Stress beliefs moderate the impact of COVID-19 related work stress on depressive, anxiety and distress symptoms in health care workers.

Health care workers are at increased risk for mental health issues due to high psychological and physical job demands. According to a recent study, stress beliefs (i.e., believing stress to be detrimental to one's health) might influence physicians' mental health in response to a naturalistic stressor (COVID-19 hospital working conditions). Due to a small sample size and high alpha error inflation, the suggested association needs to be interpreted with caution. The current study aims to replicate those findings in a larger sample. A cross-sectional survey among N = 418 (64.1% female; Median age = 30-39 years) physicians and nurses of a large German medical centre was conducted during the COVID-19 pandemic (May/June 2021). Perception of pandemic related increase of work stress was assessed via self-report. Stress beliefs were assessed with the Beliefs About Stress Scale, and mental health symptoms were assessed with the 21-item Depression Anxiety Stress Scale. Stress beliefs moderated the association between increased work stress and mental health symptoms. Increased work stress was associated with increased depressive, anxiety and distress symptoms only in health care workers with medium (simple slope = 2.22, p < .001; simple slope = 1.27, p < .001; simple slope = 3.19, p < .001) and high (simple slope = 3.13; p < .001; simple slope = 1.66, p < .05; simple slope = 4.33, p < .001) negative stress beliefs. Among health care workers with low negative stress beliefs increased work stress was not associated with increased depressive, anxiety and distress symptoms. This confirms negative stress beliefs as variable of interest in research on the impact of stress on mental health in health care workers.

Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD?

Background: Posttraumatic Stress Disorder (PTSD) is associated with high levels of functional impairments such as difficulties in academic or occupational performance and in social relationships. With an increasing number of traumatic event types experienced (trauma load), PTSD risk increases in a dose-dependent manner. Accordingly, high rates of PTSD can impair the reconstruction process in post-conflict societies. In order to meet these high needs for mental health services in societies with little access to professional care, task shifting approaches and community-based interventions have been suggested. Narrative Exposure Therapy (NET) has been developed as a short and pragmatic exposure-based PTSD treatment that can be easily trained to lay personnel. Yet, it remains unclear whether NET can be effectively provided by trained lay counsellors even at high levels of trauma load. Objective: To investigate whether trauma load influences the treatment effectiveness of NET provided by trained and supervised local lay counsellors. Method: Linear mixed models were calculated to investigate the influence of trauma load on treatment effectiveness in a sample of N = 323 rebel war survivors from Northern Uganda with PTSD. Results: We found a strong reduction of PTSD symptoms following NET, which was not influenced by trauma load. However, individuals with higher levels of trauma load reported higher PTSD symptoms before therapy as well as 4 and 10 months following treatment completion compared to individuals with lower trauma load. Conclusions: Treatment with NET by lay counsellors is effective independent of trauma load. However, individuals with higher trauma load have a higher probability to show residual symptoms, which might require additional time, sessions or treatment modules.

Antecedentes: El trastorno de estrés traumático (TEPT) se asocia con altos niveles de discapacidad funcional, tales como dificultades en el desempeño académico uocupacional yen las relaciones sociales. Con un número creciente de los tipos de eventos traumáticos experimentados (carga traumática), el riesgo de TEPT aumenta en una forma dependiente de la dosis. De la misma forma, altas tasas de TEPT pueden afectar el proceso de reconstrucción en las sociedad post-conflicto. Para abordar estas crecientes necesidades por servicios de salud mental en sociedades con poco acceso acuidado profesional, se ha sugerido el enfoque de cambio de tareas ylas intervenciones basadas en la comunidad. La Terapia de Exposición Narrativa (NET en su sigla en inglés) ha sido desarrollada como un tratamiento de TEPT basado en la exposición, breve ypragmático que puede ser fácilmente entrenado al personal laico. Aun así, permanece incierto si la NET puede ser implementada efectivamente por consejeros laicos entrenados, incluso aaltos niveles de carga traumática.Objetivo: Investigar si la carga traumática influencia la efectividad del tratamiento de la NET proporcionado por consejeros laicos locales entrenados ysupervisados.Método: Los modelos mixtos lineales se calcularon para investigar la influencia de la carga traumática en la efectividad del tratamiento, en una muestra de N= 323 sobrevivientes de guerra rebelde desde Uganda del Norte con TEPT.Resultados: Encontramos una clara reducción de los síntomas TEPT luego de la NET, la cual no fue influenciada por la carga traumática. Sin embargo, los individuos con altos niveles de carga traumática reportaron altos niveles de síntomas TEPT antes de la terapia como también 4 y 10 meses luego del término del tratamiento comparado alos individuos con carga traumáticamás baja.Conclusiones: El tratamiento con la NET administrada por consejeros laicos es efectiva independiente de la carga traumática. Sin embargo, los individuos con carga traumáticamás alta tienen una probabilidadmás alta de mostrar síntomas residuales, los cuales podrían requerir tiempo, sesiones omódulos de tratamiento adicionales.

A combination of combat experience, early abduction, and severe traumatization fuels appetitive aggression and violence among abductees of rebel war in Northern Uganda.

Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (Mage = 32.58, SDage = 9.76, range: 18-80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.

Integrated genetic, epigenetic, and gene set enrichment analyses identify NOTCH as a potential mediator for PTSD risk after trauma: Results from two independent African cohorts.

The risk of developing posttraumatic stress disorder (PTSD) increases with the number of traumatic event types experienced (trauma load) in interaction with other psychobiological risk factors. The NOTCH (neurogenic locus notch homolog proteins) signaling pathway, consisting of four different trans-membrane receptor proteins (NOTCH1-4), constitutes an evolutionarily well-conserved intercellular communication pathway (involved, e.g., in cell-cell interaction, inflammatory signaling, and learning processes). Its association with fear memory consolidation makes it an interesting candidate for PTSD research. We tested for significant associations of common genetic variants of NOTCH1-4 (investigated by microarray) and genomic methylation of saliva-derived DNA with lifetime PTSD risk in independent cohorts from Northern Uganda (N1 = 924) and Rwanda (N2 = 371), and investigated whether NOTCH-related gene sets were enriched for associations with lifetime PTSD risk. We found associations of lifetime PTSD risk with single nucleotide polymorphism (SNP) rs2074621 (NOTCH3) (puncorrected = 0.04) in both cohorts, and with methylation of CpG site cg17519949 (NOTCH3) (puncorrected = 0.05) in Rwandans. Yet, none of the (epi-)genetic associations survived multiple testing correction. Gene set enrichment analyses revealed enrichment for associations of two NOTCH pathways with lifetime PTSD risk in Ugandans: NOTCH binding (pcorrected = 0.003) and NOTCH receptor processing (pcorrected = 0.01). The environmental factor trauma load was significant in all analyses (all p < 0.001). Our integrated methodological approach suggests NOTCH as a possible mediator of PTSD risk after trauma. The results require replication, and the precise underlying pathophysiological mechanisms should be illuminated in future studies.

Higher sense of coherence is associated with better mental and physical health in emergency medical services: results from investigations on the revised sense of coherence scale (SOC-R) in rescue workers.

As rescue workers are regularly confronted with potentially traumatising on-duty events, they have an increased risk to develop trauma-related mental and physical health impairments, including post-traumatic, depressive, and somatic symptoms. For this high-risk group, it could be of particular importance to experience their occupational burden as manageable, meaningful, and coherent. This mindset - called sense of coherence - may be a potential resilience factor against the development of mental and physical health problems. In a cross-sectional cohort of 102 rescue workers (Mdn(QD)age = 26.0 (8.5), age range: 18-61), including 36 women, we investigated whether higher values on the Revised Sense of Coherence Scale (SOC-R) predicted lower post-traumatic, depressive, and somatic symptoms. In addition, we evaluated the factor structure of the SOC-R using confirmatory factor analyses. Linear regressions indicated that higher SOC-R, but particularly manageability scores were associated with less post-traumatic (ß = -.31, p = .009), depressive (ß = -.44, p < .001), and somatic symptoms (ß = -.36, p = .002). Furthermore, we found that all symptom scores significantly increased with occupational and private-life trauma exposure. The SOC-R's factor structure was replicated, comprising the three subscales manageability, reflection, and balance. However, the SOC-R's convergent factor validity was rather low in the present sample. Taken together, a high sense of coherence, and in particular a high manageability conviction, was observed as resilience factors for high-risk groups that are frequently exposed to potentially traumatic events. Future studies might investigate whether strengthening the sense of coherence could be one building block in an effective prevention program for maintaining long-term health in risk groups.

Debido a que los trabajadores de rescate se enfrentan regularmente con eventos laborales potencialmente traumatizantes, presentan un mayor riesgo de desarrollar trastornos mentales y físicos relacionados con el trauma, incluyendo síntomas postraumáticos, depresivos y somáticos. Para este grupo de alto riesgo sería importante el experimentar su trabajo como manejable, significativo y coherente. Esta perspectiva ­llamada sentido de coherencia­ podría ser un factor potencial de resiliencia en contra del desarrollo de problemas mentales y físicos. En una cohorte transversal con 102 trabajadores de rescate (Mdn(QD)edad = 26.0 (8.5), rango de edad: 18-61), de los cuáles 36 eran mujeres, investigamos si los valores más altos en la Escala del Sentido de Coherencia Revisada (SOC-R) predijeron menos síntomas postraumáticos, depresivos y somáticos. Además, evaluamos la estructura factorial del SOC-R mediante análisis factoriales confirmatorios. Las regresiones lineales indicaron que las puntuaciones más altas del SOC-R, pero particularmente la capacidad de menejabilidad, se asociaron con menos síntomas postraumáticos (ß = −.31, p = .009), depresivos (ß = −.44, p <.001) y somáticos (ß = −.36, p = .002). Además, encontramos que a mayor la exposición con traumas laborales y privados los puntajes de estos síntomas aumentaron significativamente. La estructura factorial del SOC-R se replicó con sus tres subescalas manejabilidad, reflexión y equilibrio. Sin embargo, la validez del factor convergente del SOC-R era menor en la presente muestra. En general, se observó que un alto sentido de coherencia y, en particular una alta manejabilidad, funcionan como factores de resiliencia en grupos de alto riesgo que con frecuencia están expuestos a eventos potencialmente traumáticos. Estudios futuros deberían investigar si el fortalecimiento del sentido de coherencia podría ser un componente básico en un programa de prevención eficaz para mantener la salud a largo plazo en grupos de riesgo.

Genetic variation is associated with PTSD risk and aversive memory: Evidence from two trauma-Exposed African samples and one healthy European sample.

The probability to develop posttraumatic stress disorder (PTSD), characterized by vivid, intrusive emotional memories of the encountered traumatic events, depends - among other factors - on the number of previous traumatic experiences (traumatic load) and individual genetic vulnerability. So far, our knowledge regarding the biological underpinnings of PTSD is relatively sparse. Genome-wide association studies (GWAS) followed by independent replication might help to discover novel, so far unknown biological mechanisms associated with the development of traumatic memories. Here, a GWAS was conducted in N = 924 Northern Ugandan rebel war survivors and identified seven suggestively significant single nucleotide polymorphisms (SNPs; p ≤ 1 × 10-5) for lifetime PTSD risk. Of these seven SNPs, the association of rs3852144 on chromosome 5 was replicated in an independent sample of Rwandan genocide survivors (N = 370, p < .01). While PTSD risk increased with accumulating traumatic experiences, the vulnerability was reduced in carriers of the minor G-allele in an additive manner. Correspondingly, memory for aversive pictures decreased with higher number of the minor G-allele in a sample of N = 2698 healthy Swiss individuals. Finally, investigations on N = 90 PTSD patients treated with Narrative Exposure Therapy indicated an additive effect of genotype on PTSD symptom change from pre-treatment to four months after treatment, but not between pre-treatment and the 10-months follow-up. In conclusion, emotional memory formation seems to decline with increasing number of rs3852144 G-alleles, rendering individuals more resilient to PTSD development. However, the impact on therapy outcome remains preliminary and further research is needed to determine how this intronic marker may affect memory processes in detail.

Stigmatization Is Associated With Increased PTSD Risk After Traumatic Stress and Diminished Likelihood of Spontaneous Remission-A Study With East-African Conflict Survivors.

Studies in conflict population have repeatedly documented that the number of traumatic event types experienced (trauma load) increases the risk to develop posttraumatic stress disorder (PTSD) in a dose-dependent manner. Misconceptions about survivors' experiences and actions during the war, as well as mental health symptoms frequently lead to stigmatization by their own families and the community, which might render them even more vulnerable for PTSD development and prevent successful recovery. We therefore investigated whether stigmatization affects trauma-related psychopathology beyond the well-known effect of trauma load. The study sample comprised N = 1131 survivors of the rebel war led by the Lord's Resistance Army (LRA) in Northern Uganda, including a large proportion of formerly abducted individuals and child soldiers. We investigated how the experience of stigmatization affects PTSD risk and the likelihood of spontaneous remission, taking trauma load into account. Further, the association of stigmatization with treatment outcome was determined in a subsample of N = 284 individuals with PTSD who received trauma-focused psychotherapy. More than one third of the total sample, and almost two-thirds of the therapy subsample, reported experiences of stigmatization. The main reasons for stigmatization were related to an association with a rebel group (e.g., being called a rebel), followed by mental health problems/PTSD symptoms and HIV/AIDS. Stigmatization was strongly associated with a higher prevalence of lifetime and current PTSD, a diminished probability of spontaneous remission and higher PTSD symptoms before and after trauma-focused psychotherapy, beyond the effect of trauma load. In sum, our results support the assumption that stigmatization aggravates trauma-related psychopathology and impede symptom improvement. In post-conflict regions, community and family interventions which aim at reducing stigmatization and discrimination might therefore complement individual psychotherapy in order to allow survivors to recover and reintegrate into society.

Emotion Regulation in Rescue Workers: Differential Relationship With Perceived Work-Related Stress and Stress-Related Symptoms.

Rescue workers are exposed to enduring emotional distress, as they are confronted with (potentially) traumatic mission events and chronic work-related stress. Thus, regulating negative emotions seems to be crucial to withstand the work-related strain. This cross-sectional study investigated the influence of six emotion regulation strategies (i.e., rumination, suppression, avoidance, reappraisal, acceptance, and problem solving) on perceived work-related stress and stress-related depressive, post-traumatic, and somatic symptoms in a representative sample of 102 German rescue workers. Multiple regression analyses identified rumination and suppression to be associated with more work-related stress and stress-related symptoms. Acceptance was linked to fewer symptoms and, rather unexpectedly, avoidance was linked to less work-related stress. No effects were observed for reappraisal and problem solving. Our findings confirm the dysfunctional role of rumination and suppression for the mental and physical health of high-risk populations and advance the debate on the context-specific efficacy of emotion regulation strategies.

Does trauma event type matter in the assessment of traumatic load?

Background: The likelihood of developing Posttraumatic Stress Disorder (PTSD) depends on the interaction of individual risk factors and cumulative traumatic experiences. Hence, the identification of individual susceptibility factors warrants precise quantification of trauma exposure. Previous research indicated that some traumatic events may have more severe influences on mental health than others; thus, the assessment of traumatic load may be improved by weighting event list items rather than calculating the simple sum score. Objective: We compared two statistical methods, Random Forests using Conditional Interference (RF-CI) and Least Absolute Shrinkage and Selection Operator (LASSO), based on their ability to rank traumatic experiences according to their importance for predicting lifetime PTSD. Methods: Statistical models were initially fitted in a sample of N1 = 441 survivors of the Northern Ugandan rebel war. The ability to correctly predict lifetime PTSD was then tested in an independent sample of N2 = 211, and subsequently compared with predictions by the simple sum score of different traumatic event types experienced. Results: Results indicate that RF-CI and LASSO allow for a ranking of traumatic events according to their predictive importance for lifetime PTSD. Moreover, RF-CI showed slightly better prediction accuracy than the simple sum score, followed by LASSO when comparing prediction results in the validation sample. Conclusion: Given the expense in time and calculation effort by RF-CI and LASSO, and the relatively low increase in prediction accuracy by RF-CI, we recommend using the simple sum score to measure the environmental factor traumatic load, e.g., in analyses of gene × environment interactions.