The Ukraine-Russia war : a symptoms network of complex posttraumatic stress disorder during continuous traumatic stress

Objective: This study is aimed to test the symptoms network of ICD-11 Complex Post-traumatic Stress Disorder (CPTSD) symptoms, using data collected from Ukrainian civilians during the 2022 Russia-Ukraine war. Findings can inform our understanding of the stress response in individuals exposed to continuous trauma and give insight into the nature of CPTSD during war. Methods: A network analysis was conducted on CPTSD symptoms as assessed by the International Trauma Questionnaire using data from a nationally representative sample of 2000 Ukrainians. Results: While Post-traumatic Stress Disorder (PTSD) and Disturbances in Self Organization (DSO) clusters did not enmesh, several communities within these clusters were merged. Results highlight that in terms of strength centrality, emotional dysregulation (emotional numbing) and a heightened sense of threat were most prominent. Conclusion: The results confirm the ICD-11 structure of CPTSD but suggest that continuous traumatic stress manifests in more condensed associations between CPTSD symptoms and that emotional regulation may play a vital role in activating the CPTSD network. War-exposed populations could be provided with scalable, brief self-help materials focused on fostering emotion regulation and sense of threat

Death, treatment decisions and the permanent vegetative state: evidence from families and experts

Some brain injured patients are left in a permanent vegetative state, i.e., they have irreversibly lost their capacity for consciousness but retained some autonomic physiological functions, such as breathing unaided. Having discussed the controversial nature of the permanent vegetative state as a diagnostic category, we turn to the question of the patients’ ontological status. Are the permanently vegetative alive, dead, or in some other state? We present empirical data from interviews with relatives of patients, and with experts, to support the view that the ontological state of permanently vegetative patients is unclear: such patients are neither straightforwardly alive nor simply dead. Having defended this view from counter-arguments we turn to the practical question as to how these patients ought to be treated. Some relatives and experts believe it is right for patients to be shifted from their currently unclear ontological state to that of being straightforwardly dead, but many are concerned or even horrified by the only legally sanctioned method guaranteed to achieve this, namely withdrawal of clinically assisted nutrition and hydration. A way of addressing this distress would be to allow active euthanasia for these patients. This is highly controversial; but we argue that standard objections to allowing active euthanasia for this particular class of permanently vegetative patients are weakened by these patients’ distinctive ontological status

The Interrelations of Family Relationship, Illness Cognition of Helplessness and Perceived Barriers to Medication Adherence: A Study of Adolescent and Emerging Adult Kidney Recipients and Their Parents

Yaira Hamama-Raz,1 Yaacov Frishberg,2 Menachem Ben-Ezra,1 Yafit Levin1 1School of Social Work, Ariel University, Ariel, Israel; 2Division of Pediatric Nephrology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelCorrespondence: Yaira Hamama-Raz, Email [email protected]: Medication adherence among adolescents and emerging adults following kidney transplantation was found to be lower with harmful consequences. The current study aimed to examine associations between illness cognition of helplessness, family relationships, and perceived barriers to medication adherence among post-kidney transplant adolescent and emerging adult recipients and their parents by applying a dyadic perspective.Methods: Fifty-nine dyads of adolescents and emerging adults aged 11– 26 years and their parents, were recruited from a pediatric nephrology department in a medical center in Israel. Both adolescents and emerging adults and parents completed self-report questionnaires addressing illness cognition of helplessness (subscale of Illness Cognition Questionnaire), family relationships related to conflict and cohesion (Brief Family Relationship Scale), and the adolescents’ perceived barriers (Adolescent Medication Barriers Scale) to taking their prescribed medications.Results: Adolescents’ and emerging adults’ perceptions of family conflicts moderated the link between illness cognition of helplessness among parents and barriers to medication adherence via the illness cognition of helplessness among adolescents and emerging adults. However, only the adolescents’ and emerging adults’ perceptions of family cohesion had a direct association with barriers to medication adherence. Parents’ perceived family conflict and cohesion did not directly associate with barriers to medication adherence. Findings highlight the complex interplay between family dynamics, illness cognition, and barriers to medication adherence in adolescents and emerging adults.Conclusion: Parents’, adolescents’ and emerging adults’ perceptions of family conflicts and cohesion, as well as their illness cognitions, can play important roles in understanding and addressing barriers to medication adherence in this population. The study reveals findings that highlight the dyadic transference process of illness cognition of helplessness among both adolescent and emerging adult kidney recipients and their parents in assessing barriers to medical treatment.Keywords: illness cognition of helplessness, family relationships, barriers to medication adherence, adolescents, parents, kidney transplantatio

The toll of a second lockdown : a longitudinal study

Background The mental health toll of a second lockdown during the COVID-19 pandemic has not been yet examined. The purpose of the study was to examine psychological predictors before the second lockdown and their impact on the prediction of ICD-11 probable Adjustment Disorder (AjD) after the second lockdown. Methods Using a longitudinal design we surveyed a national representative sample of the Israeli population before and after the second lockdown. In wave 1, 1029 were surveyed (Response Rate (RR) = 76.17%) and in Wave 2, 764 were surveyed (RR = 74.24%). Participants answer a questionnaire tapping COVID-19 stressful related events, uncertainty, probable depression predicting ICD-11 and probable AjD. Results The main predictors of AjD after the second lockdown were sex (OR = 1.868; p ≤0.01), having a COVID-19 occupational related stressful event (OR = 2.855; p <0.001), probable depression (OR = 2.520; p <0.001) and Uncertainty (OR = 4.485; p <0.001). Limitations We recognise the limitations of response bias. In addition, we did not measure pre COVID-19 mental health. Conclusions The study results show the mental toll of a second lockdown during the COVID-19 pandemic

The interplay between adjustment disorder symptoms network and probable diagnosis before and after second lockdown in Israel : a longitudinal study

BACKGROUND: There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology. AIMS: To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder. METHOD: This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ). RESULTS: Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was ‘difficult to relax’ in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. ‘Worry a lot more’ (preoccupation) and ‘difficult to adapt to life’ (failure to adapt) at T1 significantly predicted this diagnosis at T2. CONCLUSIONS: Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic

Disability and post-traumatic stress symptoms in the Ukrainian general population during the 2022 Russian invasion

Aims: Previous research has shown that people with disabilities are disproportionately vulnerable to symptoms of psychological distress after exposure to armed conflict. Past work has also shown that individuals displaced by conflict are at heightened risk of post-traumatic stress. Using a national online sample of Ukrainians in the early weeks of the 2022 Russian invasion we aim to examine associations between functional disability and symptoms of post-traumatic stress. Method: We examined the association between levels of functional disability in the Ukrainian population and symptoms of post-traumatic stress during the 2022 Russian invasion of Ukraine. We analysed data from a national sample of 2000 participants from across this country, assessing disability using the WHODAS-12 (six domains of disability) and the ITQ assessment of ICD-11 PTSD symptomatology. Moderated regression examined the impact of displacement status on the disability-post-traumatic stress relationship. Results: Different domains of disability predicted post-traumatic stress symptoms to varying extents, with overall disability score significantly associated with post-traumatic stress symptoms. This relationship was not moderated by displacement status. Consistent with previous research, females reported higher levels of post-traumatic stress. Conclusions: In a study of a general population during a time of armed conflict individuals with more severe disabilities were at greater risk of post-traumatic stress symptoms. Psychiatrists and related professionals should consider pre-existing disability as a risk factor for conflict-related post-traumatic stress