Background: Posttraumatic-Stress Disorder (PTSD) is less common in older adults than in younger adults, and little is known about specific risk factors for PTSD in older adults. We investigated the association between self-esteem in late adolescence and PTSD in older adults. Method: Using a cohort design, 1,436 individuals who had been assessed approximately 40 years earlier in their junior and senior year of high school with the Rosenberg Self-Esteem Scale (RSES) were evaluated for PTSD using the PTSD Checklist (PCL-17). Results: Fully controlled logistic regression models indicated that lower self-esteem in late adolescence predicted PTSD in the overall sample of older adults but not in the veterans-only subgroup. Limitations: The main limitations include self-completed measures to estimate PTSD diagnosis and lack of specific information on traumatic events. Conclusions: Our findings suggest that lower self-esteem from a young age may be a risk factor for PTSD in older age.

This paper aims to explore and discuss the points found in published research articles addressing posttraumatic stress disorder in children following the Bosnian Genocide, the terrorist attacks of 9/11, and Hurricane Katrina. The articles vary in their emphasis, methods, and conclusions, but all focus in one way or another on how the occurrence of war, terrorism, and natural disaster have resulted in posttraumatic stress disorder symptoms in youth. Intervention following traumatic events, however, rarely focus on treating mental health needs, and instead, focus on resolving any primary needs of vulnerable populations. The recommended treatment strategies for PTSD in youth require high quality mental health care and great accessibility for victims of trauma. Considering the high prevalence of PTSD in children following traumatic experiences, treatment of PTSD symptoms is necessary to ensure that youth can fully function in their daily lives without a constant reminder of the trauma they experienced.

Posttraumatic stress disorder (PTSD) has been linked to heightened engagement in risky sexual behavior (RSB) across diverse samples, and impulsivity has been postulated as a potential linkage (Weiss et al., 2012). Limited information has been published on the role that impulsivity can play in strengthening the relationship between PTSD and RSB in college students. The current study examined the moderating role of impulsivity dispositions: negative/positive urgency, (lack of) perseverance, sensation seeking, and (lack of) premeditation on the association between PTSD symptoms and past-year RSB among a sample of 221 undergraduate students (77.4% female) with at least one DSM-5 defined traumatic event. Negative binomial regression models were conducted to explore each impulsivity disposition’s moderating effect on the relationship between PTSD symptoms and RSB. PTSD symptoms and positive urgency, (lack of) perseverance, and sensation seeking were independently associated with RSB. Significant interactions were found between negative urgency and PTSD symptoms, and (lack of) premeditation and PTSD symptoms, such that PTSD symptoms were more strongly linked to RSB among individuals high in these impulsivity dispositions. The present study expands on the limited literature on the role specific impulsivity dispositions can have in the relationship between PTSD and RSB in trauma-exposed college students.

Posttraumatic stress disorder (PTSD) is a serious condition with debilitating symptoms which affects military veterans and has been understudied in the older population. Aside from treating the veterans of the Vietnam War and World War II, as service members from more recent conflicts age, the mental healthcare system needs to be able to treat them with empathy and effective therapies. As there is a need for future research focusing on this population, this paper reviews the current literature and utilizes Grounded theory to further the research related to PTSD in aging veterans. A selection of mental health clinicians with experience treating this population were interviewed and the results discussed. Those therapists who work for the Department of Veterans Affairs (VA) most often use Cognitive Behavioral Therapy to treat their clients, with Prolonged Exposure Therapy being the next most popular therapeutic modality. Those clinicians who are separate from the VA are able to employ therapies such as Cognitive Restructuring or blend theories to meet the precise needs of individual veterans. Also addressed are the differences and commonalities in PTSD symptoms between veterans of different conflict eras. Based upon these interviews, suggestions were made for changes to the treatment of military-related PTSD.

While there is considerable research linking trauma to psychological distress, such as posttraumatic stress disorder (PTSD), among military populations, some service members may develop other variants of psychological difficulties following exposure to traumatic life events. For example, moral injury, a more recently studied outcome within the field of trauma, is conceptualized to occur when a person perceives their response to a morally challenging situation as a transgression that may lead to an incongruence with their morals producing moral emotions (i.e., shame, guilt, and anxiety; Litz et al., 2009). The current study investigated the role of self-compassion in the relationship between moral injury and psychological distress (i.e., PTSD and depression) among a sample of 216 military veterans recruited from TurkPrime online panels. Among these military veterans, a conditional process analysis of our moderated mediation model suggests an indirect effect of moral injury predicting depression symptoms through guilt, Index = 1.469, SE = .460, 95% CI [.602, 2.409] and shame, Index = -.803, SE = .346, 95% CI [-1.552, -.161] was conditioned on different levels of self-compassion. Findings are expected to have important implications for treatment conceptualization for military populations.

Posttraumatic stress disorder (PTSD) affects more than 60% of Cambodian immigrants in the United States. However, researchers do not yet know why less than 5% of Cambodian immigrants are accessing mental health services. This qualitative study involved investigation of participants' perceptions of how PTSD is manifested in the Cambodian immigrant community to understand barriers to mental health services access. The social ecological theory provided a frame for understanding how traditions, values, culture, and beliefs affect Cambodian immigrants' perceptions of PTSD and the mental health system. Data was collected from semi structured interviews of 13 participants, 18 to 70 years of age, residing in Stockton, California, who shared their perceptions of PTSD. NVIVO was used to organize each data category for thematic analysis. The themes included: (a) hearing of PTSD, (b) meaning of PTSD, (c) contributing factors, (d) healing practices, (e) recognition of PTSD, (f) reactions, (g) reasons most often given, (h) encouraging family members, (i) healing practices, (j) ways of helping, (k) counseling, (l) medications, (m) mental health support, (n) mental health resources, and (o) want more information. The findings indicated that stigma continues to be one of the barriers in accessing mental health services, and that Cambodian immigrants have a strong desire to learn more about mental health and mental health services in San Joaquin County. Results from this study contribute to an area of mental health research that is limited, and they may be used by researchers and mental health practitioners to improve cultural understanding and awareness among diverse communities and help reduce the stigma regarding mental health issues.

acase@tulane.edu

BACKGROUND: Female veterans are at risk for stress-related physical disorders given unique environmental stress factors, high rates of trauma exposure and a heightened physiologic stress response. There is a need to identify modifiable risk factors which may help minimize the emergence and impact of veteran illness. RESEARCH QUESTION: The present study investigated the contributions of posttraumatic stress symptoms, maladaptive repetitive thought (MRT), depression, childhood trauma and health behaviors (sleep, alcohol use and smoking) to physical disease as operationalized by immune-mediated inflammatory disease occurrence and related functional disability. METHOD: Female Reserve or National Guard veterans (N = 643) enrolled in a parent study conducted through the Iowa City Veteran's Affairs Hospital completed a one-time computer-assisted telephone interview. The current study examined self-report measures of posttraumatic stress symptoms, MRT, depression, childhood trauma, smoking, alcohol use, sleep, inflammatory disease incidence and physical functioning. RESULTS: Proposed models of primary hypotheses were tested using structural equation modeling. Results indicated that both physical disease and functional decline were greater in veterans reporting a history of trauma. Physical disease was associated with greater depression and childhood trauma but lower levels of alcohol use after accounting for covariates. Unexpectedly, greater MRT was associated with less physical disease, although it was only related to disease when depression was included as a covariate. Reduced sleep was linked with greater disease but only when depression was not included in the model, and depression was found to fully mediate the relationship between sleep and physical disease. Smoking and the interaction between posttraumatic stress symptoms and MRT were generally unrelated to physical disease in this sample. CONCLUSIONS: Results of this study are consistent with the hypothesis that physical disorders and related functional decline are greater in trauma-exposed individuals and that depression, childhood trauma, repetitive thought and alcohol use have independent associations with physical disease. This study offers support for further research and interventions which address these relationships to protect female veteran health.

Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder (PTSD) in women as a result of their labor and delivery experiences, and identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Four to six weeks postpartum, telephone interviews were conducted with participants (n = 499) and explored the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables were not found to contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = .351, p <.0001) and the perception of inadequate intrapartum care (beta = .319, p <.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder following childbirth is an under-recognized phenomenon. Women who experienced both a high level of obstetric intervention and were dissatisfied with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. Such findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the psychological care provided to birthing women.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009