EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU.

CONTEXT: Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress. OBJECTIVES: The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), an ultra-brief (∼2-hour), 6-module manualized psychological intervention for surrogates. METHODS: Surrogates who reported significant anxiety and/or an emotionally close relationship with the patient (n=60) were randomized to receive EMPOWER or enhanced usual care (EUC) at one of three metropolitan hospitals. Participants completed evaluations of EMPOWER's acceptability and measures of psychological distress pre-intervention, immediately post-intervention, and at 1- and 3-month follow-up assessments. RESULTS: Delivery of EMPOWER appeared feasible, with 89% of participants completing all 6 modules, and acceptable, with high ratings of satisfaction (mean=4.5/5, SD = .90). Compared to EUC, intent-to-treat analyses showed EMPOWER was superior at reducing peritraumatic distress (Cohen's d = -0.21, small effect) immediately post-intervention and grief intensity (d = -0.70, medium-large effect), posttraumatic stress (d = -0.74, medium-large effect), experiential avoidance (d = -0.46, medium effect), and depression (d = -0.34, small effect) 3 months post-intervention. Surrogate satisfaction with overall critical care (d = 0.27, small effect) was higher among surrogates randomized to EMPOWER. CONCLUSIONS: EMPOWER appeared feasible and acceptable, increased surrogates' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.

Responding to concerns related to the measurement of ICD-11 complex posttraumatic stress disorder using the International Trauma Questionnaire.

BACKGROUND: A recent study in this journal by Frewen et al. (2023) provided a critical analysis of the most widely used measure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), the International Trauma Questionnaire (ITQ). The article was a thoughtful review and gave voice to several widely held concerns about the nature of CPTSD as it is represented in ICD-11 and measured by the ITQ. The primary concern expressed by Frewen et al. was that the symptom profile of ICD-11 CPTSD, as represented in the ITQ, is too simple and fails to provide adequate coverage of the construct. OBJECTIVE: Despite its quality, the article included several misunderstandings about the nature of ICD-11 CPTSD, and the function of the ITQ, that we wish to clarify. PARTICIPANTS: Not applicable. SETTING: Not applicable. RESULTS: In this article, we provide a description of what ICD-11 PTSD and CPTSD are, a review of the process that led to their inclusion in ICD-11, how the ITQ was developed and refined to measure these constructs. We then provide responses to several of the most important concerns raised by Frewen et al. CONCLUSIONS: We highlight the clinical utility of the ICD-11 descriptions of PTSD and CPTSD and discuss how the ITQ can be used as part of a suite of clinical assessments to accurately describe and understand common experiences of psychological distress that often result from exposure to traumatic life events.

Examining accurate diagnosis of complex PTSD in ICD-11.

BACKGROUND: Complex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD. METHODS: Participants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided. RESULTS: Clinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD. LIMITATIONS: The use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results. CONCLUSIONS: Findings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.

Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South Korea.

BACKGROUND: Childhood maltreatment is a risk factor for the development of post-traumatic stress disorders and psychosis. However, the association between post-traumatic stress disorder (PTSD), including complex PTSD, and psychotic symptoms is unknown. We investigated whether the presence of PTSD and complex PTSD was associated with psychotic symptom severity within survivors of developmental trauma. METHODS: As part of the Investigating Mechanisms underlying Psychosis Associated with Childhood Trauma (IMPACT) study, from Aug 20, 2020, to Jan 24, 2021, and from Sept 9, 2022, to Feb 21, 2023, using study advertisement on online platforms we recruited adult (≥18 years) participants who had experienced developmental trauma without a psychiatric diagnosis in the UK and South Korea. We measured whether participants met diagnostic thresholds for PTSD and complex PTSD using the self-reported International Trauma Questionnaire, and psychotic symptoms using the self-reported Community Assessment of Psychic Experiences. We used linear regression, adjusting for sociodemographic variables such as age, sex, ethnicity, educational attainment, and socioeconomic status, to examine whether there was an association between PTSD and complex PTSD and psychotic symptoms. The study is registered in the UK (University College London Research Ethics Committee [14317/001] and the National Health Service Research Ethics Committee [22/YH/0096]) and South Korea (Institutional Review Board of Seoul National University Bundang Hospital [B-2011-648-306]), and is ongoing. FINDINGS: Of the 2675 participants who took part in the study, 1273 had experienced developmental trauma and were included in the study in the UK (n=475) and South Korea (n=798), comprising 422 (33%) men and 851 (67%) women with a mean age of 26·9 years (SD 6, range 18-40), mostly of White British (n=328) or South Korean (n=798) ethnicity. We found no significant association between PTSD and psychotic symptom severity (total severity ß=-2·40 [SE 3·28], p=0·47), compared with participants who did not meet PTSD or complex PTSD caseness. We found a significant relationship between complex PTSD and psychotic symptom severity (total severity ß=22·62 [SE 1·65], p<0·0001), including for positive (ß=12·07 [SE 0·99], p<0·0001) and negative symptoms (ß=10·5 [SE 0·95], p<0·0001), compared with participants who did not meet PTSD or complex PTSD caseness. INTERPRETATION: Health systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected. These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion. Further work should assess whether treating complex PTSD modifies the risk of conversion to psychosis. FUNDING: UKRI Future Leaders Fellowship, British Medical Association Margaret Temple Award for Schizophrenia Research, and the National Research Foundation of Korea-Korea Government.

The memory and identity theory of ICD-11 complex posttraumatic stress disorder.

The 11th version of the International Classification of Diseases (ICD-11) includes complex posttraumatic stress disorder (CPTSD) as a separate diagnostic entity alongside posttraumatic stress disorder (PTSD). ICD-11 CPTSD is defined by six sets of symptoms, three that are shared with PTSD (reexperiencing in the here and now, avoidance, and sense of current threat) and three (affective dysregulation, negative self-concept, and disturbances in relationships) representing pervasive "disturbances in self-organization" (DSO). There is considerable evidence supporting the construct validity of ICD-11 CPTSD, but no theoretical account of its development has thus far been presented. A theory is needed to explain several phenomena that are especially relevant to ICD-11 CPTSD such as the role played by prolonged and repeated trauma exposure, the functional independence between PTSD and DSO symptoms, and diagnostic heterogeneity following trauma exposure. The memory and identity theory of ICD-11 CPTSD states that single and multiple trauma exposure occur in a context of individual vulnerability which interact to give rise to intrusive, sensation-based traumatic memories and negative identities which, together, produce the PTSD and DSO symptoms that define ICD-11 CPTSD. The model emphasizes that the two major and related causal processes of intrusive memories and negative identities exist on a continuum from prereflective experience to full self-awareness. Theoretically derived implications for the assessment and treatment of ICD-11 CPTSD are discussed, as well as areas for future research and model testing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exposure to potentially morally injurious events in U.K. health and social care workers during COVID-19: Associations with PTSD and complex PTSD.

OBJECTIVE: Health and social care workers (HSCWs) have been shown to be at risk of exposure to potentially morally injurious events (PMIEs) and mental health problems during the COVID-19 pandemic. This study aimed to examine associations between exposure to PMIEs and meeting threshold criteria for probable posttraumatic stress disorder (PTSD) and probable complex PTSD (CPTSD) in U.K. HSCWs immediately after the peak of the first COVID-19 wave. METHOD: Frontline HSCWs from across the United Kingdom working in diverse roles in hospitals, nursing or care homes, and other community settings were recruited to the Frontline-COVID study via social media. Participants (n = 1,056) completed a cross-sectional online survey (May 27, 2020-July 23, 2020) which assessed exposure to PMIEs (nine-item Moral Injury Events Scale), and meeting symptom thresholds for probable PTSD and probable CPTSD (International Trauma Questionnaire). RESULTS: PMIEs related to witnessing others' wrongful actions and betrayal events were more commonly endorsed than perceived self-transgressions. The rate of probable International Classification of Diseases, 11th Revision (ICD-11) PTSD was 8.3%, and of probable ICD-11 CPTSD was 14.2%. Betrayal-related PMIEs were a significant predictor of probable PTSD or probable CPTSD, together with having been redeployed during the pandemic. The only variable that differentially predicted probable CPTSD as compared with probable PTSD was not having had reliable access to personal protective equipment; none of the PMIE types were differential predictors for screening positive for probable PTSD versus probable CPTSD. CONCLUSIONS: Exposure to PIMEs could be important for PTSD and CPTSD development. Interventions for moral injury in HSCWs should be investigated. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Inaccuracy in the Scientific Record and Open Postpublication Critique.

There is growing evidence that the published psychological literature is marred by multiple errors and inaccuracies and often fails to reflect the changing nature of the knowledge base. At least four types of error are common-citation error, methodological error, statistical error, and interpretation error. In the face of the apparent inevitability of these inaccuracies, core scientific values such as openness and transparency require that correction mechanisms are readily available. In this article, I reviewed standard mechanisms in psychology journals and found them to have limitations. The effects of more widely enabling open postpublication critique in the same journal in addition to conventional peer review are considered. This mechanism is well established in medicine and the life sciences but rare in psychology and may assist psychological science to correct itself.

Identity - A critical but neglected construct in cognitive-behaviour therapy.

In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting reflection on and evaluation of subjective experience). There is considerable evidence that the I-Self is affected in many if not all disorders, and I review illustrative studies of OCD, eating disorders, body dysmorphic disorder, PTSD, and personality disorder. These indicate that patients often experience themselves as being defective in various ways, or as having an unstable or contradictory I-Self. Recognition of this neglected aspect of patients' experience has major implications for assessment and treatment. For example, acknowledgment that their sense of self may fluctuate dramatically from moment to moment, may be fragmented, or may consist of a sense of emptiness, may help to build a more empathic therapeutic relationship. If frightening or distressing pre-reflective experiences are the cause of avoidance or other maladaptive coping strategies, conscious attention paid to them in therapy may help to better integrate the I-Self and Me-Self, restoring a sense of predictability and control.

Multiplicity in the experience of voice-hearing: A phenomenological inquiry.

Although it is recognized that voice-hearers often report a large number and variety of voices there have been few investigations of this multiplicity. Understanding the phenomenology of voice-hearing can provide a firm foundation for theorizing about its causes. In this international online survey of voice-hearers, details were elicited of the content of up to five utterances associated with up to five voices from each respondent. The contents were independently rated and associated with characteristics of each voice such as its perceived age, whether it had changed over time, and whether it was of a familiar person. We investigated predictors (e.g., diagnoses, voice gender, age first heard) of utterance negativity, length, and whether voices referred to themselves. The average number of voices reported was approximately four. The majority were perceived as male and had negative content. Child-aged voices were significantly less negative than all other voices except those perceived as being elderly. Multi-level analyses indicated that there was significant variability at the level of different utterances within voices but variability was more prominent at the level of different voices within an individual. The data were inconsistent with general cognitive models for hearing voices such as the misattribution of inner speech and were more congruent with a dissociation model of voice-hearing. Our findings support approaches based on subtype or dimensional methods of classifying voices, and additionally indicate that research and clinical assessment may benefit from more systematic assessment of multiplicity.

Estimating the total prevalence of PTSD among the UK police force: Formal comment on Stevelink et al. (2020).

Two recent surveys have reported widely differing prevalence rates for posttraumatic stress disorder (PTSD) within the U.K. police force. Stevelink et al. (2020) reported a rate of 3.9% whereas a survey conducted for the charity Police Care UK reported a rate of 20.6%. In this comment we discuss how definitions and methodological factors can impact prevalence rates. We consider a number of possible reasons for the discrepancy between the surveys, and conclude that it is most likely a method artefact. Stevelink et al.'s survey reported the prevalence of recent-onset DSM-IV PTSD only, whereas the Police Care UK survey reported the total ICD-11 PTSD and Complex PTSD prevalence, regardless of when in the person's career the traumatic events occurred. Analysing the Police Care UK data using Stevelink et al.'s procedures produced practically identical prevalence rates, suggesting that the discrepancy was apparent rather than real.

Remembering the earthquake: intrusive memories of disaster in a rural Italian community.

Background: Disasters can have long-lasting impacts on mental health. Intrusive memories have been found to be common and persistent in the aftermath of earthquakes. Objective: To explore, using diaries, intrusive memories' presence, content, characteristics, and relationship with probable post-traumatic stress disorder (PTSD) in a small rural community exposed to mass destruction and loss of life. Methods: Survivors of the 2016-2017 Central Italy earthquakes (N = 104) were first interviewed to investigate the presence of intrusive memories of the disaster. Those that reported intrusive memories were subsequently asked to complete a 7-day paper-and-pen diary tracking their spontaneous memories of the earthquake events. Results: Twenty months after the earthquakes, 49% (n = 51) of the sample reported having experienced intrusive memories post-earthquake and 38% (n = 39) reported at least one intrusive memory in their diaries. Memories were rated as being distressing, vivid, and experienced as a mixture of images and thoughts. The content of intrusive memories generally focused on sensations and experiences during the earthquake. Other common categories of content were the material environment and physical objects as well as human loss & death. Several memories had a social focus. A minority of memories contained more positive content as well as content from before and after the earthquake. Some participants (28%) experienced repeated intrusive memories of the same content. Memories of participants with and without probable PTSD did not significantly differ on characteristics or content. Conclusions: Intrusive memories can be common, distressing, and persistent occurrences following disasters, even in survivors not suffering from probable PTSD. Highlights: Intrusive memories were common, distressing, and vivid more than 1-year post-disaster.They captured peri-earthquake sensations, material destruction, death, and social interactions.No difference in content or characteristics was found between participants with and without probable PTSD.

Antecedentes: Los desastres pueden tener impactos duraderos en la salud mental. Se ha descubierto que los recuerdos intrusivos son comunes y persistentes después de los terremotos.Objetivo: Explorar, a través de diarios, la presencia, el contenido, las características de memorias intrusivas y la relación con la probabilidad de trastorno de estrés postraumático (TEPT) en una pequeña comunidad rural expuesta a destrucción masiva y pérdida de vidas.Método: Primero se entrevistó a los sobrevivientes de los terremotos de Italia central del 2016­2017 (N = 104) para investigar la presencia de recuerdos intrusivos del desastre. A aquellos que reportaron recuerdos intrusivos se les pidió posteriormente que completaran un diario con papel y lápiz por 7 días registrando sus recuerdos espontáneos de los eventos del terremoto.Resultados: Veinte meses después de los terremotos, el 49% (n = 51) de la muestra informó haber experimentado recuerdos intrusivos posteriores al terremoto y el 38% (n = 39) informó al menos un recuerdo intrusivo en sus diarios. Los recuerdos se calificaron como angustiosos, vívidos y experimentados como una mezcla de imágenes y pensamientos. El contenido de los recuerdos intrusivos generalmente se centró en sensaciones y experiencias durante el terremoto. Otras categorías comunes de contenido fueron el entorno material y los objetos físicos, así como la pérdida y muerte humana. Varios recuerdos tenían un enfoque social. Una minoría de recuerdos contenía más contenido positivo, así como contenido de antes y después del terremoto. Algunos participantes (28%) experimentaron recuerdos intrusivos repetidos del mismo contenido. Los recuerdos de los participantes con y sin TEPT probable, no diferían significativamente en características o contenido.Conclusiones: Los recuerdos intrusivos pueden ser experiencias comunes, angustiosas y persistentes después de los desastres, incluso en sobrevivientes que no sufren de TEPT probable.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder.

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

Are memories of sexual trauma fragmented? A post publication discussion among Richard J. McNally, Dorthe Berntsen, Chris R. Brewin and David C. Rubin.

Following the publication of his article on whether memories of trauma in sexual assault victims are fragmented (McNally, 2022), McNally moderated a discussion between Chris R. Brewin and David C. Rubin/Dorthe Berntsen whose perspectives on memory fragmentation were cited by McNally. The discussion clarified their contrasting viewpoints on this controversy.

Validation of the International Trauma Interview (ITI) for the Clinical Assessment of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) in a Lithuanian Sample.

Background: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD. Objective: The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity. Method: In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years (SD = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM). Results: Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters. Conclusion: The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.

Antecedentes: La 11ª revisión de la Clasificación Internacional de Enfermedades (CIE-11) incluye un nuevo diagnóstico de trastorno de estrés postraumático complejo (TEPT-C). La Entrevista Internacional de Trauma (ITI en su sigla en inglés) es una nueva entrevista diagnóstica administrada por un clínico para la evaluación del TEPT y el TEPT-C de la CIE-11.Objetivo: El objetivo de este estudio fue evaluar las propiedades psicométricas de la ITI en una muestra lituana en relación con el acuerdo entre evaluadores, la estructura latente, la confiabilidad interna, así como la validez convergente y discriminante.Método: En total, participaron en el estudio 103 adultos con antecedentes de diversas experiencias traumáticas. La muestra fue predominantemente femenina (83.5%), con una edad media de 32.64 años (DE = 9.36). Para la evaluación del TEPT y TEPT-C de la CIE-11, se utilizaron la ITI y el Cuestionario Internacional de Trauma (ITQ en su sigla en inglés) de autoinforme. Los indicadores de salud mental, como la depresión, la ansiedad y la disociación, se midieron mediante cuestionarios de autoinforme. La estructura latente de la ITI se evaluó mediante análisis factorial confirmatorio (AFC). Para probar la validez convergente y discriminante de la ITI, llevamos a cabo un modelo de ecuaciones estructurales (SEM).Resultados: En general, según la ITI, el 18.4% de los participantes cumplió con los criterios diagnósticos de TEPT y el 21.4% de TEPT-C. El modelo AFC de dos factores de segundo orden de la ITI de TEPT y los síntomas de trastornos en la autoorganización (DSO) demostraron un buen ajuste. Las asociaciones con varios indicadores de salud mental apoyaron la validez convergente y discriminante de la ITI. La ITI administrada por un clínico y el ITQ autoinformado tuvieron una concordancia de diagnóstico pobre a moderada en diferentes grupos de síntomas.Conclusión: La ITI es una herramienta fiable y válida para evaluar y diagnosticar TEPT y TEPT-C según la CIE-11.

Impact on the legal system of the generalizability crisis in psychology.

Overgeneralizations by psychologists of the research evidence on memory and eyewitness testimony, such as "memory decays with time" or "memories are fluid and malleable," are beginning to appear in legal judgements and guidance documents, accompanied by unwarranted disparagement of lay beliefs about memory. These overgeneralizations could have significant adverse consequences for the conduct of civil and criminal law.

Anticipating PTSD in severe COVID survivors: the case for screen-and-treat.

Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.

Basados en la investigación de pandemias previas, los estudios de los sobrevivientes a cuidados críticos, y los datos emergentes de COVID-19, estimamos que hasta un 30% de los sobrevivientes del COVID grave desarrollarán TEPT. El TEPT es frecuentemente subdetectado en los servicios de salud primarios y secundarios y las necesidades psicológicas de los sobrevivientes puede verse eclipsadas por un enfoque en la recuperación física. El diagnóstico tardío de TEPT se asocia con pobres resultados. Existe un caso claro para que los sobrevivientes del COVID grave sean evaluados sistemáticamente para detectar el TEPT, y aquellos que desarrollan un TEPT deben tener acceso oportuno a tratamientos basados en la evidencia para el TEPT y para otros problemas de salud mental por equipos multidisciplinarios.

Posttraumatic stress disorder and complex posttraumatic stress disorder in UK police officers.

BACKGROUND: We investigated work-related exposure to stressful and traumatic events in police officers, including repeated exposure to traumatic materials, and predicted that ICD-11 complex PTSD (CPTSD) would be more prevalent than posttraumatic stress disorder (PTSD). The effects of demographic variables on exposure and PTSD were examined, along with whether specific types of exposure were uniquely associated with PTSD or CPTSD. METHODS: An online survey covering issues about trauma management, wellbeing and working conditions was disseminated via social media and official policing channels throughout the UK. In total, 10 401 serving police officers self-identified as having been exposed to traumatic events. Measurement of PTSD and CPTSD utilised the International Trauma Questionnaire. RESULTS: The prevalence of PTSD was 8.0% and of CPTSD was 12.6%. All exposures were associated with PTSD and CPTSD in bivariate analyses. Logistic regression indicated that both disorders were more common in male officers, and were associated independently with frequent exposure to traumatic incidents and traumatic visual material, and with exposure to humiliating behaviours and sexual harassment, but not to verbal abuse, threats or physical violence. Compared to PTSD, CPTSD was associated with exposure to humiliating behaviours and sexual harassment, and also with lower rank and more years of service. CONCLUSIONS: CPTSD was more common than PTSD in police officers, and the data supported a cumulative burden model of CPTSD. The inclusion in DSM-5 Criterion A of work-related exposure to traumatic materials was validated for the first time. Levels of PTSD and CPTSD mandate enhanced occupational mental health services.

Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients.

OBJECTIVE: The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates' mental health and patient outcomes. METHOD: Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15-20 min modules, totaling 1.5-2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. RESULTS: Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = -0.41), peritraumatic distress (d = -0.24), and experiential avoidance (d = -0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = -0.94), depression (d = -0.23), anxiety (d = -0.29), and experiential avoidance (d = -0.30). SIGNIFICANCE OF RESULTS: Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

Doing right by the eyewitness evidence: a response to Berkowitz et al.

Berkowitz et al. (Berkowitz, S. R., Garrett, B. L., Fenn, K. M., & Loftus, E. F. (2020). Convicting with confidence? Why we should not over-rely on eyewitness confidence. Memory. https://doi.org/10.1080/09658211.2020.1849308) attribute to us the claim that "confidence trumps all", and the few out-of-context quotations they selected can certainly be used to create that false impression. However, it is easily disproved, and we do so here. The notion that "confidence trumps all" is the mistake that the jurors made in the DNA exoneration cases, not a position that we have ever advocated.

Cost-effectiveness of 'screen-and-treat' interventions for post-traumatic stress disorder following major incidents.

OBJECTIVES: Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. METHODS: A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. RESULTS: The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. CONCLUSIONS: A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.