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Pediatrics Jul 2024Pediatric critical illness exposes family members to stressful experiences that may lead to subsequent psychological repercussions. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pediatric critical illness exposes family members to stressful experiences that may lead to subsequent psychological repercussions.
OBJECTIVE
To systematically review psychological outcomes among PICU survivors' family members.
DATA SOURCES
Four medical databases (PubMed, Embase, CINAHL and PsycInfo) were searched from inception till October 2023.
STUDY SELECTION
Studies reporting psychological disorders in family members of PICU patients with at least 3 months follow-up were included. Family members of nonsurvivors and palliative care patients were excluded.
DATA EXTRACTION
Screening and data extraction was performed according to PRISMA guidelines. Data were pooled using a random-effects model.
RESULTS
Of 5360 articles identified, 4 randomized controlled trials, 16 cohort studies, and 2 cross-sectional studies were included (total patients = 55 597; total family members = 97 506). Psychological distress was reported in 35.2% to 64.3% and 40.9% to 53% of family members 3 to 6 months and 1 year after their child's PICU admission, respectively. Post-traumatic stress disorder was diagnosed in 10% to 48% of parents 3 to 9 months later. Parents that experienced moderate to severe anxiety and depression 3 to 6 months later was 20.9% to 42% and 6.1% to 42.6%, respectively. Uptake of mental counseling among parents was disproportionately low at 0.7% to 29%. Risk factors for psychiatric morbidity include mothers, parents of younger children, and longer duration of PICU stay.
LIMITATIONS
The majority of studies were on parents with limited data on siblings and second degree relatives.
CONCLUSIONS
There is a high burden of psychological sequelae in family members of PICU survivors. Risk stratification to identify high-risk groups and early interventions are needed.
Topics: Child; Humans; Critical Illness; Family; Intensive Care Units, Pediatric; Stress Disorders, Post-Traumatic; Survivors
PubMed: 38916047
DOI: 10.1542/peds.2023-064210 -
Psychiatry Research Jun 2024This systematic review aimed to explore sex differences in exposure to traumatic events and posttraumatic stress disorder (PTSD) symptomatology among refugees,... (Review)
Review
This systematic review aimed to explore sex differences in exposure to traumatic events and posttraumatic stress disorder (PTSD) symptomatology among refugees, internally displaced persons (IDPs), and asylum seekers. A comprehensive search was conducted across three databases (PubMed, PsychInfo, and Embase), which yielded 2,255 studies. A total of 15 studies were included for trauma exposure assessment, and 8 studies for PTSD symptomatology assessment. The review revealed significant sex differences in trauma exposure, with women experiencing higher rates of sexual violence, while men faced greater risks of imprisonment and torture. In terms of PTSD symptomatology, our findings showed that women tend to exhibit greater symptoms of arousal and specific symptoms of avoidance such as loss of interest and avoidance of activities reminding of trauma, while men were more likely to experience estrangement and detachment. Findings regarding symptoms of reexperiencing were not entirely consistent. This review emphasizes the importance of considering sex-specific symptoms in trauma assessment among displaced populations and advocates for further research into targeted interventions, especially regarding sexual violence.
PubMed: 38906050
DOI: 10.1016/j.psychres.2024.116014 -
Psychiatry Research Jun 20243,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy, is one of the most widely used illicit substances worldwide. MDMA-assisted psychotherapy has become...
The efficacy and safety of MDMA-assisted psychotherapy for treatment of posttraumatic stress disorder: A systematic review and meta-analysis from randomized controlled trials.
3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy, is one of the most widely used illicit substances worldwide. MDMA-assisted psychotherapy has become a novel treatment for posttraumatic stress disorder (PTSD), and many randomized controlled trials (RCTs) have been performed over the past decade. Therefore, this study aimed to systematically review and demonstrate the efficacy and safety of MDMA-assisted psychotherapy for the treatment of PTSD. We conducted a systematic search of PubMed, Embase, and Web of Science databases up to October 27, 2023, selected RCTs assessing the efficacy and safety of MDMA-assisted psychotherapy for the treatment of PTSD, and evaluated their quality using the Cochrane risk of bias tool. Seven RCTs were selected from the retrieved references. The results revealed that MDMA-assisted psychotherapy effectively reduced the change from baseline score in the Clinician-Administered PTSD Scale in patients with PTSD compared with either placebo or active controls. However, MDMA causes a series of adverse events, including muscle tightness, nausea, and decreased appetite. To a certain extent, MDMA-assisted psychotherapy may improve symptoms in patients with PTSD. However, side effects and abuse issues still seriously hinder clinical application of MDMA.
PubMed: 38896930
DOI: 10.1016/j.psychres.2024.116043 -
Clinical Psychology & Psychotherapy 2024Complex post-traumatic stress disorder (CPTSD) was introduced in the International Classification of Diseases (ICD) 11 in 2013 to simplify diagnosis and increase... (Review)
Review
Complex post-traumatic stress disorder (CPTSD) was introduced in the International Classification of Diseases (ICD) 11 in 2013 to simplify diagnosis and increase clinical utility. Given the recent ICD-11 conceptualisation, there is no standard approach for its assessment, and a review of research is necessary. This systematic review focuses on ICD-11 CPTSD assessment in young people aged 7 to 17 and adults aged 18 and above, examining measures, differentiating features and clinical considerations. Data from five databases are reviewed using a narrative synthesis approach and the quality of evidence is assessed and discussed. A total of 36 studies involving 5901 participants recruited from clinical settings and 1458 professionals with CPTSD assessment experience were included. Studies predominantly focused on adults, and the most used measure for assessment was the International Trauma Questionnaire. Papers focusing on differentiating features highlighted increased symptom severity, impairment and difficulties in individuals with CPTSD, compared to those with PTSD across various characteristics in both young people and adults. This review also identified the importance of a sensitive clinical approach with adaptations based on culture and age. Although gold-standard recommendations cannot be made, this paper offers tentative clinical practice recommendations and considerations regarding ICD-11 CPTSD assessment.
Topics: Humans; Stress Disorders, Post-Traumatic; International Classification of Diseases; Adolescent; Adult; Young Adult; Child; Female; Male
PubMed: 38894553
DOI: 10.1002/cpp.3012 -
BMC Pediatrics Jun 2024Accidental and assault gunshot wounds (GSWs) are the second leading cause of injury in the United States for youth ages 1- to 17-years-old, resulting in significant... (Review)
Review
Identifying mental health outcomes and evidence-based psychological interventions for supporting pediatric gunshot wound patients: A systematic review and proposed conceptual model.
BACKGROUND
Accidental and assault gunshot wounds (GSWs) are the second leading cause of injury in the United States for youth ages 1- to 17-years-old, resulting in significant negative effects on pediatric patients' mental health functioning. Despite the critical implications of GSWs, there has yet to be a systematic review synthesizing trends in mental health outcomes for pediatric patients; a gap the present review fills. Additionally, this review identifies evidence-based psychological interventions shown to be effective in the treatment of subclinical symptoms of psychological disorders in the general population.
METHODS
A comprehensive search was conducted using five databases: American Psychological Association (APA) PsycInfo, APA PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resource Information Center (ERIC), and Medical Literature Analysis and Retrieval Systems Online (MEDLINE). Twenty-two articles met inclusion criteria.
RESULTS
Findings suggest pediatric GSW patients are at a significantly elevated risk for mental health disorders when compared to other- (e.g., motor vehicle collision) and non-injured youth. Disorders include post-traumatic stress, disruptive behavior, anxiety, depression, and substance use. Hospital-based violence intervention programs, cultivating supportive relationships with adults in one's community, and trauma-focused outpatient services were identified as effective interventions for treating subclinical psychological symptoms.
CONCLUSIONS
Depicted in the proposed conceptual model, the present study delineates a direct association between pediatric GSWs and subsequent onset of mental health disorders. This relation is buffered by evidence-based psychological interventions targeting subclinical symptoms. Results suggest brief psychological interventions can help treat mental health challenges, minimizing risk for significant long-term concerns. Cultural adaptations to enhance the utility and accessibility of interventions for all patients are recommended.
Topics: Adolescent; Child; Child, Preschool; Humans; Evidence-Based Practice; Mental Disorders; Mental Health; Psychosocial Intervention; Wounds, Gunshot; Infant
PubMed: 38890635
DOI: 10.1186/s12887-024-04878-w -
BJOG : An International Journal of... Jun 2024Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes. (Review)
Review
BACKGROUND
Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes.
OBJECTIVES
To review the published literature on pregnancy and birth complications and long-term maternal mental health outcomes.
SEARCH STRATEGY
Systematic search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PsycInfo®, PubMed® and Web of Science from inception until August 2022.
SELECTION CRITERIA
Three reviewers independently reviewed titles, abstracts and full texts.
DATA COLLECTION AND ANALYSIS
Two reviewers independently extracted data and appraised study quality. Random-effects meta-analyses were used to calculate pooled estimates. The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022359017).
MAIN RESULTS
Of the 16 310 articles identified, 33 studies were included (3 973 631 participants). Termination of pregnancy was associated with depression (pooled adjusted odds ratio, aOR 1.49, 95% CI 1.20-1.83) and anxiety disorder (pooled aOR 1.43, 95% CI 1.20-1.71). Miscarriage was associated with depression (pooled aOR 1.97, 95% CI 1.38-2.82) and anxiety disorder (pooled aOR 1.24, 95% CI 1.11-1.39). Sensitivity analyses excluding early pregnancy loss and termination reported similar results. Preterm birth was associated with depression (pooled aOR 1.37, 95% CI 1.32-1.42), anxiety disorder (pooled aOR 0.97, 95% CI 0.41-2.27) and post-traumatic stress disorder (PTSD) (pooled aOR 1.75, 95% CI 0.52-5.89). Caesarean section was not significantly associated with PTSD (pooled aOR 2.51, 95% CI 0.75-8.37). There were few studies on other mental disorders and therefore it was not possible to perform meta-analyses.
CONCLUSIONS
Exposure to complications during pregnancy and birth increases the odds of long-term depression, anxiety disorder and PTSD.
PubMed: 38887891
DOI: 10.1111/1471-0528.17889 -
Psychological Bulletin Jun 2024Although trauma-focused psychotherapy (T-F psychotherapy) is the treatment of choice for posttraumatic stress disorder (PTSD), up to one half of patients do not respond...
Although trauma-focused psychotherapy (T-F psychotherapy) is the treatment of choice for posttraumatic stress disorder (PTSD), up to one half of patients do not respond to this treatment. Attempts to improve response to T-F psychotherapy have focused on augmenting fear extinction-based factors. Here, a systematic and meta-analytic review of predictors of T-F psychotherapy outcome was conducted with the goal of using an aggregate data-driven approach to elucidate baseline factors associated with treatment outcome. There were 114 studies that met inclusion criteria ( = 61, 970; = 40.1 years; 40.1% female). There were 237 effect sizes across 24 meta-analytic categories. Poorer treatment response is associated with lower pretreatment levels of activation of fear-related brain regions, psychophysiological reactivity to fear provocation, trauma-related cognitions, anger, depression, high-risk alleles of genes linked to fear, lower levels of executive control, and social support. A range of other factors also predicted poorer responses including being male, non-Caucasian, older in age, early trauma occurrence, more trauma experience, history of combat trauma, as well as comorbid sleep, pain, poor quality life, and alcohol abuse difficulties. This review provides one potential explanation for the limited success of T-F psychotherapy augmentation strategies that have focused only on fear circuity mechanisms at the exclusion of other factors. Here, poor response relating to predictors of early trauma onset and comorbidity are consistent with clinical presentations of complex PTSD, which may suggest T-F psychotherapy is less effective for this condition. This collective evidence suggests that clinicians should consider a tailored approach that targets potential barriers to successful treatment response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
PubMed: 38884956
DOI: 10.1037/bul0000438 -
Frontiers in Neurology 2024Studies of hyperbaric oxygen therapy (HBOT) treatment of mild traumatic brain injury persistent postconcussion syndrome in military and civilian subjects have shown...
BACKGROUND
Studies of hyperbaric oxygen therapy (HBOT) treatment of mild traumatic brain injury persistent postconcussion syndrome in military and civilian subjects have shown simultaneous improvement in posttraumatic stress disorder (PTSD) or PTSD symptoms, suggesting that HBOT may be an effective treatment for PTSD. This is a systematic review and dosage analysis of HBOT treatment of patients with PTSD symptoms.
METHODS
PubMed, CINAHL, and the Cochrane Systematic Review Database were searched from September 18 to November 23, 2023, for all adult clinical studies published in English on HBOT and PTSD. Randomized trials and studies with symptomatic outcomes were selected for final analysis and analyzed according to the dose of oxygen and barometric pressure on symptom outcomes. Outcome assessment was for statistically significant change and Reliable Change or Clinically Significant Change according to the National Center for PTSD Guidelines. Methodologic quality and bias were determined with the PEDro Scale.
RESULTS
Eight studies were included, all with < 75 subjects/study, total 393 subjects: seven randomized trials and one imaging case-controlled study. Six studies were on military subjects, one on civilian and military subjects, and one on civilians. Subjects were 3-450 months post trauma. Statistically significant symptomatic improvements, as well as Reliable Change or Clinically Significant changes, were achieved for patients treated with 40-60 HBOTS over a wide range of pressures from 1.3 to 2.0 ATA. There was a linear dose-response relationship for increased symptomatic improvement with increasing cumulative oxygen dose from 1002 to 11,400 atmosphere-minutes of oxygen. The greater symptomatic response was accompanied by a greater and severe reversible exacerbation of emotional symptoms at the highest oxygen doses in 30-39% of subjects. Other side effects were transient and minor. In three studies the symptomatic improvements were associated with functional and anatomic brain imaging changes. All 7 randomized trials were found to be of good-highest quality by PEDro scale scoring.
DISCUSSION
In multiple randomized and randomized controlled clinical trials HBOT demonstrated statistically significant symptomatic improvements, Reliable Changes, or Clinically Significant Changes in patients with PTSD symptoms or PTSD over a wide range of pressure and oxygen doses. The highest doses were associated with a severe reversible exacerbation of emotional symptoms in 30-39% of subjects. Symptomatic improvements were supported by correlative functional and microstructural imaging changes in PTSD-affected brain regions. The imaging findings and hyperbaric oxygen therapy effects indicate that PTSD can no longer be considered strictly a psychiatric disease.
PubMed: 38882688
DOI: 10.3389/fneur.2024.1360311 -
General Psychiatry 2024Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders.
BACKGROUND
Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders.
AIMS
This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions.
METHODS
This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis.
RESULTS
The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country's economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries.
CONCLUSIONS
The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses.
PROSPERO REGISTRATION NUMBER
CRD42023416096.
PubMed: 38881616
DOI: 10.1136/gpsych-2023-101438 -
Eastern Mediterranean Health Journal =... May 2024The increasing emergencies and humanitarian challenges have worsened the mental health condition of women in the Eastern Mediterranean Region. (Review)
Review
BACKGROUND
The increasing emergencies and humanitarian challenges have worsened the mental health condition of women in the Eastern Mediterranean Region.
AIM
To assess the prevalence, determinants and interventions to address mental health among women in fragile and humanitarian settings in the Eastern Mediterranean Region.
METHODS
Using the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, we reviewed 59 peer-reviewed published studies (PubMed, IMEMR) and grey literature (WHO/IRIS) from January 2001 to February 2023, focusing on women's mental health in the Eastern Mediterranean Region. We then conducted a descriptive analysis of the sociodemographic characteristics.
RESULTS
Among the 59 studies reviewed, only 13 of the 48 peer-reviewed studies focused primarily on women's mental health, 11 grey literature records mostly presented grouped regional data, 11 of the 25 studies on mental health among migrants were about those taking refuge in high-income countries. The average prevalence of mental disorders from 32 cross-sectional studies on women aged 12-75 years was 49%, average prevalence of anxiety was 68%, post-traumatic stress disorder was 52%, and depression was 43%. Women exhibited higher level depression than men. Age, educational disparities, and limited access to services were important risk factors for mental health disorder. Several promising interventions emerged.
CONCLUSION
More efforts should be made to provide customized, context-specific solutions to the mental health challenges of women in humanitarian and fragile settings in the Eastern Mediterranean Region, including allocation of more resources to mental health programmes, addressing barriers, enhancing mental health surveillance, and reduction of stigma.
Topics: Adolescent; Adult; Aged; Female; Humans; Middle Aged; Young Adult; Mediterranean Region; Mental Disorders; Mental Health; Middle East; Prevalence; Women's Health
PubMed: 38874297
DOI: 10.26719/2024.30.5.369