Symptom burden and work-related impairment among patients with PTSD and complex PTSD

Background: The 11th revision of the International Classification of Diseases includes a newchapter of stress-related disorders and presents two distinct sibling conditions:Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Studies show that PTSDand CPTSD are associated with different levels of symptom burden, comorbidity andfunctional impairment, but have not yet addressed the qualitative and quantitative differences in work-related impairment between the two diagnoses.Objective: The aim of this study was to replicate differences in symptom severity, globaldistress, and the number of comorbid diagnoses between three groups that suffer from noPTSD, PTSD, or CPTSD. More importantly, we evaluated whether the three groups differ inindicators of functional impairment such as qualitative and quantitative working capacity.Finally, this study supplies information on prevalence rates of PTSD and CPTSD in a clinicalsample suffering from psychosomatic complaints.Methods: Participants were 662 patients of a Psychosomatic Rehabilitation Clinic (ageM= 50.99,SD8.99 years; 70.1% female). Self-report screening instruments were adminis-tered to participants at the beginning of their inpatient psychotherapy. Multivariate analysisof variance and Chi Square tests were utilized to assess group differences in symptomseverity, comorbidity and work-related impairment.Results: A prevalence of 13.3% CPTSD and 9.5% PTSD was found among the current sample.CPTSD was associated with heightened symptom burden and more comorbid diagnoses.More importantly, CPTSD was associated with a significantly lowered qualitative and quan-titative working capacity compared to PTSD and no-PTSD.Conclusions: The high prevalence, greater psychopathological burden and work-relatedimpairments in CPTSD compared to PTSD highlight the need for developing and evaluatingnew interventions in rehabilitation that address the complexity of the new disorder

ICD-11 Adjustment Disorder among Organ Transplant Patients and Their Relatives

Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. The current study assesses the prevalence of self-reported ICD-11 AD among organ transplantation patients and their relatives, explores the association of patients' demographic-, transplant-, and health-related characteristics and ICD-11 AD symptoms, and evaluates the role of social support in the post- transplant context. A total of N = 140 patient-relative dyads were examined cross-sectionally. Hierarchical linear regression analyses were conducted to explore potential predictive factors of AD. The results revealed an AD prevalence of 10.7% among patients and 16.4% among relatives at an average of 13.5 years after the transplantation. The time that had passed since the transplantation was unrelated to AD symptom severity. Women tended to be at a higher risk in both groups. Somatic issues were predictive for AD only among patients and social support was predictive mainly among relatives. The results suggest that ICD-11 AD is a relevant diagnosis after organ transplantations for patients and relatives and its specific symptom clusters may provide important information for developing intervention strategies

Validation and Adaptation into Spanish of the Revised Sense of Coherence Scale (SOC-R): A Scale Associated with Life Satisfaction

This study aimed to evaluate the psychometric properties of the Spanish version of the Revised Sense of Coherence (SOC-R) in Argentina, which assesses the general ability to perceive life phenomena as connected and to balance positive and negative appraisals of life experiences. A total of 575 people participated in the study with ages between 18 and 84 years (M = 43.94, SD = 15.90) and both genders (male= 35.7 %, female= 64.3 %). A 3-factor model resulted in acceptable fit indices (NNFI = .95; CFI = .97; IFI = .97; RMSEA = .054). Results indicated an acceptable internal consistency for the subscales Manageability (ω= .73; α= .69), Reflection (ω= .89; α= .85) and Balance (ω= .70; α= .55). The adaptation into Spanish presents 13 items, as proposed by the original authors. The findings showed that the scale is valid to be used in the Argentine population

Growing Apart: A Longitudinal Assessment of the Relation Between Post-traumatic Growth and Loneliness Among Combat Veterans

The aftermath of war-related trauma may entail psychological devastation and is typically accompanied by various deleterious phenomena. These include, but are not limited to, high rates of loneliness. However, trauma may also result in positive outcomes such as personal, spiritual, and relational prosperity, which are typically considered under the conceptual framework of post-traumatic growth (PTG). PTG may theoretically contribute to either loneliness amelioration (e.g., via increasing one's appreciation of close relationships) or exacerbation (e.g., by increasing one's sense of undergoing experiences that others do not share). Loneliness, on the other hand, may potentially hinder PTG by fostering negative social cognitions and behaviors, or otherwise lead to personal growth. The relations between the two phenomena, however, have yet to be investigated. Filling this gap, the current study examined the aforementioned potentialities by utilizing an autoregressive cross-lagged modeling strategy (ARCL) with a cohort of 260 Israeli combat veterans assessed 30, 35, and 42 years after their participation in the 1973 Yom Kippur War. Results indicated that higher rates of PTG were consistently related to higher rates of loneliness both cross-sectionally and longitudinally. Loneliness, however, did not longitudinally predict PTG rates. It is suggested that these findings may be understood in light of the observation that veterans' loneliness is primarily related to the experience of being experientially out of sync with people who have not endured war experiences. It is suggested that this experiential loneliness may include not only the negative but also the positive ramifications of undergoing such traumas (i.e., PTG). We, therefore, argue that while PTG may include authentic positive transformations it may also lead to more negative ramifications, and these should be identified and addressed by researchers and clinicians alike. Thus, as study limitations are acknowledged, clinical implications, and future research directions are suggested

What doesn't kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war

Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes

Validation and Adaptation into Spanish of the Revised Sense of Coherence Scale (SOC-R): A Scale Associated with Life Satisfaction

This evaluates the psychometric properties of the Spanish version of the Revised Senseof Coherence (SOC-R) scale in Argentina, which assesses the general ability to perceive lifephenomena as connected and to balance positive and negative appraisals of life experiences.A total of 575 people participated in the study with ages between 18 and 84 years (M = 43.94,SD = 15.90) and both genders (male= 35.7 %, female= 64.3 %). A 3-factor model resulted inacceptable fit indices (NNFI = .95; CFI = .97; IFI = .97; RMSEA = .054). Results indicatedan acceptable internal consistency for the subscales Manageability (ω= .73; α= .69),Reflection (ω= .89; α= .85) and Balance (ω= .70; α= .55). The adaptation into Spanishpresents 13 items, as proposed by the original authors. The findings showed that the scale isvalid for use in the Argentine population.Fil: Yaccarini, Cecilia Belen. Universidad Maimónides; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Simkin, Hugo Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Defensa. Ejército Argentino. Instituto de Enseñanza Superior del Ejército. Centro de Investigaciones Sociales y Humanas para la Defensa; Argentina. Universidad de Buenos Aires; ArgentinaFil: Bachem, Rahel. Universitat Tel Aviv; Israel. Universitat Zurich; SuizaFil: Azzollini, Susana Celeste. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Defensa. Ejército Argentino. Instituto de Enseñanza Superior del Ejército. Centro de Investigaciones Sociales y Humanas para la Defensa; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentin

Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads

Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement. Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children’s internalizing and externalizing difficulties. Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children’s direct exposure to adverse life experiences. Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35). Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings

ZIEL: Internet-Based Self-Help for Adjustment Problems: Results of a Randomized Controlled Trial

Adjustment Disorder (AjD) represents a healthcare paradox. On the one hand, it is one of the most diagnosed mental disorders worldwide. On the other hand, AjD and its possible treatment options remain a severely neglected field of research. In this context, we developed a self-guided online intervention for adjustment problems, named ZIEL, and tested its efficacy. It is based on and extends a bibliotherapeutic treatment approach for symptoms of AjD. In our study, a total of 98 individuals who had experienced a life event in the last two years, were randomly assigned to care as usual (CAU) or an online intervention group (CAU + online intervention). The primary endpoint was AjD symptom severity measured by Adjustment Disorder-New Module 20 (ADNM-20). Secondary endpoints were depressive symptoms, quality of life and other variables such as satisfaction and usability. Both the intervention and the control group improved comparably well regarding the severity of adjustment disorder symptoms post-treatment. However, participants in the intervention group showed significantly fewer depressive symptoms and a significantly higher quality of life (Cohen's d: 0.89 (BDI) and -0.49 (SF-12)). The intervention was well-received by users with an above average usability rating. Overall, the results suggest that the ZIEL intervention has the promise to contribute to the treatment of AjD and reduce symptom burden by means of a scalable low-barrier approach

The network structure of ICD-11 adjustment disorder: A comparison of clinical and nonclinical samples

Background: International Classification of Diseases, 11th revision (ICD-11) adjustment disorder (AjD) is characterized by two main symptom clusters: preoccupation with the stressor and failure to adapt to the stressor. The network analytic approach provides important information on the structural validity of a disorder and reveals which symptoms are most prominent. To date, no study compared the network structure of AjD symptoms in clinical and nonclinical samples, which could potentially inform our understanding of psychopathological mechanisms that underlie AjD and identify core targets for therapy. Methods: A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder—New Module (ADNM-8) using data from 330 clinical participants from the UK and a nonclinical sample of 699 participants from Switzerland. Results: Comparisons of network structure invariance revealed differences between the network structure of the clinical and the nonclinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms was more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the nonclinical sample. Importantly, global strength was similar across networks. Conclusions: Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. They tentatively suggest that subclinical AjD may be characterized by emerging preoccupation symptoms that may result in failure to adapt and functional impairment in clinical manifestation of AjD. However, there is a need for replication and longitudinal research to further validate this hypothesis

Longitudinal Development of Primary and Secondary Posttraumatic Growth in Aging Veterans and Their Wives: Domain-Specific Trajectories

Posttraumatic growth (PTG), the positive psychological transformations that follow traumatic events, affects both direct survivors (primary PTG) and their significant others (secondary PTG). Though primary and secondary PTG have been widely investigated in the literature, their long-term trajectories decades after a traumatic event, especially as survivors enter older age, remain largely uninvestigated. Furthermore, it remains contested whether PTG adds up to a monolithic construct or rather consists of relatively independent components. Addressing these issues, we assessed a sample of Israeli male veterans from the 1973 Yom Kippur war (N = 349) and their wives (N = 156) at three time points over the course of nearly three decades. Both the veterans (primary survivors) and their wives (secondary survivors) reported PTG relating to the veterans' experiences during the war and/or captivity. Latent growth mixture modeling was conducted to identify trajectories of PTG on the five subscales of the Posttraumatic Growth Inventory. Long-term trajectories of PTG followed heterogeneous patterns of fluctuation over time and particularly as participants entered older age. On most subscales, decreasing PTG scores were evident, a trend that was more pronounced among the primary survivors than the secondary survivors as primary and secondary PTG fluctuate considerably in the long-term and seem to decrease as individuals enter older age. Furthermore, it would seem that PTG should not be considered a holistic concept but rather a conglomeration of positive changes. Implications of the findings are discussed within the context of limitations and potential intervening factors