Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer.

OBJECTIVE: This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. METHODS: Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. RESULTS: No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. CONCLUSIONS: AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.

Rapid assessment of mental health of Detroit-area health care workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS: The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS: Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Leveraging the Biology of Adversity and Resilience to Transform Pediatric Practice.

Advances in science are fundamentally changing the way we understand how inextricable interactions among genetic predispositions, physical and social environments, and developmental timing influence early childhood development and the foundations of health and how significant early adversity can lead to a lifetime of chronic health impairments. This article and companion article illustrate the extent to which differential outcomes are shaped by ongoing interactive adaptations to context that begin at or even before conception and continue throughout life, with increasing evidence pointing to the importance of the prenatal period and early infancy for the developing brain, the immune system, and metabolic regulation. Although new discoveries in the basic sciences are transforming tertiary medical care and producing breakthrough outcomes in treating disease, this knowledge is not being leveraged effectively to inform new approaches to promoting whole-child development and preventing illness. The opportunity for pediatrics to serve as the leading edge of science-based innovation across the early childhood ecosystem has never been more compelling. In this article, we present a framework for leveraging the frontiers of scientific discovery to inform new strategies in pediatric practice and advocacy to protect all developing biological systems from the disruptive effects of excessive early adversity beyond providing information on child development for parents and enriched learning experiences for young children.

An evolutionary concept analysis of secondary traumatic stress in nurses.

PURPOSE: The purpose of this article is to provide conceptual clarification of secondary traumatic stress (STS) in nurses. BACKGROUND: As an empathetic helping profession, nurses are at increased risk for STS. Interchangeable usage of related terms among multidisciplinary literature has resulted in lack of conceptual clarity resulting in conflation of terms. Conceptual clarity is necessary for a foundation for further research on treatment. METHODS: Rodgers' evolutionary model of concept analysis. RESULTS: Nurses are predisposed to STS due to exposure, empathy, bonding, and personal factors. Essential attributes were found to be posttraumatic stress disorder-like symptoms, biological symptoms, social symptoms, and psychological symptoms. Resultant consequences included an altered worldview, interpersonal difficulties, and decreased occupational commitment. CONCLUSION: This concept analysis, the first focusing on STS, provides conceptual clarity and a concept map of STS within the nursing population.

Risk factors for the development of medical stress syndrome following surgical intervention.

BACKGROUND: Pediatric surgical procedures involve traumatic stress that may cause psychological distress, leading to decreased adherence to continued surgical follow-up and delayed physical recovery. Risk factors for pediatric medical trauma, however, have not been studied enough. We aim to define the risk factors detectable during hospitalization in pediatric surgery and characterize children at risk of developing PTSD, in order to focus preventive interventions on these children. METHODS: The participants in this prospective study were parents of 235 children aged 1-13 years hospitalized in a pediatric surgical ward, who form a representative sample of patients of this age in the ward. They completed questionnaires measuring symptoms of psychological distress, 3-5 months after discharge. RESULTS: Higher parental stress, parental concerns regarding family social support, and parental concerns regarding sibling problems had a significant positive correlation with the children's emotional distress measured 3-5 months after hospitalization. Among children aged 1-5 years, emergency (as opposed to elective) operation and a higher number of invasive procedures were also positively correlated with the children's PTSS. CONCLUSIONS: There is a need to develop measurements for identifying children at high risk for developing posttraumatic stress following surgical intervention; guidelines for developing such a screening instrument are outlined. TYPE OF STUDY: Prognosis study (level of evidence - 1).

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Multiple prenatal stresses increase sexual dimorphism in adult offspring behavior.

INTRODUCTION: Maternal gestational stress and immune activation have independently been associated with affective and neurodevelopmental disorders across the lifespan. We investigated whether rats exposed to prenatal maternal stressors (PNMS) consisting of psychological stress, interleukin (IL)-1ß or both (two-hit stress) during critical developmental windows displayed a behavioral phenotype representative of these conditions. METHODS: Long-Evans dams were exposed to psychological stressors consisting of restraint stress and forced swimming from gestational day (GD)12 to 18 or to no stress (controls). From GD17 until day of delivery, these same animals were injected with saline or IL-1ß as a second hit and immune stressor (5 µg/day, intraperitoneally). The behavior of F1 offspring adults was tested on the open field test, elevated plus maze and affective exploration task on postnatal days (P)90, 100 and 110 respectively. RESULTS: The effects of PNMS differed depending on the specific testing environment and potentially the age at assessment, especially in female offspring. Both locomotion and anxiety-like behavioral measures were susceptible to PNMS effects. In females, psychological stress increased anxiety-like behavior, whereas IL-1ß had an opposite effect, inducing exploration and risk-taking behavior on the open field test and the elevated plus maze. When present, interactions between both stressors limited the anxiogenic effect of psychological stress on its own. In contrast, prenatal psychological stress increased anxiety-like behavior in adult males overall. A similar anxiogenic effect of IL-1ß was only found on the open field test while the Stress*IL-1ß interaction appeared to limit the effect of either alone. Contrarily, the PNMS effects on anxiety-like behavior on the affective exploration task were highly similar between both sexes. Analysis of males and females together revealed an additive effect of Stress and IL-1ß on the number of exits from the refuge, a measure of risk assessment and thus correlated with anxiety. CONCLUSION: PNMS affected offspring adult behavior in a sex-dependent manner. Effects on females were more variable, whereas psychological stress mostly induced anxiety-like behavior in males. These data highlight the sexual dimorphism in vulnerability to prenatal stressors. Maternal or stress-induced programming of the stress response and neuroinflammation may play an important role in mediating stress effects on offspring adult behavior.

Toward a Better Understanding of Psychological Symptoms in People Confronted With the Disappearance of a Loved One: A Systematic Review.

OBJECTIVE: The disappearance of a loved one is claimed to be the most stressful type of loss. The present review explores the empirical evidence relating to this claim. Specifically, it summarizes studies exploring the prevalence and correlates of psychological symptoms in relatives of missing persons as well as studies comparing levels of psychopathology in relatives of the disappeared and the deceased. METHOD: Two independent reviewers performed a systematic search in PsychINFO, Web of Science, and Medline, which resulted in 15 studies meeting predefined inclusion criteria. Eligible studies included quantitative peer-reviewed articles and dissertations that assessed psychopathology in relatives of missing person. RESULTS: All reviewed studies were focused on disappearances due to war or state terrorism. Prevalence rates of psychopathology were mainly described in terms of post-traumatic stress disorder and depression and varied considerably among the studies. Number of experienced traumatic events and kinship to the missing person were identified as correlates of psychopathology. Comparative studies showed that psychopathology levels did not differ between relatives of missing and deceased persons. CONCLUSIONS: The small number of studies and the heterogeneity of the studies limit the understanding of psychopathology in those left behind. More knowledge about psychopathology postdisappearance could be gained by expanding the focus of research beyond disappearances due to war or state terrorism.

Age moderates the relationship between source of social support and mental health in racial minority lesbian, gay, and bisexual youth.

We examined the relationship between source of social support and mental health (and the moderating impact of age) in 64 low socioeconomic status, racial minority lesbian, gay, and bisexual adolescents/young adults. Social support from family ( ß = -.302, p = .03; ß = -.364, p = .008), but not friends or significant others, was independently related to posttraumatic stress disorder and depression symptoms, respectively. Family social support was associated with lower posttraumatic stress disorder and depression symptoms in participants aged 16-19 years, while friend social support was associated with lower symptoms for participants aged over 20 years. Friend social support was also associated with lower posttraumatic stress disorder symptoms in participants aged 16-17 years. Interventions should target age-appropriate sources of social support.

High-risk psychotropic medications for US children with trauma sequelae.

Children exposed to trauma are predisposed to develop a number of mental health syndromes. They are prone to under-treatment with effective psychosocial interventions and over-treatment with high-risk psychotropic medications, especially polypharmacy and the use of antipsychotics for unapproved conditions. We review the evidence for psychosocial and pharmacological treatments for mental health problems associated with high exposure to childhood trauma - identifying those in foster care as an index group - and the frequency of high-risk pharmacological practices. We describe current efforts to reduce over-treatment of children with high-risk psychotropic medications and propose further recommendations to protect and provide effective care for these vulnerable children.

The Hidden Wounds of Hurricane Dorian: Why Emergency Response Must Look Beyond Physical Trauma.

Project HOPE, a global health and humanitarian assistance organization, has responded to some of the world's largest natural disasters and humanitarian and health crises for more than 60 years. As natural disasters increase in frequency and intensity, otherwise effective health systems can become compromised, and - although less visible than traumatic injuries - populations with chronic diseases can be significantly impacted. Emergency preparedness and response efforts must adapt to address issues around continuity of care, access to pharmaceuticals, strengthening cold chain mechanisms, restoring supply chains, and educating patients with chronic illnesses on emergency preparedness. Project HOPE designs medical teams and supply donations to work alongside, rather than parallel to, existing health care infrastructure, laying the foundation for the long-term recovery of the health system.

Do police officers and firefighters have a higher risk of disease than other public officers? A 13-year nationwide cohort study in South Korea.

OBJECTIVES: The work of public officers involves repeated and long-term exposure to heavy workloads, high job strain and workplace violence, all of which negatively impact physical and mental health. This study aimed to evaluate and compare the incidences of diseases among different categories of public officers in Korea, in order to further understand the health risks associated with these occupations. DESIGN: A cohort study using the National Health Insurance data. PARTICIPANTS: We collated claims data between 2002 and 2014 for 860 221 public officers. PRIMARY AND SECONDARY OUTCOME MEASURES: Age-standardised rates were calculated using the direct standardisation method, and HRs were calculated using the Cox proportional hazard regression models. RESULTS: Overall, we found that police officers and firefighters had a higher incidence of a range of diseases when compared with national and regional government officers (NRG). The most prominent HRs were observed among police officers for angina pectoris (HR: 1.52, 95% CI 1.49 to 1.54), acute myocardial infarction (HR: 1.84, 95% CI 1.77 to 1.92) and cerebrovascular disease (HR: 1.36, 95% CI 1.31 to 1.40). Firefighters were more susceptible to physical ailments and were at a significantly higher risk for traumatic stress disorders (HR: 1.40, 95% CI 1.26 to 1.56) than NRGs. CONCLUSION: Compared withNRGs, police officers had higher HRs for all measured diseases, except for traumatic stress disorders. While firefighters had higher HRs for almost all diseases examined, public education officers had a higher HR for traumatic stress disorders, when compared with NRGs.

The Role of Parental Posttraumatic Stress, Marital Adjustment, and Dyadic Self-Disclosure in Intergenerational Transmission of Trauma: A Family System Approach.

Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans' wives and offspring (secondary traumatic stress; STS). However, the interplay between family members' characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers' PTSS, mothers' STS, marital adjustment, and self-disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent-child transmission. Combat veterans and former prisoners of war (N = 123), their spouses, and adult offspring were investigated in a multiple-step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers' PTSS to offspring.

Intersections between polyvictimisation and mental health among adolescents in five urban disadvantaged settings: the role of gender.

BACKGROUND: Polyvictimisation (PV) - exposure to violence across multiple contexts - causes considerable morbidity and mortality among adolescents. Despite high levels of violence in urban disadvantaged settings, gender differences in associations between PV and mental health have not been well established. METHODS: We analysed data from a survey with 2393 adolescents aged 15-19 years, recruited using respondent-driven sampling from urban disadvantaged settings in Baltimore (USA), Delhi (India), Ibadan (Nigeria), Johannesburg (South Africa) and Shanghai (China). PV was defined as exposure to two or more types of violence in the past 12 months with family, peers, in the community, or from intimate partners and non-partner sexual violence. Weighted logistic regression models are presented by gender to evaluate whether PV is associated with posttraumatic stress, depression, suicidal thoughts and perceived health status. RESULTS: PV was extremely common overall, but ranged widely, from 74.5% of boys and 82.0% of girls in Johannesburg, to 25.8 and 23.9% respectively in Shanghai. Community violence was the predominant violence type, affecting 72.8-93.7% across the sites. More than half of girls (53.7%) and 45.9% of boys had at least one adverse mental health outcome. Compared to those that did not report violence, boys exposed to PV had 11.4 higher odds of having a negative perception of health (95%CI adjusted OR = 2.45-53.2), whilst this figure was 2.58 times in girls (95%CI = 1.62-4.12). Among girls, PV was associated with suicidal thoughts (adjusted OR = 4.68; 95%CI = 2.29-9.54), posttraumatic stress (aOR = 4.53; 95%CI = 2.44-8.41) and depression (aOR = 2.65; 95%CI = 1.25-5.63). Among boys, an association was only detected between PV and depression (aOR = 1.82; 95%CI = 1.00-3.33). CONCLUSION: The findings demonstrate that PV is common among both sexes in urban disadvantaged settings across the world, and that it is associated with poor mental health outcomes in girls, and with poor health status in both girls and boys. Clearly, prevention interventions are failing to address violence exposure across multiple contexts, but especially within community settings and in Johannesburg. Interventions are needed to identify adolescents exposed to PV and link them to care, with services targeting a range of mental health conditions among girls and perhaps focusing on depression among boys.

The Big Role of Small RNAs in Anxiety and Stress-Related Disorders.

In the study of complex, heterogeneous disorders, such as anxiety and stress-related disorders, epigenetic factors provide an additional level of heritable complexity. MicroRNAs (miRNAs) are a class of small, noncoding RNAs that function as epigenetic modulators of gene expression by binding to target messenger RNAs (mRNAs) and subsequently blocking translation or accelerating their degradation. In light of their abundance in the central nervous system (CNS) and their involvement in synaptic plasticity and neuronal differentiation, miRNAs represent an exciting frontier to be explored in the etiology and treatment of anxiety and stress-related disorders. This chapter will present a thorough review of miRNAs, their functions, and mRNA targets in the CNS, focusing on their role in anxiety and stress-related disorders as described by studies performed in animals and human subjects.

Structural equation modeling of the relationship between posttraumatic growth and psychosocial factors in women with breast cancer.

OBJECTIVE: Posttraumatic growth (PTG) is a positive psychological change occurring after struggling with a highly challenging experience. The purposes of this study were to investigate how women's demographic and clinical characteristics as well as psychosocial factors are associated with PTG and to reveal the influence of PTG on depressive symptoms. METHODS: Participants were 157 women with breast cancer (BC) who attended a breast oncology clinic at a university hospital in Japan. The questionnaire included demographic and clinical characteristics, social support, coping strategies, depressive symptoms, and PTG. Structural equation modeling was conducted. RESULTS: Coping was directly related to PTG, and social support and having a religion were partially related to PTG. There was a moderate association between social support and coping. PTG mediated the effect of coping on depressive symptoms. PTG as well as a high level of perceived social support and using positive coping decreased depressive symptoms, whereas using self-restraining coping increased depressive symptoms. CONCLUSION: This study indicated the role of coping strategies and social support in enhancing PTG in Japanese women with BC. Furthermore, perceived social support, a positive approach coping style, and PTG may reduce depressive symptoms. Our results suggest that health care professionals should consider whether patients receive enough support from others, and whether the patients are using the appropriate coping style to adapt to stressors associated with the diagnosis and treatment of BC.