Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD.

U.S. Coast Guard (CG) personnel face occupational stressors (e.g., search and rescue) which compound daily life stressors encountered by civilians. However, the degree CG personnel express stress-related mental health symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is understudied as a military branch, and little is known concerning the interplay of vulnerabilities and neurocognitive outcomes in CG personnel. The current study addressed this knowledge gap, recruiting 241 active duty CG personnel (22% female) to assess mental health, personality, and neurocognitive function. Participants completed a battery of scales: PTSD Checklist with military and non-military prompts to screen for PTSD, Psychological Health Questionnaire 8 for MDD, and scales for behaviorally inhibited (BI) temperament, and distressed (Type D) personality. Neurocognitive performance was assessed with the Defense Automated Neurobehavioral Assessment (DANA) battery. Cluster scoring yielded an overall rate of PTSD of 15% (95% CI: 11–20%) and 8% (95% CI: 3–9%) for MDD. Non-military trauma was endorsed twice that of military trauma in those meeting criteria for PTSD. Individual vulnerabilities were predictive of stress-related mental health symptoms in active duty military personnel; specifically, BI temperament predicted PTSD whereas gender and Type D personality predicted MDD. Stress-related mental health symptoms were also associated with poorer reaction time and response inhibition. These results suggest rates of PTSD and MDD are comparable among CG personnel serving Boat Stations to those of larger military services after combat deployment. Further, vulnerabilities distinguished between PTSD and MDD, which have a high degree of co-occurrence in military samples. To what degree stress-related mental healthy symptoms and attendant neurocognitive deficits affect operational effectiveness remains unknown and warrant future study.

BackgroundThe impact of combat operations in Iraq and Afghanistan on the incidence of post-traumatic stress disorder (PTSD) in military service members has been poorly quantified. The purpose of this study was to examine trends in the incidence rate of physician-diagnosed PTSD in active-duty military personnel between 1999 and 2008.MethodsWe conducted a retrospective cohort study utilizing data extracted from the Defense Medical Surveillance System to identify incident cases of PTSD within the study population. The incidence rate of physician-diagnosed PTSD was the primary outcome of interest. Multivariable Poisson regression was used to analyze the data.ResultsThe overall incidence rate of PTSD among all active-duty US military personnel was 3.84 (95% CI: 3.81, 3.87) cases per 1000 person-years. The adjusted average annual percentage increase in the incidence rate of PTSD prior to the initiation of Operation Iraqi Freedom (OIF) was a modest 5.02% (95% CI: 1.85, 8.29%). Following the initiation of OIF, the average annual percentage increase in the rate of PTSD was 43.03% (95% CI: 40.55, 45.56%). Compared to the baseline period between 1999 and 2002, the incidence rate of PTSD in 2008 was nearly 7 times higher (RR = 6.85, 95% CI: 6.49, 7.24). Significant increases in the incidence rate of PTSD were observed following the initiation of OIF regardless of sex, age, race, marital status, military rank, or branch of military service. Notably, the rate of PTSD among females was 6–7 times higher prior to OIF, but there was no difference by gender by 2008.ConclusionsOverall, these data quantify the significant increase in the incidence rate of PTSD following the initiation of combat operations in Iraq and Afghanistan within the active-duty military population during the study period.

Since its inclusion in DSM-III, posttraumatic stress disorder (PTSD) has undergone a number of changes in its diagnostic criteria, including the expansion of Criterion A (traumatic stressor), the addition of symptom duration (none specified in DSM-III), and the requirement for impairment or distress (Criterion F, DSM-IV only). This study examined the impact of changes in PTSD diagnostic criteria using a Canadian PTSD epidemiologic sample. The rates of PTSD and its correlates were evaluated in a nationally representative random sample of 3,006 adults. DSM-III, DSM-III-R, DSM-IV, and ICD-10 criteria were employed. DSM-III, DSM-III-R, and ICD-10 rates were re-evaluated, substituting specific DSM-IV criteria (A-F). The prevalence rates of lifetime PTSD ranged from 13.4% (DSM-III) to 13.0% (ICD-10) to 12.2% (DSM-III-R) to 9.2% (DSM-IV); all rates differed significantly from each other (P < .001). Regardless of diagnostic criteria, most people reported more than 1-year duration of symptoms, although rates were significantly higher in those with DSM-IV PTSD (68.2%, P < .0001). Rates of comorbid major depressive disorder and alcohol and substance abuse and dependence were also significantly higher (P < .05) using the DSM-IV PTSD criteria, and those with DSM-IV PTSD reported significantly higher rates of help-seeking (P < .001). When Criterion F was added to earlier versions, lifetime PTSD rates became much closer to those obtained using DSM-IV criteria: 10.6% (DSM-III), 10.2% (DSM-III-R), and 9.9% (ICD-10); however, rates fluctuated when operational definitions of Criterion F were modified. DSM-III PTSD was also substantially affected by DSM-IV Criteria A and C. DSM-IV PTSD may identify a more severe disorder. The addition of the clinical significance criterion (F) appeared to affect the greatest change in prevalence rates. Defining Criterion F as having both clinically significant psychological distress and functional impairment lowered the diagnostic threshold to a greater degree than did either distress or impairment alone. This information may be useful for future revisions of PTSD diagnostic criteria.

Empirical findings suggest that psychiatric illness is associated with cardiovascular disease (CVD). The purpose of this study was to compare the strength of the association of lifetime post-traumatic stress disorder (PTSD) and lifetime major depression on CVD among Northern Plains American Indians. A total of 1414 participants aged 18-57 years completed a structured interview that assessed psychiatric diagnoses, alcohol abuse/dependence, self-reported CVD, and traditional CVD risk factors including age, sex, education, diabetes, high blood pressure, and smoking. Logistic regression analyses compared the odds ratios of CVD in participants with and without diagnosed PTSD or major depression. The rates of lifetime PTSD and major depression were 15% and 8% respectively. CVD was more commonly reported by participants with PTSD than by those without PTSD (12% v. 5%, p<or=0.01). Likewise, more participants with major depression reported CVD than did their non-depressed counterparts (14% v. 6%, p<or=0.05). PTSD was significantly associated with CVD even after controlling for traditional CVD risk factors and major depression (odds ratio 2.0, confidence interval 1.1-3.8). In contrast, the association of major depression with CVD was not significant after accounting for both traditional risk factors and PTSD. Rates of PTSD are high in American Indian communities. Rising CVD rates in this population may be better understood if PTSD is considered along with other traditional risk factors. Future research should examine the association and mechanisms of PTSD and CVD prospectively. Such data could lead to more effective CVD prevention efforts for American Indians.

Background and objective: The revisions of the DSM-5 and ICD-11 introduced several changes that altered the conceptualization of posttraumatic stress disorder (PTSD), potentially affecting diagnosis of children and adolescents. This study investigates the differences in rates of PTSD, diagnostic agreement, and comorbidity in children and adolescents when using DSM-5 or ICD-11. Method: The study is based on secondary analysis of data. Sample 1 and 2 consist of children and adolescents referred to mental health clinics (CAMHS) across Norway and sample 3 includes children referred to community services for trauma treatment. The total sample consisted of 290 children and adolescents (ages 7–18). Cohen’s kappa, McNemar tests and bootstrapped estimates with 95% CI were used to investigate our research questions. Results: The rate of DSM-5PTSD (55.9%) was significantly higher than ICD-11PTSD (33.2%), which seems to be particularly related to the re-experiencing criterion. There was a weak agreement of 74.5% between the two diagnoses manuals (kappa = .51). Using DSM-5 showed larger overlap between depression and PTSD (24.5% vs. 12.3%), as well as attention difficulties and PTSD (21.8% vs. 12.1%) as compared to ICD-11. However, our results also suggest that comorbidity rates for those with PTSD may be higher when using ICD-11 criteria compared to DSM-5 criteria (61.9% vs 53.1.% for depression). Conclusions: The results indicate that choice of diagnostic manual can influence whether children meet diagnostic criteria. Using ICD-11 criteria may help identify a subgroup of children and adolescents with more severe PTSD symptom profiles. Whereas using ICD-11 criteria is associated with high specificity of the diagnosis, it seems to also increase the comorbidity among those diagnosed. In contrast, utilizing DSM-5 criteria may identify children and adolescents with less distinct symptom presentations. Choice of diagnostic manual may influence access to evidence-based treatment.

Trauma exposure is a precursor to a diagnosis of posttraumatic stress disorder (PTSD). A dearth of empirical evidence exists on the impact of different measurement practices on estimates of trauma exposure and PTSD within representative epidemiological samples. In the present study, we examined differences in reported trauma exposure and rates of PTSD using single, open-ended question versus list-based trauma assessments in a general community sample. Using data from the third wave of the Montreal epidemiological catchment area study (N = 1029), participants were interviewed in person by a lay interviewer about lifetime history of trauma exposure and PTSD. Prevalence rates of trauma exposure and PTSD diagnosis using single, open-ended question and list-based assessment were compared using a within-subject design. A single, open-ended question versus list-based trauma assessment yielded trauma-exposure rates of 61%, 95% CI [57.8, 63.8] and 78%, 95% CI [75.2, 80.3], respectively. Conditional rates of lifetime PTSD decreased from 6.7%, 95% CI [5.8, 9.4] to 6%, 95% CI [4.4, 7.7], respectively. Increases in trauma exposure were more pronounced in women (33.7%) than men (21.5%), as well as in the younger stratum of study participants (15-24 years old; 36.1%). Underestimation of PTSD using a single, open-ended question assessment was minimal, although all missing cases were women. Our results lend support to the importance of using comprehensive assessments of exposure to potentially traumatic events when conducting epidemiological research, especially when reporting conditional rates of PTSD. Previous research may have underestimated the prevalence of trauma exposure, particularly among young women. (PsycINFO Database Record

Contingent negative variation in acute trauma patients: A prospective exploratory study

The subject of the study is the attitude towards a significant life situation, subjectivity and objectivity of the individual, the risk of developing post-traumatic stress disorder (PTSD), and sleep quality among representatives of the cities of Mariupol and St. Petersburg. The object of study – students of Mariupol State University named after A.I. Kuindzhi and Herzen University. The aim of the research was to establish possible connections between the subjective attitude towards life activities and the ability to overcome the consequences of psychological trauma ("getting out of the PTSD risk zone"), as well as quality of life, expressed in the quality of sleep and dreams. The study was also aimed at clarifying possible differences on the abovementioned and other criteria between representatives of St. Petersburg and Mariupol and opening up prospects for further research in the relevant area. Within the framework of the research, methods such as surveys, testing, source analysis, mathematical analysis, and interpretation of the obtained data were applied. The scientific novelty of the research lies, firstly, in clarifying the relationships between the risk of PTSD development, quality of life (in the area of sleep and dreams), and the level of subjectivity of the individual (including such characteristics as activity and locus of control). Additional factors of novelty were introduced into the study through a comparative analysis of the results obtained from samples of subjects from Mariupol and St. Petersburg. The conclusions of the study confirm the hypotheses formulated by its authors regarding the existence of a relationship between the risk of PTSD development and the ability of a person to express themselves as a subject of their own life activities, as well as between subjectivity and quality of life, general integration of personality (the marker of which is the ability to use dreams as a "coping strategy"). In particular, the authors draw the following conclusion: a high risk of PTSD is significantly related to the rejection of a significant situation, a refusal of the internal locus of control, and, conversely, acceptance of the external locus of control, nightmares, insomnia, a sense of loss of personal control over the situation when falling asleep, and a deterioration in overall sleep quality (the corresponding relationships vary from weak to moderately strong). Further research in this area appears to be extremely promising.

Depression Research and Treatment has issued a second compendium of papers focused on temperament, character, and depression. The psychobiology theory of personality proposed by Cloninger is a currently prevailing theory of personality that has been extensively investigated in the context of many different types of mental and personality disorders. This special issue reports up-to-date research findings on the psychobiology theory and depression from different countries. The current issue consists of six reports. Miettunen and colleagues in Finland present findings from a longitudinal birth cohort study (N = 4941). Participants with depression at 31 years of followup had higher rates of harm avoidance (HA) than participants without any psychiatric disorders. Participants without any psychiatric history were followed for another 12 years. Those who subsequently developed depression had high HA in 1997. The authors hypothesize that high HA is a potential indicator for subsequent depression. This study only used temperament scales and thus no information was available on the association between character and depression. Students in senior high schools (N = 1234) who were invited to participate in an internet-based intervention program for depression were studied by Christian and colleagues in Norway. High HA and low self-directedness (SD) emerged as strong predictors of adolescent depression. Interestingly, use of the internet intervention program was associated with low reward dependence (RD) in addition to depression severity. Garcia and colleagues studied an adolescent population (N = 304) in Sweden. Based on positive affect (PA) and negative affect (NA) scores derived from the Positive Affect and Negative Affect Schedule, the participants were categorized into four groups: self-fulfilling (high PA and low NA), high affective (high PA and high NA), low affective (low PA and low NA), and self-destructive (low PA and high NA). The self-fulfilling group was characterized by higher persistence (PS), SD, and cooperativeness (CO) than the three other groups. The self-destructive group was characterized by high HA and RD. The authors claim character maturity (expressed as high SD and CO) is important for psychological well-being. In Japan, Lu and colleagues followed graduate students (N = 184) on two occasions separated by a five-month interval. In a structural regression model, they posited that trait anxiety and depression constructs were linked to high HA and low SD. Although trait anxiety and depression scores were moderately correlated with each other, these two constructs showed different associations with Temperament and Character Inventory (TCI) subscale scores. Thus, trait depression was linked to high self-transcendence (ST) whereas trait anxiety was linked to low RD, PS, and CO. The authors claim that character maturity is linked to trait rather than state aspects of depression and anxiety. Directly exposed survivors of the Oklahoma City bombing randomly selected from a bombing survivor registry (N = 151) were examined by North and colleagues in the USA. Posttraumatic stress disorder (PTSD) after the bombing was associated with low SD and CO together with high ST and HA. Postdisaster major depression (MD) was more prevalent among those with PTSD than those without it, but low SD and CO could not be predicted by post-disaster MD. The authors emphasized the importance of developing and validating measures of resilience. A unique measure of temperament, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS), was used by Tei-Tominaga and colleagues to study job stress among employees in one Japanese company (N = 728). Depression was predicted by high levels of cyclothymic and anxious temperament traits even after controlling for the effects of work-related stressors such as demanding work conditions and overcommitment. These articles all indicate the importance of temperament and character traits in the development of depression among a variety of populations across different countries. Despite some differences between the studies, a common theme may be that low SD and high HA are predictors of depression either directly or being mediated by third variables. Toshinori Kitamura C. Robert Cloninger Andrea Fossati Jorg Richter

Posttraumatic stress disorder (PTSD) is characterized by anxiety symptoms and impulsivity and aggression, which are thought to represent examples of excessive behavioral inhibition and activation, respectively. PTSD and traumatized control subjects performed the Stop-Signal Task to assess behavioral activation and inhibition simultaneously. PTSD subjects showed no evidence of the generally increased behavioral inhibition expected to accompany anxiety, but exhibited progressively decreased behavioral activation during acquisition of the task. However, when behavior was facilitated using monetary rewards, both PTSD and traumatized control subjects showed increases in behavioral activation, whereas PTSD subjects also showed significant disinhibition. These findings argue against PTSD patients being chronically inhibited and unresponsive to rewards, and the presence of disinhibition accompanying behavioral activation in these subjects may explain the impulsivity and aggression associated with PTSD.

Objective To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters. Methods A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants. Results Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%. Conclusion Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.

Posttraumatic stress disorder (PTSD) is recognized as a debilitating psychiatric disorder affecting populations worldwide. This has inspired many countries to estimate the national prevalence rates of PTSD in Europe and beyond. At present, there are no published representative studies that have assessed the occurrence of trauma exposure and PTSD in Denmark using a valid measurement based on ICD-11 criteria. A national sample of the general population of young Danish residents, ranging in age between 15 to 29 years (n = 2,434), was surveyed cross-sectionally from April to October 2022. Data weights were applied to ensure representativity of the sample. Multiple regression was used to study the relationship between trauma exposure, sex, age, and PTSD. Accidents and violence were the most common types of trauma exposure with females being more likely to experience sexual violence. A total of 7.7% endorsed probable PTSD with women reporting higher rates of clinical and subclinical PTSD (12.3% and 12.7%, respectively) than men (3.5% and 7.3%, respectively). Findings from the multiple regression showed that female gender was associated with higher PTSD-severity, although the strongest predictor was trauma-type with other types of traumas, and sexual violence displaying the strongest relationship to PTSD-severity overall. A dose-response relationship between the number of trauma types and PTSD symptomatology was found. This is the first study of PTSD in a nationally representative Danish sample using a valid measure of ICD-11 PTSD. The identified PTSD rates were higher than Danish official estimates in a representative sample of the Danish adolescent and young adult population (7.7% weighted compared to 1%). The study replicated international findings of sex differences in probable PTSD endorsement.

BackgroundRates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored.MethodsA convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale™ (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data.ResultsHigh levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments.ConclusionA similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services.

A longitudinal study of ICD-11 PTSD and complex PTSD in the general population of Israel

Different criteria for diagnosing posttraumatic stress disorder (PTSD) have been recommended by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the proposed 11th edition of the International Classification of Diseases (ICD-11). Although children are vulnerable to PTSD following disasters, little is known about whether these revised criteria are appropriate for preadolescents, as diagnostic revisions have been based primarily on adult research. This study investigated rates of PTSD using DSM-IV, DSM-5, and ICD-11 diagnostic criteria, and their associations with symptom severity, impairment, and PTSD risk factors. Children (7-11years) exposed to Hurricanes Ike (n=327) or Charley (n=383) completed measures 8-9months postdisaster. Using diagnostic algorithms for DSM-IV, DSM-5, and ICD-11, rates of 'probable' PTSD were calculated. Across samples, rates of PTSD were similar. However, there was low agreement across the diagnostic systems, with about a third overlap in identified cases. Children identified only by ICD-11 had higher 'core' symptom severity but lower impairment than children identified only by DSM-IV or DSM-5. ICD-11 was associated with more established risk factors for PTSD than was DSM-5. Findings revealed differences in PTSD diagnosis across major diagnostic systems for preadolescent children, with no clear advantage to any one system. Further research on developmentally sensitive PTSD criteria for preadolescent children is needed.