Causal Relationship Between Post-Traumatic Stress Disorder and Immune Cell Traits: A Mendelian Randomization Study.

INTRODUCTION: Post-traumatic stress disorder (PTSD) is a debilitating psychological disorder that occurs after exposure to catastrophic-level experiences. Although alterations in immune function have been identified in individuals with PTSD, the causal relationship between the two remains unclear. METHODS: To investigate the causal relationship between PTSD and immune function, we conducted the forward and backward two-sample Mendelian randomization (MR) analyses, based on summary-level genome-wide association studies (GWAS) data on PTSD and immune cell traits. RESULTS: For the forward MR analysis, PTSD was found to reduce the levels of CD62L- dendritic cell (DC) (beta = -0.254, FDR = 0.01), CD86+ myeloid DC (beta = -0.238, FDR = 0.014), CD62L- myeloid DC (beta = -0.26, FDR = 0.01), CD62L- CD86+ myeloid DC absolute count (beta = -0.264, FDR = 0.024), and CD62L- CD86+ myeloid DC (beta = -0.328, FDR = 0.002). In contrast, PTSD was observed to increase the level of CD28- CD8dim T-cell absolute count (beta = 0.27, FDR = 0.029). For the backward MR analysis, the odds ratio (OR) for CD33 on CD33dim HLA DR+ CD11b- in relation to PTSD risk was found to be 1.045 (95% CI = 1.021-1.069, FDR = 0.008). The OR for FSC-A on HLA DR+ CD8br was 1.048 (95% CI = 1.018-1.079, FDR = 0.039) and for CCR2 on CD14- CD16+ monocyte was 1.059 (95% CI = 1.027-1.092, FDR = 0.008). No significant pleiotropy was detected in both forward and backward MR analyses. CONCLUSION: The bidirectional MR study shed light on the intricate interplay between immune function and PTSD. The identification of a bidirectional causal relationship between T cells and PTSD opens new avenues for considering innovative approaches to the prevention and early intervention of PTSD.

A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder.

Background: While there are well-established treatments for post-traumatic stress disorder (PTSD), these interventions appear to be less effective for individuals with comorbid borderline personality disorder (BPD) symptoms. Dialectical Behavior Therapy (DBT) for PTSD and DBT Prolonged Exposure (PE) are both effective interventions for treating these patients, but a comprehensive analysis evaluating the efficacy of these two interventions is lacking.Objective: To determine the effect sizes of PTSD-specific DBT treatments.Methods: We conducted a systematic review and pre-registered meta-analysis of the DBT literature for treating PTSD (osf.io/62rfq). Eligible trials and treatment evaluations published before September 2023 were searched in SCOPUS, PubMed, and the Cochrane Library databases. Thirteen articles were identified, and data were extracted for primary (PTSD symptoms) and secondary outcomes (BPD, depression, dissociation, non-suicidal self-injury [NSSI]). Treatment effects were calculated for randomised controlled trials, controlled clinical trials, and pre-post evaluations.Results: Overall, the studies involved 663 participants. Compared with control groups, PTSD-specific DBT treatments showed moderate effects in reducing PTSD symptom severity g = -0.69 (95% CI -1.03 to -0.34, p < .001) and depression g = -0.62 (95% CI -1.13 to -0.12, p = .016). Moreover, the pre-post changes showed an overall effect size for dissociative symptoms of g = -0.72 (95% CI -1.05 to -0.40, p < .001), for BPD-associated symptoms of g = -0.82 (95% CI -1.06 to -0.59, p < .001), and for NSSI frequency (g = -0.70, 95% CI -1.12 to -0.28, p = .001).Conclusions: Based on the results of our meta-analysis, DBT-PTSD and DBT PE were effective in reducing PTSD symptom severity and comorbid depressive symptoms. Further research on stage-based treatments should focus on systematically assessing NSSI, BPD symptoms, and suicidality.

We conducted the first meta-analysis assessing the efficacy of Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Dialectical Behavior Therapy Prolonged Exposure (DBT PE) for individuals with comorbid PTSD and BPD symptoms.Based on RCTs/CCTs, we found moderately beneficial effects on PTSD symptoms, and depression for both stage-based interventions and large effects on non-suicidal self-injury frequency for DBT PE.DBT-PTSD and DBT PE resulted in pre-post improvements in dissociative symptoms, BPD-associated symptoms, and non-suicidal self-injury frequency.

Successful Management of a Neglected Talonavicular Joint Dislocation Using Corrective Osteotomy and Subtalar Fixation: A Case Report.

The complete loss of articular relationships between the talus and navicular bone is known as talonavicular joint (TNJ) dislocation. Medial dislocation of the TNJ is more common than lateral dislocation. Lateral dislocation is usually associated with a fracture of the calcaneocuboid joint. Surgeons encounter difficulties when treating these dislocations. It occurs following high-energy trauma and is managed with immediate closed reduction of the joint and immobilization, but some complicated cases require open reduction and fixation to achieve alignment, strength, and function. This case report describes a six-month-old neglected case of TNJ dislocation managed with corrective osteotomy and subtalar fixation. Fusion of the talonavicular and talocalcaneal joints was performed. This procedure had a satisfactory outcome, as the patient was completely relieved of pain.

Do nurse spiritual responses to trauma explain nurse outcomes? A correlational observational study.

BACKGROUND: Various facets of spirituality are associated with well-being. Given the current urgency to promote nurse well-being, nurse spirituality merits exploration. PURPOSE: To investigate how spiritual distress and growth (i.e., spiritual/religious struggle, moral injury, and post-traumatic growth) contributed to nurse outcomes (i.e., burnout, job satisfaction, and intent to leave). METHODS: Registered nurse (RNs) providing direct patient care in three Southern California hospitals completed an online survey that included psychometrically robust measures. Hierarchical multiple regression analyses were used to test spiritual variables as predictors of nurse outcomes after accounting for demographic and work-related factors. FINDINGS: In this sample of 531 demographically diverse RNs, spiritual struggle contributed to burnout and turnover intention; post-traumatic growth and employer respect for nurse well-being contributed to all three nurse outcomes. DISCUSSION: Spiritual distress and growth are understudied but potentially important influences on job outcomes for nurses. The results here suggest that continued development of interventions to address spiritual health is worth investment.

A Study on the Relationship Between Post-Traumatic Stress Disorder, Depression and Anxiety Symptoms and the Quality of Life of Syrian Refugees: Case Study for the Province of Kayseri.

The aim of this study is to investigate the factors related to post-traumatic stress disorder (PTSD), depression and anxiety mental disorders, as well as the quality of life of Syrian refugees and to examine the relationships between mental health disorders and the quality of life of Syrian refugees. Data were collected via face-to-face surveys with 613 adult Syrian refugees in an urban setting. Brislin's methodology was used for translating scale items, involving initial translation, back-translation and review by another professional translator. The study utilised the PTSD Scale, Beck Anxiety Scale, Depression Scale and Quality of Life Scale (QOLS). Descriptive, correlational and multivariate regression analysis were applied. Findings of correlational analysis indicate that PTSD levels among Syrian refugees are significantly related to gender, income level and employment. Depression levels are significantly associated with trauma history, healthcare service use, marital status and employment. Anxiety levels are significantly related to gender, trauma history, healthcare service use, employment and income. According to the findings of the regression analyses, the relationships between depression, quality of life and PTSD are complex. Meanwhile, anxiety decreases quality of life and increases PTSD. Quality of life moderates the relationship between depression and PTSD, as well as between anxiety and PTSD. The study concludes that the mental disorder levels of Syrian refugees, in terms of PTSD, depression and anxiety, are linked to their socio-demographic characteristics. These results highlight the importance of social, economic and cultural factors, healthcare and social services and the socio-demographic characteristics of the region where refugees have settled after displacement.

Epigenetic Contributors to PTSD: a Comprehensive Review.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a complex condition triggered by traumatic events. The molecular mechanisms underlying PTSD are not fully understood, but epigenetic modifications, particularly DNA methylation, may play a key role. The objective of this review was to identify the most significant epigenetic markers associated with PTSD. MATERIALS AND METHODS: Our search yielded 325 articles, of which 19 met our inclusion criteria for detailed analysis: published between 2018 and 2024, original research, containing molecular-genetic and statistical data, reporting diagnostic verification methods, PTSD as a primary condition, and a sample of at least 40 patients Results: the strongest correlation was found between PTSD and methylation changes in cg17057218, cg22324981, cg04755409 of BDNF, cg05656210, cg12169700, cg20756026 of MAD1L1, HLA-DPA1, HLA-DPB1 (chr6: 33047185 - 33049505) and SPATC1L (chr21: 47604052 - 47605174). The most works on associations of genetic clock with PTSD found significantly increased GrimAge acceleration in patients with PTSD. CONCLUSIONS: Epigenetic modifications, particularly DNA methylation, play a significant role in PTSD pathophysiology. While specific gene methylation changes are associated with PTSD, the link between PTSD and epigenetic aging remains unclear. Variability across studies suggests that trauma type, duration, and genetic factors may influence these epigenetic processes. Further research is essential to fully understand these relationships.

MDMA-assisted psychotherapy for the treatment of PTSD: A systematic review and meta-analysis of randomized controlled trials (RCTs).

BACKGROUND: Post-traumatic stress disorder (PTSD) is a mental health disorder resulting from exposure to traumatic events, manifesting in various debilitating symptoms. Despite available treatments, many individuals experience inadequate response or significant side effects. Previous reviews suggest promising outcomes with MDMA-assisted psychotherapy (MDMA-AT), but limitations prompt the need for a comprehensive evaluation. METHODS: We searched various online databases and registries such as MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov to retrieve RCTs that fit our inclusion criteria. We performed meta-analyses using Review Manager by applying a random-effects model. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and standard mean difference (SMD), respectively. RESULTS: Nine studies with a total of 297 participants with PTSD were included in our meta-analysis. The control group consisted of inactive doses of MDMA (25-40 mg) or placebo. Our meta-analysis showed that MDMA-AT led to a significant reduction in the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) severity scores as compared to the control group (SMD -1.10, 95% CI: -1.62 to -0.59). More patients in the MDMA-AT group exhibited significant response (RR 1.59, 95% CI: 1.22, 2.08) and remission (RR 2.32, 95% CI: 1.47 to 3.66) as compared to patients in the control group. There was no significant difference regarding the incidence of ≥1 treatment-emergent adverse events (TEAE), ≥1 severe TEAE, and suicidal ideation between the two groups. CONCLUSION: MDMA-AT demonstrates significant efficacy in improving PTSD symptoms, enhancing both response and remission rates in individuals with chronic, treatment-resistant PTSD, while maintaining a favorable safety profile.

A spike is a spike: On the universality of spike features in four epilepsy models.

OBJECTIVE: Frequency properties of the EEG characteristics of different seizure types including absence seizures have been described for various rodent models of epilepsy. However, little attention has been paid to the frequency properties of individual spike-wave complexes (SWCs), the constituting elements characterizing the different generalized seizure types. Knowledge of their properties is not only important for understanding the mechanisms underlying seizure generation but also for the identification of epileptiform activity in various seizure types. Here, we compared the frequency properties of SWCs in different epilepsy models. METHODS: A software package was designed and used for the extraction and frequency analysis of SWCs from long-term EEG of four spontaneously seizing, chronic epilepsy models: a post-status epilepticus model of temporal lobe epilepsy, a lateral fluid percussion injury model of post-traumatic epilepsy, and two genetic models of absence epilepsy-GAERS and rats of the WAG/Rij strain. The SWCs within the generalized seizures were separated into fast (three-phasic spike) and slow (mostly containing the wave) components. Eight animals from each model were used (32 recordings, 104 510 SWCs in total). A limitation of our study is that the recordings were hardware-filtered (high-pass), which could affect the frequency composition of the EEG. RESULTS: We found that the three-phasic spike component was similar in all animal models both in time and frequency domains, their amplitude spectra showed a single expressed peak at 18-20 Hz. The slow component showed a much larger variability across the rat models. SIGNIFICANCE: Despite differences in the morphology of the epileptiform activity in different models, the frequency composition of the spike component of single SWCs is identical and does not depend on the particular epilepsy model. This fact may be used for the development of universal algorithms for seizure detection applicable to different rat models of epilepsy. PLAIN LANGUAGE SUMMARY: There is a large variety between people with epilepsy regarding the clinical manifestations and the electroencephalographic (EEG) phenomena accompanying the epileptic seizures. Here, we show that one of the EEG signs of epilepsy, an epileptic spike, is universal, since it has the same shape and frequency characteristics in different animal models of generalized epilepsies, despite differences in recording sites and location.

'I can feel sad about it and I can worry, but inside I know everything happens for a reason': personal experiences in the aftermath of the March 15 Christchurch mosque attacks.

BACKGROUND: On 15 March 2019, a white supremacist gunman sequentially attacked two mosques in Christchurch, New Zealand, killing 51 people aged from 3 to 77 years and bullet-injuring 40 more. Approximately 250 people survived the atrocity, and many more family and community members have been directly or indirectly affected. AIM: To develop an understanding of the personal experiences of some of those affected, including effects on daily life and well-being, in the 18-30 months following the attacks. METHOD: Qualitative thematic analysis of semi-structured interviews with 21 men and women from September 2020 to August 2021 was performed. Participants were drawn from a larger quantitative study and included injured, bereaved, witnesses, family members and those from the wider Muslim community in Christchurch. RESULTS: Four superordinate themes were identified: being overwhelmed in the midst of chaos; experiencing silent and enduring impact; living similarly, but differently; and gaining meaning and growth. These themes captured ongoing distress inclusive of physical symptoms, family and community relationship dynamics and connectedness, secondary stressors, and diversity in coping and growth. For most, the centrality of Islam as a faith tradition was woven throughout. CONCLUSION: Consistent with previous literature, post-trauma reactions were pervasive and varied. This appeared to be compounded by secondary stressors in this cohort, such as sociopolitical circumstances, demographic diversity, the COVID-19 pandemic and justice processes. Findings also revealed a strong spiritual thread in the experiences of this minority faith community, shedding light on a complex interaction between recovery and post-traumatic growth.

Attachment, emotion regulation, and their roles in refugee post-traumatic stress and post-migration living difficulties.

Background: Upon arrival in the host country, refugees and asylum seekers (RAS) experience a range of post-migration living difficulties (PMLD), which are often linked to psychological symptoms such as post-traumatic stress (PTS). Initial research suggests that attachment insecurity partly explains the association between PMLD and psychological symptoms in RAS. However, the mechanisms through which attachment insecurity may act as a mediator are not well understood, though emotion dysregulation is one of the potential candidates.Objectives: This study investigated (1) whether attachment insecurity (i.e. anxiety and avoidance) mediate the association between PMLD and PTS, and (2) whether this mediation model can be extended to emotion dysregulation.Methods: 134 treatment-seeking RAS living in Switzerland completed questionnaires assessing PMLD, attachment insecurity, emotion dysregulation, and PTS. Two models were tested: (1) a parallel mediation analysis with attachment anxiety and avoidance as mediators, and (2) a serial mediation analysis with attachment anxiety as the first and emotion dysregulation as the second mediator.Results: First, PMLD was indirectly associated with PTS through attachment anxiety but not avoidance. Second, the association between PMLD and PTS was further explained by a pathway through attachment anxiety and emotion dysregulation.Conclusions: Although this study is limited by its cross-sectional design, we identified attachment anxiety and emotion dysregulation as potential mechanisms explaining how PMLD affects symptoms of PTS in RAS. Systematically assessing attachment style and addressing emotion regulation may therefore help improve treatment of refugee and asylum-seeking patients.

Attachment anxiety but not avoidance mediated the relationship between post-migration living difficulties and post-traumatic stress through emotion dysregulation in treatment-seeking refugees and asylum seekers.Attachment and emotion regulation are important psychological processes to consider when studying refugee mental health.Systematically assessing attachment style and addressing emotion regulation may help improve treatment of refugee and asylum-seeking patients.

(2R,6R)-hydroxynorketamine alleviates PTSD-like endophenotypes by regulating the PI3K/AKT signaling pathway in rats.

BACKGROUND: Patients diagnosed with post-traumatic stress disorder (PTSD) mainly exhibit enduring adverse emotions, heightening susceptibility to suicidal thoughts and behaviors. Notably, metabolites of ketamine, particularly (2R,6R)-hydroxyketamine (HNK), have demonstrated favorable antidepressant properties. However, the precise mechanism through which HNK exerts its therapeutic effects on negative emotional symptoms in PTSD patients should be fully elucidated. METHODS: In this investigation, a model involving a single prolonged stress and plantar shock (SPS&S) was utilized, followed by the administration of (2R, 6R)-HNK into the lateral ventricle subsequent to the recovery phase. The evaluation of PTSD-related behaviors was conducted through the open field test (OFT), elevated plus maze test (EMPT), and forced swim test (FST). The expression of phosphatidylinositol 3-kinase (PI3K)/phosphokinase B (AKT) signaling pathway in rat brain regions was analyzed using molecular biology experiments. RESULTS: SPS&S rats displayed adverse emotional behaviors characterized by depression and anxiety. Treatment with (2R, 6R)-HNK enhanced exploratory behavior and reversed negative emotional behaviors. This intervention mitigated disruptions in the expression levels of PI3K/AKT signaling pathway-associated proteins in the HIP and PFC, without influencing PI3K/AKT signaling in the AMY of SPS&S rats. CONCLUSION: Traumatic stress can trigger negative emotional reactions in rats, potentially involving the PI3K/AKT signaling pathway in the HIP, PFC, and AMY. The (2R, 6R)-HNK compounds have demonstrated the potential to mitigate adverse emotions in rats subjected to the SPS&S paradigm. This effect may be attributed to the modulation of the PI3K/AKT signaling pathway in the HIP, and PFC, with a particularly notable impact observed in the HIP region.

Allopregnanolone and intrusive memories: A potential therapeutic target for PTSD treatment?

Significant amounts of research have been devoted to treatment of post-traumatic stress disorder (PTSD) and the understanding of its fear and stress-related symptoms. However, current interventions are only effective in 60 % of the patient population. Allopregnanolone has become a topic of interest for PTSD due to its influences on inhibitory neurotransmission and the physiological stress response. This review explores available literature that suggests that allopregnanolone has an influence on (a) chronic stress and anxiety-like symptoms, (b) fear conditioning and contextual fear, and (c) intrusive and emotional memories. A relationship between allopregnanolone and PTSD is suggested, postulating that allopregnanolone is a potential target for the treatment of PTSD. This very exciting prospect calls for the expansion of research investigating a direct relationship between allopregnanolone and PTSD.

A parallel investigation of trauma exposure, maladaptive appraisals and posttraumatic stress reactions in two groups of trauma-exposed adolescents.

Background: Maladaptive appraisals, such as thoughts about experiencing a permanent and disturbing change and about being a fragile person in a scary world, are associated with posttraumatic stress reactions (PTSR) for trauma-exposed children and adolescents. Less is known about what puts young people at risk for developing such appraisals, and the differential relationship between the types of appraisals and PTSR.Objective: The primary aim was to examine the role of age, gender and exposure to potentially traumatizing events (PTEs) for the levels of maladaptive appraisals. The secondary aim was to investigate the association between the levels of maladaptive appraisals (appraisals of a permanent change and appraisals about a scary world) and PTSR.Methods: We investigated these aims in two samples: survivors after the terror attack at Utøya island in Norway in 2011 (N = 165, mean age 17.65, SD = 1.19) and adolescents referred to treatment after mainly interpersonal trauma (N = 152, mean age 15.08, SD = 2.18). The aims were investigated using linear regression and partial correlation.Results: In the terror-exposed sample, female gender was significantly associated with higher levels of scary-world appraisals, witnessing or learning that someone close were exposed to physical violence was significantly associated with more permanent-change appraisals, and a higher number of PTEs was significantly associated with higher levels of both types of appraisals. For the clinical sample, we found no significant associations between exposure to PTEs, gender, age, and the level of maladaptive appraisals. Both types of maladaptive appraisals were highly associated with PTSR in both samples, and there was no significant difference in the strength of the associations between the types of appraisals and PTSR.Conclusions: The results have implications for identifying adolescents at risk for developing harmful maladaptive appraisals. Both scary-world appraisals and permanent-change appraisals were strongly associated with PTSR in both groups of trauma-exposed adolescents.

Factors associated with elevated levels of maladaptive appraisals, and associations between maladaptive appraisals and posttraumatic stress reactions were investigated in two samples of trauma-exposed adolescents.Both appraisals about experiencing a permanent and disturbing change and appraisals about being a fragile person in a scary world were significantly associated with posttraumatic stress reactions.Exposure to a higher number of potentially traumatizing events (PTEs), being female, and witnessing or learning that someone close was exposed to physical violence were significantly associated with a higher level of maladaptive appraisals among terror-exposed adolescents.

Relationship between loneliness and post-traumatic growth in patients with gynecologic malignancies: the mediating role of self-disclosure and psychological resilience.

BACKGROUND: To explore the relationship between loneliness and post-traumatic growth, with a focus on the mediating role of psychological resilience and self-disclosure. METHODS: This study was a cross-sectional survey using the Loneliness Scale for Cancer Patients, the Distress Expression Index Scale (for measuring self-disclosure), the Psychological Resilience Scale, and the Posttraumatic Growth Scale on 215 inpatients with gynecologic malignancies at a tertiary care hospital in Guangzhou. Subsequently, Correlation, regression, and mediation analyses were performed using SPSS to test the relationships between the variables. RESULTS: The results showed that loneliness was negatively correlated with posttraumatic growth (r = -0.261, P < 0.001), self-disclosure was positively correlated with posttraumatic growth (r = 0.360, P < 0.001), and psychological resilience was positively correlated with posttraumatic growth (r = 0.475, P < 0.001); loneliness was correlated with self-disclosure (r = -0.194, P < 0.01), loneliness was negatively correlated with psychological resilience (r = -0.287, P < 0.001), self-disclosure was correlated with psychological resilience (r = 0.287, P < 0.001); loneliness was significantly correlated with self-disclosure (r = -0.314, P < 0.001); loneliness was not a direct predictor of posttraumatic growth (ß = -0.108, t = 1.734, P > 0.05), but could influence posttraumatic growth through the mediated effect of self-disclosure and psychological resilience, where the total indirect effect of self-disclosure and psychological resilience was - 0.155 (95% CI: -0.236, -0.081, P < 0.001). CONCLUSIONS: The mechanism of loneliness on post-traumatic growth in patients with gynecologic malignancies is mainly through the indirect effect of self-disclosure and the indirect impact of psychological resilience. Great attention should be paid to patients' loneliness, to find factors promoting patients' self-disclosure, to improve the level of patients' psychological resilience, and promote post-traumatic growth of gynecologic malignant tumors.

Post-Traumatic Stress Disorder (PTSD) in Trauma Patients.

Post-traumatic stress disorder (PTSD) was first introduced as a diagnosis by the American Psychiatric Association in 1980. This diagnosis, included in the 3rd edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III), was to be considered after someone was exposed to a traumatic event "outside the range of usual human experience and would be markedly distressing to almost anyone." Since then, trauma survivors have been identified as being at risk for the development of post-traumatic stress symptom (PTSS) and post-traumatic stress disorder (PTSD). Despite the recognition of this fact, the screening, recognition, and diagnosis of PTSD in these at-risk populations are inconsistent. In the following review, which is designed for the clinician who is unfamiliar with PTSD and its recognition, diagnosis, and treatment, we introduce the problem in the trauma patient and define its scope. In addition, we discuss the diagnosis of PTSD in trauma patients, special considerations relating to these patient populations, treatment options, and explore future directions for how best to define, study, recognize, and treat this challenging and potentially devastating condition.

Impact of Complementary Health Approaches on Opioid Prescriptions Among Veterans with Musculoskeletal Disorders-A Retrospective Cohort Study.

To examine whether complementary and integrative health approaches mitigate opioid prescriptions for pain and whether the relationship differs by post-dramatic stress disorder (PTSD) diagnosis, we followed 1,993,455 Veterans with musculoskeletal disorders during 2005-2017 using Veterans Healthcare Administration electronic health records. Complementary and integrative health (CIH) approaches were defined as ≥1 primary care visits for meditation, Yoga, and acupuncture etc using natural language processing. Opioid prescriptions were ascertained from pharmacy dispensing records. A propensity score was estimated and used to match one control Veteran to each CIH recipient. Over the 2-year follow-up period after the index diagnosis, 140,902 (7.1%) Veterans received ≥ 1 modalities. Among the matched analytic sample (272,296 Veterans), the likelihood of dispensing opioid prescriptions was significantly lower for Veterans in the CIH group than their controls [adjusted hazard ratio (aHR), 0.45 (95% Confidence Intervals (CI): 0.44-0.46)]. The association did not differ between Veterans with [aHR: 0.46 (95% CI: 0.45-0.47)] and without [aHR: 0.44 (95% CI: 0.43-0.45)] PTSD. In sensitivity analyses, the exposure group had 3.82 (95% CI: 3.76-3.87) months longer restricted mean survival time to opioid initiation, 2% (95% CI: 4%-1%) lower morphine equivalent and 17% lower total days' supply (95% CI: 18%-16%). The relationship remains significant but was attenuated after eliminating waiting time for the exposure group (aHR, 0.63 (95% CI: 0.62-0.64)). These observations suggest that CIH approaches may help reduce opioid prescriptions for Veterans with musculoskeletal disorders and related pain. The impact of the timing of receiving such approaches warrants further investigation. PERSPECTIVE: This article presents a quasi-experimental investigation into potential benefit of complementary and integrative health approaches (CIH) on de-prescribing opioids. The findings may potentially help clinicians who are seeking non-pharmacological alternative options to manage patient pain and opioid dependence".

Beyond Physical Injury: Routine Screening for Acute Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients - A Longitudinal Cohort Pilot Study.

INTRODUCTION: Early identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive. METHODS: In 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services. RESULTS: 205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, ∗P<0.0001). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory. CONCLUSION: Early screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.

Anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence: a network analysis.

BACKGROUND: Horizontal violence can cause serious mental health problems for nurses, particularly anxiety, depression, and post-traumatic stress disorder. However, the intrinsic linkage mechanism between mental symptoms of anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence is unclear. This study aims to elucidate the characteristics of anxiety, depression, and post-traumatic stress disorder networks among nurses with horizontal violence exposure. METHODS: Data for this cross-sectional study were obtained from the baseline portion of a short longitudinal survey conducted at four tertiary hospitals in Shandong Province, China. A total of 510 nurses with horizontal violence exposure completed the General Information Scale, the Negative Acts Questionnaire, the Seven-item Generalized Anxiety Disorder Scale, the Nine-item Patient Health Questionnaire, and the Four-item SPAN. The network model was constructed using network analysis. The expected influence and the bridge expected influence of nodes were calculated. The stability and accuracy of the network were estimated. RESULTS: The results show that A4 (Trouble relaxing) and P1 (Startle) had the highest expected influence in the network. D9 (Suicidality ideation) and A5 (Restlessness) were the key bridge symptoms. CONCLUSIONS: "Trouble relaxing", "Startle", "Suicidality ideation", and "Restlessness" are all mental symptoms that need to be urgently improved the most in nurses exposed to horizontal violence. Nursing administrators and policymakers should implement mental health intervention programs for these symptoms as early as possible to maximize nurses' mental health.

Prolonged exposure to a public health event: the mediating role of resilience between social support and post-traumatic growth among frontline nurses.

BACKGROUND IN: the early days of December 2022, the Chinese government ended its restrictive quarantine measures (e.g. nationwide lockdown) against COVID-19, which started in December 2019. Three years of prolonged exposure to the COVID-19 pandemic and restrictive quarantine policy had a notable impact on the mental health of frontline nurses. Traumatic events can have negative effects on people as well as positive ones, such as post-traumatic growth (PTG). Studies have revealed that frontline nurses' self-perceived quality of life had not changed significantly when the pandemic's effects lessened. The Chinese model of fighting the pandemic provided a valuable opportunity for studying the effects of prolonged exposure traumatic events on PTG in individuals. OBJECTIVE: This cross-sectional study attempted to investigate PTG and its relationship with social support and resilience among frontline nurses during COVID-19 pandemic. METHODS: A sample of 378 frontline nurses from tertiary hospitals in China participated in this study. The study took place two weeks after the government announced the end of the quarantine policy in December 2022 in China. Participants' PTG, resilience and social support were assessed using the Post-traumatic Growth Inventory, Social Support Rate Scale and 14-Item Resilience Scale, respectively. PROCESS Procedure Model 4 was employed to examine the mediating role of resilience between social support and PTG. RESULTS: The results of mediating effect analysis showed that social support could significantly predict resilience (a = 0.752, SE = 0.079, P < 0.001). Social support could significantly predict PTG (c' = 0.366, SE = 0.103, P < 0.001), and resilience could also significantly predict PTG (b = 0.226, SE = 0.060, P < 0.001). Bootstrap test identified a significant mediating effect of resilience between social support and PTG (ab = 0.170, BootSE = 0.077, 95% CI [0.031, 0.330]). The mediating effect contributed 31.72% of the total effect ([a×b]/c=[0.752 × 0.226]/0.536 = 0.3172), indicating a partial mediating role of resilience between social support and PTG. CONCLUSION: Resilience partially mediated the relationship between social support and PTG among frontline nurses during COVID-19 pandemic. Improving social support and resilience might be effective intervention strategies for promoting PTG among frontline nurses during traumatic events.

Sex and gender considerations in cross-cultural traumatic stress studies.

Following the 1st Conference of the Global Collaboration on Traumatic Stress, the consortium committed to systematically integrating sex and gender considerations in their endeavours, which aligns with the European Journal of Psychotraumatology's Gender Policy. This initiative is vital for understanding trauma's complex impacts, but also presents significant challenges in cross-cultural research. This letter, co-authored by researchers from across the globe, outlines these challenges and proposes mitigation strategies. First, definitions of sex and gender are provided from a Western perspective, while acknowledging cultural differences in these concepts. Second, the relevance of integrating sex and gender considerations in traumatic stress studies is briefly described. Third, cultural distinctions and legal contexts shaping the understanding and inclusion of these concepts, with non-Western and low-to-middle income regions facing significant legal and ethical obstacles are highlighted. Methodological challenges including measurement, recruitment, and statistical modelling are discussed, followed by recommendations including participatory approaches that involve members of the community, including sexual and gender minority individuals, as possible, throughout the research process, conducting risk analyses, employing sensitive quantitative and qualitative methods, and ensuring clear reporting and participant protection. To conclude, with this letter, we hope to instigate dialogue and foster innovative approaches to incorporating sex and gender considerations in cross-cultural studies of traumatic stress. Addressing these considerations is essential for ethical, meaningful research that respects and safeguards diverse experiences.

Sex and gender considerations are essential to further our understanding of trauma and its consequences.Considering sex and gender poses significant legal, ethical, and methodological challenges in cross-cultural studies involving non-Western and low-to-middle-income countries.Proposed mitigation strategies include using participatory approaches that involve members of the community, including sexual and gender minority individuals, as possible in research teams, conducting risk analyses, sensitive quantitative and qualitative methods, and clear reporting.