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Psychometric properties of the PTSD checklist (PCL)
Abstract
The psychometric properties of the PTSD Checklist (PCL), a new, brief, self-report instrument, were determined on a population of 40 motor vehicle accident victims and sexual assault victims using diagnoses and scores from the CAPS (Clinician Administered PTSD Scale) as the criteria. For the PCL as a whole, the correlation with the CAPS was 0.929 and diagnostic efficiency was 0.900 versus CAPS. Examination of the individual items showed wide ranging values of individual item correlations ranging from 0.386 to 0.788, and with diagnostic efficiencies of 0.700 or better for symptoms. We support the value of the PCL as a brief screening instrument for PTSD.
... The PTSD Checklist (PCL) (Blanchard et al., 1996) is a 17-item self-report questionnaire that measures PTSD symptoms in the past month. Items (e.g., "In the past month how much have you been bothered by repeated, disturbing memories, thoughts or images of abuse or violence?") ...
... are endorsed with a 0-4 Likert scale with 0 meaning "not at all" and 4 meaning "extremely." Blanchard et al. (1996) recommend a clinical cutoff of 44. The scale has good psychometric properties (Cronbach's alpha = .94; ...
... The scale has good psychometric properties (Cronbach's alpha = .94; Blanchard et al., 1996). Cronbach's alpha in the current study is .92. ...
This mixed-methods secondary analysis examined VAW shelter use by 662 Canadian women abused by partners (50.5% Indigenous, 43.4% White, and 6.1% visible minority). Women who had never resided in shelters (n = 242) had less Severe Combined and Total IPV on the Composite Abuse Scale and fewer PTSD symptoms. More non-residents worked full time and had higher incomes and no children. The 420 women residents mentioned strengths (70.4%) such as supportive staff and safety, and concerns (29.6%) about unsupportive staff and the shelter rules or facility. Some Indigenous women reported racist attitudes by shelter staff and child apprehensions. Practice implications are presented. Keywords violence against women, intimate partner violence, domestic violence, VAW shelters While concerns about the serious impact of intimate partner violence (IPV) are global (World Health Organization, 2021), services to assist women to respond to being physically , sexually, or emotionally abused by their intimate partners are not necessarily easily accessible. Emergency shelters or "violence against women" (VAW) shelters
... The PTSD Checklist (PCL; Blanchard et al., 1996) is a 17-item self-report questionnaire that measures PTSD symptoms in the past month. Items (e.g., "In the past month how much have you been bothered by repeated, disturbing memories, thoughts or images of abuse or violence?") ...
... Item scores are summed with a range from 0 to 68, with higher scores indicating more PTSD. The PCL has demonstrated validity and reliability (Blanchard et al., 1996;Wilkins et al., 2011). Blanchard et al. recommend a clinical cutoff of 44. ...
... The scale has good psychometric properties (Cronbach's α = .94; Blanchard et al., 1996). Cronbach's alpha in the Healing Journey study is .92. ...
While population-based research confirms that women with disabilities abused by their intimate partners (IPV) experience significant mental health issues, few studies compare this in IPV-specific samples of women with or without disabilities and none analyze possible impacts based on disability type. This secondary mixed methods analysis examined 660 Canadian women (50.6% Indigenous, 43.1% White, and 6.1% visible minority) with respect to whether they reported having a disability that impacted their employability or daily living (291 or 44% yes; 369 or 56% said no). In the 291 women with disabilities, about one-third (30.7%) had a physical disability-only, one-quarter had a mental health disability-only, and 44.1% reported both physical and mental health disabilities. Women with mental health and both physical and mental health disabilities reported significantly more Severe Combined IPV on the Composite Abuse Scale (CAS), depression (CES-D-10 (Centre for Epidemiological Studies - Depression), psychological distress (Symptom Checklist Shortform-10; SCL-10) (in the clinical range), PTSD symptoms (PTSD Checklist), and lower quality of life (Quality of Life Questionnaire or QOL-9) than women without disabilities. Education about disabilities is needed for IPV advocates and disability practitioners need education about IPV. Developing services specific to survivors of IPV with disabilities is recommended.
... The PTSD Checklist (PCL; Blanchard et al., 1996) was designed to screen for PTSD. It consists of 17 items, five of which address reexperiencing symptoms, three items regarding avoidance or numbing, and two items about hyperarousal. ...
... Item scores are summed with a range from 0 to 68, with higher scores indicating more PTSD. The PCL has demonstrated validity and reliability (Blanchard et al., 1996;Wilkins et al., 2011). Cronbach's alpha in the original study (N = 665) is .92. ...
... The PCL has demonstrated validity and reliability (Blanchard et al., 1996;Wilkins et al., 2011). Cronbach's alpha in the original study (N = 665) is .92. Blanchard et al. (1996) suggest a cut-off score of 44. ...
Canadian Indigenous women often experience severe partner violence and child abuse, but few studies holistically examine risk and protective factors and evidence of resilience that affect their well-being. This mixed-methods secondary analysis explored the experiences of 40 Canadian Indigenous abused women. Risk factors included intimate partner violence (IPV), childhood abuse, poverty, colonization, and disability. Protective factors included formal and informal support, community support, spirituality, and childhood residence. Evidence of resilience is from interview quotes and none of the measures of depression, mental distress, and posttraumatic stress disorder was in the clinical range. Despite significant IPV and childhood abuse, the women's resilience is highlighted. Keywords intimate partner violence, Indigenous women, violence against women, resilience, mental health In Canada, intimate partner violence (IPV) against Indigenous women is a significant issue, with IPV rates three times higher than non-Indigenous women (21% to 7%; Brownridge, 2008; Johnson, 2006). Further, Indigenous women across North
... The total score ranges from 17 to 55, which is calculated by summing all the responses. Internal consistency ranges from .94 to .97 (Blanchard et al., 1996;Weathers et al., 1993), test-retest reliability ranges from .88 to .96 (Blanchard et al., 1996;Ruggiero et al., 2003), and there is strong convergent validity with other various PTSD measures (r = .77-.93; Blanchard et al., 1996). ...
... Internal consistency ranges from .94 to .97 (Blanchard et al., 1996;Weathers et al., 1993), test-retest reliability ranges from .88 to .96 (Blanchard et al., 1996;Ruggiero et al., 2003), and there is strong convergent validity with other various PTSD measures (r = .77-.93; Blanchard et al., 1996). ...
... Internal consistency ranges from .94 to .97 (Blanchard et al., 1996;Weathers et al., 1993), test-retest reliability ranges from .88 to .96 (Blanchard et al., 1996;Ruggiero et al., 2003), and there is strong convergent validity with other various PTSD measures (r = .77-.93; Blanchard et al., 1996). ...
Objective: Those bereaved by suicide are at greater risk of prolonged distress compared to those bereaved by other modes of death. Trauma- and emotion-related factors may increase this vulnerability. Finding the body of the deceased may intensify postsuicide distress. Anxiety sensitivity, fear of one’s anxiety-related symptoms, has been positively associated with posttraumatic stress disorder (PTSD) in other trauma populations but has not been studied in the suicide bereaved. Method: This study examined the relationships among finding the body, anxiety sensitivity, and PTSD in a treatment-seeking, suicide-bereaved sample (N = 50). Pretreatment baseline data on demographics, the Anxiety Sensitivity Index, and the PTSD Checklist were analyzed. Results: Younger age (r = −.31, p = .03), being a person of color (r = −.32, p = .02), and fewer days since the loss (r = −.30, p = .03) were associated with greater PTSD. Controlling for age, race, and days since the loss, PTSD was unrelated to finding the body, F(1, 45) = 0.01, p = .92, but was positively associated with anxiety sensitivity (pr = .32, p = .03). In simultaneous regression analyses, age, race, days since the loss, finding the body, and anxiety sensitivity accounted for 33% of the variance in PTSD, F(2, 44) = 4.29, p = .003; anxiety sensitivity was the only significant predictor of PTSD symptoms (β = .36, t = 2.35, p = .02). Conclusions: Anxiety sensitivity has important implications for the development and maintenance of PTSD in the suicide bereaved and should be assessed and targeted in suicide postvention.
... The PTSD Checklist (PCL) (Blanchard et al., 1996) is a 17-item self-report questionnaire that measures PTSD symptoms in the past month. Items (e.g., "In the past month how much have you been bothered by repeated, disturbing memories, thoughts or images of abuse or violence?") ...
... The scale has good psychometric properties (Cronbach's alpha = .94; Blanchard et al., 1996). Cronbach's alpha in the current study is .92. ...
Groups are a common clinical intervention for women survivors of intimate partner violence (IPV). This secondary mixed-methods analysis from a study of 567 Canadian women from the prairie provinces compared the mental health and well-being of 131 women who had attended a IPV group to 436 women who had not attended any group. Qualitatively, perspectives from 131 women (113 comments; 18 interviews) who attended some form of group treatment were analyzed. Of the 199 coded comments about the IPV groups, most were positive (157 or 78.9%), while the remaining 21.1% (42) reflected concerns or suggested changes. Clinical implications are provided.
... The PTSD Checklist (PCL; Blanchard et al., 1996) is used to screen for PTSD and assess for PTSD symptoms using DSM-IV criteria (APA, 1994). The 17-item PCL is the focus of this investigation and is to be distinguished from the PTSD Checklist for DSM-5 (PCL-5;Weathers et al., 2013), an updated version of the PCL, reflecting the DSM-5 criteria for PTSD, which includes four symptom clusters, with the new addition of "negative changes in cognitions and mood" (APA, 2013). ...
... In both studies, PTSD was assessed with the PCL (Weathers et al., 1993;Blanchard et al., 1996), a self-report measure of PTSD. The PCL includes 17 questions, one for each DSM-IV PTSD symptom, requiring the respondent to rate the severity of each symptom over the past month on a 5-point Likert scale. ...
... The PTSD Checklist (PCL) (Blanchard et al., 1996) screens for PTSD with 17 items, five of which address re-experiencing symptoms, three items regarding avoidance or numbing, and two items about hyperarousal. Participants rate how much they have been bothered in the past month by any symptom on a Likert scale from not at all (0) to extremely (4). ...
... Participants rate how much they have been bothered in the past month by any symptom on a Likert scale from not at all (0) to extremely (4). The measure has good validity and reliability with a suggested cut-off score of 44 (Blanchard et al., 1996). Cronbach's alpha in the current study is .92. ...
We know little about what services are accessed by Indigenous women abused by intimate partners (IPV). This mixed-methods secondary analysis examines the demographics and narratives of 40 Canadian Indigenous women regarding their use of violence against women (VAW) emergency shelters (55%), second-stage VAW shelters (7.5%), mainstream community counseling (70%), and Indigenous healing practices (42.5%). Five women who identified as LGBTQ or two-spirit accessed community services but not VAW shelters. The women had experienced severe IPV, but scored below clinical cut-offs for depression, psychological distress, and PTSD. They described strengths, concerns, and barriers in accessing services. Implications for counselors are presented.
... We considered several time-varying covariates as follows: standardized body mass index (BMI), smoking status, alcohol use, substance abuse, relationship status, participation in religious activities, number of close friends, loneliness, 35,36 social isolation, and elevated psychiatric symptoms. 35,37 Given the correlation between depressive and post-traumatic stress symptoms, 13 we defined scores ‡16 on the Center for Epidemiological Studies Depression Scale (CES-D) 35 at any wave, or ‡36 on the PTSD Checklist-Civilian version 37 starting in wave 2, as elevated psychiatric symptoms. Social isolation was assessed by the question, "How many people do you know who you can trust and confide in?" as defined in a prior VETSA study ( ‡1 confidant; no confidants). ...
Traumatic brain injury (TBI) is associated with increased risk of dementia. However, whether TBI is associated with greater cognitive decline over time in specific cognitive domains among older adults is not well understood. This prospective cohort study used data from 1476 male Vietnam Era Twin Study of Aging participants (average age at study entry = 57.9 years, range = 51–71 years; 97.6% non-Hispanic; 92.5% White) collected from 2003 to 2019, who had complete information on prior TBI. Participants completed a comprehensive neuropsychological assessment at up to three visits over up to a 12-year follow-up period during which they also self-reported their history of TBI. Multivariable, linear mixed-effects models were used to assess associations between TBI and cognitive performance trajectories. Effect measure modification by apolipoprotein E (APOE) epsilon 4 (ε4) genotype status was assessed in a subset of participants. Thirty-one percent of participants reported a history of TBI; 29.4% were APOE ε4 carriers. There were no statistically significant associations of TBI with decline in episodic memory, executive function, or processing speed among participants overall. In models stratified by APOE ε4 carrier status, TBI was associated with a larger magnitude of decline in executive function for APOE ε4 carriers (β = −0.0181; 95% confidence interval [CI] −0.0335, −0.0027) compared to noncarriers (β = −0.0031; 95% CI −0.0128, 0.0067; PInteraction = 0.03). In sensitivity analyses, TBI earlier in life (before military induction, average age = 20 years) was associated with faster declines in executive function compared to no TBI, irrespective of APOE ε4 status. In this sample of middle-to-older aged men, TBI was associated with faster declines in executive function among APOE ε4 carriers and among those who reported TBI in early life. These findings support the importance of a life course perspective when considering factors that may influence cognitive health in aging.
... Each of the 17 items asks participants to rate the severity of a DSM-IV PTSD symptom on a scale from 1 (Not at all) to 5 (Extremely), and higher total scores reflect greater symptom severity. The PCL has demonstrated strong internal consistency, test-retest reliability, and concurrent validity (Blanchard et al., 1996). The PCL served as the primary measure of PTSD in the parent trial (Kehle-Forbes et al., 2019), as it was the current version at the time of the study. ...
Objective: Dropout rates are high in treatments for co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUDs). We examined dropout predictors in PTSD-SUD treatment. Methods: Participants were 183 veterans receiving integrated or phased motivational enhancement therapy and prolonged exposure. Using survival models, we examined demographics and symptom trajectories as dropout predictors. Using latent trajectory analysis, we incorporated clusters based on symptom trajectories to improve dropout prediction. Results: Hispanic ethnicity (integrated arm), Black or African American race (phased arm), and younger age (phased arm) predicted dropout. Clusters based on PTSD and substance use trajectories improved dropout prediction. In integrated treatment, participants with consistently-high use and low-and-improving use had the highest dropout. In phased treatment, participants with the highest and lowest PTSD symptoms had lower dropout; participants with the lowest substance use had higher dropout. Conclusions: Identifying within-treatment symptom trajectories associated with dropout can help clinicians intervene to maximize outcomes. ClinicalTrials.gov Identifier: NCT01211106.
... GHQ-12 was administered at T0 and T2. . PTSD symptoms, as measured by the PTSD Checklist for DSM-5 (PCL-5), a 20-item questionnaire that measures a variety of PTSD symptoms (score 0-80), with higher scores indicating higher levels of PTSD symptoms (Blanchard et al., 1996;Wortmann et al., 2016). PCL-5 was administered at T1 and T2. . ...
... The national survey of men's health and violence experience consisted of self-report questions and standardized scales to measure demographics, CLVS, health, substance use, and attachment. Posttraumatic stress symptomatology was measured using the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C; Blanchard et al., 1996). The measure consists of 17 items using a 5-point scale asking participants to identify how much they have been bothered by each problem in the past month (not at all to extremely). ...
Cumulative lifetime violence (CLV) encompasses many different types and contexts of violence that occur across the lifespan and is associated with negative mental health outcomes in men; however, little attention has been paid to other factors that can influence these relationships such as attachment style. In this analysis, our focus is to understand how attachment styles directly and indirectly through CLV affect men’s mental health, specifically depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use. Data from 597 Canadian men with lifetime experiences of violence who participated in our national online survey focusing on violence and health were used for mediation analysis. Results indicated that CLV severity mediated the relationship between attachment anxiety (but not attachment avoidance) and depression, anxiety, PTSD, and alcohol use. Although attachment anxiety and attachment avoidance each directly affected depression, anxiety, and PTSD, neither directly affected alcohol use. Importantly, these findings provide the first evidence that the mechanism by which anxious attachment affects alcohol use is through CLV severity. These findings highlight the importance of anxious attachment on mental health outcomes for men who have experienced CLV.
... The posttraumatic stress disorder checklist-civilian (PCLC) version (Blanchard et al., 1996) is a 17-item measure designed to evaluate self-reported posttraumatic stress disorder (PTSD) symptoms, patterned specifically after the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (American Psychiatric Association, 1994) symptom criteria for PTSD. The PCLC requires the test taker to rate how much they have been bothered by each symptom in the last month on a 5-point scale (1 = not at all, 2 = a little bit, 3 = moderately, 4 = quite a bit, 5 = extremely). ...
Objective: The purpose of this study was to (a) identify the prevalence and barriers of self-reported service needs in a military sample with and without traumatic brain injury (TBI), (b) evaluate the influence of the number of service needs on overall neurobehavioral functioning, and (c) examine the longitudinal trajectories of service needs over time. Method: Participants were 941 U.S. service members and veterans (SMVs) prospectively enrolled into four groups: uncomplicated mild TBI (MTBI; n = 455); complicated mild, moderate, severe, and penetrating TBI combined (STBI; n = 164); injured controls (IC, n = 138); and noninjured controls (NIC, n = 184). Participants completed a battery of neurobehavioral measures, as well as a self-reported service need interview, 12 or more month’s postinjury. In addition, a longitudinal cohort (n = 553) was included using a subset of participants who had completed two or more evaluations. Results: When examining the total number of self-reported service needs, there was a greater proportion of the MTBI and STBI groups that had a higher number of service needs compared to the NIC and IC groups (p < .001). In the MTBI and STBI groups, as the number of service needs increased, worse scores were found on all neurobehavioral measures. In the longitudinal cohort, the STBI group reported the highest number of service needs that persisted or developed over time (six needs), followed by the MTBI (three needs), IC (one need), and NIC (zero need) groups. Conclusions: These findings call for the need to enhance the provision of information given to service members and veterans following TBI regarding available services.
... Participants rated the severity of their PTSD symptoms over the past month on a five-point Likerttype scale (0 = Not at all through 4 = Extremely). For the initial analysis, a value equal to or greater than 44 indicated probable PTSD diagnosis (e.g., Blanchard et al., 1996). However, research has demonstrated that lower cutoff values than 44 may offer better diagnostic efficiency, especially when the PCL is used in primary care settings (Bliese et al., 2008). ...
... 80 Because post-traumatic stress symptoms are associated with psychosocial outcomes and gut microbiota composition, 81 82 post-traumatic stress is measured using the Post-traumatic Stress Disorder Checklist. [83][84][85][86] To assess free-living physical activity, participants are given the same ActiGraph accelerometer (ActiGraph; Pensacola, Florida, USA) device for each assessment to be worn at the waist for seven consecutive days during waking hours (non-dominant hip; same side each time). Participants are instructed to remove the accelerometer while bathing, showering or swimming and are asked to complete an accelerometer log (times device removed, exercise not detectable by device, sleep times, etc). ...
Introduction
Breast cancer survivors have an increased risk for chronic fatigue and altered gut microbiota composition, both with negative health and quality of life affects. Exercise modestly improves fatigue and is linked to gut microbial diversity and production of beneficial metabolites. Studies suggest that gut microbiota composition is a potential mechanism underlying fatigue response to exercise. Randomised controlled trials testing the effects of exercise on the gut microbiome are limited and there is a scarcity of findings specific to breast cancer survivors. The objective of this study is to determine if fitness-related modifications to gut microbiota occur and, if so, mediate the effects of aerobic exercise on fatigue response.
Methods and analysis
The research is a randomised controlled trial among breast cancer survivors aged 18–74 with fatigue. The primary aim is to determine the effects of aerobic exercise training compared with an attention control on gut microbiota composition. The secondary study aims are to test if exercise training (1) affects the gut microbiota composition directly and/or indirectly through inflammation (serum cytokines), autonomic nervous system (heart rate variability) or hypothalamic-pituitary-adrenal axis mediators (hair cortisol assays), and (2) effects on fatigue are direct and/or indirect through changes in the gut microbiota composition. All participants receive a standardised controlled diet. Assessments occur at baseline, 5 weeks, 10 weeks and 15 weeks (5 weeks post intervention completion). Faecal samples collect the gut microbiome and 16S gene sequencing will identify the microbiome. Fatigue is measured by a 13-item multidimensional fatigue scale.
Ethics and dissemination
The University of Alabama at Birmingham Institutional Review Board (IRB) approved this study on 15 May 2019, UAB IRB#30000320. A Data and Safety Monitoring Board convenes annually or more often if indicated. Findings will be disseminated in peer-reviewed journals and conference presentations.
Trial registration number
ClinicalTrials.gov, NCT04088708 .
... Regarding the study by Berry et al. [33], four quantitative instruments and interviews were used. The four instruments used were the Negative Acts Questionnaire-Revised (NAQ-R) [41], the 10-item Perceived Stress Scale [55], which aims to assess perceived stress in the last month, the 20-item subscale of the State Trait Anxiety Inventory [56] that assesses how participants feel at the time of the survey, and finally, the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) [57], which tracks post-traumatic stress symptoms and contains seventeen assessment items. In relation to the second part of the study, telephone interviews were carried out with a semi-structured script which addressed the behaviours suffered from bullying, what they did to deal with or prevent these behaviours, and other actions taken to continue working in the same hospital unit. ...
Violence against healthcare professionals is an event that further burdens the daily lives of those who try every day to care for and assist those who need it most. In an attempt to overcome these events, there are coping strategies that can be used to reduce the stress caused. Therefore, this study aims to analyse the phenomenon of violence against healthcare professionals and the relationship between the bullying suffered by these professionals and the coping strategies they developed to overcome these moments. To this end, a scoping review was conducted in which eight articles were selected for final analysis from a total of 276 articles found in three electronic databases (EBSCO, PubMed, and Web of Science). This review concludes that the most common workplace bullying behaviours include excessive workloads, humiliation and ridicule, impossible deadlines, and verbal attacks. Professionals reported negative impacts, such as helplessness, depression, stress, insomnia, and the desire to change jobs. Victims of workplace bullying often expressed their intention to leave their current job or even abandon the profession. Problem-focused coping strategies are the most used. The studies indicated that workplace bullying negatively affects professionals in physical and mental terms, as well as in terms of quality of life at work, requiring more research and adoption of preventive measures to identify and combat the problem.
... Participants responded to each item using a six-point Likert scale (0: "not at all" and 5: "extremely"). The intensity of PTSD symptoms is determined based on the total severity score that can range from 17 to 85. Blanchard et al. (1996) recommend a cut-off score of 45 and higher to minimise false positive diagnoses. Therefore, in the present study participants who scored 45 or higher were considered to merit the diagnosis of PTSD. ...
The current study examined whether disruption to performing Islamic death rituals could be linked to core bereavement and post-traumatic stress disorder (PTSD) symptoms in Turkish-Muslim individuals who lost their close relatives to COVID-19. Participants (n = 52) completed a Demographic Information and Bereavement Experience (DIBEF) form with items probing demographics, attendance to rituals, receiving social support, and perceived disruption to bereavement via COVID-19 restrictions. The Core Bereavement Items (CBI) and the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) were used to measure symptomatology. The results showed that 92.3% of the participants did not receive condolence visitors, 98.1% failed to say goodbye, and 78.8% could not practice their religious duties. Importantly, perceived disruption score was significantly linked to the CBI (but not PCL-C) scores. The potential role of perceived disruption to bereavement in aggravating the grief response is discussed in relation to the dual process model of coping with bereavement. ARTICLE HISTORY
... Eisenman and colleagues (2003) examined the impact of exposure to political violence on mental health functioning in a sample of Latinx immigrants receiving services in communitybased primary care clinics in the U.S. (N = 638). Participants completed a checklist of exposure to political violence events, a self-report measure of symptoms of depression, anxiety, and alcohol disorders, and the PTSD Checklist-Civilian Version (PCL-C; Blanchard et al., 1996). ...
Identifying immigration court respondents with mental illness who are unable to meaningfully participate in their cases is key to preserve their procedural due process rights. Since the enactment of the Matter of M-A-M (2011) standard, immigration judges have increasingly relied on mental health professionals to assess immigrants’ competence to participate and represent themselves in immigration court proceedings. However, to date, there is no standard of practice or specialized assessment instrument to guide the evaluation of competency in immigration court. At present, evaluators are responsible for interpreting the legal standard and developing their evaluation procedures. This study examined the psychometric properties of an adaptation of the Fitness Interview Test-Revised (FIT-R; Roesch et al., 2006) for use in immigration court, the Fitness Interview Test-Immigration Court (FIT-IC), in a sample of 62 Spanish-speaking immigrants. Feedback from seven mental health experts was also obtained to assess the content validity of the FIT-IC. It was hypothesized that the FIT-IC would display good content validity, interrater reliability, and internal consistency. It was also hypothesized that performance on the FIT-IC would be associated with acculturation, symptoms of mental illness (i.e., psychotic, depressive, and posttraumatic symptoms), and intellectual functioning. The study findings showed that the FIT-IC had strong content validity, with mental health experts considering that all FIT-IC items addressed relevant psycholegal abilities for establishing a respondent’s competence. The FIT-IC items and sections also demonstrated moderate to excellent interrater reliability. However, the FIT-IC sections failed to display good internal consistency. Regarding the correlates of performance on the FIT-IC, acculturation to U.S. culture was significantly associated with more factual understanding of immigration court proceedings (Section I), but only after removing questions about understanding the concept of competency from Item 2. Performance on the FIT-IC was not significantly associated with intellectual functioning, psychotic, or depressive symptoms. Contrary to expectations, there was a significant correlation between PTSD symptoms and more understanding of legal rights and possible consequences of the proceedings (Section II). Although more research is needed with a larger sample of immigrants with severe mental illness, the FIT-IC holds promise as a new competency assessment instrument for immigration court.
... Self-Reported Symptoms. PTSD symptoms were assessed using the trauma-specific version of the PTSD Checklist (PCL-17) [21], adapted for the WTC disaster. Participants rate past-month DSM-IV symptoms from 1 (not at all) to 5 (extremely), total scores range = 17 to 85. ...
Objective
The present study examined the 20-year course of posttraumatic stress disorder (PTSD) in World Trade Center (WTC) responders to address four questions: (1) How stable are symptoms of PTSD? (2) What is the average symptom trajectory? (3) How much do responders differ from the average trend? (4) How quickly do PTSD symptoms improve or worsen?
Methods
Data include 81,298 observations from n = 12,822 responders, spanning from July 2002 to December 2022. Fourteen percent meet PTSD criteria. PTSD symptoms were measured using the PCL-17. Retest correlations were calculated to estimate stability, growth curve models to estimate individual trajectories, and Kaplan-Meier curves to estimate the rate of clinically significant change.
Results
Retest correlations were high overall (range =.49, .84), lower in PTSD cases (range =.21, .78), and decreased as a function of time between assessments. The best-fitting growth model represented trajectories continuously rather than multiple classes. Symptom burden peaked in 2011 and declined modestly by 2022 (Cohen’s d = -0.28 and -0.59 in all responders and PTSD cases, respectively). Median time before clinically significant improvement in responders with PTSD was 8.88 years (95% CI = 8.01, 9.79).
Conclusions
In the longest and largest study of PTSD symptoms tracked continuously since exposure, illness course was characterized to find that, while symptoms were highly stable in the short term, symptoms changed significantly over two decades. Most responders experienced clinical improvement after nine years, but 10% had poor course and should be the focus of public health efforts.
... We used the PTSD Checklist for DSM-5 (PCL-5) to capture each caregiver's PTSDrelated symptoms, which is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD [25]. The PTSD-related items were taken from a well-validated checklist and adapted for the undocumented community [26]. These items were followed by the 6 items making up the Brief Resilience Scale [27], another well-validated measure used with international and cross-cultural samples to capture parental resilience. ...
1) Background: Immigrant families in the U.S. face a myriad of migration-related stres-sors and trauma, and legal vulnerability can further compound such stressors, influencing both immigrant caregiver and child wellbeing. This study explored the relationships between legal vulnerability , trauma, and migration and their effects on caregiving, psychological distress, and resilience in immigrant families. (2) Methods: In total, 37 Latinx immigrant caregiver-child dyads from a community sample were interviewed and completed self-report measures on their experiences of migration, trauma, psychological functioning, and parent-child relationships. (3) Results: Using a community-based, sequential quantitative-qualitative design, person-centered analyses revealed two caregiver clusters: "Personalizing Stress" and "Meaning-making". Exemplar case analyses characterized differences between clusters, particularly related to trauma symptoms, in which the "meaning-making" cluster endorsed higher levels of psychological functioning and wellbeing compared to the "personalizing stress" cluster, in which the process of creating meaning from adversity appeared to function as a resilience resource for the "meaning-making" cluster. While most indicators of caregiver-child wellbeing were not correlated, family legal vulnerability was strongly correlated with high resilience in children. (4) Conclusions: Clinicians should attend to the resilience resources that immigrant families from legally vulnerable communities utilize, including meaning-making.
... The PCL-C has high internal consistency (a = .91-.94), test-retest reliability (r = .66-.68), and convergent validity (r = .93) (44)(45)(46)(47). At the time of commencing the primary outcomes study, the psychometric properties of the newer PCL-5 (corresponding to the DSM-5 diagnostic criteria for PTSD (1)) were unknown and no established margin of clinically meaningful change or noninferiority margin existed. ...
Introduction
High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome.
Methods
There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up.
Results
Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT.
Conclusions
To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment.
Clinical trial registration
ClinicalTrials.gov identifier, NCT02366403
... Higher scores indicate higher levels of PTSD symptom severity. The PCLC has excellent internal consistency, sensitivity, specificity, and diagnostic efficiency (Blanchard et al., 1996). Cronbach's alpha for the current sample was α = .94. ...
Objective: Body mass index (BMI) is the primary criterion differentiating anorexia nervosa (AN) and atypical anorexia nervosa despite prior literature indicating few differences between disorders. Machine learning (ML) classification provides us an efficient means of accurately distinguishing between two meaningful classes given any number of features. The aim of the present study was to determine if ML algorithms can accurately distinguish AN and atypical AN given an ensemble of features excluding BMI, and if not, if the inclusion of BMI enables ML to accurately classify between the two.
Methods: Using an aggregate sample from seven studies consisting of individuals with AN and atypical AN who completed baseline questionnaires (N = 448), we used logistic regression, decision tree, and random forest ML classification models each trained on two datasets, one containing demographic, eating disorder, and comorbid features without BMI, and one retaining all features and BMI.
Results: Model performance for all algorithms trained with BMI as a feature was deemed acceptable (mean accuracy = 74.98%, mean area under the receiving operating characteristics curve [AUC] = 74.75%), whereas model performance diminished without BMI (mean accuracy = 59.37%, mean AUC = 59.98%).
Discussion: Model performance was acceptable, but not strong, if BMI was included as a feature; no other features meaningfully improved classification. When BMI was excluded, ML algorithms performed poorly at classifying cases of AN and atypical AN when considering other demographic and clinical characteristics. Results suggest a reconceptualization of atypical AN should be considered.
... This questionnaire is one of the most widely used screening measures for PTSD, and findings support PCL5 as a psychometrically sound measure in individuals at high risk for exposure to trauma [22]. The total score for PCL5 ranges from 0 to 80, with a PCL5 cutoff score between 31 and 33 considered to be indicative of probable PTSD [23]. ...
Young women are typically thought to be protected from cardiovascular disease (CVD) before menopause. However, posttraumatic stress disorder (PTSD) increases CVD risk in women by up to threefold. Data in predominantly male cohorts point to physiological mechanisms such as vascular and autonomic derangements as contributing to increased CVD risk. The purpose of the study reported here was to determine whether young women diagnosed with PTSD, compared to those without, present with arterial stiffness and impaired autonomic control of the heart.
A total of 73 healthy young women, ranging in age from 18 to 40 years, with a history of trauma exposure were included in this study, 32 with and 41 without a clinical PTSD diagnosis. We measured resting pulse wave velocity (PWV), central hemodynamics, augmentation pressure and augmentation index (AI) via pulse wave analysis using applanation tonometry. Heart rate variability was also assessed via peripheral arterial tone.
In comparison to controls, women with PTSD showed higher central arterial pressure (mean ± standard deviation: systolic blood pressure 104 ± 8 vs. 97 ± 8 mmHg, p < 0.001; diastolic blood pressure 72 ± 7 vs. 67 ± 7 mmHg, p = 0.003), PWV (6 ± 0.3 vs. 5 ± 0.6 m/s, p < 0.001) and AI (22 ± 13 vs. 15 ± 12%, p = 0.007) but lower standard deviation of normal-to-normal intervals (SDNN; 44 ± 17 vs. 54 ± 18 ms, p = 0.005) and root mean square of successive differences between normal heartbeats (RMSSD; 37 ± 17 vs. 51 ± 22 ms, p = 0.002).
PTSD in young women is associated with higher brachial and central pressures, increased arterial stiffness and blunted parasympathetic control of the heart. These findings illustrate potential mechanisms underlying high risk for CVD in young women with PTSD, suggesting possible treatment targets for this at-risk group.
... 10 PTSD symptoms were assessed using the civilian version of the PTSD Symptom Checklist, a 17-item scale. 11 State anxiety was measured with a 20-item subscale of the State-Trait Anxiety Inventory. 12 State anger was assessed with a 15-item subscale of the Spielberger's State-Trait Anger Expression Inventory 13 ; and general perceived stress was assessed with the 10-item Perceived Stress Scale 14 . ...
BACKGROUND
Psychological distress is a recognized risk factor in patients with coronary heart disease (CHD), but its clinical significance is unclear.
OBJECTIVES
The purpose of this study was to determine if an index of psychological distress is independently associated with adverse outcomes and significantly contributes to risk prediction.
METHODS
Pooled analysis of 2 prospective cohort studies of patients with stable CHD (N = 891). A psychological distress score was constructed using measures of depression, anxiety, anger, perceived stress, and post-traumatic stress disorder, measured at baseline. The study endpoint included cardiovascular death or first or recurrent nonfatal myocardial infarction or hospitalization for heart failure at 5.9 years.
RESULTS
In both cohorts, first and recurrent events occurred more often among those in the highest tertile of distress score than those in the lowest tertile. After combining the 2 cohorts, compared with the lowest tertile, the hazards ratio for having a distress score in the highest tertile was 2.27 (95% CI: 1.69–3.06), and for the middle tertile, it was 1.52 (95% CI: 1.10–2.08). Adjustment for demographics and clinical risk factors only slightly weakened the associations. When the distress score was added to a traditional clinical risk model, C-statistic, net reclassification index, and integrative discrimination index all significantly improved.
CONCLUSIONS
Among patients with CHD, a composite measure of psychological distress was significantly associated with an increased risk of adverse events and significantly improved risk prediction.
BACKGROUND
Mental stress–induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI.
METHODS
In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI.
RESULTS
The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3–3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3–3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates.
CONCLUSIONS
In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.
Introduction
There is controversy regarding the comorbidity of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The present study translated the PTSD Checklist for DSM-5 (PCL-5) to Spanish and validated it in a sample of patients with TBI 6 months after the injury.
Methods
The study included 233 patients (162 males and 71 females) recruited from four Spanish hospitals within 24 h of traumatic brain injury. A total of 12.2% of the sample met the provisional PTSD diagnostic criteria, and the prevalence was equal between male and female participants.
Results
The analysis confirmed the internal consistency of the translated instrument ( α = 0.95). The concurrent validity of the instrument was confirmed based on high correlation coefficients of 0.7 and 0.74 with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9), respectively. Exploratory factor analysis also confirmed that the items on the PCL-5 can be differentiated from the GAD-7 and PHQ-9 items. Confirmatory factor analysis (CFA) was used to examine the structural validity of the Spanish translation of the PCL-5 with three different models. CFA partially confirmed the four-factor PTSD model, whereas both the six-factor anhedonia model and the seven-factor hybrid model showed adequate fit. However, the difference between the anhedonia and hybrid models was not statistically significant; moreover, both models showed signs of overfitting. Therefore, the utility of these models should be reexamined in future studies.
Conclusion
Overall, the results suggest that the Spanish translation of the PCL-5 is a reliable and valid instrument for screening PTSD symptoms among Spanish TBI patients. The Spanish translation of the PCL-5 is also presented in the manuscript.
Children and adolescents with a refugee background are at high risk for traumatization. Once they arrive in safe countries, schools are the institutions where teachers are responsible for caring for them sensitively and competently. Furthermore, schools are organized in learning groups consisting of multiple peers of the same age, which provides excellent opportunities for social learning and experiences of social support. In this respect, schools are the appropriate places where preventive concepts can be applied to students with a refugee background. This systematic review summarizes studies that examine or evaluate existing international concepts of trauma-sensitive schools for supporting traumatized students with a refugee background. Based on N = 41 selected articles, 17 relevant concepts of trauma-sensitive schools were identified. In 35.3% of the concepts, traumatized students with a refugee background are explicitly included in the target group of the concept, while 47.1% of the concepts refer to groups of students with trauma as a result of various adverse childhood experiences, which also occur more frequently within the population of refugee children and adolescents 17.6% of the concepts contain specific adaptations for pupils with a refugee background. The majority of these concepts were developed in the United States. Additional concepts can be reported for Australia, the United Kingdom, Turkey, and Cambodia. Based on available empirical data, no significant effectiveness regarding the researched concepts’ effects on academic and other school-related data can be determined. Although some studies indicate positive effects concerning school-related target variables, most of the studies have only limited significance due to inadequate research designs and methodological deficiencies. Therefore, there is a great need for further development, careful implementation, and evaluation of trauma-sensitive concepts in schools, especially for the growing group of refugee students.
How do we remember traumatic events, and are these memories different in individuals who experience post-traumatic stress? Some evidence suggests that traumatic events are mnemonically enhanced, or include more episodic detail, relative to other types of memories. Simultaneously, individuals with post-traumatic stress disorder (PTSD) have more non-episodic details in all of their memories, a pattern hypothesized to result from impairment in executive function. Here, we explore these questions in a unique population that experienced severely traumatic events more than 20 years ago – individuals who lived through the 1994 genocide in Rwanda. Participants recalled events from the genocide, negative events unrelated to the genocide, neutral events, and positive events. We used the Autobiographical Interview method to label memory details as episodic or non-episodic. We found that memories from the genocide showed robust mnemonic enhancement, with more episodic than non-episodic details, and contained more details overall than any other memory type. This pattern was not impacted by post-traumatic stress. Overall, this study provides evidence that traumatic events create vivid long-lasting episodic memories, in this case even more than 20 years later.
Meditation-based interventions are novel and effective non-pharmacologic treatments for veterans with PTSD. We examined relationships between treatment response, early life trauma exposure, DNA polymorphisms, and methylation in the serotonin transporter (SLC6A4) and FK506-binding protein 5 (FKBP5) genes. DNA samples and clinical outcomes were examined in 72 veterans with PTSD who received meditation-based therapy in two separate studies of mindfulness-based stress reduction (MBSR) and Transcendental Meditation (TM). The PTSD Checklist was administered to assess symptoms at baseline and after 9 weeks of meditation intervention. We examined the SLC6A4 promoter (5HTTLPR_L/S insertion/deletion + rs25531_A/G) polymorphisms according to previously defined gene expression groups, and the FKBP5 variant rs1360780 previously associated with PTSD disease risk. Methylation for CpG sites of SLC6A4 (28 sites) and FKBP5 (45 sites) genes was quantified in DNA samples collected before and after treatment. The 5HTTLPR LALA high expression genotype was associated with greater symptom improvement in participants exposed to early life trauma (p = 0.015). Separately, pre to post-treatment change of DNA methylation in a group of nine FKBP5 CpG sites was associated with greater symptom improvement (OR = 2.8, 95% CI 1.1–7.1, p = 0.027). These findings build on a wealth of existing knowledge regarding epigenetic and genetic relationships with PTSD disease risk to highlight the potential importance of SLC6A4 and FKBP5 for treatment mechanisms and as biomarkers of symptom improvement.
Background
Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood.
Methods
Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum.
Results
Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period.
Limitations
Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed.
Conclusions
Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.
Importance
Mild traumatic brain injury (mTBI) is the signature injury experienced by military service members and is associated with poor neuropsychiatric outcomes. Yet, there is a lack of reliable clinical tools for mTBI diagnosis and prognosis.
Objective
To examine the white matter microstructure and neuropsychiatric outcomes of service members with a remote history of mTBI (ie, mTBI that occurred over 2 years ago) using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI).
Design, Setting, and Participants
This case-control study examined 98 male service members enrolled in a study at the National Intrepid Center of Excellence. Eligible participants were active duty status or able to enroll in the Defense Enrollment Eligibility Reporting system, ages 18 to 60 years, and had a remote history of mTBI; controls were matched by age.
Exposures
Remote history of mTBI.
Main Outcomes and Measures
White matter microstructure was assessed using a region-of-interest approach of skeletonized diffusion images, including DTI (fractional anisotropy, mean diffusivity, radial diffusivity and axial diffusivity) and NODDI (orientation dispersion index [ODI], isotropic volume fraction, intra-cellular volume fraction). Neuropsychiatric outcomes associated with posttraumatic stress disorder (PTSD) and postconcussion syndrome were assessed.
Results
A total of 65 male patients with a remote history of mTBI (mean [SD] age, 40.5 [5.0] years) and 33 age-matched male controls (mean [SD] age, 38.9 [5.6] years) were included in analysis. Compared with the control cohort, the 65 service members with mTBI presented with significantly more severe PTSD-like symptoms (mean [SD] PTSD CheckList-Civilian [PCL-C] version scores: control, 19.0 [3.8] vs mTBI, 41.2 [11.6]; P < .001). DTI and NODDI metrics were altered in the mTBI group compared with the control, including intra-cellular volume fraction of the right cortico-spinal tract (β = −0.029, Cohen d = 0.66; P < .001), ODI of the left posterior thalamic radiation (β = −0.006, Cohen d = 0.55; P < .001), and ODI of the left uncinate fasciculus (β = 0.013, Cohen d = 0.61; P < .001). In service members with mTBI, fractional anisotropy of the left uncinate fasciculus was associated with postconcussion syndrome (β = 5.4 × 10 ⁻³ ; P = .003), isotropic volume fraction of the genu of the corpus callosum with PCL-C (β = 4.3 × 10 ⁻⁴ ; P = .01), and ODI of the left fornix and stria terminalis with PCL-C avoidance scores (β = 1.2 × 10 ⁻³ ; P = .02).
Conclusions and Relevance
In this case-control study of military-related mTBI, the results suggest that advanced magnetic resonance imaging techniques using NODDI can reveal white matter microstructural alterations associated with neuropsychiatric symptoms in the chronic phase of mTBI. Diffusion trends observed throughout widespread white matter regions-of-interest may reflect mechanisms of neurodegeneration as well as postinjury tissue scarring and reorganization.
Post-Traumatic Growth (PTG) is associated with good cardiovascular health, but the mechanisms of this are poorly understood. This cross-sectional analysis assessed whether factors of PTG (Appreciation of Life (AOL), New Possibilities (NP), Personal Strength (PS), Relating to Others (RTO) and Spiritual Change (SC)) are associated with cardiovascular health in a cohort of 1006 male UK military personnel (median age 34). The findings suggest AOL, PS and RTO are associated with better cardiovascular health through cardiometabolic effects (lower levels of triglycerides, and total cholesterol) and haemodynamic functioning (lower diastolic blood pressure), but not inflammation. However, NP and SC were associated with poorer cardiovascular health through cardiometabolic effects (lower levels of high-density lipoproteins and higher levels of total cholesterol) and AOL had a non-linear association with low-density lipoproteins. These findings suggest that the relationship between PTG and cardiovascular functioning is complex and in need of further scrutiny.
Women are more directly involved in combat operations today than ever before, currently making up 18.6% of officers and 16.8% of enlisted personnel in the US military. However, women continue to be underrepresented in military research. Studies which do consider gender differences in traumatic brain injury (TBI) outcomes have shown that women report significantly more post-concussive symptoms compared to men. Conclusions for true gender differences related to TBI is hard to make without controlling for non-TBI factors. The objective of this study was to examine the effects of gender specific to mild TBI (MTBI) sequelae from injured and non-injured control groups and investigate the role of PTSD in symptom reporting. It should be noted that the terms gender and men/women are used in this paper in place of sex or males/females given we are not discussing biological attributes. A total of 966 U.S. military service members and veterans where include in the study. Of the total sample, 455 men and 46 women where in the MTBI group, 285 men and 31 women in the Injured Controls group (IC), 111 men and 38 women in the Non-injured Controls group (NIC). Postconcussive and quality of life symptoms were compared for men and women while controlling for combat exposure. MTBI and IC groups were also stratified by PTSD presentation. Measures used included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist (PCL-C), Traumatic Brain Injury Quality of Life (TBI-QOL), and Combat Exposure Scale. In the MTBI group, women had worse scores on NSI total, NSI Somatosensory and Affective clusters; and the TBI-QOL Anxiety, Fatigue, and Headache scales (n2=.018 to .032, small to small-medium effect sizes). When PTSD was present, women had worse scores on the NSI Somatosensory cluster only (n2=.029, small-medium effect size). In contrast, when PTSD was absent, women had worse scores on the NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety and Headache scales compared to men (n2=.032 to .063, small to medium effect sizes). In the IC group, women had worse scores on the NSI Cognitive cluster and the TBI-QOL Fatigue and Pain Interference scales (n2=.024 to .042, small to small-medium effect sizes). However, group differences were no longer found when stratified by PTSD sub-groups. In the NIC group, there were no significant group differences for all analyses. We were able to identify symptoms unique to women recovering from MTBI which were not present following other forms of physical injury or healthy controls. However, the impact of PTSD exacerbates the symptom profile and its comorbidity with MTBI equates most of the noted gender differences.
Multimodal imaging using network connectivity techniques shows promise for investigating neuropathology influencing Post-Traumatic Stress Disorder (PTSD) symptom maintenance and course. We recruited World Trade Center (WTC) responders who continued to suffer from chronic PTSD into a diffusion tensor neuroimaging protocol (n=100), along with nine unexposed controls without PTSD from other sources. Using a graph theory approach to probe network alterations in brain diffusion images, we calculated weighted characteristics path length as a surrogate marker for the effective neuroanatomical distance between anatomical nodes. The sample (N=109; 47 with chronic PTSD) was in their mid-fifties, and the majority were male. Responders were matched in terms of cognitive performance, occupation, and demographics. The anatomical connectivity graph was constructed for each participant using deterministic diffusion tractography. We identified a significant difference in weighted Characteristic Path Length (wCPL) between trauma-exposed WTC responders (Cohen’s d = 0.42, P<0.001) that was highest in people with PTSD, and not explained by WTC exposure severity or duration. We also found that wCPL was associated with PTSD symptom severity in responders with PTSD. In the largest study to date to examine the relationship between chronic PTSD and anatomy, we examined the anatomical topography of neural connections and found that wCPL differed between the PTSD+ and PTSD- diagnostic categories.
Objective. Posttraumatic stress disorder (PTSD) is linked with impaired intimate relationships in postpartum women, yet less is known about couple-level manifestations of posttraumatic psychopathology and potential associations with relationship functioning for mothers and fathers during this critical time. Method. In a predominately low-to-middle income sample of 867 mother-father couple dyads assessed six months following the birth of a child, two analytic methods—a data-driven dyadic latent profile analysis and hypothesis-driven a priori categorization approach—evaluated whether discrete subgroups of couples could be identified based on both partners’ PTSD symptoms. Structural equation models then tested associations between identified subgroups with (1) self-reported relationship quality and (2) interviewer-rated relationship stress. Results. Three couple-level PTSD symptom groupings were common to both methods: both low, mother low-father high, and mother high-father low. Dyad-level PTSD symptom patterns were differentially related to relationship dysfunction for mothers and fathers, although mixed findings emerged across methods regarding the relevance of which partner had elevated symptoms for relationship functioning in PTSD symptom-discordant couples. Individuals in dyads characterized by at least one partner with elevated PTSD symptoms consistently exhibited greater relationship dysfunction—indexed both subjectively and objectively—compared to dyads where both partners had low symptoms. Conclusions. Couple-level typologies of PTSD symptoms can be identified using data- and hypothesis-driven approaches, with generally concordant results. Dyadic patterns of PTSD symptoms are relevant to relationship functioning for both mothers and fathers during the postpartum period and may help to inform more targeted intervention efforts to support couples who are parenting.
Background
Fear overgeneralization is a promising pathogenic mechanism of clinical anxiety. A dominant model posits that hippocampal pattern separation failures drive overgeneralization. Hippocampal network–targeted transcranial magnetic stimulation (HNT-TMS) has been shown to strengthen hippocampal-dependent learning/memory processes. However, no study has examined whether HNT-TMS can alter fear learning/memory.
Methods
Continuous theta burst stimulation was delivered to individualized left posterior parietal stimulation sites derived via seed-based connectivity, precision functional mapping, and electric field modeling methods. A vertex control site was also stimulated in a within-participant, randomized controlled design. Continuous theta burst stimulation was delivered prior to 2 visual discrimination tasks (1 fear based, 1 neutral). Multilevel models were used to model and test data. Participants were undergraduates with posttraumatic stress symptoms (final n = 25).
Results
Main analyses did not indicate that HNT-TMS strengthened discrimination. However, multilevel interaction analyses revealed that HNT-TMS strengthened fear discrimination in participants with lower fear sensitization (indexed by responses to a control stimulus with no similarity to the conditioned fear cue) across multiple indices (anxiety ratings: β = 0.10, 95% CI, 0.04 to 0.17, p = .001; risk ratings: β = 0.07, 95% CI, 0.00 to 0.13, p = .037).
Conclusions
Overgeneralization is an associative process that reflects deficient discrimination of the fear cue from similar cues. In contrast, sensitization reflects nonassociative responding unrelated to fear cue similarity. Our results suggest that HNT-TMS may selectively sharpen fear discrimination when associative response patterns, which putatively implicate the hippocampus, are more strongly engaged.
Background
Chronic pain after injury poses a serious health burden. As a result of advances in medical technology, ever more military personnel survive severe combat injuries, but long-term pain outcomes are unknown. We aimed to assess rates of pain in a representative sample of UK military personnel with and without combat injuries.
Methods
We used data from the ADVANCE cohort study (ISRCTN57285353). Individuals deployed as UK armed forces to Afghanistan were recruited to include those with physical combat injuries, and a frequency-matched uninjured comparison group. Participants completed self-reported questionnaires, including ‘overall’ pain intensity and self-assessment of post-traumatic stress disorder, anxiety, and depression.
Results
A total of 579 participants with combat injury, including 161 with amputations, and 565 uninjured participants were included in the analysis (median 8 yr since injury/deployment). Frequency of moderate or severe pain was 18% (n=202), and was higher in the injured group (n=140, 24%) compared with the uninjured group (n=62, 11%, relative risk: 1.1, 95% confidence interval [CI]: 1.0–1.2, P<0.001), and lower in the amputation injury subgroup (n=31, 19%) compared with the non-amputation injury subgroup (n=109, 26%, relative risk: 0.9, 95% CI: 0.9–1.0, P=0.034). Presence of at least moderate pain was associated with higher rates of post-traumatic stress (RR: 3.7, 95% CI: 2.7–5.0), anxiety (RR: 3.2, 95% CI: 2.4–4.3), and depression (RR: 3.4, 95% CI: 2.7–4.5) after accounting for injury.
Conclusion
Combat injury, but not amputation, was associated with a higher frequency of moderate to severe pain intensity in this cohort, and pain was associated with adverse mental health outcomes.
Background
HIV/AIDS remains a significant global public health issue, profoundly impacting infected individuals. Living with HIV involves complex mental health dynamics, with post-traumatic stress disorder (PTSD) being a prevalent challenge. This study aims to examine the correlation between PTSD and quality of life among HIV-positive individuals in western Uganda.
Material and Methods
Conducted between May and July 2023, this facility-based cross-sectional study surveyed 439 participants from four HIV clinics in southwestern Uganda. Data were collected through interviewer-administered questionnaires, analyzed using descriptive statistics, simple linear regression, and multiple linear regression (p<0.05).
Results
Respondents had a mean age of 40.6 years, with 68.3% female, 54.9% married, and 55.1% lacking formal education. The reported PTSD prevalence among HIV-positive individuals was 33.7%, significantly correlating with reduced overall quality of life (β = −4.52; p<0.001). The social quality of life had the highest mean score of 14.24 (±3.45) while the environmental quality of life had the lowest mean score 11.89 (±2.68).
Conclusion
Our study reveals a concerning prevalence of PTSD, affecting 1 in 3 individuals, emphasizing the pressing need for comprehensive mental health support within HIV care settings. We observed a significant negative impact of PTSD on overall quality of life, particularly in physical and social aspects. Integrating mental health screening into routine HIV care is crucial, using validated tools like the PSTD Checklist Civilian Version, alongside training for healthcare providers to recognize PTSD symptoms in the context of HIV diagnosis and treatment.
The current study investigated the associations among probable posttraumatic stress disorder (PTSD), recent Veterans Health Administration (VHA) health care use, and care-seeking for PTSD in U.S. military veterans. Analyses were conducted among 19,691 active duty military personnel enrolled in the Millennium Cohort Study who separated from the military between 2000 and 2012 and were weighted to the 1,130,103 active duty personnel who separated across this time period. VHA utilization was identified from electronic medical records in the year before survey completion, and PTSD care-seeking and PTSD symptoms were assessed through self-report on the 2014-2016 survey; thus, the observation period regarding care-seeking and VHA use encompassed 2013-2016. Veterans with probable PTSD were more likely to use VHA services than those without probable PTSD, aOR = 1.12, 95% CI [1.01, 1.24], although the strongest association with recent VHA use was a depression diagnosis, aOR = 2.47, 95% CI [2.26, 2.70]. Among veterans with probable PTSD, the strongest predictor of care-seeking was recent VHA use compared to community care, aOR = 4.01, 95% CI [3.40, 4.74); reporting a diagnosis of depression was the second strongest predictor of PTSD care-seeking, OR = 2.99, 95% CI [2.53, 3.54]. However, the absolute number of veterans with probable PTSD who were not seeking care was approximately equivalent between veterans using VHA services and those not using VHA services. Additionally, certain groups were identified as being at risk of not seeking care, namely Air Force veterans and veterans with high physical and mental functioning despite substantial PTSD symptoms.
Background
Prior studies showed that during the coronavirus disease 2019 (COVID-19) pandemic healthcare workers had a higher risk of developing post-traumatic stress disorder (PTSD) symptoms. However, studies conducted among doctors several years after the beginning of the COVID-19 pandemic are scarce.
Aims
To evaluate the prevalence of PTSD among hospital doctors and to describe potential explanatory factors.
METHODS
The Protec-Cov study was an observational, cross-sectional, multicentre study, which used an anonymous online questionnaire to evaluate PTSD in doctors from six hospitals in France between December 2021 and March 2022. The presence of PTSD was assessed using the Post-traumatic Stress Disorder Checklist Scale (PCLS) questionnaire with a cut-off of 44.
RESULTS
Among the 307 doctors included, 18% presented a PCLS ≥44. The multivariate analysis showed that factors associated with a PCLS ≥44 were having a higher workload than before the COVID-19 pandemic (odds ratio [OR] = 4.75; 95% confidence interval [CI] 1.68–13.38), not feeling recognized within the professional environment (OR = 2.83; 95% CI 1.26–6.33), and feeling isolated because of the lockdown (OR = 4.2; 95% CI 1.97–8.95). Approximately 30% of hospital doctors (n = 91) felt a need for psychological support but only 31% of them (n = 28) received support.
Conclusions
Based on our findings, a high prevalence of PTSD was observed among hospital doctors 2 years after the beginning of the COVID-19 pandemic. This study supports an early diagnosis of PTSD in this category of healthcare workers and warrants further study.
Background
Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women’s needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context.
Methods
A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6–7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics.
Results
Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain.
Conclusion
iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions.
Trial registration
Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).
While the concept of cognitive resilience is well-established it has not been defined in a way that can be measured. This has been an impediment to studying its underlying biology and to developing instruments for its clinical assessment. This perspective highlights recent work that has quantified the expression of cortical proteins associated with cognitive resilience, thus facilitating studies of its complex underlying biology and the full range of its clinical effects in aging adults. These initial studies provide empirical support for the conceptualization of resilience as a continuum. Like other conventional risk factors, some individuals manifest higher-than-average cognitive resilience and other individuals manifest lower-than-average cognitive resilience. These novel approaches for advancing studies of cognitive resilience can be generalized to other aging phenotypes and can set the stage for the development of clinical tools that might have the potential to measure other mechanisms of resilience in aging adults. These advances also have the potential to catalyze a complementary therapeutic approach that focuses on augmenting resilience via lifestyle changes or therapies targeting its underlying molecular mechanisms to maintain cognition and brain health even in the presence of untreatable stressors like brain pathologies that accumulate in aging adults.
Police officers demonstrate increased risk of physical and mental health conditions due to repeated and prolonged exposure to stressful occupational conditions. Occupational stress is broken into two types: operational stress, related to the content of field duties (e.g., physical demands); and organizational stress, related to cultural and structural contexts (e.g., interpersonal relationships). Applied police research focuses on physiological activation in operational tasks as a mechanism explaining health risk and non-optimal performance outcomes. However, recent survey-based studies indicate numerous organizational stressors associated with self-reported mental health symptoms. The question of whether organizational stressors elicit significant physiological activity remains unknown. The current proof-of-concept field study tests the hypothesis that police managers will display significant physiological reactivity before, during, and after engaging in reality-based scenarios representative of stressful police management tasks developed from evidence-based pedagogical approaches. A sample of 25 training police managers (7 female, M = 16 +/- 5.3 years of experience) completed 5 reality-based scenarios, including resolving a heated conflict between colleagues, delivering negative feedback to a subordinate, and critical incident command. Significant increases in heart rate relative to rest were observed during all tasks, and in anticipation of several tasks. Greater increases in reactive heart rate were associated with longer recovery times. Sex differences and relationships between objective biological and subjective psychological measures of stress are discussed. The current findings demonstrate significant physiological responses to organizational stressors similar to levels observed during operational tasks, despite the absence of physical or aerobic exertion. Implications for police health and training are discussed.
Supplementary Information
The online version contains supplementary material available at 10.1007/s10484-023-09613-2.
Circulating cell-free mitochondrial DNA (ccf-mtDNA) is a biomarker of cellular injury or cellular stress and is a potential novel biomarker of psychological stress and of various brain, somatic, and psychiatric disorders. No studies have yet analyzed ccf-mtDNA levels in post-traumatic stress disorder (PTSD), despite evidence of mitochondrial dysfunction in this condition. In the current study, we compared plasma ccf-mtDNA levels in combat trauma-exposed male veterans with PTSD (n = 111) with those who did not develop PTSD (n = 121) and also investigated the relationship between ccf mt-DNA levels and glucocorticoid sensitivity. In unadjusted analyses, ccf-mtDNA levels did not differ significantly between the PTSD and non-PTSD groups (t = 1.312, p = 0.191, Cohen’s d = 0.172). In a sensitivity analysis excluding participants with diabetes and those using antidepressant medication and controlling for age, the PTSD group had lower ccf-mtDNA levels than did the non-PTSD group (F(1, 179) = 5.971, p = 0.016, partial η² = 0.033). Across the entire sample, ccf-mtDNA levels were negatively correlated with post-dexamethasone adrenocorticotropic hormone (ACTH) decline (r = −0.171, p = 0.020) and cortisol decline (r = −0.149, p = 0.034) (viz., greater ACTH and cortisol suppression was associated with lower ccf-mtDNA levels) both with and without controlling for age, antidepressant status and diabetes status. Ccf-mtDNA levels were also significantly positively associated with IC50-DEX (the concentration of dexamethasone at which 50% of lysozyme activity is inhibited), a measure of lymphocyte glucocorticoid sensitivity, after controlling for age, antidepressant status, and diabetes status (β = 0.142, p = 0.038), suggesting that increased lymphocyte glucocorticoid sensitivity is associated with lower ccf-mtDNA levels. Although no overall group differences were found in unadjusted analyses, excluding subjects with diabetes and those taking antidepressants, which may affect ccf-mtDNA levels, as well as controlling for age, revealed decreased ccf-mtDNA levels in PTSD. In both adjusted and unadjusted analyses, low ccf-mtDNA levels were associated with relatively increased glucocorticoid sensitivity, often reported in PTSD, suggesting a link between mitochondrial and glucocorticoid-related abnormalities in PTSD.
This study examines the psychometric properties of two versions of the PTSD Sympton Scale (PSS). The scale contains 17 items that diagnose PTSD according to DSM-III-R criteria and assess the severity of PTSD symptoms. An interview and self-report version of the PSS were administered to a sample of 118 recent rape and non-sexual assault victims. The results indicate that both versions of the PSS have satisfactory internal consistency, high test-retest reliability, and good concurrent validity. The interview version yielded high interrater agreement when administred separately by two interviewers and excellent convergent validity with the SCID. When used to diagnose PTSD, the self-report version of the PSS was somewhat more conservative than the interview version.
Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.
We examined the effects of varying the scoring rules for the CAPS (Clinician Administered PTSD Scale) on the diagnosis of PTSD in a sample of 100 victims of recent motor vehicle accidents. This was done by assessing, for each scoring rule, the rate of categorical diagnosis and the effect on group mean scores on measures of subjective distress and role impairment. Changing from the most liberal to the most conservative scoring rule results in a change in diagnosis of PTSD from 44% to 29% of the sample. Comparisons of those included as PTSD under the most conservative scoring criteria vs those excluded (who had previously been included) reveal significantly greater subjective distress and role impairment among those who continue to be included in the PTSD category. Thus, changes in scoring rules have clinically significant effects on the incidence and severity of diagnosed PTSD. This indicates that the selection of scoring rules has important implications for epidemiological estimates of the prevalence of PTSD, and that PTSD studies using different scoring rules as inclusion criteria may be using somewhat different samples.
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