Symptoms of post-traumatic stress disorder and affects in healthcare workers during the COVID-19 pandemic / Sintomas de transtorno de estresse pós-traumático e afetos em profissionais da saúde durante a pandemia da COVID-19

Objective: This study aimed to evaluate symptoms of post-traumatic stress disorder and affects in health professionals during the COVID-19 pandemic. Method: Three hundred and seventy-four health professionals, among which 235 were front-line and 139 non-front-line workers, answered an online questionnaire consisting of socio-demographic data, identification of past mental disorders, personal experience facing the pandemic, the Impact of Event Scale, and the Positive and Negative Affect Schedule. The sample consisted mainly of physicians and nursing staff aged between 30 and 49 years. Results: The results demonstrate high scores of symptoms related to post-traumatic stress disorder, with greater expressiveness among front-line professionals, especially in the nursing staff, and a strong correlation of these results with negative affects. Conclusion: Psychological assistance and interventions directed to health professionals are urgent to mitigate the impacts caused by the COVID-19 pandemic.

Objetivo: Este estudo objetivou avaliar sintomas de transtorno de estresse pós-traumático e afetos em profissionais de saúde durante a pandemia da COVID-19. Método: Trezentos e setenta e quatro profissionais da área da saúde, dentre os quais 235 profissionais que estavam atuando na linha de frente e 139 que não estavam na linha de frente, responderam a um questionário online composto por dados sociodemográficos, identificação de transtornos mentais pregressos, experiência pessoal frente à pandemia e Escala do Impacto do Evento e Escala de Afetos Positivos e Afetos Negativos. A amostra foi composta majoritariamente de médicos e funcionários da equipe de enfermagem com idades entre 30 e 49 anos. Resultados: Os resultados demonstram altas pontuações de sintomas relativos ao transtorno de estresse pós-traumático, com maior expressividade nos profissionais da linha de frente, principalmente na equipe de enfermagem, e forte correlação desses resultados com afetos negativos. Conclusão: O atendimento e intervenções psicológicas direcionadas aos profissionais de saúde são urgentes para mitigar os impactos causados pela pandemia da COVID-19.

Estresse, coping e estados afetivos em profissionais da saúde durante a pandemia / Distress, coping and affective statesin healthcare workers durig the COVID-19 pandemic / Estrés, afrontamiento y estados afectivos em profissionales de la salud durante la pandemia de COVID-19

A pandemia da COVID-19 configurou um período de crise mundial com impactos na saúde mental de toda a população, notadamente dos profissionais de saúde da linha de frente. Objetivou-se rastrear a presença de sintomas de Transtorno de Estresse Pós-Traumático em profissionais de saúde da linha de frente e verificar sua associação com estratégias de coping e estados afetivos durante a pandemia da COVID-19 no Brasil. Realizou-se um estudo longitudinal on-line com 51 profissionais da saúde da linha de frente residentes nas cinco regiões do Brasil que responderam aos instrumentos: Escala do Impacto do Evento, Escala de Afetos Positivos e Afetos Negativos, Escala de Coping Ocupacional e questionário sobre a experiência pessoal frente à pandemia. Por meio de análises de comparação de proporções e médias, bem como análise de correlações, verificou-se alto índice de sintomas relacionados ao Transtorno de Estresse Pós-Traumático nos três momentos de coleta com correlações significativas com afetos negativos, mas não com estratégias de coping. Destaca-se o risco aumentado para o desenvolvimento ou agravo de transtornos mentais nesses profissionais, particularmente quadros de estresse pós-traumático e dificuldades de regulação emocional, que exigem ações urgentes de cuidado psicológico (AU).

The COVID-19 pandemic forgeda period of global crisis with impacts on the mental health of the entire population, notably frontline health professionals.The study aimed to track the presence of Post-Traumatic Stress Disorder symptoms in frontline healthcare workers and verify its association with coping strategies and affective states during the COVID-19 pandemic in Brazil. A longitudinal onlinestudy was carried out with 51 frontline healthcare professionalsfrom the fiveregions of Brazilwho responded to the following instruments: Impact of Event Scale, Positive Affect and Negative Affect Scale, Occupational Coping Scale, and questionnaire about personal experience during the pandemic. Comparison of proportions and means, as well as correlationanalysis,revealeda high rate of symptoms related to Post-Traumatic Stress Disorder in the three point of data collection, with significant correlations with negative affects, but not with coping strategies. The increased risk for the development or worsening of mental disorders in these professionals is highlighted, particularly post-traumatic stress and emotional regulation difficulties, which require urgent psychological care actions (AU).

La pandemia de COVID-19 estableció un período de crisis global con impactos en la salud mental de toda la población, en particular de los profesionales de la salud de primera línea. El objetivo fue rastrear la presencia de síntomas de Trastorno de Estrés Postraumático en profesionales de salud de primera línea y verificar su asociación con estrategias de afrontamiento y estados afectivos durante la pandemia de COVID-19 en Brasil. Se realizó un estudio longitudinal onlinecon 51 profesionales de salud de primera línea residentes de las cincoregiones de Brasil que respondieron los siguientes instrumentos: Escala de Impacto de Evento, Escala de Afectos Positivos y Negativos, Escala de Afrontamiento Ocupacional y cuestionario sobre experiencia personal frente ala pandemia.Los análisisde comparación de proporciones y medias, así como análisis de correlaciones, mostró una alta tasa de síntomas relacionados con el Trastorno de Estrés Postraumático en los tres momentos de recolección de datos, con correlaciones significativas con los afectos negativos, pero no con las estrategias de afrontamiento. Se destaca el mayor riesgo para el desarrollo o empeoramiento de trastornos mentales en estos profesionales, en particular el estrés postraumático y las dificultades (AU).

Analysis of post-traumatic stress disorder in nursing professionals during the covid-19 pandemic / Análisis del trastorno de estrés post-traumático en profesionales de enfermería durante la pandemia de covid-19 / Análise do transtorno do estresse pós-traumático em profissionais de enfermagem durante a pandemia da covid-19

ABSTRACT Objective to analyze the prevalence of Post-Traumatic Stress Disorder and factors associated with its development in Nursing professionals during the COVID-19 pandemic. Method an observational, analytical and cross-sectional study conducted with 309 Nursing professionals, using a questionnaire to assess sociodemographic data and work-related information, in addition to the Impact Event Scale - Revised, which aims at collecting diverse information related to Post-Traumatic Stress Disorder symptoms. Results the study participants were 176 nurses and 133 nursing technicians: 83.82% female and 56.96% male nurses. As for the hour load, 55.66% asserted working up to 40 weekly hours 47.90% had more than one employment contract, 89.32% were active in the front line against the pandemic, and 60.19% reported an increase in workload. However, 64.40% presented symptoms or were diagnosed with COVID-19 and 43.37% indicated emotional impairment. Using the classifications of the overall Impact Event Scale - Revised score, 29 (53.40%) obtained scores of at least 33, the cutoff point for likely diagnosis of Post-Traumatic Stress Disorder. Conclusion it was evidenced that more than half of the study sample presented a high risk of developing Post-Traumatic Stress Disorder in the Impact Event Scale - Revised scale. Factors associated with the development of Post-Traumatic Stress Disorders in Nursing professionals during the COVID-19 pandemic include use of psychotropic drugs, age up to 35 years old, and occurrence of physical and emotional changes.

RESUMEN Objetivo analizar la prevalencia del Trastorno de Estrés Post-Traumático y los factores asociados al desarrollo de dicho trastorno en profesionales de Enfermería durante la pandemia de COVID-19. Método estudio observacional, analítico y transversal, realizado con 309 profesionales de Enfermería por medio de un cuestionario para evaluar datos sociodemográficos y diversa información sobre el trabajo, además de la Escala de Impacto del Evento - Revisada, que tiene como objetivo recolectar diversa información relacionada con la sintomatología del Trastorno de Estrés Post-Traumático. Resultados el estudio contó con la participación de 176 enfermeros y 133 técnicos de Enfermería: 83,82% del sexo femenino y 56,96% de enfermeros. En cuanto al trabajo, el 55,66% poseían una carga horaria de hasta 40 horas semanales, el 47,90% tenían más de un vínculo laboral, el 89,32% trabajaba en la primera línea de lucha contra la pandemia y el 60,19% señaló un aumento en la carga de trabajo. No obstante, el 64,40% presentó síntomas o fueron diagnosticados con COVID-19 y el 43,37% indicó perjuicios emocionales. Utilizando las clasificaciones de la puntuación general de la escala Escala de Impacto del Evento - Revisada, 29 (53,40%) obtuvieron un puntaje de al menos 33, punto de corte para el probable diagnóstico de Trastorno de Estrés Post-Traumático. Conclusión se hizo evidente que, en la escala Escala de Impacto del Evento - Revisada, más de la mitad de la muestra del estudio presentó alto riesgo de desarrollar el Trastorno de Estrés Post-Traumático. Como factores asociados al desarrollo del Trastorno de Estrés Post-Traumático en profesionales de Enfermería durante la pandemia de COVID-19 figuran los siguientes: uso de medicamentos psicotrópicos, edad de hasta 35 años, y cambios en estado financiero y emocional.

RESUMO Objetivo analisar a prevalência de Transtorno de Estresse Pós-Traumático e os fatores associados ao desenvolvimento do Transtorno de Estresse Pós-Traumático em profissionais de enfermagem durante a pandemia da COVID-19. Método estudo observacional, analítico e transversal, realizado com 309 profissionais de enfermagem, utilizando questionário para avaliar dados sociodemográficos e informações sobre o trabalho, além da Escala do Impacto do Evento - Revisada (IES-R), que visa coletar informações relacionadas à sintomatologia do Transtorno de Estresse Pós-Traumático. Resultados o estudo contou com 176 enfermeiros e 133 técnicos de enfermagem, sendo 83,82% do sexo feminino e 56,96% de enfermeiros. Quanto ao trabalho, 55,66% possuíam carga horária de até 40 horas semanais, 47,90% tinham mais de um vínculo, 89,32% atuaram na linha de frente da pandemia e 60,19% apontaram aumento da carga de trabalho. Não obstante, 64,40% apresentaram sintomas ou foram diagnosticados com COVID-19 e 43,37% apontaram prejuízo emocional. Utilizando as classificações do escore geral da Escala do Impacto do Evento - Revisada, 29, 53,40% atingiram pontuação maior ou igual a 33, ponto de corte para o provável diagnóstico de Transtorno do Estresse Pós-Traumático. Conclusão foi evidenciado que mais da metade da amostra do estudo apresentou na escala Escala do Impacto do Evento - Revisada alto risco de desenvolver Transtorno do Estresse Pós-Traumático. Como fatores associados ao desenvolvimento do Transtorno de Estresse Pós-Traumático em profissionais de enfermagem durante a pandemia da COVID-19, estão o uso de medicamentos psicotrópicos, idade até 35 anos, mudança financeira e emocional.

Prevalencia y factores asociados al trastorno de estrés postraumático en personas desplazadas en Colombia / Prevalence and factors associated with post-traumatic stress disorder in displaced persons in Colombia

Resumen Introducción: el trastorno por estrés postraumático (TEPT) es un síndrome que sobreviene después de que una persona experimenta un acontecimiento traumático extremo como la violencia en sus diversas manifestaciones: doméstica, sexual, política o armada. Objetivo: determinar la prevalencia del TEPT, los factores demográficos y las condiciones del desplazamiento asociadas en población desplazada por la violencia producto del conflicto armado, en tres ciudades de Colombia: Bogotá, Medellín y Buenaventura. Método: estudio observacional, analítico con diseño cross-sectional, medición transversal, mediante disponibilidad de datos retrospectivos. La población objeto de estudio se compone de 1 026 registros de personas víctimas del conflicto armado, con edades entre 13 y 65 años, participantes del estudio primario "Salud mental en víctimas de desplazamiento forzado por la violencia en Colombia. El caso de Bogotá, Medellín y Buenaventura". Resultados: la prevalencia de vida del TEPT es de 9,9 %, siendo superior en la ciudad de Buenaventura; el trastorno presenta una asociación estadísticamente significativa con variables como la ocupación, el estado civil y la forma como se llevó a cabo el desplazamiento. Conclusiones: resaltan aspectos como la falta de ocupación, las características del desplazamiento y el bajo apoyo social como posibles factores que desencadenan o intensifican el TEPT.

Abstract Introduction: post-traumatic stress disorder (PTSD) is a syndrome that occurs after a person experiences an extreme traumatic event such as violence in its various manifestations: domestic, sexual, political, or armed. Objective: to determine the prevalence of PTSD and the demographic factors and associated displacement conditions in the population displaced by the violence resulting from the armed conflict, in three cities of Colombia: Bogotá, Medellín and Buenaventura. Method: observational, analytical study with cross-sectional design, cross-sectional measurement, through availability of retrospective data. The population under study consists of 1,026 records of people who are victims of the armed conflict, aged between 13 and 65 years, participants in the primary study "Mental disorders in displaced population victims of the armed conflict, in three cities of Colombia". Results: the lifetime prevalence of PTSD is 9.9%, higher in the city of Buenaventura; the disorder presents a statistically significant association with variables such as occupation, marital status, and the way in which the displacement occurred. Conclusions: aspects such as lack of job, displacement characteristics and low social support stand out as possible factors that trigger or intensify PTSD.

Unnecessarily prolonged suffering: a case of missed diagnosis of post-traumatic stress disorder in a teaching hospital / Sofrimento desnecessariamente prolongado: um caso de diagnóstico perdido de transtorno de estresse pós-traumático em um hospital de ensino

ABSTRACT We described a case in which a heavily-traumatized patient had been under psychiatric treatment for seven years (five of them in a university mental health clinic) but was never diagnosed with PTSD and, therefore, did not receive the proper treatment for a very long period. After the correct diagnosis was made and personalized treatment instituted, the patient has shown marked improvement in functionality and wellbeing. The key element in this case, was the adequacy of psychiatric training. Our report suggests that psychiatrists are not being adequately trained to identify traumatic events and to diagnose atypical cases of PTSD. With that in mind, we emphasize that theoretical modules on trauma and trauma-related disorders and practical training in specialized PTSD clinics should be incorporated into the psychiatric residency training programs wherever they may be missing, particularly in countries most impacted by violence. Furthermore, continuing medical education on trauma and PTSD should be provided by medical associations and journals to keep physicians updated on recent progress in the field.

RESUMO Descrevemos o caso de um paciente gravemente traumatizado que estava em tratamento psiquiátrico há sete anos (cinco deles em uma clínica universitária de saúde mental), mas nunca foi diagnosticado com transtorno de estresse pós-traumático (TEPT) e, portanto, não recebeu o tratamento adequado por muito tempo. Após o diagnóstico correto e o tratamento personalizado instituído, o paciente mostrou melhora acentuada na funcionalidade e no bem-estar. O elemento-chave, neste caso, foi a adequação do treinamento psiquiátrico. Nosso relatório sugere que os psiquiatras não estão sendo treinados adequadamente para identificar eventos traumáticos e diagnosticar casos atípicos de TEPT. Com isso em mente, enfatizamos que os módulos teóricos sobre eventos traumáticos e transtornos relacionados ao trauma e treinamento prático em clínicas especializadas de TEPT devem ser incorporados aos programas de treinamento em residência psiquiátrica onde quer que ainda estejam ausentes, particularmente nos países mais afetados pela violência. Além disso, a educação médica continuada sobre trauma e TEPT deve ser fornecida por associações médicas e periódicos científicos para manter os médicos atualizados sobre os avanços recentes na área.

Análisis de red de síntomas de angustia psicológica, estrés postraumático y miedo por COVID-19 en adultos peruanos

RESUMEN Introducción: la pandemia del coronavirus (COVID-19) y las medidas de distanciamiento social utilizado para mitigar la propagación del virus puede tener graves consecuencias para la salud mental. Objetivo: investigar la red de componentes de la sintomatología de la angustia psicológica, estrés y el miedo al COVID-19 en adultos peruanos durante la primera oleada pandémica en el Perú durante el 2020. Métodos: fueron incluidos 609 adultos peruanos (57,51% mujeres; M edad: 27,04) de la ciudad Metropolitana de Lima, quienes respondieron los instrumentos adaptados al español: Impact of event scale-revised-R (IES-R), Patient Health Questionnaire-4 (PHQ-4) y Fear of COVID-19 Scale (FCV-19S), cuyas respuestas de los reactivos representaron el análisis de red con las medidas de centralidad y estabilidad de los nodos. Resultados: se observaron mayores medidas de centralidad en los reactivos de estado de ánimo depresivo, miedo al contagio y miedo a la muerte por COVID-19. Las mayores conexiones de red se encontraron entre los síntomas depresivos, síntomas postraumáticos de evitación, síntomas emocionales del miedo al COVID-19. Asimismo, se demostró la estabilidad de las medidas de centralidad de fuerza y la precisión de los nodos o variables de la red. Conclusiones: los participantes manifestaron mayores niveles de síntomas de depresión y miedo al COVID-19, tales síntomas fueron más centrales en la red y reportaron conexiones de mayor activación en la red, cuya consideración es determinante para una mejor eficacia en la intervención y prevención ante la pandemia para los profesionales de las ciencias de la salud y del comportamiento

ABSTRACT Introduction: The coronavirus pandemic (COVID-19) and the social distancing measures used to mitigate the spread of the virus may have serious mental health consequences. Objective: To investigate the components network of the symptomatology of psychological distress, stress and fear of COVID-19 in Peruvian adults during the first pandemic wave in Peru during 2020. Methods: Six hundred nine Peruvian adults were includeds (57.51% women; M age: 27.04) from the Metropolitan city of Lima, who responded to the instruments adapted to Spanish: Impact of event scale-revised-R (IES-R), Patient Health Questionnaire-4 (PHQ-4) and Fear of COVID-19 Scale (FCV-19S), whose item responses represented the network analysis with measures of centrality and stability of the nodes. Results: Higher measures of centrality were observed for the depressed mood, fear of contagion and fear of death items by COVID-19. The greatest network connections were found among depressive symptoms, post-traumatic avoidance symptoms, emotional symptoms of fear of COVID-19. Also, the stability of the strength centrality measures and the accuracy of the network nodes or variables was demonstrated. Conclusions: Participants manifested higher levels of symptoms of depression and fear of COVID-19, such symptoms were more central in the network, and reported higher activation connections in the network, the consideration of which is determinant for better effectiveness in pandemic intervention and prevention for health and behavioral sciences professionals

Work-related factors in the etiology of symptoms of post-traumatic stress among first responders: the Brazilian Firefighters Longitudinal Health Study (FLoHS) / Fatores relacionados ao trabalho na etiologia de sintomas de estresse pós-traumático entre socorristas: o Estudo Longitudinal de Saúde em Bombeiros Brasileiros (FLoHS) / Factores laborales relacionados con la etiología de síntomas de estrés postraumático entre trabajadores de primeros auxilios: el Estudio Longitudinal de Salud en Bomberos Brasileños (FLoHS)

Abstract: Two important aspects must be accounted for when discussing the mental health of first responders and, in particular, their report of post-traumatic stress symptoms (PTSS). The first concerns the provision of quantitative data from longitudinal study designs, the second concerns the sophistication of the work-related model used to frame such studies. This is a report on the development of a model for Brazilian firefighters who also work as first responders, from the establishment of a longitudinal panel design study, the Brazilian Firefighter Longitudinal Health Study (FLoHS). The first objective was to compare trainee and active firefighters based on their follow-up data with a nationwide sample of similarly aged Brazilians. The second was to test the effect that operational and organizational experiences had on firefighters' PTSS level during follow up. At baseline, trainee firefighters came from higher socioeconomic backgrounds, were healthier and less exposed to trauma compared to a similarly aged national sample. At follow up, they reported higher prevalence of smoking, sleep problems, anhedonia and were more likely to be overweight. PTSS was predicted by operational and organizational stressors, even when controlled for health status at baseline. The results present not only the differences in the predictive status of operational and organizational events in relation to PTSS, but also how the effects of such events might interact. The data suggest the need for evidence-based interventions, support provided and changes at work environments to improve report rates for mental health in general and for PTSS in particular.

Resumo: Há duas questões subjacentes importantes na saúde mental dos socorristas, e particularmente em seu relato de sintomas de transtorno de estresse pós-traumático (TEPT). A primeira diz respeito à produção de dados quantitativos a partir do delineamento de estudos longitudinais, e a segunda está relacionada à sofisticação do modelo relacionado ao trabalho para contextualizar tais estudos. O artigo aborda o desenvolvimento de um modelo para bombeiros brasileiros, que também são socorristas, através do estabelecimento de um estudo com delineamento de painel longitudinal, chamado Estudo Longitudinal de Saúde em Bombeiros Brasileiros (FLoHS). O primeiro objetivo foi a comparação de bombeiros estagiários versus efetivados com base em dados de seguimento com uma amostra nacional de brasileiros com idades semelhantes. O segundo objetivo foi testar o efeito das experiências operacionais e organizacionais sobre os níveis de sintomas de TEPT nos bombeiros durante o seguimento. Na linha de base, os bombeiros estagiários vinham de origens socioeconômicas mais favoráveis e eram mais saudáveis e menos expostos a trauma, em comparação com uma amostra nacional da população com idade semelhante. No seguimento, os estagiários relatavam maior prevalência de tabagismo, problemas de sono, anedonia e maior sobrepeso. Os sintomas de TEPT eram previstos por estressores operacionais e organizacionais, mesmo despois de controlar para o estado de saúde na linha de base. Os resultados apontaram não apenas para diferenças no estado preditivo dos eventos operacionais e organizacionais em relação aos sintomas de TEPT, como também, para a maneira pela qual esses eventos podem interagir em termos de efeitos. Assim, os dados sugerem intervenções baseadas em evidências, apoio através do trabalho e organização do trabalho que possam melhorar as taxas de notificação para saúde mental em geral e sintomas de TEPT em particular.

Resumen: Existen dos importantes temas subyacentes a la salud mental de los trabajadores de primeros auxilios y, uno en particular, es la manifestación de síntomas de estrés postraumático (PTSS). El primero está relacionado con la provisión de datos cuantitativos, procedentes de estudios de diseños longitudinales, y, el segundo, con la sofisticación según el modelo de trabajo usado para enmarcar tales estudios. Este trabajo informó del desarrollo de un modelo para los bomberos brasileños, que también son trabajadores de primeros auxilios, mediante el establecimiento de un estudio de diseño longitudinal: el Estudio Longitudinal de Salud en Bomberos Brasileños (FloHS). El primer objetivo fue comparar bomberos entrenados y activos, basándonos en sus datos de seguimiento, con una muestra nacional de brasileños en edades similares. El segundo objetivo fue probar el efecto que las experiencias operacionales y organizativas tuvieron en el nivel de PTSS entre los bomberos durante el seguimiento. En la base de referencia, los bomberos entrenados contaban con antecedentes socioeconómicos más altos, estaban más sanos y menos expuestos al trauma, cuando se comparan con una muestra nacional de población en edad similar. Durante el seguimiento, informaron de una prevalencia más alta de fumadores, problemas de sueño, anhedonia y tenían más probabilidad de tener sobrepeso. Los PTSS se predijeron mediante estresores operacionales y organizativos, incluso controlando el estatus de salud en la base de referencia. Los resultados apuntaron no solo las diferencias en el estatus predictivo de eventos operacionales y organizativos, en relación con PTSS, sino también la forma en la que tal vez tales eventos interactúan en sus efectos. De este modo, los datos animan intervenciones basadas en la evidencia, además de apoyo mediante el trabajo y diseño de intervenciones, que tal vez mejore las tasas de informes para la salud mental en general y para los PTSS en particular.

Associação entre a violência psicológica e o transtorno de estresse pós-traumático em adolescentes de uma coorte / Association between psychological violence and posttraumatic stress disorder in a cohort of Brazilian adolescents / Asociación entre violencia psicológica y trastorno de estrés postraumático en adolescentes de una cohorte

Resumo: Este trabalho analisou a influência da ocorrência de violência psicológica no desenvolvimento de transtorno de estresse pós-traumático (TEPT) em adolescentes. Tratou-se de um estudo transversal aninhado a uma coorte, cujo segundo segmento foi realizado em 2016. Aplicou-se um questionário em 2.486 adolescentes, por meio do qual se abordou aspectos individuais, familiares, sociais e da vivência de violência psicológica. Utilizou-se o escore de propensão para se criar o inverso da probabilidade de seleção (IPS). Dessa forma, atribuiu-se uma probabilidade para cada adolescente, sendo 1/IPS aqueles que compõem o grupo dos expostos e 1/(1-IPS) aqueles do grupo dos não expostos. Essa condição tornou os dois grupos mais homogêneos e comparáveis entre si. A associação entre a ocorrência de violência psicológica e de TEPT foi estimada pela odds ratio (OR), enquanto o intervalo de 95% de confiança (IC95%) foi estimado por meio da regressão logística binária bruta e ajustada, ponderada pelo IPS. Verificou-se que 30,3% relataram ter sofrido violência severa. A prevalência do TEPT foi de 4,8% entre os expostos contra 1,5% entre os não expostos à violência psicológica. Observou-se uma associação da violência severa com o TEPT nas duas análises realizadas. Porém, a magnitude no modelo estruturado pelo escore de propensão (OR = 1,97; IC95%: 1,08-3,56) indicou um ajuste da medida de associação da análise bruta (OR = 3,40; IC95%: 2,03-5,69). Nesse sentido, este estudo contribui para a escassa literatura sobre a exposição à violência psicológica e a sua associação com o desenvolvimento de TEPT, confirmando o impacto negativo dessa forma de abuso na saúde mental do indivíduo.

Abstract: The study analyzed the impact of psychological violence on the development of posttraumatic stress disorder (PTSD). This was a cross-sectional study nested in a cohort in which the second follow-up was conducted in 2016. A questionnaire was applied to 2,486 adolescents and approached individual, family, and social aspects and experience with psychological violence. Propensity score was used to create inverse probability weighting (IPW). Thus, a probability was assigned to each adolescent, where 1/IPW represent those in the exposed group and 1/(1-IPW) those in the unexposed group. This procedure made the two groups more homogeneous and mutually comparable. The association between the occurrence of psychological violence and PTSD was estimated by odds ratios (OR) and 95% confidence intervals (95%CI) via crude binary logistic regression and adjusted logistic regression (weighted by IPW). According to the results, 30.3% reported having suffered severe violence. Prevalence of PTSD was 4.8% among exposed and 1.5% in unexposed to psychological violence. An association was observed between severe violence and PTSD in the two analyses, but the magnitude in the model structured by the propensity score (OR = 1.97; 95%CI: 1.08-3.56) indicated an adjustment to the measure from the crude analysis (OR = 3.40; 95%CI: 2.03-5.69). The current study contributes to the scarce literature on exposure to psychological violence and its association with the development of PTSD, confirming the negative impact of this form of abuse on the individual´s mental health.

Resumen: Se analizó la influencia de la ocurrencia de violencia psicológica en el desarrollo de trastorno de estrés postraumático (TEPT). Se trató de un estudio transversal anidado en una cohorte, cuyo segundo seguimiento se realizó en 2016. Se aplicó un cuestionario en 2.486 adolescentes, a través del cual se abordaron aspectos individuales, familiares, sociales, así como de vivencia de violencia psicológica. Se utilizó el marcador de propensión para que se creara el inverso de la probabilidad de selección (IPS). De esta forma, se atribuyó una probabilidad para cada adolescente, siendo 1/IPS para aquellos que componen el grupo de expuestos y 1/(1-IPS) para aquellos del grupo no expuestos. Esta condición hizo los dos grupos más homogéneos y comparables entre sí. La asociación entre ocurrencia de violencia psicológica y TEPT se estimó mediante OR (odds ratio) y el IC95% (intervalo de 95% de confianza) por medio de la regresión logística binaria bruta y ajustada (ponderada por el IPS). Se verificó que un 30,3% informaron haber sufrido violencia severa. La prevalencia del TEPT fue de un 4,8% entre los expuestos contra un 1,5% en no expuestos a la violencia psicológica. Se observó una asociación de la violencia severa con el TEPT en los dos análisis realizados, no obstante, la magnitud en el modelo estructurado por el marcador de propensión (OR = 1,97; IC95%: 1,08-3,56) indicó un ajuste de la medida de asociación del análisis bruto (OR = 3,40; IC95%: 2,03-5,69). Este estudio contribuye a la escasa literatura sobre la exposición de violencia psicológica y su asociación con el desarrollo del TEPT, confirmando el impacto negativo de esa forma de abuso en la salud mental del individuo.

Perspectivas neurocientíficas para uma teoria do trauma: revisão crítica dos modelos integrativos entre a biologia e a cultura / Perspectivas neurocientíficas para una teoría del trauma: revisión crítica de los modelos integradores entre la biología y la cultura / Neuroscientific perspectives for a theory of trauma: a critical review of integrative models of biology and culture

Durante o último quarto do século XX, a psicopatologia codificou um arco diversificado de fenômenos sociais sob a rubrica do traumatismo, notabilizando o estudo do trauma psicológico como área autônoma e progressivamente informada pelas pesquisas culturais e neurobiológicas. Nesse cenário, presenciamos a emergência do paradigma biocultural, perspectiva epistemológica que procura elucidar as trajetórias interativas pelas quais cultura e biologia consolidam, entre si, os seus efeitos recíprocos. Este artigo abordará as interseções entre o campo dos psicotraumatismo e as neurociências, tomando, como eixos de análise, a expansão da categoria do transtorno de estresse pós-traumático (TEPT), os pressupostos epistemológicos das pesquisas neurocomportamentais do estresse e do medo, e as limitações da tese da bidirecionalidade, preconizada pelas neurodisciplinas culturais contemporâneas. A elaboração de abordagens definitivamente integrativas pode auxiliar no desenvolvimento de modelos compreensivos capazes de conceber os saberes e as práticas ao nível da experiência humana, evitando interpretações reducionistas que submetem vivências culturais e subjetivas complexas ora aos imperativos do cérebro, ora aos códigos semiológicos do raciocínio patogênico.

Durante el último cuarto del siglo XX, la psicopatología codificó un arco diversificado de fenómenos sociales, bajo la rúbrica del traumatismo, poniendo en relevancia el estudio del trauma psicológico, como área autónoma, y progresivamente informada por las investigaciones culturales y neurobiológicas. En este escenario, presenciamos el surgimiento del paradigma biocultural, perspectiva epistemológica que procura elucidar las trayectorias interactivas por las cuales cultura y biología consolidan, entre sí, sus efectos recíprocos. Este artículo abordará las intersecciones entre el campo de los psicotraumatismos y las neurociencias, tomando, como ejes de análisis, la expansión de la categoría del trastorno de estrés postraumático (TEPT), los presupuestos epistemológicos de las investigaciones neurocomportamentales del estrés y del miedo, y las limitaciones de la tesis de la bidireccionalidad, preconizada por las neurodisciplinas culturales contemporáneas. La elaboración de abordajes definitivamente integradores pueden apoyar el desarrollo de modelos comprensivos, capaces de concebir los saberes y prácticas en el nivel de la experiencia humana, evitando interpretaciones reduccionistas que someten vivencias culturales y subjetivas complejas, bien sea a los imperativos del cerebro, bien sea a los códigos semiológicos del raciocinio patogénico.

In the last 25 years of the 20th century, psychopathology coded a diverse range of social phenomena under the heading of trauma, featuring the study of psychological trauma as an autonomous area progressively informed by cultural and neurobiological research. In this scenario, we witnessed the emergence of the biocultural paradigm, an epistemological perspective that seeks to elucidate the interactive trajectories by which culture and biology consolidate each other´s effects. This article will address the intersections between the field of psychological trauma and neurosciences, based on the analytical dimensions of expansion of the category of posttraumatic stress disorder (PTSD), the epistemological premises of neurobehavioral studies of stress and fear, and the limitations of the bidirectionality hypothesis advanced by contemporary cultural neurosciences. The elaboration of definitively integrative approaches can assist the development of comprehensive models capable of conceiving knowledges and practices at the level of human experience, avoiding reductionist interpretations that submit complex cultural and subjective experiences alternatingly to the imperatives of the brain and to semiologic codes of pathogenic reasoning.

Post-traumatic stress disorder after subsequent birth to a gestational loss: An observational study / Trastorno de estrés postraumático tras una gestación posterior a una pérdida gestacional: Un estudio observacional

Abstract Introduction The loss of a pregnancy puts women at risk of suffering post-traumatic stress disorder. This circumstance can influence a subsequent pregnancy, and the link with the future baby. Objective The main objective of this work was to identify the prevalence of post-traumatic stress disorder (PTSD) among post-partum women who give birth after having suffered a previous gestational loss and to identify possible relationships between PTSD and the variables studied. Method An observational, descriptive, and cross-sectional study. A total of 115 puerperal women who had suffered a previous gestational loss completed questionnaires containing sociodemographic variables, obstetric history, and responses to the Davidson Trauma Scale. Results A score of 40 was established as a cut-off point in the Davidson Trauma Scale for the identification of PTSD. 21.7% of the participants scored 40 or above. Significant differences were found related to age (p = .030), number of pregnancies (p = .033), and number of gestational losses (p = .001). The probability of PTSD increases significantly in relation to the number of losses. Respondents are 2.55 times (β = .94 p = .027) more likely to suffer PTSD the higher the number of gestational losses suffered. Discussion and conclusion There are significant differences in the presence of PTSD among puerperal women in terms of age, number of pregnancies, and number of gestational losses. Post-partum women are more likely to suffer PTSD after a gestational loss the higher the number of gestational losses suffered.

Resumen Introducción La pérdida de un embarazo sitúa a las mujeres en riesgo de padecer un trastorno por estrés postraumático. Esta circunstancia puede influir en un embarazo posterior, y el vínculo con el futuro bebé. Objetivo El objetivo principal de este trabajo fue identificar la prevalencia de trastorno por estrés postraumático entre puérperas que dan a luz tras haber sufrido una pérdida gestacional previa e identificar posibles relaciones entre el trastorno por estrés postraumático y las variables estudiadas. Método Se trata de un estudio observacional, descriptivo y transversal. Un total de 115 puérperas que habían sufrido una pérdida gestacional anterior llenaron cuestionarios que contenían variables sociodemográficas, de la historia obstétrica y la Escala de Trauma de Davidson. Resultados Se estableció 40 como punto de corte en la Escala de Trauma de Davidson para identificar el trastorno por estrés postraumático. Se identificó en un 21.7% de las participantes. Se encontraron diferencias significativas relacionadas con la edad (p = .030), el número de embarazos (p = .033) y el número de pérdidas gestacionales (p = .001). La probabilidad de trastorno por estrés postraumático aumenta significativamente en relación con el número de pérdidas. Es 2.55 veces (β = .94 p = .027) más probable padecer un trastorno por estrés postraumático cuanto mayor sea el número de pérdidas gestacionales sufridas. Discusión y conclusión Existen diferencias significativas en la prevalencia de trastorno por estrés postraumático entre las puérperas en cuanto a la edad, el número de embarazos y el número de pérdidas gestacionales. Es más probable padecer trastorno por estrés postraumático tras una gestación posterior a una pérdida gestacional cuanto mayor sea el número de pérdidas gestacionales sufridas.

Alteraciones en el ritmo biológico y presencia de síntomas de estrés post traumático en el contexto de la epidemia de dengue del año 2020 en médicos del Hospital de Clínicas de Paraguay

RESUMEN Introducción: El efecto psicológico de las enfermedades virales va más allá del efecto directo que estas pueden tener en el sistema nervioso central del paciente. La epidemia del virus del Dengue que sufre Paraguay en el año 2020 ha visto consigo una demanda importante por parte de la sociedad a los proveedores sanitarios. Objetivo: determinar el impacto en la salud mental de los médicos del Hospital de Clínicas la epidemia de Dengue del año 2020 utilizando las escalas TOP8 y BRIAN. Metodología: diseño observacional, descriptivo, de corte transversal. Resultados: fueron reclutados 123 sujetos, el 59,91% fueron de sexo femenino con una edad media de 29,03±3,41 años. El servicio con mayor frecuencia fue el de Clínica Médica con 27,05% de los sujetos. La percepción de los sujetos con mayor frecuencia fue que el estigma asociado a padecer Dengue es nulo y que la percepción de los pacientes acerca del estrés asociado a atender a pacientes con Dengue es nulo. El test TOP8 tuvo una medida de 3,57±4,57 (No síntomas de estrés post traumático) y BRIAN con 51,33±11,95 (elevado). Existe una asociación significativa entre haber padecido Dengue y síntomas de estrés post traumático y con alteración del ritmo circadiano. Discusión: los resultados altos del test BRIAN pueden estar relacionados con el nivel de exigencia de las especialidades estudiadas. La asociación encontrada entre haber padecido de Dengue con síntomas de estrés post traumático y con alteraciones del ritmo circadiano son compatibles con estudios anteriores. En cuanto a las consideraciones que tienen los médicos acerca del estigma y el estrés asociado a esta patología, consideran que la sociedad no coloca un estigma al hecho de tener dengue, tampoco considera el nivel de estrés asociado a los profesionales que atienden a estos pacientes.

ABSTRACT Introduction: The psychological effect of viral diseases goes beyond the direct effect they can have on the patient's central nervous system. The 2020 Dengue virus epidemic in Paraguay has seen a significant increase in the society demand for healthcare providers. Objective: to determine the impact on the mental health of the Hospital de Clínicas' doctors of the 2020 Dengue epidemic using the TOP8 and BRIAN scales. Methodology: observational, descriptive, crosssectional design. Results: 123 subjects were recruited, 59.91% were female with a mean age of 29.03 ± 3.41 years. The service with the highest frequency was Internal Medicine with 27.05% of the subjects. The perception of the subjects was that the stigma associated with having Dengue is almost none and that the perception of the patients about the stress associated with caring for patients with Dengue is null. The TOP8 test had a measure of 3.57 ± 4.57 (No symptoms of posttraumatic stress disorder) and BRIAN with 51.33 ± 11.95 (high). There is a significant association between having Dengue and posttraumatic stress disorder symptoms and with alteration of the circadian rhythm. Discussion: the high results of the BRIAN test may be related to the level of demand of the specialties studied. The association found between having Dengue with symptoms of posttraumatic stress disorder and with alterations of the circadian rhythm are compatible with previous studies. As for the considerations that doctors have about the stigma and stress associated with this pathology, they consider that society does not place stigma on having dengue, nor does it consider the level of stress associated with the professionals who care for these patients.

Neck Injuries by Traffic Accidents: Diagnosis and Treatment (review) / 中国康复理论与实践

Neck injuries caused by traffic accidents increase by years, timely and effective treatment can greatly reduce the mortality rate. This paper summarized the characteristics, image features, evoked potential detection and serum markers detection of neck injury caused by traffic accidents. Then, the condition of injuries was comprehensively considered and analyzed, and the priorities were correctly judged. The injuries were classified and treated. It is conducive for the attending doctors to carry out precise individualized first aid and surgical treatment for the patients, in order to save lives to the maximum extent, reduce disabilities, and prevent and treat post traumatic stress disorders.

Association of Traumatic Events, Post Traumatic Stress Disorder and Sexual Autonomy among Female University Students of North Korean Defectors / 여성건강간호학회지

PURPOSE: To determine associations of traumatic events and post-traumatic stress disorder (PTSD) with sexual autonomy and identify factors influencing sexual autonomy among female university students of North Korean defectors. METHODS: A cross-sectional, descriptive study was performed with a total of 103 female students who completed a structured online self-report survey from January 7 to March 31, 2018. This study was conducted using questionnaires on interpersonal trauma scale, the Traumatic Scale for North Korean Refugees (TSNKR), and sexual autonomy measurement for college students. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficients, and multiple linear regression with SPSS WIN 23.0 program. RESULTS: Traumatic events, PTSD, and sexual autonomy scores were 3.96±3.07, 31.47±10.75, and 52.66±6.89, respectively. PTSD was positively correlated with traumatic events (r=.22, p=.030). Sexual autonomy was inversely correlated with PTSD (r=−.25, p=.010). Contraceptive use, PTSD, and voluntary sexual debut explained 26% of sexual autonomy of participants. CONCLUSION: To improve sexual autonomy of young women from North Korea, reproductive intervention programs including contraception, sexual assertiveness training, and psychoeducation to reduce PTSD need to be developed and implemented.

Post-traumatic stress and related symptoms in a gestation after a gestational loss: narrative review / Estrés postraumático y síntomas relacionados en un embarazo posterior a una pérdida gestacional: revisión narrativa

Abstract Background Around 30% of pregnancies conclude in a gestational loss. Most women who suffer a gestational loss become pregnant again. However, mothers who have experienced this situation live the new pregnancy with fear and anxiety. Objective To perform an update of the main works done in the study of post-traumatic stress and related symptoms during pregnancy after a gestational loss. Method The Medline database was consulted. Articles published from 2007 to date were selected. Key words related to the topic of study were used. Results The studies reviewed showed five entities that deserve attention during a pregnancy achieved after a gestational loss: post-traumatic stress, depression, anxiety, relationship, and relationship with the future child. There is a relationship between the presence of post-traumatic stress and the risk of developing depression and anxiety. Discussion and conclusion Women who experience perinatal loss, regardless of the type of loss and the gestational age in which it occurs, are at risk of continuing grief, symptoms of depression, anxiety, and post-traumatic stress in later pregnancy. The gestational age and the time elapsed between the perinatal loss and the next pregnancy seem to be the most influential factors in the development of post-traumatic stress sindrome, and symptoms of dysfunctional grief, anxiety, and depression.

Resumen Antecedentes Alrededor de un 30% de los embarazos concluyen en una pérdida gestacional; de este porcentaje, la mayoría de las mujeres vuelve a quedar embarazada. Sin embargo quienes han experimentado esta situación viven con miedo y ansiedad su nuevo embarazo. Objetivo Realizar una actualización de los principales trabajos realizados en cuanto al estudio del estrés postraumático y los síntomas relacionados con el embarazo posterior a una pérdida gestacional. Método Se consultó la base de datos Medline y se seleccionaron artículos publicados desde 2007 hasta la fecha. Se emplearon palabras clave relacionadas con el tema de estudio. Resultados Los estudios revisados mostraron cinco entidades que merecen atención durante un embarazo experimentado tras una pérdida gestacional: estrés postraumático, depresión, ansiedad, relación de pareja y vínculo con el futuro infante. Se encontró que existe una relación entre la presencia de estrés postraumático y el riesgo de desarrollar depresión y ansiedad. Discusión y conclusión Las mujeres que experimentan pérdida perinatal, independientemente del tipo de pérdida y de la edad gestacional en la que se produce, corren el riesgo de continuar el duelo, los síntomas de depresión, la ansiedad y el estrés postraumático durante el embarazo posterior. La edad gestacional y el tiempo transcurrido entre la pérdida perinatal y el siguiente embarazo parecen ser los factores más influyentes en el desarrollo del síndrome de estrés postraumático, así como de síntomas de duelo disfuncional, ansiedad y depresión.

Psychometric properties of a Brazilian Portuguese version of the Children's Revised Impact of Event Scale (CRIES-8)

Abstract Background: Children and adolescents are considered a population at risk for developing posttraumatic stress disorder (PTSD) after a traumatic event. The Children's Revised Impact Scale (CRIES-8) is a self-report scale with 8 items that investigates avoidance and intrusion behaviors related to posttraumatic stress symptoms. Objective: The study consisted of translation and transcultural adaptation of CRIES-8 to Brazilian Portuguese and evaluation of its psychometric properties. Methods: A sample of 235 Brazilian children and adolescents exposed to natural hazards (drought or flood) and non-exposed children participated in the study. The methodological procedure for translation and cultural adaptation were in accordance with the principles described by ISPOR Task Force for Translation and Cultural Adaptation. We also evaluated test reliability and validity based on test content, the relations to other variables, and internal structure. Results: The procedures lead to a final Portuguese version proofread and cultural-adapted. Empirical evidence supports CRIES-8's division in two latent constructs (Intrusion and Avoidance), as well convergence correlations with other measures of child mental health and high reliability. Discussion: A Brazilian-Portuguese version of CRIES-8 is an important tool for a better screening of PTSD among youth who face traumatic events, being a potential informative instrument to identify children at risk.

The Influence of Spiritual Well-Being, Self-Esteem, and Perceived Social Support on Post-Traumatic Growth among Breast Cancer Survivors

PURPOSE: The purpose of this study was to identify the influence of spiritual well-being, self-esteem, and perceived social support on post-traumatic growth in breast cancer survivors in Korea. METHODS: Data were collected from March 2 to October 31, 2016 using self-reporting questionnaires from 126 breast cancer survivors who had visited out-patient clinics for follow-up in B city. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression. RESULTS: Post-traumatic growth was significantly correlated with spiritual well-being (r=.52, p < .001), self-esteem (r=.54, p < .001), and perceived social support (r=.47, p < .001). In a stepwise multiple regression, spiritual well-being (β=.26, p < .001), self-esteem (β=.23, p < .001), perceived social support (β=.21, p < .001), and presence of spouse (β=.20, p < .001) were associated with posttraumatic growth. These factors attributed to 37.0% of the total variance in post-traumatic growth in breast cancer survivors. CONCLUSION: Considering the results of this study, it is necessary to develop and implement effective nursing strategies that can improve spiritual well-being, and to develop a holistic nursing intervention that takes into account self-esteem, perceived social support, and spousal help, when applicable, in order to promote post-traumatic growth in breast cancer survivors in Korea.

Factors Influencing Posttraumatic Growth in Cancer Survivors

PURPOSE: The purpose of this study was to identify the level of post-traumatic growth (PTG) and the factors affecting the PTG of cancer survivors. METHODS: Data were collected from 147 cancer patients who were admitted to hospital to two hospitals, P and B city during July and September, 2017 using the PTG Inventory, Multidimensional Scale Perceived Social Support, Event-Related Rumination Inventory, Korean Cancer Coping Questionnaire, Resilience Scale, and Self-Esteem Scale. Data were analyzed using t-tests, ANOVA, Pearson-correlation coefficient, and multiple regression. RESULTS: The mean score for PTG in cancer survivors was 3.20 points. PTG had significant correlation with social support, deliberate rumination, coping, and resilience. Factors that had an influence on PTG in multiple regression were social support (β=0.25, p<001), personal coping (β=0.22, p=.008), resilience (β=0.21, p=.006), recognizing the need for religion (β=0.17, p=.015), religion (β=0.17 p=.011), and deliberate rumination (β=.15, p=.022). These factors explained 60.0% of the variance in the PTG of cancer patients. CONCLUSION: In order to effectively promote PTG of cancer survivors, it is necessary to develop and apply programs that can improve social support, coping (personal), resilience, religion, and deliberate rumination.

Severe Maternal Morbidity: post-traumatic suffering and social support / Morbilidad Materna Grave: estrés postraumático y soporte social / Morbidade Materna Grave: estresse pós-traumático e suporte social

ABSTRACT Objective: To assess the relationship of post-traumatic stress symptoms and the perception of social support in women submitted to Severe Maternal Morbidity (SMM). Method: A prospective cohort study, with 549 women from public hospitals. The Impact of Events and Social Support scales were used. Results: Women with SMM were from the State countryside (p=0.046), with low schooling (p=0.039) and did not work (p<0.001). They presented higher consumption of alcoholic beverages (p<0.001), did not perform prenatal (p<0.001), and were older (28.15 ± 28 years). Women with SMM had higher mean values of avoidance behavior (24.32, SD: 4.16), intrusive thinking (18.28, SD: 3.80), lower social support (0.11, SD: 0.001) with large effect size and lower social support satisfaction (0.69; SD: 0.19), with small effect size. Conclusion: SMM is a differential and negative factor for women's mental health, and social support can favor their coping.

RESUMEN Objetivo: Evaluar la relación de síntomas de estrés postraumático y la percepción del soporte social en mujeres sometidas a la Morbilidad Materna Grave (MMG). Método: Estudio de corte prospectivo, con 549 mujeres de hospitales públicos. Se utilizaron las escalas de Impacto de Eventos y de Soporte Social. Resultados: las mujeres con MMG provenían del interior del estado (p = 0,046), con baja escolaridad (p = 0,039) y no trabajaban (p <0,001). En el caso de las bebidas alcohólicas (p <0,001), no realizaron prenatal (p <0,001), y eran mayores (28,15 ± 28 años). Las mujeres expuestas a la MMG tuvieron promedios más altos de comportamiento de esquiva (24,32, DP: 4,16), pensamiento intrusivo (18,28, DP: 3,80), menor soporte social (0,11, DP: 0,001) con tamaño de efecto grande y menor satisfacción del soporte social (0,69, DP: 0,19) con tamaño de efecto pequeño. Conclusión: La MMG es un factor diferencial y negativo para la salud mental de las mujeres, y el apoyo social puede favorecer su enfrentamiento.

RESUMO Objetivo: Avaliar a relação de sintomas de estresse pós-traumático e a percepção do suporte social em mulheres submetidas à Morbidade Materna Grave (MMG). Método: Estudo de coorte prospectivo, com 549 mulheres de hospitais públicos. Foram utilizadas as escalas de Impacto de Eventos e de Suporte Social. Resultados: Mulheres com MMG eram oriundas do interior do estado (p=0,046), com baixa escolaridade (p=0,039) e não trabalhavam (p<0,001). Apresentavam maior consumo de bebidas alcoólicas (p<0,001), não realizaram pré-natal (p<0,001), e eram mais velhas (28,15±28 anos). As mulheres com MMG tiveram maiores médias de comportamento de esquiva (24,32; DP: 4,16), pensamento intrusivo (18,28; DP: 3,80), menor suporte social (0,11; DP: 0,001) com tamanho de efeito grande e menor satisfação do suporte social (0,69; DP: 0,19), com tamanho de efeito pequeno. Conclusão: A MMG é um fator diferencial e negativo para a saúde mental das mulheres, e o apoio social pode favorecer o seu enfrentamento.

Factors Influencing Post Traumatic Stress Disorder in Crime Scene Investigators

PURPOSE: The purpose of this study was to verify the relationships among social support, resilience and post traumatic stress disorder (PTSD), and especially to identify factors influencing PTSD in police crime scene investigators. METHODS: A cross-sectional design was used, with a convenience sample of 226 police crime scene investigators from 7 Metropolitan Police Agencies. Data were collected through self-report questionnaires during July and August, 2015. Data were analyzed using t-test, χ2-test, Fisher's exact test, and binary logistic regression analysis with SPSS/WIN 21.0 program. RESULTS: The mean score for PTSD in police crime scene investigators was 13.69. 11 points. Of the crime scene investigators 181 (80.1%) were in the low-risk group and 45 (19.9%) in high-risk group. Social support (t=5.68, p<.001) and resilience (t=5.47, p<.001) were higher in the low-risk group compared to the high-risk group. Logistic regression analysis showed that resilience (OR=4.74, 95% CI: 1.57~14.35), and social support (OR=2.13, 95% CI: 1.23~3.69) are effect factors for PTSD low group. CONCLUSION: For effective improvement of PTSD in police crime scene investigators, intervention programs including social support and strategies to increase should be established.

Development and Validation of the Cancer-Specific Posttraumatic Growth Inventory

PURPOSE: The purpose of this study was to develop a scale to evaluate posttraumatic growth in patients with cancer and to examine the validity and reliability of the scale. METHODS: A literature review, semi-structured patient interviews and an expert panel consultation produced a 27 preliminary item questionnaire. Participants were 150 cancer patients recruited to test the reliability and validity of the preliminary scale. Data were analyzed using item analysis, exploratory factor analysis, convergent validity and internal consistency. RESULTS: Item reduction and exploratory factor analysis led to 23 items, grouped into five subscales which were labelled new possibilities (6 items), coping skills (5 items), preciousness of life (5 items), relating to others (4 items), and personal strength (3 items). Convergent validity was evaluated by total correlation with the Functional Assessment of Cancer Therapy-General (r=.45, p<.001). The final scale demonstrated satisfactory internal consistency (Cronbach's α =.94). CONCLUSION: Findings from this study indicate that the Cancer-Specific Posttraumatic Growth Inventory has validity and reliability and is considered to be appropriate for assessing posttraumatic growth in patients with cancer.