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Impact of Event Scale: A Measure of Subjective Stress
Abstract
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.
... This scoping review included 17 distinct assessment tools [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] related to PTSD which are listed in Table 5. ...
... Cronbach's alpha = 0.94 [56], Cronbach's alpha for Intrusion = 0.88 [56], Cronbach's alpha for Avoidance = 0.90 [56], Cronbach's alpha for Hyperarousal = 0.81 [56] Convergent Validity: Pearson correlations were computed between the IES-R and the threat subscale of the Ice Storm Questionnaire, yielding the following results: intrusion (r = 0.29), avoidance (r = 0.22), hyperarousal (r = 0.23), and the total score (r = 0.29) [57] PCL-C Internal Consistency = (α = 0.94, n = 471) [58] Retest reliability (r = 0.66; n = 316) [58] Convergent Validity: The correlation between PCL-CMS and the PCL-C was strong, with a coefficient of 0.60. In comparison, the correlations between the PCL-C and all other measures ranged from 0.28 to 0.59 [58] CIES Split half reliability= (r = 0.86) [59] Cronbach's alpha for Intrusion = 0.78 [59] Cronbach's alpha for Avoidance = 0.82 [59] Test-Retest Reliability = 0.87 [59] Test-Retest Reliability for Intrusion = 0.89 [59] Test-Retest Reliability for Avoidance = 0.79 [59] ...
... Cronbach's alpha = 0.94 [56], Cronbach's alpha for Intrusion = 0.88 [56], Cronbach's alpha for Avoidance = 0.90 [56], Cronbach's alpha for Hyperarousal = 0.81 [56] Convergent Validity: Pearson correlations were computed between the IES-R and the threat subscale of the Ice Storm Questionnaire, yielding the following results: intrusion (r = 0.29), avoidance (r = 0.22), hyperarousal (r = 0.23), and the total score (r = 0.29) [57] PCL-C Internal Consistency = (α = 0.94, n = 471) [58] Retest reliability (r = 0.66; n = 316) [58] Convergent Validity: The correlation between PCL-CMS and the PCL-C was strong, with a coefficient of 0.60. In comparison, the correlations between the PCL-C and all other measures ranged from 0.28 to 0.59 [58] CIES Split half reliability= (r = 0.86) [59] Cronbach's alpha for Intrusion = 0.78 [59] Cronbach's alpha for Avoidance = 0.82 [59] Test-Retest Reliability = 0.87 [59] Test-Retest Reliability for Intrusion = 0.89 [59] Test-Retest Reliability for Avoidance = 0.79 [59] ...
As the prevalence of post-traumatic stress disorder (PTSD) among children discharged from pediatric intensive care unit (PICU) continues to rise, corresponding research efforts have also increased. This scoping review aimed to review the PTSD prevalence, influencing factors, and tools used for PTSD measurements in children discharged from the PICU. This review employed the five-stage framework proposed by Arksey and O’Malley. The data sources included PubMed, Web of Science, Ovid, ScienceDirect, Springer, Scopus, CNKI, and WANFANG. Studies in English or Chinese published up to September 2023 were eligible for inclusion. The search yielded a total of 3536 results, with 31 articles meeting the inclusion criteria. The included studies reported that the prevalence of PTSD ranged from a minimum of 13% to a maximum of 84.6%. Risk factors for PTSD included medical interventions, child-related factors, and family environment. A total of 17 assessment tools for PTSD in PICU patients were reported. Given the significance of PTSD in this pediatric population, further attention, research, and intervention are warranted to help alleviate the burden of PTSD.
... There is, therefore, an urgent need for validated trauma symptom and mental health screening tools for refugee adolescents (Gadeberg & Norredam, 2016) and for researchers to critically evaluate the utility and validity of the most used screening tools, including their cross-cultural validity (Verhagen et al., 2022). In this study, we focus on the widely used 8-item Children's Revised Impact of Event Scale (CRIES-8), which builds on the Impact of Event Scale (IES), originally developed by Horowitz et al. (1979) and later revised for use in children by Yule (1992). The CRIES-8 has been recommended for use in assessing PTSS by an international consortium of experts on PTSD among children and adolescents (Krause et al., 2021). ...
... In the development of the IES, two major response sets, describing symptoms of intrusion and avoidance, were abstracted from in-depth evaluation and psychotherapy interviews (Horowitz et al., 1979). Intrusion was characterized by unbidden thoughts and images, troubled dreams, strong pangs or waves of negative feelings, and repetitive behaviour. ...
... In the original study by Horowitz et al. (1979), the internal consistency of the subscales (Cronbach's α) was high (intrusion = 0.78, avoidance = 0.82). Also, a correlation of 0.42 (p < .01) between the intrusion and avoidance subscale scores indicated that the two subsets were associated but did not measure the same dimension. ...
Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.
Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.
Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.
Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831−.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).
Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.
... The demographic/disease-related questionnaire surveys age, gender, marital status, education level, type of disease, medication use, COVID-19 infection, and COVID-19 vaccinnation status. The anxiety and depression levels were categorized into normal (score 0-7), mild (score 8-10), moderate (score [11][12][13][14], and severe (score [15][16][17][18][19][20][21] based on the HADS score [21]. ...
... The demographic/disease-related questionnaire surveys age, gender, marital status, education level, type of disease, medication use, COVID-19 infection, and COVID-19 vaccinnation status. The anxiety and depression levels were categorized into normal (score 0-7), mild (score 8-10), moderate (score [11][12][13][14], and severe (score [15][16][17][18][19][20][21] based on the HADS score [21]. ...
... The IES-R, a revised version of the Impact of Event Scale (IES) developed by Horowitz et al. (1979) according to DSM-5 standards (Horowitz et al., 1979), was used (Weiss, 2007). The scale was adapted into Turkish by (Aytül Çorapçıoğlu, 2006). ...
... The IES-R, a revised version of the Impact of Event Scale (IES) developed by Horowitz et al. (1979) according to DSM-5 standards (Horowitz et al., 1979), was used (Weiss, 2007). The scale was adapted into Turkish by (Aytül Çorapçıoğlu, 2006). ...
The Kahramanmaraş Earthquakes (2023) are the largest and most destructive earthquakes witnessed in the era of the Republic of Turkey. Earthquakes lead to serious mental health problems such as PTSD in individuals. Earthquakes that cause significant death and injury on a large scale, such as the Kahramanmaraş Earthquakes, can result in various mental health problems. Therefore, the aim of the study was to examine the effects of variables such as Post-Traumatic Stress Disorder (PTSD), event impact, psychological resilience, depression, and anxiety levels on adult earthquake survivors affected by the Kahramanmaraş Earthquakes, using a quantitative research approach with survey techniques. A total of 662 earthquake survivors were reached. The effect of variables on each other was analyzed using Structural Equation Modeling (SEM). According to the findings of the study, event impact had a significant and positive effect on PTSD (β = 0.780, p = 0.000). Unexpectedly, resilience did not have a significant effect on PTSD (β=-0.04, p > 0.05). PTSD had a significant and positive effect on anxiety (β = 0.936, p = 0.000) and depression (β = 0.643, p = 0.000). Consequently, event impact's severity increased PTSD, which in turn led to anxiety and depression. Surprisingly, psychological resilience did not serve as a protective factor against PTSD. For future research, it is recommended to examine psychological resilience with different event types, on different sample groups, and using more comprehensive and varied methods.
... The primary outcomes were defined by a 94-item survey created by the study team and piloted by two research coordinators. Topical areas of the survey included: demographics and overall health, assessment of understanding of LCS [11], assessment of lung cancer risk, understanding of next screening steps [4], and distress following screening measured by the Impact of Event Scale (IES) [19]. Those who identified on the survey that they received the CAQ completed additional questions to assess the acceptability and appropriateness of the CAQ, using the acceptability of intervention measure (AIM) and intervention appropriateness measure (IAM) [20]. ...
... The 3 primary outcomes derived from the survey were: 1) Response to the question, "I understand the results of my most recent LCS CT scan" on a Likert Scale; 2) Self-report of next step considered correct based on Lung-RADS standardized follow-up (using methods from our prior study) [4]; 3) Distress measured by the IES [19]. Secondary outcomes included: 6 questions assessing knowledge and understanding of components of LCS and summarized measures of acceptability and appropriateness. ...
Introduction
Lung cancer screening (LCS) can reduce lung cancer mortality; however, poor understanding of results may impact patient experience and follow-up. We sought to determine whether an informational handout accompanying LCS results can improve patient-reported outcomes and adherence to follow-up.
Study design
This was a prospective alternating intervention pilot trial of a handout to accompany LCS results delivery.
Setting/Participants
Patients undergoing LCS in a multisite program over a 6-month period received a mailing containing either: 1) a standardized form letter of LCS results (control) or 2) the LCS results letter and the handout (intervention).
Intervention
A two-sided informational handout on commonly asked questions after LCS created through iterative mixed-methods evaluation with both LCS patients and providers.
Outcome measures
The primary outcomes of 1)patient understanding of LCS results, 2)correct identification of next steps in screening, and 3)patient distress were measured through survey. Adherence to recommended follow-up after LCS was determined through chart review. Outcomes were compared between the intervention and control group using generalized estimating equations.
Results
389 patients were eligible and enrolled with survey responses from 230 participants (59% response rate). We found no differences in understanding of results, identification of next steps in follow-up or distress but did find higher levels of knowledge and understanding on questions assessing individual components of LCS in the intervention group. Follow-up adherence was overall similar between the two arms, though was higher in the intervention group among those with positive findings (p = 0.007).
Conclusions
There were no differences in self-reported outcomes between the groups or overall follow-up adherence. Those receiving the intervention did report greater understanding and knowledge of key LCS components, and those with positive results had a higher rate of follow-up. This may represent a feasible component of a multi-level intervention to address knowledge and follow-up for LCS.
Trial registration
ClinicalTrials.gov NCT05265897 .
... Procedural justice behaviors fully mediated relationship between officer intrusive behaviors and PI-PTSS. + + Geller et al. (2014)Impact of Event Scale(Horowitz et al., 1979) Higher levels of intrusion were associated with more PTSD symptoms. Procedural justice moderated the association between intrusion and post-traumatic stress disorder (PTSD).+ ...
Youth exposure to violence increases the risk of poor mental and physical health outcomes lasting into adulthood. Traumatic stress is an outcome of particular concern as the physiological stress response impacts the developing brain. Recently, youth exposure to police violence has been conceptualized as an adverse childhood experience that may impact traumatic stress. To examine this possibility, we conducted a systematic review, drawing upon five databases to gather the existing quantitative and qualitative peer-reviewed research on exposure to police violence and traumatic stress in youth. Searches yielded 27 relevant articles utilizing various study designs: thirteen quantitative, thirteen qualitative, and one mixed method. Twenty-six of the 27 studies found evidence of a relationship between police violence exposure and traumatic stress in youth. Police violence was associated with youth traumatic stress across three types of exposures: direct, vicarious, and anticipated. Studies also explored differential impacts by race and gender. The review revealed current gaps in the literature, such as a lack of data on select sociodemographic groups (e.g., rural youth, LGBTQ+ youth) and potential protective factors (e.g., resilience and school connectedness). In line with the findings, we put forth a research agenda as well as policy and practice recommendations to improve police interactions with youth and mental health services for youth who have been exposed to police violence. Recommendations include improving systematic data collection to track all types of police violence exposure, creating spaces for positive police interactions with youth, and training mental health practitioners to support youth exposed to police violence.
... To assess psychological trauma and PTSD, the Impact of Events Scale-Revised from Weiss and Marmar (1997) was used. It derives from the original version of the Impact of Event Scale (Horowitz et al., 1979), which consists of a widely used self-reporting measure within the trauma literature. The internal consistency was shown to be high in all three subscales: α = .87-.94 for the Intrusion scale, α = .84-.87 for the Avoidance scale, and α = .79-.91 for the Hyperarousal scale (Weiss & Marmar, 1997). ...
Objective: To explore the relationship between psychological stress and suicidality in Yazidi refugee camps in Iraq. Method: At the time of the investigation, the Yazidi survivors of the 2014 genocide by Islamic State of Iraq and Syria had been living in refugee camps in Iraq for 9 years. The aim of this study was to investigate the relationship between psychological stress and suicidality in Yazidi refugee camps in Iraq. In total, 425 participants took part in the study and participated in interviews using standard scales to measure general physical and mental health and suicidality. Results: The results demonstrate that suicidality and psychological stress are higher among the Yazidis survivors of genocide than in the other Yazidi and Non-Yazidi participants. Conclusions: Genocide, flight, and life in refugee camps without any prospect of being able to live in peace again increases suicidal thoughts, which should also be considered in the psychosocial care and therapy of this population.
... The Korean Version of the Impact of Event Scale-Revised (IES-R-K) was adapted and validated by Eun et al. [24], based on the Event Impact Scale, a trauma-related scale developed by Horowitz et al. [25]. The frequency of symptoms over the past week is assessed using 22 questions, with responses evaluated on a five-point scale. ...
... The Impact of Events Scale Revised (IES-R) (Horowitz et al., 1979;Weiss & Marmar, 1997) was used to assess symptoms of posttraumatic stress (PTS) in the past seven days. This scale comprises eight intrusion symptoms, eight avoidance symptoms and six hypervigilance symptoms, giving a total of 22 items. ...
... The validity and reliability for healthcare settings as well as among the general population were confirmed by previous studies (Aydemir et al., 1997;Erim et al., 2010). Impact of Event Scale-Revised (IES-R): Posttraumatic stress (PTS) was measured using the IES-R, a 22-item scale, based on the original 15item IES (Horowitz et al., 1979), with additional items to measure hyperarousal symptoms (Weiss & Marmar 1997). The instrument evaluates PTS in three subdimensions (intrusion, avoidance, and hyperarousal) and provides an overall score for subjective stress (IES-R score). ...
The place where the work: A web-based survey was conducted. Abstract Background: COVID-19 is a public health emergency and has caused traumatic experiences among nurses worldwide. However, the prevalence of depression, anxiety, and post-traumatic stress symptoms in frontline nurses, and affecting factors such as demographics or working conditions have largely remained unknown. Objectives: This study aimed to analyze the levels of anxiety, depression, and post-traumatic stress of frontline nurses during the COVID-19 pandemic and related risk factors. Methodology: A web-based survey was conducted in a cross-sectional design. A total of 244 nurses working with patients diagnosed with COVID-19 were selected using convenience sampling. Multivariable logistic regression was used to identify the predictors of anxiety, depression, and post-traumatic stress. Results: Of the participants, 48% had anxiety levels higher than the cutoff value, 68% had high depression levels, and 51.2% had high post-traumatic stress levels. The inadequate organizational support was determined as a predictor of anxiety and of depression. For each one point increase in working hours per week, there was a 1 % increase in depression. Two predictors of post-traumatic stress were the unit where nurses worked and having had colleagues diagnosed with COVID-19. Conclusions: This study found that during the COVID-19 pandemic nurses had high levels of anxiety, depression, and post-traumatic stress. It was concluded that the most striking predictors affecting nurses' mental health were number of weekly working hours and the level of received organizational support. The study contributes to the literature for planning psychosocial interventions that can be implemented to frontline nurses.
... The most commonly used PTSD questionnaires were the PTSD Checklist-Civilian Version (k = 41; PCL-C, and PTSD Checklist-Specific [PCL-S]; Weathers et al., 1993), the Impact of Event Scale-Revised (k = 22; IES-R; Weiss & Marmar, 1997), and the Impact of Event Scale (k = 13; IES; Horowitz et al., 1979). The PCL-C is based on a 5-point Likert scale and corresponds to the DSM-IV criteria. ...
The ongoing debate about the stressor criterion issue concerning posttraumatic stress disorder (PTSD) diagnosis is far from the end. Prior research shows that PTSD symptoms can arise in the aftermath of events that do not fall within the current psychiatric nosology (e.g., Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision [DSM-5-TR]; American Psychiatric Association, 2022). This meta-analysis includes 124 studies (N = 23,356) that assess PTSD symptoms following non-Criterion A events, commonly referred to as stressors. A significant pooled mean was obtained, and several moderators were tested. Based on the index event, subgroup analyses estimated the pooled mean for studies examining cancer’s impact. The results show that PTSD symptoms can also develop from stressful life events such as discrimination, relationship dissolution, home eviction, workplace bullying, nontraumatic childbirth, chronic illnesses (e.g., cancer), expected loss, racism, or revealing sexual orientation. Moreover, the employed questionnaire for the assessment of PTSD symptoms yielded a significant moderating effect, emphasizing the necessity of using standardized measurement tools. These findings also underline several important methodological limitations that derive from the specific variability of this field.
... Posttraumatic stress symptomology as a result of the COVID-19 pandemic was assessed using an adapted version of the Child Revised Impact of Events Scale (CRIES-8) [34,35]. The CRIES-8 was specifically designed as a brief child-friendly screener for children at risk of PTSD, using eight items taken from the original Impact of Events Scale [36], designed to measure avoidance and intrusion symptomology. Participants were asked to rate the frequency of occurrence of these symptoms over the past week, with specific reference to the COVID-19 pandemic. ...
There has been concern about adolescent mental health during the pandemic. The current study examined adolescent mental health during the initial phase of the COVID-19 pandemic in the UK. Using indicator of psychological distress, wellbeing and resilience, latent profile analysis was used to identify homogeneous mental health groups among young people aged 13–24 ( N = 1971). Multinomial logistic regression was then used to examine which sociodemographic and psychosocial variables predicted latent class membership. Four classes were found. The largest class (Class 1, 37.2%) was characterised by moderate symptomology and moderate wellbeing . Class 2 (34.2%) was characterised by low symptomology and high wellbeing, while Class 3 (25.4%) was characterised by moderate symptomology and high wellbeing. Finally, Class 4 was the smallest (3.2%) and was characterised by high symptomology and low wellbeing. Compared to the low symptomology, high wellbeing class, all other classes were associated with less social engagement with friends, poorer family functioning, greater somatic symptoms, and a less positive model of self. A number of unique associations between the classes and predictor variables were identified. Although around two-thirds of adolescents reported moderate-to-high symptomology, most of these individuals also reported concurrent moderate-to-high levels of wellbeing, reflecting resilience. Furthermore, these findings demonstrate how a more comprehensive picture of mental health can be gained through adopting a dual-continua conceptualisation of mental health that incorporates both pathology and well-being. In this way, at-risk youth can be identified and interventions and resources targeted appropriately.
... All participants were asked to complete the 10-item Kessler Psychological Distress Scale (K10), an internationally validated tool for the screening and assessment of psychological distress (32). Participants who reported a pre-baseline positive PCR test also completed the 15-item Impact of Event Scale (IES), used to assess for post-traumatic stress (PTS) symptoms (33). ...
Introduction
More than 3 years into the pandemic, there is persisting uncertainty as to the etiology, biomarkers, and risk factors of Post COVID-19 Condition (PCC). Serological research data remain a largely untapped resource. Few studies have investigated the potential relationships between post-acute serology and PCC, while accounting for clinical covariates.
Methods
We compared clinical and serological predictors among COVID-19 survivors with (n = 102 cases) and without (n = 122 controls) persistent symptoms ≥12 weeks post-infection. We selected four primary serological predictors (anti-nucleocapsid (N), anti-Spike, and anti-receptor binding domain (RBD) IgG titres, and neutralization efficiency), and specified clinical covariates a priori.
Results
Similar proportions of PCC-cases (66.7%, n = 68) and infected-controls (71.3%, n = 87) tested positive for anti-N IgG. More cases tested positive for anti-Spike (94.1%, n = 96) and anti-RBD (95.1%, n = 97) IgG, as compared with controls (anti-Spike: 89.3%, n = 109; anti-RBD: 84.4%, n = 103). Similar trends were observed among unvaccinated participants. Effects of IgG titres on PCC status were non-significant in univariate and multivariate analyses. Adjusting for age and sex, PCC-cases were more likely to be efficient neutralizers (OR 2.2, 95% CI 1.11–4.49), and odds was further increased among cases to report deterioration in quality of life (OR 3.4, 95% CI 1.64–7.31). Clinical covariates found to be significantly related to PCC included obesity (OR 2.3, p = 0.02), number of months post COVID-19 (OR 1.1, p < 0.01), allergies (OR 1.8, p = 0.04), and need for medical support (OR 4.1, p < 0.01).
Conclusion
Despite past COVID-19 infection, approximately one third of PCC-cases and infected-controls were seronegative for anti-N IgG. Findings suggest higher neutralization efficiency among cases as compared with controls, and that this relationship is stronger among cases with more severe PCC. Cases also required more medical support for COVID-19 symptoms, and described complex, ongoing health sequelae. More data from larger cohorts are needed to substantiate results, permit subgroup analyses of IgG titres, and explore for differences between clusters of PCC symptoms. Future assessment of IgG subtypes may also elucidate new findings.
... Whether participants were actively receiving cancer treatment was not assessed. Caseness was determined by Impact of Events Scale score ≥ 24 (Horowitz et al., 1979). At 4 months postdiagnosis, four trajectories were identifiable from the published data: non-cases (72%), recovered (12%), persistent (11%), and emerging (5%). ...
To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.
... Post-traumatic stress: The Impact of Event Scale (IES) [30] is a 15-item questionnaire with a 5-point Likert scale (sum scores 0-75). A cut-off score of ≥ 19 is indicative of post-traumatic stress disorder. ...
Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury and to assess the early predictors of HRQoL. Methods: Data from a prospective follow-up study of 164 older (≥60 years) and 289 younger mTBI patients (<60 years) admitted to the emergency department were analyzed. Post-traumatic complaints, emotional distress and coping were evaluated 2 weeks post-injury using standardized questionnaires. At 12 months post-injury, HRQoL and functional recovery were determined with the abbreviated version of the World Health Organization Quality of Life scale and Glasgow Outcome Scale Extended (GOSE), respectively. Results: One year post-injury, 80% (n = 131) of the OA-mTBI rated their HRQoL as “good” or “very good”, which was comparable to younger patients (79% (n = 226), p = 0.72). Incomplete recovery (GOSE <8) was present in 43% (n = 69) of OA-mTBI, with 67% (n = 46) reporting good HRQoL. Two weeks post-injury, fewer OA-mTBI had (≥2) post-traumatic complaints compared to younger patients (68% vs. 80%, p = 0.01). In the multivariable analyses, only depression-related symptoms (OR = 1.20 for each symptom, 95% CI = 1.01–1.34, p < 0.01) were predictors of poor HRQoL in OA-mTBI. Conclusions: Similar to younger patients, most OA-mTBI rated their HRQoL as good at one year after injury, although a considerable proportion showed incomplete recovery according to the GOSE, suggesting a disability paradox. Depression-related symptoms emerged as a significant predictor for poor HRQoL and can be identified as an early target for treatment after mTBI.
... Konsep dukungan emosional, sebagaimana diungkapkan oleh Lazarus dan Folkman (1984) dalam teori mereka tentang stres dan coping, mengacu pada pentingnya sumber daya sosial dan informasi yang dapat membantu individu menghadapi stresor eksternal, termasuk penyakit dan pengobatan. Selanjutnya, Horowitz et al. (1979) Carr et al. (2001). Penyediaan informasi ini membantu mengurangi salah satu sumber stres signifikan bagi pasien dan keluarganya, memungkinkan mereka untuk fokus pada pemulihan. ...
This study evaluates the implementation of the Indonesian Healthcare Facility Accreditation Agency (LAFKI)'s Person-Centred Care (PCC) principles in healthcare settings. Focusing on patient experiences, the research addresses the effectiveness of PCC practices in enhancing health outcomes and patient experience. The methodology employed involves a quantitative descriptive design, gathering data through questionnaires distributed via Google Forms to participants selected through purposive sampling from hospitals, clinics, and puskesmas. Findings indicate that while a majority of patients felt treated as unique individuals, a significant gap exists in respecting cultural values and beliefs during the decision-making process. The study highlights the need for healthcare providers to improve cultural sensitivity and patient engagement to bridge the ideological and practical implementation of PCC. The research contributes to the empirical literature by identifying barriers to effective PCC implementation and offering evidence-based recommendations for healthcare facilities to enhance their services. This aligns with LAFKI's goal of not just meeting but exceeding standards in providing holistic, person-centred care.
... IES-R is a short self-report questionnaire including 22 questions, developed to include the hyper-arousal subscale to the original IES by Horowitz et al. (1979). The instrument measures the subjective response to a traumatic event. ...
Objective: To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. Methods: Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). Results: 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). Conclusions: Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur.
... Eighteen studies evaluated relationships between exposures of interest and birth-related PTSD. Birth-related PTSD was most commonly measured by the City Birth Trauma Scale (CBTS; n = 5) [133] and the Impact of Event Scale (IES; n = 5) [134,135]. The CBTS was published in 2018, thus, only the more recent studies have used this measure. ...
Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.
... The Impact of Events Scale-Revised (IES-R) which assesses the impact of traumatic life events, is one of the most widely used measurement tools for event-specific distress (Horowitz et al., 1979). It contains 22 items covering three domains (intrusion, avoidance, and hyperarousal subscales), and the five-point Likert scale ranging from 0 ('not at all') to 4 ('extremely') is often utilised. ...
Background
Cancer-related fatigue is common in patients with advanced lung cancer, persistently interfering with their health-related quality of life. Acceptance and Commitment Therapy (ACT) may effectively reduce fatigue interference and improve health-related quality of life in the advanced lung cancer population. This study aimed to evaluate the effects of an ACT-based intervention on fatigue interference and health-related quality of life in patients with advanced lung cancer.
Methods
An assessor-blinded, two-arm randomised controlled trial with 160 patients with advanced lung cancer was conducted. Participants were randomly allocated into either a four-week ACT-based intervention group (n = 80) or usual care control group (n = 80). The intervention consisted of a face-to-face session and three video-conferencing-based sessions and was delivered on an individual basis. The primary outcomes were fatigue interference and health-related quality of life. The secondary outcomes included cancer-related fatigue, depression and anxiety, cancer-specific distress, and activity level. Changes in psychological flexibility (PF), experiential avoidance, and cognitive fusion were also evaluated. Outcomes were measured at baselines (T0), one-week post-intervention (T1), and 3-month follow-up (T2). The intervention effects were assessed using generalised estimating equation models.
Results
Compared with the control group, the intervention group demonstrated significant improvements in fatigue interference (T1: β = −0.50, p < 0.001; T2: β = −0.16, p = 0.007), health-related quality of life (T1: β = 16.01, p < 0.001; T2: β = 11.21, p < 0.001), depression (T1: β = −0.32, p < 0.001) and anxiety (T1: β = −0.20, p < 0.001), cancer-specific distress (T1: β = −7.37, p < 0.001; T2: β = −8.00, p < 0.001), activity level (intensity, T1: β = 3.24, p = 0.004; T2: β = 2.61, p = 0.020; frequency, T1: β = 2.44, p < 0.001; T2: β = 1.96, p < 0.001; duration, T1: β = 1.36, p < 0.001), PF (T1: β = 5.54, p < 0.001; T2: β = 8.63, p < 0.001), experiential avoidance (T1: β = −7.70, p < 0.001; T2: β = −10.07, p < 0.001), and cognitive fusion (T2: β = −3.31, p = 0.007). The changes in experiential avoidance at one-week post-intervention mediated the effects of ACT on reducing cancer-specific distress (β = −7.40, p < 0.001; β = −3.68, 95%CI, −5.77 to −1.58) and promoting HRQoL (β = 11.15, p < 0.001; β = 5.49, 95%CI, 3.09 to 8.31) at three-month follow-up. The changes in PF at one-week post-intervention mediated the effect of ACT on HRQoL (β = 11.15, p < 0.001; β = 2.25, 95%CI, 0.66 to 4.19) at three-month follow-up.
Conclusions
ACT-based intervention can effectively reduce fatigue interference and improve health-related quality of life in patients with advanced lung cancer. The intervention can be integrated into palliative care within the cancer system to contribute to the well-being of patients with advanced cancer.
... Se reconocen dos tipos de respuestas agrupadas en la intrusión y la evitación. La intrusión se caracteriza por pensamientos espontáneos e imágenes, sueños turbulentos, fuertes dolores u oleadas de sentimientos y comportamientos repetitivos (Horowitz et al., 1979). También se puede señalar como la irrupción en la memoria de momentos traumáticos, especie de flashback (Bride et al., 2003). ...
The objective of the research was to validate the "Event Impact" instrument. It was quantitative in nature, non-experimental and cross-sectional in design. The sample was probabilistic obtained by sample calculation was 361 health professionals, who worked in person during the pandemic, who participated on a voluntary basis. After the psychometric analysis such as total item correlation, component factor analysis with orthogonal rotation and Cronbach's Alpha, the scale was composed of 22 items distributed in two dimensions: intrusion and avoidance. It was concluded that a valid scale was obtained to evaluate the impact of the event in the sample studied.
... The Impact of Event Scale (IES) (Horowitz et al., 1979;Pietrantonio et al., 2003) is a 15-item questionnaire measuring the distressing consequences of a traumatic event. Items are rated on a 4-point Likert scale (1 to 4) and the total score ranges from 15 to 60. Higher scores indicate higher levels of distress. ...
Background
Cancer is a life-threatening disease that triggers not only vulnerability to distressing symptoms but also a meaning-making process that may lead to post-traumatic growth. As people often struggle to integrate cancer illness into their meaning system to reach an adaptive meaning, psychological interventions focused on a reappraisal of the illness experience can facilitate this process. This multicenter randomized controlled trial (RCT) was primarily aimed at assessing the efficacy of a writing intervention known as a guided disclosure protocol (GDP), compared to a generic writing intervention, in promoting post-traumatic growth in stage I-III breast and colon cancer patients at the end of their adjuvant chemotherapy.
Methods
Between January 2016 and August 2020 recruitment of eligible subjects took place during follow-up clinical consultations. Assessment occurred at baseline (T0), after the intervention (T1, 3 months from baseline), and at 6 months from baseline (T2). Both interventions consisted of three 20-min writing sessions to be performed once every two weeks. Change in post-traumatic growth was assessed using the Posttraumatic Growth Inventory, meaning with the Constructed Meaning Scale, and psychological distress with the Impact of Event Scale and the Hospital Anxiety and Depression Scale.
Results
In the five participating centers, 102 eligible patients were randomized and 72 participants completed follow-up evaluation. Most patients were women (79.4%), had breast cancer (68.6%), and stage I (27.5%), or stage II (44.1%) disease. Mean differences did not reach statistical significance for any of the dependent variables. However, an effect of the GDP, although not statistically relevant, was observed after the intervention in terms of enhanced post-traumatic growth and increased distress measured with the Impact of Event Scale.
Conclusion
This is the first RCT investigating the efficacy of a GDP in cancer patients having post-traumatic growth as the primary aim. Though GDP is a promising intervention in promoting post-traumatic growth, the lack of statistical significance of our findings may be due to the study being underpowered, hence this trial should be replicated with an adequate sample size, paying attention to supporting recruitment.
Clinical trial registration: ClinicalTrials.gov, identifier: 2015/0024360.
... (IES) was used to measure distress at the end of the experiment, to ensure that participants did not have lasting negative emotional impacts from taking part in our study, and to identify possibly vulnerable participants. It consists of 15 items that create two sub-scales: seven items converge into the intrusion and eight items into the avoidance subscale (Horowitz et al., 1979). Items include statements such as "I thought about it when I did not mean to". ...
Campus sexual assault constitutes a frequent crime witnessed by many. Among co-witnesses such assault is oftentimes denied. We examined how false denials during an informal co-witness conversation impacted memory for the conversation and witnessed assault. Ninety Participants watched a trauma-analogue video with a co-witness. The next day, honest control dyads engaged in an honest, informal discussion about the film. In lying dyads one participant falsely denied (internal false denial group) details during this informal discussion with their co-witness (external denial group). One week later, participants’ recognition memory for the video and conversation was tested. We did not replicate denial-induced forgetting in that participants who falsely denied did not forget details of the previous conversation, relative to honest participants. Moreover, memory for the film was not statistically significantly affected by our manipulation. Thus, informal false denials might not negatively affect memory, despite previous research showing such effects in formal settings.
... Cependant le Syndrome Secondaire à un Stress Traumatique (PTSD), pour expliquer sa clinique, doit faire appel à d'autres notions comme celle "d'échec des processus d'extinction" à cause des souvenirs "hyper-consolidés" du Syndrome Secondaire à un Stress Traumatique (PTSD) et comme celle de "sensibilisation comportementale" c'est-à-dire une augmentation de la réponse de stress à toutes sortes de stimuli menaçants ou non-menaçants. Bremmer et al. 1993 ;Krystal et al. 1993 ;Charney et al. 1994 ;Davidson 1994 ;Leckman 1994 ;Perry 1994 ;Yehuda et al. 1994 ;Southwick et al. 1995 Resick et al. 1988 b ;Rothbaum et al. 1990 ;Horowitz et al. 1979 ;Blake et al. 1990 ;Di Nardo et al. 1983 ;Di Nardo et al. 1993 ; inutilité car, dit-il, la seule incitation à raconter peut souvent produire un effet analogue. ...
TRAUMATIC SYNDROMES OF INCESTUOUS AND NON-INCESTUOUS RAPE
Jean-Michel DARVES-BORNOZ
The role played by sexual assaults in the onset of mental disorders is a point which has long been
debated in psychiatry. And yet disbelief and ignorance of the facts have long hampered the development of
research and therapeutic treatments in this area.
This work first provides a historic overview of the notion of psychological trauma of sexual origin and
then describes the typology of trauma in sexual abuse. The main points concerning the epidemiology of sexual
abuse are then dealt with. Indeed, over the past decade, major epidemiological surveys have reported high
levels of sexual abuse taking place in childhood or adulthood.
Four clinical studies are presented investigating the psychopathological aftermath of incestuous or
non-incestuous rape.
The first of these is a year-long prospective study involving one hundred and two subjects over
thirteen years of age who were victims of incestuous or non-incestuous rape, and who presented consecutively
in the forensic center for victims of rape and incest, within the department of gynecology at the University
teaching hospital in Tours, France (chapter IV). The subjects were regularly interviewed by a psychiatrist using
a standardized battery of clinical instruments for the diagnosis of mental disorders, and more generally for the
assessment of their clinical condition. This study showed that three traumatic syndromes were very frequently
observed following rape. These we called :
1. Syndrome Secondary to Traumatic Stress : this nosographic entity was previously termed traumatic
neurosis, and is elsewhere called Post-Traumatic Stress Disorder (PTSD) ;
2. Dissociative and Phobic Traumatic Syndrome : this syndrome includes somatoform disorders and
specific phobias, but also and especially dissociative disorders, in Pierre Janet's meaning of that term, and
agoraphobia ;
3. Borderline-like Traumatic Syndrome : this syndrome accounts for the alteration in identity and
personality, secondary to the narcissistic wound caused by rape.
We moreover determined that the early onset of one of these two latter syndromes, the incestuous nature of the
rape and experiences of physical violence apart from rape were factors predictive of chronic Post-Traumatic
Stress Disorder one year after rape.
This work further presents specific studies giving an account of the clinical forms of disorders
following rape, in incestuous rape, in adolescents, in males and psychiatric patients :
1. for incestuous rape (chapter V), the Tours cohort is studied from this point of view ;
2. for adolescents (chapter VI), firstly those subjects from the Tours cohort are presented for whom
rape took place before the age of twenty (78% of the cohort) ; next INSERM1 survey data on rape in
adolescence are presented, as studied Marie Choquet, Jean-Michel Darves-Bornoz and Sylvie Ledoux ; the
INSERM survey was carried out using a representative sample of 8255 teenage schoolgoers from the general
population ;
3. for rape in males (chapter VII), the results from the Tours cohort are presented first ; data on rape in
boys as found in the INSERM survey by Marie Choquet, Jean-Michel Darves-Bornoz and Sylvie Ledoux are
then presented ;
4. for the psychiatric patients (chapter VIII), two systematic studies are presented. The first deals with
ninety women suffering from schizophrenia and bipolar disorder. The second study deals with ninety women
consecutively admitted to the Psychiatric Department in the Tours University Hospital. This study attempts to
explain why psychiatric patients as a whole, and whatever their initial diagnosis may be, are frequently rape
victims, and so with a comorbidity frequently presenting the three above-mentioned syndromes.
The work then shows that several approaches (neuropsychological, psychodynamic, behavioral and
psychobiological) can contribute to an understanding of the etiology in these disorders. Finally, different
methods of treating the victims are considered, and the principles applied at the Victims of Psychological
Trauma Consultation Unit at the University Teaching Hospital in Tours, set up by Jean-Michel Darves-Bornoz
in 1992, are illustrated through a single case study (chapter X).
The work firmly concludes that rape and incest form part of the more general field of trauma.
However, it is also noted that, in rape and incest, it is a narcissistic wound that causes the trauma, and that it is
the subject's psychological survival that is at stake. The significant change in impact of the trauma can
therefore be linked to both its specific cause and target.
1. National Institute of Health and Medical Research
Background
Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners.
Objective
The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention.
Methods
Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email.
Results
A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained.
Conclusions
Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL.
International Registered Report Identifier (IRRID)
DERR1-10.2196/52361
Pain and psychopathology are observed in 18% and 55% of patients, respectively, 1 year after intensive care unit (ICU) admission. It is well known that chronic pain and psychopathology have a bidirectional relation in the general population, but it is not known whether this holds true for ICU survivors. The aim of this study was to investigate whether pain before, during and after ICU admission is related to psychopathology in ICU survivors 1 year after discharge. We performed a cohort study in a mixed ICU in the Netherlands between 2013 and 2016. At 1-year follow-up, patients completed the Hospital Anxiety and Depression Scale, the Impact of Event Scale/Impact of Event Scale-Revised, and answered standardised questions regarding pain. Psychopathology was defined as having anxiety, depressive and/or post-traumatic stress disorder symptoms. We used multivariable logistic regression analysis to evaluate the association of pain before, during and after ICU admission with psychopathology at 1 year follow-up. We included 1105 patients of whom 558 (50%) (95% confidence interval (CI) 0.48 to 0.54) had psychopathology at 1 year follow-up. Pain before ICU admission (odds ratio (OR) 1.18; 95% CI 1.10 to 1.26) and pain after ICU admission (OR 2.38; 95% CI 1.68 to 3.35) were associated with psychopathology. Pain during ICU stay was not associated with psychopathology, but the memory of insufficient pain management during ICU stay was (OR 2.19; 95% CI 1.39 to 3.45). Paying attention to pain and pain treatment experiences related to ICU admission may therefore contribute to early identification of ICU survivors at risk of psychopathology development.
It is well-known that interpersonal traumatic events can impact the physical and mental health of those indirectly exposed to the events. Less studied are populations of loved ones who have been indirectly exposed to interpersonal trauma. We conducted a scoping review to synthesize literature related to potential consequences of indirect interpersonal trauma exposure, specifically vicarious traumatization (VT) and vicarious posttraumatic growth (VPTG). We used the Joanna Briggs Institute methodology. Inclusion criteria included: (1) participants were indirectly exposed to the interpersonal trauma of a loved one in adulthood, (2) discussion of VT, VPTG, or related terms, (3) published peer-reviewed empirical journal articles, and (4) available in English. We used a three-step search strategy to find relevant articles. Keywords found from the first two steps were entered into PsycINFO, PsycArticles, PubMed, Scopus, and Web of Science databases. Reference lists of the included articles were also examined. The identified articles were then screened using the inclusion and exclusion criteria. Twenty-eight articles met inclusion and exclusion criteria. Twenty-six articles referenced VT or related terms, one referenced VPTG, and one referenced vicarious trauma keywords. Results of this scoping review are summarized by definitions, measures, key findings, and knowledge gaps. Future research should focus on vocabulary management, diverse samples, and VPTG in this population, including the identification or creation of appropriate measures.
Background The West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs.
Objectives Assess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone.
Methods A cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed.
Findings EVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%–16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35–44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35).
Conclusions Concerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6–8 years after recovery.
Clinical implications Results can be used to inform policy efforts and target resources to address mental health in EVD survivors.
The book has been divided into four units and Practicum dealing with various aspects of lifestyle management in order to not only gain an insight into this subject but also to guide people to manage their lifestyle with the objective of enabling them to lead a healthy and productive life. Success is not a mechanical process, it is vigorous, flexible, and lively in nature. It is not acquired suddenly because it develops gradually. The map of success involves a change of direction, a change in path, and gives its destination a deciding form.
Introduction
Critical illness polyneuropathy and myopathy (CIP/CIM) are frequent complications in the intensive care unit (ICU) with major consequences for the progress and outcome of subjects. CIP/CIM delays the weaning process, prolongs the hospital stay and increases the mortality rate. Additionally, it may have long-term consequences beyond the hospitalisation phase with prolonged disability. Even though there is growing interest in CIP/CIM, research about the clinical and post-clinical course as well as the middle-term and long-term outcomes of subjects with CIP/CIM is scarce. A large prospective study of critically ill subjects is needed with accurate diagnosis during the acute stage and comprehensive assessment during long-term follow-up.
Methods and analysis
This prospective observational cohort study aims to compare the clinical and post-clinical course of chronically critically ill subjects with and without the diagnosis of CIP/CIM and to determine predictors for the middle-term and long-term outcomes of subjects with CIP/CIM. In addition, the influence of the preclinical health status and the preclinical frailty on the long-term outcome of subjects with CIP/CIM will be investigated.
This single-centre study will include 250 critically ill patients who were invasively ventilated for at least 5 days at the ICU and show reduced motor strength. At five study visits at admission and discharge to neurological rehabilitation, and 12, 18 and 24 months after disease onset, a comprehensive test battery will be applied including assessments of functioning and impairment, independence, health-related quality of life, activity and participation, cognition, gait and balance, fatigue, mental health and frailty.
Secondary objectives are the documentation of therapy goals, therapy content and achieved milestones during the rehabilitation, to evaluate the clinimetric properties of the Mini-BESTest in critically ill patients, and to evaluate the time course and outcome of subjects with CIP/CIM after SARS-CoV-2 infection.
Ethics and dissemination
The study was approved by the ethical committee of the Ludwig-Maximilians University Munich. Participants will be included in the study after having signed informed consent.
Results will be published in scientific, peer-reviewed journals and at national and international conferences.
Trial registration number
German Clinical Trial Register (DRKS00021753).
Background: Iranian youth encounter numerous stressors, including accidents, suicide, and unemployment, heightening their risk for posttraumatic stress disorder (PTSD). It's crucial to assess, diagnose, and treat PTSD in this demographic. Objectives: This study aimed to evaluate the factor structure and validate the Post-Traumatic Symptom Scale (PTSS). Methods: A cross-sectional approach was employed for the validation of the PTSS in Bandar Abbas, 2022, with a sample of 901 young residents selected via random cluster sampling. Data were gathered using the PTSS and the Mississippi Scale for Posttraumatic Stress Disorder (MSPSS). Validation of the scale encompassed content validity, concurrent validity, and factor analysis. Reliability assessments included internal consistency, test-retest, and split-half reliability. The optimal cut-off point was identified through receiver operating characteristic (ROC) curve analysis and the Youden Index. Results: The PTSS demonstrated robust face and content validity, evidenced by impact factor (1.6 < impact factor < 3.6), content validity ratio (CVR = 0.68 to 0.91), and Content Validity Index (CVI = 0.70 to 0.94). The PTSS's concurrent validity with the MSPSS was positively strong (r = 0.64, P < 0.001). Factor analyses, both exploratory (EFA) and confirmatory (CFA), substantiated a four-factor model of the PTSS, accounting for 56.288% of the variance (19% for arousal and reactivity, 14% for negative alterations in cognitions and mood, 11% for avoidance, and 11% for intrusion). The scale's overall Cronbach's alpha was 0.87, with subscales ranging from 0.77 to 0.88. Test-retest reliability stood at 0.81 (P < 0.01), and split-half reliability at 0.81. The PTSS's optimal cut-off for PTSD diagnosis was 60, delivering a sensitivity of 0.70, specificity of 0.99, and Youden Index of 0.69. Conclusions: The PTSS proves to be a reliable and valid instrument for assessing posttraumatic stress symptoms among young Iranians, offering a useful resource for researchers and practitioners in the prevention and treatment of PTSD.
Objectives
Understanding the long-term effects of severe COVID-19 illness on survivors is essential for effective pandemic recovery planning. Therefore, we investigated impairments among hospitalized adults discharged to long-term acute care hospitals (LTACHs) for prolonged severe COVID-19 illness who survived 1 year.
Design
The Recovery After Transfer to an LTACH for COVID-19 (RAFT COVID) study was a national, multicenter, prospective longitudinal cohort study.
Setting and Patients
We included hospitalized English-speaking adults transferred to one of nine LTACHs in the United States between March 2020 and February 2021 and completed a survey.
Interventions
None.
Measurements and Main Results
Validated instruments for impairments and free response questions about recovering. Among 282 potentially eligible participants who provided permission to be contacted, 156 (55.3%) participated (median age, 65; 38.5% female; 61.3% in good prior health; median length of stay of 57 d; 77% mechanically ventilated for a median of 26 d; 42% had a tracheostomy). Approximately two-thirds (64%) had a persistent impairment, including physical (57%), respiratory (49%; 19% on supplemental oxygen), psychiatric (24%), and cognitive impairments (15%). Nearly half (47%) had two or more impairment types. Participants also experienced persistent debility from hospital-acquired complications, including mononeuropathies and pressure ulcers. Participants described protracted recovery, attributing improvements to exercise/rehabilitation, support, and time. While considered life-altering with 78.7% not returning to their usual health, participants expressed gratitude for recovering; 99% returned home and 60% of previously employed individuals returned to work.
Conclusions
Nearly two-thirds of survivors of among the most prolonged severe COVID-19 illness had persistent impairments at 1 year that resembled post-intensive care syndrome after critical illness plus debility from hospital-acquired complications.
Background
Sedation is routinely administered to critically ill patients to alleviate anxiety, discomfort, and patient-ventilator asynchrony. However, it must be balanced against risks such as delirium and prolonged intensive care stays. This study aimed to investigate the effects of different levels of sedation in critically ill adults.
Methods
Systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials including critically ill adults admitted to the intensive care unit. CENTRAL, MEDLINE, Embase, LILACS, and Web of Science were searched from their inception to 13 June 2023. Risks of bias were assessed using the Cochrane risk of bias tool. Primary outcome was all-cause mortality. Aggregate data were synthesised with meta-analyses and TSA, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO: CRD42023386960.
Findings
Fifteen trials randomising 4352 patients were included, of which 13 were assessed high risk of bias. Meta-analyses comparing lighter to deeper sedation showed no evidence of a difference in all-cause mortality (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.83–1.06; p = 0.28; 15 trials; moderate certainty evidence), serious adverse events (RR 0.99, CI 0.92–1.06; p = 0.80; 15 trials; moderate certainty evidence), or delirium (RR 1.01, 95% CI 0.94–1.09; p = 0.78; 11 trials; moderate certainty evidence). TSA showed that when assessing mortality, a relative risk reduction of 16% or more between the compared interventions could be rejected.
Interpretation
The level of sedation has not been shown to affect the risks of death, delirium, and other serious adverse events in critically ill adult patients. While TSA suggests that additional trials are unlikely to significantly change the conclusion of the meta-analyses, the certainty of evidence was moderate. This suggests a need for future high-quality studies with higher methodological rigor.
Funding
None.
Life events are usually followed by significant changes in the everyday routines of the affected individuals. In this study, we investigated the association of the changes in daily activities caused by the strict COVID-19 lockdown measures adopted in Greece to people’s psycho-emotional adjustment. A new measure, the everyday life change index (ELCI), was administered to 853 adults, while their psychological distress was measured with the depression-anxiety-stress scale (DASS-21). Results showed that the greater the changes a person experienced in their daily life due to lockdown, the higher the symptoms of depression, anxiety, and stress they manifested. We suggest that life-event-induced changes in routine activities could be a meaningful measure for clinical practice.
This study investigates the effectiveness of the TRUST intervention, delivered through Information and Communication Technology (ICT), in addressing trauma and enhancing resilience among Eritrean refugees in impoverished camps. The research aims to explore whether the comprehensive TRUST program, compared to a shorter psycho-education session, can reduce traumatic stress levels and improve social and economic resilience and social capital, indicating a reduction in collective trauma. Ethical approval was obtained, and participants were randomly assigned to intervention groups. Livelihood support availability was assessed, and psychometric tests were administered before and after the intervention. Results indicate a significant decrease in traumatic stress levels and improvements in social and economic resilience among participants receiving the full TRUST intervention. Interestingly, the availability of livelihood support did not significantly impact trauma levels or associated improvements. Challenges in delivering therapy via ICT, such as connectivity issues, were identified. This study underscores the potential of ICT-enabled interventions in addressing mental health challenges in resource-constrained environments but highlights the importance of addressing connectivity issues for effective implementation.
Objectives
(1) To describe existing tools to assess the burden of informal caregivers of people with cancer, (2) to describe how these tools have been validated and (3) to describe the areas of interest of existing assessment tool entries.
Background
The caregiver burden of informal caregivers of people with cancer greatly affects their lives. There is a wide variety of relevant assessment tools available, but there are no studies to help researchers to select tools.
Methods
A search was conducted using the keywords ‘cancer’, ‘caregiver’, ‘burden’ and ‘scale’ in Medline (PubMed), CINAHL and EMBASE to include articles that developed or applied tools to assess the burden on informal caregivers of cancer patients. Once eligible tools were identified, we searched their ‘primary reference’ studies. If the original scale was assessed in a population other than informal caregivers of cancer patients, we again searched for psychometric measures in the population of caregivers of cancer patients.
Results
This study retrieved 938 articles on developing or applying the informal caregiver burden instrument for cancer patients, including 42 scales. Internal consistency of the original scales ranged from 0.53 to 0.96. Nineteen scales initially developed to assess caregiver burden for patients with dementia, stroke and other disorders were later used for caregivers of cancer patients, eight of which have not yet been validated. Reclassifying all scale domains of concern revealed that scale assessments focused more on caregivers' physical health, emotional state and caregiving tasks.
Conclusion
This review identifies many scales for assessing informal caregiver burden in cancer patients and gives scales recommended. However, a portion still needs to be validated. The development of a new scale proposes to be based on a theoretical framework and to consider dimensions for assessing support resources.
Impact
What problem did the study address?: This paper collates assessment tools on the burden of informal carers of people with cancer. It also provides information on the applicable population, reliability and validity.
What were the main findings?: 41 scales could be considered for use, eight of which have not been validated. The scales focus more on assessing caregivers' physical health, emotional state and caregiving tasks, and less on the dimension of support resources.
Where and on whom will the research have an impact?: There are implications for informal carers of cancer patients in hospitals or in the community, as well as for relevant researchers.
Reporting Method
Retrieved with reference to systematic evaluation.
Patient or Public Contribution
No patient or public contribution.
High rates of nonresponse to evidence-based treatment for posttraumatic stress disorder (PTSD) have fueled the search for improved intervention. Evidence suggests that improvements in dispositional mindfulness (i.e., tendency to attend to the present with nonjudgment and nonreactivity) may help reduce PTSD symptoms. While some research suggests that transdiagnostic mindfulness-based interventions particularly target avoidance symptoms, the association between dispositional mindfulness and avoidance has yet to be systematically examined. To address this gap, we examined peer-reviewed studies that reported quantitative associations between avoidance and dispositional mindfulness among trauma-exposed adults, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Sixteen studies were identified for final review from PsycINFO and PubMed databases. Results suggest that mindfulness has a weak relationship with effortful avoidance. This weak relationship may be obscured in studies where effortful avoidance is measured among other symptoms (e.g., anhedonia). Mindfulness appeared to have stronger associations with symptoms of hyperarousal and negative alterations in cognition and mood. An important clinical implication is that high effortful avoidance may manifest among patients who report strong mindfulness skills. It may be helpful for clinicians to carefully assess how mindfulness is being used to cope.
Purpose
This article reviews the literature focused on the psychological effects of craniofacial care for patients and their families. It provides an overview of pediatric medical traumatic stress (PMTS) associated with craniofacial conditions and related care, along with a review of its risk and protective factors. Findings from studies of PMTS in craniofacial populations are also reviewed.
Conclusions
The article concludes with strategies for identifying, addressing, and preventing medical traumatic stress in the context of craniofacial care. Specific implications for speech-language pathologists are also shared with respect to ways of minimizing risks for medical traumatic stress in craniofacial care. Future directions are also delineated and include strategies to improve screening and support for patients with craniofacial conditions and their families, along with the development of interventions aimed at increasing resilience.
ResearchGate has not been able to resolve any references for this publication.