PTSD Symptoms and Military-Specific Stigma in United States Veterans

Approximately 80% of reproductive age women experience physical or emotional symptoms prior to onset of menses. Of these women, approximately 20% experience symptoms severe enough to interfere with social functioning and life activities and meet criteria for premenstrual syndrome (PMS). More than 100 different symptoms are associated with PMS, the most common of which include breast tenderness, headache, anger, and depression. Symptom groupings tend to be stable within an individual but can vary distinctly between women. Potential differences in the etiology of symptoms suggest that PMS should not be considered a single condition in research or clinical studies, but rather may represent distinct entities that group by symptom patterns. The primary goal of this study was to identify symptom patterns using factor and cluster analysis. Analysis included: 1) a cohort of healthy women aged 18-30 (n =414); and 2) the subgroup of women meeting established criteria for PMS (n=80). All participants provided information on the occurrence and severity of 26 menstrual symptoms by validated questionnaire. Four distinct symptom patterns emerged: Emotional, Psychological, Physical, and Consumption. Cronbach’s alpha levels demonstrating reliability were high in both the total population (0.71 – 0.90) and in the PMS subset (0.69-0.80). Additionally, cluster analysis identified 4 clusters in both the total population and PMS subset. These symptom patterns were consistent with those identified in prior studies in diverse populations. These observations suggest that distinct subtypes of PMS may exist, and should be considered when recommending treatments and evaluating risk factors.

Background Being diagnosed with HIV/AIDS and commencement of lifelong antiretroviral therapy (ART) with the requirement of high adherence can exacerbate or trigger depressive disorders. Prevalence of major depression is substantially higher in people living with HIV/AIDS (PLWHA) than those in the general population. More than 50% of PLWHA are likely to meet one or more criteria for depression in their lifetime. However, access to interventions for depressive disorders remains limited in Low- and Middle-Income Countries (LMICs) where more than 90% of people with depressive disorders are not receiving formal treatment. The role of evidence-based psychological treatments has been fundamental in reducing the huge treatment gap in LMICs. Although brief, flexible and effective psychological treatments are emerging, issues in relation to their acceptability, feasibility and effectiveness in HIV populations remain unexplored. Therefore, this thesis aimed to adapt and pilot group interpersonal therapy (IPT) for treatment of depressive symptoms including its acceptability and feasibility for PLWHA. This thesis has been the first that attempted to adapt and pilot group IPT for treatment of depression in the HIV population in Ethiopia. The findings of this thesis can serve as a baseline for researchers interested in adapting or developing psychological treatments in the HIV population in Ethiopia. The findings contribute information on the process used in examining acceptability and feasibility of psychological interventions which provides indications for conducting future trials to test the effectiveness of group IPT. Methods First, a systematic review and meta-analysis of randomised controlled trials was conducted to identify the most effective psychological treatments for depressive symptoms for PLWHA in LMICs. Second, a survey of major depressive disorder (MDD) was conducted among PLWHA who were attending ART follow-up appointments at the Felege-Hiwot Referral Hospital (FHRH) in Northwest Ethiopia. The survey served as a baseline to identify cases for piloting of group IPT and helped to identify areas for intervention. Third, the intervention areas were further explored among stakeholders from the ART clinic including PLWHA and this was followed by a stepwise adaptation of the group IPT manual. Furthermore, a formative qualitative study was conducted to examine explanatory models of depression and to explore acceptable contexts for implementation of group IPT. A total of three focus groups were conducted with purposively selected case managers, adherence supporters and service users 2 at the ART clinic. The qualitative data were analysed based on a framework approach using predefined thematic concepts. Fourth, a pilot study of the group IPT intervention was conducted among PLWHA to evaluate the acceptability and feasibility of peer-administered group IPT for treatment of depressive symptoms for PLWHA in Ethiopia. A single-arm, prepost, peer-administered, group IPT interventional study was conducted with 31 consecutively recruited participants. The participants were assigned to four IPT groups for the intervention. A post-intervention evaluation of depressive symptoms, perceived social support (PSS), functional disability and quality of life (QoL) was conducted using the same instruments used at the baseline. No control group was included in this pilot study. Results The findings of the systematic review and meta-analysis revealed that trials that used IPT have shown good effectiveness in treating depressive symptoms of PLWHA in LMICs. The baseline study found 32.5% prevalence of MDD among randomly selected PLWHA (N=393). MDD was positively associated with reduced adherence to ART, functional disability and negatively associated with overall QoL. Overall findings of the baseline and the qualitative study indicated that psychosocial problems are the most important factors that need intervention for depression for PLWHA. The main findings in relation to the adaptation of the WHO group IPT were: i) an IPT group that contains five to ten people was perceived to be acceptable and mixed gender groups were recommended; ii) sessions were recommended to be conducted in private rooms for 1.5 to 2 hours, and on a weekly basis. Findings of the pilot study indicated that depression scores reduced significantly between baseline and postintervention (mean difference (MD)=9.92; t=-7.82; p<0.001). The mean PSS scores (MD=0.79; t=2.84; p=0.009) and the mean QoL scores (MD=0.39, t=4.58, p<0.001) improved significantly between baseline and post-intervention. All the IPT intervention areas (life change, disagreement, grief and loneliness) were found to be applicable to and important areas associated with depression in PLWHA in Ethiopia. Most importantly, disagreement within a family and life change due to HIV/AIDS, such as sickness and separation were faced by almost all PLWHA included in the study, followed by loneliness or social isolation as result of HIV stigma, and grief due to loss of loved ones including a spouse, a child, a mother or a father. Overall evaluation of the pilot indicated that the procedures and outcomes of group based IPT were perceived as acceptable. Participants of the intervention gained benefits in resolving psychosocial problems and reported high satisfaction with counsellors and intervention setting. The eight weekly sessions that lasted around two hours were acceptable; however, 3 additional sessions were recommended by some counsellors until everyone recovers from depression. Conclusion The overall findings of this thesis suggested that group IPT was found to be acceptable and feasible for PLWHA in Ethiopia. Future studies should focus on examining its effectiveness for treating depressive disorders among PLWHA in Ethiopia.

Introduction: Palliative care is the approach to the care of patients with life-threatening illnesses. An important part of this is the rational use of a pharmacological approach to relieve suffering by addressing the symptom burden of the patient. Palliative care symptoms contribute a great deal to the suffering of the patient and affects quality of life. Different studies across several countries on the palliative care symptoms have identified common symptoms with pain being the most frequent. The WHO Public Health Strategy for palliative care outlines four components: policy, education, implementation and drug availability. These components interlink and each one affects the others. The drugs used for palliative care symptoms should be classified as essential medicines and be available to all patients who need this treatment. Factors influencing the effective pharmacological management of palliative care symptoms include drug availability, policy and the approach of the prescribers. Studies have shown that developing countries rank low in the use of the essential palliative care drugs especially morphine. Aim: The aim of this study was to describe the prevalence of palliative care symptoms and the prescribing and administration patterns in oncology and haematology patients at PGH, as well as exploring the health workers' opinions on the pharmacological approach to these symptoms. Methods: A mixed method approach was used to qualitatively look at the health workers' responses using inductive thematic analysis and quantitatively obtain information on palliative care symptom management from the health workers and patient records. Results: Pain was the commonest palliative care symptom identified by health workers, and evident in the patient records. A list of other palliative care symptoms, and the frequency at which they occurred was compiled in this study. The health workers highlighted drug availability, palliative care education and need to engage some nurses in prescribing some of the palliative care drugs. Fewer than half of the patient records assessed as being in need of palliative care (N = 247) were given medications from the recognized palliative care drug list (N = 101). Conclusion: This study showed that essential medicines for palliative care symptoms are not easily available in Zimbabwe for various reasons that include cost, policy, education and training. Pain and other palliative care symptoms are not adequately managed. Therefore, palliative care is not yet integrated into the health care system in Zimbabwe as mandated by the WHO. Recommendations to improve palliative care symptom treatment are suggested.

A mixed-methods approach was utilised in order to explore the impact of group Music Therapy on the negative symptoms of forensic clients with schizophrenia. Eight participants were involved in this exploratory study at Valkenberg hospital in the Western Cape, South Africa. The Music Therapy intervention consisted of eight sessions over a period of six weeks. Qualitative data were collected through video footage, with three excerpts being selected for thick descriptions to be written and, subsequent to the process of therapy, eight semi-structured interviews were conducted with the participants. Quantitative data were generated by structured interviews with the eight participants individually using the PANNS test both before and after the music therapy process. Qualitative data were analysed using thematic analysis, while the quantitative data were presented through descriptive statistical analysis, and a paired sample t-test was conducted. Findings suggest that group Music Therapy affords forensic adult clients in a psychiatric hospital who are diagnosed with schizophrenia benefits in relation to their negative symptoms. The themes that emerged through thematic analysis were ‘Holding’, ‘Positive Experiences of Music Therapy’, ‘Togetherness’, ‘Activation’, ’Flexibility’ and ‘Inflexibility’. The quantitative data shows an overall improvement in the negative symptoms. A paired sample t-test calculates this improvement as too small to be statistically significant. However, the overall improvement shown in the quantitative data suggests the possibility that the group Music Therapy intervention may have effected a gradual positive shift over time and this requires further research. Although participants still displayed negative symptoms in their daily life in the ward, music therapy offered an environment in which well-being could be experienced and expressed. / Mini Dissertation (MMus)--University of Pretoria, 2016. / Music / MMus / Unrestricted

MPH / Department of Public Health / See the attached abstract below

The current study investigated a model explaining sexual assault victims’ severity of trauma symptoms that incorporated multiple stigma constructs. Integrating the sexual assault literature with the stigma literature, this study sought to better understand trauma-related outcomes of sexual assault by examining three levels of stigma—cultural, social, and self. Results showed self-stigma was significantly and positively related to trauma symptom severity. Thus, results revealed that the internalized aspect of stigma served as a mechanism in the relation between sexual assault severity and increased levels of trauma symptom severity, highlighting the importance of assessing self-stigma in women reporting sexual assault experiences.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Introduction: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. Results: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother–child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3–30.2) and 6.9% (95% CI: 6.1–7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85–1.30). The sample did not have moderate or severe malnutrition. Conclusions: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done. / Revisión por pares

Background: Adolescent female depressive symptomatology is an unrecognized mood disorder that impairs health in adolescence or adulthood. However, the long-term effects of pre-pregnancy depressive symptoms on birth outcomes in adulthood have not been given adequate empirical assessments. Method: In this study, we assessed the relationship between the life time duration of depressive symptoms over a 14-year period and birth outcomes (LBW and PTB) among a sample of 6023 female respondents who took part in the National Longitudinal Study of Adolescent to Adult Health (Add Health). We used the generalized estimating equation (GEE) models to assess these relationships. Results: Exposure to elevated depressive symptoms in late adolescence, but not in adulthood, was associated with increased odds of LBW by more than 2-fold in early and young adulthoods (adjusted odds ratio [aOR] = 2.19; 95% confidence interval, CI: 1.56, 3.08). Depressive symptoms in early adulthood were independently associated with increased odds of PTB and were higher for black mothers. Maternal race modified the relationship between consistent reporting of depressive symptoms in adolescence and LBW or PTB in adulthood. Conclusion: This study provides compelling evidence that effects of elevated depressive symptomatology on LBW or PTB appear to be linked to a specific development period in adolescence. National policies to address social inequalities and stratification particularly in health at all stages of human development, will provide an important step in reducing depressive symptoms prior to early adulthood and in pregnancy and childbirth.

This secondary analysis describes the additional psychological symptoms experienced by women in substance abuse treatment who have an alcohol use disorder (AUD) in addition to a drug use disorder (DUD). Results show high levels of certain patterns of psychological symptoms, which include Paranoid Ideation, Phobic Anxiety, Anxiety, and Psychoticism, on the Brief Symptom Inventory (BSI) subscales. Also, age had an adverse effect, with Depression and Psychoticism scores higher with increasing age. Nurse practitioners are ideally situated to assess and screen for patterns of co-occurring psychological symptoms in women with an AUD, which can complicate treatment and lead to practice implications.