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• Issue Information ‐ TOC.
  
  Journal of Traumatic Stress. October 22, 2018
  --- - - Journal of Traumatic Stress, Volume 31, Issue 5, Page 627-629, October 2018.
  

  October 22, 2018   doi: 10.1002/jts.22336   open full text
• An Examination of the Role of Difficulties Regulating Positive Emotions in Posttraumatic Stress Disorder.
  Nicole H. Weiss, Katherine L. Dixon‐Gordon, Courtney Peasant, Tami P. Sullivan.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Emotion regulation difficulties have been theoretically and empirically linked to posttraumatic stress disorder (PTSD). Previous research, however, has focused almost exclusively on difficulties regulating negative emotions. In this study, we explored the nature of difficulties regulating positive emotions in PTSD. Participants were women who had experienced domestic violence (N = 210; 48.6% African American; Mage = 36.14 years). Higher levels of nonacceptance of positive emotions, difficulties engaging in goal‐directed behaviors when experiencing positive emotions, and difficulties controlling impulsive behaviors when experiencing positive emotions were related to a higher level of PTSD symptom severity overall and for the intrusion, avoidance/emotional numbing, and hyperarousal clusters, rs = .24–.37. The presence (vs. absence) of a probable PTSD diagnosis was related to greater difficulties engaging in goal‐directed behaviors, d = 0.54, and controlling impulsive behaviors, d = 0.34, when experiencing positive emotions. Results suggest the potential utility of assessing and treating difficulties regulating positive emotions among domestic violence–victimized women with PTSD. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Un Estudio del Rol de las Dificultades para la Regulación de las Emociones Positivas en el Trastorno de Estrés Postraumático. DIFICULTADES EN LA REGULACIÓN DE EMOCIONES POSITIVAS EN TEPT Las dificultades para la regulación de las emociones han sido asociadas teórica y empíricamente al trastorno de estrés postraumático (TEPT). Las investigaciones previas, sin embargo, se han enfocado casi en forma exclusiva en las dificultades para la regulación de las emociones negativas. En este estudio, exploramos la naturaleza de las dificultades para la regulación de las emociones positivas en TEPT. Las participantes fueron mujeres que habían experimentado violencia doméstica (N = 210; 48.6% Afroamericanas; Medad = 36.14 años). Los altos niveles de rechazo de las emociones positivas, las dificultades para involucrarse en actividades dirigidas a un objetivo cuando se experimentan emociones positivas, y las dificultades para controlar los comportamientos impulsivos cuando se experimentan emociones positivas se relacionaron a un mayor nivel de severidad de los síntomas de TEPT en general y para los grupos sintomáticos de intrusión, evitación/embotamiento emocional e hiperactivación rs = .24‐.37. La presencia (vs. ausencia) de un probable diagnóstico de TEPT se relacionó a mayores dificultades para involucrarse en actividades dirigidas a un objetivo, d = 0.54, y para controlar los comportamientos impulsivos, d = 0.34, mientras se experimentan emociones positivas. Los resultados sugieren la potencial utilidad de la evaluación y tratamiento de las dificultades para la regulación de las emociones positivas entre las mujeres víctimas de violencia doméstica con TEPT. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 An Examination of the Role of Difficulties Regulating Positive Emotions in Posttraumatic Stress Disorder Traditional Chinese 標題: 檢視創傷後壓力症裡正面情緒調節困難的影響 撮要: 情緒調節困難在理論和實證方面都跟創傷後壓力症(PTSD)有關。然而, 過往研究幾乎都只專注檢視調節負面情緒的困難。本研究探索PTSD患者調節正面情緒的困難。樣本為曾遭受家庭暴力的女性(N = 210; 48.6% 非裔美國人; Mage = 36.14 歲)。對正面情緒的抗拒水平較高、處於正面情緒時較難投入實踐目標的行為、處於正面情緒時較難控制衝動行為, 都跟整體的PTSD症狀水平較高有關, 亦與侵擾、迴避༏情感麻木和過激反應聚類有關(rs = .24–.37)。被診斷為有可能患PTSD (相比無此診斷) , 與處於正面情緒時較難投入實踐目標的行為(d = 0.54)和較難控制衝動行為有關(d = 0.34)。結果反映, 評估及治療患PTSD的家庭暴力受害女性調節正面情緒的困難, 有潛在效用。 Simplified Chinese 标题: 检视创伤后压力症里正面情绪调节困难的影响 撮要: 情绪调节困难在理论和实证方面都跟创伤后压力症(PTSD)有关。然而, 过往研究几乎都只专注检视调节负面情绪的困难。本研究探索PTSD患者调节正面情绪的困难。样本为曾遭受家庭暴力的女性(N = 210; 48.6% 非裔美国人; Mage = 36.14 岁)。对正面情绪的抗拒水平较高、处于正面情绪时较难投入实践目标的行为、处于正面情绪时较难控制冲动行为, 都跟整体的PTSD症状水平较高有关, 亦与侵扰、回避༏情感麻木和过激反应聚类有关(rs = .24–.37)。被诊断为有可能患PTSD (相比无此诊断), 与处于正面情绪时较难投入实践目标的行为(d = 0.54)和较难控制冲动行为有关(d = 0.34)。结果反映, 评估及治疗患PTSD的家庭暴力受害女性调节正面情绪的困难, 有潜在效用。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 775-780, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22330   open full text
• Acceptance and Commitment Therapy for Co‐Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes.
  Eric C. Meyer, Robyn Walser, Barbara Hermann, Heidi Bash, Bryann B. DeBeer, Sandra B. Morissette, Nathan A. Kimbrel, Oi‐Man Kwok, Sonja V. Batten, Paula P. Schnurr.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co‐occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD–AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness‐ and acceptance‐based form of behavior therapy, has potential as a treatment option for PTSD–AUD. In this uncontrolled pilot study, we examined ACT for PTSD–AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician‐assessed and self‐reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self‐reported symptoms of PTSD remained lower at 3‐month follow‐up, d = 0.88. There were reductions on all alcohol‐related outcomes (clinician‐assessed and self‐reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3‐month follow‐up, dmean = 0.91 (d range: 0.65–1.30). Quality of life increased at posttreatment and follow‐up, ds = 0.55–0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow‐up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow‐up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow‐up. Consistent with the ACT theoretical model, these improvements were associated with more between‐session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD–AUD include assigning frequent between‐session mindfulness practice and initiating values clarification work and values‐based behavior assignments early in treatment. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Terapia de Aceptación y Compromiso para la co‐ocurrencia de Trastornos de Estrés Postraumático y Consumo de Alcohol en Veteranos: Resultados de un Tratamiento Piloto ACT PARA TEPT Y ALCOHOL El trastorno de estrés postraumático (TEPT) y el trastorno por consumo de alcohol (AUD, por sus siglas en inglés) ocurren frecuentemente de forma simultánea y están asociados con resultados peores cuando se encuentran juntos que cuando se encuentra cada uno por separado. Existe una falta de consenso con respecto a las recomendaciones para el tratamiento de TEPT‐AUD, y el abandono del tratamiento es un problema persistente. La terapia de aceptación y compromiso (ACT, por sus siglas en inglés), es una forma de terapia conductual basada en el transdiagnóstico, el mindfulness y la aceptación, tiene potencial como una opción de tratamiento para TEPT‐AUD. En este estudio piloto no controlado, examinamos la ACT para TEPT‐AUD en 43 veteranos; 29 (67%) completaron el protocolo de terapia individual ambulatoria (es decir, ≥ 10 de 12 sesiones). Los síntomas de TEPT autorreportados y evaluados por el médico se redujeron en el postratamiento, ds = 0.79 y 0.96, respectivamente. Los síntomas autorreportados de TEPT se mantuvieron más bajos a los 3 meses de seguimiento, d = 0.88. Hubo reducciones en todos los resultados relacionados con el alcohol (síntomas evaluados por el médico y autoinformados, total de bebidas alcohólicas, días de consumo excesivo de alcohol) en el postratamiento y el seguimiento a los 3 meses, d promedio = 0.91 (rango d: 0.65‐1.30). La calidad de vida aumentó en el postratamiento y el seguimiento, ds = 0.55‐0.56. La discapacidad funcional mejoró marginalmente en el postratamiento, d = 0.35; este efecto se volvió significativo en el seguimiento, d = 0.52. Se informaron menos síntomas depresivos en el postratamiento, d = 0.50 y seguimiento, d = 0.44. Los individuos que experimentaron ideación suicida informaron reducciones significativas en el seguimiento. De acuerdo con el modelo teórico de ACT, estas mejoras se asociaron con más prácticas de mindfulness entre sesiones y las reducciones en la evitación experiencial y la inflexibilidad psicológica. Las recomendaciones para adaptar ACT para abordar el TEPT‐AUD incluyen la asignación frecuente de práctica de mindfulness entre sesiones e iniciar el trabajo de aclaración de valores y tareas conductuales basadas en valores al principio del tratamiento. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Acceptance and Commitment Therapy for Co‐Occurring PTSD and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes Traditional Chinese 標題: 對同時患PTSD和酒精使用失常的退役軍人採用接受與承諾療法:試驗性治療結果 撮要: 創傷後壓力症(PTSD)和酒精使用失常(AUD)經常同時出現, 構成的後果比患單一疾病更為惡劣。對於PTSD–AUD治療, 我們一直欠缺共識, 而患者中途放棄治療的問題持續。接受與承諾療法(ACT)是跨診斷、以正念和接受為本的行為療法, 有可能是用以治療PTSD–AUD的一個選項。在這非對照的試驗研究, 我們檢視43名退役軍人接受ACT以治療PTSD–AUD的情況。當中29位(67%)完成了門診獨立治療的口語記錄(即 ≥ 10節段, 共12 節段)。臨床診斷所得及自評的PTSD症狀在完成治療後都有所減少(分別為 ds = 0.79 和 0.96)。3個月後, 自評的PTSD症狀仍有減輕(d = 0.88)。在完成治療時和3個月後, 所有酒精相關的狀況 (臨床診斷及自評的症狀、酒精使用總量、大量飲酒的日數) 都有減輕, d 平均值 = 0.91 (d 值域: 0.65–1.30)。生活質素在完成治療時和跟進期都有改善(ds = 0.55– 0.56)。功能性損傷在完成治療時有少量改善(d = 0.35), 而在跟進期的改善變得顯著(d = 0.52)。樣本的抑鬱症狀在完成治療時和跟進期都有減少(d = 0.50, 跟進期 d = 0.44)。有自殺意念的樣本, 意念在跟進期顯著減輕。與ACT的理論模型相符, 以上改善跟在節段間有更多正念練習, 以及經驗迴避及心理缺乏彈性的情況減少有關。我們對於以ACT治療PTSD–AUD的建議, 包括吩咐患者在節段間經常進行正念練習, 並在療程初期開始與患者進行價值澄清及價值為本的行為練習。 Simplified Chinese 标题: 对同时患PTSD和酒精使用失常的退役军人采用接受与承诺疗法:试验性治疗结果 撮要: 创伤后压力症(PTSD)和酒精使用失常(AUD)经常同时出现, 构成的后果比患单一疾病更为恶劣。对于PTSD–AUD治疗, 我们一直欠缺共识, 而患者中途放弃治疗的问题持续。接受与承诺疗法(ACT)是跨诊断、以正念和接受为本的行为疗法, 有可能是用以治疗PTSD–AUD的一个选项。在这非对照的试验研究, 我们检视43名退役军人接受ACT以治疗PTSD–AUD的情况。当中29位(67%)完成了门诊独立治疗的口语记录(即 ≥ 10节段, 共12 节段)。临床诊断所得及自评的PTSD症状在完成治疗后都有所减少(分别为 ds = 0.79 和 0.96)。3个月后, 自评的PTSD症状仍有减轻(d = 0.88)。在完成治疗时和3个月后, 所有酒精相关的状况 (临床诊断及自评的症状、酒精使用总量、大量饮酒的日数) 都有减轻, d 平均值 = 0.91 (d 值域: 0.65–1.30)。生活质素在完成治疗时和跟进期都有改善(ds = 0.55– 0.56)。功能性损伤在完成治疗时有少量改善(d = 0.35), 而在跟进期的改善变得显著(d = 0.52)。样本的抑郁症状在完成治疗时和跟进期都有减少(d = 0.50, 跟进期 d = 0.44)。有自杀意念的样本, 意念在跟进期显著减轻。与ACT的理论模型相符, 以上改善跟在节段间有更多正念练习, 以及经验回避及心理缺乏弹性的情况减少有关。我们对于以ACT治疗PTSD–AUD的建议, 包括吩咐患者在节段间经常进行正念练习, 并在疗程初期开始与患者进行价值澄清及价值为本的行为练习。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 781-789, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22322   open full text
• Neurophysiological Correlates of Collective Trauma Recall in 2009 L'Aquila Earthquake Survivors.
  Giuseppe Massaro, Daniela Altavilla, Paola Aceto, Gaia Romana Pellicano, Giada Lucarelli, Massimiliano Luciani, Carlo Lai.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract In the present study, we aimed to explore neural correlates of survivors of the 2009 L'Aquila, Italy earthquake in response to being shown pictures featuring their own city before and after an earthquake as well as those of an unfamiliar city. Moreover, we explored the associations among psychological variables and brain responses to the pictures of L'Aquila after the earthquake. Our final sample (N = 30 adults) comprised 15 survivors (M age = 31.40 years, SD = 9.42) and 15 controls (M age = 30.53 years, SD = 10.01). Participants’ electroencephalographic (EEG) data were recorded during a visual task that included earthquake‐related stimuli. Participants were assessed for posttraumatic and dissociation symptoms and event‐related potential components, and low‐resolution electromagnetic tomography (sLORETA) were analyzed. Compared to the control group, source localization in survivors indicated a lower intensity of the amygdala, hippocampal, parahippocampal, and temporopolar areas in response to visual stimuli concerning the earthquake, p < .001 to p < .0001. Results indicated a reduced limbic activation in response to visual stimuli that evoked the recall of earthquake in survivors. This finding suggests that survivors likely adopted a distancing strategy toward stimuli that may have elicited an emotional activation related to collective trauma. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Correlatos neurofisiológicos del recuerdo de un trauma colectivo en sobrevivientes del terremoto de El Águila 2009 CORRELATOS NEURONALES DEL RECUERDO DE TRAUMA COLECTIVO. En el presente estudio, quisimos explorar los correlatos neuronales de los sobrevivientes al terremoto del 2009 en Italia de la región de El Águila, en respuesta a las imágenes que muestran su propia ciudad antes y después de un terremoto, así como también las de una ciudad desconocida. Aún más, exploramos la asociación entre variables psicológicas y respuestas cerebrales a las fotos de El Águila después del terremoto. Nuestra muestra final (N = 30 adultos) comprendía 15 sobrevivientes (Medad = 31.40 años, DE = 9.42) y 15 controles (Medad = 30.53, DE = 10.01). Los datos electroencefalográficos (EEG) de los participantes fueron grabados durante una tarea visual que incluyó estímulos relacionados con el terremoto. Los participantes fueron evaluados por síntomas postraumáticos y disociativos y se analizaron los componentes potenciales relacionados con el evento y tomografía electromagnética de baja resolución (sLORETA en su sigla en inglés). Comparados con el grupo control, en los sobrevivientes las fuentes localizadas indicaron una más baja intensidad para la amígdala, áreas hipo campal, parahipocampal, y témporo polar en respuesta a estímulos visuales concernientes al terremoto. Los resultados indicaron una activación límbica disminuida en respuesta a estímulos visuales que evocaban el recuerdo del terremoto en los sobrevivientes. Estos hallazgos sugieren que los sobrevivientes probablemente adoptaron una estrategia de distanciamiento hacia los estímulos que pudieran haber provocado una activación emocional relacionada con el trauma colectivo. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Neurophysiological Correlates of Collective Trauma Recall in L'Aquila 2009 Earthquake Survivors Traditional Chinese 標題: 2009年意大利拉奎拉地震生還者對集體創傷的神經生理相關因素 撮要: 本研究旨在檢視2009年意大利拉奎拉地震生還者, 對拉奎拉以及另一不熟悉的城市在地震前後的照片所產生反應的神經相關因素。我們亦檢視心理變量跟對拉奎拉地震後照片的腦部反應的關連。最終的樣本(N = 30 成人)由15名生還者(Mage = 31.40 歲, SD = 9.42)和15名對照組人士(Mage = 30.53, SD = 10.01)組成。我們在視覺實驗裡提供地震相關的刺激, 記錄樣本的腦電圖(EEG)數據。我們評估樣本的創傷後壓力症狀與離解症狀, 並分析樣本的事件相關潛在成份與低解析度電磁斷層掃描(sLORETA)。腦波來源定位反映, 生還者對地震相關的視覺刺激反應, 相比對照組, 在杏仁體、海馬體、海馬旁迴、顳極動脈區域都較弱。結果顯示, 生還者面對令他們想起地震的視覺刺激時, 邊緣系統的啟動反應會減弱。結果反映生還者大多對剌激採取保持距離的策略, 有可能使其對集體創傷有情緒啟動反應。 Simplified Chinese 标题: 2009年意大利拉奎拉地震生还者对集体创伤的神经生理相关因素 撮要: 本研究旨在检视2009年意大利拉奎拉地震生还者, 对拉奎拉以及另一不熟悉的城市在地震前后的照片所产生反应的神经相关因素。我们亦检视心理变量跟对拉奎拉地震后照片的脑部反应的关连。最终的样本(N = 30 成人)由15名生还者(Mage = 31.40 岁, SD = 9.42)和15名对照组人士(Mage = 30.53, SD = 10.01)组成。我们在视觉实验里提供地震相关的刺激, 记录样本的脑电图(EEG)数据。我们评估样本的创伤后压力症状与离解症状, 并分析样本的事件相关潜在成份与低分辨率电磁断层扫描(sLORETA)。脑波来源定位反映, 生还者对地震相关的视觉刺激反应, 相比对照组, 在杏仁体、海马体、海马旁回、颞极动脉区域都较弱。结果显示, 生还者面对令他们想起地震的视觉刺激时, 边缘系统的启动反应会减弱。结果反映生还者大多对剌激采取保持距离的策略, 有可能使其对集体创伤有情绪启动反应。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 687-697, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22334   open full text
• The Preliminary Development and Validation of a Trauma‐Related Safety‐Seeking Behavior Measure for Youth: The Child Safety Behavior Scale (CSBS).
  Alice Alberici, Richard Meiser‐Stedman, Jade Claxton, Patrick Smith, Anke Ehlers, Clare Dixon, Anna Mckinnon.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Safety‐seeking behaviors (SSBs) may be employed after exposure to a traumatic event in an effort to prevent a feared outcome. Cognitive models of posttraumatic stress disorder propose SSBs contribute to maintaining this disorder by preventing disconfirmation of maladaptive beliefs and preserving a sense of current threat. Recent research has found that SSBs impact children's posttraumatic stress symptoms (PTSS) and recovery. In this paper, we sought to develop and validate a novel 22‐item Child Safety Behavior Scale (CSBS) in a school‐based sample of 391 pupils (age 12–15 years) who completed a battery of questionnaires as well as 68 youths (age 8–17 years) who were recently exposed to a trauma. Of the sample, 93.1% (N = 426) completed the new questionnaire. The sample was split (n = 213), and we utilized principal components analysis alongside parallel analysis, which revealed that 13 items loaded well onto a two‐factor structure. This structure was superior to a one‐factor model and overall demonstrated a moderately good model of fit across indices, based upon a confirmatory factory analysis with the other half of the sample. The CSBS showed excellent internal consistency, r = .90; good test–retest reliability, r = .64; and good discriminant validity and specificity. In a multiple linear regression, SSBs, negative appraisals, and number of trauma types each accounted for unique variance in a model of PTSS. This study provides initial support for the use of the CSBS in trauma‐exposed youth as a valuable tool for further research, clinical assessment, and targeted intervention. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) El Desarrollo Preliminar y la Validación de una Medida Conductual de Búsqueda de Seguridad Relacionada al Trauma para Jóvenes: La Escala de Comportamiento de Seguridad Infantil (CSBS, en sigla en inglés) DESARROLLO DE LA ESCALA DE COMPORTAMIENTO DE SEGURIDAD INFANTIL Los comportamientos de búsqueda de seguridad (SSBs, en su sigla en inglés) pueden ser empleados después de la exposición a un evento traumático en un esfuerzo por evitar un resultado temido. Los modelos cognitivos del trastorno de estrés postraumático proponen que los SSBs contribuyen a mantener este trastorno al evitar la refutación de las creencias desadaptativas y preservar un sentido de amenaza actual. Las investigaciones recientes han encontrado que los SSBs tienen un impacto en los síntomas de estrés postraumático (SEPT) y en la recuperación de los niños. En este documento, buscamos desarrollar y validar una nueva Escala de Conducta de Seguridad Infantil (CSBS) de 22 ítems en una muestra escolar de 391 estudiantes (de 12 a 15 años) que completaron una batería de cuestionarios y de 68 jóvenes (de 8 a 17 años) que estuvieron expuestos recientemente a un trauma. De la muestra, el 93.1% (N = 426) completó el nuevo cuestionario. La muestra se dividió (n = 213) y utilizamos el análisis de componentes principales junto con el análisis paralelo, revelando que 13 ítems cargaron adecuadamente en una estructura de dos factores. Esta estructura fue superior a un modelo de un factor y, en general, fue un modelo de ajuste moderadamente bueno entre los índices que investigamos (utilizando el análisis factorial confirmatorio con la otra mitad de la muestra). La CSBS mostró una excelente consistencia interna, r = .90; buena confiabilidad test‐retest, r = .64; y buena validez discriminante y especificidad. En una regresión lineal múltiple, los SSBs, las evaluaciones negativas, y el número de tipos de traumas explicaron cada uno una parte de la varianza en un modelo de SEPT. Este estudio proporciona apoyo inicial para el uso de la CSBS en jóvenes expuestos al trauma como una herramienta clínicamente valiosa para futuras investigaciones, evaluaciones clínicas, e intervenciones específicas. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 The Preliminary Development and Validation of a traumarelated safety‐seeking‐seeking behaviour measure for youth: the Child Safety Behaviour Scale (CSBS) Traditional Chinese 標題: 為青少年而設的創傷相關安全感行為測量的初步設計和驗證:兒童安全感行為量表(CSBS) 撮要: 人在經歷創傷事件後, 為提防害怕的事件發生, 可能會採取尋找安全感的行為(SSBs)。創傷後壓力症的認知模型提出, SSBs會預防適應不良的信念被推翻並保持當前的威脅感, 致使病患維持。而近期研究發現, SSBs對兒童的創傷後壓力症狀(PTSS)和康復有所影響。本研究旨在設計和驗證一個新的22項兒童安全感行為量表(CSBS)。樣本屬學校為本, 有391名學生(年齡為12–15歲)完成了一系列問卷, 並有68 名青少年 (年齡為8–17歲)近期經歷了一次創傷。樣本中93.1% (N = 426)完成了新問卷。我們把樣本分開兩半(n = 213), 利用主成分分析法及平行分析法, 發現13個項目能適切地融於一個二因素模型, 它比單因素模型更好, 綜觀所有我們檢視的指數來說 (對另一半樣本進行驗證性因素分析) , 整體上是適切度為中度良好的模型。CSBS的內部一致性為極佳(r = .90);重測信度為良好 (r = .64), 判別效度和特殊性亦為良好。多元線性迴歸分析顯示, 在一個PTSS模型裡, SSBs、負向評價和創傷類別數量都分別構成獨特的方差。本研究提供了初步數據, 支持對受創青少年使用CSBS, 證明它對未來研究、臨床評估和針對性干預治療都是有用工具。 Simplified Chinese 标题: 为青少年而设的创伤相关安全感行为测量的初步设计和验证:儿童安全感行为量表(CSBS) 撮要: 人在经历创伤事件后, 为提防害怕的事件发生, 可能会采取寻找安全感的行为(SSBs)。创伤后压力症的认知模型提出, SSBs会预防适应不良的信念被推翻并保持当前的威胁感, 致使病患维持。而近期研究发现, SSBs对儿童的创伤后压力症状(PTSS)和康复有所影响。本研究旨在设计和验证一个新的22项儿童安全感行为量表(CSBS)。样本属学校为本, 有391名学生(年龄为12–15岁)完成了一系列问卷, 并有68 名青少年 (年龄为8–17岁)近期经历了一次创伤。样本中93.1% (N = 426)完成了新问卷。我们把样本分开两半(n = 213), 利用主成分分析法及平行分析法, 发现13个项目能适切地融于一个二因素模型, 它比单因素模型更好, 综观所有我们检视的指数来说 (对另一半样本进行验证性因素分析) , 整体上是适切度为中度良好的模型。CSBS的内部一致性为极佳(r = .90);重测信度为良好 (r = .64), 判别效度和特殊性亦为良好。多元线性回归分析显示, 在一个PTSS模型里, SSBs、负向评价和创伤类别数量都分别构成独特的方差。本研究提供了初步数据, 支持对受创青少年使用CSBS, 证明它对未来研究、临床评估和针对性干预治疗都是有用工具。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 643-653, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22332   open full text
• Posttraumatic Stress Disorder Symptoms, Temperament, and the Pathway to Cellular Senescence.
  Samantha L. Connolly, Tawni B. Stoop, Mark W. Logue, Esther Hana Orr, Immaculata Vivo, Mark W. Miller, Erika J. Wolf.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Traumatic stress is thought to be associated with shortened telomere length (TL) in leukocytes, an age‐related marker of increased risk for cellular senescence, although findings thus far have been mixed. We assessed associations between posttraumatic stress disorder (PTSD) symptom severity, temperament, and TL in a sample of 453 White, non‐Hispanic, middle‐aged, trauma‐exposed male and female veterans and civilians. Given that prior research has suggested an association between PTSD and accelerated cellular age, we also examined associations between TL and an index of accelerated cellular age derived from DNA methylation data (DNAm age). Analyses revealed that, controlling for chronological age, PTSD was not directly associated with TL but rather this association was moderated by age, β = −.14, p = .003, ΔR2 = .02. Specifically, PTSD severity evidenced a stronger negative association with TL among relatively older participants (≥ 55 years of age). In a subset of veterans with data pertaining to temperament (n = 150), positive emotionality, and, specifically, a drive toward achievement, β = .26, p = .002, ΔR2 = .06, were positively associated with TL. There was no evidence of an association between age‐adjusted TL and accelerated DNAm age. Collectively, these results indicate that older adults may be more vulnerable to the negative health effects of PTSD but that traits such as achievement, resilience, and psychological hardiness may be protective. These findings underscore the importance of identifying reliable biomarkers of cellular aging and senescence and of determining the biological mechanisms that contribute to stress‐related disease and decline. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Síntomas del trastorno de estrés postraumático, temperamento y el camino a la vejez Celular TEPT Y ENVEJECIMIENTO CELULAR Se cree que el estrés traumático está asociado con la longitud acortada de los telómeros (LT) en leucocitos, un marcador de mayor riesgo de envejecimiento celular relacionado con la edad, aunque los hallazgos en la fecha han sido mixtos. En este estudio, evaluamos las asociaciones entre la severidad de los síntomas del trastorno de estrés postraumático (TEPT), el temperamento y LT en una muestra de 453 blancos, no Hispánicos, de mediana edad, hombres y mujeres veteranos y civiles expuestos al trauma. Dado que el trabajo previo sugiere una asociación entre el TEPT y aceleración de la edad celular, también examinamos asociaciones entre TL y un índice de edad celular acelerado derivado de los datos de metilación del ADN (edad de ADNm). Los análisis revelaron que, controlando la edad cronológica, el TEPT no se asoció directamente con la LT, sino que esta asociación fue moderada por edad, β = ‐.14, p = .003, λR2 = .02. Específicamente, la severidad del TEPT evidenció una asociación negativa más fuerte con LT entre participantes relativamente mayores (55 años de edad o más). En un subconjunto de veteranos con datos perteneciente al temperamento (n = 150), emocionalidad positiva, y específicamente un impulso hacia el logro, β = .26, p = .002, λR2 = .06, se asoció positivamente con LT. No hubo evidencia de una asociación entre la LT ajustada por edad y la edad acelerada del ADNm. En conjunto, estos resultados indican que los adultos mayores pueden ser más vulnerables a los efectos negativos para la salud de TEPT, pero que los rasgos tales como el logro, la capacidad de recuperación y la resistencia psicológica pueden ser protectores. Los hallazgos subrayan la importancia de identificar biomarcadores confiables de envejecimiento y senescencia y de determinar los mecanismos biológicos que contribuyen al estrés relacionado enfermedad y declive. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Posttraumatic Stress Disorder Symptoms, Temperament, and the Pathway to Cellular Senescence Traditional Chinese 標題: 創傷後壓力症症狀、脾氣以及導致細胞衰老的路徑 撮要: 過往研究一直認為創傷壓力跟白血球的端粒長度(TL)縮短有關, 而那是年齡相關的生物標記, 象徵細胞衰老的風險提升。可是, 目前仍未有一致的研究發現。本研究旨在檢視創傷後壓力症(PTSD)症狀嚴重度、脾氣和TL的關連。樣本為453名白人、非西班牙裔、中年、受創的男性和女性退役軍人以及平民。有見於過往有研究指PTSD跟細胞加速衰老有關, 我們亦檢視從DNA甲基化數據取得的細胞加速衰老指數(DNAm age)跟TL的關連。分析顯示, 我們對年齡作對照後, PTSD跟TL並無直接關連, 但其關連受年齡所調節(β = ‐.14, p = .003, ∆R2 = .02)。在相對年長的樣本 (55歲或以上) , PTSD嚴重度跟TL有較強的負向關連。有關退役軍人脾氣的子樣本數據(n = 150)反映, 正向情緒, 特別是對成就感的追求, 跟TL有正向關連(β = .26, p = .002, ∆R2 = .06)。並無證據顯示根據年齡調節後的TL跟DNAm age有所關連。以上結果反映, 年齡較高的成人可能有較大風險受PTSD影響健康, 但如成就感、復原力、心理韌力等特徵可能有保護作用。結果反映找出有關細胞衰老可靠的生物標記的重要性, 以及找出導致壓力相關的疾病和衰退的生理機制的重要。 Simplified Chinese 标题: 创伤后压力症症状、脾气以及导致细胞衰老的路径 撮要: 过往研究一直认为创伤压力跟白血球的端粒长度(TL)缩短有关, 而那是年龄相关的生物标记, 象征细胞衰老的风险提升。可是, 目前仍未有一致的研究发现。本研究旨在检视创伤后压力症(PTSD)症状严重度、脾气和TL的关连。样本为453名白人、非西班牙裔、中年、受创的男性和女性退役军人以及平民。有见于过往有研究指PTSD跟细胞加速衰老有关, 我们亦检视从DNA甲基化数据取得的细胞加速衰老指数(DNAm age)跟TL的关连。分析显示, 我们对年龄作对照后, PTSD跟TL并无直接关连, 但其关连受年龄所调节(β = ‐.14, p = .003, ∆R2 = .02)。在相对年长的样本 (55岁或以上) , PTSD严重度跟TL有较强的负向关连。有关退役军人脾气的子样本数据(n = 150)反映, 正向情绪, 特别是对成就感的追求, 跟TL有正向关连(β = .26, p = .002, ∆R2 = .06)。并无证据显示根据年龄调节后的TL跟DNAm age有所关连。以上结果反映, 年龄较高的成人可能有较大风险受PTSD影响健康, 但如成就感、复原力、心理韧力等特征可能有保护作用。结果反映找出有关细胞衰老可靠的生物标记的重要性, 以及找出导致压力相关的疾病和衰退的生理机制的重要。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 676-686, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22325   open full text
• Maladaptive Eating in Posttraumatic Stress Disorder: A Population‐Based Examination of Typologies and Medical Condition Correlates.
  Jordana L. Sommer, Natalie Mota, Renée El‐Gabalawy.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Posttraumatic stress disorder (PTSD) and eating pathology are frequently comorbid, and both are independent risk factors for various medical conditions. Using population‐based data collected as part of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC‐III; N = 36,309), the primary objectives of this study were to (a) identify eating pathology classes among PTSD and (b) investigate associations between maladaptive eating and medical conditions among PTSD. Using the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS–5), we assessed PTSD and maladaptive eating symptoms in accordance with the DSM‐5. We used a latent class analysis to identify maladaptive eating typologies among adults with lifetime PTSD (n = 2,339; 6.1%) and multivariable logistic regression models to examine associations between each of the six emergent maladaptive eating typologies and medical conditions. Results revealed that over 40% of individuals with PTSD endorsed indicators of maladaptive eating. In addition, each maladaptive eating typology among PTSD was significantly associated with unique sociodemographic characteristics and increased odds of medical conditions relative to no PTSD and no eating disorder, adjusted odds ratios (AORs) = 1.34–6.55, and PTSD with no eating psychopathology, AORs = 1.43–5.11. Results of this study provide a better understanding of maladaptive eating in adults with PTSD and potential medical sequelae. Results indicate maladaptive eating may be an important mechanism in the association between PTSD and medical conditions, which may inform targeted interventions among individuals with these comorbidities. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Hábitos Alimenticios Desadaptativos en el Trastorno de Estrés Postraumático: Un Examen Basado en las Tipologías y los Correlatos de Condiciones Médicas de la Población. TIPOLOGÍA DE HÁBITOS ALIMENTICIOS Y CORRELATOS MÉDICOS EN TEPT. El trastorno de estrés postraumático (TEPT) y la patología de hábitos alimenticios son con frecuencia comórbidos, y ambos son factores de riesgo independientes para diversas condiciones médicas. Se utilizaron los datos basados en la población recopilados como parte de la Encuesta Epidemiológica Nacional sobre el alcohol y condiciones relacionadas 2012–2013 (NESARC‐III; N = 36,309), los objetivos principales de este estudio fueron: (a) identificar las clases de patología de hábitos alimenticios en casos con TEPT, e (b) investigar las asociaciones entre hábitos alimenticios desadaptativos y condiciones médicas entre los casos con TEPT. Usamos el Programa de Entrevistas sobre Discapacidades de Consumo de Alcohol y Discapacidades Asociadas (AUDADIS‐5), evaluamos TEPT y los síntomas de hábitos alimenticios desadaptativos de acuerdo con el DSM‐5. Utilizamos un análisis de clase latente para identificar tipologías de hábitos alimentarios desadaptativos entre adultos con TEPT a lo largo de la vida (n = 2,339, 6.1%) y modelos de regresión logística multivariable para examinar las asociaciones entre cada una de las seis tipologías emergentes de desadaptación de hábitos alimenticios y condiciones médicas. Los resultados revelaron que más del 40% de las personas con TEPT endosaron indicadores de hábitos alimenticios desadaptativos. Además, cada tipología de hábitos alimenticios desadaptativos entre el TEPT se asoció significativamente con características sociodemográficas únicas y un aumento de las probabilidades de condiciones médicas, relativo a no tener TEPT y sin trastorno de hábitos alimenticios, odds ratios ajustados (AOR) = 1.34‐6.55, y TEPT y sin psicopatología de hábitos alimenticios, AORs = 1.43‐5.11. Los resultados de este estudio proporcionan una mejor comprensión de los hábitos alimenticios desadaptativos en adultos con TEPT y posibles secuelas médicas. Los resultados indican que los hábitos alimenticios desadaptativos pueden ser un mecanismo importante en la asociación entre el TEPT y las condiciones médicas, lo que puede orientar intervenciones específicas en individuos con este tipo de comorbilidades. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Maladaptive Eating in Posttraumatic Stress Disorder: A Population‐Based Examination of Typologies and Medical Condition Correlates Traditional Chinese 標題: 創傷後壓力症患者進食失常:類別與相關健康問題的人口為本研究 撮要: 創傷後壓力症(PTSD)和進食失常常為共病, 而兩者都是多種健康問題的獨立風險因素。我們從2012–2013年全國酒精及相關問題流行病學調查(NESARC‐III; N = 36,309) 取得人口為本的數據。本研究的主要目的為(a)找出PTSD患者進食失常的類別;(b)檢視PTSD患者當中, 進食失常和健康問題的關連。我們採用酒精使用失常和相關障礙面談量表(AUDADIS‐5), 根據DSM‐5評估樣本的PTSD與進食失常症狀;利用潛在類別分析, 找出患終生PTSD的成人(n = 2,339; 6.1%)其進食失常的類別, 並以多變項線性迴歸模型, 檢視6種進食失常類別中, 每一種跟健康問題的關連。結果顯示, 40%的PTSD患者有進食失常症狀。而且, 與無PTSD及無進食失常的樣本(已調節勝算比(AOR) = 1.34–6.55)及有PTSD但無進食心理疾病的樣本(AORs = 1.43–5.11)比較, 有PTSD和進食失常的樣本中, 各種進食失常類別都顯著地跟獨特的社會人口特徵有關, 亦顯著地與較大機會患健康問題有關。研究結果使我們對PTSD成年患者的進食失常情況及潛在的後遺症有更深理解。結果反映, 進食失常可能是PTSD與健康問題的關連裡一個重要的機制, 我們可能有需要為有此共病的人士提供針對性干預。 Simplified Chinese 标题: 创伤后压力症患者进食失常:类别与相关健康问题的人口为本研究 撮要: 创伤后压力症(PTSD)和进食失常常为共病, 而两者都是多种健康问题的独立风险因素。我们从2012–2013年全国酒精及相关问题流行病学调查(NESARC‐III; N = 36,309) 取得人口为本的数据。本研究的主要目的为(a)找出PTSD患者进食失常的类别;(b)检视PTSD患者当中, 进食失常和健康问题的关连。我们采用酒精使用失常和相关障碍面谈量表(AUDADIS‐5), 根据DSM‐5评估样本的PTSD与进食失常症状;利用潜在类别分析, 找出患终生PTSD的成人(n = 2,339; 6.1%)其进食失常的类别, 并以多变项线性回归模型, 检视6种进食失常类别中, 每一种跟健康问题的关连。结果显示, 40%的PTSD患者有进食失常症状。而且, 与无PTSD及无进食失常的样本(已调节胜算比(AOR) = 1.34–6.55)及有PTSD但无进食心理疾病的样本(AORs = 1.43–5.11)比较, 有PTSD和进食失常的样本中, 各种进食失常类别都显著地跟独特的社会人口特征有关, 亦显著地与较大机会患健康问题有关。研究结果使我们对PTSD成年患者的进食失常情况及潜在的后遗症有更深理解。结果反映, 进食失常可能是PTSD与健康问题的关连里一个重要的机制, 我们可能有需要为有此共病的人士提供针对性干预。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 708-718, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22323   open full text
• Posttraumatic Stress Symptoms and Emerging Adult Sexual Minority Men: Implications for Assessment and Treatment of Childhood Sexual Abuse.
  Michael S. Boroughs, Peter P. Ehlinger, Abigail W. Batchelder, Steven A. Safren, Conall O'Cleirigh.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Emerging adulthood (EA) is a developmental period marked by unique challenges that affect health including burgeoning occupational, relational, and financial stability; and increased risk taking in terms of sexual behavior(s) and substance use. Data were collected from 296 HIV‐uninfected sexual minority men with childhood sexual abuse (CSA) histories. We analyzed baseline assessment data from a multisite randomized controlled trial that tested the efficaciousness of an experimental psychosocial treatment and examined vulnerabilities known to be linked with CSA. Our analyses compared EA sexual minority men, aged 18–29, with older sexual minority men (OSMM) on posttraumatic stress disorder (PTSD) and other mental health and substance use outcomes. We found higher odds of PTSD, odds ratio (OR) = 0.57, 95% CI [0.33, 0.96]; panic disorder or panic disorder with agoraphobia, OR = 0.36, 95% CI [0.16, 0.85]; and cocaine use, OR = 0.50, 95% CI [0.25, 0.97], among OSMM and higher odds of alcohol intoxication, OR = 5.60, 95% CI [3.20, 9.82]; cannabis use, OR = 3.09, 95% CI [1.83, 5.21]; and non‐HIV sexually transmitted infections, OR = 3.03, 95% CI [1.29, 7.13], among the EA men. These results present a complex picture of health risks among sexual minority men in general and EA sexual minority men in particular. HIV seroconversion linked health risk behaviors, among sexual minority men, may be better addressed via increased attention to treating trauma and comorbid mental health and substance use problems using evidence‐based psychosocial assessments and integrated treatment platforms that are tailored to this population. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trauma entre Hombres de Minorías Sexuales Adultas Emergentes: Implicanciones para la Evaluación y el Tratamiento del Abuso Sexual Infantil HOMBRES DE MINORIA SEXUAL Y TRAUMA La adultez emergente (AE) es un período de desarrollo marcado por desafíos únicos que afectan la salud, que incluye la creciente estabilidad ocupacional, relacional y financiera; y un incremento en la toma de riesgos en términos de comportamiento(s) sexual(es) y uso de sustancias. Los datos fueron recogidos de historias de 296 hombres de minorías sexuales, no infectados por VIH, con antecedentes de abuso sexual infantil (ASI). Se analizaron los datos de una evaluación de referencia de la Fase‐III de un ensayo controlado aleatorio de múltiples sitios que probó la eficacia de un tratamiento psicosocial experimental y examinó las vulnerabilidades que se sabe están relacionadas con ASI. Nuestros análisis compararon hombres AE de minorías sexuales, de 18–29 años, con hombres de minorías sexuales mayores (HMSM) en trastorno de estrés postraumático (TEPT) y otros resultados de salud mental y uso de sustancias. Encontramos mayores probabilidades de TEPT, odds ratio (OR) = 0.57, IC 95% [0.33, 0.96]; trastorno de pánico o trastorno de pánico con agorafobia, OR = 0.36, IC del 95% [0.16, 0.85]; y consumo de cocaína, OR = 0.50, IC 95% [0.25, 0.97], entre HMSM y mayores probabilidades de intoxicación por alcohol, OR = 5.60, 95% CI [3.20, 9.82]; consumo de cannabis, OR = 3.09, 95% CI [1.83, 5.21]; e infecciones de transmisión sexual sin‐VIH, OR = 3.03, 95% CI [1.29, 7.13], entre los hombres AE. Estos resultados presentan una imagen compleja de los riesgos de salud entre los hombres de minorías sexuales, en general, y los hombres AE de minorías sexuales, en particular. Las conductas de riesgo de salud relacionadas con la seroconversión del VIH entre hombres de minorías sexuales pueden abordarse mejor a través de una mayor atención al tratamiento del trauma, la salud mental de comorbilidades y los problemas de uso de sustancias, usando evaluaciones psicosociales basadas en evidencia y plataformas de tratamiento integrado que se adapten a esta población. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Trauma among emerging adult sexual minority men: Implications for assessment and treatment of childhood sexual abuse Traditional Chinese 標題: 處於成年初顯期的性小眾男士的創傷:童年性虐待的評估與治療研究 撮要: 成年初顯期(EA)是面對獨特挑戰的發展階段, 有可能影響健康, 如影響職業、關係和經濟穩定度, 亦可致使有較高風險的性行為和濫用藥物行為。本研究從296名未受HIV感染、曾受童年性虐待(CSA)的性小眾男士取得數據。我們進行第三期多站點隨機對照試驗, 測試一項實驗性心理社會治療的功效, 並檢視與CSA有關的弱點。我們進行基線的數據評估, 並比較處於EA(18–29歲)和年齡較高的性小眾男士(OSMM), 其創傷後壓力症(PTSD)和其他心理及濫用藥物情況。我們發現, OSMM有較高機會:患PTSD(勝算比(OR) = 0.57, 95% CI [0.33, 0.96])、患驚恐症或患畏曠症及驚恐症(OR = 0.36, 95% CI [0.16, 0.85])、服食可卡因(OR = 0.50, 95% CI [0.25, 0.97]);而EA的樣本有較高機會:酒精中毒(OR = 5.60, 95% CI [3.20, 9.82])、服食大麻(OR = 3.09, 95% CI [1.83, 5.21])、受非HIV的性感染(OR = 3.03, 95% CI [1.29, 7.13])。結果反映性小眾男士其健康風險的複雜性, 特別是處於EA階段的男士。為預防性小眾男士中, 與HIV血清轉化現象有關的健康風險行為, 我們可特別為這類人口提供實證為本的心理社會評估與綜合治療平台, 加強創傷治療和心理疾病與濫藥的共病治療。 Simplified Chinese 标题: 处于成年初显期的性小众男士的创伤:童年性虐待的评估与治疗研究 撮要: 成年初显期(EA)是面对独特挑战的发展阶段, 有可能影响健康, 如影响职业、关系和经济稳定度, 亦可致使有较高风险的性行为和滥用药物行为。本研究从296名未受HIV感染、曾受童年性虐待(CSA)的性小众男士取得数据。我们进行第三期多站点随机对照试验, 测试一项实验性心理社会治疗的功效, 并检视与CSA有关的弱点。我们进行基线的数据评估, 并比较处于EA(18–29岁)和年龄较高的性小众男士(OSMM), 其创伤后压力症(PTSD)和其他心理及滥用药物情况。我们发现, OSMM有较高机会:患PTSD(胜算比(OR) = 0.57, 95% CI [0.33, 0.96])、患惊恐症或患畏旷症及惊恐症(OR = 0.36, 95% CI [0.16, 0.85])、服食可卡因(OR = 0.50, 95% CI [0.25, 0.97]);而EA的样本有较高机会:酒精中毒(OR = 5.60, 95% CI [3.20, 9.82])、服食大麻(OR = 3.09, 95% CI [1.83, 5.21])、受非HIV的性感染(OR = 3.03, 95% CI [1.29, 7.13])。结果反映性小众男士其健康风险的复杂性, 特别是处于EA阶段的男士。为预防性小众男士中, 与HIV血清转化现象有关的健康风险行为, 我们可特别为这类人口提供实证为本的心理社会评估与综合治疗平台, 加强创伤治疗和心理疾病与滥药的共病治疗。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 665-675, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22335   open full text
• Treatment Efficacy for Veterans With Posttraumatic Stress Disorder: Latent Class Trajectories of Treatment Response and Their Predictors.
  Dominic Murphy, Kirsten V. Smith.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Evidence suggests that veterans with posttraumatic stress disorder (PTSD) have a poorer treatment response than nonveterans.  In this study, we explored heterogeneity in treatment response for 960 veterans in the United Kingdom with PTSD who had been offered a residential intervention consisting of a mixture of group sessions and individual trauma‐focused cognitive behavioral therapy (TF–CBT). The primary outcome was PTSD score on the Impact of Event Scale–Revised (IES–R).  Covariates included depression, anxiety, anger, alcohol misuse, functional impairment, and sociodemographic characteristics.  Follow‐up occurred posttreatment at set time points for 12 months.  We present predictors of PTSD severity at posttreatment and follow‐up obtained using a latent class growth analysis to identify different treatment trajectories.  Multinomial logistic regression models were used to identify covariates predicting class membership, and five classes were identified. Of participants, 71.3% belonged to three classes showing positive treatment responses, and 1.2% showed initial improvement but later relapsed. Additionally, 27.5% of participants were identified within a treatment‐resistant class that showed little change in severity of presentation. Depression, anxiety, and having had a combat role during military service increased the likelihood of membership in the treatment‐resistant class, odds ratios (ORs) = 1.12–1.53, 1.16–1.32, and 2.89, respectively. Additionally, participants in the treatment‐resistant class had higher pretreatment PTSD scores for reexperiencing, avoidance, and hyperarousal symptoms, ORs = 5.24, 2.62, and 3.86, respectively. Findings suggest the importance of triaging individuals and offering interventions tailored to severity of presentation. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La Eficacia del Tratamiento para Veteranos del Reino Unido con Trastorno de Estrés Postraumático: Trayectorias de la Clase Latente de la Respuesta al Tratamiento y sus Predictores TRAYECTORIAS DE TRATAMIENTO PARA LOS VETERANOS DEL REINO UNIDO CON TEPT La evidencia sugiere que los veteranos con trastorno de estrés postraumático (TEPT) tienen una respuesta al tratamiento más pobre que aquellos que no son veteranos. En este estudio, exploramos la heterogeneidad en la respuesta al tratamiento de 960 veteranos del Reino Unido que presentaban TEPT y a quienes se les había ofrecido una intervención residencial consistente en una mezcla de sesiones grupales y terapia cognitivo‐conductual individual centrada en el trauma (TF‐CBT, en su sigla en inglés). El resultado principal fue el puntaje de TEPT en la Escala Revisada de Impacto de Eventos (IES–R, en su sigla en inglés). Las covariables incluyeron la depresión, la ansiedad, la ira, el abuso de alcohol, la discapacidad funcional, y las características sociodemográficas. El seguimiento ocurrió de forma posterior al termino del tratamiento en periodos específicos por 12 meses. Presentamos predictores de la severidad del TEPT al término el tratamiento y al seguimiento obtenidos por medio de un análisis de crecimiento de clases latentes para identificar las diferentes trayectorias de tratamiento. Modelos de regresión logística multinominales fueron usados para identificar las covariables predictoras de pertenencia a una clase, y así cinco clases fueron identificadas; de los participantes, un 71.3% perteneció a tres clases mostrando respuestas positivas al tratamiento y un 1.2% mostro una mejoría inicial pero posterior recaída. Adicionalmente, el 27.5% de los participantes fueron identificados dentro de una clase resistente al tratamiento, ya que mostraron pocos cambios en la severidad de la presentación. La depresión, odds ratios (ORs, en su sigla en inglés) = 1.12 ‐ 1.53; la ansiedad, ORs = 1.16 ‐ 1.32; y tener un rol de combate durante el servicio militar, OR = 2.89, incrementaron la probabilidad de pertenecer a la clase resistente al tratamiento. Adicionalmente, los participantes en la clase resistente al tratamiento mostraron tener puntajes de más altos de TEPT antes del tratamiento, particularmente reexperimentación, OR = 5.24; evitación, OR = 2.62; y síntomas de hiperactivación, OR = 3.86. Los hallazgos pueden sugerir la importancia de clasificar a los individuos y ofrecer intervenciones a la medida de la severidad de la presentación. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Treatment efficacy for UK veterans with post‐traumatic stress disorder: latent class trajectories of treatment response and their predictors. Traditional Chinese 標題: 患創傷後壓力症的英國退役軍人的治療成效:治療反應的潛在類別軌跡及其預測變量 撮要: 過往數據證明, 患創傷後壓力症(PTSD)的退役軍人比非退役軍人的治療成效較差。本研究透過960名患PTSD的英國退役軍人, 探索治療成效的異質性。樣本接受住院干預治療, 當中包含組別治療節段和個人的創傷聚焦認知行為治療(TF–CBT)。我們檢視的主要治療成效為於事件影響測量表(修訂版)(IES–R)的PTSD分數。共變量包括抑鬱症、焦慮症、憤怒、濫用酒精、功能性損傷和社會人口特徵。我們在樣本完成治療12個月後作跟進。我們利用潛在類別成長分析, 找出不同的治療軌跡, 並找到於完成治療及跟進期的PTSD嚴重度預測變量。多項邏輯迴歸模型用以找出可預測類別的共變量, 並得出5個類別。71.3%的樣本屬於3個正向治療成效的類別, 1.2%起初展現改善但又回復故態。27.5%的樣本屬於抗拒治療類別, 症狀嚴重度只有少量改變。以下能提升樣本屬抗拒治療類別的可能性:抑鬱症(勝算比 (ORs) = 1.12–1.53)、焦慮症(ORs = 1.16–1.32)、服役時曾參與戰鬥(OR = 2.89)。屬抗拒治療類別的樣本, 治療前以下方面的PTSD分數都較高:再體驗(OR = 5.24)、迴避(OR = 2.62)、過激反應症狀(OR = 3.86)。結果反映把患者分類, 並因應患者的嚴重度調校干預治療的重要性。 Simplified Chinese 标题: 患创伤后压力症的英国退役军人的治疗成效:治疗反应的潜在类别轨迹及其预测变量 撮要: 过往数据证明, 患创伤后压力症(PTSD)的退役军人比非退役军人的治疗成效较差。本研究透过960名患PTSD的英国退役军人, 探索治疗成效的异质性。样本接受住院干预治疗, 当中包含组别治疗节段和个人的创伤聚焦认知行为治疗(TF–CBT)。我们检视的主要治疗成效为于事件影响测量表(修订版)(IES–R)的PTSD分数。共变量包括抑郁症、焦虑症、愤怒、滥用酒精、功能性损伤和社会人口特征。我们在样本完成治疗12个月后作跟进。我们利用潜在类别成长分析, 找出不同的治疗轨迹, 并找到于完成治疗及跟进期的PTSD严重度预测变量。多项逻辑回归模型用以找出可预测类别的共变量, 并得出5个类别。71.3%的样本属于3个正向治疗成效的类别, 1.2%起初展现改善但又回复故态。27.5%的样本属于抗拒治疗类别, 症状严重度只有少量改变。以下能提升样本属抗拒治疗类别的可能性:抑郁症(胜算比 (ORs) = 1.12–1.53)、焦虑症(ORs = 1.16–1.32)、服役时曾参与战斗(OR = 2.89)。属抗拒治疗类别的样本, 治疗前以下方面的PTSD分数都较高:再体验(OR = 5.24)、回避(OR = 2.62)、过激反应症状(OR = 3.86)。结果反映把患者分类, 并因应患者的严重度调校干预治疗的重要性。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 753-763, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22333   open full text
• Longitudinal Development of Primary and Secondary Posttraumatic Growth in Aging Veterans and Their Wives: Domain‐Specific Trajectories.
  Rahel Bachem, Saskia Mitreuter, Yafit Levin, Jacob Y. Stein, Zhou Xiao, Zahava Solomon.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Posttraumatic growth (PTG), the positive psychological transformations that follow traumatic events, affects both direct survivors (primary PTG) and their significant others (secondary PTG). Though primary and secondary PTG have been widely investigated in the literature, their long‐term trajectories decades after a traumatic event, especially as survivors enter older age, remain largely uninvestigated. Furthermore, it remains contested whether PTG adds up to a monolithic construct or rather consists of relatively independent components. Addressing these issues, we assessed a sample of Israeli male veterans from the 1973 Yom Kippur war (N = 349) and their wives (N = 156) at three time points over the course of nearly three decades. Both the veterans (primary survivors) and their wives (secondary survivors) reported PTG relating to the veterans' experiences during the war and/or captivity. Latent growth mixture modeling was conducted to identify trajectories of PTG on the five subscales of the Posttraumatic Growth Inventory. Long‐term trajectories of PTG followed heterogeneous patterns of fluctuation over time and particularly as participants entered older age. On most subscales, decreasing PTG scores were evident, a trend that was more pronounced among the primary survivors than the secondary survivors as primary and secondary PTG fluctuate considerably in the long‐term and seem to decrease as individuals enter older age. Furthermore, it would seem that PTG should not be considered a holistic concept but rather a conglomeration of positive changes. Implications of the findings are discussed within the context of limitations and potential intervening factors. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Desarrollo longitudinal del crecimiento postraumático primario y secundario en veteranos ancianos y sus esposas: Trayectorias por dominios específicas TRAYECTORIAS DE LOS DOMINIOS DE CRECIMIENTO POSTRAUMÁTICO Tanto los sobrevivientes directos como sus parejas experimentan crecimiento postraumático (PTG, por sus siglas en inglés), las transformaciones positivas que siguen a los eventos traumáticos, vía PTG primaria (sobrevivientes) y PTG secundaria (parejas). Aunque el PTG primario y secundario han sido ampliamente investigados en la literatura, sus trayectorias de largo plazo décadas después de un evento traumático, y especialmente en la medida que los sobrevivientes adquieren edad avanzada, permanecen en gran parte sin investigar. Más aún, permanece controvertido si el PTG se agrega a un constructo monolítico o más bien está constituido por componentes relativamente independientes. Para abordar estos problemas, evaluamos una muestra de hombres veteranos israelíes de la guerra de Yom Kippur de 1973 (N = 349) y sus esposas (N = 156) en 3 puntos de tiempo en el curso de casi 3 décadas. Tanto los veteranos (sobrevivientes primarios) como sus esposas (sobrevivientes secundarios) reportaron PTG en relación a las experiencias de los veteranos durante la guerra y/o cautiverio. Se realizó un modelo de mezcla del crecimiento latente para identificar las trayectorias del PTG en las cinco subescalas del Inventario de Crecimiento Postraumático. Las trayectorias de largo plazo de PTG siguieron patrones heterogéneos de fluctuación a través del tiempo y particularmente en la medida que los participantes alcanzaban avanzada edad. En la mayoría de las subescalas, la disminución de los puntajes de PTG fue evidente, una tendencia que fue más pronunciada entre los sobrevivientes primarios que entre los sobrevivientes secundarios mientras que el PTG primario y secundario fluctua considerablemente en el largo plazo y parece disminuir mientras los individuos alcanzan avanzada edad. Más aún, pareciera que PTG no debería ser considerado un concepto holístico sino un conglomerado de cambios positivos. Las implicancias de los hallazgos se discuten dentro del contexto de las limitaciones y potenciales factores intervinientes. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Longitudinal development of primary and secondary posttraumatic growth in aging veterans and their wives: Domain‐specific trajectories Traditional Chinese 標題: 年紀漸長的退役軍人和他們的妻子原級和次級創傷後成長的縱貫發展: 範疇特殊的軌跡 撮要: 直接生還者與其身邊重要的人同樣會經歷創傷後成長(PTG)。那是創傷事件後的正向心理改變, 由原級PTG(生還者)和次級PTG(身邊重要的人)組成。雖然過往的文獻已廣泛地檢視原級和次級PTG, 可是, 兩者在創傷事件數十年後, 特別是當生還者踏入老年時的長遠軌跡, 仍缺乏研究。再者, PTG到底是否形成整體構念, 還是由相對獨立的成份組成, 仍備受爭議。為了解以上問題, 本研究檢視曾參與1973年贖罪日戰爭的以色列男性退役軍人(N = 349)及他們的妻子(N = 156), 在接近30年裡分3個時點進行評估。退役軍人 (原級生還者) 和妻子 (次級生還者) , 都有跟退役軍人戰爭和/或受虜經歷相關的PTG。潛在成長混合模型用以找出創傷後成長量表中5個子量表的PTG軌跡。PTG的長遠軌跡有不同的起伏模式, 特別是在樣本年紀漸長時。在大多數子量表裡, PTG分數都明顯下降, 而這趨勢在原級生還者當中更為明顯。長遠來說, 原級和次級PTG一直有顯著起伏, 並似乎因樣本年紀漸長而下降。而且, PTG似乎並非一個整體構念, 而是由一些正向改變結合而成。我們亦基於結果, 討論是次研究的限制和潛在的干擾因素。 Simplified Chinese 标题: 年纪渐长的退役军人和他们的妻子原级和次级创伤后成长的纵贯发展: 范畴特殊的轨迹 撮要: 直接生还者与其身边重要的人同样会经历创伤后成长(PTG)。那是创伤事件后的正向心理改变, 由原级PTG(生还者)和次级PTG(身边重要的人)组成。虽然过往的文献已广泛地检视原级和次级PTG, 可是, 两者在创伤事件数十年后, 特别是当生还者踏入老年时的长远轨迹, 仍缺乏研究。再者, PTG到底是否形成整体构念, 还是由相对独立的成份组成, 仍备受争议。为了解以上问题, 本研究检视曾参与1973年赎罪日战争的以色列男性退役军人(N = 349)及他们的妻子(N = 156), 在接近30年里分3个时点进行评估。退役军人 (原级生还者) 和妻子 (次级生还者) , 都有跟退役军人战争和/或受虏经历相关的PTG。潜在成长混合模型用以找出创伤后成长量表中5个子量表的PTG轨迹。PTG的长远轨迹有不同的起伏模式, 特别是在样本年纪渐长时。在大多数子量表里, PTG分数都明显下降, 而这趋势在原级生还者当中更为明显。长远来说, 原级和次级PTG一直有显著起伏, 并似乎因样本年纪渐长而下降。而且, PTG似乎并非一个整体构念, 而是由一些正向改变结合而成。我们亦基于结果, 讨论是次研究的限制和潜在的干扰因素。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 730-741, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22331   open full text
• Predictors of Outcome and Residual Symptoms Following Trauma‐Focused Psychotherapy in Police Officers With Posttraumatic Stress Disorder.
  Geert E. Smid, Christianne A. I. der Meer, Miranda Olff, Mirjam J. Nijdam.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of developing posttraumatic stress disorder (PTSD). Little is known about trauma‐focused psychotherapy outcomes in the police. In this naturalistic study, we evaluated whether PTE exposure and baseline clinical characteristics predicted PTSD symptom reduction during treatment and residual PTSD symptoms posttreatment. In consecutive referrals to a specialized mental health service for police officers (N = 665), PTSD was measured pre‐ and posttreatment using structured clinical interviews. Treatment consisted of brief eclectic psychotherapy for PTSD. We grouped PTE as follows: injury/maltreatment, loss (colleague or private), other job‐related, other private traumatic events. Data were analyzed multivariably using structural equation modeling and logistic regression. Treatment effect size was large, d = 3.6, 95% CI [3.4, 3.8]. Police officers who reported more injury/maltreatment or private traumatic had more baseline PTSD symptoms as well as larger symptom reduction during treatment; police officers who reported more losses of loved ones showed smaller PTSD symptom reduction. Concentration problems persisted in 17.7% of police officers posttreatment, and these were predicted by baseline PTSD symptoms and loss of loved ones. Proportions of variance explained by the multivariable models ranged from 0.08 to 0.14. Our findings increase insight into the type of PTE and clinical characteristics of police officers with PTSD who benefit most from trauma‐focused treatment. Because loss of loved ones can be presumed to have a profound impact on social and interpersonal functioning, a more specific treatment focus on grief processes may further enhance efficacy. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Predictores de resultados y síntomas residuales después de la psicoterapia centrada en el trauma en policías con TEPT PREDICCIÓN DEL RESULTADO DEL TRATAMIENTO DEL TEPT EN POLICÍAS Los policías expuestos a eventos potencialmente traumáticos (PTE en su sigla en inglés) corren un mayor riesgo de desarrollar trastorno de estrés postraumático (TEPT). Poco se sabe sobre los resultados de la psicoterapia centrada en el trauma en la policía. En este estudio naturalista, evaluamos si la exposición a PTE y las características clínicas iniciales predijeron la reducción de los síntomas de TEPT durante el tratamiento y los síntomas residuales de TEPT después del tratamiento. En derivaciones consecutivas a un servicio especializado de salud mental para policías (N = 665), se midió el TEPT antes y después del tratamiento mediante entrevistas clínicas estructuradas. El tratamiento consistió en psicoterapia ecléctica breve para el TEPT. Agrupamos los PTE de la siguiente manera: lesión / maltrato, pérdida (colega o personal), otros eventos relacionados con el trabajo, otros eventos traumáticos personales. Los datos se analizaron de forma multivariada utilizando modelos de ecuaciones estructurales y regresión logística. El tamaño del efecto del tratamiento fue grande, d = 3.6, IC del 95% [3.4, 3.8]. Los policías que reportaron más lesiones / maltrato o traumatismos personales tuvieron más síntomas iniciales de TEPT y una reducción más grande de los síntomas durante el tratamiento; los policías que informaron más pérdidas de seres queridos mostraron una menor reducción de los síntomas de TEPT. Los problemas de concentración persistieron en el 17.7% de los policías después del tratamiento, y fueron pronosticados por los síntomas iniciales de TEPT y la pérdida de seres queridos. Las proporciones de varianza explicadas por los modelos multivariados variaron en un rango de 0.08 a 0.14. Nuestros hallazgos aumentan el conocimiento sobre el tipo de PTE y las características clínicas de los policías con TEPT que se benefician más del tratamiento centrado en el trauma. Debido a que se puede suponer que la pérdida de seres queridos tiene un profundo impacto en el funcionamiento social e interpersonal, un enfoque de tratamiento más específico en los procesos de duelo puede mejorar aún más la eficacia. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Predictors of outcome and residual symptoms following trauma‐focused psychotherapy in police officers with PTSD Traditional Chinese 標題: 患PTSD的警員接受聚焦創傷的心理治療後, 治療成效和剩餘症狀的預測變量 撮要: 曾經歷潛在創傷性事件(PTE)的警員有較高風險發展出創傷後壓力症(PTSD)。目前, 我們對警員接受聚焦創傷的心理治療結果認知甚少。本自然研究檢視PTE經歷及基線的臨床特徵是否能預測到治療時PTSD症狀減輕, 以及治療後剩餘的PTSD症狀。我們連續向專為警員而設的心理治療服務取得樣本(N = 665), 在治療前後透過結構性臨床面談測量其PTSD。治療是為PTSD而設的短期折衷療法。我們把PTE分為以下類別:受傷༏不良對待、喪失親友 (於工作或私人生活裡) 、其他與工作相關的創傷事件、其他私人的創傷事件。我們以結構方程模型和邏輯迴歸法, 以多變量的方式分析數據。治療效應量為大(d = 3.6, 95% CI [3.4, 3.8])。經歷較多受傷༏不良對待或私人創傷事件的警員, 基線的PTSD症狀較多, 治療時症狀減輕的幅度亦較大。有較多喪失親友經歷的警員, 症狀減輕的幅度較少。17.7%警員在治療後仍有專注力問題, 而這受基線的PTSD症狀和喪失親友所能預測。多變量模型解釋到的方差比例為0.08 至 0.14。有關接受聚焦創傷治療後獲得最大改善的PTSD警員, 本研究增加了對其PTE類別和臨床特徵的理解。由於喪失摯親通常會對社會和人際功能運作構成嚴重影響, 若能提供特殊地針對哀悼過程的治療, 應可進一步提升治療功效。 Simplified Chinese 标题: 患PTSD的警员接受聚焦创伤的心理治疗后, 治疗成效和剩余症状的预测变量 撮要: 曾经历潜在创伤性事件(PTE)的警员有较高风险发展出创伤后压力症(PTSD)。目前, 我们对警员接受聚焦创伤的心理治疗结果认知甚少。本自然研究检视PTE经历及基线的临床特征是否能预测到治疗时PTSD症状减轻, 以及治疗后剩余的PTSD症状。我们连续向专为警员而设的心理治疗服务取得样本(N = 665), 在治疗前后透过结构性临床面谈测量其PTSD。治疗是为PTSD而设的短期折衷疗法。我们把PTE分为以下类别:受伤༏不良对待、丧失亲友 (于工作或私人生活里) 、其他与工作相关的创伤事件、其他私人的创伤事件。我们以结构方程模型和逻辑回归法, 以多变量的方式分析数据。治疗效应量为大(d = 3.6, 95% CI [3.4, 3.8])。经历较多受伤༏不良对待或私人创伤事件的警员, 基线的PTSD症状较多, 治疗时症状减轻的幅度亦较大。有较多丧失亲友经历的警员, 症状减轻的幅度较少。17.7%警员在治疗后仍有专注力问题, 而这受基线的PTSD症状和丧失亲友所能预测。多变量模型解释到的方差比例为0.08 至 0.14。有关接受聚焦创伤治疗后获得最大改善的PTSD警员, 本研究增加了对其PTE类别和临床特征的理解。由于丧失挚亲通常会对社会和人际功能运作构成严重影响, 若能提供特殊地针对哀悼过程的治疗, 应可进一步提升治疗功效。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 764-774, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22328   open full text
• Facilitators and Barriers to Seeking Mental Health Care Among Primary Care Veterans With Posttraumatic Stress Disorder.
  Kyle Possemato, Laura O. Wray, Emily Johnson, Brad Webster, Gregory P. Beehler.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Although posttraumatic stress disorder (PTSD) is common in primary care patients, many do not seek mental health treatment. Existing research on barriers and facilitators to receiving PTSD treatment are not specific to primary care patients. In this study, we sought to understand the psychosocial concerns, treatment barriers, and treatment facilitators among non‐treatment‐seeking primary care veterans with PTSD who reside in both rural and urban settings. Using a concurrent triangulation design, we collected qualitative focus group and quantitative self‐report data concurrently, analyzed them separately, and merged the results for interpretation. In total, 27 veteran primary care patients with PTSD participated in 1 of 4 focus groups. A modified conventional content analysis approach was used. Team‐based coding began with three broad primary codes (psychosocial concerns, barriers, and facilitators) and subcodes were allowed to emerge from the data. Self‐report measures were used to collect clinical characteristics and barriers to care. The results expanded upon existing models of PTSD treatment initiation by (a) specifying treatment preferences, such as patient‐centered care, peer support services, and open access scheduling, and (b) presenting concerns, such as anger and core symptoms of PTSD. Results also indicated that a commonly used quantitative barriers measure may offer an incomplete picture of why veterans do not seek treatment as it does not assess how past negative treatment experiences may affect utilization. Strategies to help veterans overcome barriers to care may benefit from a focus on negative treatment‐seeking beliefs and tailoring based on a veteran's rural or urban status. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Facilitadores y barreras para la búsqueda de atención de salud mental entre veteranos de atención primaria con TEPT FACILITADORES Y BARRERAS PARA BÚSQUEDA DE ATENCIÓN EN TEPT El trastorno de estrés postraumático (TEPT) es común en pacientes de atención primaria, sin embargo no buscan un tratamiento de salud mental. Las investigaciones existentes acerca de barreras y facilitadores para recibir tratamiento en TEPT no son específicas en pacientes de atención primaria. En este estudio, hemos buscado entender las preocupaciones psicosociales, barreras y facilitadores de tratamiento entre veteranos que no buscan tratamiento de atención primaria en TEPT que residen en ambos contextos urbano y rural. Utilizando un diseño de triangulación concurrente, recolectamos datos cualitativos a través de grupos focales y cuantitativos a través de autoreportes, de manera simultánea, analizándolos de manera separada, y fusionando los resultados para su interpretación. En total 27 pacientes veteranos de atención primaria con TEPT participaron en uno de cuatro grupos focales. Se utilizó un enfoque de análisis de contenido convencional modificado. La codificación realizada en el equipo comenzó con tres amplios códigos primarios (preocupaciones psicosociales, barreras y facilitadores) y se permitió la aparición de subcódigos a partir de los datos. Las medidas de autoreportes se usaron para recopilar las características clínicas y las barreras para la atención. Los resultados amplían los modelos existentes de iniciación del tratamiento de TEPT al (a) especificar preferencias de tratamiento, tales como atención centrada en el paciente, servicios de apoyo entre pares y programación de acceso abierto, y (b) presentar preocupaciones, como enojo y síntomas centrales de TEPT. Los resultados también indican que un uso común de medir barreras cuantitativamente puede ofrecer una imagen incompleta de por qué los veteranos no buscan tratamiento, ya que no evalúa cómo las experiencias pasadas de tratamiento negativo pueden afectar la utilización. Las estrategias para ayudar a los veteranos a superar las barreras para la atención pueden beneficiarse de un enfoque en las creencias negativas sobre la búsqueda de tratamiento y la adaptación en función del contexto rural o urbano de un veterano. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Facilitators and Barriers to Seeking Mental Health Care among Primary Care Veterans with PTSD Traditional Chinese 標題: 接受初級醫療並患PTSD的退役軍人尋求心理治療的促進因素和障礙 撮要: 創傷後壓力症(PTSD)在接受初級醫療的患者中普遍, 但很多患者都不尋求心理治療。現有對於接受PTSD治療的障礙和促進因素研究, 並未特殊地檢視初級醫療患者的個案。本研究透過居於郊區和市區、接受初級醫療、患PTSD但未有尋求心理治療的退役軍人, 檢視心理社會因素、尋求治療的障礙和促進因素。我們採用同步三角驗證的模型設計, 同時收集了針對組的質性數據和自評的量化數據, 對其分開分析, 再結合結果進行詮釋。共有4個針對組和27名接受初級醫療的PTSD退役軍人參與在內。我們採用經過修改的傳統式內容分析法, 在3種廣泛的初級編碼 (心理社會因素、尋求治療的障礙和促進因素) 開始進行組別為本的編碼, 亦從數據中得出副編碼。自評測量用以收集臨床特徵和尋求治療的障礙數據。是次研究擴闊了現有對開始PTSD治療的研究模型, 因為(a)特殊地檢視治療偏好, 如以患者為中心的治療、朋輩支援計劃、開放預約;及(b)關注到如憤怒和PTSD核心症狀等因素。結果亦反映, 普遍用到的量化障礙測量並未能評估過往的負面治療經歷如何影響治療使用率, 用於研究退役軍人為何不尋求治療, 得出的結果可能不夠全面。幫助退役軍人克服治療障礙的策略, 包括針對改善他們對尋求治療的負面想法, 並因應退役軍人居於郊區或市區而調校治療服務。 Simplified Chinese 标题: 接受初级医疗并患PTSD的退役军人寻求心理治疗的促进因素和障碍 撮要: 创伤后压力症(PTSD)在接受初级医疗的患者中普遍, 但很多患者都不寻求心理治疗。现有对于接受PTSD治疗的障碍和促进因素研究, 并未特殊地检视初级医疗患者的个案。本研究透过居于郊区和市区、接受初级医疗、患PTSD但未有寻求心理治疗的退役军人, 检视心理社会因素、寻求治疗的障碍和促进因素。我们采用同步三角验证的模型设计, 同时收集了针对组的质性数据和自评的量化数据, 对其分开分析, 再结合结果进行诠释。共有4个针对组和27名接受初级医疗的PTSD退役军人参与在内。我们采用经过修改的传统式内容分析法, 在3种广泛的初级编码 (心理社会因素、寻求治疗的障碍和促进因素) 开始进行组别为本的编码, 亦从数据中得出副编码。自评测量用以收集临床特征和寻求治疗的障碍数据。是次研究扩阔了现有对开始PTSD治疗的研究模型, 因为(a)特殊地检视治疗偏好, 如以患者为中心的治疗、朋辈支持计划、开放预约;及(b)关注到如愤怒和PTSD核心症状等因素。结果亦反映, 普遍用到的量化障碍测量并未能评估过往的负面治疗经历如何影响治疗使用率, 用于研究退役军人为何不寻求治疗, 得出的结果可能不够全面。帮助退役军人克服治疗障碍的策略, 包括针对改善他们对寻求治疗的负面想法, 并因应退役军人居于郊区或市区而调校治疗服务。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 742-752, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22327   open full text
• Gender‐Moderated Pathways From Childhood Abuse and Neglect to Late‐Adolescent Substance Use.
  Julia M. Kobulsky, Susan Yoon, Charlotte L. Bright, Guijin Lee, Boyoung Nam.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Substantial research has linked childhood maltreatment to the development of substance use in adolescence. However, gender differences in the mechanisms that connect child abuse and neglect to substance use remain unclear. In this study, we applied multiple‐group structural equation modeling in a sample of 1,161 youths (boys, n = 552; girls, n = 609) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to examine gender differences in the associations between childhood abuse and neglect exposure from ages 0–12 years and substance use severity at age 18 as mediated by early substance use at age 14 and psychological symptoms (anger, anxiety, and depression) at age 16. In both genders, neglect directly predicted substance use severity, β = .25, p < .001 for boys and β = .17, p = .007 for girls; and early substance use, β = .03, p = .002 for boys and β = .06, p = .005 for girls; and anger mediated this association, β = .10, p < .001 for boys and β = .06, p = .005 for girls. Anger mediated paths from abuse in boys, β = .06, p = .018. In girls, early substance use mediated the path from abuse to substance use severity, β = .06, p = .008, with the mediated effect and direct path from abuse to early substance use significantly moderated by gender. For substance use severity, R2 = .26 for girls and R2 = .27 for boys. These findings demonstrate the prominence of neglect in predicting substance use severity and gender differences in paths from abuse. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trayectorias moderadas por género desde abuso y abandono infantil al uso tardío de sustancias para adolescentes. TRAYECTORIAS MODERADAS POR GÉNERO HACIA EL USO DE SUSTANCIAS Una investigación sustancial ha vinculado el maltrato infantil con el desarrollo del uso de sustancias en la adolescencia. Sin embargo, las diferencias de género en los mecanismos que conectan el abuso y el abandono infantil al uso de sustancias siguen aún poco claros. En este estudio, aplicamos modelamiento de ecuaciones estructurales multigrupos en una muestra de 1,161 jóvenes (niños, n = 552; niñas, n = 609) de los Estudios Longitudinales de Abuso y Negligencia Infantil (LONGSCAN en sus sigla en inglés) para examinar las diferencias de género en las asociaciones entre el abuso infantil y la exposición al abandono entre las edades de 0–12 años y la gravedad del uso de sustancias a los 18 años de edad mediada por el consumo temprano de sustancias a los 14 años y los síntomas psicológicos (ira, ansiedad y depresión) a los 16 años. En ambos sexos, el abandono predijo directamente la gravedad del uso de sustancias (niños, β = .25, p <.001; niñas, β = .17, p = .007) y el uso temprano de sustancias (niños, β = .03, p = .002; niñas, β = .06, p = .005), y la ira medio esta asociación (niños, β = .10, p <.001; niñas, β = .06, p = .005). La ira medió las trayectorias del abuso en los niños (β = .06, p = .018). En las niñas, el consumo temprano de sustancias medio la vía desde el abuso a la severidad del uso de sustancias (β = .06, p = .008), con el efecto mediado y camino directo desde el abuso hasta el consumo temprano de sustancias significativamente moderado por género. Para la severidad del uso de sustancias, R2 = .26 en las niñas y R2 = .27 en los niños. Los hallazgos demuestran la prominencia del abandono en la predicción de la severidad del uso de sustancias y las diferencias de género en las trayectorias desde el abuso. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Gender moderated pathways from childhood abuse and neglect to late adolescent substance use. Traditional Chinese 標題: 性別會調節由兒時受虐和忽略到青少年後期濫用藥物的路徑 撮要: 很多研究發現, 兒時受虐跟青少年時期濫用藥物有關。不過, 我們仍不清楚童年時受到虐待和忽略跟濫用藥物的關連機制中的性別差異。本研究採用多組別結構性方程模型, 樣本為兒童虐待和忽略縱貫研究(LONGSCAN)中的1,161名青少年(男子, n = 552; 女子, n = 609)。在0–12歲受虐待和忽略跟18歲的濫用藥物嚴重度之間的關連, 受14歲早期濫用藥物和16歲的心理症狀 (憤怒、焦慮症、抑鬱症) 中介影響, 而我們檢視這機制當中的性別差異。不論男女, 忽略能直接預測到濫用藥物嚴重度(男子, β = .25, p < .001; 女子, β = .17, p = .007)及早期濫用藥物(男子, β = .03, p = .002; 女子, β = .06, p = .005), 而憤怒對此關連有中介效應(男子, β = .10, p < .001; 女子, β = .06, p = .005)。男孩子中, 憤怒在虐待產生的路徑有中介效應(β = .06, p = .018)。女孩子中, 早期濫用藥物在由虐待到濫用藥物嚴重度的路徑有中介效應(β = .06, p = .008)。性別顯著地調節了中介效應以及由虐待到早期濫用藥物的直接路徑。濫用藥物嚴重度在女孩子為R2 = .26, 男孩子為R2 = .27。結果反映了兒時受忽略對預測濫用藥物嚴重度的重要性, 而兒時受虐發展出的路徑有性別差異。 Simplified Chinese 标题: 性别会调节由儿时受虐和忽略到青少年后期滥用药物的路径 撮要: 很多研究发现, 儿时受虐跟青少年时期滥用药物有关。不过, 我们仍不清楚童年时受到虐待和忽略跟滥用药物的关连机制中的性别差异。本研究采用多组别结构性方程模型, 样本为儿童虐待和忽略纵贯研究(LONGSCAN)中的1,161名青少年(男子, n = 552; 女子, n = 609)。在0–12岁受虐待和忽略跟18岁的滥用药物严重度之间的关连, 受14岁早期滥用药物和16岁的心理症状 (愤怒、焦虑症、抑郁症) 中介影响, 而我们检视这机制当中的性别差异。不论男女, 忽略能直接预测到滥用药物严重度(男子, β = .25, p < .001; 女子, β = .17, p = .007)及早期滥用药物(男子, β = .03, p = .002; 女子, β = .06, p = .005), 而愤怒对此关连有中介效应(男子, β = .10, p < .001; 女子, β = .06, p = .005)。男孩子中, 愤怒在虐待产生的路径有中介效应(β = .06, p = .018)。女孩子中, 早期滥用药物在由虐待到滥用药物严重度的路径有中介效应(β = .06, p = .008)。性别显著地调节了中介效应以及由虐待到早期滥用药物的直接路径。滥用药物严重度在女孩子为R2 = .26, 男孩子为R2 = .27。结果反映了儿时受忽略对预测滥用药物严重度的重要性, 而儿时受虐发展出的路径有性别差异。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 654-664, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22326   open full text
• Social Support Moderates the Association Between Traumatic Life Events and Depression Among Migrant and Nonmigrant Men in Almaty, Kazakhstan.
  Kaitlin P. Ward, Stacey A. Shaw, Mingway Chang, Nabila El‐Bassel.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Across cultures, experiencing traumatic life events, particularly violence, is a salient predictor of depression. Some previous findings have shown that social support can serve as a buffer in the association between traumatic life events and depression (i.e., the buffering hypothesis) in that individuals with a high level of social support have a decreased or nonexistent association between traumatic life events and depression. The purpose of this study was to test the buffering hypothesis among a sample of 1,342 male migrant and nonmigrant market vendors in Almaty, Kazakhstan. Using multiple‐group structural equation modeling (SEM), we identified the following results: (a) higher levels of traumatic life events were associated with higher depression scores, (b) higher social support scores were associated with decreased depression scores, and (c) social support buffered the association between traumatic life events and depression among migrants and nonmigrants. The final model accounted for 45.0% and 38.4% of the variance in depression for migrants and nonmigrants, respectively. Findings suggest that social support may be an important protective factor for men in Kazakhstan who have experienced trauma and call for an incorporation of social support interventions for migrant and nonmigrant men experiencing depression. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) El apoyo social modera los efectos de los eventos de vida traumáticos sobre la depresión entre hombres migrantes y no migrantes en Almaty, Kazajistán EVENTOS DE VIDA TRAUMÁTICOS ENTRE HOMBRES EN KAZAJISTÁN En todas las culturas, experimentar eventos de vida traumáticos, en particular la violencia, es un predictor sobresaliente de la depresión. Algunos hallazgos previos muestran que el apoyo social puede servir como amortiguador en la asociación entre eventos traumáticos y depresión (es decir, “la hipótesis de amortiguación”), ya que los individuos con alto apoyo social tienen una asociación disminuida o inexistente entre eventos traumáticos y depresión. El propósito de este estudio fue probar la hipótesis de amortiguación entre una muestra de 1,342 vendedores migrantes y no inmigrantes del mercado de Almaty, Kazajstán. Usando modelos de ecuaciones estructurales multigrupo (SEM en su sigla en inglés), identificamos los siguientes resultados: (a) niveles más altos de eventos de vida traumáticos se asociaron con puntajes de depresión más altos, (b) puntajes de apoyo social más altos se asociaron con puntuaciones de depresión disminuidas, y (c) el apoyo social amortiguó la asociación entre los eventos de vida traumáticos y la depresión entre los migrantes y los no inmigrantes. El modelo final representó el 45.0% y el 38.4% de la varianza en la depresión para migrantes y no inmigrantes, respectivamente. Los hallazgos sugieren que el apoyo social puede ser un importante factor de protección para los hombres en Kazajstán que han experimentado un trauma, y ​​exige una incorporación de las intervenciones de apoyo social para los hombres migrantes y no inmigrantes que sufren depresión. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Social Support Moderates the Effects of Traumatic Life Events on Depression Among Migrant and Non‐Migrant Men in Almaty, Kazakhstan Traditional Chinese 標題: 哈薩克阿拉木圖的移民和非移民男士中, 社會支持會調節創傷性生命事件對抑鬱症構成的影響 撮要: 在不同文化裡, 創傷性的生命事件經歷, 尤其是暴力經歷, 都是抑鬱症的主要預測變量。有些過往研究反映, 社會支持能緩和創傷性生命事件與抑鬱症之間的關連(即「緩衝假設」), 即有高水平社會支持的人當中, 創傷性生命事件與抑鬱症之間的關連會減低或並無關連。本研究旨在測試緩衝假設是否真確。樣本為哈薩克阿拉木圖裡, 1,342名男性移民和非移民市集攤販。我們利用多組別結構方程模型(SEM), 得出以下發現:(a) 創傷性生命事件水平較高, 跟抑鬱症分數較高有關;(b) 社會支持分數較高, 跟抑鬱症分數減低有關;(c) 在移民和非移民當中, 社會支持緩和了創傷性生命事件與抑鬱症之間的關連。最後的模型分別解釋了移民和非移民抑鬱症45.0% 和 38.4%的方差。結果反映, 對哈薩克受創男士來說, 社會支持可能是重要的保護因素, 並反映我們對患抑鬱症的移民和非移民男士提供的干預治療裡, 有需要包含社會支持。 Simplified Chinese 标题: 哈萨克斯坦阿拉木图的移民和非移民男士中, 社会支持会调节创伤性生命事件对抑郁症构成的影响 撮要: 在不同文化里, 创伤性的生命事件经历, 尤其是暴力经历, 都是抑郁症的主要预测变量。有些过往研究反映, 社会支持能缓和创伤性生命事件与抑郁症之间的关连(即「缓冲假设」), 即有高水平社会支持的人当中, 创伤性生命事件与抑郁症之间的关连会减低或并无关连。本研究旨在测试缓冲假设是否真确。样本为哈萨克斯坦阿拉木图里, 1,342名男性移民和非移民市集摊贩。我们利用多组别结构方程模型(SEM), 得出以下发现:(a) 创伤性生命事件水平较高, 跟抑郁症分数较高有关;(b) 社会支持分数较高, 跟抑郁症分数减低有关;(c) 在移民和非移民当中, 社会支持缓和了创伤性生命事件与抑郁症之间的关连。最后的模型分别解释了移民和非移民抑郁症45.0% 和 38.4%的方差。结果反映, 对哈萨克斯坦受创男士来说, 社会支持可能是重要的保护因素, 并反映我们对患抑郁症的移民和非移民男士提供的干预治疗里, 有需要包含社会支持。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 698-707, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22324   open full text
• The Impact of Military and Nonmilitary Experiences on Marriage: Examining the Military Spouse's Perspective.
  Jacqueline C. Pflieger, Cynthia A. LeardMann, Hope S. McMaster, Carrie J. Donoho, Lyndon A. Riviere, for the Millennium Cohort Family Study Team.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract There has been conflicting research regarding direct association between deployments and marital quality, particularly from the military spouse's perspective. In the current study, we sought to extend past research by examining the direct association between both military and nonmilitary experiences and military spouse marital quality using 2011–2013 baseline data from the Millennium Cohort Family Study, a large sample of military couples representing all U.S. service branches and components. Military experiences were assessed using electronic deployment records to capture the number and length of deployments since 2001, and service members reported combat experience and symptoms indicative of posttraumatic stress disorder (PTSD). Military spouses reported on service members’ recent time away from home, nonmilitary family stressors, and marital quality. Results of the logistic regression model adjusted for demographic, relationship, and military covariates indicated that most military experiences did not have a direct statistical association with low marital quality except service member PTSD, odds ratio (OR) = 1.54, 95% CI [1.17, 2.04]. Rather, nonmilitary experiences of the military spouse, including lack of social support, OR = 2.68, 95% CI [2.07, 3.47]; caregiver burden, OR = 1.56, 95% CI [1.22, 1.99]; work–family conflict, OR = 1.42, 95% CI [1.18, 1.69]; and financial strain, OR = 1.27, 95% CI [1.03, 1.55], increased odds of low marital quality. Implications of these findings include providing additional supports to address nonmilitary family stressors that are particularly salient to military spouses with an aim to promote marital quality. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) El impacto de experiencias militares y no militares en el matrimonio: Examinando la perspectiva del cónyuge militar. CALIDAD DEL MATRIMONIO EN CÓNYUGE MILITAR. Ha habido investigaciones conflictivas que establecen una asociación directa entre despliegues militares y la calidad marital, particularmente desde la perspectiva del cónyuge militar. En el presente estudio, buscamos extender la investigación pasada examinando la asociación directa entre experiencias militares y no militares y la calidad marital del cónyuge militar usando datos de referencia de 2011–2013 del Estudio de la Familia Cohorte del Milenio, compuesto por una amplia muestra de parejas militares que representan a todas las ramas y componentes del servicio militar de E.E.U.U. Las experiencias militares fueron evaluadas usando registros electrónicos de despliegues para capturar el número y la duración de despliegues desde 2001, y los miembros del servicio informaron sobre la experiencia de combate y los síntomas indicativos de trastorno de estrés postraumático (TEPT). Los cónyuges militares informaron sobre el tiempo reciente en que los miembros del servicio estuvieron fuera de casa, los factores no militares de estrés familiar y la calidad conyugal. Los resultados del modelo de regresión logística ajustado para las covariables demográficas, de relación y militares indicaron que en la mayoría de las experiencias militares no tuvieron una asociación estadística directa con la baja calidad marital, con la excepción de TEPT de un miembro del servicio, odds ratio (OR) = 1.54, IC 95% [1.17, 2.04]. Más bien, las experiencias no militares del cónyuge militar, incluida la falta de apoyo social, OR = 2,68, 95% CI [2.07, 3.47]; carga del cuidador, OR = 1.56, IC del 95% [1.22, 1.99]; conflicto trabajo‐familia, OR = 1,42, IC del 95% [1,18, 1,69]; y la tensión financiera, OR = 1.27, IC 95% [1.03, 1.55], incrementa las probabilidades de baja calidad marital. Las implicancias de estos hallazgos incluyen proporcionar apoyos adicionales para abordar los factores no militares de estrés familiar que son particularmente importantes para los cónyuges militares con el objetivo de promover la calidad matrimonial. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 The impact of military and nonmilitary experiences on marriage: Examining the military spouse's perspective Traditional Chinese 標題: 服役與非服役經歷對婚姻的影響:檢視軍人伴侶的觀點 撮要: 過往有關服役與婚姻質素的直接關連研究, 特別是檢視到軍人伴侶觀點的, 都呈現矛盾結果。本研究旨在延伸過往的研究, 檢視服役與非服役經歷跟軍人伴侶婚姻質素的直接關連。我們利用2011–2013年千禧世代家庭研究的基線數據, 當中的大型樣本為來自各個美國軍事部門的軍人夫婦。我們利用電子服役紀錄, 取得樣本自2001年起的服役次數和為期數據, 並從軍人的報告取得戰鬥經歷和象徵創傷後壓力症(PTSD)的症狀數據。軍人伴侶則報告軍人最近一次離家的為期長度、非服役相關的家庭壓力源和婚姻質素。我們對從邏輯迴歸模型得出的結果, 因應人口變量、關係和軍事共變量作調節後, 發現大多數服役經歷跟婚姻質素低並無直接的統計性關連, 除了軍人患PTSD以外(勝算比 (OR) = 1.54, 95% CI [1.17, 2.04])。反而, 軍人伴侶的非服役經歷, 包括欠缺社會支持(OR = 2.68, 95% CI [2.07, 3.47])、作為照顧者的負擔(OR = 1.56, 95% CI [1.22, 1.99])、工作與家庭需要的衝突(OR = 1.42, 95% CI [1.18, 1.69])、以及經濟困難(OR = 1.27, 95% CI [1.03, 1.55]), 加強了婚姻質素低的機會。我們基於結果的建議, 包括提供額外支援, 處理對軍人伴侶影響特別顯著的非服役相關家庭壓力源, 以提升他們的婚姻質素。 Simplified Chinese 标题: 服役与非服役经历对婚姻的影响:检视军人伴侣的观点 撮要: 过往有关服役与婚姻质素的直接关连研究, 特别是检视到军人伴侣观点的, 都呈现矛盾结果。本研究旨在延伸过往的研究, 检视服役与非服役经历跟军人伴侣婚姻质素的直接关连。我们利用2011–2013年千禧世代家庭研究的基线数据, 当中的大型样本为来自各个美国军事部门的军人夫妇。我们利用电子服役纪录, 取得样本自2001年起的服役次数和为期数据, 并从军人的报告取得战斗经历和象征创伤后压力症(PTSD)的症状数据。军人伴侣则报告军人最近一次离家的为期长度、非服役相关的家庭压力源和婚姻质素。我们对从逻辑回归模型得出的结果, 因应人口变量、关系和军事共变量作调节后, 发现大多数服役经历跟婚姻质素低并无直接的统计性关连, 除了军人患PTSD以外(胜算比 (OR) = 1.54, 95% CI [1.17, 2.04])。反而, 军人伴侣的非服役经历, 包括欠缺社会支持(OR = 2.68, 95% CI [2.07, 3.47])、作为照顾者的负担(OR = 1.56, 95% CI [1.22, 1.99])、工作与家庭需要的冲突(OR = 1.42, 95% CI [1.18, 1.69])、以及经济困难(OR = 1.27, 95% CI [1.03, 1.55]), 加强了婚姻质素低的机会。我们基于结果的建议, 包括提供额外支持, 处理对军人伴侣影响特别显著的非服役相关家庭压力源, 以提升他们的婚姻质素。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 719-729, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22321   open full text
• When Nowhere Is Safe: Interpersonal Trauma and Attachment Adversity as Antecedents of Posttraumatic Stress Disorder and Developmental Trauma Disorder.
  Joseph Spinazzola, Bessel der Kolk, Julian D. Ford.
  Journal of Traumatic Stress. October 19, 2018
  --- - |2 Abstract Developmental trauma disorder (DTD) has been proposed as clinical framework for the sequelae of complex trauma exposure in children. In this study, we investigated whether DTD is associated with different traumatic antecedents than posttraumatic stress disorder (PTSD). In a multisite sample of 236 children referred from pediatric or mental health treatment, DTD was assessed using the DTD Structured Interview. Trauma history was assessed using the Traumatic Events Screening Instrument (TESI). On an unadjusted basis, both DTD, odds ratios (ORs) = 2.0–3.8, 95% CI [1.17, 7.19]; and PTSD, ORs = 1.8–3.0, 95% CI [1.04, 6.27], were associated with past physical assault and/or abuse, family violence, emotional abuse, neglect, and impaired caregivers; and DTD was associated community violence, OR = 2.7, 95% CI [1.35, 5.43]. On a multivariate basis after controlling for the effects of PTSD, DTD was associated with family and community violence and impaired caregivers, ORs = 2.0–2.5, 95% CI [1.09, 5.97], whereas PTSD was only associated with physical assault and/or abuse after controlling for the effects of DTD, OR = 2.4, 95% CI [1.07, 4.99]. Exposure to both interpersonal trauma and attachment adversity was associated with the highest DTD symptom count, controlling for the PTSD symptom count. Although childhood PTSD and DTD share several traumatic antecedents, DTD may be uniquely associated with pervasive exposure to violent environments and impaired caregiving. Therefore, DTD warrants further investigation as a framework for the assessment and treatment of children with histories of interpersonal victimization and attachment adversity. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Cuando Ningún Lugar es Seguro: El Trauma Interpersonal y Adversidad Del Apego como Antecedentes de los Trastornos de Estrés Traumático y de Trauma en el Desarrollo. ANTECEDENTES DEL TRASTORNO DE TRAUMA EN EL DESARROLLO El trastorno de trauma en el desarrollo (DTD, en su sigla en inglés) ha sido un marco clínico para las secuelas de la exposición a trauma complejo en niños. En este estudio, investigamos si el DTD está asociado con antecedentes traumáticos diferentes al trastorno de estrés traumático (TEPT). En una muestra de 236 niños de diferentes lugares y derivados desde el tratamiento pediátrico o de salud mental, el DTD fue evaluado usando la Entrevista Estructurada de DTD. La historia de trauma fue evaluada usando el Instrumento de Tamizaje de Eventos Traumáticos (TESI, en su sigla en inglés). En una base no ajustada, ambos DTD, odds ratios (ORs, en su sigla en inglés) = 2.0–3.8, 95% intervalo de confianza (IC) [1.17, 7.19], y TEPT, ORs = 1.8–3.0, 95% IC [1.04, 6.27], estuvieron asociados a antecedentes pasados de abuso y/o maltrato físicos, violencia familiar, abuso emocional, negligencia, y discapacidad de los cuidadores, y el DTD estuvo asociado con violencia comunitaria, OR = 2.7, 95% IC [1.35, 5.43]. Sobre una base multivariada luego de controlar los efectos de TEPT, el DTD estuvo asociado con violencia familiar y comunitaria y discapacidad de los cuidadores, ORs = 2.0–2.5, 95% IC [1.09, 5.97], mientras que el TEPT estuvo solamente asociado con abuso y maltrato físico luego de controlar los efectos de DTD, OR = 2.4, 95% IC [1.07, 4.99]. La exposición tanto a trauma interpersonal como a adversidad del apego estuvieron asociadas con la más alta contribución a los síntomas del DTD, luego de controlar la contribución de los síntomas de TEPT. Aunque los DTD y TEPT en la infancia comparten varios antecedentes traumáticos, el DTD podría ser asociado únicamente con la exposición generalizada a ambientes violentos y cuidadores discapacitados. Por lo tanto, el DTD requiere mayor investigación como un marco para la evaluación y tratamiento de niños con historias de victimización interpersonal y adversidad de apego. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 When Nowhere is Safe: Interpersonal Trauma and Attachment Adversity as Antecedents of Posttraumatic Stress Disorder and Developmental Trauma Disorder Traditional Chinese 標題: 當四周均無安全之所:人際創傷和惡劣依附經驗作為創傷後壓力症和發展性創傷障礙的前因 撮要: 過往有研究提出, 發展性創傷障礙(DTD)為兒童經歷複雜創傷後的後遺症。本研究探索DTD是否跟創傷後壓力症(PTSD)有不同的創傷前因。236名從兒科或心理治療單位轉介的兒童組成了多站點樣本。我們以DTD結構性面談評估樣本的DTD, 並以創傷事件篩查工具(TESI)評估以往的創傷經歷。在數據未經調節下, DTD (勝算比 (ORs) = 2.0–3.8, 95% 置信區間(CI) [1.17, 7.19]) 和PTSD (ORs = 1.8–3.0, 95% CI [1.04, 6.27])都跟以下有關:過往身體受襲和/或受虐、家庭暴力、情緒虐待、忽略、照顧者殘障;而DTD跟社群暴力有關(OR = 2.7, 95% CI [1.35, 5.43])。在多變量的基礎下, 我們以PTSD的效應作對照, 發現DTD跟家庭暴力、社群暴力和照顧者殘障有關(ORs = 2.0–2.5, 95% CI [1.09, 5.97]);而我們以DTD的效應作對照後, 發現PTSD只跟身體受襲和/或受虐有關(OR = 2.4, 95% CI [1.07, 4.99])。對PTSD的症狀數量作對照後, 發現經歷了人際創傷和惡劣的依附經驗跟有最多DTD症狀相關。雖然兒童的PTSD和DTD有些相同的創傷前因, 可是, DTD可能獨特地跟暴力環境和照顧者殘障的深刻經歷有關。因此, DTD仍有待進一步研究, 才能有助我們對曾經歷人際傷害和惡劣依附經驗的兒童作評估和治療。 Simplified Chinese 标题: 当四周均无安全之所:人际创伤和恶劣依附经验作为创伤后压力症和发展性创伤障碍的前因 撮要: 过往有研究提出, 发展性创伤障碍(DTD)为儿童经历复杂创伤后的后遗症。本研究探索DTD是否跟创伤后压力症(PTSD)有不同的创伤前因。236名从儿科或心理治疗单位转介的儿童组成了多站点样本。我们以DTD结构性面谈评估样本的DTD, 并以创伤事件筛查工具(TESI)评估以往的创伤经历。在数据未经调节下, DTD (胜算比 (ORs) = 2.0–3.8, 95% 置信区间(CI) [1.17, 7.19]) 和PTSD (ORs = 1.8–3.0, 95% CI [1.04, 6.27])都跟以下有关:过往身体受袭和/或受虐、家庭暴力、情绪虐待、忽略、照顾者残障;而DTD跟社群暴力有关(OR = 2.7, 95% CI [1.35, 5.43])。在多变量的基础下, 我们以PTSD的效应作对照, 发现DTD跟家庭暴力、社群暴力和照顾者残障有关(ORs = 2.0–2.5, 95% CI [1.09, 5.97]);而我们以DTD的效应作对照后, 发现PTSD只跟身体受袭和/或受虐有关(OR = 2.4, 95% CI [1.07, 4.99])。对PTSD的症状数量作对照后, 发现经历了人际创伤和恶劣的依附经验跟有最多DTD症状相关。虽然儿童的PTSD和DTD有些相同的创伤前因, 可是, DTD可能独特地跟暴力环境和照顾者残障的深刻经历有关。因此, DTD仍有待进一步研究, 才能有助我们对曾经历人际伤害和恶劣依附经验的儿童作评估和治疗。 - Journal of Traumatic Stress, Volume 31, Issue 5, Page 631-642, October 2018.
  

  October 19, 2018   doi: 10.1002/jts.22320   open full text
• Erratum for “Secondary Traumatic Stress and Burnout Among Refugee Resettlement Workers: The Role of Coping and Emotional Intelligence”.
  
  Journal of Traumatic Stress. October 08, 2018
  --- - - Journal of Traumatic Stress, Volume 31, Issue 5, Page 790-790, October 2018.
  

  October 08, 2018   doi: 10.1002/jts.22329   open full text
• Issue Information ‐ Aims and Scope.
  
  Journal of Traumatic Stress. August 23, 2018
  --- - - Journal of Traumatic Stress, Volume 31, Issue 4, Page 469-469, August 2018.
  

  August 23, 2018   doi: 10.1002/jts.22319   open full text
• Issue Information ‐ TOC.
  
  Journal of Traumatic Stress. August 23, 2018
  --- - - Journal of Traumatic Stress, Volume 31, Issue 4, Page 467-468, August 2018.
  

  August 23, 2018   doi: 10.1002/jts.22318   open full text
• Military and Premilitary Trauma, Attachment Orientations, and Posttraumatic Stress Disorder Severity Among Male and Female Veterans.
  Jenny A. Bannister, Frederick G. Lopez, Deleene S. Menefee, Peter J. Norton, Jill Wanner.
  Journal of Traumatic Stress. August 09, 2018
  --- - |2 Abstract Samples in prior studies examining attachment theory in the military have been predominantly composed of male combat veterans. Given the rates of sexual trauma among female veterans and differences in the association between attachment and posttraumatic stress disorder (PTSD) severity for sexual trauma survivors, it was necessary to consider the attachment characteristics of veterans within a mixed‐sex sample. Participants were a mixed‐sex veteran sample seeking inpatient trauma‐related treatment (N = 469). Using independent samples t tests, we examined sex differences in attachment. Consistent with our hypothesis, women reported a higher level of attachment anxiety than did men, t(351) = −2.12, p = .034. Women also reported a higher level of attachment avoidance, t(351) = −2.44, p = .015. Using hierarchical regression, we examined the contribution of attachment anxiety and avoidance to PTSD severity, partialing out variance accounted for by demographic variables and traumatic experiences. Consistent with our hypotheses, attachment avoidance predicted PTSD severity on the Clinician‐Administered PTSD Scale for DSM‐IV (CAPS), β = .20, p < .001, and the PTSD Checklist–Civilian Version (PCL‐C), β = .18, p < .001. Attachment anxiety did not predict CAPS severity but did predict PCL‐C severity, β = .11, p = .020. These results suggest the association between attachment avoidance and PTSD is not exclusive to combat trauma and may apply more generally to the larger veteran population. Higher levels of attachment anxiety and avoidance among female veterans potentially implicate the presence of greater attachment fearfulness among this particular subpopulation of veterans. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trauma militar y premilitar, orientaciones de apego y gravedad del trastorno por estrés postraumático entre veteranos hombres y mujeres TRAUMA PREMILITAR, APEGO Y TEPT Las muestras en estudios previos que examinaron la teoría del apego en el ejército han estado compuestas predominantemente por hombres veteranos de combate. Dadas las tasas de trauma sexual entre las mujeres veteranas y las diferencias en la asociación entre el apego y la gravedad del TEPT para los sobrevivientes de trauma sexual, fue necesario considerar las características de apego de los veteranos dentro de una muestra de sexo mixto. Los participantes fueron una muestra de veteranos mixtos que buscaban tratamiento hospitalario relacionado con trauma (N = 469). Usando pruebas t de muestras independientes, examinamos las diferencias de sexo en el apego. De acuerdo con nuestra hipótesis, las mujeres informaron un mayor nivel de apego ansioso que los hombres, t (351) = ‐2.12, p = .034. Las mujeres también informaron un mayor nivel de apego evitativo, t (351) = ‐2.44, p = .015. Usando la regresión jerárquica, examinamos la contribución del apego ansioso y evitativo en la severidad del TEPT, parcializando la varianza explicada por las variables demográficas y las experiencias traumáticas. Consistente con nuestra hipótesis, el apego evitativo predijo la gravedad del TEPT en la Escala de TEPT administrada por el médico para el DSM‐5 (CAPS en sus siglas en ingles), β = .20, p <.001 y la Lista de comprobación del TEPT versión civil (PCL‐C en sus siglas en ingles), β = .18, p <.001. El apego ansioso no predijo la severidad de CAPS, pero sí pronosticó la severidad de PCL‐C, β = .11, p = .020. Estos resultados sugieren que la asociación entre el apego evitativo y el TEPT no es exclusiva del trauma de combate y puede aplicarse de manera más general a la población de veteranos. Los niveles más altos de apego ansioso y evitativo entre las mujeres veteranas implican potencialmente la presencia de mayor miedo al apego entre esta subpoblación particular de veteranos. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Military and Premilitary Trauma, Attachment Orientations, and Posttraumatic Stress Disorder Severity Among Male and Female Veterans Traditional Chinese 標題: 男女性退役軍人的從軍前及軍事創傷、依附取向與創傷後壓力症嚴重度 撮要: 過往透過軍隊檢視依附理論的研究樣本多為男性退役戰鬥軍人。有見女性退役軍人遭受性創傷的比率, 以及性創傷生還者中依附與PTSD嚴重度的關連不同, 我們有需要以混合男女性別的樣本檢視退役軍人的依附特徵。本研究樣本為尋求創傷相關入院治療的男或女性退役軍人(N = 469)。我們採用獨立樣本t檢定檢視依附的性別差異。與我們的假設相符, 女性比男性有較高水平的依附焦慮(t(351) = ‐2.12, p = .034), 亦有較高水平的依附迴避(t(351) = ‐2.44, p = .015)。我們排除了人口變量與創傷經歷構成的方差, 以層次迴歸法檢視依附焦慮和依附迴避對PTSD嚴重度的影響。一如假設, 依附迴避預測了以下量表得出的PTSD嚴重度:DSM‐5的臨床治療師專用PTSD 量表(CAPS) (β = .20, p < .001) 、PTSD 檢查表(市民版)(PCL‐C) (β = .18, p < .001)。依附焦慮並無預測CAPS的PTSD嚴重度, 只預測到PCL‐C的(β = .11, p = .020)。結果反映, 依附迴避與PTSD的關連並非只見於戰鬥創傷個案, 有可能見於更廣泛的退役軍人人口;此外, 當女性退役軍人的依附焦慮和依附迴避水平較高時, 可能會引致較大的依附恐懼。 Simplified Chinese 标题: 男女性退役军人的从军前及军事创伤、依附取向与创伤后压力症严重度 撮要: 过往透过军队检视依附理论的研究样本多为男性退役战斗军人。有见女性退役军人遭受性创伤的比率, 以及性创伤生还者中依附与PTSD严重度的关连不同, 我们有需要以混合男女性别的样本检视退役军人的依附特征。本研究样本为寻求创伤相关入院治疗的男或女性退役军人(N = 469)。我们采用独立样本t检定检视依附的性别差异。与我们的假设相符, 女性比男性有较高水平的依附焦虑(t(351) = ‐2.12, p = .034), 亦有较高水平的依附回避(t(351) = ‐2.44, p = .015)。我们排除了人口变量与创伤经历构成的方差, 以层次回归法检视依附焦虑和依附回避对PTSD严重度的影响。一如假设, 依附回避预测了以下量表得出的PTSD严重度:DSM‐5的临床治疗师专用PTSD 量表(CAPS) (β = .20, p < .001) 、PTSD 检查表(市民版)(PCL‐C) (β = .18, p < .001)。依附焦虑并无预测CAPS的PTSD严重度, 只预测到PCL‐C的(β = .11, p = .020)。结果反映, 依附回避与PTSD的关连并非只见于战斗创伤个案, 有可能见于更广泛的退役军人人口;此外, 当女性退役军人的依附焦虑和依附回避水平较高时, 可能會引致較大的依附恐懼。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 558-567, August 2018.
  

  August 09, 2018   doi: 10.1002/jts.22309   open full text
• A Prospective Study of Psychiatric Symptoms Among Adolescents After the Wenchuan Earthquake.
  Fulei Geng, Yingxin Liang, Xuliang Shi, Fang Fan.
  Journal of Traumatic Stress. August 07, 2018
  --- - |2 Abstract Natural disaster exposure is associated with increased risk of mental health problems. This study aimed to investigate the prevalence, course, and risk factors of probable psychiatric disorders among 1,573 adolescents following the May 2008 Wenchuan earthquake in China. Symptoms of posttraumatic stress disorder (PTSD), depression, panic disorder (PD), generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia (SP), conduct disorder (CD), and attention deficit hyperactivity disorder (ADHD) were assessed at 6 and 18 months postearthquake using a battery of standardized measures. Approximately 62.9% and 56.1% of the sample, respectively, had at least one probable psychiatric disorder at 6 and 18 months postearthquake. The most common disorders were PTSD, depression, PD, GAD, and ADHD. With regard to the course of disorders, PTSD, GAD, PD, SAD. and ADHD decreased; SP and CD remained stable; and depression increased. Generalized estimating equations models showed that female sex, older age, having experienced the death or injury of family members, being a direct witness of tragic scenes, low social support, and a high level of negative life events were risk factors for most disorders, odds ratios (ORs) = 1.3–20.8. However, logistic regressions indicated that earthquake exposure variables were specifically related to persistent PTSD, ORs = 2.0–2.5, and negative life events were associated with persistent depression, ORs = 2.4–5.3. Various psychiatric symptoms are pervasive, intense, and persistent among adolescent survivors. Systematic and periodic screening are needed to closely monitor the onset, course, and risk factors of mental health problems after disasters. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Estudio Prospectivo de Problemas de Salud Mental entre los Adolescentes después del Terremoto de Wenchuan SALUD MENTAL ADOLESCENTE DESPUÉS DE UN DESASTRE NATURAL La exposición a desastres naturales se asocia a un incremento en el riesgo de problemas de salud mental. Este estudio tuvo como objetivo investigar la prevalencia, curso y factores de riesgo de probables trastornos psiquiátricos entre 1573 adolescentes luego del terremoto de mayo de 2008 en Wenchuan, China. Se evaluaron síntomas de Trastorno de Estrés Postraumático (TEPT), Depresión, Trastorno de Pánico (TP), Trastorno de Ansiedad Generalizada (TAG) Trastorno de Ansiedad por Separación (TAS), Fobia Social (FS) Trastornos de Conducta (TC) y Trastorno de Déficit Atencional con Hiperactividad (TDAH) a los 6 y 18 meses post terremoto usando una batería de escalas estandarizadas. Aproximadamente 62,9% y 56,1% de la muestra, respectivamente, tuvieron al menos un probable trastorno psiquiátrico a los 6 y 18 meses después del terremoto. Los trastornos más comunes fueron TEPT, Depresión, TP, TAG y TDAH. Con respecto al curso de los trastornos, TEPT; TAG, TP, TAS y TDAH disminuyeron; FS y TC permanecieron estables y la Depresión se incrementó. Los modelos de ecuaciones de estimación generalizada mostraron que el sexo femenino, mayor edad, haber experimentado la muerte o lesiones de miembros de la familia, ser testigo directo de escenas trágicas, bajo apoyo social y un alto nivel de eventos vitales negativos fueron factores de riesgo para la mayoría de los trastornos, con odds ratios (ORs) = 1.3 ‐ 20.8. Sin embargo, las regresiones logísticas indicaron que las variables de exposición al terremoto estaban específicamente relacionadas al TEPT persistente, ORs = 2.0 – 2.5, y los eventos negativos de la vida se asociaron con la depresión persistente, ORs = 2.4 ‐ 5.3. Varios síntomas psiquiátricos son penetrantes, intensos y persistentes entre los sobrevivientes adolescentes. Se requiere del tamizaje sistemático y periódico para monitorear de cerca el inicio, curso y factores de riesgo de problemas de salud mental luego de desastres. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 A prospective study of mental health problems among adolescents after the Wenchuan earthquake Traditional Chinese 標題: 汶川大地震後青少年心理問題的前瞻性研究 撮要: 天災經歷跟患心理疾病的風險提升有關。本研究旨在檢視2008年5月中國汶川大地震後, 1,573名青少年當中有可能患精神疾病的普遍率、疾病發展過程和風險因素。我們在地震發生6個月和18個月後, 以標準化測量工具評估樣本的以下症狀:創傷後壓力症(PTSD)、抑鬱症、驚恐症(PD)、廣泛性焦慮症(GAD)、分離焦慮症(SAD)、社交恐懼症(SP)、品行障礙(CD)、專注力失調或過度活躍症(ADHD)。地震6個月和18個月後, 樣本中分別約62.9% 和56.1%人士至少有可能患1種精神疾病。最普遍的疾病為PTSD、抑鬱症、PD、GAD、ADHD。疾病發展方面, PTSD、GAD、PD、SAD和 ADHD均有下降, SP 與CD維持不變, 抑鬱症上升。廣義估計方程式模型顯示, 性別為女性、年齡較高、曾經歷家人受傷或去世、曾目睹悲劇場面、社會支持度低和有高水平的負面生活事件, 都為大多數疾病的風險因素(勝算比(ORs) = 1.3–20.8)。然而, 邏輯迴歸分析顯示, 地震經歷的變量特殊地跟持續的PTSD有關(ORs = 2.0–2.5), 而負面生活事件跟持續的抑鬱症有關(ORs = 2.4–5.3)。多種精神症狀廣泛、頻密並持續地出現於青少年生還者中。我們需有系統性和週期性的篩查, 密切留意災後心理問題發病、疾病發展過程和風險因素。 Simplified Chinese 标题: 汶川大地震后青少年心理问题的前瞻性研究 撮要: 天灾经历跟患心理疾病的风险提升有关。本研究旨在检视2008年5月中国汶川大地震后, 1,573名青少年当中有可能患精神疾病的普遍率、疾病发展过程和风险因素。我们在地震发生6个月和18个月后, 以标准化测量工具评估样本的以下症状:创伤后压力症(PTSD)、抑郁症、惊恐症(PD)、广泛性焦虑症(GAD)、分离焦虑症(SAD)、社交恐惧症(SP)、品行障碍(CD)、专注力失调或过度活跃症(ADHD)。地震6个月和18个月后, 样本中分别约62.9% 和56.1%人士至少有可能患1种精神疾病。最普遍的疾病为PTSD、抑郁症、PD、GAD、ADHD。疾病发展方面, PTSD、GAD、PD、SAD和 ADHD均有下降, SP 与CD维持不变, 抑郁症上升。广义估计方程式模型显示, 性别为女性、年龄较高、曾经历家人受伤或去世、曾目睹悲剧场面、社会支持度低和有高水平的负面生活事件, 都为大多数疾病的风险因素(胜算比(ORs) = 1.3–20.8)。然而, 逻辑回归分析显示, 地震经历的变量特殊地跟持续的PTSD有关(ORs = 2.0–2.5), 而负面生活事件跟持续的抑郁症有关(ORs = 2.4–5.3)。多种精神症状广泛、频密并持续地出现于青少年生还者中。我们需有系统性和周期性的筛查, 密切留意灾后心理问题发病、疾病发展过程和风险因素。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 499-508, August 2018.
  

  August 07, 2018   doi: 10.1002/jts.22307   open full text
• Outcomes of Mental Health Screening for United Kingdom Nationals Affected by the 2015–2016 Terrorist Attacks in Tunisia, Paris, and Brussels.
  Maya Gobin, G. James Rubin, Idit Albert, Alison Beck, Andrea Danese, Neil Greenberg, Nick Grey, Patrick Smith, Isabel Oliver.
  Journal of Traumatic Stress. August 07, 2018
  --- - |2 Abstract Following several terrorist attacks in 2015 and 2016, a national program was set up to identify and support residents of England whose mental health had been affected. We report the outcomes of the program's screening and assessment components. Questionnaires and information about the program were mailed to 483 people and 49 families known to the police. Individuals who screened positive on an assessment for posttraumatic stress disorder, anxiety, depression, increased smoking, or problematic alcohol consumption were offered clinical assessment and referred to an appropriate National Health Service (NHS) service, if required. Of the 195 eligible people who returned our questionnaires, 179 (91.8%) screened positive on one or more measure. Following clinical assessment, 78 adults and three children were referred for treatment. The program was broadly successful in facilitating access to services. However, most people who had been directly exposed to the attacks did not participate and data protection issues limited communication with those who were affected. Further discussion of data protection concerns may help future programs operate more efficiently. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Resultados del Tamizaje de Salud Mental para los Nacionales del Reino Unido afectados por los ataques terroristas de 2015–2016 en Tunisia, París y Bruselas. TAMIZAJE DE SALUD MENTAL LUEGO DE ATAQUES TERRORISTAS Después de varios ataques terroristas en 2015 y 2016, se estableció un programa nacional para identificar y apoyar a los residentes de Inglaterra cuya salud mental había sido afectada. Reportamos los resultados de los componentes de tamizaje y evaluación del programa. Se enviaron, vía correo, cuestionarios e información acerca del programa a 483 personas y 49 familias conocidas por la policía. A las personas que puntuaron positivo en una evaluación para trastorno de estrés postraumático, ansiedad, depresión, aumento de consumo de tabaco o consumo problemático de alcohol, se les ofreció una evaluación clínica y fueron derivados a un servicio apropiado del Servicio Nacional de Salud (NHS por sus siglas en inglés), si así lo requerían. De las 195 personas elegibles que respondieron nuestros cuestionarios, 179 (91,8%) puntuaron positivo en una o más mediciones. Después de la evaluación clínica, 78 adultos y 3 niños fueron derivados a tratamiento. El programa fue ampliamente exitoso en facilitar el acceso a los servicios. Sin embargo, la mayoría de las personas que habían estado directamente expuestas a los ataques no participaron y los problemas de protección de datos limitaron la comunicación con quienes fueron afectados. Una mayor discusión de las preocupaciones respecto a la protección de los datos puede ayudar a que programas futuros operen más eficientemente. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Outcomes of mental health screening for UK Nationals affected by the 2015–16 terrorist attacks in Tunisia, Paris and Brussels Traditional Chinese 標題: 2015 至 2016年突尼西亞、巴黎和布魯塞爾的恐怖襲擊中, 受影響的英國國民心理狀況篩查結果 撮要: 在2015 與 2016年的恐怖襲擊過後, 英國推行全國性計劃, 找出心理受影響的市民並提供支持。本研究報告該計劃的篩查結果與評估要素。我們根據警方紀錄, 把問卷及該計劃的資料寄給483 人和49個家庭。在創傷後壓力症、焦慮症、抑鬱症、吸煙加劇或有酗酒問題幾方面有正向篩查結果的人士, 會獲提供臨床評估服務, 並按需要獲轉介至適當的國民保健署(NHS)治療單位。195名合資格人士完成了我們的問卷, 當中179人 (91.8%)在一個或以上測量方面有正向篩查結果。接受臨床評估後, 78名成人和3名兒童獲轉介接受治療。該計劃成功令更多市民取得治療。然而, 大多數直接受創人士並無參與計劃, 而資料保障規條亦限制了我們跟受影響人士溝通。日後有關資料保障的進一步討論, 可能有助未來的計劃更有效率地運作。 Simplified Chinese 标题: 2015 至 2016年突尼西亚、巴黎和布鲁塞尔的恐怖袭击中, 受影响的英国国民心理状况筛查结果 撮要: 在2015 与 2016年的恐怖袭击过后, 英国推行全国性计划, 找出心理受影响的市民并提供支持。本研究报告该计划的筛查结果与评估要素。我们根据警方纪录, 把问卷及该计划的资料寄给483 人和49个家庭。在创伤后压力症、焦虑症、抑郁症、吸烟加剧或有酗酒问题几方面有正向筛查结果的人士, 会获提供临床评估服务, 并按需要获转介至适当的国民保健署(NHS)治疗单位。195名合资格人士完成了我们的问卷, 当中179人 (91.8%)在一个或以上测量方面有正向筛查结果。接受临床评估后, 78名成人和3名儿童获转介接受治疗。该计划成功令更多市民取得治疗。然而, 大多数直接受创人士并无参与计划, 而数据保障规条亦限制了我们跟受影响人士沟通。日后有关资料保障的进一步讨论, 可能有助未来的计划更有效率地运作。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 471-479, August 2018.
  

  August 07, 2018   doi: 10.1002/jts.22317   open full text
• Military Sexual Assault as a Mediator of the Association Between Posttraumatic Stress Disorder and Depression Among Lesbian, Gay, and Bisexual Veterans.
  Carrie L. Lucas, Jeremy T. Goldbach, Mary Rose Mamey, Sara Kintzle, Carl Andrew Castro.
  Journal of Traumatic Stress. August 07, 2018
  --- - |2 Abstract Lesbian, gay, and bisexual (LGB) civilians report higher rates of sexual assault, posttraumatic stress disorder (PTSD), and depression compared to their heterosexual counterparts. In this study, we compared military sexual assault (MSA), PTSD, and depression in LGB individuals and their non‐LGB peers in two community samples of veterans (N = 2,583). Participants were selected for inclusion if they identified as LGB (n = 110) and were matched 1 to 3 on gender and age with non‐LGB veterans (n = 330). Chi‐square analyses showed significant differences for LGB veterans compared to non‐LGB veterans for experiencing MSA (32.7% vs. 16.4%, respectively), p < .001; probable PTSD (41.2% vs. 29.8%, respectively), p = .039; and probable depression (47.9% vs. 36.0%, respectively), p = .039. Multivariable logistic regression analyses showed LGB veterans were 1.93 times more likely to have experienced MSA compared to non‐LGB veterans, 95% CI [1.30, 2.88], p = .001. The experience of MSA significantly mediated associations with probable PTSD, odds ratio (OR) = 1.43, 95% CI [1.13, 1.80], p = .003, and probable depression, OR = 1.32, 95% CI [1.07, 1.64], p = .009. As the experience of MSA fully mediates the presence of PTSD and depression among LGB veterans, we highly recommend health providers assess for MSA among LGB veterans, especially those who meet clinical thresholds for PTSD and depression. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Abuso sexual militar como mediador del trastorno de estrés postraumático y depresión entre veteranos lesbianas, homosexuales y bisexuales ABUSO SEXUAL MILITAR, TEPT Y DEPRESIÓN Los civiles lesbianas, homosexuales y bisexuales (LGB por sus siglas en inglés) reportan tasas más altas de abuso sexual, trastorno de estrés postraumático (TEPT), y depresión comparados con sus contrapartes heterosexuales. En este estudio, comparamos abuso sexual militar (MSA por sus siglas en inglés), TEPT y depresión en individuos LGB y sus pares no‐LGB en dos muestras de la comunidad de veteranos (N = 2.583). Los participantes fueron seleccionados por inclusión si eran identificados como LGB (n = 110) y fueron pareados uno a tres en género y edad con los veteranos no‐LGB  (n = 330). El análisis de chi cuadrado mostró diferencias significativas para los veteranos LGB comparados con los veteranos no‐LGB en experimentación de MSA (32.7% vs. 16.4% respectivamente), p < .001; probable TEPT (41.2% vs 29.8% respectivamente), p = .039; y probable depresión (47.9% vs. 36.0%, respectivamente), p = .039. El análisis de regresión logística multivariable mostró que los veteranos LGB tuvieron 1.93 veces más probabilidades de haber experimentado MSA comparados con los veteranos no‐LGB, 95% IC [1.30, 2.88], p = .001. La experiencia de MSA medió significativamente la asociación con probable TEPT, odds ratio (OR) = 1.43, 95% IC [1.13, 1.80], p = .003, y probable depresión, OR = 1.32, 95% IC [1.07, 1.64], p = .009. Como la experiencia de MSA media completamente la presencia de TEPT y depresión entre veteranos LGB, recomendamos fuertemente a los proveedores de salud que evalúen MSA entre los veteranos LGB, especialmente aquellos que reúnen umbrales  clínicos  para TEPT y depresión. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Military Sexual Assault as a Mediator of Posttraumatic Stress Disorder and Depression among Lesbian, Gay, and Bisexual Veterans Traditional Chinese 標題: 女同性戀、男同性戀和雙性戀退役軍人中, 軍事性侵犯作為創傷後壓力症與抑鬱症的中介變數 撮要: 相比起異性戀人士, 女同性戀、男同性戀和雙性戀(LGB)人士遭受性侵犯、患創傷後壓力症(PTSD)和抑鬱症的比率較高。本研究透過兩組退役軍人社區樣本(N = 2,583), 比較LGB人士與非LGB人士的軍事性侵犯(MSA)、PTSD和抑鬱症。我們先找尋認為自己屬LGB的退役軍人為樣本(n = 110), 並根據他們的社會性別和年齡以一比三的比例找尋對應的非LGB退役軍人(n = 330)。卡方檢定分析顯示, LGB退役軍人跟非LGB退役軍人在以下方面有顯著差別:MSA經歷(分別為32.7% vs. 16.4%, p < .001)、有可能患PTSD的個案(分別為41.2% vs 29.8%, p = .039)、有可能患抑鬱症的個案(分別為47.9% vs. 36.0%, p = .039)。多變量線性迴歸分析反映, LGB退役軍人相比非LGB退役軍人曾經歷MSA的可能性高出1.93 倍(95% CI [1.30, 2.88], p = .001)。MSA經歷對有可能患PTSD的個案(勝算比(OR) = 1.43, 95% CI [1.13, 1.80], p = .003)及有可能患抑鬱症的個案(OR = 1.32, 95% CI [1.07, 1.64], p = .009)有顯著中介作用。由於MSA經歷在LGB退役軍人中對PTSD和抑鬱症有完全的中介效應, 我們強力建議心理治療人士為LGB退役軍人進行MSA評估, 特別是那些達到患PTSD和抑鬱症臨床閾限水平的人士。 Simplified Chinese 标题: 女同性恋、男同性恋和双性恋退役军人中, 军事性侵犯作为创伤后压力症与抑郁症的中介变数 撮要: 相比起异性恋人士, 女同性恋、男同性恋和双性恋(LGB)人士遭受性侵犯、患创伤后压力症(PTSD)和抑郁症的比率较高。本研究透过两组退役军人小区样本(N = 2,583), 比较LGB人士与非LGB人士的军事性侵犯(MSA)、PTSD和抑郁症。我们先找寻认为自己属LGB的退役军人为样本(n = 110), 并根据他们的社会性别和年龄以一比三的比例找寻对应的非LGB退役军人(n = 330)。卡方检定分析显示, LGB退役军人跟非LGB退役军人在以下方面有显著差别:MSA经历(分别为32.7% vs. 16.4%, p < .001)、有可能患PTSD的个案(分别为41.2% vs 29.8%, p = .039)、有可能患抑郁症的个案(分别为47.9% vs. 36.0%, p = .039)。多变量线性回归分析反映, LGB退役军人相比非LGB退役军人曾经历MSA的可能性高出1.93 倍(95% CI [1.30, 2.88], p = .001)。MSA经历对有可能患PTSD的个案(胜算比(OR) = 1.43, 95% CI [1.13, 1.80], p = .003)及有可能患抑郁症的个案(OR = 1.32, 95% CI [1.07, 1.64], p = .009)有显著中介作用。由于MSA经历在LGB退役军人中对PTSD和抑郁症有完全的中介效应, 我们强力建议心理治疗人士为LGB退役军人进行MSA评估, 特别是那些达到患PTSD和抑郁症临床阈限水平的人士。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 613-619, August 2018.
  

  August 07, 2018   doi: 10.1002/jts.22308   open full text
• Telemental Health Delivery of Skills Training in Affective and Interpersonal Regulation (STAIR) for Rural Women Veterans Who Have Experienced Military Sexual Trauma.
  Brandon J. Weiss, Kathryn Azevedo, Katie Webb, Julia Gimeno, Marylene Cloitre.
  Journal of Traumatic Stress. August 02, 2018
  --- - |2 Abstract This pilot study assessed the feasibility, acceptability, and initial efficacy of a skills‐focused treatment delivered via video teleconferencing (VTC) to women veterans living in rural areas who had experienced military sexual trauma (MST). The Skills Training in Affective and Interpersonal Regulation (STAIR) program focuses on teaching emotion management and interpersonal skills in 8 to 10 sessions. The STAIR program may be a good fit for individuals in rural areas for whom social isolation and low social support are particularly problematic. Clinic‐to‐clinic VTC was used to connect a STAIR therapist with veterans for weekly individual therapy sessions. The participants (n = 10) reported high satisfaction with the intervention and would recommend the program to others. There were significant pretreatment to posttreatment improvements in social functioning, Hedge's g = 1.41, as well as in posttraumatic stress disorder symptoms, Hedge's g = 2.35; depression, Hedge's g = 1.81; and emotion regulation, Hedge's g = 2.32. This is the first report of the successful application of a skills‐focused treatment via VTC for women veterans. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Entrega de Salud Telemental de Entrenamiento de Habilidades en Regulación Afectiva e Interpersonal (STAIR) para Mujeres Veteranas que han Experimentado Trauma Sexual Militar (MST) SALUD TELEMENTAL DE STAIR PARA MST Este estudio piloto evaluó la factibilidad, aceptabilidad, y eficacia inicial de un tratamiento focalizado en habilidades que fue entregado por medio de videoconferencia (VTC, en si sigla en inglés) a mujeres veteranas que vivían en áreas rurales y que habían experimentado trauma sexual militar (MST en su sigla en inglés). El programa de Entrenamiento de Habilidades en Regulación Afectiva de Interpersonal (STAIR, en sus siglas en inglés) se focaliza en enseñar manejo de las emociones y habilidades interpersonales en ocho a 10 sesiones. El programa STAIR podría ser adecuado para individuos en zonas rurales, para quienes el aislamiento social y bajo apoyo social son particularmente problemáticos. El VTC de clínica a clínica fue usado para conectar un terapeuta STAIR con las veteranas para sesiones terapéuticas semanales. Las participantes (n = 10) reportaron alta satisfacción con la intervención y recomendarían el programa a otras. Hubo mejoras significativas desde pre a post‐tratamiento en funcionamiento social, Hedge's g = 1.41, como también en síntomas del trastorno por estrés postraumático, Hedge's g = 2.35; depresión, Hedge's g = 1.81; y regulación emocional, Hedge's g = 2.32. Este es el primer reporte de la aplicación satisfactoria de tratamiento focalizado en habilidades usando VTC para mujeres veteranas. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Telemental Health Delivery of Skills Training in Affective and Interpersonal Regulation for Women Veterans Who Have Experienced Military Sexual Trauma Traditional Chinese 標題: 對遭受軍事性創傷的女性退役軍人以視像通訊提供情感和人際調節技能訓練 撮要: 本先導研究檢視對曾受軍事性創傷(MST)、居於郊區的女性退役軍人, 透過視像會議(VTC)提供技巧為本治療的可行性、可接受性和初步功效。情感和人際調節技能訓練(STAIR)計劃透過8‐10個節段, 針對教授情緒管理和人際技巧;它可能適合用於居住在郊區、受到社交孤立、社會支持度低的人士。診所與診所之間會進行VTC, 把STAIR治療師與退役軍人連繫上, 進行每星期一次的個人治療。參與者(n = 10)表示對干預治療感高度滿意, 並會推介他人接受此治療。樣本治療前後的社交功能有顯著改善(Hedge's g = 1.41), 以下方面亦顯著改善:創傷後壓力症狀(Hedge's g = 2.35)、抑鬱症(Hedge's g = 1.81)、情緒調節(Hedge's g = 2.32)。此為首個成功對女性退役軍人透過VTC提供技巧為本治療的報告。 Simplified Chinese 标题: 对遭受军事性创伤的女性退役军人以视像通讯提供情感和人际调节技能训练 撮要: 本先导研究检视对曾受军事性创伤(MST)、居于郊区的女性退役军人, 透过视像会议(VTC)提供技巧为本治疗的可行性、可接受性和初步功效。情感和人际调节技能训练(STAIR)计划透过8‐10个节段, 针对教授情绪管理和人际技巧;它可能适合用于居住在郊区、受到社交孤立、社会支持度低的人士。诊所与诊所之间会进行VTC, 把STAIR治疗师与退役军人连系上, 进行每星期一次的个人治疗。参与者(n = 10)表示对干预治疗感高度满意, 并会推介他人接受此治疗。样本治疗前后的社交功能有显著改善(Hedge's g = 1.41), 以下方面亦显著改善:创伤后压力症状(Hedge's g = 2.35)、抑郁症(Hedge's g = 1.81)、情绪调节(Hedge's g = 2.32)。此为首个成功对女性退役军人透过VTC提供技巧为本治疗的报告。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 620-625, August 2018.
  

  August 02, 2018   doi: 10.1002/jts.22305   open full text
• Efficacy of Imagery Rehearsal Therapy and Cognitive Behavioral Therapy in Sexual Assault Victims With Posttraumatic Stress Disorder: A Randomized Controlled Trial.
  Geneviève Belleville, Mylène Dubé‐Frenette, Andréanne Rousseau.
  Journal of Traumatic Stress. August 02, 2018
  --- - |2 Abstract Sleep disturbances are common among sexual assault victims with posttraumatic stress disorder (PTSD), but cognitive behavioral therapy (CBT) for PTSD does not directly address sleep‐related symptoms. Trauma‐related sleep disturbances are associated with more impairment and contribute to the maintenance of PTSD. In this study, we evaluated the efficacy of a combination of CBT and nightmare therapy (imagery rehearsal therapy; IRT) compared to CBT alone for the treatment of PTSD. We recruited 42 adult victims of sexual assault who were suffering from PTSD and randomly assigned them to either the experimental (IRT + CBT) or control condition (waiting period followed by CBT). After CBT, both groups demonstrated significant decreases in nighttime symptoms (except nightmare frequency) and PTSD symptoms and showed improvements in functional impairment and mental health, ds = 0.13–0.83, ps = .005–.008. Outcomes between the two groups did not differ significantly after CBT; however, we observed medium to medium‐large differences between the control group and experimental group in terms of nighttime symptoms, ds = 0.45–0.63. Although results did not clearly establish the superiority of IRT + CBT over CBT alone, they demonstrated that IRT yielded greater improvement in nighttime symptoms than the waiting period, ds = 0.72–1.13, ps = .006–.047 for all interaction effects. Findings suggest that targeting nightmares at the beginning of treatment for PTSD may yield rapid improvement in nighttime symptoms. This strategy could be useful for patients with time or resource constraints or those for whom nightmares are the primary complaint. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Eficacia de la Terapia de Ensayo de Imágenes y la Terapia Cognitivo‐Conductual en Víctimas de Agresión Sexual con Trastorno de Estrés Postraumático: Un Ensayo Controlado Aleatorizado TRATAMIENTO DE PESADILLAS Y TERAPIA COGNITIVO‐COMPORTAMIENTAL Las alteraciones del sueño son comunes entre víctimas de agresión sexual con trastorno de estrés postraumático (TEPT), pero la terapia cognitivo‐conductual (TCC) no aborda directamente los síntomas relacionados con el sueño. Las alteraciones del sueño relacionadas con el trauma están asociadas con un mayor deterioro y contribuyen al mantenimiento del TEPT. En este estudio, evaluamos la eficacia de una combinación de TCC y terapia de pesadillas (terapia de ensayo de imaginería, IRT en sus siglas en inglés) en comparación con TCC sola para el tratamiento del TEPT. Reclutamos a 42 víctimas adultas de agresión sexual que habían sufrido de TEPT y que fueron asignadas al azar a la condición experimental (IRT + TCC) o de control (período de espera seguido por TCC). Después de la TCC, ambos grupos demostraron disminuciones significativas en los síntomas nocturnos (excepto la frecuencia de pesadilla) y síntomas de TEPT y mostraron mejorías en el deterioro funcional y la salud mental, ds = 0.13 ‐ 0.83, ps = .005 ‐ .008 o < .001. Los resultados entre los dos grupos no difirieron significativamente después de la TCC; sin embargo, observamos diferencias medianas a medianas‐grandes entre el grupo de control y el grupo experimental en términos de síntomas nocturnos, ds = 0.45 – 0.63. Aunque los resultados no establecieron claramente la superioridad de IRT + TCC por sobre TCC sola, demostraron que IRT produjo una mejoría mayor en los síntomas nocturnos que el período de espera, ds = 0.72 – 1.13, ps = .006 ‐ .047 para todos los efectos de interacción. Los hallazgos sugieren que abordar terapéuticamente las pesadillas al comienzo del tratamiento para el TEPT puede producir una mejoría rápida en los síntomas nocturnos. Esta estrategia podría ser útil para pacientes con limitaciones de tiempo o recursos o aquellos para quienes las pesadillas son la principal queja. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Efficacy of Imagery Rehearsal Therapy and Cognitive‐ Behavioural Therapy in Sexual Assault Victims with Posttraumatic Stress Disorder: A Randomized Controlled Trial Traditional Chinese 標題: 患創傷後壓力症的性侵犯受害者中, 意象排演療法與認知行為療法的功效:隨機對照試驗 撮要: 睡眠障礙普遍見於患創傷後壓力症(PTSD)的性侵犯受害者, 但認知行為療法(CBT)並不能直接處理睡眠相關的症狀。創傷相關的睡眠障礙能導致更多功能受損問題並令PTSD維持。本研究檢視一個CBT與惡夢治療(意象排演療法; IRT)的組合, 和一個只用CBT的組別;比較以上兩組療法對治療PTSD的功效。樣本為42名患 PTSD的成人性侵犯受害者, 隨機分派到接受試驗性的(IRT + CBT)組別或對照組 (CBT後有一段等待時間) 。兩組樣本接受CBT後, 晚間症狀 (除惡夢頻率外) 都顯著減低, PTSD症狀顯著減輕, 功能損傷和心理健康亦有所改善(ds = 0.13–0.83, ps = .005–.008 or < .001)。CBT後, 兩組的表現則無顯著差別。然而, 晚間症狀方面, 對照組與試驗組之間有中度至中或大程度的差別(ds = 0.45–0.63)。結果雖未有清楚顯示接受IRT + CBT比只接受 CBT 有效, 但反映接受IRT相比對照組的等待時間, 在所有交互效應方面都令晚間症狀有較大改善(ds = 0.72–1.13, ps = .006–.047)。結果反映, 在PTSD治療開始時就針對處理惡夢問題, 有可能令晚間症狀迅速改善。此治療策略可能適合受時間或資源限制的患者、或惡夢為主要困擾的患者。 Simplified Chinese 标题: 患创伤后压力症的性侵犯受害者中, 意象排演疗法与认知行为疗法的功效:随机对照试验 撮要: 睡眠障碍普遍见于患创伤后压力症(PTSD)的性侵犯受害者, 但认知行为疗法(CBT)并不能直接处理睡眠相关的症状。创伤相关的睡眠障碍能导致更多功能受损问题并令PTSD维持。本研究检视一个CBT与恶梦治疗(意象排演疗法; IRT)的组合, 和一个只用CBT的组别;比较以上两组疗法对治疗PTSD的功效。样本为42名患 PTSD的成人性侵犯受害者, 随机分派到接受试验性的(IRT + CBT)组别或对照组 (CBT后有一段等待时间) 。两组样本接受CBT后, 晚间症状 (除恶梦频率外) 都显著减低, PTSD症状显著减轻, 功能损伤和心理健康亦有所改善(ds = 0.13–0.83, ps = .005–.008 or < .001)。CBT后, 两组的表现则无显著差别。然而, 晚间症状方面, 对照组与试验组之间有中度至中或大程度的差别(ds = 0.45–0.63)。结果虽未有清楚显示接受IRT + CBT比只接受 CBT 有效, 但反映接受IRT相比对照组的等待时间, 在所有交互效应方面都令晚间症状有较大改善(ds = 0.72–1.13, ps = .006–.047)。结果反映, 在PTSD治疗开始时就针对处理恶梦问题, 有可能令晚间症状迅速改善。此治疗策略可能适合受时间或资源限制的患者、或恶梦为主要困扰的患者。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 591-601, August 2018.
  

  August 02, 2018   doi: 10.1002/jts.22306   open full text
• Effects of Threat Context, Trauma History, and Posttraumatic Stress Disorder Status on Physiological Startle Reactivity in Gulf War Veterans.
  Andrea N. Niles, Adam Luxenberg, Thomas C. Neylan, Sabra S. Inslicht, Anne Richards, Thomas J. Metzler, Jennifer Hlavin, Jersey Deng, Aoife O'Donovan.
  Journal of Traumatic Stress. July 30, 2018
  --- - |2 Abstract In the current study, we explored exaggerated physiological startle responses in posttraumatic stress disorder (PTSD) and examined startle reactivity as a biomarker of PTSD in a large veteran sample. We assessed heart rate (HR), skin conductance (SC), and electromyographic (EMG) startle responses to acoustic stimuli under low‐, ambiguous‐, and high‐threat conditions in Gulf War veterans with current (n = 48), past (n = 42), and no history of PTSD (control group; n = 152). We evaluated PTSD status using the Clinician‐Administered PTSD Scale and trauma exposure using the Trauma History Questionnaire. Participants with current PTSD had higher HR, ds = 0.28–0.53; SC, d = 0.37; and startle responses than those with past or no history of PTSD. The HR startle response under ambiguous threat best differentiated current PTSD; however, sensitivity and specificity analyses revealed it to be an imprecise indicator of PTSD status, ROC AUC = .66. Participants with high levels of trauma exposure only showed elevated HR and SC startle reactivity if they had current PTSD. Results indicate that startle is particularly elevated in PTSD when safety signals are available but a possibility of danger remains and when trauma exposure is high. However, startle reactivity alone is unlikely to be a sufficient biomarker of PTSD. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Efectos del Contexto de Amenaza e Historial de Trauma en la Reactividad de Sobresalto Fisiológico en Veteranos de la Guerra del Golfo RESPUESTAS DE SOBRESALTO EN VETERANOS DE LA GUERRA DEL GOLFO En este estudio, exploramos respuestas fisiológicas de sobresalto exageradas en el trastorno de estrés postraumático (TEPT) y examinamos la reactividad de sobresalto como un biomarcador de TEPT en una muestra amplia de veteranos. Evaluamos la frecuencia cardíaca (FC), la conductancia de la piel (CP), y la respuesta electromiográfica (EMG) de asombro a estímulos acústicos en condiciones de baja, ambigua, y alta amenaza en Veteranos de la Guerra del Golfo con historial de TEPT actual (n = 48), pasado (n = 42), y sin historial (grupo control; n = 152). Evaluamos el estado del TEPT utilizando la Escala de TEPT administrada por un médico, y la exposición a trauma usando el Cuestionario del Historial de Trauma. Los participantes con TEPT actual tenían mayor FC, ds = 0.28 ‐ 0.53; CP, d = 0.37; y respuesta de sobresalto que aquellos con historial pasado o sin historial de TEPT. La respuesta de sobresalto de FC bajo amenaza ambigua fue la que mejor diferenció el TEPT actual; sin embargo, los análisis de sensibilidad y especificidad revelaron que es un indicador impreciso del estado de TEPT, ROC AUC = .66. Los participantes con altos niveles de exposición al trauma sólo mostraron una elevada reactividad de FC y CP si tenían TEPT actual. Los resultados indican que el sobresalto es particularmente elevado en TEPT cuando las señales de seguridad están disponibles, pero existe la posibilidad de peligro y cuando la exposición al trauma es alta. No obstante, es poco probable que la reactividad de sobresalto por sí sola sea un biomarcador suficiente de TEPT. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Effects of Threat Context and Trauma History on Physiological Startle Reactivity in Gulf War Veterans Traditional Chinese 標題: 威脅環境與創傷經歷對波斯灣戰爭退役軍人生理驚嚇反應度的效應 撮要: 本研究透過大型退役軍人樣本, 探索創傷後壓力症(PTSD)患者中過大的生理驚嚇反應, 檢視驚嚇反應度作為PTSD的生物標記。樣本為有當前PTSD(n = 48)、過去曾患PTSD(n = 42)、或過去無患PTSD(對照組; n = 152)的波斯灣戰爭退役軍人。我們檢視樣本在低度、不明確、或高度威脅的情況下的心跳率 (HR)、皮膚導電度(SC)、及對聲音刺激的驚嚇反應肌電記錄(EMG)。我們以臨床治療師專用的PTSD量表評估PTSD狀況, 並以創傷歷史問卷檢視創傷經歷。有當前PTSD的樣本, 相比過去曾患或無患PTSD的樣本, 有較高水平HR(ds = 0.28–0.53; SC, d = 0.37)及驚嚇反應。在威脅不明確的情況下, 驚嚇反應的HR最能用以辨認出有當前PTSD的樣本, 但敏感度和特殊度分析反映那是對PTSD狀況不準確的指標(ROC AUC = .66)。在有高水平創傷經歷的樣本中, 只有患當前PTSD的樣本有HR 和SC提升的驚嚇反應。結果反映, 當有信號表示情況安全但仍有可能發生危險, 還有當樣本有高水平創傷經歷時, PTSD患者的驚嚇反應就特別會提高。然而, 單是驚嚇反應度應該不足以成為PTSD的生物標記。 Simplified Chinese 标题: 威胁环境与创伤经历对波斯湾战争退役军人生理惊吓反应度的效应 撮要: 本研究透过大型退役军人样本, 探索创伤后压力症(PTSD)患者中过大的生理惊吓反应, 检视惊吓反应度作为PTSD的生物标记。样本为有当前PTSD(n = 48)、过去曾患PTSD(n = 42)、或过去无患PTSD(对照组; n = 152)的波斯湾战争退役军人。我们检视样本在低度、不明确、或高度威胁的情况下的心跳率 (HR)、皮肤导电度(SC)、及对声音刺激的惊吓反应肌电记录(EMG)。我们以临床治疗师专用的PTSD量表评估PTSD状况, 并以创伤历史问卷检视创伤经历。有当前PTSD的样本, 相比过去曾患或无患PTSD的样本, 有较高水平HR(ds = 0.28–0.53; SC, d = 0.37)及惊吓反应。在威胁不明确的情况下, 惊吓反应的HR最能用以辨认出有当前PTSD的样本, 但敏感度和特殊度分析反映那是对PTSD状况不准确的指标(ROC AUC = .66)。在有高水平创伤经历的样本中, 只有患当前PTSD的样本有HR 和SC提升的惊吓反应。结果反映, 当有信号表示情况安全但仍有可能发生危险, 还有当样本有高水平创伤经历时, PTSD患者的惊吓反应就特别会提高。然而, 单是惊吓反应度应该不足以成为PTSD的生物标记。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 579-590, August 2018.
  

  July 30, 2018   doi: 10.1002/jts.22302   open full text
• Patterns of Trauma Exposure in Childhood and Adolescence and Their Associations With Behavioral Well‐Being.
  Christian M. Connell, Samantha L. Pittenger, Jason M. Lang.
  Journal of Traumatic Stress. July 30, 2018
  --- - |2 Abstract The majority of youth living in the United States experience a potentially traumatic event (PTE) by 18 years of age, with many experiencing multiple PTEs. Variation in the nature and range of PTE exposure differentially impacts youth functioning, although this association is poorly understood. We used latent class analysis (LCA) to identify patterns of PTE exposure from caregiver and youth report in a treatment‐seeking sample of children and adolescents (N = 701) and examined how these patterns predict youths’ behavioral health outcomes. We identified four classes based on both caregiver and youth reports of PTE exposure, with the best‐fitting model representing a constrained measurement model across reporters; these included high polyvictimization, moderate polyvictimization (general), moderate polyvictimization (interpersonal), and low polyvictimization classes. Prevalence of classes varied across reporters, and agreement in classification based on caregiver and youth report was mixed. Despite these differences, we observed similar patterns of association between caregiver‐ and youth‐reported classes and their respective ratings of posttraumatic stress disorder and depressive symptoms, as well as both caregiver and therapist ratings of problem behavior, with Cohen's d effect size estimates of significant differences ranging from d = 0.25 to d = 0.51. The PTE exposure classes did not differ with respect to ratings of child functioning. Findings highlight the importance of gathering information from multiple informants. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Patrones de la exposición al trauma en la infancia y en la adolescencia y sus asociaciones con el bienestar conductual PATRONES DE EXPOSICION AL TRAUMA EN LA INFANCIA La mayoría de los jóvenes que viven en los Estados Unidos han experimentado un evento potencialmente traumático (PTE, en su sigla en inglés) antes de los 18 años de edad, y muchos experimentan múltiples PTEs. La variación de la naturaleza y del rango de exposición a PTEs afectan de forma diferente el funcionamiento de los jóvenes, aunque esta asociación es pobremente entendida. Utilizamos análisis de clases latentes (LCA, en su sigla en inglés) para identificar patrones de exposición a PTEs según el reporte del cuidador y del joven en una muestra de niños y adolescentes en búsqueda de tratamiento (N = 701) y examinamos cómo estos patrones predicen los resultados de salud conductual de los jóvenes. Identificamos cuatro clases basadas en el reporte de exposición a PTEs, tanto de parte de los cuidadores como de los jóvenes, con el modelo de mejor ajuste representando un modelo de medición reducido entre informantes; las clases incluyeron Alta Polivictimización, Polivictimización Moderada (General), Polivictimización Moderada (Interpersonal), y Baja Polivictimización. La prevalencia de las clases varió entre los informantes, y el acuerdo en la clasificación basada en el reporte del cuidador y del joven fue diverso. A pesar de estas diferencias, observamos patrones similares de asociación entre las clases reportadas por los cuidadores y los jóvenes y sus respectivas calificaciones de trastorno de estrés postraumático y síntomas depresivos, así como las calificaciones del comportamiento problemático tanto del cuidador como del terapeuta (estimaciones del tamaño del efecto d de Cohen indicando diferencias significativas oscilaron entre d = 0.25 y d = 0.51). Las clases de exposición a PTEs no difirieron con respecto a las calificaciones del funcionamiento infantil. Los hallazgos destacan la importancia de recopilar información de múltiples informantes. Se discuten las implicancias para el tratamiento. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Patterns of Trauma Exposure in Childhood and Adolescence and Their Associations With Behavioral Well‐Being Traditional Chinese 標題: 兒童及青少年創傷經歷的模式及其與行為問題的關連 撮要: 大多數居於美國的青少年到了18歲時已經歷了一次潛在創傷事件(PTE), 當中很多都經歷了多次PTEs。不同的PTE經歷本質和種類對青少年有不同影響, 不過我們缺乏對這些關連的了解。本研究樣本為尋求治療的兒童和青少年(N = 701)。我們以潛在類別分析(LCA), 透過青少年與照料者的報告找出PTE經歷的模式, 並檢視那些模式如何預測青少年的行為。基於青少年與照料者的PTE經歷報告, 得出4個類別, 最合適的模型為對報告者設限測量的模型。4個類別為高度多重傷害、中度多重傷害(一般)、中度多重傷害(人際)、低度多重傷害。各個類別在報告者當中的普遍率不同, 基於青少年與照料者的報告得出的類別吻合度亦不一樣。然而, 我們在青少年與照料者的報告得出的類別, 以及他們分別的創傷後壓力症評分和抑鬱症狀評分之間, 觀察到相似的關連模式;照料者與治療師給予的行為問題評分亦有相似模式(對顯著差別的Cohen's d效應量估計值值域為 d = 0.25 至 d = 0.51)。在兒童功能評分方面, PTE經歷類別並無差異。結果反映從多方人士搜集數據的重要性, 我們亦討論到研究發現對治療的幫助。 Simplified Chinese 标题: 儿童及青少年创伤经历的模式及其与行为问题的关连 撮要: 大多数居于美国的青少年到了18岁时已经历了一次潜在创伤事件(PTE), 当中很多都经历了多次PTEs。不同的PTE经历本质和种类对青少年有不同影响, 不过我们缺乏对这些关连的了解。本研究样本为寻求治疗的儿童和青少年(N = 701)。我们以潜在类别分析(LCA), 透过青少年与照料者的报告找出PTE经历的模式, 并检视那些模式如何预测青少年的行为。基于青少年与照料者的PTE经历报告, 得出4个类别, 最合适的模型为对报告者设限测量的模型。4个类别为高度多重伤害、中度多重伤害(一般)、中度多重伤害(人际)、低度多重伤害。各个类别在报告者当中的普遍率不同, 基于青少年与照料者的报告得出的类别吻合度亦不一样。然而, 我们在青少年与照料者的报告得出的类别, 以及他们分别的创伤后压力症评分和抑郁症状评分之间, 观察到相似的关连模式;照料者与治疗师给予的行为问题评分亦有相似模式(对显著差别的Cohen's d效应量估计值值域为 d = 0.25 至 d = 0.51)。在儿童功能评分方面, PTE经历类别并无差异。结果反映从多方人士搜集数据的重要性, 我们亦讨论到研究发现对治疗的帮助。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 518-528, August 2018.
  

  July 30, 2018   doi: 10.1002/jts.22315   open full text
• Predicting Avoidance Symptoms in U.S. Latino Youth Exposed to Community Violence: The Role of Cultural Values and Behavioral Inhibition.
  Aimee Schneider, Omar G. Gudiño.
  Journal of Traumatic Stress. July 30, 2018
  --- - |2 Abstract Not all youth exposed to violence are at equal risk for developing posttraumatic stress disorder (PTSD), reflecting potential variability in risk factors influencing the development of PTSD beyond exposure to violence. In particular, Latino youth have been found to be at a higher risk for developing PTSD after exposure to violence. Similarly, youth with high levels of behavioral inhibition appear to be at greater risk of developing PTSD following exposure to violence. In this study, we examined how Latino cultural values might be associated with behavioral inhibition and how these two factors together may interact to predict risk for developing PTSD avoidance symptoms, specifically. Data from a longitudinal sample of 168 Latino adolescents (11–15 years of age) indicated that Latino values were positively associated with behavioral inhibition, r = .26, p < .001, and that Latino values moderated the association between behavioral inhibition and avoidance symptoms, β = .16, p = .009, such that the association was stronger as Latino cultural values increased. Results from this study highlight the importance of considering cultural, individual, and contextual factors for understanding risk for PTSD. Future research should further assess the biological and cultural correlates of behavioral inhibition in order to improve understanding of risk and increase effectiveness of individualized intervention approaches. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Predicción de los síntomas de evitación en jóvenes latinos estadounidenses expuestos a la violencia comunitaria: El rol de los valores culturales y la inhibición conductual VALORES CULTURALES E INHIBICIÓN CONDUCTUAL No todos los jóvenes expuestos a la violencia presentan el mismo riesgo de desarrollar un trastorno por estrés postraumático (TEPT), lo que refleja la variabilidad potencial en los factores de riesgo que influyen en el desarrollo del TEPT más allá de la exposición a la violencia. En particular, se ha descubierto que los jóvenes latinos presentan un riesgo mayor de desarrollar TEPT después de la exposición a la violencia. Similarmente, los jóvenes con altos niveles de inhibición conductual parecen estar en un riesgo mayor de desarrollar TEPT luego de la exposición a la violencia. En este estudio, examinamos cómo los valores culturales latinos podrían estar asociados con la inhibición conductual y cómo estos dos factores juntos pueden interactuar para predecir el riesgo de desarrollar síntomas de evitación del TEPT, específicamente. Datos de una muestra longitudinal de 168 adolescentes latinos (rango de edades de 11–15 años) indicó que los valores culturales latinos se asociaron positivamente con la inhibición conductual, r = .26, p <.001, y que los valores culturales latinos moderaron la asociación entre la inhibición conductual y síntomas de evitación, β = .16, p = .009, de tal manera que la asociación fue más fuerte a medida que los valores culturales latinos aumentaban. Los resultados de este estudio destacan la importancia de considerar los factores culturales, individuales, y contextuales para comprender el riesgo de TEPT. Las investigaciones futuras deberían evaluar aún más los correlatos biológicos y culturales de la inhibición conductual con el fin de mejorar la comprensión del riesgo y aumentar la efectividad de los enfoques de intervención individualizada. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Predicting Avoidance Symptoms in U.S. Latino Youth Exposed to Community Violence: The Role of Cultural Values and Behavioral Inhibition Traditional Chinese 標題: 預測遭受社區暴力的美國拉丁裔青少年的迴避症狀:文化價值觀和行為抑制的影響 撮要: 青少年遭受暴力後, 患創傷後壓力症(PTSD)的風險水平不一定一樣, 反映在暴力經歷外, 導致PTSD的風險因素有潛在變化的可能。過往研究發現, 拉丁裔青少年遭受暴力後有較高風險患PTSD, 而行為抑制水平較高的青少年似乎在遭受暴力後亦有較高風險患PTSD。本研究檢視拉丁文化是否跟行為抑制有關, 還有這兩種因素結合起來是否能預測發展出PTSD迴避症狀的風險。我們從168名拉丁裔青少年 (年齡為11–15歲) 組成的縱貫樣本取得數據, 發現拉丁文化的價值觀跟行為抑制有正向關連(r = .26, p < .001)。拉丁文化的價值觀在行為抑制與迴避症狀的關連間有調節效應(β = .16, p = .009), 即當拉丁文化的價值觀越強, 行為抑制與迴避症狀的關連亦較強。研究結果反映, 為了解患PTSD的風險, 我們有需要考慮文化、個人和環境因素。未來研究應進一步評估與行為抑制有關的生理和文化因素, 以加深對疾病風險的理解和提升個人治療的效用。 Simplified Chinese 标题: 预测遭受小区暴力的美国拉丁裔青少年的回避症状:文化价值观和行为抑制的影响 撮要: 青少年遭受暴力后, 患创伤后压力症(PTSD)的风险水平不一定一样, 反映在暴力经历外, 导致PTSD的风险因素有潜在变化的可能。过往研究发现, 拉丁裔青少年遭受暴力后有较高风险患PTSD, 而行为抑制水平较高的青少年似乎在遭受暴力后亦有较高风险患PTSD。本研究检视拉丁文化是否跟行为抑制有关, 还有这两种因素结合起来是否能预测发展出PTSD回避症状的风险。我们从168名拉丁裔青少年 (年龄为11–15岁) 组成的纵贯样本取得数据, 发现拉丁文化的价值观跟行为抑制有正向关连(r = .26, p < .001)。拉丁文化的价值观在行为抑制与回避症状的关连间有调节效应(β = .16, p = .009), 即当拉丁文化的价值观越强, 行为抑制与回避症状的关连亦较强。研究结果反映, 为了解患PTSD的风险, 我们有需要考虑文化、个人和环境因素。未来研究应进一步评估与行为抑制有关的生理和文化因素, 以加深对疾病风险的理解和提升个人治疗的效用。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 509-517, August 2018.
  

  July 30, 2018   doi: 10.1002/jts.22313   open full text
• Mapping the Mental Health of Residents After the 2013 Boston Marathon Bombings.
  Rupa Jose.
  Journal of Traumatic Stress. July 30, 2018
  --- - |2 Abstract Postdisaster mental health is typically assessed and treated on an individual basis. Ecological assessments, however, can be a more cost‐effective means to identify and promote mental health after a disaster. In this study, the spatial patterning of acute stress scores, probable posttraumatic stress disorder (PTSD), and fears and worries among a representative sample of Boston metropolitan area participants (N = 788) was examined using data collected 2–4 weeks to 2 years after the 2013 Boston Marathon bombings. Findings indicate significant clustering of acute stress scores, Moran's I = 0.24, z = 2.91, p = .004; fears and worries, Moran's I = 0.25, z = 2.39, p = .017; and probable PTSD at Wave 2, Moran's I = 0.49, z = 5.16; p < .001, and at Wave 5, Moran's I = 0.26, z = 2.51, p = .012, in the Boston metropolitan area, with high distress clusters found near downtown Boston and the attack site. These results suggest that disaster mental health is not uniformly distributed across space. Instead, patterns emerge to identify persons and neighborhoods at risk for poor mental health outcomes. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Mapeo de la salud mental de los residentes después del atentado con bombas en la maratón de Boston 2013 SALUD MENTAL DESPUÉS DEL ATENTADO CON BOMBAS EN LA MARATÓN DE BOSTON La salud mental posterior al desastre generalmente se evalúa y se trata de forma individual. Las evaluaciones ecológicas, sin embargo, pueden ser un medio más rentable para identificar y promover la salud mental después de un desastre. En este estudio, el patrón espacial de puntuaciones de estrés agudas, probable trastorno de estrés postraumático (TEPT) y temores y preocupaciones entre una muestra representativa de participantes del área metropolitana de Boston (N = 788) se examinó utilizando datos recogidos de 2 a 4 semanas a 2 años después de los atentados del atentado con bombas en la Maratón de Boston. Los resultados indican un agrupamiento significativo de las puntuaciones de estrés agudas, I de Moran = 0.24, z = 2.91, p = .004; temores y preocupaciones, I de Moran = 0.25, z = 2.39, p = .017; y probable TEPT en la segunda onda, I de Moran = 0.49, z = 5.16; p < .001, y en la onda 5, Moran's I = 0.26, z = 2.51, p = .012, en el área metropolitana de Boston, con grupos de angustia altos que se encuentran cerca del centro de Boston y del sitio de ataque. Estos resultados sugieren que la salud mental de desastre no se distribuye uniformemente en el espacio. En cambio, surgen patrones para identificar a las personas y los vecindarios en riesgo de tener resultados deficientes de salud mental. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Mapping the Mental Health of Residents after the 2013 Boston Marathon Bombings Traditional Chinese 標題: 2013年波士頓馬拉松爆炸案後, 患心理問題的居民地域記錄 撮要: 災難發生後, 常有為個人提供的心理評估與治療服務。然而, 生態評估可能是較具成本效益的方法, 以在災後找出心理問題患者和推廣心理健康。本研究於2013年波士頓馬拉松爆炸案發生後2至4星期至2年間收集數據, 取得波士頓都市內具代表性的樣本(N = 788), 從數據檢視急性壓力分數、有可能患創傷後壓力症(PTSD)的個案、以及恐懼和憂慮的空間分佈模式。結果顯示, 在波士頓都市第2波(Wave 2)有顯著的急性壓力分數聚類(Moran's I = 0.24, z = 2.91, p = .004)、恐懼和憂慮聚類(Moran's I = 0.25, z = 2.39, p = .017)和有可能患PTSD的個案聚類(Moran's I = 0.49, z = 5.16; p < .001);在第5波(Wave 5), 有可能患PTSD的個案聚類亦顯著(Moran's I = 0.26, z = 2.51, p = .012);鄰近波士頓市中心和受襲位置則有大型的悲痛聚類。結果顯示, 災後的心理問題非平均分佈於地域, 而是有模式地出現, 能反映有風險患心理問題的人口和社區。 Simplified Chinese 标题: 2013年波士顿马拉松爆炸案后, 患心理问题的居民地域记录 撮要: 灾难发生后, 常有为个人提供的心理评估与治疗服务。然而, 生态评估可能是较具成本效益的方法, 以在灾后找出心理问题患者和推广心理健康。本研究于2013年波士顿马拉松爆炸案发生后2至4星期至2年间收集数据, 取得波士顿都市内具代表性的样本(N = 788), 从数据检视急性压力分数、有可能患创伤后压力症(PTSD)的个案、以及恐惧和忧虑的空间分布模式。结果显示, 在波士顿都市第2波(Wave 2)有显著的急性压力分数聚类(Moran's I = 0.24, z = 2.91, p = .004)、恐惧和忧虑聚类(Moran's I = 0.25, z = 2.39, p = .017)和有可能患PTSD的个案聚类(Moran's I = 0.49, z = 5.16; p < .001);在第5波(Wave 5), 有可能患PTSD的个案聚类亦显著(Moran's I = 0.26, z = 2.51, p = .012);邻近波士顿市中心和受袭位置则有大型的悲痛聚类。结果显示, 灾后的心理问题非平均分布于地域, 而是有模式地出现, 能反映有风险患心理问题的人口和小区。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 480-486, August 2018.
  

  July 30, 2018   doi: 10.1002/jts.22312   open full text
• The Relative Impact of Traumatic Experiences and Daily Stressors on Mental Health Outcomes in Sri Lankan Adolescents.
  Thyagi Ponnamperuma, Nancy A. Nicolson.
  Journal of Traumatic Stress. July 30, 2018
  --- - |2 Abstract Prior trauma, current stress, and poor social support contribute to youth mental health problems. As daily stressors often increase in the aftermath of traumatic events, trauma could plausibly impact psychopathology not only directly but also indirectly via ongoing stress. In this study, we examined the relative roles of trauma and daily stressors in mental health outcomes in 753 Sri Lankan adolescents residing in areas impacted by the 2004 tsunami. In 2008, participants completed measures of trauma exposure, daily stressors, social support, posttraumatic stress symptoms (PTSS), emotional and behavioral problems (EBP), and functional impairment; a subsample (n = 89) repeated these assessments 16 months later. Regression models revealed positive associations between cumulative trauma and all three mental health measures. Significant variance in these associations could be explained indirectly, via daily stressors. For PTSS, the indirect effect accounted for 26.1% of the total effect of trauma, unstandardized coefficient ab = 0. 739, 95% CI [0.459, 1.122]. For EBP this percentage was 42.4%, ab = 0.287, 95% CI [0.189, 0. 404], and for functional impairment 70.0%, ab = 0.072, 95% CI [0.049, 0.121]. Indirect effects on impairment were strongest when perceived social support was low. Although we also present evidence that pathways between stressors and psychopathology may have been bidirectional, findings support the notion that adolescents' daily stressors are important transmitters of the impact of traumatic events and highlight the need for interventions focused not only on trauma processing but also on reducing current stress and improving social support. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) El impacto relativo de las experiencias traumáticas y los estresores diarios en los resultados de salud mental en los adolescentes de Sri Lanka IMPACTO EN LA SALUD MENTAL DE TRAUMA Y LOS ESTRESORES DIARIOS El trauma previo, el estrés actual y el apoyo social deficiente contribuyen a los problemas de salud mental de los jóvenes. Como los factores estresantes diarios a menudo aumentan después de los eventos traumáticos, el trauma podría tener un impacto plausible en la psicopatología no solo directa sino también indirectamente, a través del estrés continuo. En este estudio, examinamos los roles relativos del trauma y los factores estresantes diarios en los resultados de salud mental en 753 adolescentes de Sri Lanka que residen en el área afectada por el tsunami de 2004. En 2008, los participantes completaron medidas de exposición al trauma, factores estresantes diarios, apoyo social, síntomas de estrés postraumático (SEPT), problemas emocionales y de comportamiento (EBP en sus siglas en inglés) y deterioro funcional; una submuestra (n = 89) repitió estas evaluaciones 16 meses después. Los modelos de regresión revelaron asociaciones positivas entre el trauma acumulado y las tres medidas de salud mental. La variación significativa en estas asociaciones podría explicarse indirectamesnte, a través de factores estresantes diarios. Para SEPT, el efecto indirecto representó el 26.1% del efecto total del trauma, coeficiente no estandarizado ab = 0. 739, IC del 95% [0.459, 1.122]. Para EBP este porcentaje fue 42.4%, ab = 0.287, IC 95% [0.189, 0. 404], y para deterioro funcional 70.0%, ab = 0.072, IC 95% [0.049, 0.121]. Los efectos indirectos sobre el deterioro fueron más fuertes cuando el apoyo social percibido fue bajo. Aunque también presentamos evidencia de que las vías entre estresores y psicopatología pueden haber sido bidireccionales, los hallazgos respaldan la noción de que los factores estresantes diarios de los adolescentes son transmisores importantes del impacto de eventos traumáticos y resaltan la necesidad de intervenciones enfocadas no solo en el procesamiento del trauma sino también en la reducción del estrés actual y en mejorar el apoyo social. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 The Relative Impact of Traumatic Experiences and Daily Stressors on Mental Health Outcomes in Sri Lankan Adolescents Traditional Chinese 標題: 創傷經歷和日常壓力源對斯里蘭卡青少年心理的相對影響 撮要: 過往的創傷、當前的壓力以及缺乏社會支持, 都能導致青少年有心理問題。由於經歷創傷事件後日常壓力源一般都會提升, 創傷有可能透過持續的壓力直接和間接地影響個人的精神病理學。斯里蘭卡曾於2004年發生海嘯, 本研究透過753名居於受影響地區的青少年其心理狀況, 檢視創傷和日常壓力源帶來的相對影響。樣本於2008年進行以下測量:創傷經歷、日常壓力源、社會支持、創傷後壓力症狀(PTSS)、情緒和行為問題(EBP)、功能性損傷。16個月後, 一群子樣本(n = 89)再次進行以上測量。迴歸模型均顯示累積創傷跟其他3項心理健康測量有正向關連, 而日常壓力源能間接解釋這些關連之間顯著的方差。在PTSS方面, 這種間接效應解釋了創傷總效應的26.1%(非標準化迴歸係數ab = 0. 739, 95% CI [0.459, 1.122]);在EBP方面則為42.4% (ab = 0.287, 95% CI [0.189, 0. 404]);功能性損傷方面為70.0% (ab = 0.072, 95% CI [0.049, 0.121])。當社會支持感知為低水平時, 功能性損傷的間接效應便最強。雖然本研究提供了證據, 顯示壓力源與精神病理學之間的路徑可能為雙向性, 可是, 結果反映青少年的日常壓力源為創傷事件影響裡重要的遞質, 凸顯干預治療不應只針對處理創傷, 更應針對減輕當前壓力和提高社會支持。 Simplified Chinese 标题: 创伤经历和日常压力源对斯里兰卡青少年心理的相对影响 撮要: 过往的创伤、当前的压力以及缺乏社会支持, 都能导致青少年有心理问题。由于经历创伤事件后日常压力源一般都会提升, 创伤有可能透过持续的压力直接和间接地影响个人的精神病理学。斯里兰卡曾于2004年发生海啸, 本研究透过753名居于受影响地区的青少年其心理状况, 检视创伤和日常压力源带来的相对影响。样本于2008年进行以下测量:创伤经历、日常压力源、社会支持、创伤后压力症状(PTSS)、情绪和行为问题(EBP)、功能性损伤。16个月后, 一群子样本(n = 89)再次进行以上测量。回归模型均显示累积创伤跟其他3项心理健康测量有正向关连, 而日常压力源能间接解释这些关连之间显著的方差。在PTSS方面, 这种间接效应解释了创伤总效应的26.1%(非标准化回归系数ab = 0. 739, 95% CI [0.459, 1.122]);在EBP方面则为42.4% (ab = 0.287, 95% CI [0.189, 0. 404]);功能性损伤方面为70.0% (ab = 0.072, 95% CI [0.049, 0.121])。当社会支持感知为低水平时, 功能性损伤的间接效应便最强。虽然本研究提供了证据, 显示压力源与精神病理学之间的路径可能为双向性, 可是, 结果反映青少年的日常压力源为创伤事件影响里重要的递质, 凸显干预治疗不应只针对处理创伤, 更应针对减轻当前压力和提高社会支持。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 487-498, August 2018.
  

  July 30, 2018   doi: 10.1002/jts.22311   open full text
• The Child Trauma Screen: A Follow‐Up Validation.
  Jason M. Lang, Christian M. Connell.
  Journal of Traumatic Stress. July 30, 2018
  --- - |2 Abstract Although the prevalence of exposure to potentially traumatic events and associated outcomes among children is well documented, widespread trauma screening remains limited. This study provides additional data supporting the psychometrics of the Child Trauma Screen (CTS), a free, brief, empirically derived measure that was intended as a trauma screen for use across child‐serving systems. Participants were an ethnically diverse sample of 187 children aged 6–18 years recruited from an urban children's community mental health clinic. At intake, children and their caregivers completed the CTS and other standardized measures of posttraumatic stress disorder, externalizing behavior, anxiety, and depression. Results indicated that the CTS had strong properties on both child and caregiver reports, including internal consistency (Cronbach's α = .78 for both), convergent validity (r = .83 and r = .86), divergent validity (mean across measures and reporters, r = .31; range r = .01–.70), and criterion validity (sensitivity = 0.83 and 0.76; specificity = 0.95 and 0.79, correct classification 89.3% and 81.4%). Suggested cut points and recommendations for using the CTS as a trauma screen are provided. This study provides further empirical support for the use of the CTS as a brief trauma screening measure and provides recommendations for further research. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La Detección de Trauma para niños: una validación de seguimiento VALIDACIÓN DE SEGUIMIENTO DEL INSTRUMENTO DETECCIÓN DE TRAUMA PARA NIÑOS La prevalencia de la exposición a eventos potencialmente traumáticos y su asociación a algunas consecuencias en niños está bien documentada, sin embargo, la cobertura de la detección de trauma sigue siendo limitada. Este estudio provee información adicional que apoya las propiedades psicométricas de la Detección de Trauma para Niños (CTS por sus siglas en inglés), una medida gratuita, breve, y derivada empíricamente, que se concibió como un instrumento de detección de trauma para su uso en los sistemas de servicios infantiles. Los participantes fueron una muestra étnicamente diversa de 187 niños urbanos, entre los 6–18 años, reclutados en una clínica de salud mental comunitaria. Al ingreso, los niños y sus cuidadores completaron la CTS y otras mediciones estandarizadas para trastorno de estrés postraumático, conducta externalizante, ansiedad y depresión. Los resultados indicaron que la CTS tenía fuertes propiedades, tanto para el reporte de los niños como de los cuidadores, incluyendo consistencia interna (α de Cronbach = 0.78 en ambos), validez convergente (r = .83 y r = .86), validez divergente (promedio a través de las mediciones y los respondedores, r = .31; rango r = .02 ‐ .70), y validez de criterio (sensibilidad = 0.83 y 0.76; especificidad = 0.95 y 0.79, clasificación correcta 89.3% y 81.4%). Se proporcionan puntos de cortes y recomendaciones para el uso del CTS como detección para trauma. Este estudio proporciona apoyo empírico adicional para el uso del CTS como una medida breve para la detección de trauma y proporciona recomendaciones para futuras investigaciones. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 The Child Trauma Screen: A Follow‐up Validation Traditional Chinese 標題: 兒童創傷篩檢:進一步的效度建立 撮要: 過往已有大量研究檢視兒童經歷潛在創傷事件的普遍率與相關心理狀況, 但我們仍缺乏廣泛的創傷篩檢工具。兒童創傷篩檢(CTS)是免費、簡短並基於實證的測量工具, 予照顧兒童的組織進行創傷篩檢用。本研究旨在找出更多計量心理學數據支持CTS。我們從市區內一所為兒童而設的社區心理治療診所, 取得由187名年齡為6–18歲、不同種族的兒童組成的樣本。兒童與他們的照料者完成CTS及對以下方面的標準化測量:創傷後壓力症、外化行為、焦慮症、抑鬱症。結果反映CTS對兒童和照料者的報告均有強的測量特性, 包括內部一致性(兩者均為Cronbach's α = 0.78)、匯聚效度(r = .83 和r = .86)、區別效度(測量工具與報告者之間的平均數, r = .31; 值域r = .01–.70)、標準效度(敏感性 = 0.83 和0.76; 特殊性 = 0.95 和0.79, 正確區別率為89.3% 和81.4%)。我們為採用CTS作創傷篩檢及其分界點作出建議。本研究為使用CTS作為簡短的創傷篩檢工具提供更多實證數據, 並為未來研究提供建議。 Simplified Chinese 标题: 儿童创伤筛检:进一步的效度建立 撮要: 过往已有大量研究检视儿童经历潜在创伤事件的普遍率与相关心理状况, 但我们仍缺乏广泛的创伤筛检工具。儿童创伤筛检(CTS)是免费、简短并基于实证的测量工具, 予照顾儿童的组织进行创伤筛检用。本研究旨在找出更多计量心理学数据支持CTS。我们从市区内一所为儿童而设的小区心理治疗诊所, 取得由187名年龄为6–18岁、不同种族的儿童组成的样本。儿童与他们的照料者完成CTS及对以下方面的标准化测量:创伤后压力症、外化行为、焦虑症、抑郁症。结果反映CTS对儿童和照料者的报告均有强的测量特性, 包括内部一致性(两者均为Cronbach's α = 0.78)、汇聚效度(r = .83 和r = .86)、区别效度(测量工具与报告者之间的平均数, r = .31; 值域r = .01–.70)、标准效度(敏感性 = 0.83 和0.76; 特殊性 = 0.95 和0.79, 正确区别率为89.3% 和81.4%)。我们为采用CTS作创伤筛检及其分界点作出建议。本研究为使用CTS作为简短的创伤筛检工具提供更多实证数据, 并为未来研究提供建议。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 540-548, August 2018.
  

  July 30, 2018   doi: 10.1002/jts.22310   open full text
• Posttraumatic Stress Disorder in Very Young Children: Diagnostic Agreement Between ICD‐11 and DSM‐5.
  Mira Vasileva, Ann‐Christin Haag, Markus A. Landolt, Franz Petermann.
  Journal of Traumatic Stress. July 27, 2018
  --- - |2 Abstract The prevalence of posttraumatic stress disorder (PTSD) in very young children depends on the diagnostic criteria. Thus far, studies have investigated the International Classification of Diseases (11th rev.; ICD‐11) criteria for PTSD only in samples of children older than 6 years of age. The aim of this study was to test the diagnostic agreement between the ICD‐11 and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5) criteria for children who are 6 years old and younger. Caregivers of children aged 3–6 years in foster care in Germany (N = 147) and parents of children aged 1–4 years who had attended a hospital in Switzerland following burn injuries (N  = 149) completed a questionnaire about children's PTSD. Rates of PTSD were calculated according to ICD‐11 (considering a specific and a more general conceptualization of intrusive memories) and DSM‐5 criteria and were compared using McNemar's tests and Cohen's kappa. The proportion of children who met the ICD‐11 criteria was 0.6–25.8% lower than the proportion of PTSD cases according to the DSM‐5 criteria. The diagnostic agreement between each ICD‐11 algorithm and DSM‐5 was moderate, κ = 0.52–0.66. A systematic investigation of adaptions of the ICD‐11 avoidance cluster identified alternative symptom combinations leading to higher agreement with the DSM‐5 requirements. Furthermore, DSM‐5 had higher predictive power for functional impairment than the ICD‐11 algorithms. In conclusion, the findings suggest that the ICD‐11 criteria show less sensitivity in very young children, which can be explained by the more stringent avoidance cluster. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trastorno de estrés postraumático en niños muy pequeños: Acuerdos diagnósticos entre el CIE‐11 y el DSM‐5 TEPT EN NIÑOS MUY PEQUEÑOS: CIE‐11 Y DSM‐5 La prevalencia del trastorno de estrés postraumático (TEPT) en niños muy pequeños depende de los criterios de diagnóstico. Hasta el momento, los estudios han investigado el criterio propuesto en la Clasificación Internacional de Enfermedades (11ª rev.; CIE‐11) para el TEPT solo en muestras de niños mayores de 6 años. El objetivo de este estudio fue probar el acuerdo de diagnóstico entre los criterios del CIE‐11 y el Manual Diagnóstico y Estadístico de los Trastornos Mentales (5ª ed., DSM‐5 en su sigla en inglés) para niños de hasta 6 años. Cuidadores de niños de 3–6 años en hogares de acogida en Alemania (n = 147) y niños de 1 a 4 años que habían asistido a un hospital en Suiza debido a lesiones por quemaduras (n = 149) completaron un cuestionario sobre TEPT infantil. Las tasas de TEPT se calcularon de acuerdo a los criterios CIE‐11 (considerando una conceptualización específica y una más general sobre los recuerdos intrusivos) y los criterios DSM‐5 y fueron comparadas usando las pruebas de McNemar y la kappa de Cohen. La proporción de niños que cumplieron los criterios de la CIE‐11 fue 0.6 ‐ 25.8% más baja que la proporción de casos de TEPT según el criterio DSM‐5. El acuerdo de diagnóstico entre cada algoritmo CIE‐11 y DSM‐5 fue moderado, κs = 0.52 ‐ 0.66. Una investigación sistemática de las adaptaciones del clúster de evitación CIE‐11 identificó las combinaciones de síntomas alternativos llevando a un mayor acuerdo con los requerimientos DSM‐5. Además, el DSM‐5 tuvo mayor poder predictivo para deterioro funcional que los algoritmos CIE‐11. En conclusión, los hallazgos sugieren que los criterios CIE‐11 planeados muestran menos sensibilidad en niños muy pequeños, lo que puede explicarse por el clúster de evitación más estricto. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Posttraumatic Stress Disorder in Very Young Children: Diagnostic Agreement between ICD‐11 and DSM‐5 Traditional Chinese 標題: 年紀很小的兒童的創傷後壓力症:ICD‐11 與DSM‐5的診斷吻合度 撮要: 要得出幼兒的創傷後壓力症(PTSD)普遍率, 視乎用以診斷的準則。目前為止的研究只檢視對6歲以上兒童採用第十一版國際疾病分類(ICD‐11)提出的PTSD準則的效果。本研究旨在測試對6歲或以下兒童來說, 使用ICD‐11和精神疾病診斷與統計手冊第五版(DSM‐5)的準則是否能取得吻合的診斷。德國兒童寄養所裡3–6歲兒童的照顧者(n = 147), 以及瑞士一醫院裡1–4歲燒傷兒童的照顧者(n = 149), 均完成了有關兒童PTSD的問卷。我們根據ICD‐11 (考慮到特殊與較普遍的侵擾記憶概念) 和DSM‐5的準則取得PTSD比率, 並以McNemar檢定法和Cohen's kappa係數分析進行比較。以ICD‐11得出的兒童PTSD比率, 比用DSM‐5低0.6–25.8%。每項ICD‐11與DSM‐5計算法的診斷吻合度為中等(κs = 0.52–0.66)。我們對ICD‐11的迴避聚類進行系統性調查, 發現有其他症狀組合跟DSM‐5準則較為吻合。此外, 相比ICD‐11, DSM‐5對功能性損傷有較強的預測力。總結, 較具體的迴避聚類反映, ICD‐11提出的準則對幼兒的敏感度較低。 Simplified Chinese 标题: 年纪很小的儿童的创伤后压力症:ICD‐11 与DSM‐5的诊断吻合度 撮要: 要得出幼儿的创伤后压力症(PTSD)普遍率, 视乎用以诊断的准则。目前为止的研究只检视对6岁以上儿童采用第十一版国际疾病分类(ICD‐11)提出的PTSD准则的效果。本研究旨在测试对6岁或以下儿童来说, 使用ICD‐11和精神疾病诊断与统计手册第五版(DSM‐5)的准则是否能取得吻合的诊断。德国儿童寄养所里3–6岁儿童的照顾者(n = 147), 以及瑞士一医院里1–4岁烧伤儿童的照顾者(n = 149), 均完成了有关儿童PTSD的问卷。我们根据ICD‐11 (考虑到特殊与较普遍的侵扰记忆概念) 和DSM‐5的准则取得PTSD比率, 并以McNemar检定法和Cohen's kappa系数分析进行比较。以ICD‐11得出的儿童PTSD比率, 比用DSM‐5低0.6–25.8%。每项ICD‐11与DSM‐5计算法的诊断吻合度为中等(κs = 0.52–0.66)。我们对ICD‐11的回避聚类进行系统性调查, 发现有其他症状组合跟DSM‐5准则较为吻合。此外, 相比ICD‐11, DSM‐5对功能性损伤有较强的预测力。总结, 较具体的回避聚类反映, ICD‐11提出的准则对幼儿的敏感度较低。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 529-539, August 2018.
  

  July 27, 2018   doi: 10.1002/jts.22314   open full text
• The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men.
  Nikhil Banerjee, Gail Ironson, Calvin Fitch, Michael S. Boroughs, Steven A. Safren, Alexis Powell, Conall O'Cleirigh.
  Journal of Traumatic Stress. July 20, 2018
  --- - |2 Abstract Self‐medication theory posits that some trauma survivors use alcohol to cope with posttraumatic stress disorder (PTSD) symptoms, but the role of negative posttraumatic cognitions in this relationship is not well defined. We examined associations among PTSD symptoms, posttraumatic cognitions, and alcohol intoxication frequency in 290 men who have sex with men (MSM), who reported a history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined the indirect effects of PTSD symptoms on alcohol intoxication frequency through posttraumatic cognitions regarding the self, world, and self‐blame. In separate regression models, higher levels of PTSD symptoms and posttraumatic cognitions were each associated with more frequent intoxication, accounting for 2.6% and 5.2% of the variance above demographics, respectively. When examined simultaneously, posttraumatic cognitions remained significantly correlated with intoxication frequency whereas PTSD symptoms did not. Men reporting elevated posttraumatic cognitions faced increased odds for current alcohol dependence, odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low posttraumatic cognitions, independent of current PTSD diagnosis. A higher level of PTSD symptom severity was indirectly associated with more frequent alcohol intoxication through cognitions about the self and world; the indirect to total effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions pertaining to individuals’ self‐perceptions and appraisals of the world as dangerous may play a role in self‐medication with alcohol among MSM with a history of CSA. Interventions targeting these cognitions may offer potential for reducing alcohol misuse in this population, with possible broader implications for HIV‐infection risk. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Los efectos indirectos de los síntomas de TEPT en el consumo actual de alcohol a través de cogniciones negativas en hombres de minorías sexuales TEPT, COGNICIONES Y CONSUMO DE ALCOHOL EN HSH La teoría de la automedicación postula que algunos sobrevivientes de trauma usan alcohol para hacer frente a los síntomas del trastorno de estrés postraumático (TEPT), pero el papel de las cogniciones postraumáticas negativas en esta relación no está bien definida. Examinamos las asociaciones entre los síntomas de TEPT, cogniciones postraumáticas y frecuencia de intoxicación alcohólica en 290 hombres que tienen sexo con hombres (HSH), que reportan un historial de abuso sexual infantil (ASI). Usando un enfoque de bootstrap, examinamos los efectos indirectos de los síntomas de TEPT en la frecuencia de intoxicación por alcohol a través de las cogniciones postraumáticas con respecto al yo, el mundo y la auto‐culpa. En modelos de regresión separada, niveles más altos de síntomas de TEPT y cogniciones postraumáticas se asociaron cada uno con intoxicación más frecuente, representando el 2.6% y 5.2% de la varianza sobre las variables demográficas, respectivamente. Cuando se examinaron simultáneamente, las cogniciones postraumáticas permanecieron correlacionados significativamente con la frecuencia de intoxicación mientras que los síntomas de TEPT no lo hicieron. Los hombres que reportaron cogniciones postraumáticas elevadas enfrentaron mayores probabilidades de dependencia actual del alcohol, odds ratio (OR) = 2,19, IC del 95% [1,13, 4,22], en comparación con los hombres que informaron bajas cogniciones postraumáticas, independientemente del diagnóstico actual de TEPT. Un nivel más alto de severidad de los síntomas de TEPT se asoció indirectamente con la intoxicación alcohólica más frecuente mediada por cogniciones sobre la yo y mundo; las razones de los efectos indirectos a totales fueron de 0.74 y 0.35, respectivamente. Las cogniciones postraumáticas negativas pertenecientes a las autopercepciones y valoraciones individuales del mundo como peligrosas pueden jugar un papel en la automedicación con alcohol entre los HSH con un historial de ASI. Las intervenciones dirigidas a estas cogniciones pueden ofrecer un potencial para la reducción del mal uso del alcohol en esta población, con posibles implicaciones más amplias para el riesgo de infección por VIH. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 The Indirect Effects of PTSD Symptoms on Current Alcohol Use through Negative Cognitions in Sexual Minority Men Traditional Chinese 標題: 男性性小眾中, PTSD症狀透過負面認知對當前酒精使用的間接效應 撮要: 自我醫療理論(Self‐medication theory)假設, 一些創傷生還者會使用酒精來應對創傷後壓力症(PTSD)症狀, 可是我們不清楚創傷後負面的認知在這關係中的影響。我們透過290名與男性發生性行為(MSM)並在兒時曾受性虐待(CSA)的男性, 檢視PTSD症狀、創傷後認知和酒精中毒頻率之間的關連。我們採用拔靴(Bootstrap)法, 檢視PTSD症狀透過創傷後對個人、世界與自責的認知, 對酒精中毒頻率的間接效應。在不同的迴歸模型裡, PTSD症狀水平較高和創傷後認知水平較高分別都跟酒精中毒較頻繁有關, 分別解釋了人口變量以外2.6%和5.2%的方差;若同時檢視它們, 創傷後認知跟酒精中毒頻率仍顯著相關, 但PTSD症狀則沒有。暫不考慮當前的PTSD診斷結果, 創傷後認知水平提升的男士, 相比創傷後認知水平低的男士有較大機會於當前依賴酒精(勝算比(OR) = 2.19, 95% CI [1.13, 4.22])。PTSD症狀水平較高, 會透過對個人與世界的認知而間接地跟酒精中毒較頻繁有關, 間接比對總效應的比值分別為0.74和0.35。創傷後負面的認知 (有關個人的自我感知及認為世界危險) , 可能對有CSA的MSM人士以酒精作自我醫療有所影響。針對這些認知的干預治療, 可能可減輕這類人口濫用酒精的情況, 亦可能可廣泛地減低HIV感染的風險。 Simplified Chinese 标题: 男性性小众中, PTSD症状透过负面认知对当前酒精使用的间接效应 撮要: 自我医疗理论(Self‐medication theory)假设, 一些创伤生还者会使用酒精来应对创伤后压力症(PTSD)症状, 可是我们不清楚创伤后负面的认知在这关系中的影响。我们透过290名与男性发生性行为(MSM)并在儿时曾受性虐待(CSA)的男性, 检视PTSD症状、创伤后认知和酒精中毒频率之间的关连。我们采用拔靴(Bootstrap)法, 检视PTSD症状透过创伤后对个人、世界与自责的认知, 对酒精中毒频率的间接效应。在不同的回归模型里, PTSD症状水平较高和创伤后认知水平较高分别都跟酒精中毒较频繁有关, 分别解释了人口变量以外2.6%和5.2%的方差;若同时检视它们, 创伤后认知跟酒精中毒频率仍显著相关, 但PTSD症状则没有。暂不考虑当前的PTSD诊断结果, 创伤后认知水平提升的男士, 相比创伤后认知水平低的男士有较大机会于当前依赖酒精(胜算比(OR) = 2.19, 95% CI [1.13, 4.22])。PTSD症状水平较高, 会透过对个人与世界的认知而间接地跟酒精中毒较频繁有关, 间接比对总效应的比值分别为0.74和0.35。创伤后负面的认知 (有关个人的自我感知及认为世界危险) , 可能对有CSA的MSM人士以酒精作自我医疗有所影响。针对这些认知的干预治疗, 可能可减轻这类人口滥用酒精的情况, 亦可能可广泛地减低HIV感染的风险。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 602-612, August 2018.
  

  July 20, 2018   doi: 10.1002/jts.22304   open full text
• Crowdsourcing Trauma: Psychopathology in a Trauma‐Exposed Sample Recruited via Mechanical Turk.
  Katherine Stolk‐Cooke, Andrew Brown, Anne Maheux, Justin Parent, Rex Forehand, Matthew Price.
  Journal of Traumatic Stress. July 19, 2018
  --- - |2 Abstract Although crowdsourcing websites like Amazon's Mechanical Turk (MTurk) allow researchers to conduct research efficiently, it is unclear if MTurk and traditionally recruited samples are comparable when assessing the sequela of traumatic events. We compared the responses to validated self‐report measures of posttraumatic stress disorder (PTSD) and related constructs that were given by 822 participants recruited via MTurk and had experienced a DSM‐5 Criterion A traumatic event to responses obtained in recent samples of participants recruited via traditional methods. Results suggested that the rate of PTSD in the present sample (19.8%) was statistically higher than that found in a recent systematic review of studies that used only traditional recruitment methods. The severity of PTSD reported in the MTurk sample was significantly greater than that reported in a college sample, d = 0.24, and significantly less than that reported in a veteran sample, d = 0.90. The factor structure of PTSD found in the MTurk sample was consistent with prevailing models of PTSD. Findings indicate that crowdsourcing may improve access to this hard‐to‐reach population. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trauma en Crowdsourcing (Colaboración Masiva Abierta): Psicopatología en una muestra expuesta a trauma reclutada por medio de Mechanical Turk RECLUTAMIENTO DE TRAUMA MEDIANTE MECHANICAL TURK (MTURK) Aunque sitios de crowdsourcing como Mechanical Turk (MTurk) de Amazon permiten a los investigadores llevar a cabo investigaciones eficientemente, no es claro si estas muestras de MTurk y aquellas reclutadas por mecanismos tradicionales son comparables cuando se evalúa la secuela de eventos traumáticos. Comparamos las respuestas, a medidas de auto‐reporte validadas de trastorno de estrés postraumático (TEPT) y constructos relacionados, proporcionadas por 822 participantes reclutados por medio de MTurk y que habían experimentado un evento traumático del Criterio A del DSM‐5, con las respuestas obtenidas en muestras recientes de participantes reclutados por medio de métodos tradicionales. Los resultados sugirieron que la tasa de TEPT en la presente muestra (19.8%) fue significativamente mayor que la encontrada en una reciente revisión sistemática de estudios que usaron solo métodos de reclutamiento tradicionales. La severidad del TEPT reportado en la muestra MTurk fue significativamente mayor a la reportada en una muestra de estudiantes universitarios, d = 0.24, y significativamente menor que la reportada en una muestra de veteranos, d = 0.90. La estructura factorial de TEPT encontrada en la muestra MTurk fue consistente con los modelos predominantes de TEPT. Los hallazgos indican que el sistema de crowdsourcing podría mejorar el acceso a poblaciones difíciles de reclutar. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Crowdsourcing Trauma: psychopathology in a traumaexposed sample recruited via Mechanical Turk Traditional Chinese 標題: 創傷的群眾外包:透過Mechanical Turk收集的受創樣本的精神病理學 撮要: 群眾外包網站如亞馬遜公司(Amazon)的Mechanical Turk (MTurk)給予研究員一個有效率地進行研究的渠道。可是, 在評估創傷事件後遺症時, 我們不清楚是否可拿從MTurk收集的數據來跟以傳統方式收集的數據比較。我們從MTurk收集822名人士的數據, 他們提供有關創傷後壓力症(PTSD)有效的自評測量及相關構念數據, 而且均經歷過符合DSM‐5準則A (Criterion A)的創傷事件。我們拿MTurk的數據跟近期以傳統方式收集的樣本數據比較, 對只用傳統方式收集數據的研究作系統性檢討, 發現現有樣本的PTSD比率(19.8%)較高。MTurk樣本的PTSD嚴重度比大學生樣本顯著較高(d = 0.24), 但比退役軍人樣本顯著較低(d = 0.90)。MTurk樣本裡的PTSD因素結構跟既有的PTSD模型一致。結果顯示, 群眾外包的方法有可能可令我們更易聯絡到這群難以接觸的人口。 Simplified Chinese 标题: 创伤的群众外包:透过Mechanical Turk收集的受创样本的精神病理学 撮要: 群众外包网站如亚马逊公司(Amazon)的Mechanical Turk (MTurk)给予研究员一个有效率地进行研究的渠道。可是, 在评估创伤事件后遗症时, 我们不清楚是否可拿从MTurk收集的数据来跟以传统方式收集的数据比较。我们从MTurk收集822名人士的数据, 他们提供有关创伤后压力症(PTSD)有效的自评测量及相关构念数据, 而且均经历过符合DSM‐5准则A (Criterion A)的创伤事件。我们拿MTurk的数据跟近期以传统方式收集的样本数据比较, 对只用传统方式收集数据的研究作系统性检讨, 发现现有样本的PTSD比率(19.8%)较高。MTurk样本的PTSD严重度比大学生样本显著较高(d = 0.24), 但比退役军人样本显著较低(d = 0.90)。MTurk样本里的PTSD因素结构跟既有的PTSD模型一致。结果显示, 群众外包的方法有可能可令我们更易联络到这群难以接触的人口。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 549-557, August 2018.
  

  July 19, 2018   doi: 10.1002/jts.22303   open full text
• Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and Any Mental Health Condition Among U.S. Soldiers and Marines, 2001–2011.
  Alison Levin‐Rector, Laurel L. Hourani, Richard A. Dorn, Robert M. Bray, Valerie A. Stander, Joel K. Cartwright, Jessica K. Morgan, James Trudeau, Pamela K. Lattimore.
  Journal of Traumatic Stress. July 19, 2018
  --- - |2 Abstract Understanding mental health disorder diagnosis and treatment seeking among active‐duty military personnel is a topic with both clinical and policy implications. It has been well documented in military populations that individual‐level military experience, including deployment history and combat exposure, influences mental health outcomes, but the impact of unit‐level factors is less well understood. In the current study, we used administrative longitudinal data to examine a comprehensive set of unit‐ and individual‐level predictors of posttraumatic stress disorder (PTSD), non‐PTSD anxiety disorders, depressive disorders, and overall mental health diagnoses among Army and Marines Corps personnel. Using Cox survival models for time‐dependent variables, we analyzed time from military accession (between January 1, 2001 and December 31, 2011) until first mental health diagnosis for 773,359 soldiers and 332,093 Marines. Prior diagnosis of a substance abuse disorder during one's military career, hazard ratios (HRs) = 1.68–3.10, and cumulative time spent deployed, HRs = 1.11–2.04, were the most predictive risk factors for all outcomes. Male sex, HRs = 0.35–0.57, and officer rank, HRs = 0.13–0.23, were the most protective factors. Unit‐level rate of high deployment stress was a small but significant predictor of all outcomes after controlling for individual‐level deployment history and other predictors, HRs = 1.01–1.05. Findings suggest both unit‐ and individual‐level risk and protective factors of mental health diagnoses associated with treatment seeking. Clinical, including mental health assessment and management, and policy implications related to the military environment and the individual as it relates to mental health disorders are discussed. Resumen Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Predictores de Trastorno de Estrés Postraumático, Trastornos de Ansiedad, Trastornos Depresivos y cualquier Condición de Salud Mental entre los Soldados e Infantería de Marina de EE. UU., 2001–2011 TRASTORNO DE LA SALUD MENTAL EN LOS MILITARES DE EE. UU Comprender el diagnóstico de trastornos de salud mental y la búsqueda de tratamiento entre el personal militar activo es un tópico con implicaciones clínicas y políticas. Se ha documentado bien en poblaciones militares que la experiencia militar a nivel individual, incluyendo el historial de despliegue y la exposición al combate, influyen en los resultados de salud mental, pero el impacto de los factores a nivel de unidad son menos comprendidos. Este estudio examinó un conjunto completo de predictores a nivel de unidad y a nivel individual del trastorno de estrés postraumático (TEPT), trastornos de ansiedad no TEPT, trastornos depresivos y diagnósticos generales de salud mental entre el personal del ejército y del cuerpo de marines utilizando datos administrativos longitudinales. Usando modelos de supervivencia de Cox para variables dependientes del tiempo, analizamos el tiempo desde la adhesión militar (entre el 1 de enero de 2001 y 31 de diciembre de 2011) hasta el primer diagnóstico de salud mental para 773,359 soldados y 332,093 Infantes de marina. El diagnóstico previo de un trastorno por abuso de sustancias durante la carrera militar, con proporciones de riesgo [HRs] = 1.68‐3.10, y el tiempo acumulado en despliegue, HRs = 1.11‐2.04, fueron los más factores de riesgo más predictivos para todos los resultados. Sexo masculino, HRs = 0.35‐0.57, y rango de oficial, HRs = 0.13‐0.23, fueron los factores más protectores. La tasa a nivel de unidad de alto estrés en el despliegue fue un predictor menor pero significativo de todos los resultados después de controlar por la historia de despliegue a nivel individual y otros predictores, HRs = 1.01‐1.05. Los hallazgos sugieren factores de riesgo y de protección a nivel individual y de unidad de los diagnósticos de salud mental asociados con la búsqueda de tratamiento. Se discuten implicaciones clínicas, incluida la evaluación y gestión de la salud mental, y las implicancias de política relacionadas con el entorno militar y del individuo en lo que se refiere a los trastornos de salud mental. 抽象 Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and any Mental Health Condition among U.S. Soldiers and Marines, 2001–2011 Traditional Chinese 標題: 2001–2011年美國陸軍與海軍創傷後壓力症、焦慮症、抑鬱症及其他心理問題的預測變量 撮要: 加深理解現役軍人的精神疾病診斷與尋求治療情況, 對臨床治療和政策制訂都有幫助。過往研究已發現軍人個人的從軍經驗, 包括服役歷史和戰鬥經歷, 會影響其心理健康。然而, 我們對軍事單位層面構成的影響仍缺乏理解。本研究透過縱貫行政數據, 全面地檢視美國陸軍與海軍陸戰隊成員當中, 個人與單位層面對以下問題的預測變量:創傷後壓力症(PTSD)、非PTSD的焦慮症、抑鬱症及整體心理問題。我們以Cox存活分析模型(Cox survival models)找出時間相依的變量, 分析 773,359 名陸軍與 332,093 名海軍由開始從軍 (2001年1月1日至2011年12月31日之間) 到首次被診斷有心理問題的時間。過往從軍被診斷有濫用藥物問題(風險比率 [HRs] = 1.68–3.10), 以及累積的服役時間(HRs = 1.11–2.04)兩者對所有心理問題均為預測力最強的風險因素。性別為男性(HRs = 0.35–0.57)和軍官軍銜(HRs = 0.13–0.23)均為最強的保護因素。以個人層面的服役歷史和其他預測變量作對照試驗後, 在單位層面服役壓力大是所有心理問題小而顯著的預測變量(HRs = 1.01–1.05)。研究指出了與軍人心理診斷相關、個人及單位層面的風險因素與保護因素。我們亦討論到臨床工作如心理評估和治療, 及與軍事環境及個人相關的政策對精神疾病有何影響。 Simplified Chinese 标题: 2001–2011年美国陆军与海军创伤后压力症、焦虑症、抑郁症及其他心理问题的预测变量 撮要: 加深理解现役军人的精神疾病诊断与寻求治疗情况, 对临床治疗和政策制订都有帮助。过往研究已发现军人个人的从军经验, 包括服役历史和战斗经历, 会影响其心理健康。然而, 我们对军事单位层面构成的影响仍缺乏理解。本研究透过纵贯行政数据, 全面地检视美国陆军与海军陆战队成员当中, 个人与单位层面对以下问题的预测变量:创伤后压力症(PTSD)、非PTSD的焦虑症、抑郁症及整体心理问题。我们以Cox存活分析模型(Cox survival models)找出时间相依的变量, 分析 773,359 名陆军与 332,093 名海军由开始从军 (2001年1月1日至2011年12月31日之间) 到首次被诊断有心理问题的时间。过往从军被诊断有滥用药物问题(风险比率 [HRs] = 1.68–3.10), 以及累积的服役时间(HRs = 1.11–2.04)两者对所有心理问题均为预测力最强的风险因素。性别为男性(HRs = 0.35–0.57)和军官军衔(HRs = 0.13–0.23)均为最强的保护因素。以个人层面的服役历史和其他预测变量作对照试验后, 在单位层面服役压力大是所有心理问题小而显著的预测变量(HRs = 1.01–1.05)。研究指出了与军人心理诊断相关、个人及单位层面的风险因素与保护因素。我们亦讨论到临床工作如心理评估和治疗, 及与军事环境及个人相关的政策对精神疾病有何影响。 - Journal of Traumatic Stress, Volume 31, Issue 4, Page 568-578, August 2018.
  

  July 19, 2018   doi: 10.1002/jts.22316   open full text
• The Association Between PTSD and Functional Outcome Is Mediated by Perception of Cognitive Problems Rather Than Objective Neurological Test Performance.
  Kristin W. Samuelson, Linda Abadjian, Joshua T. Jordan, Alisa Bartel, Jennifer Vasterling, Karen Seal.
  Journal of Traumatic Stress. October 14, 2017
  Posttraumatic stress disorder (PTSD) has been consistently linked to poorer functional outcomes, including quality of life, health problems, and social and occupational functioning. Less is known about the potential mechanisms by which PTSD leads to poorer functional outcomes. We hypothesized that neurocognitive functioning and perception of cognitive problems would both mediate the relationship between PTSD diagnosis and functioning. In a sample of 140 veterans of the recent wars and conflicts in Iraq and Afghanistan, we assessed PTSD symptoms, history of traumatic brain injury (TBI), depression, self‐report measures of quality of life, social and occupational functioning, and reintegration to civilian life, as well as perception of cognitive problems. Veterans also completed a comprehensive neuropsychological battery of tests. Structural equation modeling revealed that perception of cognitive problems, but not objective neuropsychological performance, mediated the relationship between PTSD diagnosis and functional outcomes after controlling for TBI, depression, education, and a premorbid IQ estimate, b = −6.29, 95% bias‐corrected bootstrapped confidence interval [−11.03, −2.88], showing a large effect size. These results highlight the importance of addressing appraisals of posttrauma cognitive functioning in treatment as a means of improving functional outcomes.

  October 14, 2017   doi: 10.1002/jts.22223   open full text
• Examining a Dual‐Process Model of Desensitization and Hypersensitization to Community Violence in African American Male Adolescents.
  Noni K. Gaylord‐Harden, Grace J. Bai, Dusan Simic.
  Journal of Traumatic Stress. October 12, 2017
  The purpose of the current study was to examine a dual‐process model of reactivity to community violence exposure in African American male adolescents from urban communities. The model focused on desensitization and hypersensitization effects as well as desensitization and hypersensitization as predictors of aggressive behavior. Participants were 133 African American male high school students, mean age = 15.17 years, SD = 0.96. Participants completed measures of exposure to community violence, depressive symptoms, hyperarousal symptoms, aggressive beliefs, and aggressive behaviors at two time points. Community violence exposure predicted changes in aggression, β = .25, p = .004, and physiological arousal, β = .22, p = .010, over time, but not aggressive beliefs. The curvilinear association between community violence exposure and changes in depression over time was not significant, β = .42, p = .083, but there was a significant linear association between the exposure to community violence (ECV) and changes in levels of depression over time, β = .21, p = .014. Results indicated a significant mediation effect for hyperarousal on the association between community violence exposure and aggressive behavior, B = 0.20, 95% CI = [0.04, 0.54]. Results showed support for physiological hypersensitization, with hypersensitization increasing the risk for aggressive behavior.

  October 12, 2017   doi: 10.1002/jts.22220   open full text
• Friendship in War: Camaraderie and Prevention of Posttraumatic Stress Disorder Prevention.
  Michael D. Nevarez, Hannah M. Yee, Robert J. Waldinger.
  Journal of Traumatic Stress. October 12, 2017
  Aspects of social support during combat deployment, such as unit cohesion, have been shown to affect later posttraumatic stress disorder (PTSD) development among veterans. We utilized a longitudinal database to assess how relationship quality with fellow soldiers in World War II (WWII) might be linked with postwar PTSD symptoms. Data were available on 101 men who experienced combat exposure in WWII, documented through postwar assessment. Upon study entry (1939 to 1942), data were collected on the quality of participants’ early childhood relationships and their emotional adjustment during college. Data on WWII experiences were collected in 1946. Relationship quality with fellow soldiers in WWII was examined as a moderator of the link between combat exposure and postwar PTSD symptoms. Prewar emotional adjustment was examined as a mediator between quality of childhood relationships and subsequent quality of relationships quality with fellow soldiers during war. Better quality relationships with fellow soldiers attenuated (i.e., moderated) the link between combat exposure severity and PTSD symptom count, explaining a significant percent of the variance, R2 = .19, p < .001. There was also a significant indirect mediation effect of childhood relationship quality on relationships with soldiers through prewar emotional adjustment, ab = 0.02, 95% BCa CI [0.01, 0.05]. Results suggest that better peer relationship quality during deployment may reduce the likelihood of subsequent PTSD symptom development, and that the quality of early relationships may set the stage for better relationships during stressful contexts such as war. These findings have implications for PTSD risk factor screening prior to deployment, and underscore the importance of interpersonal support among soldiers during deployment.

  October 12, 2017   doi: 10.1002/jts.22224   open full text
• Functional Limitations Among Responders to the World Trade Center Attacks 14 Years After the Disaster: Implications of Chronic Posttraumatic Stress Disorder.
  Sean A. P. Clouston, Jack M. Guralnik, Roman Kotov, Evelyn J. Bromet, Benjamin J. Luft.
  Journal of Traumatic Stress. October 12, 2017
  Posttraumatic stress disorder (PTSD) is associated with self‐reported difficulties navigating the social and physical world and may also be associated with risk of functional limitations. The Short Physical Performance Battery (SPPB), an objective functional assessment, was administered during monitoring exams between January and December 2015 to a consecutive sample of 1,268 rescue workers, volunteers, and other responders who had aided in response, recovery, and cleanup efforts at the World Trade Center (WTC) in New York after the September 11, 2011 attacks. Data were linked with diagnostic and longitudinal data from the WTC monitoring study. Multivariable analyses were used to examine predictors of functional limitations. Prevalence estimates weighted to the general responder population revealed a relatively high prevalence of functional limitations, SPPB ≤ 9; 16.0%, 95% CI [13.7, 18.4]. Current PTSD was associated with a twofold increased risk of functional limitations after controlling for predisposing factors, trauma severity, behavioral factors, and WTC‐related medical conditions, adjusted risk ratio (aRR) = 2.11, 95% CI [1.48, 3.01]. Exposure to ergonomic risk factors at the WTC also increased the risk of functional impairments, aRR = 1.34 95% CI [1.05, 1.70]. Longitudinal results suggest that individuals with current functional limitations experienced high baseline PTSD severity, B = 2.94, SE = 1.33, and increasing PTSD symptom severity, B = 0.29, SE = 0.10, since September 11, 2001. This study identified a cross‐sectional relationship between functional limitations and PTSD and a worsening of PTSD symptoms in persons who eventually demonstrated functional limitations. Results highlight the potential role of chronic PTSD in functional limitations.

  October 12, 2017   doi: 10.1002/jts.22219   open full text
• Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members.
  Amber D. Seelig, Anna C. Rivera, Teresa M. Powell, Emily C. Williams, Arthur V. Peterson, Alyson J. Littman, Charles Maynard, Amy E. Street, Jonathan B. Bricker, Edward J. Boyko.
  Journal of Traumatic Stress. September 14, 2017
  In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001–2012). Adjusted complementary log–log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.

  September 14, 2017   doi: 10.1002/jts.22214   open full text
• Comorbidity of Posttraumatic Stress Disorder and Depression in Tortured, Treatment‐Seeking Refugees.
  Angela Nickerson, Matthis Schick, Ulrich Schnyder, Richard A. Bryant, Naser Morina.
  Journal of Traumatic Stress. August 01, 2017
  Comorbid posttraumatic stress disorder (PTSD) and depression is common in refugee groups; however, little is known about the predictors and correlates of comorbidity in treatment‐seeking refugees. Participants in this study were 134 refugees resettled in Switzerland. Most participants were from Turkey, Iran, and Sri Lanka, and 92.7% had been exposed to torture. Self‐report measures were implemented to assess PTSD, depression, mental and physical health‐related quality of life (QoL), as well as pre‐ and postmigration experiences. Findings indicated that approximately half the sample met criteria for PTSD and depression, 33.6% met criteria for depression only, and only 2.2% met criteria for PTSD only. Several variables emerged as predictors of comorbidity in contrast to no diagnosis: female gender, odds ratio (OR) = 0.17; age, OR = 0.93; time in Switzerland, OR = 1.16; and trauma exposure, OR = 1.19. Postmigration stress was also associated with greater likelihood of comorbidity compared with no diagnosis, OR = 1.32, and a single diagnosis, OR = 1.14. Further, dual diagnosis was associated with significantly poorer mental health‐related and physical health‐related QoL (mental health‐related QoL: dual diagnosis vs. single diagnosis, d = −0.52 and dual diagnosis vs. no diagnosis, d = −1.30; physical health‐related QoL: dual diagnosis vs. single diagnosis, d = −0.73 and dual diagnosis vs. no diagnosis: d = −1.04). Findings indicated that comorbidity was highly prevalent in this sample of treatment‐seeking refugees and was associated with a substantial impairment burden. Psychological interventions for refugees should consider the dual impact of PTSD and depression symptoms to optimally decrease distress and improve QoL in this vulnerable group. La comorbilidad del trastorno de estrés postraumático (TEPT) y depresión es común en los grupos de refugiados, sin embargo, se sabe poco acerca de los predictores y correlatos de la comorbilidad en los refugiados que buscan tratamiento. Los participantes en este estudio fueron 134 refugiados reasentados en Suiza. La mayoría de los participantes eran de Turquía, Irán y Sri Lanka, y el 92,6% había sido expuesto a tortura. Se implementaron medidas de autoreporte para evaluar el TEPT, la depresión, la calidad de vida relacionada con la salud mental y física, así como experiencias pre y post migración. Los resultados indicaron que aproximadamente la mitad de la muestra cumplía los criterios para TEPT y depresión, el 33,6% cumplía sólo los criterios de depresión y el 2,2% cumplía los criterios de TEPT solamente. El sexo femenino (odds ratio [OR] = 0,17), la edad (OR = 0,93), el tiempo en Suiza (OR = 1,16) y la exposición al trauma (OR = 1,19) surgieron como predictores de comorbilidad en comparación con la ausencia de diagnóstico. El estrés post‐migración también se asoció con una mayor probabilidad de comorbilidad en comparación con la ausencia de diagnóstico (OR = 1,32) y un único diagnóstico (OR = 1,14). Además, el diagnóstico dual se asoció significativamente con una pobre calidad de vida relacionada con la salud mental y física (calidad de vida relacionada con la salud mental: diagnóstico dual versus diagnóstico único, d = ‐0,52 y diagnóstico dual versus sin diagnóstico, d = ‐1,30; calidad de vida relacionada con la salud física: diagnóstico dual versus diagnóstico único, d = ‐0,73 y diagnóstico dual versus sin diagnóstico: d = ‐1,04). Los hallazgos indican que la comorbilidad es muy prevalente entre los refugiados que buscan tratamiento y se asocia con una carga sustancial de discapacidad. Las intervenciones psicológicas para los refugiados deben considerar el doble impacto del TEPT y los síntomas depresivos, para disminuir de manera óptima la angustia y mejorar la calidad de vida en este grupo vulnerable. Traditional Chinese 標題: 尋求治療及曾受折磨的難民的創傷後壓力症與抑鬱症共病 撮要: 創傷後壓力症(PTSD)與抑鬱症共病在難民中普遍, 但我們仍不清楚在尋求治療的難民裡, 這種共病的預測變量和關連因素。本研究樣本為134名遷居到瑞士的難民。他們大部分來自土耳其、伊朗和斯里蘭卡, 92.6%曾遭受折磨。我們採用自評測量, 評估樣本的PTSD、抑鬱症、跟心理和身體健康相關的生活質素、和遷徙前與遷徙後的經歷。結果反映, 約一半樣本達到患PTSD與抑鬱症的標準, 33.6%只患抑鬱症, 2.2%只有PTSD。與無患病的樣本比較之下, 性別為女性 (機會比例[OR] = 0.17)、年齡(OR = 0.93)、於瑞士的時間(OR = 1.16)、和創傷經歷(OR = 1.19), 都是患共病的預測變量。與無患病的樣本(OR = 1.32)和只患一種病的樣本(OR = 1.14)比較, 遷徙後的壓力跟較大機會患共病相關。患有共病跟心理和身體健康相關的生活質素顯著較差有關 (心理健康相關的生活質素:共病比對只患一種病, d = ‐0.52, 共病比對無患病, d = ‐1.30༛身體健康相關的生活質素:共病比對只患一種病, d = ‐0.73, 共病比對無患病, d = ‐1.04) 。結果反映, 共病在尋求治療的難民中非常普遍, 並跟顯著的功能損傷有關。為難民提供的心理治療應加倍留意PTSD與抑鬱症的共病症狀, 務求更有效地減輕這種脆弱人口承受的悲痛, 提升他們的生活質素。 Simplified Chinese 标题: 寻求治疗及曾受折磨的难民的创伤后压力症与抑郁症共病 撮要: 创伤后压力症(PTSD)与抑郁症共病在难民中普遍, 但我们仍不清楚在寻求治疗的难民里, 这种共病的预测变量和关连因素。本研究样本为134名迁居到瑞士的难民。他们大部分来自土耳其、伊朗和斯里兰卡, 92.6%曾遭受折磨。我们采用自评测量, 评估样本的PTSD、抑郁症、跟心理和身体健康相关的生活质素、和迁徙前与迁徙后的经历。结果反映, 约一半样本达到患PTSD与抑郁症的标准, 33.6%只患抑郁症, 2.2%只有PTSD。与无患病的样本比较之下, 性别为女性 (机会比例[OR] = 0.17)、年龄(OR = 0.93)、于瑞士的时间(OR = 1.16)、和创伤经历(OR = 1.19), 都是患共病的预测变量。与无患病的样本(OR = 1.32)和只患一种病的样本(OR = 1.14)比较, 迁徙后的压力跟较大机会患共病相关。患有共病跟心理和身体健康相关的生活质素显着较差有关 (心理健康相关的生活质素:共病比对只患一种病, d = ‐0.52, 共病比对无患病, d = ‐1.30༛身体健康相关的生活质素:共病比对只患一种病, d = ‐0.73, 共病比对无患病, d = ‐1.04) 。结果反映, 共病在寻求治疗的难民中非常普遍, 并跟显着的功能损伤有关。为难民提供的心理治疗应加倍留意PTSD与抑郁症的共病症状, 务求更有效地减轻这种脆弱人口承受的悲痛, 提升他们的生活质素。

  August 01, 2017   doi: 10.1002/jts.22205   open full text
• Resilience and Posttraumatic Stress Disorder Symptoms in National Guard Soldiers Deployed to Iraq: A Prospective Study of Latent Class Trajectories and Their Predictors.
  Melissa A. Polusny, Christopher R. Erbes, Mark D. Kramer, Paul Thuras, Dave DeGarmo, Erin Koffel, Brett Litz, Paul A. Arbisi.
  Journal of Traumatic Stress. August 01, 2017
  This study examined the prospective course of posttraumatic stress disorder (PTSD) symptoms in a cohort of National Guard soldiers (N = 522) deployed to combat operations in Iraq. Participants were assessed 4 times: 1 month before deployment, 2–3 months after returning from deployment, 1 year later, and 2 years postdeployment. Growth mixture modeling revealed 3 distinct trajectories: low‐stable symptoms, resilient, 76.4%; new‐onset symptoms, 14.2%; and chronic distress, 9.4%. Relative to the resilient class, membership in both the new‐onset symptoms and chronic distress trajectory classes was predicted by negative emotionality/neuroticism, odds ratios (ORs) = 1.09, 95% CI [1.02, 1.17], and OR = 1.22, 95% CI [1.09,1.35], respectively; and combat exposure, OR = 1.07, 95% CI [1.02, 1.12], and OR = 1.12, 95% CI [1.02, 1.24], respectively. Membership in the new‐onset trajectory class was predicted by predeployment military preparedness, OR = 0.95, 95% CI [0.91, 0.98], perceived threat during deployment, OR = 1.07, 95% CI [1.03, 1.10], and stressful life events following deployment, OR = 1.44, 95% CI [1.05, 1.96]. Prior deployment to Iraq or Afghanistan, OR = 3.85, 95% CI [1.72, 8.69], predeployment depression, OR = 1.27, 95% CI [1.20, 1.36], and predeployment concerns about a deployment's impact on civilian/family life, OR = 1.09, 95% CI [1.02, 1.16], distinguished the chronic distress group relative to the resilient group. Identifying predeployment vulnerability and postdeployment contextual factors provides insight for future efforts to bolster resilience, prevent, and treat posttraumatic symptoms. Este estudio examinó el curso prospectivo de los síntomas del trastorno por estrés postraumático (TEPT) en una cohorte de Soldados de la Guardia Nacional (N = 522) desplegados para operaciones de combate en Iraq. Los participantes fueron evaluados cuatro veces: un mes antes del despliegue, 2 a 3 meses después del retorno tras el despliegue, 1 año y 2 años después del despliegue. El modelo de crecimiento de mezcla reveló tres trayectorias distintas: síntomas bajos y estables, resiliente, 76,4%; síntomas de inicio nuevo, 14,2%; y estrés crónico, 9,4%. Relativo a la clase resiliente, la pertenencia tanto a las clases de los síntomas de inicio nuevo, y la trayectorias de estrés crónico fue predicha por emocionalidad negativa/neuroticismo, razón de probabilidades (OR) = 1,09, 95% CI [1,02, 1,17] y OR = 1,22, 95% CI [1,09, 1,35], respectivamente; y exposición a combate OR = 1,07, 95% CI [1,02, 1,12] y OR = 1,12, 95% CI [1,02, 1,24], respectivamente. Pertenecer a la clase de trayectoria de inicio nuevo fue predicho por la preparación militar previa al despliegue, OR = 0,9, 95% CI [0,91, 0,98]; amenaza percibida durante el despliegue, OR = 1,44, 95% CI [1,03, 1,10; y eventos vitales estresantes tras el despliegue, OR = 1m44m 95% CI [1,05, 1,96]. Previo al despliegue a Iraq o Afganistán, OR = 3,85, 95% CI [1,72‐8,69]; depresión pre despliegue, OR = 1,27, 95% CI [1,20, 1,36]), y preocupaciones pre despliegue sobre el impacto del despliegue sobre la vida civil o familiar, OR = 1,09, 95% CI [1,02, 1,16], distinguiendo el grupo de estrés crónico con el grupo resiliente. Identificar la vulnerabilidad pre despliegue y factores contextuales post despliegue provee entendimiento sobre futuros esfuerzos para reforzar la resiliencia, prevenir, y tratar los síntomas postraumáticos. Traditional Chinese 標題: 出征伊拉克的美國國民警衛隊的恢復力與創傷後壓力症狀:針對潛在組別軌跡及其預測變量的前瞻性研究 撮要: 本研究透過出征伊拉克戰鬥的美國國民警衛隊樣本(N = 522), 檢視創傷後壓力症(PTSD)症狀的前瞻性發展。樣本接受了4次評估:於服役前1個月、完成服役歸來2至3個月後、1年後和2年後。增長混合模型顯示3種不同軌跡:低水平和穩定症狀—具恢復力(76.4%)、有新症狀(14.2%)、長期悲痛(9.4%)。與具恢復力的組別相比, 有新症狀與長期悲痛組別可被以下因素預測:負面情緒༏神經質 (機會比例(OR) 分別為 OR = 1.09, 95% CI [1.02, 1.17] 及 OR = 1.22, 95% CI [1.09‐1.35])、和戰鬥經歷 (分別為 OR = 1.07, 95% CI [1.02, 1.12] 及 OR = 1.12, 95% CI [1.02, 1.24])。有新症狀的組別能被以下因素預測:服役前的從軍準備 (OR = 0.95, 95% CI [0.91, 0.98])、服役時的威脅感知 (OR = 1.07, 95% CI [1.03, 1.10])、以及服役後構成壓力的生命事件 (OR = 1.44, 95% CI [1.05, 1.96])。曾前往伊拉克或阿富汗服役 (OR = 3.85, 95% CI [1.72‐8.69])、服役前的抑鬱症 (OR = 1.27, 95% CI [1.20, 1.36])、及服役前憂慮會對家庭與生活構成影響 (OR = 1.09, 95% CI [1.02, 1.16]), 構成長期悲痛軌跡, 使它不同於具恢復力組別。找出樣本服役前使其脆弱的因素與服役後的環境因素, 能有助我們日後提升患者的恢復力, 以及預防和治療創傷後壓力症狀。 Simplified Chinese 标题: 出征伊拉克的美国国民警卫队的恢复力与创伤后压力症状:针对潜在组别轨迹及其预测变量的前瞻性研究 撮要: 本研究透过出征伊拉克战斗的美国国民警卫队样本(N = 522), 检视创伤后压力症(PTSD)症状的前瞻性发展。样本接受了4次评估:于服役前1个月、完成服役归来2至3个月后、1年后和2年后。增长混合模型显示3种不同轨迹:低水平和稳定症状—具恢复力(76.4%)、有新症状(14.2%)、长期悲痛(9.4%)。与具恢复力的组别相比, 有新症状与长期悲痛组别可被以下因素预测:负面情绪༏神经质 (机会比例(OR) 分别为 OR = 1.09, 95% CI [1.02, 1.17] 及 OR = 1.22, 95% CI [1.09‐1.35])、和战斗经历 (分别为 OR = 1.07, 95% CI [1.02, 1.12] 及 OR = 1.12, 95% CI [1.02, 1.24])。有新症状的组别能被以下因素预测:服役前的从军准备 (OR = 0.95, 95% CI [0.91, 0.98])、服役时的威胁感知 (OR = 1.07, 95% CI [1.03, 1.10])、以及服役后构成压力的生命事件 (OR = 1.44, 95% CI [1.05, 1.96])。曾前往伊拉克或阿富汗服役 (OR = 3.85, 95% CI [1.72‐8.69])、服役前的抑郁症 (OR = 1.27, 95% CI [1.20, 1.36])、及服役前忧虑会对家庭与生活构成影响 (OR = 1.09, 95% CI [1.02, 1.16]), 构成长期悲痛轨迹, 使它不同于具恢复力组别。找出样本服役前使其脆弱的因素与服役后的环境因素, 能有助我们日后提升患者的恢复力, 以及预防和治疗创伤后压力症状。

  August 01, 2017   doi: 10.1002/jts.22199   open full text
• Association of Posttraumatic Stress Disorder With rs2267735 in the ADCYAP1R1 Gene: A Meta‐Analysis.
  Mackenzie J. Lind, Marisa E. Marraccini, Christina M. Sheerin, Kaitlin Bountress, Silviu‐Alin Bacanu, Ananda B. Amstadter, Nicole R. Nugent.
  Journal of Traumatic Stress. July 26, 2017
  Recent studies point to the potential role of the (pituitary) adenylate cyclase activating polypeptide receptor 1 (ADCYAP1R1) gene, which has been implicated in stress response, in posttraumatic stress disorder (PTSD). Multiple genetic association studies have examined potential PTSD risk related to this gene, with mixed results. We conducted a meta‐analysis of rs2267735 in ADCYAP1R1 in PTSD. A literature search was conducted using PubMed and PsycINFO, resulting in nine studies that met criteria for inclusion in analysis. Biostat's Comprehensive Meta‐Analysis was used to conduct the main meta‐analysis on the combined sex sample, as well as two subanalyses examining effects separately in female and male participants. Results indicated that the C allele of rs2267735 conferred significant risk for PTSD in the combined sex data, OR = 1.210, 95% CI [1.007, 1.454], p = .042, and in the subsample of women and girls, OR = 1.328, 95% CI [1.026, 1.719], p = .031; but not in the subsample of men and boys, OR = 0.964, 95% CI [0.733, 1.269], p = .796. These results provide evidence for an association between ADCYAP1R1 and PTSD and indicate that there may indeed be sex differences. Implications of these findings, including the role of rs2267735 as one modulator of the stress system, are discussed. Estudios recientes apuntan al rol potencial de la adenilato ciclasa (pituitaria) activando el gen receptor polipéptido 1 (ADCYAP1R1), el cual ha sido implicado en la respuesta de estrés en el estrés postraumático (TEPT). Múltiples estudios de asociaciones genéticas han examinado el riesgo potencial de TEPT relacionado con este gen, con resultados variados. Condujimos un meta‐análisis de rs2267735 en ADCYAP1R1 en TEPT. Una búsqueda de literatura fue llevada a cabo utilizando PubMed y PsycINFO, resultando en 9 estudios que cumplían los criterios de inclusión en el análisis. Un meta‐análisis comprensivo en Biostat se utilizó para conducir el meta‐análisis principal en la muestra de sexo combinada, del mismo modo que dos sub análisis examinando efectos separadamente en mujeres y hombres. Los resultados indicaron que el alelo C de rs2267735 otorga un riesgo significativo de TEPT en los datos combinados de sexo, PR = 1,210, 95% CI [1,007,1,454], p = 0,42, y en la sub muestra de mujeres, OR = 1,328, 95% CI [1,026, 1,719], p = .031, pero no en la sub muestra de hombres, OR = 0,964, 95% CI [0.733, 1,269], p = .796. Estos resultados proveen evidencia para una asociación entre ADCYAP1R1 y TEPT e indica que pueden existir efectivamente diferencias según el sexo. Son discutidas las implicaciones para estos descubrimientos, incluyendo el rol del rs2267735 como un modulador del sistema de estrés. Traditional Chinese 標題: ADCYAP1R1基因裡的rs2267735與創傷後壓力症的關連:一項元分析 撮要: 近期研究開始關注與創傷後壓力症 (PTSD) 裡的壓力反應有牽連的腦垂體腺苷酸環化酶激活化多肽受體1 (ADCYAP1R1)基因的潛在效應。過往有多個基因關連研究曾檢視這基因相關的PTSD風險, 但未取得一致結果。本研究對PTSD患者中, ADCYAP1R1裡的rs2267735進行元分析。我們利用PubMed 與PsycINFO搜索文獻, 找出9個符合我們分析範圍的研究。我們採用Biostat綜合元分析, 對混合性別的樣本進行主要的元分析, 並進行兩項子分析, 分別檢視女性和男性樣本中的效應。我們發現, rs2267735 的C等位基因在混合性別的樣本中構成顯著的PTSD風險(OR = 1.210, 95% CI [1.007, 1.454], p = .042), 在女性的子樣本中亦然(OR = 1.328, 95% CI [1.026, 1.719], p = .031) ༛但在男性子樣本裡則沒有(OR = 0.964, 95% CI [0.733, 1.269], p = .796)。研究結果證實ADCYAP1R1與PTSD有關, 並反映這關連可能在不同性別有異。我們亦有討論結果的意味, 包括rs2267735在壓力系統裡作為調節體的角色。 Simplified Chinese 标题: ADCYAP1R1基因里的rs2267735与创伤后压力症的关连:一项元分析 撮要: 近期研究开始关注与创伤后压力症 (PTSD) 里的压力反应有牵连的脑垂体腺苷酸环化酶激活化多肽受体1 (ADCYAP1R1)基因的潜在效应。过往有多个基因关连研究曾检视这基因相关的PTSD风险, 但未取得一致结果。本研究对PTSD患者中, ADCYAP1R1里的rs2267735进行元分析。我们利用PubMed 与PsycINFO搜索文献, 找出9个符合我们分析范围的研究。我们采用Biostat综合元分析, 对混合性别的样本进行主要的元分析, 并进行两项子分析, 分别检视女性和男性样本中的效应。我们发现, rs2267735 的C等位基因在混合性别的样本中构成显著的PTSD风险(OR = 1.210, 95% CI [1.007, 1.454], p = .042), 在女性的子样本中亦然(OR = 1.328, 95% CI [1.026, 1.719], p = .031) ༛但在男性子样本里则没有(OR = 0.964, 95% CI [0.733, 1.269], p = .796)。研究结果证实ADCYAP1R1与PTSD有关, 并反映这关连可能在不同性别有异。我们亦有讨论结果的意味, 包括rs2267735在压力系统里作为调节体的角色。

  July 26, 2017   doi: 10.1002/jts.22211   open full text
• Increased Mindfulness Skills as Predictors of Reduced Trauma‐Related Guilt in Treatment‐Seeking Veterans.
  Philip Held, Gina P. Owens, J. Richard Monroe, Kathleen M. Chard.
  Journal of Traumatic Stress. July 25, 2017
  The present study examined the predictive role of increased self‐reported mindfulness skills on reduced trauma‐related guilt in a sample of veterans over the course of residential treatment for posttraumatic stress disorder (PTSD; N = 128). The residential treatment consisted of seven weeks of intensive cognitive processing therapy (CPT) for PTSD, as well as additional psychoeducational groups, including seven sessions on mindfulness skills. Increased mindfulness skills describing, acting with awareness, and accepting without judgment were significantly associated with reductions in trauma‐related guilt over the course of treatment. Increases in the ability to act with awareness and accept without judgment were significantly associated with reductions in global guilt, R2 = .26, guilt distress, R2= .23, guilt cognitions, R2= .23, and lack of justification, R2= .11. An increase in the ability to accept without judgment was the only self‐reported mindfulness skill that was associated with reductions in hindsight bias, β = −.34 and wrongdoing, β = −.44. Increases in self‐reported mindfulness skills explained 15.1 to 24.1% of the variance in reductions in trauma‐related guilt, suggesting that mindfulness skills may play a key role in reducing the experience of trauma‐related guilt during psychotherapy. Our results provide preliminary support for the use of mindfulness groups as an adjunct to traditional evidence‐based treatments aimed at reducing trauma‐related guilt, though this claim needs to be tested further using experimental designs. El presente estudio examinó el rol predictivo del incremento de las habilidades mindfulness autoreportadas en la reducción de la culpa relacionada al trauma en una muestra de veteranos en el curso de un tratamiento residencial para trastorno de estrés postraumático (TEPT; N = 128). El tratamiento residencial consistió en siete semanas de terapia cognitivo conductual intensiva (TCC) para TEPT, también como adicionalmente grupos de psicoeducación, que incluía siete sesiones sobre habilidades mindfulness. El incremento de las habilidades mindfulness que describen, actuar consciente y aceptación sin juzgar, se asociaron en forma significativa a reducción en la culpa relacionada al trauma en el curso del tratamiento. El incremento en la capacidad de actuar conscientemente y aceptar sin juzgar se asociaron en forma significativa con la reducción de la culpa global (R² = .26), aflicción por la culpa (R2 = .23), cogniciones culposas (R² = .23), y falta de justificación (R² = .11). El incremento en la capacidad de aceptar sin juzgar fue la única habilidad autoreportada de mindfulness que se asoció a reducción en sesgo retrospectivo (β = ‐.34) y alteraciones de conducta (β = ‐.44). El incremento en las habilidades mindfulness autoreportadas explicó el 15–24% de la varianza en la reducción de la culpa relacionada al trauma, lo que sugiere que las habilidades mindfulness pueden jugar un rol clave en la reducción de la experiencia de culpa relacionada al trauma durante la psicoterapia. Nuestros resultados proveen soporte preliminar al uso de grupos de mindfulness como un adjunto a los tratamientos tradicionales basados en la evidencia orientados a reducir la culpa relacionada al trauma, aunque esta premisa requiere ser probada usando diseños experimentales. Traditional Chinese 標題: 尋求治療的退役軍人中, 覺察技巧提升作為創傷相關的內疚感減低的預測變量 撮要: 本研究透過退役軍人(N = 128)接受創傷後壓力症(PTSD)住院治療的過程, 檢視自評的覺察技巧提升, 對於創傷相關的內疚感減低的預測效應。該PTSD住院療程為7星期密集式的認知整理治療(CPT), 及額外的心理教育小組, 當中包括7個覺察技巧節段。在治療期間覺察技巧提升, 以至個人能具意識地描述和行動, 及不下判斷地接受事情, 顯著地跟創傷相關的內疚感減低有關。具意識地行動的能力提升、和不下判斷地接受事情的能力提升, 都顯著地跟整體的內疚感(R2 = .26)、內疚性悲痛(R2 = .23)、內疚認知(R2 = .23)、和欠缺辯解(R2 = .11)的減低有關。在各種自評的覺察技巧裡, 唯一是不下判斷地接受事情的能力提升跟事後聰明偏差(hindsight bias)減低(β = ‐.34)和作惡減低(β = ‐.44)有關。自評的覺察技巧提升, 解釋了創傷相關的內疚感減低的方差裡15‐24%, 反映覺察技巧在心理治療中減低創傷相關的內疚感方面, 可能擔當著關鍵角色。本研究提供了初步數據, 支持在傳統實證為本、針對減低創傷相關的內疚感治療以外, 增加覺察小組作為附屬治療, 但這提議仍需更多實驗作進一步驗證。 Simplified Chinese 标题: 寻求治疗的退役军人中, 觉察技巧提升作为创伤相关的内疚感减低的预测变量 撮要: 本研究透过退役军人(N = 128)接受创伤后压力症(PTSD)住院治疗的过程, 检视自评的觉察技巧提升, 对于创伤相关的内疚感减低的预测效应。该PTSD住院疗程为7星期密集式的认知整理治疗(CPT), 及额外的心理教育小组, 当中包括7个觉察技巧节段。在治疗期间觉察技巧提升, 以至个人能具意识地描述和行动, 及不下判断地接受事情, 显著地跟创伤相关的内疚感减低有关。具意识地行动的能力提升、和不下判断地接受事情的能力提升, 都显著地跟整体的内疚感(R2 = .26)、内疚性悲痛(R2 = .23)、内疚认知(R2 = .23)、和欠缺辩解(R2 = .11)的减低有关。在各种自评的觉察技巧里, 唯一是不下判断地接受事情的能力提升跟事后聪明偏差(hindsight bias)减低(β = ‐.34)和作恶减低(β = ‐.44)有关。自评的觉察技巧提升, 解释了创伤相关的内疚感减低的方差里15‐24%, 反映觉察技巧在心理治疗中减低创伤相关的内疚感方面, 可能担当着关键角色。本研究提供了初步数据, 支持在传统实证为本、针对减低创伤相关的内疚感治疗以外, 增加觉察小组作为附属治疗, 但这提议仍需更多实验作进一步验证。

  July 25, 2017   doi: 10.1002/jts.22209   open full text
• Gender Differences in Machine Learning Models of Trauma and Suicidal Ideation in Veterans of the Iraq and Afghanistan Wars.
  Jaimie L. Gradus, Matthew W. King, Isaac Galatzer‐Levy, Amy E. Street.
  Journal of Traumatic Stress. July 25, 2017
  Suicide rates among recent veterans have led to interest in risk identification. Evidence of gender‐and trauma‐specific predictors of suicidal ideation necessitates the use of advanced computational methods capable of elucidating these important and complex associations. In this study, we used machine learning to examine gender‐specific associations between predeployment and military factors, traumatic deployment experiences, and psychopathology and suicidal ideation (SI) in a national sample of veterans deployed during the Iraq and Afghanistan conflicts (n = 2,244). Classification, regression tree analyses, and random forests were used to identify associations with SI and determine their classification accuracy. Findings converged on several associations for men that included depression, posttraumatic stress disorder (PTSD), and somatic complaints. Sexual harassment during deployment emerged as a key factor that interacted with PTSD and depression and demonstrated a stronger association with SI among women. Classification accuracy for SI presence or absence was good based on the receiver operating characteristic area under the curve, men = .91, women = .92. The risk for SI was classifiable with good accuracy, with associations that varied by gender. The use of machine learning analyses allowed for the discovery of rich, nuanced results that should be replicated in other samples and may eventually be a basis for the development of gender‐specific actuarial tools to assess SI risk among veterans. Las tasas de suicidio entre los veteranos recientes han liderado el interés en la identificación de riesgo. Las evidencias de los predictores  específicos de trauma y género de ideación suicida necesita el uso de métodos computacionales avanzados capaces de dilucidar estas asociaciones importantes y complejas. En este estudio, usamos el aprendizaje automático para examinar asociaciones específicas de género entre pre‐desplazamiento y factores militares, experiencias traumáticas en el desplazamiento y psicopatología e ideación suicida (IS) en una muestra nacional de veteranos desplazados durante los conflictos de Iraq y Afganistán (n = 2.244). Se utilizaron análisis de árboles de clasificación y regresión y bosques aleatorios para identificar las asociaciones con IS y determinar su rigurosa clasificación. Los hallazgos convergieron en varias asociaciones para los varones, las que incluyeron depresión, trastorno por estrés postraumático (TEPT) y quejas somáticas. El acoso sexual durante el desplazamiento surgió como un factor clave que interactuó con el TEPT y depresión y demostró una asociación más fuerte con IS entre las mujeres. La exactitud de la clasificación para IS+/IS‐ fue una buena base en el Área bajo la Curva ROC, varones =   .91, mujeres =   .92. El riesgo para IS fue clasificable con buena exactitud, con asociaciones que variaron por género. El uso del análisis de aprendizaje automático permitió el descubrimiento de resultados ricos y matizados que deberían ser replicados en otras muestras y pueden eventualmente ser una base para el desarrollo de herramientas actuariales específicas de género para evaluar riesgo de IS entre veteranos. Traditional Chinese 標題 : 曾出征伊拉克和阿富汗的退役軍人༌其創傷和自殺意念的機器學習模型裡的性別差異 撮要: 近年退役軍人的自殺率使大家更希望找出自殺的風險因素。過往證實自殺意念有性別及創傷特殊的預測變量༌這令我們有需要以更高科技的電腦方法༌找出當中那些重要又複雜的關連。本研究採用機器學習༌檢視服役前因素與從軍因素、服役時的創傷經歷、和精神病理學與自殺意念(SI)之間༌性別特殊的關連。樣本為國內曾出征伊拉克和阿富汗的退役軍人(n = 2,244)。我們利用分類與迴歸樹分析和隨機森林༌找出SI的關連因素及它們的分類準確性。我們發現數項男性的關連因素༌包括抑鬱症、 創傷後壓力症(PTSD)和軀體不適。對於女性༌服役時受性侵犯是一個與PTSD和抑鬱症有交互作用的重點因素༌跟SI有較強關連。根據接收者操作特徵(ROC)曲線༌SI+/SI‐的分類準確性為良好༈男性 = .91༌女性 = .92༉。我們能以良好的準確性把SI風險分類༌關連因應性別而異。機器學習分析能得出豐富而具細微差別的結果。應用這種分析於其他樣本可能會有助發展出用以評估退役軍人SI風險、性別特殊的精算工具。 Simplified Chinese 标题 : 曾出征伊拉克和阿富汗的退役军人༌其创伤和自杀意念的机器学习模型里的性别差异 撮要: 近年退役军人的自杀率使大家更希望找出自杀的风险因素。过往证实自杀意念有性别及创伤特殊的预测变量༌这令我们有需要以更高科技的计算机方法༌找出当中那些重要又复杂的关连。本研究采用机器学习༌检视服役前因素与从军因素、服役时的创伤经历、和精神病理学与自杀意念(SI)之间༌性别特殊的关连。样本为国内曾出征伊拉克和阿富汗的退役军人(n = 2,244)。我们利用分类与回归树分析和随机森林༌找出SI的关连因素及它们的分类准确性。我们发现数项男性的关连因素༌包括抑郁症、 创伤后压力症(PTSD)和躯体不适。对于女性༌服役时受性侵犯是一个与PTSD和抑郁症有交互作用的重点因素༌跟SI有较强关连。根据接收者操作特征(ROC)曲线༌SI+/SI‐的分类准确性为良好༈男性 = .91༌女性 = .92༉。我们能以良好的准确性把SI风险分类༌关连因应性别而异。机器学习分析能得出丰富而具细微差别的结果。应用这种分析于其他样本可能会有助发展出用以评估退役军人SI风险、性别特殊的精算工具。

  July 25, 2017   doi: 10.1002/jts.22210   open full text
• Self‐Regulation Shift Theory: A Dynamic Systems Approach to Traumatic Stress.
  Charles C. Benight, Kotaro Shoji, Douglas L. Delahanty.
  Journal of Traumatic Stress. July 25, 2017
  Self‐regulation shift theory (SRST) is a threshold theory explaining self‐regulation following trauma that utilizes nonlinear dynamics to capture systemic shifts in trauma adaptation. Cusp catastrophe modeling tests nonlinear changes in an outcome (e.g., posttraumatic distress) based on an identified bifurcation factor under specific conditions (i.e., asymmetry variables). We evaluated two cusp models in a motor vehicle accident (MVA) database and then confirmed findings within a similar dataset. Based on SRST, we tested coping self‐efficacy (CSE) as the bifurcation factor and a set of asymmetry controlling variables. Results demonstrated significant cusp models with CSE as a consistent bifurcation factor in all models. When participants reported lower peritraumatic dissociation, early lower CSE was a significant bifurcation factor for 3‐month trauma symptoms in Sample 1, R2 = .18. The cusp model for changes in symptoms from 30 days to 3 months showed CSE as a significant bifurcation variable with higher levels of avoidant coping (R2 = .27). In a separate sample, early lower CSE was again a significant bifurcation variable with lower injury severity (R2 = .52). Results support the importance of self‐regulatory appraisals in nonlinear shifts in posttraumatic stress symptoms 3 months post‐MVA. Theoretical and practical implications are discussed. La Teoría del Cambio de Auto‐Regulación (SRST, por su sigla en inglés) es una teoría umbral que explica la auto–regulación posterior al trauma, utilizando dinámicas no lineales para capturar los cambios sistémicos en la adaptación respecto del trauma. Modelado de catástrofes cúspides prueban los cambios no lineales en un resultado (p.e., sufrimiento postraumático) basados en un factor identificado de bifurcación bajo condiciones específicas (p.e., variables asimétricas). Se evaluaron dos modelos cúspide en una base de datos de accidentes vehiculares y luego se confirmaron los hallazgos con una base de datos similar. Basados en la SRST, se probó la Autoeficacia en el Afrontamiento (CSE, por su sigla en inglés) como el factor de bifurcación y un set de variables para el control de la asimetría. Los resultados demostraron modelos cúspide significativos con la CSE como un factor de bifurcación consistente en todos los modelos. Cuando los participantes mostraron baja disociación peritraumática, la baja CSE temprana fue un factor de bifurcación significativa para síntomas traumáticos de tres meses en la muestra 1 (R2 = .18). El modelo cúspide para cambios en los síntomas entre 30 días y 3 meses mostró la CSE como una variable de bifurcación significativa con altos niveles de afrontamiento evitativo (R2 = .27). En una muestra separada, la baja CSE temprana, fue nuevamente una variable de bifurcación significativa, con baja severidad del daño (R2 = .52). Los resultados respaldan la importancia de las estimaciones autoreguladas en los cambios no lineales en síntomas de estrés postraumático en los tres meses posteriores a un accidente vehicular. Son discutidas las implicaciones teóricas y prácticas. Traditional Chinese 標題: 自我調節變動理論:測量創傷後壓力的動態系統法 撮要: 自我調節變動理論(SRST)是一套閾限理論, 用以解釋個人受創後的自我調節, 透過非線性的動態來記錄個人在適應創傷期間的系統改變。尖點劇變模型(cusp catastrophe modeling)能基於在特殊環境下 (即不對稱變量) 找出的一個分岔因素, 測量結果 (如創傷後悲痛) 的非線性改變。我們檢視一個汽車意外(MVA)資料庫裡的2個尖點劇變模型, 然後以一組類近的數據驗證結果。我們基於SRST, 以應對自我效能(CSE)作為分岔因素, 及一組不對稱的控制變量進行測量。結果顯示顯著的尖點劇變模型, 而CSE是所有模型裡一致的分岔因素。在有創傷症狀達3個月的樣本組別1裡, 當個人創傷當下的離解為較低水平, 早期較低的CSE便是顯著的分岔因素(R2 = .18)。測量症狀由30天至3個月的改變的尖點劇變模型, 顯示有較高水平的迴避應對的樣本中(R2 = .27), CSE是顯著的分岔變量。在另一組樣本, 受傷嚴重度較低的樣本中(R2 = .52), 早期較低的CSE也是顯著的分岔變量。研究結果證實, 在MVA的3個月後針對創傷後壓力症狀的非線性改變進行自我調節評估有其重要性。我們亦討論到研究結果在理論和實際層面的貢獻。 Simplified Chinese 标题: 自我调节变动理论:测量创伤后压力的动态系统法 撮要: 自我调节变动理论(SRST)是一套阈限理论, 用以解释个人受创后的自我调节, 透过非线性的动态来记录个人在适应创伤期间的系统改变。尖点剧变模型(cusp catastrophe modeling)能基于在特殊环境下 (即不对称变量) 找出的一个分岔因素, 测量结果 (如创伤后悲痛) 的非线性改变。我们检视一个汽车意外(MVA)数据库里的2个尖点剧变模型, 然后以一组类近的数据验证结果。我们基于SRST, 以应对自我效能(CSE)作为分岔因素, 及一组不对称的控制变量进行测量。结果显示显著的尖点剧变模型, 而CSE是所有模型里一致的分岔因素。在有创伤症状达3个月的样本组别1里, 当个人创伤当下的离解为较低水平, 早期较低的CSE便是显著的分岔因素(R2 = .18)。测量症状由30天至3个月的改变的尖点剧变模型, 显示有较高水平的回避应对的样本中(R2 = .27), CSE是显著的分岔变量。在另一组样本, 受伤严重度较低的样本中(R2 = .52), 早期较低的CSE也是显著的分岔变量。研究结果证实, 在MVA的3个月后针对创伤后压力症状的非线性改变进行自我调节评估有其重要性。我们亦讨论到研究结果在理论和实际层面的贡献。

  July 25, 2017   doi: 10.1002/jts.22208   open full text
• Acute Stress Symptoms in Seriously Injured Patients: Precipitating Versus Cumulative Trauma and the Contribution of Peritraumatic Distress.
  John Briere, Colin P. Dias, Randye J. Semple, Catherine Scott, Noémie Bigras, Natacha Godbout.
  Journal of Traumatic Stress. July 14, 2017
  The relationship between type of trauma exposure, cumulative trauma, peritraumatic distress, and subsequent acute stress disorder (ASD) symptoms was examined prospectively in 96 individuals presenting with acute medical injuries to a Level 1 emergency/trauma department. Common precipitating traumas included motor vehicle‐related events, stabbings, shootings, and physical assaults. At 2 to 3 weeks follow‐up, 22.9% of participants had developed ASD. Univariate analysis revealed no relationship between type of precipitating trauma and ASD symptoms, whereas robust path analysis indicated direct effects of gender, lifetime cumulative trauma exposure, and peritraumatic distress. Peritraumatic distress did not mediate the association between cumulative trauma and symptoms, but did mediate the association between gender and symptomatology. These results, which account for 23.1% of the variance in ASD symptoms, suggest that ASD may be more due to cumulative trauma exposure than the nature of the precipitating trauma, but that cumulative trauma does not exert its primary effect by increasing peritraumatic distress to the most recent trauma. La relación entre el tipo de exposición al trauma, el trauma acumulado, la angustia peri‐traumática, y los síntomas de trastorno de estrés agudo (TEA) posteriores fueron examinados prospectivamente en 96 Individuos que presentan lesiones médicas agudas en un departamento de emergencia / trauma de nivel 1. Los traumatismos precipitantes comunes incluyeron eventos relacionados con vehículos motorizados, puñaladas, tiroteos y asaltos físicos. A las 2 a 3 semanas de seguimiento, el 22,9% de los participantes habían desarrollado TEA. El análisis univariado no reveló una relación entre el tipo de traumatismo precipitante y los síntomas de TEA, mientras que un análisis de trayectoria robusta indicó efectos directos de género, la exposición al trauma acumulativo durante la vida y la angustia peri‐traumática, lo que representa el 23,1% de la varianza en los síntomas TEA. La angustia peri‐traumática no influyó en la asociación entre el trauma acumulado y los síntomas, pero mediaron en la asociación entre el género y la sintomatología. Estos resultados sugieren que el TEA puede ser mayor debido a la exposición al trauma acumulativo que a la naturaleza del trauma precipitante, pero que el trauma acumulativo no ejerce su efecto primario por un aumento de la angustia peri‐traumática debida al trauma más reciente Principio del formularioFinal del formulario Traditional Chinese 標題: 傷重患者的急性壓力症狀:比較創傷近因與累積創傷, 及創傷當下悲痛的效應 撮要: 本前瞻性研究透過96名於一級緊急或創傷治療部呈現急性醫療創傷的患者, 檢視創傷經歷種類、累積創傷、創傷當下的悲痛、及隨後的急性壓力症(ASD)症狀之間的關係。汽車相關事故、持刀傷人事件、槍擊事件和身體襲擊事件是普遍的創傷近因。在2至3星期後的跟進中, 22.9%樣本有ASD。單變量分析顯示, 創傷近因種類與ASD症狀無關༛強勁的路徑分析則顯示, 性別、人生裡累積的創傷經歷、及創傷當下的悲痛有直接效應, 能解釋ASD症狀裡 23.1%的方差。創傷當下的悲痛對累積創傷與症狀間的關連並無中介效應, 但在性別與症狀學的關連裡有中介效應。結果反映, 累積的創傷經歷相比創傷近因的種類, 可能有較大機會導致ASD。然而, 累積創傷產生的主要效應, 並非由提升最近期創傷的當下悲痛構成。 Simplified Chinese 标题: 伤重患者的急性压力症状:比较创伤近因与累积创伤, 及创伤当下悲痛的效应 撮要: 本前瞻性研究透过96名于一级紧急或创伤治疗部呈现急性医疗创伤的患者, 检视创伤经历种类、累积创伤、创伤当下的悲痛、及随后的急性压力症(ASD)症状之间的关系。汽车相关事故、持刀伤人事件、枪击事件和身体袭击事件是普遍的创伤近因。在2至3星期后的跟进中, 22.9%样本有ASD。单变量分析显示, 创伤近因种类与ASD症状无关༛强劲的路径分析则显示, 性别、人生里累积的创伤经历、及创伤当下的悲痛有直接效应, 能解释ASD症状里 23.1%的方差。创伤当下的悲痛对累积创伤与症状间的关连并无中介效应, 但在性别与症状学的关连里有中介效应。结果反映, 累积的创伤经历相比创伤近因的种类, 可能有较大机会导致ASD。然而, 累积创伤产生的主要效应, 并非由提升最近期创伤的当下悲痛构成。

  July 14, 2017   doi: 10.1002/jts.22200   open full text
• Posttraumatic Stress Symptoms and Alcohol‐Related Outcomes Among Municipal Firefighters.
  Joe Tomaka, Dejan Magoc, Stormy M. Morales‐Monks, Anabel C. Reyes.
  Journal of Traumatic Stress. July 12, 2017
  This study examined levels of posttraumatic stress symptoms (PTSS) and relationships between PTSS and alcohol‐related outcomes in a near census of municipal firefighters. The study also assessed substance‐use coping and drinking to cope as potential mediators of such outcomes. Firefighters (N = 740) completed measures that assessed PTSS, alcohol risk behaviors, alcohol problems, drinking motives, and coping with stress. Results showed that 32.4% of firefighters reported significant levels of PTSS using National Center for PTSD (2014) screening cutoff scores. Correlational analysis showed that PTSS was related to at‐risk drinking (r = .18) and alcohol‐related problems (r = .33), as well as use of maladaptive coping strategies (r = .58) and substance use coping (r = .40). Structural analyses comparing multiple alternative models suggested that a model that included substance use coping and drinking to cope as mediators of the association between PTSS and problem drinking provided the best fit to the data. Tests of multigroup invariance confirmed this model. Overall, PTSS were common in this population and they predicted maladaptive coping patterns and alcohol‐related consequences. One implication of these findings is that fire departments might consider adding or enhancing screening and treatment options for PTS, alcohol misuse, or both. Este estudio examinó los niveles de síntomas de estrés postraumático (SEPT) y las relaciones entre SEPT y los resultados relacionados con el alcohol en un casi censo de bomberos municipales. El estudio también evaluó el hacer frente mediante el uso de sustancias y el consumo de alcohol como posibles mediadores de tales resultados. Los bomberos (N = 740) completaron las mediciones de SEPT, comportamientos de riesgo de alcohol, problemas de alcohol, motivación para beber y hacer frente al estrés como parte de sus requisitos de educación continua y de un estudio de mayor duración. Los resultados mostraron que el 32,4% de los bomberos reportó niveles significativos de sintomatología SEPT usando cortes de detección del Centro Nacional para el SEPT (2014). El análisis correlacional mostró que TEPT relacionado con el riesgo de beber (r = .18) y problemas relacionados con el alcohol (r = .33), así como el uso de estrategias de adaptación desadaptativas (r = .58) y el manejo del uso de sustancias (r = .40). Los análisis estructurales que compararon modelos alternativos múltiples sugirieron que un modelo que incluía el uso de sustancias y el consumo de alcohol para hacer frente como mediadores de la asociación entre SEPT y el problema con la bebida proporcionaron el mejor ajuste a los datos. Las pruebas de invariancia multi‐grupo confirmaron este modelo. En general, SEPT fueron comunes en esta población y predijeron patrones de afrontamiento maladaptivos y las consecuencias relacionadas con el alcohol. Una consecuencia de estos hallazgos es que los departamentos de bomberos podrían considerar la posibilidad de agregar o mejorar las opciones de detección y tratamiento para EPT, abuso del alcohol, o ambos. Traditional Chinese 標題: 消防員的創傷後壓力症狀與酒精相關的健康問題 撮要: 本研究透過市內消防員的人口普查, 檢視樣本的創傷後壓力症狀(PTSS)水平, 及PTSS與酒精相關健康問題的關係。我們亦評估, 倚賴藥物及倚賴酒精是否以上健康問題的潛在中介因素。樣本裡的消防員(N = 740)為了符合進修資格及參與另一項較大型的研究, 完成了以下範疇的測量:PTSS、有風險的酒精使用行為、酗酒問題、喝酒的動機及應對壓力的方法。結果顯示, 根據全國創傷後壓力症候群中心2014年設立的篩查取錄線, 32.4%的消防員有顯著水平的PTS症狀學。相關分析顯示, PTSS與以下範疇有關:有風險地使用酒精(r = .18)、酒精相關問題(r = .33)、不良的應對策略(r = .58)、和倚賴藥物(r = .40)。我們採用結構分析比較了多種模型, 發現一個模型以倚賴藥物及倚賴酒精作為PTSS與酗酒問題之間的中介變量, 其反映的結果跟數據最吻合。多組別不變性測試驗證了這模型。整體來說, PTSS在樣本裡普遍, 並能預測不良的應對模式和酒精相關的健康問題。研究結果反映, 消防局可能應該提供或提升PTS和/及濫用酒精的篩查與治療選擇。 Simplified Chinese 标题: 消防员的创伤后压力症状与酒精相关的健康问题 撮要: 本研究透过市内消防员的人口普查, 检视样本的创伤后压力症状(PTSS)水平, 及PTSS与酒精相关健康问题的关系。我们亦评估, 倚赖药物及倚赖酒精是否以上健康问题的潜在中介因素。样本里的消防员(N = 740)为了符合进修资格及参与另一项较大型的研究, 完成了以下范畴的测量:PTSS、有风险的酒精使用行为、酗酒问题、喝酒的动机及应对压力的方法。结果显示, 根据全国创伤后压力症候群中心2014年设立的筛查取录线, 32.4%的消防员有显著水平的PTS症状学。相关分析显示, PTSS与以下范畴有关:有风险地使用酒精(r = .18)、酒精相关问题(r = .33)、不良的应对策略(r = .58)、和倚赖药物(r = .40)。我们采用结构分析比较了多种模型, 发现一个模型以倚赖药物及倚赖酒精作为PTSS与酗酒问题之间的中介变量, 其反映的结果跟数据最吻合。多组别不变性测试验证了这模型。整体来说, PTSS在样本里普遍, 并能预测不良的应对模式和酒精相关的健康问题。研究结果反映, 消防局可能应该提供或提升PTS和/及滥用酒精的筛查与治疗选择。

  July 12, 2017   doi: 10.1002/jts.22203   open full text
• Sense of Threat as a Mediator of Peritraumatic Stress Symptom Development During Wartime: An Experience Sampling Study.
  Liron Lapid Pickman, Talya Greene, Marc Gelkopf.
  Journal of Traumatic Stress. July 11, 2017
  Exposure and sense of threat have been associated with stress symptoms, yet these relationships have not been clarified during the peritraumatic period. We investigated the mediating role of sense of threat in the link between exposure to rocket warning sirens and stress symptoms during wartime, and the effect of severe mental illness (SMI) status and gender on this mediation. A 30‐day twice‐daily smartphone‐based intensive assessment of exposure to sirens, sense of threat, and peritraumatic stress symptoms was performed during the 2014 Israel–Gaza conflict. Participants included 182 highly exposed individuals with or without SMI. Multilevel structural equation modeling analysis was performed, with SMI status and gender as confounders. Exposure affected the level of peritraumatic stress symptoms both directly, b = 1.07, p < .001, 95% CI [0.32, 1.82], and indirectly, b = 0.78, p < .001, 95% CI [0.24, 1.33], through sense of threat. The effect of sense of threat on stress symptoms was larger in the SMI group, b = 0.86, p < .001, 95% CI [0.31, 1.40]. Gender did not have a significant effect. Sense of threat has a key role in symptom development during the peritraumatic timeframe. Intervention and prevention efforts should start early and focus on promoting a sense of safety, particularly with people with SMI. La exposición y la sensación de amenaza se han asociado con síntomas del estrés, sin embargo estas relaciones no han sido clarificadas durante el período peritraumático. Investigamos el papel mediador de la sensación de amenaza en la relación entre la exposición a las sirenas de alerta de cohetes y los síntomas de estrés durante la guerra, y el efecto de la condición de enfermedad mental severa (SMI por sus siglas en inglés) y el género en esta mediación. Durante el conflicto entre Israel y Gaza en el 2014, se realizó una evaluación intensiva, basada en smartphones, durante 30 días dos veces por día, de la exposición a sirenas, sensación de amenaza y síntomas de estrés peritraumático. Los participantes incluyeron 182 individuos altamente expuestos con o sin SMI. Se realizó un análisis de modelos de ecuación estructural multinivel, con la condición de SMI y el género como factores de confusión. La exposición afectó el nivel de síntomas de estrés peritraumático directamente 1,07; p <0,001; IC del 95% [0,32; 1,82], e indirectamente 0,78; p <0,001; IC del 95% [0,24; 1,33], a través de la sensación de amenaza. Los efectos de la sensación de amenaza sobre los síntomas de estrés fueron mayores en el grupo SMI 0,86; p <0,001; IC del 95% [0,31; 1,40]. El género no tuvo un efecto significativo. La sensación de amenaza tiene un papel clave en el desarrollo de los síntomas durante el período peritraumático. Los esfuerzos de intervención y prevención deben comenzar temprano y enfocarse en promover un sentido de seguridad, particularmente en personas con enfermedades mentales severas. Traditional Chinese 標題: 戰爭時期, 威脅感作為創傷當下壓力症狀發展的中介物:一項抽樣經歷研究 撮要: 過往研究發現, 創傷經歷與威脅感跟壓力症狀相關, 但我們仍不清楚它們在創傷當下時段裡的關係。本研究探查在戰爭中, 威脅感在經歷火箭彈警報與壓力症狀的關連裡的中介作用, 並檢視樣本的嚴重精神疾病(SMI)狀況與性別在這中介裡產生的效應。我們在2014年以巴衝突裡, 進行為期30天、每天兩次以智能手機進行的密集式評估, 檢視樣本的警報經歷、威脅感、和創傷當下的壓力症狀。樣本為182名有高水平經歷並且有或無SMI的人。我們採用多層次結構方程模型分析, 以SMI狀況和性別作為混淆因素。警報經歷透過威脅感, 對創傷當下的壓力症狀構成直接(1.07, p < .001, 95% CI [0.32, 1.82]) 和間接影響(0.78, p < .001, 95% CI [0.24, 1.33])。在SMI組別, 威脅感對壓力症狀產生的效應較大(0.86, p < .001, 95% CI [0.31, 1.40])。性別並無產生特殊效應。於創傷當下的時段, 威脅感在壓力症狀的發展裡有關鍵角色。我們應盡早開始為患者提供干預和預防性治療, 特別是對於有嚴重精神疾病的患者, 治療應針對提升安全感。 Simplified Chinese 标题: 战争时期, 威胁感作为创伤当下压力症状发展的中介物:一项抽样经历研究 撮要: 过往研究发现, 创伤经历与威胁感跟压力症状相关, 但我们仍不清楚它们在创伤当下时段里的关系。本研究探查在战争中, 威胁感在经历火箭弹警报与压力症状的关连里的中介作用, 并检视样本的严重精神疾病(SMI)状况与性别在这中介里产生的效应。我们在2014年以巴冲突里, 进行为期30天、每天两次以智能手机进行的密集式评估, 检视样本的警报经历、威胁感、和创伤当下的压力症状。样本为182名有高水平经历并且有或无SMI的人。我们采用多层次结构方程模型分析, 以SMI状况和性别作为混淆因素。警报经历透过威胁感, 对创伤当下的压力症状构成直接(1.07, p < .001, 95% CI [0.32, 1.82]) 和间接影响(0.78, p < .001, 95% CI [0.24, 1.33])。在SMI组别, 威胁感对压力症状产生的效应较大(0.86, p < .001, 95% CI [0.31, 1.40])。性别并无产生特殊效应。于创伤当下的时段, 威胁感在压力症状的发展里有关键角色。我们应尽早开始为患者提供干预和预防性治疗, 特别是对于有严重精神疾病的患者, 治疗应针对提升安全感。

  July 11, 2017   doi: 10.1002/jts.22207   open full text
• Secondary Traumatization and Differentiation Among the Wives of Former POWs: A Reciprocal Association.
  Yael Lahav, Yafit Levin, Moshe Bensimon, Yaniv Kanat‐Maymon, Zahava Solomon.
  Journal of Traumatic Stress. July 11, 2017
  Repercussions of war captivity may transmit to spouses of former prisoners of war (POW) via posttraumatic stress symptoms (PTSS). Overidentification with their partners underlies the PTSS experienced by former wives of POWs, thus implying impaired self‐differentiation. Although wives’ indirect exposure to their husbands' captivity and subsequent PTSS has been associated with the wives' PTSS and differentiation, the combined effects remain unclear. Furthermore, previous cross‐sectional studies could not illuminate directionality. This prospective study investigates (a) the moderating role of indirect exposure to captivity in the association between husbands’ PTSS and wives’ PTSS and differentiation; and (b) the directionality of the association between wives' differentiation and PTSS over time. The wives of both former POWs (n = 143) and combatants (n = 102) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. The wives of former POWs endorsed higher PTSS and fusion differentiation, η2p = .06 to .14. Indirect exposure to captivity moderated the associations between husbands' PTSS and wives' PTSS, Cohen's f2 = .01 to .03. The association between the wives' differentiation and PTSS over time was bidirectional, β = −0.18 to 0.68; R2 = .54 to .73. Results suggest a vicious cycle between PTSS and differentiation, and the need for clinical interventions that further differentiation for spouses of prolonged trauma victims. Las repercusiones del cautiverio de guerra pueden transmitirse a los cónyuges de ex prisioneros de guerra (CPG) a través de síntomas de estrés postraumático (SEPT). La sobreidentificación con sus compañeros subyace al PTSS experimentado por ex esposas de prisioneros de guerra, lo que implica una auto‐diferenciación deteriorada. Aunque la exposición indirecta de las esposas al cautiverio de sus maridos y al SEPT posterior se ha asociado con el SEPT y la diferenciación de las esposas, los efectos combinados siguen siendo poco claros. Además, estudios transeccionales previos no pudieron iluminar la direccionalidad. Este estudio prospectivo investiga: a) el papel moderador de la exposición indirecta al cautiverio en la asociación entre el SEPT de los esposos y el SEPT de las esposas y la diferenciación; y (b) la direccionalidad de la asociación entre la diferenciación de las esposas y el SEPT con el tiempo. Las esposas de los ex prisioneros de guerra (n = 143) y combatientes (n = 102) fueron evaluados 30 años (T1) y 38 años (T2) después de la guerra de Yom Kippur en 1973. Las esposas de los antiguos prisioneros de guerra respaldaron una mayor SEPT y diferenciación de fusión, η2p = .06 a .14. La exposición indirecta al cautiverio moderó las asociaciones entre SEPT de los esposos y el SEPT de las esposas, f2 de Cohen = .01 a .03. La asociación entre la diferenciación de las esposas y el SEPT en el tiempo fue bidireccional, B = ‐0.18 a 0.68; R2 = .54 a .73. Los resultados sugieren un círculo vicioso entre SEPT y diferenciación y la necesidad de intervenciones clínicas para una mayor diferenciación para las esposas de víctimas de trauma prolongado. Traditional Chinese 標題: 前戰俘(POW)的妻子的次級創傷和自我區分:一種相互關連 撮要: 曾當戰俘(POW)的軍人可透過創傷後壓力症狀(PTSS), 以其受虜的迴響影響伴侶。過度認同伴侶會致使POW的妻子有PTSS, 構成自我區分功能的損傷。雖然妻子對於丈夫受虜及隨後的PTSS的間接經歷, 跟她們的PTSS與自我區分有關, 但我們仍不清楚它們結合的效應。而且, 過往的橫斷研究並未能解釋定向性。本前瞻性研究旨在探查: (一) 在丈夫的PTSS與妻子的PTSS及自我區分的關連之間, 妻子間接經歷受虜所產生的調節作用༛ (二) 妻子的自我區分與PTSS的關連發展的定向性。我們於1973年的贖罪日戰爭30年(T1)和38年 (T2)後, 對前戰俘的妻子(n = 143)和前戰鬥軍的妻子(n = 102)進行評估。前戰俘的妻子有較高水平的PTSS和混合的自我區分(η2p = .06 至 .14)。間接經歷受虜, 在丈夫的PTSS與妻子的PTSS關連之間造成調節效應(Cohen's f2 = .01 至 .03)。妻子的自我區分與PTSS的關連發展為雙向性(B = ‐ 0.18 至 0.68; R2 = .54 至 .73)。結果反映PTSS與自我區分之間有惡性循環。我們有需要為長期受創的患者提供臨床干預, 加強夫妻各自的自我區分。 Simplified Chinese 标题: 前战俘(POW)的妻子的次级创伤和自我区分:一种相互关连 撮要: 曾当战俘(POW)的军人可透过创伤后压力症状(PTSS), 以其受虏的回响影响伴侣。过度认同伴侣会致使POW的妻子有PTSS, 构成自我区分功能的损伤。虽然妻子对于丈夫受虏及随后的PTSS的间接经历, 跟她们的PTSS与自我区分有关, 但我们仍不清楚它们结合的效应。而且, 过往的横断研究并未能解释定向性。本前瞻性研究旨在探查: (一) 在丈夫的PTSS与妻子的PTSS及自我区分的关连之间, 妻子间接经历受虏所产生的调节作用༛ (二) 妻子的自我区分与PTSS的关连发展的定向性。我们于1973年的赎罪日战争30年(T1)和38年 (T2)后, 对前战俘的妻子(n = 143)和前战斗军的妻子(n = 102)进行评估。前战俘的妻子有较高水平的PTSS和混合的自我区分(η2p = .06 至 .14)。间接经历受虏, 在丈夫的PTSS与妻子的PTSS关连之间造成调节效应(Cohen's f2 = .01 至 .03)。妻子的自我区分与PTSS的关连发展为双向性(B = ‐ 0.18 至 0.68; R2 = .54 至 .73)。结果反映PTSS与自我区分之间有恶性循环。我们有需要为长期受创的患者提供临床干预, 加强夫妻各自的自我区分。

  July 11, 2017   doi: 10.1002/jts.22204   open full text
• Cognitive Emotion Regulation Strategies Associated With the DSM‐5 Posttraumatic Stress Disorder Criteria.
  Antonia N. Kaczkurkin, Yinyin Zang, Natalie G. Gay, Alan L. Peterson, Jeffrey S. Yarvis, Elisa V. Borah, Katherine A. Dondanville, Elizabeth A. Hembree, Brett T. Litz, Jim Mintz, Stacey Young‐McCaughan, Edna B. Foa,.
  Journal of Traumatic Stress. June 30, 2017
  Maladaptive cognitive emotion regulation strategies have been proposed to contribute to the maintenance of posttraumatic stress disorder (PTSD). Prior work has focused on the relationship between these strategies and PTSD as a whole, rather than on how they are related to each PTSD symptom cluster. The purpose of the current study was to determine whether cognitive emotion regulation strategies are predictive of certain PTSD symptom clusters under the Diagnostic and Statistical Manual of Mental Disorders 5th ed. (DSM‐5; American Psychiatric Association, 2013) criteria (intrusive thoughts, avoidance, negative alterations in cognitions and mood, and hyperarousal). Participants included 365 treatment‐seeking, active‐duty military personnel with PTSD. The negative alterations in cognitions and mood cluster were associated with dysfunctional cognitions: greater negative cognitions about the self, negative cognitions about the world, and self‐blame, as well as catastrophizing (Rc2 = .519). The negative alterations in cognitions and mood cluster did not show a strong relationship with blaming others, possibly due to the complex nature of self‐ and other‐blame in this primarily deployment‐related PTSD sample. Finally, the intrusive thoughts cluster was associated with catastrophizing (Rc2 = .211), suggesting an association between frequent intrusive memories and excessively negative interpretation of those memories. Se ha sugerido que las estrategias de regulación emocional cognitiva maladaptativas contribuyen en la mantención del trastorno de estrés postraumático (TEPT). Trabajos anteriores se han focalizado en la relación entre estas estrategias y TEPT en su conjunto, en lugar de cómo están relacionados con cada grupo de síntomas de TEPT. El propósito de este estudio fue determinar si las estrategias de regulación emocional cognitiva son predictores de ciertos grupos de síntomas de TEPT, bajo los criterios del Manual Estadístico de Trastornos Mentales, quinta edición (DSM‐5) (pensamientos intrusivos, evitación, alteraciones negativas en la cognición y animo e hiperactivación).Se incluyeron 365 personas del personal militar activo en función con TEPT en búsqueda de tratamiento. El grupo de alteraciones en cognición y ánimo estuvo asociado con cogniciones disfuncionales; mayores cogniciones negativas sobre el yo, cogniciones negativas acerca del mundo y culpa de sí mismo, así como las catastróficas (Rc² = .519). Las alteraciones negativas en el grupo de cogniciones y ánimo no mostraron una relación fuerte con culpar a otros, posiblemente debido la compleja naturaleza de la culpa a sí mismo y de otro tipo en esta muestra de TEPT relacionada principalmente con el despliegue. Finalmente, el grupo de pensamientos intrusivos estuvo asociado con pensamientos catastróficos (Rc² = .211), sugiriendo una asociación entre frecuencia de recuerdos intrusivos e interpretación excesivamente negativa de estos recuerdos. Traditional Chinese 標題: 與DSM‐5創傷後壓力症標準相關的認知情緒調節策略 撮要: 有研究指, 不良的認知情緒調節策略能助長創傷後壓力症(PTSD)。過往研究都把焦點放在這些策略跟PTSD整體的關係, 而非它們如何跟各種PTSD症狀聚類相關。本研究旨在根據《精神疾病診斷與統計手冊第五版》(DSM‐5)的準則 (侵擾念頭、迴避、認知與情緒的負向改變、過激反應) , 找出認知情緒調節策略是否能預測某種PTSD症狀聚類。樣本為365名患PTSD並尋求治療的現役軍隊成員。認知與情緒的負向改變聚類跟認知功能障礙相關, 這些認知功能障礙包括:自我認知較負面、對世界的認知負面、自責、和災難化(Rc2 = .519)。認知與情緒的負向改變聚類跟怪責別人沒有強大關連, 這可能是因為自責與怪責他人的本質在這個軍人為主的樣本裡較為複雜。最後, 侵擾念頭聚類跟災難化相關(Rc2 = .211), 反映頻繁的侵擾回憶跟對回憶有過度負面的詮釋有關。 Simplified Chinese 标题: 与DSM‐5创伤后压力症标准相关的认知情绪调节策略 撮要: 有研究指, 不良的认知情绪调节策略能助长创伤后压力症(PTSD)。过往研究都把焦点放在这些策略跟PTSD整体的关系, 而非它们如何跟各种PTSD症状聚类相关。本研究旨在根据《精神疾病诊断与统计手册第五版》(DSM‐5)的准则 (侵扰念头、回避、认知与情绪的负向改变、过激反应) , 找出认知情绪调节策略是否能预测某种PTSD症状聚类。样本为365名患PTSD并寻求治疗的现役军队成员。认知与情绪的负向改变聚类跟认知功能障碍相关, 这些认知功能障碍包括:自我认知较负面、对世界的认知负面、自责、和灾难化(Rc2 = .519)。认知与情绪的负向改变聚类跟怪责别人没有强大关连, 这可能是因为自责与怪责他人的本质在这个军人为主的样本里较为复杂。最后, 侵扰念头聚类跟灾难化相关(Rc2 = .211), 反映频繁的侵扰回忆跟对回忆有过度负面的诠释有关。

  June 30, 2017   doi: 10.1002/jts.22202   open full text
• Protective Factors, Coping Appraisals, and Social Barriers Predict Mental Health Following Community Violence: A Prospective Test of Social Cognitive Theory.
  Andrew J. Smith, Erika D. Felix, Charles C. Benight, Russell T. Jones.
  Journal of Traumatic Stress. June 23, 2017
  This study tested social cognitive theory of posttraumatic adaptation in the context of mass violence, hypothesizing that pre‐event protective factors (general self‐efficacy and perceived social support) would reduce posttraumatic stress symptoms (PTSS) and depression severity through boosting post‐event coping self‐efficacy appraisals (mediator). We qualified hypotheses by predicting that post‐event social support barriers would disrupt (moderate) the health‐promoting indirect effects of pre‐event protective factors. With a prospective longitudinal sample, we employed path models with bootstrapping resampling to test hypotheses. Participants included 70 university students (71.4% female; 40.0% White; 34.3% Asian; 14.3% Hispanic) enrolled during a mass violence event who completed surveys one year pre‐event and 5–6 months post‐event. Results revealed significant large effects in predicting coping self‐efficacy (mastery model, R2= .34; enabling model, R2= .36), PTSS (mastery model, R2= .35; enabling model, R2= .41), and depression severity (mastery model, R2= .43; enabling model, R2= .46). Overall findings supported study hypotheses, showing that at low levels of post‐event social support barriers, pre‐event protective factors reduced distress severity through boosting coping self‐efficacy. However, as post‐event social support barriers increased, the indirect, distress‐reducing effects of pre‐event protective factors were reduced to nonsignificance. Study implications focus on preventative and responsive intervention. Resumen Dinámicas cognitivas sociales y adaptación al trauma Este estudio probó la teoría cognitiva social de la adaptación postraumática en el contexto de la violencia de masas, hipotetizando que los factores protectores previos al evento (autoeficacia general y apoyo social percibido) reducirían los síntomas de estrés postraumático (SEPT) y la gravedad de la depresión mediante el impulso de las evaluaciones de autoeficacia de afrontamiento (mediador). Calificamos hipótesis prediciendo que las barreras de apoyo social posteriores al evento perturbarían (moderarían) los efectos indirectos de promoción de salud de los factores protectores previos al evento. Con una muestra prospectiva longitudinal, empleamos modelos de trayectoria con re‐muestreo autodocimante para probar hipótesis. Los participantes incluyeron a 70 estudiantes universitarios (71,4% mujeres, 40,0% blancos, 34,3% asiáticos, 14,3% hispanos) matriculados durante un evento de violencia de masas y que completaron las encuestas un año antes del evento y 5 a 6 meses después del evento. Los resultados revelaron efectos grandes significativos en la predicción de la autoeficacia de afrontamiento (modelo de dominio, R2 = .34; modelo habilitador, R2 = .36), SEPT (modelo de dominio, R2 = .35; modelo habilitador, R2 = .41), y la severidad de la depresión (modelo de dominio, R2 = .43; modelo habilitador, R2 = .46).Los hallazgos generales apoyaron las hipótesis del estudio, mostrando que a niveles bajos de barreras de apoyo social post evento, los factores de protección previos al evento redujeron la gravedad del estrés a través de la potenciación de la autoeficacia en afrontamiento. Sin embargo, a medida que aumentaron las barreras de apoyo social post‐evento, los efectos indirectos reductores de los factores protectores previos al evento se redujeron a no significancia. Las implicancias del estudio se enfocan en la intervención preventiva y responsiva. Traditional Chinese 標題: 在社群暴力事件後, 保護因素、應對力評估與社會障礙能預測心理健康༚一項社會認知理論的前瞻性測試 撮要: 本研究測試於集體暴力的情況下, 有關創傷後應對力的社會認知理論。我們假設事件前的保護因素 (一般自我效能與社會支持感知) , 會透過提高事件後的應對力自我效能評估 (介質) , 減輕創傷後壓力症狀(PTSS)及抑鬱症嚴重度。我們預計事件後的社會支持障礙, 會破壞 (調節) 事件前保護因素所產生有利健康的間接效應。我們對前瞻性縱貫樣本採用路徑模型, 以拔靴帶及重複取樣的方法測試假設。參與者包含70名經歷過集體暴力事件的大學生 (71.4% 女性; 40.0% 白人; 34.3% 亞洲人; 14.3% 西班牙裔人) 。他們在事件發生1年前、和事件發生後5至6個月完成問卷。結果在預測應對自我效能 (精通模型, R2 = .34; 賦能模型, R2 = .36) 、PTSS (精通模型, R2 = .35; 賦能模型, R2 = .41) 、及抑鬱症嚴重度 (精通模型, R2 = .43; 賦能模型, R2 = .46) 方面, 均顯示顯著地大的效應量。整體結果支持我們的假設, 反映事件後社會支持障礙為低水平時, 事件前保護因素會透過提高應對力自我效能, 減低悲痛嚴重度。然而, 當事件後的社會支持障礙提升, 事件前保護因素減低悲痛的間接效應就降為不顯著。研究針對預防性及反應性干預, 討論結果含意。 Simplified Chinese 标题: 在社群暴力事件后, 保护因素、应对力评估与社会障碍能预测心理健康༚一项社会认知理论的前瞻性测试 撮要: 本研究测试于集体暴力的情况下, 有关创伤后应对力的社会认知理论。我们假设事件前的保护因素 (一般自我效能与社会支持感知) , 会透过提高事件后的应对力自我效能评估 (介质) , 减轻创伤后压力症状(PTSS)及抑郁症严重度。我们预计事件后的社会支持障碍, 会破坏 (调节) 事件前保护因素所产生有利健康的间接效应。我们对前瞻性纵贯样本采用路径模型, 以拔靴带及重复取样的方法测试假设。参与者包含70名经历过集体暴力事件的大学生 (71.4% 女性; 40.0% 白人; 34.3% 亚洲人; 14.3% 西班牙裔人) 。他们在事件发生1年前、和事件发生后5至6个月完成问卷。结果在预测应对自我效能 (精通模型, R2 = .34; 赋能模型, R2 = .36) 、PTSS (精通模型, R2 = .35; 赋能模型, R2 = .41) 、及抑郁症严重度 (精通模型, R2 = .43; 赋能模型, R2 = .46) 方面, 均显示显著地大的效应量。整体结果支持我们的假设, 反映事件后社会支持障碍为低水平时, 事件前保护因素会透过提高应对力自我效能, 减低悲痛严重度。然而, 当事件后的社会支持障碍提升, 事件前保护因素减低悲痛的间接效应就降为不显著。研究针对预防性及反应性干预, 讨论结果含意。

  June 23, 2017   doi: 10.1002/jts.22197   open full text
• Psychosocial, Demographic, and Illness‐Related Factors Associated With Acute Traumatic Stress Responses in Parents of Children With a Serious Illness or Injury.
  Frank Muscara, Maria C. McCarthy, Emma J. Thompson, Claire‐Marie Heaney, Stephen J. C. Hearps, Meredith Rayner, Kylie Burke, Jan M. Nicholson, Vicki A. Anderson.
  Journal of Traumatic Stress. June 23, 2017
  This study investigated factors associated with acute stress symptoms in parents of seriously ill children across a range of illnesses and treatment settings within a pediatric hospital setting. It was hypothesized that psychosocial variables would be more strongly associated with acute stress responses than demographic and child illness variables. Participants were 115 mothers and 56 fathers of children treated within the oncology, cardiology, and intensive care departments of a pediatric hospital. Acute stress, psychosocial, demographic, and medical data were collected within the first 4 weeks of the child's hospital admission. A robust hierarchical regression model revealed that psychosocial factors significantly explained 36.8% of the variance in parent acute stress responses (p < .001); demographic variables significantly added a further 4.5% (p = .022), but illness‐related factors did not contribute to the model. Findings support the implementation of a general psychosocial screening approach for parents across the wider hospital system, and that psychosocial risk factors may be targeted in interventions across different illnesses and treatment settings to improve parent outcomes. Resumen PREDICTORES DE RESPUESTAS AGUDAS A ESTRÉS EN PADRES Este estudio investigó factores asociados con los síntomas de estrés agudo en padres de niños seriamente enfermos,en un amplio rango de enfermedades y escenarios de tratamiento, dentro del contexto de un hospital pediátrico. Se hipotetizó que las variables psicosociales estarían más fuertemente asociadas con las respuestas agudas a estrés que las variables demográficas y de la enfermedad del niño. Los participantes fueron 115 madres y 56 padres de niños tratados dentro de los departamentos de oncología, cardiología, y cuidados intensivos de un hospital pediátrico. Se recogieron datos de estrés agudo, psicosociales, demográficos y médicos dentro de las primeras cuatro semanas del ingreso del niño al hospital.Un robusto modelo de regresión jerárquico reveló que los factores psicosociales explicaban de forma significativa el 36.8% de la varianza de las respuestas a estrés agudo de los padres (p<.001); las variables demográficas agregaban, significativamente, un 4.5% (p = .022), pero los factores relacionados a la enfermedad no contribuyeron al modelo. Los hallazgos apoyan la implementación de un abordaje general de tamizaje psicosocial para los padres a través del más amplio sistema hospitalario, y los factores de riesgo psicosocial pueden ser abordados en intervenciones en diferentes enfermedades y escenarios de tratamiento, para mejorar los resultados de los padres. Traditional Chinese 標題: 病重或傷重兒童的家長中, 與急性創傷壓力症狀有關的心理社會、人口統計和疾病相關因素 撮要: 本研究探查在兒科醫院裡, 患不同病症和接受不同治療的病重兒童, 其家長的急性壓力症狀的關連因素。我們假設比起人口變量和兒童病患變量, 心理社會變量跟急性壓力症狀有較強關連。研究樣本為一家兒科醫院裡, 於腫瘤科、心臟科和深切治療部留醫兒童的家長, 共有115名母親和56名父親。我們在兒童入院的首4週內, 取得急性壓力、心理社會、人口統計和醫療數據。強勁的層次迴歸模型顯示, 心理社會因素顯著地解釋了家長急性壓力症狀36.8%的方差(p < .001), 人口變量顯著地解釋了4.5%(p = .022), 而疾病相關的因素卻無關。研究結果為在廣泛的醫院系統, 採取普及的心理社會篩查方法提供支持理據。為面對不同病症和治療情況的家長提供干預治療時, 可能應針對心理社會的風險因素。 Simplified Chinese 标题: 病重或伤重儿童的家长中, 与急性创伤压力症状有关的心理社会、人口统计和疾病相关因素 撮要: 本研究探查在儿科医院里, 患不同病症和接受不同治疗的病重儿童, 其家长的急性压力症状的关连因素。我们假设比起人口变量和儿童病患变量, 心理社会变量跟急性压力症状有较强关连。研究样本为一家儿科医院里, 于肿瘤科、心脏科和深切治疗部留医儿童的家长, 共有115名母亲和56名父亲。我们在儿童入院的首4周内, 取得急性压力、心理社会、人口统计和医疗数据。强劲的层次回归模型显示, 心理社会因素显著地解释了家长急性压力症状36.8%的方差(p < .001), 人口变量显著地解释了4.5%(p = .022), 而疾病相关的因素却无关。研究结果为在广泛的医院系统, 采取普及的心理社会筛查方法提供支持理据。为面对不同病症和治疗情况的家长提供干预治疗时, 可能应针对心理社会的风险因素。

  June 23, 2017   doi: 10.1002/jts.22193   open full text
• Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study.
  Danny Brom, Yaffa Stokar, Cathy Lawi, Vered Nuriel‐Porat, Yuval Ziv, Karen Lerner, Gina Ross.
  Journal of Traumatic Stress. June 06, 2017
  This study presents the first known randomized controlled study evaluating the effectiveness of somatic experiencing (SE), an integrative body‐focused therapy for treating people with posttraumatic stress disorder (PTSD). There were 63 participants meeting DSM‐IV‐TR full criteria for PTSD included. Baseline clinical interviews and self‐report measures were completed by all participants, who were then randomly assigned to study (n = 33) or waitlist (n = 30) groups. Study participants began 15 weekly SE sessions, whereas waitlist participants waited the same period, after which the second evaluation was conducted. All participants were evaluated a third time after an additional 15 weeks, during which time the waitlist group received SE therapy. Pretreatment evaluation showed no significant differences between groups. Mixed model linear regression analysis showed significant intervention effects for posttraumatic symptoms severity (Cohen's d = 0.94 to 1.26) and depression (Cohen's d = 0.7 to 1.08) both pre‐post and pre‐follow‐up. This randomized controlled study of SE shows positive results indicating SE may be an effective therapy method for PTSD. Further research is needed to understand who shall benefit most from this treatment modality. Resumen VIVENCIAS SOMATICAS PARA TEPT Este estudio presenta el primer estudio controlado randomizado conocido para evaluar la efectividad de las Vivencias Somáticas (VS), una terapia integrativa enfocada en el cuerpo para tratar a las personas con trastorno de estrés pos traumático TEPT). Sesenta y tres participantes que cumplieron con el criterio completo del DSM IV‐TR (4ª ed., text.rev.; DSM‐IV‐TR; Sociedad Americana de Psiquiatría, 2000) para TEPT fueron incluidos. Entrevistas clínicas de línea base y medidas de auto‐reporte fueron completados por todos los participantes, quienes fueron asignados azarosamente al grupo estudio (n = 33) o lista de espera (n = 30). Los participantes del grupo estudio comenzaron 15 sesiones semanales de VS, mientras que los participantes de la lista de espera esperaron el mismo periodo de tiempo, después del cual la segunda evaluación fue conducida. Todos los participantes fueron evaluados una tercera vez después de 15 semanas adicionales, durante este tiempo, el grupo de lista de espera recibió terapia VS. La evaluación de pretratamiento no mostró diferencias significativas entre los grupos. Análisis de regresión lineal de modelo mixto mostró efectos significativos de intervención para la severidad de los síntomas postraumático (Cohen's d = 0.94 a 1.26) y depresión (Cohen's d = 0.7 a 1.08) ambos pre–post y pre‐seguimiento. Este estudio controlado randomizado de VS muestra resultados positivos indicando que VS puede ser un método terapéutico efectivo para TEPT. Se necesita más investigación para entender quiénes pueden beneficiarse más de esta modalidad de tratamiento. Estudios prospectivos describen y predicen diferencias individuales en el curso de los síntomas de estrés postraumático (SEPT) después de los desastres son escasos. El presente estudio tiene como objetivo describir y predecir las diferencias individuales en el nively la velocidad de cambio en SEPT después de la bomba de Oslo en 2011, que fue un ataque terrorista dirigido al gobierno Noruego. Los dato de encuestas de empleados ministeriales (N = 256) fueron recogidos 10, 22 y 34 meses después del bombardeo. Utilizamos el modelo de crecimiento latente para examinar el desarrollo del SEPT, y para identificar la fuerza de lasvariables predictorespotenciales. Alta exposición, siendo mujer, y altos niveles de neuroticismo se asociaron con altos niveles de SEPT 10 meses después del evento traumático (β vario de .25 a .30, p < .001), mientras el apoyo social se asoció con menores niveles de SEPT (β = –.30, p < .001).Ser mujer con alto neuroticismo se asoció con una rápida reducción de SEPT. (βvario de–.20 to .39, p < .05).Una alta exposición parece tener una influencia duradera mediante la mantención de altos niveles de SEPT. Nuestros hallazgos sugieren que ser mujer, ser altamente expuesta, y tener bajos niveles de apoyo social fueron marcadores de riesgo para el SEPT duradero. Traditional Chinese 標題: 為治療創傷後壓力症的體感治療༚一項隨機對照的臨床實效研究 撮要: 這是首個隨機對照研究, 檢視為創傷後壓力症(PTSD)患者提供、針對軀體的綜合療法──體感治療(SE)的功效。樣本包含63名完全符合DSM IV‐TR (精神疾病診斷與統計手冊第四修訂版; 美國精神醫學學會, 2000) PTSD準則的人士。所有參與者均完成了基線的臨床面談和自評測量。他們隨後被隨機分派到研究組(n = 33)和等待組(n = 30)。研究組進行每週1次、共15次的SE節段, 其後我們對等待組和研究組進行第二次評估。然後, 等待組接受SE, 我們在15週後再為兩組進行第三次評估。在療法前的評估結果裡, 兩組之間並無顯著差異。然而, 線性迴歸混合模型分析反映, 在治療前後(pre‐post)及治療前與跟進後(pre‐follow‐up), 創傷後症狀嚴重度(Cohen's d = 0.94 至 1.26)和抑鬱症(Cohen's d = 0.7 至 1.08)有顯著的干預效應。這個對SE的隨機對照研究反映正向結果, 顯示SE可能是對PTSD患者有效的療法。未來需有更多研究以找出此治療方式對哪種人最為有效。 Simplified Chinese 标题: 为治疗创伤后压力症的体感治疗༚一项随机对照的临床实效研究 撮要: 这是首个随机对照研究, 检视为创伤后压力症(PTSD)患者提供、针对躯体的综合疗法──体感治疗(SE)的功效。样本包含63名完全符合DSM IV‐TR (精神疾病诊断与统计手册第四修订版; 美国精神医学学会, 2000) PTSD准则的人士。所有参与者均完成了基线的临床面谈和自评测量。他们随后被随机分派到研究组(n = 33)和等待组(n = 30)。研究组进行每周1次、共15次的SE节段, 其后我们对等待组和研究组进行第二次评估。然后, 等待组接受SE, 我们在15周后再为两组进行第三次评估。在疗法前的评估结果里, 两组之间并无显著差异。然而, 线性回归混合模型分析反映, 在治疗前后(pre‐post)及治疗前与跟进后(pre‐follow‐up), 创伤后症状严重度(Cohen's d = 0.94 至 1.26)和抑郁症(Cohen's d = 0.7 至 1.08)有显著的干预效应。这个对SE的随机对照研究反映正向结果, 显示SE可能是对PTSD患者有效的疗法。未来需有更多研究以找出此治疗方式对哪种人最为有效。

  June 06, 2017   doi: 10.1002/jts.22189   open full text
• Randomized Clinical Trial Investigating the Effects of an Anxiety Sensitivity Intervention on Posttraumatic Stress Symptoms: A Replication and Extension.
  Nicole A. Short, Joseph W. Boffa, Aaron M. Norr, Brian J. Albanese, Nicholas P. Allan, Norman B. Schmidt.
  Journal of Traumatic Stress. June 06, 2017
  A growing body of research suggests the importance of anxiety sensitivity (AS) in the development and maintenance of posttraumatic stress symptoms (PTSS). Specifically, AS cognitive concerns (fears of cognitive dyscontrol) may be particularly relevant for those with elevated PTSS. Preliminary research has suggested that interventions targeting AS may be beneficial in decreasing PTSS, but to date there has been no randomized controlled trial testing the direct and indirect effects of an AS cognitive concerns intervention among a clinical sample of trauma‐exposed individuals. The current study tested these effects among a sample 63 trauma‐exposed participants who were randomized to either an AS cognitive concerns intervention or a repeated contact control. Results indicated a direct effect of the intervention on PTSS 1 month postintervention, and that this effect was mediated by changes in AS, specifically AS cognitive concerns, during the intervention period. Effect sizes were in the small‐to‐medium range (variance accounted for ranged from .05 to .15; odds ratio for diagnostic change = .06). These findings provide further evidence that targeting AS may be beneficial in the treatment of PTSS, and expansion upon this area of research by demonstrating these effects may be specific to AS cognitive concerns and can be achieved within a mixed clinical sample. Resumen Intervención sobre la sensibilidad a la ansiedad para TEPT Un cuerpo de investigación creciente sugiere la importancia de la sensibilidad a la ansiedad (SA) en el desarrollo y mantenimiento de los síntomas de estrés postraumático (TEPT). Específicamente, las preocupaciones cognitivas respecto a SA (miedos de descontrol cognitivo) pueden ser particularmente relevantes para aquellos con TEPT elevados. Las investigaciones preliminares sugieren que las intervenciones que abordan el SA pueden ser beneficiosas para disminuir el TEPT, pero a la fecha no han existido ensayos clínicos aleatorizados testeando los efectos directos e indirectos de una intervención sobre las preocupaciones cognitivas de SA en una muestra clínica de individuos expuestos a trauma. El presente estudio testeó estos efectos en una muestra de 63 participantes expuestos a trauma quienes fueron aleatorizados, ya sea para intervenciones de preocupaciones cognitivas sobre SA, o a un contacto de control repetido. Los resultados indican un efecto directo de la intervención en TEPT a un mes post intervención, y este efecto estaba mediado por cambios en SA, específicamente preocupaciones cognitivas de SA, durante el período de la intervención. Los tamaños del efecto fluctuaban en un rango de pequeño a mediano (la varianza contabilizada fue desde los .05 a .15; con un ratio de cambio de diagnóstico = .06). Estos resultados proveen evidencia adicional sobre focalizar en la SA pudiera ser beneficioso en el tratamiento de TEPT, y expandirse en esta área de investigación, al demostrar que estos efectos pueden ser específicos sobre las preocupaciones cognitivas de SA y pueden ser alcanzadas dentro de una muestra clínica mixta. Traditional Chinese 標題: 探查針對焦慮敏感度的干預, 對創傷後壓力症狀效應的隨機臨床試驗༚一項重複與擴展驗證 撮要: 越來越多研究提出, 焦慮敏感度(AS)在創傷後壓力症狀(PTSS)的發展和維持過程裡有重要角色。在PTSS提升的患者中, AS的認知顧慮 (對認知失控的恐懼) 可能產生特殊影響。過往的初步研究指出, 針對AS的干預可能有助減輕PTSS, 但至今仍未有隨機對照試驗, 檢視受創人士組成的臨床樣本中, 針對AS的認知顧慮干預有何直接及間接效應。本研究透過63名受創的參與者, 檢視以上提及的效應。樣本被隨機分派到接受AS的認知顧慮干預組和重複接觸的對照組。結果顯示, 接受干預一個月後, 干預對PTSS有直接效應, 而這效應受干預期間AS的改變、特別是AS認知顧慮的改變所中介影響。效應量值域介乎小至中等 (能解釋的方差值域為 .05 至.15; 診斷改變的機會比例 = .06) 。研究結果進一步證實, 針對AS的干預可能有助治療PTSS, 並以混合的臨床樣本, 反映以上的干預效應可能只特殊地適用於有AS認知顧慮的患者, 擴展了這方面的研究。 Simplified Chinese 标题: 探查针对焦虑敏感度的干预, 对创伤后压力症状效应的随机临床试验༚一项重复与扩展验证 撮要: 越来越多研究提出, 焦虑敏感度(AS)在创伤后压力症状(PTSS)的发展和维持过程里有重要角色。在PTSS提升的患者中, AS的认知顾虑 (对认知失控的恐惧) 可能产生特殊影响。过往的初步研究指出, 针对AS的干预可能有助减轻PTSS, 但至今仍未有随机对照试验, 检视受创人士组成的临床样本中, 针对AS的认知顾虑干预有何直接及间接效应。本研究透过63名受创的参与者, 检视以上提及的效应。样本被随机分派到接受AS的认知顾虑干预组和重复接触的对照组。结果显示, 接受干预一个月后, 干预对PTSS有直接效应, 而这效应受干预期间AS的改变、特别是AS认知顾虑的改变所中介影响。效应量值域介乎小至中等 (能解释的方差值域为 .05 至.15; 诊断改变的机会比例 = .06) 。研究结果进一步证实, 针对AS的干预可能有助治疗PTSS, 并以混合的临床样本, 反映以上的干预效应可能只特殊地适用于有AS认知顾虑的患者, 扩展了这方面的研究。

  June 06, 2017   doi: 10.1002/jts.22194   open full text
• Natural Course of Co‐Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans.
  Kyle Possemato, Stephen A. Maisto, Michael Wade, Kimberly Barrie, Emily M. Johnson, Paige C. Ouimette.
  Journal of Traumatic Stress. June 06, 2017
  Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co‐occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11 months. Latent class growth mixture modeling was used to classify individuals into distinct classes with similar PTSD symptom and alcohol use growth trajectories. We then investigated theorized predictors of class membership including sociodemographics; pre‐, peri‐, and postdeployment factors; coping; symptom severity; and number of mental health/substance use appointments attended. Results revealed that most participants had severe and nonremitting PTSD. Trajectories for alcohol use included gradual and drastic declines, and chronic low‐level drinking. The use of behavioral health services (odds ratio = 2.47) and fewer current stressors (odds ratio = 0.42) predicted AUD remission. Because little variation was observed in the PTSD course, our study did not observe coordinated fluctuations of PTSD symptoms and heavy drinking. Our findings suggest that treatment impacts the course of AUD and that recent combat veterans who do not seek PTSD treatment may have chronic and severe PTSD symptoms. RESUMEN CURSO NATURAL DEL TEPT Y USO DE ALCOHOL Es común la co‐ocurrencia del Trastorno por Estrés Postraumático y el uso de Alcohol en veteranos de guerra, pero aún se sabe poco del curso longitudinal de esta comorbilidad en estas poblaciones. Este estudio evaluó el curso natural del consumo diario de alcohol y los cambios semanales de síntomas de TEPT en 112 veteranos de guerra durante 11 meses. Se usó un modelo de clase de mezcla de crecimiento latente para clasificar individuos en distintas clases con síntomas similares de TEPT y trayectorias de crecimiento de uso del alcohol. Luego se investigaron los factores predictivos de la pertenencia a la clase, incluidos los factores sociodemográficos, pre, peri y post despliegue, afrontamiento, la gravedad de los síntomas y el número de atenciones en consultas de salud mental por consumo de sustancias. Los resultados revelaron que la mayoría de los participantes tenían síntomas severos de TEPT sin remitir. Las trayectorias para el consumo del alcohol incluyeron disminuciones graduales y drásticas, y consumo crónico de alcohol de bajo nivel. El uso de servicios de salud (OR = 2.47) y estresores actuales menores (OR = 0.42), predijeron remisión del trastorno por consumo de alcohol. Nuestro estudio no observó fluctuaciones coordinadas de síntomas de TEPT y consumo de alcohol severo, sólo unas pequeñas variaciones. Nuestros hallazgos sugieren que el tratamiento impacta en el consumo del alcohol y que los veteranos de guerra que no buscan tratamiento para TEPT, pueden tener síntomas crónicos y severos de TEPT. Traditional Chinese 標題: 近期退役的戰鬥軍人其PTSD與酒精使用疾患共病的自然發展 撮要: 同時患創傷後壓力症(PTSD)和酒精使用疾患(AUD)共病, 在退役軍人中屬普遍現象, 但有關有此共病的人口裡PTSD與酒精使用的縱貫發展, 我們仍缺乏了解。本研究對112名近期退役的戰鬥軍人進行為期11個月的評估, 檢視他們每天的酒精消耗量和PTSD症狀每週改變的自然發展過程。我們採用潛在類別增長混合模型, 把有相似PTSD症狀和酒精使用增長軌跡的樣本歸類。然後, 我們檢視有關類別的理論性預測變量, 包括༚社會人口統計、服役前、中和後的因素、應對能力、症狀嚴重度、及接受心理或濫用藥物治療的次數。結果反映, 大部分參與者有嚴重並沒有減緩的PTSD。酒精使用軌跡包括緩慢下降、大幅度下降、和長期低水平的酒精使用。接受健康行為治療(OR = 2.47)和有較少當前壓力源, 都能預測AUD減緩。研究裡PTSD的發展呈現很少變化, 所以我們並無發現PTSD症狀改變與嚴重酒精使用的關係。研究結果反映, 治療會影響AUD的發展༛而沒有尋求PTSD治療的近期退役戰鬥軍人, 有可能有慢性及嚴重的PTSD症狀。 Simplified Chinese 标题: 近期退役的战斗军人其PTSD与酒精使用疾患共病的自然发展 撮要: 同时患创伤后压力症(PTSD)和酒精使用疾患(AUD)共病, 在退役军人中属普遍现象, 但有关有此共病的人口里PTSD与酒精使用的纵贯发展, 我们仍缺乏了解。本研究对112名近期退役的战斗军人进行为期11个月的评估, 检视他们每天的酒精消耗量和PTSD症状每周改变的自然发展过程。我们采用潜在类别增长混合模型, 把有相似PTSD症状和酒精使用增长轨迹的样本归类。然后, 我们检视有关类别的理论性预测变量, 包括༚社会人口统计、服役前、中和后的因素、应对能力、症状严重度、及接受心理或滥用药物治疗的次数。结果反映, 大部分参与者有严重并没有减缓的PTSD。酒精使用轨迹包括缓慢下降、大幅度下降、和长期低水平的酒精使用。接受健康行为治疗(OR = 2.47)和有较少当前压力源, 都能预测AUD减缓。研究里PTSD的发展呈现很少变化, 所以我们并无发现PTSD症状改变与严重酒精使用的关系。研究结果反映, 治疗会影响AUD的发展༛而没有寻求PTSD治疗的近期退役战斗军人, 有可能有慢性及严重的PTSD症状。

  June 06, 2017   doi: 10.1002/jts.22192   open full text
• Life Threat and Sleep Disturbances in Adolescents: A Two‐Year Follow‐Up of Survivors From the 2011 Utøya, Norway, Terror Attack.
  Janne Grønli, Annika Melinder, Olga Therese Ousdal, Ståle Pallesen, Tor Endestad, Anne Marita Milde.
  Journal of Traumatic Stress. June 06, 2017
  A significant number of adolescents have been exposed to traumatic life events. However, knowledge about the specific sleep disturbance that occurs in individuals after trauma exposure is predominantly based on studies of adults. This study reports specific sleep disturbance in 42 survivors of the 2011 mass shooting at a youth summer camp on the Norwegian island Utøya, mean age = 20.91 years, SD = 2.32, 62.5% females. When compared with matched controls, significantly more survivors reported having sleep disturbances, 52.4% versus 13.6%, d = 0.93, of which onset began at the time of the shooting, χ2= 14.9, p < .001. The prevalence of insomnia, 56.3% versus 11.0%, d = 0.73; excessive daytime sleepiness, 34.4% versus 13.6%, d = 0.61; symptoms of obstructive sleep apnea, 18.8% versus 0%, d = 0.70; and frequent nightmares, 37.5% versus 2.3%, d = 0.90, were all higher in the survivors than in the controls. In a subgroup of survivors (n = 20) with psychiatric diagnoses, sleep disturbances were more prevalent than in survivors without psychiatric diagnosis. Actigraphy data revealed delayed bedtime, sleep onset, and rise time in survivors compared with controls, ts > 1.7, ps = .044 to .028. These results corroborate the effects of a life threat on the range and extent of sleep disturbances, and emphasize the need to better assess and treat sleep disorders in adolescents exposed to trauma. Resumen TRASTORNOS DEL SUEÑO EN JÓVENES DESPUÉS DE UNA AMENAZA DE VIDA Un significativo número de adolescentes ha estado expuesto a eventos traumáticos en la vida. Sin embargo los conocimientos acerca de trastornos del sueño específicos que ocurren en individuos después de estar expuestos a trauma están predominantemente basados en estudios en adultos. Este estudio reporta específicas alteraciones del sueño en 42 sobrevivientes del tiroteo masivo a jóvenes del campamento de verano en la isla de Utøya, Noruega en el 2011, promedio de edad = 20.91 años, DE = 2.32, 62.5% femenino. Cuando se compara con el grupo de control, significativamente más sobrevivientes reportan haber tenido alteraciones del sueño, 52.4% vs. 13.6%, d = 0.93 los cuales aparecen al momento del tiroteo X2 = 14.9, p < .001. La prevalencia de insomnio 56.3% vs. 11.0%, d = 0.73, excesivo sueño diurno 34.4% vs. 13.6%, d = 0.61, síntomas de apnea obstructiva del sueño, 18.8% vs. 0%, d = 0.70, y frecuentes pesadillas, 37.5% vs. 2.3%, d = 0.90, fueron todos más altos en los sobrevivientes que en el grupo de control. En un subgrupo de sobrevivientes (n = 20) con diagnóstico psiquiátrico, los trastornos del sueño eran más prevalentes que en sobrevivientes sin un diagnóstico psiquiátrico. Los datos de la Actigrafía, revelan un retraso en la hora de dormir, sueño repentino y hora de levantarse en sobrevivientes comparado con el grupo control ts> 1.7, ps = 0.44 a .028. Estos resultados corroboran los efectos de la amenaza de vida en las alteraciones de sueño en un rango extenso, y enfatiza la necesidad de mejorar la medición y tratamientos de las alteraciones de sueño en adolescentes expuestos a trauma. Traditional Chinese 標題: 青少年經歷的生命威脅和睡眠障礙༚對2011年挪威于特島恐襲的生還者為期兩年的跟進研究 撮要: 不少青少年曾經歷創傷性的生命事件。可是, 我們現有關於個人經歷創傷後特殊的睡眠障礙的資訊, 卻大多由針對成人的研究取得。2011年, 挪威于特島一個青年夏令營發生槍擊事件。本研究檢視當中42名生還者特殊的睡眠障礙。樣本的平均年齡為20.91歲, SD = 2.32, 62.5%為女性。跟已進行匹配的對照組相比, 生還者樣本顯著地較多人有睡眠障礙 (52.4% vs 13.6%, d = 0.93), 而他們的症狀都是從槍擊事件後開始出現 (χ2 = 14.9, p < .001)。跟對照組相比, 以下狀況在生還者當中都呈現較高水平༚失眠普遍度 (56.3% vs. 11.0%, d = 0.73)、白天過度睏倦 (34.4% vs. 13.6%, d = 0.61)、阻塞睡眠窒息症狀 (18.8% vs. 0%, d = 0.70)、及頻繁地做惡夢 (37.5% vs 2.3%, d = 0.90)。生還者樣本裡獲診斷有精神問題的次組別(n = 20), 睡眠障礙普遍度比無精神問題的樣本較高。腕動計數據反映, 與對照組相比, 生還者樣本顯示延遲的睡眠時間、入睡時間和起床時間 (ts > 1.7, ps = .044 至 .028)。本研究結果證實了生命威脅對睡眠障礙幅度的影響, 並強調我們有需要更有效地評估和治理受創青少年的睡眠障礙。 Simplified Chinese 标题: 青少年经历的生命威胁和睡眠障碍༚对2011年挪威于特岛恐袭的生还者为期两年的跟进研究 撮要: 不少青少年曾经历创伤性的生命事件。可是, 我们现有关于个人经历创伤后特殊的睡眠障碍的信息, 却大多由针对成人的研究取得。2011年, 挪威于特岛一个青年夏令营发生枪击事件。本研究检视当中42名生还者特殊的睡眠障碍。样本的平均年龄为20.91岁, SD = 2.32, 62.5%为女性。跟已进行匹配的对照组相比, 生还者样本显著地较多人有睡眠障碍 (52.4% vs 13.6%, d = 0.93), 而他们的症状都是从枪击事件后开始出现 (χ2 = 14.9, p < .001)。跟对照组相比, 以下状况在生还者当中都呈现较高水平༚失眠普遍度 (56.3% vs. 11.0%, d = 0.73)、白天过度困倦 (34.4% vs. 13.6%, d = 0.61)、阻塞睡眠窒息症状 (18.8% vs. 0%, d = 0.70)、及频繁地做恶梦 (37.5% vs 2.3%, d = 0.90)。生还者样本里获诊断有精神问题的次组别(n = 20), 睡眠障碍普遍度比无精神问题的样本较高。腕动计数据反映, 与对照组相比, 生还者样本显示延迟的睡眠时间、入睡时间和起床时间 (ts > 1.7, ps = .044 至 .028)。本研究结果证实了生命威胁对睡眠障碍幅度的影响, 并强调我们有需要更有效地评估和治理受创青少年的睡眠障碍。

  June 06, 2017   doi: 10.1002/jts.22196   open full text
• Comparing Trauma Exposure, Mental Health Needs, and Service Utilization Across Clinical Samples of Refugee, Immigrant, and U.S.‐Origin Children.
  Theresa S. Betancourt, Elizabeth A. Newnham, Dina Birman, Robert Lee, B. Heidi Ellis, Christopher M. Layne.
  Journal of Traumatic Stress. June 06, 2017
  Most mental health services for trauma‐exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee‐origin, immigrant‐origin, and U.S.‐origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee‐origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity‐matched samples of immigrant‐origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.‐origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.‐origin youth (p < .001) or immigrant youth (p ≤ .001). Compared with U.S.‐origin youth, refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.  In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (ps ranging from .030 to < .001).This clinic‐referred sample of refugee‐origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning. Resumen Trauma y uso de servicios de salud mental en niños refugiados La mayoría de los servicios mentales para niños y adolescentes expuestos a trauma no fueron originalmente desarrollados para refugiados. Se necesita información para ayudar a los clínicos a diseñar servicios que aborden las consecuencias del trauma en poblaciones de refugiados. Comparamos la exposición al trauma, la angustia psicológica y la utilización de servicios mentales entre niños y adolescentes de grupos refugiados, inmigrantes y de origen americano para la evaluación y tratamiento por los proveedores americanos en la Red Nacional de Estrés Traumático infantil (RNETI). Usamos la puntuación de pares de propensión para comparar los perfiles de trauma, necesidades de salud mental y uso de servicios en los tres grupos. La muestra comprendió jóvenes refugiados (n = 60, 48,3% femenino, edad promedio = 13.7 años) ymuestras de pares de propensión de jóvenes inmigrantes (n = 143, 60,8%, femenino, edad promedio = 13.26 años) y jóvenes de origen americano (n = 140 56,1%, femenino, edad promedio = 12.11 años). En promedio, hubo significativamente más tipos de exposición a traumas entre los jóvenes refugiados que en los jóvenes de origen americano (p<.001) o jóvenes inmigrantes (p<.001). Comparados con los jóvenes de origen americano, los jóvenes refugiados tuvieron mayores tasas de exposición a violencia comunitaria, síntomas disociativos, duelo traumático, somatización y trastorno fóbico. En contraste, el grupo de refugiados tuvo en comparación tasas más bajas de abuso de sustancias y trastorno oposicionista desafiante (ps que van desde .030 a < .001). Esta muestra clínica referida de jóvenes refugiados presentados con patrones distintivos de exposición a trauma, síntomas de angustia y necesidades de servicio, merecen una consideración en la planificación de los servicios. Traditional Chinese 標題: 透過難民、移民及美國藉的兒童臨床樣本, 比較創傷經歷、心理需要和 心理治療服務使用模式 撮要: 大部分現有為受創兒童及青少年提供的心理治療服務都不是專為難民而設。臨床治療師需要更多數據為難民設計治療, 治理創傷對他們的影響。本研究樣本為獲美國醫療單位轉介去國家兒童創傷壓力網絡(NCTSN), 接受評估和治療的兒童及青少年。我們比較難民、移民及美國藉的兒童及青少年的創傷經歷、心理悲痛和心理治療服務的使用模式。我們利用傾向評分匹配法, 比較三組樣本的創傷剖象、心理需要和治療服務使用。樣本包括難民青少年 (n = 60, 48.3% 女性, 平均年齡 = 13.07 歲), 及採用了傾向評分匹配法的青少年移民樣本 (n = 143, 60.8% 女性, 平均年齡 = 13.26 歲), 及美國藉青少年樣本 (n = 140, 56.1% 女性, 平均年齡 = 12.11 歲)。平均來說, 相比美國藉青少年(p < .001)和青少年移民(p < .001), 難民青少年顯著地反映更多種創傷經歷。與美國藉青少年相比, 難民青少年有較高水平的社群暴力經歷、離解症狀、創傷後悲傷、軀體化和恐懼症, 但有較低水平的濫用藥物狀況和對抗性蔑視失常 (ps 值域為 .030 至 < .001)。本研究的難民青少年樣本展現明顯的創傷經歷、悲痛症狀和心理治療服務需要的模式, 醫療單位日後設計治療時值得考慮這些數據。 Simplified Chinese 标题: 透过难民、移民及美国藉的儿童临床样本, 比较创伤经历、心理需要和心理治疗服务使用模式 撮要: 大部分现有为受创儿童及青少年提供的心理治疗服务都不是专为难民而设。临床治疗师需要更多数据为难民设计治疗, 治理创伤对他们的影响。本研究样本为获美国医疗单位转介去国家儿童创伤压力网络(NCTSN), 接受评估和治疗的儿童及青少年。我们比较难民、移民及美国藉的儿童及青少年的创伤经历、心理悲痛和心理治疗服务的使用模式。我们利用倾向评分匹配法, 比较三组样本的创伤剖象、心理需要和治疗服务使用。样本包括难民青少年 (n = 60, 48.3% 女性, 平均年龄 = 13.07 岁), 及采用了倾向评分匹配法的青少年移民样本 (n = 143, 60.8% 女性, 平均年龄 = 13.26 岁), 及美国藉青少年样本 (n = 140, 56.1% 女性, 平均年龄 = 12.11 岁)。平均来说, 相比美国藉青少年(p < .001)和青少年移民(p < .001), 难民青少年显著地反映更多种创伤经历。与美国藉青少年相比, 难民青少年有较高水平的社群暴力经历、离解症状、创伤后悲伤、躯体化和恐惧症, 但有较低水平的滥用药物状况和对抗性蔑视失常 (ps 值域为 .030 至 < .001)。本研究的难民青少年样本展现明显的创伤经历、悲痛症状和心理治疗服务需要的模式, 医疗单位日后设计治疗时值得考虑这些数据。

  June 06, 2017   doi: 10.1002/jts.22186   open full text
• Beta Blocker Administration During Emergency Department Evaluation for Acute Coronary Syndrome Is Associated With Lower Posttraumatic Stress Symptoms 1‐Month Later.
  Laura Meli, Bernard P. Chang, Daichi Shimbo, Brendan W. Swan, Donald Edmondson, Jennifer A. Sumner.
  Journal of Traumatic Stress. May 31, 2017
  We examined whether beta blocker administration in the emergency department (ED) during evaluation for suspected acute coronary syndrome (ACS) was associated with posttraumatic stress disorder (PTSD) symptoms 1‐month later. Participants (N = 350) were enrolled in the Reactions to Acute Care and Hospitalization (REACH) study, an ongoing observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected ACS. Beta blockade during evaluation in the ED was extracted from medical records, and PTSD symptoms in response to the experience of suspected ACS were assessed 1‐month later via telephone. Beta blockade in the ED was associated with lower PTSD symptoms 1‐month later, b = −2.80, β = −.09, p = .045, after adjustment for demographics, preexisting psychological and medical covariates, and participants’ distress during ED evaluation. Despite small effects, findings suggest that beta blockade during ED evaluation for suspected ACS—a time period relevant to fear consolidation of the memory of this potentially life‐threatening event—may have protective effects for later psychological health. Resumen Beta bloqueador y síntomas de estrés postraumático Examinamos si la administración de un beta bloqueador en el servicio de emergencia (SE) durante la evaluación de sospecha de un síndrome coronario agudo (SCA) estaba asociado con los síntomas de estrés postraumático (TEPT) al mes de sucedido el evento. Los participantes (N = 350) fueron inscritos en el estudio de Reacciones a Cuidado Intensivo y Hospitalización (RECIH), un estudio actual de cohorte observacional de predictores en SE de resultados médicos y psicológicos tras evaluación por sospecha de SCA. El beta bloqueo durante la evaluación en el SE fue extraída de los archivos médicos, y los síntomas de TEPT en respuesta a la experiencia de sospecha de SCA fue evaluada al mes vía telefónica. El beta bloqueo en el SE se asoció con síntomas de TEPT bajos al mes de sucedido el evento (b = ‐2.80, β = ‐.09, p = .045), tras un ajuste demográfico, covarianzas psicológicas y médicas preexistentes, y la angustia durante la evaluación en el SE. A pesar de los efectos pequeños, los resultados sugieren que el beta bloqueo durante la evaluación en el SE durante la sospecha de SCA – un período relevante a temer por la consolidación de la memoria de este evento potencialmente amenazante para la vida‐ puede tener efectos positivos en la posterior salud psicológica. Traditional Chinese 標題: 急症室在急性冠狀動脈綜合症的評估過程使用β受體阻斷劑, 跟患者1個月後的創傷後壓力症狀較低有關 撮要: 本研究檢視急症室(ED)對懷疑有急性冠狀動脈綜合症(ACS)的患者使用β受體阻斷劑(beta blockers), 是否跟患者1個月後的創傷後壓力症(PTSD)症狀有關。本研究樣本為急性治療與住院反應(REACH)研究計劃的參與者(N = 350), 該研究計劃是個持續進行的觀察性同代研究, 檢視ACS懷疑個案裡, 有關身心後果的ED預測變量。我們從醫療紀錄裡找出ED使用β受體阻斷劑的數據, 並於1個月後透過電話評估樣本在懷疑患ACS的經歷得出的PTSD症狀。我們對人口統計、過往已存在的心理和醫療共變量、及參與者接受ED評估時的悲痛作調節後, 發現ED使用β受體阻斷劑跟樣本於1個月後的PTSD症狀較低有關(b = ‐2.80, β = ‐.09, p = .045)。雖然我們得出的效應量小, 但研究結果指出, 懷疑患ACS的期間跟對此潛在威脅生命事件的恐懼形成有關, 而ED對ACS懷疑個案使用β受體阻斷劑, 對患者日後的心理健康可能有保護作用。 Simplified Chinese 标题: 急症室在急性冠状动脉综合症的评估过程使用β受体阻断剂, 跟患者1个月后的创伤后压力症状较低有关 撮要: 本研究检视急症室(ED)对怀疑有急性冠状动脉综合症(ACS)的患者使用β受体阻断剂(beta blockers), 是否跟患者1个月后的创伤后压力症(PTSD)症状有关。本研究样本为急性治疗与住院反应(REACH)研究计划的参与者(N = 350), 该研究计划是个持续进行的观察性同代研究, 检视ACS怀疑个案里, 有关身心后果的ED预测变量。我们从医疗纪录里找出ED使用β受体阻断剂的数据, 并于1个月后透过电话评估样本在怀疑患ACS的经历得出的PTSD症状。我们对人口统计、过往已存在的心理和医疗共变量、及参与者接受ED评估时的悲痛作调节后, 发现ED使用β受体阻断剂跟样本于1个月后的PTSD症状较低有关(b = ‐2.80, β = ‐.09, p = .045)。虽然我们得出的效应量小, 但研究结果指出, 怀疑患ACS的期间跟对此潜在威胁生命事件的恐惧形成有关, 而ED对ACS怀疑个案使用β受体阻断剂, 对患者日后的心理健康可能有保护作用。

  May 31, 2017   doi: 10.1002/jts.22195   open full text
• Sometimes Less is More: Establishing the Core Symptoms of PTSD.
  Jessica L. Walton, Lisa‐Ann J. Cuccurullo, Amanda M. Raines, Desirae N. Vidaurri, Nicholas P. Allan, Kelly P. Maieritsch, C. Laurel Franklin.
  Journal of Traumatic Stress. May 29, 2017
  Historically, the symptoms of posttraumatic stress disorder (PTSD) have garnered attention and controversy due to symptom overlap with other disorders. To improve diagnostic specificity, researchers have proposed to reformulate PTSD symptoms into a parsimonious set of core criteria. The core symptoms consisted of recurrent distressing dreams or flashbacks; internal or external avoidance; and hypervigilance or exaggerated startle. The purpose of this study was to examine a previously proposed set of “core” PTSD criteria in identifying cases of PTSD within a veteran sample. Veterans (N = 383) presenting to a Veterans Affairs (VA) Medical Center PTSD clinic for psychological services were assessed using the Clinician Administered PTSD Scale for DSM‐5 (CAPS‐5). A logistic regression analysis revealed that the core criteria accurately identified 79% of veterans with PTSD (OR = 11.57). Findings support a parsimonious set of core criteria in the assessment and diagnosis of PTSD. Future studies should replicate these findings in diverse, nonveteran samples. Resumen ESTABLECIMIENTO DE LOS SÍNTOMAS CENTRALES DEL TEPT Históricamente los síntomas del trastorno por estrés postraumático (TEPT) han obtenido atención y controversia debido a que los síntomas se sobreponen con otros trastornos. Para mejorar la especificidad diagnóstica, los investigadores han propuesto reformular los síntomas del TEPT en un conjunto  acotado de criterios básicos. Los criterios básicos consisten en sueños recurrentes pertubadores o flashbacks, evitación interna o externa e hiperalerta o sobresalto exagerado. El propósito de este estudio fue examinar una propuesta previa de set de criterios "básicos" de TEPT identificando casos de TEPT en una muestra de veteranos. Los veteranos (N = 383) que se presentaron a una clínica de TEPT del Centro Médico de los Asuntos para Veteranos para servicios psicológicos se  evaluaron usando la Escala de TEPT del DSM ‐5 Administrada por Clínicos (CAPS‐5). Un análisis de regresión logística mostró que los criterios básicos identificó  con precisión el 79% de los veteranos con TEPT (OR = 11,57). Estos hallazgos apoyan un conjunto acotado de criterios básicos en la evaluación y diagnóstico del TEPT. Futuros estudios deben replicar estos hallazgos  en muestras distintas, no veteranas. Traditional Chinese 標題: 有時精簡反而更有效༚確立PTSD的核心症狀 撮要: 一直以來, 創傷後壓力症(PTSD)的症狀定義由於跟其他病症重疊, 引來關注和爭議。為提升診斷的特殊性, 曾有研究員提議重新確立一套精簡的PTSD核心準則。這套核心準則裡的症狀包括反復出現的惡夢和回憶、內在或外在迴避、和過度警覺或過度受驚。本研究旨在檢視一套先前提出的PTSD「核心」準則, 對找出退役軍人樣本中的PTSD個案是否有效。樣本為往美國退伍軍人事務部(VA)醫療中心的PTSD診所尋求心理治療的退役軍人(N = 383)。他們接受了基於DSM‐5的「৶床專業施ਈ的創傷後壓ঊ症ॾ表(CAPS‐5)」評估。邏輯迴歸分析顯示, 核心準則能準確地找出79%患PTSD的退役軍人(OR = 11.57)。研究結果對於確立精簡的核心準則以評估和診斷PTSD, 提供理據。未來對這方面的研究應採用更多元和非退役軍人的樣本。 Simplified Chinese 标题: 有时精简反而更有效༚确立PTSD的核心症状 撮要: 一直以来, 创伤后压力症(PTSD)的症状定义由于跟其他病症重迭, 引来关注和争议。为提升诊断的特殊性, 曾有研究员提议重新确立一套精简的PTSD核心准则。这套核心准则里的症状包括反复出现的恶梦和回忆、内在或外在回避、和过度警觉或过度受惊。本研究旨在检视一套先前提出的PTSD「核心」准则, 对找出退役军人样本中的PTSD个案是否有效。样本为往美国退伍军人事务部(VA)医疗中心的PTSD诊所寻求心理治疗的退役军人(N = 383)。他们接受了基于DSM‐5的「৶床专业施ਈ的创伤后压ঊ症ॾ表(CAPS‐5)」评估。逻辑回归分析显示, 核心准则能准确地找出79%患PTSD的退役军人(OR = 11.57)。研究结果对于确立精简的核心准则以评估和诊断PTSD, 提供理据。未来对这方面的研究应采用更多元和非退役军人的样本。

  May 29, 2017   doi: 10.1002/jts.22185   open full text
• Physical Injury and Somatic Complaints: The Mediating Role of Posttraumatic Stress Symptoms in Young Survivors of a Terror Attack.
  Ingrid Bugge, Grete Dyb, Synne Øien Stensland, Øivind Ekeberg, Tore Wentzel‐Larsen, Trond H. Diseth.
  Journal of Traumatic Stress. May 27, 2017
  Physically injured trauma survivors have particularly high risk for later somatic complaints and posttraumatic stress symptoms (PTSS). However, the potential mediating role of PTSS linking injury to later somatic complaints has been poorly investigated. In this study, survivors (N = 255) were interviewed longitudinally at 2 timepoints after the terror attack on Utøya Island, Norway, in 2011. Assessments included injury sustained during the attack, PTSS (after 4–5 months), somatic complaints (after 14–15 months), and background factors. Causal mediation analysis was conducted to evaluate the potential mediating role of PTSS in linking injury to somatic complaints comparing 2 groups of injured survivors with noninjured survivors. For the nonhospitalized injured versus the noninjured survivors, the mediated pathway was significant (average causal mediation effect; ACME = 0.09, p = .028, proportion = 55.8%). For the hospitalized versus the noninjured survivors, the mediated pathway was not significant (ACME = 0.04, p = .453, proportion = 11.6%). PTSS may play a significant mediating role in the development of somatic complaints among nonhospitalized injured trauma survivors. Intervening health professionals should be aware of this possible pathway to somatic complaints. Resumen LESIONES, QUEJAS SOMÁTICAS Y ESTRÉS POSTRAUMÁTICO Los sobrevivientes de trauma con lesiones físicas tienen un riesgo particularmente alto de quejas somáticas y síntomas de estrés postraumático (PTSS) posteriores. Sin embargo, el potencial rol mediador de los síntomas de TEPTvinculando las lesiones sufridas a las quejas somáticas posteriores ha sido poco investigado. En este estudio, los sobrevivientes (N = 255) fueron entrevistados longitudinalmente en dos momentos, después del ataque terrorista en la isla de Utøya, Noruega, en 2011. Las evaluaciones incluyeron:lesiones sufridas durante el ataque, TEPT (después de 4 a 5 meses), quejas somáticas (después de 14 a 15 meses) y factores contextuales. Se realizó un análisis de mediación para evaluar el posible rol mediador de TEPT en el vínculo entre sufrir lesiones y las quejas somáticas, comparando dos grupos de sobrevivientes heridos y no heridos. Para los sobrevivientes heridos no hospitalizados versus los no heridos, la mediación fue significativa (efecto medio de mediación causal‐ ACME = 0,09, p = 0,028, proporción = 55,8%). Para los sobrevivientes hospitalizados versus los no heridos, la mediación no fue significativa (ACME = 0.04, p = .453, proporción = 11.6%). Los síntomas de estrés postraumático pueden desempeñar un papel mediador importante en el desarrollo de quejas somáticas entre los sobrevivientes de trauma heridos no hospitalizados. Los profesionales de la salud que intervienen deben estar conscientes de esta posible vía hacia las quejas somáticas. Traditional Chinese 標題: 受傷與軀體不適༚年青的恐襲生還者裡創傷後壓力症狀的中介角色 撮要: 受傷及受創的生還者日後有特別高風險, 出現軀體不適和創傷後壓力症狀(PTSS)。可是, 對於PTSS連繫著受傷與日後軀體不適的潛在中介角色, 我們一直缺乏研究。本研究的生還者樣本(N = 255), 於2011年挪威于特島的恐襲事件後兩個時點接受縱貫面談。評估範疇包括恐襲時持續的傷勢、PTSS (4至5個月後) 、軀體不適 (14至15個月後) 、及背景因素。我們採用因果中介分析, 對兩組受傷的生還者與無受傷的生還者作比較, 評估PTSS連繫著受傷與軀體不適的潛在中介角色。在無住院但受傷的生還者跟無受傷的生還者對比中, 中介路徑顯著 (平均因果中介效應; ACME = 0.09, p = .028, 比例 = 55.8%) 。在住院生還者跟無受傷的生還者對比中, 中介路徑卻不顯著 (ACME = 0.04, p = .453, 比例 = 11.6%) 。對於無住院但受傷的生還者, 創傷後壓力症狀在軀體不適的發展過程可能有顯著的中介角色。為他們提供治療的醫護人士應加倍留意這個軀體不適的潛在路徑。 Simplified Chinese 标题: 受伤与躯体不适༚年青的恐袭生还者里创伤后压力症状的中介角色 撮要: 受伤及受创的生还者日后有特别高风险, 出现躯体不适和创伤后压力症状(PTSS)。可是, 对于PTSS连系着受伤与日后躯体不适的潜在中介角色, 我们一直缺乏研究。本研究的生还者样本(N = 255), 于2011年挪威于特岛的恐袭事件后两个时点接受纵贯面谈。评估范畴包括恐袭时持续的伤势、PTSS (4至5个月后) 、躯体不适 (14至15个月后) 、及背景因素。我们采用因果中介分析, 对两组受伤的生还者与无受伤的生还者作比较, 评估PTSS连系着受伤与躯体不适的潜在中介角色。在无住院但受伤的生还者跟无受伤的生还者对比中, 中介路径显著 (平均因果中介效应; ACME = 0.09, p = .028, 比例 = 55.8%) 。在住院生还者跟无受伤的生还者对比中, 中介路径却不显著 (ACME = 0.04, p = .453, 比例 = 11.6%) 。对于无住院但受伤的生还者, 创伤后压力症状在躯体不适的发展过程可能有显著的中介角色。为他们提供治疗的医护人士应加倍留意这个躯体不适的潜在路径。

  May 27, 2017   doi: 10.1002/jts.22191   open full text
• Trauma‐Related Pain, Reexperiencing Symptoms, and Treatment of Posttraumatic Stress Disorder: A Longitudinal Study of Veterans.
  Gregory Bartoszek, Susan M. Hannan, Janina Kamm, Barbara Pamp, Kelly P. Maieritsch.
  Journal of Traumatic Stress. May 12, 2017
  Research has demonstrated a strong positive association between posttraumatic stress disorder (PTSD) symptoms and physical pain. However, few studies have explored the impact of pain problems on the symptoms and treatment of PTSD, and results remain inconsistent. This longitudinal study examined whether trauma‐related and trauma‐unrelated pain differentially and uniquely predicted reexperiencing symptoms. We also examined whether levels of reexperiencing symptoms mediated the relationship between pain intensity and posttreatment symptoms of avoidance, numbing, and hyperarousal (ANH). Analyses were conducted using archival data from 99 treatment‐seeking veterans who reported the etiology and intensity of their pain and severity of PTSD symptoms pre‐ and posttreatment. Among veterans with trauma‐related pain, pain intensity (a) uniquely corresponded to greater posttreatment reexperiencing symptoms (b = 1.09), and (b) was indirectly predictive of ANH symptoms via the reexperiencing symptoms (b = 1.93). However, veterans with trauma‐unrelated pain evidenced no associations between pain intensity and reexperiencing (b = 0.04) or ANH symptoms (b = 0.06). We thus found that trauma‐related pain was indirectly related to poor PTSD treatment outcomes via reexperiencing symptoms. These findings offer additional insight into factors that may influence PTSD treatment outcomes for pain‐suffering trauma survivors. Resumen DOLOR RELACIONADO CON TRAUMA Las investigaciones han demostrado una fuerte y positiva asociación entre trastorno de estrés postraumático (TEPT) y síntomas de dolor físico. Sin embargo, pocos estudios han explorado el impacto de problemas de dolor sobre síntomas y tratamiento del TEPT, y los resultados siguen siendo inconsistentes. Este estudio longitudinal examina si el dolor relacionado con trauma y el dolor sin relación al trauma predicen de manera diferenciada y única los síntomas de re‐experimentación. También examinamos si los niveles de síntomas de re‐ experimentación median la relación entre la intensidad del dolor y los síntomas de evitación, adormecimiento e hiperexitación (ANH) post tratamiento. Los análisis fueron conducidos usando datos de archivo de 99 búsquedas de tratamiento de veteranos que reportaron la etiología e intensidad de sus dolores y severidad de síntomas de TEPT pre y post tratamiento. Entre veteranos con dolor relacionado con trauma, la intensada del dolor (1) únicamente corresponde con mayor síntomas de re experimentación post tratamiento (b = 1.09), y (2) fue indirectamente predictivo de síntomas ANH vía síntomas de re experimentación(b = 1.93). Sin embargo, veteranos con dolor relacionado al trauma no evidenciaron asociaciones entre intensidad de dolor y re experimentación (b = 0.04) o síntomas de ANH (b = 0.06). Así mismo encontramos que el dolor relacionado al trauma estuvo indirectamente relacionado con pobres resultados de tratamiento para el TEPT vía síntomas de re‐experimentación. Estos resultados ofrecen información adicional sobre factores que pueden influenciar los resultados de tratamiento de TEPT para los sobrevivientes a traumas que sufran dolor. Traditional Chinese 標題: 創傷相關痛症、再體驗症狀與創傷後壓力症治療༚一項退役軍人縱貫研究 撮要: 過往研究反映, 創傷後壓力症(PTSD)症狀跟身體痛症有強大的正向關連。然而, 少有研究探查痛症對PTSD症狀和PTSD治療產生的影響, 過往有關的研究結果亦不一致。是次縱貫研究檢視與創傷相關的痛症和與創傷無關的痛症, 是否能獨特並有差別地預測再體驗症狀。我們亦檢視再體驗症狀水平, 是否在痛楚強度和迴避、麻木及過度激發(ANH)這些治療後症狀的關係之間, 產生中介效應。我們以檔案數據進行分析。樣本為99名尋求治療的退役軍人, 他們在接受治療前後報告痛症的病原和強度, 以及PTSD症狀嚴重度。有創傷相關痛症的退役軍人當中, 痛症的強度༚ (一) 獨特地與治療後再體驗症狀較多相關(b = 1.09)༛ (二) 能透過再體驗症狀, 間接地預測ANH症狀(b = 1.93)。可是, 有與創傷無關痛症的退役軍人當中, 痛症強度跟再體驗症狀(b = 0.04)和ANH症狀(b = 0.06)都無關。因此, 我們發現由於再體驗症狀, 創傷相關痛症跟不良的PTSD治療結果間接相關。本研究結果有助了解對於有痛症的受創生還者而言, 有可能影響PTSD治療結果的因素。 Simplified Chinese 标题: 创伤相关痛症、再体验症状与创伤后压力症治疗༚一项退役军人纵贯研究 撮要: 过往研究反映, 创伤后压力症(PTSD)症状跟身体痛症有强大的正向关连。然而, 少有研究探查痛症对PTSD症状和PTSD治疗产生的影响, 过往有关的研究结果亦不一致。是次纵贯研究检视与创伤相关的痛症和与创伤无关的痛症, 是否能独特并有差别地预测再体验症状。我们亦检视再体验症状水平, 是否在痛楚强度和回避、麻木及过度激发(ANH)这些治疗后症状的关系之间, 产生中介效应。我们以档案数据进行分析。样本为99名寻求治疗的退役军人, 他们在接受治疗前后报告痛症的病原和强度, 以及PTSD症状严重度。有创伤相关痛症的退役军人当中, 痛症的强度༚ (一) 独特地与治疗后再体验症状较多相关(b = 1.09)༛ (二) 能透过再体验症状, 间接地预测ANH症状(b = 1.93)。可是, 有与创伤无关痛症的退役军人当中, 痛症强度跟再体验症状(b = 0.04)和ANH症状(b = 0.06)都无关。因此, 我们发现由于再体验症状, 创伤相关痛症跟不良的PTSD治疗结果间接相关。本研究结果有助了解对于有痛症的受创生还者而言, 有可能影响PTSD治疗结果的因素。

  May 12, 2017   doi: 10.1002/jts.22183   open full text
• Reckless Self‐Destructive Behavior and PTSD in Veterans: The Mediating Role of New Adverse Events.
  Joanna D. Lusk, Naomi Sadeh, Erika J. Wolf, Mark W. Miller.
  Journal of Traumatic Stress. May 04, 2017
  The addition of self‐destructive and reckless behavior as a symptom of posttraumatic stress disorder (PTSD) in DSM‐5 has stimulated renewed interest in understanding relationships between these behaviors and trauma‐related psychopathology. This study examined the relationship between reckless and self‐destructive behaviors (RSDB), intervening exposure to new adverse events, and later PTSD severity in a sample of trauma‐exposed veterans. At baseline, participants were assessed for RSDB (past 5 years) and current PTSD severity (N = 222). PTSD severity was then reassessed approximately 4 years later (N = 148). Overall, RSDB were reported by 74.4% of the sample, with 61.3% engaging in multiple forms of RSDB. The most commonly endorsed behaviors included alcohol/drug abuse (42.8%), driving while intoxicated (29.4%), gambling (24.7%), and aggression (23.1%). There was a positive correlation between RSDB and PTSD severity at both the baseline (r = .16, p = .031) and follow‐up assessment (r = .24, p = .005). Path models indicated that exposure to new adverse events fully mediated the effect of Time 1 RSDB on PTSD symptoms at Time 2 (indirect association: β = .05, p = .046). Results suggest that RSDB are common among trauma‐exposed veterans and may perpetuate PTSD symptoms by increasing exposure to new adverse events. Resumen Comportamiento imprudente, TEPT y nuevos eventos La adición del comportamiento autodestructivo e imprudente como un síntoma del Trastorno de Estrés Postraumático (TEPT) en el DSM‐5 ha estimulado un renovado interés por entender las relaciones entre estas conductas y la psicopatología relacionada con el trauma. Este estudio examinó la relación entre los comportamientos imprudentes y autodestructivos (CIAD), la exposición interviniente a nuevos eventos adversos y gravedad del TEPT posterior en una muestra de veteranos expuestos a trauma. En la línea de base, los participantes fueron evaluados para CIAD (últimos 5 años) y actual gravedad del TEPT (N = 222). La gravedad del TEPT se reevaluó aproximadamente 4 años después (N = 148). En general, el CIAD fue reportado por el 74,4% de la muestra, con el 61,3% involucrándose en múltiples formas de CIAD. Los comportamientos más comúnmente aprobados incluyeron abuso de alcohol / drogas(42,8%), conducción en estado de intoxicación (29,4%), juegos de azar (24,7%) y agresión(23,1%). Hubo una correlación positiva entre CIAD y severidad del TEPT tanto en la línea base (r = .16, p = .031) comoen la evaluación de seguimiento (r = .24, p = .005). Los modelos de trayectoria indicaron que la exposición a nuevos eventos adversos medió completamente el efecto del CIAD en el Tiempo 1 sobre los síntomas TEPT en el Tiempo 2 (asociación indirecta: β = .05, p = .046). Los resultados sugieren que los CIAD son comunes entre los veteranos expuestos a trauma y pueden perpetuar los síntomas de TEPT por aumentar la exposición a nuevos eventos adversos. Traditional Chinese 標題: 退役軍人不顧後果的自我毀滅行為與PTSD: 新的不利生命事件的中介效應 撮要: DSM‐5在創傷後壓力症(PTSD)的準則, 增加了不顧後果的自我毀滅行為作為症狀之一, 重新引起大家關注這類行為與創傷相關的精神病理學的關係。本研究透過受創的退役軍人樣本, 檢視不顧後果的自我毀滅行為(RSDB)、新的具干預性的不利事件經歷、和後期PTSD嚴重度之間的關係。參與者(N = 222)在基線接受了過去5年RSDB、及當前PTSD嚴重度的評估。我們約於4年後再次評估他們的PTSD嚴重度(N = 148)。整體來說, 樣本中74.4%的人有RSDB, 61.3%人士有多種形式的RSDB。最普遍的行為包括濫用酒精或藥物(42.8%)、醉酒駕駛(29.4%)、賭博(24.7%)、及攻擊性行為(23.1%)。在基線(r = .16, p = .031)和跟進評估(r = .24, p = .005)中, RSDB與PTSD嚴重度都有正向關連。路徑模型顯示, 對於時點1的RSDB對時點2的PTSD症狀產生的影響, 新的不利事件經歷有完全的中介效應(間接關連: β = .05, p = .046)。結果反映, RSDB在受創的退役軍人當中普遍, 而RSDB有可能會透過增加新的不利事件經歷, 延續患者的PTSD症狀。 Simplified Chinese 标题: 退役军人不顾后果的自我毁灭行为与PTSD: 新的不利生命事件的中介效应 撮要: DSM‐5在创伤后压力症(PTSD)的准则, 增加了不顾后果的自我毁灭行为作为症状之一, 重新引起大家关注这类行为与创伤相关的精神病理学的关系。本研究透过受创的退役军人样本, 检视不顾后果的自我毁灭行为(RSDB)、新的具干预性的不利事件经历、和后期PTSD严重度之间的关系。参与者(N = 222)在基线接受了过去5年RSDB、及当前PTSD严重度的评估。我们约于4年后再次评估他们的PTSD严重度(N = 148)。整体来说, 样本中74.4%的人有RSDB, 61.3%人士有多种形式的RSDB。最普遍的行为包括滥用酒精或药物(42.8%)、醉酒驾驶(29.4%)、赌博(24.7%)、及攻击性行为(23.1%)。在基线(r = .16, p = .031)和跟进评估(r = .24, p = .005)中, RSDB与PTSD严重度都有正向关连。路径模型显示, 对于时点1的RSDB对时点2的PTSD症状产生的影响, 新的不利事件经历有完全的中介效应(间接关连: β = .05, p = .046)。结果反映, RSDB在受创的退役军人当中普遍, 而RSDB有可能会透过增加新的不利事件经历, 延续患者的PTSD症状。

  May 04, 2017   doi: 10.1002/jts.22182   open full text
• Longitudinal Measurement Invariance of Posttraumatic Stress Disorder in Deployed Marines.
  Ateka A. Contractor, Elisa Bolton, Matthew W. Gallagher, Charla Rhodes, William P. Nash, Brett Litz.
  Journal of Traumatic Stress. May 04, 2017
  The meaningful interpretation of longitudinal study findings requires temporal stability of the constructs assessed (i.e., measurement invariance). We sought to examine measurement invariance of the construct of posttraumatic stress disorder (PTSD) as based on the Diagnostic and Statistical Manual of Mental Disorders indexed by the PTSD Checklist (PCL) and the Clinician‐Administered PTSD Scale (CAPS) in a sample of 834 Marines with significant combat experience. PTSD was assessed 1‐month predeployment (T0), and again at 1‐month (T1), 5‐months (T2), and 8‐months postdeployment (T3). We tested configural (pattern of item/parcel loadings), metric (item/parcel loadings on latent factors), and scalar (item/parcel‐level severity) invariance and explored sources of measurement instability (partial invariance testing). The T0 best‐fitting emotional numbing model factor structure informed the conceptualization of PTSD's latent factors and parcel formations. We found (1) scalar noninvariance for the construct of PTSD as measured by the PCL and the CAPS, and for PTSD symptom clusters as assessed by the CAPS; and (2) metric noninvariance for PTSD symptom clusters as measured by the PCL. Exploratory analyses revealed factor‐loading and intercept differences from pre‐ to postdeployment for avoidance symptoms, numbing symptoms (mainly psychogenic amnesia and foreshortened future), and the item assessing startle, each of which reduced construct stability. Implications of these findings for longitudinal studies of PTSD are discussed. Resumen Invarianza de medición longitudinal del TEPT La interpretación significativa de los hallazgos del estudio longitudinal requiere de estabilidad temporal de los constructos evaluados (es decir, la invariancia de la medición). Buscamos examinar la invariancia de la medición de la construcción del trastorno de estrés postraumático basado en el DSM‐IV (TEPT) indexado por la Lista de Verificación del TEPT (PCL) y la Escala de TEPT Administrada por Clínicos (CAPS) en una muestra de 834 infantes de marina con combate significativo. El trastorno de estrés postraumático se evaluó un mes antes del despliegue (T0), y de nuevo al mes (T1), 5 meses (T2) y 8 meses post‐despliegue (T3). Probamos invarianza configural (patrón de carga de ítems/parcelas), métrica (carga de ítems/parcelas sobre factores latentes) y escalar (intensidad de nivel ítem/parcela) y exploramos fuentes de inestabilidad de medición (prueba de invariancia parcial). La estructura de modelo factorial de mejor ajuste en T0para el entumecimiento emocional reportó la conceptualización de los factores latentes del TEPT y las formaciones de parcela. Encontramos: (1) la no‐invarianza escalar para el constructo del TEPT medido por el PCL y el CAPS, y para los clústers de síntomas de TEPT como son evaluados por el CAPS; Y (2) la no‐variabilidad métrica para los grupos de síntomas de TEPT medidos por el PCL. Los análisis exploratorios revelaron la carga de factores y las diferencias de intercepción de pre a post‐despliegue para síntomas de evitación, entumecimiento (principalmente amnesia psicógena y futuro interrumpido) y el ítem que evalúa el sobresalto, cada uno de los cuales redujo la estabilidad de constructo. Se discuten las implicaciones de estos hallazgos para los estudios longitudinales del TEPT. Traditional Chinese 標題: 海軍的創傷後壓ঊ症縱貫研究的測量不變性 撮要: 要有意義地分析縱貫研究結果, 我們需要確保受評估構念的時間穩定性 (即測量不變性) 。我們透過834名具顯著戰鬥經歷的海軍, 檢視「PTSD檢查表(PCL)」和「৶床專業施ਈ的創傷後壓ঊ症ॾ表(CAPS)」裡, 基於DSM‐IV的創傷後壓力症(PTSD)指標構念的測量不變性。樣本在服役前1個月(T0)、服役後1個月(T1)、5個月(T2)和8個月(T3), 接受創傷後壓ঊ症評估。我們測試構形不變性 (項目༏包裹負荷模式) 、計量不變性 (潛在因素的項目༏包裹負荷) 、及純量不變性 (項目༏包裹水平嚴重度) , 並探查測量不穩定性的來由 (部分不變性測試) 。T0最佳吻合的情感麻木模型因素結構, 提供了PTSD潛在因素和包裹組成的概念化。我們發現༚ (一) 以PCL和CAPS測量的PTSD構念、及以CAPS測量的PTSD症狀聚類有純量非不變性༛ (二) 以PCL測量的PTSD症狀聚類有計量非不變性。探索分析反映, 在迴避症狀和麻木症狀(主要為心因性失憶 、及感到自己的生命縮短)方面, 服役前後有因素負荷與截距差別༛而項目評估出乎意料, 以上都減低了構念穩定性。我們亦討論到是次發現對PTSD的縱貫研究有何貢獻。 Simplified Chinese 标题: 海军的创伤后压ঊ症纵贯研究的测量不变性 撮要: 要有意义地分析纵贯研究结果, 我们需要确保受评估构念的时间稳定性 (即测量不变性) 。我们透过834名具显著战斗经历的海军, 检视「PTSD检查表(PCL)」和「৶床专业施ਈ的创伤后压ঊ症ॾ表(CAPS)」里, 基于DSM‐IV的创伤后压力症(PTSD)指标构念的测量不变性。样本在服役前1个月(T0)、服役后1个月(T1)、5个月(T2)和8个月(T3), 接受创伤后压ঊ症评估。我们测试构形不变性 (项目༏包裹负荷模式) 、计量不变性 (潜在因素的项目༏包裹负荷) 、及纯量不变性 (项目༏包裹水平严重度) , 并探查测量不稳定性的来由 (部分不变性测试) 。T0最佳吻合的情感麻木模型因素结构, 提供了PTSD潜在因素和包裹组成的概念化。我们发现༚ (一) 以PCL和CAPS测量的PTSD构念、及以CAPS测量的PTSD症状聚类有纯量非不变性༛ (二) 以PCL测量的PTSD症状聚类有计量非不变性。探索分析反映, 在回避症状和麻木症状(主要为心因性失忆 、及感到自己的生命缩短)方面, 服役前后有因素负荷与截距差别༛而项目评估出乎意料, 以上都减低了构念稳定性。我们亦讨论到是次发现对PTSD的纵贯研究有何贡献。

  May 04, 2017   doi: 10.1002/jts.22181   open full text
• Duty‐Related Trauma Exposure and Posttraumatic Stress Symptoms in Professional Firefighters.
  Junghyun H. Lee, Dayoung Lee, Jiae Kim, Kyoungsun Jeon, Minyoung Sim.
  Journal of Traumatic Stress. April 27, 2017
  Firefighters commonly encounter traumatic events during duty hours. The purpose of this study was to investigate the characteristics of duty‐related trauma as risk factors for posttraumatic stress disorder in professional firefighters. A sample of 212 firefighters participated in the study and completed self‐reported questionnaires. Potentially traumatic events (PTE) were assessed using a list of 17 traumatic event types. The posttraumatic stress symptoms (PTSS) were measured by the Impact of Event Scale‐Revised (Lim et al., 2009; Weiss, 2007). A higher score for the composite index, which reflects both multiple PTE and peritraumatic suffering, increased the odds for significant PTSS after adjusting for age, sex, marital status, education, numbers of years worked, childhood trauma, and depressive symptoms (adjusted odds ratio [AOR] = 2.26, p = .001, Cohen's d = 0.20). Furthermore, indirect (AOR = 1.93, p = .009, Cohen's d = .16) and colleague‐related PTE (AOR = 1.97, p = .037, Cohen's d = .16) showed significant associations with PTSS. It is noteworthy that the combination of multiple PTE and peritraumatic suffering was more predictive of PTSS than either factor alone. Our findings also suggest that daily work exposure to indirect PTE may contribute to the occurrence of PTSS among professional firefighters.

  April 27, 2017   doi: 10.1002/jts.22180   open full text
• Trauma‐Related Disgust in Veterans With Interpersonal Trauma.
  Jessica Bomyea, Carolyn B. Allard.
  Journal of Traumatic Stress. April 21, 2017
  Although traditionally conceptualized as an anxiety disorder, variability in posttraumatic stress disorder (PTSD) may be explained by individual differences in peri‐ or posttraumatic disgust. We examined relationships between disgust reactions and other trauma‐related symptoms in 100 veterans with a history of interpersonal trauma and gender differences in these variables. We also evaluated the mediating role of posttraumatic disgust and guilt in the relationship between peritraumatic disgust and PTSD symptoms. Participants completed cross‐sectional self‐report questionnaires of trauma‐related emotions, PTSD, and other psychological symptoms as part of clinical intake procedures. Women and men did not differ on trauma‐related emotions or symptoms. However, the relationship between peri‐ and posttraumatic disgust depended on gender, with men reporting a stronger association between peri‐ and posttraumatic disgust than women (p = .013, ΔR2 = .04). Posttraumatic disgust and guilt mediated the relationship between peritraumatic disgust and PTSD symptoms, controlling for gender (a1a2 b1 = 0.18, SE = 0.09, PM = .19). Our results converge with those found in other studies suggesting that disgust is a common trauma‐related emotion and that men and women may experience differential relationships between peri‐ and posttraumatic emotional experiences. Further study of the role of trauma‐related emotional responses in PTSD etiology and treatment is warranted.

  April 21, 2017   doi: 10.1002/jts.22169   open full text
• Validating a Virtual Environment for Sexual Assault Victims.
  Claudie Loranger, Stéphane Bouchard.
  Journal of Traumatic Stress. April 19, 2017
  Virtual reality has shown promising results in the treatment of posttraumatic stress disorder (PTSD) for some traumatic experiences, but sexual assault has been understudied. One important question to address is the relevance and safety of a virtual environment (VE) allowing patients to be progressively exposed to a sexual assault scenario. The aim of this study was to validate such a VE. Thirty women (victims and nonvictims of sexual assault) were randomly assigned in a counter‐balanced order to 2 immersions in a virtual bar: a control scenario where the encounter with the aggressor does not lead to sexual assault and an experimental scenario where the participant is assaulted. Immersions were conducted in a fully immersive 6‐wall system. Questionnaires were administered and psychophysiological measures were recorded. No adverse events were reported during or after the immersions. Repeated‐measures analyses of covariance revealed a significant time effect and significantly more anxiety (Cohen's f = 0.41, large effect size) and negative affect (Cohen's f = 0.35, medium effect size) in the experimental scenario than in the control condition. Given the safety of the scenario and its potential to induce emotions, it can be further tested to document its usefulness with sexual assault victims who suffer from PTSD.

  April 19, 2017   doi: 10.1002/jts.22170   open full text
• Stability and Change in Posttraumatic Distress: A 7‐Year Follow‐Up Study of Mothers and Young Children Exposed to Cumulative Trauma.
  Ruth Pat‐Horenczyk, Sarale Cohen, Yuval Ziv, M. Achituv, Sophie Brickman, Tamar Blanchard, Danny Brom.
  Journal of Traumatic Stress. April 13, 2017
  In situations of cumulative trauma, it is often unclear why some people remain resilient, whereas others experience distress, and how likely these responses are to change over time. To investigate the constancy of responses to cumulative trauma, stability and change in posttraumatic distress and resistance (as defined by no evidence of clinical symptoms) were assessed twice in 140 Israeli children and mothers exposed to continual rocket attacks over approximately 7 years, when the children were 2–4 (Time 1) and 9–11 years of age (Time 2). Measures included trauma exposure, posttraumatic and depressive symptoms, and child behavioral problems. We identified 4 longitudinal courses (LCs): resilient (resistance at Time 1 and Time 2), recovered (clinical distress at Time 1 and resistance at Time 2), developed symptoms (resistance at Time 1 and clinical distress at Time 2), and chronic distress (clinical distress at Time 1 and Time 2). Results showed more stability than change in the frequencies of resistance at both times of measurement. The resilient LC was the most common longitudinal course for both mothers and children. Multinomial regression models indicated that maternal posttraumatic symptoms predicted the recovered and chronic distress LCs of the children.

  April 13, 2017   doi: 10.1002/jts.22177   open full text
• Hurricane Sandy Exposure and the Mental Health of World Trade Center Responders.
  Evelyn J. Bromet, Sean Clouston, Adam Gonzalez, Roman Kotov, Kathryn M. Guerrera, Benjamin J. Luft.
  Journal of Traumatic Stress. April 03, 2017
  The psychological consequences of a second disaster on populations exposed to an earlier disaster have rarely been studied prospectively. Using a pre‐ and postdesign, we examined the effects of Hurricane Sandy on possible World Trade Center (WTC) related posttraumatic stress disorder (PTSD Checklist score of ≥ 50) and overall depression (major depressive disorder [MDD]; Patient Health Questionnaire depression score of ≥ 10) among 870 WTC responders with a follow‐up monitoring visit at the Long Island WTC Health Program during the 6 months post‐Hurricane Sandy. The Hurricane Sandy exposures evaluated were damage to home (8.3%) and to possessions (7.8%), gasoline shortage (24.1%), prolonged power outage (42.7%), and filing a Federal Emergency Management Agency claim (11.3%). A composite exposure score also was constructed. In unadjusted analyses, Hurricane Sandy exposures were associated with 1.77 to 5.38 increased likelihood of PTSD and 1.58 to 4.13 likelihood of MDD; odds ratios for ≥ 3 exposures were 6.47 for PTSD and 6.45 for MDD. After adjusting for demographic characteristics, WTC exposure, pre‐Hurricane Sandy mental health status, and time between assessments, reporting ≥ 3 Hurricane Sandy exposures was associated with a 3.29 and 3.71 increased likelihood of PTSD and MDD, respectively. These findings underscore the importance of assessing the impact of a subsequent disaster in ongoing responder health surveillance programs.

  April 03, 2017   doi: 10.1002/jts.22178   open full text
• Predictive Validity of ICD‐11 PTSD as Measured by the Impact of Event Scale‐Revised: A 15‐Year Prospective Study of Political Prisoners.
  Philip Hyland, Chris R. Brewin, Andreas Maercker.
  Journal of Traumatic Stress. March 29, 2017
  The 11th edition of the International Classification of Diseases (ICD‐11; World Health Organization, 2017) proposes a model of posttraumatic stress disorder (PTSD) that includes 6 symptoms. This study assessed the ability of a classification‐independent measure of posttraumatic stress symptoms, the Impact of Event Scale‐Revised (Weiss & Marmar, 1996), to capture the ICD‐11 model of PTSD. The current study also provided the first assessment of the predictive validity of ICD‐11 PTSD. Former East German political prisoners were assessed in 1994 (N = 144) and in 2008‐2009 (N = 88) on numerous psychological variables using self‐report measures. Of the participants, 48.2% and 36.8% met probable diagnosis for ICD‐11 PTSD at the first and second assessments, respectively. Confirmatory factor analysis supported the factorial validity of the 3‐factor ICD‐11 model of PTSD, as represented by items selected from the Impact of Event Scale‐Revised. Hierarchical multiple regression analysis demonstrated that, controlling for sex, the symptom clusters of ICD‐11 PTSD (reexperiencing, avoidance, and sense of threat) significantly contributed to the explanation of depression (R2 = .17), quality of life (R2 = .21), internalized anger (R2 = .10), externalized anger (R2 = .12), hatred of perpetrators (R2 = .15), dysfunctional disclosure (R2 = .27), and social acknowledgment as a victim (R2 = .12) across the 15‐year study period. Current findings add support for the factorial and predictive validity of ICD‐11 PTSD within a unique cohort of political prisoners.

  March 29, 2017   doi: 10.1002/jts.22171   open full text
• Integrated Treatment of PTSD and Substance Use Disorders: Examination of Imaginal Exposure Length.
  Adam C. Mills, Christal L. Badour, Kristina J. Korte, Therese K. Killeen, Aisling V. Henschel, Sudie E. Back.
  Journal of Traumatic Stress. March 22, 2017
  Efforts to improve the efficiency of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) have demonstrated that reducing the length of imaginal exposures does not negatively affect treatment outcome. A recent adaptation of PE, called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure [COPE], integrates substance use disorder treatment with PE in the same timeframe (twelve 90‐minute sessions, 8 of which include imaginal exposure). The current study, which represents a subanalysis of a larger randomized controlled trial, examined how the length of imaginal exposures (nonrandomized and measured continually) related to PTSD, substance use, and depression in a sample of military veterans (N = 31) who completed the COPE treatment. Participants completed an average of 11.5 of the 12 therapy sessions and 7.2 of the 8 imaginal exposures during treatment. Results of 3 linear mixed models indicate that PTSD, substance use, and depressive symptoms all improved over the course of treatment (ps < .001; η2 ranged between .17 and .40), and that the length of imaginal exposures did not significantly interact with any outcome. Although preliminary, the findings suggest that it may be feasible to shorten imaginal exposures without mitigating treatment gains. Implications for treatment are discussed.

  March 22, 2017   doi: 10.1002/jts.22175   open full text
• The Amplification of Common Somatic Symptoms by Posttraumatic Stress Disorder in Firefighters.
  Josie S. Milligan‐Saville, Helen M. Paterson, Emily L. Harkness, Annabel M. Marsh, Mark Dobson, Richard I. Kemp, Richard A. Bryant, Samuel B. Harvey.
  Journal of Traumatic Stress. March 08, 2017
  Posttraumatic stress disorder (PTSD) in emergency service personnel and other trauma‐exposed populations is known to be associated with a variety of physical health problems. However, little attention has been paid to the health of ageing emergency service personnel, who may be forced into early medical retirement because of a combination of these issues. Currently employed (N = 274) Australian firefighters completed a cross‐sectional survey using validated, self‐report measures of PTSD and somatic symptoms. Analyses examined the association between probable PTSD and a range of common somatic symptoms, and whether any association differed depending on the age of the firefighters. Firefighters with PTSD reported greater levels of neurological (p = .024), gastrointestinal (p = .015), and cardiorespiratory (p = .027) symptoms compared to those without PTSD. After adjusting for sex, age, and rank, linear regression analysis demonstrated that PTSD was significantly associated with increased total somatic symptom severity (p = .024), with PTSD accounting for 9.8% of the variance in levels of somatic symptoms. There was no interaction between age and the association between PTSD and somatic symptom severity. These results suggest that PTSD is associated with a significant increase in a wide range of somatic symptoms among firefighters, regardless of age. The implications for the identification and treatment of PTSD are discussed.

  March 08, 2017   doi: 10.1002/jts.22166   open full text
• For Whom Does Time Heal Wounds? Individual Differences in Stability and Change in Posttraumatic Stress After the 2011 Oslo Bombing.
  Marianne Skogbrott Birkeland, Marianne Bang Hansen, Ines Blix, Øivind Solberg, Trond Heir.
  Journal of Traumatic Stress. January 19, 2017
  Prospective studies describing and predicting individual differences in the course of posttraumatic stress symptoms (PTSS) after disasters are scarce. The present study aimed to describe and predict individual differences in both the level and the rate of change in PTSS after the 2011 Oslo bombing, a terrorist attack directed at the Norwegian government. Survey data from ministerial employees (N = 256) were collected 10, 22, and 34 months after the bombing. We used latent growth modeling to examine the development of PTSS, and to identify the strength of predictor variables. High exposure, female sex, and high levels of neuroticism were associated with higher levels of PTSS 10 months after the traumatic event (β ranged from .25 to .30, p < .001), whereas social support was associated with lower levels of PTSS (β = −.30, p < .001). The combination of being female and high in neuroticism was associated with a faster decline in PTSS (β range: −.20 to −.39, p = .010 < .05). High exposure seemed to have a lasting influence by maintaining high levels of PTSS. Our findings suggested that being female, being highly exposed, and having low levels of social support were risk markers for enduring PTSS. Estudios prospectivos que describen y predicen diferencias individuales en el curso de los síntomas de estrés postraumático (SEPT) después de los desastres son escasos. El presente estudio tiene como objetivo describir y predecir las diferencias individuales en el nivel y la velocidad de cambio en SEPT después de la bomba de Oslo en 2011, que fue un ataque terrorista dirigido al gobierno Noruego. Los datos de encuestas de empleados ministeriales (N = 256) fueron recogidos 10, 22 y 34 meses después del bombardeo. Utilizamos el modelo de crecimiento latente para examinar el desarrollo del SEPT, y para identificar la fuerza de las variables predictoras potenciales. Alta exposición, ser mujer, y altos niveles de neuroticismo se asociaron con altos niveles de SEPT 10 meses después del evento traumático (β varió de .25 a .30, p < .001), mientras el apoyo social se asoció con menores niveles de SEPT (β = –.30, p < .001). Ser mujer con alto neuroticismo se asoció con una rápida reducción de SEPT. (β varió de –.20 a .39, p < .05). Una alta exposición parece tener una influencia duradera mediante la mantención de altos niveles de SEPT. Nuestros hallazgos sugieren que ser mujer, estar altamente expuesto, y tener bajos niveles de apoyo social fueron marcadores de riesgo para el SEPT duradero. 標題: 時間能療癒哪些人的傷༟2011年挪威奧斯陸市爆炸事件後, 創傷後壓力的穩定性和改變在不同患者間的個別差異 撮要: 目前少有前瞻性研究描述和預測不同人在災後, 創傷後壓力症狀(PTSS)發展的個別差異。2011年, 挪威奧斯陸市發生針對政府的恐怖襲擊爆炸事件。本研究旨在描述和預測爆炸事件後, 患者間PTSS水平和改變率的個別差異。我們取得行政部門員工在爆炸事件發生10、22及34個月後的調查數據(N = 256)。我們採用潛在增長模型檢視PTSS的發展, 並找出潛在預測變量的強度。研究發現, 爆炸事件發生10個月後, 有高水平經歷、性別為女性、及高水平的神經質, 都跟有較高水平PTSS有關(β 值域為.25 至 .30, p < .001), 而社會支持跟有較低水平PTSS有關(β = –.30, p < .001)。性別為女性和有高水平神經質跟PTSS較快速減少有關(β 值域為 –.20 至 .39, p < .05)。有高水平經歷似乎令PTSS保持在高水平, 有持久影響。研究結果反映, 性別為女性、有高水平經歷和低水平社會支持, 都是PTSS持續發展的風險指標。 标题: 时间能疗愈哪些人的伤༟2011年挪威奥斯陆市爆炸事件后, 创伤后压力的稳定性和改变在不同患者间的个别差异 撮要: 目前少有前瞻性研究描述和预测不同人在灾后, 创伤后压力症状(PTSS)发展的个别差异。2011年, 挪威奥斯陆市发生针对政府的恐怖袭击爆炸事件。本研究旨在描述和预测爆炸事件后, 患者间PTSS水平和改变率的个别差异。我们取得行政部门员工在爆炸事件发生10、22及34个月后的调查数据(N = 256)。我们采用潜在增长模型检视PTSS的发展, 并找出潜在预测变量的强度。研究发现, 爆炸事件发生10个月后, 有高水平经历、性别为女性、及高水平的神经质, 都跟有较高水平PTSS有关(β 值域为.25 至 .30, p < .001), 而社会支持跟有较低水平PTSS有关(β = –.30, p < .001)。性别为女性和有高水平神经质跟PTSS较快速减少有关(β 值域为 –.20 至 .39, p < .05)。有高水平经历似乎令PTSS保持在高水平, 有持久影响。研究结果反映, 性别为女性、有高水平经历和低水平社会支持, 都是PTSS持续发展的风险指标。

  January 19, 2017   doi: 10.1002/jts.22158   open full text
• Predictors of PTSD Symptom Change Among Outpatients in the U.S. Department of Veterans Affairs Health Care System.
  Rebecca K. Sripada, Paul N. Pfeiffer, Jessica Rampton, Dara Ganoczy, Sheila A. M. Rauch, Melissa A. Polusny, Kipling M. Bohnert.
  Journal of Traumatic Stress. January 19, 2017
  Although the U.S. Department of Veterans Affairs (VA) has prioritized care for posttraumatic stress disorder (PTSD), many patients with PTSD remain symptomatic. Patterns of PTSD symptom change are not well understood. Thus, the current study was designed to categorize and investigate potential predictors of symptom trajectories in patients with PTSD. The sample comprised 2,237 VA patients who were diagnosed with PTSD in 2013 and completed at least 4 PTSD Checklist (PCL) assessments over 12 weeks. Latent trajectory analysis was used to identify latent classes of patients based on PCL scores. Based on model fit indices, 3 trajectories were identified. Compared to patients in the mild‐improving trajectory (21.9%), those in the severe‐stable trajectory (34.3%) were more likely to be male, relative risk ratio (RRR) = 1.48, 95% CI [1.08, 2.02]; non‐White, RRR = 1.77, 95% CI [1.33, 2.35]; Hispanic, RRR = 2.07, 95% CI [1.40, 3.04]; and have comorbid depression, RRR = 1.58, 95% CI [1.25, 1.99]. Compared to patients in the moderate‐improving trajectory (43.8%), those in the severe‐stable trajectory were more likely to have sleep disorders, RRR = 1.25, 95% CI [1.01, 1.55]. Our findings suggest that male veterans, minority veterans, and veterans with certain comorbid conditions may be less likely to achieve improved PTSD symptoms. Targeted efforts are needed to improve outcomes for PTSD patients on nonremitting trajectories and to improve the consistency of PTSD assessment across the VA health care system. A pesar que el departamento de asuntos para veteranos (AV) ha priorizado la atención del trastorno por estrés postraumático (TEPT), muchos pacientes con TEPT permanecen sintomáticos. Los patrones de cambio de los síntomas de TEPT no se conocen bien. De este modo, el presente estudio fue formulado para categorizar e investigar los potenciales predictores de las trayectorias de síntomas en pacientes con TEPT. La muestra comprendía a 2.237 pacientes AV que fueron diagnosticados con TEPT en el 2013 y completaron al menos 4 evaluaciones de listas de chequeo de TEPT (PCL) a lo largo de 12 semanas. Se utilizó el análisis de trayectoria latente para identificar clases latentes de pacientes basados en los puntajes de PCL. Basado en los índices de ajuste del modelo, 3 trayectorias fueron identificadas. En comparación con los pacientes en la trayectoria de mejoría leve (21,9%),los de la trayectoria severa estable (34,3%) fueron más propensos a ser hombres (Radio de Riesgo Relativo [RRR] = 1.48, 95% CI [1.08, 2.02]), de color (RRR = 1.77, 95% CI [1.33, 2.35]), Hispánicos (RRR = 2.07, 95% CI [1.40, 3.04]), y con depresión comorbida (RRR = 1.58, 95% CI [1.25, 1.99]).En comparación con los pacientes en la trayectoria de mejoría moderada (43,8%) aquellos en la trayectoria severa estable tenían más probabilidades de tener trastornos del sueño (RRR = 1.25, 95% CI [1.01, 1.55]). Nuestros hallazgos sugieren que veteranos hombres, de grupos minoritarios, y con ciertas condiciones de comorbilidad pueden tener menos probabilidad de conseguir una mejoría en los síntomas de TEPT. Es necesario dirigir los esfuerzos en mejorar las consecuencias del TEPT para pacientes en las trayectorias sin remisión y para mejorar la consistencia de la evaluación del TEPT en toda la AV. 標題: 退伍軍人事務部門診患者中PTSD症狀變化的預測變量 撮要: 雖然退伍軍人事務部(VA)會優先治療創傷後壓力症(PTSD)患者, 但仍有很多PTSD患者還未康復。目前我們還未了解PTSD症狀變化的模式。因此, 本研究透過PTSD患者, 分類並探查症狀軌跡的潛在預測變量。樣本為2,237名於2013年在VA被確診患PTSD的患者, 他們在12星期裡進行了至少4次的PTSD檢查表(PCL)評估。我們利用潛在軌跡分析, 基於PCL分數得出患者的潛在類別。 我們基於模型吻合指數, 找出3種軌跡。跟「輕微與正在改善」軌跡的患者(21.9%)相比, 在「嚴重與穩定」軌跡的患者(34.3%)有更大可能是男性 (相對風險率 [RRR] = 1.48, 95% CI [1.08, 2.02])、非白人 (RRR = 1.77, 95% CI [1.33, 2.35])、西班牙裔 (RRR = 2.07, 95% CI [1.40, 3.04]), 並有共病抑鬱症 (RRR = 1.58, 95% CI [1.25, 1.99])。跟「中度與正在改善」軌跡的患者(43.8%)相比, 在「嚴重與穩定」軌跡的患者更大可能有睡眠失常(RRR = 1.25, 95% CI [1.01, 1.55])。結果反映, 男性、少數族裔退役軍人, 和有某些共病狀況的退役軍人, PTSD症狀改善的可能性較小。對於在無改善軌跡的患者, 我們需加以提供針對性治療, 並提升VA普遍評估PTSD的一致性。 标题: 退伍军人事务部门诊患者中PTSD症状变化的预测变量 撮要: 虽然退伍军人事务部(VA)会优先治疗创伤后压力症(PTSD)患者, 但仍有很多PTSD患者还未康复。目前我们还未了解PTSD症状变化的模式。因此, 本研究透过PTSD患者, 分类并探查症状轨迹的潜在预测变量。样本为2,237名于2013年在VA被确诊患PTSD的患者, 他们在12星期里进行了至少4次的PTSD检查表(PCL)评估。我们利用潜在轨迹分析, 基于PCL分数得出患者的潜在类别。 我们基于模型吻合指数, 找出3种轨迹。跟「轻微与正在改善」轨迹的患者(21.9%)相比, 在「严重与稳定」轨迹的患者(34.3%)有更大可能是男性 (相对风险率 [RRR] = 1.48, 95% CI [1.08, 2.02])、非白人 (RRR = 1.77, 95% CI [1.33, 2.35])、西班牙裔 (RRR = 2.07, 95% CI [1.40, 3.04]), 并有共病抑郁症 (RRR = 1.58, 95% CI [1.25, 1.99])。跟「中度与正在改善」轨迹的患者(43.8%)相比, 在「严重与稳定」轨迹的患者更大可能有睡眠失常(RRR = 1.25, 95% CI [1.01, 1.55])。结果反映, 男性、少数族裔退役军人, 和有某些共病状况的退役军人, PTSD症状改善的可能性较小。对于在无改善轨迹的患者, 我们需加以提供针对性治疗, 并提升VA普遍评估PTSD的一致性。

  January 19, 2017   doi: 10.1002/jts.22156   open full text
• Maintenance and Reach of Exposure Psychotherapy for Posttraumatic Stress Disorder 18 Months After Training.
  Craig S. Rosen, Afsoon Eftekhari, Jill J. Crowley, Brandy N. Smith, Eric Kuhn, Lindsay Trent, Nicole Martin, Thuy Tran, Josef I. Ruzek.
  Journal of Traumatic Stress. January 19, 2017
  This study examined aspects of clinicians’ work environment that facilitated sustained use of prolonged exposure (PE) therapy. Surveys were completed by 566 U.S. Department of Veterans Affairs clinicians 6 and 18 months after intensive training in PE. The number of patients treated with PE at 18 months (reach) was modeled as a function of clinician demographics, clinician beliefs about PE, and work context factors. There were 342 clinicians (60.4%) who used PE at 6 and 18 months after training, 58 (10.2%) who used PE at 18 but not 6 months, 95 (16.7%) who used PE at 6 but not 18 months, and 71 (12.5%) who never adopted PE. Median reach was 12% of clinicians’ appointments with patients with posttraumatic stress disorder. Reach was predicted by flow of interested patients (incident response ratio [IRR] = 1.21 to 1.51), PE's perceived effectiveness (IRR = 1.04 to 1.31), working in a PTSD specialty clinic (IRR = 1.06 to 1.26), seeing more patients weekly (IRR = 1.04 to 1.25), and seeing fewer patients in groups (IRR = 0.83 to 0.99). Most clinicians trained in PE sustained use of the treatment, but on a limited basis. Strategies to increase reach of PE should address organizational barriers and patient engagement. MANTENIMIENTO Y ALCANCE DE EXPOSICIÓN PROLONGADA Este estudio examinó los aspectos del ambiente de trabajo de los clínicos que facilitaron el uso sostenido de la Psicoterapia de Exposición Prolongada (PE). Se aplicaron encuestas a 566 clínicos del Departamento de Asuntos de los Veteranos de los Estados Unidos, 6 y 18 meses después del entrenamiento intensivo en PE. El número de pacientes tratados con PE a los 18 meses (alcance) se modeló en función de la demografía de los clínicos, las creencias de los clínicos sobre PE, y factores de contexto laboral. Trescientos cuarenta y dos clínicos (60,4%) usaron PE a los 6 y 18 meses después del entrenamiento; 58 (10,2%) usaron PE a los 18 pero no a los 6 meses; 95 (16,7%)) utilizaron PE a los 6 pero no a los 18 meses; y 71 (12,5%) nunca adoptaron PE. El alcance promedio fue de un 12% de citas con pacientes con trastorno de estrés postraumático. El alcance fue predicho por el flujo de pacientes interesados (Tasa de respuesta a los incidentes = 1,21 a 1,51), la eficacia percibida de PE (IRR = 1,04 a 1,31), trabajar en una clínica especializada en TEPT (IRR = 1,06 a 1,26), ver más pacientes semanalmente (IRR = 1,04 a 1,25), y ver menos pacientes en grupos (IRR = 0,83 a 0,99). La mayoría de los clínicos entrenados en PE continuaron utilizando el tratamiento, pero de manera limitada. Las estrategias para aumentar el alcance de la PE deberían abordar las barreras organizacionales y el compromiso del paciente. 標題: 臨床治療師完成用以治療創傷後壓力症的暴露心理治療訓練18個月後, 維持採用療法和患者接受療法的機率 撮要: 本研究檢視臨床治療師的工作環境裡, 有助持續採用延長暴露療法(PE)的因素。共566名退伍軍人事務部的臨床治療師, 在完成PE加強訓練後6及18個月接受調查。我們以18個月後接受PE的患者數量, 作為臨床治療師的人口變量、臨床治療師對PE的看法及工作環境因素的函數。342名臨床治療師(60.4%)在完成訓練的6及18個月後有採用PE༛58名(10.2%)在完成訓練6個月後沒用過PE, 但在18個月後用過༛95名(16.7%)在完成訓練6個月後用過PE, 但18個月後沒用༛71名 (12.5%)從沒採用PE。患者接受療法的機率中位數, 為臨床治療師跟創傷後壓力症患者12%的診症預約。對這療法有興趣的患者出現頻率 (發生反應比率 = 1.21 至1.51)、臨床治療師對PE功效的感知(IRR = 1.04 至 1.31)、在PTSD專科診所工作 (IRR = 1.06 至1.26)、每星期接見的患者較多(IRR = 1.04 至1.25)、及較少以組別形式接見患者(IRR = 0.83 至0.99), 均能預測患者接受療法的機率。大部分接受過PE訓練的臨床治療師都持續採用此療法, 但採用次數不頻密。為了策略性地提高患者接受PE的機率, 我們應針對改善機構導致的治療障礙, 及提升患者投入治療的程度。

  January 19, 2017   doi: 10.1002/jts.22153   open full text
• What Determines Posttraumatic Stress and Growth Following Various Traumatic Events? A Study in a Turkish Community Sample.
  Ervin Gul, A. Nuray Karanci.
  Journal of Traumatic Stress. January 19, 2017
  This study aimed to examine the roles of personality traits, traumatic event types, coping, rumination, and social support in explaining posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in a representative community sample of 498 Turkish adults. The results of 2 multiple regression analyses showed that PTS was associated with neuroticism, experiencing events involving intentional/assaultive violence, intrusive and deliberate rumination, and fatalistic coping. In contrast, PTG was related to conscientiousness, openness to experience, injury/shocking and sudden‐death type of events, deliberate rumination, problem‐solving coping, and perceived social support. When all variables were entered into the equation, almost two thirds of the variability (R2 = .64) in the severity of PTS and more than one third of the variability (R2 = .40) in PTG was explained. The findings can aid in the development of psychosocial support programs for individuals experiencing traumatic events. Este estudio tuvo por objetivo examinar el rol de los rasgos de personalidad, tipos de eventos traumáticos, afrontamiento, rumiación y apoyo social en la explicación del desarrollo de síntomas de estrés postraumático (SEP) y crecimiento postraumático (CPT) en una muestra representativa de 498 adultos turcos. Los resultados de 2 análisis de regresión múltiple mostraron que los SEP, se asociaron a neuroticismo, experimentar eventos asociados a violencia intencional o relacionada a asaltos, rumiación deliberada e intrusiva y afrontamiento de estilo catastrófico. En contraste, el CPT se relacionó con la meticulosidad, apertura a la experiencia, tipo de eventos como heridas/impactantes o muertes repentinas, rumiación deliberada, afrontamiento del tipo solución de problemas y apoyo social percibido. Cuando todas las variables entraron en la ecuación, casi dos tercios de la variabilidad (R2 = .64) de la severidad de los SEP y más de un tercio de la variabilidad (R2 = .40) en el CPT fueron explicadas. Los hallazgos pueden ayudar al desarrollo de programas de apoyo psicosocial para individuos que experimentan eventos traumáticos. 標題: 什麼因素導致在各種創傷事件後的創傷後壓力與成長༟一項針對土耳其社群樣本的研究 撮要: 本研究旨在透過一項由498名土耳其成人組成、具代表性的社群樣本, 檢視性格特質、創傷事件類型、應對能力、反芻及社會支持能如何導致創傷後壓力(PTS)症狀和創傷後成長 (PTG)。2項多重迴歸分析顯示, PTS跟神經質、經歷刻意/具攻擊性的暴力事件、侵擾性反芻和故意反芻、及聽天由命、被動的應對方法有關。相反, PTG跟按良心行事、對體驗持開放態度、受傷/受驚及突然身亡種類的事件、故意反芻、解決問題的應對方法、及社會支持感知有關。如果我們把所有變量加進計算程式裡, 能解釋到PTS嚴重度接近三分之二的變異性(R2 = .64)、及PTG方面超過三分之一的變異性 (R2 = .40)。研究結果有助我們發展為經歷創傷人士提供的心理社會支援計劃 标题: 什么因素导致在各种创伤事件后的创伤后压力与成长༟一项针对土耳其社群样本的研究 撮要: 本研究旨在透过一项由498名土耳其成人组成、具代表性的社群样本, 检视性格特质、创伤事件类型、应对能力、反刍及社会支持能如何导致创伤后压力(PTS)症状和创伤后成长 (PTG)。2项多重回归分析显示, PTS跟神经质、经历刻意/具攻击性的暴力事件、侵扰性反刍和故意反刍、及听天由命、被动的应对方法有关。相反, PTG跟按良心行事、对体验持开放态度、受伤/受惊及突然身亡种类的事件、故意反刍、解决问题的应对方法、及社会支持感知有关。如果我们把所有变量加进计算程序里, 能解释到PTS严重度接近三分之二的变异性(R2 = .64)、及PTG方面超过三分之一的变异性 (R2 = .40)。研究结果有助我们发展为经历创伤人士提供的心理社会支持计划。

  January 19, 2017   doi: 10.1002/jts.22161   open full text
• The Course and Correlates of Combat‐Related PTSD in Australian Vietnam Veterans in the Three Decades After the War.
  Brian I. O'Toole, Stanley V. Catts.
  Journal of Traumatic Stress. January 19, 2017
  Australian male Vietnam veterans (N = 388) were assessed 22 and 36 years after their return to Australia using standardized diagnostic interviews, with added data from Army records and self‐report questionnaires. Among veterans who ever had posttraumatic stress disorder (PTSD), 50.3% had a current diagnosis at the second assessment; of those who had a current diagnosis at Wave 1, 46.9% were also current at Wave 2. Late onset occurred for 19.0% of veterans, of whom 60.8% were current at Wave 2. Multivariate analysis compared veterans with no history of PTSD (n = 231) with veterans who had ever had PTSD (n = 157) to assess risk factors for PTSD incidence; and veterans with a history, but not current PTSD (n = 78) with veterans who had current PTSD at the second assessment (n = 79) to assess risk factors for failure to remit. Incidence was associated with lower education, shorter Army training predeployment, higher combat, excess drinking, and help‐seeking after return to Australia. Prevalence was associated with having a father who saw combat in World War II, being injured in battle, having a lower intelligence test score, experiencing higher combat, and having a diagnosis of phobia at the first assessment. Only combat was common to incidence and prevalence. Hombres veteranos de Vietnam australianos (N = 388) fueron evaluados 22 y 36 años después del regreso, usando entrevistas de diagnóstico estandarizadas realizadas en toda Australia, con datos adicionales de registros del ejército y cuestionarios de auto‐reporte. De los veteranos que habían tenido TEPT, el 50,3% tenía un diagnóstico actual en la segunda evaluación; de los que tenían un diagnóstico actual en la Onda 1, el 46,9% también lo tenían en la Onda 2. Un inicio tardío ocurrió en el 19.0% de los cuales un 60.8% tenía el diagnostico durante la Onda 2. Un análisis multivariado comparó a los veteranos sin antecedentes de TEPT (n = 231) con los veteranos que habían tenido TEPT (n = 157) para evaluar los factores de riesgo para la incidencia de TEPT; y veteranos con antecedentes de TEPT (n = 78), pero sin TEPT actual, con veteranos que tenían TEPT actual en la segunda evaluación (n = 79) para evaluar los factores de riesgo para el fracaso de remisión. La incidencia se asoció con baja educación, entrenamiento más corto en el ejército antes del despliegue, mayor exposición a combate, consumo excesivo de alcohol y búsqueda de ayuda después del regreso. La prevalencia se asoció con haber tenido un padre que vio el combate en la Segunda Guerra Mundial, haber resultado herido en la batalla, haber tenido menor puntaje de inteligencia, haber experimentado un mayor combate y haber tenido un diagnóstico de fobia en la primera evaluación. Sólo el combate fue la característica común a la incidencia y la prevalencia. 標題: 曾參與越南戰爭的澳洲退役軍人在戰後的三個十年, 戰鬥相關的PTSD的發展及關連因素 撮要: 曾參與越南戰爭的澳洲男性退役軍人(N = 388), 在退役22及36年後接受全國性標準化診斷面談༛本研究同時從軍隊取得額外數據, 並取得樣本完成的自評問卷。在曾患PTSD的退役軍人中, 50.3%在第二次評估被確診患PTSD༛在第一波被確診當前患PTSD的人中, 46.9%在第二波仍有當前PTSD。19.0%的樣本屬晚期病發, 當中60.8%在第二波有當前PTSD。我們利用多變量分析, 比較沒患過(n = 231)和曾患(n = 157) PTSD的退役軍人, 以評估PTSD發病的風險因素༛我們亦比較曾患PTSD但當前沒有PTSD的退役軍人(n = 78), 與在第二次評估有當前PTSD的退役軍人(n = 79), 以評估未能康復的風險因素。發病率跟教育水平較低、服役前受軍訓的時間較短、有較高水平的戰鬥經歷、過量酗酒、及退役後求醫有關。普遍度則跟以下情況有關༚父親在第二次世界大戰目擊戰爭、在戰爭中受傷、智力測驗分數較低、有較高水平的戰鬥經歷、及在第一次評估裡被診斷有恐懼症。發病率跟普遍度的唯一共同因素是戰鬥。 标题: 曾参与越南战争的澳洲退役军人在战后的三个十年, 战斗相关的PTSD的发展及关连因素 撮要: 曾参与越南战争的澳洲男性退役军人(N = 388), 在退役22及36年后接受全国性标准化诊断面谈༛本研究同时从军队取得额外数据, 并取得样本完成的自评问卷。在曾患PTSD的退役军人中, 50.3%在第二次评估被确诊患PTSD༛在第一波被确诊当前患PTSD的人中, 46.9%在第二波仍有当前PTSD。19.0%的样本属晚期病发, 当中60.8%在第二波有当前PTSD。我们利用多变量分析, 比较没患过(n = 231)和曾患(n = 157) PTSD的退役军人, 以评估PTSD发病的风险因素༛我们亦比较曾患PTSD但当前没有PTSD的退役军人(n = 78), 与在第二次评估有当前PTSD的退役军人(n = 79), 以评估未能康复的风险因素。发病率跟教育水平较低、服役前受军训的时间较短、有较高水平的战斗经历、过量酗酒、及退役后求医有关。普遍度则跟以下情况有关༚父亲在第二次世界大战目击战争、在战争中受伤、智力测验分数较低、有较高水平的战斗经历、及在第一次评估里被诊断有恐惧症。发病率跟普遍度的唯一共同因素是战斗。

  January 19, 2017   doi: 10.1002/jts.22160   open full text
• Quality of Memories in Women Abused by Their Intimate Partner: Analysis of Traumatic and Nontraumatic Narratives.
  Violeta Fernández‐Lansac, María Crespo.
  Journal of Traumatic Stress. January 18, 2017
  Traditional models of posttraumatic stress disorder (PTSD) claim that the high emotional intensity of traumatic events leads to deficits in the voluntary access of traumatic memories. This may result in disorganized narratives, with a high sense of emotional and sensory reliving. Alternatively, the basic mechanisms view suggests that high arousal leads to more available involuntary and voluntary memories. Traumatic narratives would not be impaired; indeed, they would be immersive and rich in detail. To test this perspective, this study compared the trauma narratives of 50 battered women (trauma‐exposed group) with narratives about positive experiences and narratives of 50 nonexposed women (controls), and analyzed the relationship between trauma narrative aspects and the severity of PTSD. Results showed that trauma narratives were detailed, oriented, and coherent. Affective process words and emotional tone were related to trauma centrality and anxiety during disclosure, and predicted the severity of PTSD (R2 = .26). These variables, together with the use of present tense verbs, accounted for a significant variance in intrusions (R2 = .34). As hypothesized, narrative aspects related to a sense of reliving and narrative immersion were better predictors of PTSD than aspects reflecting impaired access to voluntary traumatic memories. Los modelos tradicionales de trastorno de estrés postraumático (TEPT) afirman que la alta intensidad emocional de los acontecimientos traumáticos conduce a déficits en el acceso voluntario de los recuerdos traumáticos. Esto puede resultar en narrativas desorganizadas, con un alto sentido de reavivamiento emocional y sensorial. Alternativamente, la visión del mecanismo básico sugiere que el arousal elevado conduce a más recuerdos involuntarios y voluntarios disponibles. Por lo tanto, las narrativas traumáticas no se verían afectadas, y serían inmersivas y ricas en detalles. Para probar esta perspectiva, este estudio comparó las narrativas de trauma de 50 mujeres maltratadas (grupo expuesto a trauma) con narrativas sobre experiencias positivas y narrativas de 50 mujeres no expuestas (controles) y analizó la relación entre los aspectos narrativos del trauma y la gravedad del TEPT. Los resultados mostraron que las narrativas de trauma fueron detalladas, orientadas y coherentes. Las palabras del proceso afectivo y el tono emocional se relacionaron con la centralidad y la ansiedad del trauma durante la develación, y predijeron la gravedad del TEPT (R2 = .26). Estas variables, junto con el uso de los verbos en tiempo presente, explicaron una varianza significativa en las intrusiones (R2 = .34). Como se hipotetizó, los aspectos narrativos relacionados con un sentido de revivir y la inmersión narrativa fueron mejores predictores de TEPT que los aspectos que reflejan el acceso deteriorado a los recuerdos traumáticos voluntarios. 標題: 受親密伴侶虐待的女性的記憶質素༚對創傷與非創傷敘述的分析 撮要: 傳統的創傷後壓力症(PTSD)模型指出, 創傷事件引致的高情緒強度, 能使人的自主創傷記憶能力受損。這有可能導致患者敘述混亂, 並有高水平的情緒和感覺再經歷。另一方面, 基本機制論卻指, 高水平激發會導致更活躍的非自主與自主記憶。創傷敘述亦因此不受影響, 而且內容接近真實而豐富。為測試這看法, 本研究比較50位曾受虐的女性(受創組)的創傷敘述、正面經歷敘述、及50位沒受創的女性(對照組)的敘述, 分析創傷敘述方面跟PTSD嚴重度的關係。結果得出的創傷敘述仔細、有條理和具一致性。情感用字和激動語氣跟樣本透露敘述時的創傷中心性和焦慮有關, 它們能預測PTSD嚴重度 (R2 = .26)。這些變量跟現在式動詞的使用率, 一同解釋了侵擾方面顯著的方差(R2 = .34)。一如假設, 比起能反映自主創傷記憶受損的方面, 與再經歷和敘述投入度有關的敘述方面, 是對PTSD較好的預測變量。 标题: 受亲密伴侣虐待的女性的记忆质素༚对创伤与非创伤叙述的分析 撮要: 传统的创伤后压力症(PTSD)模型指出, 创伤事件引致的高情绪强度, 能使人的自主创伤记忆能力受损。这有可能导致患者叙述混乱, 并有高水平的情绪和感觉再经历。另一方面, 基本机制论却指, 高水平激发会导致更活跃的非自主与自主记忆。创伤叙述亦因此不受影响, 而且内容接近真实而丰富。为测试这看法, 本研究比较50位曾受虐的女性(受创组)的创伤叙述、正面经历叙述、及50位没受创的女性(对照组)的叙述, 分析创伤叙述方面跟PTSD严重度的关系。结果得出的创伤叙述仔细、有条理和具一致性。情感用字和激动语气跟样本透露叙述时的创伤中心性和焦虑有关, 它们能预测PTSD严重度 (R2 = .26)。这些变量跟现在式动词的使用率, 一同解释了侵扰方面显著的方差(R2 = .34)。一如假设, 比起能反映自主创伤记忆受损的方面, 与再经历和叙述投入度有关的叙述方面, 是对PTSD较好的预测变量。

  January 18, 2017   doi: 10.1002/jts.22154   open full text
• The Posttraumatic Growth Inventory: A Revision Integrating Existential and Spiritual Change.
  Richard G. Tedeschi, Arnie Cann, Kanako Taku, Emre Senol‐Durak, Lawrence G. Calhoun.
  Journal of Traumatic Stress. January 18, 2017
  Spiritual Change (SC) is one of 5 domains of posttraumatic growth (PTG). The current Posttraumatic Growth Inventory (PTGI) assesses this area of growth with only 2 items, one focusing on religiosity and the other focusing on spiritual understanding. The addition of 4 newly developed spiritual–existential change (SEC) items, creating an expanded PTGI (Posttraumatic Growth Inventory‐X), reflects a diversity of perspectives on spiritual–existential experiences that are represented in different cultures. Samples were obtained from 3 countries: the United States (n = 250), Turkey (n = 502), and Japan (n = 314). Analyses indicated that the newly added items capture additional experiences of growth outside traditional religious concepts, yet still are correlated with the original SC items, especially in the U.S. and Turkish samples. Relationships of the PTGI‐X to established predictors of PTG, event‐related rumination, and core beliefs, were as predicted in all 3 countries. The new 6‐item SEC factor demonstrated high internal reliability, and the 5‐factor structure of the expanded scale was supported by confirmatory factor analysis. The resulting 25‐item PTGI‐X can be used as a validated instrument in a wide range of samples in which traditional religious beliefs are less dominant. El cambio espiritual (CE) es uno de los 5 dominios del crecimiento postraumático (CPT). El actual inventario de Crecimiento Postraumático (ICP) evalúa esta área del crecimiento con solo 2 ítems, uno que se focaliza en la religiosidad y otro que se enfoca en el entendimiento espiritual. La incorporación de 4 ítems nuevos desarrollados sobre cambio espiritual‐existencial (CES), la creación de un ICPT expandido (Inventario de crecimiento postraumático‐X), refleja una diversidad de perspectivas sobre experiencias espirituales‐existenciales que son representadas en diferentes culturas. Se obtuvieron muestras de 3 países, EEUU (n = 250), Turquía (n = 502), y Japón (n = 314). Los análisis indicaron que los nuevos ítems agregados capturan experiencias adicionales de crecimiento fuera de los conceptos religiosos tradicionales, y aun así están correlacionados con los ítems originales de CE, especialmente en las muestras de EEUU y Turquía. Las relaciones del ICPT ‐X a predictores establecidos de CPT, rumiación relacionada con el evento y creencias centrales, fueron predichas en los 3 países. El nuevo factor CES de 6 ítems demostró una alta confiabilidad interna, y la estructura de 5 factores de la escala expandida fue apoyada por un análisis factorial confirmatorio. Los 25 factores resultantes del ICPT ‐X pueden ser utilizados como un instrumento validado en un amplio rango de muestras en las cuales las creencias religiosas tradicionales son menos dominantes. 標題: 創傷後成長量表༚結合存在與心靈改變的修訂 撮要: 心靈改變(SC)是創傷後成長(PTG)的5個領域之一。目前的創傷後成長量表(PTGI)只利用兩方面評估心靈改變༚宗教信仰程度和靈性上的理解。創傷後成長量表加長版(PTGIX)則包含了新增的4個心靈與存在改變(SEC)項目, 這些新增項目能反映不同文化裡對心靈與存在體驗的多元看法。我們從3個國家取得樣本༚美國 (n = 250)、土耳其 (n = 502)和日本 (n = 314)。分析顯示, 特別在美國和土耳其的樣本裡, 新增項目能包含傳統信仰概念以外的成長體驗, 而這些新增項目仍跟本來的SC項目相關。在3個國家裡, PTGIX跟已確立的PTG預測變量、事件相關的反芻和核心信念的關係也符合預測。這個新的由6個項目組成的SEC因素內在信度為高, 而加長版的量表有5個因素結構, 受驗證性因素分析支持。這個共包含25個項目的PTGI‐X是個受驗證的工具, 能被廣泛用於傳統宗教信仰不如從前般主導的地方。 标题: 创伤后成长量表༚结合存在与心灵改变的修订 撮要: 心灵改变(SC)是创伤后成长(PTG)的5个领域之一。目前的创伤后成长量表(PTGI)只利用两方面评估心灵改变༚宗教信仰程度和灵性上的理解。创伤后成长量表加长版(PTGIX)则包含了新增的4个心灵与存在改变(SEC)项目, 这些新增项目能反映不同文化里对心灵与存在体验的多元看法。我们从3个国家取得样本༚美国 (n = 250)、土耳其 (n = 502)和日本 (n = 314)。分析显示, 特别在美国和土耳其的样本里, 新增项目能包含传统信仰概念以外的成长体验, 而这些新增项目仍跟本来的SC项目相关。在3个国家里, PTGIX跟已确立的PTG预测变量、事件相关的反刍和核心信念的关系也符合预测。这个新的由6个项目组成的SEC因素内在信度为高, 而加长版的量表有5个因素结构, 受验证性因素分析支持。这个共包含25个项目的PTGI‐X是个受验证的工具, 能被广泛用于传统宗教信仰不如从前般主导的地方。

  January 18, 2017   doi: 10.1002/jts.22155   open full text
• Persistent Serious Mental Illness Among Former Applicants for VA PTSD Disability Benefits and Long‐Term Outcomes: Symptoms, Functioning, and Employment.
  Maureen Murdoch, Michele Roxanne Spoont, Shannon Marie Kehle‐Forbes, Eileen Mae Harwood, Nina Aileen Sayer, Barbara Ann Clothier, Ann Kay Bangerter.
  Journal of Traumatic Stress. January 18, 2017
  Millions of U.S. veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive U.S. Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness (defined here as schizophrenia, schizoaffective disorder, and bipolar spectrum disorders) could complicate these veterans’ recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self‐reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10.0% of men and 20.0% of women had persistent serious mental illness; of these, more than 80.0% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general U.S. population. The implications of these findings are discussed. Millones de veteranos en EE. UU. han regresado del servicio militar con trastorno por estrés postraumático (TEPT), para el cual un número sustancial recibe beneficios por discapacidad del Departamento de Asuntos de Veteranos (VA). Aunque el TEPT es tratable, la enfermedad mental grave comórbida podría complicar la recuperación de estos veteranos. Utilizando datos administrativos del VA, examinamos la carga de la enfermedad mental grave persistente en un cohorte nacionalmente representativo de 1.067 hombres y de 1.513 mujeres que solicitaron los beneficios de discapacidad por TEPT de la VA entre 1994 y 1998 y que prestaron servicios durante o después del conflicto de Vietnam. Los resultados auto‐reportados se limitaron a los 713 hombres y 1.015 mujeres que devolvieron encuestas en cada uno de los 3 puntos de recolección. Más del 10% de los hombres y el 20% de las mujeres tenían una enfermedad mental grave y persistente; de éstos, más del 80% también tenían TEPT persistente. En el modelo de medidas repetidas, aquellos con enfermedad mental grave persistente reportaron consistentemente síntomas más severos de PTSD y un funcionamiento más pobre en comparación con otros participantes (p <0,001); su tasa de empleo no superó el 21%. Las interacciones entre la enfermedad mental grave persistente y el TEPT fueron significativas sólo para el empleo (p = 0,002). La enfermedad mental grave persistente en esta población era casi 2 a 19 veces más alta que en la población general estadounidense. Se discuten las implicaciones. 標題: 曾申領退伍軍人事務部(VA)的PTSD殘疾福利人士, 其持續的嚴重精神病及長遠影響༚症狀、功能運作和就業 撮要: 數以百萬計的美國退役軍人在退役後患上創傷後壓力症(PTSD), 當中大部分都取得退伍軍人事務部(VA)的殘疾福利。雖然PTSD可被治理, 嚴重的共病精神病有可能阻礙退役軍人康復。我們利用VA的行政數據, 檢視具全國代表性的世代研究樣本༚曾於越戰時期或越戰後服役、在1994至1998年間申領VA的PTSD殘疾福利的1,067 名男性與1,513 名女性。我們檢視樣本中, 持續的嚴重精神病帶來的影響。共有713 名男性與1,015 名女性在3次數據收集時期遞交自評報告。超過10% 男性與20% 女性有持續的嚴重精神病, 而他們當中超過80%也有持續的PTSD。重複測量模型反映, 跟其他參與者相比, 持續有嚴重精神病的人一致性地報告有較嚴重的PTSD症狀, 及有較差的功能運作(ps < .001), 而他們的就業率並不超過21.0%。只有在就業時, 持續的嚴重精神病跟PTSD才有顯著交互作用(p = .002)。在這些人口中, 持續的嚴重精神病比一般美國人口高約2 至19 倍。本研究亦討論結果含意。 标题: 曾申领退伍军人事务部(VA)的PTSD残疾福利人士, 其持续的严重精神病及长远影响༚症状、功能运作和就业 撮要: 数以百万计的美国退役军人在退役后患上创伤后压力症(PTSD), 当中大部分都取得退伍军人事务部(VA)的残疾福利。虽然PTSD可被治理, 严重的共病精神病有可能阻碍退役军人康复。我们利用VA的行政数据, 检视具全国代表性的世代研究样本༚曾于越战时期或越战后服役、在1994至1998年间申领VA的PTSD残疾福利的1,067 名男性与1,513 名女性。我们检视样本中, 持续的严重精神病带来的影响。共有713 名男性与1,015 名女性在3次数据收集时期递交自评报告。超过10% 男性与20% 女性有持续的严重精神病, 而他们当中超过80%也有持续的PTSD。重复测量模型反映, 跟其他参与者相比, 持续有严重精神病的人一致性地报告有较严重的PTSD症状, 及有较差的功能运作(ps < .001), 而他们的就业率并不超过21.0%。只有在就业时, 持续的严重精神病跟PTSD才有显著交互作用(p = .002)。在这些人口中, 持续的严重精神病比一般美国人口高约2 至19 倍。本研究亦讨论结果含意。

  January 18, 2017   doi: 10.1002/jts.22162   open full text
• Understanding the Connection Between Posttraumatic Stress Symptoms and Respiratory Problems: Contributions of Anxiety Sensitivity.
  Brittain L. Mahaffey, Adam Gonzalez, Samantha G. Farris, Michael J. Zvolensky, Evelyn J. Bromet, Benjamin J. Luft, Roman Kotov.
  Journal of Traumatic Stress. January 18, 2017
  Respiratory problems and posttraumatic stress disorder (PTSD) are the signature health consequences associated with the September 11, 2001 (9/11), World Trade Center disaster and frequently co‐occur. The reasons for this comorbidity, however, remain unknown. Anxiety sensitivity is a transdiagnostic trait that is associated with both PTSD and respiratory symptoms. The present study explored whether anxiety sensitivity could explain the experience of respiratory symptoms in trauma‐exposed smokers with PTSD symptoms. Participants (N = 135; Mage = 49.18 years, SD = 10.01) were 9/11‐exposed daily smokers. Cross‐sectional self‐report measures were used to assess PTSD symptoms, anxiety sensitivity, and respiratory symptoms. After controlling for covariates and PTSD symptoms, anxiety sensitivity accounted for significant additional variance in respiratory symptoms (ΔR2 = .04 to .08). This effect was specific to the somatic concerns dimension (β = .29, p = .020); somatic concerns contributed significantly to accounting for the overlap between PTSD and respiratory symptoms, b = 0.03, 95% CI [0.01, 0.07]. These findings suggest that the somatic dimension of anxiety sensitivity is important in understanding respiratory symptoms in individuals with PTSD symptoms. These findings also suggest that it may be critical to address anxiety sensitivity when treating patients with comorbid respiratory problems and PTSD. TEPT Y SÍNTOMAS RESPIRATORIOS BAJOS Los problemas respiratorios y el Trastorno de Estrés Postraumático (TEPT) son las consecuencias de salud características asociadas con el desastre de las Torres Gemelas (World Trade Center, WTC) el 11 de septiembre y frecuentemente coexisten. Las razones de esta comorbilidad, sin embargo, aún se desconocen. La sensibilidad a la ansiedad es un rasgo trans‐diagnóstico que se asocia con ambos, TEPT y síntomas respiratorios. El presente estudio exploró la posibilidad de que la sensibilidad a la ansiedad pudiera explicar la experiencia de síntomas respiratorios en fumadores expuestos a trauma con síntomas de TEPT. Los participantes (N = 135, Medad = 49.18, SD = 10.01) fueron fumadores diarios, expuestos al 11 de septiembre. Se usaron mediciones transversales de auto‐reporte para evaluar síntomas de TEPT, sensibilidad a la ansiedad y síntomas respiratorios. Después de controlar las covariables y los síntomas de TEPT, la sensibilidad a la ansiedad representó una varianza adicional significativa en los síntomas respiratorios (∆R2 = .04 a .08). Este efecto fue específico para la dimensión de las quejas somáticas (β = 0.29, p = .020) y éstas, contribuyeron de forma significativa para explicar la superposición entre los síntomas de TEPT y los respiratorios (b = 0.03, 95% CI = [0.01 a 0.07]). Estos hallazgos sugieren que la dimensión somática de la sensibilidad a la ansiedad es un aspecto importante en la comprensión de los síntomas respiratorios en personas con síntomas de TEPT. Sugieren además, que puede ser crítico abordar la sensibilidad a la ansiedad al tratar pacientes con comorbilidad de TEPT y síntomas respiratorios. 標題: 理解創傷後壓力症狀與呼吸問題的關連༚焦慮敏感性的影響 撮要: 呼吸問題與創傷後壓力症(PTSD)屬紐約世界貿易中心(WTC)九一一襲擊事件相關的標誌病患, 它們經常同時發生, 但我們仍不知道是什麼導致這種共病性。焦慮敏感性跟PTSD和呼吸症狀均有關連, 是一種跨診斷的心理特質。本研究檢視焦慮敏感性可否解釋受創並有PTSD症狀的吸煙人士的呼吸症狀。參與者(N = 135; Mage = 49.18, SD = 10.01)都是經歷了九一一襲擊事件、有每日吸煙習慣的人士。我們利用橫斷的自評測量, 評估樣本的PTSD症狀、焦慮敏感性和呼吸症狀。我們對共變量和PTSD症狀作控制後, 發現焦慮敏感性解釋了呼吸症狀顯著的額外方差 (R2 = .04 to .08)。這效應特殊地在軀體問題方面發生(β = 0.29, p = .020)༛而軀體問題能顯著地解釋PTSD與呼吸症狀重疊(b = 0.03, 95% CI = [0.01 to 0.07])。本研究發現指出, 要理解有PTSD症狀人士的呼吸症狀, 焦慮敏感性對軀體方面的影響有其重要性。研究亦反映, 為有呼吸問題與PTSD共病的人提供治療時, 治療他們的焦慮敏感性可能是關鍵。 标题: 理解创伤后压力症状与呼吸问题的关连༚焦虑敏感性的影响 撮要: 呼吸问题与创伤后压力症(PTSD)属纽约世界贸易中心(WTC)九一一袭击事件相关的标志病患, 它们经常同时发生, 但我们仍不知道是什么导致这种共病性。焦虑敏感性跟PTSD和呼吸症状均有关连, 是一种跨诊断的心理特质。本研究检视焦虑敏感性可否解释受创并有PTSD症状的吸烟人士的呼吸症状。参与者(N = 135; Mage = 49.18, SD = 10.01)都是经历了九一一袭击事件、有每日吸烟习惯的人士。我们利用横断的自评测量, 评估样本的PTSD症状、焦虑敏感性和呼吸症状。我们对共变量和PTSD症状作控制后, 发现焦虑敏感性解释了呼吸症状显著的额外方差 (∆R2 = .04 to .08)。这效应特殊地在躯体问题方面发生(β = 0.29, p = .020)༛而躯体问题能显著地解释PTSD与呼吸症状重迭(b = 0.03, 95% CI = [0.01 to 0.07])。本研究发现指出, 要理解有PTSD症状人士的呼吸症状, 焦虑敏感性对躯体方面的影响有其重要性。研究亦反映, 为有呼吸问题与PTSD共病的人提供治疗时, 治疗他们的焦虑敏感性可能是关键。

  January 18, 2017   doi: 10.1002/jts.22159   open full text
• Brief Practical Screeners in English and Spanish for Acute Posttraumatic Stress Symptoms in Children.
  Nancy Kassam‐Adams, Meghan L. Marsac.
  Journal of Traumatic Stress. December 06, 2016
  With millions of children experiencing acute traumatic events, validated screening tools are needed in both research and service contexts. We aimed to identify and evaluate short forms of the Acute Stress Checklist for Children in English (ASC‐Kids) and Spanish (Cuestionario de Estrés Agudo‐Niños [CEA‐N]), using data from 4 samples (Ns of 254, 225, 176, and 80) of children with recent acute trauma. Confirmatory factor analyses of the full checklist in the largest sample guided item selection for 6‐item and 3‐item short forms. Across samples, both short forms (ASC‐6/ASC‐3 in English; CEA‐6/CEA‐3 in Spanish) were correlated with acute stress disorder (ASD) symptom severity on the full checklist (r = .79 to .92), and on an interview measure (r = .52 to .62). Receiver operating curve analyses for each short form detecting current ASD status showed high areas under the curve (.76 to .95). Cutoff scores identified based on Sample 1 provided acceptable sensitivity (.59 to 1.00) and specificity (.57 to .86) across samples. Children scoring above the cutoff on each screener reported greater concurrent impairment from ASD symptoms and more severe posttraumatic stress 3 months later. These very brief measures could expand clinicians’ and researchers’ ability to screen for acute posttraumatic stress in children. Breves Detectores para Estrés Traumático Agudo Con millones de niños experimentando eventos traumáticos agudos, se necesita herramientas de evaluación validadas tanto en contextos de investigación como de servicios. Nuestro objetivo fue identificar y evaluar las versiones cortas de la Lista de Chequeo de Estrés Agudo para los niños en Inglés (ASC‐Kids) y Español (CEA‐N), utilizando datos de 4 muestras (Ns de 254, 225, 176 y 80) de niños con trauma agudo reciente. Los análisis factoriales confirmatorios de la lista de chequeo completa en la muestra más grande guiaron la selección de ítems para las versiones cortas de 6 y 3 ítems. En las muestras, ambas formas cortas (ASC‐6 / ASC‐3 en Inglés; CEA‐6 / CEA‐3 en español) se correlacionaron con la gravedad de los síntomas en la lista de chequeo completa del trastorno de estrés agudo (TEA) (r = .79 a .92) y en una medida de entrevista (r = .52 a .62). Los análisis de Curva Operativa del Receptor para cada forma corta que detectaba el estado actual de trastorno de estrés agudo, mostraron áreas altas bajo la curva (ABC; .76 a .95). Los puntajes de corte identificados basados en la Muestra 1 proveyeron aceptables sensibilidad (.59 a 1.00) y especificidad (.57 a .86) en las muestras. Los niños con puntajes por encima del punto de corte en cada lista reportaron un mayor deterioro concomitante por los síntomas de TEA y estrés postraumático más severo tres meses más tarde. Estas medidas muy breves podrían ampliar la habilidad de los clínicos e investigadores de detectar estrés postraumático agudo en los niños. 標題: 為找出兒童的急性創傷後壓力症狀、簡單實用的英語和西班牙語篩選項目 撮要: 由於數百萬兒童曾經歷急性創傷事件, 我們在研究和服務領域都需要受驗證有效的篩選工具。我們旨在製造簡短的兒童急性壓力量表(英語版) (ASC‐Kids)及兒童急性壓力量表(西班牙語版) (CEA‐N), 並對其作評估。我們利用4組樣本的數據(Ns = 254, 225, 176 和 80), 樣本為近期經歷急性創傷的兒童。我們以最大樣本對完整量表進行驗證性因素分析, 以此引導我們為6項及3項的簡短版作項目選擇。各個樣本中, 兩種量表的簡短版(英語版: ASC‐6 / ASC‐3; 西班牙語版: CEA‐6 / CEA‐3)都跟完整量表裡(r = .79 至 .92)和面談測量裡(r = .52 至 .62)的急性歷力症(ASD)症狀嚴重度有關。為查出當前ASD狀況, 我們對每個簡短版進行接收者操作曲線分析, 分析顯示曲線下的範圍為高(AUC; .76 至 .95)。我們以樣本1得出取錄分數, 這取錄分數為我們提供不同樣本間可接受的敏感度(.59 至 1.00)和特殊性(.57 至 .86)。在每個篩選項目裡, 分數高於取錄線的兒童有較多ASD症狀同時引致的功能損傷, 並在三個月後有較嚴重的創傷後壓力。這些非常簡短的測量方法, 可進一步幫助臨床治療師和研究人員篩選兒童的急性創傷後壓力。 标题: 为找出儿童的急性创伤后压力症状、简单实用的英语和西班牙语筛选项目 撮要: 由于数百万儿童曾经历急性创伤事件, 我们在研究和服务领域都需要受验证有效的筛选工具。我们旨在制造简短的儿童急性压力量表(英语版) (ASC‐Kids)及儿童急性压力量表(西班牙语版) (CEA‐N), 并对其作评估。我们利用4组样本的数据(Ns = 254, 225, 176 和 80), 样本为近期经历急性创伤的儿童。我们以最大样本对完整量表进行验证性因素分析, 以此引导我们为6项及3项的简短版作项目选择。各个样本中, 两种量表的简短版(英语版: ASC‐6 / ASC‐3; 西班牙语版: CEA‐6 / CEA‐3)都跟完整量表里(r = .79 至 .92)和面谈测量里(r = .52 至 .62)的急性历力症(ASD)症状严重度有关。为查出当前ASD状况, 我们对每个简短版进行接收者操作曲线分析, 分析显示曲线下的范围为高(AUC; .76 至 .95)。我们以样本1得出取录分数, 这取录分数为我们提供不同样本间可接受的敏感度(.59 至 1.00)和特殊性(.57 至 .86)。在每个筛选项目里, 分数高于取录线的儿童有较多ASD症状同时引致的功能损伤, 并在三个月后有较严重的创伤后压力。这些非常简短的测量方法, 可进一步帮助临床治疗师和研究人员筛选儿童的急性创伤后压力。

  December 06, 2016   doi: 10.1002/jts.22141   open full text
• Indirect Exposure to Captivity Details Is Not Related to Posttraumatic Stress Symptoms Among the Spouses and Offspring of Former Prisoners of War.
  Gadi Zerach, Zahava Solomon.
  Journal of Traumatic Stress. November 21, 2016
  Indirect exposure to the aversive details of the primary victim's traumatic event(s) has been introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013) as a new event criterion (Criterion A4). However, this new criterion has been criticized for its significant emphasis on the exposure to trauma “details” or trauma narrative. This study assessed the associations between reported exposure to details about captivity and posttraumatic stress symptoms (PTSS) among 2 groups of family members of former prisoners of war (ex‐POWs): spouses (n = 115) and adult offspring (n = 78). Results show that in both groups exposure to details regarding captivity was not significantly related to the severity of total PTSS and specifically, high levels of exposure to captivity details were related to lower avoidance symptoms among ex‐POWs' spouses. Among offspring, exposure to paternal behaviors stemming from the fathers' posttraumatic stress disorder was related to PTSS, above and beyond negative life events, quality of relationship with the father, and exposure to captivity details (R2 = .34). These results suggest that behavioral displays of the fathers' posttraumatic symptoms, rather than the recounting of trauma‐related details, is related to PTSS among ex‐POWs' offspring. 標題: 間接經歷囚禁細節跟前戰犯的伴侶和子女的創傷後壓力症狀無關 撮要: 精神疾病診斷與統計手冊第五版(DSM‐5)新增了事件準則 (準則A4)༚間接經歷主要受害人的創傷事件中的厭惡性細節。可是, 這項準則因為顯著強調創傷「細節」的經歷或創傷敘述而受批評。本研究透過兩組前戰犯(ex‐ POWs)的家庭成員, 檢視經歷囚禁細節與創傷後壓力症狀(PTSS)的關連。兩組分別為 (一) 伴侶(n = 115) 和 (二) 成年子女(n = 78)。結果顯示, 兩組裡, 經歷有關囚禁的細節跟PTSS的總嚴重度並無顯著關連。ex‐ POWs的伴侶中, 高水平的囚禁細節經歷跟低水平的迴避症狀有關。子女中, 經歷有PTSD的父親的家長式行為跟PTSS有關, 其關連程度遠比負面生命事件、跟父親的關係質素及囚禁細節經歷還大(R2 = .34)。結果反映, 對ex‐ POWs的子女來說, PTSS跟父親因創傷後壓力症狀驅使的行為有關, 而非跟經歷創傷相關的細節敘述有關。 标题: 间接经历囚禁细节跟前战犯的伴侣和子女的创伤后压力症状无关 撮要: 精神疾病诊断与统计手册第五版(DSM‐5)新增了事件准则 (准则A4)༚间接经历主要受害人的创伤事件中的厌恶性细节。可是, 这项准则因为显著强调创伤「细节」的经历或创伤叙述而受批评。本研究透过两组前战犯(ex‐ POWs)的家庭成员, 检视经历囚禁细节与创伤后压力症状(PTSS)的关连。两组分别为 (一) 伴侣(n = 115) 和 (二) 成年子女(n = 78)。结果显示, 两组里, 经历有关囚禁的细节跟PTSS的总严重度并无显著关连。ex‐ POWs的伴侣中, 高水平的囚禁细节经历跟低水平的回避症状有关。子女中, 经历有PTSD的父亲的家长式行为跟PTSS有关, 其关连程度远比负面生命事件、跟父亲的关系质素及囚禁细节经历还大(R2 = .34)。结果反映, 对ex‐ POWs的子女来说, PTSS跟父亲因创伤后压力症状驱使的行为有关, 而非跟经历创伤相关的细节叙述有关。

  November 21, 2016   doi: 10.1002/jts.22140   open full text
• Exploring Reliability and Validity of the Deployment Risk and Resilience Inventory‐2 Among a Nonclinical Sample of Discharged Soldiers Following Mandatory Military Service.
  Hagai Maoz, Yiftach Goldwin, Yael Doreen Lewis, Yuval Bloch.
  Journal of Traumatic Stress. November 17, 2016
  The Deployment Risk and Resilience Inventory (DRRI) is a widely used questionnaire assessing deployment‐related risk and resilience factors among war veterans. Its successor, the DRRI‐2, has only been validated and used among veterans deployed for overseas military missions, but because many countries still enforce compulsory military service, validating it among nonclinical samples of healthy discharged soldiers following mandatory service is also a necessity. In the current study, a sample of 101 discharged Israeli soldiers (39 males, 62 females; mean time since discharge 13.92, SD = 9.09 years) completed the DRRI‐2. There were 52 participants who completed the questionnaire at a second time point (mean time between assessments 19.02, SD = 6.21 days). Both physical and mental health status were examined, as well as symptomatology of depression, anxiety, and posttraumatic stress disorder. Cronbach's αs for all latent variables in the inventory ranged from .47 to .95. The DRRI‐2 risk factors were negatively associated with psychological functioning, whereas resilience factors were positively associated with better self‐reported mental health. Test‐retest reliability coefficients were generally high (Pearson correlations were .61 to .94, all p values < .01). Our study provides evidence for the reliability and validity of the DRRI‐2 in assessing salient deployment experiences among a nonclinical sample following mandatory military service. El cuestionario de riesgo y resiliencia de despliegue (DRRI), es un cuestionario ampliamente usado para evaluar factores de riesgo y resiliencia asociados al despliegue en veteranos de guerra. Su sucesor, el DRRI‐2, ha sido validado y usado sólo en veteranos en misiones militares en el extranjero, pero debido a que muchos países continúan aplicando el servicio militar obligatorio, validarlo en muestras no clínicas de soldados retirados sanos después del servicio obligatorio también es una necesidad. En el presente estudio, 101 soldados israelíes retirados (39 varones y 62 mujeres; promedio de tiempo después del cumplimiento del servicio 13,92, DS = 9,09 años) completaron el DRRI‐2. Hubo 52 participantes que completaron el cuestionario en un segundo punto de tiempo (tiempo promedio entre evaluaciones 19,02, DS = 6,21 días). Se examinó tanto el estado físico como mental y la presencia de sintomatología de ansiedad, depresión y de Trastorno de Estrés Postraumático. Los alfas de Cronbach para todas las variables latentes en el cuestionario oscilaron de .47 a .95. Los factores de riesgo en el DRRI‐2 se asociaron negativamente al funcionamiento psicológico, mientras que los factores de resiliencia se asociaron positivamente a mejor salud mental auto‐reportada. Los coeficientes de fiabilidad test‐ retest fueron generalmente altos (la correlación de Pearson fue de .61 a .94, todos los p< .01). Nuestro estudio provee evidencia de la confiabilidad y validez del DRRI‐2 al evaluar las experiencias salientes de despliegue en soldados luego del servicio militar obligatorio. 標題: 探索「服役風險和恢復力問卷二」對接受強制服役的非臨床退役人口的效用 撮要: 「服役風險和恢復力問卷 (DRRI) 」受廣泛用以評估退役軍人的服役相關風險和恢復力因素。它的第二版DRRI‐2, 證實能有效被用以在海外進行軍事任務的退役軍人。然而, 由於很多國家仍實行強制服役, 我們有必要驗證此問卷對接受強制服役、健康的退役軍人組成的非臨床樣本是否有效。本研究樣本為101名以色列退役軍人(39名男性, 62名女性; 平均退役為期 13.92, SD = 9.09 年)。他們完成DRRI‐2, 共有52名參與者進行第二次問卷評估(兩次評估間的平均時間為 19.02, SD = 6.21日)。研究檢視樣本的身體和心理健康狀況, 以及抑鬱症、焦慮症和創傷後壓力症的症狀學。問卷中所有潛在變量的克隆巴赫系數介乎.47 至 .95。DRRI‐2的風險因素跟心理運作有負向關連, 而恢復力因素跟自評心理狀況較好有正向關連。重測信度系數普遍為高 (皮爾遜積差相關系數為.61 至 .94, 所有 p 數值 < .01)。本研究證實DRRI‐2能有效和可信地被用於受強制服役的非臨床樣本, 以評估他們的顯著服役經驗。 撮要: 「服役风险和恢复力问卷 (DRRI) 」受广泛用以评估退役军人的服役相关风险和恢复力因素。它的第二版DRRI‐2, 证实能有效被用以在海外进行军事任务的退役军人。然而, 由于很多国家仍实行强制服役, 我们有必要验证此问卷对接受强制服役、健康的退役军人组成的非临床样本是否有效。本研究样本为101名以色列退役军人(39名男性, 62名女性; 平均退役为期 13.92, SD = 9.09 年)。他们完成DRRI‐2, 共有52名参与者进行第二次问卷评估(两次评估间的平均时间为 19.02, SD = 6.21日)。研究检视样本的身体和心理健康状况, 以及抑郁症、焦虑症和创伤后压力症的症状学。问卷中所有潜在变量的克隆巴赫系数介乎.47 至 .95。DRRI‐2的风险因素跟心理运作有负向关连, 而恢复力因素跟自评心理状况较好有正向关连。重测信度系数普遍为高 (皮尔逊积差相关系数为.61 至 .94, 所有 p 数值 < .01)。本研究证实DRRI‐2能有效和可信地被用于受强制服役的非临床样本, 以评估他们的显著服役经验。

  November 17, 2016   doi: 10.1002/jts.22135   open full text
• Treatment of Adolescent PTSD: The Impact of Prolonged Exposure Versus Client‐Centered Therapy on Co‐Occurring Emotional and Behavioral Problems.
  Laurie Zandberg, Antonia N. Kaczkurkin, Carmen P. McLean, Leslie Rescorla, Elna Yadin, Edna B. Foa.
  Journal of Traumatic Stress. November 17, 2016
  The present study evaluated secondary emotional and behavioral outcomes among adolescents who received prolonged exposure (PE‐A) or client‐centered therapy (CCT) for posttraumatic stress disorder (PTSD) in a randomized controlled trial. Participants were 61 adolescent girls (age: M = 15.33, SD = 1.50 years) with sexual abuse related PTSD seeking treatment at a community mental health clinic. Multilevel modeling was employed to evaluate group differences on the Youth Self‐Report (YSR) over acute treatment and 12‐month follow‐up. Both treatment groups showed significant improvements on all YSR scales from baseline to 12‐month follow‐up. Adolescents who received PE‐A showed significantly greater reductions than those receiving CCT on the Externalizing subscale (d = 0.70), rule‐breaking behavior (d = 0.63), aggressive behavior (d = 0.62), and conduct problems (d = 0.78). No treatment differences were found on the Internalizing subscale or among other YSR problem areas. Both PE‐A and CCT effectively reduced many co‐occurring problems among adolescents with PTSD. Although PE‐A focuses on PTSD and not on disruptive behaviors, PE‐A was associated with greater sustained changes in externalizing symptoms, supporting broad effects of trauma‐focused treatment on associated problem areas. 標題: 為青少年而設的創傷後壓力症治療༚比較延長暴露療法與受輔者中心療法對同時出現的情緒和行為問題的療效 撮要: 本研究透過隨機對照試驗, 評估青少年接受治療創傷後壓力症(PTSD)的延長暴露療法(PE‐A)或受輔者中心療法(CCT)後的續發情緒和行為。樣本為61名在社區心理治療診所尋求治療、有性侵犯相關PTSD的女青少年(年齡: M = 15.33, SD = 1.50歲)。我們利用多層模型, 評估樣本在接受緊急治療時和完成治療12個月後的跟進期, 在青少年行為自陳量表(YSR)反映的組別差異。從基線到12個月的跟進期, 兩種治療組在所有YSR測量項目均顯示顯著改善。接受PE‐A的青少年相比接受CCT的, 在外化行為問題子量表(d = 0.70)、犯規行為(d = 0.63)、攻擊性行為(d = 0.62)、和操行問題(d = 0.78)顯著有較大改善。兩種治療在內化行為問題子量表或其他YSR問題方面沒有差異。PE‐A與CCT治療都能有效減低患PTSD青少年多種同時出現的徵狀。雖然PE‐A專門治療PTSD而非破壞行為, 但PE‐A跟外化行為症狀持續改變較多有關。結果反映, 對準創傷的治療療效範圍廣, 能有助減低創傷相關的問題。 标题: 为青少年而设的创伤后压力症治疗༚比较延长暴露疗法与受辅者中心疗法对同时出现的情绪和行为问题的疗效 撮要: 本研究透过随机对照试验, 评估青少年接受治疗创伤后压力症(PTSD)的延长暴露疗法(PE‐A)或受辅者中心疗法(CCT)后的续发情绪和行为。样本为61名在小区心理治疗诊所寻求治疗、有性侵犯相关PTSD的女青少年(年龄: M = 15.33, SD = 1.50岁)。我们利用多层模型, 评估样本在接受紧急治疗时和完成治疗12个月后的跟进期, 在青少年行为自陈量表(YSR)反映的组别差异。从基线到12个月的跟进期, 两种治疗组在所有YSR测量项目均显示显著改善。接受PE‐A的青少年相比接受CCT的, 在外化行为问题子量表(d = 0.70)、犯规行为(d = 0.63)、攻击性行为(d = 0.62)、和操行问题(d = 0.78)显著有较大改善。两种治疗在内化行为问题子量表或其他YSR问题方面没有差异。PE‐A与CCT治疗都能有效减低患PTSD青少年多种同时出现的征状。虽然PE‐A专门治疗PTSD而非破坏行为, 但PE‐A跟外化行为症状持续改变较多有关。结果反映, 对准创伤的治疗疗效范围广, 能有助减低创伤相关的问题。

  November 17, 2016   doi: 10.1002/jts.22138   open full text
• Resilience in Men and Women Experiencing Sexual Assault or Traumatic Stress: Validation and Replication of the Scale of Protective Factors.
  Elisabeth Ponce‐Garcia, Amy N. Madewell, Marina E. Brown.
  Journal of Traumatic Stress. November 17, 2016
  The literature on sexual assault (SA) typically has been generalized to women and children. However, both men and women experience SA. Research shows that not all individuals experience the negative impacts of SA in the same way. The ability to buffer the negative effects of SA may lie in specific protective factors that determine resilience. Resilience scales used in adult populations have not been validated for use in SA samples. The purpose of the present study was to replicate the factor structure of a resilience scale, the Scale of Protective Factors (SPF), in a sample of emerging adults (n = 571) and to validate the replicated model on a subsample of the participants who reported SA (n = 173). Additionally, we sought to examine gender differences in mental health outcomes including depression and anxiety, and the availability of protective factors that determine resilience among those participants who reported experiencing SA (n = 173) as compared to other forms of traumatic stress (n = 132). The SPF achieved good model fit in the larger emerging adult sample and adequate model fit was achieved in the SA subsample. Results indicated significant gender differences in mental health outcomes with η2 ranging between .03 and .21. Implications and future directions are discussed. 標題: 經歷性侵犯或創傷後壓力的男性和女性的恢復力༚驗證與複製保護因素量表 撮要: 有關性侵犯(SA)的文獻普遍以女性和兒童為研究樣本, 但男女都有可能經歷SA。過往研究顯示, 不同人有不同方法經歷SA帶來的壞影響。有可能是特殊的保護因素構成減緩SA壞影響的能力, 繼而為受害者帶來恢復力。能被用於成人樣本的恢復力量表從未被驗證是否能被用於SA樣本。本研究目的旨在複製「保護因素量表」(SPF)的因素結構。樣本為初成年人士(n = 571), 當中曾經歷SA的人形成子樣本(n = 173)。我們透過子樣本來驗證複製模型。另外, 我們亦檢視心理影響如抑鬱症和焦慮症的性別差異, 並檢視能為樣本帶來恢復力的保護因素, 在曾經歷SA的子樣本(n = 173)裡, 和有其他形式創傷後壓力的樣本(TS; n = 132)裡的可得性。SPF在大型的初成年人士樣本有良好的模型吻合性, 並在SA子樣本有足夠的模型吻合性。結果顯示, 心理影響有顯著的性別差異, η2為.03 至 .21。本研究對結果進行分析和討論未來研究方向。 标题: 经历性侵犯或创伤后压力的男性和女性的恢复力༚验证与复制保护因素量表 撮要: 有关性侵犯(SA)的文献普遍以女性和儿童为研究样本, 但男女都有可能经历SA。过往研究显示, 不同人有不同方法经历SA带来的坏影响。有可能是特殊的保护因素构成减缓SA坏影响的能力, 继而为受害者带来恢复力。能被用于成人样本的恢复力量表从未被验证是否能被用于SA样本。本研究目的旨在复制「保护因素量表」(SPF)的因素结构。样本为初成年人士(n = 571), 当中曾经历SA的人形成子样本(n = 173)。我们透过子样本来验证复制模型。另外, 我们亦检视心理影响如抑郁症和焦虑症的性别差异, 并检视能为样本带来恢复力的保护因素, 在曾经历SA的子样本(n = 173)里, 和有其他形式创伤后压力的样本(TS; n = 132)里的可得性。SPF在大型的初成年人士样本有良好的模型吻合性, 并在SA子样本有足够的模型吻合性。结果显示, 心理影响有显著的性别差异, η2为.03 至 .21。本研究对结果进行分析和讨论未来研究方向。

  November 17, 2016   doi: 10.1002/jts.22148   open full text
• Psychosocial Group Intervention Among War‐Affected Children: An Analysis of Changes in Posttraumatic Cognitions.
  Samuli Kangaslampi, Raija‐Leena Punamäki, Samir Qouta, Marwan Diab, Kirsi Peltonen.
  Journal of Traumatic Stress. November 17, 2016
  Cognitive theories point to reduction in dysfunctional posttraumatic cognitions (PTCs) as one mechanism involved in recovery from posttraumatic stress symptoms (PTSS), yet research findings have shown individual differences in the recovery process. We tested the cognitive mediation hypothesis above in a previously published psychosocial group intervention among war‐affected children. We also examined heterogeneity in children's PTCs during the intervention. We used a cluster randomized trial of Smith et al.'s (2002) teaching recovery techniques (TRT) intervention among 482 Palestinians 10–13 years of age (n = 242 for intervention group, n = 240 for control group). Children reported PTSS, PTCs, and depressive symptoms at baseline, midpoint, postintervention, and at 6‐month follow‐up. Path analysis results showed that TRT was not effective in reducing dysfunctional PTCs, and the reductions did not mediate intervention effects on PTSS. Using latent class growth analysis, we chose the model with 3 differing trajectories in the intervention group: high, decreasing, moderate, downward trending, and severe, stable levels of PTCs. Higher PTSS and depressive symptoms at baseline were associated with membership in the severe, stable trajectory. The intervention did not produce the kind of beneficial cognitive change needed in the cognitive mediation conceptualization. Nevertheless, cognitive changes differed substantially across children during the intervention, and were associated with their preintervention mental health status. These findings call for more detailed examination of the process of cognitive mediation. Las teorías cognitivas apuntan a una reducción de las cogniciones postraumáticas disfuncionales (CPT) como un mecanismo de cambio involucrado en la recuperación de los síntomas de estrés postraumático (SEPT), aunque los hallazgos de investigación han mostrado diferencias individuales significativas en el proceso de recuperación. Nosotros probamos esta hipótesis de mediación cognitiva en una intervención psicosocial de grupo entre niños afectados por la guerra. Nosotros también examinamos la heterogeneidad en niños con CPT durante la intervención. En una prueba de grupos aleatorizados de las Enseñanza de Técnicas de Recuperación (ETR) en la intervención entre 482 palestinos de 10–13 años de edad (n = 242 en el grupo de intervención, n = 240 en el grupo control), los niños reportaron SEPT, CPT y síntomas depresivos al inicio del estudio, en la mitad, posterior a la intervención, y 6 meses de seguimiento. Los resultados de análisis de vías mostraron que ETR no fue efectivo en reducir los CPT disfuncionales, y estas reducciones no mediaron los efectos de la intervención en los SEPT. Usando análisis de crecimiento de clases latente, seleccionamos el modelo con 3 trayectorias diferentes en el grupo de intervención: alto, decreciente, moderado, con tendencia hacia abajo, y niveles severos estables de CPT. SEPT altos y los síntomas depresivos al inicio predijeron la pertenencia a la trayectoria estable severa. La intervención no mostró la clase de cambio cognitivo beneficioso visto como necesario en la conceptualización de la mediación cognitiva. Sin embargo, los cambios cognitivos en los niños difirieron sustancialmente durante la intervención, y estuvieron asociados con el estado de salud mental pre intervención. Estos hallazgos sugieren una examinación más detallada del proceso de mediación cognitiva.

  November 17, 2016   doi: 10.1002/jts.22149   open full text
• Social Support, Coping, and Posttraumatic Stress Symptoms in Female Sexual Assault Survivors: A Longitudinal Analysis.
  Sarah E. Ullman, Mark Relyea.
  Journal of Traumatic Stress. November 15, 2016
  Social support and coping affect each other after stressful life events, including sexual assault (Taylor & Stanton, 2007). The present study examined the associations among assault‐specific support, maladaptive coping, and posttraumatic stress symptoms (PTSS) over 3 years in a sample of female sexual assault survivors from a large metropolitan area (N = 1,863). A 3‐wave cross‐lagged panel model revealed significant weak‐to‐moderate reciprocal associations between maladaptive coping and PTSS (βs = .09 to .21), significant weak reciprocal associations between turning against social reactions and PTSS (βs = .07 to .10), and inconsistent weak reciprocal associations between maladaptive coping and unsupportive acknowledgment reactions (βs = .06 to .14). We conclude with implications regarding treatment and intervention for survivors and their support networks. Afrontamiento y Síntomas de Estrés Postraumático El apoyo social y afrontamiento se influencian mutuamente tras eventos vitales estresantes, incluyendo el ataque sexual (Taylor & Stanton, 2007). El presente estudio evaluó las asociaciones entre apoyo específico tras un ataque, afrontamiento desadaptativo, y síntomas de estrés postraumático (TEPT) durante 3 años en una muestra de mujeres sobrevivientes a un ataque sexual de una gran área metropolitana (N: 1863). Un modelo de correlaciones cruzadas en tres etapas mostró asociaciones recíprocas débiles a moderadas significativas entre afrontamiento desadaptativo y TEPT (βs: .09 a .21), asociaciones recíprocas débiles significativas entre el volcarse contra las reacciones sociales y TEPT (βs: .07 a .10), y asociaciones recíprocas débiles inconsistentes entre afrontamiento desadaptativo y reacciones de aceptación sin apoyo (βs: .06 a .14). Finalizamos con implicancias relacionadas al tratamiento e intervención a los sobrevivientes y sus redes de apoyo. 標題: 女性性侵犯生還者的社會支持、應對能力和創傷後壓力症狀縱貫分析 撮要: 人面對大壓力的生命事件包括性侵犯(Taylor & Stanton, 2007)後, 社會支持和應對能力兩方面會互相影響。本研究透過一份大都市女性性侵犯生還者的樣本(N = 1,863), 檢視在3年間, 針對侵犯事件的支持、適應不良和創傷後壓力症狀(PTS)之間的關連。三波跨時滯追蹤模型明顯顯示, 適應不良和PTS有微弱至中等的交互關連(βs = .09 至 .21)、厭惡社會反應和PTS有微弱交互關連(βs = .07 至 .10)、適應不良和不支持的確認反應有不一致的微弱交互關連(βs = .06 至 .14)。最後, 我們作出總結, 對為生還者及為其提供支持的網絡提供治療和干預作出提議。 标题: 女性性侵犯生还者的社会支持、应对能力和创伤后压力症状纵贯分析 撮要: 人面对大压力的生命事件包括性侵犯(Taylor & Stanton, 2007)后, 社会支持和应对能力两方面会互相影响。本研究透过一份大都市女性性侵犯生还者的样本(N = 1,863), 检视在3年间, 针对侵犯事件的支持、适应不良和创伤后压力症状(PTS)之间的关连。三波跨时滞追踪模型明显显示, 适应不良和PTS有微弱至中等的交互关连(βs = .09 至 .21)、厌恶社会反应和PTS有微弱交互关连(βs = .07 至 .10)、适应不良和不支持的确认反应有不一致的微弱交互关连(βs = .06 至 .14)。最后, 我们作出总结, 对为生还者及为其提供支持的网络提供治疗和干预作出提议。

  November 15, 2016   doi: 10.1002/jts.22143   open full text
• Influence of Sleep Disturbance on Global Functioning After Posttraumatic Stress Disorder Treatment.
  Janeese A. Brownlow, Carmen P. McLean, Philip R. Gehrman, Gerlinde C. Harb, Richard J. Ross, Edna B. Foa.
  Journal of Traumatic Stress. November 09, 2016
  Chronic insomnia and recurrent nightmares are prominent features of posttraumatic stress disorder (PTSD). Evidence from adult research indicates that these sleep disturbances do not respond as well to cognitive–behavioral therapies for PTSD and are associated with poorer functional outcomes. This study examined the effect of prolonged exposure therapy for adolescents versus client‐centered therapy on posttraumatic sleep disturbance, and the extent to which sleep symptoms impacted global functioning among adolescents with sexual abuse‐related PTSD. Participants included 61 adolescent girls seeking treatment at a rape crisis center. The Child PTSD Symptom Scale‐Interview (Foa, Johnson, Feeny, & Treadwell, 2001) was used to assess PTSD diagnosis and severity of symptoms, including insomnia and nightmares. The Children's Global Assessment Scale (Shaffer et al., 1983) was used to assess global functioning. There were significant main effects of time and treatment on insomnia symptoms. Additionally, there was a main effect of time on nightmares. Results also showed that insomnia and nightmares significantly predicted poorer global functioning posttreatment (R2 = .21). Despite significant improvements in posttraumatic sleep disturbance, there were still clinically significant insomnia symptoms after treatment, suggesting that additional interventions may be warranted to address residual sleep disturbance in PTSD. El insomnio crónico y las pesadillas recurrentes son características prominentes del trastorno de estrés postraumático (TEPT). La evidencia de la investigación en adultos indica que estas alteraciones del sueño no responden bien a las terapias cognitivas conductuales para TEPT y están asociadas con peores resultados funcionales. Este estudio examinó el efecto de la terapia de exposición prolongada para adolescentes (EP‐A) versus la terapia centrada en el cliente (TCC) en las alteraciones postraumáticas del sueño, y la extensión a la cual los síntomas del sueño impactan el funcionamiento global entre los adolescentes con TEPT relacionado a abuso sexual. Los participantes incluyeron 61 adolescentes del sexo femenino que buscaron tratamiento en un centro de crisis de violación. Una escala‐entrevista de síntomas de TEPT en niños fue usada para evaluar el diagnostico de TEPT y la severidad de los síntomas, incluyendo insomnio y pesadillas. La Escala de Evaluación Global de Niños (EEGN) fue usada para evaluar el funcionamiento global. Hubo efectos principales significativos del tiempo y tratamiento en los síntomas de insomnio. Adicionalmente, hubo un efecto principal del tiempo en las pesadillas. Los resultados también muestran que el insomnio y las pesadillas predijeron significativamente un peor funcionamiento global pos tratamiento (R2 = .21). A pesar de las mejoras significativas en las alteraciones postraumáticas del sueño, aún había síntomas de insomnio clínicamente significativos después del tratamiento, sugiriendo que las intervenciones adicionales pueden estar justificadas para abordar las perturbaciones del sueño residuales en TEPT. 標題: 完成創傷後壓力症治療後, 睡眠障礙對整體功能運作的影響 撮要: 長期失眠和重複做惡夢是創傷後壓力症(PTSD)的主要特徵。一些針對成人的研究證據顯示, PTSD的認知行為治療未能有效醫治以上睡眠障礙, 而這些睡眠障礙跟治療後功能運作較差有關。本研究透過一群患性侵犯相關PTSD的青少年, 檢視為青少年而設的延長暴露療法(PE‐A)與受輔者中心療法(CCT)用以治療創傷後睡眠障礙的效用, 以及睡眠症狀影響整體功能運作的程度。參與研究的樣本為61名於一所強暴康復中心尋求治療的女青少年。我們利用兒童PTSD症狀量表面談(CPSS‐I)取得樣本的PTSD診斷, 和包括失眠和做惡夢等症狀的嚴重度, 並用兒童整體評估量表(CGAS)測量樣本的整體功能運作。治療對失眠症狀為期和症狀康復有顯著的主要影響, 對做惡夢的為期也有主要影響。結果顯示, 失眠和做惡夢能顯著地預測治療後整體運作較差(R2 = .21)。即使樣本接受治療後, 創傷後睡眠障礙顯著改善, 她們仍有臨床顯著的失眠症狀, 反映我們可能需提供額外干預, 處理PTSD患者治療後餘下的睡眠障礙問題。 标题: 完成创伤后压力症治疗后, 睡眠障碍对整体功能运作的影响 撮要: 长期失眠和重复做恶梦是创伤后压力症(PTSD)的主要特征。一些针对成人的研究证据显示, PTSD的认知行为治疗未能有效医治以上睡眠障碍, 而这些睡眠障碍跟治疗后功能运作较差有关。本研究透过一群患性侵犯相关PTSD的青少年, 检视为青少年而设的延长暴露疗法(PE‐A)与受辅者中心疗法(CCT)用以治疗创伤后睡眠障碍的效用, 以及睡眠症状影响整体功能运作的程度。参与研究的样本为61名于一所强暴康复中心寻求治疗的女青少年。我们利用儿童PTSD症状量表面谈(CPSS‐I)取得样本的PTSD诊断, 和包括失眠和做恶梦等症状的严重度, 并用儿童整体评估量表(CGAS)测量样本的整体功能运作。治疗对失眠症状为期和症状康复有显著的主要影响, 对做恶梦的为期也有主要影响。结果显示, 失眠和做恶梦能显著地预测治疗后整体运作较差(R2 = .21)。即使样本接受治疗后, 创伤后睡眠障碍显著改善, 她们仍有临床显著的失眠症状, 反映我们可能需提供额外干预, 处理PTSD患者治疗后余下的睡眠障碍问题。

  November 09, 2016   doi: 10.1002/jts.22139   open full text
• Examining Patterns of Exposure to Family Violence in Preschool Children: A Latent Class Approach.
  Damion J. Grasso, Amélie Petitclerc, David B. Henry, Kimberly J. McCarthy, Lauren S. Wakschlag, Margaret J. Briggs‐Gowan.
  Journal of Traumatic Stress. November 09, 2016
  Young children can experience violence directly or indirectly in the home, with some children exposed to multiple forms of violence. These polyvictims often experience violence that is severe, chronic, and multifaceted. The current study used latent class analysis to identify and examine the pattern of profiles of exposure to family violence (i.e., violence directed towards the child and between caregivers) among a sample of 474 children ages 3–6 year who were drawn from the Multidimensional Assessment of Preschoolers Study (Wakschlag et al., 2014). The data yielded 3 classes: a polyvictimized class (n = 72; 15.2%) with high probability of exposure to all forms of violence, a harsh parenting class (n = 235; 49.5%), distinguished mainly by child‐directed physical discipline in the absence of more severe forms of violence, and a low‐exposure class (n = 167; 35.2%). Classes were differentiated by contextual factors, maternal characteristics, and mother‐reported and observational indicators of parenting and child functioning with most effect sizes between medium and large. These findings add to emerging evidence linking polyvictimization to impaired caregiving and adverse psychological outcomes for children and offer important insight for prevention and intervention for this vulnerable population. Los niños pequeños pueden experimentar violencia directa o indirecta en el hogar, con algunos niños expuestos a múltiples formas de violencia. Estas polivíctimas a menudo experimentan violencia que es severa, crónica y multifacética. El presente estudio utilizó análisis de clases latente (ACL) para identificar y examinar los perfiles de violencia intrafamiliar (ej. violencia dirigida al niño, y entre los cuidadores) entre una muestra de 474 niños, de 3 a 6 años de edad. Los datos produjeron 3 clases: Una clase poli victimizada (n = 72; 15,2%), con alta probabilidad de exposición a todas las formas de violencia, Una con un estilo parental exigente (n = 235; 49,5%), distinguida principalmente por disciplina  física dirigida al niño, en ausencia de formas más severas de violencia, Y una clase de baja exposición (n = 167; 35,2%). Las clases se diferenciaron por factores con textuales, características maternas e indicadores  reportados por la madre y observacionales de cuidado parental y funcionamiento del niño, con los efectos de  tamaño mayor entre mediano y grande. Estos hallazgos se agregan a la evidencia emergente que vincula la polivictimización con un cuidado parental desmejorado y consecuencias psicológicas adversas para los niños y ofrece una perspectiva importante para la prevención e intervención de esta población vulnerable.

  November 09, 2016   doi: 10.1002/jts.22147   open full text
• International Tourists’ Reactions to a Natural Disaster: Experiences of the 2015 Earthquake in Nepal Among Israeli Travelers.
  Haya Itzhaky, Karni Kissil, Shlomit Weiss‐Dagan.
  Journal of Traumatic Stress. November 03, 2016
  There is a scarcity of research exploring the experiences of foreign travelers exposed to natural disasters while abroad. This qualitative study explored the experiences of the 2015 earthquake in Nepal among international travelers immediately following the earthquake. In‐depth interviews were conducted with 21 Israeli backpackers who were traveling in Nepal at the time of the earthquake. Thematic analysis revealed 4 themes: emotional turmoil, quick recovery, springing into action, and connection to the army. Findings suggest that foreign travelers initially respond with emotional turmoil to the disaster. Then they actively search for ways to effectively cope with the situation by problem solving, creating a community of action and support, and searching their own history for similar circumstances that can provide a sense of competence or clear directions for coping. Implications and limitations of the study, as well as suggestions for future research are discussed. Existe escasa investigación que explora las experiencias de viajeros expuestos a desastres naturales mientras están en el extranjero. Este estudio cualitativo exploró la experiencia del terremoto del 2015 en Nepal, entre viajeros internacionales inmediatamente después del terremoto. Se realizaron entrevistas en profundidad a 21 mochileros israelitas que estaban viajando en Nepal al momento del terremoto. Un análisis temático reveló  cuatro temas: conmoción emocional, recuperación rápida, movilización hacia la acción y conexión con la Armada. Los hallazgos sugieren que los viajeros extranjeros inicialmente responden con conmoción emocional. Luego buscan activamente vías efectivas de afrontamiento  para resolver el problema, creando una comunidad de acción y apoyo, y buscando en sus propias historias las circunstancias similares que les puedan proporcionar una sensación de competencia o direcciones claras de afrontamiento. Se discuten las implicancias y limitaciones en este estudio, así como también sugerencias para futuras investigaciones. 標題: 國際旅客對天災的反應༚以色列旅客在2015年尼泊爾地震的經歷 撮要: 我們缺乏對外國旅客在外地旅遊時的天災經歷研究。本非量化研究在2015年的尼泊爾地震發生後, 即時檢視外國旅客的經歷。我們跟21名在尼泊爾地震發生時正在當地的以色列背包客進行深入面談。主題分析顯示四個主題༚情緒混亂、快速康復、即時行動、及與軍隊連繫。結果顯示, 情緒混亂是旅客面對天災的起首反應。然後他們會主動尋求解決方法, 有效地應對情況, 建立群體集體行動和互相支持, 並會思考自己過往一些類似經歷, 令自己感到更有能力和更清楚如何應對。我們分析研究結果, 討論研究局限, 並對未來研究作出提議。 标题: 国际旅客对天灾的反应༚以色列旅客在2015年尼泊尔地震的经历 撮要: 我们缺乏对外国旅客在外地旅游时的天灾经历研究。本非量化研究在2015年的尼泊尔地震发生后, 实时检视外国旅客的经历。我们跟21名在尼泊尔地震发生时正在当地的以色列背包客进行深入面谈。主题分析显示四个主题༚情绪混乱、快速康复、实时行动、及与军队连系。结果显示, 情绪混乱是旅客面对天灾的起首反应。然后他们会主动寻求解决方法, 有效地应对情况, 建立群体集体行动和互相支持, 并会思考自己过往一些类似经历, 令自己感到更有能力和更清楚如何应对。我们分析研究结果, 讨论研究局限, 并对未来研究作出提议。

  November 03, 2016   doi: 10.1002/jts.22136   open full text
• Homogeneity of Severe Posttraumatic Stress Disorder Symptom Profiles in Children and Adolescents Across Gender, Age, and Traumatic Experiences Related to 9/11.
  Guia Guffanti, Lupo Geronazzo‐Alman, Bin Fan, Cristiane S. Duarte, George J. Musa, Christina W. Hoven.
  Journal of Traumatic Stress. October 11, 2016
  Patients with a posttraumatic stress disorder (PTSD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM‐IV; American Psychiatric Association, 1994) will very likely not share all of the same symptoms, a consequence of the polythetic approach used in the DSM. We examined heterogeneity in the latent structure of PTSD symptoms using data from a previously published sample of 8,236 youth a subset of which had been exposed to the September 11, 2001 attacks (N = 6,670; Hoven et al., 2005). Latent class analysis was applied (a) to PTSD symptoms alone, (b) to symptoms in combination with impairment indicators, and (c) to PTSD symptoms when stratified by age and gender, as well as by empirically defined classes of exposure. We identified 4 symptom classes: no disturbance (49.4%), intermediate disturbance (2 classes; 21.5% and 18.6%, respectively), and severe disturbance (10.5%). These classes varied not only in the severity of symptoms, but also in the configuration of symptoms. We observed a high probability of endorsing both PTSD symptoms and indicators of impairment only in the severe disturbance class. A similar 4‐class structure was found when the data were stratified by age, gender, and exposure classes. There were no significant differences as a function of age, gender, or exposure in the presence of severe PTSD. Heterogeneity was observed at intermediate levels of PTSD symptom severity. The specific PTSD symptoms that defined the severe PTSD profile could constitute the pathogenic aspects of a largely invariant and clinically meaningful PTSD syndrome. Perfiles sintomáticos de TEPT en la juventud. Pacientes con diagnóstico de estrés postraumático (TEPT) según DSM‐IV, lo más probable es que no compartan los mismos síntomas, consecuencia del abordaje politético utilizado en el DSM. Examinamos heterogeneidad en la estructura latente de los síntomas de TEPT utilizando datos de una muestra publicada previamente de 8.236 jóvenes de los cuales una parte habían sido expuestos a los ataques del 9/11 (N = 6670) Hoven et al. (2005). Análisis de clases latentes se aplicaron a: (a) los síntomas de TEPT solamente, (b) síntomas en combinación con indicadores de discapacidad, y a (c) síntomas de TEPT estratificados por edad y género, así como también por clases de exposición definidas empíricamente. Identificamos 4 clases de síntomas: sin perturbación (49,4%), perturbación intermedia (dos clases; 21,5% y 18,6%, respectivamente), y perturbación severa (10,5%). Estas clases varían no solo en severidad del síntoma, sino que también en la configuración de los síntomas. Observamos una alta probabilidad de endosar ambos sintomas de TEPT e indicadores de discapacidad solo en la clase de perturbación severa. Una estructura similar de 4 clases se encontró cuando los datos fueron estratificados por edad, género y clases de exposición. No existieron diferencias significativas en función de la edad, género, o exposición en la presencia de TEPT severo. Heterogeneidad se observó en niveles intermedios de severidad sintomática de TEPT. Los síntomas específicos de TEPT que definieron el perfil de TEPT severo podrían constituir los aspectos patogénicos de un síntoma de TEPT clínicamente significativo e invariante. 標題: 不同性別、年齡及有不同九一一相關創傷經歷的兒童和青少年༌其嚴重創傷後壓力症狀特徵剖象的同質性 撮要: 基於DSM‐IV而被診斷為有創傷後壓力症(PTSD)的患者༌全部都有相同症狀的機會不大༌因為DSM採用多生分類法。有一項已發表、有關8,236名青年的研究數據༌當中部分人曾經歷九一一襲擊(N = 6,670)༈Hoven et al (2005)༉༌本研究則透過當中數據檢視 PTSD症狀潛在結構的異質性。我們對༈一༉PTSD症狀、༈二༉與功能損傷指標一同出現的症狀、和༈三༉以年齡和性別分層、及以實證經歷類別分層的PTSD症狀༌共三組進行潛在類別分析༌並找出四個症狀類別༚無干擾(49.4%)、中度干擾(兩組༌分別為 21.5% 和18.6%)、和嚴重干擾(10.5%)。類別之間不但有不同症狀嚴重度༌症狀結構亦不同。我們只在嚴重干擾類別裡發現༌患者既有PTSD症狀及功能損傷指標的概率為高。我們把數據以年齡、性別及經歷水平分層༌得出相似的四個類別結構。有嚴重PTSD的患者中༌年齡、性別及經歷因素並無構成顯著差異。我們在中水平PTSD症狀嚴重度的患者中發現異質性。能用以定義嚴重PTSD剖象的特殊PTSD症狀༌有可能被視為大致固定、臨床顯著的PTSD的致病原因。 标题: 不同性别、年龄及有不同九一一相关创伤经历的儿童和青少年༌其严重创伤后压力症状特征剖象的同构型 撮要: 基于DSM‐IV而被诊断为有创伤后压力症(PTSD)的患者༌全部都有相同症状的机会不大༌因为DSM采用多生分类法。有一项已发表、有关8,236名青年的研究数据༌当中部分人曾经历九一一袭击(N = 6,670)༈Hoven et al (2005)༉༌本研究则透过当中数据检视 PTSD症状潜在结构的异质性。我们对༈一༉PTSD症状、༈二༉与功能损伤指针一同出现的症状、和༈三༉以年龄和性别分层、及以实证经历类别分层的PTSD症状༌共三组进行潜在类别分析༌并找出四个症状类别༚无干扰(49.4%)、中度干扰(两组༌分别为 21.5% 和18.6%)、和严重干扰(10.5%)。类别之间不但有不同症状严重度༌症状结构亦不同。我们只在严重干扰类别里发现༌患者既有PTSD症状及功能损伤指针的概率为高。我们把数据以年龄、性别及经历水平分层༌得出相似的四个类别结构。有严重PTSD的患者中༌年龄、性别及经历因素并无构成显著差异。我们在中水平PTSD症状严重度的患者中发现异质性。能用以定义严重PTSD剖象的特殊PTSD症状༌有可能被视为大致固定、临床显著的PTSD的致病原因。

  October 11, 2016   doi: 10.1002/jts.22134   open full text
• Community Unemployment and Disaster‐Related Stressors Shape Risk for Posttraumatic Stress in the Longer‐Term Aftermath of Hurricane Sandy*.
  Sarah R. Lowe, Laura Sampson, Oliver Gruebner, Sandro Galea.
  Journal of Traumatic Stress. October 03, 2016
  Persons living in communities with limited resources are at heightened risk of posttraumatic stress (PTS) after disasters, especially if they were highly exposed. The support deterrence desistence model and the conservation of resources theory suggest that this risk might increase in the longer‐term aftermath of disasters. In the present study, we aimed to test this hypothesis. Two population‐based samples of New York City residents in communities affected by Hurricane Sandy were surveyed at either 13–16 months (Time 1; n = 421) or 25–28 months (Time 2; n = 420) postdisaster. Participants reported on their exposure to disaster‐related stressors and PTS. The percentage of residents who were unemployed in participants’ census tracts was collected from the 2008–2012 American Community Survey. Multilevel models found that disaster‐related stressors were more strongly associated with PTS for participants living in communities with high unemployment, but only at Time 2 (Est. = .58, SE = .21, p = .006). Mapping of community unemployment and disaster‐related stressors suggested that communities in southern Brooklyn and Queens, and northeastern Staten Island were at particularly high risk for PTS at Time 2. The results suggest the need for ongoing support to economically disadvantaged communities in which residents have endured disaster‐related stressors.

  October 03, 2016   doi: 10.1002/jts.22126   open full text
• Posttraumatic Stress Disorder Symptoms, Intimate Partner Violence, and Relationship Functioning: A Meta‐Analytic Review.
  Erica L. Birkley, Christopher I. Eckhardt, Rita E. Dykstra.
  Journal of Traumatic Stress. September 19, 2016
  This meta‐analysis was the first study of which we are aware to investigate the association between Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000) PTSD symptom clusters and parent, child, family, and marital/partner functioning problems (e.g., intimate partner violence [IPV] and intimacy). Of the 23 studies that met inclusion criteria, the sample was predominantly male (83.8%), Caucasian (65.0%), and from the military (98.9%). The average age was 43.65 years old (SD = 6.27); the average sample size was 397.4 (SD = 416.9; total N = 9,935). PTSD symptom clusters were assessed primarily by self‐report (87.0%), with 8.7% using a rating by a clinician. We used fixed analysis following Fisher's r to z transformation and an unbiased weighing and summing of effect sizes within samples and across studies. We found a small association between hyperarousal and IPV (z = .20). We also found two moderate associations for the emotional numbing and avoidance symptom clusters: (a) with parent, child, and family functioning (z = .32, z = .28, respectively); and (b) with intimacy problems (z = .35, z = .42, respectively). We found two large associations for emotional numbing: marital and parent problems (z = .47) and parent, child, and family functioning problems (z = .32, respectively). Our findings suggested that treatments aim to lessen the effect on those who have close relationships with the individual with PTSD. TEPT, VIF y Funcionamiento Relacional Este metaanálisis fue el primer estudio de la que somos conscientes de investigar la asociación entre los clusters DSM‐IV para síntomas de TEPT y problemas en el padre, niño, familia y funcionamiento conyugal/de pareja (por ejemplo, la violencia en la pareja [IPV] e intimidad). De los 23 estudios que cumplieron los criterios de inclusión, la muestra fue de sexo masculino en un 83,8%, era de raza blanca en un 65% y era militar en el 98,9%. La edad promedio fue de 43.65 (DE = 6,27) años y el tamaño promedio de la muestra fue de 397,4 (SD = 416,9; N total = 9.935). Los clusters de síntomas de TEPT fueron evaluados principalmente con autorreporte (87%) con 8,7% utilizando la calificación de un clínico. Se utilizó el análisis ajustado siguiendo la transformación de Fisher de r a z, ponderación imparcial y suma de los tamaños del efecto dentro de las muestras y entre todos los estudios. Encontramos una pequeña asociación entre la hiperactivación y la IPV (z = .20). Encontramos dos asociaciones moderadas para los clusters de entumecimiento emocional y evitación: (a) con los padres, el niño y el funcionamiento familiar (z = 0.32; z = 0,28, respectivamente) y (b) con problemas de intimidad (z = 0.35; z = 0.42, respectivamente). Encontramos dos grandes asociaciones para el embotamiento emocional: problemas conyugales y parentales (z = 0.47) y los problemas en padre, niño y funcionamiento familiar (z = 0.32, respectivamente). Nuestros hallazgos sugieren que los tratamientos deben ser diseñados para disminuir el efecto sobre aquellos que tienen una estrecha relación con la persona con el trastorno por estrés postraumático. 標題: 對創傷後壓力症狀、親密伴侶暴力及關係運作的元分析 撮要: 本元分析是我們所知首個研究༌探查基於DSM‐IV界定的PTSD症狀聚類༌與家長、孩子、家庭和夫妻或伴侶間關係的運作問題༈如親密伴侶暴力[IPV]和親密程度༉的關連。共有23項符合分析範圍的研究༌整體樣本中83.8%為男性༌65.0%為白人༌98.9%為軍人༌平均年齡為43.65歲 (SD = 6.27)༌平均樣本人數為397.4人 (SD = 416.9; 總數 N = 9,935)。我們主要以自評測量(87.0%)評估PTSD症狀聚類༌有8.7%透過臨床治療師評分進行評估。我們檢視個別樣本及比較各個研究樣本時༌採用費希爾R至Z轉換法༌進行固定因素分析༌無偏地測量和計算效應量。我們發現過激分應和IPV間有輕微關連(z = .20)༛而情感麻木和迴避症狀聚類跟以下兩個因素有中等關連༚༈一༉家長、孩子、家庭關係運作(分別為 z = .32; z = .28)、༈二༉親密障礙(分別為 z = .35; z = .42)。我們亦發現情感麻木跟以下兩個因素有強烈關連༚夫妻和家長關係問題(z = .47)和家長、孩子、家庭關係運作問題(分別為 z = .32)。研究數據反映༌設計PTSD治療時應注意避免令跟患者有親密關係的人受影響。 标题: 对创伤后压力症状、亲密伴侣暴力及关系运作的元分析 撮要: 本元分析是我们所知首个研究༌探查基于DSM‐IV界定的PTSD症状聚类༌与家长、孩子、家庭和夫妻或伴侣间关系的运作问题༈如亲密伴侣暴力[IPV]和亲密程度༉的关连。共有23项符合分析范围的研究༌整体样本中83.8%为男性༌65.0%为白人༌98.9%为军人༌平均年龄为43.65岁 (SD = 6.27)༌平均样本人数为397.4人 (SD = 416.9; 总数 N = 9,935)。我们主要以自评测量(87.0%)评估PTSD症状聚类༌有8.7%透过临床治疗师评分进行评估。我们检视个别样本及比较各个研究样本时༌采用费希尔R至Z转换法༌进行固定因素分析༌无偏地测量和计算效应量。我们发现过激分应和IPV间有轻微关连(z = .20)༛而情感麻木和回避症状聚类跟以下两个因素有中等关连༚༈一༉家长、孩子、家庭关系运作(分别为 z = .32; z = .28)、༈二༉亲密障碍(分别为 z = .35; z = .42)。我们亦发现情感麻木跟以下两个因素有强烈关连༚夫妻和家长关系问题(z = .47)和家长、孩子、家庭关系运作问题(分别为 z = .32)。研究数据反映༌设计PTSD治疗时应注意避免令跟患者有亲密关系的人受影响。

  September 19, 2016   doi: 10.1002/jts.22129   open full text
• Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma.
  Amar Mandavia, Gabriella G. N. Robinson, Bekh Bradley, Kerry J. Ressler, Abigail Powers.
  Journal of Traumatic Stress. September 13, 2016
  Little is known about how emotion dysregulation (ED) and trauma exposure differentially affect the relationship between abuse in childhood and adult substance use. We examined associations between child abuse, trauma exposure, ED, and current substance use in an already existing dataset. Participants (N = 2,014 adults, 90% African American) had been recruited from an urban hospital for a parent study. Analyses showed that drug and alcohol use was significantly positively correlated with child abuse (emotional, physical, and sexual), later trauma exposure, and ED (all ps < .001). Linear regression showed that exposure to abuse when older than a child was significantly associated with drug and alcohol use independent of child abuse and demographic variables (R2Δ = .08, p < .001; R2Δ = .04, p < .001). ED was significantly associated with drug and alcohol use independently of child abuse, nonabuse trauma, and demographic variables (R2Δ = .02, p < .001; R2Δ = .04, p < .001). Multiple mediation analyses showed that ED and later trauma exposure accounted for variance in the association between emotional abuse and substance use (p < .001). A better understanding of vulnerabilities to additional traumatization and emotion‐regulation deficits in individuals who have been exposed to child abuse and in addition have comorbid substance use problems may inform treatments that lead to improved outcomes. Regulación Emocional como mediador de la niñez Poco se sabe acerca de cómo la disregulación emocional (DE) y el trauma afectan diferencialmente la relación entre el maltrato en la infancia y el consumo de sustancias en la adultez. Se examinaron las asociaciones entre el maltrato infantil, la exposición al trauma, la disregulación emocional y el uso de sustancias actual en un conjunto de datos ya existente. Los participantes (N = 2.014 adultos, 90% afroamericanos) habían sido reclutados en un hospital urbano para un estudio parental. Los resultados fueron que las drogas y el alcohol se correlacionaron significativamente con el maltrato infantil (emocional, físico y sexual), exposición a trauma posterior y disregulación emocional (todos los p < .001). La regresión lineal mostró que la exposición al maltrato cuando se es mayor, más que cuando se es niño, se asoció significativamente con uso de drogas y alcohol independiente del maltrato infantil y de las variables demográficas (R2Δ = .08, p < .001; R2Δ = .04, p < .001). La disregulación emocional se asoció significativamente con el consumo de drogas y alcohol, independientemente del maltrato infantil, el trauma no causado por maltrato y las variables demográficas (R2Δ = .02, p < .001; R2Δ = .04, p < .001). Los análisis de mediación múltiples mostraron que la disregulación emocional y la exposición a trauma posterior contribuyeron a la varianza en la relación entre el maltrato emocional y el consumo de sustancias (p < .001). Una mejor comprensión de ambas vulnerabilidades, a la traumatización adicional y al déficit de regulación emocional, pueden dar mejor información a los tratamientos que tienen mejores resultados en los individuos que han estado expuestos a maltrato infantil y, que además, tienen problemas de consumo de sustancias comórbidos. 標題: 兒時受虐和後期濫用藥物༚情緒失調和創傷經歷的間接影響 撮要: 對於情緒失調(ED)和創傷經歷如何有差別地影響兒時受虐和成年時濫藥之間的關係༌我們仍缺乏了解。本研究透過現有的數據樣本༌檢視兒時受虐、創傷經歷、ED和當前濫用藥物狀況之間的關連。本研究樣本取自一家都市醫院的家長研究(N = 2,014 名成人, 90.0% 為非裔美國人)。研究發現༌濫用藥物和酒精跟兒時受虐༈情緒、身體及性虐待༉、後來的創傷經歷、和ED有顯著關連(全部 ps < .001)。線性迴歸法反映༌在童年過後受虐跟濫用藥物和酒精有顯著關連༌並不受兒時受虐情況和人口變量影響(R2Δ = .08, p < .001; R2Δ = .04, p < .001)༛ED跟濫用藥物和酒精有顯著關連༌並不受兒時受虐情況、非受虐創傷和人口變量影響(R2Δ = .02, p < .001; R2Δ = .04, p < .001)。多重中介分析顯示༌ED和後來創傷經歷能解釋情緒虐待和濫藥之間關連的方差(p < .001)。若我們能多加了解兒時受虐及有共病濫藥問題的人士༌其對額外創傷及情緒調節障礙的脆弱度༌可能有助提升治療效果。 标题: 儿时受虐和后期滥用药物༚情绪失调和创伤经历的间接影响 撮要: 对于情绪失调(ED)和创伤经历如何有差别地影响儿时受虐和成年时滥药之间的关系༌我们仍缺乏了解。本研究透过现有的数据样本༌检视儿时受虐、创伤经历、ED和当前滥用药物状况之间的关连。本研究样本取自一家都市医院的家长研究(N = 2,014 名成人, 90.0% 为非裔美国人)。研究发现༌滥用药物和酒精跟儿时受虐༈情绪、身体及性虐待༉、后来的创伤经历、和ED有显著关连(全部 ps < .001)。线性回归法反映༌在童年过后受虐跟滥用药物和酒精有显著关连༌并不受儿时受虐情况和人口变量影响(R2Δ = .08, p < .001; R2Δ = .04, p < .001)༛ED跟滥用药物和酒精有显著关连༌并不受儿时受虐情况、非受虐创伤和人口变量影响(R2Δ = .02, p < .001; R2Δ = .04, p < .001)。多重中介分析显示༌ED和后来创伤经历能解释情绪虐待和滥药之间关连的方差(p < .001)。若我们能多加了解儿时受虐及有共病滥药问题的人士༌其对额外创伤及情绪调节障碍的脆弱度༌可能有助提升治疗效果。

  September 13, 2016   doi: 10.1002/jts.22131   open full text
• The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type.
  Joanne Haldane, Angela Nickerson.
  Journal of Traumatic Stress. September 07, 2016
  Research findings have documented a relationship between the number of types of traumatic events to which refugees were exposed and psychological disorders. It is unclear, however, if gender moderates the impact of trauma on refugee mental health. The participants in this study were 60 male and 31 female refugees and asylum‐seekers resettled in Australia. Participants had a mean age of 34.54 years (SD = 9.70), and were from a variety of countries including Iraq, Iran, and Sri Lanka. We conducted a multigroup path analysis to test if the relationship between psychological outcomes of exposure to trauma (posttraumatic stress disorder [PTSD] symptoms, symptoms of anxiety, and symptoms of depression) was different as a function of the type of traumatic exposure (interpersonal vs. noninterpersonal) or as a function of gender. We found a significant relationship between interpersonal trauma exposure and PTSD symptoms (β = .77) and anxiety symptoms (β = .32) in women, and a significant association between noninterpersonal trauma exposure and PTSD symptoms (β = .59), anxiety (β =.49), and depression symptoms (β = .32) in men. For men, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = 0.14 to 1.01; for exposure to interpersonal trauma, they ranged from d = −0.53 to 0.43. For women, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = −0.79 to 0.67; for exposure to interpersonal trauma, they ranged from d = −0.09 to 1.46. These results suggested supporting refugees in their efforts to overcome the psychological impact of trauma, including the allocation of resources in clinical services to support the psychological recovery of refugees. Género e impacto del trauma en la salud mental de refugiados La investigación ha documentado una relación entre el número de tipos de eventos traumáticos a los que están expuestos los refugiados y los trastornos psicológicos. Sin embargo, no está claro si el género modera el impacto del trauma en la salud mental del refugiado. Los participantes de este estudio fueron 91 refugiados y buscadores de asilo reinstalados en Australia (60 hombres y 31 mujeres). Los participantes tenían una Edad Media de34,54 años (DE = 9.7), de distintos lugares, incluyendo Iraq, Irán, y Sri Lanka. Realizamos un análisis de via multigrupo para probar si la relación entre los resultados psicológicos de la exposición a trauma (síntomas de trastorno por estrés postraumático [TEPT], síntomas de ansiedad y síntomas de depresión) eran diferentes en función de: (a) el tipo de exposición traumática (interpersonal vs. No‐interpersonal) o (b) género. Los hallazgos en mujeres fueron significativos entre exposición a trauma interpersonal y síntomas de TEPT (B = .77) y síntomas de ansiedad (B = .32) para mujeres, y en hombres una asociación significativa entre exposición a trauma no‐ interpersonal y síntomas de TEPT (B = .59), síntomas de ansiedad (B = .49) y depresión (B = .32). El tamaño del efecto de la relación entre la exposición a tipos de traumas no‐ interpersonales específicos y síntomas psicológicos tuvo un rango de d = 0.14 a 1.01 para los hombres; para exposición a trauma interpersonal, el rango fue de d = 0.53 a 0.43. Para las mujeres, los tamaños del efecto de la relación entre exposición a tipos específicos de trauma no interpersonal y síntomas psicológicos varió de d = ‐0.79 a 0.67; para exposición a trauma interpersonal varió de d = ‐0.09 a 1.46. Estos resultados sugieren apoyar a los refugiados para superar el impacto psicológico del trauma, así como indicar la asignación de recursos en los servicios clínicos para apoyar la recuperación psicológica de los refugiados. 標題: 人際與非人際創傷對難民心理症狀的影響༚性別與創傷類別的調節效應 撮要: 過往研究已發現難民經歷創傷事件的種類數目跟其心理失常有關。然而༌我們仍不清楚性別會否在創傷對難民造成的心理影響帶來調節效應。本研究樣本為獲安置於澳洲的91名難民和尋求庇護人士(60名男士和31名女士)。參與者的平均年齡為34.54歲 (SD = 9.70)༌來自不同地方背景༌包括伊拉克、伊朗和斯里蘭卡。我們採用多群組路徑分析༌測試創傷經歷帶來的各種心理失常之間的關係༈創傷後壓力症[PTSD]症狀、焦慮和抑鬱症狀༉是否因༈一༉創傷經歷類別༈人際或非人際༉或༈二༉性別而生異。我們發現女性當中༌人際創傷經歷跟PTSD症狀(β = .77)及焦慮症狀(β = .32)有顯著關連༛男士當中༌非人際創傷經歷跟PTSD症狀(β = .59)、焦慮症狀(β = .49)及抑鬱症狀(β = .32) 有顯著關連。男士當中༌特殊類別的非人際創傷經歷跟心理症狀關係的效應量為d = 0.14 至 1.01༌而人際創傷經歷跟心理症狀關係的效應量為d = ‐ 0.53 至 0.43༛ 女士當中༌特殊類別的非人際創傷經歷跟心理症狀關係的效應量為d = ‐0.79至 0.67༌而人際創傷經歷跟心理症狀關係的效應量為d = ‐0.09 至1.46。本研究建議支持難民克服創傷帶來的心理影響༌並提出臨床治療服務應如何分配資源以助難民的心理康復過程。 标题: 人际与非人际创伤对难民心理症状的影响༚性别与创伤类别的调节效应 撮要: 过往研究已发现难民经历创伤事件的种类数目跟其心理失常有关。然而༌我们仍不清楚性别会否在创伤对难民造成的心理影响带来调节效应。本研究样本为获安置于澳洲的91名难民和寻求庇护人士(60名男士和31名女士)。参与者的平均年龄为34.54岁 (SD = 9.70)༌来自不同地方背景༌包括伊拉克、伊朗和斯里兰卡。我们采用多群组路径分析༌测试创伤经历带来的各种心理失常之间的关系༈创伤后压力症[PTSD]症状、焦虑和抑郁症状༉是否因༈一༉创伤经历类别༈人际或非人际༉或༈二༉性别而生异。我们发现女性当中༌人际创伤经历跟PTSD症状(β = .77)及焦虑症状(β = .32)有显著关连༛男士当中༌非人际创伤经历跟PTSD症状(β = .59)、焦虑症状(β = .49)及抑郁症状(β = .32) 有显著关连。男士当中༌特殊类别的非人际创伤经历跟心理症状关系的效应量为d = 0.14 至 1.01༌而人际创伤经历跟心理症状关系的效应量为d = ‐ 0.53 至 0.43༛ 女士当中༌特殊类别的非人际创伤经历跟心理症状关系的效应量为d = ‐0.79至 0.67༌而人际创伤经历跟心理症状关系的效应量为d = ‐0.09 至1.46。本研究建议支持难民克服创伤带来的心理影响༌并提出临床治疗服务应如何分配资源以助难民的心理康复过程。

  September 07, 2016   doi: 10.1002/jts.22132   open full text
• A Randomized Controlled Study of Cognitive–Behavioral Therapy for Posttraumatic Stress in Street Children in Mexico City.
  Janet Shein‐Szydlo, Denis G. Sukhodolsky, David Szydlo Kon, Miguel Marin Tejeda, Esteli Ramirez, Vladislav Ruchkin.
  Journal of Traumatic Stress. September 07, 2016
  The study aimed to evaluate cognitive–behavioral therapy (CBT) for posttraumatic stress (PTS), depression, anxiety, and anger in street children by a randomized controlled trial of CBT versus a waitlist control. It was conducted in 8 residential facilities for street children in Mexico City, with assessments at baseline, posttreatment, and 3 months later. Children who reported at least moderate posttraumatic stress, and fulfilled the study requirement were enrolled in the study (N = 100, 12–18 years old, 36 boys). There were 51 children randomized to CBT and 49 to the waitlist condition. Randomization was stratified by gender. CBT consisted of 12 individual 1‐hour sessions administered weekly by 2 trained, master's‐level clinicians. Outcome measures included self‐reports of PTS, depression, anxiety, and anger; global improvement was assessed by the independent evaluator. Compared to participants in the waitlist condition participants in CBT showed a significant reduction in all symptoms, with effects sizes of 1.73 to 1.75. At follow up there was attrition (n = 36), and no change from posttreatment scores. The study did find statistically significant improvement in symptoms in the CBT group compared to the waitlist condition; symptoms remained stable at 3 months. The study found that CBT for trauma in a sample of street children provided a reduction of a broad range of mental health symptoms. TCC PARA TEPT EN CIUDAD DE MEJICO El estudio tuvo como objetivo evaluar la terapia cognitivo‐conductual (TCC) para el estrés postraumático (EPT), depresión, ansiedad y rabia en niños de la calle por un ensayo aleatorizado controlado de TCC versus un control de lista de espera. Fue realizado en 8 establecimientos residenciales para niños de la calle en la ciudad de Méjico con evaluaciones inmediatamente posterior al tratamiento y 3 meses más tarde. Los niños que reportaron al menos estrés postraumático moderado y llenaron los requerimientos del estudio (N = 100, 12–18 años de edad, 36 del sexo masculino) fueron incluidos en el estudio. Hubo 51 niños asignados al azar a TCC y 49 a la condición de lista de espera. La aleatorización fue estratificada por género. La TCC consistió en 12 sesiones individuales de 1 hora administradas semanalmente por 2 clínicos entrenados con nivel de master. Las medidas de resultados incluyeron auto‐reportes de EPT, depresión, ansiedad y rabia, mejoría global estimada por un evaluador independiente. Comparado con los participantes en lista de espera, los participantes de la TCC mostraron una reducción significativa en todos los síntomas, con tamaño de efecto de 1.73 a 1.75. Hubo desgaste en el seguimiento (n = 36), y no hubo diferencias significativas de la puntuación postratamiento. El estudio encontró diferencias estadísticamente significativas en la mejoría en los síntomas en el grupo TCC comparado con la condición de lista de espera; los síntomas permanecieron estables a los 3 meses. El estudio mostró que la TCC para trauma en una muestra de niños de la calle proporcionó una reducción de un rango amplio de síntomas de salud mental. 標題: 治療墨西哥城流浪兒童的創傷後壓力的認知行為療法隨機對照試驗 撮要: 本研究透過一項認知行為療法(CBT)的隨機對照試驗༌並以等候名單作對照༌評估CBT用以治療流浪兒童的創傷後壓力(PTS)、抑鬱症、焦慮症和憤怒的療效。這項隨機對照試驗在墨西哥城的8個流浪兒童收容所進行༌並在完成療程及療程後3個月再作跟進評估。我們選出有中水平或以上創傷後壓力、符合本研究要求的兒童(N = 100, 12–18歲, 36名男生)參與研究。共有51名兒童獲隨機分派接受CBT༌49名兒童獲派到等候名單組別。隨機分派以性別分層進行。CBT為12次1小時個人節段༌每星期一次༌由2名完成受訓、達碩士水平的臨床治療師進行。研究以PTS 、抑鬱症、焦慮症和憤怒的自評測量評估療效༌以獨立評鑑者評估整體改善。與等候名單組別的樣本相比༌CBT組別的樣本所有症狀都顯著減少༌效應量為1.73 至 1.75。研究在跟進期發現有療效減弱的情況(n = 36)༌療程後的分數則無顯著差異。研究發現༌CBT組別與等候名單組別相比༌CBT組別的症狀改善具統計顯著性。症狀水平在療程後3個月維持穩定。本研究反映༌用以治療創傷的CBT在流浪兒童樣本裡༌使其廣泛的心理症狀得以改善。 标题: 治疗墨西哥城流浪儿童的创伤后压力的认知行为疗法随机对照试验 撮要: 本研究透过一项认知行为疗法(CBT)的随机对照试验༌并以等候名单作对照༌评估CBT用以治疗流浪儿童的创伤后压力(PTS)、抑郁症、焦虑症和愤怒的疗效。这项随机对照试验在墨西哥城的8个流浪儿童收容所进行༌并在完成疗程及疗程后3个月再作跟进评估。我们选出有中水平或以上创伤后压力、符合本研究要求的儿童(N = 100, 12–18岁, 36名男生)参与研究。共有51名儿童获随机分派接受CBT༌49名儿童获派到等候名单组别。随机分派以性别分层进行。CBT为12次1小时个人节段༌每星期一次༌由2名完成受训、达硕士水平的临床治疗师进行。研究以PTS 、抑郁症、焦虑症和愤怒的自评测量评估疗效༌以独立评鉴者评估整体改善。与等候名单组别的样本相比༌CBT组别的样本所有症状都显著减少༌效应量为1.73 至 1.75。研究在跟进期发现有疗效减弱的情况(n = 36)༌疗程后的分数则无显著差异。研究发现༌CBT组别与等候名单组别相比༌CBT组别的症状改善具统计显著性。症状水平在疗程后3个月维持稳定。本研究反映༌用以治疗创伤的CBT在流浪儿童样本里༌使其广泛的心理症状得以改善。

  September 07, 2016   doi: 10.1002/jts.22124   open full text
• Circadian Contrasts in Heart Rate Variability Associated With Posttraumatic Stress Disorder Symptoms in a Young Adult Cohort.
  Michelle B. Rissling, Paul A. Dennis, Lana L. Watkins, Patrick S. Calhoun, Michelle F. Dennis, Jean C. Beckham, Junichiro Hayano, Christi S. Ulmer.
  Journal of Traumatic Stress. September 07, 2016
  Prior research has demonstrated that individuals exposed to trauma have shown impaired autonomic function. We sought to determine if heart rate variability (HRV), a marker of impaired autonomic function, differed across periods of wake, rest, and sleep as a function of the level of symptoms of posttraumatic stress disorder (PTSD). A sample of young adults (N = 209), 95 of whom met full criteria for current PTSD based on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1995), were evaluated for ≈ 24 hr using actigraphy and electrocardiogram. Actigraphy data were categorized as active, rest, or sleep. Multilevel modeling analyses showed that individuals with high PTSD symptom severity had lower high‐frequency HRV than individuals with low PTSD symptom severity during periods of sleep, t(1083) = 2.20, p = .028, Cohen's d = 0.12. No differences were found during periods of activity, t(1083) = 1.34, p = .499, d = 0.05, or rest, t(1083) = 1.34, p = .180, d = 0.09. Our findings extended the import of prior studies to suggest that those with elevated PTSD symptoms may have decreased parasympathetic control during sleep. Moreover, relative to periods of wake and rest, sleep may represent a state of increased vulnerability for decreased parasympathetic cardiac control. Individuals with elevated PTSD symptoms may benefit from early screening for detection of cardiovascular disease. VARIABILIDAD DEL PULSO CARDÍACO, SUEÑO Y SÍNTOMAS DE ESTRÉS POSTRAUMÁTICO Investigaciones previas han demostrado que individuos expuestos a traumas pueden presentar deterioro en el funcionamiento autonómico. Buscamos determinar si la variabilidad del pulso cardíaco (HRV, heart rate variability), un marcador de función autonómica, difiere a través de la vigilia, descanso y períodos de sueño en función de presencia de síntomas severos en Trastorno por Estrés Postraumático (TEPT). Una muestra de 209 adultos jóvenes en que 95 de ellos cumplieron criterios para TEPT actual de acuerdo a la Escala Clínica Administrada de TEPT (CAPS), fueron evaluados por 24 horas con actigrafía y electrocardiograma. La información de la actigrafía fue categorizada como activa, descanso y sueño. En un modelado de múltiples niveles, individuos con TEPT de gran severidad sintomática, presentaron menores niveles de alta‐frecuencia cardíaca (HRV) que los individuos con TEPT con menor severidad sintomática durante períodos de sueño, t (1083) = 2.20, p = .028, Cohen´s d = 0.18, pero no durante los períodos activos, t (1083) = 1.34, p = .499, d = 0.05, o de descanso t (1083) = 1.34, p = .180, d = 0.09. Nuestros hallazgos fueron coincidentes con estudios anteriores que sugieren que individuos con TEPT con síntomas severos, no sólo pueden tener disminuido el control parasimpático durante períodos de sueño, sino que, en relación a períodos activos, de descanso y sueño, puede representar un estado de vulnerabilidad aumentada de control cardíaco parasimpático disminuido. Individuos con síntomas de TEPT severos se beneficiarían con un screening de detección temprana de enfermedad cardiovascular. 標題: 初成年樣本同代分析中༌與創傷後壓力症症狀相關的心率變異晝夜節律差異 撮要: 過往研究證實༌受創人士的神經自主功能有可能受損。本研究旨在探索 心率變異(HRV)作為自主功能的指標༌在患者清醒、休息和睡覺時會否受創傷後壓力症(PTSD)嚴重度影響而改變。樣本為初成年人士(N = 209)༌95名完全符合臨床專業人員執行的PTSD量表(CAPS)定義༌患當前PTSD。他們受約24小時的腕動計及心電圖評估。腕動計取得的數據被分為活躍、休息和睡眠三個類別。多層次模型顯示༌有高水平PTSD症狀的人比低水平症狀的人༌在睡眠時展現較低水平的高頻HRV (t(1083) = 2.20, p = .028, Cohen's d = 0.12)༌但在活躍 (t(1083) = 1.34, p = .499, d = 0.05) 或休息時 (t(1083) = 1.34, p = .180, d = 0.09)則無此特徵。本研究延伸過往的研究發現༌提出PTSD症狀提升的患者༌其副交感神經控制力不單在睡眠時有可能下降༌在清醒和休息時亦有可能༛而心臟的副交感神經控制力下降可能較易發生於患者睡眠時。在治療早期對心臟血管疾病進行篩查༌可能有助PTSD症狀提升的患者得到更有效的治療。 标题: 初成年样本同代分析中༌与创伤后压力症症状相关的心率变异昼夜节律差异 撮要: 过往研究证实༌受创人士的神经自主功能有可能受损。本研究旨在探索 心率变异(HRV)作为自主功能的指针༌在患者清醒、休息和睡觉时会否受创伤后压力症(PTSD)严重度影响而改变。样本为初成年人士(N = 209)༌95名完全符合临床专业人员执行的PTSD量表(CAPS)定义༌患当前PTSD。他们受约24小时的腕动计及心电图评估。腕动计取得的数据被分为活跃、休息和睡眠三个类别。多层次模型显示༌有高水平PTSD症状的人比低水平症状的人༌在睡眠时展现较低水平的高频HRV (t(1083) = 2.20, p = .028, Cohen's d = 0.12)༌但在活跃 (t(1083) = 1.34, p = .499, d = 0.05) 或休息时 (t(1083) = 1.34, p = .180, d = 0.09)则无此特征。本研究延伸过往的研究发现༌提出PTSD症状提升的患者༌其副交感神经控制力不单在睡眠时有可能下降༌在清醒和休息时亦有可能༛而心脏的副交感神经控制力下降可能较易发生于患者睡眠时。在治疗早期对心脏血管疾病进行筛查༌可能有助PTSD症状提升的患者得到更有效的治疗。

  September 07, 2016   doi: 10.1002/jts.22125   open full text
• Association of Posttraumatic Growth and Illness‐Related Burden With Psychosocial Factors of Patient, Family, and Provider in Pediatric Cancer Survivors.
  J. Zachary Wilson, Donna Marin, Katherine Maxwell, Joseph Cumming, Ryan Berger, Shermini Saini, William Ferguson, John T. Chibnall.
  Journal of Traumatic Stress. August 31, 2016
  Research has indicated that childhood cancer may lead to posttraumatic growth (PTG), given cancer's association with posttraumatic stress. PTG may be associated with family/home and health care dynamics, as well as parental resilience, distress, and coping. This cross‐sectional study investigated the associations of psychosocial factors of the patient, family, and health care team with PTG and illness‐related burden (IRB) in childhood cancer survivors. The sample comprised 61 children and adolescents (7–18 years of age), their parents, and their nurses. Respondents completed their assessment an average of 1.73 years after the end of treatment for the child's disease, which was either leukemia, a solid tumor, or lymphoma. Regression analyses showed that PTG was positively associated with the patients’ posttraumatic stress symptoms. It was also positively associated with the parents’ religious coping, and with measures of stronger family and oncologist relationships (R2 = .32). IRB was positively associated with patient‐reported posttraumatic stress symptoms, negatively associated with the nurse's trust in the family, and positively associated with parent‐reported mental distress, lower family socioeconomic status, and female gender (R2 = .53). There was no significant association with parenting style or parent‐reported posttraumatic stress symptoms in the child. The findings suggested that the young cancer patient's psychosocial and resource milieu (e.g., financial) may be instrumental in PTG and IRB. Psychosocial interventions with high‐risk families and their health care teams could increase growth and reduce burden. Crecimiento Postraumático en Cáncer Pediátrico La investigación ha indicado que el cáncer en la niñez puede llevar a crecimiento postraumático (CPT), dadas sus asociaciones con estrés postraumático. El CPT se puede asociar con dinámicas familiares/del hogar y de cuidados de salud, resiliencia parental, sufrimiento y afrontamiento. Este estudio transversal investigó las asociaciones de factores psicosociales en el paciente, familia y equipo de salud con CPT y la carga relacionada a la enfermedad (CRE) en sobrevivientes de cáncer en la niñez. La muestra incluyó 61 niños y adolescentes (7 a 18 años de edad), sus padres y enfermeras. Los participantes completaron su evaluación en promedio 1.73 años después del término del tratamiento por la enfermedad del niño, la cual era leucemia, un tumor sólido o linfoma. Los análisis de regresión mostraron que el CPT se asoció positivamente con el afrontamiento religioso de los padres, y con medidas de relaciones con la familia y el oncólogo más fuertes (R² = .32). La CRE se asoció positivamente a síntomas de estrés postraumático reportados por el paciente, negativamente a la confianza de la enfermera en la familia, y positivamente al sufrimiento mental reportado por los padres, menor estatus socioeconómico de la familia y género femenino (R² = .53). No hubo asociación significativa con el estilo parental o los síntomas de estrés postraumático en el niño reportados por los padres. Los hallazgos sugieren que el entorno psicosocial y de recursos (Ej. financieros) del paciente pediátrico de cáncer puede ser instrumental en el CPT y la CRE. Las intervenciones psicosociales con familias de alto riesgo y sus equipos de salud podría incrementar el crecimiento y disminuir la carga. 標題: 兒童癌症生還者中༌創傷後成長與疾病相關的負擔跟患者、其家人和治療人員的心理社會因素關連 撮要: 過往研究發現༌兒時患癌跟創傷後壓力有關༌並有可能引發創傷後成長(PTG)。PTG有可能跟家庭和治療互動、家長的恢復力、悲痛和適應力相關。本橫斷研究探查患者、其家人和治療人員的心理社會因素༌跟兒時患癌的生還者的PTG及疾病相關的負擔(IRB)的關連。研究樣本為61名兒童及青少年(7‐18歲)、他們的家長及護士。樣本兒時曾患白血病、腫瘤或淋巴癌。他們平均在完成治療後1.73年完成本心理評估。迴歸分析顯示༌PTG跟患者的創傷後壓力症狀有正向關連༛PTG亦跟家長的信仰適應力、及與家庭和腫瘤科醫生的關係較好有正向關連(R2 = .32)。IRB跟患者呈報的創傷後壓力症狀有正向關連༌但跟家庭對護士的信任有負向關連༛IRB亦跟家長的心理悲痛、家庭的社會經濟地位較低及性別為女性有正向關連(R2 = .53)。家長的管教方法或家長的創傷後壓力症狀跟兒童無顯著關連。研究結果反映༌兒童癌症患者的心理社會和資源狀況༈如經濟方面༉可能對PTG 和 IRB有工具性影響。對高風險的家庭及其治療團隊提供心理社會干預༌有可能提升患者的心理成長和減輕他們的心理負擔。 标题: 儿童癌症生还者中༌创伤后成长与疾病相关的负担跟患者、其家人和治疗人员的心理社会因素关连 撮要: 过往研究发现༌儿时患癌跟创伤后压力有关༌并有可能引发创伤后成长(PTG)。PTG有可能跟家庭和治疗互动、家长的恢复力、悲痛和适应力相关。本横断研究探查患者、其家人和治疗人员的心理社会因素༌跟儿时患癌的生还者的PTG及疾病相关的负担(IRB)的关连。研究样本为61名儿童及青少年(7‐18岁)、他们的家长及护士。样本儿时曾患白血病、肿瘤或淋巴癌。他们平均在完成治疗后1.73年完成本心理评估。回归分析显示༌PTG跟患者的创伤后压力症状有正向关连༛PTG亦跟家长的信仰适应力、及与家庭和肿瘤科医生的关系较好有正向关连(R2 = .32)。IRB跟患者呈报的创伤后压力症状有正向关连༌但跟家庭对护士的信任有负向关连༛IRB亦跟家长的心理悲痛、家庭的社会经济地位较低及性别为女性有正向关连(R2 = .53)。家长的管教方法或家长的创伤后压力症状跟儿童无显著关连。研究结果反映༌儿童癌症患者的心理社会和资源状况༈如经济方面༉可能对PTG 和 IRB有工具性影响。对高风险的家庭及其治疗团队提供心理社会干预༌有可能提升患者的心理成长和减轻他们的心理负担。

  August 31, 2016   doi: 10.1002/jts.22123   open full text
• Existential Anxiety Among Adolescents Exposed to Disaster: Linkages Among Level of Exposure, PTSD, and Depression Symptoms*.
  Carl F. Weems, Justin D. Russell, Erin L. Neill, Steven L. Berman, Brandon G. Scott.
  Journal of Traumatic Stress. August 31, 2016
  Exposure to natural disasters can be highly traumatic and have a detrimental effect on youth mental health by threatening the satisfaction of basic human needs and goals. Recent research in adults suggests that exposure to disasters may exacerbate existential anxiety about the meaning of life. The current study expands this investigation to adolescents, who may be particularly vulnerable to the negative effects of disaster. Data came from 325 adolescents (mean age = 15.05 years, SD = 1.05) residing in the Greater New Orleans area who were exposed to Hurricanes Katrina and/or Gustav. Existential anxiety concerns were highly prevalent in the sample and were associated with elevated levels of posttraumatic stress disorder (R2 = .09) and depression symptoms (R2 = .13). Consistent with theoretical predictions, disaster exposure levels moderated the association between facets of existential anxiety and mental health symptoms. Findings highlight the salience of existential concerns in disaster exposed youth, and provide evidence that exposure to traumatic stress may strengthen their association with mental health problems. Angustia existencial en adolescentes post catástrofe. La exposición a desastres naturales puede ser altamente traumática y puede tener un efecto perjudicial en la salud mental de la juventud al poner en riesgo la satisfacción de necesidades humanas básicas y sus metas. La investigación reciente en adultos sugiere que la exposición a desastres puede exacerbar la angustia existencial acerca del sentido de la vida. El presente estudio expande esta investigación en adolescentes, quienes podrían ser particularmente vulnerables a los efectos negativos del desastre. La información se obtuvo de 325 adolescentes (edad promedio: 15.05, SD: 1.05) residentes del área del Gran New Orleans quienes estuvieron expuestos a los huracanes Katrina y/o Gustav. Aspectos relacionados a angustia existencial fueron altamente prevalentes en la muestra y fueron asociados con niveles elevados de TEPT y síntomas de depresión. Consistente con la teoría, los niveles de exposición a desastre mediaron la asociación entre aspectos de angustia existencial y síntomas de salud mental. Los hallazgos resaltan la importancia de aspectos existenciales en la juventud expuesta a desastre, y proveen evidencia que la exposición a estrés traumático podría fortalecer su asociación con problemas de salud mental. 標題: 經歷災難的青少年的存在焦慮༚經歷水平、PTSD和抑鬱症狀的關連 撮要: 自然災害經歷能帶來嚴重創傷༌亦因為威脅到人類的基本需要和目標༌能對青少年的心理健康造成損害。近期研究發現災難經歷能對成人構成存在焦慮。本研究旨在延伸這項調查到青少年。他們在面對災難帶來的負面影響時可能更為脆弱。研究數據來自居於新奧爾良都市、曾經歷颶風卡特里娜和/或颶風古斯塔夫的325名青少年(平均年齡 = 15.05, SD = 1.05)。存在焦慮在樣本中極為普遍༌並跟創傷後壓力症狀提升(PTSD; R2 = .09)及抑鬱症狀提升(R2 = .13)有關。研究的發現符合理論預測༚災難經歷水平對各方面存在焦慮和心理症狀之間的關連產生調節效應。本研究突出了曾經歷災難的青少年當中存在焦慮的特殊性༌並證明經歷創傷後壓力有可能強化存在焦慮跟心理問題的關連。 标题: 经历灾难的青少年的存在焦虑༚经历水平、PTSD和抑郁症状的关连 撮要: 自然灾害经历能带来严重创伤༌亦因为威胁到人类的基本需要和目标༌能对青少年的心理健康造成损害。近期研究发现灾难经历能对成人构成存在焦虑。本研究旨在延伸这项调查到青少年。他们在面对灾难带来的负面影响时可能更为脆弱。研究数据来自居于新奥尔良都市、曾经历飓风卡特里娜和/或飓风古斯塔夫的325名青少年(平均年龄 = 15.05, SD = 1.05)。存在焦虑在样本中极为普遍༌并跟创伤后压力症状提升(PTSD; R2 = .09)及抑郁症状提升(R2 = .13)有关。研究的发现符合理论预测༚灾难经历水平对各方面存在焦虑和心理症状之间的关连产生调节效应。本研究突出了曾经历灾难的青少年当中存在焦虑的特殊性༌并证明经历创伤后压力有可能强化存在焦虑跟心理问题的关连。

  August 31, 2016   doi: 10.1002/jts.22128   open full text
• Secondary Traumatization in Vietnam Veterans’ Families.
  Thomas J. Yager, Nicole Gerszberg, Bruce P. Dohrenwend.
  Journal of Traumatic Stress. August 16, 2016
  This research focused on secondary traumatization of wives and offspring of 115 male Vietnam veterans, a subsample from the National Vietnam Veterans Readjustment Study who had one or more children aged 6 to 16 years and had had a clinical interview. Traumatization was defined as meeting criteria for lifetime war‐related posttraumatic stress disorder (PTSD). Secondary traumatization was operationalized by elevated scores on children's internalizing or externalizing behavior problems and on wives’ demoralization. There was evidence of secondary traumatization in the veterans’ sons (odds ratio [OR] = 20.31 for internalizing behavior problems). Current PTSD in the veterans was associated with demoralization in their wives or partners (β = 0.24), which in turn was associated with behavior problems in their daughters (ORs = 2.67 and 4.61 for internalizing and externalizing behavior problems, respectively; these were adjusted for veteran's PTSD). Demoralization of the wife or partner was also associated with current alcoholism in the veterans (β = 0.30, adjusting for veteran's PTSD). These associations were also adjusted for other veteran risk factors, including severity of combat exposure, involvement in harming civilians or prisoners, and prewar vulnerability. Even with the degree of secondary traumatization present, the veterans’ children appeared at least as healthy as counterparts in the general population. Traumatización Secundaria en Familias de Veteranos de Vietnam Esta investigación se centró en las esposas y descendencia de 115 veteranos de Vietnam entrevistados clínicamente, una sub‐muestra del Estudio Nacional de Reajuste de Veteranos de Vietnam que tenían uno o más hijos entre 6 y 16 años. La traumatización se definió como experimentar durante la vida trastorno por Estrés Postraumático (TEPT) relacionado a la guerra, en especial actualmente, al momento de la encuesta. La traumatización secundaria fue operacionalizada por las puntuaciones elevadas en problemas de comportamiento internalizantes o externalizantes de los hijos y en la desmoralización de las esposas. Hubo evidencia de traumatización secundaria en los hijos de los veteranos (OR = 20,31 para los problemas de comportamiento internalizante). El TEPT actual en los veteranos se asoció con la desmoralización de sus esposas o parejas (β = 0.24), que a su vez se asocia con problemas de comportamiento en sus hijas (OR = 2,67 y 4,61 para los problemas de comportamiento internalizantes y externalizantes, respectivamente, ajustando el TEPT de veteranos). La desmoralización de la esposa o pareja también se asoció con el alcoholismo actual de los veteranos (β = 0,30 ajustado para TEPT de veteranos). Estas asociaciones se ajustaron para otros factores de riesgo de los veteranos, entre ellos la severidad de la exposición al combate, la participación en el daño a civiles o prisioneros, y la vulnerabilidad antes de la guerra. Sin embargo, incluso con esta evidencia de traumatización secundaria, los niños de los veteranos aparecen al menos tan saludables como sus contrapartes en la población general. 標題 : 美國越戰退役軍人家庭成員的次級創傷 撮要: 在「國家越南退伍軍人再調整研究」裡有一名或以上子女༈年齡介乎6至16歲༉的子樣本中༌115名越戰退役男軍人進行了臨床面談༛本研究則重點檢視他們妻兒的狀況。研究中༌受創定義為經歷與戰爭相關的終生創傷後壓力症(PTSD)༌特別是在調查當前有此狀況༛此外༌我們以孩子內化或外化行為問題的分數提升及妻子的失志(demoralization) 分數提升來定義次級創傷。研究找出證據顯示退役軍人的兒子有次級創傷(內化行為問題 OR = 20.31)。退役軍人的當前PTSD跟妻子或伴侶失志有關(β = 0.24)༛而其妻子或伴侶失志跟女兒的行為問題有關(因應退役軍人的PTSD作調節後༌女兒的內化和外化行為問題ORs分別為 2.67 和 4.61)。妻子或伴侶失志亦跟退役軍人當前的酗酒問題有關(因應退役軍人的PTSD作調節後 β = 0.30)。我們評估這些關連時༌已因應退役軍人的其他風險因素作調節༌包括戰爭經歷嚴重度、參與傷害百姓或囚犯的程度和戰前的脆弱程度。雖然有證據顯示退役軍人的孩子有次級創傷༌但這些孩子表現與他們相應的一般人口無異。 标题 : 美国越战退役军人家庭成员的次级创伤 撮要: 在「国家越南退伍军人再调整研究」里有一名或以上子女༈年龄介乎6至16岁༉的子样本中༌115名越战退役男军人进行了临床面谈༛本研究则重点检视他们妻儿的状况。研究中༌受创定义为经历与战争相关的终生创伤后压力症(PTSD)༌特别是在调查当前有此状况༛此外༌我们以孩子内化或外化行为问题的分数提升及妻子的失志(demoralization) 分数提升来定义次级创伤。研究找出证据显示退役军人的儿子有次级创伤(内化行为问题 OR = 20.31)。退役军人的当前PTSD跟妻子或伴侣失志有关(β = 0.24)༛而其妻子或伴侣失志跟女儿的行为问题有关(因应退役军人的PTSD作调节后༌女儿的内化和外化行为问题ORs分别为 2.67 和 4.61)。妻子或伴侣失志亦跟退役军人当前的酗酒问题有关(因应退役军人的PTSD作调节后 β = 0.30)。我们评估这些关连时༌已因应退役军人的其他风险因素作调节༌包括战争经历严重度、参与伤害百姓或囚犯的程度和战前的脆弱程度。虽然有证据显示退役军人的孩子有次级创伤༌但这些孩子表现与他们相应的一般人口无异。

  August 16, 2016   doi: 10.1002/jts.22115   open full text
• The Association of Combat Exposure With Postdeployment Behavioral Health Problems Among U.S. Army Enlisted Women Returning From Afghanistan or Iraq.
  Rachel Sayko Adams, Ruslan V. Nikitin, Nikki R. Wooten, Thomas V. Williams, Mary Jo Larson.
  Journal of Traumatic Stress. August 01, 2016
  An association between combat exposure and postdeployment behavioral health problems has been demonstrated among U.S. military service members returning from Afghanistan or Iraq in predominantly male samples, yet few studies have focused on the experiences of women. Using data from the longitudinal, observational Substance Use and Psychological Injury Combat (SUPIC) Study, we explored the self‐report of 4 combat exposure items and postdeployment behavioral health screening results for 42,397 Army enlisted women who had returned from Afghanistan or Iraq from fiscal years 2008 through 2011. We ran multivariate logistic regression models to examine how a constructed composite combat exposure score (0, 1, 2, 3+) was associated with screening positive postdeployment for posttraumatic stress disorder (PTSD), depression, and at‐risk drinking among active duty (AD) and National Guard/Reserve (NG/R) women. AD and NG/R women commonly reported being wounded, injured, assaulted, or hurt (17.3% and 29.0%, respectively). In all 6 multivariate models, Army women with any report of combat exposure had increased odds of the behavioral health problem (i.e., PTSD, depression, or at‐risk drinking). The magnitude of the association between combat exposure and PTSD was most striking, indicating increased odds of PTSD as combat exposure score increased. AD and NG/R women with a combat exposure score of 3+ had increased odds of PTSD, 20.7, 95% confidence interval (CI) [17.0, 25.1] and 27.8, 95% CI [21.0, 36.9], respectively. Women who report combat exposure may benefit from early prevention and confidential intervention to promote postdeployment health and reduce long‐term behavioral health problems. Exposición a combate entre mujeres del ejército. Una asociación entre exposición a combate con problemas de salud conductuales post despliegue ha sido demostrado en miembros del servicio militar Americano que retornan de Afganistan o Iraq predominantemente en muestras masculinas, sin embargo, pocos estudios se han focalizado en las experiencias de las mujeres. Utilizando información del estudio longitudinal observacional de combate acerca del uso de substancias y heridas psicológicas (SUPIC), este estudio exploró el auto‐reporte de 4 items de exposición a combate y resultados de un screening de conductas de salud post despliegue para 42.397 mujeres enlistadas que retornaron de Afganistan o Iraq de los años fiscales del 2008 al 2011. Se realizaron modelos de regresión logística multivariada para examinar cómo un puntaje compuesto construido de exposición a combate (0, 1, 2, 3+) se asociaba con un screening positivo de post‐despliegue para trastorno por estrés postraumático (TEPT), depresión, o consumo riesgoso de alcohol entre mujeres del servicio activo (AD) y guardia/reserva nacional (NG/R). Las mujeres AD y NG/R comúnmente reportaron ser heridas, lesionadas, atacadas o dañadas (17.4% y 29,1%, respectivamente). En los 6 modelos multivariados, las mujeres del ejercito con algún reporte de exposición a combare tuvieron mayores probabilidades de tener problemas de salud conductuales (ej., TEPT, depresión, o consumo riesgoso de alcohol). La magnitud de la asociación entre exposición a combate y TEPT fue el más sorprendente, indicando mayores probabilidades de TEPT mientras aumenta el puntaje de exposición a combate. Mujeres AD y NG/R con un puntaje de exposición a combate de 3+ tuvieron mayores probabilidades de TEPT, 20.7, 95% CI [17.0, 25.1] y 27.8, 95% CI [21.0, 36,9], respectivamente. Las mujeres que reportaron exposición a combate se pueden beneficiar de prevenciones tempranas e intervenciones confidenciales para promover salud post despliegue y reducir problemas de salud conductuales a largo plazo. 標題 : 從阿富汗或伊拉克服役回來的女軍人其戰鬥經歷和退役後行為健康問題的關連 撮要: 過往已發現從阿富汗或伊拉克服役回來的軍人展現戰鬥經歷和退役後行為健康問題的關連༌但他們大多為男性樣本。少有研究檢視女性的狀況。本研究利用「濫用藥物及心理傷害戰鬥研究」(SUPIC)的縱貫及觀察數據༌檢視在財政年份2008至2011從阿富汗或伊拉克服役回來的42,397名女軍人༌她們自評測量的4個戰鬥經歷項目和退役後行為健康的篩查結果。我們採用多變量邏輯迴歸模型༌檢視現正服役(AD)和美國國民警衛隊༏預備役軍事部隊(NG/R)女軍人當中༌戰鬥經歷合成分數(0, 1, 2, 3+)跟取得創傷後壓力症(PTSD)、抑鬱症或有酗酒風險的正向篩查結果有何關連。AD和NG/R女軍人普遍經歷受傷、受襲༈分別為17.4% 和 29.1%༉。在全6個多變量模型中༌凡有戰鬥經歷的女軍人都有較高機會有行為健康問題(即 PTSD 、抑鬱症或有酗酒風險)。戰鬥經歷跟PTSD有明顯關連༌反映戰鬥經歷分數提升即有較高機會患PTSD。戰鬥經歷分數為3+的AD和NG/R女軍人有較高機會患PTSD༈分別為20.7, 95% CI [17.0, 25.1] 和 27.8, 95% CI [21.0, 36.9]༉。早期防預治療和保密干預治療可能有助有戰鬥經歷的女性༌改善退役後的健康和減輕長期行為健康問題。 标题 : 从阿富汗或伊拉克服役回来的女军人其战斗经历和退役后行为健康问题的关连 撮要: 过往已发现从阿富汗或伊拉克服役回来的军人展现战斗经历和退役后行为健康问题的关连༌但他们大多为男性样本。少有研究检视女性的状况。本研究利用「滥用药物及心理伤害战斗研究」(SUPIC)的纵贯及观察数据༌检视在财政年份2008至2011从阿富汗或伊拉克服役回来的42,397名女军人༌她们自评测量的4个战斗经历项目和退役后行为健康的筛查结果。我们采用多变量逻辑回归模型༌检视现正服役(AD)和美国国民警卫队༏预备役军事部队(NG/R)女军人当中༌战斗经历合成分数(0, 1, 2, 3+)跟取得创伤后压力症(PTSD)、抑郁症或有酗酒风险的正向筛查结果有何关连。AD和NG/R女军人普遍经历受伤、受袭༈分别为17.4% 和 29.1%༉。在全6个多变量模型中༌凡有战斗经历的女军人都有较高机会有行为健康问题(即 PTSD 、抑郁症或有酗酒风险)。战斗经历跟PTSD有明显关连༌反映战斗经历分数提升即有较高机会患PTSD。战斗经历分数为3+的AD和NG/R女军人有较高机会患PTSD༈分别为20.7, 95% CI [17.0, 25.1] 和 27.8, 95% CI [21.0, 36.9]༉。早期防预治疗和保密干预治疗可能有助有战斗经历的女性༌改善退役后的健康和减轻长期行为健康问题。

  August 01, 2016   doi: 10.1002/jts.22121   open full text
• Neural Correlates of Trait Rumination During an Emotion Interference Task in Women With PTSD.
  Katherine R. Buchholz, Steven E. Bruce, Ellen M. Koucky, Tiffany M. Artime, Jessica A. Wojtalik, Wilson J. Brown, Yvette I. Sheline.
  Journal of Traumatic Stress. July 29, 2016
  Rumination, defined as repetitive, negative, self‐focused thinking, is hypothesized to be a transdiagnostic factor that is associated with depression, anxiety, and posttraumatic stress disorder (PTSD). Theory has suggested that in individuals with PTSD, rumination serves as a cognitive avoidance factor that contributes to the maintenance of symptoms by inhibiting the cognitive and emotional processing of the traumatic event, subsequently interfering with treatment engagement and outcome. Little is known about the neural correlates of rumination in women with PTSD. The current study utilized functional magnetic resonance imaging (fMRI) to examine neural correlates during an emotion interference task of self‐reported rumination in women with PTSD. Women with PTSD (39 participants) were recruited at a university‐based trauma clinic and completed a clinical evaluation that included measures of PTSD symptoms, rumination, and depressive symptoms, as well as a neuroimaging session in which the participants were administered an emotion interference task. There was a significant relationship between self‐reported rumination and activity in the right orbital frontal cortex, BA 11; t(37) = 5.62, p = .004, k = 46 during the task. This finding suggested that women with PTSD, who had higher levels of rumination, may experience greater difficulty inhibiting negative emotional stimuli compared to women with lower levels of rumination. Correlatos Neurales de Rumiación en TEPT La rumiación, definida como un pensamiento negativo, repetitivo, auto‐centrado, es hipotetizada como un factor trans‐diagnóstico asociado con depresión, ansiedad y trastorno por estrés postraumático (TEPT). La teoría ha sugerido que en individuos con TEPT, la rumiación sirve como un factor de evitación cognitiva que contribuye al mantenimiento de los síntomas a través de la inhibición del procesamiento cognitivo y emocional del evento traumático, interfiriendo subsecuentemente con la adhesión a tratamiento y los resultados. Poco se conoce acerca de los correlatos neurales de la rumiación en mujeres con TEPT. El presente estudio utilizó imágenes de resonancia magnética funcional (fMRI) para examinar los correlatos neurales, durante una tarea de interferencia emocional, de la rumiación auto‐reportada en mujeres con TEPT. Se reclutó mujeres con TEPT (39) a través de una clínica de trauma universitaria y completaron una evaluación clínica que incluyó mediciones de síntomas de TEPT, rumiación, y síntomas depresivos, así como también una sesión de neuroimágenes en la cual se administró a las participantes una tarea de interferencia emocional. Hubo una relación significativa entre la rumiación auto‐reportada y la actividad de la corteza órbitofrontal derecha durante la tarea, BA 11; t(37) = 5.62, p = .004, k = 46. Este hallazgo sugiere que las mujeres con TEPT que tienen mayores niveles de rumiación, podrían experimentar mayor dificultad en inhibir los estímulos emocionales negativos comparado con las mujeres con menores niveles de rumiación. 標題 : PTSD女患者在情感干擾任務裡特質反芻的神經關連因素 撮要: 反芻──一種重複、負面、專注個人的思考༌一向被假設為跨界診斷因素༌跟抑鬱症、焦慮症和創傷後壓力症(PTSD)有關。學術理論指出༌PTSD患者的反芻是一個認知迴避因素༌抑制患者對創傷事件的認知和情感處理過程༌使症狀延續༌繼而阻礙患者的治療投入度和療效。過往少有對於PTSD女患者反芻的神經關連因素研究。本研究利用功能性磁振造影(fMRI)༌檢視自評有反芻的PTSD女患者在一項情感干擾任務裡的神經關連因素。我們透過一間大學創傷診所取得PTSD女患者樣本(39)༌她們接受臨床評估༌包括對其PTSD症狀、反芻、抑鬱症狀的測量༌並進行了一次神經成像節段༌在其中進行情感干擾任務。情感干擾任務結果反映༌自評有反芻跟右眶額皮質活動有顯著關連༈BA 11; t(37) = 5.62, p = .004, k = 46༉。結果顯示༌有較高水平反芻的PTSD女患者༌相比反芻水平較低的PTSD女患者༌在抑制負面情感刺激方面可能面對較大困難。 标题 : PTSD女患者在情感干扰任务里特质反刍的神经关连因素 撮要: 反刍──一种重复、负面、专注个人的思考༌一向被假设为跨界诊断因素༌跟抑郁症、焦虑症和创伤后压力症(PTSD)有关。学术理论指出༌PTSD患者的反刍是一个认知回避因素༌抑制患者对创伤事件的认知和情感处理过程༌使症状延续༌继而阻碍患者的治疗投入度和疗效。过往少有对于PTSD女患者反刍的神经关连因素研究。本研究利用功能性磁振造影(fMRI)༌检视自评有反刍的PTSD女患者在一项情感干扰任务里的神经关连因素。我们透过一间大学创伤诊所取得PTSD女患者样本(39)༌她们接受临床评估༌包括对其PTSD症状、反刍、抑郁症状的测量༌并进行了一次神经成像节段༌在其中进行情感干扰任务。情感干扰任务结果反映༌自评有反刍跟右眶额皮质活动有显著关连༈BA 11; t(37) = 5.62, p = .004, k = 46༉。结果显示༌有较高水平反刍的PTSD女患者༌相比反刍水平较低的PTSD女患者༌在抑制负面情感刺激方面可能面对较大困难。

  July 29, 2016   doi: 10.1002/jts.22112   open full text
• The Moderating Effect of State Anger on Treatment Outcome in Female Adolescents With PTSD*.
  Antonia N. Kaczkurkin, Anu Asnaani, Jody Zhong, Edna B. Foa.
  Journal of Traumatic Stress. July 26, 2016
  Trauma experienced in childhood and adolescence negatively affects the development of adaptive regulation of emotions and is associated with greater symptoms of anger. Prior research has suggested that high levels of anger may impede the outcome of treatment in adults with posttraumatic stress disorder (PTSD). The current study investigated whether high levels of anger resulted in poorer treatment outcomes in adolescent girls with PTSD. Participants included 61 female adolescent survivors of sexual abuse or assault who were randomized to either prolonged exposure for adolescents (PE‐A) or client‐centered therapy (CCT) for traumatized children for 8–14 weekly sessions. Participants were followed for 12 months posttreatment. High levels of state anger at baseline were associated with less improvement in PTSD symptoms in the CCT group than the PE‐A group (d = 0.62). The moderating effects of state anger on improvement in PTSD symptoms was significant with emotion regulation difficulties, which may underlie anger symptoms (d = 0.58) in the model. The results of this study suggessted that high state anger was less of an impediment to treatment of PTSD for those receiving PE‐A than those receiving less differentiated approaches such as CCT. El efecto moderador del estado de la ira en el resultado del TEPT. El trauma experimentado en la infancia y adolescencia afecta negativamente el desarrollo de la regulación emocional adaptativa y se asocia con más sintomatología de rabia. Las investigaciones previas han sugerido que mayores niveles de rabia pueden impedir los resultados del tratamiento en adultos con trastorno por estrés postraumático (TEPT). El presente estudio investigó si mayores niveles de rabia resultaban en peores resultados del tratamiento en una muestra de niñas adolescentes con TEPT. Los participantes incluyeron 61 adolescentes mujeres sobrevivientes de abuso o ataque sexual que fueron aleatorizadas en exposición prolongada para adolescentes (PE‐A) o terapia centrada en el cliente (CCT) para niños traumatizados por 8 a 14 sesiones semanales. Se siguió a los participantes por 12 meses post tratamiento. Altos niveles del estado de la rabia resultaron en menor mejoría en sintomatología de TEPT en el grupo CCT comparado con el grupo PE‐A (diferencias entre el CCT y PE‐A en el estado de la rabia en el seguimiento a los 12 meses: d = 0.62). Los efectos moderadores del estado de la rabia en la mejoría en síntomas de TEPT continuaron siendo significativos incluso tras ajustar por las dificultades en regulación emocional, que pueden subyacer la sintomatología de rabia (d = 0,58). Los resultados de este estudio sugieren que un alto estado de rabia es un menor impedimento en el resultado del tratamiento para el TEPT para aquellos que reciben PE‐A versus asesoramiento tradicional como CCT. 標題 : PTSD女青少年患者當中情境性憤怒對療效的調節效應 撮要: 童年和青少年時期經歷創傷༌能對情感適應調節的發展造成負面影響༌亦跟有較多憤怒症狀相關。過往研究曾指出高水平的憤怒有可能阻礙創傷後壓力症(PTSD)成人患者接受治療的療效。本研究透過一項PTSD女青少年患者樣本༌探查高水平憤怒是否會導致較差療效。研究參與者為61名曾經歷性侵犯的女青少年༌她們被隨機分派到接受為青少年而設的延長暴露療法(PE‐A)或為受創兒童而設的受輔者中心療法(CCT)༌每星期進行一次治療節段༌為期8至14星期。研究在治療後12個月再跟進參與者狀況。與PE‐A組相比༌在CCT組高水平情境性憤怒導致PTSD症狀改善較少(治療後12個月༌CCT與PE‐A組的情境性憤怒差別: d = 0.62)。情感調節困難能構成憤怒症狀(d = 0.58)༛即使我們因應情感調節困難作數據調節༌情境性憤怒對PTSD症狀改善的調節效應仍為顯著。研究結果反映༌相比起接受傳統輔導如CCT༌高水平情境性憤怒對PTSD治療療效造成的阻礙於接受PE‐A的患者當中相對較少。 标题 : PTSD女青少年患者当中情境性愤怒对疗效的调节效应 撮要: 童年和青少年时期经历创伤༌能对情感适应调节的发展造成负面影响༌亦跟有较多愤怒症状相关。过往研究曾指出高水平的愤怒有可能阻碍创伤后压力症(PTSD)成人患者接受治疗的疗效。本研究透过一项PTSD女青少年患者样本༌探查高水平愤怒是否会导致较差疗效。研究参与者为61名曾经历性侵犯的女青少年༌她们被随机分派到接受为青少年而设的延长暴露疗法(PE‐A)或为受创儿童而设的受辅者中心疗法(CCT)༌每星期进行一次治疗节段༌为期8至14星期。研究在治疗后12个月再跟进参与者状况。与PE‐A组相比༌在CCT组高水平情境性愤怒导致PTSD症状改善较少(治疗后12个月༌CCT与PE‐A组的情境性愤怒差别: d = 0.62)。情感调节困难能构成愤怒症状(d = 0.58)༛即使我们因应情感调节困难作数据调节༌情境性愤怒对PTSD症状改善的调节效应仍为显著。研究结果反映༌相比起接受传统辅导如CCT༌高水平情境性愤怒对PTSD治疗疗效造成的阻碍于接受PE‐A的患者当中相对较少。

  July 26, 2016   doi: 10.1002/jts.22116   open full text
• Comparison of Adding Treatment of PTSD During and After Shelter Stay to Standard Care in Residents of Battered Women's Shelters: Results of a Randomized Clinical Trial.
  Dawn M. Johnson, Nicole L. Johnson, Sara K. Perez, Patrick A. Palmieri, Caron Zlotnick.
  Journal of Traumatic Stress. July 26, 2016
  This study explored the acceptability, feasibility, and initial efficacy of an expanded version of a PTSD treatment developed for residents of battered women's shelters, Helping to Overcome PTSD through Empowerment (HOPE) in women who received standard shelter services (SSSs). A Phase I randomized clinical trial comparing HOPE + SSSs (n = 30) to SSSs (n = 30) was conducted. Primary outcome measures included the Clinician‐Administered PTSD Scale (Blake et al., 1995) and the Revised Conflict Tactic Scales (Straus, Hamby, Boney‐McCoy, & Sugarman, ). Participants were followed at 1‐week, and 3‐ and 6‐months posttreatment. Only 2 women dropped out of HOPE + SSS treatment. Latent growth curve analyses found significant treatment effects for PTSD from intimate partner violence (IPV) (β = −.007, p = .021), but not for future IPV (β = .002, p = .709) across follow‐up points. Significant effects were also found for secondary outcomes of depression severity (β = −.006, p = .052), empowerment (β = .155, p = .022), and resource gain (β = .158, p = .036). Additionally, more women in HOPE + SSSs were employed at 3‐ and 6‐month follow‐up compared to those in SSSs only. Results showed the acceptability and feasibility of adding IPV‐related treatment to standard services. They also suggested that HOPE may be a promising treatment for residents of battered women's shelters. Further research with a larger sample, utilizing more diverse shelter settings and a more rigorous control condition, is needed to confirm these findings. Tratamiento continuo para el TEPT Este estudio exploró la aceptabilidad, viabilidad y eficacia inicial de una versión ampliada de un tratamiento para el TEPT desarrollado para residentes de casas de acogida para mujeres maltratadas, Ayudando a Superar el TEPT a través del Empoderamiento (HOPE, por sus siglas en inglés) en mujeres que recibieron servicios de acogida estandar (SSS por sus siglas en inglés). Se condujo un estudio clínico aleatorizado Fase l que comparó HOPE+SSS (n = 30) con SSS (n = 30). Los resultados de las mediciones primarias incluyeron la Escala de TEPT Administrada por el Clínico y la Escala Táctica de Conflictos Revisada. Las participantes fueron seguidas a la semana, 3 y 6 meses postratamiento. Solo 2 mujeres abandonaron el tratamiento HOPE+SSS. El análisis de la curva de crecimiento latente encontró  efectos significativos en el tratamiento para TEPT por Violencia de pareja (ß = ‐0.007, p = .021), pero no para Violencia de Pareja futura (ß = 0.002, p = .709) en todos los puntos del seguimiento. Se encontraron también efectos significativos para resultados secundarios de severidad de la depresión (ß = ‐0.006, p = .052), empoderamiento (ß = 0.155, p = .022), y aumento de recursos (ß = 0.158, p = .036). Adicionalmente, más mujeres en el HOPE+SSS estuvieron empleadas, a los 3 y 6 meses del seguimiento en comparación con aquellas en SSS. Los resultados mostraron la aceptabilidad y viabilidad de agregar un tratamiento para la Violencia de Pareja a los servicios estándares. Ellos también sugieren que HOPE puede ser un tratamiento promisorio para residentes de casas de acogida para mujeres maltratadas. Se necesitan estudios con muestras más numerosas, utilizando tipos de casas de acogida más diversos y una condición de control más riguroso para confirmar estos hallazgos. 標題 : 在受虐女性庇護所進行的PTSD治療延伸版༚一項隨機臨床試驗結果 撮要: 本研究透過接受標準庇護服務(SSS)的女性༌探索為住在庇護所的受虐女性而設的PTSD治療延伸版──「透過増強信心以助克服PTSD」(HOPE)的可接受性、可行性和初步功效。第一階段的隨機臨床試驗比較接受HOPE加SSS(n = 30)和只接受SSS(n = 30)的樣本。研究以「৶床專業施ਈ的創傷後壓ঊ症ॾ表」及「衝突策略量表修訂版」等測量初步結果༌並在治療後一星期、三個月和六個月跟進參與者的狀況。只有兩名女士中途退出HOPE加SSS治療。潛在增長曲線分析顯示༌因IPV而有PTSD的參與者得到顯著治療功效(β = ‐0.007, p = .021)༌但在治療後經歷IPV的參與者就無此顯著功效(β = 0.002, p = .709)。抑鬱症嚴重度(β = ‐0.006, p = .052)、増強信心(β = 0.155, p = .022)、和資源收穫(β = 0.158, p = .036)的次級結果亦反映顯著治療功效。另外༌與只接受 SSS的組別相比༌接受HOPE加SSS的組別有較多女士在治療後三和六個月獲聘。研究結果反映了在標準庇護服務中加入IPV相關的治療的可接受性和可行性。結果亦反映༌HOPE可能是對住在庇護所的受虐女性一項有效的治療。未來研究需有較大的樣本、較多元的庇護所設定和更嚴謹的對照狀況༌以確認是次研究發現。 标题 : 在受虐女性庇护所进行的PTSD治疗延伸版༚一项随机临床试验结果 撮要: 本研究透过接受标准庇护服务(SSS)的女性༌探索为住在庇护所的受虐女性而设的PTSD治疗延伸版──「透过増强信心以助克服PTSD」(HOPE)的可接受性、可行性和初步功效。第一阶段的随机临床试验比较接受HOPE加SSS(n = 30)和只接受SSS(n = 30)的样本。研究以「৶床专业施ਈ的创伤后压ঊ症ॾ表」及「冲突策略量表修订版」等测量初步结果༌并在治疗后一星期、三个月和六个月跟进参与者的状况。只有两名女士中途退出HOPE加SSS治疗。潜在增长曲线分析显示༌因IPV而有PTSD的参与者得到显著治疗功效(β = ‐0.007, p = .021)༌但在治疗后经历IPV的参与者就无此显著功效(β = 0.002, p = .709)。抑郁症严重度(β = ‐0.006, p = .052)、増强信心(β = 0.155, p = .022)、和资源收获(β = 0.158, p = .036)的次级结果亦反映显著治疗功效。另外༌与只接受 SSS的组别相比༌接受HOPE加SSS的组别有较多女士在治疗后三和六个月获聘。研究结果反映了在标准庇护服务中加入IPV相关的治疗的可接受性和可行性。结果亦反映༌HOPE可能是对住在庇护所的受虐女性一项有效的治疗。未来研究需有较大的样本、较多元的庇护所设定和更严谨的对照状况༌以确认是次研究发现。

  July 26, 2016   doi: 10.1002/jts.22117   open full text
• Perceived Support From Multiple Sources: Associations With PTSD Symptoms.
  Jennifer DiMauro, Keith D. Renshaw, Brian N. Smith, Dawne Vogt.
  Journal of Traumatic Stress. July 26, 2016
  Perceived social support is negatively associated with severity of posttraumatic stress disorder (PTSD), but the literature lacks data about specific sources of support. Using 2 service member (SM) samples (n = 207 and 465), this study examined perceived support from family/friends and the broader public. SMs perceived high support from both sources. In multivariate regressions, perceived support from the broader public was not significantly associated with severity of PTSD symptoms, but it demonstrated a nearly identical effect size (β = −.21) as support from family/friends (β = −.23) in a sample of active duty and National Guard/Reserve SMs. We found that, SMs perceived high levels of support from the broader public, with modest evidence that such perceptions may relate to severity of PTSD. Apoyo Percibido desde Múltiples Fuentes en TEPT El apoyo social percibido está negativamente asociado con la severidad del trastorno por estrés postraumático (TEPT) pero la literatura carece de datos acerca de las fuentes de apoyo. Utilizando 2 muestras de miembros de servicio (MS) (n = 207; 465), este estudio examinó el apoyo percibido desde la familia/amigos y del público en general. Los MSs percibieron alto apoyo de ambas fuentes. En una regresión multivariada, el apoyo percibido desde el público en general no estuvo significativamente asociado con la severidad de los síntomas de TEPT, pero demostró un casi idéntico tamaño del efecto (β = ‐.21) como el apoyo desde la familia/amigos (β = ‐.23) en una muestra de servicio activo y Guardia Nacional/ Reserva MSs. En conclusión, MSs percibieron altos niveles de apoyo desde el público en general, con una modesta evidencia que tales percepciones pueden estar relacionadas con la severidad de TEPT. 標題 : 來自多種源頭的支持感知跟創傷後壓力症的關連 撮要: 雖然社會支持感知跟創傷後壓力症(PTSD)嚴重度有負向關連༌但過往研究缺乏特定支持源頭的數據。本研究透過兩項軍人(SM)樣本(n = 207; 465)༌檢視來自家人或朋友及廣泛大眾的社會支持感知數據。軍人均從兩種源頭取得高水平的社會支持感知。多變量迴歸分析顯示༌從廣泛大眾所得的社會支持感知跟PTSD症狀嚴重度並無顯著關連༛但在現役軍人和美國國民警衛隊༏預備役軍事部隊的樣本裡༌從廣泛大眾所得的社會支持感知(β = ‐.21)與從家人或朋友所取得的(β = ‐.23)效應量近乎相等。總括而言༌軍人從廣泛大眾取得高水平的社會支持感知༌但這種社會支持感知跟PTSD嚴重度的關連證據輕微。 标题 : 来自多种源头的支持感知跟创伤后压力症的关连 撮要: 虽然社会支持感知跟创伤后压力症(PTSD)严重度有负向关连༌但过往研究缺乏特定支持源头的数据。本研究透过两项军人(SM)样本(n = 207; 465)༌检视来自家人或朋友及广泛大众的社会支持感知数据。军人均从两种源头取得高水平的社会支持感知。多变量回归分析显示༌从广泛大众所得的社会支持感知跟PTSD症状严重度并无显著关连༛但在现役军人和美国国民警卫队༏预备役军事部队的样本里༌从广泛大众所得的社会支持感知(β = ‐.21)与从家人或朋友所取得的(β = ‐.23)效应量近乎相等。总括而言༌军人从广泛大众取得高水平的社会支持感知༌但这种社会支持感知跟PTSD严重度的关连证据轻微。

  July 26, 2016   doi: 10.1002/jts.22114   open full text
• Posttraumatic Stress Disorder in U.S. Military Primary Care: Trajectories and Predictors of One‐Year Prognosis.
  Robert M. Bray, Charles C. Engel, Jason Williams, Lisa H. Jaycox, Marian E. Lane, Jessica K. Morgan, Jürgen Unützer.
  Journal of Traumatic Stress. July 22, 2016
  We examined the longitudinal course of primary care patients in the active duty Army with posttraumatic stress disorder (PTSD) and identified prognostic indicators of PTSD severity. Data were drawn from a 6‐site randomized trial of collaborative primary care for PTSD and dpression in the military. Subjects were 474 soldiers with PTSD (scores ≥ 50 on the PTSD Checklist ‐Civilian Version). Four assessments were completed at U.S. Army installations: baseline, and follow‐ups at 3 months (92.8% response rate [RR]), 6 months (90.1% RR), and 12 months (87.1% RR). Combat exposure and 7 validated indicators of baseline clinical status (alcohol misuse, depression, pain, somatic symptoms, low mental health functioning, low physical health functioning, mild traumatic brain injury) were used to predict PTSD symptom severity on the Posttraumatic Diagnostic Scale (Cronbach's α = .87, .92, .95, .95, at assessments 1–4, respectively). Growth mixture modeling identified 2 PTSD symptom trajectories: subjects reporting persistent symptoms (Persisters, 81.9%, n = 388), and subjects reporting improved symptoms (Improvers 18.1%, n = 86). Logistic regression modeling examined baseline predictors of symptom trajectories, adjusting for demographics, installation, and treatment condition. Subjects who reported moderate combat exposure, adjusted odds ratio (OR) = 0.44, 95% CI [0.20, 0.98], or who reported high exposure, OR = 0.39, 95% CI [0.17, 0.87], were less likely to be Improvers. Other baseline clinical problems were not related to symptom trajectories. Findings suggested that most military primary care patients with PTSD experience persistent symptoms, highlighting the importance of improving the effectiveness of their care. Most indicators of clinical status offered little prognostic information beyond the brief assessment of combat exposure. Trayectorias de TEPT y Predictores Pronósticos Evaluamos el curso longitudinal en la atención primaria de pacientes con Trastorno por Estrés Postraumático (TEPT) activos en el ejército e identificamos indicadores pronósticos de severidad de TEPT. La información se recolectó de un estudio randomizado de 6 lugares de atención primaria para TEPT/Depresión en el Ejército. Los sujetos fueron 474 soldados con TEPT (puntajes ≥ 50 en PTSD Checklist versión civil). Cuatro evaluaciones se realizaron en instalaciones del Ejército de Estados Unidos: en la línea de base, con seguimientos a 3 meses (92.8% tasa de respuesta [RR]), 6 meses (90.1% RR), y 12 meses (87.1% RR). La exposición al combate y 7 indicadores validados del estado clínico en la línea de base (abuso de alcohol, depresión, dolor, síntomas somáticos, funcionamiento de salud mental bajo, funcionamiento de salud física bajo, lesión cerebral traumática leve) se utilizaron para predecir la severidad de síntomas TEPT en la Escala Diagnostica Postraumática (Cronbach's α: .87, .92, .95, .95 en evaluaciones 1–4, respectivamente). El modelo de crecimiento de mezcla identificó dos trayectorias de síntomas de TEPT: sujetos que reportaron síntomas persistentes (Persistidores, 81.9%, n:388), y sujetos que reportaron mejoría de los síntomas (Mejoradores 18.1%, n: 86). Modelos de regresión logístico evaluaron predictores de la trayectoria de síntomas en la línea de base, controlando aspectos demográficos, implementación y condición del tratamiento. Los sujetos que reportaron exposición al combate moderado (OR ajustado: 0.44, 95% CI: [0.20, 0.98]) o más alto (OR: 0.39, 95% CI: [0.17, 0.87]) tuvieron menos probabilidades de ser Mejoradores. Otros problemas clínicos en la línea de base no se relacionaron a trayectorias de síntomas. Los hallazgos sugieren que la mayoría de los pacientes de atención primaria en el ejército con TEPT experimentan síntomas persistentes, resaltando la importancia de mejorar la efectividad de su cuidado. La mayoría de los indicadores de estado clínico ofrecieron información pronóstica escasa más allá de la evaluación breve de exposición a combate. 標題 : 軍事基層治療裡創傷後壓力症的軌跡和一年預斷的預測變量 撮要: 本研究檢視現役軍人當中接受基層治療的創傷後壓力症(PTSD)患者其病症的縱貫發展過程༌並找出PTSD嚴重度的預斷指標。研究透過在6個地點進行的一項隨機試驗༌取得軍隊裡PTSD及抑鬱症合作基層治療的數據。樣本為474名患PTSD的軍人(在PTSD檢查表普通版分數 ≥ 50)。研究在美軍設施進行了4次評估༚基線、第3個月(反應率[RR]為 92.8%)、第6個月(90.1% RR)、和第12個月(87.1% RR)。我們利用以下因素預測患者根據「創傷後診斷量表」的PTSD症狀嚴重度༚戰鬥經歷、及7個基線臨床狀態的有效指標༈濫用酒精、抑鬱症、痛楚、軀體症狀、惡劣心理功能、惡劣身體功能、輕微創傷性腦損傷༉༈在第1至4次評估 Cronbach's α 分別為.87, .92, .95, .95༉。我們利用增長混合模型找出兩條PTSD症狀軌跡༚持續出現症狀的患者 (持續者, 81.9%, n = 388)༌和症狀得到改善的患者(改善者, 18.1%, n = 86) 。我們利用邏輯迴歸模型檢視症狀軌跡的基線臨床預測變量༌以人口變量、軍事設施和治療狀況作對照。研究發現༌有中水平(已調節OR = 0.44, 95% CI = [0.20, 0.98])或高水平(OR = 0.39, 95% CI = [0.17, 0.87])戰鬥經歷的樣本較小機會為改善者。其他基線臨床問題跟症狀軌跡無關。結果反映大部分患PTSD並接受基層治療的軍人均持續出現症狀༌凸顯提升治療功效的需要。大部分臨床狀態指標除了有助評估戰鬥經歷༌無助研究找出預斷資訊。 标题 : 军事基层治疗里创伤后压力症的轨迹和一年预断的预测变量 撮要: 本研究检视现役军人当中接受基层治疗的创伤后压力症(PTSD)患者其病症的纵贯发展过程༌并找出PTSD严重度的预断指标。研究透过在6个地点进行的一项随机试验༌取得军队里PTSD及抑郁症合作基层治疗的数据。样本为474名患PTSD的军人(在PTSD检查表普通版分数 ≥ 50)。研究在美军设施进行了4次评估༚基线、第3个月(反应率[RR]为 92.8%)、第6个月(90.1% RR)、和第12个月(87.1% RR)。我们利用以下因素预测患者根据「创伤后诊断量表」的PTSD症状严重度༚战斗经历、及7个基线临床状态的有效指标༈滥用酒精、抑郁症、痛楚、躯体症状、恶劣心理功能、恶劣身体功能、轻微创伤性脑损伤༉༈在第1至4次评估 Cronbach's α 分别为.87, .92, .95, .95༉。我们利用增长混合模型找出两条PTSD症状轨迹༚持续出现症状的患者 (持续者, 81.9%, n = 388)༌和症状得到改善的患者(改善者, 18.1%, n = 86) 。我们利用逻辑回归模型检视症状轨迹的基线临床预测变量༌以人口变量、军事设施和治疗状况作对照。研究发现༌有中水平(已调节OR = 0.44, 95% CI = [0.20, 0.98])或高水平(OR = 0.39, 95% CI = [0.17, 0.87])战斗经历的样本较小机会为改善者。其他基线临床问题跟症状轨迹无关。结果反映大部分患PTSD并接受基层治疗的军人均持续出现症状༌凸显提升治疗功效的需要。大部分临床状态指标除了有助评估战斗经历༌无助研究找出预断信息。

  July 22, 2016   doi: 10.1002/jts.22119   open full text
• Place and Posttraumatic Stress Disorder.
  Eva Monson, Catherine Paquet, Mark Daniel, Alain Brunet, Jean Caron.
  Journal of Traumatic Stress. July 21, 2016
  Research on traumatic stress has focused largely on individual risk factors. A more thorough understanding of risk factors may require investigation of the contribution of neighborhood context, such as the associations between perceived neighbourhood disorder and social cohesion with reported trauma exposure (yes/no) and posttraumatic stress disorder (PTSD) diagnostic status (past‐year PTSD, remitted). To examine these associations, we used a cross‐sectional analysis of an epidemiological catchment area survey (N = 2,433). Visible cues, indicating a lack of order and social control in the community (neighbourhood disorder), were associated with increased trauma exposure (adjusted odds ratio [AOR] = 1.21, 95% confidence interval [CI] [1.12, 1.31]). For trauma‐exposed individuals, neighbourhood disorder was associated with greater odds of lifetime PTSD (AOR = 1.38, 95% CI [1.10, 1.75]), and the willingness of residents who realize common values to intervene for the common good (social cohesion), was associated with lower likelihood of past‐year PTSD (AOR = 0.64, 95% CI [0.42, 0.97]). For participants with a lifetime diagnosis of PTSD (including past‐year), increased social cohesion was associated with higher odds of remission (AOR = 2.59, 95% CI [1.55, 4.30]). Environmental contexts play a role in the development and progression of PTSD. As such, traumatic stress outcomes may be better understood through a perspective that integrates individual and contextual risk factors. Lugar y Trastorno por Estrés Postraumático Investigaciones en estrés traumático se han focalizado en gran medida en factores de riesgo individuales. Un entendimiento más exhaustivo de factores de riesgo puede requerir investigaciones de la contribución del contexto del vecindario, tal como la asociación entre el trastorno percibido del vecindario y la cohesión social con exposición a trauma reportado (si/no) y el estado de diagnóstico el trastorno de estrés postraumático (TEPT) (TEPT del año anterior, remitido). Para examinar estas asociaciones, utilizamos un análisis transaccional de una encuesta epidemiológica del área geográfica (N = 2.433). Visibles señales indican una falta de orden y control social en la comunidad (trastorno en el vecindario) el cual asociado con un incremento de exposición a trauma (ajuste de razón de posibilidades [ARP] = 1.21, 95% CI [1.12, 1.31]). Para la exposición a trauma individual, el trastorno en el vecindario fue asociado con mayor posibilidad de duración del TEPT (ARP = 1.38, 95%CI [1.10, 1.75]), y la disposición de residentes quienes se dan cuenta de valores comunes para intervenir por el bien común (cohesión social), fue asociado con baja probabilidad de trastorno por estrés postraumático en el año anterior (ARP = 0.64, 95%CI [0.42, 0.97]).Para participantes con un diagnóstico de TEPT de por vida (incluyendo el año anterior) el incremento de la cohesión social fue asociado con altas posibilidades de remisión (ARP = 2.59, 95%CI [1.55, 4.30]). El contexto medio ambiental juega un rol en el desarrollo de la progresión de TEPT. De este modo, los resultados del estrés traumático pueden ser mejor entendidos a través de la perspectiva que integra factores de riesgo individuales y contextuales. 標題 : 地方與創傷後壓力症 撮要: 過往對創傷後壓力的研究多著重於個別風險因素。然而༌為了更全面了解風險因素༌我們可能需要探查鄰里狀況構成的影響༌如鄰里失調感知及社會凝聚力跟過往創傷經歷༈有或無༉和創傷後壓力症(PTSD)診斷結果༈過去一年有PTSD、已康復༉的關連。為檢視這些關連༌我們對一項流行病社區調查(N = 2,433)作橫斷分析。社區裡欠缺秩序和社會操控的可見線索༈鄰里失調༉跟創傷經歷提升有關(調整後機會比例[AOR] = 1.21, 95% CI [1.12, 1.31])。對曾經歷創傷的人來說༌鄰里失調跟較大機會患終生PTSD有關(AOR = 1.38, 95%CI [1.10, 1.75])༛而有共同價值觀的住客願意爭取共同利益༈社會凝聚力༉跟較低機會過去一年有PTSD相關(AOR = 0.64, 95%CI [0.42, 0.97])。樣本裡被診斷為有終生PTSD的人༈包括過去一年有PTSD的人༉當中༌社會凝聚力提升跟較大機會康復有關(AOR = 2.59, 95%CI [1.55, 4.30])。環境狀況能影響PTSD發展和惡化。因此༌一併檢視個別及環境風險因素可能有助我們更了解創傷後壓力症狀。 标题 : 地方与创伤后压力症 撮要: 过往对创伤后压力的研究多着重于个别风险因素。然而༌为了更全面了解风险因素༌我们可能需要探查邻里状况构成的影响༌如邻里失调感知及社会凝聚力跟过往创伤经历༈有或无༉和创伤后压力症(PTSD)诊断结果༈过去一年有PTSD、已康复༉的关连。为检视这些关连༌我们对一项流行病小区调查(N = 2,433)作横断分析。小区里欠缺秩序和社会操控的可见线索༈邻里失调༉跟创伤经历提升有关(调整后机会比例[AOR] = 1.21, 95% CI [1.12, 1.31])。对曾经历创伤的人来说༌邻里失调跟较大机会患终生PTSD有关(AOR = 1.38, 95%CI [1.10, 1.75])༛而有共同价值观的住客愿意争取共同利益༈社会凝聚力༉跟较低机会过去一年有PTSD相关(AOR = 0.64, 95%CI [0.42, 0.97])。样本里被诊断为有终生PTSD的人༈包括过去一年有PTSD的人༉当中༌社会凝聚力提升跟较大机会康复有关(AOR = 2.59, 95%CI [1.55, 4.30])。环境状况能影响PTSD发展和恶化。因此༌一并检视个别及环境风险因素可能有助我们更了解创伤后压力症状。

  July 21, 2016   doi: 10.1002/jts.22108   open full text
• Intrusive Cognitive Content and Postdeployment Distress.
  Jillian C. Shipherd, Kristalyn Salters‐Pedneault, Alexis Matza.
  Journal of Traumatic Stress. July 12, 2016
  Although intrusive cognitions (ICs) are common posttrauma, little is known about trauma‐related IC content, or associations between IC content and posttraumatic adjustment. A mixed‐method cross‐sectional approach was used in a secondary analysis of IC content and postdeployment distress. Participants were 1,521 U.S. Army soldiers 3–12 months postdeployment reporting their most distressing postdeployment ICs (mean number of ICs reported was 1.20). ICs were transcribed and content was categorized by 13 emergent themes. The most commonly reported ICs were of injury or death (48.2%) and combat (43.5%), and soldiers with probable posttraumatic stress disorder (PTSD; n = 187) were more likely to report the presence of these ICs, χ2s(1) = 35.27, ps < .001, φs < .16 than those without probable PTSD (n = 1,331). Other domains also emerged frequently, including ICs about friends (31.0%), family (15.8%), and leadership concerns (13.8%). IC content was a small, but significant correlate of distress after adjusting for combat exposure (ΔR2≥ .02, ps ≤ .001). The presence of ICs of injury or death, combat, military sexual trauma, health, leadership, and family (βs > .06, ps < .02) were unique correlates of distress. Results suggested that ICs about a wide range of topics should be addressed in postdeployment interventions. Cognición Intrusiva Post Despliegue Aunque las cogniciones intrusivas (CI) son comunes post trauma, se sabe poco acerca de su contenido relacionado al trauma, o de las asociaciones entre su contenido y la adaptación post‐traumática. Se usó una aproximación transversal de método mixto en un análisis secundario de contenido de CI y sufrimiento post despliegue. Los participantes fueron 1.521 soldados del ejército de USA, que reportaron sus más angustiantes CI post despliegue, 3 a 12 meses posterior a éste (el número promedio de CI reportadas fue 1.20). Las CI fueron transcritas y su contenido fue categorizado en 13 temas emergentes. Las CI más comunmente reportadas fueron de daño o muerte (48,2%) y combate (43,5%), y los soldados con probable TEPT (n = 187) reportaban con mayor probabilidad la presencia de estas CI, χ²s (1) = 35.27, ps < .001, φs < .16 que aquellos sin probable TEPT (n = 1331). Otros dominios, que también emergieron frecuentemente, incluyen CI acerca de amigos (31,0%), familia (15,8%) y preocupaciones de liderazgo (13,8%). El contenido de las CI se correlacionó de forma pequeña pero significativa con el sufrimiento luego de ajustar por exposición a combate (∆R 2 > .02, ps < .001). La presencia de CIs de lesión o muerte, combate, trauma sexual militar salud, liderazgo y familia (βs > .06, ps < .02) fueron correlatos únicos de sufrimiento. Los resultados sugieren que se debería abordar las CI acerca de un amplio rango de temas en las intervenciones post despliegue. 標題 : 侵擾認知內容和退役後悲痛 撮要: 雖然我們已知侵擾認知(ICs)在創傷後普遍發生༌但我們對創傷相關的IC內容༌或IC內容跟創傷後適應的關連仍缺乏了解。本研究利用混合橫斷研究༌對IC內容和退役後悲痛進行次級分析。參與者為1,521名已退役3至12個月的美國軍人。他們分別報告退役後最令其痛苦的ICs(ICs平均數目為1.20)。本研究記錄下這些ICs༌並把內容分類至13個主題類別。最普遍的ICs是與受傷或死亡相關(48.2%)和與戰鬥相關(43.5%)。而很可能患PTSD的軍人(n = 187)༌跟不大可能患PTSD的軍人(n = 1331)相比༌較大機會有以上提及的ICs༈χ2s (1) = 35.27, ps < .001, φs < .16༉。其他普遍範疇包括與朋友(31.0%)、家人(15.8%)和領導才能有關(13.8%)的ICs。因應戰鬥經歷作調節後༌IC內容是悲痛小型而顯著的關連因素(ΔR2 > .02, ps < .001)。而與受傷或死亡、戰鬥、軍事性創傷、健康、領導才能及家庭相關的ICs(βs > .06, ps < .02)༌是悲痛的獨特關連因素。研究結果反映༌退役後的干預治療應處理患者的各種ICs。 标题 : 侵扰认知内容和退役后悲痛 撮要: 虽然我们已知侵扰认知(ICs)在创伤后普遍发生༌但我们对创伤相关的IC内容༌或IC内容跟创伤后适应的关连仍缺乏了解。本研究利用混合横断研究༌对IC内容和退役后悲痛进行次级分析。参与者为1,521名已退役3至12个月的美国军人。他们分别报告退役后最令其痛苦的ICs(ICs平均数目为1.20)。本研究记录下这些ICs༌并把内容分类至13个主题类别。最普遍的ICs是与受伤或死亡相关(48.2%)和与战斗相关(43.5%)。而很可能患PTSD的军人(n = 187)༌跟不大可能患PTSD的军人(n = 1331)相比༌较大机会有以上提及的ICs༈χ2s (1) = 35.27, ps < .001, φs < .16༉。其他普遍范畴包括与朋友(31.0%)、家人(15.8%)和领导才能有关(13.8%)的ICs。因应战斗经历作调节后༌IC内容是悲痛小型而显著的关连因素(ΔR2 > .02, ps < .001)。而与受伤或死亡、战斗、军事性创伤、健康、领导才能及家庭相关的ICs(βs > .06, ps < .02)༌是悲痛的独特关连因素。研究结果反映༌退役后的干预治疗应处理患者的各种ICs。

  July 12, 2016   doi: 10.1002/jts.22113   open full text
• Mild Traumatic Brain Injury, PTSD, and Psychosocial Functioning Among Male and Female U.S. OEF/OIF Veterans.
  Colleen E. Jackson, Jonathan D. Green, Michelle J. Bovin, Jennifer J. Vasterling, Darren W. Holowka, Gayatri Ranganathan, Raymond C. Rosen, Terence M. Keane, Brian P. Marx.
  Journal of Traumatic Stress. July 12, 2016
  This study examined the unique and combined relationship between mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) with psychosocial functioning in a cohort of 1,312 U.S. male and female veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) enrolled in the Veterans After‐Discharge Longitudinal Registry (Project VALOR). We assessed mTBI with structured screening questions reflective of current TBI classification standards and PTSD via the SCID‐IV PTSD module; all other variables were assessed by self‐report questionnaires. We identified significant diagnostic group differences in psychosocial functioning for both sexes. Individuals with PTSD, with or without a history of mTBI, reported significantly worse psychosocial functioning than individuals with mTBI alone or neither mTBI nor PTSD (males, η2p = .11, p < .001; females, η2p = .14, p < .001), even after adjusting for demographics and severity of chronic pain. The results suggested that veterans experiencing PTSD, regardless of whether they had a history of mTBI, were at increased risk for long‐term psychosocial impairment. Further research examining possible benefits from improved access to resources and treatment to address these needs would be valuable. Este estudio examinó la relación única y combinada entre la lesión cerebral traumática leve (LCTL) y trastorno por estrés postraumático (TEPT) con el funcionamiento psicosocial en una cohorte de 1.312 hombres y mujeres veteranos de las operaciones Enduring Freedom (OEF) y Libertad Iraquí (OIF) inscritos en el Registro Longitudinal de Veteranos después de descargos (Proyecto VALOR). Se evaluó LCTL con preguntas de screening estructuradas que reflejan los criterios de clasificación de LCT actual y trastorno por estrés postraumático a través del módulo de TEPT SCID‐IV; todas las demás variables se evaluaron mediante cuestionarios de auto‐reporte. Se identificaron diferencias significativas entre los grupos de diagnóstico en el funcionamiento psicosocial para ambos sexos, de tal manera que las personas con trastorno de estrés postraumático, con o sin historial de LCTL, reportaron significativamente peor funcionamiento psicosocial en comparación con los individuos con LCTL solo o los que no tenían LCTL ni trastorno por estrés postraumático (hombres, η 2 p = 0,11, p <0,001; mujeres, η 2 p = 0,14, p <0,001), incluso después de ajustar las variables demográficas y la severidad del dolor crónico. Los resultados sugieren que los veteranos que experimentan trastorno por estrés postraumático, independientemente de si tenían un historial de LCTL, estaban en mayor riesgo de deterioro psicosocial a largo plazo. Futuras investigaciones que examinen los posibles beneficios de un acceso mejorado a los recursos y el tratamiento para dirigir estas necesidades serían valiosas. 標題 : OEF/OIF男性和女性退役軍人的輕微創傷性腦損傷、創傷後壓力症和心理社會功能 撮要: 本研究透過退役軍人縱貫研究(VALOR計劃)༌在曾參與「持久自由行動」(OEF)和伊拉克戰爭(OIF)的1,312名男性和女性退役軍人的世代研究樣本裡༌檢視輕微創傷性腦損傷(mTBI)跟創傷後壓力症(PTSD)的獨特和共同關係與心理社會功能的關係。我們透過符合目前TBI分類標準的結構性篩查問題評估mTBI༌並以SCID‐IV PTSD單元來評估PTSD༛我們亦以自評問卷測量其他變量。研究發現兩種性別裡心理社會功能的診斷均有顯著的組別差異༚即使已因應人口變量和慢性痛楚嚴重度作調節༌PTSD患者༌不論有或無患過mTBI༌與只患mTBI或全無mTBI和PTSD的人相比༌有顯著較差的心理社會功能 (男性 η2p = .11, p < .001; 女性 η2p = .14, p < .001)。結果反映患PTSD的退役軍人༌不論有沒有患過mTBI༌都有較高風險有長期心理社會功能損傷。我們未來需有進一步研究༌檢視提高這些患者取得治療的機會有何潛在好處。 标题 : OEF/OIF男性和女性退役军人的轻微创伤性脑损伤、创伤后压力症和心理社会功能 撮要: 本研究透过退役军人纵贯研究(VALOR计划)༌在曾参与「持久自由行动」(OEF)和伊拉克战争(OIF)的1,312名男性和女性退役军人的世代研究样本里༌检视轻微创伤性脑损伤(mTBI)跟创伤后压力症(PTSD)的独特和共同关系与心理社会功能的关系。我们透过符合目前TBI分类标准的结构性筛查问题评估mTBI༌并以SCID‐IV PTSD单元来评估PTSD༛我们亦以自评问卷测量其他变量。研究发现两种性别里心理社会功能的诊断均有显著的组别差异༚即使已因应人口变量和慢性痛楚严重度作调节༌PTSD患者༌不论有或无患过mTBI༌与只患mTBI或全无mTBI和PTSD的人相比༌有显著较差的心理社会功能 (男性 η2p = .11, p < .001; 女性 η2p = .14, p < .001)。结果反映患PTSD的退役军人༌不论有没有患过mTBI༌都有较高风险有长期心理社会功能损伤。我们未来需有进一步研究༌检视提高这些患者取得治疗的机会有何潜在好处。

  July 12, 2016   doi: 10.1002/jts.22110   open full text
• The Effects of Trauma History and Prenatal Affective Symptoms on Obstetric Outcomes.
  Emma Robertson Blackmore, Frank W. Putnam, Eva K. Pressman, David R. Rubinow, Karen T. Putnam, Monica M. Matthieu, Michelle A. Gilchrist, Ian Jones, Thomas G. O'Connor.
  Journal of Traumatic Stress. June 08, 2016
  Prenatal maternal mood may inform the adverse obstetric outcomes seen in disadvantaged populations. The contribution of having a trauma history is not well studied. We examined the impact of trauma exposure and mood symptoms on obstetric outcomes in 358 women. Women with antecedent trauma were more likely to have a history of depression, odds ratio = 2.83, 95% confidence interval [1.81, 4.42], were younger at their first pregnancy, 18.86 years versus 20.10 years, and had a higher number of previous pregnancies, 2.01 versus 1.54, compared to those with no trauma exposure. Women with prenatal anxiety had significantly smaller babies than nonanxious women, 3,313.17 g, (SD = 441.58) versus 3,429.27 g, (SD = 437.82) Trauma history magnified the effects of maternal prenatal mood on birthweight; the moderating effect was limited to those who first experienced a trauma under 18 years of age. Childhood trauma exposure increased vulnerability for low birthweight delivery associated with prenatal mood disturbance. Screening pregnant women for trauma history and current mood symptoms is indicated. TRAUMA, ANSIEDAD Y PESO AL NACER El ánimo materno prenatal puede explicar los resultados obstétricos adversos en poblaciones en desventaja, aunque los efectos de una historia de trauma no han sido bien estudiados. Examinamos el impacto de la exposición a trauma y síntomas anímicos en los resultados obstétricos en 358 mujeres. Las mujeres con antecedente de trauma tuvieron mayor probabilidad de tener historia de depresión X2 (1, N = 358) = 19.2, p = .001; OR = 2.83, 95% CI [1.82, 4.42], tenían menor edad en su primer embarazo t ( = 356) = ‐ 2.97, p = .003 y tenían mayor número de embarazos previos t( = 356) = 2.77, p = .011 comparadas con aquellas sin historia de trauma. Mujeres con ansiedad prenatal tuvieron bebés más pequeños que el grupo sin ansiedad, en forma significativa F (1,322), = 5.32, p = .024. La historia de trauma magnificó los efectos del estado de ánimo materno prenatal sobre el peso al nacer. El efecto moderador estuvo limitado a aquellas mujeres con experiencia de trauma previo a los 18 años F (14.320) = 244, p = .005. La exposición a trauma en la infancia aumenta la vulnerabilidad de bajo peso al nacer asociado con una alteración del ánimo prenatales. Es necesario indagar por antecedentes de trauma en la infancia y síntomas anímicos en mujeres embarazadas. 標題 : 創傷歷史和產前情感症狀對懷孕的影響 撮要: 過往研究發現༌貧窮人口當中༌孕婦的產前情緒有可能解釋到其不良的懷孕後果༌但目前仍缺乏對創傷歷史在當中影響的研究。本研究透過358名女士༌檢視創傷經歷及情緒症狀對懷孕的影響。與無創傷經歷的女士相比༌曾經歷創傷的女士較大機會曾患抑鬱症 (χ2(1, N = 358) = 19.2, p = .001; OR = 2.83, 95% CI [1.81, 4.42])༌而她們首次懷孕時較年輕 (t(356) = ‐2.97, p = .003)༌過往懷孕次數亦較高 (t(356) = 2.77, p = .011)。比起無產前焦慮的女士༌有產前焦慮的女士誕下顯著較小的嬰兒(F(1, 322) = 5.32, p = .024)。創傷歷史加強了孕婦產前情緒對嬰兒出生重量的影響༌調節效應僅發生於在18歲前首次經歷創傷的女士(F(14, 320) = 2.44, p = .005)。童年創傷經歷會加大孕婦因產前情緒障礙而誕下過輕嬰兒的可能。研究提出需篩查找出有創傷歷史及當前有情緒症狀的孕婦。 标题 : 创伤历史和产前情感症状对怀孕的影响 撮要: 过往研究发现༌贫穷人口当中༌孕妇的产前情绪有可能解释到其不良的怀孕后果༌但目前仍缺乏对创伤历史在当中影响的研究。本研究透过358名女士༌检视创伤经历及情绪症状对怀孕的影响。与无创伤经历的女士相比༌曾经历创伤的女士较大机会曾患抑郁症 (χ2(1, N = 358) = 19.2, p = .001; OR = 2.83, 95% CI [1.81, 4.42])༌而她们首次怀孕时较年轻 (t(356) = ‐2.97, p = .003)༌过往怀孕次数亦较高 (t(356) = 2.77, p = .011)。比起无产前焦虑的女士༌有产前焦虑的女士诞下显著较小的婴儿(F(1, 322) = 5.32, p = .024)。创伤历史加强了孕妇产前情绪对婴儿出生重量的影响༌调节效应仅发生于在18岁前首次经历创伤的女士(F(14, 320) = 2.44, p = .005)。童年创伤经历会加大孕妇因产前情绪障碍而诞下过轻婴儿的可能。研究提出需筛查找出有创伤历史及当前有情绪症状的孕妇。

  June 08, 2016   doi: 10.1002/jts.22095   open full text
• Exposure to Violence During Ferguson Protests: Mental Health Effects for Law Enforcement and Community Members.
  Tara E. Galovski, Zoë D. Peterson, Marin C. Beagley, David R. Strasshofer, Philip Held, Thomas D. Fletcher.
  Journal of Traumatic Stress. June 02, 2016
  There is little information available on the mental health effects of exposure to shared community violence such as the August 2014 violence that occurred in Ferguson, Missouri. This study sought to examine the relationship between proximity to community violence and mental health in both community members and police officers. We recruited 565 adults (community, n = 304, and police, n = 261) exposed to the violence in Ferguson to complete measures of proximity to violence, posttraumatic stress, depression, and anger. Using structural equation modeling, we assessed aspects of proximity to violence—connectedness, direct exposure, fear from exposure, media exposure, reactions to media, and life interruption—as correlates of posttraumatic stress disorder (PTSD) symptoms, depression, and anger. The final model yielded (n = 432), χ2(d = 12) = 7.4, p = .830; comparative fit index = 1.0, root mean square error of approximation = 0 [0, .04]. All aspects of proximity except direct exposure were associated with mental health outcomes. There was no moderation as a function of community versus police. Race moderated the relationship between life interruptions and negative outcomes; interruption was related to distress for White, but not Black community members. Based on group comparisons, community members reported more symptoms of PTSD and depression than law enforcement (ηp2 = .06 and .02, respectively). Black community members reported more PTSD and depression than White community members (ηp2 = .05 and .02, respectively). Overall, distress was high, and mental health interventions are likely indicated for some individuals exposed to the Ferguson events. EFECTOS DE LA EXPOSICIÓN A LA VIOLENCIA EN FERGUSON Hay muy poca información disponible sobre los efectos en la salud mental de la exposición a violencia comunitaria compartida tales como la violencia en Agosto del 2014 ocurrida en Ferguson, Missouri. Este estudio buscó examinar la relación entre la proximidad a la violencia comunitaria y la salud mental en los miembros de la comunidad y oficiales de policía. Reclutamos 565 adultos (comunidad [n = 304] y policía [n = 261]) expuestos a la violencia en Ferguson para completar medidas de proximidad a la violencia, estrés postraumático, depresión y rabia. Usando la ecuación de modelamiento estructural, evaluamos los aspectos de proximidad a la violencia – conectividad, exposición directa, miedo por exposición, exposición a los medios, reacciones a los medios e interrupción de la vida – como correlatos de trastorno por estrés postraumático (TEPT), depresión y rabia. En el modelo final (n = 432),X ² (d = 12); p = .830, CFI = 1.0, RMSEA = 0 [0,.04], todos los aspectos de la proximidad excepto la exposición directa se asociaron con los resultados en la salud mental. No hubo moderación en función de la membresía en la comunidad versus la muestra de la policía. La raza moderó la relación entre las interrupciones de vida y los resultados negativos, la interrupción estuvo relacionada a la angustia para miembros de la comunidad Blancos pero no para los Negros. Basado en comparaciones por grupo, los miembros de la comunidad reportaron más síntomas de TEPT y depresión que la policía (ηp² = .06 y .02, respectivamente), y los miembros de la comunidad Negra reportaron más TEPT y depresión que los miembros de la comunidad Blanca (ηp2 = .05 y .02, respectivamente). En general, la angustia fue alta y las intervenciones de salud mental fueron probablemente indicadas para algunos individuos expuestos a los eventos de Ferguson. 標題 : 弗格森鎮暴力事件經歷༚對執法人員和區內人士構成的心理影響 撮要: 過往缺乏研究社區暴力事件༌如2014年8月美國密蘇里州弗格森鎮的暴力事件༌對人造成的心理影響。本研究旨在檢視與區內暴力的距離跟區內人士和警察的心理健康的關係。樣本為565名經歷了弗格森鎮暴力事件的成人(區內人士 [n = 304] 和警察 [n = 261])。研究測量他們與暴力的距離、創傷後壓力、抑鬱症和憤怒。我們採用結構方程式模型法༌評估以下有關與暴力距離的數方面作為創傷後壓力症(PTSD) 、抑鬱症和憤怒的關連因素༚關連程度、直接經歷、對經歷恐懼、媒體經歷、對媒體反應、和生活干擾。最後一個模型裡(n = 432), χ2 (d = 12) = 7.4; p = .830, CFI = 1.0, RMSEA = 0 [0, .04])༌所有有關與暴力距離的方面༈除了直接經歷༉都跟心理問題有關。作為區內人士對比警察樣本無調節效應。種族對生活干擾和負面影響的關係有調節效應。干擾跟區內白人承受悲痛有關༌但跟區內黑人承受悲痛無關。從組別對比可見༌區內人士比執法人員有較多PTSD和抑鬱症症狀(分別為 ηp2 = .06 和 .02)༛而區內黑人比白人有較多PTSD和抑鬱症症狀(分別為ηp2 = .05 和 .02)。總括༌樣本承受高水平悲痛༌ 而一些經歷過弗格森鎮暴力事件的人士有可能需要接受心理干預治療。 标题 : 弗格森镇暴力事件经历༚对执法人员和区内人士构成的心理影响 撮要: 过往缺乏研究小区暴力事件༌如2014年8月美国密苏里州弗格森镇的暴力事件༌对人造成的心理影响。本研究旨在检视与区内暴力的距离跟区内人士和警察的心理健康的关系。样本为565名经历了弗格森镇暴力事件的成人(区内人士 [n = 304] 和警察 [n = 261])。研究测量他们与暴力的距离、创伤后压力、抑郁症和愤怒。我们采用结构方程式模型法༌评估以下有关与暴力距离的数方面作为创伤后压力症(PTSD) 、抑郁症和愤怒的关连因素༚关连程度、直接经历、对经历恐惧、媒体经历、对媒体反应、和生活干扰。最后一个模型里(n = 432), χ2 (d = 12) = 7.4; p = .830, CFI = 1.0, RMSEA = 0 [0, .04])༌所有有关与暴力距离的方面༈除了直接经历༉都跟心理问题有关。作为区内人士对比警察样本无调节效应。种族对生活干扰和负面影响的关系有调节效应。干扰跟区内白人承受悲痛有关༌但跟区内黑人承受悲痛无关。从组别对比可见༌区内人士比执法人员有较多PTSD和抑郁症症状(分别为 ηp2 = .06 和 .02)༛而区内黑人比白人有较多PTSD和抑郁症症状(分别为ηp2 = .05 和 .02)。总括༌样本承受高水平悲痛༌ 而一些经历过弗格森镇暴力事件的人士有可能需要接受心理干预治疗。

  June 02, 2016   doi: 10.1002/jts.22105   open full text
• Evidence of Shared Genome‐Wide Additive Genetic Effects on Interpersonal Trauma Exposure and Generalized Vulnerability to Drug Dependence in a Population of Substance Users.
  Rohan H. C. Palmer, Nicole R. Nugent, Leslie A. Brick, Cinnamon L. Bidwell, John E. McGeary, Matthew C. Keller, Valerie S. Knopik.
  Journal of Traumatic Stress. May 23, 2016
  Exposure to traumatic experiences is associated with an increased risk for drug dependence and poorer response to substance abuse treatment (Claus & Kindleberger, 2002; Jaycox, Ebener, Damesek, & Becker, 2004). Despite this evidence, the reasons for the observed associations of trauma and the general tendency to be dependent upon drugs of abuse remain unclear. Data (N = 2,596) from the Study of Addiction: Genetics and Environment were used to analyze (a) the degree to which commonly occurring single nucleotide polymorphisms (SNPs; minor allele frequency > 1%) in the human genome explains exposure to interpersonal traumatic experiences, and (b) the extent to which additive genetic effects on trauma are shared with additive genetic effects on drug dependence. Our results suggested moderate additive genetic influences on interpersonal trauma, h2SNP‐Interpersonal = .47, 95% confidence interval (CI) [.10, .85], that are partially shared with additive genetic effects on generalized vulnerability to drug dependence, h2SNP‐DD = .36, 95% CI [.11, .61]; rG‐SNP = .49, 95% CI [.02, .96]. Although the design/technique does not exclude the possibility that substance abuse causally increases risk for traumatic experiences (or vice versa), these findings raise the possibility that commonly occurring SNPs influence both the general tendency towards drug dependence and interpersonal trauma.

  May 23, 2016   doi: 10.1002/jts.22103   open full text
• Disgusted by Sexual Abuse: Exploring the Association Between Disgust Sensitivity and Posttraumatic Stress Symptoms Among Mothers of Sexually Abused Children.
  Ivanka Delft, Catrin Finkenauer, Joshua M. Tybur, Francien Lamers‐Winkelman.
  Journal of Traumatic Stress. May 23, 2016
  Nonoffending mothers of sexually abused children often exhibit high levels of posttraumatic stress (PTS) symptoms. Emerging evidence suggests that trait‐like individual differences in sensitivity to disgust play a role in the development of PTS symptoms. One such individual difference, disgust sensitivity, has not been examined as far as we are aware among victims of secondary traumatic stress. The current study examined associations between disgust sensitivity and PTS symptoms among mothers of sexually abused children (N = 72). Mothers completed the Impact of Event Scale‐Revised and the Three Domain Disgust Scale (Tybur, Lieberman, & Griskevicius, 2009). More than one third of mothers scored above a suggested cutoff (mean score = 1.5) for high levels of PTS symptoms. Hierarchical linear regression analysis results indicated that sexual disgust sensitivity (β = .39, p = .002) was associated with PTS symptoms (R2 = .18). An interaction analysis showed that sexual disgust sensitivity was associated with maternal PTS symptoms only when the perpetrator was not biologically related to the child (β = −.32, p = .047; R2 = .28). Our findings suggested that sexual disgust sensitivity may be a risk factor for developing PTS symptoms among mothers of sexually abused children. Sensibilidad al asco y estrés postraumático Las madres no abusadoras de los niños víctimas de abuso sexual a menudo exhiben altos niveles de síntomas de estrés postraumático (SEPT). Nuevas evidencias sugieren que los rasgos de las diferencias individuales en la sensibilidad al asco juega un papel en el desarrollo de los síntomas de los SEPT. Sin embargo, la sensibilidad al asco no ha sido examinada entre las víctimas de estrés traumático secundario. El presente estudio examinó asociaciones entre los síntomas de sensibilidad al asco y SEPT en las madres de niños víctimas de abuso sexual (n = 72). Las madres completaron la Escala de Impacto del Evento Revisada (Impact Event Scale‐Revised) y la Escala de los Tres Dominios del Disgusto. Más de un tercio de las madres puntuó por encima del punto de corte (puntuación media de 1,5) para altos niveles de síntomas de EPT. Los resultados del análisis de regresión lineal jerárquica indicaron que la sensibilidad al asco sexual (β = 0,39, p = 0,002) se asoció con síntomas de EPT (R2 = 0,18). Un análisis de la interacción mostró que la sensibilidad a la repugnancia sexual sólo se asoció con los síntomas de EPT maternos cuando el perpetrador no estaba biológicamente relacionado con su hijo (β = ‐.32, p = 0,047; R2 = .28). Nuestros hallazgos sugieren que la sensibilidad al asco sexual puede ser un factor de riesgo para el desarrollo de síntomas de EPT en las madres de los niños abusados ​​sexualmente. 標題 : 厭惡性侵犯༚探索性侵犯孩子的母親當中厭惡敏感度和創傷後壓力症狀的關連 撮要: 受性侵犯孩子其無辜的母親經常有高水平的創傷後壓力症狀(PTS)。越來越多研究證據反映厭惡敏感度的個人特質差異能導致PTS症狀。然而༌目前仍未有研究檢視間接性創傷後壓力患者的厭惡敏感度。本研究透過受性侵犯孩子的母親(N = 72)༌檢視厭惡敏感度和PTS症狀的關連。樣本完成了事件影響測量表༈修訂版༉和三種領域厭惡量表。超過三分一母親展現高水平的PTS症狀༌得出取錄線以上的分數(平均分為 1.5)。層次線性迴歸分析結果顯示༌性厭惡敏感度(β = .39, p = .002)跟PTS症狀有關(R2 = .18)。交互作用分析顯示༌當犯罪者跟孩子無血緣關係༌性厭惡敏感度就只跟母親的PTS症狀有關(β = ‐.32, p = .047; R2 = .28)。結果反映༌受性侵犯孩子的母親當中༌性厭惡敏感度可能是發展PTS症狀的風險因素。 标题 : 厌恶性侵犯༚探索性侵犯孩子的母亲当中厌恶敏感度和创伤后压力症状的关连 撮要: 受性侵犯孩子其无辜的母亲经常有高水平的创伤后压力症状(PTS)。越来越多研究证据反映厌恶敏感度的个人特质差异能导致PTS症状。然而༌目前仍未有研究检视间接性创伤后压力患者的厌恶敏感度。本研究透过受性侵犯孩子的母亲(N = 72)༌检视厌恶敏感度和PTS症状的关连。样本完成了事件影响测量表༈修订版༉和三种领域厌恶量表。超过三分一母亲展现高水平的PTS症状༌得出取录线以上的分数(平均分为 1.5)。层次线性回归分析结果显示༌性厌恶敏感度(β = .39, p = .002)跟PTS症状有关(R2 = .18)。交互作用分析显示༌当犯罪者跟孩子无血缘关系༌性厌恶敏感度就只跟母亲的PTS症状有关(β = ‐.32, p = .047; R2 = .28)。结果反映༌受性侵犯孩子的母亲当中༌性厌恶敏感度可能是发展PTS症状的风险因素。

  May 23, 2016   doi: 10.1002/jts.22099   open full text
• An Update on the Clinical Utility of the Children's Post‐Traumatic Cognitions Inventory.
  Anna McKinnon, Patrick Smith, Richard Bryant, Karen Salmon, William Yule, Tim Dalgleish, Clare Dixon, Reginald D. V. Nixon, Richard Meiser‐Stedman.
  Journal of Traumatic Stress. May 18, 2016
  The Children's Post‐Traumatic Cognitions Inventory (CPTCI) is a self‐report questionnaire that measures maladaptive cognitions in children and young people following exposure to trauma. In this study, the psychometric properties of the CPTCI were examined in further detail with the objective of furthering its utility as a clinical tool. Specifically, we investigated the CPTCI's discriminant validity, test‐retest reliability, and the potential for the development of a short form of the measure. Three samples (London, East Anglia, Australia) of children and young people exposed to trauma (N = 535; 7–17 years old) completed the CPTCI and a structured clinical interview to measure posttraumatic stress disorder (PTSD) symptoms between 1 and 6 months following trauma. Test‐retest reliability was investigated in a subsample of 203 cases. The results showed that a score in the range of 46 to 48 on the CPTCI was indicative of clinically significant appraisals as determined by the presence of PTSD. The measure also had moderate‐to‐high test‐retest reliability (r = .78) over a 2‐month period. The Children's Post‐Traumatic Cognitions Inventory‐Short Form (CPTCI‐S) had excellent internal consistency (α = .92), and moderate‐to‐high test‐retest reliability (r = .78). The examination of construct validity showed the model had an excellent fitting factor structure (Comparative Fit index = 0.95, Tucker‐Lewis index = 0.91, Root Mean Square Error of Approximation = .07). A score ranging from 16 to 18 was the best cutoff point on the CPTCI‐S, in that it was indicative of clinically significant appraisals as determined by the presence of PTSD. Based on these results, we concluded that the CPTCI is a useful tool to support the practice of clinicians and that the CPTCI‐S has excellent psychometric properties.

  May 18, 2016   doi: 10.1002/jts.22096   open full text
• Desired Involvement in Treatment Decisions Among Adults with PTSD Symptoms.
  Juliette M. Harik, Natalie E. Hundt, Nancy C. Bernardy, Sonya B. Norman, Jessica L. Hamblen.
  Journal of Traumatic Stress. May 12, 2016
  Most medical patients want to be involved in decisions about their care. Whether this is true for people with posttraumatic stress disorder (PTSD)—a disorder characterized by avoidance of trauma‐related discussions—is unknown. We conducted an online survey assessing preferences for involvement in PTSD treatment decisions (level of control, timing) and information about PTSD treatment (content, format). Adults who screened positive for possible PTSD (N = 301) were recruited from a large online survey panel representative of the U. S. population. Virtually all respondents (97.3%) desired involvement in treatment decisions; two thirds (67.8%) wanted primary responsibility for decisions. Most (64.2%) wanted 30–60 minutes to learn about treatments and 80.1% wanted at least 1–3 days to consider their options. Respondents expressed more interest in informational content on treatment effectiveness and side effects than any other topic. In‐person discussion with a provider was preferred more than other learning formats (e.g., websites, brochures). Results suggested that people with symptoms of PTSD want involvement in decisions about their treatment and want to discuss treatment options with their provider. Providers may wish to prioritize information about effectiveness and side effects, and should expect that many patients will need several days after their visit to make a decision.

  May 12, 2016   doi: 10.1002/jts.22102   open full text
• Trauma‐Exposed Community‐Dwelling Women and Men Respond Similarly to the DAR‐5 Anger Scale: Factor Structure Invariance and Differential Item Functioning.
  Gordon J. G. Asmundson, Daniel M. LeBouthillier, Holly A. Parkerson, Samantha C. Horswill.
  Journal of Traumatic Stress. May 11, 2016
  Anger is associated with the development of posttraumatic stress disorder (PTSD) and with poor treatment outcomes. The Dimensions of Anger Reactions Scale‐5 (DAR‐5) has demonstrated preliminary evidence of unitary factor structure and sound psychometric properties. Gender‐based differences in psychometric properties have not been explored. The current study examined gender‐based factor structure invariance and differential item functioning of the DAR‐5 and gender differences in PTSD symptoms as a function of anger severity using a community sample of adults who had been exposed to trauma. Data were collected from 512 trauma‐exposed community‐dwelling adults (47.9% women). Confirmatory factor analyses, Mantel‐Haenszel χ2 tests and a comparison of characteristic curves, and 2‐way analyses of variance, respectively, were used to assess gender‐based factor structure invariance, gender‐based response patterns to DAR‐5 items, and gender differences in PTSD symptoms as a function of anger. The unitary DAR‐5 factor structure did not differ between men and women. Significant gender differences in the response pattern to the DAR‐5 items were not present. Trauma‐exposed individuals with high anger reported greater overall PTSD symptoms (p < .001), regardless of gender. The DAR‐5 can be used to assess anger in trauma‐exposed individuals without concern of gender biases influencing factor structure or item functioning. Findings further suggested that the established relationship between anger and PTSD severity did not differ by gender. Factor de Invarianza y DIF (Funcionamiento Diferencial de Items) DAR‐5 en mujeres y hombres La ira está asociada con el desarrollo del trastorno por estrés postraumático (TEPT) y respuestas bajas al tratamiento. Las dimensiones de la Escala de Reacciones de Ira (DAR‐5, por sus cifras en inglés) han demostrado evidencias preliminares de un factor estructural unitario y propiedades psicométricas sólidas. Las diferencias basadas en el género en las propiedades psicométricas no han sido exploradas. El presente estudio examinó la diferencia de género en el factor de invarianza estructural y el funcionamiento diferencial de los ítems de la DAR‐5 y las diferencias de género en los síntomas de TEPT como una función de la severidad de la ira en una muestra de la comunidad de adultos expuestos a trauma. Los datos fueron recogidos de 512 adultos en una residencia comunitaria expuestos a trauma (47,9% mujeres). Un análisis de factor confirmatorio, test del chi‐cuadrado de Mantel‐Haenszel y curvas características de comparación, y análisis de varianza de dos vías respectivamente fueron usadas para evaluar el factor de invarianza estructural basado en el género, patrones de respuesta a los ítems de la DAR‐5 basado en el género y diferencias de género en los síntomas de TEPT en función de la ira. El factor estructural unitario de la DAR‐5 no difirió entre hombres y mujeres. No se encontraron diferencias significativas de género en los patrones de respuesta a los ítems de la DAR‐5. Los individuos expuestos a trauma con altos niveles de ira reportaron mayor sintomatología de TEPT (p≤.001), independientes del género. La DAR‐5 puede ser usada para evaluar la ira en individuos expuestos a trauma sin preocuparse de sesgos de género que influyan en el factor estructural o ítem de funcionamiento. Estos hallazgos sugieren además que la relación establecida entre ira y severidad del TEPT no difiere entre los géneros. 標題 : 社區裡受創的男女對DAR‐5憤怒量表反應相近༚因素結構不變性及差別 項目運作 撮要: 憤怒跟創傷後壓力症(PTSD)和不良治療結果相關。「憤怒反應領域量表5」(DAR‐5)已初步證實具備單一因素結構和健全的心理測量特性༌但目前仍未有針對不同性別的心理測量特性研究。本研究透過受創的成人社區樣本༌檢視DAR‐5性別為本的因素結構不變性及差別項目運作༌以及PTSD症狀作為憤怒作用的性別差異。我們從512名社區裡的受創成人(47.9%女性)取得數據༌並分別採用驗證性因素分析、Mantel‐Haenszel卡方檢驗、特性曲線比較和方差雙向分析༌以評估性別為本的因素結構不變性、對DAR‐5項目性別為本的反應模式、和PTSD症狀作為憤怒作用的性別差異。DAR‐5的單一因素結構並無因性別生異。對DAR‐5項目的反應模式亦無顯著的性別差異。不論性別༌有高水平憤怒的受創人士整體有較多PTSD症狀(p < .001)。DAR‐5能用以評估受創人士的憤怒水平༌而性別差異並不影響DAR‐5的因素結構和項目運作。結果亦反映༌憤怒和PTSD嚴重度之間已知的關連並不受性別影響。 标题 : 社区里受创的男女对DAR‐5愤怒量表反应相近༚因素结构不变性及差别 项目运作 撮要: 愤怒跟创伤后压力症(PTSD)和不良治疗结果相关。「愤怒反应领域量表5」(DAR‐5)已初步证实具备单一因素结构和健全的心理测量特性༌但目前仍未有针对不同性别的心理测量特性研究。本研究透过受创的成人社区样本༌检视DAR‐5性别为本的因素结构不变性及差别项目运作༌以及PTSD症状作为愤怒作用的性别差异。我们从512名社区里的受创成人(47.9%女性)取得数据༌并分别采用验证性因素分析、Mantel‐Haenszel卡方检验、特性曲线比较和方差双向分析༌以评估性别为本的因素结构不变性、对DAR‐5项目性别为本的反应模式、和PTSD症状作为愤怒作用的性别差异。DAR‐5的单一因素结构并无因性别生异。对DAR‐5项目的反应模式亦无显著的性别差异。不论性别༌有高水平愤怒的受创人士整体有较多PTSD症状(p < .001)。DAR‐5能用以评估受创人士的愤怒水平༌而性别差异并不影响DAR‐5的因素结构和项目运作。结果亦反映༌愤怒和PTSD严重度之间已知的关连并不受性别影响。

  May 11, 2016   doi: 10.1002/jts.22098   open full text
• A Longitudinal Study of the Bidirectional Relationship Between Social Support and Posttraumatic Stress Following a Natural Disaster.
  Jonathan M. Platt, Sarah R. Lowe, Sandro Galea, Fran H. Norris, Karestan C. Koenen.
  Journal of Traumatic Stress. May 10, 2016
  There is ample evidence that social support is protective against posttraumatic stress (PTS) symptoms through social causation processes. It is also likely that PTS is associated with decreased social support through social selection processes. Few studies, however, have examined the longitudinal and bidirectional associations between social support and PTS in a postdisaster context, and whether such associations vary by type of support (e.g., emotional, informational, or tangible). We examined these relationships using Galveston Bay Recovery Study data. Participants (N = 658) were interviewed 2–6 months (W1), 5–9 months (W2), and 14–19 months (W3) after Hurricane Ike in 2008. Longitudinal relationships between each support type and PTS were examined in cross‐lagged models. W1 emotional support was negatively associated with W2 PTS (Estimate = –.13, p = .007), consistent with social causation. W1 PTS was negatively associated with W2 emotional support (Estimate = –.14, p = .019), consistent with social selection. In contrast, pathways were nonsignificant at subsequent waves and for informational and tangible support. Results suggested that postdisaster social causation and selection were limited to emotional support and diminish over time. Based on these findings, postdisaster services should emphasize restoring supportive social connections to minimize the psychiatric consequences of disaster, especially among those with prior evidence of distress. APOYO SOCIAL Y ESTRÉS TRAUMATICO DESPUES DE UN DESASTRE Hay una amplia evidencia de que el apoyo social protege contra los síntomas de estrés postraumático (EPT) a través de procesos causales sociales. Es también probable que el EPT esté asociado a una disminución del apoyo social, a través de procesos de selección social. Sin embargo, pocos estudios han examinado las asociaciones longitudinales y bidireccionales entre el apoyo social y el EPT en un contexto posterior a un desastre, y si tales asociaciones varían con el tipo de apoyo (ej. emocional, informacional o tangible). Nosotros examinamos estas relaciones usando los datos del Estudio de Recuperación de la Bahía de Galveston. Los participantes (N = 658) fueron entrevistados 2–6 meses (W1), 5–9 meses (W2), y 14–19 meses (W3) después del huracán Ike en el 2008. Las relaciones longitudinales entre el tipo de soporte y el EPT fueron examinados en modelos de cruce‐desfasado. El apoyo emocional W1 se asoció negativamente con el EPT W2 (estimado = ‐.13, p = .007), consistente con una causalidad social. EPT W1 se asoció negativamente con el apoyo emocional W2 (estimado = ‐.14, p = .019), consistente con una selección social. En contraste, las vías fueron no significativas en etapas subsecuentes y para apoyo informacional y tangible. Los resultados sugieren que la causalidad social después del desastre y la selección están limitados al apoyo emocional y disminuyen a medida que transcurre el tiempo. Basado en estos hallazgos, los servicios después del desastre debieran enfatizar la restauración de conexiones sociales apoyadoras para minimizar las consecuencias psiquiátricas del desastre, especialmente entre aquellos con evidencia previa de angustia. 標題 : 天災後社會支持跟創傷後壓力症狀的雙向關係縱貫研究 撮要: 目前已有充分證據༌社會支持能透過社會因果過程減免創傷後壓力(PTS) 症狀。PTS亦有可能透過社會選擇過程跟社會支持度減低相關。然而༌目前仍少有研究檢視災後社會支持度跟PTS的縱貫及雙向關連༌以及這些關連是否會因應不同類別的支持༈如情感、資料性和實質支持༉而生異༛本研究則以「加爾維斯敦灣康復研究」(Galveston Bay Recovery Study)的數據檢視以上關連。參與者(N = 658)於2008年的艾克颶風災難後2至6個月(W1)、5至9個月(W2)及 14至19 個月(W3)接受面談。我們採用跨時滯模型檢視各種支持類別跟PTS的縱貫關係。W1的情感支持跟W2 PTS有負向關連(估計值 = ‐.13, p = .007)༌符合社會因果過程。W1 PTS跟W2情感支持有負向關連(估計值 = ‐.14, p = .019)༌符合社會選擇過程。然而༌在其後的數據裡及在資料性支持和實質支持方面都無明顯路徑。結果反映༌災後的社會因果和社會選擇過程只發生於情感支持方面༌並會隨時間減弱。因此༌災後的治療服務應針對重建具支持性的社交網絡༌以減輕災難構成的精神傷害༌特別是對曾經歷悲痛的人士而言。 标题 : 天灾后社会支持跟创伤后压力症状的双向关系纵贯研究 撮要: 目前已有充分证据༌社会支持能透过社会因果过程减免创伤后压力(PTS) 症状。PTS亦有可能透过社会选择过程跟社会支持度减低相关。然而༌目前仍少有研究检视灾后社会支持度跟PTS的纵贯及双向关连༌以及这些关连是否会因应不同类别的支持༈如情感、数据性和实质支持༉而生异༛本研究则以「加尔维斯敦湾康复研究」(Galveston Bay Recovery Study)的数据检视以上关连。参与者(N = 658)于2008年的艾克飓风灾难后2至6个月(W1)、5至9个月(W2)及 14至19 个月(W3)接受面谈。我们采用跨时滞模型检视各种支持类别跟PTS的纵贯关系。W1的情感支持跟W2 PTS有负向关连(估计值 = ‐.13, p = .007)༌符合社会因果过程。W1 PTS跟W2情感支持有负向关连(估计值 = ‐.14, p = .019)༌符合社会选择过程。然而༌在其后的数据里及在数据性支持和实质支持方面都无明显路径。结果反映༌灾后的社会因果和社会选择过程只发生于情感支持方面༌并会随时间减弱。因此༌灾后的治疗服务应针对重建具支持性的社交网络༌以减轻灾难构成的精神伤害༌特别是对曾经历悲痛的人士而言。

  May 10, 2016   doi: 10.1002/jts.22092   open full text
• PTSD and Romantic Relationship Satisfaction: Cluster‐ and Symptom‐Level Analyses.
  Nicole J. LeBlanc, Louise Dixon, Donald J. Robinaugh, Sarah E. Valentine, Hannah G. Bosley, Monica W. Gerber, Luana Marques.
  Journal of Traumatic Stress. May 09, 2016
  Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder‐level approach is problematic for trauma theorists who posit symptom‐level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist‐Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time‐lagged mixed‐effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom‐level mechanisms. SINTOMAS TEPT Y SATISFACCION EN LAS RELACIONES Estudios previos han demostrado asociaciones bidireccionales entre trastorno de estrés postraumático (TEPT) y la insatisfacción en las relaciones románticas. La mayoría de los estudios de asociación se han enfocado a nivel del trastorno, examinando las asociaciones entre la insatisfacción en las relaciones y el diagnostico TEPT o los puntajes totales de los síntomas TEPT. Esta aproximación a nivel de trastorno es problemático dado que los teóricos de trauma frecuentemente proponen mecanismos a nivel de los síntomas para estos efectos. En este estudio, examinamos las asociaciones bidireccionales prospectivas entre los grupos de síntomas TEPT (ej. Re experimentar) y la satisfacción en las relaciones usando datos de 101 sobrevivientes de accidentes de vehículos motorizados (AVM) recientes que habían sido previamente estudiados. Luego realizamos análisis exploratorios examinando las asociaciones bidireccionales prospectivas entre síntomas individuales TEPT y la satisfacción en las relaciones. Los participantes completaron cuestionarios (Lista de chequeo TEPT en versión civil y escala de evaluación de relaciones) a 1, 10 y 16 semanas post trauma. Realizamos regresiones de efectos mixtos retardados para examinar los efectos de la satisfacción retardada en los síntomas y grupos de síntomas TEPT, y viceversa. El efecto de grupo no fue significativa después de la corrección de la tasa de falso descubrimiento. La satisfacción en las relaciones predijeron prospectivamente la disminución de la revivencia del trauma (d = 0.42), adormecimiento emocional (d = 0.46), y la irritabilidad (d = 0.49). Estos hallazgos fueron consistentes con la conclusión que la satisfacción en las relaciones afecta el TEPT a través de mecanismos a nivel de los síntomas. 標題 : PTSD和戀愛關係滿足度༚聚類與症狀水平分析 撮要: 過往研究發現創傷後壓力症(PTSD)跟對戀愛關係不滿足有雙向關連༌這些關連研究很多都針對失常病症作評估༌檢視對關係不滿足跟PTSD診斷或PTSD症狀總分數的關係。這種以失常病症作評估的方法有不足之處༌因為創傷理論學者經常就影響作出症狀水平機制的假設。本研究透過101名近期的交通意外生還者曾被研究的數據༌檢視PTSD症狀聚類༈如再體驗症狀༉跟關係滿足度的預期雙向關連。然後༌我們採用探索分析檢視個別的PTSD症狀跟關係滿足度的預期雙向關連。參與者分別在創傷事件後第4、10和16個星期完成問卷評估༈PTSD檢查表普通版和關係評估量表༉。我們利用時滯混合效果迴歸法༌檢視時滯關係滿足度對PTSD症狀聚類和症狀的影響༌相反亦然。我們對錯誤發現率進行校正後༌並無發現顯著的聚類影響。對關係感到滿足能預測出再體驗創傷(d = 0.42)、情感麻木(d = 0.46)和躁性(d = 0.49)預期下降。這些發現反映關係滿足度會透過症狀水平機制影響PTSD。 标题 : PTSD和恋爱关系满足度༚聚类与症状水平分析 撮要: 过往研究发现创伤后压力症(PTSD)跟对恋爱关系不满足有双向关连༌这些关连研究很多都针对失常病症作评估༌检视对关系不满足跟PTSD诊断或PTSD症状总分数的关系。这种以失常病症作评估的方法有不足之处༌因为创伤理论学者经常就影响作出症状水平机制的假设。本研究透过101名近期的交通意外生还者曾被研究的数据༌检视PTSD症状聚类༈如再体验症状༉跟关系满足度的预期双向关连。然后༌我们采用探索分析检视个别的PTSD症状跟关系满足度的预期双向关连。参与者分别在创伤事件后第4、10和16个星期完成问卷评估༈PTSD检查表普通版和关系评估量表༉。我们利用时滞混合效果回归法༌检视时滞关系满足度对PTSD症状聚类和症状的影响༌相反亦然。我们对错误发现率进行校正后༌并无发现显著的聚类影响。对关系感到满足能预测出再体验创伤(d = 0.42)、情感麻木(d = 0.46)和躁性(d = 0.49)预期下降。这些发现反映关系满足度会透过症状水平机制影响PTSD。

  May 09, 2016   doi: 10.1002/jts.22100   open full text
• Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort.
  Benjamin N. Breyer, Shona C. Fang, Karen H. Seal, Gayatri Ranganathan, Brian P. Marx, Terence M. Keane, Raymond C. Rosen.
  Journal of Traumatic Stress. April 29, 2016
  We sought to determine whether posttraumatic stress disorder (PTSD) was associated with sexual health in returned warzone‐deployed veterans from the recent Iraq and Afghanistan conflicts. We studied 1,581 males and females from the Veterans After‐Discharge Longitudinal Registry, a gender‐balanced U.S. Department of Veterans Affairs registry of health care‐seeking veterans with and without PTSD. Approximately one quarter (25.1%) of males (n = 198) and 12.7% of females (n = 101) had a sexual dysfunction diagnosis and/or prescription treatment for sexual dysfunction. Both genders were more likely to have a sexual dysfunction diagnosis and/or prescription treatment if they had PTSD compared with those without PTSD (male: 27.3% vs. 21.1%, p = .054; female: 14.9% vs. 9.4%, p = .022). Among the 1,557 subjects analyzed here, males with PTSD had similar levels of sexual activity compared to those without PTSD (71.2% vs. 75.4%, p = .22), whereas females with PTSD were less likely to be sexually active compared to females without PTSD (58.7% vs. 72.1%, p < .001). Participants with PTSD were also less likely to report sex‐life satisfaction (male: 27.6% vs. 46.0%, p < .001; female: 23.0% vs. 45.7%, p < .001) compared with those without PTSD. Although PTSD was not associated with sexual dysfunction after adjusting for confounding factors, it was significantly negatively associated with sex‐life satisfaction in female veterans with a prevalence ratio of .71, 95% confidence interval [.57, .90]. Calidad de vida sexual y TEPT en Veteranos de Guerra Buscamos determinar si el Trastorno por Estrés Postraumático (TEPT) se asociaba con la salud sexual en veteranos desplegados en zona de guerra, a su regreso desde los conflictos recientes de Iraq y Afganistán. Estudiamos 1.581 hombres y mujeres del Registro Longitudinal de Veteranos Post‐Descarga (VALOR, por sus siglas en inglés), un registro balanceado por género de veteranos que solicitan atención de salud en VA, con y sin TEPT. Aproximadamente un cuarto (25,1%) de los hombres (n = 198) y 12,7% de las mujeres (n = 101) tenían un diagnóstico de disfunción sexual y/o tratamiento de prescripción para una disfunción sexual. En ambos géneros era más probable tener un diagnóstico y/o tratamiento por una disfunción sexual si tenían TEPT, comparados con aquellos sin TEPT (hombres: 27,3% vs 21,1%, p = .054; mujeres: 14,9% vs 9,4%, p = .022). Entre los 1.557 sujetos analizados, los hombres con TEPT tenían niveles similares de actividad sexual comparado a aquellos sin TEPT (71,2% vs 75,4%, p = .22), mientras que las mujeres con TEPT eran menos propensas a ser sexualmente activas comparadas con las mujeres sin TEPT. (58,7% vs 72,1%, p< .001). Los participantes con TEPT tenían además menor probabilidad de reportar una vida sexual satisfactoria (hombres: 27,6% vs 46,0%, p<.001; mujeres: 23,0% vs 45,7%, p<.001) comparado con aquellos sin TEPT. A pesar de que el TEPT no se asoció a disfunción sexual luego de ajustarlo por factores de confusión, estuvo asociado significativamente en forma negativa con una vida sexual satisfactoria en veteranas mujeres con una tasa de prevalencia de .71 [IC 95% : .57, .90]. 標題 : 有和無PTSD的伊拉克和阿富汗退役男女軍人的性健康༚VALOR世代研究 撮要: 本研究旨在檢視於近年伊拉克和阿富汗戰爭中服役的戰鬥軍人༌其創傷後壓力症(PTSD)是否跟退役後的性健康相關。退役軍人縱貫研究登記處(VALOR)有男女相等的數據紀錄༌包含有和無PTSD的退役軍人到退伍軍人事務所尋求治療的紀錄。我們從VALOR 找出1581名男性和女性進行研究。約四分一(25.1%)男性(n = 198)和12.7%女性(n = 101)被診斷有性功能障礙和༏或得到性功能障礙的處方治療。不論男女༌曾患PTSD比無PTSD的人有較大機會被診斷有性功能障礙和༏或得到性功能障礙治療(男性: 27.3% 比 21.1%, p = .054; 女性: 14.9% 比 9.4%, p = .022)。1557名被研究的樣本裡༌有PTSD的男性跟無PTSD的男性有相近水平的性行為(71.2% 比 75.4%, p = .22)༌而有PTSD的女性比無PTSD的女性有較少性行為(58.7% 比 72.1%, p < .001)。比起無PTSD的參與者༌有PTSD的參與者性生活滿足感較低(男性: 27.6% 比 46.0%, p < .001; 女性: 23.0% 比 45.7%, p < .001)。我們對混亂因素進行調節後༌發現PTSD跟性功能障礙並無關連༌但在女性退役軍人當中༌PTSD顯著地跟性生活滿足感有負向關連༌普遍比率為.71 [95% CI .57, .90]。 标题 : 有和无PTSD的伊拉克和阿富汗退役男女军人的性健康༚VALOR世代研究 撮要: 本研究旨在检视于近年伊拉克和阿富汗战争中服役的战斗军人༌其创伤后压力症(PTSD)是否跟退役后的性健康相关。退役军人纵贯研究登记处(VALOR)有男女相等的数据纪录༌包含有和无PTSD的退役军人到退伍军人事务所寻求治疗的纪录。我们从VALOR 找出1581名男性和女性进行研究。约四分一(25.1%)男性(n = 198)和12.7%女性(n = 101)被诊断有性功能障碍和༏或得到性功能障碍的处方治疗。不论男女༌曾患PTSD比无PTSD的人有较大机会被诊断有性功能障碍和༏或得到性功能障碍治疗(男性: 27.3% 比 21.1%, p = .054; 女性: 14.9% 比 9.4%, p = .022)。1557名被研究的样本里༌有PTSD的男性跟无PTSD的男性有相近水平的性行为(71.2% 比 75.4%, p = .22)༌而有PTSD的女性比无PTSD的女性有较少性行为(58.7% 比 72.1%, p < .001)。比起无PTSD的参与者༌有PTSD的参与者性生活满足感较低(男性: 27.6% 比 46.0%, p < .001; 女性: 23.0% 比 45.7%, p < .001)。我们对混乱因素进行调节后༌发现PTSD跟性功能障碍并无关连༌但在女性退役军人当中༌PTSD显著地跟性生活满足感有负向关连༌普遍比率为.71 [95% CI .57, .90]。

  April 29, 2016   doi: 10.1002/jts.22097   open full text
• Social Causation Versus Social Erosion: Comparisons of Causal Models for Relations Between Support and PTSD Symptoms.
  Sandra L. Shallcross, Paul A. Arbisi, Melissa A. Polusny, Mark D. Kramer, Christopher R. Erbes.
  Journal of Traumatic Stress. April 14, 2016
  Social support is a robust correlate of posttraumatic stress disorder (PTSD) symptoms and of general psychological distress (Ozer, Best, Lipsey, & Weiss, 2003). The nature of the causal relationship between support and PTSD remains the subject of debate, with 2 models, social erosion and social causation, often used to explain findings. Despite extensive research using these models, no studies of which we are aware have included tests of both models within the same series of analyses, across more than 2 time points, in veterans. These competing models were tested in a sample of National Guard soldiers (N = 521) who completed measures of perceived social support and the PTSD Checklist‐Military version (Weathers, Litz, Herman, Huska, & Keane, 1993) at 3 months, 15 months, and 27 months following a combat deployment to Iraq. Analyses were run separately for overall PTSD symptoms and the PTSD components of intrusion, trauma‐avoidance, dysphoria, and hyperarousal. Both the social erosion (βs ranging from −.10 to −.19) and social causation (βs ranging from −.08 to −.13) hypotheses were supported. Results suggested PTSD‐specific symptom dimensions may both erode and be influenced by social support, whereas general psychological distress erodes social support. Implications for clinical intervention and research are discussed. LA CAUSALIDAD SOCIAL FRENTE A LA EROSIÓN SOCIAL El apoyo social tiene una fuerte correlación con los síntomas de estrés postraumático (TEPT) y con los trastornos psicológicos en general (Ozer, Best, Lipsey, y Weiss, 2003). La naturaleza de la relación causal entre el apoyo social y TEPT es sujeto de debate, con 2 modelos, el de erosión social y de causalidad social, usados con frecuencia para explicar los hallazgos. A pesar de la extensa investigación usando estos modelos, no hay estudios de los que tengamos conocimientos, en veteranos, que hayan incluido pruebas de ambos modelos con la misma serie de análisis, a través de más de dos puntos de tiempo. Estos modelos competitivos fueron probados en una muestra de soldados de la Guardia Nacional (N = 521) quienes completaron las mediciones del apoyo social percibido y la lista de chequeo para TEPT‐ versión militar, a los 3 meses, 15 meses, y 27 meses seguidos al desplazamiento de combate en Iraq. Los análisis se ejecutaron separadamente para los síntomas generales de TEPT y los componentes de intrusión, evitación relacionada con el trauma, disforia e hiperalerta del TEPT. Ambas hipótesis, tanto la erosión social (rangos ßs desde ‐.10 a ‐.19) como la causalidad social (rangos ßs desde ‐.08 a ‐.13) tuvieron soporte. Los resultados sugieren que las dimensiones de síntomas específicos de TEPT pueden tanto erosionar como ser influenciados por el apoyo social, mientras que los trastornos psicológicos en general erosionan el apoyo social. Se discuten las implicancias para las intervenciones clínicas e investigación. 標題 : 社會因果論和社會蠶蝕論༚用以解釋社會支持和PTSD症狀關連的因果模型比較 撮要: 社會支持是創傷後壓力症(PTSD)症狀及一般心理悲痛的強勁相關因素(Ozer, Best, Lipsey, & Weiss, 2003)。PTSD跟社會支持的因果關係本質仍具爭議性༛一般研究常以社會蠶蝕論和社會因果論兩種模型來解釋發現。目前雖有大量研究使用兩種模型༌但仍無針對退役軍人的研究在同一系列並多於兩個時點的分析中༌包含兩種模型的測試。本研究透過美國國民警衛隊組成的樣本(N = 521)༌測試這兩個相對的模型。樣本於完成伊拉克戰役後第3、15和27個月༌進行社會支持度感知的測量和完成PTSD檢查表(軍人版)。研究分別對整體的PTSD症狀、PTSD裡的侵擾、迴避創傷、不安和過度激發成份作個別分析。社會蠶蝕論(βs值域為 ‐.10 至 ‐.19)和社會因果論模型(βs值域為‐.08 至 ‐.13)的假設都合適。結果指出༌PTSD的特殊症狀既有可能蠶蝕社會支持༌又可能受社會支持影響༛而一般心理悲痛會蠶蝕社會支持。研究亦有討論這些發現對日後的臨床干預治療和研究有何幫助。 标题 : 社会因果论和社会蚕蚀论༚用以解释社会支持和PTSD症状关连的因果模型比较 撮要: 社会支持是创伤后压力症(PTSD)症状及一般心理悲痛的强劲相关因素(Ozer, Best, Lipsey, & Weiss, 2003)。PTSD跟社会支持的因果关系本质仍具争议性༛一般研究常以社会蚕蚀论和社会因果论两种模型来解释发现。目前虽有大量研究使用两种模型༌但仍无针对退役军人的研究在同一系列并多于两个时点的分析中༌包含两种模型的测试。本研究透过美国国民警卫队组成的样本(N = 521)༌测试这两个相对的模型。样本于完成伊拉克战役后第3、15和27个月༌进行社会支持度感知的测量和完成PTSD检查表(军人版)。研究分别对整体的PTSD症状、PTSD里的侵扰、回避创伤、不安和过度激发成份作个别分析。社会蚕蚀论(βs值域为 ‐.10 至 ‐.19)和社会因果论模型(βs值域为‐.08 至 ‐.13)的假设都合适。结果指出༌PTSD的特殊症状既有可能蚕蚀社会支持༌又可能受社会支持影响༛而一般心理悲痛会蚕蚀社会支持。研究亦有讨论这些发现对日后的临床干预治疗和研究有何帮助。

  April 14, 2016   doi: 10.1002/jts.22086   open full text
• Numbing of Positive, Negative, and General Emotions: Associations With Trauma Exposure, Posttraumatic Stress, and Depressive Symptoms Among Justice‐Involved Youth.
  Patricia K. Kerig, Diana C. Bennett, Shannon D. Chaplo, Crosby A. Modrowski, Andrew B. McGee.
  Journal of Traumatic Stress. April 14, 2016
  Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD), particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5; American Psychiatric Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders, particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at‐risk adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD symptoms (total R2 = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms (total R2 = .24). Further tests using Hayes’ Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger, 95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.

  April 14, 2016   doi: 10.1002/jts.22087   open full text
• Treatment of Mental or Physical Health Problems in a Combat Zone: Comparisons of Postdeployment Mental Health and Early Separation From Service.
  Terry L. Conway, Emily A. Schmied, Gerald E. Larson, Michael R. Galarneau, Paul S. Hammer, Kimberly H. Quinn, Kimberly J. Schmitz, Jennifer A. Webb‐Murphy, Wayne C. Boucher, Nathan K. Edwards, Hoa L. Ly.
  Journal of Traumatic Stress. March 18, 2016
  The primary aim of this study was to evaluate whether being treated for mental health or nonbattle physical injury during military combat deployment was associated with higher risk for postdeployment mental disorders and poorer career outcomes than seen in the general combat‐deployed population. Service members treated in theater for mental health (n = 964) or noncombat injury (n = 853) were compared with randomly sampled personnel (n = 7,220) from the general deployed population on diagnosed mental disorders and early separation from service. Deployment, medical, and career information were obtained from Department of Defense archival databases. Over half of the personnel who received mental health treatment while deployed were diagnosed with 1 or more mental disorders postdeployment and/or were separated from service before completing their full‐term enlistment. This was significantly higher than expected compared to the general deployed group, adjusting for demographic/military characteristics and mental health history (adjusted odds ratios [ORs] ranging 1.62 to 2.96). Frequencies of problems also were higher in the mental health‐treated group than in the group treated for nonbattle physical injuries (significant adjusted ORs ranging 1.65 to 2.58). The documented higher risks for postdeployment adjustment problems suggested that especially those treated in theater by mental health providers might benefit from postdeployment risk‐reduction programs. Tratamiento de los Problemas de Salud en Combate El objetivo primario fue evaluar si el ser tratado por salud mental o heridas físicas extra‐batalla durante el despliegue de combate militar se asociaba a mayor riesgo de trastornos mentales post‐despliegue y peores resultados en sus carreras que los vistos en la población general desplegada en combate. Miembros del servicio tratados en el escenario de guerra por salud mental (n = 964) o heridas extra‐combate ( = 853) fueron comparados con personal seleccionado al azar de la población general en despliegue (n = 7220), respecto a trastornos mentales diagnosticados y separación precoz del servicio. La información de despliegue, médica y de carrera fue obtenida de la base de datos de archivo del Departamento de Defensa. Más de la mitad del personal que recibió tratamiento de salud mental durante su despliegue fueron diagnosticados con uno o más trastornos mentales post‐despliegue y/o fueron separados del servicio antes de completar su alistamiento de tiempo completo. Esto fue significativamente mayor a lo esperado comparado al grupo general de despliegue, ajustando por características demográficas/militares y por historia de salud mental [OR en rango de 1.62 a 2.96]. Las frecuencias de problemas también fueron mayores en el grupo tratado por salud mental que en el grupo tratado por heridas físicas extra‐batalla (OR ajustados significativos, 1.65 a 2.58). Los altos riesgos documentados para problemas de adaptación post‐despliegue sugirió que especialmente aquellos tratados en el escenario de guerra por proveedores de salud mental se podrían beneficiar de programas de reducción de riesgo post‐despliegue. 標題 : 戰區的心理和身體治療༚比較退役後的心理狀況和提前退役的關係 撮要: 本研究主要目的為評估戰鬥軍人服役時因心理問題或非戰爭受傷而接受治療༌是否跟退役後比一般戰鬥軍人有較高風險患精神失常、有較差的就業結果相關。研究檢視因心理問題(n = 964)或非戰爭受傷(n = 853)而接受治療的軍人༌ 及隨機抽樣的一般服役人口(n = 7,220)༌比較他們的精神失常診斷數據和提前退役數據。研究從美國國防部檔案數據庫取得軍人的服役、醫療和就業資料。超過一半服役時曾接受心理治療的人口༌退役後被診斷出有一種或以上精神失常༌以及༏或未完成役期就需提前退役༛其與一般服役人口的差異比預期顯著較高。本研究因應人口統計特徵、軍事特徵及過往精神病歷作調節[調整後機會比例值域為 1.62 至 2.96]。與因非戰爭受傷而接受治療的人口相比༌接受心理治療的人口面對問題的頻次夠高༈調整後機會比例顯著༌值域為 1.65 至 2.58༉。研究找出了退役後有較高風險面對適應問題的人口類別༌並指出服役時曾接受心理治療的人應特別受惠於為退役軍人而設的減低風險治療計劃。 标题 : 战区的心理和身体治疗༚比较退役后的心理状况和提前退役的关系 撮要: 本研究主要目的为评估战斗军人服役时因心理问题或非战争受伤而接受治疗༌是否跟退役后比一般战斗军人有较高风险患精神失常、有较差的就业结果相关。研究检视因心理问题(n = 964)或非战争受伤(n = 853)而接受治疗的军人༌ 及随机抽样的一般服役人口(n = 7,220)༌比较他们的精神失常诊断数据和提前退役数据。研究从美国国防部档案数据库取得军人的服役、医疗和就业资料。超过一半服役时曾接受心理治疗的人口༌退役后被诊断出有一种或以上精神失常༌以及༏或未完成役期就需提前退役༛其与一般服役人口的差异比预期显著较高。本研究因应人口统计特征、军事特征及过往精神病历作调节[调整后机会比例值域为 1.62 至 2.96]。与因非战争受伤而接受治疗的人口相比༌接受心理治疗的人口面对问题的频次够高༈调整后机会比例显著༌值域为 1.65 至 2.58༉。研究找出了退役后有较高风险面对适应问题的人口类别༌并指出服役时曾接受心理治疗的人应特别受惠于为退役军人而设的减低风险治疗计划。

  March 18, 2016   doi: 10.1002/jts.22091   open full text
• Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003–2012.
  Alice E. Welch, Kimberly Caramanica, Carey B. Maslow, Robert M. Brackbill, Steven D. Stellman, Mark R. Farfel.
  Journal of Traumatic Stress. March 08, 2016
  Group‐based trajectory modeling was used to explore empirical trajectories of symptoms of posttraumatic stress disorder (PTSD) among 17,062 adult area residents/workers (nonrescue/recovery workers) enrolled in the World Trade Center (WTC) Health Registry using 3 administrations of the PTSD Checklist (PCL) over 9 years of observation. Six trajectories described PTSD over time: low‐stable (48.9%), moderate‐stable (28.3%), moderate‐increasing (8.2%), high‐stable (6.0%), high‐decreasing (6.6 %), and very high‐stable (2.0%). To examine factors associated with improving or worsening PTSD symptoms, groups with similar intercepts, but different trajectories were compared using bivariate analyses and logistic regression. The adjusted odds of being in the moderate‐increasing relative to the moderate‐stable group were significantly greater among enrollees reporting low social integration (OR = 2.18), WTC exposures (range = 1.34 to 1.53), job loss related to the September 11, 2001 disaster (OR = 1.41), or unmet mental health need/treatment (OR = 4.37). The odds of being in the high‐stable relative to the high‐decreasing group were significantly greater among enrollees reporting low social integration (OR = 2.23), WTC exposures (range = 1.39 to 1.45), or unmet mental health need/treatment (OR = 3.42). The influence of severe exposures, scarce personal/financial resources, and treatment barriers on PTSD trajectories suggest a need for early and ongoing PTSD screening postdisaster.

  March 08, 2016   doi: 10.1002/jts.22090   open full text
• Psychosocial Pathways Linking Adverse Childhood Experiences to Mental Health in Recently Deployed Canadian Military Service Members.
  Jennifer E.C. Lee, Brigitte Phinney, Kimberley Watkins, Mark A. Zamorski.
  Journal of Traumatic Stress. March 08, 2016
  Multiple pathways have been suggested to account for the relationship of adverse childhood experiences (ACEs) and well‐being in adulthood, including interpersonal difficulties, the underestimation of one's sense of mastery, and a greater propensity to experience stressors later in life. This study was conducted to examine the association between ACEs and mental health in Canadian Armed Forces (CAF) personnel, and the possible mediating roles of social support, mastery, and combat stressors in that relationship. The study consisted of a prospective analysis involving 3,319 CAF members upon their return from an overseas deployment. Results were that ACEs were associated with poorer mental health (β = −.14, p < .001) and that approximately 42.6% of this relationship could be explained by the mediating effects of low social support, low mastery, and a greater number of combat stressors. The full model, including the covariates, ACEs, social support, mastery, and combat stressors as correlates of postdeployment mental health, was statistically significant with adjusted R2 = .28, F(9, 3309) = 141.96, p < .001. On the whole, results suggested that social support, mastery, and life stressors may be possible targets for interventions to minimize the impact of ACEs on later mental health in military personnel. EAI y Desplazamiento Militar Multiples factores han sido sugeridos para dar cuenta de la relación entre experiencias adversas en la infancia (EAI) y bienestar en la adultez, incluyendo dificultades interpersonales, la subestimación del sentido de la propia maestría, y una mayor propensión a experimentar estresores más tarde en la vida. Este estudio fue conducido para examinar la asociación entre EAI y la salud mental en el personal de las Fuerzas Armadas Canadienses (CAF), y los posibles roles mediadores de soporte social, maestría, y estresores de combate en esta relación. Consistió en un análisis prospectivo que implicaba a 3.319 miembros CAF sobre su regreso de un despliegue internacional de ultramar. Los resultados revelaron que EIA estaban relacionadas con peor salud mental (β = ‐.14, p <.001) y que aproximadamente el 42.6% de esta relación podría explicarse por los efectos mediadores del bajo soporte social, baja maestría, y un mayor número de estresores. El modelo completo, incluyendo las covariables, EAI, soporte social, maestría, y estresores de combate como predictores de salud mental postdespliegue, fue estadísticamente significativo con R2 = .28 ajustada, F (9,3309) = 141.96, p <.001. En términos globales, los resultados sugieren que bajo apoyo social, baja maestría, y estresores vitales pueden ser posibles objetivos para intervenciones que minimicen el impacto de EAI en la salud mental posterior en el personal militar. 標題 : 剛完成服役的軍人中不良童年經歷跟心理健康的心理社會連結路徑 撮要: 過往研究曾提出多種路徑以解釋不良童年經歷(ACE)跟成年健康之間的關係༌這些路徑包括人際交往問題、看輕自己的精通能力及日後有較大傾向經歷壓力源。本研究透過加拿大軍隊(CAF)的人口樣本༌檢視ACE跟心理健康的關連༌及檢視社會支持、精通能力和戰鬥壓力源在關連裡潛在的中介角色。研究採用前瞻性分析༌樣本為3,319名剛從海外服役完畢歸來的CAF成員。結果顯示ACE跟心理健康較差相關(β = ‐.14, p < .001)༌而這關連中約42.6%能被低社會支持度、低精通能力和壓力源較多的中介影響解釋。共變量、ACE、社會支持、精通能力和戰鬥壓力源等等組成退役後心理健康的預測變量༌整個模型具統計顯著性༌已調節R2 = .28, F(9, 3309) = 141.96, p < .001。研究結果反映༌若要把ACE對軍人日後的心理影響減至最低༌社會支持、精通能力和生活壓力源將是潛在的干預治療目標。 标题 : 刚完成服役的军人中不良童年经历跟心理健康的心理社会链接路径 撮要: 过往研究曾提出多种路径以解释不良童年经历(ACE)跟成年健康之间的关系༌这些路径包括人际交往问题、看轻自己的精通能力及日后有较大倾向经历压力源。本研究透过加拿大军队(CAF)的人口样本༌检视ACE跟心理健康的关连༌及检视社会支持、精通能力和战斗压力源在关连里潜在的中介角色。研究采用前瞻性分析༌样本为3,319名刚从海外服役完毕归来的CAF成员。结果显示ACE跟心理健康较差相关(β = ‐.14, p < .001)༌而这关连中约42.6%能被低社会支持度、低精通能力和压力源较多的中介影响解释。共变量、ACE、社会支持、精通能力和战斗压力源等等组成退役后心理健康的预测变量༌整个模型具统计显著性༌已调节R2 = .28, F(9, 3309) = 141.96, p < .001。研究结果反映༌若要把ACE对军人日后的心理影响减至最低༌社会支持、精通能力和生活压力源将是潜在的干预治疗目标。

  March 08, 2016   doi: 10.1002/jts.22085   open full text
• The Effectiveness of Eye Movement Desensitization and Reprocessing Therapy to Treat Symptoms Following Trauma in Timor Leste.
  Sarah J. Schubert, Christopher W. Lee, Guilhermina Araujo, Susan R. Butler, Graham Taylor, Peter D. Drummond.
  Journal of Traumatic Stress. March 02, 2016
  The effectiveness of eye movement desensitization and reprocessing (EMDR) therapy for treating trauma symptoms was examined in a postwar/conflict, developing nation, Timor Leste. Participants were 21 Timorese adults with symptoms of posttraumatic stress disorder (PTSD), assessed as those who scored ≥2 on the Harvard Trauma Questionnaire (HTQ). Participants were treated with EMDR therapy. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist. Symptom changes post‐EMDR treatment were compared to a stabilization control intervention period in which participants served as their own waitlist control. Sessions were 60–90 mins. The average number of sessions was 4.15 (SD = 2.06). Despite difficulties providing treatment cross‐culturally (i.e., language barriers), EMDR therapy was followed by significant and large reductions in trauma symptoms (Cohen's d = 2.48), depression (d = 2.09), and anxiety (d = 1.77). At posttreatment, 20 (95.2%) participants scored below the HTQ PTSD cutoff of 2. Reliable reductions in trauma symptoms were reported by 18 participants (85.7%) posttreatment and 16 (76.2%) at 3‐month follow‐up. Symptoms did not improve during the control period. Findings support the use of EMDR therapy for treatment of adults with PTSD in a cross‐cultural, postwar/conflict setting, and suggest that structured trauma treatments can be applied in Timor Leste. EFECTIVIDAD DE EMDR EN EL TRATAMIENTO DEL TRAUMA: TIMOR ORIENTAL Se evaluó la efectividad de la terapia de EMDR (desensibilización y reprocesamiento a través de los movimientos oculares) en tiempos de postguerra en la nación en vías de desarrollo de Timor Oriental. Los participantes fueron 23 timorenses adultos con síntomas de trastorno por estrés postraumático (TEPT), evaluados con el Cuestionario de Trauma de Harvard y que obtuvieron ≥ 2 puntos. De éstos, 21 fueron tratados con EMDR. Los síntomas depresivos y ansiosos fueron evaluados usando la Lista de Chequeo de Síntomas de Hopkins. Los cambios de síntomas post tratamiento EMDR se compararon con un periodo de intervención de control de estabilización en el que los participantes sirvieron como su propio control en la lista de espera. Las sesiones fueron de 60 a 90 minutos. El promedio de número de sesiones fue 4,15 (DS = 2,06). A pesar de las dificultades de proveer tratamiento transculturalmente (por ejemplo: barreras idiomáticas), EMDR fue seguido por una gran y significativa reducción en los síntomas de trauma (Cohen´s d = 2,48), depresión (d = 2.09) y ansiedad (d = 1,77). 20 de los participantes (95,2%) obtuvieron menos de 2 puntos en el Cuestionario de TEPT de Harvard. 18 de los participantes (85,7%) reportaron reducción confiable de los síntomas posterior al tratamiento y 16 (76,2%) a los 3 meses de seguimiento. Los síntomas no mejoraron durante el período de control. Los hallazgos apoyan el uso de EMDR como tratamiento en escenarios de conflicto/ post‐guerra, transcultural y sugieren que tratamientos estructurados para Trauma pueden ser aplicados en Timor Oriental. 標題 : 眼動減敏與歷程更新(EMDR)療法在東帝汶治療創傷症狀的效用 撮要: 本研究檢視在戰後的發展中國家──東帝汶裡༌眼動減敏與歷程更新 (EMDR)療法用以治療創傷症狀的效用。研究樣本為23名有創傷後壓力症 (PTSD) 症狀的東帝汶成人༌他們在哈佛創傷問卷(HTQ)裡得分>2。當中༌21名成人接受EMDR治療。我們以霍普金斯症狀檢查表評估樣本的抑鬱及焦慮症狀。研究比較EMDR治療後的症狀改變及穩定干預對照期的症狀改變。在穩定干預對照期༌參與者成為研究裡的等待對照組。治療節段為60至90分鐘༌平均節段數量為4.15 (SD = 2.06)。雖然提供治療時面對跨文化困難༈即語言障礙༉༌但創傷症狀(Cohen's d = 2.48)、抑鬱症狀(d = 2.09)及焦慮症狀(d = 1.77)都在EMDR治療後顯著地大幅減少。治療後༌20名參與者(95.2%)在HTQ的PTSD分數都低於2分的介定線。18名參與者(85.7%)的創傷症狀在治療後可靠地減少༛在完成治療三個月後的跟進調查裡༌16名參與者(76.2%)的創傷症狀可靠地減少。樣本在對照期的症狀並無改善。結果顯示༌在跨文化及戰後環境裡༌EMDR是對成人PTSD患者有效的療法。研究亦反映結構性創傷療法能用於東帝汶。 标题 : 眼动减敏与历程更新(EMDR)疗法在东帝汶治疗创伤症状的效用 撮要: 本研究检视在战后的发展中国家──东帝汶里༌眼动减敏与历程更新 (EMDR)疗法用以治疗创伤症状的效用。研究样本为23名有创伤后压力症 (PTSD) 症状的东帝汶成人༌他们在哈佛创伤问卷(HTQ)里得分>2。当中༌21名成人接受EMDR治疗。我们以霍普金斯症状检查表评估样本的抑郁及焦虑症状。研究比较EMDR治疗后的症状改变及稳定干预对照期的症状改变。在稳定干预对照期༌参与者成为研究里的等待对照组。治疗节段为60至90分钟༌平均节段数量为4.15 (SD = 2.06)。虽然提供治疗时面对跨文化困难༈即语言障碍༉༌但创伤症状(Cohen's d = 2.48)、抑郁症状(d = 2.09)及焦虑症状(d = 1.77)都在EMDR治疗后显著地大幅减少。治疗后༌20名参与者(95.2%)在HTQ的PTSD分数都低于2分的介定线。18名参与者(85.7%)的创伤症状在治疗后可靠地减少༛在完成治疗三个月后的跟进调查里༌16名参与者(76.2%)的创伤症状可靠地减少。样本在对照期的症状并无改善。结果显示༌在跨文化及战后环境里༌EMDR是对成人PTSD患者有效的疗法。研究亦反映结构性创伤疗法能用于东帝汶。

  March 02, 2016   doi: 10.1002/jts.22084   open full text
• Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military.
  Jeffrey Millegan, Lawrence Wang, Cynthia A. LeardMann, Derek Miletich, Amy E. Street.
  Journal of Traumatic Stress. February 24, 2016
  Although absolute counts of U.S. service men who experience sexual trauma are comparable to service women, little is known about the impact of sexual trauma on men. The association of recent sexual trauma (last 3 years) with health and occupational outcomes was investigated using longitudinal data (2004–2013) from the Millennium Cohort Study. Of 37,711 service men, 391 (1.0%) reported recent sexual harassment and 76 (0.2%) sexual assault. In multivariable models, sexual harassment or assault, respectively, was associated with poorer mental health: AOR = 1.60, 95% CI [1.22, 2.12], AOR = 4.39, 95% CI [2.40, 8.05]; posttraumatic stress disorder: AOR = 2.50, 95% CI [1.87, 3.33], AOR = 6.63, 95% CI [3.65, 12.06]; depression: AOR = 2.37, 95% CI [1.69, 3.33], AOR = 5.60, 95% CI [2.83, 11.09]; and multiple physical symptoms: AOR = 2.22, 95% CI [1.69, 2.92]; AOR = 3.57, 95% CI [1.98, 6.42], after adjustment for relevant covariates. Sexual harassment was also associated with poorer physical health: AOR = 1.68, 95% CI [1.27, 2.22]. Men who reported sexual trauma were more likely to have left military service: AOR = 1.60, 95% CI [1.14, 2.24], and be disabled/unemployed postservice: AOR = 1.76, 95% CI [1.02, 3.02]. Results suggest that sexual trauma was significantly associated with adverse health and functionality extending to postmilitary life. Findings support the need for developing better prevention strategies and services to reduce the burden of sexual trauma on service men.

  February 24, 2016   doi: 10.1002/jts.22081   open full text
• Consequences of the Diagnostic Criteria Proposed for the ICD‐11 on the Prevalence of PTSD in Children and Adolescents.
  Cedric Sachser, Lutz Goldbeck.
  Journal of Traumatic Stress. February 24, 2016
  In 2013, a working group of the World Health Organization (WHO) proposed a reformulation of the posttraumatic stress disorder (PTSD) diagnostic criteria for the upcoming 11th edition of the International Classification of Diseases (ICD‐11; Maercker, Brewin, Bryant, Cloitre, van Ommeren, et al., 2013). This study investigated the consequences of the proposed ICD‐11 PTSD symptom reduction on the prevalence of PTSD in children and adolescents. Prevalence rates of PTSD in a clinical sample of 159 traumatized children and adolescents were compared applying criteria according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV; American Psychiatric Association, 1994), the ICD‐10 (WHO, 1992), and the ICD‐11. The prevalence rate was 76.1% using DSM‐IV, 88.1% using ICD‐10, and 61.0% using ICD‐11. The use of the criteria proposed for ICD‐11 resulted in 27.1% less positive cases compared with ICD‐10 and 15.1% less positive cases compared with DSM‐IV. Our results showed that in a clinical sample of children and adolescents the prevalence of PTSD was significantly affected by the use of different diagnostic systems. This will constitute a major challenge for research and practice because, depending on the algorithm used, different groups of patients will be included in studies and different groups of individuals will be able to access medical care and therapy.

  February 24, 2016   doi: 10.1002/jts.22080   open full text
• The Cycle of Violence: Associations Between Exposure to Violence, Trauma‐Related Symptoms and Aggression—Findings from Congolese Refugees in Uganda.
  Tobias Hecker, Simon Fetz, Herbert Ainamani, Thomas Elbert.
  Journal of Traumatic Stress. October 14, 2015
  War‐related trauma exposure has been linked to aggression and enhanced levels of community and family violence, suggesting a cycle of violence. Reactive aggression—an aggressive reaction to a perceived threat—has been associated with posttraumatic stress disorder (PTSD). In contrast, appetitive aggression—a hedonic, intrinsically motivated form of aggression—seems to be negatively related to PTSD in offender and military populations. This study examined the associations between exposure to violence, trauma‐related symptoms and aggression in a civilian population. In semistructured interviews, 290 Congolese refugees were questioned about trauma exposure, PTSD symptoms, and aggression. War‐related trauma exposure correlated positively with exposure to family and community violence in the past month (r = .31, p < .001), and appetitive (r = .18, p = .002) and reactive aggression (r = .29, p < .001). The relationship between war‐related trauma exposure and reactive aggressive behavior was mediated by PTSD symptoms and appetitive aggression. In a multiple sequential regression analysis, trauma exposure (β = .43, p < .001) and reactive aggression (β = .36, p < .001) were positively associated with PTSD symptoms, whereas appetitive aggression was negatively associated (β = −.13, p = .007) with PTSD symptoms. Our findings were congruent with the cycle of violence hypothesis and indicate a differential relation between distinct subtypes of aggression and PTSD. Exposición a Trauma, TEPT y Agresión La exposición a traumas relacionados con guerras se ha asociado a agresión y aumentados niveles de violencia tanto doméstica como en la comunidad, sugiriéndose un ciclo de la violencia. La agresión reactiva‐ una reacción agresiva a una amenaza percibida‐ se ha asociado con trastorno por estrés post‐ traumático (TEPT). En contraste la agresión apetitiva‐ una forma de agresión motivada intrínsecamente, hedónica‐ pareciera estar relacionada negativamente a TEPT en delincuentes y población militar. Este estudio examinó las asociaciones entre exposición a la violencia, síntomas relacionados con trauma y agresión en una población civil. Doscientos noventa refugiados congoleses fueron evaluados, en entrevistas semiestructuradas, acerca de exposición a traumas, síntomas TEPT y agresión. La exposición a traumas relacionados con guerra se correlacionó positivamente con exposición a violencia en la familia y en la comunidad en el último mes (r = .29, p<.001); agresión apetitiva (r = .18, p = .002) y agresión reactiva (r = .29, p<001). La relación entre exposición a traumas relacionados con guerras y conducta agresiva reactiva estuvo mediada por síntomas de TEPT y agresión apetitiva. En un análisis de regresión secuencial múltiple, la exposición a trauma (B = .43, p<.001) y agresión reactiva (B = . 36, p<.001) se asociaron positivamente con síntomas de TEPT, mientras que agresión apetitiva se asoció negativamente (B = ‐.36, p = .007) con síntomas de TEPT. Nuestros hallazgos fueron congruentes con la hipótesis del ciclo de la violencia e indica una relación diferencial entre distintos subtipos de agresión y TEPT. 標題 : 「暴力循環」༚暴力經歷、與創傷相關的失常和攻擊行為──有關烏干達的剛果難民研究發現 撮要: 過往研究發現戰爭相關的創傷經歷跟攻擊行為及社群與家庭暴力增加相關༌暗示當中可能存在暴力循環。反應式攻擊乃對感知到的威脅作出攻擊反應༌跟創傷後壓力症(PTSD)有關༛慾求式攻擊乃內在推動、具享受性的攻擊行為༌似乎在攻擊者和軍事人口裡跟PTSD有負向關連。本研究檢視一般人口的暴力經歷、與創傷相關的症狀及攻擊行為。研究透過半結構式面談༌訪問290名剛果難民的創傷經歷、PTSD症狀和攻擊行為。戰爭相關的創傷經歷跟過去一個月的社群與家庭暴力經歷有正向關連(r = .31, p < .001)༌跟慾求式攻擊(r = .18, p = .002)及反應式攻擊(r = .29, p < .001)亦有正向關連。戰爭相關的創傷經歷與反應式攻擊行為的關係受PTSD症狀和慾求式攻擊仲介影響。多重時序迴歸分析顯示༌創傷經歷(β = .43, p < .001)和反應式攻擊(β = .36, p < .001)跟PTSD症狀有正向關連༛而慾求式攻擊(β = ‐.13, p = .007) 跟PTSD症狀有負向關連。研究發現跟「暴力循環」的假設相符༌顯示不同種類的攻擊行為跟PTSD有差別關係。 标题 : 「暴力循环」༚暴力经历、与创伤相关的失常和攻击行为──有关乌干达的刚果难民研究发现 撮要: 过往研究发现战争相关的创伤经历跟攻击行为及社群与家庭暴力增加相关༌暗示当中可能存在暴力循环。反应式攻击乃对感知到的威胁作出攻击反应༌跟创伤后压力症(PTSD)有关༛欲求式攻击乃内在推动、具享受性的攻击行为༌似乎在攻击者和军事人口里跟PTSD有负向关连。本研究检视一般人口的暴力经历、与创伤相关的症状及攻击行为。研究透过半结构式面谈༌访问290名刚果难民的创伤经历、PTSD症状和攻击行为。战争相关的创伤经历跟过去一个月的社群与家庭暴力经历有正向关连(r = .31, p < .001)༌跟欲求式攻击(r = .18, p = .002)及反应式攻击(r = .29, p < .001)亦有正向关连。战争相关的创伤经历与反应式攻击行为的关系受PTSD症状和欲求式攻击中介影响。多重时序回归分析显示༌创伤经历(β = .43, p < .001)和反应式攻击(β = .36, p < .001)跟PTSD症状有正向关连༛而欲求式攻击(β = ‐.13, p = .007) 跟PTSD症状有负向关连。研究发现跟「暴力循环」的假设相符༌显示不同种类的攻击行为跟PTSD有差别关系。

  October 14, 2015   doi: 10.1002/jts.22046   open full text
• Technology‐Enhanced Stepped Collaborative Care Targeting Posttraumatic Stress Disorder and Comorbidity After Injury: A Randomized Controlled Trial.
  Douglas Zatzick, Stephen S. O'Connor, Joan Russo, Jin Wang, Nigel Bush, Jeff Love, Roselyn Peterson, Leah Ingraham, Doyanne Darnell, Lauren Whiteside, Erik Eaton.
  Journal of Traumatic Stress. October 14, 2015
  Posttraumatic stress disorder (PTSD) and its comorbidities are endemic among injured trauma survivors. Previous collaborative care trials targeting PTSD after injury have been effective, but they have required intensive clinical resources. The present pragmatic clinical trial randomized acutely injured trauma survivors who screened positive on an automated electronic medical record PTSD assessment to collaborative care intervention (n = 60) and usual care control (n = 61) conditions. The stepped measurement‐based intervention included care management, psychopharmacology, and psychotherapy elements. Embedded within the intervention were a series of information technology (IT) components. PTSD symptoms were assessed with the PTSD Checklist at baseline prerandomization and again, 1‐, 3‐, and 6‐months postinjury. IT utilization was also assessed. The technology‐assisted intervention required a median of 2.25 hours (interquartile range = 1.57 hours) per patient. The intervention was associated with modest symptom reductions, but beyond the margin of statistical significance in the unadjusted model: F(2, 204) = 2.95, p = .055. The covariate adjusted regression was significant: F(2, 204) = 3.06, p = .049. The PTSD intervention effect was greatest at the 3‐month (Cohen's effect size d = 0.35, F(1, 204) = 4.11, p = .044) and 6‐month (d = 0.38, F(1, 204) = 4.10, p = .044) time points. IT‐enhanced collaborative care was associated with modest PTSD symptom reductions and reduced delivery times; the intervention model could potentially facilitate efficient PTSD treatment after injury. El Trastorno por Estrés Postraumático y sus comorbilidades son endémicas entre los sobrevivientes heridos traumáticamente. Ensayos colaborativos previos de atención del TEPT han sido efectivos, pero han requerido de muchos recursos clínicos. El presente ensayo práctico randomizó sobrevivientes heridos traumáticamente en forma aguda quienes dieron positivo en un registro médico electrónico automatizado que evalúa TEPT para una intervención de atención colaborativa (n = 60) y atención usual (n = 61). La intervención basada en mediciones escalonadas incluyó elementos de gestión de la atención, psicofarmacológicos y psicoterapéuticos .Dentro de la intervención se consideró una serie de componentes de tecnología de la información. Los síntomas de TEPT fueron evaluados a través de una lista de cotejo para TEPT, previo a la randomización y nuevamente después de 1, 3 y 6 meses de la injuria. También fue evaluado el uso de la tecnología de la información. La intervención de asistencia tecnológica requirió una media de 2.25 horas (rango intercuartil = 1,57 horas) por paciente. La intervención se asoció con reducciones modestas de síntomas, pero más allá del margen de significación estadística en el modelo no ajustado: f (2.204) = 3.06, p = .049. El efecto de la intervención en TEPT fue mayor en el tercer mes, el tamaño de efecto Cohen d = 0,35, F (1,204) = 4,11, p = .044 puntos de tiempo. La atención de colaboración mejorada con la tecnología de la información se asoció con una modesta disminución de síntomas y plazos de entrega reducidos. El modelo de intervención podría facilitar la eficiencia en el tratamiento del TEPT después de la lesión. 標題 : 針對受傷後的創傷後壓力症及共病༚科技加強的逐步合作療法隨機對照試驗 撮要: 創傷後壓力症(PTSD)及其共病多發生於受傷的創傷生還者中。過往針對受傷後PTSD的合作療法試驗雖有效༌但需用到密集的臨床資源。是次臨床試驗務實地透過電腦醫療紀錄自動的PTSD評估༌從篩選結果為正的人口裡༌隨機抽取並分派受傷的創傷生還者到兩個治療組別༚合作干預療法(n = 60)和一般治療對照(n = 61)。以測量為本的逐步干預療法包括治療管理、精神藥理學、心理治療元素及一系列資訊科技。研究利用PTSD檢查表༌在隨機分派前的基線及受傷後一、三和六個月評估患者的PTSD症狀。研究亦評估療法的資訊科技使用。為每位患者提供以科技輔助進行的干預所需小時中位數為2.25(四分位距為 1.57 小時)。在未經調節的模型༌干預跟症狀少量減輕相關༌但量值超越了統計顯著性༚F(2, 204) = 2.95, p = .055。已調節共變量的迴歸結果顯著༚F(2, 204) = 3.06, p = .049。PTSD干預於受傷後第三個月༈Cohen's 效應量 d = 0.35, F(1, 204) = 4.11, p = .044༉及第六個月༈d = 0.38, F(1, 204) = 4.10, p = .044༉最有效。資訊科技加強的合作療法跟PTSD症狀少量減輕和提供治療時間縮短有關。這個干預模型可能促進發展有效針對受傷後PTSD的治療。 标题 : 针对受伤后的创伤后压力症及共病༚科技加强的逐步合作疗法随机对照试验 撮要: 创伤后压力症(PTSD)及其共病多发生于受伤的创伤生还者中。过往针对受伤后PTSD的合作疗法试验虽有效༌但需用到密集的临床资源。是次临床试验务实地透过计算机医疗纪录自动的PTSD评估༌从筛选结果为正的人口里༌随机抽取并分派受伤的创伤生还者到两个治疗组别༚合作干预疗法(n = 60)和一般治疗对照(n = 61)。以测量为本的逐步干预疗法包括治疗管理、精神药理学、心理治疗元素及一系列信息科技。研究利用PTSD检查表༌在随机分派前的基线及受伤后一、三和六个月评估患者的PTSD症状。研究亦评估疗法的信息科技使用。为每位患者提供以科技辅助进行的干预所需小时中位数为2.25(四分位距为 1.57 小时)。在未经调节的模型༌干预跟症状少量减轻相关༌但量值超越了统计显著性༚F(2, 204) = 2.95, p = .055。已调节共变量的回归结果显著༚F(2, 204) = 3.06, p = .049。PTSD干预于受伤后第三个月༈Cohen's 效应量 d = 0.35, F(1, 204) = 4.11, p = .044༉及第六个月༈d = 0.38, F(1, 204) = 4.10, p = .044༉最有效。信息科技加强的合作疗法跟PTSD症状少量减轻和提供治疗时间缩短有关。这个干预模型可能促进发展有效针对受伤后PTSD的治疗。

  October 14, 2015   doi: 10.1002/jts.22041   open full text
• Randomized Controlled Trial of Online Expressive Writing to Address Readjustment Difficulties Among U.S. Afghanistan and Iraq War Veterans.
  Nina A. Sayer, Siamak Noorbaloochi, Patricia A. Frazier, James W. Pennebaker, Robert J. Orazem, Paula P. Schnurr, Maureen Murdoch, Kathleen F. Carlson, Amy Gravely, Brett T. Litz.
  Journal of Traumatic Stress. October 14, 2015
  We examined the efficacy of a brief, accessible, nonstigmatizing online intervention—writing expressively about transitioning to civilian life. U.S. Afghanistan and Iraq war veterans with self‐reported reintegration difficulty (N = 1,292, 39.3% female, M = 36.87, SD = 9.78 years) were randomly assigned to expressive writing (n = 508), factual control writing (n = 507), or no writing (n = 277). Using intention to treat, generalized linear mixed models demonstrated that 6‐months postintervention, veterans who wrote expressively experienced greater reductions in physical complaints, anger, and distress compared with veterans who wrote factually (ds = 0.13 to 0.20; ps < .05) and greater reductions in PTSD symptoms, distress, anger, physical complaints, and reintegration difficulty compared with veterans who did not write at all (ds = 0.22 to 0.35; ps ≤ .001). Veterans who wrote expressively also experienced greater improvement in social support compared to those who did not write (d = 0.17). Relative to both control conditions, expressive writing did not lead to improved life satisfaction. Secondary analyses also found beneficial effects of expressive writing on clinically significant distress, PTSD screening, and employment status. Online expressive writing holds promise for improving health and functioning among veterans experiencing reintegration difficulty, albeit with small effect sizes. Examinamos la eficacia de una intervención breve, accesible, no estigmatizante, en línea ‐ escritura expresiva acerca de la transición a la vida civil. Veteranos norteamericanos de la guerra de Afganistán/ Irak con dificultades de reintegración (N = 1.292, 39,3% mujeres, M = 36,87, DS = 9,78 años) fueron asignandos aleatoriamente a escritura expresiva (n = 508), escritura de control facticio (n = 507) o no escritura (n = 277). Usando la intención a tratar, los Modelos Generalizados Mixtos Lineales demostraron que a los 6 meses post intervención, los veteranos que escribieron expresivamente experimentaron mayores reducciones en las quejas físicas, la ira y la angustia, comparados con veteranos que simplemente escribieron los hechos (DS = 0.13 a 0.20; ps<.05) y mayores reducciones en los síntomas de TEPT,angustia, rabia, quejas físicas y dificultades de reintegración comparados con los veteranos que no escribieron en absoluto (DS = 0.22 a 0.35; ps < = .001). Los veteranos que escribieron expresivamente también experimentaron una mayor mejoría en el apoyo social comparado con quienes no escribieron (d = 0.17). En relación a con las dos condiciones de control, la escritura expresiva no condujo a mejorar la satisfacción de vida. Análisis secundarios también encontraron efectos beneficiosos de la escritura expresiva en el malestar clínicamente significativo, chequeo de TEPT y situación laboral. La escritura expresiva en línea es promisoria para mejorar la salud y el funcionamiento entre los veteranos que experimentan dificultades para la reinserción, aunque con un efecto de tamaño pequeño. 標題 : 為有重新適應困難的阿富汗和伊拉克戰爭美國退役軍人而設的網上表達性寫作隨機對照試驗 撮要: 網上干預治療簡短方便༌亦不帶污名性。本研究檢視有關回歸平民生活的表達性寫作作為網上干預的治療效用。有重返社會困難的阿富汗和伊拉克戰爭美國退役軍人(N = 1,292, 39.3% 女性, M = 36.87, SD = 9.78 年)༌分別被隨機分派去進行表達性寫作(n = 508)、實證寫作對照(n = 507)和不進行寫作(n = 277)。干預利用意向治療。概化線性混合模型顯示完成治療六個月後༌進行表達性寫作的退役軍人跟進行實證寫作的相比༌在對健康不滿、憤怒和悲痛方面有較大改善(ds = 0.13 至 0.20; ps < .05)༛與沒寫作的退役軍人相比༌進行表達性寫作的退役軍人亦在PTSD症狀、悲痛、憤怒、對健康不滿和重返社會的困難度有較大改善(ds = 0.22 至 0.35; ps ≤ . 001)。進行表達性寫作的退役軍人比沒寫作的在社會支持度方面亦有較大改善(d = 0.17)。與兩種對照狀況相比༌表達性寫作並無提高軍人的生活滿足感。次級資料分析發現༌表達性寫作對臨床顯著的悲痛、PTSD篩查和就業狀態帶有良好效應。即使效應量小༌網上表達性寫作有望能幫助對重返社會感困難的退役軍人༌改善他們的健康和功能運作。 clinicaltrials.gov 試驗註冊驗證碼༚NCT00640445 标题 : 为有重新适应困难的阿富汗和伊拉克战争美国退役军人而设的网上表达性写作随机对照试验 撮要: 网上干预治疗简短方便༌亦不带污名性。本研究检视有关回归平民生活的表达性写作作为网上干预的治疗效用。有重返社会困难的阿富汗和伊拉克战争美国退役军人(N = 1,292, 39.3% 女性, M = 36.87, SD = 9.78 年)༌分别被随机分派去进行表达性写作(n = 508)、实证写作对照(n = 507)和不进行写作(n = 277)。干预利用意向治疗。概化线性混合模型显示完成治疗六个月后༌进行表达性写作的退役军人跟进行实证写作的相比༌在对健康不满、愤怒和悲痛方面有较大改善(ds = 0.13 至 0.20; ps < .05)༛与没写作的退役军人相比༌进行表达性写作的退役军人亦在PTSD症状、悲痛、愤怒、对健康不满和重返社会的困难度有较大改善(ds = 0.22 至 0.35; ps ≤ . 001)。进行表达性写作的退役军人比没写作的在社会支持度方面亦有较大改善(d = 0.17)。与两种对照状况相比༌表达性写作并无提高军人的生活满足感。次级资料分析发现༌表达性写作对临床显著的悲痛、PTSD筛查和就业状态带有良好效应。即使效应量小༌网上表达性写作有望能帮助对重返社会感困难的退役军人༌改善他们的健康和功能运作。

  October 14, 2015   doi: 10.1002/jts.22047   open full text
• Improvements in the Child‐Rearing Attitudes of Latina Mothers Exposed to Interpersonal Trauma Predict Greater Maternal Sensitivity Toward Their 6‐Month‐Old Infants.
  Sara F. Waters, Melissa J. Hagan, Luisa Rivera, Alicia F. Lieberman.
  Journal of Traumatic Stress. September 29, 2015
  The current study investigated maternal sensitivity in a treatment‐seeking sample of predominately Latina, low‐income pregnant women with histories of interpersonal trauma exposure. Pregnant women (N = 52; M = 27.08 years, SD = 5.66) who enrolled in a study of a perinatal adaptation of child–parent psychotherapy reported on their posttraumatic stress symptoms and child‐rearing attitudes at baseline and again at 6‐months postpartum. Maternal sensitivity was measured via observational coding of a free‐play episode at 6‐months postpartum. Two thirds of mothers exhibited healthy levels of maternal sensitivity, M > 4.0 (range = 2.5–7.0). The results of multiple linear regression predicting maternal sensitivity, R2 = .26, indicated that greater improvements in child‐rearing attitudes over the course of treatment predicted higher levels of maternal sensitivity, β = .33, whereas improvements in posttraumatic stress symptoms over the course of treatment did not, β = −.10. Mothers’ attitudes regarding parenting during the perinatal period may be a mechanism by which intervention fosters healthy mother–infant relationship dynamics. Thus, parenting attitudes are a worthy target of intervention in vulnerable families. El presente estudio investigó la sensibilidad materna en una muestra de mujeres embarazadas con historia de exposición a trauma interpersonal, que solicitaron tratamiento, predominantemente latinas, de bajos ingresos.Mujeres embarazadas (N = 52; M = 27.08 años, DS = 5.66) enroladas en un estudio de adaptación perinatal de una Psicoterapia Padres‐Hijo reportaron sus síntomas de estrés postraumático y sus actitudes de crianza al inicio y nuevamente a los 6 meses postparto. La sensibilidad materna se midió vía codificación observacional de un episodio de juego libre a los 6 meses del postparto. Dos tercios de las madres exhibieron niveles saludables de sensibilidad materna, M>4.0 (rango: 2.5 a 7). Los resultados de la regresión lineal múltiple que predicen la sensibilidad materna, R² = .26, indicaron que mayores mejorías en las actitudes de crianza de los hijos durante el tratamiento predijo mayores niveles de sensibilidad materna, β = .33, mientras que las mejorías en los síntomas de estrés postraumático en el curso del tratamiento no lo hacían, β = ‐.10. Actitudes de las madres con respecto a la crianza durante el período perinatal pueden ser un mecanismo por el cual la intervención fomenta dinámicas relacionales madre‐hijo saludables. Por lo tanto, las actitudes de crianza son dignos objetivos de la intervención en las familias vulnerables. 標題 : 曾經歷人際創傷的拉丁裔母親育兒態度改善能預測對其六個月大嬰兒持較高母性敏感度 撮要: 本研究透過來自低收入家庭、曾經歷人際創傷並尋求治療的孕婦探索母性敏感度。樣本主要為拉丁裔人士。她們懷孕時參與親子心理治療的圍產期適應力研究 (N = 52; M = 27.08 歲, SD = 5.66)༌分別在基線和產後六個月報告創傷後壓力症狀和育兒態度。研究於她們產後六個月的一次自由節段進行觀察編碼法༌測量母性敏感度。三分之二的母親展現健康的敏感度༌M > 4.0 (值域為 2.5 至 7)。多重線性迴歸預測母性敏感度(R2 = .26)༌顯示療程中育兒態度改善越大便預測到較高水平的母性敏感度(β = .33)༌而創傷後壓力症狀在療程中改善則無此預測(β = ‐.10)。干預治療可能透過調整母親在圍產期的育兒態度來培養健康的母嬰關係。因此༌為弱勢家庭提供的干預治療值得以改善育兒態度為目標。 标题 : 曾经历人际创伤的拉丁裔母亲育儿态度改善能预测对其六个月大婴儿持较高母性敏感度 撮要: 本研究透过来自低收入家庭、曾经历人际创伤并寻求治疗的孕妇探索母性敏感度。样本主要为拉丁裔人士。她们怀孕时参与亲子心理治疗的围产期适应力研究 (N = 52; M = 27.08 岁, SD = 5.66)༌分别在基线和产后六个月报告创伤后压力症状和育儿态度。研究于她们产后六个月的一次自由节段进行观察编码法༌测量母性敏感度。三分之二的母亲展现健康的敏感度༌M > 4.0 (值域为 2.5 至 7)。多重线性回归预测母性敏感度(R2 = .26)༌显示疗程中育儿态度改善越大便预测到较高水平的母性敏感度(β = .33)༌而创伤后压力症状在疗程中改善则无此预测(β = ‐.10)。干预治疗可能透过调整母亲在围产期的育儿态度来培养健康的母婴关系。因此༌为弱势家庭提供的干预治疗值得以改善育儿态度为目标。

  September 29, 2015   doi: 10.1002/jts.22043   open full text
• Preschool Israeli Children Exposed to Rocket Attacks: Assessment, Risk, and Resilience.
  Leo Wolmer, Daniel Hamiel, Tali Versano‐Eisman, Michelle Slone, Nitzan Margalit, Nathaniel Laor.
  Journal of Traumatic Stress. September 24, 2015
  Preschool children are among the most vulnerable populations to adversity. This study described the effects of 4 weeks of daily exposure to rocket attacks on children living on Israel's southern border. Participants enrolled in this study were 122 preschool children (50% boys) between the ages 3 and 6 years from 10 kindergartens. We assessed mothers' report of children's symptoms according to the DSM‐IV and alternative criteria resembling the DSM‐5 criteria for posttraumatic stress disorder (PTSD), general adaptation, traumatic exposure, and stressful life events 3 months after the war. The prevalence of PTSD was lower when the diagnosis was derived from the DSM‐IV (4%) than from the DSM‐5 criteria (14%). Mothers of children with 4 or more stressful life events reported more functional impairment in social, occupational, and other important areas of functioning compared to children with 0 or 1 stressful life event. Children with more severe exposure showed more severe symptoms and mothers had more concerns about the child's functioning (ηp2 = .09–.25). Stressful life events and exposure to traumatic experiences accounted for 32% of the variance in PTSD and 19% of the variance in the adaptation scale. Results were explored in terms of risk and resilience factors. Los preescolares están entre las poblaciones más vulnerables a la adversidad. Este estudio describe los efectos de la exposición continua a ataques con misiles en niños viviendo en la frontera sur de Israel. Los participantes enrolados en este estudio fueron 122 preescolares (50% varones) entre 3 y 6 años de 10 jardines infantiles. Evaluamos los reportes de los padres sobre los síntomas de los niños de acuerdo al DSM‐IV y criterios alternativos pareciéndose a los criterios DSM 5 para TEPT, adaptación general, exposición traumática, y eventos vitales estresantes. La prevalencia de TEPT fue menor cuando el diagnóstico se obtuvo de criterios del DSM IV (4%) comparado al DSM 5 (14%). Los padres de niños con 4 o más eventos vitales estresantes reportaron mayor disfunción social, ocupacional y de otras importantes áreas de funcionamiento comparado a niños con 1 o sin eventos vitales estresantes. Los niños con exposición más severa mostraron síntomas más severos y mayor preocupación parental sobre el funcionamiento del niño. Los eventos vitales estresantes y la exposición a experiencias traumáticas dieron cuenta del 32% de la varianza en la aparición de TEPT y 19% de la varianza en la escala de adaptación. Los resultados son discutidos en términos de factores de riesgo y resiliencia. 標題 : 評估經歷飛彈襲擊的以色列學前兒童和他們抱有的風險與復原力 撮要: 學前兒童是災難裡最容易受創的人口之一。本研究描述在以色列南部邊境持續的飛彈襲擊經歷對兒童的影響。研究樣本為122名來自10間幼兒園、年齡介乎3至6歲的學前兒童(50% 為男生)。研究檢視家長的兒童症狀報告༌根據DSM‐IV和與DSM‐5近似的準則༌評估兒童的創傷後壓力症(PTSD)、一般適應力、創傷經歷和壓力生活事件。以DSM‐IV準則得出的PTSD普遍度(4%)比以DSM‐5低(14%)。從家長的報告所得༌經歷四次或以上壓力生活事件的兒童與經歷零至一次的兒童相比༌在社交、職業和其他重要方面有較多功能性損傷。經歷較嚴重的兒童展現出較嚴重的症狀༌家長亦對其身體功能反映較大關注(ηp2 = .09 至 .25)。壓力生活事件和創傷經歷構成PTSD數據32%的方差和適應力量表上19%的方差。研究討論結果反映的風險及復原力因素。 标题 : 评估经历飞弹袭击的以色列学前儿童和他们抱有的风险与复原力 撮要: 学前儿童是灾难里最容易受创的人口之一。本研究描述在以色列南部边境持续的飞弹袭击经历对儿童的影响。研究样本为122名来自10间幼儿园、年龄介乎3至6岁的学前儿童(50% 为男生)。研究检视家长的儿童症状报告༌根据DSM‐IV和与DSM‐5近似的准则༌评估儿童的创伤后压力症(PTSD)、一般适应力、创伤经历和压力生活事件。以DSM‐IV准则得出的PTSD普遍度(4%)比以DSM‐5低(14%)。从家长的报告所得༌经历四次或以上压力生活事件的儿童与经历零至一次的儿童相比༌在社交、职业和其他重要方面有较多功能性损伤。经历较严重的儿童展现出较严重的症状༌家长亦对其身体功能反映较大关注(ηp2 = .09 至 .25)。压力生活事件和创伤经历构成PTSD数据32%的方差和适应力量表上19%的方差。研究讨论结果反映的风险及复原力因素。

  September 24, 2015   doi: 10.1002/jts.22040   open full text
• The Impact of Infidelity on Combat‐Exposed Service Members.
  Lorig K. Kachadourian, Brian N. Smith, Casey T. Taft, Dawne Vogt.
  Journal of Traumatic Stress. September 23, 2015
  This study examined relationships between combat‐exposed Operation Enduring Freedom/Operation Iraqi Freedom veterans’ experiences related to infidelity during deployment (i.e., indicating that a partner was unfaithful or reporting concern about potential infidelity) and postdeployment mental health, as well as the role of subsequent stress exposure and social support in these associations. The sample consisted of 571 individuals (338 men). There were 128 participants (22.2%) who indicated that their partners were unfaithful during their most recent deployment. Of the remaining 443 participants, 168 (37.8%) indicated that they were concerned that their partners might have been unfaithful. Individuals who indicated that their partners were unfaithful exhibited higher levels of posttraumatic stress symptomatology (β = .08; f2= .18) and depression symptom severity (β = .09; f2 = .14), compared to individuals who did not indicate that their partners were unfaithful. For both men and women, reported infidelity was associated with mental health indirectly via postdeployment life stressors, whereas infidelity concerns were indirectly associated with mental health via postdeployment life stressors for men only. Findings suggested that infidelity can have a significant impact on combat‐exposed veterans’ mental health and highlight the need for additional research on this understudied topic within the military population. EL IMPACTO DE LA INFIDELIDAD EN LOS SOLDADOS QUE REGRESAN Este estudio examinó las relaciones entre las experiencias de veteranos OEF/OIF expuestos a combate relacionada con la infidelidad durante el despliegue (es decir, Indicando que la pareja fue infiel o reporta preocupación acerca de una potencial infidelidad) y la salud mental post despliegue, así como el rol de la exposición subsecuente a estrés y el apoyo social en estas asociaciones. La muestra consistió en 571 individuos (338 hombres). Ciento veintiocho participantes (22.2 %) indicaron que sus parejas fueron infieles durante el despliegue más reciente. De los 443 participantes restantes, 168 (37.8%) indicaron que estaban preocupados que sus parejas podrían ser infieles. Los individuos que indicaron que sus parejas fueron infieles, exhibieron mayores niveles de sintomatología de estrés postraumático (β = .08; f2 = .18) y severidad de los síntomas de depresión (β = .09; f2 = .14), comparados con los individuos que no indicaron que sus parejas fueron infieles. Para ambos, hombres y mujeres, la infidelidad reportada se asoció a salud mental indirectamente vía estresores de vida post despliegue, mientras que las preocupaciones de infidelidad se asociaron directamente con salud mental vía estresores de vida post despliegue, solo en hombres. Estos hallazgos sugieren que la infidelidad puede tener un impacto significativo en la salud mental de los veteranos expuestos a combate y destacan la necesidad de investigación adicional en este tópico poco estudiado entre la población militar. 標題 : 不忠對曾經歷戰鬥的軍人造成的影響 撮要: 本研究檢視曾經歷戰鬥的OEF/OIF退役軍人༌服役時與不忠相關的經歷༈即伴侶不忠或表示憂慮伴侶可能不忠 ༉跟服役後心理健康的關係༌以及隨後的壓力暴露與社會支持在這關係中的影響。樣本包含571名人士༈338名男士༉༌128名參與者(22.2 %)表示在最近一次服役時༌伴侶曾有不忠。其餘的443名參與者當中༌168位(37.8 %)表示憂慮伴侶可能不忠。與無表示伴侶不忠的人士比較༌表示伴侶不忠的人展現較高水平的創傷後壓力症狀學(β = .08; f2 = .18)及抑鬱症狀嚴重度(β = .09; f2 = .14)。不論男女༌經歷不忠會因退役後的生活壓力源而間接影響心理健康༛憂慮伴侶可能不忠會因退役後的生活壓力源而間接影響男性的心理健康。結果顯示不忠對經歷戰鬥的退役軍人能造成顯著的心理影響༌並強調需在這方面對軍人作更多研究。 标题 : 不忠对曾经历战斗的军人造成的影响 撮要: 本研究检视曾经历战斗的OEF/OIF退役军人༌服役时与不忠相关的经历༈即伴侣不忠或表示忧虑伴侣可能不忠 ༉跟服役后心理健康的关系༌以及随后的压力暴露与社会支持在这关系中的影响。样本包含571名人士༈338名男士༉༌128名参与者(22.2 %)表示在最近一次服役时༌伴侣曾有不忠。其余的443名参与者当中༌168位(37.8 %)表示忧虑伴侣可能不忠。与无表示伴侣不忠的人士比较༌表示伴侣不忠的人展现较高水平的创伤后压力症状学(β = .08; f2 = .18)及抑郁症状严重度(β = .09; f2 = .14)。不论男女༌经历不忠会因退役后的生活压力源而间接影响心理健康༛忧虑伴侣可能不忠会因退役后的生活压力源而间接影响男性的心理健康。结果显示不忠对经历战斗的退役军人能造成显著的心理影响༌并强调需在这方面对军人作更多研究。

  September 23, 2015   doi: 10.1002/jts.22033   open full text
• The Strongest Correlates of PTSD for Firefighters: Number, Recency, Frequency, or Perceived Threat of Traumatic Events?
  Ricardo J. Pinto, Sandra P. Henriques, Inês Jongenelen, Cláudia Carvalho, Ângela C. Maia.
  Journal of Traumatic Stress. September 21, 2015
  Firefighters experience a wide range of traumatic events while on duty and are at risk to develop psychopathology and posttraumatic stress disorder (PTSD). According to cognitive models, the person's interpretation of the traumatic event is responsible for the development of PTSD rather than the traumatic event itself. This cross‐sectional study aimed to explore the contribution of perceived threat to explain PTSD symptoms in Portuguese firefighters, after adjusting for potential confounding factors. A sample of 397 firefighters completed self‐report measures of exposure to traumatic events, psychopathology, and PTSD. Perceived threat explained unique variance in PTSD symptoms, R2 = .40, ΔR2 = .02, F(10, 367) = 24.55, p < .001, Cohen's f2 =.03, after adjusting for psychopathology, number, recency, and frequency of the events, and other potential confounding variables. The association between psychopathology and PTSD was also moderated by perceived threat, R2 = .43, ΔR2 = .03, F(11, 366) = 25.33, p < .001, Cohen's f2 =.05. Firefighters may benefit from interventions that focus on perceived threat to prevent PTSD symptoms. Los bomberos experimentan una amplia gama de eventos traumáticos durante el servicio y están en riesgo de desarrollar psicopatología y trastorno por estrés postraumático (TEPT). De acuerdo a modelos cognitivos, la interpretación que la persona hace del evento traumático, es responsable del desarrollo de TEPT más que el evento traumático per se. Este estudio transveral tuvo como objetivo explorar la contribución de la amenaza percibida para explicar los síntomas de TEPT en bomberos portugueses, después de hacer un ajuste por posibles factores de confusión. Una muestra de 397 bomberos completó mediciones de autorreporte de exposición a eventos traumáticos, psicopatología y TEPT. La amenaza percibida explicó la varianza única en los síntomas de TEPT, R² = .40, ɅR ² = .02, F(10,36) = 24.55,p<.001, ƒ ² de Cohen = .03, después de ajustar por la psicopatología,el número, lo reciente, y la frecuencia de los eventos y otras variables confusión potenciales. La asociación entre psicopatología y TEPT también fue moderada por amenaza percibida,, R ² = .43, ɅR ² = .03, F(11,366) = 25.33, p<.001, ƒ ² de Cohen = .05. Los bomberos se pueden beneficiar de intervenciones que se focalicen en la amenaza percibida para prevenir los síntomas de TEPT. 標題 : 消防員中PTSD的最強關連༚創傷性事件的次數、近期性、頻次還是威脅感知༟ 撮要: 消防員當值時面對多種創傷性事件༌有風險患上精神問題和創傷後壓力症(PTSD)。根據認知研究模型༌個人對創傷性事件的理解可導致PTSD༌而非創傷性事件本身能直接引發。本橫斷研究對潛在混亂的因素作調節後༌探索威脅感知的影響༌分析葡萄牙消防員的PTSD症狀。樣本裡༌397名消防員完成了對創傷性事件的暴露程度、精神病理學和PTSD的自評測量。研究對精神病理學、事件的次數、近期性和頻次及其他潛在混亂的變量作調節後༌發現威脅感知解釋了PTSD症狀中獨特的方差(R2 = .40, ΔR2 = .02, F(10, 367) = 24.55, p < .001, Cohen's f2 = .03)。精神病理學與PTSD的關連亦受威脅感知調節 (R2 = .43, ΔR2 = .03, F(11, 366) = 25.33, p < .001, Cohen's f2 = .05)。 針對威脅感知的干預可能有助消防員避免發展出PTSD症狀。 标题 : 消防员中PTSD的最强关连༚创伤性事件的次数、近期性、频次还是威胁感知༟ 撮要: 消防员当值时面对多种创伤性事件༌有风险患上精神问题和创伤后压力症(PTSD)。根据认知研究模型༌个人对创伤性事件的理解可导致PTSD༌而非创伤性事件本身能直接引发。本横断研究对潜在混乱的因素作调节后༌探索威胁感知的影响༌分析葡萄牙消防员的PTSD症状。样本里༌397名消防员完成了对创伤性事件的暴露程度、精神病理学和PTSD的自评测量。研究对精神病理学、事件的次数、近期性和频次及其他潜在混乱的变量作调节后༌发现威胁感知解释了PTSD症状中独特的方差(R2 = .40, ΔR2 = .02, F(10, 367) = 24.55, p < .001, Cohen's f2 = .03)。精神病理学与PTSD的关连亦受威胁感知调节 (R2 = .43, ΔR2 = .03, F(11, 366) = 25.33, p < .001, Cohen's f2 = .05)。 针对威胁感知的干预可能有助消防员避免发展出PTSD症状。

  September 21, 2015   doi: 10.1002/jts.22035   open full text
• A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans.
  Elizabeth M. Goetter, Eric Bui, Rebecca A. Ojserkis, Rebecca J. Zakarian, Rebecca Weintraub Brendel, Naomi M. Simon.
  Journal of Traumatic Stress. September 16, 2015
  A significant number of veterans of the conflicts in Iraq and Afghanistan have posttraumatic stress disorder (PTSD), yet underutilization of mental health treatment remains a significant problem. The purpose of this review was to summarize rates of dropout from outpatient, psychosocial PTSD interventions provided to U.S. Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) veterans with combat‐related PTSD. There were 788 articles that were identified which yielded 20 studies involving 1,191 individuals eligible for the review. The dropout rates in individual studies ranged from 5.0% to 78.2%, and the overall pooled dropout rate was 36%, 95% CI [26.20, 43.90]. The dropout rate differed marginally by study type (routine clinical care settings had higher dropout rates than clinical trials) and treatment format (group treatment had higher dropout rates than individual treatment), but not by whether comorbid substance dependence was excluded, by treatment modality (telemedicine vs. in‐person treatment), or treatment type (exposure therapy vs. nonexposure therapy). Dropout is a critical aspect of the problem of underutilization of care among OEF/OIF/OND veterans with combat‐related PTSD. Innovative strategies to enhance treatment retention are needed. Un número significativo de veteranos de los conflictos en Irak y Afganistán tienen trastorno por estrés postraumático (TEPT), sin embargo, la subutilización de tratamiento de salud mental sigue siendo un problema significativo. El propósito de esta revisión fue resumir las tasas de deserción de pacientes ambulatorios, en intervenciones psicosociales para TEPT realizadas a los veteranos con TEPT relacionado a combate de las Operaciones Libertad Iraquí (OIF), Libertad Duradera (OEF) y Nuevo Amanecer (OND). Se identificó un total de 788 artículos y se obtuvo 20 estudios que involucran a 1.191 personas, elegibles para la revisión. Las tasas de deserción en estudios individuales variaron del 5,0% al 78,2%, y la tasa global de deserción agrupada fue de 36%, IC 95% [26,20, 43,90]. Las tasas de deserción difirieron según el tipo de estudio (contextos de cuidado clínico de rutina tuvieron mayores tasas de abandono que los ensayos clínicos) y según el formato de tratamiento (tratamiento grupal tuvo mayores tasas de abandono que el tratamiento individual), pero no difería ya fuera que se excluyera o no la comorbilidad con dependencia a sustancias, por modalidad de tratamiento (telemedicina vs.tratamiento en persona), o el tipo de tratamiento (terapia de exposición vs. terapia sin exposición). El abandono es un aspecto crítico del problema de la subutilización de la atención entre losveteranos con TEPT relacionado con el combate de las OEF, OIF y OND. Se necesitan estrategias innovadoras para mejorar la retención en el tratamiento. 標題 : 伊拉克和阿富汗戰爭退役軍人接受創傷後壓力症治療的放棄率༚一項系統性的審核 撮要: 患創傷後壓力症(PTSD)的伊拉克和阿富汗戰爭退役軍人數目顯著༌但他們接受心理治療的比率持續偏低。有為「持久自由行動」(OEF)和伊拉克戰爭(OIF、OND) 中患戰鬥相關PTSD的退役軍人提供的PTSD心理社會干預門診治療༌本研究旨在概述這項治療服務裡的放棄率。研究共找出788份過往研究紀錄༌當中20項研究包含1,191名符合審核條件的人士。個別研究的放棄治療率為5.0% 至 78.2%༌整體的放棄治療率為36%༌95% CI [26.20, 43.90]。放棄治療率因以下因素生異༚研究樣式 ༈例行的治療設定比臨床試驗的放棄率更高༉和治療樣式༈團體治療比個人治療的放棄率更高༉。不論治療有沒有考慮到濫用藥物共病༌還是治療方式༈遠距或親身醫療༉、治療種類༈暴露或非暴露療法༉༌也沒影響放棄治療率。放棄治療是患戰鬥相關PTSD的OEF/OIF/OND退役軍人接受心理治療率偏低的關鍵問題༌需有創新的策略使他們保持接受治療。 标题 : 伊拉克和阿富汗战争退役军人接受创伤后压力症治疗的放弃率༚一项系统性的审核 撮要: 患创伤后压力症(PTSD)的伊拉克和阿富汗战争退役军人数目显著༌但他们接受心理治疗的比率持续偏低。有为「持久自由行动」(OEF)和伊拉克战争(OIF、OND) 中患战斗相关PTSD的退役军人提供的PTSD心理社会干预门诊治疗༌本研究旨在概述这项治疗服务里的放弃率。研究共找出788份过往研究纪录༌当中20项研究包含1,191名符合审核条件的人士。个别研究的放弃治疗率为5.0% 至 78.2%༌整体的放弃治疗率为36%༌95% CI [26.20, 43.90]。放弃治疗率因以下因素生异༚研究样式 ༈例行的治疗设定比临床试验的放弃率更高༉和治疗样式༈团体治疗比个人治疗的放弃率更高༉。不论治疗有没有考虑到滥用药物共病༌还是治疗方式༈远距或亲身医疗༉、治疗种类༈暴露或非暴露疗法༉༌也没影响放弃治疗率。放弃治疗是患战斗相关PTSD的OEF/OIF/OND退役军人接受心理治疗率偏低的关键问题༌需有创新的策略使他们保持接受治疗。

  September 16, 2015   doi: 10.1002/jts.22038   open full text
• Temporal Associations Among Chronic PTSD Symptoms in U.S. Combat Veterans.
  Susan Doron‐LaMarca, Barbara L. Niles, Daniel W. King, Lynda A. King, Anica Pless Kaiser, Michael J. Lyons.
  Journal of Traumatic Stress. September 14, 2015
  The present study examined fluctuation over time in symptoms of posttraumatic stress disorder (PTSD) among 34 combat veterans (28 with diagnosed PTSD, 6 with subclinical symptoms) assessed every 2 weeks for up to 2 years (range of assessments = 13–52). Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross‐lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2‐week intervals (rs = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (rs = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal → emotional numbing → reexperiencing → hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration. El siguiente estudio examinó la fluctuación en el tiempo de los síntomas de Trastorno por estrés postraumático (TEPT) en 34 veteranos de combate (28 con diagnóstico de TEPT, 6 con síntomas subclínicos) evaluados cada 2 semanas por 2 años (rango de evaluaciones 13 a 52). La relación temporal fue examinada a través de 4 grupos sintomáticos de TEPT (re‐experimentación, evitación, embotamiento emocional, e hiperalerta) con particular atención a la influencia de la hiperalerta. Coeficientes de autoregresión aleatoria cruzada multinivel para el análisis de series de tiempo intensivo fueron utilizados para modelar la fluctuación sintomática décadas después de experiencias de combate. Como se anticipó, la hiperalerta predijo fluctuaciones subsecuentes en otros tres grupos sintomáticos de TEPT (re‐expermentación, evitación y embotamiento emocional) en intervalos posteriores de 2 semanas (rs: .45, .36, y .40, respectivamente). Además, el embotamiento emocional influyó en la re‐experimentación y evitación posterior, y la re‐experimentación influyó en la hiperalerta posterior (rs: .44, .40, y .34 respectivamente). Estos hallazgos subestiman la importante influencia de la hiperalerta. Además, los resultados indican una relación bidireccional entre hiperalerta y re‐experimentación así como una posible cadena de síntomas (hiperalerta → embotamiento emocional→ re‐experimentación → hiperalerta) y establecen mecanismos internos e interpersonales para el mantenimiento de síntomas de TEPT persistentes. Los resultados sugieren que intervenciones clínicas dirigidas a la hiperalerta y embotamiento emocional podrían ser promisorios para TEPT de larga duración. 標題 : 退役戰鬥軍人慢性PTSD症狀的時間關連 撮要: 本研究檢視34名退役戰鬥軍人༈28 名確診患 PTSD༌6名有輕微症狀༉創傷後壓力症(PTSD)症狀隨時間的變動。評估每兩星期進行༌為期兩年(評估值域為 13 至 52)。研究檢視四個PTSD症狀聚類༈再體驗、迴避、情感麻木和過度激發༉中的時間關係༌並特別關注過度激發的影響。研究利用多層次跨時滯的隨機系數自我迴歸法༌進行密集的時間序列數據分析༌得出退役軍人於經歷戰鬥十年或以後症狀變動的模型。一如預期༌過度激發能預測隨後每兩星期的評估中༌三個症狀聚類༈再體驗、迴避、情感麻木༉的症狀變動(rs 分別為 .45, .36, 和 .40)。情感麻木影響隨後的再體驗和迴避症狀༛再體驗則影響隨後的過度激發症狀(rs 分別為 .44, .40, 和 .34)。研究結果突顯過度激發的重要影響。結果亦反映出過度激發與再體驗症狀的雙向關係༌以及症狀之間潛在的連鎖性༈過度激發è情感麻木è再體驗è過度激發༉。研究得出持續的PTSD症狀在個體的潛在機制。研究結果顯示༌針對過度激發和情感麻木症狀的臨床干預有可能有效醫治長期的PTSD 。 标题 : 退役战斗军人慢性PTSD症状的时间关连 撮要: 本研究检视34名退役战斗军人༈28 名确诊患 PTSD༌6名有轻微症状༉创伤后压力症(PTSD)症状随时间的变动。评估每两星期进行༌为期两年(评估值域为 13 至 52)。研究检视四个PTSD症状聚类༈再体验、回避、情感麻木和过度激发༉中的时间关系༌并特别关注过度激发的影响。研究利用多层次跨时滞的随机系数自我回归法༌进行密集的时间序列数据分析༌得出退役军人于经历战斗十年或以后症状变动的模型。一如预期༌过度激发能预测随后每两星期的评估中༌三个症状聚类༈再体验、回避、情感麻木༉的症状变动(rs 分别为 .45, .36, 和 .40)。情感麻木影响随后的再体验和回避症状༛再体验则影响随后的过度激发症状(rs 分别为 .44, .40, 和 .34)。研究结果突显过度激发的重要影响。结果亦反映出过度激发与再体验症状的双向关系༌以及症状之间潜在的连锁性༈过度激发è情感麻木è再体验è过度激发༉。研究得出持续的PTSD症状在个体的潜在机制。研究结果显示༌针对过度激发和情感麻木症状的临床干预有可能有效医治长期的PTSD 。

  September 14, 2015   doi: 10.1002/jts.22039   open full text
• Brief Narrative Exposure Therapy for Posttraumatic Stress in Iraqi Refugees: A Preliminary Randomized Clinical Trial.
  Alaa M. Hijazi, Mark A. Lumley, Maisa S. Ziadni, Luay Haddad, Lisa J. Rapport, Bengt B. Arnetz.
  Journal of Traumatic Stress. May 27, 2014
  Many Iraqi refugees suffer from posttraumatic stress. Efficient, culturally sensitive interventions are needed, and so we adapted narrative exposure therapy into a brief version (brief NET) and tested its effects in a sample of traumatized Iraqi refugees. Iraqi refugees in the United States reporting elevated posttraumatic stress (N = 63) were randomized to brief NET or waitlist control conditions in a 2:1 ratio; brief NET was 3 sessions, conducted individually, in Arabic. Positive indicators (posttraumatic growth and well‐being) and symptoms (posttraumatic stress, depressive, and somatic) were assessed at baseline and 2‐ and 4‐month follow‐up. Treatment participation (95.1% completion) and study retention (98.4% provided follow‐up data) were very high. Significant condition by time interactions showed that those receiving brief NET had greater posttraumatic growth (d = 0.83) and well‐being (d = 0.54) through 4 months than controls. Brief NET reduced symptoms of posttraumatic stress (d = −0.48) and depression (d = −0.46) more, but only at 2 months; symptoms of controls also decreased from 2 to 4 months, eliminating condition differences at 4 months. Three sessions of brief NET increased growth and well‐being and led to symptom reduction in highly traumatized Iraqi refugees. This preliminary study suggests that brief NET is both acceptable and potentially efficacious in traumatized Iraqi refugees.

  May 27, 2014   doi: 10.1002/jts.21922   open full text
• Prevalence and Correlates of Posttrauma Distorted Beliefs: Evaluating DSM‐5 PTSD Expanded Cognitive Symptoms in a National Sample.
  Keith S. Cox, Heidi S. Resnick, Dean G. Kilpatrick.
  Journal of Traumatic Stress. May 27, 2014
  The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association [APA], 2013) modified the diagnostic criteria for posttraumatic stress disorder (PTSD), including expanding the scope of dysfunctional, posttrauma changes in belief (symptoms D2—persistent negative beliefs and expectations about oneself or the world, and D3—persistent distorted blame of self or others for the cause or consequences of the traumatic event). D2 and D3 were investigated using a national sample of U.S. adults (N = 2,498) recruited from an online panel. The prevalence of D2 and D3 was substantially higher among those with lifetime PTSD than among trauma‐exposed individuals without lifetime PTSD (D2: 74.6% vs 23.9%; D3: 80.6% vs 35.7%). In multivariate analyses, the strongest associates of D2 were interpersonal assault (OR = 2.39), witnessing interpersonal assault (OR = 1.63), gender (female, OR = 2.11), and number of reported traumatic events (OR = 1.88). The strongest correlates of D3 were interpersonal assault (OR = 3.08), witnessing interpersonal assault (OR = 1.57), gender (female, OR = 2.30), and number of reported traumatic events (OR = 1.91). The findings suggested the expanded cognitive symptoms in the DSM‐5 diagnostic criteria better capture the cognitive complexity of PTSD than those of the DSM‐IV.

  May 27, 2014   doi: 10.1002/jts.21925   open full text
• Effects of Psychotherapy on Trauma‐Related Cognitions in Posttraumatic Stress Disorder: A Meta‐Analysis.
  Julia Diehle, Katja Schmitt, Joost G. Daams, Frits Boer, Ramón J. L. Lindauer.
  Journal of Traumatic Stress. May 22, 2014
  In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders criteria for posttraumatic stress disorder (PTSD) incorporate trauma‐related cognitions. This adaptation of the criteria has consequences for the treatment of PTSD. Until now, comprehensive information about the effect of psychotherapy on trauma‐related cognitions has been lacking. Therefore, the goal of our meta‐analysis was to determine which psychotherapy most effectively reduces trauma‐related cognitions. Our literature search for randomized controlled trials resulted in 16 studies with data from 994 participants. We found significant effect sizes favoring trauma‐focused cognitive–behavioral therapy as compared to nonactive or active nontrauma‐focused control conditions of Hedges’ g = 1.21, 95% CI [0.69, 1.72], p < .001 and g = 0.36, 95% CI [0.09, 0.63], p = .009, respectively. Treatment conditions with elements of cognitive restructuring and treatment conditions with elements of exposure, but no cognitive restructuring reduced trauma‐related cognitions almost to the same degree. Treatments with cognitive restructuring had small advantages over treatments without cognitive restructuring. We concluded that trauma‐focused cognitive–behavioral therapy effectively reduces trauma‐related cognitions. Treatments comprising either combinations of cognitive restructuring and imaginal exposure and in vivo exposure, or imaginal exposure and in vivo exposure alone showed the largest effects.

  May 22, 2014   doi: 10.1002/jts.21924   open full text
• Predictors of Using Mental Health Services After Sexual Assault.
  Matthew Price, Tatiana M. Davidson, Kenneth J. Ruggiero, Ron Acierno, Heidi S. Resnick.
  Journal of Traumatic Stress. May 22, 2014
  Sexual assault increases the risk for psychopathology. Despite the availability of effective interventions, relatively few victims who need treatment receive care in the months following an assault. Prior work identified several factors associated with utilizing care, including ethnicity, insurance, and posttraumatic stress disorder (PTSD) symptoms. Few studies, however, have examined predictors of treatment utilization prospectively from the time of assault. The present study hypothesized that White racial status, younger age, being partnered, having health insurance, having previously received mental health treatment, and having more PTSD and depression symptoms would predict utilization of care in the 6 months postassault. This was examined in a sample of 266 female sexual assault victims with an average age of 26.2 years, of whom 62.0% were White and 38.0% were African American assessed at 1.5 and 6 months postassault. Available information on utilizing care varied across assessments (1.5 months, n = 214; 3 months, n = 126; 6 months, n = 204). Significant predictors included having previously received mental health treatment (OR = 4.09), 1 day depressive symptoms (OR = 1.06), and having private insurance (OR = 2.24) or Medicaid (OR = 2.19). Alcohol abuse and prior mental health care were associated with a substantial increase in treatment utilization (OR = 4.07). The findings highlight the need to help victims at risk obtain treatment after sexual assault.

  May 22, 2014   doi: 10.1002/jts.21915   open full text
• Posttraumatic Stress Disorder in a Nationally Representative Mexican Community Sample.
  Guilherme Borges, Corina Benjet, Maria Petukhova, Maria Elena Medina‐Mora.
  Journal of Traumatic Stress. May 21, 2014
  This study describes the public health burden of trauma exposure and posttraumatic stress disorder (PTSD) in relation to the full range of traumatic events to identify the conditional risk of PTSD from each traumatic event experienced in the Mexican population and other risk factors. The representative sample comprised a subsample (N = 2,362) of the urban participants of the Mexican National Comorbidity Survey (2001−2002). We used the World Health Organization's Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and the presence of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM‐IV; American Psychiatric Association, ) in each respondents’ self‐reported worst traumatic event, as well as a randomly selected lifetime trauma. The results showed that traumatic events were extremely common in Mexico (68.8%). The estimate of lifetime PTSD in the whole population was 1.5%; among only those with a traumatic event it was 2.1%. The 12‐month prevalence of PTSD in the whole population was 0.6%; among only those with a traumatic event it was 0.8%. Violence‐related events were responsible for a large share of PTSD. Sexual violence, in particular, was one of the greatest risks for developing PTSD. These findings support the idea that trauma in Mexico should be considered a public health concern.

  May 21, 2014   doi: 10.1002/jts.21917   open full text
• Verbal Learning Deficits in Posttraumatic Stress Disorder and Depression.
  Diane L. Scheiner, John Keilp, Monica Rivera Mindt, Ainsley K. Burke, Maria A. Oquendo, J. John Mann.
  Journal of Traumatic Stress. May 21, 2014
  Verbal learning and memory deficits are frequently reported in posttraumatic stress disorder (PTSD), but may be a product of its psychiatric comorbidities, especially major depressive disorder (MDD). To evaluate this hypothesis, 25 medication‐free patients with PTSD and comorbid MDD were compared to 148 medication‐free patients with equally severe MDD alone and to 96 nonpatients on a measure of verbal learning and memory. Additional measures of attention, working memory, and executive function were administered to evaluate their contribution to verbal memory impairment. Patients with comorbid PTSD and MDD demonstrated the greatest deficit in verbal learning compared to both MDD patients and nonpatients (omnibus effect sizes ranged d = 0.41 to 0.50), one that was not accounted for by other cognitive deficits. Findings suggest that a current diagnosis of PTSD makes a contribution to verbal learning deficits beyond the effect of depression alone.

  May 21, 2014   doi: 10.1002/jts.21921   open full text
• Mental Health Beliefs and Their Relationship With Treatment Seeking Among U.S. OEF/OIF Veterans.
  Dawne Vogt, Annie B. Fox, Brooke A. L. Di Leone.
  Journal of Traumatic Stress. May 16, 2014
  Many veterans who would benefit from mental health care do not seek treatment. The current study provided an in‐depth examination of mental health‐related beliefs and their relationship with mental health and substance abuse service use in a national sample of 640 U.S. Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans. Both concerns about mental health stigma from others and personal beliefs about mental illness and mental health treatment were examined. Data were weighted to adjust for oversampling of women and nonresponse bias. Results revealed substantial variation in the nature of OEF/OIF veterans’ mental health beliefs, with greater anticipated stigma in the workplace (M = 23.74) than from loved ones (M = 19.30), and stronger endorsement of negative beliefs related to mental health treatment‐seeking (M = 21.78) than either mental illness (M = 18.56) or mental health treatment (M = 20.34). As expected, individuals with probable mental health problems reported more negative mental health‐related beliefs than those without these conditions. Scales addressing negative personal beliefs were related to lower likelihood of seeking care (ORs = 0.80–0.93), whereas scales addressing anticipated stigma were not associated with service use. Findings can be applied to address factors that impede treatment seeking.

  May 16, 2014   doi: 10.1002/jts.21919   open full text
• Gender Differences in the Associations of PTSD Symptom Clusters With Relationship Distress in U.S. Vietnam Veterans and Their Partners.
  Keith D. Renshaw, Sarah B. Campbell, Laura Meis, Christopher Erbes.
  Journal of Traumatic Stress. May 13, 2014
  Research has consistently linked symptoms of posttraumatic stress disorder (PTSD) with relationship distress in combat veterans and their partners. Studies of specific clusters of PTSD symptoms indicate that symptoms of emotional numbing/withdrawal (now referred to as negative alterations in cognition and mood) are more strongly linked with relationship distress than other symptom clusters. These findings, however, are based predominantly on samples of male veterans. Given the increasing numbers of female veterans, research on potential gender differences in these associations is needed. The present study examined gender differences in the multivariate associations of PTSD symptom clusters with relationship distress in 465 opposite‐sex couples (375 with male veterans and 90 with female veterans) from the National Vietnam Veterans Readjustment Study. Comparisons of nested path models revealed that emotional numbing/withdrawal symptoms were associated with relationship distress in both types of couples. The strength of this association, however, was stronger for female veterans (b = .46) and female partners (b = .28), compared to male veterans (b = .38) and male partners (b = .26). Results suggest that couples‐based interventions (e.g., psychoeducation regarding emotional numbing symptoms as part of PTSD) are particularly important for both female partners of male veterans and female veterans themselves.

  May 13, 2014   doi: 10.1002/jts.21916   open full text
• Prospective Trajectories of Posttraumatic Stress in College Women Following a Campus Mass Shooting.
  Holly K. Orcutt, George A. Bonanno, Susan M. Hannan, Lynsey R. Miron.
  Journal of Traumatic Stress. May 12, 2014
  In a sample with known levels of preshooting posttraumatic stress (PTS) symptoms, we examined the impact of a campus mass shooting on trajectories of PTS in the 31 months following the shooting using latent growth mixture modeling. Female students completed 7 waves of a longitudinal study (sample sizes ranged from 812 to 559). We identified 4 distinct trajectories (n = 660): (a) minimal impact‐resilience (60.9%), (b) high impact‐recovery (29.1%), (c) moderate impact‐moderate symptoms (8.2%), and (d) chronic dysfunction (1.8%). Individuals in each trajectory class remained at or returned to preshooting levels of PTS approximately 6 months postshooting. The minimal impact‐resilience class reported less prior trauma exposure (η2 = .13), less shooting exposure (η2 = .07), and greater emotion regulation skills than all other classes (η2 > .30). The chronic dysfunction class endorsed higher rates of experiential avoidance prior to the shooting than the minimal‐impact resilient and high impact‐recovery classes (η2 = .15), as well as greater shooting exposure than the high impact‐recovery class (η2 = .07). Findings suggest that preshooting functioning and emotion regulation distinguish between those who experience prolonged distress following mass violence and those who gradually recover.

  May 12, 2014   doi: 10.1002/jts.21914   open full text
• Characteristics of the Children's Revised Impact of Event Scale in a Clinically Referred Dutch Sample.
  Eva Verlinden, Els P. M. Meijel, Brent C. Opmeer, Renée Beer, Carlijn Roos, Iva A. E. Bicanic, Francien Lamers‐Winkelman, Miranda Olff, Frits Boer, Ramón J. L. Lindauer.
  Journal of Traumatic Stress. May 02, 2014
  Early identification of posttraumatic stress disorder (PTSD) in children is important to offer them appropriate and timely treatment. The Children's Revised Impact of Event Scale (CRIES) is a brief self‐report measure designed to screen children for PTSD. Research regarding the diagnostic validity of the CRIES is still insufficient, has been restricted to specific populations, and sample sizes have often been small. This study evaluated the reliability and validity of the 8‐item (CRIES‐8) and 13‐item (CRIES‐13) versions of the CRIES in a large clinically referred sample. The measure was completed by 395 Dutch children (7–18 years) who had experienced a wide variety of traumatic events. PTSD was assessed using the Anxiety Disorders Interview Schedule for DSM‐IV: Child and Parent version. A cutoff score of 17 on the CRIES‐8 and 30 on the CRIES‐13 emerged as the best balance between sensitivity and specificity, and correctly classified 78%–81% of all children. The CRIES‐13 outperformed the CRIES‐8, in that the overall efficiency of the CRIES‐13 was slightly superior (.81 and .78, respectively). The CRIES appears to be a reliable and valid measure, which gives clinicians a brief and user‐friendly instrument to identify children who may have PTSD and offer them appropriate and timely treatment.

  May 02, 2014   doi: 10.1002/jts.21910   open full text
• Relationships of Posttraumatic Stress Symptoms and Sleep Measures to Cognitive Performance in Young‐Adult African Americans.
  Janeese A. Brownlow, Tyish S. Hall Brown, Thomas A. Mellman.
  Journal of Traumatic Stress. April 16, 2014
  Disturbed sleep is a prominent feature of posttraumatic stress disorder (PTSD). PTSD and disrupted sleep have been independently linked to cognitive deficits; however, synergistic effects of PTSD and poor sleep on cognition have not been investigated. The purpose of this study was to examine the effects of PTSD symptoms and objectively measured disruptions to sleep on cognitive function. Forty‐four young‐adult African American urban residents comprised the study sample. The Clinician‐Administered PTSD Scale (CAPS; Blake et al., 1995) was utilized to determine the severity of PTSD symptoms. Participants underwent 2 consecutive nights of polysomnography. The Automated Neuropsychological Assessment Metrics (Reeves, Winter, Bleiberg, & Kang, ) was utilized to assess sustained attention and the Rey Auditory Verbal Learning Test (Schmidt, ) was used to evaluate verbal memory. PTSD symptom severity, r(42) = .40, p = .007, was significantly associated with omission errors on the sustained attention task, and sleep duration, r(42) = .41, p = .006, and rapid eye movement sleep, r(42) = .43, p = .003, were positively correlated with verbal memory. There was an interaction of PTSD symptom severity and sleep duration on omission errors such that more than 7 hours 12 minutes of sleep mitigated attentional lapses that were associated with PTSD. 標題：非裔美國年輕人中創傷後壓力症和睡眠測量與認知表現的關係 撮要：睡眠困擾是創傷後壓力左(PTSD)的顯著病癥。PTSD和睡眠問題各自與認知受損有關，但PTSD和失眠對認知的協同效應則未有探討。本研究檢視PTSD症狀的影響和客觀地量度睡眠困擾對認知功能的效果。樣本是53名非裔美國年輕市區居民。醫生施行PTSD量表(CAPS)測量PTSD症狀的嚴重程度，而參加者亦會連續兩晚接受多重睡眠電圖測試。持續注意力會採用自動化神經心理評估指標來評核，而雷伊聽覺言語學習測試則評定言語記憶。PTSD症狀的嚴重程度 r(42)= .40, p= .007統計上顯著與持續注意力任務的遺漏錯誤相連，而睡眠持續時間r(42)= .41, p= .006和快速眼動睡眠r(42)= .43, p= .003均與言語記憶有正相連。PTSD症狀嚴重程度和睡眠持續時間對遺漏錯誤有相互影響，以致多於7小時12分的睡眠可減輕與PTSD相關的注意力失誤。 标题：非裔美国年轻人中创伤后压力症和睡眠测量与认知表现的关系 撮要：睡眠困扰是创伤后压力左(PTSD)的显著病症。PTSD和睡眠问题各自与认知受损有关，但PTSD和失眠对认知的协同效应则未有探讨。本研究检视PTSD症状的影响和客观地量度睡眠困扰对认知功能的效果。样本是53名非裔美国年轻市区居民。医生施行PTSD量表(CAPS)测量PTSD症状的严重程度，而参加者亦会连续两晚接受多重睡眠电图测试。持续注意力会采用自动化神经心理评估指标来评核，而雷伊听觉言语学习测试则评定言语记忆。PTSD症状的严重程度 r(42)= .40, p= .007统计上显著与持续注意力任务的遗漏错误相连，而睡眠持续时间r(42)= .41, p= .006和快速眼动睡眠r(42)= .43, p= .003均与言语记忆有正相连。PTSD症状严重程度和睡眠持续时间对遗漏错误有相互影响，以致多于7小时12分的睡眠可减轻与PTSD相关的注意力失误。

  April 16, 2014   doi: 10.1002/jts.21906   open full text
• Outcome of Depression and Anxiety After War: A Prospective Epidemiologic Study of Children and Adolescents.
  Elie G. Karam, John Fayyad, Aimee N. Karam, Nadine Melhem, Zeina Mneimneh, Hani Dimassi, Caroline Cordahi Tabet.
  Journal of Traumatic Stress. April 16, 2014
  Prospective studies of children exposed to war have not investigated disorders other than posttraumatic stress disorder (PTSD) and have methodological limitations. From a stratified random sample of 386 children and adolescents who had been interviewed 3 weeks after war exposure (Phase 1) a random subsample (N = 143) was interviewed a year later (Phase 2). PTSD, major depressive disorder (MDD), separation anxiety disorder (SAD), overanxious disorder (OAD), and psychosocial stressors were assessed using structured interviews administered to both children and adolescents and their parents. The prevalence of disorders among the 143 at Phase 1 was MDD 25.9%, SAD 16.1%, OAD 28.0%, and PTSD 26.0%, with 44.1% having any disorder. At Phase 2 the prevalence was MDD, 5.6%; SAD, 4.2%; OAD, 0%; and PTSD, 1.4%, with 9.2% having any disorder. Occurrence of disorders at Phase 1 was associated with older age, prewar disorders, financial problems, fear of being beaten, and witnessing any war event (ORs ranged from 2.5 to 28.6). Persistence of disorders to Phase 2 was associated with prewar disorders (OR = 6.0) and witnessing any war event (OR = 14.3). There are implications for detection of at‐risk cases following wars by screening for adolescents exposed to family violence, those with prewar disorders, and those who directly witnessed war events to target them for specific interventions. 標題：一個前瞻性流行病學研究有關兒童及青少年在戰後抑鬱和焦慮的結果 撮要：戰後兒童的前瞻性研究沒有對創傷後壓力症(PTSD)以外病症作探討，而且研究方法上有限制。分層隨機樣本是386名兒童和青少年在戰後3週面見(階段1)，和一個隨機子樣本(n=143)在一年後評估(階段2)。利用結構化面見在兒童/青少年和父母中評估PTSD，重性抑鬱症(MDD)，分離焦慮症(SAD)，過度焦慮症(OAD)和心理社會壓力。階段1患病率為：MDD 25.9%, SAD 16.1%, OAD 28.0%和PTSD 26.0%，而44.1% 為任何疾病類別。階段2患病率為MDD 5.6%, SAD 4.2%, OAD 0%, 和PTSD 1.4%，而9.2%為任何疾病類別。階段1的精神疾患與經濟問題，恐懼被虐打，和目睹任何戰事 (ORs值域從2.5至28.6) 有相連。階段2持續有病則與戰前疾病(OR=6.0)和目睹戰事(OR=16.1)有關連。結果建議我們可以篩選經歷家庭暴力，戰前已有疾病，和目睹戰事的青少年來識別戰後風險個案，從而提供獨特介入治療。 标题：一个前瞻性流行病学研究有关儿童及青少年在战后抑郁和焦虑的结果 撮要：战后儿童的前瞻性研究没有对创伤后压力症(PTSD)以外病症作探讨，而且研究方法上有限制。分层随机样本是386名儿童和青少年在战后3周面见(阶段1)，和一个随机子样本(n=143)在一年后评估(阶段2)。利用结构化面见在儿童/青少年和父母中评估PTSD，重性抑郁症(MDD)，分离焦虑症(SAD)，过度焦虑症(OAD)和心理社会压力。阶段1患病率为：MDD 25.9%, SAD 16.1%, OAD 28.0%和PTSD 26.0%，而44.1% 为任何疾病类别。阶段2患病率为MDD 5.6%, SAD 4.2%, OAD 0%, 和PTSD 1.4%，而9.2%为任何疾病类别。阶段1的精神疾患与经济问题，恐惧被虐打，和目睹任何战事 (ORs值域从2.5至28.6) 有相连。阶段2持续有病则与战前疾病(OR=6.0)和目睹战事(OR=16.1)有关连。结果建议我们可以筛选经历家庭暴力，战前已有疾病，和目睹战事的青少年来识别战后风险个案，从而提供独特介入治疗。

  April 16, 2014   doi: 10.1002/jts.21895   open full text
• Diagnostic Accuracy of the Composite International Diagnostic Interview (CIDI 3.0) PTSD Module Among Female Vietnam‐Era Veterans.
  Rachel Kimerling, Tracey Serpi, Frank Weathers, Amy M. Kilbourne, Han Kang, Joseph F. Collins, Yasmin Cypel, Susan M. Frayne, Joan Furey, Grant D. Huang, Matthew J. Reinhard, Avron Spiro, Kathryn Magruder.
  Journal of Traumatic Stress. April 16, 2014
  The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) posttraumatic stress disorder (PTSD) module is widely used in epidemiological studies of PTSD, yet relatively few data attest to the instrument's diagnostic utility. The current study evaluated the diagnostic utility of the CIDI 3.0 PTSD module with U. S. women Vietnam‐era veterans. The CIDI and the Clinician‐Administered PTSD Scale (CAPS) were independently administered to a stratified sample of 160 women, oversampled for current PTSD. Both lifetime PTSD and recent (past year) PTSD were assessed within a 3‐week interval. Forty‐five percent of the sample met criteria for a CAPS diagnosis of lifetime PTSD, and 21.9% of the sample met criteria for a CAPS diagnosis of past‐year PTSD. Using CAPS as the diagnostic criterion, the CIDI correctly classified 78.8% of cases for lifetime PTSD (κ = .56) and 82.0% of past year PTSD cases (κ = .51). Estimates of diagnostic performance for the CIDI were sensitivity of .61 and specificity of .91 for lifetime PTSD and sensitivity of .71 and specificity of .85 for past‐year PTSD. Results suggest that the CIDI has good utility for identifying PTSD, though it is a somewhat conservative indicator of lifetime PTSD as compared to the CAPS. 標題：女越南戰事退役軍中綜合國際診斷會見(CIDI 3.0) 的診斷準確性 撮要：世界衛生組織(WHO)綜合國際診斷會見(CIDI)創傷後壓力症(PTSD)單元被廣泛應用於PTSD流行學研究，但只有少數研究其相關診斷效用。本研究在女性越南戰事退役軍中評定CIDI 3.0 PTSD單元的診斷效能。這是160名女士的分層和過度採樣現有PTSD的樣本，然後獨立地施行CIDI 和醫生施行PTSD量表(CAPS)。在三週內使用評估其終生PTSD和現有(過去一年)PTSD。總數45.0%符合CAPS終生PTSD診斷準則，和21.9%為CAPS過去一年PTSD診斷準則。以CAPS為診斷標準，CIDI 正確判別78.8% 終生PTSD個案(K= .56)和82.0% 過去一年PTSD 個案(K= .51) 。利用CAPS為標準估計CIDI的診斷表現，終生PTSD的靈敏度為.61和特異性為.091，而過往一年PTSD的靈敏度是.71 和特異性是.85。結果確認CIDI對辨識PTSD有高效用，但對比CAPS在終生PTSD方面卻是較保守的指標。 标题：女越南战事退役军中综合国际诊断会见(CIDI 3.0) 的诊断准确性 撮要：世界卫生组织(WHO)综合国际诊断会见(CIDI)创伤后压力症(PTSD)单元被广泛应用于PTSD流行学研究，但只有少数研究其相关诊断效用。本研究在女性越南战事退役军中评定CIDI 3.0 PTSD单元的诊断效能。这是160名女士的分层和过度采样现有PTSD的样本，然后独立地施行CIDI 和医生施行PTSD量表(CAPS)。在三周内使用评估其终生PTSD和现有(过去一年)PTSD。总数45.0%符合CAPS终生PTSD诊断准则，和21.9%为CAPS过去一年PTSD诊断准则。以CAPS为诊断标准，CIDI 正确判别78.8% 终生PTSD个案(K= .56)和82.0% 过去一年PTSD 个案(K= .51) 。利用CAPS为标准估计CIDI的诊断表现，终生PTSD的灵敏度为.61和特异性为.091，而过往一年PTSD的灵敏度是.71 和特异性是.85。结果确认CIDI对辨识PTSD有高效用，但比对CAPS在终生PTSD方面却是较保守的指标。

  April 16, 2014   doi: 10.1002/jts.21905   open full text
• Anger: Cause or Consequence of Posttraumatic Stress? A Prospective Study of Dutch Soldiers.
  Miriam J. J. Lommen, Iris M. Engelhard, Rens Schoot, Marcel A. Hout.
  Journal of Traumatic Stress. April 04, 2014
  Many studies have shown that individuals with posttraumatic stress disorder (PTSD) experience more anger over time and across situations (i.e., trait anger) than trauma‐exposed individuals without PTSD. There is a lack of prospective research, however, that considers anger levels before trauma exposure. The aim of this study was to prospectively assess the relationship between trait anger and PTSD symptoms, with several known risk factors, including baseline symptoms, neuroticism, and stressor severity in the model. Participants were 249 Dutch soldiers tested approximately 2 months before and approximately 2 months and 9 months after their deployment to Afghanistan. Trait anger and PTSD symptom severity were measured at all assessments. Structural equation modeling including cross‐lagged effects showed that higher trait anger before deployment predicted higher PTSD symptoms 2 months after deployment (β = .36), with stressor severity and baseline symptoms in the model, but not with neuroticism in the model. Trait anger at 2 months postdeployment did not predict PTSD symptom severity at 9 months, and PTSD symptom severity 2 months postdeployment did not predict subsequent trait anger scores. Findings suggest that trait anger may be a pretrauma vulnerability factor for PTSD symptoms, but does not add variance beyond the effect of neuroticism. 標題：憤怒：創傷後壓力是因是果?一個前瞻性軍人研究。 撮要：研究大多指出創傷後壓力症(PTSD)患者對比經歷創傷但未有PTSD人士，有著更多與時俱增及跨越不同狀況的憤怒(即憤怒素質)。但現時未有前瞻性研究評估創傷前憤怒水平。本文前瞻性評估憤怒素質和PTSD症狀之間的關係，及其他模型內風險因素，包括基準症狀、「神經質」和壓力水平。參與者是249名荷蘭士兵，在派駐阿富汗兩個月前、兩個及九個月後接受評估。在所有階段中都評估憤怒素質和PTSD症狀的程度。包括交叉滯後效應在內的結構方程式模型顯示較高派駐前憤怒素質預知派駐後兩個月的較高PTSD症狀(β=.36)，而模型內包括壓力程度和基準症狀但卻不可有「神經質」這一因素在內。派駐後兩個月的憤怒素質不能預測九個月後PTSD症狀的程度，而兩個月後PTSD症狀程度亦不能預知繼後憤怒素質得分。結果指出憤怒素質可能是PTSD症狀的創傷前弱點，但未能在「神經質」效應外加添變量。 标题：愤怒：创伤后压力是因是果?一个前瞻性军人研究。 撮要：研究大多指出创伤后压力症(PTSD)患者对比经历创伤但未有PTSD人士，有着更多与时俱增及跨越不同状况的愤怒(即愤怒素质)。但现时未有前瞻性研究评估创伤前愤怒水平。本文前瞻性评估愤怒素质和PTSD症状之间的关系，及其他模型内风险因素，包括基准症状、「神经质」和压力水平。参与者是249名荷兰士兵，在派驻阿富汗两个月前、两个及九个月后接受评估。在所有阶段中都评估愤怒素质和PTSD症状的程度。包括交叉滞后效应在内的结构方程式模型显示较高派驻前愤怒素质预知派驻后两个月的较高PTSD症状(β=.36)，而模型内包括压力程度和基准症状但却不可有「神经质」这一因素在内。派驻后两个月的愤怒素质不能预测九个月后PTSD症状的程度，而两个月后PTSD症状程度亦不能预知继后愤怒素质得分。结果指出愤怒素质可能是PTSD症状的创伤前弱点，但未能在「神经质」效应外加添变量。

  April 04, 2014   doi: 10.1002/jts.21904   open full text
• Effects of Cognitive–Behavioral Conjoint Therapy for PTSD on Partners’ Psychological Functioning.
  Philippe Shnaider, Nicole D. Pukay‐Martin, Steffany J. Fredman, Alexandra Macdonald, Candice M. Monson.
  Journal of Traumatic Stress. April 04, 2014
  A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in “one” partner are negatively associated with their intimate partner's psychological functioning. The present study investigated intimate partners’ mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive–behavioral conjoint therapy for PTSD (Monson & Fredman, ). There were no significant differences between active treatment and waitlist in intimate partners’ psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive–behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress. 標題：PTSD 認知行為聯合治療對伴侶心理功能的影響 撮要：很多研究發現病人的創傷後壓力症(PTSD)症狀與他們親密伴侶的心理功能呈負關連。本研究調查親密伴侶精神健康結果(即抑鬱、焦慮和憤怒)，而樣本是一個(PTSD認知行為聯合治療)隨機候補對照試驗內患有PTSD的四十名病者的伴侶 (Mansion & Fredman, 2012)。治療後親密伴侶的心理功能在治療及候補組別之間未有明顯差別。小組分析卻見治療前有臨床多項量度有明顯困擾的伴侶，在治療後有可能及臨床顯著心理功能的改進，而未見惡化跡象。結論是PTSD認知行為聯合治療可能對有心理困擾的伴侶有益。 标题：PTSD 认知行为联合治疗对伴侣心理功能的影响 撮要：很多研究发现病人的创伤后压力症(PTSD)症状与他们亲密伴侣的心理功能呈负关连。本研究调查亲密伴侣精神健康结果(即忧郁、焦虑和愤怒)，而样本是一个(PTSD认知行为联合治疗)随机候补对照试验内患有PTSD的四十名病者的伴侣 (Mansion & Fredman, 2012)。治疗后亲密伴侣的心理功能在治疗及候补组别之间未有明显差别。小组分析却见治疗前有临床多项量度有明显困扰的伴侣，在治疗后有可能及临床显着心理功能的改进，而未见恶化情况。结论是PTSD认知行为联合治疗可能对有心理困扰的伴侣有益。

  April 04, 2014   doi: 10.1002/jts.21893   open full text
• Comparison of Clinician‐ and Self‐Assessments of Posttraumatic Stress Symptoms in Older Versus Younger Veterans.
  Carole A. Lunney, Paula P. Schnurr, Joan M. Cook.
  Journal of Traumatic Stress. April 02, 2014
  Assessment of posttraumatic stress disorder (PTSD) in older adults has received limited investigation. The purpose of this study was to compare the severity of PTSD symptoms in treatment‐seeking older and younger U.S. veterans with PTSD. Participants were 360 male and 284 female veterans enrolled in 2 separate clinical trials of psychotherapy for PTSD. About 4% of the participants were age 60 years or older. Symptoms were assessed before treatment using clinician‐rated and self‐report measures. For men, only numbing symptoms were lower in older veterans; this was so in clinician ratings, d = 0.76, and self‐reports, d = 0.65. For women, clinician‐rated hyperarousal symptoms were lower in older veterans, d = 0.57. Clinician‐rated and self‐reported symptoms were strongly related, Bs = 0.95 and 0.80 in the male and female samples, respectively. Among men, clinician‐rated and self‐reported reexperiencing and hyperarousal symptoms were associated only in younger veterans. Accurate assessment of PTSD symptoms in older adults is essential to identifying and implementing effective treatment. Our findings suggest that some symptoms may be lower in older men, and that some symptoms of PTSD may be underdetected in older women. Future research should assess the combined effect of gender and age on PTSD symptom presentation. 標題：年長和年輕退役軍人中醫生評核和自我評估的創傷後壓力症狀的比較。 撮要：我們對年長成人的創傷後壓力症(PTSD)評估只有有限度研究。本文旨在比較尋求治療而患有PTSD的年長和年輕退役兵的PTSD症狀。樣本是360名男性和284名女性退役軍，分別從2個獨立的PTSD臨床心理治療研究中錄取，而其中4%是年齡60或以上。治療前先以醫生評估和自我報告量度症狀。男士中年長者只有麻木症狀有較低程度(醫生評估，d=0.76，和自我報告，d=0.65)；而女士中年長者只有醫生評估過激症狀有較低程度，d=0.57。醫生評估和自我報告症狀強烈地相連，分別在男和女樣本中Bs=0.95和.80。男性中只有年輕者的醫生評估和自我報告再經歷及過激症狀有相關。準確的PTSD症狀評估在年長者是必須的，有助辨識和採用有效療法。結果指出在年長男士中有些症狀可能較輕，而年長女士中PTSD的某些症狀較難發現。未來研究必須評估性別和年齡對PTSD症狀表現的綜合效果。 标题：年长和年轻退役军人中医生评核和自我评估的创伤后压力症状的比较。 撮要：我们对年长成人的创伤后压力症(PTSD)评估只有有限度研究。本文旨在比较寻求治疗而患有PTSD的年长和年轻退役兵的PTSD症状。样本是360名男性和284名女性退役军，分别从2个独立的PTSD临床心理治疗研究中录取，而其中4%是年龄60或以上。治疗前先以医生评估和自我报告量度症状。男士中年长者只有麻木症状有较低程度(医生评估，d=0.76，和自我报告，d=0.65)；而女士中年长者只有医生评估过激症状有较低程度，d=0.57。医生评估和自我报告症状强烈地相连，分别在男和女样本中Bs=0.95和.80。男性中只有年轻者的医生评估和自我报告再经历及过激症状有相关。准确的PTSD症状评估在年长者是必须的，有助辨识和采用有效疗法。结果指出在年长男士中有些症状可能较轻，而年长女士中PTSD的某些症状较难发现。未来研究必须评估性别和年龄对PTSD症状表现的综合效果。

  April 02, 2014   doi: 10.1002/jts.21908   open full text
• Glasgow Coma Scores, Early Opioids, and Posttraumatic Stress Disorder Among Combat Amputees.
  Ted Melcer, Jay Walker, V. Franklin Sechriest, Martin Lebedda, Kimberly Quinn, Michael Galarneau.
  Journal of Traumatic Stress. March 25, 2014
  A recent study found that combat amputees had a reduced prevalence of posttraumatic stress disorder (PTSD) compared with nonamputees with serious extremity injuries. We hypothesized that an extended period of impaired consciousness or early treatment with morphine could prevent consolidation of traumatic memory and the development of PTSD. To examine this hypothesis, we retrospectively reviewed 258 combat casualty records from the Iraq or Afghanistan conflicts from 2001–2008 in the Expeditionary Medical Encounter Database, including medications and Glasgow Coma Scale (GCS) scores recorded at in‐theater facilities within hours of the index injury. All patients sustained amputations from injuries. Psychological diagnoses were extracted from medical records for 24 months postinjury. None of 20 patients (0%) with GCS scores of 12 or lower had PTSD compared to 20% of patients with GCS scores of 12 or greater who did have PTSD. For patients with traumatic brain injury, those treated with intravenous morphine within hours of injury had a significantly lower prevalence of PTSD (6.3%) and mood disorders (15.6%) compared to patients treated with fentanyl only (prevalence of PTSD = 41.2%, prevalence of mood disorder = 47.1%). GCS scores and morphine and fentanyl treatments were not significantly associated with adjustment, anxiety, or substance abuse disorders. 標題：戰鬥中截肢生還者的格拉斯哥昏迷評分，早期鴉片類藥物使用和創傷後壓力症 撮要：近日研究指出戰鬥中截肢生還者對比其他嚴重肢體受創但無截肢者有較低創傷後壓力症(PTSD)患病率。我們假設較長神志不清時間或早期嗎啡治療能避免創傷記憶鞏固和PTSD形成。我們追溯覆審258個伊拉克或阿富汗戰鬥傷亡紀錄來驗證假設，包括2001至2008年遠征行動醫療數據庫中藥物和格拉斯哥昏迷評分(GCS)(是受傷事件數小時內手術室中記下)。所有病人受傷後需截肢，而受傷後24個月內醫療紀錄中抽取其心理學診斷，但GCS 12分或以下者(共20名病人)全部沒有PTSD(0%)，而GCS 12分或以上者有20%有PTSD。創傷性腦受創者在受傷後數小時內接受靜脈嗎啡注射對比只接受芬太尼者 (PTSD患病率=41.2%，情緒病患病率=47.1%)，則有統計學上顯著較低PTSD患病率(6.3%)和情緒病患病率(15.6%)。GCS評分，嗎啡和芬太尼治療未有顯著地與適應，焦慮或物質濫用有關連。 标题：战斗中截肢生还者的格拉斯哥昏迷评分，早期鸦片类药物使用和创伤后压力症 撮要：近日研究指出战斗中截肢生还者对比其他严重肢体受创但无截肢者有较低创伤后压力症(PTSD)患病率。我们假设较长神志不清时间或早期吗啡治疗能避免创伤记忆巩固和PTSD形成。我们追溯覆审258个伊拉克或阿富汗战斗伤亡纪录来验证假设，包括2001至2008年远征行动医疗数据库中药物和格拉斯哥昏迷评分(GCS)(是受伤事件数小时内手术室中记下)。所有病人受伤后需截肢，而受伤后24个月内医疗纪录中抽取其心理学诊断，但GCS 12分或以下者(共20名病人)全部没有PTSD(0%)，而GCS 12分或以上者有20%有PTSD。创伤性脑受创者在受伤后数小时内接受静脉吗啡注射对比只接受芬太尼者 (PTSD患病率=41.2%，情绪病患病率=47.1%)，则有统计学上显著较低PTSD患病率(6.3%)和情绪病患病率(15.6%)。GCS评分，吗啡和芬太尼治疗未有显著地与适应，焦虑或物质滥用有关连。

  March 25, 2014   doi: 10.1002/jts.21909   open full text
• Changes in Implementation of Two Evidence‐Based Psychotherapies for PTSD in VA Residential Treatment Programs: A National Investigation.
  Joan M. Cook, Stephanie Dinnen, Richard Thompson, Vanessa Simiola, Paula P. Schnurr.
  Journal of Traumatic Stress. March 25, 2014
  There has been little investigation of the natural course of evidence‐based treatments (EBTs) over time following the draw‐down of initial implementation efforts. Thus, we undertook qualitative interviews with the providers at 38 U.S. Department of Veterans Affairs’ residential treatment programs for posttraumatic stress disorder (PTSD) to understand implementation and adaptation of 2 EBTs, prolonged exposure (PE), and cognitive processing therapy (CPT), at 2 time points over a 4‐year period. The number of providers trained in the therapies and level of training improved over time. At baseline, of the 179 providers eligible per VA training requirements, 65 (36.4%) had received VA training in PE and 111 (62.0%) in CPT with 17 (9.5%) completing case consultation or becoming national trainers in both PE and CPT. By follow‐up, of the increased number of 190 eligible providers, 87 (45.8%) had received VA training in PE and 135 (71.1%) in CPT, with 69 (36.3%) and 81 (42.6%) achieving certification, respectively. Twenty‐two programs (57.9%) reported no change in PE use between baseline and follow‐up, whereas 16 (42.1%) reported an increase. Twenty‐four (63.2%) programs reported no change in their use of CPT between baseline and follow‐up, 12 (31.6%) programs experienced an increase, and 2 (5.2%) programs experienced a decrease in use. A significant number of providers indicated that they made modifications to the manuals (e.g., tailoring, lengthening). Reasons for adaptations are discussed. The need to dedicate time and resources toward the implementation of EBTs is noted. 標題：全國性偵查有關VA 住宿治療計劃方面兩個PTSD 實證為本心理治療實施的變更 撮要：很少有調查有關實證為本治療(EBTs)在初期實施縮編後的自然進程，所以我們對38美國退役軍人事務部門創傷後壓力症(PTSD)住宿治療計劃的提供者進行定性訪談，以瞭解兩種EBTs(即延續暴露(PE)和認知處理法(CPT))在4年期間的兩個時間點的實施及適應情況。底線上有179名符合VA訓練要求的服務提供者，其中65名(36.4%)接受VA對PE的培訓而111名(62.0%)則接受CPT培訓，共17名(9.5%)完成個案諮詢或是PE和CP的全國教練。跟進時已增至190名合適的服務提供者，其中87名(45.8%)接受PE培訓和135名(71.1%)接受CPT 培訓，分別為69名(36.3%)和81名(42.6%)達致認可資格。22個計劃(57.9%)在底線和跟進間沒有PE應用的改變，而16個(42.1%)則增加使用。 24個(63.2%)計劃在底線和跟進期間沒有改變CPT的應用，12個(31.6%)則增加使用而2個(5.2%)則減少應用。相當數量的服務提供者指出他們對手冊作出修改(如剪裁和延長)，改動的理由在本文也有討論。EBTs 實施時我們要注意時間和資源方面的需要。 标题：全国性侦查有关VA 住宿治疗计划方面两个PTSD 实证为本心理治疗实施的变更 撮要：很少有调查有关实证为本治疗(EBTs)在初期实施缩编后的自然进程，所以我们对38美国退役军人事务部门创伤后压力症(PTSD)住宿治疗计划的提供者进行定性访谈，以了解两种EBTs(即延续暴露(PE)和认知处理法(CPT))在4年期间的两个时间点的实施及适应情况。底在线有179名符合VA训练要求的服务提供商，其中65名(36.4%)接受VA对PE的培训而111名(62.0%)则接受CPT培训，共17名(9.5%)完成个案咨询或是PE和CP的全国教练。跟进时已增至190名合适的服务提供商，其中87名(45.8%)接受PE培训和135名(71.1%)接受CPT 培训，分别为69名(36.3%)和81名(42.6%)达致认可资格。22个计划(57.9%)在底线和跟进间没有PE应用的改变，而16个(42.1%)则增加使用。 24个(63.2%)计划在底线和跟进期间没有改变CPT的应用，12个(31.6%)则增加使用而2个(5.2%)则减少应用。相当数量的服务提供商指出他们对手册作出修改(如剪裁和延长)，改动的理由在本文也有讨论。EBTs 实施时我们要注意时间和资源方面的需要。

  March 25, 2014   doi: 10.1002/jts.21902   open full text
• A Pilot Study of a Randomized Controlled Trial of Yoga as an Intervention for PTSD Symptoms in Women.
  Karen S. Mitchell, Alexandra M. Dick, Dawn M. DiMartino, Brian N. Smith, Barbara Niles, Karestan C. Koenen, Amy Street.
  Journal of Traumatic Stress. March 25, 2014
  Posttraumatic stress disorder (PTSD) is a debilitating condition that affects approximately 10% of women in the United States. Although effective psychotherapeutic treatments for PTSD exist, clients with PTSD report additional benefits of complementary and alternative approaches such as yoga. In particular, yoga may downregulate the stress response and positively impact PTSD and comorbid depression and anxiety symptoms. We conducted a pilot study of a randomized controlled trial comparing a 12‐session Kripalu‐based yoga intervention with an assessment control group. Participants included 38 women with current full or subthreshold PTSD symptoms. During the intervention, yoga participants showed decreases in reexperiencing and hyperarousal symptoms. The assessment control group, however, showed decreases in reexperiencing and anxiety symptoms as well, which may be a result of the positive effect of self‐monitoring on PTSD and associated symptoms. Between‐groups effect sizes were small to moderate (0.08–0.31). Although more research is needed, yoga may be an effective adjunctive treatment for PTSD. Participants responded positively to the intervention, suggesting that it was tolerable for this sample. Findings underscore the need for future research investigating mechanisms by which yoga may impact mental health symptoms, gender comparisons, and the long‐term effects of yoga practice. 標題：一個隨機對照研究有關瑜伽作為婦女PTSD症狀的介入治療的先導計劃。 撮要：創傷後壓力症(PTSD)削弱大約10%美國婦女的能力。雖然PTSD已有有效的心理治療，但患者接受另類輔助醫療方案如瑜伽等都能有所裨益。再者，瑜伽可能調低壓力反應，及正面影響PTSD和焦慮、抑鬱的共病症狀。本研究隨機對照12節Kripalu瑜伽介入治療及一個評核對照組樣本包括38名現在患有充份或亞限度PTSD症狀 (即最少每一羣組有一症狀) 的婦女。在治療期間，瑜伽組的再經歷和過激反應降低；對照組再經歷和焦慮症狀亦有降低，這可能是對PTSD和相關症狀自己監察的正面效果。組別間有效值是小到中度 (0.08‐0.31)。瑜伽可能是PTSD的有效附加治療，但還需更多研究。參與者對比反應正面，顯示其可受性。結果強調將來我們對瑜伽如何影響精神健康症狀、性別差異和長遠效果各方面作進一步研究。 标题：一个随机对照研究有关瑜伽作为妇女PTSD症状的介入治疗的先导计划。 撮要：创伤后压力症(PTSD)削弱大约10%美国妇女的能力。虽然PTSD已有有效的心理治疗，但患者接受另类辅助医疗方案如瑜伽等都能有所裨益。再者，瑜伽可能调低压力反应，及正面影响PTSD和焦虑、忧郁的共病症状。本研究随机对照12节Kripalu瑜伽介入治疗及一个评核对照组样本包括38名现在患有充份或亚限度PTSD症状 (即最少每一羣组有一症状) 的妇女。在治疗期间，瑜伽组的再经历和过激反应降低；对照组再经历和焦虑症状亦有降低，这可能是对PTSD和相关症状自己监察的正面效果。组别间有效值是小到中度 (0.08‐0.31)。瑜伽可能是PTSD的有效附加治疗，但还需更多研究。参与者对比反应正面，显示其可受性。结果强调将来我们对瑜伽如何影响精神健康症状、性别差异和长远效果各方面作进一步研究。

  March 25, 2014   doi: 10.1002/jts.21903   open full text
• Posttraumatic Stress Symptoms in Breast Cancer Patients: Temporal Evolution, Predictors, and Mediation.
  Sandra Pérez, María José Galdón, Yolanda Andreu, Elena Ibáñez, Estrella Durá, Andrea Conchado, Etzel Cardeña.
  Journal of Traumatic Stress. March 21, 2014
  This study (N = 102 women) evaluated the time course of posttraumatic stress symptomatology (PTSS) at different stages of nonmetastastic cancer diagnosis and treatment: during treatment, at the end of treatment, and at a 6–12 months follow‐up. We also assessed the contribution of demographic, trait, and state predictors to PTSS, and coping processes as proximal mediators of the relation between Type C personality and PTSS. Results indicated that PTSS remained constant across all phases. There were significant correlations (range = .28 to .81) between PTSS and psychosocial variables and age, but not with other sociodemographic or medical factors. A linear growth curve model showed that hopelessness/helplessness (B = 1.45) and Type C personality (B = 1.40) were the best predictors of PTSD symptomatology, followed by trait dissociation (B = 0.55), and the coping strategies of anxious preoccupation (B = 1.20), cognitive avoidance (B = 0.91), and symptoms of acute stress disorder (B = 0.19). A mediation model showed that the coping strategies of anxious preoccupation, cognitive avoidance, and helplessness/hopelessness mediated the relationship between Type C personality and PTSS during treatment, posttreatment, and follow‐up. These results clarify the contribution of different predictors of PTSS and can help develop prevention programs. 標題：乳癌病人的創傷後壓力症狀：時空演進，預測因素和調解 撮要：本文 (N=102名女性) 評估在非轉移癌症的不同診斷和治療階段中創傷後壓力症狀學 (PTSS )的時間進程：包括在治療中、治療末和6到12月後覆診期。我們也評核人口統計學、素質和狀態的預測因素對PTSS的影響，和評定應對過程在C類性格與PTSS之間如何近端調節。結果顯示PTSS在所有階段保持穩定。PTSS和心理社會變量及年紀呈顯著關連 (值域 .28至 .81)，但與其他社會人口統計或醫學因素則未有此等關連。綫性生長曲綫模型可見無望/無助 (β=1.45) 和C類性格 (β=1.40) 是最佳預測PTSD症狀學的因素，其次為解離素質 (β=0.55)，與焦慮關注 (β=1.20) 和認知迴避 (β=0.91) 應對策略，及急性應激障礙症狀 (β=0.19)。調節模型顯示焦慮關注、認知迴避和無望/無助等應對策略有助調整C類性格和PTSS的關係 (包括治療中、後和覆診時)。結果閳明不同PTSS的預測因素的貢獻，和有助發展預防方案。 标题：乳癌病人的创伤后压力症状：时空演进，预测因素和调解 撮要：本文 (N=102名女性) 评估在非转移癌症的不同诊断和治疗阶段中创伤后压力症状学 (PTSS )的时间进程：包括在治疗中、治疗末和6到12月后覆诊期。我们也评核人口统计学、素质和状态的预测因素对PTSS的影响，和评定应对过程在C类性格与PTSS之间如何近端调节。结果显示PTSS在所有阶段保持稳定。PTSS和心理社会变量及年纪呈显著关连 (值域 .28至 .81)，但与其他社会人口统计或医学因素则未有此等关连。线性生长曲线模型可见无望/无助 (β=1.45) 和C类性格 (β=1.40) 是最佳预测PTSD症状学的因素，其次为解离素质 (β=0.55)，与焦虑关注 (β=1.20) 和认知回避 (β=0.91) 应对策略，及急性应激障碍症状 (β=0.19)。调节模型显示焦虑关注、认知回避和无望/无助等应对策略有助调整C类性格和PTSS的关系 (包括治疗中、后和覆诊时)。结果閳明不同PTSS的预测因素的贡献，和有助发展预防方案。

  March 21, 2014   doi: 10.1002/jts.21901   open full text
• Negative Cognitions as a Moderator in the Relationship Between PTSD and Substance Use in a Psychiatrically Hospitalized Adolescent Sample.
  Maureen A. Allwood, Christianne Esposito‐Smythers, Lance P. Swenson, Anthony Spirito.
  Journal of Traumatic Stress. March 21, 2014
  Adolescents exposed to trauma are more likely to engage in alcohol and marijuana use compared to their nontrauma‐exposed counterparts; however, little is known about factors that may moderate these associations. This study examined the potential moderating effect of cognitions relevant to exposure to trauma (i.e., negative view of self, world, and future) in the association between posttraumatic stress disorder (PTSD) diagnosis and substance use among a psychiatric inpatient sample of 188 adolescents. Findings were that PTSD diagnosis was not significantly associated with substance‐use diagnoses, but was associated with substance‐use symptoms, accounting for 2.9% and 9.6% of the variance in alcohol and marijuana symptoms, respectively. The association between PTSD diagnosis and substance use symptoms, however, was moderated by negative cognitions, with PTSD and high negative cognitions (but not low negative cognitions) being significantly positively associated with substance use symptoms. The relevant cognitions differed for alcohol symptoms and marijuana symptoms. Children and adolescents who experience trauma and PTSD may benefit from early interventions that focus on cognitive processes as one potential moderator in the development of posttrauma substance use. 標題：精神病院住院青少年中負面認知緩和PTSD和物質濫用間的關係 撮要：受創青少年比未受創者更多濫用酒精和大麻，但未知有何因素緩解當中關係。本文檢視188名精神科住院青少年，其中與創傷經歷有關的認知的潛在緩解作用在創傷後壓力症(PTSD)診斷和物質濫用兩者的關係。結果是PTSD診斷未與物質濫用診斷有明顯關係，但卻與物質濫用症狀相連(分別是2.9%和9.6%酒精和大麻症狀的變量) 。負面認知能緩和PTSD診斷及物質濫用症狀之間的關係，而PTSD和強烈負面認知(但非輕微負面認知)顯著地與物質濫用症狀呈正相連。酒精和大麻症狀的相應認知有異。兒童及青少年經歷創傷及PTSD後可受惠於聚焦認知過程的早期介入，以期緩解創傷後物質濫用的發生。 标题：精神病院住院青少年中负面认知缓和PTSD和物质滥用间的关系 撮要：受创青少年比未受创者更多滥用酒精和大麻，但未知有何因素缓解当中关系。本文检视188名精神科住院青少年，其中与创伤经历有关的认知的潜在缓解作用在创伤后压力症(PTSD)诊断和物质滥用两者的关系。结果是PTSD诊断未与物质滥用诊断有明显关系，但却与物质滥用症状相连(分别是2.9%和9.6%酒精和大麻症状的变量) 。负面认知能缓和PTSD诊断及物质滥用症状之间的关系，而PTSD和强烈负面认知(但非轻微负面认知)显著地与物质滥用症状呈正相连。酒精和大麻症状的相应认知有异。儿童及青少年经历创伤及PTSD后可受惠于聚焦认知过程的早期介入，以期缓解创伤后物质滥用的发生。

  March 21, 2014   doi: 10.1002/jts.21907   open full text
• Posttraumatic Stress Disorder and Substance Use Disorder Comorbidity Among Individuals With Physical Disabilities:Findings From the National Comorbidity Survey Replication.
  Melissa L. Anderson, Douglas M. Ziedonis, Lisa M. Najavits.
  Journal of Traumatic Stress. March 21, 2014
  Co‐occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) affects multiple domains of functioning and presents complex challenges to recovery. Using data from the National Comorbidity Study Replication, a national epidemiological study of mental disorders (weighted N = 4,883), the current study sought to determine the prevalence of PTSD and SUD, the symptom presentation of these disorders, and help‐seeking behaviors in relation to PTSD and SUD among individuals with physical disabilities (weighted n = 491; nondisabled weighted n = 4,392). Results indicated that individuals with physical disabilities exhibited higher rates of PTSD, SUD, and comorbid PTSD/SUD than nondisabled individuals. For example, they were 2.6 times more likely to meet criteria for lifetime PTSD, 1.5 times more likely for lifetime SUD, and 3.6 times more likely for lifetime PTSD/SUD compared to their nondisabled peers. Additionally, individuals with physical disabilities endorsed more recent/severe PTSD symptoms and more lifetime trauma events than nondisabled individuals with an average of 5 different trauma events compared to 3 in the nondisabled group. No significant pattern of differences was noted for SUD symptom presentation, or for receipt of lifetime or past‐year PTSD or SUD treatment. Implications of these findings and recommendations for future research are discussed. 標題：全國共病性調查(複製)的結果：身體傷殘人士的創傷後壓力症與物質濫用共病性。 撮要：創傷後壓力症(PTSD)和物質濫用(SUD)的共同發生影響多方面功能及構成復原路上極複雜的挑戰。從全國共病性調查(複製)的數據(此乃全國精神病流行學調查(加權N=4,883))中，我們找出在身體傷殘人士中PTSD和SUD的流行率，它們的症狀表現，和求助行為的關係(加權n=491;非傷殘加權n=4,392)。結果指出身體傷殘人士有更高PTSD, SUD,和PTSD/SUD共病性的比率(比非傷殘人士)。例如：比對非傷殘人士，他們符合終生PTSD準則的是2.6倍，終生SUD為1.5倍，及终生PTSD/SUD為3.6倍。再者，身體傷殘人士有更多近期/嚴重PTSD症狀和終生創傷事件(如對比非傷殘組有3種而傷殘者有5種不同創傷事件)。SUD症狀表現，終生和去年接受PTSD和SUD治療都未見顯着差異模式。上述結果和未來研究建議都在本文加以論述。 标题：全国共病性调查(复制)的结果：身体伤残人士的创伤后压力症与物质滥用共病性。 撮要：创伤后压力症(PTSD)和物质滥用(SUD)的共同发生影响多方面功能及构成复原路上极复杂的挑战。从全国共病性调查(复制)的数据(此乃全国精神病流行学调查(加权N=4,883))中，我们找出在身体伤残人士中PTSD和SUD的流行率，它们的症状表现，和求助行为的关系(加权n=491;非伤残加权n=4,392)。结果指出身体伤残人士有更高PTSD, SUD,和PTSD/SUD共病性的比率(比非伤残人士)。例如：比对非伤残人士，他们符合终生PTSD准则的是2.6倍，终生SUD为1.5倍，及终生PTSD/SUD为3.6倍。再者，身体伤残人士有更多近期/严重PTSD症状和终生创伤事件(如对比非伤残组有3种而伤残者有5种不同创伤事件)。SUD症状表现，终生和去年接受PTSD和SUD治疗都未见显着差异模式。上述结果和未来研究建议都在本文加以论述。

  March 21, 2014   doi: 10.1002/jts.21894   open full text
• PTSD Symptoms and Pain in Canadian Military Veterans: The Mediating Roles of Anxiety, Depression, and Alcohol Use.
  Kara C. Irwin, Candace Konnert, May Wong, Thomas A. O'Neill.
  Journal of Traumatic Stress. March 17, 2014
  Symptoms of posttraumatic stress disorder (PTSD) and pain are often comorbid among veterans. The purpose of this study was to investigate to what extent symptoms of anxiety, depression, and alcohol use mediated the relationship between PTSD symptoms and pain among 113 treated male Canadian veterans. Measures of PTSD, pain, anxiety symptoms, depression symptoms, and alcohol use were collected as part of the initial assessment. The bootstrapped resampling analyses were consistent with the hypothesis of mediation for anxiety and depression, but not alcohol use. The confidence intervals did not include zero and the indirect effect of PTSD on pain through anxiety was .04, CI [.03, .07]. The indirect effect of PTSD on pain through depression was .04, CI [.02, .07]. These findings suggest that PTSD and pain symptoms among veterans may be related through the underlying symptoms of anxiety and depression, thus emphasizing the importance of targeting anxiety and depression symptoms when treating comorbid PTSD and pain patients. 標題：加拿大退役軍人的創傷後壓力症狀和痛楚：焦慮、抑鬱和酗酒的調節角色 撮要：退役軍人多有經歷創傷後壓力症 (PTSD) 症狀與痛症共同發生。本研究旨在調查在113名接受治療的加拿大退役軍人中PTSD症狀和痛症之間的關係有多大程度是由焦慮、抑鬱和酗酒等症狀所調節。我們首先評估PTSD、痛症、焦慮症狀、抑鬱症狀和酗酒的情況。引導樣本重採分析與焦慮及抑鬱調節假設一致，但酗酒卻未能調節。置信區間未包含「零」，而PTSD透過焦慮而間接影響痛症為 .04, CI=﹝.03, .07﹞。但PTSD透過抑鬱而間接影響痛症則是 .04, CI=﹝.02, .07﹞。結果顯示退役軍人中PTSD和痛症症狀可能經由焦慮和抑鬱相關症狀而關連，所以在治療PTSD共病痛症病人時，我們須注重焦慮和抑鬱症狀的治療。 标题：加拿大退役军人的创伤后压力症状和痛楚：焦虑、忧郁和酗酒的调节角色 撮要：退役军人多有经历创伤后压力症 (PTSD) 症状与痛症共同发生。本研究旨在调查在113名接受治疗的加拿大退役军人中PTSD症状和痛症之间的关系有多大程度是由焦虑、忧郁和酗酒等症状所调节。我们首先评估PTSD、痛症、焦虑症状、忧郁症状和酗酒的情况。引导样本重采分析与焦虑及忧郁调节假设一致，但酗酒却未能调节。置信区间未包含「零」，而PTSD透过焦虑而间接影响痛症为 .04, CI=﹝.03, .07﹞。但PTSD透过忧郁而间接影响痛症则是 .04, CI=﹝.02, .07﹞。结果显示退役军人中PTSD和痛症症状可能经由焦虑和忧郁相关症状而关连，所以在治疗PTSD共病痛症病人时，我们须注重焦虑和忧郁症状的治疗。

  March 17, 2014   doi: 10.1002/jts.21897   open full text
• Unique PTSD Clusters Predict Intention to Seek Mental Health Care and Subsequent Utilization in US Veterans with PTSD Symptoms.
  Rebecca K. Blais, Katherine D. Hoerster, Carol Malte, Stephen Hunt, Matthew Jakupcak.
  Journal of Traumatic Stress. March 14, 2014
  Many veterans return from deployment with posttraumatic stress disorder (PTSD), but most attend only a limited number of mental health care visits. Although global PTSD relates to seeking mental health care, it is unclear whether specific features of PTSD inform the low rates of mental health care utilization. This study examined PTSD cluster severities of avoidance, reexperiencing, dysphoria, and hyperarousal as predictors of intention to seek mental health care and prospective treatment utilization. US veterans with at least subthreshold PTSD (N = 189) completed a PTSD symptom measure and indicated whether they intended to seek mental health care. Prospective Department of Veterans Affairs mental health care utilization was extracted from the medical record. At the bivariate level, each cluster was positively associated with a positive intention to seek mental health care and prospective treatment utilization. In multivariate models, however, dysphoria severity (OR = 1.16, 95% CI [1.06, 1.26]) was uniquely and positively correlated with intention to seek mental health care, whereas higher avoidance severity (IRR = 0.86, 95% CI [0.76, 0.98]) predicted lower treatment utilization, and higher reexperiencing severity (IRR = 1.07, 95% CI [1.01, 1.14]) predicted greater treatment utilization. It is critical to tailor interventions to target specific features of PTSD and to meet patients where they are. 標題：患有PTSD症狀的退役軍人中獨特PTSD群集預測尋求精神健康服務的意圖和續後使用情況。 撮要：很多退役軍人從派駐任務回國後患上創傷後壓力症(PTSD)，但大多只接受少量精神健康服務。雖然全球PTSD都與尋求精神健康服務相關，PTSD獨特性質未知能否預測精神健康服務的低使用率。本文檢視PTSD羣集(迴避、再經歷、煩躁和過激反應)嚴重程度作為尋求精神健康服務意願和未來服務使用率的預知因素。患有最少亞閾值PTSD的退役兵(N=189)完成一個PTSD症狀測試，和表明他們會否尋求精神健康服務。退役軍人事務部門精神健康服務的預期使用情況則從病歷中獲取。在雙變量水平，每一羣集與尋求精神健康服務和預期治療使用情況的正面意圖呈正相連。在複合變量模型中，煩燥程度(OR=1.16,95%CI=[1.06,1.26])獨特地與尋求精神健康服務呈正相連，而較重迴避程度(IRR=0.86,95%CI=[0.76,0.98])預測較低治療使用量。較嚴重再經歷程度(IRR=1.07,95%CI=[1.01,1.14])則預知較多治療使用。我們急需聚焦PTSD獨特性質的合適介入服務和接觸病者的確實狀況。 标题：患有PTSD症状的退役军人中独特PTSD群集预测寻求精神健康服务的意图和续后使用情况。 撮要：很多退役军人从派驻任务回国后患上创伤后压力症(PTSD)，但大多只接受少量精神健康服务。虽然全球PTSD都与寻求精神健康服务相关，PTSD独特性质未知能否预测精神健康服务的低使用率。本文检视PTSD羣集(回避、再经历、烦躁和过激反应)严重程度作为寻求精神健康服务意愿和未来服务使用率的预知因素。患有最少亚阈值PTSD的退役兵(N=189)完成一个PTSD症状测试，和表明他们会否寻求精神健康服务。退役军人事务部门精神健康服务的预期使用情况则从病历中获取。在双变量水平，每一羣集与寻求精神健康服务和预期治疗使用情况的正面意图呈正相连。在复合变量模型中，烦燥程度(OR=1.16,95%CI=[1.06,1.26])独特地与寻求精神健康服务呈正相连，而较重回避程度(IRR=0.86,95%CI=[0.76,0.98])预测较低治疗使用量。较严重再经历程度(IRR=1.07,95%CI=[1.01,1.14])则预知较多治疗使用。我们急需聚焦PTSD独特性质的合适介入服务和接触病者的确实状况。

  March 14, 2014   doi: 10.1002/jts.21898   open full text
• Attention Bias Variability and Symptoms of Posttraumatic Stress Disorder.
  Brian M. Iacoviello, Gang Wu, Rany Abend, James W. Murrough, Adriana Feder, Eyal Fruchter, Yoav Levinstein, Ilan Wald, Christopher R. Bailey, Daniel S. Pine, Alexander Neumeister, Yair Bar‐Haim, Dennis S. Charney.
  Journal of Traumatic Stress. March 06, 2014
  Cognitive theories implicate information‐processing biases in the etiology of anxiety disorders. Results of attention‐bias studies in posttraumatic stress disorder (PTSD) have been inconsistent, suggesting biases towards and away from threat. Within‐subject variability of attention biases in posttraumatic patients may be a useful marker for attentional control impairment and the development of posttrauma symptoms. This study reports 2 experiments investigating threat‐related attention biases, mood and anxiety symptoms, and attention‐bias variability following trauma. Experiment 1 included 3 groups in a cross‐sectional design: (a) PTSD, (b) trauma‐exposed without PTSD, and (c) healthy controls with no trauma or Axis I diagnoses. Greater attention‐bias variability was found in the PTSD group compared to the other 2 groups (ηp2=.23); attention‐bias variability was significantly and positively correlated (r = .37) with PTSD symptoms. Experiment 2 evaluated combat‐exposed and nonexposed soldiers before and during deployment. Attention‐bias variability did not differentiate groups before deployment, but did differentiate groups during deployment (ηp2=.16); increased variability was observed in groups with acute posttraumatic stress symptoms and acute depression symptoms only. Attention‐bias variability could be a useful marker for attentional impairment related to threat cues associated with mood and anxiety symptoms after trauma exposure. 標題：注意力偏差的變動和創傷後壓力症症狀 撮要：認知理論指出焦慮症的起源會是資訊處理偏差。創傷後壓力症(PTSD)的注意力偏差研究未有一致的結果，或許是偏差可以是接近或遠離威脅。受創病人注意力偏差的個體內變化可能是注意力控制障礙和創傷後症狀的標記。本研究報告兩個試驗，檢測創傷後威脅相關的注意力偏差，情緒和焦慮症狀，和注意力偏差的變動。試驗1包括橫斷面設計內三個組別：(a)PTSD，(b)經歷創傷但未有PTSD，和(c)沒有創傷或軸1診斷的健康對照組。對比其他兩組(n2p=.23)PTSD有更高注意力偏差的變動；而注意力偏差的變動與PTSD症狀呈顯着的正相連(r=.37)。試驗2評估經歷戰鬥及非經歷士兵在派駐前及期間的狀況。注意力偏差變動未能辨別派駐前組別，但可分辨派駐期間的組別(n2p=.16)；添加的變動只見於急性創傷後壓力症狀和急性抑鬱症狀組別。注意力偏差的變動可以是經歷創傷後情緒和焦慮症狀相連威脅暗示的注意力障礙的有效標記。 标题：注意力偏差的变动和创伤后压力症症状 撮要：认知理论指出焦虑症的起源会是信息处理偏差。创伤后压力症(PTSD)的注意力偏差研究未有一致的结果，或许是偏差可以是接近或远离威胁。受创病人注意力偏差的个体内变化可能是注意力控制障碍和创伤后症状的标记。本研究报告两个试验，检测创伤后威胁相关的注意力偏差，情绪和焦虑症状，和注意力偏差的变动。试验1包括横断面设计内三个组别：(a)PTSD，(b)经历创伤但未有PTSD，和(c)没有创伤或轴1诊断的健康对照组。对比其他两组(n2p=.23)PTSD有更高注意力偏差的变动；而注意力偏差的变动与PTSD症状呈显着的正相连(r=.37)。试验2评估经历战斗及非经历士兵在派驻前及期间的状况。注意力偏差变动未能辨别派驻前组别，但可分辨派驻期间的组别(n2p=.16)；添加的变动只见于急性创伤后压力症状和急性忧郁症状组别。注意力偏差的变动可以是经历创伤后情绪和焦虑症状相连威胁暗示的注意力障碍的有效标记。

  March 06, 2014   doi: 10.1002/jts.21899   open full text
• Physical Injury, PTSD Symptoms, and Medication Use: Examination in Two Trauma Types.
  Meghan W. Cody, J. Gayle Beck.
  Journal of Traumatic Stress. February 10, 2014
  Physical injury is prevalent across many types of trauma experiences and can be associated with posttraumatic stress disorder (PTSD) symptoms and physical health effects, including increased medication use. Recent studies suggest that PTSD symptoms may mediate the effects of traumatic injury on health outcomes, but it is unknown whether this finding holds for survivors of different types of traumas. The current study examined cross‐sectional relationships between injury, PTSD, and pain and psychiatric medication use in 2 trauma‐exposed samples, female survivors of motor vehicle accidents (MVAs; n = 315) and intimate partner violence (IPV; n = 167). Data were obtained from participants at 2 trauma research clinics who underwent a comprehensive assessment of psychopathology following the stressor. Regression with bootstrapping suggested that PTSD symptoms mediate the relationship between injury severity and use of pain medications, R2 = .11, F(2, 452) = 28.37, p < .001, and psychiatric medications, R2 = .06, F(2, 452) = 13.18, p < .001, as hypothesized. Mediation, however, was not moderated by trauma type (ps > .05). Results confirm an association between posttraumatic psychopathology and medication usage and suggest that MVA and IPV survivors alike may benefit from assessment and treatment of emotional distress after physical injury.

  February 10, 2014   doi: 10.1002/jts.21880   open full text
• The Evidence for Present‐Centered Therapy as a Treatment for Posttraumatic Stress Disorder.
  Nickolas D. Frost, Kevin M. Laska, Bruce E. Wampold.
  Journal of Traumatic Stress. February 10, 2014
  To examine the evidence for present‐centered therapy (PCT) as a treatment for posttraumatic stress disorder (PTSD), 5 randomized clinical trials that compared PCT to an existing evidence‐based treatment for PTSD were reviewed. A meta‐analysis was used to estimate between‐treatment differences on targeted measures, secondary measures, and dropout. PCT was found to be as efficacious as the comparison evidence‐based treatment in 3 of the 5 trials, and in the 2 cases where a no‐treatment condition was included, PCT was superior, with large effect sizes for targeted variables (d = 0.88, 0.74, and 1.27). When results were aggregated using meta‐analysis, effects for PCT versus an evidence‐based treatment for both targeted and secondary measures were small and nonsignificant (d = 0.13 and d = 0.09, respectively). As well, the dropout rate for PCT was significantly less than for the comparison evidence‐based treatments (14.3% and 31.3%, respectively). It appears that PCT is an efficacious and acceptable treatment for PTSD.

  February 10, 2014   doi: 10.1002/jts.21881   open full text
• Predictors of Treatment Engagement in Ethnically Diverse, Urban Children Receiving Treatment for Trauma Exposure.
  Rebecca Fraynt, Leslie Ross, Bruce L. Baker, Ida Rystad, Janet Lee, Ernestine C. Briggs.
  Journal of Traumatic Stress. January 29, 2014
  Keeping traditionally underrepresented children and their families engaged in treatment until completion is a major challenge for many community‐based mental health clinics. The current study used data collected as part of the National Child Traumatic Stress Network Core Data Set to examine whether racial/ethnic disparities exist in treatment duration and completion in children seeking treatment for trauma exposure. We then explored whether disparities persist after accounting for other variables associated with children's social contexts and the treatment setting. The sample included 562 ethnically diverse children receiving services from a child abuse prevention and treatment agency in Southern California. The results indicated that African American children had significantly shorter trauma‐informed treatment duration and higher rates of premature termination than Spanish‐speaking Latino children. These disparities persisted even with other variables associated with treatment duration and completion (e.g., child's age, level of functional impairment, and receipt of group and field services) in the model. Implications and future directions for research and practice are discussed.

  January 29, 2014   doi: 10.1002/jts.21889   open full text
• Do Circumstances of the Death Matter? Identifying Socioenvironmental Risks for Grief‐Related Psychopathology in Bereaved Youth.
  Julie B. Kaplow, Kathryn H. Howell, Christopher M. Layne.
  Journal of Traumatic Stress. January 29, 2014
  We examined bereaved children's and surviving caregivers’ psychological responses following the death of the other caregiver as a function of the stated cause of death. Participants included 63 parentally bereaved children and 38 surviving caregivers who were assessed using self‐report instruments and in‐person interviews. Surviving caregivers reported the causes of death as resulting from sudden natural death (34.9%), illness (33.3%), accident (17.5%), and suicide (14.3%). Results revealed differences between caregiver‐reported versus child‐reported cause of death, particularly in cases of suicide. Children who lost a caregiver due to a prolonged illness exhibited higher levels of both maladaptive grief (d = 3.13) and posttraumatic stress symptoms (PTSS; d = 3.33) when compared to children who lost a caregiver due to sudden natural death (e.g., heart attack). In contrast, surviving caregivers did not differ in their levels of maladaptive grief and PTSS as a function of the cause of death; however, caregivers bereaved by sudden natural death reported higher levels of depression than those bereaved by prolonged illness (d = 1.36). Limited sample size prevented analysis of outcomes among those bereaved by suicide or accident. These findings suggest that anticipated deaths may contain etiologic risk factors for maladaptive grief and PTSS in children.

  January 29, 2014   doi: 10.1002/jts.21877   open full text
• The Hidden Effects of Child Maltreatment in a War Region: Correlates of Psychopathology in Two Generations Living in Northern Uganda.
  David Kani Olema, Claudia Catani, Verena Ertl, Regina Saile, Frank Neuner.
  Journal of Traumatic Stress. January 29, 2014
  Adverse life experiences are a major risk factor for psychopathology. Studies from industrialized countries have consistently shown the detrimental effects of child maltreatment on the mental health of the victims. Research in war‐affected populations, however, has mostly been restricted to the psychological damage caused by the war. Both war trauma and child maltreatment have rarely been studied simultaneously. In a comparative study of 2 generations living in severely war‐affected regions in Northern Uganda, we determined the relationship between both trauma types and posttraumatic stress disorder (PTSD), anxiety, depression, and suicide ideation. A total of 100 adolescents, 50 with and 50 without a history of abduction by the rebel army with both their parents (100 mothers and 100 fathers) living in camps in northern Uganda were interviewed. The study showed that both generations were severely affected by war and child maltreatment. Both trauma types were independently correlated with psychological disorders in the adolescent group. Only child maltreatment, however, not war violence, accounted for PTSD symptoms in the parent group (β = .253, p = .002). We conclude that, even in the context of severe war, the impact of child maltreatment on psychological disorders surpasses the damage of war trauma.

  January 29, 2014   doi: 10.1002/jts.21892   open full text
• Changes in Sleep Disruption in the Treatment of Co‐Occurring Posttraumatic Stress Disorder and Substance Use Disorders.
  R. Kathryn McHugh, Mei‐Chen Hu, Aimee N. C. Campbell, E. Yvette Hilario, Roger D. Weiss, Denise A. Hien.
  Journal of Traumatic Stress. January 28, 2014
  Sleep disruption appears not only to reflect a symptom of posttraumatic stress disorder (PTSD), but also a unique vulnerability for its development and maintenance. Studies examining the impact of psychosocial treatments for PTSD on sleep symptoms are few and no studies to date of which we are aware have examined this question in samples with co‐occurring substance use disorders. The current study is a secondary analysis of a large clinical trial comparing 2 psychological treatments for co‐occurring PTSD and substance use disorders. Women (N = 353) completed measures of PTSD at baseline, end of treatment, and 3‐, 6‐, and 12‐month follow‐ups. Results indicated that the prevalence of insomnia, but not nightmares, decreased during treatment, and that 63.8% of participants reported at least 1 clinical‐level sleep symptom at the end of treatment. Improvement in sleep symptoms during treatment was associated with better overall PTSD outcomes over time, χ2(1) = 33.81, p < .001. These results extend the existing literature to suggest that residual sleep disruption following PTSD treatment is common in women with co‐occurring PTSD and substance use disorders. Research on the benefits of adding sleep‐specific intervention for those with residual sleep disruption in this population may be a promising future direction.

  January 28, 2014   doi: 10.1002/jts.21878   open full text
• Reduced Corpus‐Callosum Volume in Posttraumatic Stress Disorder Highlights the Importance of Interhemispheric Connectivity for Associative Memory.
  Rotem Saar‐Ashkenazy, Jonathan E. Cohen, Jonathan Guez, Chris Gasho, Ilan Shelef, Alon Friedman, Hadar Shalev.
  Journal of Traumatic Stress. January 28, 2014
  Memory deficits are a common complaint of patients with posttraumatic stress disorder (PTSD). Despite vivid trauma‐related memory, previous studies report memory impairment for nontrauma‐related stimuli when compared to controls, specifically in associative memory (Guez et al., 2011). Healthy individuals show hemispheric memory asymmetry with left‐prefrontal lateralization of encoding and right‐prefrontal lateralization of episodic retrieval, suggesting a role for interhemispheric communication in memory‐related tasks (Gazzaniga, ; Ringo, Doty, Demeter, & Simard, ). Because brain magnetic resonance imaging (bMRI) studies in PTSD patients report volume changes in various regions, including white matter and corpus callosum (CC), we aimed to test the relationship between memory deficits and CC volume in PTSD patients. We probed for specific alterations in associative memory in PTSD and measured the volume of subportions within the CC employing bMRI. Our main finding was a reduction in CC white‐matter volume in PTSD patients, as compared to controls, t(35) = −2.7, p = .010, that was correlated with lower associative performance (r = .76, p = .003). We propose that CC volume reduction is a substrate for the associative memory deficits found in PTSD.

  January 28, 2014   doi: 10.1002/jts.21887   open full text
• Multiple Deployments and Combat Trauma: Do Homefront Stressors Increase the Risk for Posttraumatic Stress Symptoms?
  Alejandro Interian, Anna Kline, Malvin Janal, Shirley Glynn, Miklos Losonczy.
  Journal of Traumatic Stress. January 24, 2014
  Multiple deployments are common among military personnel who served in Operation Enduring Freedom and Operation Iraqi Freedom and are associated with greater posttraumatic stress symptoms (PTSS). Homefront stressors (i.e., family, occupational problems) resulting from deployments may increase the risk of PTSS. Moreover, with multiple deployments, a new deployment may occur while still experiencing homefront stressors from previous tours. This prospective study assessed whether homefront stressors from a previous tour increased the risk of PTSS after a new deployment. It also examined the effects of homefront stressors at postdeployment. Survey data were obtained from U.S. National Guard soldiers with previous deployments prior to (Wave 1) and after (Wave 2) a new deployment to Iraq (N = 196). Homefront stressors reported at Wave 1 (β = .154, p = .015) and Wave 2 (β = .214, p = .002) were both significantly predictive of PTSS at postdeployment, even after adjusting for warzone stressors, predeployment PTSS, and other variables. A pattern of chronic homefront stressors (i.e., homefront stressors at pre‐ and postdeployment) was associated with higher levels of PTSS at postdeployment (β = .220, p = .002). Service members with multiple deployments are at greater risk for PTSS if deployed with homefront stressors from previous tours and/or face these stressors at postdeployment.

  January 24, 2014   doi: 10.1002/jts.21885   open full text
• Impact of Combat Deployment on Psychological and Relationship Health: A Longitudinal Study.
  Jeffrey A. Cigrang, G. Wayne Talcott, JoLyn Tatum, Monty Baker, Daniel Cassidy, Scott Sonnek, Douglas K. Snyder, Christina Balderrama‐Durbin, Richard E. Heyman, Amy M. Smith Slep.
  Journal of Traumatic Stress. January 24, 2014
  Although previous research has indicated an elevated prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among veterans of Operations Iraqi Freedom and Enduring Freedom following deployment, most of this research has been cross‐sectional and has focused on a limited range of military groups and outcome criteria. This investigation was a longitudinal study of U.S. Air Force security forces assigned to a year‐long high‐threat ground mission in Iraq to determine the degree to which airmen's emotional and behavioral health and committed relationships were adversely impacted by an extended deployment to a warzone. Participants were a cohort of 164 security forces airmen tasked to a 365‐day deployment to train Iraqi police. Airmen completed study measures both prior to and 6–9 months following deployment. Rates of deterioration in individual and interpersonal adjustment were both significant and medium to large in magnitude of effect, d = 0.43 to 0.90. Results suggest that the negative effects of deployment are related to levels of traumatic experiences and do not spontaneously remit within the first 6–9 months following return from deployment—particularly among those service members having relatively lower levels of social support.

  January 24, 2014   doi: 10.1002/jts.21890   open full text
• Psychometric Properties of the Child PTSD Symptom Scale in Latino Children.
  Omar G. Gudiño, Laura A. Rindlaub.
  Journal of Traumatic Stress. January 24, 2014
  The Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, ) is a self‐report measure of posttraumatic stress disorder symptoms (PTSD) in children and adolescents. Despite widespread use of this measure, no study to our knowledge has examined its psychometric properties in Latino children. This study examined the factor structure, internal consistency, and convergent validity of the measure utilizing a sample of 161 Latino students (M = 11.42 years, SD = 0.70) at high risk of exposure to community violence. Confirmatory factor analyses suggested that a 3‐factor model consistent with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, ) provided the best fit to the data. Internal consistency of the total scale and subscales was high when completed in English or Spanish. All Child PTSD Symptom Scale scores were positively correlated with violence exposure. As additional evidence of convergent validity, scores evidenced stronger correlations with internalizing symptoms than with externalizing symptoms. Results supported the use of the Child PTSD Symptom Scale as a measure of PTSD severity in Latino children, but additional research is needed to determine appropriate clinical cutoffs for Latino youths exposed to chronic levels of violence. Implications for clinical practice and future research are discussed.

  January 24, 2014   doi: 10.1002/jts.21884   open full text
• Association Between Parents’ PTSD Severity and Children's Psychological Distress: A Meta‐Analysis.
  Jessica E. Lambert, Jessica Holzer, Amber Hasbun.
  Journal of Traumatic Stress. January 24, 2014
  The authors conducted a meta‐analysis of studies on the correlation between parents’ PTSD symptom severity and children's psychological status. An extensive search of the literature yielded 550 studies that were screened for inclusion criteria (i.e., parent assessed for PTSD, child assessed for distress or behavioral problems, associations between parent PTSD and child status examined). Sixty‐two studies were further reviewed, resulting in a final sample of 42 studies. Results yielded a moderate overall effect size r = .35. The authors compared effect sizes for studies where only the parent was exposed to a potentially traumatic event to studies where both parents and children were exposed. A series of moderators related to sample characteristics (sex of parent, type of traumatic event) and study methods (self‐report vs. diagnostic interview, type of child assessment administered) were also evaluated. The only significant moderator was type of trauma; the effect size was larger for studies with parent–child dyads who were both exposed to interpersonal trauma (r = .46) than for combat veterans and their children (r = .27) and civilian parent–child dyads who were both exposed to war (r = .25). Results support the importance of considering the family context of trauma survivors and highlight areas for future research.

  January 24, 2014   doi: 10.1002/jts.21891   open full text
• Associations Between Perceived Social Reactions to Trauma‐Related Experiences With PTSD and Depression Among Veterans Seeking PTSD Treatment.
  Jeremiah A. Schumm, Ellen M. Koucky, Alisa Bartel.
  Journal of Traumatic Stress. January 22, 2014
  The Social Acknowledgment Questionnaire (SAQ; Maercker & Mueller, ) is a measure of trauma survivors’ perceptions of social acknowledgment and disapproval from others, and these factors are shown to be associated with posttraumatic stress disorder (PTSD) among civilian trauma survivors. This study seeks to validate the structure of the SAQ among U.S. military veterans and test the hypothesis that family and general disapproval are associated with PTSD and depression among veterans. Participants were 198 U.S. veterans who experienced military trauma and completed an intake evaluation through a Veterans Affairs PTSD treatment program. Structural equation modeling (SEM) results supported a well‐fitting 3‐factor model for the SAQ that was similar to prior studies in capturing the constructs of social acknowledgment, general disapproval, and family disapproval. SEM results also showed that all 3 of the SAQ factors were associated with veterans’ depression (−.31, .22, and .39, respectively), whereas only general disapproval was related to veterans’ PTSD. This is the first study of which we are aware to investigate the factor structure of the SAQ in a veteran sample and to investigate the relationship between SAQ factors and trauma survivors’ depression. Results build upon prior findings by showing the importance of positive and negative social reactions to veterans’ traumatic experiences.

  January 22, 2014   doi: 10.1002/jts.21879   open full text
• Posttraumatic Responses to the July 22, 2011 Oslo Terror Among Norwegian High School Students.
  Dag Ø. Nordanger, Mari Hysing, Maj‐Britt Posserud, Astri Johansen Lundervold, Reidar Jakobsen, Miranda Olff, Kjell Morten Stormark.
  Journal of Traumatic Stress. November 15, 2013
  The July 22, 2011, Oslo Terror was defined as a national disaster. Former studies on terror attacks and mass shootings have shown elevated levels of posttraumatic complaints both in direct victims and in general populations. Little is known about how such extreme events in a generally safe society such as Norway would affect an adolescent population. This study examines posttraumatic stress reactions and changes in worldview in relationship to risk factors among 10,220 high school students using data from the ung@hordaland survey. One out of 5 respondents knew someone directly exposed, 55.7% experienced the events to some extent as threatening to their own or their close ones’ lives, and 79.9% reported their worldview to be changed. For posttraumatic stress disorder (PTSD) DSM IV criteria, 0.8% reported substantial symptoms of reexperiencing (Criterion B), 4.9% of avoidance (Criterion C), and 1.1% of hyperarousal (Criterion D). Greater personal proximity to the events, higher levels of perceived life threat, and being a female or an immigrant predicted higher levels of PTSD symptom distress. Results indicate that the terror events made a deep impression on Norwegian adolescents, but without causing markedly elevated levels of PTSD symptomatology in the general young population.

  November 15, 2013   doi: 10.1002/jts.21856   open full text
• Comparing Response to Cognitive Processing Therapy in Military Veterans With Subthreshold and Threshold Posttraumatic Stress Disorder.
  Benjamin D. Dickstein, Kristen H. Walter, Jeremiah A. Schumm, Kathleen M. Chard.
  Journal of Traumatic Stress. November 15, 2013
  Research suggests that subthreshold posttraumatic stress disorder (PTSD) symptomatology is associated with increased risk for psychological and functional impairment, including increased risk for suicidal ideation. However, it does not appear that any studies to date have investigated whether subthreshold PTSD can effectively be treated with evidence‐based, trauma‐focused treatment. Accordingly, we tested response to cognitive processing therapy (CPT) in 2 groups of military veterans receiving care at a VA outpatient specialty clinic, 1 with subthreshold PTSD at pretreatment (n = 51) and the other with full, diagnostic PTSD (n = 483). Multilevel analysis revealed that both groups experienced a significant decrease in PTSD symptoms over the course of therapy (the full and subthreshold PTSD groups experienced an average decrease of 1.79 and 1.52 points, respectively, on the PTSD Checklist with each increment of time, which was coded from 0 at pretreatment to 13 at posttreatment). After controlling for pretreatment symptom severity, a between‐groups difference was not found. These results suggest that CPT is an effective form of treatment among military veterans, and that its effectiveness does not differ between subthreshold and threshold groups.

  November 15, 2013   doi: 10.1002/jts.21869   open full text
• The 5‐HTTLPR Polymorphism and Posttraumatic Stress Disorder: A Meta‐Analysis.
  Florence Gressier, Raffaella Calati, Martina Balestri, Agnese Marsano, Siegfried Alberti, Niki Antypa, Alessandro Serretti.
  Journal of Traumatic Stress. November 12, 2013
  Environmental and genetic factors contribute to the development of posttraumatic stress disorder (PTSD). Variation in the 5‐HTTLPR polymorphism of the serotonin transporter gene has been hypothesized to affect risk for PTSD. With the aim of investigating this association, we conducted a meta‐analysis to shed light on prior controversial results and increase statistical power to detect smaller effect sizes. PubMed and ISI databases were searched for studies published until December 2012. Twelve studies have been included, all based on trauma‐exposed samples. Data were analyzed with Cochrane Collaboration Review Manager Software (Version 5). Quality and publication bias were assessed. Metaregressions were performed using Comprehensive Meta‐Analysis software, Version 2. Taking into account all studies, no association was found between 5‐HTTLPR and PTSD (p = .10), with evidence of between‐study heterogeneity, which could be partly explained by gender differences. In sensitivity analyses, we found an association between SS genotype and PTSD in high trauma‐exposed participants (p < .001). To be a carrier of the SS genotype seems to represent a risk factor for PTSD in high trauma exposure. Further studies focusing on Gene × Environment interactions are needed to better understand the role of this polymorphism in PTSD.

  November 12, 2013   doi: 10.1002/jts.21855   open full text
• Finalizing PTSD in DSM‐5: Getting Here From There and Where to Go Next.
  Matthew J. Friedman.
  Journal of Traumatic Stress. October 22, 2013
  The process that resulted in the diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5; American Psychiatric Association; ) was empirically based and rigorous. There was a high threshold for any changes in any DSM‐IV diagnostic criterion. The process is described in this article. The rationale is presented that led to the creation of the new chapter, “Trauma‐ and Stressor‐Related Disorders,” within the DSM‐5 metastructure. Specific issues discussed about the DSM‐5 PTSD criteria themselves include a broad versus narrow PTSD construct, the decisions regarding Criterion A, the evidence supporting other PTSD symptom clusters and specifiers, the addition of the dissociative and preschool subtypes, research on the new criteria from both Internet surveys and the DSM‐5 field trials, the addition of PTSD subtypes, the noninclusion of complex PTSD, and comparisons between DSM‐5 versus the World Health Association's forthcoming International Classification of Diseases (ICD‐11) criteria for PTSD. The PTSD construct continues to evolve. In DSM‐5, it has moved beyond a narrow fear‐based anxiety disorder to include dysphoric/anhedonic and externalizing PTSD phenotypes. The dissociative subtype may open the way to a fresh approach to complex PTSD. The preschool subtype incorporates important developmental factors affecting the expression of PTSD in young children. Finally, the very different approaches taken by DSM‐5 and ICD‐11 should have a profound effect on future research and practice. 標題：敲定DSM‐5中的PTSD：從這裏到那裏，下一步又如何 撮要：敲定精神疾病診斷和統計手冊(DSM‐5；美國精神學會；2013)中創傷後壓力症(PTSD)的診斷準則是嚴謹而建基於臨床經驗的。改變任何DSM‐Ⅳ診斷準則要求都有高門檻。本文詳述當中過程和理據，因而有新一章，即〝創傷和壓力相關障礙〞在DSM‐5的元結構中設立。而DSM‐5 PTSD準則中曾討論的特定議題包括：闊或窄的PTSD結構，對準則A的決定，其他PTSD症狀羣和區分符的支持實証，加入解離和學前子類別，在互聯網調查和DSM‐5現場測試新準則的研究，加入PTSD子類別，取消複雜PTSD，和比較DSM‐5與世界衛生組織即將實行的國際疾病分類(ICD‐11)兩者的PTSD準則。PTSD結構不斷演變。DSM‐5中，它從一個狹窄地以驚恐為本的焦慮症走到包括煩躁/快感和外在化PTSD等表型。解離子類別可能開展對複雜PTSD的新研究路向。學前子類別包括影響幼兒表現PTSD的重要發展因素。DSM‐5和ICD‐11在不同的方向發展，對未來研究和臨床工作方面必定有深遠影響。 标题：敲定DSM‐5中的PTSD：从这里到那里，下一步又如何 撮要：敲定精神疾病诊断和统计手册(DSM‐5；美国精神学会；2013)中创伤后压力症(PTSD)的诊断准则是严谨而建基于临床经验的。改变任何DSM‐Ⅳ诊断准则要求都有高门坎。本文详述当中过程和理据，因而有新一章，即〝创伤和压力相关障碍〞在DSM‐5的元结构中设立。而DSM‐5 PTSD准则中曾讨论的特定议题包括：宽或窄的PTSD结构，对准则A的决定，其他PTSD症状羣和区分符的支持实证，加入解离和学前子类别，在互联网调查和DSM‐5现场测试新准则的研究，加入PTSD子类别，取消复杂PTSD，和比较DSM‐5与世界卫生组织即将实行的国际疾病分类(ICD‐11)两者的PTSD准则。PTSD结构不断演变。DSM‐5中，它从一个狭窄地以惊恐为本的焦虑症走到包括烦躁/快感和外在化PTSD等表型。解离子类别可能开展对复杂PTSD的新研究路向。学前子类别包括影响幼儿表现PTSD的重要发展因素。DSM‐5和ICD‐11在不同的方向发展，对未来研究和临床工作方面必定有深远影响。

  October 22, 2013   doi: 10.1002/jts.21840   open full text
• National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM‐IV and DSM‐5 Criteria.
  Dean G. Kilpatrick, Heidi S. Resnick, Melissa E. Milanak, Mark W. Miller, Katherine M. Keyes, Matthew J. Friedman.
  Journal of Traumatic Stress. October 22, 2013
  Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM‐5; 2013) and fourth edition (DSM‐IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self‐administered survey. Traumatic event exposure using DSM‐5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past‐12‐month, and past 6‐month PTSD prevalence using the Same Event definition for DSM‐5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM‐5 prevalence estimates were slightly lower than their DSM‐IV counterparts, although only 2 of these differences were statistically significant. DSM‐5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM‐IV criteria, but not DSM‐5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom. 標題：使用DSM‐Ⅳ和DSM‐5準則去估算全國的創傷經歷和PTSD患病率 撮要 : 透過網上小組集合美國全國成人樣本(N=2,953), 套用美國精神學協會的精神疾病診斷和統計手冊(DSM)的DSM‐5和DSM IV版本來診斷PTSD的患病率並比較。評估是在網上利用一個高度結構自我評估調查：創傷經歷，PTSD症狀，和功能障礙。創傷經歷若使用DSM‐5準則會有高比率(89.7%)，但標準是多重創傷經歷。利用同一事件(即所有症狀準則符合同一事件類別)和綜合事件(即症狀準則符合事件類別的混合)定義來決定PTSD病例。使用DSM‐5和同一事件定義的終身、過去12個月及過去6個月PTSD患病率分別為8.3%，4.7%和3.8%。所有6個DSM‐5患病率估量都比DSM‐IV者為低，雖然其中只有2個的差別是統計上有效的。DSM‐5 PTSD患病率是女性高於男性，而且隨着更大創傷經歷而增加。有些人符合DSM‐IV但不合DSM‐5診斷的主因是：撇除在準則A內非意外非暴力死亡和新加的最少一個主動迴避症狀的要求。 标题：使用DSM‐Ⅳ和DSM‐5准则去估算全国的创伤经历和PTSD患病率 撮要 : 透过网上小组集合美国全国成人样本(N=2,953), 套用美国精神学协会的精神疾病诊断和统计手册(DSM)的DSM‐5和DSM IV版本来诊断PTSD的患病率并比较。评估是在网上利用一个高度结构自我评估调查：创伤经历，PTSD症状，和功能障碍。创伤经历若使用DSM‐5准则会有高比率(89.7%)，但标准是多重创伤经历。利用同一事件(即所有症状准则符合同一事件类别)和综合事件(即症状准则符合事件类别的混合)定义来决定PTSD病例。使用DSM‐5和同一事件定义的终身、过去12个月及过去6个月PTSD患病率分别为8.3%，4.7%和3.8%。所有6个DSM‐5患病率估量都比DSM‐IV者为低，虽然其中只有2个的差别是统计上有效的。DSM‐5 PTSD患病率是女性高于男性，而且随着更大创伤经历而增加。有些人符合DSM‐IV但不合DSM‐5诊断的主因是：撇除在准则A内非意外非暴力死亡和新加的最少一个主动回避症状的要求。

  October 22, 2013   doi: 10.1002/jts.21848   open full text
• Patterns of Multiple Victimization Among Maltreated Children in Navy Families.
  Damion J. Grasso, Benjamin E. Saunders, Linda M. Williams, Rochelle Hanson, Daniel W. Smith, Monica M. Fitzgerald.
  Journal of Traumatic Stress. September 30, 2013
  The current study examined the cumulative risk associated with children's exposure to multiple types of parent‐inflicted victimization. The sample was comprised of 195 children who were 7 to 17 years old (64.1% female and 48.2% non‐White) at the time of referral to the United States Navy's Family Advocacy Program due to allegations of sexual abuse, physical abuse, or parental intimate partner violence. We conducted an exploratory latent class analysis to identify distinct subgroups of children based on lifetime victimization. We hypothesized that at least 2 classes or subgroups would be identified, with 1 characterized by greater victimization and poorer outcomes. Results indicated that 3 classes of children best fit the data: (a) high victimization across all 3 categories, (b) high rates of physical abuse and witnessing intimate partner violence, and (c) high rates of physical abuse only. Findings indicated that the high victimization class was at greatest risk for alcohol and substance use, delinquent behavior, and meeting criteria for posttraumatic stress disorder (PTSD) and/or depression 1 year later (odds ratio = 4.53). These findings highlight the serious mental health needs of a small but significantly high‐risk portion of multiply victimized children entering the child welfare system. 標題：海軍家庭受虐兒童的多重受害模式。 撮要：本研究檢視經歷多重至親傷害的兒童的累積風險。樣本是195名7至17歲的兒童(64.1%女性和48.2%非白種人)，由於性侵犯、身體受虐或雙親的伴侶暴力等各種指控，而轉介至海軍家庭支援計劃。我們採用探索性潛階級分析來區分不同兒童組別(按其終身受害情況)。我們假設有不少於兩個階級或組別，而其一為較嚴重受害和較差結果。結果顯示有3種階級的兒童最切合資料：(a) 三個組別都有嚴重受害程度；(b)身體受虐和目睹伴侶暴力的高比率，及(c)只有高比率身體受虐。研究指出高受害階級有：酒精及物質濫用、不良行為和一年後符合創傷後壓力症(PTSD) 及／或抑鬱症(OR=4.53)的最高風險。本研究亦指出接受兒童福利服務的多重受害兒童中，有一批少數卻有顯著高危兒童極需精神健康服務支援。 标题：海军家庭受虐儿童的多重受害模式。 撮要：本研究检视经历多重至亲伤害的儿童的累积风险。样本是195名7至17岁的儿童(64.1%女性和48.2%非白种人)，由于性侵犯、身体受虐或双亲的伴侣暴力等各种指控，而转介至海军家庭支持计划。我们采用探索性潜阶级分析来区分不同儿童组别(按其终身受害情况)。我们假设有不少于两个阶级或组别，而其一为较严重受害和较差结果。结果显示有3种组别的儿童最符合资料：(a) 三个组别都有严重受害程度；(b)身体受虐和目睹伴侣暴力的高比率，及(c)只有高比率身体受虐。研究指出高受害组别有：酒精及物质滥用、不良行为和一年后符合创伤后压力症(PTSD) 及／或抑郁症(OR=4.53)的最高风险。本研究亦指出接受儿童福利服务的多重受害儿童中，有一批少数却有显着高危儿童极需精神健康服务支持。

  September 30, 2013   doi: 10.1002/jts.21853   open full text
• A Critical Review of the Evidence Base of Imagery Rehearsal for Posttraumatic Nightmares: Pointing the Way for Future Research.
  Gerlinde C. Harb, Andrea J. Phelps, David Forbes, Richard J. Ross, Philip R. Gehrman, Joan M. Cook.
  Journal of Traumatic Stress. September 30, 2013
  In this article, the authors provide information on key characteristics of imagery rehearsal treatment protocols and examine the quality of reporting of randomized controlled and uncontrolled trials of imagery rehearsal for treating posttraumatic nightmares. Using a reliable and valid scale, two independent psychologists rated 16 trials. Most reports provided insufficient information on a range of variables including the definition of treatment delivery (e.g., therapist supervision, treatment fidelity), description of the participant sample, data analysis (e.g., determination of sample size), and treatment assignment (e.g., randomization procedures). Low methodological quality and poor reporting can lead to inflation of estimates of treatment effects and inadequately substantiated conclusions, such as inflated effect sizes in meta‐analytic studies. Numerous imagery rehearsal protocols exist, but in some cases are given different names and tested in pilot studies, slowing progression in the field. Randomized controlled trials of imagery rehearsal with credible comparison conditions, examination of predictors of dropout and outcome, as well as dismantling studies of imagery rehearsal treatment components are needed. 標題 : 意象綵排治療創傷後噩夢的證據根基的批判性回顧 : 未來研究的路標 撮要 : 本文描述意象綵排治療方案的主要特徵，並檢討治療創傷後噩夢的意象綵排療法的隨機制約和非制約試驗的報告質素。採用可靠和認可的量表，2名獨立的心理學家對16個試驗評核。多數報告在一系列變量(包括提供治療的定義，如治療師的監察、治療的保真度；参與人樣本描述；資料分析，如確定樣本大小；和治療分配，如隨機程序)方面的資料不足。低方法學質量和報告差劣都使療效估量和不充份結論被擴大效果，例如元分析研究擴大效應值。眾多意象綵排方案存在，有時卻在先導研究中用了不同名稱和測試，令進步拖慢。隨機制約的意象綵排測試有可信的對照情況，加上退出研究者和結果的預測檢查，及意象綵排治療的部件分解研究都是需要的。 标题 : 意象彩排治疗创伤后噩梦的证据基础的批判性回顾 : 未来研究的路标 撮要 : 本文描述意象彩排治疗方案的主要特征，并检讨治疗创伤后噩梦的意象彩排疗法的随机制约和非制约试验的报告质素。采用可靠和认可的量表，2名独立的心理学家对16个试验评核。多数报告在一系列变量(包括提供治疗的定义，如治疗师的监察、治疗的保真度；参与人样本描述；数据分析，如确定样本大小；和治疗分配，如随机程序)方面的数据不足。低方法学质量和报告差劣都使疗效估量和不充份结论被扩大效果，例如元分析研究扩大效应值。众多意象彩排方案存在，有时却在先导研究中用了不同名称和测试，令进步拖慢。随机制约的意象彩排测试有可信的对照情况，加上退出研究者和结果的预测检查，及意象彩排治疗的部件分解研究都是需要的。

  September 30, 2013   doi: 10.1002/jts.21854   open full text
• The Effect of Long‐Term Relocation on Child and Adolescent Survivors of Hurricane Katrina.
  Tonya C. Hansel, Joy D. Osofsky, Howard J. Osofsky, Patricia Friedrich.
  Journal of Traumatic Stress. September 24, 2013
  The current study is designed to increase knowledge of the effects of relocation and its association with longer‐term psychological symptoms following disaster. Following clinical observations and in discussions held with school officials expressing concerns about relocated students, it was hypothesized that students who relocated to a different city following Hurricane Katrina in 2005 would have more symptoms of posttraumatic stress compared to students who returned to New Orleans. The effect of Hurricane Katrina relocation was assessed on a sample of child and adolescent survivors in 5th through 12th grades (N = 795). Students with Orleans Parish zip codes prior to Hurricane Katrina were categorized into relocation groupings: (a) relocated to Baton Rouge, (b) returned to prior zip code, and (c) moved to a different zip code within Orleans Parish. Overall results revealed more trauma symptoms for relocated students. Results also revealed that younger relocated students had fewer symptoms compared to older students. The opposite was found for students who returned to their same zip code, with older students having fewer symptoms. This study supports the need for school‐based services not only in disaster areas, but also in schools where survivors tend to migrate. 標題：卡蒂尼娜颶風後兒童及青少年倖存者長期遷移的效果。 撮要：本研究旨在認識遷移的效果和對災後長期心理症狀的關連。我們先作臨床觀察，和學校員工商討有關遷移學生的憂慮，然後假設在2005年卡蒂尼娜颶風後遷移到其他地方城市的學生比較重回新奧爾良的學生會有更多創傷後壓力症症狀。本研究樣本為第五班至十二班的兒童及青少年倖存者(N=795)。利用災前他們在奧爾良的郵遞區號分為不同的遷移組別：(a)遷至Baton Rouge；(b)回到本來郵遞區號的住處；和(c)搬至奧爾良不同郵遞區號的地方。總括而言，遷移了的學生有更多創傷症狀，亦顯示年青的遷移學生有較少症狀(對比年長學生)。但重回舊郵遞區號的學生，年長學生卻有較少症狀。本文支持校內服務不只在災難地區，亦應在倖存者遷移的學校提供。 标题：卡蒂尼娜飓风后儿童及青少年幸存者长期迁移的效果。 撮要：本研究旨在认识迁移的效果和对灾后长期心理症状的关连。我们先作临床观察，和学校员工商讨有关迁移学生的忧虑，然后假设在2005年卡蒂尼娜飓风后迁移到其他地方城市的学生比较重回新奥尔良的学生会有更多创伤后压力症症状。本研究样本为第五班至十二班的儿童及青少年幸存者(N=795)。利用灾前他们在奥尔良的邮政编码分为不同的迁移组别：(a)迁至Baton Rouge；(b)回到本来邮政编码的住处；和(c)搬至奥尔良不同邮政编码的地方。总括而言，迁移了的学生有更多创伤症状，亦显示年青的迁移学生有较少症状(对比年长学生)。但重回旧邮政编码的学生，年长学生却有较少症状。本文支持校内服务不只在灾难地区，亦应在幸存者迁移的学校提供。

  September 24, 2013   doi: 10.1002/jts.21837   open full text
• Psychiatric and Physical Sequelae of Childhood Physical and Sexual Abuse and Forced Sexual Trauma Among Individuals With Serious Mental Illness.
  Andrew M. Subica.
  Journal of Traumatic Stress. September 24, 2013
  Trauma and posttraumatic stress disorder (PTSD) frequently co‐occur with serious mental illness, yet the unique mental and physical health influences of childhood physical abuse (CPA), childhood sexual abuse (CSA), and forced sexual trauma on individuals with serious mental illness remain unevaluated. The present study of 172 individuals with serious mental illness investigated the adverse effects of CPA, CSA, and forced sexual trauma on severity of PTSD and depression, and overall mental and physical health functioning. Data analysis consisted of chi‐square tests, independent t tests, bivariate odds ratios, and linear regressions. Prevalence of CPA (44.8%), CSA (29.1%), and forced sexual trauma (33.1%) were elevated, and nearly one third of participants (31.4%) reported clinical PTSD. Participants exposed to CSA or forced sexual trauma evidenced bivariate ORs ranging from 4.13 to 7.02 for PTSD, 2.44 to 2.50 for major depression, and 2.14 to 2.31 for serious physical illness/disability. Sexual trauma exposure associated with heightened PTSD and depression, and reduced mental and physical health functioning, with CSA uniquely predicting PTSD, depression, and physical health difficulties. CPA less significantly affected these clinical domains. Sexual traumas have profound negative effects on mental and physical health outcomes among individuals with serious mental illness; increased screening and treatment of sexual traumas is needed. 標題：在嚴重精神病患者中，童年身體和性侵犯及強迫性性創傷的精神和身體後遺症 撮要：創傷和創傷後壓力症(PTSD)常與嚴重精神病(SMI)共同出現，但SMI病者中童年身體受虐(CPA)，童年性侵犯(CSA)和強迫性性創傷的精神和身體健康方面的獨特影響卻甚少探討。樣本為172名SMI病者，檢查CPA，CSA，強迫性性創傷對PTSD和抑鬱症嚴重程度的壞影響，和綜合精神及身體功能。數據分析包括卡方測試，獨立t測試，二元奇比和綫性回歸。CPA(45%)，CSA(29%)和強迫性性創傷(33%)的流行率都上升了，而且近三份之一人(31%)報告患上臨床PTSD。經歷CSA或強迫性性創傷者的二元ORs分別是：PTSD為4.13 ‐ 7.02，抑鬱症為2.44 ‐ 2.50，和嚴重身體疾病或傷殘為2.14 ‐ 2.31。性創傷經歷與PTSD和抑鬱症上升相關，但與精神和健康功能下降相連，而CSA則獨特地預測PTSD、抑鬱症和身體健康問題。性創傷對SMI患者的精神和身體健康有極壞影響，所以加強篩查和性創傷治療是需要的。 标题：在严重精神病患者中，童年身体和性侵犯及强迫性性创伤的精神和身体后遗症 撮要：创伤和创伤后压力症(PTSD)常与严重精神病(SMI)共同出现，但SMI病者中童年身体受虐(CPA)，童年性侵犯(CSA)和强迫性性创伤的精神和身体健康方面的独特影响却甚少探讨。样本为172名SMI病者，检查CPA，CSA，强迫性性创伤对PTSD和忧郁症严重程度的坏影响，和综合精神及身体功能。数据分析包括卡方测试，独立t测试，二元奇比和线性回归。CPA(45%)，CSA(29%)和强迫性性创伤(33%)的流行率都上升了，而且近三份之一人(31%)报告患上临床PTSD。经历CSA或强迫性性创伤者的二元ORs分别是：PTSD为4.13 ‐ 7.02，忧郁症为2.44 ‐ 2.50，和严重身体疾病或伤残为2.14 ‐ 2.31。性创伤经历与PTSD和抑郁症上升相关，但与精神和健康功能下降相连，而CSA则独特地预测PTSD、忧郁症和身体健康问题。性创伤对SMI患者的精神和身体健康有极坏的影响，所以加强筛查和性创伤治疗是需要的。

  September 24, 2013   doi: 10.1002/jts.21845   open full text
• The Role of Parenting Stress in Young Children's Mental Health Functioning After Exposure to Family Violence.
  Yvonne Humenay Roberts, Christina A. Campbell, Monette Ferguson, Cindy A. Crusto.
  Journal of Traumatic Stress. September 13, 2013
  This study evaluates the associations of young children's exposure to family violence events, parenting stress, and children's mental health functioning. Caregivers provided data for 188 children ages 3 to 5 years attending Head Start programming. Caregivers reported 75% of children had experienced at least 1 type of trauma event, and 27% of children had experienced a family violence event. Child mental health functioning was significantly associated with family violence exposure after controlling for children's age, gender, household income, and other trauma exposure (β = .14, p = .033). Stress in the parenting role partially mediated the relationship between family violence exposure and young children's mental health functioning (β = .12, p = .015, 95% confidence interval [0.02, 0.21]). Interventions for young children exposed to family violence should address the needs of the child, as well as the caregiver while also building healthy parent–child relationships to facilitate positive outcomes in children faced with trauma. 標題 : 經歷家庭暴力後幼兒精神健康功能中撫育壓力的角色 撮要 : 本文評核幼兒的家庭暴力經歷、撫育壓力、及精神健康功能之間的關係｡樣本為188名參與頭腦開發計劃的3至5歲兒童，照顧者則提供研究資料。當中75%兒童有最少一種創傷經歷，而27%則有一次家庭暴力事件。在控制兒童年紀、性別、家庭收入和其他創傷經歷等變量後，兒童精神健康功能與家庭暴力經歷有著統計上有效的關連(β=.14,p=.033)。撫育角色的壓力局部地協調家庭暴力經歷和幼兒精神健康功能之間的關係(β=.12,p=.015,95%CI[0.02,0.21])。經歷家庭暴力的幼兒的介入服務必須重視兒童和照顧者的需要, 而建構健康的親子關係亦有助面對創傷的兒童復原。 标题 : 经历家庭暴力后幼儿精神健康功能中抚育压力的角色 撮要 : 本文评估幼儿的家庭暴力经历、抚育压力、及精神健康功能之间的关系｡样本为188名参与头脑开发计划的3至5岁儿童，照顾者则提供研究资料。当中75%儿童有最少一种创伤经历，而27%则有一次家庭暴力事件。在控制儿童年纪、性别、家庭收入和其他创伤经历等变量后，儿童精神健康功能与家庭暴力经历有着统计上有效的关连(β=.14,p=.033)。抚育角色的压力局部地协调家庭暴力经历和幼儿精神健康功能之间的关系(β=.12,p=.015,95%CI[0.02,0.21])。经历家庭暴力的幼儿的介入服务必须重视儿童和照顾者的需要, 而建构健康的亲子关系亦有助面对创伤的儿童复原。

  September 13, 2013   doi: 10.1002/jts.21842   open full text
• Maladaptive Dependency Schemas, Posttraumatic Stress Hyperarousal Symptoms, and Intimate Partner Aggression Perpetration.
  Lorig K. Kachadourian, Casey T. Taft, Darren W. Holowka, Halley Woodward, Brian P. Marx, Anthony Burns.
  Journal of Traumatic Stress. September 12, 2013
  This study examined the associations between maladaptive dependency‐related schemas, posttraumatic stress disorder (PTSD) hyperarousal symptoms, and intimate‐partner psychological and physical aggression in a sample of court‐referred men (N = 174) participating in a domestic‐abuser‐intervention program. The men were largely African American; average age was 33.5 years. The extent to which hyperarousal symptoms moderated the association between dependency schemas and aggression was also examined. Maladaptive dependency‐related schemas were positively associated with severe psychological, and mild and severe physical aggression perpetration. Hyperarousal symptoms were positively associated with mild and severe psychological aggression, and mild physical aggression perpetration. Multiple regression analyses showed a significant interaction for mild physical aggression: For those with high levels of hyperarousal symptoms, greater endorsement of maladaptive dependency schemas was associated with the perpetration of aggression (B = 0.98, p = .001). For those with low levels of hyperarousal symptoms, there was no association between dependency schemas and aggression (B = 0.04, ns). These findings suggest that focusing on problematic dependency and PTSD‐hyperarousal symptoms in domestic‐abuser‐intervention programs may be helpful, and that examining related variables as possible moderators between dependency schemas and intimate aggression would be a fruitful area for future research. 標題：不良適應的依賴架構，創傷後壓力症過激反應症狀和親密伴侶暴力延續的關係 撮要：本文檢視參與一個家庭暴力介入治療方案的男士樣本(全由法庭轉介，N=174)中，不良適應的依賴相關架構，創傷後壓力症(PTSD)過激反應症狀，和親密伴侶心理及身體暴力之間的關係。大部份是非裔美國人，平均年齡為33.5歲。過激反應症狀在依賴架構和暴力之間是否起緩和作用也會在本研究中分析。不良適應依賴相關架構與嚴重心理暴力、及輕度和嚴重身體暴力延續呈正相連。過激反應症狀則與輕度和嚴重心理暴力、及輕度身體暴力延續呈正相關。多元回歸分析指出輕度身體暴力有顯著作用：嚴重過激反應症狀患者對不良反應依賴結構的强認受會與暴力延續有相連(B = .98, p = .001)。輕度過激反應症狀患者中，依賴結構和暴力並不相關(B = .04, ns)。上述發現顯示：在家庭暴力介入治療方案中需要聚焦依賴問題和PTSD過激反應症狀，而未來研究或應檢視依賴結構和親密關係暴力之間的相關變數是否在兩者之間起了緩解作用。 标题：不良适应的依赖架构，创伤后压力症过激反应症状和亲密伴侣暴力延续的关系 撮要：本文检视参与一个家庭暴力介入治疗方案的男士样本(全由法庭转介，N=174)中，不良适应的依赖相关架构，创伤后压力症(PTSD)过激反应症状，和亲密伴侣心理及身体暴力之间的关系。大部份是非裔美国人，平均年龄为33.5岁。过激反应症状在依赖架构和暴力之间是否起缓和作用也会在本研究中分析。不良适应依赖相关架构与严重心理暴力、及轻度和严重身体暴力延续呈正相连。过激反应症状则与轻度和严重心理暴力、及轻度身体暴力延续呈正相关。多元回归分析指出轻度身体暴力有显著作用：严重过激反应症状患者对不良反应依赖结构的强认受会与暴力延续有相连(B = .98, p = .001)。轻度过激反应症状患者中，依赖结构和暴力并不相关(B = .04, ns)。上述发现显示：在家庭暴力介入治疗方案中需要聚焦依赖问题和PTSD过激反应症状，而未来研究或应检查依赖结构和亲密关系暴力之间的相关变量是否在两者之间起了缓解作用。

  September 12, 2013   doi: 10.1002/jts.21850   open full text
• Outcomes of Prolonged Exposure Therapy for Veterans With Posttraumatic Stress Disorder.
  Jason T. Goodson, Carin M. Lefkowitz, Amy W. Helstrom, Michael J. Gawrysiak.
  Journal of Traumatic Stress. August 09, 2013
  Prolonged Exposure (PE) is an evidenced‐based psychotherapy for posttraumatic stress disorder (PTSD) that is being disseminated nationally within the U.S. Department of Veterans Affairs (VA) with promising initial results. Empirical evidence, however, regarding the effectiveness of PE for treatment of PTSD in military veterans is limited. Building on previous treatment outcome research, the current study investigated the effectiveness of PE in a diverse veteran sample. One‐hundred fifteen veterans were enrolled in PE at an urban VA medical center and its surrounding outpatient clinics. PTSD and depression symptoms as well as quality of life were measured before and after treatment. Several baseline patient characteristics were examined as predictors of treatment response. Eighty‐four participants completed treatment. Participants experienced a 42% reduction in PTSD symptoms, a 31% reduction in depression symptoms, and an increase in quality of life following PE. Veterans not prescribed psychotropic medication reported greater PTSD symptom reduction than veterans prescribed such medication. The implications of these results for treatment programs targeting PTSD in veterans are discussed. 標題:患上PTSD的退役軍接受延展暴露治療的效果 撮要:延展暴露治療(PE)是治療創傷後壓力症(PTSD)的實証為本的心理治療，亦在全國退役軍人事務部中廣泛使用及有初步療效。關於PE在退役軍人的PTSD治療療效的實踐經驗卻是少有的。在前人治療效果研究中抽取概念，我們試圖在今次研究檢查PE在廣泛退伍軍人樣本的效果。樣本是在一個市區VA醫療中心和周邊門診登記接受PE的115名退役軍人，在治療前後會被量度PTSD和抑鬱症狀，及生活質素。我們檢視若干基準病人特點以確定療效的預測因素。總共84名病人完成治療，而他們PTSD在症狀方面有42%減少， 在抑鬱症狀則有31%減退，和PE後生活質素有改進。沒有藥物治療的退役軍人比服藥者有更多PTSD症狀方面的減退。我們也討論本文結果如何對PTSD治療方案方面有所啟發。 标题:患上PTSD的退役军接受延展暴露治疗的效果 撮要:延展暴露治疗(PE)是治疗创伤后压力症(PTSD)的实证为本的心理治疗，亦在全国退役军人事务部中广泛使用及有初步疗效。关于PE在退役军人的PTSD治疗疗效的实践经验却是少有的。在前人治疗效果研究中抽取概念，我们试图在今次研究检查PE在广泛退伍军人样本的效果。样本是在一个市区VA医疗中心和周边门诊登记接受PE的115名退役军人，在治疗前后会被量度PTSD和抑郁症状，及生活质素。我们检视若干基准病人特点以确定疗效的预测因素。总共84名病人完成治疗，而他们PTSD在症状方面有42%减少， 在抑郁症状则有31%减退，和PE后生活质素有改进。没有药物治疗的退役军人比服药者有更多PTSD症状方面的减退。我们也讨论本文结果如何对PTSD治疗方案方面有所启发。

  August 09, 2013   doi: 10.1002/jts.21830   open full text
• Lifetime Prevalence of Posttraumatic Stress Disorder in Two American Indian Reservation Populations.
  Janette Beals, Spero M. Manson, Calvin Croy, Suzell A. Klein, Nancy Rumbaugh Whitesell, Christina M. Mitchell,.
  Journal of Traumatic Stress. July 30, 2013
  Posttraumatic stress disorder (PTSD) has been found to be more common among American Indian populations than among other Americans. A complex diagnosis, the assessment methods for PTSD have varied across epidemiological studies, especially in terms of the trauma criteria. Here, we examined data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI‐SUPERPFP) to estimate the lifetime prevalence of PTSD in two culturally distinct American Indian reservation communities, using two formulas for calculating PTSD prevalence. The AI‐SUPERPFP was a cross‐sectional probability sample survey conducted between 1997 and 2000. Southwest (n = 1,446) and Northern Plains (n = 1,638) tribal members living on or near their reservations, aged 15–57 years at time of interview, were randomly sampled from tribal rolls. PTSD estimates were derived based on both the single worst and 3 worst traumas. Prevalence estimates varied by ascertainment method: single worst trauma (lifetime: 5.9% to 14.8%) versus 3 worst traumas (lifetime, 8.9% to 19.5%). Use of the 3‐worst‐event approach increased prevalence by 28.3% over the single‐event method. PTSD was prevalent in these tribal communities. These results also serve to underscore the need to better understand the implications for PTSD prevalence with the current focus on a single worst event. 標題:在兩個美國印弟安保育區族群中創傷後壓力症的流行率 撮要:創傷後壓力症(PTSD)在美國人中較常見於印弟安裔人。但流行病學研究上由於PTSD為一複雜診斷，而且評核方法亦隨不同研究而異，尤其是關於創傷的定義。所以我們選取了美國印弟安醫療服務使用者的精神病流行學，風險及保護因素研究計劃(AI‐SUSERPFP)來估計在兩個文化不同的美國印弟安保育社區中PTSD的終身發病率，其中使用兩個不同的程式去計算。AI‐SUSERPFP 為在1997–2000年進行的一個橫斷面概率樣本調查。從部落名册中隨機抽樣了15–57歲居住在西南(N = 1,446)和北部(N = 1,638)平原的部族人士。從單一最重和三個嚴重創傷中得出PTSD估值。發病率估值依不同確認方法而異：單一最重創傷(終身：5.9%至14.8%)比對三個嚴重創傷(終身：8.9%至19.5%)。使用三個嚴重創傷事件方法比單一事件增多28.3%發病率。在這些部落社區中，PTSD是普遍的。本研究結果對現行聚焦單一嚴重事件的PTSD發病率有更深層次的理解。 标题:在两个美国印弟安保育区族群中创伤后压力症的流行率 撮要:创伤后压力症(PTSD)在美国人中较常见于印弟安裔人。但流行病学研究上由于PTSD为一复杂诊断，而且评核方法亦随不同研究而异，尤其是关于创伤的定义。所以我们选取了美国印弟安医疗服务使用者的精神病流行学，风险及保护因素研究计划(AI‐SUSERPFP)来估计在两个文化不同的美国印弟安保育小区中PTSD的终身发病率，其中使用两个不同的程序去计算。AI‐SUSERPFP 为在1997–2000年进行的一个横断面概率样本调查。从部落名册中随机抽样了15–57岁居住在西南(N = 1,446)和北部(N = 1,638)平原的部族人士。从单一最重和三个严重创伤中得出PTSD估值。发病率估值依不同确认方法而异：单一最重创伤(终身：5.9%至14.8%)比对三个严重创伤(终身：8.9%至19.5%)。使用三个严重创伤事件方法比单一事件增多28.3%发病率。在这些部落小区中，PTSD是普遍的。本研究结果对现行聚焦单一严重事件的PTSD发病率有更深层次的理解。

  July 30, 2013   doi: 10.1002/jts.21835   open full text
• Impact of Coping Style and PTSD on Family Functioning After Deployment in Operation Desert Shield/Storm Returnees.
  Suzannah K. Creech, Justin K. Benzer, Brittany K. Liebsack, Susan Proctor, Casey T. Taft.
  Journal of Traumatic Stress. July 25, 2013
  The relationship between military combat and postdeployment family functioning difficulties has been frequently investigated in the literature, as has the relationship between types of coping and posttraumatic stress disorder (PTSD). Few studies, however, have examined these variables together, and no studies of which we are aware have examined the effect of coping on family functioning after combat exposure. This study examined coping style measured immediately after return from deployment, and PTSD symptoms and family functioning 18–24 months after return from deployment in a sample of Operation Desert Shield/Storm veterans (N = 2,949). Structural equation models suggested that the relationships between distinct coping styles on family functioning were differentially mediated by postdeployment PTSD symptoms. Results are consistent with full mediation for avoidant coping (βdirect = −.09, p = .07; βindirect = −.17, p < .001) and partial mediation for approach coping (βdirect = .16, p < .001; βindirect = .09, p < .001). Results suggest that the strategies used to cope with a combat stress event may impact both PTSD and family functioning outcomes, and highlight the potential utility of pre‐ and postdeployment coping skills training. 標題：沙漠屏障/風暴行動後退役軍的應對策略和PTSD對家庭功能的影響 撮要：武裝戰鬥和退役後家庭功能障礙的關係，在文獻中多有研究，而應對策略和創傷後壓力症(PTSD)的關係亦有不少論述。但少有一併研究上述因素，亦未有研究戰後應對在家庭功能方面的影響。本文樣本為沙漠屏障/風暴行動(ODS)的退役軍人(N = 2,949)，研究他們退役後的即時應對策略，和退役後18–24個月的PTSD症狀和家庭功能。結構方程式模型顯示不同應對策略與家庭功能之間的關係都由退役後PTSD症狀差異作調節。結果指出迴避應對一致地全面調節(β直接 = ‐.09, p = .07；β非直接 = ‐.17, p<.001)，而接觸應對則局部調節(β直接 = .16, p<.001；β間接 = .09, p<.001)。結果亦顯示應對戰鬥壓力事件的各種策略可能影響PTSD和家庭功能結果，亦突顯退役前後應對技巧訓練的可能效用。 标题：沙漠屏障/风暴行动后退役军的应对策略和PTSD对家庭功能的影响 撮要：武装战斗和退役后家庭功能障碍的关系，在文献中多有研究，而应对策略和创伤后压力症(PTSD)的关系亦有不少论述。但少有一并研究上述因素，亦未有研究战后应对在家庭功能方面的影响。本文样本为沙漠屏障/风暴行动(ODS)的退役军人(N = 2,949)，研究他们退役后的实时应对策略，和退役后18–24个月的PTSD症状和家庭功能。结构方程式模型显示不同应对策略与家庭功能之间的关系都由退役后PTSD症状差异作调节。结果指出回避应对一致地全面调节(β直接 = ‐.09, p = .07；β非直接 = ‐.17, p<.001)，而接触应对则局部调节(β直接 = .16, p<.001；β间接 = .09,p<.001)。结果亦显示应对战斗压力事件的各种策略可能影响PTSD和家庭功能结果，亦突显退役前后应对技巧训练的可能效用。

  July 25, 2013   doi: 10.1002/jts.21823   open full text
• Relationships Among Predeployment Risk Factors, Warzone‐Threat Appraisal, and Postdeployment PTSD Symptoms.
  Molly R. Franz, Erika J. Wolf, Helen Z. MacDonald, Brian P. Marx, Susan P. Proctor, Jennifer J. Vasterling.
  Journal of Traumatic Stress. July 25, 2013
  Previous research indicates a relationship between perceived fear for one's safety (i.e., threat appraisal) and posttraumatic stress disorder (PTSD). This prospective study examined relationships among deployment‐ and predeployment‐related variables, threat appraisal, and postdeployment PTSD symptom severity. Prior to Iraq deployment, 774 U.S. Army soldiers completed self‐report measures assessing previous life stressors, deployment history, current (predeployment) PTSD symptoms, deployment preparedness, and unit cohesion. Following deployment, participants completed self‐report measures assessing combat intensity, deployment threat appraisal, and current (postdeployment) PTSD symptoms. Structural equation modeling revealed that predeployment PTSD symptom severity, prior warzone deployment, unit cohesion, and preparedness were each independently associated with deployment threat appraisal, even after taking into account combat intensity. Deployment threat appraisal was associated with postdeployment PTSD severity. Results indicated that predeployment PTSD symptom severity, history of warzone deployment, and preparedness—risk factors previously thought to influence PTSD outcomes directly—were either partially or fully mediated by threat appraisal. The model explained 15% of the variance in deployment threat appraisal and 50% of the variance in postdeployment PTSD severity. Helping service members cope with exposure to extreme stress during deployment by modifying certain prewar risk factors may facilitate reduction of PTSD symptoms following deployment. 標題：服役前風險因素、戰區危險度評價和退役後PTSD症狀的關係 撮要：有研究指出自身安全的覺察恐懼(即危險度評價)和創傷後壓力症(PTSD)互相關連。本前瞻性研究檢視服役中和服役前的相關變量、危險度評價、和退役後PTSD症狀幅度。774名美國人到伊拉克服役前完成自我報告測試，評核：昔日生活壓力、服役史、現行(服役前)PTSD症狀、服役準備、和單位凝聚力。而退役後，軍人亦會填寫自我報告測試，評估：戰鬥劇烈程度、服役危險度評價和現行(退役後)PTSD症狀。結構方程式模型顯示：在撇除戰鬥劇烈程度後，服役前PTSD症狀幅度，以往戰區服役情況，單位凝聚力和服役準備都各自獨立地與服役危險度評價有關連。服役危險度評價亦與退役後PTSD幅度相關。結果指出服役前PTSD症狀幅度、戰區服役史和服役準備此等風險因素，曾被認為直接影響PTSD後果，都是局部或全部經由危險評價作中介。此模型能有效解釋服役危險度評價的15%方差，和服役後PTSD幅度的50%方差。透過調整某些戰前風險因素，以協助軍人面對極端服役壓力，可能服役後有效減少PTSD症狀。 标题：服役前风险因素、战区危险度评价和退役后PTSD症状的关系 撮要：有研究指出自身安全的觉察恐惧(即危险度评价)和创伤后压力症(PTSD)互相关连。本前瞻性研究检视服役中和服役前的相关变量、危险度评价、和退役后PTSD症状幅度。774名美国人到伊拉克服役前完成自我报告测试，评核：昔日生活压力、服役史、现行(服役前)PTSD症状、服役准备、和单位凝聚力。而退役后，军人亦会填写自我报告测试，评估：战斗剧烈程度、服役危险度评价和现行(退役后)PTSD症状。结构方程式模型显示：在撇除战斗剧烈程度后，服役前PTSD症状幅度，以往战区服役情况，单位凝聚力和服役准备都各自独立地与服役危险度评价有关连。服役危险度评价亦与退役后PTSD幅度相关。结果指出服役前PTSD症状幅度、战区服役史和服役准备此等风险因素，曾被认为直接影响PTSD后果，都是局部或全部经由危险评价作中介。此模型能有效解释服役危险度评价的15%方差，和服役后PTSD幅度的50%方差。透过调整某些战前风险因素，以协助军人面对极端服役压力，可能服役后有效减少PTSD症状。

  July 25, 2013   doi: 10.1002/jts.21827   open full text
• Spontaneous and Deliberate Dissociative States in Military Personnel: Are Such States Helpful?
  Charles A. Morgan, Marcus K. Taylor.
  Journal of Traumatic Stress. July 25, 2013
  This study explored distinctions between spontaneous and deliberate dissociative states in 335 military personnel exposed to stressful survival training. Participants completed the Clinician‐Administered Dissociative States Scale (CADSS) after a stressful mock‐captivity event. They were also asked to indicate whether the dissociative experiences just happened (i.e., spontaneous), or whether they chose to have them happen (i.e., deliberate); and whether they appraised the dissociative experience as helpful (i.e., facilitative) or hurtful (i.e., debilitative) to their ability to cope with the stressful event. A majority (95.4%) endorsed dissociative states during stress. More than half (57.4%) described dissociative experiences as spontaneous, 13.0% as deliberate, and 29.5% endorsed neither. In Special Forces soldiers only, those who endorsed facilitative dissociation exhibited higher total CADSS scores than those who endorsed debilitative dissociation. Seventy‐three percent of spontaneous dissociators described the experience as debilitative to coping with stress; conversely, 76% of deliberate dissociators said these experiences facilitated coping with stress. Individuals with prior trauma exposure tended to appraise dissociative states as more debilitative to coping. This research may enhance the fidelity of studies of dissociation constructs and may offer pivot points for prevention and treatment of stress‐related disorders. 標題：軍人中自發和蓄意解離狀況：有益還是有害？ 撮要：本研究在335名軍人中探討受壓生還特訓後自發和蓄意解離狀況的區別。參與者在一次受壓模擬囚禁訓練後接受臨床診斷解離狀況量表(CADSS)評估，和回答此等狀況是”自然發生”(即自發)或”選擇發生”(即蓄意)，及自評此等狀況是有益(即促進)或有礙(即減弱)於本身應對此訓練的能力。大多數人(95.4%)贊同受壓時出現解離現象。多於半數(57.4%)人士形容為自發解離，13.0%則是蓄意解離，29.5%則兩者都不是。在特種部隊中，贊同解離為促進的人較減弱者有更高CADSS 總評分。73%自發解離者形容此等經歷減弱應付壓力的能力；反之，有76%蓄意解離者則認為此等經歷促進應付壓力的能力。有創傷經歷史的人士評價解離狀況嚴重減弱應對能力。本研究可能有助理解解離結構研究的真實情況，和提供了壓力相關疾病的預防和治療的重點。 标题：军人中自发和蓄意解离状况：有益还是有害？ 撮要：本研究在335名军人中探讨受压生还特训后自发和蓄意解离状况的区别。参与者在一次受压模拟囚禁训练后接受临床诊断解离状况量表(CADSS)评估，和回答此等状况是”自然发生”(即自发)或”选择发生”(即蓄意)，及自评此等状况是有益(即促进)或有碍(即减弱)于本身应对此训练的能力。大多数人(95.4%)赞同受压时出现解离现象。多于半数(57.4%)人士形容为自发解离，13.0%则是蓄意解离，29.5%则两者都不是。在特种部队中，赞同解离为促进的人较减弱者有更高CADSS 总评分。73%自发解离者形容此等经历减弱应付压力的能力；反之，有76%蓄意解离者则认为此等经历促进应付压力的能力。有创伤经历史的人士评价解离状况严重减弱应对能力。本研究可能有助理解解离结构研究的真实情况，和提供了压力相关疾病的预防和治疗的重点。

  July 25, 2013   doi: 10.1002/jts.21834   open full text
• Complex Trauma Exposure and Symptoms in Urban Traumatized Children: A Preliminary Test of Proposed Criteria for Developmental Trauma Disorder.
  Bradley C. Stolbach, Reese Minshew, Vikki Rompala, Renee Z. Dominguez, Tanja Gazibara, Robert Finke.
  Journal of Traumatic Stress. July 25, 2013
  Recently, a new diagnostic construct, developmental trauma disorder (DTD), was proposed to describe the effects of chronic exposure to violence in combination with disruptions in caregiving systems. This study uses archival data to field test the consensus proposed diagnostic criteria for DTD in a sample of urban children (N = 214). Children with complex trauma histories as defined in the proposed DTD Criterion A were much more likely to meet the proposed DTD symptom criteria than children who did not meet the exposure criterion. This field trial of the proposed DTD criteria suggests that the proposed construct of DTD is useful for describing the symptoms induced by ongoing traumatic stressors and disrupted caregiving and that the proposed symptom criteria can differentiate children with histories of exposure to developmental trauma from other trauma‐exposed children. 標題：市區受創兒童中複雜創傷經歷和症狀：發育期創傷症的建議準則的初期測試。 撮要：發育期創傷症(DTD)是一個新增診斷，用來形容長期暴力經歷及照顧系統擾亂的影響。本文使用市區兒童(N = 214)的檔案數據實地測試DTD的共識建議診斷準則。如DTD建議診斷準則A所言，有複雜創傷經歷兒童比其他沒有此等經歷兒童更吻合建議DTD症狀準則。本實地測試顯示：建議中發育期創傷症的診斷能有效地形容持續創傷壓力及照顧受擾引發的症狀，而且症狀準則能區別兒童有發育期創傷經歷或曾受創傷。 标题：市区受创儿童中复杂创伤经历和症状：发育期创伤症的建议准则的初期测试。 撮要：发育期创伤症(DTD)是一个新增诊断，用来形容长期暴力经历及照顾系统扰乱的影响。本文使用市区儿童(N = 214)的档案数据实地测试DTD的共识建议诊断准则。如DTD建议诊断准则A所言，有复杂创伤经历儿童比其他没有此等经历儿童更吻合建议DTD症状准则。本实地测试显示：建议中发育期创伤症的诊断能有效地形容持续创伤压力及照顾受扰引发的症状，而且症状准则能区别儿童有发育期创伤经历或曾受创伤。

  July 25, 2013   doi: 10.1002/jts.21826   open full text
• Reexperiencing Symptoms, Dissociation, and Avoidance Behaviors in Daily Life of Patients With PTSD and Patients With Panic Disorder With Agoraphobia.
  Monique C. Pfaltz, Tanja Michael, Andrea H. Meyer, Frank H. Wilhelm.
  Journal of Traumatic Stress. July 25, 2013
  Panic attacks are frequently perceived as life threatening. Panic disorder (PD) patients may therefore experience symptoms of posttraumatic stress disorder (PTSD). The authors explored this in 28 healthy controls, 17 PTSD patients, and 24 PD patients with agoraphobia who completed electronic diaries 36 times during 1 week. Patient groups frequently reported dissociation as well as thoughts, memories, and reliving of their trauma or panic attacks. PTSD patients reported more trauma/panic attack thoughts (incidence rate ratio [IRR] = 2.9) and memories (IRR = 2.8) than PD patients. Patient groups relived their trauma or panic attacks equally frequently, and reported comparable bodily reactions and distress associated with trauma or panic attack memories. Clinical groups avoided trauma or panic attack reminders more often than healthy controls (avoidance of trauma‐ or panic attack‐related thoughts (IRR = 8.0); avoidance of things associated with the trauma or panic attack (IRR = 40.7). PD patients avoided trauma or panic attack reminders less often than PTSD patients (avoidance of trauma‐ or panic attack‐related thoughts [IRR = 2.5]; avoidance of things associated with the trauma or panic attack [IRR = 4.1]), yet these differences were nonsignificant when controlling for functional impairment. In conclusion, trauma‐like symptoms are common in PD with agoraphobia and panic attacks may be processed similarly as trauma in PTSD. 標題:創傷後壓力症病者，和恐慌症併廣場恐懼症的病者在日常生活的再經歷、解離和迴避 撮要：恐慌突襲令人有死亡的恐懼，所以恐慌症(PD)病者可能經歷創傷後壓力症(PTSD)症狀。我們研究了28名健康對照人士，17名PTSD病者，和24名PD併廣場恐懼症病者。他們在一週內寫下36篇電子日誌。病者組別經常提及創傷或恐慌突襲中的解離、想法、回憶及再經歷。PTSD病者比PD病者有更多創傷/恐慌突襲想法(病發比率﹝IRR﹞ = 2.9)及記憶(IRR = 2.8)。不同病者組別在創傷/恐慌突襲的再經歷方面都有相似密度，及與創傷/恐慌突襲回憶有關的相類似身體反應和困擾。臨床組別對比健康對照人士較多迴避創傷/恐慌突襲的提示(迴避創傷/恐慌突襲想法：IRR = 8.0；迴避創傷/恐慌突襲相關事物：IRR = 40.7)。PD病人比PTSD病人較少迴避創傷/恐慌突襲的提示(迴避創傷/恐慌突襲想法：IRR = 2.5；迴避創傷/恐慌突襲相關事物：IRR = 4.1)，但這些差異在功能障礙受控後並不顯著。結論是：創傷症狀在PD併廣場恐懼症的病人中是常見的，而恐慌突襲則可能與PTSD的創傷有相同整理過程。 标题:创伤后压力症病患，和恐慌症并广场恐惧症的病患在日常生活的再经历、解离和回避 撮要：恐慌突袭令人有死亡的恐惧，所以恐慌症(PD)病患可能经历创伤后压力症(PTSD)症状。我们研究了28名健康对照人士，17名PTSD病患，和24名PD并广场恐惧症病患。他们在一周内写下36篇电子日志。病患组别经常提及创伤或恐慌突袭中的解离、想法、回忆及再经历。PTSD病患比PD病患有更多创伤/恐慌突袭想法(病发比率﹝IRR﹞ = 2.9)及记忆(IRR = 2.8)。不同病患组别在创伤/恐慌突袭的再经历方面都有相似密度，及与创伤/恐慌突袭回忆有关的相类似身体反应和困扰。临床组别对比健康对照人士较多回避创伤/恐慌突袭的提示(回避创伤/恐慌突袭想法：IRR = 8.0；回避创伤/恐慌突袭相关事物：IRR = 40.7)。PD病患比PTSD病患较少回避创伤/恐慌突袭的提示(回避创伤/恐慌突袭想法：IRR = 2.5；回避创伤/恐慌突袭相关事物：IRR = 4.1)，但这些差异在功能障碍受控后并不显着。结论是：创伤症状在PD并广场恐惧症的病患中是常见的，而恐慌突袭则可能与PTSD的创伤有相同整理过程。

  July 25, 2013   doi: 10.1002/jts.21822   open full text
• Synergistic Childhood Adversities and Complex Adult Psychopathology.
  Karen T. Putnam, William W. Harris, Frank W. Putnam.
  Journal of Traumatic Stress. July 25, 2013
  Numerous studies find a cumulative effect of different types of childhood adversities on increasing risk for serious adult mental and medical outcomes. This study uses the National Comorbidity Survey‐Replication sample to investigate the cumulative impact of 8 childhood adversities on complex adult psychopathology as indexed by (a) number of lifetime diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM‐IV; American Psychiatric Association, 1994); (b) number of 4 DSM‐IV disorder categories (mood, anxiety, impulse control, and substance abuse disorders); and (c) coexistence of internalizing and externalizing disorders. Seven of the 8 childhood adversities were significantly associated with complex adult psychopathology. Individuals with 4 or more childhood adversities had an odds ratio of 7.3, 95% confidence interval [4.7, 11.7] for 4 disorder categories. Additive and multiplicative synergistic effects increasing adult psychopathology were found for specific pairwise combinations of childhood adversities. Synergistic patterns differed by gender suggesting that women are more impacted by sexual abuse and men by economic hardship. The absence of childhood adversities was protective, in that it significantly decreased an individual's risk for subsequent adult mental illness. The results support the clinical impression that increased childhood adversity is associated with more complex adult psychopathology. 標題:童年協同逆境與複雜成人精神病理學 撮要:眾多研究指出不同種類的童年逆境的累進效應增加成人嚴重精神和身体疾病的風險。我們採用全國共病普查－複製樣本來研究8種童年逆境的累進影響,在下列複雜成人精神病理等方面：(1)終身DSM‐IV診斷數目；(2)4個DSM病類別的數目(情緒、焦慮、控制衝動、和物質濫用)；及(3)內化和外化疾病的共存。8種童年逆境中有7種與複雜成人精神病理學有統計學上顯著關連，有4個或以上童年逆境人士對4種疾病類別的優勢比為7.3, 95%CI[4.7,11.7] 。只有童年逆境專屬配對組合才能有添加和相乘的協同效應去增加成人精神病理學方面。協同模式有性別差異,如女性受性侵犯影響大些，而男性則被經濟困難影響多些。沒有任何童年逆境是有保護作用，對日後成人精神病的個人發病風險有統計上顯著的減少。本研究証實臨床經驗，即更多童年逆境與更複雜成人精神病學有相連。 标题:童年协同逆境与复杂成人精神病理学 撮要:众多研究指出不同种类的童年逆境的累进效应增加成人严重精神和身体疾病的风险。我们采用全国共病普查－复制样本来研究8种童年逆境的累进影响,在下列复杂成人精神病理等方面：(1)终身DSM‐IV诊断数目；(2)4个DSM病类别的数目(情绪、焦虑、控制冲动、和物质滥用)；及(3)内化和外化疾病的共存。8种童年逆境中有7种与复杂成人精神病理学有统计学上显著关连，有4个或以上童年逆境人士对4种疾病类别的优势比为7.3, 95%CI[4.7,11.7] 。只有童年逆境专属配对组合才能有添加和相乘的协同效应去增加成人精神病理学方面。协同模式有性别差异,如女性受性侵犯影响大些，而男性则被经济困难影响多些。没有任何童年逆境是有保护作用，对日后成人精神病的个人发病风险有统计上显著的减少。本研究证实临床经验，即更多童年逆境与更复杂成人精神病学有相连。

  July 25, 2013   doi: 10.1002/jts.21833   open full text
• Loving‐Kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study.
  David J. Kearney, Carol A. Malte, Carolyn McManus, Michelle E. Martinez, Ben Felleman, Tracy L. Simpson.
  Journal of Traumatic Stress. July 25, 2013
  Loving‐kindness meditation is a practice designed to enhance feelings of kindness and compassion for self and others. Loving‐kindness meditation involves repetition of phrases of positive intention for self and others. We undertook an open pilot trial of loving‐kindness meditation for veterans with posttraumatic stress disorder (PTSD). Measures of PTSD, depression, self‐compassion, and mindfulness were obtained at baseline, after a 12‐week loving‐kindness meditation course, and 3 months later. Effect sizes were calculated from baseline to each follow‐up point, and self‐compassion was assessed as a mediator. Attendance was high; 74% attended 9–12 classes. Self‐compassion increased with large effect sizes and mindfulness increased with medium to large effect sizes. A large effect size was found for PTSD symptoms at 3‐month follow‐up (d = −0.89), and a medium effect size was found for depression at 3‐month follow‐up (d = −0.49). There was evidence of mediation of reductions in PTSD symptoms and depression by enhanced self‐compassion. Overall, loving‐kindness meditation appeared safe and acceptable and was associated with reduced symptoms of PTSD and depression. Additional study of loving‐kindness meditation for PTSD is warranted to determine whether the changes seen are due to the loving‐kindness meditation intervention versus other influences, including concurrent receipt of other treatments. 標題:一個治療創傷後壓力症的 ⌈愛與慈悲⌋ 冥想的先導研究 撮要: ⌈愛與慈悲⌋ 冥想加強待人待己的慈悲和同情心，練習包括重覆默念一些對自己和他人有正向的語句。本研究為一開放先導研究，是關於患有創傷後壓力症(PTSD)退役軍人中使用 ⌈愛與慈悲⌋ 冥想。我們在基綫，12週 ⌈愛與慈悲⌋ 冥想療程後，和治療3個月後，評估患者的PTSD、自身同情心和靜觀正念。從基綫到每一個評估點計算效應值，而自身同情心則評估其中介者角色。治療的出席率高，有74%人出席9到12節治療。自身同情心隨着高效應值增加,而中至高效應值則令靜觀正念增長。在3個月後評估點的PTSD症狀則有高效應(d = ‐0.89)，但同期抑鬱症狀只有中效應值(d = ‐0.49)。加強自身同情心則在PTSD和抑鬱症狀減少中有中介角色。總括而言， ⌈愛與慈悲⌋ 冥想安全及易被接受，亦與PTSD和抑鬱症狀減退有關連。更多使用 ⌈愛與慈悲⌋ 冥想治療PTSD的研究有助決定這些改變只是由於 ⌈愛與慈悲⌋ 冥想介入治療，或只是其他影响(包括同期的其他治療) 。 标题:一个治疗创伤后压力症的 ⌈爱与慈悲⌋ 冥想的先导研究 撮要: ⌈爱与慈悲⌋ 冥想加强待人待己的慈悲和同情心，练习包括重复默念一些对自己和他人有正向的语句。本研究为一开放先导研究，是关于患有创伤后压力症(PTSD)退役军人中使用 ⌈爱与慈悲⌋ 冥想。我们在基线，12周 ⌈爱与慈悲⌋ 冥想疗程后，和治疗3个月后，评估患者的PTSD、自身同情心和静观正念。从基线到每一个评估点计算效应值，而自身同情心则评估其中介者角色。治疗的出席率高，有74%人出席9到12节治疗。自身同情心随着高效应值增加,而中至高效应值则令静观正念增长。在3个月后评估点的PTSD症状则有高效应(d = ‐0.89)，但同期抑郁症状只有中效应值(d = ‐0.49)。加强自身同情心则在PTSD和抑郁症状减少中有中介角色。总括而言， ⌈爱与慈悲⌋ 冥想安全及易被接受，亦与PTSD和抑郁症状减退有关连。更多使用 ⌈爱与慈悲⌋ 冥想治疗PTSD的研究有助决定这些改变只是由于 ⌈爱与慈悲⌋ 冥想介入治疗，或只是其他影响(包括同期的其他治疗) 。

  July 25, 2013   doi: 10.1002/jts.21832   open full text
• Posttraumatic Stress Disorder Symptom Clusters, Alcohol Misuse, and Women's Use of Intimate Partner Violence.
  Julianne C. Hellmuth, Véronique Jaquier, Kelly Young‐Wolff, Tami P. Sullivan.
  Journal of Traumatic Stress. July 18, 2013
  Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance‐using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self‐medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women. 標題：創傷後壓力症狀群、濫用酒精、受親密伴侶暴力對待的婦女、與這些婦女受害情形之間的關係 撮要：為了瞭解婦女被親密伴侶暴力對待(IPV)的情況，我們探討PTSD、酗酒與受親密伴侶暴力對待的婦女之間的關係。這樣有助我們介入並協助她們。控制婦女IPV受害情況後，我們透過酗酒路徑，檢視創傷後壓力症(PTSD)症狀羣對婦女應用IPV的直接和非直接影響幅度。樣本是正面對IPV受害的社會經濟地位低和濫用物質的社區婦女(N = 143)。樣本中大多數為非裔美國人(n = 115, 80.42%)，她們年均家庭收入為$14,368.68 (SD = $12,800.68) 而且擁有中學教育程度(11.94年, SD = 1.32)。路徑分析指出婦女應用IPV和婦女IPV受害情況之間出現最強統計學上關係。PTSD再經歷和麻木症狀幅度，與婦女使用心理的、輕度身體的和嚴重身體的IPV有關連，但這種關係是間接地經由酒精濫用。結果初步証實「自我用藥」假設可用作研究婦女PTSD，酒精濫用及IPV之間的關係。 标题：创伤后压力症状群、滥用酒精、受亲密伴侣暴力对待的妇女、与这些妇女受害情形之间的关系 撮要：为了了解妇女被亲密伴侣暴力对待(IPV)的情况，我们探讨PTSD、酗酒与受亲密伴侣暴力对待的妇女之间的关系。这样有助我们介入并协助她们。控制妇女IPV受害情况后，我们透过酗酒路径，检视创伤后压力症(PTSD)症状羣对妇女应用IPV的直接和非直接影响幅度。样本是正面对IPV受害的社会经济地位低和滥用物质的小区妇女(N = 143)。样本中大多数为非裔美国人(n = 115, 80.42%)，她们年均家庭收入为$14,368.68 (SD = $12,800.68) 而且拥有中学教育程度(11.94年, SD = 1.32)。路径分析指出妇女应用IPV和妇女IPV受害情况之间出现最强统计学上关系。PTSD再经历和麻木症状幅度，与妇女使用心理的、轻度身体的和严重身体的IPV有关连，但这种关系是间接地经由酒精滥用。结果初步证实「自我用药」假设可用作研究妇女PTSD，酒精滥用及IPV之间的关系。

  July 18, 2013   doi: 10.1002/jts.21829   open full text
• Identifying Youth at Risk for Difficulties Following a Traumatic Event: Pre‐event Factors are Associated with Acute Symptomatology.
  Megan C. Goslin, Carla Smith Stover, Steven Berkowitz, Steven Marans.
  Journal of Traumatic Stress. July 16, 2013
  This study examined factors related to children's acute symptoms following a potentially traumatic event (PTE) to more clearly identify domains that should be included in screenings of youth exposed to a PTE. In particular, the authors examined whether trauma category (i.e., sexual abuse/disclosure of abuse, intentionally perpetrated traumas other than sexual abuse, and unintentional traumas) was related to symptoms after controlling for other relevant factors. Participants were 112 youth presenting for clinical evaluation within a month of a PTE and their nonoffending caregivers. Using data from baseline assessments collected as part of a randomized controlled trial of a secondary prevention program, the following factors were tested in 3 hierarchical regression models: index PTE category, history of traumatic exposure, preindex event functioning, and parenting behaviors. Prior trauma exposure, preindex event functioning, and hostile parenting were uniquely related to children's symptoms in the acute posttraumatic period after controlling for time since the event and child age, but trauma category was not. Implications for identifying and referring children at high risk for poor outcomes in the early aftermath of a PTE are discussed. An exclusive focus on the event is insufficient and more comprehensive understanding of the child and family is required. 標題：如何發掘創傷事件後有困擾的高危青少年：事件前因素與急性症狀學的關係。 撮要：本研究檢視潛在創傷事件(PTE)後兒童急性症狀的相關因素，以期辨識PTE後必要的青少年篩查領域；亦研究控制其他相關因素後，創傷種類(即性侵犯/侵犯的揭露，其他蓄意的和非蓄意的傷害)與症狀的關係。樣本是在PTE發生後一個月內進行臨床診斷的112名青少年，及他們的照顧者(非引致傷害者)。我們利用一個二級預防計劃的隨機對照試驗的基準評核數據來設計三層回歸模型，而下列因素則用此模型來測試，包括：PTE指標類別，創傷經歷史，指標事件前的功能，和親子行為。在對照事件後時差和兒童年紀後，曾有創傷經歷，指標事件前的功能，和敵意親子行為都與兒童創傷後的急性症狀各有獨特關連；而創傷類別則未有相似發現。我們也探討在PTE後的早期階段，如何能發掘及轉介高危兒童接受治療。聚焦事件本身並不足夠，而我們必須對兒童及其家庭有更深入瞭解。 标题：如何发掘创伤事件后有困扰的高危青少年：事件前因素与急性症状学的关系。 撮要：本研究检视潜在创伤事件(PTE)后儿童急性症状的相关因素，以期辨识PTE后必要的青少年筛查领域；亦研究控制其他相关因素后，创伤种类(即性侵犯/侵犯的揭露，其他蓄意的和非蓄意的伤害)与症状的关系。样本是在PTE发生后一个月内进行临床诊断的112名青少年，及他们的照顾者(非引致伤害者)。我们利用一个二级预防计划的随机对照试验的基准评核数据来设计三层回归模型，而下列因素则用此模型来测试，包括：PTE指标类别，创伤经历史，指针事件前的功能，和亲子行为。在对照事件后时差和儿童年纪后，曾有创伤经历，指针事件前的功能，和敌意亲子行为都与儿童创伤后的急性症状各有独特关连；而创伤类别则未有相似发现。我们也探讨在PTE后的早期阶段，如何能发掘及转介高危儿童接受治疗。聚焦事件本身并不足够，而我们必须对儿童及其家庭有更深入了解。

  July 16, 2013   doi: 10.1002/jts.21825   open full text
• Gender Differences in Subjective Sleep After Trauma and the Development of Posttraumatic Stress Disorder Symptoms: A Pilot Study.
  Ihori Kobayashi, Douglas L. Delahanty.
  Journal of Traumatic Stress. July 16, 2013
  Women are at higher risk than men for developing posttraumatic stress disorder (PTSD) following certain types of trauma such as accidents and assaults. Sleep disturbances have been implicated in the development of PTSD. Although gender differences in objective sleep soon after trauma have been found in a prior polysomnographic study, gender differences in subjective sleep soon after trauma and their associations to the development of PTSD have not been examined. This pilot study prospectively examined whether gender moderated the relationship between subjective sleep soon after trauma and PTSD symptom development. Injury patients (17 women, 28 men) completed a sleep questionnaire and a 1‐week sleep diary 2 weeks after their injuries, and the Clinician Administered PTSD Scale at 7‐weeks postinjury. Results showed that women reported greater frequency of nightmares and disruptive nocturnal behaviors (e.g., hot flashes, memories/nightmares about trauma) following the trauma and more severe PTSD symptoms at 7 weeks. Further, gender moderated the relationship between sleep‐onset latency and PTSD symptom severity, such that longer sleep‐onset latency predicted more severe PTSD symptoms in men, but less severe PTSD symptoms in women. These findings suggest that gender‐specific mechanisms may underlie the relationship between sleep impairment and the development of PTSD. 標題 :關於創傷後主觀睡眠的兩性差異與創傷後壓力症的先導研究 撮要 :在某些創傷(如意外和襲擊)後，女性比男性更容易患上創傷後壓力症(PTSD)，而PTSD的發病可能與睡眠問題有關。 雖然曾有睡眠多導儀研究指出創傷後即時客觀睡眠有兩性差異，但是未有研究關於創傷後即時主觀睡眠的兩性差異及與PTSD的關係。本先導研究前膽性檢視創傷後即時主觀睡眠與PTSD之間是否由性別作制約角色。受傷病人(17名女士及28名男士)在傷後兩週完成睡眠問卷和睡眠一週日記，而在傷害後七週完成醫療人員評估PTSD量表。結果指出女士有更頻密的創傷後惡夢和擾亂性夜間行為(如潮熱，與創傷相關的記憶/惡夢)，和創傷後七週有更重的PTSD症狀。再者，入睡潛伏期和PTSD症狀幅度之間有性別作制約角色，如在男性中較長入睡潛伏期預測更重PTSD症狀，但在女性中則PTSD症狀則較輕。上述結論建議性別專屬機制可能突出睡眠失調和PTSD病發之間的關係。 标题 :关于创伤后主观睡眠的两性差异与创伤后压力症的先导研究 撮要 :在某些创伤(如意外和袭击)后，女性比男性更容易患上创伤后压力症(PTSD)，而PTSD的发病可能与睡眠问题有关。 虽然曾有睡眠多导仪研究指出创伤后实时客观睡眠有两性差异，但是未有研究关于创伤后实时主观睡眠的两性差异及与PTSD的关系。本先导研究前胆性检视创伤后实时主观睡眠与PTSD之间是否由性别作制约角色。受伤病人(17名女士及28名男士)在伤后两周完成睡眠问卷和睡眠一周日记，而在伤害后七周完成医疗人员评估PTSD量表。结果指出女士有更频密的创伤后恶梦和扰乱性夜间行为(如潮热，与创伤相关的记忆/恶梦)，和创伤后七周有更重的PTSD症状。再者，入睡潜伏期和PTSD症状幅度之间有性别作制约角色，如在男性中较长入睡潜伏期预测更重PTSD症状，但在女性中则PTSD症状则较轻。上述结论建议性别专属机制可能突出睡眠失调和PTSD病发之间的关系。

  July 16, 2013   doi: 10.1002/jts.21828   open full text
• Mental Disorders Associated With Subpopulations of Women Affected by Violence and Abuse.
  Courtenay E. Cavanaugh, Silvia S. Martins, Hanno Petras, Jacquelyn C. Campbell.
  Journal of Traumatic Stress. June 28, 2013
  Violence against women is a major public health problem associated with mental disorders. Few studies have examined the heterogeneity of interpersonal violence and abuse (IVA) among women and associated mental health problems. Latent class analysis was used to identify subpopulations of women with similar lifetime histories of IVA victimization and to examine 10 associated past‐year mental disorders. Participants were 19,816 adult women who participated in Wave 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC). The 3‐class model was best supported by the data. Class 1 (6.7%) had a high probability of witnessing domestic violence as a child. Class 2 (21.8%) had a low probability of all events except lifetime sexual assault. Class 3 (71.5%) had a low probability for all events. Mental disorders were more common among members of Classes 1 and 2 than Class 3. For example, members in Class 1 were approximately 8 and 9 times more likely than members in Class 3 to have had posttraumatic stress disorder or a drug use disorder, respectively, during the past year. Of the 10 mental disorders, 5 were more common among members of Class 1 than of Class 2. Findings suggest the mental health consequences of IVA among women are extensive and interventions should be tailored for distinct subpopulations affected by IVA. 標題：受暴力及侵犯所傷害的婦女羣的精神病 撮要：婦女被施暴是重要公共衛生課題，也帶來精神問題。研究少有探討女性人際暴力和侵犯(IVA)的不同種類和相關精神問題。使用潛伏組分析，我們分辨有相似IVA受害終身歷史的婦女羣組，和檢查過去一年10種相關精神病。樣本是19,816名成年婦女，她們都是參加第二階段的全國酒精及相關情況的流行病學研究(NESARC)。數據支持三等級模型。第一等級(6.7%)有高機會率在兒時目睹家庭暴力。第二等級(21.8%) 除了終身性侵犯外，對其他暴力事件有低機會率。而第三等級(71.5%)則對所有暴力事件有低機會率。第一和第二等級比第三等級有更多精神病出現。例如在過去一年間，第一等級人士比第三等級分別多八倍機會有創傷後壓力症，和多九倍機會有藥物濫用。在10種精神病中，第一等級人士比第二等級較多有其中5種病。本研究顯示女士在IVA後出現廣泛精神問題，而介入治療必須依從IVA影響群組來度身安排。 标题：受暴力及侵犯所伤害的妇女羣的精神病 撮要：妇女被施暴是重要公共卫生课题，也带来精神问题。研究少有探讨女性人际暴力和侵犯(IVA)的不同种类和相关精神问题。使用潜伏组分析，我们分辨有相似IVA受害终身历史的妇女羣组，和检查过去一年10种相关精神病。样本是19,816名成年妇女，她们都是参加第二阶段的全国酒精及相关情况的流行病学研究(NESARC)。数据支持三等级模型。第一等级(6.7%)有高机会率在儿时目睹家庭暴力。第二等级(21.8%) 除了终身性侵犯外，对其他暴力事件有低机会率。而第三等级(71.5%)则对所有暴力事件有低机会率。第一和第二等级比第三等级有更多精神病出现。例如在过去一年间，第一等级人士比第三等级分别多八倍机会有创伤后压力症，和多九倍机会有药物滥用。在10种精神病中，第一等级人士比第二等级较多有其中5种病。本研究显示女士在IVA后出现广泛精神问题，而介入治疗必须依从IVA影响群组来度身安排。

  June 28, 2013   doi: 10.1002/jts.21821   open full text