Posttraumatic Stress Disorder and Health-Related Quality of Life among a Sample of Treatment- and Pension-Seeking Deployed Canadian Forces Peacekeeping Veterans

Objectives: To examine the health-related quality of life (HRQOL) in deployed Canadian Forces peacekeeping veterans, addressing associations with posttraumatic stress disorder (PTSD), and depression severity. Methods: Participants (n = 125) were consecutive male veterans who were referred for a psychiatric assessment. Instruments administered included the Clinician-Administered PTSD Scale, Hamilton Depression Scale, Short-Form-36 Health Survey, and sociodemographic characteristics. Results: Mental HRQOL was significantly lower for peacekeepers with, than without, PTSD. Using univariate analyses, PTSD and depression severity were each significantly negatively related to mental HRQOL. In sequential regression analyses controlling for age, we found that PTSD and depression severity significantly predicted both mental and physical HRQOL. Conclusions: Veterans with PTSD have significant impairments in mental and physical HRQOL. This information is useful for clinicians and Veterans Affairs administrators working with the newer generation of veterans, as it stresses the importance of including measures of quality of life in the psychiatric evaluation of veterans to better address their rehabilitation needs

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

Objective: This study examined associations between sociodemographic, military, and psychiatric need variables and past-year mental health service use among active Canadian military members. The likelihood and intensity of services were examined across two provider types— mental health providers and medical providers. Methods: Data were drawn from the first epidemiological survey of mental health in the Canadian Forces, conducted by Statistics Canada in 2002. Survey instruments included the Composite International Diagnostic Interview, which was used to assess mental health and service use. Results: Of the 8,441 military members who participated in the survey, 14.5% (N=1,220) met criteria for having a mental disorder in the past year. However, of the 8,441 only 9.1% (N=767) contacted a mental health provider in the past year for mental health problems; even fewer (N=539, 6.4%) contacted a medical provider. Across the two provider types, the majority of those seeing a provider reported five or fewer mental health visits in the past year. In univariate and multivariate analyses across the two provider types, psychiatric need variables were consistently associated with both greater service use likelihood and intensity. In multivariate analyses, lower military rank was consistently associated with both greater service use likelihood and intensity. Conclusions: Of the entire military sample, only a small percentage used mental health services. The observed associations between military and psychiatric need variables and mental health service use in this study should be used by military health care providers and administrators to increase mental health service use among those most at risk of not using services

Problematic social media use in childhood and adolescence.

At the time of writing, about 4.59 billion people use social media with many adolescents using their social media accounts across a myriad of applications and platforms. According to recent statistics, in 2022 individuals spent an average of 151 minutes on social media each day, illustrating the global relevance of social media (Dixon, 2022a,b). One of the pressing questions, internationally, is whether social media use is harmful and/or addictive. This question is of particular importance because many teenagers - and younger adolescents - spend considerable time on these platforms, which have increasingly become an integral part of their lives. Moreover, considering lifespan development, adolescents may be particularly vulnerable to specific features and advertisements shown to them on social media platforms. Growing prevalence of poor mental health in young people has led to recent recommendations in the United States to routinely screen for anxiety in 8-18 year olds, and for depression and suicide risk for adolescents between 12-18 years of age (US Preventive Services Task Force et al., 2022 a,b) - the conditions often accompanying problematic social media use. The present work not only provides insights into the current state of the literature but provides also recommendations. [Abstract copyright: Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Disseminating Evidence-Based Practices for Adults With PTSD and Severe Mental Illness in Public-Sector Mental Health Agencies

Posttraumatic stress disorder (PTSD) remains largely untreated among adults with severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes precedence in the care of adults with SMI. Such oversight is problematic in that PTSD in SMI populations is common (19-43%), contributes a significant illness burden, and hinders mental health care. Yet, few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the paper is to describe strategies and efforts to disseminate trauma-focused empirically-based practices (EBPs) in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are: set clear goals; nurture broad-based organizational commitment and key stakeholder involvement; implement specialty training efforts to provide information and change attitudes; provide on-going supervision; conduct fidelity monitoring; and ensure accountability to the extent possible

Diagnostic Utility of the Impact of Event Scale-Revised in Two Samples of Survivors of War

The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) as a screening tool for post-traumatic stress disorder (PTSD) in survivors of war. The IES-R was completed by two independent samples that had survived the war in the Balkans: a sample of randomly selected people who had stayed in the area of former conflict (n = 3,313) and a sample of refugees to Western European countries (n = 854). PTSD was diagnosed using the MINI International Neuropsychiatric Interview. Prevalence of PTSD was 20.1% in the Balkan sample and 33.1% in the refugee sample. Results revealed that when considering a minimum value of specificity of 0.80, the optimally sensitive cut-off score for screening for PTSD in the Balkan sample was 34. In both the Balkan sample and the refugee sample, this cut-off score provided good values on sensitivity (0.86 and 0.89, respectively) and overall efficiency (0.81 and 0.79, respectively). Further, the kappa coefficients for sensitivity for the cut-off of 34 were 0.80 in both samples. Findings of this study support the clinical utility of the IES-R as a screening tool for PTSD in large-scale research studies and intervention studies if structured diagnostic interviews are regarded as too labor-intensive and too costly

PTSD-8: A Short PTSD Inventory

Traumatic events pose great challenges on mental health services in scarcity of specialist trauma clinicians and services. Simple short screening instruments for detecting adverse psychological responses are needed. Several brief screening instruments have been developed. However, some are limited, especially in relation to reflecting the posttraumatic stress disorder (PTSD) diagnosis. Recently, several studies have challenged pre-existing ideas about PTSD’s latent structure. Factor analytic research currently supports two four factor models. One particular model contains a dysphoria factor which has been associated with depression and anxiety. The symptoms in this factor have been hailed as less specific to PTSD. The scope of this article is therefore to present a short screening instrument, based on this research; Posttraumatic Stress Disorder (PTSD) – 8 items. The PTSD-8 is shown to have good psychometric properties in three independent samples of whiplash patients (n=1710), rape victims (n=305), and disaster victims (n=516). Good test-rest reliability is also shown in a pilot study of young adults from families with alcohol problems (n=56)

Preliminary Study of Acute Changes in Emotion Processing in Trauma Survivors with PTSD Symptoms

Accumulating evidence suggests traumatic experience can rapidly alter brain activation associated with emotion processing. However, little is known about acute changes in emotion neurocircuits that underlie PTSD symptom development. To examine acute alterations in emotion circuit activation and structure that may be linked to PTSD symptoms, thirty-eight subjects performed a task of appraisal of emotional faces as their brains were functionally and structurally studied with MRI at both two weeks and three months after motor vehicle collision (MVC). As determined by symptoms reported in the PTSD Checklist at three months, sixteen survivors developed probable PTSD, whereas the remaining 22 did not meet criteria for PTSD diagnosis (non-PTSD). The probable PTSD group had greater activation than the non-PTSD group in dorsal and ventral medial prefrontal cortex (dmPFC and vmPFC) while appraising fearful faces within two weeks after MVC and in left insular cortex (IC) three months after MVC. dmPFC activation at two weeks significantly positively correlated with PTSD symptom severity at two weeks (R = 0.462, P = 0.006) and three months (R = 0.418, p = 0.012). Changes over time in dmPFC activation and in PTSD symptom severity were also significantly positively correlated in the probable PTSD group (R = 0.641, P = 0.018). A significant time by group interaction was found for volume changes in left superior frontal gyrus (SFG, F = 6.048, p = 0.019) that partially overlapped dmPFC active region. Between two weeks and three months, left SFG volume decreased in probable PTSD survivors. These findings identify alterations in frontal cortical activity and structure during the early post-trauma period that appear to be associated with development of PTSD symptoms

Therapist fidelity with an exposure-based treatment of ptsd in adults with schizophrenia or schizoaffective disorder

This study examined therapists’ fidelity to a manualized multi-component cognitive-behavioral intervention for posttraumatic stress disorder (PTSD), including exposure therapy, among public sector patients with a psychotic disorder. Therapists’ competence and adherence was assessed by clinicians at the master’s level or higher who rated 20% of randomly selected audiotaped sessions (n = 57 sessions, coded by two independent raters, with strong interrater agreement). Adherence ratings indicated that therapists complied well with the protocol, and competency ratings typically averaged above “very good” (6 on 7-point Likert scale). Findings suggest that therapists can effectively deliver a manualized cognitive-behavioral intervention for PTSD, with exposure therapy, to patients with severe mental illness without compromise to the structure of sessions and/or to the therapeutic relationship. These data add needed support for the implementation of cognitive-behavioral interventions, including exposure therapy, as effective treatments for PTSD in complicated patient populations such as those with severe forms of mental illness