Recurrence of post-traumatic stress disorder: systematic review of definitions, prevalence and predictors.

BACKGROUND: Many people will experience a potentially traumatic event in their lifetime and a minority will go on to develop post-traumatic stress disorder (PTSD). A wealth of literature explores different trajectories of PTSD, focusing mostly on resilient, chronic, recovered and delayed-onset trajectories. Less is known about other potential trajectories such as recurring episodes of PTSD after initial recovery, and to date there has been no estimate of what percentage of those who initially recover from PTSD later go on to experience a recurrence. This systematic review aimed to synthesise existing literature to identify (i) how 'recurrence' of PTSD is defined in the literature; (ii) the prevalence of recurrent episodes of PTSD; and (iii) factors associated with recurrence. METHODS: A literature search of five electronic databases identified primary, quantitative studies relevant to the research aims. Reference lists of studies meeting pre-defined inclusion criteria were also hand-searched. Relevant data were extracted systematically from the included studies and results are reported narratively. RESULTS: Searches identified 5,398 studies, and 35 were deemed relevant to the aims of the review. Results showed there is little consensus in the terminology or definitions used to refer to recurrence of PTSD. Because recurrence was defined and measured in different ways across the literature, and prevalence rates were reported in numerous different ways, it was not possible to perform meta-analysis to estimate the prevalence of recurrence. We also found no consistent evidence regarding predictors of PTSD recurrence. CONCLUSION: A clear and consistent evidence-based definition of recurrence is urgently needed before the prevalence and predictors of recurrence can be truly understood.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic.

The COVID-19 pandemic profoundly affected physical, mental, and economic well-being across the globe and has disproportionately affected certain vulnerable groups. This paper provides a scoping review of literature on the impact of the COVID-19 pandemic on sex workers, published between December 2019 and December 2022. Six databases were systematically searched, identifying 1009 citations; 63 studies were included in the review. Thematic analysis revealed eight main themes: financial issues; exposure to harm; alternate ways of working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, mental health, and coping; access to support; access to health care; and the impact of COVID-19 on research with sex workers. COVID-associated restrictions led to reduced work and income, leaving many sex workers struggling to cover basic needs; additionally, government protections excluded those working in the informal economy. Fearing the loss of their already reduced number of clients, many felt compelled to compromise both prices and protective measures. Although some engaged in online sex work, this raised concerns about visibility and was impossible for those without technological access or skills. Many feared COVID-19, but felt pressure to continue working, often with clients who refused to wear masks or share exposure history. Other negative impacts on well-being related to the pandemic included reduced access to financial support or health care. Marginalized populations (and especially those in professions which require close contact like sex workers) need further support and capacity-building within the community to recover from the impact of COVID-19.

The psychological impact of quarantine and how to reduce it: rapid review of the evidence.

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

A systematic review of factors affecting adherence to malaria chemoprophylaxis amongst travellers from non-endemic countries.

BACKGROUND: The aim of this systematic review was to identify predictors of actual or intended adherence with malaria chemoprophylaxis amongst travellers from non-endemic countries visiting endemic countries. METHODS: A systematic review of the literature was conducted using MEDLINE, Embase, PsycINFO and Global Health databases for studies published up to April 2019. Studies were included if they assessed reasons for adherence among people travelling from a country where malaria was not endemic to a country where it was. RESULTS: Thirty-two studies were included. Predictors of adherence were categorized as relating to either the nature of the travel or the traveller themselves. The three main predictors associated with nature of travel included: destination (e.g. country visited, urban vs rural areas), length of travel and type of travel (e.g. package vs backpacking holiday). The four main traveller-associated predictors were: age, reason for travel (e.g. business, leisure or visiting friends and relatives), perceived risk of catching malaria and experienced or expected medication effects. CONCLUSIONS: In order to improve adherence, clinicians should focus on travellers who are least likely to exhibit adherent behaviour. This includes travellers visiting destinations known to have lower adherence figures (such as rural areas), backpackers, business travellers, younger travellers and those travelling for longer periods of time. They should also check to ensure travellers' perceptions of the risks of malaria are realistic. Where appropriate, misperceptions (such as believing that curing malaria is easier than taking prophylaxis or that travellers visiting relatives have some level of innate immunity) should be corrected. All travellers should be informed of the potential side-effects of medication and given guidance on why it is nonetheless beneficial to continue to take prophylaxis. Further research is required to test interventions to improve adherence.

The impact of unplanned school closure on children's social contact: rapid evidence review.

BackgroundEmergency school closures are often used as public health interventions during infectious disease outbreaks to minimise the spread of infection. However, if children continue mixing with others outside the home during closures, the effect of these measures may be limited.AimThis review aimed to summarise existing literature on children's activities and contacts made outside the home during unplanned school closures.MethodsIn February 2020, we searched four databases, MEDLINE, PsycInfo, Embase and Web of Science, from inception to 5 February 2020 for papers published in English or Italian in peer-reviewed journals reporting on primary research exploring children's social activities during unplanned school closures. Main findings were extracted.ResultsA total of 3,343 citations were screened and 19 included in the review. Activities and social contacts appeared to decrease during closures, but contact remained common. All studies reported children leaving the home or being cared for by non-household members. There was some evidence that older child age (two studies) and parental disagreement (two studies) with closure were predictive of children leaving the home, and mixed evidence regarding the relationship between infection status and such. Parental agreement with closure was generally high, but some disagreed because of perceived low risk of infection and issues regarding childcare and financial impact.ConclusionEvidence suggests that many children continue to leave home and mix with others during school closures despite public health recommendations to avoid social contact. This review of behaviour during unplanned school closures could be used to improve infectious disease modelling.

Research fatigue in COVID-19 pandemic and post-disaster research: Causes, consequences and recommendations.

PURPOSE: Research fatigue occurs when an individual or population of interest tires of engaging with research, consequently avoiding further participation. This paper considers research fatigue in the context of the current COVID-19 pandemic, to identify contributory factors and possible solutions for future post-disaster research. METHODOLOGY: We draw on examples from the literature and our own observations from the recruitment and data collection phases of qualitative and quantitative studies, to provide an overview of possible research fatigue in the current COVID-19 pandemic, with implications for future post-disaster research. FINDINGS: People affected by disasters sometimes receive multiple requests for study participation by separate teams who may not necessarily be coordinating their work. Not keeping participants informed of the research process or outcomes can lead to disillusionment. Being overburdened with too many research requests and failing to see any subsequent changes following participation may cause individuals to experience research fatigue. ORIGINALITY: Guidelines for researchers wishing to reduce the occurrence of research fatigue include ensuring greater transparency within research; sharing of results; and using oversight or gatekeeper bodies to aid coordination. Failure to restrict the number of times that people are asked to participate in studies risks poor participation rates. This can subsequently affect the quality of information with which to inform policy-makers and protect the health of the public during the COVID-19 pandemic or other public health disasters/emergencies.

Traumatic stress within disaster-exposed occupations: overview of the literature and suggestions for the management of traumatic stress in the workplace.

BACKGROUND: Many people who experience a disaster will do so as part of an occupational group, either by chance or due to the nature of their role. SOURCES OF DATA: This review is based on literature published in scientific journals. AREAS OF AGREEMENT: There are many social and occupational factors, which affect post-disaster mental health. In particular, effective social support-both during and post-disaster-appears to enhance psychological resilience. AREAS OF CONTROVERSY: There is conflicting evidence regarding the best way to support trauma-exposed employees. Many organisations carry out post-incident debriefing despite evidence that this is unhelpful. GROWING POINTS: Employees who are well supported tend to have better psychological outcomes and as a result may be more likely to perform well at work. AREAS TIMELY FOR DEVELOPING RESEARCH: The development and evaluation of workplace interventions designed to help managers facilitate psychological resilience in their workforce is a priority. Successful interventions could substantially increase resilience and reduce the risk of long-term mental health problems in trauma-exposed employees.

Non-deployment factors affecting psychological wellbeing in military personnel: literature review.

BACKGROUND: Most military mental health research focuses on the impact of deployment-related stress; less is known about how everyday work-related factors affect wellbeing. AIMS: This systematic narrative literature review aimed to identify non-deployment-related factors contributing to the wellbeing of military personnel. METHOD: Electronic literature databases were searched and the findings of relevant studies were used to explore non-deployment-related risk and resilience factors. RESULTS: Fifty publications met the inclusion criteria. Determinants of non-deployment stress were identified as: relationships with others (including leadership/supervisory support; social support/cohesion; harassment/discrimination) and role-related stressors (role conflict; commitment and effort-reward imbalance; work overload/job demands; family-related issues/work-life balance; and other factors including control/autonomy, physical work environment and financial strain). Factors positively impacting wellbeing (such as exercise) were also identified. CONCLUSIONS: The literature suggests that non-deployment stressors present a significant occupational health hazard in routine military environments and interpersonal relationships at work are of fundamental importance. Findings suggest that in order to protect the wellbeing of personnel and improve performance, military organisations should prioritise strengthening relationships between employees and their supervisors/colleagues. Recommendations for addressing these stressors in British military personnel were developed.

Factors associated with Type II trauma in occupational groups working with traumatised children: a systematic review.

BACKGROUND: There is evidence that "Type II trauma" (TTT) - repeated exposure to traumatic events - can lead to the development of post-traumatic stress disorder (PTSD). TTT frequently occurs in occupational groups working with children who are themselves victims of trauma. AIM: To conduct a systematic review identifying risk factors for/protective factors against TTT-associated mental ill-health in employees working with traumatised children and explore how this type of work impacts upon social functioning. METHOD: Databases were searched for relevant studies and supplemented by hand searches. RESULTS: 836 papers were found and 13 were included in the review. The key themes identified were coping mechanisms; social support; personality; demographics; occupational support; work-related stressors; traumatic exposure; organisational satisfaction; training/experience and impact on life. CONCLUSION: Unhelpful coping strategies (e.g. denial) appeared to increase the risk of TTT. Training and strong support may be protective and work-related stressors (e.g. excessive workload) appeared detrimental. Despite some positive impacts of the work (e.g. becoming more appreciative of life) many negative impacts were identified, demonstrating the importance of minimising risk factors and maximising protective factors for staff at risk of TTT.

Training and post-disaster interventions for the psychological impacts on disaster-exposed employees: a systematic review.

BACKGROUND: When organisations are exposed to traumatic situations, such as disasters, often staff are not prepared for the potential psychological impact which can negatively affect their wellbeing. AIMS: To conduct a systematic review of the literature on psychological interventions aimed at improving staff wellbeing during or after disasters. METHOD: Four electronic literature databases were searched. Reference lists of relevant articles were hand-searched. RESULTS: Fifteen articles were included. Five studies suggested that pre-disaster skills training and disaster education can improve employee confidence. Ten studies on post-disaster interventions revealed mixed findings on the effectiveness of psychological debriefing and limited evidence for cognitive behavioural therapy, psychoeducation and meditation. CONCLUSIONS: Pre-disaster training and education can improve employees' confidence in their ability to cope with disasters. The routine use of post-disaster psychological debriefings is not supported; further research is needed to determine if debriefing interventions could be useful in some circumstances. Further research is needed to provide more evidence on the potential positive effects of cognitive behavioural therapy, psychoeducation and meditation. More experimental studies on psychological disaster interventions are needed.

Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents' secondary traumatic stress?

PURPOSE: Previous research has mainly focused on veterans' mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran's experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans. METHODS: We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles. RESULTS: Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring's experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent's experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %. CONCLUSIONS: Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail.

Chronic Fatigue Syndrome: Cognitive, Behavioural and Emotional Processing Vulnerability Factors.

BACKGROUND: Cognitive-behavioural models of chronic fatigue syndrome (CFS) suggest that personality factors such as perfectionism and high moral standards may contribute to the development of CFS. AIMS: To investigate cognitive, behavioural and emotional processing risk factors for CFS. METHOD: CFS patients (n = 67) at a UK specialist clinic completed questionnaires about psychological characteristics both currently and retrospectively (6 months pre-CFS onset). Responses were compared with those of healthy individuals (n = 73) who rated their current characteristics. Forty-four relatives retrospectively rated the pre-morbid psychological characteristics of the CFS participants. RESULTS: CFS patients showed similar levels of current perfectionism to controls, though higher pre-morbid perfectionism. CFS patients showed greater self-sacrificial beliefs and more unhelpful beliefs about experiencing and expressing negative emotions, both currently but more markedly prior to onset. In the 6 months pre-illness onset, CFS patients showed more disruption to their primary goal and greater general stress than controls. Ratings of pre-morbid psychological characteristics by relatives were consistent with patients' self-reports. The extent of overinvestment in one goal was significantly associated with fatigue. CONCLUSIONS: Perfectionism, self-sacrificial tendencies, unhelpful beliefs about emotions, and perceived stress may be present to a greater extent pre-morbidly in CFS patients compared with healthy individuals.

The specific needs of doctors with mental health problems: qualitative analysis of doctor-patients' experiences with the Practitioner Health Programme.

OBJECTIVES: The current paper aimed to explore doctor-patients' views about their treatment from the Practitioner Health Programme (PHP), a UK-based service treating health professionals with mental health/addiction problems. Aims were to gain insights into the issues most important to patients and consider whether a service specifically for doctors is important in helping to overcome barriers to accessing mental healthcare. METHODS: Nine doctor-patients attending PHP took part in semi-structured interviews between September 2010 and June 2011. Thematic analysis was used to explore recurring patterns in the data. 134 written comments from PHP patients were also included. RESULTS: Participants reported difficulties in finding appropriate treatment; problems were often severe by the time PHP was involved. Concerns about confidentiality, judgement and impact on career were obstacles to help-seeking and important issues during treatment. Analysis of written comments provided further support for these findings. CONCLUSION: Whilst some of the needs of mentally unwell doctors mirror the needs of patients in general - e.g. a supportive and non-judgemental attitude from clinicians - they do have specific needs related to confidentiality and stigma.

Social and occupational factors associated with psychological wellbeing among occupational groups affected by disaster: a systematic review.

BACKGROUND: The psychological impact of disasters has been well-documented; less attention has been paid to factors affecting the wellbeing of those exposed to disasters as occupational groups. AIMS: To conduct a systematic literature review identifying social and occupational factors affecting the wellbeing of disaster-exposed employees; to use these factors to identify recommendations for potential interventions. METHOD: Four electronic literature databases were searched; reference lists of relevant papers were hand-searched. RESULTS: A total of 18 005 papers were found, 571 full texts were read and 36 included in the review. The psychological impact of disasters on employees was associated with pre-disaster factors (experience/training; income; life events/health; job satisfaction), peri-disaster factors (exposure; peri-traumatic experiences; perceptions of safety; injury), social factors (organisational support; social support generally) and post-disaster factors (impact on life). CONCLUSIONS: It is important to build a resilient workforce outside of a crisis. Pre-disaster training in recognising signs of distress, understanding vulnerability factors such as those described above, which may put certain employees at greater risk of distress and how to support colleagues may be useful. Further research into the effectiveness of post-disaster interventions is needed.

Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster.

BACKGROUND: When disasters occur, humanitarian relief workers frequently deploy to assist in rescue/recovery efforts. AIMS: To conduct a systematic review of factors affecting the psychological wellbeing of disaster relief workers and identify recommendations for interventions. METHOD: We searched MEDLINE®, Embase, PsycINFO® and Web of Science for relevant studies, supplemented by hand searches. We performed thematic analysis on their results to identify factors predicting wellbeing. RESULTS: Sixty-one publications were included. Key themes were: pre-deployment factors (preparedness/training); peri-deployment factors (deployment length/timing; traumatic exposure; emotional involvement; leadership; inter-agency cooperation; support; role; demands and workload; safety/equipment; self-doubt/guilt; coping strategies) and post-deployment factors (support; media; personal and professional growth). CONCLUSIONS: As well as role-specific stressors, many occupational stressors not specific to humanitarian relief (e.g. poor leadership, poor support) present a significant health hazard to relief workers. Humanitarian organisations should prioritise strengthening relationships between team members and supervisors, and dealing effectively with non-role-specific stressors, to improve the psychological resilience of their workforce.

Experiences of working from home: umbrella review.

INTRODUCTION: The concept of "working from home" is extremely topical following the COVID-19 pandemic; therefore, it is unsurprising that there has been an increased interest in collating research related to homeworking. This has been carried out by multiple reviews, all with slightly different research aims and methodologies. Collating the findings from the available reviews is therefore highly beneficial to establish the experience of homeworking to create recommendations for the future of home-based work. METHODS: An umbrella review was carried out. In June 2022, literature searches were conducted across 4 electronic databases. Published reviews of literature that used a systematic process, were focused on working from home populations, and detailed factors that could be related to the personal experience of homeworking (eg, barriers, facilitators, advantages, disadvantages) were included. RESULTS: A total of 1930 records were screened and 6 review articles were included. Results report on the following sections: working environment (eg, workplace design, space conditions), personal impact (eg, satisfaction, career impact), and health (eg, physical health, well-being) including a total of 19 themes. Mixed findings were apparent for nearly all included themes, highlighting the need to consider individual and contextual circumstances when researching working from home. CONCLUSIONS: This review establishes the importance of retaining flexibility while homeworking for employees, managers, and organizations. Essentially, a one-size-fits-all approach to working from home is impractical as individual circumstances limit application. Eight recommendations for the future of working from home are suggested.

Doctors and dentists with mental ill health and addictions: outcomes of treatment from the Practitioner Health Programme.

BACKGROUND: The Practitioner Health Programme (PHP) was developed to provide expert assessment and support to practitioners (doctors and dentists) with mental and physical health problems affecting their ability to work. AIMS: This paper examines the treatment outcomes of the practitioner-patients utilising PHP. METHOD: We assessed outcomes on consecutive patients using the PHP. The Clinical Outcomes in Routine Evaluation Outcome Measure and the Work and Social Adjustment Scale were completed at initial assessment, 8- and 26-week follow-up. We also report the percentages of practitioner-patients off work at each interval, and examine global improvement and satisfaction scores for both follow-up intervals. RESULTS: Two hundred practitioner-patients entered PHP due to a mental health or substance abuse problem and subsequently completed questionnaires at baseline; 102 patients returned questionnaires after 8 weeks and 95 returned questionnaires after 26 weeks. Results suggested that patients reported less distress and less impairment of functioning at 8 and 26 weeks. Scores for satisfaction and global improvement were consistently high. CONCLUSIONS: The PHP is providing a valuable service to practitioner-patients, significantly helping to decrease levels of distress and improve work and social functioning.

The Well-Being of Companion Animal Caregivers and Their Companion Animals during the COVID-19 Pandemic: Scoping Review.

It is important to understand the effects of the COVID-19 pandemic on animal caregivers and their companion animals in order to inform responses to future crises. Prior research is inconsistent, with the benefits of animal companionship believed to be overstated. In this scoping review, we searched four electronic databases and hand-searched reference lists of included studies. Over 4000 citations were found, and 122 were included in the review. Reflecting on the pre-COVID literature, quantitative evidence of the association between psychological well-being and animal companionship during the pandemic was mixed, with numerous positive, negative, and null findings reported. Studies highlighted the benefits of animal companionship during the pandemic, with animals reported to provide their caregivers with a routine, a sense of greater purpose, a positive distraction from COVID-19, companionship, and emotional support. However, participants also reported concerns about meeting animals' needs, fears of animals catching or spreading the virus, and financial worries. Concerns about what would happen to animals if caregivers were hospitalized led some to delay COVID-19 testing or treatment. Animals also experienced benefits (such as increased companionship and calmer mood) and negative impacts (such as increased clinginess and separation anxiety). Companion animals should be a key consideration in emergency preparedness plans.

"Exceptionally challenging time for all of us": Qualitative study of the COVID-19 experiences of partners of diplomatic personnel.

BACKGROUND: Although the romantic partners of diplomatic personnel frequently accompany their spouses to overseas postings and face the challenges of having to adjust to new cultures and separation from friends and family, they have rarely been the focus of academic research. This study explores the lived experiences of the partners/spouses of diplomatic personnel from the United Kingdom's Foreign, Commonwealth and Development Office (FCDO) during the COVID-19 pandemic. METHODS: Partners of FCDO staff took part in semi-structured interviews about how COVID-19 had affected their lives and their perceptions of the organisation's response to the pandemic. Thematic analysis was used to analyse the data. RESULTS: Eleven partners of FCDO staff took part, who between them had lived in 14 different countries during the pandemic. The analysis identified six key themes: deployment-specific challenges such as travel restrictions, quarantine and evacuation; children; impacts of the pandemic including financial and psychological; perceptions of the organisational response to COVID-19; support and help-seeking; and suggestions for the future. Overall participants reported experiencing a number of challenges, many of which left them feeling powerless and not in control of their own lives. Participants frequently described a lack of clarity around policies and support. Social support appeared to be valuable, but many participants wanted more support from the organisation and from informal networks. CONCLUSIONS: Diplomatic (and similar) organisations could enhance the wellbeing of the partners of their staff through improved communication and support. Keeping families informed about restrictions, requirements, policies and available help during a crisis, and reaching out to them to offer advice and support, would likely be beneficial. It is important that lessons are learned from the COVID-19 crisis in order for organisations to be able to support their employees and families if another prolonged crisis were to occur.

The relationship between homeworking during COVID-19 and both, mental health, and productivity: a systematic review.

BACKGROUND: As of March 2020, the UK public were instructed to work from home where possible and as a result, nearly half of those in employment did so during the following month. Pre-pandemic, around 5% of workers chose to work from home; it was often seen as advantageous, for example due to eliminating commuting time and increasing flexibility. However, homeworking also had negative connotations, for example, blurred boundaries between work and home life due to a sense of constant connectivity to the workplace. Understanding the psychological impact of working from home in an enforced and prolonged manner due to the COVID-19 pandemic is important. Therefore, this review sought to establish the relationship between working from home, mental health, and productivity. METHODS: In January 2022, literature searches were conducted across four electronic databases: Medline, Embase, PsycInfo and Web of Science. In February 2022 grey literature searches were conducted using Google Advanced Search, NHS Evidence; Gov.uk Publications and the British Library directory of online doctoral theses. Published and unpublished literature which collected data after March 2020, included participants who experienced working from home for at least some of their working hours, and detailed the association in terms of mental health or productivity were included. RESULTS: In total 6,906 citations were screened and 25 papers from electronic databases were included. Grey literature searching resulted in two additional papers. Therefore, 27 studies were included in this review. Findings suggest the association between homeworking and both, mental health and productivity varies considerably, suggesting a complex relationship, with many factors (e.g., demographics, occupation) having an influence on the relationship. CONCLUSION: We found that there was no clear consensus as to the association between working from home and mental health or productivity. However, there are indications that those who start homeworking for the first time during a pandemic are at risk of poor productivity, as are those who experience poor mental health. Suggestions for future research are suggested.