A Retrospective Matched Comparison Study of Prolonged Seizures in ECT.

OBJECTIVE: This study assessed the incidence of and risk factors for prolonged seizures (>180 sec) in electroconvulsive therapy (ECT). METHOD: In 611 adult patients undergoing 6697 ECT treatments administered over a 2.5-year study period, 29 individuals experienced 42 prolonged seizures. A comparison sample (n = 29) was matched on sex, age, and treatment, and compared on psychiatric and medical diagnoses, as well as current medications. To examine the association between the characteristics and prolonged seizure, conditional logistic regression models or exact McNemar tests were conducted. RESULTS: Prolonged seizures occurred on average in 1 of every 167 treatments. No specific psychiatric disorders or medical conditions were associated with the prolonged seizure group. Antipsychotic drugs were used in a higher proportion of the comparison group than in the prolonged seizure group, suggesting a protective effect. Atropine was used in a lower proportion of the long seizure group than in the comparison group. No untoward sequelae occurred, and no progression to status epilepticus was observed. CONCLUSIONS: Prolonged seizures appear to be an uncommon complication of ECT in adults. The characteristics examined in this study suggest limited association of psychotropic medications with prolonged seizures. Treatment of prolonged seizures was straightforward. Prolonged seizures had no impact on the course of treatment. Further exploration of prolonged seizures would enhance the generalizability of the findings from this single site study.

A longitudinal follow-up study of Oklahoma City bombing survivors in the first quarter century after the disaster.

BACKGROUND: This study is one of the longest postdisaster prospective longitudinal studies of disaster-related psychopathology, completed nearly a quarter century after a terrorist bombing, and the longest follow-up study ever conducted using full diagnostic assessment in highly exposed disaster survivors. METHODS: Oklahoma City bombing survivors (87% injured) were randomly selected from a state survivor registry and interviewed approximately 6 months postdisaster (N = 182; 71% participation) and again nearly 25 years later (N = 103; 72% participation). Interviews were conducted using the Diagnostic Interview Schedule (a structured interview assessing full diagnostic criteria) for panic disorder, generalized anxiety disorder, and substance use disorder at baseline and also for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) at follow-up. The Disaster Supplement assessed disaster trauma exposure and subjective experience. RESULTS: At follow-up, 37% of participants exhibited bombing-related PTSD (34% at baseline) and 36% had MDD (23% at baseline). More new cases of PTSD than MDD developed over time. Nonremission rates were 51% for bombing-related PTSD and 33% for MDD. One-third of participants reported long-term nonemployability. CONCLUSIONS: The presence of long-term medical problems among survivors parallels the persistence of psychopathology. Ongoing medical problems might have contributed to psychiatric morbidity. Because no major variables predicted remission from bombing-related PTSD and MDD, all survivors with postdisaster psychopathology likely need access to long-term evaluation and care.

Characteristics and experiences of professionals providing 9/11 mental health services.

BACKGROUND: After disasters, mental health professionals might be called upon to help address the emotional consequences of the disaster among survivors and other affected groups, but the clinicians themselves could be affected. This exploratory study examined the experiences of 60 mental health professionals, most of whom provided mental health care to individuals affected by the September 11, 2001 terrorist attacks (9/11), and/or experienced 9/11 sequelae themselves. METHODS: Participants completed structured interviews 3 and/or 6 years after the disaster, with full diagnostic assessment of psychiatric disorders and questions specific to their personal and professional post-9/11 experience. RESULTS: Providing postdisaster care was somewhat stressful initially, but long-term effects were more positive than negative, with overall benefit to many personal lives. Most found their clients' 9/11 stories emotionally upsetting, yet characterized their 9/11 mental health work as positive. Work satisfaction increased by 3-fold, but this effect was transitory. One-third had postdisaster psychopathology, but most was pre-existing and therefore not a product of disaster-related stressors. CONCLUSIONS: Although most mental health professionals initially found the emotional difficulty of their work increased after 9/11, this negative effect had largely dissipated over the years. Opportunities for disaster mental health training and initial logistical support could benefit these professionals.

A systematic review of alcohol consumption and disorders in relation to disasters.

BACKGROUND: Excessive alcohol use and alcohol use disorders (AUDs) are serious medical problems in general populations. Alcohol use is associated with stressful events. Thus it is possible that problems with alcohol use increase in association with disasters. It is important to know the extent to which disasters contribute to these problems in exposed populations. METHODS: This review focused on the associations of alcohol use, problematic alcohol use, and AUDs with disasters. Alcohol variables were examined for predisaster to postdisaster changes and differences between samples according to disaster exposures. RESULTS: In all, 44 studies were found that addressed the association of alcohol variables with disaster. Much of this research had substantive methodological difficulties limiting the conclusions. Most research examining changes in alcohol use after disasters reported increases, but the increases were clinically small, amounting to ≤1 drink per day, and alcohol use returned to predisaster levels over time. The research on problematic alcohol use provided little evidence of an association with disasters. The studies of AUDs did not support their association with disaster. CONCLUSIONS: Even without clear evidence that disasters cause increases in alcohol use problems, it is important in the postdisaster setting to assess problems of alcohol use along with psychopathology.

Learning and achievement characteristics of sheltered homeless population subgroups.

BACKGROUND: There is little systematic information about intelligence and academic achievement among sheltered homeless adults. This study adds descriptive data on intelligence and academic achievement, examines discrepancies across these concepts, and explores the associations among demographic and psychosocial characteristics in the context of intelligence categories and discrepancies. METHODS: We studied intelligence, academic achievement, and discrepancies between IQ and academic achievement among 188 individuals experiencing homelessness who were systematically recruited from a large, urban, 24-hour homeless recovery center. Participants completed structured interviews, urine drug testing, the Wechsler Abbreviated Scale of Intelligence, and the Wide Range Achievement Test, 4th edition. RESULTS: Average full-scale intelligence was low average (90) but higher than scores obtained in other studies of homeless populations. Academic achievement was lower than average (82 to 88). Performance/math deficits in the higher intelligence group indicate functional difficulties that could have contributed to homeless risk. CONCLUSIONS: The low-normal intelligence and below-average achievement scores are not extreme enough to warrant immediate attention and intervention for most individuals. Systematic screening during entry into homeless services might identify learning strengths and weaknesses, presenting modifiable factors that could be addressed in focused educational/vocational interventions.

Tobacco and Illicit Drug Use and Drug Use Disorders Among Employees of Businesses Affected by the 9/11 Attacks on the World Trade Center in New York City.

OBJECTIVE: To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders. METHODS: A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders. RESULTS: Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11. CONCLUSIONS: The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.

Groundhog Day: research without old data and old references.

BACKGROUND: The use of older data and references is becoming increasingly disfavored for publication. A myopic focus on newer research risks losing sight of important research questions already addressed by now-invisible older studies. This creates a 'Groundhog Day' effect as illustrated by the 1993 movie of this name in which the protagonist has to relive the same day (Groundhog Day) over and over and over within a world with no memory of it. This article examines the consequences of the recent preference for newer data and references in current publication practices and is intended to stimulate new consideration of the utility of selected older data and references for the advancement of scientific knowledge. METHODS: Examples from the literature are used to exemplify the value of older data and older references. To illustrate the recency of references published in original medical research articles in a selected sample of recent academic medical journals, original research articles were examined in recent issues in selected psychiatry, medicine, and surgery journals. RESULTS: The literature examined reflected this article's initial assertion that journals are emphasizing the publication of research with newer data and more recent references. CONCLUSIONS: The current valuation of newer data above older data fails to appreciate the fact that new data eventually become old, and that old data were once new. The bias demonstrated in arbitrary policies pertaining to older data and older references can be addressed by instituting comparable treatment of older and newer data and references.

Deconstructing childhood conduct and adult antisocial criteria for the diagnosis of antisocial personality disorder.

BACKGROUND: Antisocial personality disorder (ASPD) is a serious psychiatric disorder that can be incapacitating and costly to individuals and society. The ASPD diagnosis has 2 main components, childhood conduct problems and adult antisocial behaviors, with specific age requirements. The nosological effects of these criteria on population subgroups defined by these aspects of the criteria have not been fully explored. METHODS: Data for ASPD were analyzed for 3,498 individuals in the St Louis, Missouri, site of the Epidemiologic Catchment Area study of general population psychiatric disorders collected in the early 1980s using structured diagnostic interviews for DSM-III criteria. Effects of the criteria on population subgroups defined by various combinations of the criteria were examined. RESULTS: Earlier-onset conduct disorder was more severe than later-onset childhood conduct disorder, with more total childhood and adult symptoms and negative psychosocial adult outcomes (substance use disorders, criminality, and homelessness). Three subgroups with adult antisocial behaviors (differentiated by no conduct disorder, later-onset conduct disorder, and earlier-onset conduct disorder meeting ASPD criteria) were similar in numbers of adult antisocial symptoms, but the ASPD subgroup had more negative psychosocial adult outcomes. CONCLUSIONS: These findings provide evidence for and against reconsideration of the 15-year age-of-onset requirement for conduct symptoms in ASPD criteria.

A prospective longitudinal study of tobacco use and tobacco use disorder in a homeless population.

BACKGROUND: Little is known about smoking habits and disorders among homeless populations. Previous research has not generally differentiated tobacco use from tobacco use disorders in this population. Known associations of tobacco use and morbidity and mortality in general populations may also apply to homeless populations. METHODS: A 2-year longitudinal prospective study of 255 homeless individuals examined tobacco use and tobacco use disorders in association with other psychiatric disorders and service use and homeless outcomes. RESULTS: The majority of the sample used tobacco daily and had a tobacco use disorder, characteristics that changed little over the 2-year follow-up period. Tobacco use disorder was associated with greater substance, medical, and psychiatric service use during the 2 follow-up years. However, tobacco use was not associated with change in housing status over the 2-year follow-up period. Cessation of tobacco use was associated with cessation of alcohol use. CONCLUSIONS: Smoking is a major health issue for homeless populations. This study found that smoking status was unassociated with the achievement of stable housing. In addition, homeless people who smoke were found to be more likely to use health care services, indicating a potential source of intervention for smoking cessation.

A systematic mental health assessment of first-year students at a historically Black college.

BACKGROUND: A systematic diagnostic mental health assessment was conducted with first-year students at Paul Quinn College, a small historically Black college/university (HBCU) in Dallas, Texas. METHODS: A sample of 128 students was assessed with the Mini-International Neuropsychiatric Interview for DSM-5 and the Childhood Trauma Questionnaire. RESULTS: Nearly one-third of students were diagnosed with a current psychiatric disorder, most commonly substance use disorders (17%) and major depressive disorder (9%). Despite these findings, few students had ever received psychiatric treatment, and considering their substantial trauma histories, few developed posttraumatic stress disorder, reflecting protective factors in the HBCU. CONCLUSIONS: The prevalence of psychiatric disorders in this HBCU study is consistent with findings of studies conducted at predominately White institutions. However, the relatively low access to treatment of these HBCU students suggests relevant mental health care disparities in this population. Further research is needed to develop interventions designed to help connect HBCU students to mental health care.

Dissociation and psychopathology in Kenyan survivors of a terrorist bombing.

BACKGROUND: Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology. METHODS: A sample of 278 disaster-affected Kenyans was assessed 8 to 10 months after the 1998 terrorist bombing of the US Embassy in Nairobi for a study of trauma-related psychopathology and dissociation in the context of personality and culture. Instruments of assessment were the Diagnostic Interview Schedule, the Dissociative Experiences Scale, and the Temperament and Character Inventory. RESULTS: Dissociation appeared to represent a largely nonpathological response to the disaster experience that reflected personality variables and a cultural context. CONCLUSIONS: These findings suggest that dissociation encountered in disaster-exposed groups in this cultural setting does not necessarily represent psychopathology, but attention to dissociative responses might help clinicians identify and provide interventions for individuals experiencing distressing intrusive and hyperarousal symptoms.

Association between headache and suicidality: An analysis of universal suicide screening data at a large urban county hospital.

BACKGROUND: Identifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined specific components of suicidality in relation to headache subtypes. METHODS: This study retrospectively reviewed 2,832,835 nonpsychiatric adult clinical encounters at a large county hospital, where a standardized suicide risk screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS), was universally implemented. The C-SSRS assesses specific components of suicidality: wish to be dead and suicidal ideation, method, intent, plan, and action. Multivariate logistic regressions were performed to assess the association between headache, as well as headache subtype (migraine, tension, or cluster), and each component of suicidality. RESULTS: There were significant positive associations between presenting with a headache and 2 specific components of suicidality: wish to be dead and suicidal action. Individuals with tension headache may have a lower risk of wishing to be dead compared to those with migraine and cluster headaches. CONCLUSIONS: The association of headaches with specific elements of sui-cidality demonstrates the potential yield of identification of suicide risk among individuals with nonpsychiatric presentations.

Impaired sympathetic neural recruitment during exercise pressor reflex activation in women with post-traumatic stress disorder.

Muscle sympathetic nerve activity (MSNA) increases during isometric exercise via increased firing of low-threshold action potentials (AP), recruitment of larger, higher-threshold APs, and synaptic delay modifications. Recent work found that women with post-traumatic stress disorder (PTSD) demonstrate exaggerated early-onset MSNA responses to exercise; however, it is unclear how PTSD affects AP recruitment patterns during fatiguing exercise. We hypothesized that women with PTSD (n = 11, 43 [11] [SD] years) would exhibit exaggerated sympathetic neural recruitment compared to women without PTSD (controls; n = 13, 40 [8] years). MSNA and AP discharge patterns (via microneurography and a continuous wavelet transform) were measured during 1 min of baseline, isometric handgrip exercise (IHG) to fatigue, 2 min of post-exercise circulatory occlusion (PECO), and 3 min of recovery. Women with PTSD were unable to increase AP content per burst compared to controls throughout IHG and PECO (main effect of group: P = 0.026). Furthermore, relative to controls, women with PTSD recruited fewer AP clusters per burst during the first (controls: ∆1.3 [1.2] vs. PTSD: ∆-0.2 [0.8]; P = 0.016) and second minute (controls: ∆1.2 [1.1] vs. PTSD: ∆-0.1 [0.8]; P = 0.022) of PECO, and fewer subpopulations of larger, previously silent axons during the first (controls: ∆5 [4] vs. PTSD: ∆1 [2]; P = 0.020) and second minute (controls: ∆4 [2] vs. PTSD: ∆1 [2]; P = 0.021) of PECO. Conversely, PTSD did not modify the AP cluster size-latency relationship during baseline, the end of IHG, or PECO (all P = 0.658-0.745). Collectively, these data indicate that women with PTSD demonstrate inherent impairments in the fundamental neural coding patterns elicited by the sympathetic nervous system during IHG and exercise pressor reflex activation.

A study of suicidal thoughts and behaviour in a sample of adults affected by the 9/11 attacks on New York City's World Trade Center.

Previous research on suicide risk in relation to disasters has yielded varying findings, likely resulting at least in part from inconsistencies in definitions of disaster exposure and assessment of psychiatric disorders. This study examined suicidal thoughts and behaviour in a sample of 379 adults affected by the 9/11 attacks on New York City, using carefully-defined disaster exposure variables and assessing psychopathology with full diagnostic criteria, nearly 3 years after the disaster. Only 7% of the sample reported any postdisaster suicidal thoughts or behaviour, only 1% of which were new (incident) after the disaster, amounting to very little evidence of incident suicidal risk. The occurrence of a postdisaster psychiatric disorder in nearly one-half of the sample (45%) was significantly associated with postdisaster suicide risk (15% vs 1%). Disaster trauma exposure was not associated with postdisaster suicide risk. The findings of this study are not consistent with the disaster experience itself giving rise to suicide risk. Nonetheless, the postdisaster setting provides opportunities for education about and surveillance for suicide risk and other mental health concerns.

Recovery 101: A Community Psychoeducation Program on Mental Health Recovery and Peer Support Services Created by an Academic Psychiatrist and Delivered by Peers.

OBJECTIVE: Despite the ongoing growing interest and established benefits of mental health recovery and peer support services, little is known about the effects of mental health recovery and peer support services specifically in community education programs. Seeking to further expand this scope, this article details the development, implementation, and evaluation of a recovery and peer services community psychoeducation program created by an academic psychiatrist and delivered by trained mental health peers. METHODS: A community psychoeducation intervention on recovery and peer services was provided in 2 different series: 5-session and 1-session series. Participants in the intervention were recruited from 2 local nonprofit recovery-oriented organizations and a public mental health service agency. Surveys were administered before and after each presentation session and analyzed both quantitatively and qualitatively. RESULTS: Quantitative survey items covering knowledge, awareness, interest, and likelihood of involvement in peer services for recovery all showed statistically significant gains from before to after the sessions. The qualitative data provided information about the participants' interests in the program in terms of knowledge of recovery, self-improvement, advocacy, resources, support, and nonspecific positive comments. CONCLUSIONS: An essential contribution of the program was to introduce participants to recovery and peer services. It also provided them with foundational knowledge that placed participants in a position to begin to practice the concepts of recovery. According to the participants' comments in the surveys, the program imbued a sense of hope and motivation; support and fellowship; and, importantly, role modeling and wisdom from the presenters.

Comparison of hospital course and outcome in hospital-acquired vs pre-existing delirium.

BACKGROUND: Delirium is a major source of morbidity in the inpatient hospital setting. This study examined differences between patients with delirium present prior to hospital admission and those with hospitalacquired delirium in several health outcomes. METHODS: A total of 12,529 patients on 2 inpatient units were included in this retrospective cohort study. Outcomes were assessed using chart review. Other variables were compared across groups and included in multivariate models predicting discharge location within the hospitalacquired delirium group. RESULTS: Of 709 patients with delirium, 83% had pre-admission prevalent and 17% had post-admission incident delirium. Compared with patients with preexisting delirium, patients with hospital-acquired delirium had greater hospital durations and mortality and were more likely to receive ICU care, more likely to receive multiple classes of medications, and less likely to be discharged home without home health services. Multivariate analysis in the hospital-acquired delirium group found that several variables independently predicted discharge location. CONCLUSIONS: Patients with hospital-acquired delirium had worse hospital outcomes and a more complicated hospital course than those with preexisting delirium. Administration of various medications, several demographic variables, and some hospital-related variables were independently associated with worse outcomes within the hospital-acquired delirium group. These results demonstrate that patients with hospitalacquired delirium are a vulnerable subgroup deserving special attention.

Are There Differences in Pediatric Psychiatric Emergency Department Patients Related to Utilization Frequency?

OBJECTIVES: The increasing frequency of visits to the pediatric psychiatric emergency department in the United States signals a need for a better understanding of factors contributing to more frequent utilization. This study examined characteristics of patients associated with higher utilization of the pediatric psychiatric emergency department to increase understanding of this group of patients. METHODS: This was a retrospective observational study. Data were abstracted from the electronic medical record system from January 2012 to December 2017 for patients with a completed mental health consultation. There were 8504 total encounters for 6950 unique patients during this period. Analyses were conducted to test associations between maximum number of visits in any 1-year period for each patient and demographic and clinical factors. RESULTS: Younger age was independently associated with greater mean number of visits within any 1 year. No independent associations were found between maximum number of visits within 1 year and sex, race, language, insurance type, distance from emergency department, time spent in the emergency department, or reason for visit. CONCLUSIONS: The greater emergency department use by younger children found in this study may be an indicator of insufficient treatment at other levels of care. Additional research examining more demographic variables and demographic characteristics in greater detail is needed to fully characterize the most frequent users of costly pediatric psychiatric emergency department care.

Personality in Combination with Alcohol and Drug Use and Psychiatric Disorders to Predict Psychosocial Characteristics and Behaviors of Hepatitis C Patients.

The objectives of this study were to assess the prevalence of personality disorders and to examine personality as a predictor of psychosocial characteristics and behaviors of HCV patients. HCV patients (n = 259) from three infectious disease and liver clinics who completed Cloninger's Temperament and Character Inventory (TCI), an inventory for personality traits, were included in the study. Patients with low scale scores in the character dimension of both cooperativeness and self-directedness (low CO/SD) were defined as having a personality disorder. Using low CO/SD in combination with demographic, psychiatric/substance use, and HCV-related variables, linear regression was used to construct separate models of risky behaviors, quality of life, functioning, burden of illness, and social support. The prevalence of low CO/SD was high in this sample of HCV patients. Low CO/SD was an independent predictor of risky behaviors, quality of life, functioning, and social support.

Early onset neurocirculatory response to static handgrip is associated with greater blood pressure variability in women with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a psychiatric illness that is more prevalent in women, and accumulating evidence suggests a link between PTSD and future development of cardiovascular disease. The underlying mechanisms are unclear, but augmented sympathetic reactivity to daily stressors may be involved. We measured muscle sympathetic nerve activity (MSNA), blood pressure (BP), and heart rate responses in 14 women with PTSD and 14 healthy women (controls) during static handgrip (SHG) exercise to fatigue at 40% of maximal voluntary contraction (MVC). Two minutes of postexercise circulatory arrest (PECA) was followed immediately after SHG to fatigue. MVC and the time to fatigue during SHG did not differ between groups (both P > 0.05). At the first 30 s of SHG, women with PTSD showed augmented sympathetic neural [mean ± SD, ∆MSNA burst frequency (BF): 5 ± 4 vs. 2 ± 3 bursts/30 s, P = 0.02 and ∆MSNA total activity (TA): 82 ± 58 vs. 25 ± 38 arbitrary units/30 s, P = 0.004] and pressor (∆systolic BP: 10 ± 5 vs. 4 ± 3 mmHg, P = 0.003) responses compared with controls. However, MSNA and BP responses at fatigue and during PECA were not different between groups. More interestingly, the augmented initial neural and pressor responses to SHG were associated with greater awake systolic BP variability during ambulation in women with PTSD (MSNA BF: r = 0.55, MSNA TA: r = 0.62, and SBP: r = 0.69, all P < 0.05). These results suggest that early onset exercise pressor response in women with PTSD may be attributed to enhanced mechano- rather than metaboreflexes, which might contribute to the mechanisms underlying the link between PTSD and cardiovascular risk.NEW & NOTEWORTHY The novel findings of the current study are that women with posttraumatic stress disorder (PTSD) exhibited augmented sympathetic neural and pressor responses at the first 30 s of submaximal isometric muscle contraction. More interestingly, exaggerated neurocirculatory responses at the onset of muscle contraction were associated with greater ambulatory awake systolic blood pressure fluctuations in women with PTSD. Our findings expand the knowledge on the physiological mechanisms that perhaps contribute to increased risk of cardiovascular disease in such a population.

Association of PTSD symptom groups with functional impairment and distress in trauma-exposed disaster survivors.

BACKGROUND: In the nearly a quarter of a century since the addition of the clinically significant distress/impairment criterion to the definition of PTSD in DSM-IV, little research has been done to examine the association of this criterion with symptom group criteria and with the numbing subgroup specifically. This study was conducted to examine these relationships in a large database of disaster survivors consistently studied across 12 different incidents of the full range of disaster typology. METHODS: Analysis was conducted on a merged database representing 1187 trauma-exposed survivors of 12 different disasters studied systematically. DSM-IV-TR criteria for disaster-related PTSD were assessed with the Diagnostic Interview Schedule. RESULTS: PTSD Group C (avoidance/numbing) and numbing specifically were less common and more associated than other symptom groups with criterion F (distress/impairment). Consistently in multivariable models, group C and numbing were independently associated with criterion F. Group D (hyperarousal) was less strongly associated with criterion F. Neither group B (intrusion) nor avoidance were associated with criterion F. CONCLUSIONS: In this and other studies, group C and numbing specifically have been shown to be associated with criterion F, which is consistent with the demonstration that group C and the numbing component specifically are central to the psychopathology of PTSD. The addition of the distress/impairment requirement broadly across the psychiatric diagnoses in DSM-IV added little value to PTSD symptom criteria. Future revisions of diagnostic criteria may benefit by carefully considering these findings to possibly re-include a prominent numbing symptom section.