Gender differences in depression and PTSD symptoms following combat exposure

Background: This research examined gender as a moderator of the association between combat exposure (CE) and depression as well as CE and PTSD symptoms among a nonclinical sample of Soldiers following deployment in support of operations in Afghanistan and Iraq. Methods: Cases included 6,943 (516 women, 6,427 men) active duty Soldiers that were retrospectively analyzed from a pre‐ and post‐deployment screening database at a large Army installation. Results: Gender moderated the association between CE and depressive and PTSD symptoms such that higher levels of CE were more strongly associated with depression and PTSD symptoms in women compared to men. Female Soldiers also reported higher severity of depressive symptoms compared to male Soldiers, whereas men reported higher levels of CE and a greater number of previous deployments compared to women. Conclusions: CE was a stronger predictor of post‐deployment depression and PTSD symptoms for women compared to men. These results provide evidence for gender‐based differences in depression and PTSD risk. Screening for degree of CE in addition to symptoms associated with depression and PTSD can help with the care for service members who are returning from deployments to combat zones. Depression and Anxiety, 2010. Published 2010 Wiley‐Liss, Inc.     

Over-time changes in PTSD and depression among children surviving the 1999 Istanbul earthquake

Objective  To follow-up on child and adolescent victims with full criteria of PTSD and depression, and to examine the impact of treatment. Method  One to two months following a 7.4-magnitude quake in Turkey, 160 students were examined by self-report questionnaire, psychiatric interview, clinician-administered post-traumatic stress disorder scale (CAPS), and depression and anxiety inventories. At baseline, 96 students were diagnosed with PTSD, and 49 had comorbid depression with anxiety symptoms. After 18–20 months, 74 of 96 students were found and reassessed by psychiatric interview and CAPS; 25 had been treated with cognitive-behavioral therapy (CBT) and pharmocotherapy, and 49 did not have any treatment. Binary logistic regression was used to identify significant predictors of persistent PTSD. Variables entered included pre-quake, quake and post-quake factors, having co-morbid depression upon initial interview, receipt of drug therapy, and number of months of CBT. Results  At follow-up, many had symptoms of PTSD with anxiety, but only 14 subjects met the full criteria of PTSD, and four students had major depression with anxiety symptoms. Only one variable—having been in serious personal danger during the quake (e.g., trapped in the house or under rubble)—was significantly associated with being symptomatic at follow-up. Conclusion  Regardless of receipt of treatment, diagnoses of PTSD and depression were much reduced. More research is needed about resiliency factors.     

Post-traumatic stress disorder,anxiety and depression symptoms among adolescent earthquake victims: comorbidity and associated sleep-disturbing factors

Purpose

Our study aimed to examine the prevalence of psychiatric symptoms and their comorbidity and correlation with sleep problems among adolescent survivors 3 years after the 2013 Ya’an earthquake.

Methods

A representative sample of 6132 adolescent students was analysed from 11 primary and high schools in the three counties most severely affected by the earthquake. Students were invited to complete the Pittsburgh Sleep Quality Index, Children’s Revised Impact of Event Scale-13, Short Mood and Feelings Questionnaire, the Adolescent Self-Rating Life Events Checklist, and Screen for Child Anxiety-Related Emotional Disorders.

Results

Three years after this major earthquake, 1-month prevalence of mental health problems was 13.1% for PTSD, 37.3% for anxiety, and 19.8% for depression. Among the participants who reported PTSD, 71.5% also reported anxiety, and 49.7% also reported depression. At least half of those with any type of mental health problem reported concurrent sleeping problems. Specific sleep risk factors were independently associated with increased risk of PTSD, depression or anxiety. Girls were more likely than boys to exhibit symptoms of PTSD, depression or anxiety. Older adolescents were more likely to have depression and anxiety.

Conclusions

Mental health problems are prevalent with high comorbidity and are associated with sleep-related problems among adolescent survivors, even years after the occurrence of a major earthquake. Nightmares and difficulty initiating sleep are independently associated with PTSD. Insufficient sleep is independently associated with anxiety and depression. Sleep-related problems may be effective targets of preventive interventions, which may need to be optimised for gender and age.

     

Predicting the future development of depression or PTSD after injury

Objective

The objective was to develop a predictive screener that when given soon after injury will accurately differentiate those who will later develop depression or posttraumatic stress disorder (PTSD) from those who will not.

Method

This study used a prospective, longitudinal cohort design. Subjects were randomly selected from all injured patients in the emergency department; the majority was assessed within 1 week postinjury with a short predictive screener, followed with in-person interviews after 3 and 6 months to determine the emergence of depression or PTSD within 6 months after injury.

Results

A total of 192 completed a risk factor survey at baseline; 165 were assessed over 6 months. Twenty-six subjects [15.8%, 95% confidence interval (CI) 10.2-21.3] were diagnosed with depression, four (2.4%, 95% CI 0.7-5.9) with PTSD and one with both. The final eight-item predictive screener was derived; optimal cutoff scores were ≥2 (of 4) depression risk items and ≥3 (of 5) PTSD risk items. The final screener demonstrated excellent sensitivity and moderate specificity both for clinically significant symptoms and for the diagnoses of depression and PTSD.

Conclusions

A simple screener that can help identify those patients at highest risk for future development of PTSD and depression postinjury allows the judicious allocation of costly mental health resources.     

Exposure to war trauma and PTSD among parents and children in the Gaza strip

Objective Exposure to war trauma has been independently associated with posttraumatic stress (PTSD) and other emotional disorders in children and adults. The aim of this study was to establish the relationship between ongoing war traumatic experiences, PTSD and anxiety symptoms in children, accounting for their parents’ equivalent mental health responses. Methods The study was conducted in the Gaza Strip, in areas under ongoing shelling and other acts of military violence. The sample included 100 families, with 200 parents and 197 children aged 9–18 years. Parents and children completed measures of experience of traumatic events (Gaza Traumatic Checklist), PTSD (Children’s Revised Impact of Events Scale, PTSD Checklist for parents), and anxiety (Revised Children’s Manifest Anxiety Scale, and Taylor Manifest Anxiety Scale for parents). Results Both children and parents reported a high number of experienced traumatic events, and high rates of PTSD and anxiety scores above previously established cut-offs. Among children, trauma exposure was significantly associated with total and subscales PTSD scores, and with anxiety scores. In contrast, trauma exposure was significantly associated with PTSD intrusion symptoms in parents. Both war trauma and parents’ emotional responses were significantly associated with children’s PTSD and anxiety symptoms. Conclusions Exposure to war trauma impacts on both parents’ and children’s mental health, whose emotional responses are inter-related. Both universal and targeted interventions should preferably involve families. These could be provided by non-governmental organizations in the first instance.     

Impaired fear inhibition is a biomarker of PTSD but not depression

Background: A central problem in posttraumatic stress disorder (PTSD) is a reduced capacity to suppress fear under safe conditions. Previously, we have shown that combat‐related PTSD patients have impaired inhibition of fear‐potentiated startle (FPS). Given the high comorbidity between PTSD and depression, our goal was to see whether this impairment is specific to PTSD, or a non‐specific symptom associated with both disorders. Methods: Fear‐potentiated startle was assessed in 106 trauma‐exposed individuals divided into four groups: (a) No diagnosis control, (b) PTSD only, (c) major depression (MDD) only, and (d) comorbid PTSD and MDD. We used a novel conditional discrimination procedure, in which one set of shapes (the danger signal) was paired with aversive airblasts to the throat, and different shapes (the safety signal) were presented without airblasts. The paradigm also included fear inhibition transfer test. Results: Subjects with comorbid MDD and PTSD had higher FPS to the safety signal and to the transfer test compared to controls and MDD only subjects. In contrast to the control and MDD groups, the PTSD and comorbid PTSD and MDD groups did not show fear inhibition to safety cues. Conclusions: These results suggest that impaired fear inhibition may be a specific biomarker of PTSD symptoms. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Prevalence and risk factors for posttraumatic stress disorder: a cross‐sectional study among survivors of the Wenchuan 2008 earthquake in China

Background: The impact of the May 2008 Wenchuan earthquake, measuring a massive 8.0 on the surface wave magnitude scale, on public health in China has been significant and multifaceted. In light of extant data on prevalence and risk factors for posttraumatic stress disorder (PTSD) after other natural diasters, we collected data from the Wenchuan earthquake survivors to estimate the prevalence of PTSD and to characterize a range of PTSD risk factors. Methods: A cross‐sectional multicluster sample survey of 446 respondents (201 from the Qiang ethnic‐minority group, 245 the majority Han Chinese group) was conducted in August 2008 in Beichuan county, Sichuan province, a region that was severely affected by the earthquake. In total, 240 households were represented, with a mean of 2.2 respondents per household. Data were collected from structured interviews and the Harvard Trauma Questionnaire (HTQ) and DSM‐IV criteria were used to diagnose PTSD. Results: The prevalence of PTSD was 45.5% (203/446). Low household income, being from an ethnic minority, living in a shelter or temporary house, death in family, and household damage were factors significantly related to increased odds of PTSD. Conclusions: PTSD is common after a major disaster. Postdisaster mental health recovery programs that include early identification, ongoing monitoring, preventive and intervention programs, and sustained psychosocial support are needed for the highest‐risk population, namely, the bereaved, people without incomes and those with serious household damage. These populations may also benefit from governmental and nongovernmental programs that provide social and economic support, as suggested by earlier studies. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

PTSD,Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian,Gay, and Bisexual Youth

Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth.     

Risk factors for depression among older adults with dual sensory loss

Objectives: The purpose of this study was to identify risk factors that are associated with depression among older adults with dual sensory loss, evaluating variables typically associated with depression in an elderly population and variables related to sensory loss.

Method: Survey data was collected from a sample of 203 adults aged 55 years and older with significant hearing and vision loss. Independent variables included demographics (as control variables), sensory loss-related factors, activity factors, and social factors. Correlation and hierarchical linear regression were used to analyze the data.

Results: A large proportion of participants experienced depression. Risk factors typically associated with depression in the elderly were also significant for this group, with the exception of functional disability, but only one variable directly related to sensory loss was significant in the final model. The block of variables with the greatest relationship to depression was the social factor.

Discussion: Receipt of rehabilitation services and use of assistive devices are two strategies that could be used to address the issue of depression with this population. Interventions could target some of the variables found to be associated with depression in this study: communication problems, loss of activity, and physical activity.     

A cross-sectional study among survivors of the 2008 Sichuan earthquake: prevalence and risk factors of posttraumatic stress disorder

Objective

The objective of this study is to estimate the prevalence of probable posttraumatic stress disorder (PTSD), explore the related risk factors among Sichuan earthquake survivors in different counties and compare the findings in our study to others.

Method

A cross-sectional sample survey was conducted to collect data in heavily (n=367) and moderately damaged counties (n=337). We used the PTSD Check List—Civilian Version (PCL-C), which consists of 17 items corresponding to each symptom of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results

The prevalence of probable PTSD in heavily damaged counties (48.2%) was higher than that in moderately damaged counties (14.5%). Many associated risk factors were identified in the cross-sectional study.

Conclusion

Female, Han nationality, low monthly income, fear during earthquake and low social support in the past year were significant risk factors in heavily damaged counties, while the probable PTSD in moderately damaged counties was related to female, youth, fear during earthquake and low social support.     

Posttraumatic stress reactions among children following the Athens earthquake of September 1999

Abstract. The objective of the present study was to assess symptoms of posttraumatic stress disorder (PTSD), depression and anxiety among children 6 months after they had been exposed to an earthquake (EQ) affecting the northwestern suburbs of Athens in September 1999. A total of 115 children attending two elementary schools located at the epicentre of the EQ were assessed. A group of 48 children not affected by the EQ attending a school not affected by the EQ were used as controls. The children and their parents completed a number of questionnaires. Overall, there was a high rate (78%) of severe to mild PTSD symptoms in the EQ exposed group. Additionally, a substantial proportion of these children scored above criteria (32%) for depression compared to the control group (12.5%). Severe or moderate symptoms of PTSD were associated with high scores of depression (p = 0.002). The relationship between PTSD symptoms and anxiety was limited to the avoidance factor of the anxiety questionnaire (p = 0.029). Those who were most likely to be affected were children alone at the time of the EQ, and children who sustained injuries. In summary, countries where EQs are frequent should be prepared to offer psychological support to a substantial proportion of children presenting with PTSD and depressive symptoms and should educate and prepare children to cope with these events.     

Demographic and clinical characteristics of motor vehicle accident victims in the community general health outpatient clinic: a comparison of PTSD and non-PTSD subjects

Motor vehicle accidents (MVAs) are the leading cause of posttraumatic stress disorder (PTSD) in the general population, often with enduring symptomatology. This study details epidemiological and clinical features that characterize PTSD among MVA victims living in a nonhospitalized community setting long after the MVA event, and includes exploration of premorbid and peritraumatic factors. MVA victims (n=60; 23 males, 37 females) identified from the registry of a community general health outpatient clinic during a 7-year period were administered an extensive structured battery of epidemiological, diagnostic and clinical ratings. Results indicated that 30 subjects (50%; 12 males, 18 females) had MVA-related PTSD (MVAR-PTSD). Among those with PTSD, 16 individuals exhibited PTSD in partial remission, and six, in full remission. There were no significant demographic or occupational function differences between PTSD and non-PTSD groups. The most common comorbid conditions with MVAR-PTSD were social phobia (20%), generalized anxiety disorder (7.8%) and obsessive-compulsive disorder (0.5%). Previous MVA's were not predictive of PTSD. Subjects with MVAR-PTSD scored worse on the Clinician-Administered Posttraumatic Stress Disorder Scale, Part 2 (CAPS-2), Impact of Event Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Impulsivity Scale, and Toronto Alexithymia Rating Scale. Study observations indicate a relatively high rate of PTSD following an MVA in a community-based sample. The relatively high rate of partially remitted MVAR-PTSD (N=16) underscores the importance of subsyndromal forms of illness. Alexithymia may be an adaptive method of coping with event stress. The development of PTSD appears not to be associated with the severity of MVA-related physical injury.     

Does pre-event lack of emotional support increase the risk of post-event PTSD,anxiety, depression symptoms and lack of support? A comparative population-based study among victims of threat and violence

Our knowledge about the effects of perceived emotional support on PTSD, anxiety and depressive symptoms after serious threat and violence is primarily based on post-event studies. Very little is known about the extent to which (1) victims lacking pre-event emotional support are more at risk of post-event symptoms and lack of post-event support than victims with pre-event emotional support, and (2) victims with pre-event emotional support and victims lacking emotional support are more at risk of post-event anxiety and depressive symptoms than nonvictims with similar pre-event support levels. For this purpose, we conducted a 2-wave prospective study (VICTIMS) using the Dutch population-based longitudinal LISS panel. Multivariate logistic regression analyses were conducted, controlling for pre-event demographics, symptoms, and physical, work-related and financial problems. As hypothesized, victims (N^{victims total} = 187) lacking pre-event support more often had high post-event PTSD, anxiety and depressive symptoms than victims with pre-event support. No significant differences were found between victims and nonvictims with pre-event emotional support (N^{nonvictims total} = 2,828, not exposed to any event). Since victims and nonvictims with pre-event support did not differ in post-event symptoms and support, the findings offer strong evidence for the buffering hypothesis of emotional support.     

Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country

OBJECTIVES: This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. STUDY SUBJECTS AND SAMPLE: Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. RESEARCH INSTRUMENTS: CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder. RESULTS: PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. CONCLUSION: No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor.     

Risk factors for depression in elderly people: a prospective study.

In 1982-1983 a random sample of 1486 people aged 65 years and above was generated from general practitioner lists; 1070 were interviewed in the community using the Geriatric Mental State and a Social History questionnaire. The cohort was followed up by interview 3 years later. At year 3 the diagnostic computer program AGECAT diagnosed 44 incident cases of depression. Information from the depressed group's initial and further interviews was compared with a control group (which excluded cases of affective or organic mental illness). Univariate analysis yielded three factors that were significantly associated with the development of depression 3 years later: a lack of satisfaction with life; feelings of loneliness; and smoking. Multivariate analysis confirmed their independent effects and revealed 2 further factors attaining significance: female gender and a trigger factor, bereavement of a close figure within 6 months of the third-year diagnosis. Some other factors traditionally associated with depression, such as poor housing, marital status and living alone, failed to attain significance as risk factors.     

Posttraumatic stress disorders and depression among male inpatient adults involved in the Lebanese war

Purpose : to evaluate factors associated with posttraumatic stress disorder (PTSD) and depression in a sample of hospitalized Lebanese adult males who directly or indirectly were involved in armed conflicts. Design : Cross-sectional. Methods : Seventy-seven hospitalized males were enrolled between June and December 2016. The Hamilton Anxiety and Depression Scale and the Mini International Neuropsychiatric Interview were used to assess anxiety, depression, and PTSD. Results : Participation in war (adjusted odds ratio [ORa] = 6.35) and depression (ORa = 1.08) were associated with higher PTSD, whereas age (ORa = 0.94) and substance use (ORa = 0.19) were associated with lower PTSD. Anxiety (β = .87), substance use (β = 6.27) and PTSD (β = 8.78; P = .008) were associated with higher depression. Practice Implications : People who experienced war conflicts (directly or indirectly) are more prone to suffer from mental health disorders.