Exploring trauma exposure and post-traumatic stress in university students of different identity statuses in Lithuania and Japan.

Emerging adulthood is the time when identity questions are addressed. It is also a time of excessive stress and risk for mental health problems. Different identity statuses relate to different mental health outcomes. Yet, little research has addressed how identity status is interlinked with trauma exposure and post-traumatic stress reactions, especially in multicultural contexts. The current study aimed to explore whether different traumatic experiences are related to the current identity status of university students aged between 18 and 29 years and investigate to what extent trauma-exposed emerging adults of different identity statuses report symptoms of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). In total, 2237 university students from Lithuania (n = 791) and Japan (n = 1345) participated in the current study. Identity profiles were revealed by using the Latent Class Analysis approach. Lithuania and Japan were comparable in terms of identity profiles and structure of PTSD/CPTSD. Trauma-exposed emerging adults reported a higher probability of being in troubled diffusion identity status; students in achievement identity status had a lower probability of CPTSD and lower rates of symptoms of disturbances in self-organization. The diffused identity of emerging adults from Lithuania and Japan is associated with trauma exposure, and positive identity is linked with fewer CPTSD reactions.

Trauma exposure, posttraumatic stress, and identity content valences among Japanese adolescents.

INTRODUCTION: Theorists and a few empirical studies have suggested that traumatic experiences, posttraumatic stress disorder (PTSD), and complex PTSD (CPTSD) may affect identity development. However, existing studies have overlooked how adolescents' traumas are associated with the alignment of their identity with socio-cultural expectations, which is a crucial component of identity development. To address this gap, this study examined the associations of various types of potentially traumatic experiences and PTSD and CPTSD symptoms with the positive and negative valences of identity affected by desirable and undesirable images within socio-cultural contexts. METHODS: A cross-sectional survey of 341 adolescents (44.0% girls; Mage = 14.8, SD = 1.8) was conducted in Japan. RESULTS: Exposure to certain types of potentially traumatic events (e.g., family violence and physical attack) were related to high levels of negative identity elements, whereas none of the types were related to positive identity elements. The results also indicated that CPTSD-specific symptoms of disturbances in self-organization (DSO) were related to high levels of negative identity elements rather than PTSD. CONCLUSIONS: The findings expand upon related research by suggesting that adolescents' exposure to some types of traumatic events (e.g., family violence and physical attack) and posttraumatic DSO symptoms have the potential to disturb the alignment of their identities with socio-cultural expectations.

The role of therapist support on the efficacy of an internet-delivered stress recovery intervention for healthcare workers: a randomized control trial.

Internet-delivered CBT interventions effectively improve different aspects of mental health, although the therapist's role remains unclear. The aim of this trial was to evaluate the efficacy of a therapist-supported 6-week internet-delivered intervention in improving stress recovery among healthcare workers compared to a group with optional therapist support. A total of 196 participants were recruited and randomly allocated to regular therapists' support or optional therapists' support groups. The primary outcome measure was the Recovery Experiences Questionnaire (REQ), developed to assess four components of stress recovery: psychological detachment, relaxation, mastery, and control. Secondary outcomes measured perceived stress (PSS-10), anxiety (GAD-7), depression (PHQ-9), and psychological well-being (WHO-5). All four stress recovery skills improved significantly after participating in the intervention at a 3-month follow-up, with small to medium effects (0.27-0.65) in both groups. At follow-up, we also found a significant reduction in perceived stress, depression, and anxiety in both groups, as well as an improvement in psychological well-being. The results indicate that ICBT can be effective in improving stress recovery skills among healthcare workers with optional support from the therapist, provided at the participants' request. This RCT suggests that optional therapist support could meet participants' needs and reduce resources needed in routine care.

Can Cardiac Surgery Lead to ICD-11 PTSD and Complex PTSD? Findings of a 5-year Follow-up Study.

Cardiac surgery may lead to various neuropsychiatric conditions, including posttraumatic stress disorder (PTSD). The 11th revision of the International Classification of Diseases (ICD-11) included a new complex posttraumatic stress disorder (CPTSD) disorder in addition to PTSD. This study aimed to explore whether cardiac surgery could be associated with PTSD and CPTSD at a five-year follow-up after cardiac surgery. The study sample comprised 210 patients (mean age 67, 69.5% male) who had undergone cardiac surgery. The self-report International Trauma Questionnaire (ITQ) was used to assess ICD-11 PTSD and CPTSD. The Medical Outcomes Study 36 Item Short Form Health Survey (SF-36) questionnaire was used to measure health-related quality of life (HRQOL). We found 5.2% of cardiac surgery-related probable PTSD and CPTSD at a 5-year follow-up, 1.9% PTSD, and 3.3% CPTSD. Low HRQOL was associated with a high risk for PTSD/CPTSD at follow-up. The results showed that cardiac surgery might have a long-term effect on PTSD and CPTSD symptoms. Patients with low HRQOL are at higher risk of having PTSD/CPTSD risk. The study informs about the need for psychosocial interventions to reduce the impact of cardiac surgery on neuropsychiatric conditions and the improvement of HRQOL.

A Longitudinal Course of ICD-11 Adjustment Disorder Symptom Profiles: A 12-Month Follow-Up Study.

INTRODUCTION: Adjustment disorder is frequently diagnosed in clinical practice; however, the course of adjustment disorder over time has not yet been studied extensively. METHODS: This longitudinal study was one of the first that aimed to analyze trajectories of adjustment disorder symptoms in a 12-month follow-up among a high-risk community sample (n = 205) exposed to various stressors. Adjustment disorder symptoms were measured at baseline and 12-month follow-up with the Brief Adjustment Disorder New Module based on the definition of adjustment disorder provided in the 11th Edition of International Classification of Diseases (ICD-11) released in 2018 by the World Health Organization (WHO). RESULTS: A latent transition analysis of adjustment symptoms identified four distinct trajectories: "high symptom," "recovery," "onset," and "low symptom." We found 46% of ICD-11 adjustment disorder at baseline, and 29% of the sample was classified as having a high-symptom adjustment symptom profile. The high-symptom profile was predicted by ongoing stressors, female gender, and higher education. CONCLUSION: Study findings indicate that adjustment disorder among high-risk samples, in particular, those exposed to ongoing stressors, could have a high-symptom course over 12 months.

The Network Structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Complex Posttraumatic Stress Disorder.

INTRODUCTION: The ICD-11 includes a new grouping for "disorders specifically associated with stress" that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. METHODS: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. RESULTS: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was "startle response." DISCUSSION/CONCLUSION: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.

Do emotion regulation difficulties mediate the association between neuroticism, insecure attachment, and prolonged grief?

In this study, we aimed to test the mediating role of emotion regulation difficulties between prolonged grief disorder symptoms and three risk factors: neuroticism, avoidant attachment, and anxious attachment. A total sample of 203 bereaved participants was included in the study. Path analysis revealed that emotion regulation difficulties partly mediated the links between neuroticism, avoidant attachment, and prolonged grief symptoms, and mediated the link between anxious attachment and prolonged grief symptoms. The findings suggested that emotion regulation difficulties might be an important factor contributing to prolonged grief symptoms among bereaved individuals with high neuroticism and insecure attachment.

Suicidal ideation in university students in Lithuania amid the COVID-19 pandemic: A prospective study with pre-pandemic measures.

We aimed to identify patterns of changes in suicidal ideation among university students six months after the COVID-19 outbreak, in comparison to the pre-pandemic suicidal ideation. Furthermore, we explored the links among these patterns and mental health indicators. 474 university students participated in the study in October-December 2019 and October-December 2020. The latent class change analysis revealed four groups: no-ideation (68.1%), stable low ideation (16.2%), increased ideation (8.9%), and decreased ideation (6.8%). Increased, in comparison to decreased ideation, was positively linked to changes in depression, stress, and anxiety. More loneliness during the pandemic was related to higher suicidal ideation.

Fear of Death and Death Acceptance Among Bereaved Adults: Associations With Prolonged Grief.

This study aimed to analyze fear of death and neutral acceptance of death after a significant loss and their associations with prolonged grief. The sample of the study included 239 bereaved participants. Time since the loss ranged from 6 to 72 months. We found that neutral acceptance of death was associated with older age, a natural cause of death, and the ability to find meaning in the death of a close one. Fear of death was negatively associated with the frequency of practicing religion. We found that fear of death but not neutral acceptance was significantly associated with prolonged grief symptoms.

Commentary: The need for research on PTSD in Children and adolescents - a commentary on Elliot et al. (2020).

The recent release of the 11th version of The International Classification of Diseases (ICD-11: WHO, 2018) marked a significant departure from the previous similarities between it and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013) in terms of their conceptualization of posttraumatic stress disorder (PTSD). The ICD-11 proposed a reduced symptom set for PTSD and a sibling disorder called Complex PTSD. There have been numerous studies that have provided support for the integrity of, and distinction between, PTSD and CPTSD diagnoses in adult samples. Elliot and colleagues (2020) have added to the research literature by providing a valuable examination of the differences between ICD and DSM PTSD/CPTSD in a sample of youth aged 8 to 17 years. This commentary reviews this study and reflects on the need for greater understanding of developmental changes in the presentation of PTSD and Complex PTSD.

Predictors of long-term HRQOL following cardiac surgery: a 5-year follow-up study.

BACKGROUND: The study aimed to evaluate the long-term change of health-related quality of life (HRQOL) and to identify predictors of HRQOL 5 years after cardiac surgery. METHODS: Consecutive adult patients, undergoing elective cardiac surgery were enrolled in the study. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before and 5-years after cardiac surgery. A multivariate latent change modeling approach was used for data analysis. RESULTS: 210 participants (30.5% female) were reached at 5-year follow-up and included in final data analysis. The study revealed, after controlling for gender effects, a significant long-term positive change, in physical functioning (PF, Mslope = 19.79, p < 0.001), social functioning (SF, Mslope = 17.27, p < 0.001), vitality (VT, Mslope = 6.309, p < 0.001) and mental health (MH, Mslope = 8.40, p < .001) in the total sample. Lower education was associated with an increase in PF (Mslope = 24.09, p < 0.001) and VT (Mslope = 8.39, p < 0.001), more complicated surgery (other than the coronary artery bypass graft (CABG) predicted increase in general health (GH, Mslope = 6.76, p = 0.005). Arrhythmia was a significant predictor for lower pre- and post-operative VT and SF. CONCLUSIONS: Overall HRQOL in our sample improved from baseline to five years postoperatively. Further studies including larger patient groups are needed to confirm these findings.

Internet-Based Cognitive Behavioral Therapy for Informal Caregivers: Randomized Controlled Pilot Trial.

BACKGROUND: Caregiving for a family member can result in reduced well-being for the caregiver. Internet-delivered cognitive behavioral therapy (ICBT) may be one way to support this population. This is especially the case for caregivers in countries with limited resources, but high demand for psychological services. OBJECTIVE: In this study we evaluated the effects of a therapist-guided 8-week-long ICBT intervention for informal caregivers. METHODS: In total, 63 participants were recruited online and randomized either to the intervention or to the wait-list control group. The main study outcome was the Caregiver Burden Inventory (CBI). Secondary outcomes included measures of caregiver depression, anxiety, stress, and quality of life. RESULTS: Moderate between-group effect sizes were observed for the CBI measure, in favor of the intervention group, with a Cohen d=-0.70 for the intention-to-treat analysis. Analyses of the subscales of the CBI showed significant reductions on the subscales of Development and Physical Health. Moderate reductions were found for depression and anxiety scores as indicated by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Large between-group effects were observed for reduction in stress and increase in quality of life as indicated by the Perceived Stress Scale-14 (PSS-14), The Brunnsviken Brief Quality of Life Scale (BBQ), and The World Health Organization-Five Well-Being Index (WHO-5). In addition, participants experienced little to no difficulty in using the program and were mostly satisfied with the intervention's platform and the choice of content. CONCLUSIONS: This is the first internet intervention study for informal caregivers in Lithuania. The results suggest that therapist-guided ICBT can be effective in reducing caregiver burden, anxiety, depression, stress, and improving quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT04052724; https://clinicaltrials.gov/ct2/show/NCT04052724.

A Cross-Cultural Comparison of ICD-11 Complex Posttraumatic Stress Disorder Symptom Networks in Austria, the United Kingdom, and Lithuania.

The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) includes a new disorder, complex posttraumatic stress disorder (CPTSD). The network approach to psychopathology enables investigation of the structure of disorders at the symptom level, which allows for analysis of direct symptom interactions. The network structure of ICD-11 CPTSD has not yet been studied, and it remains unclear whether similar networks replicate across different samples. We investigated the network models of four different trauma samples that included a total of 879 participants (M age = 47.17 years, SD = 11.92; 59.04% women) drawn from Austria, Lithuania, and Scotland and Wales in the United Kingdom. The International Trauma Questionnaire was used to assess symptoms of ICD-11 CPTSD in all samples. The prevalence of PTSD and CPTSD ranged from 23.7% to 37.3% and from 9.3% to 53.1%, respectively. Regularized partial correlation networks were estimated and the resulting networks compared. Despite several differences in the symptom presentation and cultural background, the networks across the four samples were considerably similar, with high correlations between symptom profiles (ρs = .48-.87), network structures (ρs = .69-.75), and centrality estimates (ρs = .59-.82). These results support the replicability of CPTSD network models across different samples and provide further evidence about the robust structure of CPTSD. The most central symptom in all four sample-specific networks and the overall network was "feelings of worthlessness." Implications of the network approach in research and practice are discussed.

The Role of Traumatic Experiences and Posttraumatic Stress on Social Anxiety in a Youth Sample in Lithuania.

Emerging adulthood is a developmental stage with an increased vulnerability to mental disorders. Social anxiety disorder (SAD) is highly prevalent anxiety disorder especially among adolescents and young adults. Furthermore, SAD is highly comorbid with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the prevalence of SAD, life-time traumatic experiences and PTSD among Lithuanian young adults studying at the Universities. We also aimed to search for associations between social anxiety, traumatic experiences, and posttraumatic stress in our sample. In total 590 young adults (67.7% female), aged 20 years on average and studying at the Universities in Lithuania were recruited for this study. Self-report measures were used to measure SAD and PTSD. SAD was measured using the Social Phobia Inventory (SPIN), and PTSD was measured using the Impact of Event Scale - Revised (IES-R). SAD prevalence based on SPIN cut-off >26 in our sample was 15.3%, life-time trauma exposure was 67.5%. No association between accumulative trauma exposure and SAD was found. SAD symptoms were highly correlated with PTSD symptoms. Comorbidity between SAD and PTSD was high, with 32.2% cases of PTSD in SAD group. We found high comorbidity between SAD and PTSD in our study among young adults. Further studies are needed to explore development of SAD and PTSD in longitudinal studies.

A Brief Measure of the International Classification of Diseases-11 Adjustment Disorder: Investigation of Psychometric Properties in an Adult Help-Seeking Sample.

Adjustment disorder is one of the most prevalent mental disorders. However, there are almost no measures available for its assessment. We aimed to analyze the psychometric properties of a brief version of the International Classification of Diseases (ICD)-11 adjustment disorder scale (Adjustment Disorder New Module-8; ADNM-8) in a help-seeking sample. Data from 1,174 participants with an average age of 35 years who registered for the internet-based self-help adjustment disorder intervention were analyzed. Psychometric properties of the brief 8-item self-report (ADNM-8) scale measuring the 2 core adjustment disorder symptoms of preoccupation and failure to adapt were tested. Confirmatory factor analysis (CFA) was applied for the analysis of construct validity. CFA supported the 2-factor structure of ADNM-8. Further research is needed for validation of ADNM-8 in cross-cultural studies.

Internet-Based Self-Help Intervention for ICD-11 Adjustment Disorder: Preliminary Findings.

Adjustment disorder is one of the most diagnosed mental disorders. However, there is a lack of studies of specialized internet-based psychosocial interventions for adjustment disorder. We aimed to analyze the outcomes of an internet-based unguided self-help psychosocial intervention BADI for adjustment disorder in a two armed randomized controlled trial with a waiting list control group. In total 284 adult participants were randomized in this study. We measured adjustment disorder as a primary outcome, and psychological well-being as a secondary outcome at pre-intervention (T1) and one month after the intervention (T2). We found medium effect size of the intervention for the completer sample on adjustment disorder symptoms. Intervention was effective for those participants who used it at least one time in 30-day period. Our results revealed the potential of unguided internet-based self-help intervention for adjustment disorder. However, high dropout rates in the study limits the generalization of the outcomes of the intervention only to completers.

"No Posttraumatic Stress Disorder in Lithuania": National Health Care Fails to Identify PTSD.

Lithuanian National Health Insurance (NHI) registry data from 2014 and 2015 were used to estimate the annual rates of posttraumatic stress disorder (PTSD) and other stress-related disorders in Lithuania. A large gap was found between 12-month PTSD prevalence based on epidemiological data and annual PTSD rates based on health care service utilization in Lithuania. Estimations from the health care service's utilization data revealed that only about 0.01% to 0.02% of the population in Lithuania is diagnosed with PTSD annually, indicating that the national health care system identifies only about 1% of potential PTSD cases in Lithuania. The low rates of PTSD diagnoses in the health care system seem to indicate a lack of recognition of psychological trauma among general practitioners and mental health professionals in Lithuania. The lack of visibility of PTSD in the national health care system could be a major barrier to the treatment of PTSD in the country. The study indicates the importance of social factors, especially the recognition of trauma and PTSD, among health care professionals.

'It will get even better': preliminary findings from a trauma-focused psychotherapy effectiveness study reveal false positive patients' long-term outcome expectations after the treatment.

BACKGROUND: There is considerable evidence that outcome expectations may predict psychotherapy outcomes. However, little is known about the long-term outcome expectations following the end of the treatment. AIMS: The aim of this study was to evaluate patients' long-term outcome expectations after trauma-focused post-traumatic stress disorder (PTSD) psychotherapy in a single group effectiveness study. METHODS: Twenty participants with various traumatic experiences who completed the Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder (BEPP) and all the assessments were included into the study. Self-report measures were used to evaluate the therapeutic outcomes: Impact of Event Scale-Revised (IES-R), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, post-treatment, and 6-month follow-up. Subjective Units of Distress Scale was used to measure long-term outcome expectations at post-treatment, asking participants to measure the expected distress in 6 months following the treatment. Assessments at 6-month follow-up were used to estimate the accuracy of patients' expectations of their distress at previous post-treatment assessment. RESULTS: Significant decline of PTSD symptoms at post-treatment with large effect sizes was observed. At post-treatment assessment participants expected significant improvement of their condition in 6 months after the treatment. However, therapeutic effects remained stable at the 6-month follow-up. CONCLUSION: It is concluded that the PTSD patients, even after successful trauma-focused treatment, tend to expect further significant positive changes. However, therapeutic effects were stable half a year after the psychotherapy, and patients tend to have false expectations about further improvement of their condition.

Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial.

BACKGROUND: Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11. METHODS/DESIGN: This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed. DISCUSSION: Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder. TRIAL REGISTRATION: The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.