Affective personality type,post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence

The current study explored the differential association between affective personality type, post‐traumatic stress disorder (PTSD) symptom severity, and post‐traumatic growth (PTG) in victims of violence (N = 113). Relying on previous research, median cut off‐scores on the Positive and Negative Affect Schedule Short Form were used to classify participants as high affective [i.e. high positive affectivity (PA) and high negative affectivity (NA)], self‐actualizing (i.e. high PA and low NA), self‐destructive (i.e. low PA and high NA) and low affective (i.e. low PA and low NA). Results indicated that the self‐destructive and high affective personality styles were strongly associated with increased PTSD symptoms severity. High affective personality type was found to be the only significant predictor of PTG. Results, study limitations and directions for future research were discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Coping Behaviours and Post‐traumatic Stress in War‐affected Eastern Congolese Adolescents

This study explores coping strategies used by war‐affected eastern Congolese adolescents across age and sex, and the association between post‐traumatic stress symptoms and engagement and disengagement coping. Cross‐sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13–21 years (M = 15.83, standard deviation = 1.81) participated in self‐report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post‐traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war‐affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences. Copyright © 2013 John Wiley & Sons, Ltd.     

Post‐traumatic stress and psychological health following infidelity in unmarried young adults

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity‐related post‐traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity‐related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post‐traumatic cognitions mediated the associations between infidelity‐related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity‐related PTSD. Whether used as continuous or categorical predictor, infidelity‐related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post‐traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post‐traumatic cognitions.     

Memory functioning in post‐traumatic stress disorder: objective findings versus subjective complaints

Although memory complaints are common in post‐traumatic stress disorder (PTSD), the only published study of objective and subjective memory in PTSD by Roca and Freeman indicates that subjective complaints may not accurately reflect objective performance. The present study examined memory in 21 PTSD patients, 20 combat controls and 23 non‐combat controls using two objective memory measures (Rey Auditory Verbal Learning Test; Backward Digit Span) and one subjective measure (Memory Functioning Questionnaire). Analysis of variances (ANOVAs) and analysis of co‐variances generally did not reveal group differences for objective memory performance. For subjective memory complaints, ANOVAs indicated group differences; PTSD participants reported more memory problems than controls. These differences disappeared, however, when depression was included as a covariate. Also, we provide some preliminary evidence that depression may mediate the relationship between PTSD symptomatology and subjective memory complaints. Findings suggest that reductions in depressive symptomatology in PTSD may be associated with decreased subjective memory complaints. Copyright © 2010 John Wiley & Sons, Ltd.     

MMPI‐2 assessed post‐traumatic stress disorder related to job stress,coping, and personality in police agencies

The PK and PS scales of the MMPI‐2 were developed to index the degree of post‐traumatic stress disorder (PTSD). These scales were applied to a sample of 254 mostly male sworn and civilian law enforcement employees from four police agencies. Participants also completed surveys measuring their perceived levels of job stress, their use of a set of coping strategies, and their performance on measures of five global personality domains. The two PTSD scales appeared to have good internal structures and relatively high reliabilities. Employees at greater risk for PTSD reported higher levels of work‐related stress, seemed to use more maladaptive coping strategies, were more neurotic, and tended to be less extraverted, agreeable, and conscientious. Copyright © 2004 John Wiley & Sons, Ltd.     

Post‐traumatic stress disorder's relation with positive and negative emotional avoidance: The moderating role of gender

Post‐traumatic stress disorder (PTSD) is characterized by avoidance of trauma‐related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma‐exposed individuals (65.9% female, 65.6% White, M_age = 19.24) from a university in the north‐eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender‐sensitive recommendations for assessment and treatment of emotional avoidance in PTSD.     

A retrospective study of ketamine administration and the development of acute or post‐traumatic stress disorder in 274 war‐wounded soldiers

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post‐traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010–2012). The diagnosis of post‐traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post‐traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post‐traumatic stress disorder and 89 (32%) had received ketamine. Fifty‐four patients (55%) in the post‐traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3–13 [1–26]) vs. 3 (2–4 [1–6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post‐traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post‐traumatic stress disorder in the military trauma setting.     

Safety and efficacy of sildenafil citrate in treating erectile dysfunction in patients with combat‐related post‐traumatic stress disorder: a double‐blind,randomized and placebo‐controlled study

OBJECTIVE

To evaluate the safety and efficacy of sildenafil citrate for treating erectile dysfunction (ED) in patients with combat‐related post‐traumatic stress disorder (PTSD).

PATIENTS AND METHODS

In all, 266 combat‐exposed war veterans with ED (aged 37–59 years) were recruited. They met the Diagnostic and Statistical Manual of Mental Disorders‐IV criteria for PTSD according to the Structured Clinical Interview for Patients, Investigator Version. The patients were also evaluated with the Clinician‐Administered PTSD Scale, both to establish the diagnosis of PTSD and to measure symptom severity. Only patients with psychogenic ED were included in the study. Patients with comorbid conditions (diabetes mellitus, hypercholesterolaemia, hypertension, Peyronie’s disease) and smokers of more than five cigarettes daily were excluded. The patients were randomly divided into a group of 133 who received 100 mg of on‐demand sildenafil 0.75–2 h before sexual stimulation, and 133 who received placebo. Patients were asked to use ≥16 doses or attempts at home. The efficacy of the treatments was assessed every four attempts during treatment, and at the end of the study, using responses to the 15‐question International Index of Erectile Function (IIEF), Sexual Encounter Profile diary questions 2 and 3, Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, patients’ event logs of sexual activity, and a Global Assessment Question about erections.

RESULTS

Sildenafil did not produce significantly and substantially greater improvement than placebo in each of the primary and secondary outcome measures (P = 0.08). A normal EF domain score (≥26) at endpoint was reported by 13 (9.8%), and 11 (8.3%) of patients on the sildenafil and placebo regimens, respectively (P = 0.09). Patients treated with sildenafil had no statistically significantly greater improvement in the five sexual function domains of the IIEF questionnaire than those treated with placebo (P = 0.08). The incidences of treatment‐emergent adverse events were significantly greater in the sildenafil arm than in the placebo group (P = 0.01).

CONCLUSIONS

Sildenafil is no better than placebo in treating PTSD‐emergent ED. Further randomized clinical trials are warranted in combat veterans and other populations with PTSD to better elucidate the role of phosphodiesterase type 5 inhibitors in treating PTSD‐emergent ED.     

Covering traumatic news stories: Factors associated with post‐traumatic stress disorder among journalists

The current study examined personal and environmental factors that placed 167 U.S. journalists from diverse media organizations at risk for post‐traumatic stress disorder (PTSD) after covering work‐related traumatic stories. These factors included exposure to traumatic stressors in their personal lives, work‐related traumatic stressors, and general organizational stressors. Further, personality attributes and coping styles associated with risk and resiliency were examined. Regression analyses identified avoidant emotional coping, higher levels of perceived organizational stressors, intensity of exposure to work‐related traumatic stressors, and personal trauma history as statistically significant risk factors for PTSD. The results provide empirical support for the negative impact of organizational stressors and avoidant emotional coping on journalists covering trauma‐related stories. Understanding the organizational climate journalists are working in, as well as the manner in which journalists manage work‐related stressors, is important in the development of a more comprehensive model of who may develop work‐related PTSD symptoms. Opportunities for news organizations to reduce PTSD risk among journalists are discussed.     

Relation of post‐traumatic stress disorder symptom severity to the efficacy of an animal‐assisted intervention for stress reduction after military aeromedical evacuation

Animal‐assisted interventions (AAIs) have been found to decrease stress in some settings, but it is not known if AAI is feasible in an aeromedical staging facility or effective in reducing stress following aeromedical evacuation (AE) of military personnel. An experimental design was used to evaluate the efficacy of AAI at reducing stress in AE military patients (N = 120). Patients participated in a 20‐min AAI (n = 60) or 20‐min informational session about assistance dogs as an attention‐control group (n = 60). Demographics, post‐traumatic stress symptom severity (PTSSS), and stress biomarkers (cortisol, alpha‐amylase, and immunoglobulin A) were collected regular intervals. AAI was found feasible and efficacious at reducing stress. Cortisol decreased significantly (p < .05) in the AAI group compared with the attention‐control group. PTSSS moderated the immunoglobulin A responses to AAI as demonstrated by the interaction of PTSD Checklist–Military Version score, group, and time, F(1, 111.23) = 4.15 p = .044; effect size: d = 0.31. This research supports AAI as a stress‐reducing modality in AE patients, particularly those who report higher PTSSS. Implications for future research are discussed.     

Racism,stress and health in Asian Americans: A structural equation analysis of mediation and social support group differences

The buffering effect of social support on the negative effects of racism exposure on health outcomes has been mixed in prior studies regarding Asian Americans. Based on the stress-coping framework and using structural equation modelling (SEM) methods, we tested a theoretical model portraying simultaneous mediational paths from racism exposure to general physical and mental health through racism-related stress. Bootstrap analysis was used to test the indirect effects present in the model. Additionally, multi-group SEM analysis was conducted to investigate the moderation effect of social support from family and friends on the paths in the model. The sample consisted of 310 Asian American adults who completed an online survey. The results from the two-step SEM analysis and bootstrap analysis supported the theoretical model—racism exposure can simultaneously have a negative indirect effect on Asian Americans' physical and mental health via racism-related stress. Multi-group SEM analysis showed that there were no differences in model path coefficients based on having varying levels of social support from friends or family.     

脑卒中患者急性应激障碍及影响因素研究

目的探讨脑卒中患者急性应激障碍发生现状及影响因素。方法采用斯坦福急性应激反应问卷对349例脑卒中住院患者进行调查。结果共163例(46.70%)患者发生急性应激障碍;Logistic回归分析结果显示,患者性格、是否存在偏瘫及是否吞咽功能障碍是脑卒中患者发生急性应激障碍的主要影响因素(P0.05,P0.01)。结论脑卒中患者急性应激障碍发生率较高,内向性格及存在偏瘫和吞咽功能障碍的患者更容易发生急性应激障碍。医护人员应及时为高危患者提供个体化治疗及预见性护理,防止脑卒中患者发生急性应激障碍。     

Mental Health in Offspring of Traumatized Refugees with and without Post‐traumatic Stress Disorder

Intergenerational transmission of psychological trauma and the impact of parental post‐traumatic stress disorder (PTSD) on offspring are controversially discussed. We studied 50 offspring (36 women and 14 men, mean age 42.1 years) of refugees who were severely traumatized as children at the end of World War II. From these, 25 of the refugees currently suffered from chronic PTSD, and 25 had no PTSD. Parental PTSD status did not significantly influence mental health [as per the Symptom Checklist (SCL)‐90‐R] or quality of life (assessed by the 36‐item Short‐form Health Survey) in their children. In the entire sample, frequency of talking with the mother about the flight correlated with phobic anxiety (r = 0.67, p = 0.03). Interestingly, the stated burden of having a parent with a history of flight significantly (p < 0.05) correlated with almost all subscales of the SCL‐90‐R. These results in a non‐clinical sample do not support a specific role of parental PTSD in intergenerational trauma transmission. Our other remarkable, but preliminary, results need to be studied in larger samples using more subtle interaction or schema analyses. Copyright © 2015 John Wiley & Sons, Ltd.     

Post‐traumatic Recovery to Distress Symptoms Ratio Mediates Relations of Resilience Fostering Resources and Their Predictors

A large‐scale study investigated the direct and indirect effects of demographic predictors and traumatic experiences on resilience fostering resources following a war. The sample consisted of 829 Israeli adults, living in a border town, 1 year after experiencing the 2006 war with Lebanon. Resilience was assessed by measures of individual and public resilience and low sense of danger. Results show that as hypothesized the proportion of post‐traumatic recovery to post‐war distress symptoms predicts these indices of resilience and partly mediates the direct links between these indices and demographic predictors (age, gender and economic condition) and exposure to war. Research of resilience has proposed several prototypical trajectories that characterize responses to potentially traumatic events. Our discussion suggests that these trajectories and their changes over time can be accounted for by the balance of post‐war recovery to symptoms level. Copyright © 2014 John Wiley & Sons, Ltd.     

Metabolomic serum profiling after ACL injury in rats: A pilot study implicating inflammation and immune dysregulation in post‐traumatic osteoarthritis

ACL rupture is a major risk factor for post‐traumatic osteoarthritis (PTOA) development. Little information exists on acute systemic metabolic indicators of disease development. Thirty‐six female Lewis rats were randomized to Control or noninvasive anterior cruciate ligament rupture (ACLR) and to three post‐injury time points: 72 h, 4 weeks, 10 weeks (n = 6). Serum was collected and analyzed by ¹H nuclear magnetic resonance (NMR) spectroscopy and combined direct injection and liquid chromatography (LC)‐mass spectrometry (MS)/MS (DI‐MS). Univariate and multivariate statistics were used to analyze metabolomic data, and predictive biomarker models were analyzed by receiver operating characteristic (ROC) analysis. Topological pathway analysis was used to identify perturbed pathways. Two hundred twenty‐two metabolites were identified by ¹H NMR and DI‐MS. Differences in the serum metabolome between ACLR and Control were dominated by medium‐ and long‐chain acylcarnitine species. Further, decreases in several tryptophan metabolites were either found to be significantly different in univariate analysis or to play important contributory roles to multivariate model separation. In addition to acylcarnitines and tryptophan metabolites, glycine, carnosine, and D‐mannose were found to differentiate ACLR from Control. Glycine, 9‐hexadecenoylcarnitine, trans‐2‐Dodecenoylcarnitine, linoelaidyl carnitine, hydroxypropionylcarnitine, and D‐Mannose were identified as biomarkers with high area under ROC curve values and high predictive accuracies. Our analysis provides new information regarding the potential contribution of inflammatory processes and immune dysregulation to the onset and progression of PTOA following ACL injury. As these processes have most commonly been associated with inflammatory arthropathies, larger‐scale studies elucidating their involvement in PTOA development and progression are necessary. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1969–1979, 2018.

     

“Plasma Cell Hepatitis” in Liver Allografts: Identification and Characterization of an IgG4‐Rich Cohort

Plasma cell hepatitis (PCH), also known as “de novo autoimmune” hepatitis, is an increasingly recognized, but suboptimally named and poorly understood, category of late allograft dysfunction strongly resembling autoimmune hepatitis (AIH): They share plasma‐cell‐rich necro‐inflammatory activity on biopsy, autoantibodies and steroid responsiveness, but overlap with rejection is problematic. A retrospective study of clinical, serological, histopathological and IgG4 immunohistological features of PCH (n = 20) in liver allograft recipients, native liver AIH (n = 19) and plasma‐cell‐rich renal allograft rejection (n = 20) showed: (1) high frequency (44%) of HLA‐DR15; (2) less female predominance (p = 0.03) and (3) n = 9/20 PCH recipients showed >25 IgG4+ plasma cells/high‐power field (IgG4+ PCH) versus AIH (n = 1/19, p = 0.008) or plasma‐cell‐rich kidney rejection (n = 2/20, p = 0.03). The IgG4+ PCH (n = 9) subgroup showed lower alanine transaminase (ALT) (p < 0.01) and aspartate transaminase (AST) (p < 0.05) at index biopsy but (a) higher plasma cell number/percentage, (b) more aggressive‐appearing portal/periportal and perivenular necro‐inflammatory activity and (c) more severe portal/periportal fibrosis than IgG4? PCH (n = 11). Significant demographic, histopathologic and plasma cell phenotype differences between PCH and AIH suggest distinct pathogenic mechanisms for at least the IgG4+ PCH subgroup likely representing an overlap between allo‐ and auto‐immunity. IgG4+ PCH was associated with fibrosis, but also highly responsive to increased immunosuppression.