Posttraumatic stress symptomatology after childhood traumatic brain injury

The purpose of this study was to quantify and to identify predictors of posttraumatic stress disorder (PTSD) symptomatology after traumatic brain injury (TBI). Fifty children aged 6 to 14 years, hospitalized after TBI, were assessed soon after TBI regarding injury severity and preinjury psychiatric, socioeconomic, family functioning, and family psychiatric history status; neuroimaging was also analyzed. Psychiatric assessments were repeated 3, 6, 12, and 24 months after TBI. Only 2 of 46 (4%) subjects with at least one follow-up assessment developed PTSD. However, the frequency with which subjects experienced at least one PTSD symptom ranged from 68% in the first 3 months to 12% at 2 years in assessed children. The presence of an internalizing disorder at time of injury followed by greater injury severity were the most consistent predictors of PTSD symptomatology. It is apparent, therefore, that PTSD and subsyndromal posttraumatic stress disturbances occur despite neurogenic amnesia. These problems should be treated, particularly if symptoms persist beyond 3 months.     

Impaired specific autobiographical memory as a risk factor for posttraumatic stress after trauma.

This study tested the proposal that impaired retrieval of specific autobiographical memories is a risk factor for psychological disturbance after trauma exposure. Trainee firefighters (N = 60) were assessed during training (before trauma exposure) on the Autobiographical Memory Test, Clinician Administered PTSD Scale, Beck Depression Inventory (BDI-II), and Traumatic Events Questionnaire. Participants were reassessed 4 years later (N = 46) on the Posttraumatic Diagnostic Scale and BDI-II. All participants had been exposed to multiple traumatic events, and 15% met criteria for posttraumatic stress disorder. Impaired retrieval of specific memories in response to positive cues prior to trauma exposure significantly predicted posttraumatic stress severity after trauma exposure. These findings provide initial evidence that impaired specific retrieval of memories may be a risk factor for posttraumatic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complex posttraumatic stress disorder in women from a psychometric perspective

The Brief Symptom Inventory was administered to 228 women (M age: 37) consecutively admitted to specialized inpatient treatment for trauma-related disorders. Subsamples of patients were administered different posttraumatic stress disorder scales, the Impact of Events Scale-Revised, the Posttraumatic Stress Diagnostic Scale, and the PTSD scale of the Millon Clinical Multiaxial Inventory-III, as well as a measure of child abuse and neglect, the Childhood Trauma Questionnaire. In this severely traumatized group, every scale of the Brief Symptom Inventory was significantly more elevated than the inpatient female norms, with the five most highly elevated scales being Depression, Obsessive-Compulsive, Anxiety, Interpersonal Sensitivity, and Psychoticism. Different indicators of trauma (Childhood Trauma Questionnaire, PTSD scales, and PTSD diagnosis) show different patterns of relationships with the individual scales of the Brief Symptom Inventory. There is no simple relationship between trauma and BSI symptoms, but clinicians should consider severe interpersonal trauma to be one pathway to pervasively elevated profiles of the Brief Symptom Inventory.     

A prospective study of predictors of disability at 3 months after non-central nervous system trauma

OBJECTIVE: To delineate which injury-related, demographic, and psychosocial variables were predictive of severe disability (limitations in the performance of socially defined roles and tasks) at 3 months after discharge from acute hospitalization for non-central nervous system traumatic injury. PATIENTS AND METHODS: The study design was prospective, longitudinal, and correlational. The sample consisted of 109 injured patients at three urban trauma centers. Data were obtained from patient interview using the Sickness Impact Profile, the Impact of Event Scale, and the Social Support Questionnaire; injury-related data were obtained from the medical record and computerized trauma registries. RESULTS: The sample had a mean age of 37.4 +/- 16.8 years, a mean number of injuries per person of 4.4 +/- 2.8, and a mean Injury Severity Score of 15.5 +/- 9.9. Motor vehicle crashes (34.9%) and violent injuries (33%) were the predominant causes of injuries. Patients experienced severe levels of disability (Sickness Impact Profile, mean = 26.1) and moderate levels of psychological distress (Impact of Event Scale, mean = 30.6; intrusion mean = 14.6 and avoidance mean = 16.0). Three variables were predictive of severe disability at 3 months: high levels of intrusive thoughts (odds ratio, 2.9; 95% confidence interval, 1.1-7.7); injury with a maximal Abbreviated Injury Scale score in an extremity (odds ratio, 2.9; 95% confidence interval, 1.2-6.9); and having not graduated from high school (odds ratio, 3.4; 95% confidence interval, 1.2-10). CONCLUSION: Extremity injuries, lack of high school graduation, and high level of posttraumatic psychological distress with intrusive thoughts are risk factors for severe disability at 3 months after discharge from the hospital.     

Does preinjury alcohol use or blood alcohol level influence cognitive functioning after traumatic brain injury?

Objective: To examine the relations among preinjury alcohol use patterns and admission blood alcohol level (BAL) and postinjury cognitive functioning among individuals with recent TBI. Design: Cohort survey with chart review and follow-up cognitive assessment. Setting: Acute inpatient rehabilitation program in a Level I trauma center. Participants: 124 consecutive initial admissions meeting inclusion criteria. Measures: Admission BAL, preinjury alcohol consumption, consequences, and symptoms of dependence, as well as initial injury severity and subsequent cognitive functioning. Results: Higher BAL at hospital admission was related to greater initial injury severity (lower Glasgow Coma Scale score). Preinjury alcohol consumption and admission BAL were not consistently related to any postinjury assessment of cognition. Conclusion: Alcohol use at the time of injury may exacerbate the initial severity of TBI. Cognitive functioning soon after injury does not appear to be related to any preinjury drinking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of blood pressure, cortisol, and prolactine among soldiers injured in the 1991-1993 war in Croatia

Ninety soldiers with at least three months of combat exposure--60 injured soldiers (30 with permanent disabling and 30 with nondisabling injuries), 30 noninjured soldiers and 30 healthy controls--were interviewed and investigated with physiological (Prolactine, Cortisol, BP, Hb) and psychological tests (MMPI), IES-15 (Impact of Event Scale), PTSS (Post-Traumatic Symptom Scale). Their war related injuries had a different effect on the physiological stress response of the soldiers as reflected in the levels of prolactine, cortisol, hemoglobin and blood pressure. In a report of personality characteristics of the same soldiers, we demonstrated that the experience of posttraumatic stress was not dependent upon physical injury, but rather on the psychological appraisal of the situation. The results of the present article confirm earlier findings that the relationship between physiological and psychological consequences of trauma are complex, and that the perception of an event and the social context within which the traumatized soldier exists is as important as the event itself. The physiological response to the trauma varied greatly among the soldiers regarding the psychosocial impact of the consequence of the injury. So the anticipation of future possible trauma among less severely wounded soldiers (expected to go back to war) was followed by pathological stress responses. Trauma seems to operate somewhat independently from the overt conscious appraisal of the situation and relationship between psychological, psychosocial, and physiological aspects are interrelated in a multifactorial way. An integrative approach is therefore of great importance in assessment as well as in treatment of Posttraumatic Stress Disorder (PTSD).     

Psychometric properties of the Race-Related Events Scale.

This article describes the development and preliminary validation of the Race-Related Events Scale (RES). The RES is a brief screening measure used to assess exposure to stressful and potentially traumatizing experiences of race-related stress and was designed to be both consistent with standard diagnostic definitions of traumatic events and applicable to diverse ethnic groups. Its psychometric properties were assessed in an ethnically diverse sample of undergraduate students (N = 408). The measure showed good internal consistency (α = .86) and adequate 1-month test–retest reliability (rs = .66). Its validity was supported by findings that Whites reported significantly less race-related stress than other ethnic groups and African Americans reported significantly more race-related stress than Asian Americans. A subset of participants who reported ongoing distress following a race-related stressor (n = 91) also completed posttraumatic stress disorder measures. Close to one-third of these participants reported a race-related stressor involving exposure to threat of injury or death to self or others and almost half reported fear, helplessness, or horror during a race-related stressor. Participants who met these DSM–IV–TR criteria for trauma exposure reported significantly more race-related stressors and more severe posttraumatic stress disorder symptoms. Greater exposure to race-related stressors was associated with more severe posttraumatic stress disorder symptoms among ethnic minority but not White respondents. These findings suggest that the RES is a useful screening measure of potentially traumatizing race-related experiences across diverse ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms and depression in mothers of children with severe burn injuries

This study examined posttraumatic stress symptoms and depressive symptoms in mothers of children with burn injuries from accidentally falling into a bathtub filled with hot water. Subjects were 16 pairs, children with burn injuries and their mothers. Psychiatric interviews were administered to the mothers to check the presence or absence of mental disorders. The severity of mothers' depressive symptoms was rated on the Hamilton Depression Scale. Prevalence rates of DSM-IV posttraumatic stress disorder and major depression were 6.3% and 0% in children with burn injury and 12.5% and 18.8% in their mothers, respectively. For three symptoms of posttraumatic stress disorder (intense distress at similar event, restricted range of affect, and hypervigilance), prevalence rates were significantly higher for the mothers than for the children. Ratings of the three symptoms of posttraumatic stress disorder for the mothers were significantly and positively correlated with scores for guilt feelings. Compared with children with burn injury, mothers are prone to posttraumatic stress symptoms mixed with guilt feelings for children with burn injury.     

Controlled study of treatment of PTSD using EMDR in an HMO setting.

67 individuals (aged 18–73 yrs) diagnosed with posttraumatic stress disorder (PTSD) were randomly assigned to either Eye Movement Desensitization and Reprocessing (EMDR) treatment or Standard Care (SC) treatment. Participants were assessed pretreatment, after 3 sessions, and at the completion of treatment using the SCL-90, Beck Depression Inventory, Impact of Event Scale (M. Horowitz et al, 1979), modified PTSD Symptom Scale (S. A. Falsetti et al, 1993), State Trait Anxiety Inventory, and other measures. In addition, an independent evaluator assessed participants using Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for PTSD including Global Assessment of Functioning at the 3 data points. Ss in the EMDR treatment group showed significantly greater improvement with greater rapidity than those in the SC treatment group on measures of PTSD, depression, anxiety, and general symptoms. Ss who received EMDR treatment used fewer medication appointments for their psychological symptoms and needed fewer psychotherapy appointments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with Gulf War combat stress: Mediating and moderating effects.

The authors examined relationships between method of coping with combat-related stress and psychological symptoms among Gulf War Army personnel (N?=?1,058). Participants were surveyed on return from the Gulf region (Time 1) with the Coping Responses Inventory (R. Moos, 1990) and a measure of combat exposure. Outcomes were symptom measures of posttraumatic stress disorder (PTSD) and depression. At Time 2 (18–24 months) participants completed the same symptom measures and an index of postwar stress. Higher proportions of approach-based coping in the war zone were related to lower levels of psychological symptoms. Combat exposure moderated the effects of coping on Time 1 PTSD. Coping predicted changes in symptoms of depression but not PTSD. Combat exposure affected changes in depression through postwar stress but had a direct negative effect on PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury.

The authors examined the temporal relation among posttraumatic stress disorder symptom clusters, using data derived from a longitudinal study of survivors of orofacial injury (N = 264). They conducted cross-lagged panel analyses, with self-reported symptom data collected at 1, 6, and 12 months postinjury. Results demonstrate that hyperarousal was a potent predictor of subsequent symptoms of reexperiencing and avoidance as well as hyperarousal. By contrast, neither reexperiencing nor avoidance was significantly related to other symptom clusters other than themselves over time. These findings underscore the distinctive nature of hyperarousal in the manifestation of posttraumatic psychological distress over time. Implications for theory, clinical intervention, and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer.

Diagnosis of life-threatening illness now meets Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for traumatic stressor exposure for posttraumatic stress disorder (PTSD). Quality of life (QOL) and PTSD-like symptoms were assessed in 55 women posttreatment for breast cancer. PTSD symptom measures included the PTSD Checklist—Civilian Version (PCL-C) and the Impact of Events Scale. QOL was assessed using the 20-item Medical Outcomes Study Questionnaire. PTSD symptomatology was negatively related to QOL, income, and age. Time since treatment, type of cytotoxic treatment, and stage of disease were unrelated to PTSD symptoms. With suggested criteria for the PCL-C, 5% to 10% of the sample would likely meet DSM-IV PTSD criteria. Findings suggest that in survivors of breast cancer, these symptoms might be fairly common, may exceed the base rate of these symptoms in the general population, are associated with reports of poorer QOL, and, therefore, warrant further research and clinical attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting posttraumatic growth in breast cancer survivors.

Wide variability exists with respect to how breast cancer survivors respond to common psychological and psychosocial challenges of their disease, ranging from posttraumatic stress disorder to posttraumatic growth. This cross-sectional study examined contextual, disease-related, and intraindividual predictors of posttraumatic growth in 224 randomly selected breast cancer survivors. A series of hierarchical regression analyses found that age at diagnosis, marital status, employment, education, perceived intensity of disease, and active coping accounted for 34%, 35%, and 28% of the variance in growth in relationships with others, new possibilities, and appreciation for life. These findings suggest that a more comprehensive model of growth will be helpful in understanding the various factors that play a role in breast cancer survivors' perception of psychological and psychosocial growth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic brain injury in children and adolescents: psychiatric disorders at two years

OBJECTIVE: To extend findings regarding predictive factors of psychiatric outcome from the first to the second year after traumatic brain injury (TBI) in children and adolescents. METHOD: Subjects were children aged 6 to 14 years at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury psychiatric, behavioral, adaptive functioning, family functioning and family psychiatric history status were conducted. Severity of injury was assessed by standard clinical scales and neuroimaging was analyzed. The outcome measure was the presence of a psychiatric disorder, not present before the injury ("novel"), during the second year after TBI. RESULTS: Fifty subjects enrolled, and the analyses focused on 42 subjects followed at 24 months. Severity of injury, preinjury family function, and preinjury lifetime psychiatric history predicted the development of a "novel" psychiatric disorder present in the second year. CONCLUSION: These data suggest that there are children, identifiable through clinical assessment, at increased risk for "novel" psychiatric disorders in the second year after TBI.     

Posttraumatic stress symptoms and subclinical cardiovascular disease in police officers.

The present study examined associations of posttraumatic stress disorder (PTSD) symptoms with subclinical cardiovascular disease in police officers. A stratified sample of 100 police officers was randomly selected from the Buffalo, New York, Police Department. Cardiovascular disease biomarkers were assessed by ultrasound of the brachial artery (flow-mediated dilation [FMD]). PTSD symptoms were measured with the Impact of Event Scale (IES). FMD was lowest in the severe PTSD symptom category when compared to the mild PTSD symptom category (1.91 vs. 5.15% increase, respectively; p=.21) even after adjustment for lifestyle and demographics. In conclusion, higher PTSD symptomatology in this police sample was associated with a nearly twofold reduction in brachial artery FMD, a biomarker for subclinical cardiovascular disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p     

Pretrauma problems, prior stressor exposure, and gender as predictors of change in posttraumatic stress symptoms among physically injured children and adolescents.

Objective: This study addressed predictors of change in posttraumatic stress symptoms (PTSS) among youths who had experienced physical injuries. The influences of pretrauma internalizing and externalizing problems, prior stressor exposure, and gender were investigated. Additionally, gender was examined as a moderator of the associations between internalizing problems and PTSS, externalizing problems and PTSS, and prior stressor exposure and PTSS. Method: Participants were 157 children and adolescents (75% male; age M = 13.30 years, SD = 3.60; 44% Caucasian, 39% African American, 13% Hispanic, and 4% other) admitted to 2 hospitals for physical injuries. Youths and their parents completed measures of PTSS (Child Posttraumatic Stress Reaction Index), internalizing and externalizing problems (Child Behavior Checklist), and prior stressor exposure (Coddington Life Events Scale, Child) during the hospital stay; youths completed up to 3 additional PTSS assessments targeted at 3, 6, and 12 months postinjury. Results: Multilevel regression analyses revealed a significant average decline in PTSS over time (p p p     

Open capsulorrhaphy with suture anchors for recurrent anterior dislocation of the shoulder

OBJECTIVE: The aim of this study was to index the frequency of occurrence of acute stress disorder following mild traumatic brain injury and to determine its utility in predicting posttraumatic stress disorder (PTSD). METHOD: Consecutive adult patients who sustained a mild traumatic brain injury following a motor vehicle accident (N = 79) were assessed for acute stress disorder within 1 month of their trauma with the Acute Stress Disorder Inventory, a structured clinical interview based on DSM-IV criteria. Patients were followed up 6 months after the trauma (N = 63) and were administered the PTSD module of the Composite International Diagnostic Interview. RESULTS: Acute stress disorder was diagnosed in 14% of patients, and at follow-up 24% satisfied criteria for PTSD. Six months after the trauma PTSD was diagnosed in 82% of patients who had been diagnosed with acute stress disorder and in 11% of those who had not been diagnosed with acute stress disorder. CONCLUSIONS: These findings point to the frequency of PTSD following mild traumatic brain injury. While the criteria for acute stress disorder are useful in identifying those individuals who are at risk of developing chronic PTSD, the findings suggest that current criteria require modification in order to optimally predict PTSD following mild traumatic brain injury.     

Prevalence and relationships of posttraumatic stress in families experiencing pediatric spinal cord injury.

Objective: To investigate the severity of posttraumatic stress (PTS) and the prevalence of posttraumatic stress disorder (PTSD) in individuals with pediatric spinal cord injury (SCI) and their parents and to assess relationships among family members' degree of PTS and PTSD diagnoses. Study Design: Cross-sectional mail survey. Setting: A pediatric orthopedic surgical and rehabilitation hospital. Participants: A volunteer sample of 64 pediatric SCI patients (59% male and 41% female), 64 mothers, and 49 fathers. Main Outcome Measures: The Posttraumatic Diagnostic Scale was used for parents and for patients more than 18 years of age and the Child Posttraumatic Stress Scale was used for patients 18 years of age and under. Results: Sixteen (25.4%) patients, 25 (41%) mothers, and 16 (35.6%) fathers reported current PTSD. Mothers' total PTS scores statistically predicted patients' and fathers' PTS scores, and patients' PTS scores statistically predicted mothers' PTS scores. In addition, mothers' and patients' PTSD diagnoses related significantly. Conclusions: PTSD may be among the most prevalent psychological comorbidities in families experiencing pediatric SCI. Screening and treatment for PTSD appear warranted as part of standard psychosocial care for these families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents

A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.