The different impacts of COVID-19 on the mental health of distinct health care worker categories.

The present study sought to explore the factors associated with the odds of having probable depression and posttraumatic stress disorder (PTSD) related to traumatic COVID-19 experiences and their impact on health care workers in distinct categories. In this cross-sectional study, 1843 health care workers (nurses, nurse technicians, physicians, physical therapists, and other healthcare workers) were recruited via convenience sampling. A survey was administered to obtain information regarding sociodemographic, occupational, and mental health status. Descriptive statistics and multivariable logistic regression were used for the analyses. Being a nurse technician was associated with an odds ratio of 1.76 for probable PTSD. No relation was observed between health care worker categories and the odds of probable depression. Additionally, being female and not receiving adequate PPE were related to greater odds of having probable PTSD and depression.

The COVID-19 pandemic and its impact on mental health of healthcare workers / A pandemia de COVID-19 e seu impacto na saúde mental dos profissionais de saúde

ABSTRACT The COVID-19 pandemic has imposed a health crisis around the world. Health professionals are frequently exposed to stressors that put them at high risk for the development or progression of disabling mental disorders, including posttraumatic stress disorder (PTSD). To understand how pandemic stressors have affected the mental health of healthcare workers, our group conducted a longitudinal and nationwide survey. We investigated the occurrence of traumatic events related to the COVID-19 pandemic and the association between exposure to these events and PTSD symptomatology. Importantly, we also investigated factors that might increase or decrease the risk for PTSD. Depression symptoms were also investigated. The results of the first wave of the project were published in a series of three articles, each focused on different risk or protective factors. The results showed that female sex, young age, a lack of adequate personal protective equipment, social isolation and a previous history of mental illness were consistent predictors of PTSD symptoms. Healthcare workers who reported high levels of peritraumatic tonic immobility, a defensive response that is involuntary, reflexive, and evoked by an intense and inescapable threat, also exhibited an increase in the probability of being diagnosed with PTSD. On the other hand, professional recognition had a negative relationship with PTSD and depression symptoms, emerging as a significant protective factor for psychological health. The identification of protective and risk factors in these situations is crucial to guide the adoption of long-term measures in work environments that will enhance the psychological health of these professionals.

RESUMO A pandemia de COVID-19 impôs uma crise de saúde no mundo. Profissionais de saúde foram frequentemente expostos a estressores que os colocam em alto risco para o desenvolvimento ou progressão de transtornos mentais incapacitantes, incluindo o transtorno de estresse pós-traumático (TEPT). Para entender como esses estressores afetaram a saúde mental desses profissionais, nosso grupo realizou um estudo longitudinal nacional. Investigamos a ocorrência de eventos traumáticos especificamente relacionados à pandemia e a associação entre a exposição a esses eventos traumáticos e a sintomatologia do TEPT. É importante ressaltar que também investigamos fatores que podem aumentar ou diminuir o risco de TEPT. Sintomas de depressão também foram investigados. Os resultados da primeira onda do projeto foram publicados em uma série de três artigos, cada um focado em diferentes fatores de risco ou proteção. Os resultados mostraram que sexo feminino, idade jovem, falta de equipamento de proteção individual adequado, isolamento social e história prévia de doença mental foram preditores consistentes de sintomas de TEPT. Os profissionais de saúde que relataram altos níveis de imobilidade tônica, uma resposta peritraumática involuntária e reflexa evocada em situações de ameaça intensa e inescapável, exibiram aumento na probabilidade de um provável diagnóstico de TEPT. Por outro lado, reconhecimento profissional teve relação negativa com sintomas de TEPT e depressão, emergindo como importante fator de proteção para a saúde mental. Identificar fatores protetores ou de risco nessas situações é fundamental para orientar a adoção de medidas de longo prazo nos ambientes de trabalho que melhorem a saúde mental desses profissionais.

Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma.

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

The invisible scars of emotional abuse: a common and highly harmful form of childhood maltreatment.

BACKGROUND: Childhood maltreatment (CM) is unfortunately widespread globally and has been linked with an increased risk of a variety of psychiatric disorders in adults, including posttraumatic stress disorder (PTSD). These associations are well established in the literature for some maltreatment forms, such as sexual and physical abuse. However, the effects of emotional maltreatment are much less explored, even though this type figures among the most common forms of childhood maltreatment. Thus, the present study aims to investigate the impact of each type of childhood maltreatment, both individually and conjointly, on revictimization and PTSD symptom severity using a nonclinical college student sample. METHODS: Five hundred and two graduate and undergraduate students participated in the study by completing questionnaires assessing lifetime traumatic experiences in general, maltreatment during childhood and PTSD symptoms. Bivariate and multivariate negative binomial regressions were applied to examine the associations among childhood maltreatment, revictimization, and PTSD symptom severity. RESULTS: Our results showed that using bivariate models, all types of CM were significantly associated with revictimization and PTSD symptom severity. Multivariate models showed that emotional abuse was the type of maltreatment associated with the highest incidence rates of revictimization and PTSD symptom severity. CONCLUSIONS: These data provide additional evidence of the harmful effects of childhood maltreatment and its long-term consequences for individuals' mental health. Notably, the findings highlight the importance of studying the impacts of emotional abuse, which seems to be a highly prevalent, understudied, and chronic form of maltreatment that is as toxic as other maltreatment forms.

Vulnerability and Protective Factors for PTSD and Depression Symptoms Among Healthcare Workers During COVID-19: A Machine Learning Approach.

Background: Healthcare workers are at high risk for developing mental health problems during the COVID-19 pandemic. There is an urgent need to identify vulnerability and protective factors related to the severity of psychiatric symptoms among healthcare workers to implement targeted prevention and intervention programs to reduce the mental health burden worldwide during COVID-19. Objective: The present study aimed to apply a machine learning approach to predict depression and PTSD symptoms based on psychometric questions that assessed: (1) the level of stress due to being isolated from one's family; (2) professional recognition before and during the pandemic; and (3) altruistic acceptance of risk during the COVID-19 pandemic among healthcare workers. Methods: A total of 437 healthcare workers who experienced some level of isolation at the time of the pandemic participated in the study. Data were collected using a web survey conducted between June 12, 2020, and September 19, 2020. We trained two regression models to predict PTSD and depression symptoms. Pattern regression analyses consisted of a linear epsilon-insensitive support vector machine (ε-SVM). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r), the coefficient of determination (r2), and the normalized mean squared error (NMSE) to evaluate the model performance. A permutation test was applied to estimate significance levels. Results: Results were significant using two different cross-validation strategies to significantly decode both PTSD and depression symptoms. For all of the models, the stress due to social isolation and professional recognition were the variables with the greatest contributions to the predictive function. Interestingly, professional recognition had a negative predictive value, indicating an inverse relationship with PTSD and depression symptoms. Conclusions: Our findings emphasize the protective role of professional recognition and the vulnerability role of the level of stress due to social isolation in the severity of posttraumatic stress and depression symptoms. The insights gleaned from the current study will advance efforts in terms of intervention programs and public health messaging.

Concepções sobre maternidade, parto e amamentação em grupo de gestantes / Conceptions about motherhood, childbirth and breastfeeding in group of pregnancies / Concepciones sobre la maternidad, el parto y la lactancia materna en el grupo de embarazadas

Considerando a importância do vínculo mãe-bebê para o desenvolvimento socioafetivo infantil e a função cumprida pela amamentação e pelo parto na promoção deste vínculo, o presente trabalho tem como objetivo investigar as concepções sobre parto e amamentação de um grupo de gestantes de uma empresa estatal, composto por mulheres, gestantes ou puérperas, e coordenado por uma equipe multidisciplinar; além de levar a uma reflexão acerca da prática de intervenção psicológica nessa área específica da saúde materno-infantil. Os dados obtidos na pesquisa sugerem que, para esse grupo, existe grande importância atribuída ao ato de amamentar e aos cuidados com o bebê no período de pós-parto e que a intervenção em saúde permitiria que as mulheres discutissem sobre suas escolhas e decisões relacionadas ao processo de maternidade:

Considering the importance of mother-infant development and infant socio-affective function fulfilled by delivery and through breastfeeding in promoting this relationship, this study aims to investigate perceptions about childbirth and breastfeeding from a group of pregnant women from a state enterprise. Composed of women, pregnant or lactating women, and coordinated by a multidisciplinary team as well as lead to a reflection on the contribution of the psychological practice intervention on this specific area of maternal and child health. The data obtained in this research suggest that, for this group, there is great importance attached to the act of breastfeeding and baby care in the post partum period and the intervention allowed to discuss about the women choices and decisions regarding the process of motherhood:

Teniendo en cuenta la importancia de la función que cumple la lactancia materna y el parto en la promoción de este enlace madre-hijo para el desarrollo socio-afectivo del bebé, este estudio pretende investigar las concepciones sobre el parto y la lactancia de un grupo de mujeres embarazadas de una empresa del Estado compuesto por mujeres, mujeres embarazadas o que han dado a luz recientemente, y coordinado por un equipo multidisciplinario, además de conducir a una reflexión sobre la práctica de intervención psicológica en esa área específica de la salud materno-infantil. Los datos obtenidos en la encuesta sugieren que, para este grupo, se concede una gran importancia al acto de la lactancia materna y cuidado del bebé en el período posparto y que la intervención en la salud les permitiría a las mujeres embarazadas discutir sus opciones y decisiones sobre el proceso de la maternidad:

Concepções sobre maternidade, parto e amamentação em grupo de gestantes / Conceptions about motherhood, childbirth and breastfeeding in group of pregnancies / Concepciones sobre la maternidad, el parto y la lactancia materna en el grupo de embarazadas

Considerando a importância do vínculo mãe-bebê para o desenvolvimento socioafetivo infantil e a função cumprida pela amamentação e pelo parto na promoção deste vínculo, o presente trabalho tem como objetivo investigar as concepções sobre parto e amamentação de um grupo de gestantes de uma empresa estatal, composto por mulheres, gestantes ou puérperas, e coordenado por uma equipe multidisciplinar; além de levar a uma reflexão acerca da prática de intervenção psicológica nessa área específica da saúde materno-infantil. Os dados obtidos na pesquisa sugerem que, para esse grupo, existe grande importância atribuída ao ato de amamentar e aos cuidados com o bebê no período de pós-parto e que a intervenção em saúde permitiria que as mulheres discutissem sobre suas escolhas e decisões relacionadas ao processo de maternidade

Considering the importance of mother-infant development and infant socio-affective function fulfilled by delivery and through breastfeeding in promoting this relationship, this study aims to investigate perceptions about childbirth and breastfeeding from a group of pregnant women from a state enterprise. Composed of women, pregnant or lactating women, and coordinated by a multidisciplinary team as well as lead to a reflection on the contribution of the psychological practice intervention on this specific area of maternal and child health. The data obtained in this research suggest that, for this group, there is great importance attached to the act of breastfeeding and baby care in the post partum period and the intervention allowed to discuss about the women choices and decisions regarding the process of motherhood

Teniendo en cuenta la importancia de la función que cumple la lactancia materna y el parto en la promoción de este enlace madre-hijo para el desarrollo socio-afectivo del bebé, este estudio pretende investigar las concepciones sobre el parto y la lactancia de un grupo de mujeres embarazadas de una empresa del Estado compuesto por mujeres, mujeres embarazadas o que han dado a luz recientemente, y coordinado por un equipo multidisciplinario, además de conducir a una reflexión sobre la práctica de intervención psicológica en esa área específica de la salud materno-infantil. Los datos obtenidos en la encuesta sugieren que, para este grupo, se concede una gran importancia al acto de la lactancia materna y cuidado del bebé en el período posparto y que la intervención en la salud les permitiría a las mujeres embarazadas discutir sus opciones y decisiones sobre el proceso de la maternidad

Marcadores neurobiológicos e psicométricos da eficácia da terapia cognitivo-comportamental no transtorno de estresse pós-traumático associado a sintomas dissociativos: relato de caso / Neurobiological and psychometric markers of the efficacy of cognitive behavioral therapy in post-traumatic stress disorder with dissociative symptoms: a case report

INTRODUÇÃO: O transtorno de estresse pós-traumático (TEPT) tem sido associado à desregulação de diversos parâmetros psicofisiológicos e pode apresentar comorbidade com diversas psicopatologias, inclusive a dissociação, podendo dificultar o tratamento. O objetivo do presente trabalho foi investigar os efeitos da terapia cognitivo-comportamental em um paciente com TEPT e sintomas dissociativos com base em medidas psicofisiológicas e psicométricas em diferentes momentos do tratamento. DESCRIÇÃO DO CASO: O paciente é um homem de 38 anos, com diagnósticos de TEPT e transtorno depressivo maior recorrente com sintomas dissociativos e resistência ao tratamento farmacológico. O tratamento psicoterápico teve duração de 4 meses, sendo composto por uma sessão semanal de terapia e três sessões semanais de coterapia. Os parâmetros fisiológicos (frequência cardíaca, tônus vagal, balanço simpático e cortisol) e psicométricos (afeto negativo e positivo, resiliência e sintomas de estresse pós-traumático, depressão, ansiedade e dissociação) foram medidos antes, durante (uma vez ao mês) e após o tratamento. COMENTÁRIOS: Os resultados mostraram diminuição do balanço simpático e aumento do tônus vagal, da frequência cardíaca e dos níveis de cortisol ao longo do tratamento. O tratamento também promoveu redução no afeto negativo e nos sintomas de estresse pós-traumático, depressão, ansiedade e dissociação, além de um aumento nos escores de resiliência, apoio social e afeto positivo. Esses resultados sugerem que a terapia cognitivo-comportamental é um tratamento eficaz para o TEPT com sintomas dissociativos. Além disso, parece promover a normalização das alterações fisiológicas do sistema nervoso autônomo e neuroendócrino relacionadas ao TEPT.

INTRODUCTION: Post-traumatic stress disorder (PTSD) has been associated with dysregulation of many psychophysiological parameters and may present comorbidity with different psychopathologies, including dissociation, potentially affecting treatment outcome. The aim of this study was to evaluate the effects of cognitive behavioral therapy in a patient with PTSD and dissociative symptoms based on psychophysiological and psychometric measures at different time points throughout the course of treatment. CASE DESCRIPTION: Our patient is a 38-year old man diagnosed with PTSD, major depression, and dissociative symptoms, resistant to pharmacotherapy. Psychological treatment lasted for 4 months and consisted of one weekly therapy session and three weekly coaching sessions. Physiological (heart rate, vagal tone, sympathovagal balance, and cortisol) and psychometric measures (negative and positive affect, resilience, and post-traumatic stress, depression, anxiety, and dissociative symptoms) were obtained before, during (once a month) and after treatment. COMMENTS: Results showed a decrease in sympathovagal balance and an increase in heart rate, vagal tone and cortisol levels during the course of treatment. Treatment also lead to a decrease in negative affect and in post-traumatic stress, depression, anxiety, and dissociation symptoms, as well as to an increase in resilience, social support and positive affect scores. These results suggest that cognitive behavioral therapy is an effective treatment for PTSD patients with dissociative symptoms. Moreover, the treatment seems to be able to normalize PTSD-related physiological parameters in the neuroendocrine and autonomic nervous systems.

Impacto da co-terapia no tratamento do TEPT com terapia cognitivo-comportamental / Impact of co-therapy in the cognitive behavioral treatment of PTSD

A terapia cognitivo-comportamental (TCC) apresenta eficácia comprovada no tratamento do Transtorno de Estresse Pós-Traumático (TEPT), contando com técnicas tais como psicoeducação, reestruturação cognitiva, relaxamento muscular progressivo, respiração diafragmática, exposição in vivo e imaginária. A utilização de co-terapia no tratamento individual de pacientes praticamente não foi investigada. O objetivo deste estudo foi ilustrar a adaptação do protocolo da Edna Foa para TCC no TEPT com destaque para a introdução da co-terapia, não presente no protocolo original. Trata-se da avaliação do tratamento de uma paciente com TEPT que não tolerou os medicamentos de primeira escolha, através de escalas de auto-relato e heteroavaliação realizada por psiquiatras. Observou-se diminuição dos escores do Inventário Beck de Depressão (BDI), Inventário Beck de Ansiedade (BAI), Clinical Global Impression (CGI) e do PTSD Checklist - civilian version (PCL-C) ao longo do tratamento. O presente caso sugere que a administração do protocolo foi adequada, havendo evidências de eficácia da TCC e da relevância da co-terapia como ingrediente importante neste processo. Ensaios randomizados controlados poderão testar o custo-efetividade da adição da co-terapia ao tratamento, particularmente em casos de TEPT resistentes ou intolerantes aos tratamentos convencionais e com comorbidades psiquiátricas

Cognitive behavioral therapy (CBT) is an effective treatment for Post Traumatic Stress Disorder (PTSD) and use techniques such as psychoeducation, cognitive restructuring, relaxation, breathing retraining, imaginal and in vivo exposure. The role of co-therapy in individual treatment of patients hasn't been well investigated. The aim of the present study was to illustrate the adaptation of a version of Edna Foa's protocol of CBT for the treatment of PTSD, highlighting the addition of co-therapy, not included at the original protocol. It was evaluated the treatment of a medication intolerant PTSD patient through self report scales and psychiatric evaluation. It was observed that scores of Depression Beck Inventory, Anxiety Beck Inventory, Clinical Global Impression and PTSD Checklist - civilian version decreased over treatment. This case report suggests that the administration of the protocol was satisfactory, with evidences of CBT efficacy and co-therapy relevance as an important element in this process. Randomized controlled trials are necessary to test the cost-effectiveness of co-therapy addition in the treatment protocol, particularly in patients with treatment-resistant or treatment-intolerant PTSD and psychiatric comorbidity.