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Journal of Affective Disorders Jul 2023In this systematic review and meta-analysis, we aimed to provide a comprehensive overview of gray matter alterations of adult- and underage patients with posttraumatic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this systematic review and meta-analysis, we aimed to provide a comprehensive overview of gray matter alterations of adult- and underage patients with posttraumatic stress disorder (PTSD) in comparison to healthy trauma-exposed (TC) and non-exposed (HC) individuals.
METHODS
We subdivided our groups into patients with PTSD after trauma exposure in adulthood (aa) or childhood (ac) as well as children with PTSD (cc). We identified 113 studies, including 6.800 participants in our review, which we divided into studies focusing on whole-brain and region-of-interest (ROI) analysis. We performed a coordinate-based meta-analysis on 14 studies in the group of aa-PTSD.
RESULTS
We and found lower gray matter volume in patients with PTSD (aa) in the medial frontal gyrus (PTSD
LIMITATIONS
Due to a limited number of studies reporting whole-brain results, the meta-analyses could only be performed in one subgroup and within this subgroup for a limited number of studies.
CONCLUSIONS
Our results are in line with psychobiological models of PTSD that associate the identified regions with brain circuits involved in context processing, threat detection and emotion regulation.
Topics: Humans; Adult; Child; Gray Matter; Stress Disorders, Post-Traumatic; Magnetic Resonance Imaging; Cerebral Cortex; Brain
PubMed: 37086802
DOI: 10.1016/j.jad.2023.04.028 -
Clinical Psychology & Psychotherapy Mar 2022Therapeutic alliance is a key element of successful therapy. Despite being particularly relevant in people with posttraumatic stress disorder (PTSD), due to fear,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Therapeutic alliance is a key element of successful therapy. Despite being particularly relevant in people with posttraumatic stress disorder (PTSD), due to fear, mistrust and avoidance, there has not yet been a comprehensive systematic review of therapeutic alliance in this population. This review explored (a) variables which may predict alliance and (b) whether alliance predicts PTSD outcomes.
METHOD
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, the review identified 34 eligible studies. Studies were subjected to a quality assessment. Predictors of alliance were considered in a narrative synthesis. Twelve studies were entered into a meta-analysis of the association between therapeutic alliance and PTSD outcomes.
RESULTS
There was some evidence for individual variables including attachment, coping styles and psychophysiological variables predicting the alliance. Therapy variables did not predict alliance. The therapeutic alliance was found to significantly predict PTSD outcomes, with an aggregated effect size of r = -.34, across both in-person and remote therapies.
LIMITATIONS
Included studies were restricted to peer-reviewed, English language studies. Quality of included studies was mostly rated weak to moderate, primarily reflecting issues with selection bias in this area of research.
CONCLUSIONS
This is the first review to demonstrate that therapeutic alliance is a consistent predictor of PTSD outcomes, in both in-person and remote therapies, and the effect appears at least as strong as in other populations. This is of relevance to clinicians working with traumatized populations. The review identified a need for further research to determine variables predicting alliance in therapy for PTSD.
Topics: Adaptation, Psychological; Humans; Stress Disorders, Post-Traumatic; Therapeutic Alliance
PubMed: 34237173
DOI: 10.1002/cpp.2642 -
Clinical Psychology Review Dec 2020Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now... (Review)
Review
Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now well-established as a transdiagnostic cognitive process, including in the context of posttraumatic stress. To clarify the current understanding of rumination in posttraumatic stress, we conducted a systematic review of the empirical literature on rumination in posttraumatic stress disorder (PTSD). Six sub-groups of studies on this topic were identified; these addressed: (i) the frequency and nature of rumination, (ii) cross-sectional relationships between rumination and PTSD symptoms, (iii) the capacity of rumination to predict PTSD longitudinally, (iv) other processes associated with rumination, (v) neurobiological correlates of rumination, and (vi) whether treating PTSD reduces rumination. This review synthesizes these domains of research and identifies key methodological limitations which limit causal inferences, and points to important areas of future research to advance knowledge on rumination in PTSD.
Topics: Humans; Stress Disorders, Post-Traumatic
PubMed: 32971312
DOI: 10.1016/j.cpr.2020.101910 -
Journal of Traumatic Stress Oct 2020There is evidence of an association between posttraumatic stress disorder (PTSD) and criminal justice involvement among military veterans. For this study, we... (Meta-Analysis)
Meta-Analysis
There is evidence of an association between posttraumatic stress disorder (PTSD) and criminal justice involvement among military veterans. For this study, we systematically reviewed the literature to examine the association between PTSD and criminal justice involvement among military veterans, assess the magnitude of this association, and identify strengths and limitations of the underlying evidence. Five databases were searched for a larger scoping review, and observational studies that assessed PTSD and criminal justice involvement were selected from the scoping review database (N = 191). Meta-analyses were conducted, pooling odds ratios (ORs) via restricted maximum likelihood random-effects models. The main outcomes were criminal justice involvement (i.e., documentation of arrest) and PTSD (i.e., PTSD assessment score indicating probable PTSD). Of 143 unique articles identified, 10 studies were eligible for the meta-analysis. Veterans with PTSD had higher odds of criminal justice involvement (OR = 1.61, 95% CI [1.16, 2.23], p = .002) and arrest for violent offenses (OR = 1.59, 95% CI [1.15, 2.19], p = .002) compared to veterans without PTSD. The odds ratio of criminal justice involvement among military veterans with PTSD assessed using the PTSD Checklist was 1.98, 95% CI [1.08, 3.63], p = .014. Considerable heterogeneity was identified, but no evidence of publication bias was found. Criminal justice involvement and PTSD are linked among military veterans, highlighting an important need for clinicians and healthcare systems working with this population to prioritize PTSD treatment to reduce veterans' new and recurring risk of criminal justice involvement.
Topics: Adult; Aged; Crime; Criminals; Female; Humans; Male; Middle Aged; Observational Studies as Topic; Stress Disorders, Post-Traumatic; Veterans
PubMed: 32516492
DOI: 10.1002/jts.22526 -
The Journal of Clinical Psychiatry Feb 2024Given the high rate of comorbid posttraumatic stress disorder (PTSD) and cannabis use, it is critical that further research be conducted to address the associated...
Given the high rate of comorbid posttraumatic stress disorder (PTSD) and cannabis use, it is critical that further research be conducted to address the associated benefits and risks of cannabis use in this population. This systematic review evaluated evidence on the effects of cannabis and cannabinoids on PTSD symptoms and PTSD clusters. A systematic search of PubMed, PsycINFO, and EMBASE databases was performed using terms related to cannabis, cannabinoids, and PTSD. Peer-reviewed studies available online in English and published from January 1990 through February 2023 were considered. Included studies were experimental or observational in design, were conducted in cannabis-using patients with PTSD, used validated measures of PTSD, and were published in English. : Extracted information included study aims, study design, sample size and sex, comparator group, cannabis-related characteristics, psychometric instruments, and relevant clinical findings regarding overall PTSD symptoms and cluster symptoms. Fourteen studies were included, 3 in a comorbid PTSD and cannabis use disorder (CUD) sample and 11 in a non-CUD sample. Of the 10 studies examining overall PTSD symptoms in a non-CUD sample, 5 suggested benefits associated with cannabis use and 5 suggested no effect or worsening of symptoms. Four studies reported benefits of cannabis for cluster B- and E-related symptoms in a non-CUD sample. All 3 studies in cannabis-using patients with a comorbid PTSD and CUD diagnosis reported risks for worsening of overall symptoms. This review did not find major benefits of cannabinoids in improving overall PTSD symptoms. Some benefits with regard to cluster B and E symptoms were observed. Some risks with regard to worsening suicidal ideation and violent behavior were also reported. Individuals with a comorbid CUD diagnosis may be at greater risk for negative cannabis-related PTSD outcomes. More experimental studies are needed to determine the causal effects of cannabis and cannabinoids in PTSD.
Topics: Humans; Cannabinoids; Cannabis; Stress Disorders, Post-Traumatic; Syndrome; Hallucinogens
PubMed: 38353645
DOI: 10.4088/JCP.23r14862 -
International Journal of Geriatric... Jun 2023Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two-thirds having two... (Review)
Review
BACKGROUND
Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two-thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co-occur in older adults with PTSD can have implications to improve diagnosis and treatment. This systematic literature review explores the current empirical literature on psychiatric comorbidity in older adults with PTSD.
METHOD
Literature databases PubMed, Embase, PsycINFO, and CINAHL were searched. The following inclusion criteria were applied: research done since 2013, PTSD diagnosis based on diagnostic criteria according to Diagnostic and Statistics Manual-Fifth Edition, International Classification of Diseases-10th Revision (ICD-10), or ICD-11, and studies include individuals aged 60 years or older.
RESULTS
Of 2068 potentially relevant papers identified, 246 articles were examined based on titles and abstracts. Five papers met the inclusion criteria and were included. Major depressive disorder and alcohol use disorder were the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD.
CONCLUSIONS AND IMPLICATIONS
Screening for depression and substance use in older adults should include an assessment of trauma and PTSD. Additional studies in the general older adult population with PTSD and a broader range of comorbid psychiatric disorders are needed.
Topics: Humans; Aged; Stress Disorders, Post-Traumatic; Depressive Disorder, Major; Aging; Alcoholism; Comorbidity
PubMed: 37303126
DOI: 10.1002/gps.5947 -
Neuroscience and Biobehavioral Reviews Dec 2022Psychological distress can be conceptualized as an umbrella term encompassing symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), or stress more... (Review)
Review
Psychological distress can be conceptualized as an umbrella term encompassing symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), or stress more generally. A systematic review of metabolomic markers associated with distress has the potential to reveal underlying molecular mechanisms linking distress to adverse health outcomes. The current systematic review extends prior reviews of clinical depressive disorders by synthesizing 39 existing studies that examined metabolomic markers for PTSD, anxiety disorders, and subclinical psychological distress in biological specimens. Most studies were based on small sets of pre-selected candidate metabolites, with few metabolites overlapping between studies. Vast heterogeneity was observed in study design and inconsistent patterns of association emerged between distress and metabolites. To gain a more robust understanding of distress and its metabolomic signatures, future research should include 1) large, population-based samples and longitudinal assessments, 2) replication and validation in diverse populations, 3) and agnostic metabolomic strategies profiling hundreds of targeted and nontargeted metabolites. Addressing these research priorities will improve the scope and reproducibility of future metabolomic studies of psychological distress.
Topics: Humans; Stress Disorders, Post-Traumatic; Reproducibility of Results; Anxiety Disorders; Anxiety; Psychological Distress; Stress, Psychological; Depression
PubMed: 36368524
DOI: 10.1016/j.neubiorev.2022.104954 -
Disaster Medicine and Public Health... Apr 2022Posttraumatic stress disorder (PTSD) is a common mental disorder following traumatic events. The present study was conducted to understand the prevalence of PTSD after... (Meta-Analysis)
Meta-Analysis Review
Posttraumatic stress disorder (PTSD) is a common mental disorder following traumatic events. The present study was conducted to understand the prevalence of PTSD after the earthquake in Iran and Pakistan. The review includes all articles published from inception to March 2019. The pooled prevalence for overall PTSD was 55.6% (95% CI: 49.9-61.3). It was 60.2% (95% CI: 54.1-66.3) and 49.2% (95% CI: 39.4-59) for Iranian and Pakistani survivors, respectively. Women experienced higher incidence of PTSD than men. The variation of PTSD based on the clinical interview was lower than the self-report approach. The interval time between the earthquakes and the assessment showed that the prevalence of PTSD decreased over time. The prevalence of PTSD in Iran and Pakistan was higher than the global average, and the rate of the disorder in Iran was higher than in Pakistan. Sex, method of assessment, and time lag between the occurrence of disaster and assessment of PTSD affect the prevalence.
Topics: China; Earthquakes; Female; Humans; Iran; Male; Pakistan; Prevalence; Risk Factors; Stress Disorders, Post-Traumatic
PubMed: 33779538
DOI: 10.1017/dmp.2020.411 -
Sleep Medicine Reviews Dec 2019Polysomnographic studies have been performed to examine sleep abnormalities in posttraumatic stress disorder (PTSD), but clear associations between PTSD and sleep... (Meta-Analysis)
Meta-Analysis
Polysomnographic studies have been performed to examine sleep abnormalities in posttraumatic stress disorder (PTSD), but clear associations between PTSD and sleep disturbances have not been established. A systematic review of the evidence examining the polysomnographic changes in PTSD patients compared with controls was conducted using MEDLINE, EMBASE, All EBM databases, PsycINFO, and CINAHL databases. Meta-analysis was undertaken where possible. The searches identified 34 studies, 31 of which were appropriate for meta-analysis. Pooled results indicated decreased total sleep time, slow wave sleep and sleep efficiency, and increased wake time after sleep onset in PTSD patients compared with healthy controls. PTSD severity was associated with decreased sleep efficiency and slow wave sleep percentage. Rapid eye movement (REM) sleep percentage was significantly decreased in PTSD patients compared with controls in studies including participants with mean age below 30 y, but not in studies with other mean age groups (30-40 y and >40 y). Our study shows that polysomnographic abnormalities are present in PTSD. Sex, age, PTSD severity, type of controls, medication status, adaptation night, polysomnographic scoring rules and study location are several of the demographic, clinical and methodological factors that contribute to heterogeneity between studies.
Topics: Age Factors; Humans; Polysomnography; Severity of Illness Index; Sleep Wake Disorders; Sleep, REM; Stress Disorders, Post-Traumatic
PubMed: 31518950
DOI: 10.1016/j.smrv.2019.08.004 -
Journal of Traumatic Stress Apr 2023The objective of the present study was to systematically review the existing literature for studies examining the association between posttraumatic stress disorder... (Meta-Analysis)
Meta-Analysis Review
The objective of the present study was to systematically review the existing literature for studies examining the association between posttraumatic stress disorder (PTSD) and stroke risk and perform a meta-analysis to obtain a pooled risk estimate describing the association. A literature search was conducted in PubMed, Embase, PSYCInfo, and CINAHL to identify relevant studies. Cohort and cross-sectional studies that reported PTSD exposure (i.e., PTSD diagnosis, probable PTSD, or the presence of PTSD symptoms) at baseline and the risk or odds of stroke associated with PTSD exposure during the study period were included in the analysis. A random-effects model was used to calculate the pooled hazard ratio (HR) for cohort studies estimating the association between PTSD and stroke. Overall, 11 studies met the inclusion criteria; eight were cohort studies, and three were cross-sectional studies. Two cohort studies and all cross-sectional studies used self-report of PTSD symptoms to measure the exposure. The pooled hazard ratio for the eight cohort studies showed that having PTSD was associated with a 59% higher risk of incident stroke, HR = 1.59, 95% CI [1.36, 1.86], I = 81%. The association remained statistically significant in a subgroup analysis of six United States-based studies, HR = 1.38; 95% CI [1.29, 1.49], I = 18%. The findings suggest that PTSD is associated with an increased risk of stroke. More studies are required to explore a causal association between PTSD and stroke.
Topics: Humans; United States; Stress Disorders, Post-Traumatic; Stroke; Cohort Studies; Proportional Hazards Models
PubMed: 36987695
DOI: 10.1002/jts.22925