Text in Afrikaans / This study is aimed at the development of strategies for therapists to be used with adolescents and late adolescents (15 to 20 years of age) who have lost a loved one. This will be done by focussing on the redefining of identity as a way of becoming. The starting point of the study is to be found in the problem formulation that the process of becoming of adolescents who have suffered the loss of a loved one, may be blocked because they do not have the necessary skills to overcome the loss. The second problem is that therapists do not have the necessary skills to empower these adolescents so that the redefining of identity can be achieved. / Social work / D. Diac. (Spelterapie)

Total institutions' (which include prisons) unique context prescribes "confinement" of inmates. Coping mechanisms applied "outside" (especially the ability to create distance from stressful events) is thus ineffective. Another common feature is lack of privacy, which may result in "forced intimacy" - individuals being forced into a situation of physical and psychological "invasion" (beyond the norm) of their person/personal space. Victims lose control over intimate decisions, including who may and may not be intimate with them. Within prisons, gangs "force intimacy" by sexually victimizing inmates, taking advantage of the context to heighten their power, and to control inmates "under" them. Four (subjects) victims' experiences and means of adaptation/ empowerment were investigated phenomenologically. Results indicated that inadequately empowered victims suffer prolonged and repeated victimization - a continued "posttraumatic stress disorder" - which is more traumatizing and draining than one circumscribed traumatic event (due to its intensity, immobilization and resulting drastic change of "personality"). / Psychology / M.A. (Clinical Psychology)

The purpose of this study was to investigate whether a psycho-educational intervention program could support traumatised people to increase their mental toughness. Mental toughness is a well proven phenomenon in sports psychology as well as in leadership in the corporate world. I wanted to apply the use of mental toughness in trauma. Literature was consulted to understand the phenomena of mental toughness and trauma respectively. The corresponding aspects of mental toughness and trauma were selected for the literature review and many similarities between mental toughness and trauma were discovered. The corresponding aspects included action taking, the importance of the “self”, facing negativity and adversity, the importance of support systems, flexibility and adjustment, dealing with guilt and self-blame, the role of self-talk, people’s perceptions, goal-setting, commitment, helplessness / learned helplessness and dealing with stress. I used the corresponding aspects to compile a psycho-educational intervention programme to support traumatised persons to develop increased mental toughness that will support them to better deal with trauma. A valid and reliable psychometric instrument, the MTQ48 (Mental Toughness Questionnaire 48), has been successfully used to determine people’s mental toughness in sports psychology and in corporate management, but has never been tested before in supporting traumatised people. An action research design was employed, where both qualitative as well as quantitative methods were used. This is also known as a mixed research design. Eight traumatised people took part in the research which was presented weekly, as individual sessions, over eight weeks. Data collection methods included questionnaires, observation and individual therapy. The results of the study indicated that seven of the eight participants’ overall mental toughness increased after the intervention program, and four of the eight participants’ mental toughness components increased. As an additional benefit, all respondents indicated that they could better deal and cope with their trauma after the intervention program. The conclusion could be drawn that the psycho-educational intervention program was successful in supporting the traumatised participants to increase their mental toughness. / Psychology of Education / D. Ed. (Psychology of Education)

The purpose of this study was to investigate factors that influence resilience after trauma among internally displaced persons in Kiambaa village, Uasin Gishu County, Kenya. The rationale, the problem statement, the objectives as well as the research questions and the theoretical framework were presented in chapter one. The theoretical concepts of Richardson’s “meta-theory of resilience and resiliency” and Joseph and Linley “organism valuing theory” guided this study. The problem statement posited revealed that when people experience tragic events such as violence they get traumatized. Despite this, there are individuals who are able to adopt and bounce back with minimal disruptions to their lives, a factor referred to as resilience. Chapter two presented related literature by reviewing empirical research studies on the internal and external factors that contribute to resilience after trauma. Chapter three discussed the methodology of the study. The study adopted a mixed design approach. The target population for this study was 50. It comprised all individuals who were victims of the fire tragedy at Kiambaa village. Twenty two respondents for this study were selected from the target population using purposive and snow ball sampling techniques. Questionnaires and unstructured interview schedule were the main tools of data collection. The Big Five Inventory (BFI) by John, Donahue, & Kentle, (1991) personality were used to classify respondents’ personalities.The 25 item Connor-Davidson Resilience Scale 25 (CD-RISC-25) (used with permission) (Connor, & Davidson, 2003) was used to measure the resilience levels of the respondents. Means and Standard deviations were computed to quantify the amount of variation or dispersion of resilience among the respondents. Responses from research tools were cleaned, coded and entered into Statistical Package for Social Sciences (SPSS) for analysis. Descriptive data were organized into themes and categories and presented according to the objectives of the study. Pearson product moment correlation analysis, Chi square correlation analysis and Spearman rank correlation analysis were computed to establish the relationships between study variables. Chapter four presented findings in form of tables, cumulative frequency counts, graphs and charts. The major findings of the study were as follows: The internal factors that contribute to resilience in individuals were age, gender and personality. However, gender had a greater influence on individuals’ resilience levels. Other factors included personality and age. The main external factors that contributed to resilience in individuals of the fire tragedy at Kiambaa were spirituality and social support. The results of a Pearson correlation analysis confirmed a strong positive correlation between social support and resilience of individuals (r=0.835, p<0.05). Chapter five presented conclusions arising from the findings which indicated that age, gender, personality, spirituality and social support are significant internal and external factors that influence resilience levels of individuals. The study recommends that there is need for professionals working with traumatized individuals to be more familiar with these factors that contribute to resilience. The researcher also recommends that there is need to extend the present study by including other potentially important variables such as a wider range of psychosocial resources or health-related variables. Understanding the influence and importance of these variables may help to clarify the role of resilience in post-disaster adaptation. In addition, the researcher recommends that there is need to further extend the study to investigate the relationship between psychological resilience and another positive outcome, such as posttraumatic growth (PTG). / Psychology / Ph.D. (Psychology)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O transtorno do estresse pós-traumático (TEPT) e alterações lipídicas são as temáticas principais dessa Dissertação. Seu objetivo principal foi investigar a associação entre o TEPT e as concentrações séricas de colesterol total (CT), lipoproteína de baixa densidade (LDL), lipoproteína de alta densidade (HDL) e triglicerídeos (TG) através de uma revisão sistemática da literatura seguida de metanálise. Adicionalmente, a relação entre essas variáveis lipídicas e os grupos de sintomas do TEPT revivescência, esquiva/entorpecimento emocional e hiperestimulação autonômica foi avaliada em um segundo estudo com dados primários. A metanálise incluiu 18 artigos, totalizando 2.110 indivíduos com TEPT e 17.550 indivíduos sem TEPT. As diferenças de médias ponderadas (DMP) mg/dL dos parâmetros lipídicos foram calculadas por modelos de efeitos aleatórios e modelos de meta-regressão foram ajustados para investigar possíveis fontes de heterogeneidade. O estudo encontrou que o TEPT foi associado a um pior perfil lipídico quando comparados a controles sem o transtorno (DMPCT= 20,57, IC 95% 12,21 28,93; DMPLDL= 12,11, IC 95% 5,89 18,32; DMPHDL= -3,73, IC 95% -5,97 -1,49; DMPTG= 35,87, IC 95% 21,12 50,61). A heterogeneidade estatística entre os resultados dos estudos foi alta para todos os parâmetros lipídicos e a variável que mais pareceu explicar essas inconsistências foi idade. O segundo artigo faz parte de um estudo maior conduzido em 2004 com 157 policiais do sexo masculino do Batalhão de Choque da Polícia Militar do Estado de Goiás (BPMCHOQUE). Somente oficiais de férias ou em dispensa inclusive dispensa médica não foram avaliados. O instrumento utilizado para o rastreio do TEPT foi a versão em português para civis da Post-Traumatic Stress Disorder Checklist (PCL-C). Trinta e nove participantes (25%) foram excluídos do estudo: dois porque falharam no preenchimento dos questionários e 37 cujas amostras de sangue não foram coletadas por vários motivos. Neste trabalho, encontrou-se uma forte correlação positiva entre as concentrações séricas de CT e LDL com o grupo de sintomas de hiperestimulação autonômica, somente no grupo TEPT: &#961;= 0,89 (p<0,01) e &#961; =0,92 (p<0,01), respectivamente. Em suma, espera-se que os resultados dessa Dissertação possam colaborar para o estabelecimento de um melhor acompanhamento clínico de pacientes com TEPT, particularmente porque estes parecem estar sob um maior risco de doenças cardiovasculares devido a um pior perfil lipídico. / Post-traumatic stress disorder (PTSD) and lipid profile changes are the main themes of this Dissertation, whose main purpose was to investigate the association between PTSD and serum lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and Triglycerides (TGs). Additionally, the relationship between these serum lipid parameters and PTSD symptom clusters - re-experiencing, avoidance and hyperarousal was assessed in a second study with primary data. The meta-analysis included 18 articles, for an overall number of 2,110 people with PTSD and 17,550 individuals without PTSD. Pooled weighted mean differences (WMD) - mg/dL - of serum lipid parameters were calculated using random effects model and meta-regression models were fitted to investigate the sources of heterogeneity. The study showed that PTSD was associated with worsened lipid profile when compared to controls without PTSD (DMPCT= 20.57, IC 95% 12.21 28.93; DMPLDL= 12.11, IC 95% 5.89 18.32; DMPHDL= -3.73, IC 95% -5.97 -1.49; DMPTG= 35.87, IC 95% 21.12 50.61). Statistical heterogeneity between the results of the studies was high for all lipid parameters and the variable that most explained these inconsistencies was age. The second article is part of a larger study conducted in 2004 with 157 active duty male police officers of an elite unit of the Police Force of the State of Goiás-Brazil (BPMCHOQUE). Only officers on vacation or on leave including those on sick leave were not assessed. The diagnostic tool applied to screen for PTSD was a Portuguese version of the PTSD Checklist Civilian Version (PCL-C). Thirty nine (25%) participants were excluded: 2 respondents who failed to fill out the questionnaires and 37 whose blood samples were not collected for various reasons. The study found a significant and strong positive correlation between TC and LDL-C with hyperarousal symptom cluster, only in the full PTSD group: &#961;= 0.89 (p<.01) and &#961;= 0.92 (p<.01), respectively. As a synthesis, the results found in this Dissertation can contribute to a better clinical follow-up of PTSD patients, especially because they appear to be at higher risk for cardiovascular diseases due to worsened serum lipid profile.

Made available in DSpace on 2016-06-02T20:30:09Z (GMT). No. of bitstreams: 1 5826.pdf: 1477811 bytes, checksum: 7e98346cb582d2360d7e7ca4a0cb751a (MD5) Previous issue date: 2014-02-20 / Universidade Federal de Minas Gerais / School victimization may favor the occurrence of traumatic symptoms and Post Traumatic Stress Disorder (PTSD). This Doctoral Thesis had the following objectives: validate the American retrospective instrument Student Alienation and Trauma Survey - R (SATS-R), to Brazil, in terms of construct and content validity; characterize how violence is expressed at school, identifying the main types of violence, the worst school events experienced by students, the frequency and duration of these events, main perpetrators, as well as victims' characteristics (age, grade and type of school); investigate the occurrence of traumatic symptoms, especially PTSD, after the worst school experience; analyze the association between PTSD symptoms and variables associated with the worst school experience, and investigate the relationship between the explanatory variables (individual characteristics and aversive school experiences), and development of PTSD symptoms, using an ordinal logistic regression model. The study included 691 students (54.8% female and 45.2% male), of a public university in São Paulo State, Brazil, who responded to Portuguese versions of the Student Alienation and Trauma Survey-R (SATS-R) and the Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C). In terms of content validity, the following procedures were conducted: translation, back-translation, semantic equivalence, instrument analysis by experts in the field, and a sample assessment of the target population; for construct validity, an exploratory factor analysis was conduct and Cronbach's alpha was calculated. The study results indicate the feasibility of using the instrument in the Brazilian context for research purposes. Frequency of victimization types reported by participants were: relational violence (at least one item reported by 85.2%); verbal violence (77.7%); physical violence (50.8%); unfair discipline (43.1%); property violence (33.4%); witnessing violence (27.9%); and sexual violence (21.4%). The most frequent types of worst school experiences described were: relational (35.7%), and verbal violence (27.4%). Girls experienced more episodes of verbal, relational and sexual violence, and boys experienced more physical violence and unfair discipline, and the aggressors were mostly male students. The mean age when these worst experiences occurred was 12.3 years, and although most events occurred at low frequency and with short duration, a considerable percentage of participants indicated a duration of "years", particularly in verbal and relational victimization cases. Most participants indicated that they were greatly bothered by their worst school experience, and 7.8% had PTSD symptons after experiencing this event. The percentage of participants with clinically significant scores on the subscales ranged from 4.7% (somatic symptoms) to 20% (hypervigilance), and described symptoms frequently in the literature, such as depression, hopelessness, cognitive difficulties and traumatic event recollection. Significant variables for the regression model were: age, duration and discomfort after the worst experience; relational violence; and verbal violence. In general, student who expressed the greatest discomfort, reported traumatic experiences that were longer in duration, occured when they were older, and the greater the number of verbal and relational victimization events experienced, the greater the possibility of presenting clinically significant symptoms of PTSD. Despite the limitations of the retrospective methodo, the study obtained interesting results which coincide with the literature, drawing attention to the long-term effects of school victimization. In addition, these results may contribute to the development of new research on the topic, as well as offering treatment parameters for victims who were traumatized in school, improving school violence prevention programs. / A vitimização escolar pode favorecer a ocorrência de sintomas traumáticos, como de Transtorno de Estresse Pós-Traumático (TEPT). A presente Tese de Doutorado teve os seguintes objetivos: buscar evidências de validade de conteúdo e de constructo do instrumento retrospectivo norte-americano Student Alienation and Trauma Survey R (SATS-R), para o Brasil; caracterizar como a violência se expressa na escola, identificando os principais tipos de violência, as piores experiências escolares vivenciadas por estudantes, a frequência e a duração desses eventos, os agressores principais, bem como as características das vítimas (idade, série e tipo de escola); investigar a ocorrência de sintomas traumáticos, principalmente TEPT, nos estudantes, após a vivência da pior experiência escolar; analisar a associação dos sintomas de TEPT a variáveis relacionadas à pior experiência escolar; e investigar o relacionamento de variáveis explicativas (características do indivíduo e das experiências escolares aversivas vivenciadas) e o desenvolvimento de sintomas de TEPT, por meio de um modelo de regressão logística ordinal. Participaram do estudo 691 estudantes (54,8% do sexo feminino e 45,2% do masculino), de uma universidade pública do interior do estado de São Paulo, que responderam a versões brasileiras dos instrumentos Student Alienation and Trauma Survey e Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C). Para a validação de conteúdo, foram feitas: tradução, retrotradução, equivalência semântica, análise do instrumento por profissionais da área e avaliação por amostra da população alvo; para a validação de constructo foi realizada análise fatorial exploratória e cálculo do alfa de Cronbach do instrumento. Os resultados do estudo apontaram para a viabilidade da utilização do instrumento no contexto brasileiro para fins de pesquisa. A frequência dos tipos de vitimização relatados pelos participantes foi: violência relacional (ao menos um item relatado por 85,2%), violência verbal (77,7%) violência física (50,8%), disciplina injusta (43,1%), violência contra o patrimônio (33,4%), presenciar violência (27,9%) e violência sexual (21,4%). Os tipos de piores experiências mais frequentes descritos foram violência relacional (35,7%) e verbal (27,4%). As meninas sofreram mais episódios de violência verbal, relacional e sexual e os meninos violência física e disciplina injusta, sendo que os agressores foram, em sua maioria, estudantes e do sexo masculino. A idade média de ocorrência das piores experiências foi 12,3 anos e, embora a maior parte dos eventos tenha ocorrido em baixa frequência e com curta duração, porcentagem considerável dos participantes apontou duração de anos nos casos de vitimização verbal e relacional, principalmente. A maior parte dos participantes apontou ter se incomodado muito com a pior experiência escolar, sendo que 7,8% apresentaram indicação de TEPT após a vivência dessa experiência. A porcentagem de participantes com escores clinicamente significativos nas subescalas variou de 4,7% (sintomas somáticos) a 20% (hipervigilância), sendo frequentes sintomas comumente descritos na literatura como depressão, desesperança, dificuldades cognitivas e rememoração do evento traumático. As variáveis significativas para o modelo de regressão realizado foram: idade, duração e incômodo após a pior experiência, violência relacional e violência verbal. De forma geral, quanto maior o incômodo do estudante, maior a duração da experiência, maior a idade e quanto mais eventos vivenciados de vitimização relacional e verbal, maior a possibilidade de apresentação de sintomas clinicamente significativos de TEPT. Apesar das limitações da metodologia retrospectiva, foram obtidos resultados interessantes que coincidem com a literatura, chamando a atenção para os efeitos a longo prazo da vitimização escolar. Além disso, o estudo pode contribuir para o desenvolvimento de novas pesquisas sobre o tema, bem como oferecer parâmetros de tratamento às vítimas que apresentem sintomas decorrentes de experiências traumáticas na escola, podendo aprimorar, também, programas de prevenção à violência escolar.

Made available in DSpace on 2016-06-02T19:22:49Z (GMT). No. of bitstreams: 1 1958.pdf: 10581288 bytes, checksum: 1dc2b5264737849b6a8842144f1ad052 (MD5) Previous issue date: 2008-05-21 / Financiadora de Estudos e Projetos / The post-traumatic stress disorder (PTSD) affects a portion of subjects exposed to a traumatic event. This disorder leads to long-term alterations in the hypothalamus-pituitaryadrenal (HPA) axis, autonomic and cognitive function. The aim of our study was to evaluate whether the animal model of PTSD proposed for rats could be used in mice and, to evaluate the effect of benzodiazepine, tricycle antidepressant and selective serotonin reuptake inhibitor drugs in the PTSD model. For this we realized the following experiments: Experiment 1- The test consisted of exposure the male mice to inescapable electric footshock (0.3 mA) in the black side (BS) of the black-white box (BW). In the 7th, 14th and 21th day, mice were reexposed to the traumatic reminder on the white side (WS) or BS for 2 min, without footshock. In the 29th day, the animals were submitted to elevated plus-maze (EPM) for record the anxiety indexes [percentage of open arm entries (%OA) and percentage of open arm time (%OT) and as well as general locomotor activity, closed arm entries (CE)]. On day 34 the same animals were submitted to BW test for record the latency to escape (LE) from WS and time spent on WS of the BW box. Experiment 2 the same procedure of experiment 1 was performed, except that the animals were re-exposed at 7th, 14th e 21th days to reminder situation only in WS of BW box for 2 min, without footshock. On day 29th, the animals were exposed to EPM, 30 min after receiving treatment with midazolam. In 34th day the same animals after receiving treatment with midazolam were submitted to BW box test. Experiment 3, 4 and 5 - the same procedure was adopted from experiment 2, except that in 29th day, the animals were not submitted to EPM test and on 34th day 30 minutes after treatment with midazolam, imipramine and sertraline were submitted to BW box. Two-way ANOVA (stimulus x place remainder or treatment) followed by Duncan test showed that PTSD model increased anxiety in mice (P<0.05). The re-exposure in BS promoted anxiogenic-like effect extinction of the model. The midazolam treatment (1.0 and 2.0 mg/kg, i.p.) produced anxiolytic-like effect in maze-mice (P < 0.05) and the 0.5 mg/kg decreased latency to escape of WS (P < 0.05) of BW box and increased the exploratory activity, suggesting involvement of this GABA-benzodiazepine agonist on this PTSD modulation. The EPM test does not interfere in the evaluation of the BW test. It is important to note that no other behaviors were significantly altered by imipramine per se (P < 0.05). The sertraline (5.0 mg/kg), selective serotonin reuptake inhibitor, produced anxiolytic-like effect in the BW test (P < 0.05) and increase exploration activity. These results suggest that the employed PTSD model to study neurobiological disturbances associated with this disorder. / O Transtorno de Estresse Pós-Traumático (TEPT) afeta uma parcela de indivíduos que são expostos a um evento traumático. Este distúrbio induz em longo prazo alterações no eixo HPA, autonômicas e cognitivas. O objetivo deste estudo foi avaliar se o modelo animal de TEPT proposto para ratos poderia ser utilizado em camundongos e investigar o efeito dos fármacos benzodiazepínico, antidepressivo tricíclico e inibidor seletivo da recaptação de serotonina, no modelo de TEPT. Para isso realizamos os seguintes experimentos: Experimento 1- O teste consistiu em submeter camundongos machos, Suíço-albino ao choque inescapável (0,3mA) nas patas no lado escuro (LE) da caixa claro-escuro (CE). No 7º, 14º e 21º dia os camundongos foram reexpostos a situação de lembrança no lado claro (LC) ou LE da caixa por 2 min, sem choque. No 29º dia os animais foram expostos ao labirinto em cruz elevado (LCE), para o registro dos índices de ansiedade [porcentagem de entradas (%EBA) e de tempo gasto nos braços abertos (%TBA) e atividade locomotora, entrada nos braços fechados (EBF)]. No 34º dia os mesmos animais foram submetidos ao teste CE para o registro da latência de fuga (LF) e do tempo gasto no LC da caixa CE. Experimento 2 o mesmo procedimento do experimento 1 foi adotado, exceto que os animais foram reexpostos no 7º, 14º e 21º dia a situação de lembrança apenas no LC da caixa por 2 min, sem choque. No 29º dia os animais, 30 min após receberem tratamento com midazolam, foram expostos ao labirinto em cruz elevado (LCE). No 34º dia os mesmos animais após receberem o mesmo tratamento farmacológico, foram submetidos ao teste CE. Experimento 3, 4 e 5 o mesmo procedimento do experimento 2 foi adotado, exceto que no 29º dia os animais não foram submetidos ao LCE e no 34º dia, 30 min após receberem tratamento com midazolam, imipramina e sertralina foram submetidos ao teste CE. A ANOVA de duas vias (estímulo x local da SL ou tratamento) seguido do teste de Duncan mostrou que o modelo de TEPT produziu aumento da ansiedade nos camundongos (P < 0,05). As reexposições no LE promoveram extinção do efeito ansiogênico do modelo. O tratamento com midazolam (1,0 e 2,0 mg/kg) produziu efeito ansiolítico no LCE (P < 0,05), e a dose de 0,5 mg/kg reduziu a latência de fuga do ambiente claro (P < 0,05) no teste CE e aumentou a atividade exploratória, sugerindo o envolvimento deste agonista GABA-benzodiazepínico na modulação do TEPT. O LCE não interferiu na avaliação do teste CE. A imipramina não apresentou efeito sobre os camundongos (P > 0,05), ou seja, ausência de efeito deste antidepressivo tricíclico nos sintomas do TEPT. A sertralina (5,0 mg/kg) produziu efeito ansiolítico no teste CE (P < 0,05) e aumento na atividade exploratória, mostrando o envolvimento deste inibidor seletivo da recaptação de serotonina na modulação do modelo. Estes resultados sugerem que o modelo de TEPT utilizado poderá ser empregado para o estudo das alterações neurobiológicas envolvidas neste distúrbio.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O transtorno do estresse pós-traumático (TEPT) e alterações lipídicas são as temáticas principais dessa Dissertação. Seu objetivo principal foi investigar a associação entre o TEPT e as concentrações séricas de colesterol total (CT), lipoproteína de baixa densidade (LDL), lipoproteína de alta densidade (HDL) e triglicerídeos (TG) através de uma revisão sistemática da literatura seguida de metanálise. Adicionalmente, a relação entre essas variáveis lipídicas e os grupos de sintomas do TEPT revivescência, esquiva/entorpecimento emocional e hiperestimulação autonômica foi avaliada em um segundo estudo com dados primários. A metanálise incluiu 18 artigos, totalizando 2.110 indivíduos com TEPT e 17.550 indivíduos sem TEPT. As diferenças de médias ponderadas (DMP) mg/dL dos parâmetros lipídicos foram calculadas por modelos de efeitos aleatórios e modelos de meta-regressão foram ajustados para investigar possíveis fontes de heterogeneidade. O estudo encontrou que o TEPT foi associado a um pior perfil lipídico quando comparados a controles sem o transtorno (DMPCT= 20,57, IC 95% 12,21 28,93; DMPLDL= 12,11, IC 95% 5,89 18,32; DMPHDL= -3,73, IC 95% -5,97 -1,49; DMPTG= 35,87, IC 95% 21,12 50,61). A heterogeneidade estatística entre os resultados dos estudos foi alta para todos os parâmetros lipídicos e a variável que mais pareceu explicar essas inconsistências foi idade. O segundo artigo faz parte de um estudo maior conduzido em 2004 com 157 policiais do sexo masculino do Batalhão de Choque da Polícia Militar do Estado de Goiás (BPMCHOQUE). Somente oficiais de férias ou em dispensa inclusive dispensa médica não foram avaliados. O instrumento utilizado para o rastreio do TEPT foi a versão em português para civis da Post-Traumatic Stress Disorder Checklist (PCL-C). Trinta e nove participantes (25%) foram excluídos do estudo: dois porque falharam no preenchimento dos questionários e 37 cujas amostras de sangue não foram coletadas por vários motivos. Neste trabalho, encontrou-se uma forte correlação positiva entre as concentrações séricas de CT e LDL com o grupo de sintomas de hiperestimulação autonômica, somente no grupo TEPT: &#961;= 0,89 (p<0,01) e &#961; =0,92 (p<0,01), respectivamente. Em suma, espera-se que os resultados dessa Dissertação possam colaborar para o estabelecimento de um melhor acompanhamento clínico de pacientes com TEPT, particularmente porque estes parecem estar sob um maior risco de doenças cardiovasculares devido a um pior perfil lipídico. / Post-traumatic stress disorder (PTSD) and lipid profile changes are the main themes of this Dissertation, whose main purpose was to investigate the association between PTSD and serum lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and Triglycerides (TGs). Additionally, the relationship between these serum lipid parameters and PTSD symptom clusters - re-experiencing, avoidance and hyperarousal was assessed in a second study with primary data. The meta-analysis included 18 articles, for an overall number of 2,110 people with PTSD and 17,550 individuals without PTSD. Pooled weighted mean differences (WMD) - mg/dL - of serum lipid parameters were calculated using random effects model and meta-regression models were fitted to investigate the sources of heterogeneity. The study showed that PTSD was associated with worsened lipid profile when compared to controls without PTSD (DMPCT= 20.57, IC 95% 12.21 28.93; DMPLDL= 12.11, IC 95% 5.89 18.32; DMPHDL= -3.73, IC 95% -5.97 -1.49; DMPTG= 35.87, IC 95% 21.12 50.61). Statistical heterogeneity between the results of the studies was high for all lipid parameters and the variable that most explained these inconsistencies was age. The second article is part of a larger study conducted in 2004 with 157 active duty male police officers of an elite unit of the Police Force of the State of Goiás-Brazil (BPMCHOQUE). Only officers on vacation or on leave including those on sick leave were not assessed. The diagnostic tool applied to screen for PTSD was a Portuguese version of the PTSD Checklist Civilian Version (PCL-C). Thirty nine (25%) participants were excluded: 2 respondents who failed to fill out the questionnaires and 37 whose blood samples were not collected for various reasons. The study found a significant and strong positive correlation between TC and LDL-C with hyperarousal symptom cluster, only in the full PTSD group: &#961;= 0.89 (p<.01) and &#961;= 0.92 (p<.01), respectively. As a synthesis, the results found in this Dissertation can contribute to a better clinical follow-up of PTSD patients, especially because they appear to be at higher risk for cardiovascular diseases due to worsened serum lipid profile.

INTRODUÇÃO: o Transtorno de Estresse Pós-Traumático (TEPT) se caracteriza pelo desenvolvimento de sintomas específicos após a ocorrência de um evento traumático intenso, envolvendo a participação direta ou não do indivíduo. A prevalência do TEPT na população pode variar entre 1,4% e 11,2% na vida, sendo que mulheres apresentam uma vulnerabilidade maior para o transtorno, apesar dos homens geralmente serem expostos a um número maior de eventos traumáticos. Além de trazer inúmeros prejuízos na vida do sujeito, observam-se altas taxas de comorbidade entre TEPT e Abuso e Dependência de Álcool e Drogas (ADAD), o que por sua vez está associado a níveis mais graves de psicopatologia, maior comprometimento do funcionamento social global, uso mais freqüente de serviços de saúde e pior resposta ao tratamento. OBJETIVOS: 1) examinar a distribuição de eventos traumáticos e a prevalência de TEPT e ADAD de acordo com o gênero dos indivíduos, 2) identificar a prevalência de TEPT por tipo de evento traumático e o risco condicional de TEPT entre homens e mulheres, 3) examinar a existência de comorbidade entre TEPT e ADAD e 4) verificar as associações entre diferentes tipos de eventos traumáticos e ADAD quando são levados em conta no modelo número de traumas, categorias de eventos traumáticos e fatores sócio-demográficos (gênero, idade, anos de escolaridade, estado civil e renda), controlando para o TEPT. MÉTODOS: estudo de corte transversal com uma amostra representativa da região metropolitana de São Paulo (n=2.942). O trabalho é um subprojeto do São Paulo Megacity, parte de uma iniciativa internacional coordenada pela Organização Mundial de Saúde (World Mental Health Survey). As análises utilizaram dados dos módulos de Abuso de Substâncias e Transtorno de Estresse Pós Traumático do Composite International Diagnostic Interview (CIDI) desenhada para produzir diagnósticos do CID-10 e do DSM-IV. A análise estatística utilizou o programa Statistical Analysis System (SAS). Foram aplicados algoritmos às respostas dos módulos clínicos para identificação diagnóstica e as taxas de prevalência foram calculadas em porcentagens, assim como os erros-padrão. Ainda foram levantados os traumas que ocasionaram o TEPT, bem como os riscos condicionais para o desenvolvimento do transtorno. Foram realizadas análises de regressão logística simples para verificar a comorbidade entre TEPT e ADAD e regressões logísticas múltiplas para explorar as associações entre TEPT e ADAD. RESULTADOS: a prevalência de TEPT na vida foi de 3,2% (EP=0,2) e no último ano de 1,6% (EP=0,2). 4,6% das mulheres e 1,6% dos homens desenvolveram o transtorno na vida (OR 3; IC 95% 1,8-4,9); dentre a população com TEPT, o principal fator que desencadeou o transtorno foi morte inesperada de um ente os principais riscos condicionais para o desenvolvimento de TEPT para a população feminina foram agressão sexual e estupro e para a população masculina, sequestro relâmpago e estupro; foi identificada comorbidade entre TEPT e ADAD, porém houve diferença entre homens e mulheres de acordo com o padrão de consumo de substâncias (dependência e abuso) e categoria de substâncias psicoativas (álcool e drogas); o número de traumas é um fator diretamente associado ao ADAD, sendo que a categoria de eventos envolvendo violência intencional mostrou-se associada a todos os padrões de abuso e dependência de álcool e drogas. CONCLUSÕES: foi identificada comorbidade entre TEPT e ADAD, sendo o número de traumas e a categoria de eventos envolvendo violência intencional particularmente importantes na associação com o ADAD. / INTRODUCTION: Post-Traumatic Stress Disorder (PTSD) is characterized by the development of specific symptoms after an intense traumatic event that affects the person directly or indirectly. The lifetime prevalence of PTSD ranges from 1.4% to 11.2%. Women are more vulnerable than men, although men experience more lifetime traumatic events. Other than causing a number of problems in someone´s life, there are high comorbidity rates between PTSD and substance abuse and dependence (SAD), which in turns is associated with worse psychopathological conditions, lower levels of social functioning, more frequent utilization of health care services and worse treatment outcomes. OBJECTIVES: to examine the distribution of traumatic events and the prevalence of PTSD and alcohol/drug abuse and dependence; to examine the distributions of PTSD cases across different types of traumatic events and to investigate the conditional risk of PTSD in females and males; to examine the comorbidity between PTSD and SAD, and to verify the associations between number and different categories traumatic events and SAD when controlling for PTSD. METHODS: cross-sectional study with a probabilistic sample of household residents in the Sao Paulo Metropolitan Area (n=2.942). The study is a subproject of the São Paulo Megacity, a counterpart of an international initiative coordinated by the World Health Organization (World Mental Health Survey). The analysis were based in the substance abuse and PTSD sections of the Composite International Diagnostic Interview (CIDI), created to generate diagnoses of the CID-10 and the DSM-IV. The statistical analyses were calculated by the Statistical Analysis System (SAS) software. Prevalence of the diagnosis and their standard errors were calculated, as well as the traumatic events that led to PTSD cases and the conditional risk of PTSD. A series of simple logistic regressions were performed to examine the comorbidity between PTSD and SAD. Multiple regressions were conducted to examine the associations between number and categories of traumas and SUD after controlling for PTSD. RESULTS: lifetime PTSD prevalence was 3.2% (SE=0.2) and last year´s prevalence was 1.6% (SE=0,2). 4.6% of women versus 1.6% of men had lifetime PTSD prevalence (OR 3,0; CI 95% 1.8-4.9); among the PTSD group, the most frequent traumatic event associated with the disorder was sudden unexpected death of relative or/friend ;in females,sexual assault and rape were associated with the highest conditional risk of PTSD and and rape were associated with the highest conditional risk of PTSD in males; comorbidity between PTSD and SAD was found in the sample, however there were differences between males and females related to the pattern of consumption (dependence and abuse) and type of substance (alcohol and drug); in the multiple regression models, number of traumatic events and interpersonal violence were strongly associated with SAD. CONCLUSIONS: comorbidity between PTSD and SAD was found in the sample, and alcohol abuse and number of traumatic events and well as the category of events involving interpersonal violence were particularly important in the association with PTSD

The aim of this study was to explore the effect a coloring condition had on minimizing anxiety and stress experienced daily by veterans. The effect that coloring had on working memory was also explored. A sample of 24 armed forces veterans were split into two coloring conditions, a mandala and a free draw condition, and asked to complete the Primary Care PTSD Screen, the Perceived Stress Scale and the Brief State Trait Anxiety Inventory. Working memory scores were established via a Backward Digit Recall task; pre-and posttest scores were evaluated for significant differences. Our research suggests the act of coloring, not the coloring condition, resulted in significant decreases in stress and anxiety and an increase in working memory. We also found that participants who suffer from PTSD displayed significant decreases in stress and anxiety and significant increases in working memory when compared to individuals without PTSD.