Efficacy of internet-based interventions for common mental disorder symptoms and psychosocial problems in older adults: A systematic review and meta-analysis.

Although a high proportion of older adults suffer from common mental disorder symptoms and psychosocial problems, only a small number of older individuals seek psychological treatment. Internet-based interventions have the potential to bridge this treatment gap. However, while there is extensive literature on internet-based treatments in younger to middle-aged adults, research on older individuals is lacking. We aimed to summarize narratively and empirically the existing literature on the efficacy of internet-based interventions for the treatment of common mental disorder symptoms and psychosocial problems (loneliness, stress) in older individuals. This systematic review and meta-analysis was registered in PROSPERO (registration number: CRD42021235129). Systematic literature searches were conducted in PsycInfo, Ageline, Medline, CINHAL, and Psyndex. Studies were eligible for inclusion if they a) focused on older adults, b) assessed the efficacy of an internet-delivered psychological intervention, c) included a control condition and d) assessed common mental disorder symptoms or psychosocial problems as outcomes. Meta-analyses were conducted based on studies that included a passive, minimally active or placebo control condition to estimate pooled effects on overall symptom severity as well as on specific psychological outcomes. 11 Studies met inclusion criteria, with the majority of interventions focusing on depression or anxiety symptoms and being based on CBT principles. Significant large effect of internet-based interventions for older adults were found for overall symptom severity (depression, anxiety, PTSD, stress) as well as for depression symptom severity. No significant effects were found for anxiety symptom severity. Our findings provide preliminary support that internet-based interventions might be a feasible and effective intervention method for the treatment of common mental disorder symptoms and stress in older adults. However, research in this area is still at an early stage. More studies are needed to shed light on the role of various treatment and patient characteristics in the efficacy of internet-delivered treatments

Verläufe von Traumafolgen bei ehemaligen politisch Inhaftierten der DDR: Ein 15-Jahres-Follow-up

Zusammenfassung: Hintergrund: In einer Mitte der 1990er Jahre untersuchten Stichprobe ehemaliger politisch Inhaftierter der DDR wurden im 15-Jahres-Follow-up die Veränderungen der Diagnose- und Symptomprävalenzen der posttraumatischen Belastungsstörung (PTBS) sowie anderer psychischer Störungen untersucht. Zudem wurden die durch Kliniker erhobenen Diagnosenverläufe mit den retrospektiven subjektiven Einschätzungen der Studienteilnehmer verglichen. Methode: Dreiundneunzig ehemals politisch inhaftierte Personen nahmen an der Folgestudie teil (85% Wiederteilnahme), ihr mittleres Alter betrug 64Jahre. Diagnosen und Symptome wurden mittels strukturierter klinischer Interviews sowie Fragebögen erfasst. Die retrospektiven subjektiven Verlaufseinschätzungen der Teilnehmer wurden mittels eines PTBS-Symptomindex basierend auf 4Symptomgruppen (Intrusionen, Vermeidung, Numbing, Hyperarousal) errechnet. Ergebnisse: Eine aktuelle PTBS lag bei 33% vor (1997: 29%). Nur ca. in der Hälfte der Fälle lag diese schon 1994 vor, bei der anderen Hälfte handelt es sich um neu-inzidente bzw. remittierte Fälle. Nächsthäufige Diagnosen waren Major-Depression, Episode (26%), Panik (mit oder ohne Agoraphobie: 24%) sowie somatoforme Störungen (19%). Im PTBS-Symptomprofil nahmen Intrusionen, Flashbacks bzw. Entfremdungsgefühl im Zeitverlauf ab, Reizbarkeit und Schreckreaktionen hingegen zu. Die subjektive Selbsteinschätzung der PTBS-Symptomverläufe durch die Studienteilnehmer ergab im Vergleich mit den Diagnostikern häufiger ein resilientes ("nie PTBS") oder verzögertes und seltener ein remittiertes Verlaufsmuster. Schlussfolgerung: Die Ergebnisse sprechen für eine traumabezogene Langzeitmorbidität, die allerdings instabiler ist als bisher angenomme

Cardiovascular correlates of motor vehicle accident related posttraumatic stress disorder and its successful treatment

Springer Open Choice ArticlePersons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.This study was supported by the Deutsche Forschungsgemeinschaft (KA 1476/3

Posttraumatische Belastungsstörungen in Deutschland: Ergebnisse einer gesamtdeutschen epidemiologischen Untersuchung

Zusammenfassung: In einer repräsentativen Bevölkerungsstichprobe (n=2426) über ein breites Alterspektrum (14-93Jahre) wurden die Prävalenz traumatischer Ereignisse, des Vollbildes der posttraumatische Belastungsstörung (PTBS) und partieller PTBS-Syndrome geschätzt. Ein standardisiertes Interview mit einer Traumaliste des Composite International Diagnostic Interviews (CIDI) und eine PTSD-Symptomliste nach DSM-IV (modifizierte PTSD-Symptomskala) wurden eingesetzt. Die Einmonatsprävalenzrate lag bei 2,3% für das PTBS-Vollbild sowie 2,7% für die partiellen PTBS-Syndrome. Während sich keine Geschlechtsunterschiede hinsichtlich der Prävalenz ergaben, zeigten sich Altersgruppenunterschiede: Die über 60-Jährigen hatten eine Prävalenz bez. des PTBS-Vollbildes von 3,4%, während diese bei den 14- bis 29-Jährigen 1,3% und bei den 30- bis 59-Jährigen 1,9% betrug. Die partiellen PTBS-Syndrome zeigten ebenfalls einen Altersgipfel mit 3,8% in der Gruppe der Älteren sowie 2,4% bei Mittelalten und 1,3% bei jungen Erwachsenen. Die Ergebnisse entsprechen weitgehend denen anderer internationaler Studien, wenn Kriegsauswirkungen für bestimmte Altersgruppen als nationale Besonderheiten berücksichtigt werden. Erstmals konnte unsere repräsentative Studie eine - wahrscheinlich durch den 2.Weltkrieg mitbedingte - relativ hohe Prävalenz der PTBS in der höchsten Altersgruppe der deutschen Bevölkerung aufzeige

ALMA observations of TiO2_2 around VY Canis Majoris

Titanium dioxide, TiO$_2$, is a refractory species that could play a crucial role in the dust-condensation sequence around oxygen-rich evolved stars. To date, gas phase TiO$_2$ has been detected only in the complex environment of the red supergiant VY CMa. We aim to constrain the distribution and excitation of TiO$_2$ around VY CMa in order to clarify its role in dust formation. We analyse spectra and channel maps for TiO$_2$ extracted from ALMA science verification data. We detect 15 transitions of TiO$_2$, and spatially resolve the emission for the first time. The maps demonstrate a highly clumpy, anisotropic outflow in which the TiO$_2$ emission likely traces gas exposed to the stellar radiation field. A roughly east-west oriented, accelerating bipolar-like structure is found, of which the blue component runs into and breaks up around a solid continuum component. A distinct tail to the south-west is seen for some transitions, consistent with features seen in the optical and near-infrared. We find that a significant fraction of TiO$_2$ remains in the gas phase outside the dust-formation zone and suggest that this species might play only a minor role in the dust-condensation process around extreme oxygen-rich evolved stars like VY CMa.Comment: Accepted for publication in Astronomy & Astrophysics, 25 pages, 20 figure

Post- and peritraumatic stress in disaster survivors: An explorative study about the influence of individual and event characteristics across different types of disasters

Background: Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards. Objective: To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters. Additionally, to investigate individual and event characteristics. Design: In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event. Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R). Peritraumatic emotional stress and risk perception were rated retrospectively. Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed. Results: Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters. Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes. Conclusion: Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters. However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics. As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables

ALMA observations of the variable 12CO/13CO ratio around the asymptotic giant branch star R Sculptoris

[abridged] The 12CO/13CO ratio is often used as a measure of the 12C/13C ratio in the circumstellar environment, carrying important information about the stellar nucleosynthesis. External processes can change the 12CO and 13CO abundances, and spatially resolved studies of the 12CO/13CO ratio are needed to quantify the effect of these processes on the globally determined values. Additionally, such studies provide important information on the conditions in the circumstellar environment. The detached-shell source R Scl, displaying CO emission from recent mass loss, in a binary-induced spiral structure as well as in a clumpy shell produced during a thermal pulse, provides a unique laboratory for studying the differences in CO isotope abundances throughout its recent evolution. We observed both the 12CO(J=3-2) and the 13CO(J=3-2) line using ALMA. We find significant variations in the 12CO/13CO intensity ratios and consequently in the abundance ratios. The average CO isotope abundance ratio is at least a factor three lower in the shell (~19) than that in the present-day (60). Additionally, variations in the ratio of more than an order of magnitude are found in the shell itself. We attribute these variations to the competition between selective dissociation and isotope fractionation in the shell, of which large parts cannot be warmer than ~35 K. However, we also find that the 12CO/13CO ratio in the present-day mass loss is significantly higher than the 12C/13C ratio determined in the stellar photosphere from molecular tracers (~19). The origin of this discrepancy is still unclear, but we speculate that it is due to an embedded source of UV-radiation that is primarily photo-dissociating 13CO. This radiation source could be the hitherto hidden companion. Alternatively, the UV-radiation could originate from an active chromosphere of R Scl itself....Comment: 6 pages, 5 figures, online data available at http://vizier.u-strasbg.fr/viz-bin/VizieR?-source=J/A+A/556/L

Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis

Background: The WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses, posttraumatic stress disorder (PTSD) and complex PTSD within the spectrum of trauma and stress-related disorders. Objective: To use latent profile analysis (LPA) to determine whether there are classes of individuals that are distinguishable according to the PTSD and complex PTSD symptom profiles and to identify potential differences in the type of stressor and severity of impairment associated with each profile. Method: An LPA and related analyses were conducted on 302 individuals who had sought treatment for interpersonal traumas ranging from chronic trauma (e.g., childhood abuse) to single-incident events (e.g., exposure to 9/11 attacks). Results: The LPA revealed three classes of individuals: (1) a complex PTSD class defined by elevated PTSD symptoms as well as disturbances in three domains of self-organization: affective dysregulation, negative self-concept, and interpersonal problems; (2) a PTSD class defined by elevated PTSD symptoms but low scores on the three self-organization symptom domains; and (3) a low symptom class defined by low scores on all symptoms and problems. Chronic trauma was more strongly predictive of complex PTSD than PTSD and, conversely, single-event trauma was more strongly predictive of PTSD. In addition, complex PTSD was associated with greater impairment than PTSD. The LPA analysis was completed both with and without individuals with borderline personality disorder (BPD) yielding identical results, suggesting the stability of these classes regardless of BPD comorbidity. Conclusion: Preliminary data support the proposed ICD-11 distinction between PTSD and complex PTSD and support the value of testing the clinical utility of this distinction in field trials. Replication of results is necessary.For the abstract or full text in other languages, please see Supplementary files under Article Tools onlin

Unexpectedly large mass loss during the thermal pulse cycle of the red giant R Sculptoris!

The asymptotic giant branch star R Sculptoris is surrounded by a detached shell of dust and gas. The shell originates from a thermal pulse during which the star undergoes a brief period of increased mass loss. It has hitherto been impossible to constrain observationally the timescales and mass-loss properties during and after a thermal pulse - parameters that determine the lifetime on the asymptotic giant branch and the amount of elements returned by the star. Here we report observations of CO emission from the circumstellar envelope and shell around R Sculptoris with an angular resolution of 1.3 arcsec. What was hitherto thought to be only a thin, spherical shell with a clumpy structure, is revealed to contain a spiral structure. Spiral structures associated with circumstellar envelopes have been seen previously, from which it was concluded that the systems must be binaries. Using the data, combined with hydrodynamic simulations, we conclude that R Sculptoris is a binary system that underwent a thermal pulse approximately 1800 years ago, lasting approximately 200 years. About 0.003 Msun of mass was ejected at a velocity of 14.3 km s-1 and at a rate approximately 30 times higher than the prepulse mass-loss rate. This shows that approximately 3 times more mass is returned to the interstellar medium during and immediately after a pulse than previously thought.Comment: Accepted by Natur