Training plus intensive consultation improves uptake and outcome expectations of prolonged exposure therapy among practitioners treating emergency service personnel with post-traumatic stress disorder.

OBJECTIVE: Prolonged exposure (PE) therapy is an evidence-based psychological treatment of post-traumatic stress disorder (PTSD), yet uptake amongst practitioners is less than desirable. The aim of this study was to evaluate the efficacy of a PE training workshop plus intensive consultation programme to improve practitioners' self-efficacy and outcome expectations as well as uptake of PE for emergency service patients with PTSD. METHOD: Forty-five psychologists attended a PE training workshop in Sydney. Participants completed questionnaires at pre- and post-workshop and six-month follow-up. RESULTS: The findings suggest that participation in the programme was associated with improvements in practitioners' beliefs in their ability to deliver PE to patients, an increase in their use of a range of PE components and an increase in their use of in vivo exposure with a greater proportion of patients. CONCLUSION: Effective training approaches for evidence-based treatments of PTSD should incorporate intensive consultation following training. Future studies should consider additional strategies to encourage practitioners to deliver PE to more patients with PTSD.

Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward.

Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.

The impact of potentially traumatic events on the mental health of males who have served in the military: Findings from the Australian National Survey of Mental Health and Wellbeing.

OBJECTIVE: The study investigated the impact of potentially traumatic events on mental health outcomes among males who had ever served in the Australian Defence Force. METHOD: Data from a nationally representative household survey of Australian residents, the 2007 National Survey of Mental Health and Wellbeing, were used for this study. RESULTS: Compared with community members, Australian Defence Force males were significantly more likely to have experienced not only deployment and other war-like events but also accidents or other unexpected events, and trauma to someone close. For non-deployed males, Australian Defence Force members were at increased risk of accidents or other unexpected events compared to community members. After controlling for the effect of potentially traumatic events that were more prevalent among all Australian Defence Force members, the increased risk of mental disorders among Australian Defence Force members was no longer evident. For non-deployed males, Australian Defence Force and community members were at comparable risk of poor mental health outcomes. A significant minority of Australian Defence Force members had onset of a mental disorder prior to their first deployment. CONCLUSIONS: Deployment and other potentially traumatic events among Australian Defence Force members can help to explain their increased vulnerability to mental disorders compared with community members. Providers should routinely enquire about a range of potentially traumatic events among serving and ex-serving military personnel.

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) in the assessment of alcohol use disorders among acute injury patients.

BACKGROUND: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief alcohol screening test and a candidate for inclusion in recommended screening and brief intervention protocols for acute injury patients. The objective of the current study was to examine the performance of the AUDIT-C to risk stratify injury patients with regard to their probability of having an alcohol use disorder. METHODS: Participants (n = 1,004) were from a multisite Australian acute injury study. Stratum-specific likelihood ratio (SSLR) analysis was used to examine the performance of previously recommended AUDIT-C risk zones based on a dichotomous cut-point (0 to 3, 4 to 12) and risk zones derived from SSLR analysis to estimate the probability of a current alcohol use disorder. RESULTS: Almost a quarter (23%) of patients met criteria for a current alcohol use disorder. SSLR analysis identified multiple AUDIT-C risk zones (0 to 3, 4 to 5, 6, 7 to 8, 9 to 12) with a wide range of posttest probabilities of alcohol use disorder, from 5 to 68%. The area under receiver operating characteristic curve (AUROC) score was 0.82 for the derived AUDIT-C zones and 0.70 for the recommended AUDIT-C zones. A comparison between AUROCs revealed that overall the derived zones performed significantly better than the recommended zones in being able to discriminate between patients with and without alcohol use disorder. CONCLUSIONS: The findings of SSLR analysis can be used to improve estimates of the probability of alcohol use disorder in acute injury patients based on AUDIT-C scores. In turn, this information can inform clinical interventions and the development of screening and intervention protocols in a range of settings.

The impact of first episode psychosis on sibling quality of life.

PURPOSE: The adverse impact of first episode psychosis (FEP) upon parents' quality of life (QoL) has been well documented. However, the determinants and levels of QoL remain poorly understood in siblings of young people experiencing FEP. This study aimed to characterise and establish the predictors of QoL for siblings of young people with FEP. METHOD: Survey methodology was used to examine the experience of 157 siblings in the first 18 months of their brother or sister's treatment for FEP. The World Health Organisation Quality of Life Scale-Bref (WHOQOL-Bref) was used to assess siblings' QoL. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings' QoL. RESULTS: Younger sisters reported the lowest satisfaction of QoL. Older brothers were the most satisfied. When the young person with FEP had attempted suicide and/or had been physically violent, siblings reported less satisfaction in all domains of QoL. Living with the ill brother or sister resulted in less satisfaction in the social domain. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness-related variables on QoL, particularly suicide attempts. CONCLUSION: Suicide attempts and a history of violence impacted negatively on all four domains of QoL. Female siblings are at higher risk of reduced QoL and may be particularly vulnerable to the effects of suicide attempts and violence. These findings have significant implications for early, targeted interventions for this vulnerable group.

Early response to psychological trauma--what GPs can do.

BACKGROUND: There is a high prevalence of psychological trauma exposure among primary care patients. General practitioners are well placed to provide appropriate support for patients coping with trauma. OBJECTIVE: This article outlines an evidence-based early response to psychological trauma. DISCUSSION: Psychological first aid is the preferred approach in providing early assistance to patients who have experienced a traumatic event. General practitioners can be guided by five empirically derived principles in their early response: promoting a sense of safety, calming, self efficacy, connectedness and hope. Structured psychological interventions, including psychological debriefing, are not routinely recommended in the first few weeks following trauma exposure. General practitioner self care is an important aspect of providing post-trauma patient care.

The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality.

OBJECTIVE: Few studies have investigated the relationship between received social support (actual help received) and posttraumatic growth (PTG), and these studies focused only on the quantity of support received. This study examined the joint implications of both the quantity and quality of postdisaster received social support for PTG. METHOD: Data were collected from Lushan earthquake (China, in 2013) survivors at 7 (n = 199) and 31 (n = 161) months after the earthquake. The main effects of quantity and quality of received support, and the interaction between support quantity and support quality, were examined using hierarchical multiple regression analyses controlling for the extent of disaster exposure, postdisaster negative life events, and sociodemographic factors. RESULTS: Neither quantity nor quality of received social support exerted significant main effects on PTG. However, the influence of the amount of received social support on PTG was moderated by the quality of received social support. Among survivors who appraised the postdisaster social support they received as higher in quality, greater amounts of received support were associated with more subsequent PTG. Among those survivors who appraised the postdisaster social support they received as lower in quality, greater quantity of received support was associated with lower levels of reported PTG. CONCLUSION: This study calls attention to the importance of enhancing the quality of help provided to disaster survivors because simply "more" support is not necessarily better. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PTSD among military personnel.

Although symptoms characteristic of post-traumatic stress disorder (PTSD) have been noted in military personnel for many centuries, it was not until 1980 that the disorder was formally recognized and became the focus of legitimate study. This paper reviews our current state of knowledge regarding the prevalence and course of this complex condition in past and present members of the defence forces. Although rates vary across conflicts and countries, there is no doubt that PTSD affects substantial numbers of personnel and results in considerable impairment in functioning and quality of life. The paper goes on to discuss recent attempts to build resilience and to promote adjustment following deployment, noting that there is little evidence at this stage upon which to draw firm conclusions. Finally, effective treatment for PTSD is reviewed, with particular reference to the challenges posed by this population in a treatment setting.

A Mobile Phone App to Improve the Mental Health of Taxi Drivers: Single-Arm Feasibility Trial.

BACKGROUND: Psychological distress among taxi drivers is 5 times higher than that in the general population, and more than half of all drivers have experienced 3 or more potentially traumatic events in their lifetime. Nevertheless, help-seeking for mental health problems in this male-dominated, predominately immigrant workforce is low. Mobile technologies have the potential to increase mental health awareness, teach self-help skills, and encourage help-seeking in this hard-to-reach population. OBJECTIVE: This study aimed to assess the feasibility, acceptability, and potential efficacy of Driving to Health, a mobile phone-friendly mental health website app designed for people working as taxi drivers. METHODS: Drivers (n=46) were recruited from the Melbourne Airport Taxi Holding Yard to participate in a single-arm trial. Self-reported, paper-based assessments were completed at baseline and at 1 month. Feasibility was measured by completion rates, representativeness of study participants, and levels of use. Acceptability was assessed by measuring users' perception of the quality of the app and anticipated levels of future use. The efficacy of Driving to Health to increase awareness, self-help behaviors, and intentions to seek help was assessed using the user version of the Mobile App Rating Scale (uMARS) and the General Help-Seeking Questionnaire (GHSQ). Psychological symptoms were measured using the short form of the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using complete case analysis. RESULTS: In total, 42 participants comprising drivers from 10 different countries of origin, and 14 different languages, completed pre- and poststudy measures (42/46, 91% completion rate). Just under half (45%) of all users used the app more than once with an average visit of 4 min 8 seconds. Responding to the uMARS, 62% (26/42) of the participants said that they would recommend the app to many people. Nearly all (40/42, 95%) participants said that Driving to Health increased awareness of their own mental health; 86% (36/42) said that it increased their mental health knowledge; and 76% (32/42) said that it increased their self-help behaviors. Increases in help-seeking intentions on the GHSQ were not significant, and increases on all 3 scales of DASS-21 were not reliable or meaningful. CONCLUSIONS: This study suggests that Driving to Health is an acceptable and feasible electronic health intervention for a hard-to-reach population. Our findings also suggest that Driving to Health results in increases in mental health awareness, behaviors, and willingness to seek help.

Predictors of adherence to cognitive-behavioural therapy in first-episode psychosis.

OBJECTIVE: To investigate predictors of adherence with a cognitive-behavioural intervention in first-episode psychosis (FEP) patients. METHOD: Predictors of adherence to cognitive-behavioural therapy (CBT) were longitudinally investigated in the experimental arm of a randomized controlled trial designed to evaluate the effectiveness of a CBT intervention for relapse prevention early in the course of psychosis when compared with treatment as usual within 2 high quality, youth oriented, specialist FEP programs (the EPISODE II trial). RESULTS: Longer duration of untreated psychosis (DUP) and poorer level of insight predicted poor adherence to CBT. This association remained significant after controlling for potential confounders. CONCLUSIONS: Treatment delay may decrease adherence with CBT in FEP patients. Reducing DUP and promoting insight early in the course of psychosis are likely to enhance adherence with CBT.

Social support following a natural disaster: A longitudinal study of survivors of the 2013 Lushan earthquake in China.

The idea that social support post-disaster is beneficial to survivors' mental health is widely accepted by both researchers and practitioners. However previous social support studies are mainly focused on perceived social support, and the limited received social support studies have produced mixed results. In this study we modelled the influence of both quantity and quality of received social support on long-term mental health outcomes in a longitudinal study of 2013 Lushan earthquake survivors in China. Survivors were invited to complete a questionnaire interview 7 months after the earthquake and were followed up 31 months later (n = 161). Hierarchical regression analyses that controlled for disaster exposure variables showed that greater quality of social support received 7 months after disaster predicted lower levels of posttraumatic stress symptoms and psychological distress two years later, however quantity of received social support was not significant in predicting these two outcomes. These results remained robust when controlled for gender, negative life events and family financial status. The findings of this study suggest that what appears to be critical in the process of supporting disaster survivors is the quality, not necessarily the quantity, of support provided.

Enhancing treatment fidelity in psychotherapy research: novel approach to measure the components of cognitive behavioural therapy for relapse prevention in first-episode psychosis.

OBJECTIVES: Establishing treatment fidelity is one of the most important aspects of psychotherapy research. Treatment fidelity refers to the methodological strategies used to examine and enhance the reliability and validity of psychotherapy. This study sought to develop and evaluate a measure specifically designed to assess fidelity to the different therapeutic components (i.e. therapy phases) of the individual intervention of a psychotherapy clinical trial (the EPISODE II trial). METHOD: A representative sample of sessions stratified by therapy phase was assessed using a specifically developed fidelity measure (Relapse Prevention Therapy-Fidelity Scale, RPT-FS). Each RPT-FS subscale was designed to include a different component/phase of therapy and its major therapeutic ingredients. RESULTS: The measure was found to be reliable and had good internal consistency. The RPT-FS discriminated, almost perfectly, between therapy phases. The analysis of the therapeutic strategies implemented during the intervention indicated that treatment fidelity was good throughout therapy phases. While therapists primarily engaged in interventions from the appropriate therapeutic phase, flexibility in therapy was evident. CONCLUSIONS: This study described the development of a brief, reliable and internally consistent measure to determine both treatment fidelity and the therapy components implemented throughout the intervention. This methodology can be potentially useful to determine those components related to therapeutic change.

The role of site and severity of injury as predictors of mental health outcomes following traumatic injury.

The aim of this study was to investigate the influence of injury site and severity as predictors of mental health outcomes in the initial 12 months following traumatic injury. Using a multisite, longitudinal study, participants with a traumatic physical injury (N = 1,098) were assessed during hospital admission and followed up at 3 months (N = 932, 86%) and at 12 months (N = 715, 71%). Injury site was measured using the Abbreviated Injury Scale 90, and objective injury severity was measured using the Injury Severity Score. Participants also completed the Hospital Anxiety and Depression Scale and the Clinician Administered Post-traumatic Stress Disorder (PTSD) Scale. A random intercept mixed modelling analysis was conducted to evaluate the effects of site and severity of injury in relation to anxiety, PTSD, and depressive symptoms. Injury severity, as well as head and facial injuries, was predictive of elevated PTSD symptoms, and external injuries were associated with both PTSD and depression severity. In contrast, lower extremity injuries were associated with depressive and anxiety symptoms. The findings suggest that visible injuries are predictive of reduced mental health, particularly PTSD following traumatic injury. This has clinical implications for further advancing the screening for vulnerable injured trauma survivors at risk of chronic psychopathology.

Antibodies to infectious agents in individuals at ultra-high risk for psychosis.

BACKGROUND: While there is evidence that some cases of schizophrenia may be associated with microbial infections, the role of microbial agents has not been investigated in people with emerging psychosis. METHODS: Participants were 105 help seeking ultra-high risk individuals. Psychiatric measures included the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Serum IgG antibodies against human herpesviruses and Toxoplasma gondii were determined using immunoassay methods. Multiple linear regression with adjustment for age and sex was applied to test associations between serum antibodies and psychiatric measures. RESULTS: Higher levels of serum IgG antibodies against Toxoplasma gondii in Toxoplasma-positive individuals were significantly associated with more severe positive psychotic symptoms. No significant association was observed between antibody levels and psychiatric measures in individuals positive for human herpesviruses. CONCLUSIONS: In some individuals infection with Toxoplasma gondii may be an environmental factor contributing to the manifestation of positive psychotic symptoms.

The Positive and Negative Experiences of Caregiving for Siblings of Young People with First Episode Psychosis.

Background: The impact of first episode psychosis (FEP) upon parents' experience of caregiving has been well-documented. However, the determinants and nature of this remain poorly understood in siblings. It is hypothesized that siblings of young people with FEP are also impacted by caregiving and burden. This study aimed to characterize the experience of caregiving for siblings of young people with FEP. Method: Survey methodology was used to explore the experience of 157 siblings in the first 18 months of their brother or sister's treatment for FEP. Participants reported on their appraisal of the negative and positive aspects of caregiving as measured by the Experience of Caregiving Inventory (ECI). Descriptive statistics were used to establish the results for the total sample as well as for gender and birth order differences. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings' experience of caregiving. Results: Older brothers reported the lowest scores for negative experiences in caregiving and younger sisters reported the highest. Negative experiences in caregiving resulted in less warmth within the sibling relationship and impacted negatively upon quality of life. When the young person with FEP had attempted suicide and/or been physically violent, siblings experienced more caregiver burden. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness related variables on the experience of caregiving. Conclusion: Suicide attempts and a history of violence resulted in higher caregiving burden for siblings regardless of whether they lived with the young person experiencing FEP or not. Female siblings are at higher risk of negative experiences from caregiving resulting in a reduced quality of life and a changed sibling relationship. Suicide attempts and violence are indicators for intensive case management to improve outcomes for the individual with FEP which may in turn reduce the burden experienced by the sibling. Clinicians can use these findings to identify siblings, assertively intervene and provide increased psychological support, psychoeducation and practical problem solving to reduce the burden. The caregiving role that they already play for their ill brother or sister should be recognized.

Course of substance misuse and daily tobacco use in first-episode psychosis.

BACKGROUND: Study of the course of substance misuse and daily tobacco use in first-episode psychosis may enhance detection and treatment of these substance-related problems. METHODS: This 15-month follow-up study examined the course of substance misuse and daily tobacco use in 103 individuals treated for first-episode psychosis. RESULTS: Three-quarters (72.6%) of patients with lifetime substance misuse, or half (51.5%) of all patients, continued substance misuse (primarily cannabis) during the 15-month follow-up period. There was a significant reduction in the rate of any substance misuse (70.9% versus 53.4%) but not daily tobacco use (76.7% versus 75.7%) between baseline and 15-month follow-up. Patients who continued substance misuse showed a significant reduction in the severity and frequency of substance use between baseline and follow-up. Patients who continued substance misuse were more likely to be younger, male and single, less likely to have completed secondary school, and more likely to have had more severe cannabis use prior to entry to treatment compared to patients who ceased substance misuse. DISCUSSION: A significant proportion of young patients treated for first-episode psychosis are at risk of mental and physical health problems associated with substance misuse and/or regular tobacco use.

Gender difference in outcomes following trauma-focused interventions for posttraumatic stress disorder: Systematic review and meta-analysis.

OBJECTIVE: Currently, there is a lack of evidence on whether women and men respond differently to trauma-focused psychological treatments for posttraumatic stress disorder (PTSD). This study was a systematic review and meta-analysis to examine whether gender is associated with response to trauma-focused psychological interventions for PTSD. METHOD: The Cochrane Collaboration systematic review methodology (Higgins & Green, 2011) was used as a guide for this study. Randomized controlled trials comparing trauma-focused interventions for PTSD with comparison conditions were identified in a literature review. RESULTS: Forty-eight randomized controlled trials were included in the meta-analysis: 25 had a mixed gender sample, 18 were female only, and 5 were male only. There was evidence that women had greater reductions than men in the primary outcome measure of clinician-rated PTSD symptoms when trauma-focused psychological interventions were compared with any comparison condition at both postintervention and short-term follow-up. This finding was supported by a direct effects meta-analysis of studies that provided data on both females and males. CONCLUSIONS: The current findings support a gender difference in outcomes following trauma-focused psychological interventions for PTSD. Future research should seek to identify specific factors related to gender that facilitate or inhibit response to these interventions. (PsycINFO Database Record

The Impact of First-Episode Psychosis on the Sibling Relationship.

OBJECTIVE: Research and clinical practice in first-episode psychosis (FEP) has predominantly focused on parents and partners and has neglected siblings needs. This study aims to characterize the sibling relationship in FEP and to examine the illness-related variables that influence this relationship. METHOD: Survey methodology explored the experience of 157 siblings during the first 18 months of their brother or sister's treatment. The Adult Sibling Relationship Questionnaire was used to measure the warmth, conflict, and rivalry within the relationship. A series of multivariate regression analyses were conducted to determine the relationship between illness characteristics and sibling relationship. RESULTS: When the young person experiencing FEP had a period of untreated psychosis longer than six months, required more than one hospital admission, had persisting psychotic symptoms, continued to use substances, and/or had a history of physical violence, warmth within the sibling relationship deteriorated. Regression analysis revealed that a history of violence was a significant predictor of the warmth, conflict, and rivalry within the sibling relationship. Suicide attempts were a significant predictor of conflict. CONCLUSIONS: This study has established associations between the sibling relationship and illness-related variables. This study promotes consideration of the importance of including siblings in early intervention. Given the powerful role this relationship can have as a protective factor, this study could inform future interventions involving siblings.

Mental health service use: comparing people who served in the military or received Veterans' Affairs benefits and the general population.

OBJECTIVES: To compare the lifetime prevalence of affective, anxiety and substance use disorders and the use of mental health services between people who had served in the Australian Defence Force (ADF) or received Department of Veterans' Affairs (DVA) benefits and the general population. METHOD: The 2007 National Survey of Mental Health and Wellbeing obtained data from a nationally representative household survey of 8,841 respondents. RESULTS: Fewer than 20% of men who had served in the ADF reported receiving benefits from DVA. ADF men were older and more likely to report poorer health than other men. They were 50% more likely to be diagnosed with any lifetime mental disorder, any affective disorder, depression, PTSD, any substance use and alcohol disorder. Almost 90% of women who received DVA benefits had not served in the ADF. DVA women were older, and more likely to report moderate/severe psychological distress and less life satisfaction than other women. There was no evidence of greater lifetime use of mental health services by ADF men or DVA women compared to the general population. CONCLUSIONS: Health care providers should ask their patients if they have connections with the military in order to better detect and treat potential mental health problems.

Forgotten family members: the importance of siblings in early psychosis.

OBJECTIVE: This paper reviews the evidence on the significance of sibling inclusion in family interventions and support during early psychosis. METHOD: This narrative review presents the current research related to the importance of family work during early psychosis, the needs and developmental significance of siblings during adolescence and early adulthood, the protective effects of sibling relationships, and the characteristics of early psychosis relevant to the sibling experience. It will also review the evidence of the sibling experience in chronic physical illness and disability, as well as long-term psychotic illness. CONCLUSIONS: Despite the evidence that working with families is important during early psychosis, siblings have been largely ignored. Siblings are an important reciprocal relationship of long duration. They play an important role in development during adolescence and early adulthood. These relationships may be an underutilized protective factor due to their inherent benefits and social support. Developmental theories imply that early psychosis could negatively impact the sibling relationship and their quality of life, effecting personality development and health outcomes. The evidence shows that adolescent physical illness or disability has a significantly negative impact on the sibling's quality of life and increases the risk for the onset of mental health issues. Long-term psychotic illness also results in negative experiences for siblings. Current evidence shows that siblings in early psychosis experience psychological distress and changes in functional performance. Further research using standard measures is required to understand the impact early psychosis has on the sibling relationship and their quality of life.