Brain Response After Trauma May Predict Recovery Outcome

BackgroundExperimentally inducing dyspnoea in healthy volunteers is a powerful research tool. Even though this approach is not considered to carry particular risks, dyspnoea occurs in a general context of stress. We hypothesised that experimental dyspnoea could be traumatic in some individuals, with immediate or delayed adverse psychological reactions.Methods40 participants (median (interquartile range) age 38.7 (29.7–49.1) years; 20 women) were exposed, in random order, to inspiratory threshold loading (ITL; “excessive breathing effort”; unpleasantness rating 6 (4–7) on a 0–10 scale) and carbon dioxide stimulation with restricted ventilatory response (CO2-rv; “air hunger”; unpleasantness rating 7 (7–8)). Participants were evaluated immediately after induced dyspnoea, at 7 days and after a further 3 months.ResultsPeritraumatic Distress Inventory (PDI) scores were higher immediately after CO2-rv than after ITL (3 (1–6.5) versus 2 (0–3); p<0.0001). After 7 days, six participants (15%) had an Impact of Event Scale-Revised (IES-R) score ≥12 (high risk of post-traumatic stress disorder (PTSD)). They had significantly higher baseline anxiety trait indicators than the participants with an IES-R score <12 (baseline Anxiety Sensitivity Index 27.5 (14.75–61.25) versus 10 (3–19); p=0.0087). At 3 months, no participant had a PTSD Checklist for DSM-5 (PCL-5) score suggestive of PTSD (1 (0–4), range 0–23, threshold 33) but the six participants with IES-R ≥12 on day 7 had significantly higher PCL-5 scores (13.5 (1–21.5) versus 0 (0–4); p=0.0014).ConclusionsAlthough no severe situations were encountered, this study highlights the need for caution when designing experimental dyspnoea studies, particularly when involving individuals with high trait anxiety.

L’intensité de la détresse péritraumatique prédit la survenue des symptômes post-traumatiques parmi des victimes d’agressions

The purpose of the current study was to investigate the effects of COVID-19 on high school students' psychological symptoms and to understand how ready counselors and school counseling services are based on the data we have. Therefore, this research is designed under two different studies: (A) Study 1: Effects of COVID-19 pandemic on students' psychological symptoms and (B) Study 2: Views and expectations of students and school counselors about school counseling services. The first study was a quantitative study and included 549 high school students (398 female, 151 male). A structural equation model (SEM) was created to examine the effects of COVID-19 pandemic on participants' psychological symptoms. The Impact of Event Scale-Revised (IES-R) scores showed that 107 (19.50%) individuals had a score of 50 and above pointing out that individuals in this group had severe impact of event/trauma symptomologies. The SEM analysis indicated that IES-R scores had a total effect of 0.79 on anxiety, 0.75 on depression, 0.74 on negative self-concept, 0.68 on somatization, and 0.66 on hostility scores. Furthermore, female students had significantly higher scores on anxiety, depression, negative self-concept, somatization, hostility, and impact of events variables than male students. Study 2 was a qualitative design and consisted of five school counselors and five students from different schools. The results indicated that students' difficulties during the coronavirus disease 2019 (COVID-19) outbreak were educational, cognitive, emotional, physiological, relational, technological, and related to routines. Academic, social, emotional, and behavioral issues came to the fore among the difficulties that can be experienced if students start face-to-face education. On the other hand, the school counselors listed that family relations, personal–social, emotional, and academic themes were the difficulties experienced by the students at the beginning of the COVID-19. In addition, when COVID-19 started, the services offered by school counselors were discussed under (1) services for the student, (2) services for the family, and (3) services for the teacher. Finally, according to the opinions of the school counselors, if students start face-to-face education, they may experience emotional, academic, and relational difficulties. In summary, it is vital that student personality services be prepared and implemented by school counseling services for schools based on the results.

Objective To know about the post-traumatic stress disorders (PTSD) of women with termination of pregnancy for fetal anomalies (TOPFA) , and investigate the relationship of PTSD and the big five personality traits. Methods The general questionnaire, the Impact of Event Scale-Revised (IES-R) and the Big Five Questionnaire were administered to the women with TOPFA in hospital from February 2014 to February 2015. Results The total score of IES-R of 84 cases was 26.20 ± 16.38. The scores of 49 cases (58.3%) were more than 19 and that of 20 cases (23.8%) more than 35. Women who had the first pregnancy had higher level of arousal symptoms,12.84±7.41 vs. 9.65±5.53 (t = 2.25,P < 0.05) . Women whose scores were above 19 had lower adaptation, sociality, altruism and conscience compared with those scored ≤19, 14.96±3.29, 16.84±3.00, 18.55±3.49, 17.57±2.99 vs. 13.57±2.82, 18.31±2.65, 20.03±2.32, 18.86±2.21,t= 2.02-2.33,P < 0.05. The IES-R score had no linear correlation with that of the big five personalities, and intrusion subscale had linear correlation with the adaptation. Avoidance symptoms had low positive relationship with sociality in women whose IES-R were above 19,r = 0.23,P < 0.05. In populations whose IES-R scored above 19, avoidance subscale had positive weak correlation with sociality,r=0.31,P < 0.05. Conclusions The women with TOPFA had high level of PTSD before termination. Women with sever posttraumatic stress symptoms had lower sociality and altruism. Moreover, of the women who had sever posttraumatic stress symptoms, one with higher sociality always had higher avoidance symptoms. Key words: Pregnant women; Fetal anomaly; Post-traumatic stress; Big five personality traits

Objective To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. Methods Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). Results 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). Conclusions Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur. Trial Registration ClinicalTrials.gov Identifier: NCT04694482

COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March–April 2020) and T2 as restarting (May–June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482

RationaleFamilies of critically ill patients with coronavirus disease (COVID-19) may be at particularly high risk for anxiety, depression, and post-traumatic stress disorder after hospital discharge.ObjectivesTo assess symptoms of anxiety, depression, and stress among families of patients with COVID-19 during and after intensive care unit (ICU) admissions and to use qualitative methods to determine the sources of emotional distress.MethodsFamilies of patients with COVID-19 who participated in an ICU study were approached for participation in this post–hospital discharge study. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Impact of Events Scale–Revised (IES-R) at up to three points during the ICU stay and once after the ICU stay. Mixed-effects models were used to compare trajectories of HADS and IES-R scores over the ICU and post-ICU periods. Telephone interviews with participants were evaluated using thematic content analysis.ResultsAmong the 90 families that participated from September 2020 to April 2021, 47 respective patients were alive and 43 were deceased. Average HADS anxiety, HADS depression, and IES-R scores after hospital discharge were significantly higher (greater symptom burden) among families of deceased versus surviving patients: 9.2 (95% confidence interval [CI], 7.8–10.6) versus 6.3 (95% CI, 4.9–7.6) (P < 0.01), 7.1 (95% CI, 5.7–8.6) versus 3.2 (95% CI, 2.3–4.1) (P < 0.001), and 36.1 (95% CI, 31.0–41.2) versus 20.4 (95% CI, 16.1–24.8) (P < 0.001), respectively. HADS anxiety and HADS depression scores began to diverge during the ICU stay, whereas IES-R scores diverged after the stay for families of surviving versus deceased patients. Qualitative analysis confirmed a higher burden of psychological symptoms among families of deceased patients. Memories from the ICU stay became a focal point for participants who lost their loved ones, whereas families of surviving patients were able to look positively toward the future. In addition, families of deceased patients often viewed friends and family as sources of stress, whereas families of surviving patients typically viewed their community as a source of support.ConclusionsPatient death was associated with symptoms of anxiety, depression, and post-traumatic stress disorder among families of ICU patients with COVID-19. Psychological support interventions may be most beneficial for families of patients who died of COVID-19.Clinical trial registered with www.clinicaltrials.gov (NCT 04501445).

To determine if an age-appropriate intervention is more effective than treatment as usual (TAU) in reducing post-traumatic stress disorder (PTSD) symptoms in parents/guardians of children discharged from paediatric intensive care unit (PICU). A two-arm, parallel-group, single-centre randomised controlled trial. PICU, St Mary's Hospital, London, UK. Children admitted to the PICU between July 2021 and September 2022, with a length of stay >24 hours, and a corrected gestational age of >36 weeks at the time of PICU admission, up to <16 years of age. Parents/guardians were required to be >18 years old. We predefined subgroups of children as those <4 years and those ≥4 years. An age-appropriate educational booklet given at PICU discharge and a targeted telephone call at 6 weeks posthospital discharge. Parental PTSD symptoms 6 months after PICU discharge, measured by the Impact of Events Scale-Revised (IES-R). 679 children were admitted to PICU, 212 were eligible for enrolment, 81 declined and 131 were included, of which 126 completed the study. 64 were randomised to TAU and 62 to intervention. 6-month questionnaires were returned by 60 families (36 from TAU group and 24 from intervention group (p=0.049)). There was no significant difference in IES-R scores between the TAU and intervention groups overall (IES-R score 37 vs 17 (p=0.132)). The ≥4-year intervention group had lower IES-R scores compared with TAU (13 in intervention vs 42 in TAU (p=0.008)). There was no difference in the <4-year group or in any secondary outcome. This intervention was effective in reducing PTSD symptoms in parents of children ≥4 years after PICU discharge. NCT04635449.

The aim of this study was to assess the levels of psychological distress experienced among the families of those killed and those wounded on Bloody Sunday. A longitudinal design was used. A measure of psychological distress was administered to four groups of participants at four times over a period of approximately 4½ years. The Impact of Events Scale—Revised (IES-R) was administered to 69 participants who comprised four groups; those wounded during Bloody Sunday, the immediate family of victims, second-generation family members of victims, and a comparison group. Significant between-group and within-group main effects were found using a mixed analysis of variance. This indicated that there were significant differences in IES-R scores across the four groups and that the scores decreased across time. The group by time interaction was statistically significant, which indicated that the changes in IES-R scores across time differed across groups. The results attest to the persistent and far-reaching effects of traumatic events on individuals, with psychological distress still being reported more than 30 years after the event.

Aim: The coronavirus disease 2019 (COVID-19) pandemic has abruptly changed the life of millions as travel and social contacts have been severely restricted. We assessed the psychological impact of COVID-19 on adults and children, with special attention to health care workers (HCWs).Methods: A self-rated online survey, including the Impact of Event Scale-Revised (IES-R) for adults and the Children Revised Impact of Event Scale-Revised-13 items (CRIES-13) for their 8–18-year-old offspring, was conducted in Italy on March 20–26, 2020. Linear mixed-effects models were applied to the data, accounting for age, sex, education, and other demographic characteristics.Results: Data were available from 2,419 adults (78.4% females, mean age 38.1 ± SD 13.1 years; 15.7% HCW) and 786 children (50.1% male, mean age 12.3 ± 3.2 years). Median (IQR) IES-R score was 30.0 (21.0–40.0), corresponding to mild psychological impact, with 33.2% reporting severe psychological impact. IES-R was lower in HCWs (29.0) than non-HCWs (31.0), but HCWs directly involved in COVID-19 care had higher scores [33.0 (26.0–43.2)] than uninvolved HCWs [28.0 (19.0–36.0)]. Median CRIES-13 score was [21.0 (11.0–32.0)], with 30.9% of the children at high risk for post-traumatic stress disorder. Parent and child scores were correlated.Conclusions: Up to 30% of adult and children in the pandemic area are at high risk for post-traumatic stress disturbances. The risk is greater for HCWs directly involved in COVID-19 care and for their children.

Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).

281 - Post Intensive Care Syndrome in out-of-hospital cardiac arrest patients: A prospective observational study

Background/ObjectiveDeath in intensive care units (ICUs) may increase bereaved family members’ risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care.MethodIn this longitudinal observational study, 319 family members of deceased ICU patients were consecutively recruited from medical ICUs from two Taiwanese medical centers. PTSD symptoms were assessed at 1, 3, 6, and 13 months post-loss using the Impact of Event Scale-Revised (IES-R). Family satisfaction with end-of-life care in ICUs was assessed at 1 month post-loss. End-of-life care received in ICUs was documented over the patient’s ICU stay. Predictors for developing clinically significant PTSD symptoms (IES-R score ≥ 33) were identified by multivariate logistic regression with generalized estimating equation modeling.ResultsThe prevalence of clinically significant PTSD symptoms decreased significantly over time (from 11.0% at 1 month to 1.6% at 13 months post-loss). Longer ICU stays (adjusted odds ratio [95% confidence interval] = 1.036 [1.006, 1.066]), financial insufficiency (3.166 [1.159, 8.647]), and reported use of pain medications (3.408 [1.230, 9.441]) by family members were associated with a higher likelihood of clinically significant PTSD symptoms among family members during bereavement. Stronger perceived social support (0.937 [0.911, 0.965]) and having a Do-Not-Resuscitate (DNR) order issued before the patient’s death (0.073 [0.011, 0.490]) were associated with a lower likelihood of clinically significant PTSD symptoms. No significant association was observed for family members’ satisfaction with end-of-life care (0.988 [0.944, 1.034]) or decision-making in ICUs (0.980 [0.944, 1.018]).ConclusionsThe likelihood of clinically significant PTSD symptoms among family members decreased significantly over the first bereavement year and was lower when a DNR order was issued before death. Enhancing social support and facilitating a DNR order may reduce the trauma of ICU death of a beloved for family members at risk for developing clinically significant PTSD symptoms.

BackgroundCoronavirus disease 2019 (COVID-19) and related isolation measures have substantial adverse economic, social, and psychological consequences and expose children to increased risk of violence. The present study aimed to investigate the impact of the COVID-19 pandemic on violence against children in Egypt.MethodsAn online survey, in Arabic, was disseminated during the period from 9 to 13 April 2020, to parents of children who were up to 18 years old residing in Egypt, selected using a snowball sampling technique, during the period from 25 March to 8 April during the implementation of the nationwide compulsory isolation measures against COVID-19 (25 March to 8 April 2020). The survey covered three areas: socio-demographic data, psychological impact measured using the Impact of Event Scale-Revised (IES-R), and violence against children during the past 2 weeks measured using a modified parent-report of a child abuse screening tool (ICAST-P) developed by the International Society for the Prevention of Child Abuse and Neglect.ResultsOut of 1118 completed survey responses, 90.5% of children were subjected to violent discipline, 88.7% experienced psychological aggression, and 43.2% encountered severe physical punishment. Approximately 60% of respondents reported a moderate-to-severe psychological impact (IES-R scores ≥ 33), which was associated with a higher rate of violent discipline (OR: 9.3; 95% CI: 5.37–16.027; p < 0.001).ConclusionsThis is the first study in Egypt to provide evidence on the association of COVID-19 pandemic, its psychological impact, and increased rates of violence against children. Effective multilevel strategies are urgently required to protect children from violence and its catastrophic consequences during the continually evolving COVID-19 pandemic.

Background Healthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown. Objectives To assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes. Methods A cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM. Results HCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact. Conclusion Family physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.