Treatment of Gay Men for Post-Traumatic Stress Disorder Resulting from Social Ostracism and Ridicule: Cognitive Behavior Therapy and Eye Movement Desensitization and Reprocessing Approaches

This report describes the clinical treatment of a sample of four gay men suffering from Post-Traumatic Stress Disorder (PTSD) attributed to their repeated experiences with peer ridicule and ostracism throughout childhood and adolescence, caused by their gender variant appearance and behavior. All of the men in the sample shared the following features: (1) a childhood history of ridicule and ostracism from both peers and adults focused on their gender variant presentation designed to elicit gender norm compliance; (2) a lack of social support networks to assist them in coping with the stress; (3) self-destructive coping responses that began in childhood and continued into adulthood in an attempt to lessen the experience of shame; and (4) symptoms of PTSD. A treatment model utilizing cognitive-behavioral therapy and eye movement desensitization and reprocessing was discussed.     

Post-traumatic stress disorder in occupational settings: anticipating and managing the risk

BACKGROUND: Post-traumatic stress disorder has had a substantial impact on employer liability for workplace psychological injury. The emergency services are an example of high-risk workforces that demand clear policies and procedures within an organization. The challenge is to minimize the injury to individuals and lessen the cost to organizations through the optimal application of preventative strategies. METHODS: This field is not well represented in standard keyword searches and Medline was examined with linked fields of practice and research. Consensus guidelines that refer to this domain were also utilized. Few conclusions can be reached from the literature which directly examined occupational settings. RESULTS: Organizations need to anticipate the possible traumatic exposures that may affect the workforce and have strategies to deal with the effects in the workplace, particularly the negative mental health outcomes in some personnel. This domain is relevant to all employers as accidents and violence are possible in most workplaces. Screening should be considered for high-risk individuals, particularly following a major traumatic event or cumulative exposure, such as in the emergency services. While psychological debriefing has no demonstrated benefit, the benefits of early intervention necessitate ready access to evidence-based treatments that have minimum barriers to care. Employers should be aware that distress may present indirectly in a similar way as conflict with management, poor performance and poor general health. CONCLUSION: The knowledge about the impact of traumatic events obliges employers to have an active strategy to anticipate and manage the aftermath of such events as well as cumulative traumatic exposures.     

Post-traumatic stress disorder among family physicians in Bosnia and Herzegovina

BACKGROUND: The traumatic events experienced by thousands of people in Bosnia and Herzegovina during the 1992-1995 conflict may have a lasting effect on the mental health of the country, characterized by high rates of post-traumatic stress disorder (PTSD). A diagnosis of PTSD among family physicians could affect their ability to diagnose and treat patients for depression, anxiety and PTSD. OBJECTIVE: The aim of the present study was to determine the prevalence of PTSD among family medicine physicians in Bosnia and Herzegovina. METHODS: A self-administered questionnaire, including the PTSD Checklist-Civilian Version (PCL-C) which is a validated scale for PTSD screening, was distributed to family medicine residents and specialists in Bosnia and Herzegovina. The prevalence of PTSD was determined, and factors related to PTSD were considered. RESULTS: One hundred and thirty-three (90.5%) of the 147 physicians who were available to be surveyed completed the questionnaire. Of the 88% who had a traumatic experience during the war, 18% met the criteria for PTSD. The likelihood of meeting the criteria for PTSD was not affected by age, sex or whether the physician had worked in a field hospital during the war. However, a positive response to the question "Do you think the traumatic event you experienced during the war still affects you today?" was highly associated with the diagnosis of PTSD (odds ratio 7.26, 95% confidence interval: 1.57-33.60). Also, this question was shown to have a high degree of sensitivity and negative predictive value, and may be of use as a screening tool for ruling out the presence of PTSD after a traumatic war experience.     

MoCA量表对创伤后应激障碍患者认知功能损伤的临床研究

目的 探讨MoCA量表在创伤后应激障碍（PTSD）患者认知功能损伤中的应用。 方法 纳入PTSD患者28例、经历创伤事件未发生PTSD患者28例和心理健康测评者28例,共3组。均行PTSD自评量表（PCL - C）和认知功能评定量表（MoCA）评估。结果 PCL - C总分与再体验、回避麻木与警觉性增高分项得分PTSD组＞非PTSD组＞对照组（F = 164.790,F = 98.570,F = 124.879,F = 138.570,P＜0.05）;PTSD组和对照组在MoCA总分和各个分项上的差异具有统计学意义（P＜0.05）;除了语言表达能力（2组无统计学差异,F = 7.572,P＞0.05）,PTSD组和非PTSD组在MoCA总分和各个分项上的差异具有统计学意义（P＜0.05）;非PTSD组和对照组在语言表达和注意力上的得分差异具有统计学意义（F = 7.572,F = 38.626,P＜0.05）;在空间与执行能力、命名能力、抽象、延时回忆、定向力和MoCA总分的差异无统计学意义（P = 0.074,P = 0.256,P = 0.316,P = 0.274,P = 0.063,P = 0.052）;行Spearman相关分析显示,PTSD组PCL - C总分及3个症状群均和MoCA总分和7个认知小分项呈显著负相关（P＜0.01）;行多元线性回归分析显示,R2 = 0.968,F = 240.135,表明再体验、麻木回避和警觉性增高联合起来对PTSD患者的认知功能损伤的影响是显著的,在对单个预测变量的回归系数B进行t检验时发现,只有预测变量警觉性增高的P = 0.275＞0.05,说明警觉性增高对PTSD患者认知功能损伤的影响是不显著的,而再体验和麻木回避对PTSD患者认知功能损伤的影响是显著的。结论 PTSD患者存在认知功能损伤,且随着PTSD症状加重,认知功能的损伤越明显;其中再体验和麻木回避这两大症状群对认知功能的损伤有显著的影响。     

Post-trauma support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK

Employers' duties of care under both common and statute law include the need to take reasonable care of the health and safety of the workforce. This includes both the moral and legal duties to consider the psychological needs of personnel following exposure to traumatic events related to the workplace. While this has been recognized within many high-risk occupations such the police, fire and rescue services and the military, there is also evidence that post-trauma support in the workplace is increasingly commonly provided not only among health and social services agencies, but within many private sector organizations. Over the past decade, however, there has been considerable controversy over the provision of early psychological support to personnel in the form of critical incident stress management (CISM) processes. In particular, one aspect of CISM, the use of psychological debriefing (PD) has come under scrutiny and criticism as two studies indicated that PD was ineffective and had the potential to do harm. Inevitably, this has provoked much uncertainty and confusion among some organizations as what should be the most appropriate support. It has also led to misconceptions and misunderstandings as to the aims and purpose of PD, together with inaccuracies of terminology, for example describing PD as 'counselling'. Despite the controversy, both CISM and PD continue to be provided on a widespread basis, often utilizing a framework of voluntary peer group support. This paper intends to (i) present a review of the current status of CISM practices, including the use of PD within various organizations in the UK and (ii) provide a clear framework and understanding of the main issues and to clarify conceptual misunderstandings. The history, principles and background of the use of post-trauma support in the workplace, charting trends over the past two decades, previous research, problems with the evidence base and current thinking and practice in the field are reviewed. The relevance and implications of the National Institute for Clinical Excellence Guidelines on the Assessment and Management of Post Traumatic Stress Disorder, which make recommendations for early interventions for post-traumatic stress disorder are discussed. Reference is made to the use of CISM and PD within both statutory and voluntary organizations in an international context.     

The scale of perceived occupational stress

This article reviews previous research on the scale of occupational stress and describes in detail the Bristol Stress and Health at Work study. This study had three main aims: firstly, to determine the scale and severity of occupational stress in a random population sample; secondly, to distinguish the effects of stress at work from those of stress in general life; and finally, to determine whether objective indicators of health status and performance efficiency were related to perceived occupational stress. These aims were investigated by conducting an epidemiological survey of 17,000 randomly selected people from the Bristol electoral register, a follow-up survey 12 months later, and detailed investigation of a cohort from the original sample. The results revealed that approximately 20% of the sample reported that they had very high or extremely high levels of stress at work. This effect was reliable over time, related to potentially stressful working conditions and associated with impaired physical and mental health. The effects of occupational stress could not be attributed to life stress or negative affectivity. The cohort study also suggested that high levels of occupational stress may influence physiology and mental performance. The prevalence rate obtained in this study suggests that 5 million workers in the UK have very high levels of occupational stress.     

胚胎停育患者创伤后应激症状及相关因素分析

目的:了解胚胎停育患者的心理损伤情况和创伤后应激障碍(PTSD)症状阳性的相关因素。方法:对2012年10月~2013年10月就诊于宁夏医科大学总医院、银川市妇幼保健院的206对胚胎停育患者及配偶,应用创伤后应激障碍筛查量表平民版(PCL-C)对其反复创伤性体验症状、情感麻木与回避状及警觉性过强所致易激惹症状进行客观测量。结果:206名胚胎停育患者PCL-C量表分值为23.7±2.7分,PTSD筛查症状阳性率为13.6%(28/206)。多因素非条件logistic回归分析结果显示,配偶PTSD症状筛查阳性时,胚胎停育患者PTSD症状阳性率高(OR:2.9,95%CI:1.8~9.7),社会支持中从兄弟姐妹得到支持和照顾时,胚胎停育患者PTSD症状阳性率低(OR:0.5,95%CI:0.3~0.9)。结论:胚胎停育事件可能会引起孕妇产生创伤后应激障碍症状。配偶PTSD症状阳性会增加胚胎停育孕妇PTSD症状阳性率,而社会支持,尤其是从兄弟姐妹得到支持和照顾,有助于缓解胚胎停育孕妇PTSD症状。     

The relationship between occupational psychological stress and female fertility

OBJECTIVE: To investigate the association between occupational psychological stress and female fertility. METHODS: This was a case-control study including consecutive working female patients attending fertility and in vitro fertilization clinics in the Soroka University Medical Center. We compared occupational stress between 64 working patients who had attended the clinics due to female infertility (case group) and 106 working patients who had attended the clinics due to their partner's reproductive impairment (control group). RESULTS: Patients from the female infertility group were older (31.9 +/- 6.2 versus 30.2 +/- 4.6, P = 0.047) and tended to participate more in sporting activity [23.4 versus 10.4%, odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.05-6.73, P = 0.022] as compared with patients from the male infertility group. Patients from the case group tended to work more weekly hours as compared with the controls (33.6 +/- 16.8 versus 26.9 +/- 17.4, P = 0.028). High reliability was found, as demonstrated by Cronbach's alpha of 0.81-0.90 for the four burnout parameters. Patients from the female infertility group had significantly lower listlessness scores as compared with the control group, using the Mann-Whitney test (2.6 +/- 1.1 versus 3.1 +/- 1.2, P = 0.013). CONCLUSIONS: Patients admitted due to female infertility tended to have lower listlessness scores as compared with patients admitted due to their partner's infertility problem. No significant association was found between other burnout, job strain and job satisfaction scores and women's fertility status.     

Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore

AIMS: To describe the psychological impact of severe acute respiratory syndrome (SARS) on health care workers in a regional general hospital 2 months post-outbreak. METHOD: Doctors and nurses were encouraged to participate. The survey consisted of self-report measures: demographics, the General Health Questionnaire (GHQ) 28 and Impact of Events Scale (IES). A questionnaire enquiring about changes in life's priorities due to SARS and circumstances that helped with coping was used. Participation was strictly voluntary and responses anonymous. RESULTS: In total 177 out of 661 (27%) participants [40 out of 113 (35%) doctors and 137 out of 544 (25%) nurses] had a GHQ 28 score >or=5. Doctors [P = 0.026, odds ratio (OR) = 1.6 and 95% confidence interval (CI) = 1.1-2.5] and single health care workers were at higher risk (P = 0.048, OR = 1.4 and 95% CI = 1.02-2.0) compared to nurses and those who were married. Approximately 20% of the participants had IES scores >or=30, indicating the presence of post-traumatic stress disorder (PTSD). Four areas were classified as more important using factor analysis: health and relationship with the family, relationship with friends/colleagues, work and spiritual. The areas for coping strategies were clear directives/precautionary measures, ability to give feedback to/obtain support from management, support from supervisors/colleagues, support from the family, ability to talk to someone and religious convictions. Support from supervisors/colleagues was a significant negative predictor for psychiatric symptoms and PTSD. Work and clear communication of directives/precautionary measures also helped reduce psychiatric symptoms. CONCLUSIONS: Many health care workers were emotionally affected and traumatized during the SARS outbreak. Hence, it is important for health care institutions to provide psychosocial support and intervention for their health care workers.     

Work-related post-traumatic stress disorder: report of five cases

Post-traumatic stress disorder (PTSD) may arise after events involving a risk to physical integrity or to life, one’s own or that of others. It is characterized by intrusive symptoms, avoidance behaviors, and hyper-excitability. Outside certain categories (e.g., military and police), the syndrome is rarely described in the occupational setting. We report here five unusual cases of work-related PTSD, diagnosed with an interdisciplinary protocol (occupational health visit, psychiatric interview, psychological counselling and testing): (1) a 51-yr-old woman who had undergone three armed robbery attempts while working in a peripheral post office; (2) a 53-yr-old maintenance workman who had suffered serious burns on the job; (3) a 33-yr-old beauty center receptionist after sexual harassment and stalking by her male employer; (4) a 57-yr-old male psychiatrist assaulted by a psychotic outpatient; (5) a 40-yr-old woman, sales manager in a shoe store, after physical aggression by a thief. All patients required psychiatric help and pharmacological treatment, with difficulty of varying degrees in resuming work. We conclude that PTSD can develop even in professional categories generally considered to be at low risk. In such cases, a correct interdisciplinary diagnostic approach is fundamental for addressing therapy and for medico-legal actions.     

Overtime work and stress response in a group of Japanese workers

Background Working long overtime hours is considered a causeof mental health problems among workers but such a relationshiphas yet to be empirically confirmed. Aim To clarify the influence of overtime work on response tostress and to assess the role of other stress-related factorson this relationship. Methods The study was conducted among 24 685 employees of acompany in Japan. Stress response, job stressors and socialsupports were assessed by the Brief Job Stress Questionnaire.Participants were divided into five categories of overtime (0–19,20–39, 40–59, 60 h of overtime per month and exemptedemployees). Results The nonadjusted odds ratios for stress response for40–59 and 60 overtime hours per month in reference to0–19 overtime hours were 1.11 [95% confidence interval(CI) 1.03–1.19] and 1.62 (95% CI 1.50–1.76), respectively.After adjustment for self-assessed amount of work, mental workloadand sleeping time, the association between overtime work andstress response disappeared. Conclusions This large cross-sectional study shows that overtimework appears to influence stress response indirectly throughother stress factors such as self-assessed amount of work, mentalworkload and sleeping time.     

Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa

The South African population is exposed to multiple forms of violence. Using nationally representative data from 4351 South African adults, this study examined the relative risk for post-traumatic stress disorder (PTSD) associated with political, domestic, criminal, sexual and other (miscellaneous) forms of assault in the South African population. Violence exposure was assessed using the 'worst event' list from the WHO's Composite International Diagnostic Interview (CIDI) and a separate questionnaire assessing experiences of human rights abuses, and lifetime PTSD was assessed according to the APA's Diagnostic and Statistical Manual of Mental Disorders criteria using the CIDI. Findings indicated that over a third of the South African population has been exposed to some form of violence. The most common forms of violence experienced by men were criminal and miscellaneous assaults, while physical abuse by an intimate partner, childhood physical abuse and criminal assaults were most common for women. Among men, political detention and torture were the forms of violence most strongly associated with a lifetime diagnosis of PTSD, while rape had the strongest association with PTSD among women. At a population level, criminal assault and childhood abuse were associated with the greatest number of PTSD cases among men, while intimate partner violence was associated with the greatest number of PTSD cases among women. Recommendations for mental health service provision in South Africa and for future research on the relative risk for PTSD are offered.     

Post-traumatic stress and psychiatric disorders in Palestinian adolescents following intifada-related injuries

This study was designed to assess the occurrence of post-traumatic stress disorder (PTSD) and psychiatric disorders (i.e., anxiety and depression) in Palestinian adolescents following intifada-related injuries. It was hypothesized that a combination of pre-trauma variables (e.g., age, geographic location), trauma-specific variables such as trauma recency, type of trauma (deliberately violent vs. accidental), and post-trauma variables (e.g., social support, coping strategies, belief in fate) would be predictive of these psychological sequelae. The participants were 179 boys who were injured during Al-Aqsa intifada and as a result sustained a permanent physical disability. They ranged in age from 12 to 18 years (M=16.30, SD=1.64). Questionnaires were administered in an interview format with adolescents at home. Approximately 76.5% of the injured victims qualify as having PTSD and that the disorder had a heterogeneous course, with excess risk for chronic symptoms and comorbidity with other psychiatric disorders such as anxiety and depression. Among all the predictors in the PTSD, anxiety and depression models, only geographical location, fatalism, and negative coping were significant predictors. In conclusion, post-traumatic reactions and psychiatric disorders in adolescents involved in armed conflict injuries can persist for several months. Given the apparent significant relationship between psychological sequelae of intifada-related injuries and certain predictors (i.e., negative coping style and fatalism), treatments such as trauma-focused cognitive behaviour therapy may yield positive results. Negative coping and fatalism should be addressed more directly during therapy.     

The relationship between sense of hope,family support and post-traumatic stress disorder among children: The case of young victims of rocket attacks in Israel

Post-traumatic stress disorder (PTSD) is diagnosed commonly in Israeli children following violent episodes of the ongoing Arab–Israeli conflict. Research has suggested that as many as 70% of war-affected children present symptoms of PTSD. This study examined two factors that may contribute to resiliency: perceived social support and sense of hope. The research participants (n?=?311) were children who experienced the rocket attacks during Israel's Second Lebanon War and a control group of Israeli children from a town that was not affected directly by the 2006 war. It was hypothesized that a complex relationship would be demonstrated between presentation of symptoms of PTSD and perceived social support. It was hypothesized further that an inverse relationship would be measured between sense of hope and presentation of symptoms of PTSD in the children who experienced the rocket attacks and that those in the control group would show less symptoms of PTSD than those in the experimental group. Finally, females were expected to show more symptoms of PTSD than males. The results showed a negative correlation between sense of hope and PTSD, while family support was correlated positively with PTSD.