Stress and Post-traumatic Growth of people with cancer: identification of associated factors / Estrés y Crescimiento Postraumático de personas con cáncer: identificación de factores asociados

Objectives: Evaluate indicators and identify associated factors of post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) in individuals undergoing oncological treatment. Method: Quantitative, cross-sectional, analytical survey design with a non-probabilistic sample of 74 participants. Six instruments measuring PTSD, PTG, spiritual well-being, illness perception, and social support were employed. Data were analyzed using descriptive and inferential statistics in the Statistical Package for Social Science (SPSS). Results: It was evidenced that 21.60% of patients presented clinical indices of PTSD, and 85.12% showed a high index for PTG. High satisfaction indices were also observed for social support (86.48%), spiritual well-being (95.94%), and in identifying cancer as a potential threat to life (71.57%). Females, unmarried individuals, those inactive or unemployed, and those receiving public health support exhibited higher PTG indices. Women exhibit higher PTSD indices than men. Negative correlations were found between PTSD and spiritual well-being, and positive correlations with illness perception. Illness perception emerged as the variable with the greatest predictive power for PTSD indices. Conclusions: It is concluded that the threatening perception of the illness is a predictor of PTSD, highlighting it as a risk factor that requires attention in health prevention plans.(AU)

Objetivos: Evaluar los indicadores e identificar los factores asociados al trastorno de estrés postraumático (TEPT) y al crecimiento postraumático (CPT) en personas sometidas a tratamiento oncológico. Método: Diseño cuantitativo, transversal, analítico y de encuesta, con una muestra no probabilística compuesta por 74 participantes, utilizando seis instrumentos que miden TEPT, CPT, bienestar espiritual, percepción de la enfermedad y apoyo social, analizados a través de estadísticas descriptivas e inferenciales, en el Programa Estadístico para Ciencias Sociales (SPSS). Resultado: Se evidenció que 21,60% de los pacientes presentaron índices clínicos de TEPT y 85,12% un índice elevado para CPT. También se observaron índices elevados de satisfacción con el apoyo social (86,48%), bienestar espiritual (95,94%) e identificación del cáncer como una posible amenaza a la vida (71,57%). Las personas del género femenino, solteras, inactivas o desempleadas y atendidas por el servicio público de salud presentan mayores índices de CPT. Las mujeres muestran mayores índices de TEPT que los hombres. Se encontraron correlaciones negativas entre TEPT y bienestar espiritual y correlaciones positivas con la percepción de la enfermedad. La percepción de la enfermedad fue la variable con mayor poder predictivo para los índices de TEPT. Conclusiones: Se concluye que la percepción amenazante de la enfermedad es un predictor de TEPT, siendo esta una variable de riesgo que requiere atención en los planes de prevención de daños a la salud.(AU)

Antihéroes que sufren trauma por estrés postraumático y villanos con trastorno de personalidad narcisista: el cisma de los problemas de salud mental en el cine / Antiheroes suffering from post-traumatic stress trauma and villains with narcissistic personality disorder: the schism of mental health problems in cinema

Actualmente existe una tendencia hacia la introducción de problemas de salud mental en los protagonistas de películas, particularmente en los antihéroes. Este hecho contrasta con la tradicional asociación de estas enfermedades con los villanos. Este manuscrito tiene el objetivo de detectar los problemas de salud mental que poseen los villanos y los antihéroes en el cine para averiguar si reciben el mismo tratamiento y si existen enfermedades estigmatizadas y vinculadas a unos y a otros. A partir del análisis cuantitativo y cualitativo de los resultados, se han identificado patrones, tendencias y se han establecido contrastes entre las narrativas de la salud mental entre villanos y antihéroes. Los hallazgos demuestran que el trastorno de estrés postraumático es el más frecuente en antihéroes, mientras que en villanos es el trastorno de personalidad narcisista, lo que evidencia los estigmas existentes en el imaginario cinematográfico.(AU)

Currently there is a trend towards the introduction of mental health problems in the protagonists of films, particularly in antiheroes. This fact contrasts with the traditional association of these diseases with villains. This manuscript has the objective of detecting the mental health problems that villains and antiheroes have in the cinema to find out if they receive the same treatment and if there are stigmatized diseases linked to each other. From the quantitative and qualitative analysis of the results, patterns, trends and contrasts have been identified between the narratives of mental health between villains and antiheroes. The findings show that post-traumatic stress disorder is the most frequent in antiheroes, while in villains it is narcissistic personality disorder, which shows the existing stigmas in the cinematographic imaginary.(AU)

Trust in higher guidance and suicidality in Afghan students under the Taliban regime

Background/Objective: After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation. Method: A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used. Results: Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated. Conclusion: PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance. (AU)

Post-traumatic Stress Disorder after the first wave of the Pandemic in Hospitalized COVID-19 Patients and Health Professionals in a Front-line Spanish Tertiary Hospital: a retrospective observational study / Trastorno por estrés postraumático tras la primera ola de la pandemia en pacientes hospitalizados por COVID-19 y profesionales sanitarios de primera línea en un hospital terciario español: un estudio observacional retrospectivo

The COVID-19 pandemic had a serious impact on mental health, associated with Post Traumatic Stress Disorder (PTSD) after infection and within healthcare professionals. We propose to compare the semiology, evolution and trauma-associated variables between both groups in a sample of patients. An observational retrospective study was performed, including 42 hospitalized COVID-19 patients and 31 health professionals, treated at the Mental Health Service of the Hospital 12 de Octubre, between June 2020/21, with a diagnosis of PTSD. Mental state evaluation was performed through a standard clinical interview. Additionally, the 8-item treatment-outcome post-traumatic stress disorder scale (TOP-8) was administered. Demographic data, variables related to hospital stay and pre/peri/post-trauma variables considered of interest were collected. All analyses were performed using the Stata 16 program. Health professionals showed higher levels of recovery, however no significant differences were found in the initial severity of the PTSD. Regarding the symptom pattern it was similar between both groups, except that professionals presented more dissociation during the traumatic event. In general, the subjects presented mainly intrusive symptoms, hyperarousal and sleep-related difficulties. Having witnessed suffering or death, and the gypsy ethnic group, were the variables with the greatest impact in the PTSD severity. These results suggest that the COVID-19 leaves important psychological sequelae such as PTSD, both in infection survivors and in health professionals. Differences found could be due to dissimilarities in coping resources and therapeutic adherence styles. We consider that knowing the variables involved can help improve intervention in these vulnerable groups.(AU)

La pandemia por COVID-19 ha tenido grave impacto sobre la salud mental, asociándose con Trastorno por estrés postraumático (TEPT) tras la infección y en profesionales sanitarios. Nos proponemos comparar la semiología, evolución y variables asociadas al trauma entre ambos grupos en una muestra de pacientes. Se realizó un estudio observacional retrospectivo, incluyendo 42 pacientes hospitalizados por COVID-19 y 31 profesionales sanitarios, tratados en el Servicio de Psiquiatría del Hospital 12 de Octubre, entre junio 2020/21, con diagnóstico de TEPT. Se realizó entrevista clínica estándar. Adicionalmente, se pasó la Escala de 8 ítems para los resultados del tratamiento del TEPT (TOP-8). Se recogieron datos demográficos, variables relacionadas con la estancia hospitalaria y variables pre/peri/post-trauma. Se analizaron los datos usando el programa Stata 16. Los profesionales sanitarios mostraron mayores niveles de recuperación, sin embargo, no hubo diferencias significativas en la severidad inicial del TEPT. El patrón sintomático fue similar entre ambos grupos, excepto que los profesionales presentaron más disociación durante el evento traumático. Todos presentaron principalmente síntomas intrusivos, hiperactivación y dificultades de sueño. Haber presenciado sufrimiento o muerte, y la etnia gitana, fueron las variables con mayor impacto en la severidad del TEPT. Estos resultados sugieren que la COVID-19 deja importantes secuelas psicológicas como el TEPT, tanto en supervivientes de la infección como en profesionales sanitarios. Las diferencias encontradas podrían ser debidas a disimilitudes en recursos de afrontamiento y estilos de adherencia terapéutica. Consideramos que conocer las variables involucradas puede ayudar a mejorar la intervención en estos grupos vulnerables.(AU)

¿Existe el duelo complicado traumático? Diferencias sintomatológicas entre el duelo complicado tras una muerte traumática y una no traumática / Is there a traumatic complicated grief? Symptomatological differences between complicated grief after a traumatic and a non-traumatic death

Objetivo: Examinar la existencia del duelo complicado traumático como un constructo diferente al de duelo complicado analizando si la sintomatología de duelo complicado y de estrés postraumático es diferente en las personas que sufren duelo complicado tras una muerte traumática y no traumática. Método: Un grupo de 89 dolientes con duelo complicado tras una muerte por atentado terrorista y un grupo de 54 dolientes con duelo complicado tras una muerte por edad o enfermedad completaron el Inventario de Duelo Complicado (IDC) y versiones de la Escala de Verificación del Trastorno de Estrés Postraumático (PCL-S o PCL-5). Resultados: ANCOVA realizados sobre las puntuaciones en los ítems del IDC y en los 16 ítems comunes a las dos versiones de la PCL revelaron que los dos grupos de dolientes no diferían en ninguno de los síntomas de duelo complicado ni de estrés postraumático, salvo en dos síntomas de duelo complicado en los cuales las diferencias iban en direcciones opuestas. Conclusiones: Aunque una muerte traumática como, por ejemplo, por atentado terrorista, incrementa la gravedad de las reacciones de duelo y la probabilidad de sufrir duelo complicado, este duelo complicado es similar al que pueden sufrir las personas tras una muerte no traumática, al menos respecto a sus síntomas y a los síntomas simultáneos de estrés postraumático. Por tanto, no se puede hablar de un duelo complicado traumático como diferente al duelo complicado (AU)

Objective: To examine the existence of complicated traumatic grief as a different construct from complicated grief, analyzing whether the symptoms of complicated grief and post-traumatic stress are different in people who suffer complicated grief after a traumatic and non-traumatic death. Method: A group of 89 mourners with complicated grief after a death from a terrorist attack and a group of 54 mourners with complicated grief after a death due to age or illness completed the Inventory of Complicated Grief (ICG) and versions of the PTSD Checklist Scale (PCL-S or PCL-5). Results: ANCOVA performed on the scores on the IDC items and on the 16 items common to the two versions of the PCL revealed that the two groups of mourners did not differ in any of the symptoms of complicated grief or post-traumatic stress, except in two complicated grief symptoms in which the differences went in opposite directions. Conclusions: Although a traumatic death, such as a terrorist attack, increases the severity of grief reactions and the probability of suffering complicated grief, this complicated grief is similar to what people can suffer after a non-traumatic death, at least concerning its symptoms and the simultaneous symptoms of post-traumatic stress. Therefore, one cannot speak of complicated traumatic grief as different from complicated grief (AU)

Estrés post traumático en el personal sanitario de la Unidad de Emergencia de un hospital terciario en pandemia SARS COV-2 / Post traumatic stress in the health personnel of the Emergency Unit of a tertiary hospital in SARS COV-2 pandemic

Introducción: El personal sanitario de emergencia se encuentra extremadamente expuesto a situaciones estresantes. El trastorno de estrés post traumático es una patología emergente en el personal sanitario durante los últimos años y es reconocida únicamente como enfermedad mental de carácter laboral. Objetivos: Establecer la prevalencia y síntomas asociados al trastorno de estrés post traumático obtenidos del tamizaje con lista de verificación del trastorno de estrés post traumático para DSM-5 aplicado al personal sanitario de la unidad de emergencia de un hospital terciario durante la pandemia por SARS-CoV-2. Material y Métodos: Estudio retrospectivo, de cohorte observacional, transversal, unicéntrico en los (5) estamentos profesional y no profesional, entre el periodo abril 2021 a diciembre 2022. Resultados: Participaron 241 funcionarios (69.45% de esta unidad de emergencia). Donde, un 19.9% presentó síntomas de estrés post traumático, desagregados en; 36.0% auxiliar de servicio, 26.7% kinesiología, 26.1% técnico en enfermería nivel superior, 13.3% enfermería y un 9.8% médicos. La mayor sintomatología correspondió a recuerdos intrusivos, malestar psicológico intenso, comportamiento imprudente-autodestructivo e hipervigilancia. Asimismo, a mayor antigüedad laboral y los estamentos auxiliares, kinesiología incrementan la probabilidad de puntaje alto en el tamizaje (variables de riesgo), mientras que a mayor edad disminuye (variable protector). El 29.46% fue vinculado a una atención en salud mental posterior al tamizaje. Discusión y conclusión: El estudio identificó y caracterizó a un grupo representativo de la unidad de emergencia presentó síntomas de estrés post traumático durante la pandemia SARS-CoV-2. Una red de apoyo psicológico permanente podría ser una intervención efectiva de promoción en salud mental (AU)

Introduction: Emergency medical personnel are extremely exposed to stressful situations. Post-traumatic stress disorder is an emerging pathology in health personnel in recent years and is only recognized as a mental illness of an occupational nature. Objective: To establish the prevalence and symptoms associated with post-traumatic stress disorder obtained from the screening with the checklist of post-traumatic stress disorder for DSM-5 applied to health personnel from the emergency unit of a tertiary hospital during the SARS-CoV-pandemic. 2. Material and Method: Retrospective, observational, cross-sectional, single-center study in the (5) professional and non-professional levels, between the period April 2021 to December 2022. Results: 241 officials participated (69.45% of this emergency unit). Where, 19.9% presented symptoms of post-traumatic stress, broken down into 36.0% service assistant, 26.7% kinesiology, 26.1% higher level nursing technician, 13.3% nursing and 9.8% doctors. The greatest symptomatology corresponded to intrusive memories, intense psychological discomfort, reckless-self-destructive behavior and hypervigilance. Likewise, the higher the job seniority and the auxiliary levels, kinesiology increase the probability of a high score in the screening (risk variables), while at an older age it decreases (protective variable). 29.46% were linked to mental health care after the screening. Discussion: The study identified and characterized a representative group from the emergency unit who presented post-traumatic stress symptoms during the SARS-CoV-2 pandemic. A permanent psychological support network could be an effective promotion intervention in mental health. (AU)

High molar ratios of tumor necrosis factor α (TNF α) soluble receptors I and II to the TNF ligand in human plasma from male veterans with comorbid posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI)

Background and Objectives Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with chronic inflammation, as inferred from increased, but variable, peripheral levels of cytokines. We sought proof of concept for the notion that peripheral cytokine binding proteins and/or soluble receptors can confound measures of cytokines in those with a history of physical and psychological traumatic exposures. Efforts were focused on one of the major cytokines involved in inflammation, tumor necrosis factor-α (TNF- α). Methods We examined blood plasma concentrations of TNF-α, its soluble receptors (TNF-soluble receptors (sR) I and TNFsRII), and C-reactive protein (CRP-1) in a cohort of US Veterans. In a previous study, CRP-1 was shown to be reduced by probiotic anti-inflammatory treatment in this patient cohort. All participants (n = 22) were diagnosed with PTSD and had a history of mild TBI with persistent post-concussive symptoms. Exclusion criteria included medications directly targeting inflammation. Results Molar concentrations of soluble TNFsRI and II exceeded concentrations of the TNF-α ligand. TNFsRI, but not TNFsRII, was significantly associated with CRP-1 (Spearman Rho correlations = 0.518; p=.016 and 0.365; p = .104, respectively). Conclusions TNF soluble receptors may bind to and sequester free TNF-α, suggesting that only measuring ligand concentrations may not provide a fully comprehensive view of inflammation, and potentially lead to inaccurate conclusions. TNFsRI concentration may provide a better estimate of inflammation than TNF-α for those with PTSD and post-acute mTBI with post-concussive symptoms, a hypothesis that invites further testing in larger studies. (AU)

Evidence-based umbrella review of non-invasive brain stimulation in anxiety disorders

Background and objectives Although several meta-analyses have suggested the efficacy of non-invasive brain stimulation (NIBS) mainly in prefrontal brain areas to treat mental disorders, no synthetic approach has been performed for other psychiatric disorders rather than depression. The objective is to assess the available evidence of NIBS in the treatment of anxiety disorders. Methods An umbrella review (CRD42021239577) was performed only looking for reviews with meta-analyses of randomized clinical trials using a source strategy MeSH keywords in MEDLINE through Pubmed by two independent researchers. The effects of different methods of NIBS in anxiety disorders were assessed using the PICO strategy. The methodological quality was evaluated using AMSTAR-2 and certainty of evidence using the GRADE-pro framework. Results From 136 screening meta-analyses, 16 from 14 studies were included in the final analysis. Generalized Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD) respond best to low frequency repetitive transcranial magnetic stimulation (rTMS), while Posttraumatic Stress Disorder (PTSD) has the largest effect size at high frequency rTMS. Panic Disorder (PD) has no evidence for clinical use of NIBS. There were not identified meta-analyses about other anxiety disorders. In general, the included studies had good methodological quality, but low to moderate evidence for clinical recommendation. Conclusion Available evidence reveals NIBS as an effective and safe approach to treat GAD, PTSD and OCD with low recommendation level to clinical application. A great heterogeneity of studies indicates the necessity to develop new randomized clinical trials applying NIBS to treat those and other mental disorders. (AU)

Trastorno por Estrés Postraumático Complejo y Trastorno Límite de la Personalidad: El Debate Continúa. Propuesta de Diagnóstico Diferencial / Complex Posttraumatic Stress Disorder and Borderline Personality Disorder: The Debate Continues. Differential Diagnosis Proposal

Tras la inclusión en la CIE-11 del diagnóstico de trastorno por estrés postraumático complejo (TEPTc) en 2020, se han sucedido las publicaciones que debaten sobre la pertinencia o no de tal entidad y sobre su distinción del trastorno límite de la personalidad (TLP). En el presente artículo de reflexión se persigue: 1. conocer si el TEPTc y el TLP son entidades distintas; 2. conocer el estado de la cuestión respecto a este tema; y 3. proponer un diagnóstico diferencial que ayude a su discriminación. Para dar cuenta de las dos primeras cuestiones, se ha realizado una revisión bibliográfica (no sistemática) de tipo cualitativo entre los años 2020 y 2022 (tiempo de vigencia del TEPTc en la CIE-11). En función de la información teórica y empírica hallada, y cumpliendo con el tercer objetivo, se propone un diagnóstico diferencial con el fin de arrojar luz a la distinción nosológica entre ambos constructos.(AU)

Following the inclusion in the ICD-11 of the diagnosis of complex post-traumatic stress disorder (cPTSD) in 2020, there has been a succession of publications debating the relevance or not of this entity and regarding its distinction from borderline personality disorder (BPD). The present reflection article aims to: 1. to understand whether c-PTSD and BPD are different entities; 2. to understand the state of the art regarding this issue; and 3. to propose a differential diagnosis that will help to distinguish between the two. To account for the first two questions, a qualitative (non-systematic) literature review was carried out between 2020 and 2022 (the period of validity of cPTSD in the ICD-11). Based on the theoretical and empirical information found, and achieving the third objective, a differential diagnosis is proposed in order to shed light on the nosological distinction between the two constructs.(AU)

Delayed-onset posttraumatic stress disorder with response to methylphenidate / Trastorno por estrés postraumático de expresión retardada con respuesta a metilfenidato

Introduction: Posttraumatic stress disorder (PTSD) is extremely frequent in war veterans and has been widely studied. However, the efficacy of currently available pharmacological and psychotherapeutic treatments of war PTSD and other causes of PTSD is very limited. Method We present a case of war PTSD with delayed expression, with a good response to complementation with methylphenidate after a failed treatment with venlafaxine and risperidone. Results We review the role of dopamine in the pathophysiology of PTSD and the scarce studies in the treatment of PTSD with dopaminergic drugs that show an improvement in re-experimentation and in affective symptoms, especially anhedonia and cognitive impairment. Conclusions We conclude that the use of methylphenidate and other dopaminergic drugs can be a promising treatment for PTSD, a high prevalent disease with a high resistance to treatment, for which we encourage the use of large sample studies. (AU)

Introducción: El trastorno por estrés postraumático (TEPT) es extremadamente prevalente en veteranos de guerra y ha sido ampliamente estudiado. Sin embargo, la eficacia de los tratamientos farmacológicos y psicoterapéuticos disponibles es aún muy limitada, tanto en el TEPT de guerra como en el TEPT por otras causas. Método Presentamos un caso de TEPT de guerra con expresión retardada, con una buena respuesta al metilfenidato a su tratamiento con venlafaxina y risperidona, que había resultado ineficaz. Resultados Revisamos el rol de la dopamina en la psicopatología del TEPT y los pocos estudios del tratamiento del TEPT con fármacos dopaminérgicos, en los que se muestra una mejoría en los síntomas de reexperimentación y los síntomas afectivos, especialmente la anhedonia y los déficits cognitivos secundarios. Conclusiones Consideramos que el uso del metilfenidato y de otros fármacos dopaminérgicos podrían ser prometedores el tratamiento del TEPT, un trastorno altamente prevalente y con alta resistencia al tratamiento habitual. Por esto, animamos a realizar estudios con muestras amplias. (AU)

Meta-Analysis of Web-based Treatments for PTSD in Women Exposed to Intimate Partner Violence and Sexual Abuse

Aggression towards women can lead to serious psychopathological consequences such as PTSD, and web-based treatments can be promising tools to reduce this symptomatology, reaching as large a population as possible. This study presents a meta-analysis of web-based online treatments to reduce PTSD in women exposed to intimate partner violence, sexual abuse or maltreatment. A systematic review and meta-analysis were carried out. The search for studies was conducted in SCOPUS, PsycINFO, PSICODOC, PsycARTICLES and Medline, between 2010 and 2022, in September 2022. A random-effects model was used to obtain the effect size and the analysis of moderator variables. Effect sizes were calculated for PTSD, Anxiety and Depression variables in two different ways, analyzing exclusively treatment groups and comparing treatment groups with control groups and waiting lists. 9 articles were included in the meta-analysis. The effect size of PTSD when comparing treatment groups was high (d= -.809; 95% CI: -1.237/-.381; k= 8). It was smaller when compared with active control groups (d= -.315; 95% CI: -.942/.312; k= 4) or waiting lists (d= -.302; 95% CI: -.515/-.089; k= 3). Web-based treatments for women exposed to intimate partner violence, sexual abuse or maltreatment are effective and can improve the quality of care for this population (AU)

Efficacy of EMDR in Post-Traumatic Stress Disorder: A Systematic Review and Meta-analysis of Randomized Clinical Trials / Eficacia del EMDR en el Trastorno de Estrés Post-traumático: una Revisión Sistemática y Meta-análisis de Ensayos Clínicos Aleatorizados

Background: In recent years, eye movement desensitization and reprocessing (EMDR) has spread, in both the number of publications and professionals who use this technique in the clinical setting. The objective of this meta-analysis was to verify the efficacy of EMDR in treatment of post-traumatic stress disorder. Method: Based on the inclusion/exclusion criteria, 18 articles were selected (n = 1213 subjects), published between 1991-2022. Results: The effect sizes found in the meta-analysis were small in the reduction of symptoms associated with PTSD, anxiety and depression, both in post-treatment and in maintenance. The analysis of the moderating variables revealed that both intervention time, the number and duration of the sessions, the experience of the therapist, and the type of therapist in charge of the intervention play an important role in the size of the final effect. No statistically significant data were found in the meta-regression analysis. Conclusions: Although the study had restrictive criteria for study selection, there is a certain risk of bias in the selected articles, which lack sufficient methodological quality to be extrapolated to the clinical field.(AU)

Antecedentes: En los últimos años la desensibilización y reprocesamiento por movimientos oculares (EMDR) se está extendiendo tanto en su número de publicaciones como de profesionales que utilizan esta técnica en el ámbito clínico. El presente meta-análisis tiene como objetivo comprobar la eficacia del EMDR en el tratamiento del trastorno de estrés post-traumático. Método: A partir de los criterios de inclusión/exclusión fueron seleccionados 18 artículos (n = 1213 sujetos), entre los años 1991-2022. Resultados: Los tamaños del efecto hallados en el meta-análisis fueron pequeños en la reducción de síntomas asociados al TEPT, ansiosos y depresivos, tanto en el pos-tratamiento como en el mantenimiento. El análisis de las variables moderadoras reveló que el tiempo de intervención, el número y la duración de las sesiones, la veteranía del terapeuta y el tipo de terapeuta encargado de la intervención juegan un papel importante en el tamaño del efecto final. No se encontraron datos estadísticamente significativos en el análisis de la metarregresión. Conclusiones: Sin embargo, aunque el estudio cuenta con criterios restrictivos en cuanto a la selección de los estudios, existe cierto riesgo de sesgo en los artículos seleccionados que carecen de una calidad metodológica suficiente para ser extrapolados al ámbito clínico.(AU)

A Retrospective Study on the Effect of Empowerment Psychological Intervention Led by Specialist Nurses on Post-traumatic Stress Disorder in ICU Patients

Background: Many patients in the intensive care unit (ICU) suffer from post-traumatic stress disorder (PTSD), which seriously affects the treatment, recovery, and prognosis of patients. Objective: To observe the effect of empowerment psychological intervention on the status of PTSD in ICU patients. Methods: A total of 86 patients with PTSD who were treated in ICU from July 2019 to December 2021 were divided into two groups according to the intervention method. The control group (n = 43) used routine psychological intervention, while the intervention group (n = 43) used empowerment psychological intervention led by specialist nurses. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of the patients. The Resilience Questionnaire (CD-RISC) was used to evaluate the resilience of the patients, and the Post Traumatic Stress Disorder Self-Rating Scale (PTSD-SS) was used to assess the severity of the symptoms. The Hamilton Anxiety and Depression Inventory (HAMA and HAMD) was adapted to assess the degree of anxiety and depression, and the Post-Traumatic Growth Inventory (PTGI) was adapted to evaluate the post-traumatic growth of the patients. Results: After the intervention, the total CD-RISC score and its tenacity, self-improvement, and optimism scores in the two groups were all higher than before, and the total PSQI score and its sleep quality, time, efficiency and impairment, as well as hypnotic drugs, daytime dysfunction and time to sleep were lower than before, and the CD-RISC score in the intervention group was higher than that in the control group, PSQI score was lower than that in the control group (p < 0.05). After the intervention, PTSD-SS scores and anxiety-depression scores were lower, and PTGI scores were higher in both groups than before (p < 0.05). Conclusion: The empowerment psychological intervention ... (AU)

El descuido y lo inhóspito. Habitar tiempos de pandemia / The carelessness and the inhospitable. Inhabiting times of pandemic

La pandemia nos ha colocado en una situación de extrañamiento hacia nosotros mismos. Hemos sido muy conscientes de nuestravulnerabilidad y fragilidad. A través de los relatos de las experiencias vividas hemos conocido y asistido a circunstancias trágicas enlas que se han puesto de manifiesto lo inhóspito y el descuido. Nos ha conmocionado la toma de conciencia sobre la falta de recono-cimiento, de acompañamiento, de acogida. Las decisiones institucionales han primado la Salud Pública, el bien de todos, pero se hanolvidado de las biografías de las personas, llenas de sufrimiento. Y esto ha producido un daño moral, una pérdida de la confianza, unasensación de injusticia ante la que no se ha podido luchar. Por eso es necesaria una construcción de la hospitalidad que se puedelograr a través del cuidado. Un cuidado con dimensión política que se haga cargo de la realidad y que transforme la sociedad. Laclave es una responsabilidad solidaria. Ante la posibilidad de deshumanizarnos buscamos la hospitalidad como forma alternativa denarrar las vidas que tienen que reconstruirse, que tienen que reaprender cómo cuidarnos mutuamente en medio de las múltiplesposibilidades de extrañamiento que nos amenazan. La hospitalidad es el corazón de una ética narrativa a la altura de nuestro tiempo.(AU)

The pandemic has placed us in a situation of estrangement from ourselves. We have been acutely aware of our vulnerability andfragility. Through the stories of lived experiences, we have learned about and witnessed tragic circumstances in which inhospitalityand neglect have become evident. We have been shocked by the awareness of the lack of recognition, accompaniment and welcome.Institutional decisions have prioritized public health, the good for all, but have forgotten the biographies of people, full of suffering.And this has produced a moral damage, a loss of trust, a feeling of injustice that we have not been able to fight against. This is why itis necessary to build hospitality, which can be achieved through care. Care with a political dimension that takes charge of reality andtransforms society. The key is a responsibility in solidarity. Faced with the possibility of dehumanizing ourselves, we seek hospitalityas an alternative way of narrating lives that have to be reconstructed, that have to relearn how to take care of each other amidstthe multiple possibilities of estrangement that threaten us. Hospitality is at the heart of a narrative ethics at the height of our times.(AU)

Pandemia, ignorancia y sufrimiento evitable / Pandemic, ignorance and avoidable suffering

La pandemia de la COVID-19 ha dejado lecciones relevantes que van a marcar, durante años, nuestra experiencia individual y colectiva.Son lecciones tanto prácticas como de orden moral. Pero la pandemia ha dejado también un rastro de experiencias pobremente ela-boradas que conducen, con cierta premura, al silencio forzado y a la cancelación del trauma. El propósito de este trabajo fue mostrarla compleja relación que, en condiciones de incertidumbre, se establece entre conocimiento e ignorancia, tanto en la perspectivade los expertos, como en la de los políticos e incluso de los ciudadanos corrientes, víctimas o no del virus SARS-CoV-2. Para ello sedistingue entre tres diferentes niveles de análisis (de la agencia, de las instituciones y de los marcos ideológicos subyacentes) y seargumenta que los desajustes que se producen en cada uno de estos niveles, y entre ellos, son fuente de sufrimiento evitable. Elpropósito del trabajo fue, por tanto, sacar a flote, con los instrumentos conceptuales de la epistemología política, tanto los principalesperfiles que siguen sin ser adecuadamente elaborados en esta experiencia traumática como los factores que hacen posible unamayor resiliencia, para los individuos y las sociedades, a la hora afrontar las consecuencias dramáticas de la pandemia.(AU)

COVID-19 pandemics gave us relevant lessons that are going to leave a durable mark in our individual and collective experience. Thoselessons are both practical and endowed with a moral import. But the pandemic has left a trail of experiences poorly elaborated thatleads, with some urgency, to forced silence and to the cancellation of emotional trauma. The aim of this paper was to disentanglethe complex relationship that arises, under conditions of uncertainty, between knowledge and ignorance, both from the perspectiveof experts and of policy makers, and even of the ordinary people, struck or not by the SARS-CoV-2 virus. To that end, I distinguishbetween three different levels of analysis (agency, institutions, and ideological frameworks) so to argue that the mismatches thatoccur in all of them, and between them, are sources of avoidable harm. The purpose of this exploration was, therefore, to bring tothe floor, relying on the conceptual tools of the political epistemology, both the aspects of the traumatic experience that still lack anadequate elaboration and the features that provide an improved resilience for individuals and societies in tackling with the frightfulconsequences of the pandemic.(AU)

Trastorno de estrés postraumático y calidad de vida del paciente post-COVID-19 en Atención Primaria / Post-traumatic stress and quality of life of post-COVID-19 patients in primary care

Objetivo: Determinar la asociación entre los síntomas de trastorno por estrés postraumático (TEPT) con la calidad de vida relacionada con la salud (CVRS) del paciente post-COVID-19 en Atención Primaria. Diseño: Estudio transversal, multicéntrico, con muestreo probabilístico aleatorizado. Emplazamiento: Centros de Atención Primaria de Ica-Perú. Participantes: Seiscientos treinta y seis pacientes con diagnóstico previo de COVID-19. Mediciones principales: La variable síntomas de TEPT, fue medida con el cuestionario COVID-19-PTSD y la CVRS con la escala EuroQol (EQ-5D). Se analizaron factores sociodemográficos y de salud que incluyó el síndrome post-COVID-19. Se realizó un análisis descriptivo y se calcularon razones de prevalencia (RP) crudas y ajustadas, mediante modelos lineales generalizados de la familia Poisson, para buscar asociación entre las variables. Resultados: De los participantes, el 21,4% presentó síntomas de TEPT; el 33,6%, síntomas de excitación disfórica y ansiosa; el 22,3%, intrusión, evitación y afecto negativo; 22,6%, anhedonia, y el 23,6%, comportamiento exteriorizante. El 50,3% reveló al menos un componente de la CVRS afectada; el 35,5%, problemas vinculados con ansiedad/depresión; el 34,9%, dolor/malestar; el 11%, actividad cotidiana; el 10,7%, movilidad y el 6,6%, cuidado personal. La presencia de síntomas de TEPT mostró asociación con la CVRS afectada (RP = 2,46: IC del 95%: 2,19-2,78). Asimismo, ciertas variables sociodemográficas y de salud se asociaron con los síntomas de TEPT y la CVRS afectada. Conclusiones: Los síntomas de TEPT incrementan la probabilidad de afectar la CVRS del paciente post-COVID-19. Existen variables sociodemográficas y de salud potencialmente modificables que podrían mermar los síntomas de TEPT y mejorar la CVRS.(AU)

Objective: To determine the association between post-traumatic stress disorder (PTSD) symptoms and health-related quality of life (HRQoL) of post-COVID-19 patients in primary care. Design: Cross-sectional, multicenter, random probability sampling study. Location: Primary care centers in Ica-Peru. Participants: Six hundred and thirty-six patients with previous diagnosis of COVID-19. Main measures: The variable PTSD symptoms was measured with the COVID-19-PTSD questionnaire and HRQOL with the EuroQol scale (EQ-5D). Sociodemographic and health factors including post-COVID-19 syndrome were analyzed. A descriptive analysis was performed and crude and adjusted prevalence ratios (PR) were calculated using generalized linear models of the Poisson family to search for associations between variables. Results: Of the participants, 21.4% presented symptoms of PTSD; 33.6% symptoms of dysphoric and anxious arousal; 22.3% intrusion, avoidance and negative affect; 22.6% anhedonia; and 23.6% externalizing behavior. 50.3% revealed at least one component of HRQoL affected; 35.5% problems linked to anxiety/depression; 34.9% pain/discomfort; 11% daily activity; 10.7% mobility and 6.6% self-care. The presence of PTSD symptoms was associated with the HRQoL affected (PR=2.46: 95% CI: 2.19–2.78). Also, certain sociodemographic and health variables were associated with PTSD symptoms and affected HRQoL. Conclusions: PTSD symptoms, increase the probability of affecting the patient's HRQoL post COVID-19. There are potentially modifiable sociodemographic and health variables that could decrease PTSD symptoms and improve HRQoL.(AU)

Causal Attributions and Perceived Severity as Predictors of Posttraumatic Stress Symptoms after a First Myocardial Infarction / Atribuciones causales y gravedad percibida como predictores de síntomas de estrés post-traumático tras un primer infarto de miocardio

Recent meta-analyses have shown a significant link between symptoms of anxiety and depression, and cardiovascular diseases (CVDs). The presence of these symptoms has a direct impact on the course and the recovery from the CVDs. A less analyzed aspect is the role played by the stress induced by the onset of CVDs conditions and, especially, by acute myocardial infarction (AMI). In this study, we assessed posttraumatic stress symptoms (PTSS), emotional state, health habits, and subjective perception of the event and causal attributions regarding the infarct, in a sample of 76 patients who had suffered an AMI in the previous 48-72 hours. Structural equation analyses and path analyses showed that the severity of PTSS was predicted by the perceived severity of the AMI and by two specific beliefs (i.e., considering that the AMI is a hereditary condition and that the help of others will not be beneficial). The results suggest the possibility of early identification of patients with a higher risk of suffering a high level of stress derived from the AMI. Based on this evidence, we discuss the possibilities of making effective interventions to reduce these symptoms, often ignored in clinical practice, and improve the medical and psychological prognosis of people with AMI.(AU)

Metanálisis recientes han demostrado una asociación significativa entre los síntomas postraumáticos y las enfermedades cardiovasculares (ECV). La presencia de este tipo de síntomas psicopatológicos tiene un impacto directo en el curso y la recuperación de dichas enfermedades. Un aspecto menos estudiado es el papel que juega el estrés provocado por la vivencia de una enfermedad cardiovascular, y, en especial, por el infarto agudo de miocardio (IAM). En este estudio se evaluaron los síntomas postraumáticos, el estado emocional, los hábitos de salud, la percepción subjetiva del suceso y las atribuciones causales respecto al infarto, en una muestra de 76 pacientes que habían sufrido un IAM en las 48-72 horas previas. El análisis de ecuaciones estructurales y el análisis de sendero (path analysis) mostraron que tanto la gravedad percibida del IAM, como dos creencias concretas (considerar que el infarto es un problema hereditario y que la ayuda de otros no es beneficiosa), predecían la gravedad percibida de los síntomas postraumáticos. Los resultados sugieren la posibilidad de identificar precozmente a los pacientes con mayor riesgo de sufrir un alto nivel de estrés derivado del IAM, gracias a sus atribuciones y su percepción de la gravedad del infarto. En base a esta evidencia, se discuten las posibilidades de realizar intervenciones efectivas para reducir estos síntomas y mejorar el pronóstico de las personas que han sufrido un IAM.(AU)

Discapacidad militar: revisión de recursos psicosociales en los ejércitos de nuestro entorno / Military disability: review of psychosocial resources in the armies of our environment

El avance legislativo y social respecto a los derechos e igualdad de oportunidades de las personas con discapacidad, no excluye a los contextos militares. Estados Unidos, Francia, Reino Unido o España, han desarrollado instrumentos para garantizar la protección legal, administrativa y económica de los militares con discapacidad, pero los proyectos y programas de recuperación social parecen insuficientes, por lo que este trabajo se centra en el objetivo de revisar los recursos psicosociales disponibles en los ejércitos de nuestro entorno.Los resultados muestran que la mayor parte de los estudios revisados se centran en la recuperación de militares con trastorno de estrés postraumático (TEPT), aunque también se recogen trabajos con lesionados medulares o con daño cerebral. Las temáticas abordadas, con relación al apoyo psicosocial y los recursos disponibles, se enfocan a la empleabilidad, las compensaciones económicas, los tratamientos y los factores que favorecen la integración social. Destacan los estudios sobre: (1) los beneficios aportados por los programas de empleo con apoyo para la salud, la integración social y la autoestima, (2) el uso de perros de servicio, que mejoran la calidad de vida y la producción laboral, y (3) los programas de deporte, que mejoran la autoestima y la calidad de vida, y favorecen el crecimiento postraumático.Como conclusión, se apunta la necesidad de establecer programas de recuperación integral, no solamente sanitaria, sino también psicosocial. Los militares y veteranos con discapacidad deben ser informados y asesorados acerca de los recursos que tienen a su disposición, pero también acompañados en la transición a la vida civil, iniciando proyectos laborales, sociales, deportivos y de ocio, que favorezcan su calidad de vida, su autoestima y su recuperación. (AU)

The legislative and social progress regarding the rights and equal opportunities of people with disabilities does not exclude military contexts. The United States, France, the United Kingdom and Spain have developed instruments to guarantee legal, administrative, and economic protection for military personnel with disabilities, although social recovery projects and programs seem insufficient. Therefore, this bibliographic review focuses on the objective of reviewing the psychosocial resources available in the Armies of our environment.The results show that most of the studies reviewed focus on the recovery of military personnel with post-traumatic stress disorder (PTSD), although there are also studies on spinal cord injury or brain damage. The topics addressed, in relation to psychosocial support and available resources, focus on employability, economic compensation, treatments and factors that favour social integration. Of note are studies on: (1) the benefits brought by supported employment programs, for health, social integration, and self-esteem, (2) the use of service dogs, that improve quality of life and work production, and (3) sports programs, which improve self-esteem and quality of life, and favour post traumatic growth.In conclusion, the need to establish comprehensive recovery programs, not only health, but also psychosocial, is pointed out. Military personnel and veterans with disabilities should be informed and advised about the resources available to them, and accompanied in the transition to civilian life, initiating work, social, sports and leisure projects that favour their quality of life, self-esteem, and recovery. (AU)