intensity (VAS), depression, and anxiety (Hospital Anxiety and Depression Scale [HAD]).

Results

Moderate to severe post-traumatic stress was reported by 48.1% of the patients. Possible–probable anxiety on the HAD was scored by 44.5% and possible–probable depression by 45.2%. Pain intensity (VAS) was significantly correlated to post-traumatic stress (r = 0.183, p = 0.022), the HAD-scores anxiety (r = 0.186, p = 0.0021), and depression (r = 0.252, p = 0.002). No statistically significant differences were found between genders for post-traumatic stress, pain intensity, anxiety, or depression. Participants with moderate to severe stress reaction reported statistically significant higher anxiety scores on the HAD (p = 0.030) in comparison with patients with mild stress.

Conclusion

The findings of relationships between pain intensity, post-traumatic stress, depression, and anxiety may have implications for clinicians and underline the importance of considering all these factors when managing patients with injury-related chronic pain.     

Psychiatric morbidity and comorbidity following accidental man-made traumatic events: incidence and risk factors

The aims of this study were to examine the incidence and risk factors of major depression, bipolar disorder, psychoactive substance use, psychotic and anxiety disorders in relation to post-traumatic stress disorders (PTSD) in a study group exposed to two different traumatic events, i. e. 128 fire and 55 motor vehicle accident victims. Data have been collected 7–9 months after the traumatic event. The diagnosis of axis-I diagnoses, other than PTSD, was made according to DSM-III-R criteria using the Structured Interview according to the DSN-III-R. The incidence of new-onset major depression was 13.4%, generalised anxiety disorder (GAD) 12.6%, agoraphobia 10.2% and psychoactive substance use disorders 6%. Simple phobia, panic disorder and obsessive compulsive disorder had a much lower incidence (< 2.0%). Fifty-one percent of the victims with PTSD had one or more addition axis-I diagnoses, major depression (26.2%), agoraphobia (21.0%) and generalised anxiety disorder (24.6%) being the most common. Physical injury was the single best predictor for major depression. The best predictors for the development of new-onset anxiety disorders, other than PTSD, were: type and horror of the trauma, the extent of physical injury, the loss of control during the traumatic event, contextual stimuli, younger age and female sex. In conclusion: comorbid disorders, such as depression, GAD and agoraphobia, commonly occur within the first few months after man-made accidental traumata. Trauma variables, which are known to be related to the development of PTSD, are also related to the occurrence of these comorbid disorders. Received: 2 July 1999 / Accepted: 27 January 2000     

Does post-traumatic stress disorder occur after stroke: a preliminary study

Background and purpose. Psychological reactions after stroke have been recognized for some time. The present study examined whether psychological symptoms consistent with post-traumatic stress disorder (PTSD) could occur after stroke as a consequence of the sudden and unpredictable occurrence of a life-threatening internal stressor. Methods. Sixty-one patients who had experienced a first-ever stroke or transient ischaemic attack were assessed using standard self-report clinical measures for anxiety, depression and PTSD. Those patients who fulfilled criteria on at least one PTSD self-report measure were subsequently assessed using a structured clinical interview for PTSD. Results. Six (9·8%) patients fulfilled criteria for PTSD. No significant differences were found between the post-stroke PTSD group and the non-PTSD group in terms of premorbid health and lifestyle, or experiences of adverse life events. Significant differences were noted with respect to self-reported post-stroke mental health and premorbid neuroticism. The post-stroke PTSD group also scored consistently higher on measures of anxiety, depression and psychiatric caseness. Conclusions. The results of this study demonstrate a number of close similarities between post-stroke PTSD and classical PTSD. We therefore conclude that PTSD or a PTSD-like syndrome can occur after stroke. © 1998 John Wiley & Sons, Ltd.     

Mental health consequences of intimate partner violence in Vhembe district,South Africa

Objective

The aim of this study was to assess the contributions of different forms of intimate partner violence (physical violence, sexual violence, psychological abuse, and stalking) on symptoms of posttraumatic stress disorder (PTSD) and depression.

Methods

In all 268 women (18 years and older) consecutively receiving a protection order in the Vhembe district in South Africa were assessed by an external interviewer. Hierarchical regressions tested the unique effects of different types of intimate partner violence on PTSD and depression.

Results

In terms of PTSD symptom severity, more than half (51.9%) of the sample reported severe PTSD and 66.4% reported severe depression symptoms. Two types of intimate partner violence (physical and sexual) were significantly associated with PTSD symptoms, while only psychological violence was moderately correlated with depression symptoms. Physical abuse contributed to the prediction of PTSD and psychological abuse to depression.

Conclusions

A significant number of women with protection orders suffer from PTSD and depression. The results confirm a relationship between severity of intimate partner violence and mental health problems (PTSD and depression). Assessment of intimate partner violence should incorporate the multiple dimensions that have been identified as contributing to poor mental health.     

Psychological Distress for African-American Adolescent Males: Exposure to Community Violence and Social Support as Factors

This study examined exposure to community violence and depressive and post-traumatic stress disorder (PTSD) symptoms within a non-random sample of low-income, African-American male adolescents. The moderating effect of social support on these relationships was also examined. Seventy-seven African-American adolescent males were recruited from an inner-city, Midwestern high school and surveyed on exposure to violence, depression, post-traumatic stress, and social support. Regression analyses revealed that exposure to violence was significantly associated with both depressive and PTSD symptoms. However, social support was not found to moderate the relationship between exposure to community violence and psychological distress. Implications for intervention are discussed.     

Cross-cultural use of the predetermined scale cutoff points in refugee mental health research

Background Cross-cultural use of the cutoff points determined in Indo-Chinese refugees of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ) is common in refugee mental health research but it might have caused misclassifications. Methods We assessed the validity of the predetermined cutoff points in identifying depression and post-traumatic stress disorder (PTSD) cases among Afghan refugees, with the algorithm method as a gold standard. We estimated the prevalence of depression and PTSD, using the HSCL-25 and the HTQ with the cutoff points and the algorithm method, and calculated sensitivity, specificity, positive and negative predictive values of the cutoff points. Results Nine in ten PTSD cases/non-cases were correctly identified as cases/non-cases, and nine in ten respondents classified as PTSD cases/non-cases were actually cases/non-cases. In contrast, only one in three non-depression cases was correctly identified as a non-case, and three in five respondents who were classified as depression cases was actually a case. The prevalence of depression was estimated to be 86% with the cutoff points and 53% with the algorithm method, and that of PTSD 46% and 44%, respectively. Conclusions The cutoff point approach might have low specificity and positive predictive value particularly for depression in our study. Cross-cultural use of the scale cutoff points determined in one cultural group to another needs to be reconsidered.     

Post-traumatic symptoms,emotional distress and quality of life in long-term survivors of breast cancer: a preliminary research

The present study is a preliminary study assessing long-term psychological effects in survivors of breast cancer. Thirty-nine long-term female survivors of breast cancer were compared with 39 matched women who had not been exposed to any chronic disease regarding post-traumatic stress disorder (PTSD), quality of life (QoL), emotional distress and coping styles. Survivors revealed significantly higher rates of full and partial PTSD, scored significantly higher on emotional distress, scored significantly lower on physical and psychological QoL and exhibited coping styles significantly different from those of the control group. PTSD was associated with the coping style of suppression. Multiple regression analysis showed that receiving chemotherapy and disease stage, as well as the interaction between chemotherapy and disease stage, were significant predictors of hyperarousal. The findings show that post-traumatic symptoms are a common sequel after recovery from cancer. Furthermore, finding suggest a conceptual distinction between PTSD symptoms and QoL in the study of long-term effects of cancer.     

Correlates of community violence exposure in hospitalized adolescents.

To examine psychological and behavioral correlates of community violence exposure in psychiatrically hospitalized adolescents, 89 inpatients were administered a battery of psychometrically well-established self-report instruments. Violence exposure was assessed using the Child's Exposure to Violence Checklist (CEVC). Half of the patients reported exposure to multiple incidents violence in their community (52%) and home (53%). Sixty-one percent were victims of physical assault, and 39% were victims of sexual assault. Patients who had witnessed community violence reported significantly more post-traumatic stress disorder (PTSD) symptoms, drug use, and violence potential than patients without a history of witnessing community violence. Patients exposed to community violence were also more likely to be the victim of childhood maltreatment, as well as a perpetrator of violence. In conclusion, traumatization via exposure to community violence may serve as one important determinant in the development of mixed internalizing and externalizing psychopathology in adolescent inpatients, thus necessitating accurate assessment and treatment planning.     

Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression

Although anxiety disorders have been associated with impairments in self-reported health functioning, the relative effect of various anxiety disorders has not been studied. We compared health functioning of patients with a principal diagnosis of posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Patients with PTSD and MDD were equally impaired on overall mental health functioning, and both were significantly worse than patients with PD and GAD. PTSD was associated with significantly worse physical health functioning relative to PD, GAD, and MDD. Hierarchical regression showed that the association of PTSD with physical health functioning was unique and was not caused by the effects of age, depression, or comorbid anxiety disorders. Both PTSD and comorbid anxiety accounted for unique variance in mental functioning. These results highlight the association of PTSD with impaired physical and mental functioning and suggest that effective treatment of PTSD may affect overall health.     

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients. Received: 20 April 1998 / Accepted: 9 October 1998     

How do attachment style and social support contribute to women's psychopathology following intimate partner violence? Examining clinician ratings versus self-report

Concurrent associations between attachment style and social support in posttraumatic stress disorder, depression, and generalized anxiety disorder were explored using regression analyses in a sample of 108 victims of intimate partner violence. To examine whether assessment modality influenced findings, self-report and clinician ratings of psychopathology were compared. Both lower perceived social support and higher attachment anxiety were significantly associated with higher self-reported PTSD; however, only lower social support was significantly associated with clinician assessed PTSD. Lower social support, higher attachment anxiety, and lower attachment closeness were related with higher self-reported depression; however, only lower social support was related to clinician assessed depression. Lastly, only higher attachment anxiety was associated with self-reported GAD, whereas lower attachment dependency showed the only significant association in clinician assessed GAD. Possible explanations for discrepancies between assessment modalities are discussed, with emphasis on application to intimate partner violence and suggestions for future research.     

Efficacy of an Internet-based intervention for posttraumatic stress disorder in Iraq: a pilot study

In the past 20 years, war and human rights violations have led to high rates of exposure to traumatic events among the Iraqi population. Due to the ongoing violence, many physicians and mental health professionals have left Iraq in recent years. The Internet offers new possibilities for the psychological treatment of posttraumatic stress disorder (PTSD) in conflict areas. A therapist-supported cognitive-behavioral treatment manual that has been evaluated in Western countries was translated into Arabic and culturally adapted. The treatment was conducted via the Internet by Arabic-speaking therapists and was evaluated in an uncontrolled pilot study with 15 participants. Main outcome measures were PTSD (Posttraumatic Diagnostic Scale (PDS)), depression, anxiety (Hopkins Symptom Check List-25 (HSCL-25)), and quality of life (EUROHIS). The intervention resulted in a highly significant decrease in symptoms of PTSD, depression, and anxiety. Quality of life was higher at posttreatment. All treatment effect sizes were in the large range, indicating a significant improvement in mental health symptoms and quality of life. Preliminary clinical evidence indicates that new technologies can be used to provide humanitarian aid in the form of e-mental health services, even in areas that remain highly unstable.     

The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners

The aim of this study was to investigate the validity of the Harvard Trauma Questionnaire (HTQ) and the depression sub-scale of the Hopkins Symptom Checklist-25 (HSCL-25) in screening for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) among Vietnamese former political prisoners (POWs). The study population included Vietnamese POWs (n= 51) who migrated to the Boston metropolitan area between January 1990 and July 1992 under the Special Released Re-education Center Detainees Resettlement Program. The criterion validity of the HTQ in assessing PTSD and of the depression sub-scale of the HSCL-25 in assessing MDD is supported by the results. Consideration of an appropriate cut-off score should include examination of the utility of a given screening instrument for PTSD or MDD within different settings, such as refugee camps vs. countries of third asylum.     

玉树地震后罹患创伤后应激障碍、焦虑症和抑郁症调查

目的:调查玉树地震后不同人群创伤后应激障碍(PTSD)、焦虑症、抑郁症的发生情况。方法:抽取震后灾区人群、其非灾区的亲属人群、灾区救援人群及非灾区人群为对象,每一人群进行随机分成两组,第1组每周进行1次集体心理干预;第2组每周进行3次集体心理干预。采用PTSD检查量表平民版(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对不同人群在3个月、6个月进行问卷调查。结果:各人群在干预3个月和6个月均检出PTSD、焦虑症、抑郁症。各人群中第2组干预6个月时PTSD、焦虑症、抑郁症检出率明显低于干预3个月时(P均0.05)。结论:震后不同人群均存有PTSD、焦虑症、抑郁症发生;随着时间推移及积极干预可明显降低其发生。