Factores de riesgo y protectores para el trastorno de éstres postráumatico en individuos expuestos a trauma durante la pandemia COVID-19 – hallazgos de un estudio paneuropeo

Background: The COVID-19 pandemic is a health emergency resulting in multiple stressors that may be related to posttraumatic stress disorder (PTSD). Objective: This study examined relationships between risk and protective factors, pandemic-related stressors, and PTSD during the COVID-19 pandemic. Methods: Data from the European Society of Traumatic Stress Studies (ESTSS) ADJUST Study were used. N = 4,607 trauma-exposed participants aged 18 years and above were recruited from the general populations of eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. We assessed sociodemographic (e.g. gender), pandemic-related (e.g. news consumption), and health-related (e.g. general health condition) risk and protective factors, pandemic-related stressors (e.g. fear of infection), and probable PTSD (PC-PTSD-5). The relationships between these variables were examined using logistic regression on multiple imputed data sets. Results: The prevalence of probable PTSD was 17.7%. Factors associated with an increased risk for PTSD were younger age, female gender, more than 3 h of daily pandemic-related news consumption (vs. no consumption), a satisfactory, poor, or very poor health condition (vs. a very good condition), a current or previous diagnosis of a mental disorder, and trauma exposure during the COVID-19 pandemic. Factors associated with a reduced risk for PTSD included a medium and high income (vs. very low income), face-to-face contact less than once a week or 3–7 times a week (vs. no contact), and digital social contact less than once a week or 1–7 days a week (vs. no contact). Pandemic-related stressors associated with an increased risk for PTSD included governmental crisis management and communication, restricted resources, restricted social contact, and difficult housing conditions. Conclusion: We identified risk and protective factors as well as stressors that may help identify trauma-exposed individuals at risk for PTSD, enabling more efficient and rapid access to care.Antecedentes: La pandemia COVID-19 es una emergencia sanitaria que genera múltiples estresores que pueden estar relacionados con el trastorno de estrés postraumático (TEPT). Objetivo: Este estudio examinó las relaciones entre los factores de riesgo y protectores, estresores relacionados con la pandemia y TEPT durante la pandemia de COVID-19. Métodos: Se utilizaron los datos del estudio ADJUST de la Sociedad Europea de Estudios de Estrés Traumático (ESTSS por sus siglas en ingles). N=4.607 participantes mayores de 18 años expuestos a trauma fueron reclutados de la población general de once países (Austria, Croacia, Georgia, Alemania, Grecia, Italia, Lituania, Países Bajos, Polonia, Portugal y Suecia) desde junio a noviembre 2020. Evaluamos factores de riesgo y protectores sociodemográficos (p.ej. género), relacionados con la pandemia (p.ej. consumo de noticias) y relacionados con la salud (p.ej. estado de salud general), estresores relacionados con la pandemia (p.ej. temor a la infección) y TEPT probable (PC-PTSD-5 por sus siglas en ingles). Las relaciones entre estas variables se examinaron mediante regresión logística en múltiples conjuntos de datos imputados. Resultados: La prevalencia de TEPT probable fue del 17.7%. Los factores asociados con un mayor riesgo de TEPT fueron edad más joven, sexo femenino, más de 3 horas de consumo diario de noticias relacionadas con la pandemia (frente a ningún consumo), un estado de salud satisfactorio, malo o muy malo (frente a un estado muy bueno), un diagnóstico de trastorno mental actual o previo y exposición a un trauma durante la pandemia de COVID-19. Los factores asociados con un riesgo reducido de TEPT incluyeron ingresos medios y altos (frente a ingresos muy bajos), contacto cara a cara menos de una vez a la semana o de 3 a 7 veces por semana (frente a ningún contacto) y contacto social digital menos de una vez a la semana o de 1 a 7 días a la semana (frente a ningún contacto). Los estresores relacionados con la pandemia asociados con un mayor riesgo de TEPT incluyeron la gestión y comunicación de crisis gubernamental, recursos restringidos, contacto social restringido y condiciones de vivienda difíciles. Conclusiones: Identificamos factores de riesgo y protectores, así como estresores que pueden ayudar a identificar a las personas expuestas a traumas en riesgo de TEPT, lo que permite un acceso más eficiente y rápido a la atención

Posttraumatic Stress and Cognitive Processes in Patients with Burns

A severe burn is one of the most traumatic injuries a person can experience. Posttraumatic stress disorder (PTSD) is relatively common after burns, and can be devastating for the individual’s possibilities for recovery. The principal aims were to gain knowledge regarding posttraumatic stress symptoms and cognitive processes after burn and to evaluate methods for assessing symptoms of PTSD up to one year after burn. The psychometric properties of a Swedish version of the Impact of Event Scale-Revised (IES-R) were examined. The results indicate that the IES-R is a valid screening instrument for measuring PTSD symptoms in patients with burns and it can be used during hospitalisation to identify resilient individuals. The pattern of PTSD symptoms over time was also investigated. Four distinct trajectories of PTSD symptoms were identified, i.e. four groups of patients with significantly different onsets and courses. The trajectories differed in the expected direction regarding several risk factors associated with PTSD symptoms. Several previously known risk factors for PTSD symptoms were also identified including burn severity, psychiatric history, previous life events, early psychological symptoms, neuroticism-related personality traits, avoidant coping and low social support. The risk factors correspond well with those reported in the international trauma literature, which strengthens the findings in this thesis. Finally, using the emotional Stroop task at one year post burn it was found that burn-specific attentional bias was common and associated with more previous life events, more perceived life threat, larger burns and higher levels of PTSD symptoms. In summary, there are individual differences in the development and course of PTSD symptoms after burn and attentional bias is a common cognitive phenomenon related to these symptoms. The findings also support the use of the IES-R as a screening instrument for PTSD symptoms in patients with burns.

Feelings of guilt and embitterment in parents of children with burns and its associations with depression

Objectives: The aim was to examine guilt and embitterment in mothers and fathers of children with burns and its associations with depression and burn severity. Methods: Parents (N=61, mothers n=41, fathers n=20) completed self-report questionnaires on guilt and embitterment, 0.8-5.6 years after their child's burn. Burn severity and sociodemographic variables were obtained from medical records and symptoms of depression were assessed with the Montgomery-Asberg Depression Rating Scale (MADRS). Results: The parents reported low levels of guilt, embitterment and depression. Burn-specific and general guilt were higher in mothers than fathers, but there were no differences in embitterment or symptoms of depression. General guilt was associated with depression, whereas burn-specific guilt and embitterment were not. Conclusions: Parents with general guilt may suffer from symptoms of depression. An implication is that clinicians should address guilt feelings among parents in order to alleviate distress and to identify any need for further counseling

Psychometric properties of the PTSD Checklist for DSM-5 : a pilot study

Background: To date there is a lack of studies assessing the psychometric properties of the recently revised PTSD Checklist (PCL), the PTSD Checklist for DSM-5 (PCL-5). The aim of this pilot study was to examine the psychometric properties of the PCL-5 in parents of children with burns. Methods: The participating parents (N = 62, mean age = 38) completed self-report questionnaires, 0.8-5.6 years after their child's burn. Measures were the PCL-5, the Impact of Event Scale-Revised (IES-R), the Montgomery Asberg Depression Rating Scale (MADRS), and the Perceived Stress Scale (PSS). Burn severity of the child and sociodemographic variables was obtained. Results: The parents' average PCL-5 scores were low to moderate. The internal consistency of the PCL-5 was satisfactory, with Cronbach's alpha ranging from 0.56 to 0.77 and mean inter-item correlations ranging from 0.22 to 0.73 for the four PCL-5 subscales and the PCL-5 total. The PCL-5 subscales were moderately to highly correlated with the corresponding IES-R subscales as well as MADRS and PSS (p < 0.05), whereas associations with sociodemographics and burn severity were low to moderate. Conclusions: This study provides preliminary support for the use of PCL-5. The results indicate satisfactory psychometric properties of the PCL-5 as measured with internal consistency, test retest reliability, and aspects of convergent validity

Psychometric Properties of the PTSD Checklist for DSM-5 in parents to children with burns (018)

Introduction Symptoms of post-traumatic stress disorder (PTSD) is a common problem among parents of children with burns. However, there is a paucity of evaluated screening tools for this population. The aim was to evaluate the psychometric properties of the PTSD Checklist (PCL), which is recently revised in accordance to the Diagnostic and statistical manual of mental disorders, 5th ed.   Methods The participating parents (N= 62, mean age= 38) completed self-report questionnaires 0.8-5.6 years after their child’s burn. Measures were the PCL-5 (consisting of four subscales; Intrusion, Avoidance, Negative alterations in cognitions and mood, and Arousal and reactivity), the Impact of Event Scale-Revised (with three subscales; Intrusion, Avoidance and Hyperarousal) and the Perceived Stress Scale. The children had a TBSA burned ranging from 1 to 31 % and were 0.1-15.0 years of age at injury. Results The average PCL-5 scores were low to moderate and indicated that no parent was above the recommended preliminary cut off of 38 for PTSD. Cronbach’s alpha values were acceptable and varied between 0.56 and 0.77 for the four PCL-5 subscales and mean inter-item correlations ranged from 0.22 to 0.73. The PCL-5 subscales were positively correlated with the corresponding IES-R subscales as well as the total PSS score (p<.05). There were no associations between the PCL-5 and  burn severity (TBSA, TBSA-FT, and LOS), time since injury, child age or gender, or parent gender.  Conclusion In conclusion, the PCL-5 had high internal consistency and evaluation of concurrent validity suggested moderate associations with other measures of traumatic stress and perceived stress as expected. The moderate associations with other measures of stress is to be expected, taking into account the slightly different constructs targeted by the three measures in this study. This first study suggests that the PCL-5 is a psychometrically sound instrument that deserves further evaluation as a screening tool for parents of children with burns

Panel discussion : early interventions after traumatic events

This abstract is part of the European Journal of Psychotraumatology, Special Issue: The Swedish Psychotrauma Society Scientific Conference - Selected Abstracts.</p