Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms After Potentially Traumatic Events: Latent Classes and Cognitive Correlates.

ABSTRACT: People exposed to potentially traumatic events (PTEs) may develop distinct symptom patterns, which may require different therapeutic approaches. We aimed to identify classes of people exposed to PTEs based on the presence of posttraumatic stress disorder (PTSD) clusters, anxiety, and depression and to explore which cognitive factors (rumination, worry, and negative cognitions) are associated with class membership. Latent class analyses were conducted to identify subgroups of 258 PTE-exposed Spanish adults. A three-class solution emerged: a resilient class with low odds of all symptoms ( n = 188); a partial PTSD class, characterized by partial PTSD clusters, moderate anxiety, and low depression ( n = 36); and a high symptom class, characterized by high PTSD, moderate anxiety, and low depression ( n = 34). These classes related meaningfully to rumination, worry, and negative cognitions. Distinct symptom patterns of PTSD clusters, anxiety, and depression can be distinguished in people exposed to PTEs and relate to cognitive risk factors of psychopathology.

Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: a systematic and meta-analytic review.

Background: Previous studies have reviewed the evidence on the increase in alcohol consumption after a terrorist attack. However, an increase does not necessarily imply the presence of an alcohol use disorder.Objectives: To conduct a systematic and meta-analytic review of the literature on the prevalence of increased alcohol consumption and alcohol use disorders in adult exposed to terrorism.Methods: A search of PsycINFO, MEDLINE and PTSDpubs identified 29 studies published up to March 2023 in which 38 adult samples totaling 282,753 persons exposed to terrorism were assessed. Using inverse variance heterogeneity models, pooled prevalence rates of increased alcohol use and alcohol use disorders were calculated.Results: 6% (95% CI [2.9, 9.5]) of the adults exposed to a terrorist attack increased their alcohol consumption. The prevalence of increased alcohol use varied depending on the degree of exposure (p = .006, R2 = .18) and the procedure for measuring increases (p = .043, R2 = .37). The prevalence of alcohol use disorders in adults exposed to a terrorist attack was 5.5% (95% CI [3.7, 7.5]), a rate that was not higher than that obtained in the general population and varied depending on the type of alcohol disorder (p = .015, R2 = .30).Conclusions: A relevant number of adults exposed to terrorist attacks will subsequently increase their alcohol consumption, but this increase is not associated with an increase in the prevalence of alcohol use disorders. Effects of terrorism on people's health are potentially widespread, but concerns of excessive alcohol use after terrorist attacks may be unwarranted.

Relationships of the Big Five facets and dysfunctional attitudes with depression.

There are two parallel lines of research on the relationship between personality and depression, one based on the Big Five personality model and one on Beck's cognitive theory of depression. However, no study has jointly examined the dimensions and facets of the Big Five and the dysfunctional attitudes of Beck's theory. This was the objective of the present study. The Revised NEO Personality Inventory (NEO PI-R), the Dysfunctional Attitude Scale (DAS-A), and the Beck Depression Inventory (BDI-IA) were applied to 221 adults from the Spanish general population (53.7% females; mean age: 38.3 years). Various multiple linear regression analyses revealed that only the facet of depression was significantly related to depressive symptomatology. The different associations of the broad and specific personality traits and the need to control as many third variables as possible to prevent the finding of spurious relationships are discussed.

Complicated Grief in a Spanish Sample of Victims of Terrorism: Evidence of Validity of the Inventory of Complicated Grief.

The Inventory of Complicated Grief (ICG) is the most widely used instrument to measure complicated grief (CG), but its psychometric properties have hardly been examined in relatives of those who died by violent means. The objective of this study was to obtain evidence of validity of the ICG in a relatives of those who died due to terrorist attacks in Spain. The factorial structure, internal consistency, and relationship with depression, anxiety, and post-traumatic stress were analyzed in a Spanish sample of 211 relatives of people who died in terrorist attacks. The ICG presented a one-factor structure that supports the validity of its total score. This score showed excellent internal consistency indices (alpha = .927; omega = .932) and adequate correlation indices with depression, anxiety, and post-traumatic stress (r = .71, .63 and .76, respectively). The ICG provides reliable and valid measures of CG in adults who have lost a family member due to violent death.

Is it time to replace the Big Five personality model? Factorial structure of the NEO PI-R in a community sample of Spanish adults.

Recent studies have revived the issue of whether the five-factor personality model or Big Five is the most valid to summarize the most relevant personality traits or whether, on the contrary, the basic structure of personality traits would better fit a six-factor model such as the HEXACO model: Honesty-Humility (H), Emotionality (E), Extraversion (X), Agreeableness (A), Conscientiousness (C), and Openness to Experience (O). In a Spanish community sample of 682 adults, the factorial structure of the 30 facets of the NEO-Revised Personality Inventory (NEO PI-R) and its 16 facets common to the HEXACO model was analyzed. In two subsamples of participants, the internal structure of the NEO PI-R, of 30 and 16 facets, fit the five-factor Big Five model better than the six-factor HEXACO model. In addition, the internal 30-facet structure of the NEO-PI-R replicated that obtained in the original US validation and those previously obtained in Spain, although the latter used different participant samples (people evaluated in personnel selection processes, university students). These results suggest that, at least in Spain, the five-factor personality model or Big Five is still the most valid taxonomy of personality traits.

A study of patients who go to a psychology clinic seeking treatment.

In order to characterize a typical clinical context, as opposed to an academic or research context, this article will analyze the sociodemographic and clinical characteristics of patients who turn to a psychology clinic in need of professional help. This study was conducted using an initial sample of 1,305 patients at the Universidad Complutense de Madrid (UCM) Clínica Universitaria de Psicología. Of the sociodemographic characteristics studied, it is noteworthy that the majority of patients were women (65%) and relatively young (the average age is 29.7 years-old). The disorders for which psychological help was most often needed were anxiety and mood disorders and relationship problems, which together made up 50% of cases. In 17.70% of cases, patients had at least one comorbid disorder in addition to the one that brought them to the clinic. The generalizability and implications of the results are discussed.

Prevalence of psychopathy in a community sample of Spanish adults: Definitions and measurements matter.

The main objective of this work is to examine the prevalence of psychopathy in the general adult population from the main currently existing theoretical perspectives of psychopathy, using for this purpose the five-factor or Big Five model as a common language that allows the comparison and integration of the personality traits considered as defining psychopathy by these different perspectives. The NEO Personality Inventory-Revised (NEO PI-R) was applied to a sample of 682 adults of the general Spanish population. The prevalence of clinical and subclinical psychopathy was calculated according to six different definitions of these two constructs based on Hare's, Lilienfeld's, triarchic, and DSM-5-hybrid models, and the simultaneous presence of a minimum number of personality traits that differed from the sample mean by one standard deviation. Prevalence rates for the different definitions were consistently low, indicating that the prevalence of clinical psychopathy in the general Spanish population is around 0.55%, and that of subclinical psychopathy is around 1.65%. There were no significant sex differences in the prevalence of psychopathy. These results question the alarmist claims that warn about the existence in society of a very high number of people with psychopathy who can cause many social, economic, physical, and psychological damage to others.

Prevalence of Psychopathy in the General Adult Population: A Systematic Review and Meta-Analysis.

The main objective of this study was to systematically and meta-analytically review the scientific literature on the prevalence of psychopathy in the general adult population. A search in PsycInfo, MEDLINE, and PSICODOC identified 15 studies published as of June 2021. Altogether, 16 samples of adults totaling 11,497 people were evaluated. Joint prevalence rates were calculated using reverse variance heterogeneity models. Meta-regression analyses were conducted to examine whether the type of instrument, sex, type of sample, and country influenced prevalence. The meta-analytical results obtained allow us to estimate the prevalence rate of psychopathy in the general adult population at 4.5%. That being said, this rate varies depending on the participants' sex (higher in males), the type of sample from the general population (higher in samples from organizations than in community samples or university students), and the type of instrument used to define psychopathy. In fact, using the PCL-R, which is currently considered the "gold standard" for the assessment and definition of psychopathy, the prevalence is only 1.2%. These results are discussed in the context of the different theoretical perspectives and the existing problems when it comes to defining the construct of psychopathy.

Growing Up With Terrorism: The Age at Which a Terrorist Attack Was Suffered and Emotional Disorders in Adulthood.

Abundant scientific literature shows that exposure to traumatic situations during childhood or adolescence has long-term psychopathological consequences, for example, in the form of a higher prevalence of emotional disorders in adulthood. However, an evolutionary perspective suggests that there may be differential vulnerabilities depending on the age at which the trauma was suffered. As there are no studies on the psychopathological impact in adulthood of attacks suffered during childhood or adolescence, the objective of this study was to analyze the influence of the age at which a terrorist attack was suffered in the presence of emotional disorders many years after the attack. A sample of 566 direct and indirect victims of terrorist attacks in Spain was recruited, of whom 50 people were between the age of 3 and 9 when they suffered the attack, 46 were between 10 and 17 years old, and 470 were adults. All of them underwent a structured diagnostic interview (SCID-I-VC) an average of 21 years after the attacks. No significant differences were found between the three age groups at which the attack occurred in terms of the current prevalence of post-traumatic stress disorder, major depressive disorder, or anxiety disorders. The results of several multiple binary logistic regression analyses also indicated that, after controlling for the effect of sex, current age, the type of victims, and the time since the attack, the age at which the attack was suffered was not related to the current prevalence of those emotional disorders. The results are discussed concerning the differences between various types of trauma and in the context of the theories that propose that traumatic experiences are processed differently at different ages and can lead to differences in the likelihood of developing different emotional disorders.

Anger and hostility from the perspective of the Big Five personality model.

This study was aimed at examining the relationships of the personality dimensions of the five-factor model or Big Five with trait anger and with two specific traits of hostility (mistrust and confrontational attitude), and identifying the similarities and differences between trait anger and hostility in the framework of the Big Five. In a sample of 353 male and female adults, the Big Five explained a significant percentage of individual differences in trait anger and hostility after controlling the effects due to the relationship between both constructs and content overlapping across scales. In addition, trait anger was primarily associated with neuroticism, whereas mistrust and confrontational attitude were principally related to low agreeableness. These findings are discussed in the context of the anger-hostility-aggression syndrome and the capability of the Big Five for organizing and clarifying related personality constructs.

Psychological factors associated with poor hypertension control: differences in personality and stress between patients with controlled and uncontrolled hypertension.

Only one-third of patients with hypertension under pharmacological treatment achieve the recommended blood pressure goals. Psychological factors could partially account for poor hypertension control through the existence of personality traits related to treatment compliance (e.g., self-discipline, deliberation, impulsiveness), and the fact that stress and some personality traits (e.g., anxiety, depression, anger expression, Type A) are involved in the etiology of some hypertension cases. This study was aimed at examining the differences in personality and stress between patients taking antihypertensive medications with controlled and uncontrolled hypertension. Results revealed that after controlling sex, age, and traditional variables associated with poor hypertension control, the uncontrolled hypertension group showed higher scores on impulsiveness, depression, anger expression-out, and stress, with differences ranging between medium and large (Hedges' g effect size = 0.77 to 1.08). These results support the hypothesized relationship between psychological factors and poor hypertension control.

[Psychological care demand in clinical practice: treatment and results]. / Demanda de atención psicológica en la práctica clínica: tratamientos y resultados.

With the aim of describing the usual clinical context as opposed to the academic or research context, the characteristics of patients and psychological treatments applied in a sample of 856 patients from the Clinic of Psychology of the Complutense University is analyzed. The disorders that require attention, the characteristics of the therapists and their interventions are identified. Out of the total patients, 24.3% withdrew from treatment; 68.3% of the patients who started treatment completed it with therapeutic success. 83% of patients were assessed in 4 sessions or fewer (median=4). 75.3% of patients who finished the treatment received 18 or fewer treatment sessions (median=11). The generalization of the results and their implications for professional clinical practice and for training clinical psychologists are discussed.

[The COVID-19 psychological helpline of the Spanish Ministry of Health and Spanish Psychological Association: characteristics and demand.] / El teléfono de asistencia psicológica por la COVID-19 del Ministerio de Sanidad y del Consejo General de la Psicología de España: Características y demanda.

Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System.

Entre marzo y mayo de 2020, el Ministerio de Sanidad y el Consejo General de la Psicología de España, pusieron en marcha el Servicio de Primera Ayuda Psicológica (SPAP), un servicio telefónico para toda España, diseñado para proveer atención psicológica temprana a las personas afectadas por la COVID-19. En el tiempo en que el servicio estuvo disponible, se gestionaron 15.170 llamadas, que condujeron a realizar 11.417 intervenciones psicológicas con personal sanitario y otros intervinientes, con enfermos y familiares de enfermos o fallecidos, y población general. Los resultados muestran que la mayoría de llamadas (45,7%) provenían de la Comunidad Autónoma de Madrid, que hubo significativamente más mujeres que utilizaron el servicio (73,5%) y que el rango de edad más común entre los usuarios era el de 40-59 años. El 75,9% de las consultas tuvo que ver con problemas psicológicos relacionados con sintomatología ansiosa y depresiva, aunque también destacaba la sintomatología de duelo entre los enfermos o familiares de enfermos y fallecidos y, en menor medida, la sintomatología de estrés en el grupo de intervinientes. Estos datos muestran la necesidad de este servicio de atención psicológica temprana y sugieren que recursos como este deberían implementarse de manera integrada en el Sistema Nacional de Salud.

Psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in general population.

This is the first study that provides normative, reliability, factor validity and discriminant validity data of the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) in the Spanish general population, Sanz and Navarro's (2003) Spanish version of the BAI was administered to 249 adults. Factor analyses suggested that the BAI taps a general anxiety dimension comprising two related factors (somatic and affective-cognitive symptoms), but these factors hardly explained any additional variance and, therefore, little information is lost in considering only full-scale scores. Internal consistency estimate for the BAI was high (alpha = .93). The BAI was correlated .63 with the BDI-II and .32 with the Trait-Anger scale of the STAXI 2, but a factor analysis of their items revealed three factors, suggesting that the correlations between the instruments may be better accounted for by relationships between anxiety, depression, and anger, than by problems of discriminant validity. The mean BAI total score and the distribution of BAI scores were similar to those found in other countries. BAI norm scores for the community sample were provided from the total sample and from the male and female subsamples, as females scored higher than males. The utility of these scores for assessing clinical significance of treatment outcomes for anxiety is discussed.

Disaster complexity and the Santiago de Compostela train derailment.

This disaster complexity case study examines Spain's deadliest train derailment that occurred on July 24, 2013 on the outskirts of Santiago de Compostela, Galicia, Spain. Train derailments are typically survivable. However, in this case, human error was a primary factor as the train driver powered the Alvia train into a left curve at more than twice the posted speed. All 13 cars came off the rails with many of the carriages careening into a concrete barrier lining the curve, leading to exceptional mortality and injury. Among the 224 train occupants, 80 (36%) were killed and all of the remaining 144 (4%) were injured. The official investigative report determined that this crash was completely preventable.

Clinical utility of the combination of cognitive-behavioral techniques with nicotine patches as a smoking-cessation treatment: five-year results of the "Ex-Moker" program.

This article examines the clinical utility of behavior therapy combined with nicotine patches as a smoking-cessation treatment, by presenting the results obtained at 5 years with 142 persons who attended a private center specialized in smoking-cessation treatment and who received a multicomponent program with cognitive-behavioral techniques and 24-hour nicotine patches. Abstinence rates at posttreatment and at 5-year follow-up were 58.5% (point prevalence abstinence) and 33.1% (continuous abstinence for the last 12 months), respectively (94.3% and 51.6%, taking into account only those persons who were contacted at posttreatment and at follow-up). After 5 years, the rate of cigarettes smoked per day was reduced by 7 in those persons who were unable to quit smoking. Results are discussed in the context of previous studies that examine the efficacy of behavior therapy and its combination with nicotine patches, using more fully controlled designs and conditions. It is suggested that results in clinical practice seem to be as good as those obtained in efficacy studies.

Blood pressure variability and stress management training for essential hypertension.

The purpose of this study was to determine whether stress management training reduces blood pressure (BP) variability in hypertensive patients. Previous literature suggests that cardiovascular risk is not only a function of BP levels, but also of BP variability, and this partially depends on changes induced by the stress of everyday life. The authors reanalyzed data from a previous study of 43 male patients with essential hypertension who were randomly assigned to 2 groups (stress management training and waiting list). Patients in the stress management group lowered their self-measured BP variability significantly from pretreatment to the 4-month follow-up examination, showing a mean reduction of 2.6/1.5 mm Hg in the standard deviation of systolic/diastolic BP (SBP/DBP), and a mean decrease of 1.84/1.59% in the coefficient of variation of SBP/DBP. For SBP, these reductions were significantly greater than those showed by the control group. These results suggest that stress management training is effective in reducing day-to-day BP variability, providing an additional reduction in cardiovascular risk for hypertensive patients.

Can blood pressure measurements taken in the physician's office avoid the 'white coat' bias?

OBJECTIVE: Obtaining an accurate blood pressure (BP) reading is vital for diagnosing hypertension. However, BP measures taken in the physician's clinic (CBP) are subject to the 'white coat' bias. Measurements taken outside the office using ambulatory (ABP) and home (HBP) monitoring are superior predictors of cardiovascular diseases compared with CBP, but ABP remains underutilized because of the effort and expense involved. Unfortunately, HBP has limitations, including questionable device validity and patient compliance. Thus, it is important to identify feasible alternative techniques to measure BP in the office that will increase the accuracy of the diagnosis. METHODS: Auscultatory BP was measured in 249 patients in a nonclinical setting by trained technicians (NCBP); on the following day, patients were taken to their physician (CBP). They were also given an HBP monitor, and a 36 h ABP monitoring. Because ABP is considered the gold standard for prediction of cardiovascular disease, these readings were used as the criterion in a statistical model in which CBP, HBP, and NCBP were entered as predictors. The level of agreement between measurements was estimated. RESULTS: Multiple regression analysis showed that HBP and NCBP (P < 0.001) explained 94 and 87% of the variance in systolic and diastolic ABP, respectively. The agreement between NCBP and ABP was greater than that between CBP and ABP or between HBP. CONCLUSION: When ABP monitoring and HBP monitoring are not options, the NCBP at the clinic can avoid the white coat bias and therefore improve diagnosis.

Differences in emotional personality traits and stress between sustained hypertension and normotension.

This study was aimed at determining whether there are differences in emotional personality traits and psychosocial stress between hypertension and normotension. From a large community sample of adults, 14 individuals having hypertension and showing clinic blood pressures (BP) >or=140/90 mm Hg and self-measured BPs >or=135/85 mm Hg (sustained hypertensives) were selected and compared with a sex- and age-matched group of 14 individuals with normotension (clinic BPs <140/90 mm Hg and self-measured BPs <135/85 mm Hg) on measures of trait anxiety, trait depression, trait anger and stress derived from standardized questionnaires. There were no significant differences between hypertensives and normotensives on trait anger, but, in line with hypotheses, the sustained hypertensive group showed higher levels of trait anxiety, trait depression and stress than did the normotensive group. A discriminant analysis revealed that trait depression was the most important psychological variable to discriminate between sustained hypertension and normotension. Results provide support to the hypothesized relationship of emotional personality traits and stress with hypertension, and underscore the need to define hypertension on the basis of both clinic and home/ambulatory BP measurements and to simultaneously evaluate all relevant negative emotional constructs, when conducting research on psychological factors in hypertension.

Orienting-defense responses and psychophysiological reactivity in isolated clinic versus sustained hypertension.

This study sought to determine whether patients with white-coat or isolated clinic hypertension (ICH) show, in comparison to patients with sustained hypertension (SH), a defense response pattern to novel stimuli and an enhanced psychophysiological reactivity to stress. Forty-three patients with essential hypertension were divided into two groups after 16 days of self-monitoring blood pressure (BP): ICH (24 men; self-measured BP < 135/85 mmHg) and SH (19 men; self-measured BP >or= 135/85 mmHg). Defense responses were measured as the cardiac changes to phasic non-aversive auditory stimuli. Psychophysiological reactivity (heart and breath rate, blood volume pulse, electromyography, and skin conductance) was measured during mental arithmetic and video game tasks. The standard deviation of self-measured BPs and the difference between mean BPs at work and at home were used as indicators of cardiovascular reactivity to daily stress. No significant differences were seen in defense responses or psychophysiological reactivity to laboratory or naturally occurring stressors. These results do not support the hypothesis that ICH can be explained in terms of a generalized hyperreactivity to novel or stressful stimuli.