Potentially Psychologically Traumatic Event Exposure Histories of new Royal Canadian Mounted Police Cadets.

OBJECTIVE: Royal Canadian Mounted Police (RCMP) report extremely frequent and varied exposures to potentially psychologically traumatic events (PPTEs). While occupational exposures to PPTEs may be one explanation for the symptoms of mental disorders prevalent among serving RCMP, exposures occurring prior to service may also play a role. The objective of the current study was to provide estimates of lifetime PPTE exposures among RCMP cadets in training and assess for associations with mental disorders or sociodemographic variables. METHODS: RCMP cadets (n = 772; 72.0% male) beginning the Cadet Training Program (CTP) completed a survey assessing self-reported PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition-Extended. Binomial tests were conducted to compare the current results to previously collected data from the general population, a diverse sample of public safety personnel (PSP) and serving RCMP. RESULTS: Cadets reported statistically significantly fewer PPTE exposures for all PPTE types than serving RCMP (all p's < 0.001) and PSP (all p's < 0.001) but more PPTE exposures for all PPTE types than the general population (all p's < 0.001). Cadets also endorsed fewer PPTE types (6.00 ± 4.47) than serving RCMP (11.64 ± 3.40; p < 0.001) and other PSP (11.08 ± 3.23) but more types than the general population (2.31 ± 2.33; p < 0.001). Participants who reported being exposed to any PPTE type reported the exposures occurred 1-5 times (29.1% of participants), 6-10 times (18.3%) or 10 + times (43.1%) before starting the CTP. Several PPTE types were associated with positive screens for one or more mental disorders. There were associations between PPTE types and increased odds of screening positive for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) (all p's < 0.05). Serious transport accident (11.1%), physical assault (9.5%) and sudden accidental death (8.4%) were the PPTEs most identified as the worst event, and all were associated with positive screens for one or more mental disorders. CONCLUSION: The current results provide the first information describing PPTE histories of cadets, evidencing exposure frequencies and types much higher than the general population. PPTE exposures may have contributed to the cadet's vocational choices. The current results support the growing evidence that PPTEs can be associated with diverse mental disorders; however, the results also suggest cadets may be uncommonly resilient, based on how few screened positive for mental disorders, despite reporting higher frequencies of PPTE exposures prior to CTP than the general population.

Suicidal Ideation, Planning, and Attempts Among new Royal Canadian Mounted Police Cadets.

BACKGROUND: Royal Canadian Mounted Police (RCMP) report diverse occupational stressors and repeated exposures to potentially psychologically traumatic events, which may increase the odds of screening positive for a mental disorder, and increase the risk of death by suicide. The current study was designed to provide prevalence information regarding suicidal behaviours (i.e., ideation, planning, attempts) and assess for sociodemographic differences among cadets at the start of the RCMP Cadet Training Program (CTP). METHOD: Cadets (n = 736, 74.0% male) were administered the structured Mini International Neuropsychiatric Interview by a mental health clinician or a supervised clinical psychologist trainee. The interview includes an assessment of past month suicidal ideation, planning, attempts and lifetime suicide attempts. RESULTS: Within 1 month of starting the CTP, a small percentage of cadets reported past month suicidal ideation (1.6%) and no cadets reported any suicidal planning (0%) or attempts (0%). Lifetime suicide attempts were reported by (1.5%) of cadets. CONCLUSIONS: The current results provide the first information describing the prevalence of suicidal ideation, planning, and attempts among RCMP cadets starting the CTP. The estimates of suicidal behaviours appear lower than the general population and lower than reports from serving RCMP. Higher prevalence estimates of suicidal behaviours reported by serving RCMP, relative to lower estimates among cadets starting the CTP in the current study, may be related to age, cumulative experiences or protracted exposures to operational and organizational stressors, rather than insufficient screening of recruits.

Mental Health of Royal Canadian Mounted Police at the Start of the Cadet Training Program.

OBJECTIVE: Serving Royal Canadian Mounted Police (RCMP) have screened positive for one or more mental disorders based on self-reported symptoms with substantial prevalence (i.e., 50.2%). Mental health challenges for military and paramilitary populations have historically been attributed to insufficient recruit screening; however, cadet mental health when starting the Cadet Training Program (CTP) was unknown. Our objective was to estimate RCMP Cadet mental health when starting the CTP and test for sociodemographic differences. METHOD: Cadets starting the CTP completed a survey assessing self-reported mental health symptoms (n = 772, 72.0% male) and a clinical interview (n = 736, 74.4% male) with a clinician or supervised trainee using the Mini-International Neuropsychiatric Interview to assess current and past mental health. RESULTS: The percentage of participants screening positive for one or more current mental disorders based on self-reported symptoms (15.0%) was higher than the diagnostic prevalence for the general population (10.1%); however, based on clinical interviews, participants were less likely to screen positive for any current mental disorder (6.3%) than the general population. Participants were also less likely to screen positive for any past mental disorder based on self-report (3.9%) and clinical interviews (12.5%) than the general population (33.1%). Females were more likely to score higher than males (all ps<.01; Cohen's ds .23 to .32) on several self-report mental disorder symptom measures. CONCLUSIONS: The current results are the first to describe RCMP cadet mental health when starting the CTP. The data evidenced a lower prevalence of anxiety, depressive, and trauma-related mental disorders than the general population based on clinical interviews, contrasting notions that more rigorous mental health screening would reduce the high prevalence of mental disorders among serving RCMP. Instead, protecting RCMP mental health may require ongoing efforts to mitigate operational and organizational stressors.

Body image interventions within breast cancer care: A systematic review and concept analysis.

There needs to be a consensus regarding the definition of body image in oncology the literature. This lack of agreement leads to conflicting results in psychosocial interventions aimed to improve body image among breast cancer patients. Through an instrumentalist approach, this systematic review aims to analyze how body image as a concept is described and operationalized in breast cancer studies with the focus to enhance body image through psychosocial interventions. Databases were searched in October 2022 and updated in February 2023 to find empirical studies reporting psychosocial intervention targeting body image efficacy. The results from 24 studies show many similarities and differences between the definitions (e.g. characteristics) and questionnaires (e.g. Cronbach's alpha coefficient) used to evaluate this concept. Most definitions include thoughts, feelings, and behaviors related to body image. Finally, the psychosocial implications are discussed. This systematic review is registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022326393).

Impairing memory reconsolidation with propranolol in healthy and clinical samples: a meta-analysis.

BACKGROUND: Reconsolidation impairment using propranolol is a novel intervention for mental disorders with an emotional memory at their core. In this systematic review and meta-analysis, we examined the evidence for this intervention in healthy and clinical adult samples. METHODS: We searched 8 databases for randomized, double-blind studies that involved at least 1 propranolol group and 1 placebo group. We conducted a meta-analysis of 14 studies (n = 478) in healthy adults and 12 studies in clinical samples (n = 446). RESULTS: Compared to placebo, reconsolidation impairment under propranolol resulted in reduced recall of aversive material and cue-elicited conditioned emotional responses in healthy adults, as evidenced by an effect size (Hedges g) of -0.51 (p = 0.002, 2-tailed). Moreover, compared to placebo, reconsolidation impairment under propranolol alleviated psychiatric symptoms and reduced cue-elicited reactivity in clinical samples with posttraumatic stress disorder, addiction or phobia (g = -0.42, p = 0.010). LIMITATIONS: Methodological differences between studies posed an obstacle for identifying sources of heterogeneity. CONCLUSION: Reconsolidation impairment is a robust, well-replicated phenomenon in humans. Its clinical use is promising and deserves further controlled investigation.

PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD's life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked. METHODS: An online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale - Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical 'caseness'. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory's life-threat item was endorsed or not. RESULTS: The participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others. CONCLUSIONS: Studies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.

Media Use During the COVID-19 Pandemic: Cross-sectional Study.

BACKGROUND: Throughout the pandemic, the general population was encouraged to use media to be kept informed about sanitary measures while staying connected with others to obtain social support. However, due to mixed findings in the literature, it is not clear whether media use in such a context would be pathogenic or salutogenic. OBJECTIVE: Therefore, the associations between COVID-19-related stressors and frequency of media use for information-seeking on trauma- and stressor-related (TSR) symptoms were examined while also investigating how social media use for support-seeking and peritraumatic distress interact with those variables. METHODS: A path model was tested in a sample of 5913 adults who completed an online survey. RESULTS: The number of COVID-19-related stressors (ß=.25; P<.001) and extent of information-seeking through media (ß=.24; P=.006) were significantly associated with the severity of TSR symptoms in bivariate comparisons. Associations between levels of peritraumatic distress and both COVID-19-related stressors and information-seeking through media, and social media use for support- and information-seeking through media were found (ßCOVID-19 stressors: Peritraumatic Distress Inventory=.49, P<.001; ßseeking information: Peritraumatic Distress Inventory=.70, P<.001; ßseeking information-seeking support=.04, P<.001). CONCLUSIONS: Results suggest that exposure to COVID-19-related stressors and seeking COVID-19-related information through the media are associated with higher levels of peritraumatic distress that, in turn, lead to higher levels of TSR symptoms. Although exposure to the stress of the COVID-19 pandemic may be unavoidable, the frequency of COVID-19-related information consumption through various media should be approached with caution.

The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis.

BACKGROUND: Receiving a breast cancer diagnosis can be a turning point with negative impacts on mental health, treatment and prognosis. This meta-analysis sought to determine the nature and prevalence of clinically significant psychological distress-related symptoms in the wake of a breast cancer diagnosis. METHODS: Ten databases were searched between March and August 2020. Thirty-nine quantitative studies were meta-analysed. RESULTS: The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25). No studies reporting breast cancer patients' well-being in our specific time frame were found. CONCLUSION: Mental health can be impacted in at least four domains following a diagnosis of breast cancer and such effects are commonplace. This study outlines a clear need for mitigating the impacts on mental health brought about by breast cancer diagnosis. CRD42020203990.

Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women.

BACKGROUND: Expressive writing requires journaling stressor-related thoughts and feelings over four daily sessions of 15 min. Thirty years of research have popularized expressive writing as a brief intervention for fostering trauma-related resilience; however, its ability to surpass placebo remains unclear. This study aimed to determine the efficacy of expressive writing for improving post-traumatic stress symptoms in perinatal women who were living in the Houston area during major flooding caused by Hurricane Harvey. METHODS: A total of 1090 women were randomly allocated (1:1:1) to expressive writing, neutral writing or no writing. Interventions were internet-based. Online questionnaires were completed before randomization and at 2 months post-intervention. The primary outcome was post-traumatic stress symptoms, measured with the Impact of Event Scale-Revised; secondary outcomes were affective symptoms, measured with the 40-item Inventory of Depression and Anxiety Scales. Feelings throughout the intervention were reported daily using tailored questionnaires. RESULTS: In intention-to-treat analyses, no post-treatment between-group differences were found on the primary and secondary outcomes. Per-protocol analyses yielded similar results. A number of putative moderators were tested, but none interacted with expressive writing. Expressive writing produced greater feelings of anxiety and sadness during the intervention compared to neutral writing; further, overall experiences from the intervention mediated associations between expressive writing and greater post-traumatic stress at 2 months post-intervention. CONCLUSIONS: Among disaster-stricken perinatal women, expressive writing was ineffective in reducing levels of post-traumatic stress, and may have exacerbated these symptoms in some.

Tackling the global problem of traumatic stress in low-income countries: a pilot clinical trial comparing reconsolidation therapy to paroxetine in Nepal.

BACKGROUND: Traumatic stress is a global mental health problem requiring novel, easily implemented treatment solutions. We compared the effectiveness and efficiency of Reconsolidation Therapy (RT) to the well-established antidepressant paroxetine, in reducing symptoms of traumatic stress among patients from Nepal, a low-income country. METHODS: Forty-six adults with posttraumatic stress disorder (PTSD) were randomized to one of two groups. The reconsolidation blocker propranolol was administered 90 min before briefly recalling a traumatic memory with a therapist, weekly for six consecutive weeks. This was compared to daily paroxetine for 26 weeks. Self-reported PTSD symptoms were assessed blindly at the 7th, 13th, and 26th weeks. RESULTS: An intent-to-treat analysis revealed a robust pre- to post-treatment main effect (ß1 = - 4.83, 95% CI = [- 5.66, - 4.01], p < .001), whereby both groups improved, with Cohen's effect sizes of d = 2.34 (95% CI = [1.57, 3.12]) for paroxetine, and of 2.82 (95% CI = [1.98, 3.66]) for RT after 7 weeks, suggesting treatment effectiveness for both groups in a real-world setting. Three and six-month follow-up yielded further significant improvement in both groups, which did not differ from each other. CONCLUSION: RT also displayed promising efficiency, considering that it had been discontinued weeks earlier while the paroxetine treatment was continued, as recommended. RT could be taught in low-income countries as part of the local therapeutic resources to treat the core symptoms of PTSD, provided that such results are replicated on a broader scale. TRIAL REGISTRATION: ISRCTN34308454 (11/10/2017).

Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees.

We applied semi-structured and in-depth interviews to explore the perceptions and experiences of 60 practitioners/policymakers and 25 Syrian participants involved in mental health services for refugees in Lebanon. Refugees were found to view their distress as a normal shared reaction to adversity while professionals perceived it as symptomatic of mental illness. Practitioners viewed Syrian culture as an obstacle to providing care and prioritized educating refugees about mental health conditions. Policymakers invoked the state of crisis to justify short-term interventions, while Syrian refugees requested community interventions and considered resettlement in a third country the only solution to their adverse living conditions. The therapeutic relationship seems threatened by mistrust, since refugees change their narratives as an adaptive mechanism in response to the humanitarian system, which professionals consider manipulative. We discuss the implications of our findings for mental health practice in humanitarian settings.

The 5-HTTLPR polymorphism of the serotonin transporter gene and child's sex moderate the relationship between disaster-related prenatal maternal stress and autism spectrum disorder traits: The QF2011 Queensland flood study.

The 5-HTTLPR polymorphism of the serotonin transporter has been shown to play a role in autism spectrum disorders (ASD). Moreover, disaster-related prenatal maternal stress (PNMS) has also been shown to be associated with ASD. However, no study to date has examined whether these two factors, either individually or in combination, are predictive of ASD traits in the same sample. We hypothesized that children, particularly boys, with the LL genotype exposed to high levels of disaster-related PNMS would exhibit higher levels of ASD traits compared to boys with the LS or SS genotypes and girls regardless of genotype. Genotype and ASD levels obtained using the Australian normed Autism Spectrum Rating Scales - Short Form were available for 105 30-month-old children exposed to varying levels of PNMS following the 2011 Queensland Flood. For boys, higher ASD traits were associated with the 5-HTTLPR LL genotype in combination with either a negative maternal appraisal of the flood, or high levels of maternal composite subjective stress, PSTD-like or peritraumatic dissociation symptoms. For girls, maternal peritraumatic dissociation levels in combination with the 5-HTTLPR LS or SS genotype were associated with higher ASD traits. The present findings are the first to demonstrate that children's genotype moderates effects of disaster-related PNMS on ASD traits, with different pattern according to child sex.

Predictors of Dissociative Experiences Among Adolescents in Nepal: A Path Analysis.

In recent years, many adolescents in Nepal have been affected by episodes of mass psychogenic illness, which seem to involve dissociative symptoms. To identify the potential contributors to dissociation, the present study examined correlates of dissociative experiences among adolescents in Nepal. In a cross-sectional survey, 314 adolescents were assessed with the Adolescent Dissociative Experiences Scale and measures of childhood trauma exposure, as well as cognitive and personality traits found to be associated with dissociation in studies on other populations. Path analysis confirmed that childhood trauma, cognitive and personality traits, and current distress each predicted dissociative experiences and behaviors. However, an integrated path model found that the effect of childhood trauma on dissociation was mediated either by posttraumatic stress symptoms or by cognitive failures. Future studies should develop and test multifactorial models of dissociation and multiple pathways.

Mental Disorder Symptoms among Public Safety Personnel in Canada.

BACKGROUND: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. METHODS: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. RESULTS: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. INTERPRETATION: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Consolidation and reconsolidation are impaired by oral propranolol administered before but not after memory (re)activation in humans.

Propranolol administered immediately after learning or after recall has been found to impair memory consolidation or reconsolidation (respectively) in animals, but less reliably so in humans. Since reconsolidation impairment has been proposed as a treatment for mental disorders that have at their core an emotional memory, it is desirable to understand how to reliably reduce the strength of pathogenic memories in humans. We postulated that since humans (unlike experimental animals) typically receive propranolol orally, this introduces a delay before this drug can exert its memory impairment effects, which may render it less effective. As a means to test this, in two double-blind placebo-controlled experiments, we examined the capacity of propranolol to impair consolidation and reconsolidation as a function of timing of ingestion in healthy subjects. In Experiment 1, (n=36), propranolol administered immediately after learning or recall failed to impair the consolidation or reconsolidation of the memory of a standardized slideshow with an accompanying emotional story. In Experiment 2 (n=50), propranolol given 60-75min before learning or recall successfully impaired memory consolidation and reconsolidation. These results suggest that it is possible to achieve reliable memory impairment in humans if propranolol is given before learning or before recall, but not after.

The effects of maternal stress and illness during pregnancy on infant temperament: Project Ice Storm.

BACKGROUND: To determine whether disaster-related prenatal maternal stress and maternal illness during pregnancy predict maternal-rated temperament status in 6-mo-old infants. METHOD: The temperamental status of 121 infants (60 boys and 61 girls) exposed in utero to varying degrees of maternal stress and/or illness during either first (n = 40), second (n = 43), or third (n = 38) trimester of pregnancy was assessed using the Infant Characteristics Questionnaire. RESULTS: Higher levels of maternal subjective distress and illness were primarily independently associated with poorer temperamental status in the infants. Maternal subjective distress explained 3.4, 3.1, and 9.8% and early pregnancy illness explained 4.3, 5.8, and 2.9% of the variance of the infants' fussy/difficult, dullness, and needs attention temperament dimensions, respectively. CONCLUSION: This is the first study to assess whether temperament status is influenced by disaster-related prenatal maternal stress. Moreover, this is the first study to assess whether maternal stress and illness during pregnancy interact to determine infant temperament status. The findings suggest that while both factors predict temperament status at 6 mo, they do so primarily in an independent manner. These results suggest that pathways through which maternal stress and illness during pregnancy influence temperament status differ.