Operationalization, implications and correlates of the cultural deviance criterion for ICD-11 and DSM-5 prolonged grief disorder.

Prolonged Grief Disorder (PGD) is included in ICD-11 and DSM-5-TR and includes a requirement of cultural deviance. This study examined endorsement rates and factors associated with endorsement of this criterion among Danish bereaved spouses (n = 425) and their adult children (n = 159) four years post-loss. In total, 7.5% (n = 44) participants endorsed this criterion. Both including and excluding the criterion, the prevalence rates for probable DSM-5-TR PGD were 1.4% (n = 8) and 1.7% (n = 10), respectively and for probable ICD-11 PGD were 1.4% (n = 8) and 2.2% (n = 13), respectively. Age and gender of the deceased, age of the bereaved, greater grief severity, and comorbid psychopathology were positively associated with endorsement of the criterion. Findings demonstrate low endorsement of the cultural deviation criterion, that its inclusion excludes several potential PGD cases, and unanticipated associations with several factors raise questions about the criterion's validity.

Do we all grieve the same? A multigroup test of the dimensional structure of prolonged grief disorder among Danish bereaved partners and children.

Prolonged Grief Disorder (PGD) is a newly recognized mental disorder in ICD-11 and DSM-5-TR. Several studies using exploratory factor analysis have found a unidimensional structure of the Prolonged Grief-13 (PG-13) measure of PGD. The recently published ICD-11 proposal proposes a distinction between two clusters of symptoms: Separation distress symptoms and associated cognitive, emotional and behavioral symptoms. The aim of the current study is to test competing factor structures of PGD in Danish samples of bereaved. Confirmatory factor analysis was used to test competing models of PGD among two samples of in total 1093 adults that completed the questionnaires 6 months post loss of either a parent or a partner. Convergent and divergent validity was tested via the relationship to depression, anxiety, post-traumatic stress disorder (PTSD) and general wellbeing using regression analysis. The Danish version of the PG 13 appeared to be both valid and reliable. A two-factor model reflecting the division of core- and associated symptoms of prolonged grief disorder provided the best description of the PG-13 among Danish bereaved adults and there was evidence of partial structural invariance of the latent structure of PGD across bereavement types. Convergent and divergent validity analysis supported the validity of the two-factor model of PGD. SIGNIFICANT OUTCOMES: : A latent variable model differing between core- and associated symptomatology of grief is supported. The Danish translation of PG-13 is a valid measure of prolonged grief symptomatology.

The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses.

PURPOSE: The present study examines the association between psychological violence and posttraumatic stress disorder (PTSD), depression, and anxiety, while comparing the specific subtypes of psychological violence and simultaneously focusing on methodological shortcomings. METHOD: A systematic review and random-effects meta-analyses were applied on the three main outcomes: PTSD, depression, and anxiety. Four electronic databases were searched (PsycINFO, PubMed, EMBASE, and Web of Science), and a total of 194 studies were included (k = 149 for meta-analyses). GRADEpro was used to evaluate the certainty of the evidence from the meta-analyses. RESULTS: Psychological violence had strong associations with the three main outcomes, with the strongest association for PTSD in both female and male victims. Coercive control was particularly associated with PTSD for female victims, while emotional/verbal and dominance/isolation had the strongest association with depression. Although the identified studies were characterized by gender bias, psychological violence appear to affect male mental health too. DISCUSSION: Findings from the meta-analyses support the notion that psychological violence is a traumatic experience, which is strongly association with PTSD and other common mental health problems linked to trauma. GRADEpro rated the certainty of evince to be low, and thus, our confidence in the estimated effect is limited. Gender bias, the applied terminology, and other methodological shortcomings are discussed. Despite the substantial amount of research on this topic, more research is needed before we can draw any final conclusions on the effect of psychological violence on mental health.

Attachment and symptom reporting in adolescents and young adults after a concussion.

BACKGROUND: The incidence of hospital-treated concussion is 100-300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5-15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion. METHODS: This cross-sectional study was embedded in a cohort of 15-30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions. RESULTS: In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, ß = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, ß = 1.09 (95%CI: 0.18; 2.01); 75th percentile, ß = 2.71 (95%CI: 1.80; 3.61)). CONCLUSION: Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.

The role of age and mode of delivery in the STEPS intervention: a longitudinal pilot-study in treatment of posttraumatic stress symptoms in Danish survivors of sexual assault.

Background: The STEPS programme has been succesfully implemented as a group-based treatment of trauma symptoms after rape for adolescents. The STEPS intervention was translated from Dutch to Danish and offered to adults in addition to adolescents as well as an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. The programme was translated from Dutch to Danish and expanded to adults in addition to adolescents as well as to an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. Objective: The present study observes  development in trauma symptoms and ICD-11 diagnostic status during an adapted version of the intervention programme 'STEPS' for survivors of sexual assault. Methods: A prospective uncontrolled study was conducted, monitoring symptoms of posttraumatic stress and other trauma-related symptomatology before treatment, after treatment and at 6 and 12 months' follow up for 103 referrals receiving individual or group-based STEPS. Tentative diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD were assigned to participants according to the ICD-11 to observe the development in diagnostic status across time, and multilevel modelling was used to assess the development of symptom severity and to assess the moderating effect of age-group and mode of delivery. Results: A loglinear function representing large and statistically significant decline in symptomatology over time provided the best fit for all measures of trauma-related symptomatology. The decline was not moderated by age-group or mode of intervention. Dropout rates were independent of mode of intervention and age. Conclusion: The adaption of the STEPS programme to adults and as an individual intervention is feasible and maintains effect sizes comparable to those observed in the original intervention. Further research using randomized controlled trials is needed to ascribe the observed effect to the STEPS programme.

Antecedentes: El programa STEPS se ha implementado con éxito como un tratamiento grupal de síntomas de trauma después de una violación en adolescentes. La intervención STEPS se tradujo del holandés al danés y se ofreció a adultos además de adolescentes, así como una intervención individual además de una intervención grupal en un Centro danés para víctimas de violación hasta el 2011 y el 2014.Objetivo: El presente estudio observa el desarrollo de síntomas de trauma y el estado de diagnóstico de la CIE-11 durante una versión adaptada del programa de intervención "PASOS" para los sobrevivientes de agresión sexual.Métodos: Se realizó un estudio prospectivo no controlado, monitorizando los síntomas de estrés postraumático y otras sintomatologías relacionadas con trauma antes del tratamiento, después del tratamiento y a los 6 y 12 meses de seguimiento para 103 derivaciones. Se asignaron a los participantes los diagnósticos tentativos de trastorno de estrés postraumático (TEPT) y TEPT complejo según la CIE-11 para observar el desarrollo en el estado de diagnóstico a través del tiempo, y se usó un modelado multinivel para evaluar el desarrollo de la severidad de los síntomas y evaluar el efecto moderador del grupo de edad y modo de entrega.Resultados: Un función lineal logarítmica que representa una disminución grande y estadísticamente significativa de la sintomatología a lo largo del tiempo proporcionó el mejor ajuste para todas las medidas de la sintomatología relacionada con trauma. El efecto no fue moderado por grupo de edad o tipo de intervención. Las tasas de abandono fueron independientes del tipo de intervención y edad.Conclusión:: La adaptación del programa STEPS para adultos y como una intervención individual es factible y mantiene el tamaño del efecto comparable con aquellos observados en la intervención original. Se necesita más investigación usando estudios controlados aleatorizados para atribuir el efecto observado al programa STEPS.

Traumatic experiences, ICD-11 PTSD, ICD-11 complex PTSD, and the overlap with ICD-10 diagnoses.

OBJECTIVES: This study investigated the frequency of traumatic experiences, prevalence rates of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD-10 classified disorders in outpatient psychiatry. METHOD: Overall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life Event Checklist, and the World Health Organization Well-being Index. ICD-10 diagnoses were extracted from the hospital record. Chi-square analysis, t-tests, and conditional probability analysis were used for statistical analysis. RESULTS: Nearly, all patients (94%) had experienced at least one traumatic event. CPTSD (36%) was more common than PTSD (8%) and had considerable overlap with ICD-10 affective, anxiety, PTSD, personality, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. ICD-11 PTSD overlapped with ICD-10 anxiety, PTSD, adjustment and stress-reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. A subgroup of patients with ICD-10 PTSD (23%) did not meet criteria for ICD-11 PTSD or CPTSD. CONCLUSION: Traumatic experiences are common. ICD-11 CPTSD is a highly prevalent disorder in psychiatric outpatients. One quarter with ICD-10 PTSD did not meet criteria for either ICD-11 PTSD or CPTSD. PTSD and CPTSD had considerable overlap with ICD-10 disorders.

Pilot study: undetected post-traumatic stress disorder symptoms among intellectually disabled.

Background: Individuals with intellectual disability respond differently to traumatic events, compared to the general population, which makes post-traumatic stress disorder (PTSD) symptoms difficult to recognize. The current study aims to examine the presence of undetected PTSD among individuals with intellectual disability and a known history of trauma exposure. Method: Nine individuals, who have not previously been diagnosed with PTSD, were evaluated for PTSD symptoms through case reports, which include descriptions of medical history, symptoms and behavior described in the former diagnostic reports, potential traumatic experiences, current symptoms and behavior in accordance to the Lancaster and North Gate Trauma Scale, and PTSD criteria from DM-ID. Results: Four out of the nine participants met the DM-ID criteria for PTSD. Conclusions: The current findings highlight the importance of including cognitive impairment and developmental level in the screening, referral and treatment process of PTSD.

Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study.

BACKGROUND: Knowledge about the course of recovery after whiplash injury is important. Most valuable is identification of prognostic factors that may be reversed by intervention. The mutual maintenance model outlines how post-traumatic stress symptoms (PTSS) and pain may be mutually maintained by attention bias, fear, negative affect and avoidance behaviours. In a similar vein, the fear-avoidance model describes how pain-catastrophizing (PCS), fear-avoidance beliefs (FA) and depression may result in persistent pain. These mechanisms still need to be investigated longitudinally in a whiplash cohort. METHODS: A longitudinal cohort design was used to assess patients for pain intensity and psychological distress after whiplash injury. Consecutive patients were all contacted within 3 weeks after their whiplash injury (n = 198). Follow-up questionnaires were sent 3 and 6 months post-injury. Latent Growth Mixture Modelling was used to identify distinct trajectories of recovery from pain. RESULTS: Five distinct trajectories were identified. Six months post-injury, 64.6% could be classified as recovered and 35.4% as non-recovered. The non-recovered (the medium stable, high stable and very high stable trajectories) displayed significantly higher levels of PTSS, PCS, FA and depression at all time points compared to the recovered trajectories. Importantly, PCS and FA mediated the effect of PTSS on pain intensity. CONCLUSIONS: The present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash-associated disorders. WHAT DOES THIS STUDY ADD?: The study confirms the mechanisms as outlined in the fear-avoidance model and the mutual maintenance model. The study adds important knowledge of pain-catastrophizing and fear-avoidance beliefs as mediating mechanisms in the effect of post-traumatic stress on pain intensity. Hence, cognitive behavioural techniques targeting avoidance behaviour and catastrophizing may be beneficial preventing the development of chronic pain.

Rehabilitation of women with gynaecological cancer: the association between adult attachment, post-traumatic stress disorder and depression.

OBJECTIVE: We hypothesised that being diagnosed with gynaecological cancer influences adult attachment and occurrence of depression and post-traumatic stress disorder (PTSD). The main aim of the study was to assess changes in the attachment dimensions, PTSD and depression from baseline to 5-month post-treatment. Further, we evaluated the association between attachment avoidance/anxiety dimensions and PTSD/depression among women newly diagnosed with ovarian, endometrial, or cervical cancer. METHODS: Consecutive Danish-speaking women aged 20 to 75 years and treated surgically for primary gynaecological cancer were eligible. All patients were offered a rehabilitation programme consisting of two face-to-face sessions and two phone calls carried out by a nurse. Patients were asked to complete the Revised Adult Attachment Scale, the Harvard Trauma Questionnaire and the Major Depression Inventory at baseline and at 5-month follow-up. In all, 151 women consent to participate in the sessions where 51 fulfilled Revised Adult Attachment Scale questionnaire and contribute with socio-demographic data. RESULTS: We found significant positive changes within the attachment anxiety dimension among women with ovarian cancer, a significant reduction of PTSD among endometrial cancer patients and insignificant changes in depression among all cancer types. The attachment anxiety dimension significantly increased the odds for PTSD and depression. CONCLUSIONS: Depression and PTSD were prevalent among ovarian and cervical cancer patients. The adjustment of rehabilitation according to patients' attachment anxiety dimension contains possibilities for indirect impact on PTSD and depression symptoms. Copyright © 2015 John Wiley & Sons, Ltd.

Sexual victimization and anxiety and mood disorders: a case-control study based on the Danish registry system.

Aims This study aimed to examine the relationship between rape and the subsequent psychiatric diagnosis of any anxiety or mood disorder. METHOD: Data from the Danish Civil Registration System and the Danish Psychiatric Central Register were used to identify a sample of female victims who had visited a centre for rape victims during an index year and their subsequent psychiatric records were compared with a matched control group. RESULTS: While controlling for demographic variables and previous psychiatric disorders, the effect of sexual victimization increased the likelihood of a subsequent diagnosis of an anxiety disorder but not a mood disorder. CONCLUSION: Sexual victimization significantly increases the likelihood of experiencing an anxiety disorder, and therefore victims require post-assault information and support.

Sexual victimization as a risk factor for residential mobility: a case-control study using the Danish registry system.

OBJECTIVES: Increased residential mobility has been proposed as an undesirable consequence for the victims of sexual victimization. This study aimed to test the hypothesis that serious sexual victimization predicted high levels of residential mobility after controlling for previous levels of residential mobility. STUDY DESIGN: A case-control design was used. Data were from the Danish civil registry system. METHODS: All females who had visited a centre for rape victims over a 1-year period were identified, and demographic information was collected based on the Danish civil registry number. A control group of 20 women for each rape victim with the same age and living in the same municipality in the year of the rape was also used. RESULTS: The results indicate that attendance at the centre for rape victims, higher previous levels of residential mobility and being single significantly increase the likelihood of subsequent high residential mobility. CONCLUSIONS: Sexual victimization has a unique and significant role in predicting residential mobility, above and beyond the influence of previous residential mobility.

Effectiveness of psychological debriefing.

OBJECTIVE: To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format. METHOD: Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty-five studies were selected for a thorough description. Forty-two studies provided additional information. RESULTS: Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found. CONCLUSION: Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified.

Psychological characteristics of women with eating disorders: permanent or transient features?

The purpose of the study was to make a psychological profile of Danish women with Eating Disorders, who were not currently hospitalized. 75 women between the ages of 19 and 46 years participated. 22 participants suffered from a clinical eating disorder (ED). 20 women had previously suffered from a clinical ED, and 33 women had never suffered from ED. The study included sociodemographic data, problems in relation to eating and weight, exposure to stressful life events, and the following questionnaires: The Eating Disorder Inventory, the Rosenberg Self-Esteem Scale, the Coping Styles Questionnaire, the Perceived Stress Scale, the Defense Style Questionnaire, and the Trauma Symptom Checklist. Psychologically, women with ED differed significantly from women without ED by using a more primitive defense style, perceiving themselves as being more exposed to stress, using more inefficient methods of coping and having lower self-esteem. Unexpectedly, the study also showed that recovery from an ED was resulting in normalisation of both behavioral and psychological characteristics. The implications of these findings are discussed.

Traumatisation, psychological defence style, coping, symptomatology, and social support in HIV-positive: a pilot study.

This paper examines degree of traumatisation, defence styles, coping strategies, symptomatology, and social support in a small sample of HIV-positive men and women in an effort to ascertain the psychological implications of living with Human Immunodeficiency Virus (HIV). Traumatisation and the potentially mediating effects of defence styles have only been the subject of a few studies of HIV positives. The study is based on a socio-demographic questionnaire, the Impact of Event Scale, the Defence Style Questionnaire, the Coping Styles Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. A degree of traumatisation that warrants treatment was found together with an association between particular coping strategies and symptomatology, and particular defence styles and symptomatology, respectively. Social support had increased over time, which is contrary to other research findings on social support.

[Occurrence and type of traumatic experiences among young Bosnian refugees in Denmark]. / Forekomst og art af traumatiserende begivenheder hos unge bosniske flygtninge i Danmark.

Prior research has shown that young refugees may be especially traumatised. The study includes 123 young Bosnian refugees, living at two Bosnian boarding-schools in Denmark who were given a revised version of the Harvard Trauma Questionnaire (HTQ). The subjects themselves have on average experienced seven traumatic events, and have either witnessed or had a family member experience an additional six events. Three-quarters have been shot at, have lost their homes and private possession and have been exposed to violence in the form of harassment or humiliation. Two-thirds have lost friends. Three-fifths have lived with uncertainty as to whether friends and family were alive or dead. More than half have seen dead and wounded people, have had their lives threatened and have thought that they would die. More than a third have lost close family members, have been wounded and have had their homes destroyed. Just under a third have been exposed to physical violence or have witnessed somebody being killed. A quarter have starved and been ill without being able to receive treatment. About a fifth have experienced captivity, torture and forced labour. 6% have been raped or exposed to other forms of sexual abuse. It is concluded that the young Bosnians examined are a multitraumatised group. Use of the HTQ increased the number of traumatic events quite considerably compared to the case notes.

The aftermath of an industrial disaster.

An explosion in a Danish supertanker under construction in 1994 caused the death of six workers and injured 15. Six months later 270 workers took part in this study, which analyses the relationships between objective stressors, the workers' own feelings and the reactions of their families after the explosion together with training, attitude to the workplace, general out-look, and received crisis help. Traumatisation, coping style and crisis support was assessed via the Impact of Event Scale (IES), the Coping Styles Questionnaire (CSQ) and the Crisis Support Scale (CSS). Emotionally, workers and their families were strongly affected by the explosion. The IES-score was 17.6 and the invasion score 9.1. The degree of traumatisation was higher in the group who had an 'audience position' than in the group who was directly hit by the explosion. Training in rescue work did not protect against adverse effects. Rescue work had a strong impact on the involved. Social support was a significant factor, that seems to buffer negative effects. High level of social integration, effective leadership in the situation, and professional crisis intervention characterised the disaster situation. All the same, 41 per cent of the workers reached the caseness criteria by Horowitz (IES > or = 19).