RESUMEN
BACKGROUND: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.
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COVID-19 , Pandemias , COVID-19/epidemiología , Personal de Salud/psicología , Humanos , Salud Mental , SARS-CoV-2RESUMEN
BACKGROUND: The association between incarceration and psychiatric disorders has been noted. Yet, existing studies are cross-sectional or examine the risk of recidivism, which has limited the predictive validity of psychiatric disorders as a risk factor for incarceration. To overcome this limitation, this study used a prospective cohort to examine whether psychiatric diagnoses in early adulthood predicted incarceration throughout a 30-year follow-up. It tested the association between psychiatric diagnoses with future incarcerations, their number and durations, controlling for education and ethnic status. METHODS: This study merged data from three sources in Israel: a prospective 10-year birth cohort study of young adults aged 25-34, conducted in the 1980s (N = 4914) that included a psychiatric interview; data from the Prison Service, including the cause, number and duration of incarcerations; and from the Vital Statistics Registry on death records. RESULTS: Multivariate analysis showed that substance-use disorders, antisocial personality and lower levels of education predicted future incarceration, their number and maximum duration. The remainder diagnoses were not significantly associated with future incarceration. CONCLUSIONS: Results limited the prediction of future incarcerations to persons diagnosed with substance use and antisocial personality, and do not support an independent predictive association between additional psychiatric diagnoses and future incarceration.
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Trastorno de Personalidad Antisocial/psicología , Prisioneros/psicología , Prisioneros/estadística & datos numéricos , Trastornos Relacionados con Sustancias/psicología , Adulto , Trastorno de Personalidad Antisocial/epidemiología , Estudios Transversales , Femenino , Humanos , Israel/epidemiología , Modelos Logísticos , Masculino , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
This research focused on secondary traumatization of wives and offspring of 115 male Vietnam veterans, a subsample from the National Vietnam Veterans Readjustment Study who had one or more children aged 6 to 16 years and had had a clinical interview. Traumatization was defined as meeting criteria for lifetime war-related posttraumatic stress disorder (PTSD). Secondary traumatization was operationalized by elevated scores on children's internalizing or externalizing behavior problems and on wives' demoralization. There was evidence of secondary traumatization in the veterans' sons (odds ratio [OR] = 20.31 for internalizing behavior problems). Current PTSD in the veterans was associated with demoralization in their wives or partners (ß = 0.24), which in turn was associated with behavior problems in their daughters (ORs = 2.67 and 4.61 for internalizing and externalizing behavior problems, respectively; these were adjusted for veteran's PTSD). Demoralization of the wife or partner was also associated with current alcoholism in the veterans (ß = 0.30, adjusting for veteran's PTSD). These associations were also adjusted for other veteran risk factors, including severity of combat exposure, involvement in harming civilians or prisoners, and prewar vulnerability. Even with the degree of secondary traumatization present, the veterans' children appeared at least as healthy as counterparts in the general population.
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Desgaste por Empatía/epidemiología , Familia Militar/psicología , Esposos/psicología , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Alcoholismo/epidemiología , Niño , Femenino , Humanos , Masculino , Núcleo Familiar/psicología , Factores de Riesgo , Factores Sexuales , Estados Unidos , Veteranos/psicología , Guerra de VietnamRESUMEN
BACKGROUND: There have been very few prospective studies of death by suicide in the general population. Rather, studies of suicide have generally used psychological autopsies, a method that has the potential weakness of recall bias. AIMS: To examine correlates of death by suicide among a community-based nonclinical sample prospectively assessed years before death by suicide. METHOD: We analyzed data from an epidemiological study of a 10-year birth cohort (n = 4,914) conducted in Israel in the 1980s, with follow-up mortality data over 25 years. RESULTS: Eight participants died by suicide during follow-up (6/100,000 per year; mean follow-up to suicide = 18.3â±â2.0 years), the majority of whom were rated as functioning relatively well at baseline. Male sex, psychiatric hospitalizations, major depressive disorder, and previous suicide attempts were associated with later suicide. CONCLUSION: In this nonclinical sample of persons assessed between ages 25 and 34, several correlates of suicide were identified, but the majority of persons who died by suicide were relatively high functioning at baseline. Major precursors of suicide may be more proximal factors of acute or chronic negative changes in life circumstances.
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Suicidio/psicología , Adulto , Trastorno Depresivo Mayor/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Israel/epidemiología , Estudios Longitudinales , Masculino , Trastornos Mentales/epidemiología , Factores de Riesgo , Factores Sexuales , Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricosRESUMEN
BACKGROUND: Psychotic experiences are common in the general population, and predict later psychotic illness. Much less is known about negative symptoms in the general population. METHOD: This study utilized a sample of 4,914 Israel-born individuals aged 25-34 years who were screened for psychopathology in the 1980's. Though not designed to specifically assess negative symptoms, data were available on 9 self-report items representing avolition and social withdrawal, and on 5 interviewer-rated items assessing speech deficits, flat affect and poor hygiene. Psychotic experiences were assessed using the False Beliefs and Perceptions subscale of the Psychiatric Epidemiology Research Interview. Psychiatric hospitalization was ascertained 24 years later using a nation-wide psychiatric hospitalization registry. RESULTS: After removing subjects with diagnosable psychotic disorders at baseline, 20.2% had at least one negative symptom. Negative symptoms were associated with increased risk of later schizophrenia only in the presence of strong (frequent) psychotic experiences (OR = 13.0, 9% CI: 2.1-79.4). CONCLUSIONS: Negative symptoms are common in the general population, though the majority of people with negative symptoms do not manifest a clinically diagnosed psychiatric disorder. Negative symptoms and psychotic experiences critically depend on each other's co-occurrence in increasing risk for later schizophrenia.
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Trastornos Psicóticos , Sistema de Registros , Esquizofrenia , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/fisiopatología , Trastornos Psicóticos/psicología , Esquizofrenia/epidemiología , Esquizofrenia/etiología , Esquizofrenia/fisiopatologíaRESUMEN
The diagnosis, Posttraumatic Stress Disorder, was introduced in 1980 amidst debate about the psychiatric toll of the Vietnam War. There is controversy, however, about its central assumption that potentially traumatic stressors are more important than personal vulnerability in causing the disorder. We tested this assumption with data from a rigorously diagnosed male subsample (n = 260) from the National Vietnam Veterans Readjustment Study. Combat exposure, pre-war vulnerability, and involvement in harming civilians or prisoners were examined, with only combat exposure proving necessary for disorder onset. While none of the three factors proved sufficient, estimated onset reached 97% for veterans high on all three, with harm to civilians or prisoners showing the largest independent contribution. Severity of combat exposure proved more important than pre-war vulnerability in onset; pre-war vulnerability at least as important in long-term persistence. Implications for the primacy of the stressor assumption, further research, and policy are discussed.
RESUMEN
OBJECTIVE: The definition of the stressor criterion (DSM criterion A1) for posttraumatic stress disorder (PTSD) is hotly debated with major revisions being considered for DSM-5. We examine whether symptoms, course, and consequences of PTSD vary predictably with the type of stressful event that precipitates symptoms. METHOD: We used data from the 2009 PTSD diagnostic subsample (N = 3,013) of women from the Nurses' Health Study II. We asked respondents about exposure to stressful events that qualified under DSM-III or DSM-IV or did not qualify under DSM criterion A1. Respondents selected the event they considered worst and reported subsequent PTSD symptoms. Among participants who met all other DSM-IV PTSD criteria, we compared distress, symptom severity, duration, impairment, receipt of professional help, and 9 physical, behavioral, and psychiatric sequelae (eg, physical functioning, unemployment, depression) by precipitating event group. Various assessment tools were used to determine fulfillment of PTSD criteria B through F and to assess these 14 outcomes. RESULTS: Participants with PTSD from DSM-III events reported, on average, 1 more symptom (DSM-III, mean = 11.8 symptoms; DSM-IV, mean = 10.7 [P < .001]; non-DSM, mean = 10.9 [P < .01]) and more often reported that symptoms lasted 1 year or longer compared to participants with PTSD from other groups (DSM-III vs DSM-IV, P < .01; DSM-III vs non-DSM, P < .001). However, sequelae of PTSD did not vary systematically with precipitating event type. CONCLUSIONS: Results indicate the stressor criterion as defined by the DSM may not be informative in characterizing PTSD symptoms and sequelae. In the context of ongoing DSM-5 revision, these results suggest that criterion A1 could be expanded in DSM-5 without much consequence for our understanding of PTSD phenomenology. Events not considered qualifying stressors under the DSM produced PTSD as consequential as PTSD following DSM-III events, suggesting PTSD may be an aberrantly severe but nonspecific stress response syndrome.
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Manual Diagnóstico y Estadístico de los Trastornos Mentales , Acontecimientos que Cambian la Vida , Trastornos por Estrés Postraumático/diagnóstico , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Trastornos por Estrés Postraumático/psicologíaRESUMEN
CONTEXT: It has been suggested that attenuated psychotic symptoms (APSs) reported by people who do not have psychotic disorders signal risk for later severe mental illness. OBJECTIVE: To investigate this suggestion using follow-up assessments of hospitalization for clinical diagnoses of nonaffective psychotic and other psychiatric disorders. DESIGN: Longitudinal cohort study of self-reported APSs with outcome assessment of severe mental illness obtained through linkage with a national hospitalization case registry. SETTING: Israel. PARTICIPANTS: A stratified full probability sample of 4914 persons aged 25 to 34 years who were screened for psychopathology in the 1980s. MAIN OUTCOME MEASURE: Subsequent psychiatric hospitalization was ascertained using the psychiatric hospitalization registry, with a mean follow-up of 24 years. RESULTS: After removing subjects with diagnosable psychotic disorders at baseline, 57.2% of the remaining sample reported at least 1 weak (infrequent) APS and 14.3% reported at least 1 strong (frequent) APS in the year preceding the assessment. Self-reported APSs predicted risk of later hospitalization for nonaffective psychotic disorders, mostly during the 5 years after baseline (adjusted odds ratio = 4.31; 95% CI, 2.21-8.41; positive predictive value = 1.27%; population attributable risk fraction = 33%). Also, APSs increased the risk of later hospitalization for other psychiatric disorders, albeit to a lesser extent (adjusted odds ratio = 2.21; 95% CI, 1.02-4.82). CONCLUSIONS: Self-reported APSs signal risk for later nonaffective psychotic disorders but are not clinically useful as predictors. The difference between these population-based data and the high-risk literature in terms of the positive predictive value (1% vs 10%, respectively) and the time window of transition (5 years vs 12 months, respectively) can be attributed to the selective enrichment strategies that produce high-risk samples.
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Trastornos Mentales/psicología , Trastornos Psicóticos/psicología , Adulto , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Israel , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , AutoinformeRESUMEN
BACKGROUND: Psychiatric hospitalization registries are utilized to investigate the incidence and prevalence of schizophrenia for both research and administrative purposes. The assumption behind this is that most individuals with schizophrenia will be hospitalized at least once in their life-time. METHOD: In an epidemiological survey conducted in the 1980s, a population-based sample (n = 4914) of Israel-born individuals then aged 25-34 were screened in the community, and 29 (0.6%) were subsequently diagnosed by psychiatrists using SADS/RDC criteria. Twenty four years later we linked data from the epidemiological survey with the Israeli National Psychiatric Hospitalization Registry. RESULTS: Twenty seven of the 29 individuals (93%) diagnosed with schizophrenia in the survey were identified in the hospitalization registry with the same diagnosis. Fifty-two (1.0%) participants not diagnosed during the survey with schizophrenia were identified in the psychiatric hospitalization registry 24 years later with schizophrenia. The majority of them were diagnosed with other psychiatric disorders in the survey. If all diagnoses of schizophrenia are accepted at face value, the lifetime prevalence rate would be 1.8% for this cohort. CONCLUSION: The overwhelming majority of individuals diagnosed with schizophrenia at ages 25-34 in an epidemiological survey were present in the Psychiatric Hospitalization Registry. However, the assessment of life-time rates of schizophrenia at these ages is problematic because some future cases are asymptomatic, others have premorbid non-psychotic disorders, while in others it is difficult to differentiate between affective disorders and schizophrenia. Availability of psychiatric services and hospitalization policy must be considered when generalizing these findings to other countries.
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Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Sistema de Registros/estadística & datos numéricos , Esquizofrenia/epidemiología , Adulto , Análisis de Varianza , Planificación en Salud Comunitaria , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Israel/epidemiología , Estudios Longitudinales , Masculino , Prevalencia , Escalas de Valoración PsiquiátricaRESUMEN
The elevated rate of current posttraumatic stress disorder (PTSD) among Hispanic Vietnam veterans has been attributed to culturally based expressiveness that inflates symptom self-reports. To investigate this possibility, the authors conducted three hypothesis-driven analyses with National Vietnam Veterans Readjustment Study (NVVRS) data from the Structured Clinical Interview for DSM-III-R (SCID-) diagnosed subsample of male Vietnam Theater veterans (N = 260). First, persistence of the Hispanic elevation after adjusting for war-zone stress exposure initially suggested the effect of greater expressiveness. Second, symptom-based analyses isolated this effect to the self-report Mississippi Scale for Combat-Related PTSD and not to the clinician-rated SCID interview. Third, objective measures of functioning did not reveal a unique Hispanic pattern of lower impairment associated with current PTSD. These tests suggest that greater Hispanic expressiveness does not account for the Hispanic elevation in current PTSD in the NVVRS SCID-diagnosed subsample.
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Hispánicos o Latinos/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Veteranos/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Algoritmos , Trastornos de Combate/diagnóstico , Trastornos de Combate/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Escolaridad , Hispánicos o Latinos/psicología , Humanos , Masculino , Padres/psicología , Prevalencia , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Clase Social , Trastornos por Estrés Postraumático/diagnóstico , Desempleo/estadística & datos numéricos , Estados Unidos/epidemiología , Guerra de Vietnam , Población Blanca/estadística & datos numéricosRESUMEN
Elevated prevalence rates of chronic posttraumatic stress disorder (PTSD) have been reported for Black and Hispanic Vietnam veterans. There has been no comprehensive explanation of these group differences. Moreover, previous research has relied on retrospective reports of war-zone stress and on PTSD assessments that fail to distinguish between prevalence and incidence. These limitations are addressed by use of record-based exposure measures and clinical diagnoses of a subsample of veterans from the National Vietnam Veterans Readjustment Study (NVVRS). Compared with Majority White, the Black elevation is explained by Blacks' greater exposure; the Hispanic elevation, by Hispanics' greater exposure, younger age, lesser education, and lower Armed Forces Qualification Test scores. The PTSD elevation in Hispanics versus Blacks is accounted for mainly by Hispanics' younger age.
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Trastornos de Combate/epidemiología , Etnicidad/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Veteranos/estadística & datos numéricos , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Trastornos de Combate/diagnóstico , Trastornos de Combate/psicología , Susceptibilidad a Enfermedades/diagnóstico , Susceptibilidad a Enfermedades/epidemiología , Susceptibilidad a Enfermedades/psicología , Evaluación Educacional , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Incidencia , Modelos Logísticos , Masculino , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Guerra de Vietnam , Población Blanca/estadística & datos numéricosRESUMEN
Much research has shown that reports of stressful life events are related to a wide variety of psychiatric and physical health outcomes. Relatively little research exists, however, on the distribution of the events according to gender, age, racial/ethnic background, and socioeconomic status (SES). Such information would help identify groups at greatest risk for further investigation. This paper presents a review of the relevant studies. We find that traumatic (e.g., life threatening) events appear to be more frequent for men, while men and women differ more consistently on types rather than on overall numbers of stressful events other than traumatic. Traumatic and other stressful events tend to be more frequent in low SES and racial/ethnic minorities groups, and finally, both traumatic and other stressful events are reported more by younger age groups in samples 18 years of age and older. The limitations and implications of these findings for further research and preventive interventions are discussed, especially the need for more detailed information about individual events.
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Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Acontecimientos que Cambian la Vida , Adolescente , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
In 1988, the National Vietnam Veterans Readjustment Study (NVVRS) reported 30.9% lifetime and 15.2% current rates of posttraumatic stress disorder (PTSD), and a strong dose/response relationship with retrospective reports of combat exposure. Skeptics argued that recall bias and other flaws inflated the results. Using a new record-based exposure measure and diagnoses in an NVVRS subsample, the authors addressed this controversy in a recent issue of Science (B. P. Dohrenwend et al., 2006). They found little evidence of falsification, an even stronger dose/response relationship and, when fully adjusted for impairment and evidence of exposure, 18.7% onset and 9.1% current rates of war-related PTSD. The fact that these rates are lower than the original NVVRS rates has stimulated continuing controversy that has tended to obscure the more important implications of the study's results.
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Trastornos de Combate/epidemiología , Trastornos de Combate/psicología , Veteranos/psicología , Guerra de Vietnam , Adaptación Psicológica , Adulto , Sesgo , Trastornos de Combate/diagnóstico , Estudios Transversales , Evaluación de la Discapacidad , Encuestas Epidemiológicas , Humanos , Masculino , Simulación de Enfermedad/diagnóstico , Simulación de Enfermedad/epidemiología , Simulación de Enfermedad/psicología , Recuerdo Mental , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Autorrevelación , Estados Unidos , Veteranos/estadística & datos numéricosRESUMEN
Data from the National Vietnam Veteran Readjustment Study (NVVRS) revealed a prevalence of current posttraumatic stress disorder (PTSD) in female Vietnam Theater veterans half the size of the prevalence in their male counterparts. This stands in contrast to the elevated prevalence of PTSD in women obtained in general population surveys. This study undertakes further analyses of gender differences in the NVVRS and how these differences might be specified by the amount and type of exposure to war-zone stress. The findings indicate that male elevations in PTSD are limited to men who served under circumstances of high probable severity of war-zone stress exposure. When prewar demographic differences are controlled, male veterans in low-exposure circumstances display a level of PTSD prevalence substantially lower than female veterans.
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Trastornos de Combate/epidemiología , Veteranos/psicología , Guerra de Vietnam , Adaptación Psicológica , Adulto , Trastornos de Combate/diagnóstico , Trastornos de Combate/psicología , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Determinación de la Personalidad , Probabilidad , Factores de Riesgo , Factores Sexuales , Estados UnidosRESUMEN
In 1988, the National Vietnam Veterans Readjustment Study (NVVRS) of a representative sample of 1200 veterans estimated that 30.9% had developed posttraumatic stress disorder (PTSD) during their lifetimes and that 15.2% were currently suffering from PTSD. The study also found a strong dose-response relationship: As retrospective reports of combat exposure increased, PTSD occurrence increased. Skeptics have argued that these results are inflated by recall bias and other flaws. We used military records to construct a new exposure measure and to cross-check exposure reports in diagnoses of 260 NVVRS veterans. We found little evidence of falsification, an even stronger dose-response relationship, and psychological costs that were lower than previously estimated but still substantial. According to our fully adjusted PTSD rates, 18.7% of the veterans had developed war-related PTSD during their lifetimes and 9.1% were currently suffering from PTSD 11 to 12 years after the war; current PTSD was typically associated with moderate impairment.
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Personal Militar/psicología , Trastornos por Estrés Postraumático/epidemiología , Veteranos/psicología , Guerra de Vietnam , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Registros , Medición de Riesgo , Trastornos por Estrés Postraumático/diagnóstico , Estados Unidos/epidemiología , Veteranos/estadística & datos numéricos , Ayuda a Lisiados de GuerraRESUMEN
An explosion of research on life events has occurred since the publication of the Holmes and Rahe checklist in 1967. Despite criticism, especially of their use in research on psychopathology, such economical inventories have remained dominant. Most of the problems of reliability and validity with traditional inventories can be traced to the intracategory variability of actual events reported in their broad checklist categories. The purposes of this review are, first, to examine how this problem has been addressed within the tradition of economical checklist approaches; second, to determine how it has been dealt with by far less widely used and far less economical labor-intensive interview and narrative-rating approaches; and, third, to assess the prospects for relatively economical, as well as reliable and valid, solutions.
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Conflicto Psicológico , Acontecimientos que Cambian la Vida , Trastornos Mentales/etiología , Trastornos Mentales/psicología , Humanos , Narración , Factores de RiesgoRESUMEN
A subsample of 255 male Vietnam veterans from the National Vietnam Veterans Readjustment Study received in-depth psychiatric diagnostic interviews. This paper focuses on the 88 veterans with a war-related onset of PTSD. Among these veterans, the avoidance cluster, especially its symptoms of numbing, was most strongly associated with chronic PTSD; less strongly but also significantly associated was the hyperarousal cluster. Further analyses show that these associations are not artifacts of the relationship of symptom patterns to prewar demographic factors (race/ethnicity, socioeconomic status, age at entry into Vietnam), comorbidity, treatment and compensation seeking, or probable severity of war-related trauma. We conclude that certain symptom profiles may predict enduring pathological responses to trauma and therefore provide targets for intervention efforts.
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Trastornos por Estrés Postraumático/diagnóstico , Veteranos/psicología , Enfermedad Crónica , Trastornos de Combate/diagnóstico , Trastornos de Combate/epidemiología , Trastornos de Combate/psicología , Comorbilidad , Humanos , Acontecimientos que Cambian la Vida , Masculino , Trastornos Mentales/epidemiología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Ayuda a Lisiados de Guerra/estadística & datos numéricos , Guerra de VietnamRESUMEN
A 70.9% majority of the U.S. male veterans in a nationwide sample appraised the impact of their service in Vietnam on their present lives as mainly positive. A substantial minority, 41.7%, judged the effects to be highly salient. With controls on level of exposure to war-zone stressors measured with data from military records, the valence and salience of these appraisals are investigated in relation to posttraumatic stress disorder (PTSD) and other indicators of wartime and postwar functioning. The results are consistent with the hypothesis that mainly positive tertiary appraisals are affirmations of successful wartime and postwar adaptation rather than defensive denials related to maladaptive outcomes. The possibility that mainly positive tertiary appraisals also contribute to successful postwar adaptation is discussed.
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Afecto , Negación en Psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Veteranos/psicología , Guerra , Adaptación Psicológica , Mecanismos de Defensa , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos por Estrés Postraumático/diagnóstico , VietnamRESUMEN
Seasonal variability has been detected in a variety of illnesses. The purpose of this study is to examine seasonal variability in pain intensity, demoralization and range of mandibular motion among patients suffering from myofascial face pain. Pain and demoralization for cases (n = 140) and demoralization for controls (n = 133) were measured in each of 10 monthly interviews. Range of motion was measured once only for cases. Their pain intensity (P < 0.009) and demoralization (P < 0.04) were significantly greater in the peak dark months than in the peak light months. There was a non-significant trend (P < 0.07) toward elevated demoralization in the darker months for controls. Range of motion, assessed cross-sectionally, did not demonstrate a seasonal pattern. These data support our prior finding that myofascial face pain and depressed mood are co-morbid and may be maintained by common risk factors.