[Prevalence and predictors of post-traumatic stress disorder in road traffic accidents]. / Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique.

Introduction: trauma-related disorders following a road accident have both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of these disorders, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress disorder was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Influencing factors and early predictive model of acute stress disorder in traumatic patients: A clinical comparative cohort study.

OBJECTIVE: To analyze the main influencing factors of ASD (Acute Stress Disorder) in inpatients, and provide some evidence for early clinical identification and intervention of ASD. METHODS: In this study, 489 inpatients were selected from 3 general hospitals in Zunyi City from September 2020 to August 2021. The patients were followed up with questionnaires. Mann Whitney U test, Logistic Regression analysis and Generalized Estimation Equation were used for difference comparison and influencing factor analyses. RESULTS: Multivariate logistic regression showed that trauma exposure, psychological burden, fear and pain degree were risk factors of ASD in all inpatients. The sensitivity and specificity of combined using of "trauma, psychological burden, fear and pain" in predicting ASD reached 89.40 % and 79.20 %, respectively; and the area under ROC could reach 0.897. CONCLUSION: Based on the different risk factors, an early effective model could be built for ASD prediction in both traumatic and nontraumatic patients.

Predictors of acute stress disorder in victims of violence in Eastern Democratic Republic of the Congo.

Background: The Democratic Republic of the Congo underwent more than 25 years of war resulting in millions of deaths and in survivants struggling with trauma related disorders. The factors contributing to acute stress disorder following a traumatic event remain little understood. Emotion regulation might play a role in the development of acute stress disorder among victims of war-related violence. Objectives: We assessed the association between acute stress disorder expression and cognitive strategies of emotion regulation among injured victims of violence in the Eastern Democratic Republic of the Congo. Methods: This cross-sectional study included 120 patients (77% males, mean age 30 ± 11 years) with traumatic wounds admitted at the Bukavu General Hospital. We assessed acute stress disorder through the Stanford Acute Reaction Stress Questionnaire and emotion regulation strategies through the Cognitive emotional regulation questionnaire. Results: Using Pearson Chi2 and Student t-test we found that compared with patients without acute stress disorder (N = 56), patients with acute stress disorder (N = 64) were more likely to be victims of armed robbery (p = .02), of a bullet (p = .04), of having wounds with fracture (p = .03) or neurological damage (p = .05). In multivariate logistic regression, wounds with neurological damage [OR = 2.23 (1.03-6.05)] and maladaptive emotion regulation, namely self-blame [OR = 1.71 (1.01-3.21)] and rumination [OR = 1.97 (1.04-4.13)], were significant predictors of acute stress disorder. Conclusion: Acute stress disorder was prevalent in the aftermath of violence induced injuries and might be associated with emotion regulation strategies such as self-blame and rumination. HIGHLIGHTS Acute stress disorder is strongly associated with maladaptive emotion regulation strategies such as self-blame and rumination.Interventions targeting emotion regulation may reduce acute stress reactions in the aftermath of violence induced injuries.

Antecedentes: La República Democrática del Congo atravesó más de 25 años de guerra, resultando en millones de muertos y en los sobrevivientes experimentando trastornos relacionados con trauma. Los factores que contribuyen a desarrollar un trastorno de estrés agudo después de un evento traumático permanecen poco comprendidos. La regulación emocional podría jugar un rol en el desarrollo del trastorno de estrés agudo entre las víctimas de violencia relacionada con la guerra.Objetivos: Evaluamos la asociación entre la expresión del trastorno de estrés agudo y estrategias cognitivas de regulación emocional entre las víctimas de violencia lesionadas en el este de la República Democrática del Congo.Métodos: Este estudio transversal incluyó a 120 pacientes (77% varones, edad media 30 ± 11 años) con heridas traumáticas ingresados al Hospital General de Bukavu. Evaluamos el trastorno de estrés agudo a través del Cuestionario de Reacción Aguda al Estrés de Stanford y estrategias de regulación emocional a través del Cuestionario de Regulación Emocional Cognitiva.Resultados: Usando el Chi2 de Pearson y la prueba de t de Student encontramos que en comparación con pacientes sin trastorno de estrés agudo (N=56), los pacientes con trastorno de estrés agudo (N=64) fueron más probablemente víctimas de robo a mano armada (p=.02), de bala (p=.04), de tener heridas con fractura (p=.03) o daño neurológico [OR= 2.23 (1.03-6.05)] y regulación emocional desadaptativa, esto es, culpa [OR= 1.71 (1.01-3.21)] y rumiación [OR= 1.97 (1.04-4.13)], fueron predictores significativos de trastorno de estrés agudo.Conclusión: El trastorno de estrés agudo fue prevalente después de lesiones provocadas por violencia y podría asociarse con estrategias de regulación emocional como la culpa y la rumiación.

Acute stress disorder in trauma patients discharged in 72 h or less.

INTRODUCTION: Acute Stress Disorder (ASD) is a psychiatric condition affecting individuals exposed to trauma and requires the presence of symptoms 72 h following trauma. Patients evaluated for trauma related injury are often discharged prior to 72 h, but the risk of ASD remains. The aim of this study was to quantify the rate of acute stress disorder in trauma patients admitted for fewer than 72 h. MATERIALS AND METHODS: We performed a prospective, observational study of trauma patients discharged prior to 72 h at our ACS Level I Trauma Center between June 2020 and December 2020. Participants were administered an institutional screening tool following hospital discharge. Positive screens were then administered the diagnostic Acute Stress Disorder Scale (ASDS) tool. The rate of ASD was calculated and bivariate comparisons between participants who met diagnostic criteria and those who did not were performed to identify risk factors for the development of acute stress disorder. RESULTS: 116 patients participated (median age 54, 66% male, median injury severity score (ISS) 9). Forty patients (34%) screened positive via the institutional screening tool, with 14 (12%) ultimately demonstrating ASD by ASDS. Participants who developed ASD were more likely to be female (71 vs. 30%, p = 0.005), African American (43 vs. 12% White, p = 0.016), spend less time in the hospital overall (1-2 vs. 2-3 days. p = 0.045), and have a lower ISS (6 vs. 9, p = 0.041). CONCLUSIONS: Our study found 12% of trauma patients discharged prior to 72 h developed ASD. These data point to possible benefit in reassessment of injured patients following hospital discharge and the importance of developing pathways for trauma patients to access mental health resources.

The prevalence of acute stress disorder after acute myocardial infarction and its psychosocial risk factors among young and middle-aged patients.

Young and middle-aged people are vulnerable to developing acute stress disorder (ASD) following acute myocardial infarction (AMI). This study aims to explore the factors that contribute to ASD in young and middle-aged AMI patients. 190 AMI patients aged 18 to 60 years were enrolled in this study. We assessed the association between ASD and demographic data, adult attachment, and social support. This study examined a total of 190 young and middle-aged people. Among them, 65 participants were diagnosed with ASD, representing a 34.21% positive rate. Multivariate stepwise regression showed that adult attachment, infarct-related artery, social support, in-hospital complications are the main factors affecting ASD. Path analysis showed that social support had mediated the relationship between adult attachment and ASD. The incidence of ASD in young and middle-aged patients with AMI is high. Social support plays an important role in adult attachment and ASD relationships. Adult attachment and social support should be incorporated into post-traumatic cardiac rehabilitation to help patients cope with traumatic occurrences.

Acute stress disorder and the associated factors among traumatized patients admitted at Felege-Hiwot and the University of Gondar comprehensive specialized hospitals in Northwest Ethiopia.

BACKGROUND: Acute stress disorder is the main factor of impairment in multiple areas of functioning that affects almost all age groups and which also influences mental and physical health. However, it negatively impacts the quality of life and social activities. The empirical evidence about probable acute stress disorder (ASD) and its associated factors is not available in Ethiopia to date. Therefore, the present study was aimed at identifying the magnitude and associated factors of probable ASD among traumatized patients in order to plan and render informed intervention for these vulnerable people. METHODS: An institutional-based cross-sectional study was conducted at Felege-Hiwot and the University of Gondar comprehensive specialized hospitals from March 11/2020 to April 20/2020, by using a structured and semi-structured questionnaire. Systematic random sampling was used to recruit a total of 422 patients. The standard acute stress disorder scale was used to identify the prevalence of acute stress disorder by employing a face-to-face interview. Bivariate and multivariate logistic regression analysis was used to identify associated factors with probable acute stress disorder. Statistical significance was declared on 95% of confidence intervals (CI) at P < 0.05. RESULTS: The prevalence of probable acute stress disorder was found to be 45% (95% CI: 40.2 to 49.6). In the multivariate logistic analysis; exposure to past history of trauma (AOR = 3.46, 95%, CI: 1.01-11.80), past psychiatry illness (AOR = 3.02, 95% CI: 1.15-7.92), anxiety (AOR = 2.38, 95% CI: 1.30-4.38), poor social support (AOR = 4.07, 95% CI: 2.20-7.52) and moderate (AOR = 4.56, 95% CI:2.44-8.52), and sever perceived threat to life (AOR = 2.75, 95% CI: 1.64, 4.60) were factors significantly associated with probable acute stress disorder. CONCLUSION: Findings of this study indicated that the prevalence of probable acute stress disorder among study participants exposed to multiple forms of traumatic events was considerably high. History of trauma and past psychiatric illness, poor and moderate social support, and moderate perceived stress were factors significantly associated with probable acute stress disorder. The ministry of health and other concerned health organizations may find the current finding useful for early detection, prevention, and intervention strategies to minimize the factor of acute stress disorder in trauma survivors.

Storm Alex: acute stress responses in the pediatric population.

Introduction: On 2 October 2020, a violent storm (Alex) reached the French Riviera and caused significant damage in three inhabited valleys in the hinterland of the city of Nice. Entire populations were exposed to prolonged stress (no means of communication, electricity nor water) and were particularly at risk of suffering from psychological consequences. We first hypothesized that a majority of children would experience an acute stress reaction. However, we also hypothesized that their clinical expression would differ depending on their developmental age. Thus, we aimed to evaluate, according to the child's level of development, the presence of acute stress symptoms. Methods: Consecutive interviews with the child/adolescent and his/her parents were conducted by child and adolescent psychologists and psychiatrists to assess symptomatology following storm Alex (from day 1 to day 3). Each interview assessed nine classes of symptoms that have been compared according to age-groups. Results: 116 children have been evaluated (0.2-17.6 years, mean 9.1). The 0-5-years-old showed more agitation as well as developmental regression than children aged 6-11 (p = .011, p = .045) and 12-18 years (p < .001, p < .001). Anxiety was reported more frequently among the 6-11 years old than the 0-5 years children (p = .018). Overall, the interviewed children presented at least one manifestation of acute stress after the storm (94% for the 0-5 years; 83% for the 6-11 years and 74% for the 12-18 years). Discussion: The results highlight the high rate of acute stress symptoms in a natural disaster context, their specificity depending on children's age. Therefore; it emphasizes the need to develop, improve and validate specific assessment tools. Scheduled follow-up evaluations will help to understand, after a natural disaster, the long-term stress response in children, paving the way for targeting early, intensive, specific and multidisciplinary symptomatic treatment approaches.Trial registration: ClinicalTrials.gov identifier: NCT04850924. HIGHLIGHTS: Acute stress symptoms in children and adolescents are very frequent in the context of exposure to a natural disaster with specifications depending on the developmental age.

From work stress to disease: A computational model.

In modern society, work stress is highly prevalent. Problematically, work stress can cause disease. To help understand the causal relationship between work stress and disease, we present a computational model of this relationship. That is, drawing from allostatic load theory, we captured the link between work stress and disease in a set of mathematical formulas. With simulation studies, we then examined our model's ability to reproduce key findings from previous empirical research. Specifically, results from Study 1 suggested that our model could accurately reproduce established findings on daily fluctuations in cortisol levels (both on the group level and the individual level). Results from Study 2 suggested that our model could accurately reproduce established findings on the relationship between work stress and cardiovascular disease. Finally, results from Study 3 yielded new predictions about the relationship between workweek configurations (i.e., how working hours are distributed over days) and the subsequent development of disease. Together, our studies suggest a new, computational approach to studying the causal link between work stress and disease. We suggest that this approach is fruitful, as it aids the development of falsifiable theory, and as it opens up new ways of generating predictions about why and when work stress is (un)healthy.

Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis.

Background: The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. Objective: The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients' sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Method: Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen's d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Results: Altogether, 267 patients were included. The mean age was 54.0 (SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91-12.25). Conclusions: Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.

Antecedentes: El curso y las diferentes características del trastorno de estrés agudo y postraumático (TEA, TEPT) en poblaciones traumatizadas no están claros.Objetivo: Los objetivos fueron identificar las trayectorias longitudinales del TEPT, establecer un perfil de riesgo para el TEA y el TEPT basado en las características sociodemográficas, clínicas y psicológicas de los pacientes, y estudiar el efecto del TEA y la disociación en el TEPT durante los 12 meses posteriores al trauma.Método: Los pacientes completaron cuestionarios tras la inclusión y a los 3, 6, 9 y 12 meses después. Las trayectorias se identificaron mediante un análisis de clases latentes de medidas repetidas (RMLCA). El perfil de riesgo se basó en una clasificación de la importancia de cada característica utilizando los tamaños del efecto d de Cohen y cocientes de probabilidades (odds ratios). El impacto del TEA y la disociación en el TEPT se examinó mediante análisis de regresión logística.Resultados: En total, se incluyeron 267 pacientes. La edad media era de 54,0 (SD = 16,1) y el 62% eran hombres. La tasa de prevalencia de TEA fue de aproximadamente el 21,7% al inicio, y el 36,1% de los pacientes traumatizados presentaban TEPT a los 12 meses de la lesión. Se identificaron cinco trayectorias: (1) sin síntomas de TEPT, (2) leve, (3) moderada, (4) subclínica y (5) síntomas graves de TEPT. Estas trayectorias parecían permanecer estables a lo largo del tiempo. En comparación con los pacientes de otras trayectorias, los pacientes con TEA y TEPT (subclínico) eran más jóvenes y puntuaban más alto en ansiedad, síntomas depresivos, rasgos de neuroticismo y ansiedad. En cuanto a los síntomas de disociación, la incapacidad de recordar el suceso estaba significativamente más presente que la alteración del sentido de la realidad (105 (40,7%) frente a 56 (21,7%), p = 0,031), aunque este síntoma tenía la probabilidad más alta de TEPT. Los pacientes con disociación tenían un riesgo significativo de TEPT que los pacientes sin disociación (OR = 4,82; IC 95%: 1,91-12,25).Conclusiones: Los factores psicológicos caracterizaron el TEA y las trayectorias del TEPT durante los 12 meses posteriores al trauma. Los profesionales de la salud que conozcan estos hallazgos podrían identificar precozmente a los pacientes con riesgo de TEA y TEPT y remitirlos a intervenciones centradas en el paciente.

Systematic Review and Meta-Analysis on Acute Stress Disorder: Rates Following Different Types of Traumatic Events.

Studies investigating rates of acute stress disorder following exposure to a traumatic event report widely varying results, even when examining the same types of traumatic events. The first purpose of this systematic review and meta-analysis was to describe rates of acute stress disorder following five different types of traumatic events. The second goal was to assess the methodological and trauma-related factors influencing these rates. Between May 2017 and October 2019, studies were identified by searching through the PsychINFO, PubMed/Medline, OVID, CINAHL, Scopus, and PILOTS databases. Records were included if (1) participants were 16 years old and over, (2) the assessment was completed within 30 days of the event, (3) a standardized assessment instrument was utilized, (4) the type of traumatic event was specified, and (5) the acute stress disorder rate was reported. The list of traumatic events used for the search strategy was based on the Diagnostic and Statistical Manual of Mental Disorders and was complemented by those listed in the Life Events Checklist and the National Comorbidity Survey Replication. Seventy-three samples from 70 studies totaling 20,065 participants met inclusion criteria. Results revealed that rates of acute stress disorder ranged from 14.1% for war-related trauma to 36.0% for interpersonal trauma. Interpersonal trauma was significantly more likely to lead to acute stress disorder than other types of events, except for disaster-related trauma. Differing assessment instruments, types of exposure and geographical locations, and the intentional nature of certain events contributed to heterogeneity in rates within each type of traumatic event.

Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury.

BACKGROUND: Psychological consequences of burn injury can be profound. Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are known sequelae, but routine identification is challenging. This study aims to identify patient characteristics associated with outpatient positive screens. METHODS: The Primary Care Posttraumatic Stress Disorder questionnaire (PC-PTSD-4) was administered at initial outpatient Burn Center visits between 5/2018-12/2018. Demographics, injury mechanism, and total body surface area (TBSA) were recorded. Those with ≥3 affirmative answers were considered positive. Patients with positive and negative screens were compared. RESULTS: Of 307 surveys collected, 292 (median TBSA 1.5 %, IQR 0.5-4.0 %) remained for analysis after exclusions. Of those, 24.0 % screened positive. Positive screens were associated with presence of a deep component of the injury, injury mechanism, upper extremity involvement, ICU admission, and prolonged hospital length of stay. CONCLUSIONS: Numerous factors distinguish burn injury from other traumatic mechanisms and contribute to disproportionate rates of traumatic stress disorders. Optimization of burn-oriented ASD and PTSD screening protocols can enable earlier intervention.

Epidemiology and factors associated with acute stress disorder in burned patients: a case-control study.

INTRODUCTION: A burn injury is a very painful experience, with subsequent emotional problems, which have been gaining relevance to the extent that survival from burns has improved. Among the alterations of the mental sphere in this population is Acute Stress Disorder (ASD) that has been described in up to one-third of patients with major burns. METHODOLOGY: A nested case-control study was carried out in a cohort of hospitalized patients in a burn referral unit, in patients over 16 years of age. A total of 135 patients, 41 cases, and 94 controls were included. All of them underwent a psychiatric interview, a standardized form was filled out on sociodemographic and clinical information, and the PID-5-BF scale was applied to evaluate associated personality elements. The diagnosis of acute stress was made with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. RESULTS: The incidence of acute stress was 23.4%. When the clinical and sociodemographic characteristics of both the cases and the controls were compared, the risk factors were subsidized insurance, flame burn, burn in a special area, third-degree burn, high pain, stay in the Intensive Care Unit (ICU), peritraumatic amnesia and life threat. Patients also had a higher percentage of burned body surface, higher average pulse, longer hospital length of stay, higher average in the negative affect variable and in the psychoticism variable of the PID-5-BF scale. But for the multivariate analysis using logistic regression, the model that best explains the presence of acute stress only includes the variables life threat (Odds Ratio adjusted (ORa): 117.0; Confidence Interval (CI): 10.9-1258.5), severe pain (ORa: 9.9; CI: 1.8-52.8), electrical burn (ORa: 20.8; CI: 17.2-250), burn in a special area (ORa: 8.9; CI: 1, 0-76.8), third-degree burn (ORa: 10.4; CI: 0.7-166.7). CONCLUSION: Acute stress disorder is frequent in the hospitalised burn population, and is more frequent than in other types of trauma. Associated factors with the presentation of Acute Stress Disorder are the feeling of life threat at the time of the burn, having pain classified as strong (Visual Analog Scale (VAS) 5-10), electrical burn, and burns in special areas.

Prevalence and risk factors for acute stress disorder in female victims of sexual assault.

Sexual assault is one of the most traumatic events a person can experience. Despite this, information regarding the risk factors associated with the development of Acute Stress Disorder (ASD) in sexual assault victims is scarce. A follow-up prospective cohort study was designed to examine the prevalence and risk factors of ASD in women exposed to a recent sexual assault. A total of 156 women were treated at the Emergency Department of a university general hospital shortly after sexual assault. Sociodemographic, clinical and sexual assault-related variables were collected. The Acute Stress Disorder Interview was used to estimate the prevalence of ASD at three weeks post-SA. From the 156 victims, 66.6% (N = 104) met ASD diagnosis using DSM-5 criteria, whereas 59.6% (N = 93) met ASD diagnosis using DSM-IV criteria. The risk factors associated with the development of ASD were nationality, psychiatric history, peritraumatic dissociation and type of assault. In conclusion, the prevalence of ASD in female victims of recent sexual assault was high, affecting approximately two thirds of them. The recognition of the risk factors associated with ASD development, like peritraumatic dissociation or type of assault, may aid in the prompt detection of vulnerable women that require early and specific interventions shortly after trauma.

Prediction of posttraumatic stress disorder by acute stress disorder in traffic accident survivors.

BACKGROUND: To investigate the predictive effect of different symptoms of early acute stress disorder (ASD) on posttraumatic stress disorder (PTSD) in traffic accident survivors. METHODS: A total of 206 traffic accident survivors were assessed with the acute stress disorder scale (ASDS) within 2-23 days after accidents, as well as with 17-item PTSD checklist-specific stressor version (PCL-S) during 4-12 months after accidents. All into the first group of subjects by senior surgeon assessment, based on the clinical, radiological and laboratory examination, excluded traumatic brain injuries, and mild brain injury. And then, assessment by clinical psychological practitioner. RESULTS: The severity of ASD can significantly predict the severity of PTSD symptoms. ASD reexperience symptoms and avoidance symptoms can significantly predict PTSD reexperience symptoms and avoidance symptoms. ASD hyperarousal symptoms can significantly predict PTSD hyperarousal symptoms. DISCUSSION: ASD and PTSD are common psychological disorders among traffic accident survivors. ASD can predict the symptoms and severity of PTSD.

Incidence and Direct Medical Cost of Acute Stress Disorder and Post-traumatic Stress Disorder in Korea: Based on National Health Insurance Service Claims Data from 2011 to 2017.

BACKGROUND: We aimed to investigate the annual incidence of trauma and stress-related mental disorder including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) using the National Health Insurance Service Database. In addition, we estimated direct medical cost of ASD and PTSD in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems code for ASD (F43.0) and PTSD (F43.1) and had not been diagnosed in the previous 360 days, from 2010 to 2017. We estimated annual incidence and the number of newly diagnosed patients of ASD and PTSD. Annual prevalence and direct medical cost of ASD and PTSD were also estimated. RESULTS: The number of newly diagnosed cases of ASD and PTSD from 2011 to 2017 totaled 38,298 and 21,402, respectively. The mean annual incidence of ASD ranged from 8.4 to 13.7 per 100,000 population and that of PTSD ranged from 4.2 to 8.3 per 100,000 population, respectively. The incidence of ASD was found more in females and was highest among the 70-79 years of age group and the self-employed individuals group. The incidence of PTSD was also more common in the female group. However, the incidence of PTSD was highest in the 60-69 years of age group and in the medical aid beneficiaries group. The annual estimated medical cost per person of ASD ranged from 104 to 149 US dollars (USD). In addition, that of PTSD ranged from 310 to 426 USD. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of ASD and PTSD in Korea were increased. Proper information on ASD and PTSD will not only allows us to accumulate more knowledge about these disorders themselves but also lead to more appropriate therapeutic interventions by improving the ability to cope with these trauma related psychiatric sequelae.

COVID-19-related psychiatric impact on Italian adolescent population: A cross-sectional cohort study.

We investigated the prevalence rate and sociodemographic correlates of COVID-19-related posttraumatic stress disorder (PTSD), and COVID-19-related acute stress disorder (ASD) among Italian adolescents, their level of stress, perception of parental stress, and connection with mental health. Adolescents aged 12-18 years compiled an online questionnaire designed through validated diagnostic instruments. We enrolled 1262 adolescents who declared that they had not experienced any previous traumatic events. Participants were divided into two groups: 118 adolescents with psychiatric problems (APP+) and 1144 without (APP-). In total, 79.52% reported isolated COVID-19-related ASD (29.48%) or PTSD symptoms (50.04%). One adolescent met the diagnosis of COVID-19-related ASD and two met the diagnosis of COVID-19-related PTSD, according to DSM-5. Adolescents with subthreshold COVID-19-related ASD and PTSD symptoms referred the highest levels of personal stress and adolescents with psychiatric/psychological conditions experienced higher stress. Health measures should be urgently employed prioritizing psychosocial stressors among adolescent population.

Síntomas de ansiedad y depresión en personal de salud que trabaja con enfermos de COVID-19 / Anxiety and depression symptoms in health personnel who work with COVID-19 patients

El personal de salud pública que se enfrenta a la COVID-19, está expuesto a múltiples riesgos entre ellos los trastornos psicológicos. El objetivo de este estudio fue determinar la presencia de síntomas asociados a ansiedad y depresión en personal de salud que trabaja con enfermos de la COVID-19. Se realizó un estudio descriptivo de corte transversal en el que participaron 61 profesionales y técnicos de atención sanitaria, que trabajaban directamente con pacientes con COVID-19, a los cuales se les consultó acerca de la presencia de síntomas asociados a la depresión y ansiedad, sus principales preocupaciones y el tiempo de trabajo continuo para evitar la aparición de síntomas psicológicos. El 64,1% de los participantes relató nerviosismo y 59,2% cansancio, para el 90,16% la principal preocupación fue el fallecimiento del paciente y el 60,66% de los participantes indicó que el período ideal, de atención continua de pacientes COVID-19, para evitar la aparición de síntomas psicológicos era de 7 días. Nuestros resultados sugieren que es necesario elaborar estrategias de trabajo para disminuir la aparición de síntomas asociados al deterioro de la salud mental de los profesionales de la salud que atienden pacientes COVID-19

Public health personnel facing COVID-19 are exposed to multiple risks including psychological disorders. The goal of this study was to determine the presence of symptoms associated with anxiety and depression in health personnel working with COVID-19 patients. A descriptive cross-sectional study involving 61 health care professionals and technicians was conducted, working directly with COVID-19 patients, who were consulted about the presence of symptoms associated with depression and anxiety, their main concerns and ongoing working time to avoid the onset of psychological symptoms. 64.1% of participants reported nervousness and 59.2% tiredness, for 90.16% the main concern was the patient's death and 60.66% of participants indicated that the ideal period, of continuous care of COVID-19 patients, to prevent the onset of psychological symptoms was 7 days. Our results suggest that work strategies need to be developed to decrease the onset of symptoms associated with deteriorating mental health of health professionals caring for COVID-19 patients

Acute Stress Disorder Among Frontline Health Professionals During the COVID-19 Outbreak: A Structural Equation Modeling Investigation.

OBJECTIVE: The outbreak of COVID-19 that commenced in December 2019 in Wuhan, China, has caused extensive public health concerns and posed substantial challenges to health professionals, especially for those in the center of the epidemic. The current study aimed to assess the prevalence, related factors, and mechanism of acute stress disorder (ASD) among health professionals in Wuhan during this critical period. METHODS: The study used a cross-sectional design. Self-administered questionnaires were distributed to the frontline health professionals in Wuhan hospitals from January 28 to February 1, 2020. Mental health-related measurements included ASD, depression, anxiety, conflict experiences, hostility, and psychosomatic symptoms. Structural equation modeling was used to analyze the factors associated with ASD among health professionals. RESULTS: A total of 332 frontline health professionals were included in the analysis (mean [standard deviation] age = 32.21 [8.77] years; 78.0% women). ASD was a prominent mental health problem in the health professionals surveyed, with a prevalence of 38.3%. Anxiety (24.7%) and depression (20.2%) were also common. Structural equation modeling analyses revealed that emotional distress (i.e., anxiety and depressive symptoms) fully mediated the association between conflicts with ASD (the standardized indirect coefficient ß = 0.47, p = .016). The most common reported symptom was chest pain (51.2%). ASD was significantly associated with psychosomatic symptoms. The majority (67.8%) reported being easily annoyed or irritated, and ASD was associated with hostility. CONCLUSIONS: During the COVID-19 outbreak, a substantial number of health professionals in Wuhan suffered from ASD. Furthermore, ASD was found to be associated with psychosomatic symptoms as well as the hostility. The poor mental health of health professionals has detrimental impacts both on the well-being of staff in health care systems and may adversely affect the quality of patient care. We call for interventions that aim to relieve the psychological and occupational stress. Considering that most of our participants were young, female frontline health professionals, the results may not be generalized to more heterogenous samples.

Does acute stress disorder predict posttraumatic stress disorder following workplace violence? A prospective study of psychiatric staff.

OBJECTIVES: Psychiatric staff is at risk of workplace violence (WV) and subsequent posttraumatic symptomatology. The current study assesses the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in psychiatric staff following WV. This also examines the prospective association between ASD and PTSD. METHODS: This is a prospective cohort study of staff from 18 psychiatric wards in Denmark (n = 250), that reported an incident of workplace violence. RESULTS: The prevalence of ASD was 10.8%, while 8% had PTSD 3 months post-assault. Generalized linear mixed models showed a significant predictive power of ASD on PTSD (OR 8.45, p < 0.001) in the fully adjusted model. CONCLUSIONS: ASD seems to be a predictor of future PTSD in an occupational context and should be considered a possible instrument in enactment of preventive strategies.

Psychological distress among health professional students during the COVID-19 outbreak.

BACKGROUND: Due to the drastic surge of COVID-19 patients, many countries are considering or already graduating health professional students early to aid professional resources. We aimed to assess outbreak-related psychological distress and symptoms of acute stress reaction (ASR) in health professional students and to characterize individuals with potential need for interventions. METHODS: We conducted a prospective cohort study of 1442 health professional students at Sichuan University, China. At baseline (October 2019), participants were assessed for childhood adversity, stressful life events, internet addiction, and family functioning. Using multivariable logistic regression, we examined associations of the above exposures with subsequent psychological distress and ASR in response to the outbreak. RESULTS: Three hundred and eighty-four (26.63%) participants demonstrated clinically significant psychological distress, while 160 (11.10%) met the criterion for a probable ASR. Individuals who scored high on both childhood adversity and stressful life event experiences during the past year were at increased risks of both distress (ORs 2.00-2.66) and probable ASR (ORs 2.23-3.10), respectively. Moreover, internet addiction was associated with elevated risks of distress (OR 2.05, 95% CI 1.60-2.64) and probable ASR (OR 2.15, 95% CI 1.50-3.10). By contrast, good family functioning was associated with decreased risks of distress (OR 0.43, 95% CI 0.33-0.55) and probable ASR (OR 0.48, 95% CI 0.33-0.69). All associations were independent of baseline psychological distress. CONCLUSIONS: Our findings suggest that COVID-19 related psychological distress and high symptoms burden of ASR are common among health professional students. Extended family and professional support should be considered for vulnerable individuals during these unprecedented times.