Associations among posttraumatic stress disorder symptoms, life satisfaction, and well-being comparisons: A longitudinal investigation.

Many individuals who encounter potentially traumatic events go on to develop symptoms of posttraumatic stress disorder (PTSD). Research suggests that survivors of traumatic events frequently compare their current well-being to different standards; yet, knowledge regarding the role of comparative thinking in well-being is limited to a few cross-sectional studies. We therefore examined the temporal associations among aversive well-being comparisons (i.e., comparisons threatening self-motives), PTSD symptoms, and life satisfaction in individuals exposed to traumatic events. Participants (N = 518) with a trauma history completed measures of PTSD symptoms and life satisfaction, as well as the Comparison Standards Scale for Well-being (CSS-W), at assessment points 3 months apart. The CSS-W assesses the frequency, perceived discrepancy, and affective impact of aversive social, temporal, counterfactual, and criteria-based comparisons related to well-being. All participants reported having engaged in aversive well-being comparisons during the last 3 weeks. Comparison frequency emerged as a significant predictor of PTSD symptoms, ß = .24, beyond baseline PTSD symptom severity. Life satisfaction contributed unique variance to the comparison process by predicting comparison frequency, ß = -.18; discrepancy, ß = -.24; and affective impact, ß = .20. The findings suggest that frequent aversive comparisons may lead to a persistent focus on negative aspects of well-being, thereby exacerbating PTSD symptoms, and further indicate that comparison frequency, discrepancy, and affective impact are significantly influenced by life satisfaction. Taken together, the findings support the need for a thorough examination of the role of comparative thinking in clinical populations, which may ultimately help improve clinical care.

Evaluation of the Scales for Social Comparison of Appearance and Social Comparison of Well-Being.

People constantly compare their appearance and well-being to that of other individuals. However, a measure of social comparison of well-being is lacking and existing appearance-related social comparison assessment is limited to comparison tendency using predefined social situations. This limits our understanding of the role of social comparison in appearance and well-being. Therefore, we developed the Scale for Social Comparison of Appearance (SSC-A) and the Scale for Social Comparison of Well-Being (SSC-W) to assess upward and downward social comparisons with regard to (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective impact during the last 3 weeks. In one longitudinal and three cross-sectional studies (Ns = 500-1,121), we administered the SSC-A or SSC-W alongside measures of appearance social comparison, body satisfaction, self-concept, social rank, well-being, envy, rumination, depression, and anxiety. Confirmatory factor analyses supported the expected two-factor model representing upward and downward social comparison for both scales. Overall, upward comparison displayed the anticipated associations with the measured constructs, whereas downward comparison showed mostly small or nonsignificant correlations with the validators. The SSC-A and SSC-W are efficient measures of social comparison for appearance and well-being with good evidence for their reliability and validity in our samples.

The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials.

BACKGROUND: Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. METHODS: For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). FINDINGS: Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. INTERPRETATION: Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. FUNDING: None.

The efficacy and acceptability of psychological interventions for adult PTSD: A network and pairwise meta-analysis of randomized controlled trials.

OBJECTIVE: A comprehensive quantitative summary of the efficacy and acceptability of psychological interventions (PIs) for adult posttraumatic stress disorder (PTSD) is lacking. METHOD: We conducted a systematic literature search to identify randomized controlled trials (RCTs) examining the efficacy and acceptability (all-cause dropout) of psychological interventions (i.e., trauma-focused cognitive behavior therapy [TF-CBT], eye movement desensitization and reprocessing [EMDR], other trauma-focused interventions and non-trauma-focused interventions). RESULTS: One hundred fifty-seven RCTs were included comprising 11,565 patients. Most research (64% of RCTs) accumulated for TF-CBT. In network meta-analyses, all therapies were effective when compared to control conditions. Interventions did not differ significantly in their efficacy. Yet, TF-CBT yielded higher short- (g = 0.17, 95% CI [0.03-0.31], number of comparisons kes = 190), mid- (i.e., ≤5 months posttreatment, g = 0.23, 95% CI [0.06-0.40], kes = 73) and long-term efficacy (i.e., >5 months posttreatment, g = 0.20, 95% CI [0.04-0.35], kes = 41) than non-trauma-focused interventions. There was some evidence of network inconsistencies, and heterogeneity in outcomes was large. In pairwise meta-analysis, slightly more patients dropped out from TF-CBT than non-trauma-focused interventions (RR = 1.36; 95% CI [1.08-1.70], kes = 22). Other than that, interventions did not differ in their acceptability. CONCLUSIONS: Interventions with and without trauma focus are effective and acceptable in the treatment of PTSD. While TF-CBT yields the highest efficacy, slightly more patients discontinued TF-CBT than non-trauma-focused interventions. Altogether, the present results align with results of most previous quantitative reviews. Yet, results need to be interpreted with caution in light of some network inconsistencies and high heterogeneity in outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials.

BACKGROUND: Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas. AIMS: To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas. METHOD: We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy. RESULTS: Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' g = 1.09; 95% CI 0.70-1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74-1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only). CONCLUSIONS: The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.

Are psychological interventions for adult PTSD more efficacious and acceptable when treatment is delivered in higher frequency? A meta-analysis of randomized controlled trials.

BACKGROUND: Two systematic reviews indicated that higher treatment frequency of psychological interventions for adult PTSD may lead to higher efficacy and less dropout. Yet, a quantitative review is missing. METHODS: We conducted a thorough systematic literature search and included trials meeting the following criteria: a) random allocation, 2) PTSD was primary treatment focus, 3) ≥ 70% interview-based PTSD rate 4) mean age ≥ 18 years, and 5) N ≥ 20. Treatment session frequency was analyzed dichotomously (< 1.5 vs. ≥ 1.5 sessions/week) and continuously (sessions per week & minutes per week). RESULTS: A total of 160 RCTs with data from 10,556 patients were included. Analyses yielded similar treatment efficacy irrespective of treatment frequency definitions and whether differential efficacy was estimated directly via head-to-head trials or indirectly via comparisons to the same comparison group. Intense (≥ 1.5 sessions/week) vs. standard (< 1.5 sessions/week) delivery was, however, associated with significantly lower dropout rates (as a proxy for acceptability) for trauma-focused interventions (18.64% vs 11.54%, respectively, p = .024), but not for non-trauma-focused interventions. CONCLUSIONS: We found no evidence for differential treatment efficacy of intense vs. standard psychotherapies for adult PTSD. Evidence for increased acceptability was found for intense vs. standard trauma-focused interventions.

Psychological Interventions for Adult Post-Traumatic Stress Disorder Are Effective Irrespective of Concurrent Psychotropic Medication Intake: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD). OBJECTIVES: We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy. METHOD: To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) N ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported. RESULTS: Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53-1.22) rather than unmedicated (g = 0.27; 95% CI 0.01-0.54, p = 0.017), with younger age (b1 = -0.04, p = 0.008) and higher proportion of females (b1 = 0.01, p = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up. CONCLUSIONS: Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.

Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events.

BACKGROUND: Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking. AIMS: To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD. METHOD: We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms. RESULTS: We included 56 RCTs (4230 patients). Incidences of harms were generally low (0-5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15-0.28) and active control conditions (RR = 0.36, 95% CI 0.14-0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive-behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31-0.95) and with no differential risk of deterioration and AEs. CONCLUSIONS: The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.

Anxiety disorders and age-related changes in physiology.

BACKGROUND: Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and associated with substantially increased morbidity and early mortality. AIMS: The aim of this study was to examine age-related changes across a wide range of physiological measures in middle-aged and older adults with a lifetime history of anxiety disorders compared with healthy controls. METHOD: The UK Biobank study recruited >500 000 adults, aged 37-73, between 2006 and 2010. We used generalised additive models to estimate non-linear associations between age and hand-grip strength, cardiovascular function, body composition, lung function and heel bone mineral density in a case group and in a control group. RESULTS: The main data-set included 332 078 adults (mean age 56.37 years; 52.65% females). In both sexes, individuals with anxiety disorders had a lower hand-grip strength and lower blood pressure, whereas their pulse rate and body composition measures were higher than in the healthy control group. Case-control group differences were larger when considering individuals with chronic and/or severe anxiety disorders, and differences in body composition were modulated by depression comorbidity status. Differences in age-related physiological changes between females in the anxiety disorder case group and healthy controls were most evident for blood pressure, pulse rate and body composition, whereas this was the case in males for hand-grip strength, blood pressure and body composition. Most differences in physiological measures between the case and control groups decreased with increasing age. CONCLUSIONS: Findings in individuals with a lifetime history of anxiety disorders differed from a healthy control group across multiple physiological measures, with some evidence of case-control group differences by age. The differences observed varied by chronicity/severity and depression comorbidity.

Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis.

OBJECTIVE: Extensive research has demonstrated high prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) in war-surviving populations. However, absolute estimates are lacking, which may additionally inform policy making, research and healthcare. We aimed at estimating the absolute global prevalence and disease burden of adult survivors of recent wars (1989-2019) affected by PTSD and/or MD. METHODS: We conducted a systematic literature search and meta-analysis of interview-based epidemiological surveys assessing the prevalence of PTSD and/or MD in representative samples from countries with a recent war history (1989-2019). Drawing on the war definition and geo-referenced data of the Uppsala Conflict Database Programme and population estimates of the United Nations for 2019, we extrapolated the meta-analytic results to absolute global numbers of affected people. Drawing on disability-adjusted life years (DALYs) data of the Global Burden of Diseases Study 2019, we further calculated the PTSD-associated and MD-associated DALYs. RESULTS: Twenty-two surveys (N=15 420) for PTSD, 13 surveys for MD (N=9836) and six surveys on the comorbidity of PTSD and MD (N=1131) were included. Random effects meta-analyses yielded point prevalences of 26.51% for PTSD and 23.31% for MD. Of those affected by PTSD, 55.26% presented with comorbid MD. Prevalence rates were not significantly associated with war intensity and length, time since war, response rate or survey quality. The extrapolation yielded 316 million adult war-survivors globally who suffered from PTSD and/or MD in 2019. War-survivors were almost exclusively living in low/middle-income countries (LMICs) and carried a burden of 3 105 387 and 4 083 950 DALYs associated with PTSD and MD, respectively. CONCLUSIONS: Since LMICs lack sufficient funding and qualified professionals to provide evidence-based psychological treatments for such large numbers of affected people, alternative and scalable strategies using existing resources in primary care and communities are required. Research is required to assist upscaling.

Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials.

BACKGROUND: Research indicates that higher study quality may be associated with smaller treatment effects. Yet, knowledge about the association between study quality and treatment efficacy for posttraumatic stress disorder (PTSD) is limited. We aimed at evaluating the efficacy of psychological interventions for adult PTSD and the association between study quality and treatment effects. METHODS: We conducted a systematic search to identify randomized controlled trials (RCTs) that examined the efficacy of psychological interventions for chronic PTSD symptoms in adult samples with at least 70% of patients being diagnosed with PTSD by means of a structured interview. We assessed study quality using the following eight criteria from prior research: N ⩾ 50, all patients met criteria for PTSD, a treatment manual was used, therapists were trained, treatment integrity was checked, intent-to-treat analyses were applied, randomization was conducted by an independent party, and treatment outcome was conducted by blind assessors. RESULTS: The search resulted in 136 RCTs with 8978 patients. Active treatment conditions were largely effective in reducing PTSD symptoms at posttreatment and follow-up (Hedges' g = 1.09 and 0.81, respectively) when compared to passive control conditions. The comparison to active control conditions at posttreatment and follow-up resulted in medium effect sizes. A total of 14 trials met all study quality criteria and these trials produced large effect sizes when compared to passive control conditions at posttreatment and follow-up. CONCLUSIONS: Overall, study quality was not significantly associated with effect size. The findings indicate that psychological interventions can effectively reduce PTSD symptoms irrespective of study quality.

I'd do much better, if only counterfactual comparisons related to traumatic life events.

The association between posttraumatic stress disorder (PTSD) and counterfactual comparisons (CFC) is poorly understood and CFC-measures are missing. We developed and applied the Posttraumatic Counterfactual Comparisons Scale (P-CFC-S), which measures frequency, intensity and affective impact of trauma-related CFC. We further measured trauma history, PTSD symptoms, probable PTSD diagnosis, posttraumatic cognitions, satisfaction with life and basic sociodemographic information. The sample consisted of 556 adults (62.95% female) who had all experienced at least one potentially traumatic event and of whom 15.29% fulfilled a probable PTSD diagnosis. The P-CFC-S yielded adequate internal consistency and a one-factor structure in the explorative factor analysis. CFC were common, and about two-fold more common in individuals with probable PTSD compared to those without. In hierarchical regression analyses, the frequency and intensity in CFC explained a significant amount of variance in PTSD symptoms when potentially confounding variables (i.e. age, gender, posttraumatic cognitions and counterfactual thinking) were accounted for. Our findings suggest that CFC may be an active ingredient in PTSD maintenance. Longitudinal research is needed to examine the dynamics between CFC and PTSD and the hypothesis that CFC is related to cognitive avoidance and/or maladaptive appraisals of trauma meaning.

Clofazimine for Treatment of Cryptosporidiosis in Human Immunodeficiency Virus Infected Adults: An Experimental Medicine, Randomized, Double-blind, Placebo-controlled Phase 2a Trial.

BACKGROUND: We evaluated the efficacy, pharmacokinetics (PK), and safety of clofazimine (CFZ) in patients living with human immunodeficiency virus (HIV) with cryptosporidiosis. METHODS: We performed a randomized, double-blind, placebo-controlled study. Primary outcomes in part A were reduction in Cryptosporidium shedding, safety, and PK. Primary analysis was according to protocol (ATP). Part B of the study compared CFZ PK in matched individuals living with HIV without cryptosporidiosis. RESULTS: Twenty part A and 10 part B participants completed the study ATP. Almost all part A participants had high viral loads and low CD4 counts, consistent with failure of antiretroviral (ARV) therapy. At study entry, the part A CFZ group had higher Cryptosporidium shedding, total stool weight, and more diarrheal episodes compared with the placebo group. Over the inpatient period, compared with those who received placebo, the CFZ group Cryptosporidium shedding increased by 2.17 log2 Cryptosporidium per gram stool (95% upper confidence limit, 3.82), total stool weight decreased by 45.3 g (P = .37), and number of diarrheal episodes increased by 2.32 (P = .87). The most frequent solicited adverse effects were diarrhea, abdominal pain, and malaise. One placebo and 3 CFZ participants died during the study. Plasma levels of CFZ in participants with cryptosporidiosis were 2-fold lower than in part B controls. CONCLUSIONS: Our findings do not support the efficacy of CFZ for the treatment of cryptosporidiosis in a severely immunocompromised HIV population. However, this trial demonstrates a pathway to assess the therapeutic potential of drugs for cryptosporidiosis treatment. Screening persons living with HIV for diarrhea, and especially Cryptosporidium infection, may identify those failing ARV therapy. CLINICAL TRIALS REGISTRATION: NCT03341767.

A potential impact of physical distancing on physical and mental health. A rapid narrative umbrella review of meta-analyses on the link between social isolation and health

BackgroundThe imperative for physical distancing during the coronavirus disease 2019 (COVID-19) pandemic may deteriorate physical and mental health. We aimed at summarizing the strength of evidence in the published literature on the association of social isolation and loneliness with physical and mental health. MethodsWe conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO, and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone, and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social isolation and any physical or mental health outcome. The findings were summarized in a narrative synthesis. ResultsTwenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. A total of more than 3 million individuals had participated in the 692 primary studies. The results suggest that social isolation is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life, and suicidal ideation. ConclusionsThe existing evidence clearly indicates that social isolation is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures. Strengths and limitations of this studyO_LIThis rapid umbrella review focuses on a timely and societally relevant issue. C_LIO_LIThe systematic literature search was conducted in three major databases from inception up to April 2020 warranting an extensive and up-to-date overview on relevant meta-analyses in the field. C_LIO_LIQuality of included meta-analyses was rated with a standardized measure. C_LIO_LIDifferent indicators of social isolation were included. C_LIO_LIThe utilized method did not allow for a quantitative comparison of associations with health outcomes. C_LI

Is high-quality of trials associated with lower treatment efficacy? A meta-analysis on the association between study quality and effect sizes of psychological interventions for pediatric PTSD.

This meta-analysis aimed at providing an up-to-date estimate on the efficacy of psychological interventions for pediatric PTSD and to analyze the association between treatment efficacy and study quality. We systematically searched PsycINFO, Medline and recent meta-analyses for randomized controlled trials (RCTs). RCTs were eligible if a) they included at least 10 participants per group, b) compared a psychological intervention to a control condition or another psychological intervention and c) mean age was below 19 years. Study quality was assessed independently by both authors on the basis of eight quality criteria. We explored the potential associations between study quality and effect sizes in three ways. Firstly, we compared effect-sizes of high-quality vs. lower-quality studies. Secondly, we analyzed study quality as a continuous predictor of effect sizes. And thirdly, we examined the relationship between the eight individual quality criteria and effect sizes. A total of 46 eligible RCTs were included in the meta-analysis. Psychological interventions produced a large effect size when compared to waitlist (g = 1.07, k = 23, NNT = 1.81) and a medium effect size when compared to active control conditions (g = 0.60, k = 15, NNT = 3.03) at post-treatment. Overall, study quality was moderate. Comparisons of high-quality trials (k = 16) with lower-quality trials (k = 30) produced only non-significant findings in main-analyses as well as moderator sub-analyses. Study quality as a continuous variable was also not found to be related to effect sizes in any of the main analyses, nor was any of the eight individual quality criteria. The summary of the available literature strongly suggests that psychological interventions are effective in treating PTSD in children and adolescents. No significant associations between study quality and treatment efficacy were observed.

If only a systematic review and meta-analysis of social, temporal and counterfactual comparative thinking in PTSD.

Comparative thinking is ubiquitous in human cognition. Empirical evidence is accumulating that PTSD symptomatology is linked to various changes in social, temporal and counterfactual comparative thinking. However, no systematic review and meta-analysis in this line of research have been conducted to this date. We searched titles, abstracts and subject terms of electronic records in PsycInfo and Medline from inception to January 2019 with various search terms for social, temporal and counterfactual comparative thinking as well as PTSD. Journal articles were included if they reported a quantitative association between PTSD and social, temporal and/or counterfactual comparative thinking in trauma-exposed clinical or sub-clinical samples. A total of 36 publications were included in the qualitative synthesis. The number of publications on the association between PTSD and social and temporal comparative thinking was too scarce to warrant a meta-analytic review. A narrative review of available literature suggests that PTSD is associated with distortions in social and temporal comparative thinking. A meta-analysis of 24 independent samples (n = 4423) assessing the association between PTSD and the frequency of counterfactual comparative thinking yielded a medium to large positive association of r =.464 (p <.001, 95% CI =.404; .520). Higher study quality was associated with higher magnitude of association in a meta-regression. Most studies collected data cross-sectionally, precluding conclusions regarding causality. Overall, study quality was found to be moderate. More longitudinal and experimental research with validated comparative thinking measures in clinical samples is needed to acquire a more sophisticated understanding of the role of comparative cognitions in the aetiology and maintenance of PTSD. Comparative thinking might be a fruitful avenue for a better understanding of posttraumatic reactions and improving treatment.

El pensamiento comparativo es omnipresente en la cognición humana. Se está acumulando evidencia empírica de que la sintomatología del TEPT está vinculada a varios cambios en el pensamiento comparativo social, temporal y contrafactual. Sin embargo, ninguna revisión sistemática y meta-análisis en esta línea de investigación se ha llevado a cabo hasta la fecha. Se realizaron búsquedas en títulos, resúmenes y términos de materia de registros electrónicos en PsycInfo y Medline desde el inicio hasta enero de 2019 con varios términos de búsqueda para el pensamiento comparativo social, temporal y contrafactual, así como para TEPT. Se incluyeron artículos de revistas si reportaban una asociación cuantitativa entre el TEPT y el pensamiento comparativo social, temporal y/o contrafactual en muestras clínicas o subclínicas expuestas a traumas. Se incluyeron un total de 36 publicaciones en la síntesis cualitativa. El número de publicaciones sobre la asociación entre el TEPT y el pensamiento comparativo social y temporal era demasiado escaso como para justificar una revisión meta-analítica. Una revisión narrativa de la literatura disponible sugiere que el TEPT está asociado con distorsiones en el pensamiento comparativo social y temporal. Un meta-análisis de 24 muestras independientes (n = 4423) que evalúa la asociación entre el TEPT y la frecuencia del pensamiento comparativo contrafactual arrojó una asociación positiva de mediana a grande de r =.464 (p <.001, IC 95% =.404;.520). Una mayor calidad de estudio se asoció con una mayor magnitud de asociación en una metarregresión. La mayoría de los estudios recopilaron datos de forma transversal, lo que excluye conclusiones sobre la causalidad. En general, la calidad del estudio fue moderada. Se necesita más investigación longitudinal y experimental con medidas validadas de pensamiento comparativo en muestras clínicas para adquirir una comprensión más sofisticada del papel de las cogniciones comparativas en la etiología y la mantención del TEPT. El pensamiento comparativo podría ser una vía fructífera para una mejor comprensión de las reacciones postraumáticas y mejorar el tratamiento.

Estrogen metabolizing enzymes in endometrium and endometriosis.

BACKGROUND: Estradiol (E(2)) is an important promoter of the growth of both eutopic and ectopic endometrium. The findings with regard to the expression and activity of steroidogenic enzymes in endometrium of controls, in endometrium of endometriosis patients and in endometriotic lesions are not consistent. METHODS: In this study, we have looked at the mRNA expression and protein levels of a range of steroidogenic enzymes [aromatase, 17beta-hydroxysteroid dehydrogenases (17beta-HSD) type 1, 2 and 4, estrogen sulfotransferase (EST) and steroid sulfatase (STS)] in eutopic and ectopic endometrium of patients (n = 14) with deep-infiltrative endometriosis as well as in disease-free endometrium (n = 48) using real-time PCR and immunocytochemistry. In addition, we evaluated their menstrual cycle-related expression patterns, and investigated their steroid responsiveness in explant cultures. RESULTS: Aromatase and 17beta-HSD type 1 mRNA levels were extremely low in normal human endometrium, while mRNAs for types 2 and 4 17beta-HSD, EST and STS were readily detectable. Only 17beta-HSD type 2 and EST genes showed sensitivity to progesterone in normal endometrium. Types 1 and 2 17beta-HSD and STS protein was detected in normal endometrium using new polyclonal antibodies. CONCLUSIONS: In endometriosis lesions, the balance is tilted in favor of enzymes producing E(2). This is due to a suppression of types 2 and 4 17beta-HSD, and an increased expression of aromatase and type 1 17beta-HSD in ectopic endometrium.