Adaptación y validación del Cuestionario de Trastorno de Estrés Postraumático (COVID-19-PTSD) en población peruana / Adaptation and Validation of the Questionnaire on Posttraumatic Stress Disorder in a Peruvian Population

Introducción: La alta prevalencia de trastornos mentales como el estrés, en situaciones estresantes prolongadas inducidas por una pandemia, demanda su detección y valoración oportuna; para ello se requieren instrumentos contextualizados y con adecuadas propiedades métricas. Objetivo: Validar el Cuestionario sobre el Trastorno de Estrés Postraumático y Prevalencia de Sintomatología de Estrés Postraumático en población peruana. Métodos: Estudio de tipo instrumental, realizado en la región Ica del Perú, de junio a noviembre del 2021, en 412 participantes adultos. El proceso incluyó traducción al español, evaluación del contenido por jueces y prueba piloto. La validez de constructo se evaluó mediante el Análisis Factorial Exploratorio y el ajuste con Análisis Factorial Confirmatorio, que incluyó el Método de Estimación de Mínimos Cuadrados no Ponderados Robustos; se evaluó la confiabilidad con el Omega de McDonald y comparó la sintomatología del trastorno de estrés postraumático con variables generales. Resultados: Se obtuvo una versión de dieciocho ítems, agrupados en cuatro factores que explicaron el 70,78 por ciento de la varianza total y un ajuste aceptable [x2/gl = 1,54; NFI y CFI = 0,99; SRMR = 0,052; RMSEA = 0,036 (IC90 por ciento: 0,26-0,46)]. Los ítems discriminan de forma satisfactoria; así como la escala según variable sexo, estado civil y los que tienen familiar fallecido por COVID-19. La consistencia interna fue adecuada para la escala global (ω = 0,924) y sus dimensiones (EDA = 0,740; IEAN = 0,882; A = 0,786 y CE = 0,811). Conclusión: La nueva versión peruana del instrumento posee propiedades métricas aceptables; por tanto, se recomienda su uso para valorar el trastorno de estrés postraumático y estudios de validación(AU)

Introduction: The high prevalence of mental disorders such as stress, in prolonged stressful situations induced by a pandemic, demands their timely identification and assessment; in order to do this, contextualized instruments with adequate metric properties are required. Objective: To validate the Questionnaire on Posttraumatic Stress Disorder and Prevalence of Posttraumatic Stress Symptomatology in a Peruvian population. Methods: An instrumental study was conducted in the region of Ica, in Peru, from June to November 2021, with 412 adult participants. The process included translation into Spanish, content assessment by judges, and pilot testing. Construct validity was evaluated by exploratory factor analysis; and fit, with confirmatory factor analysis, which included the robust unweighted least squares estimation method. Reliability was evaluated with McDonald's Omega, while the posttraumatic stress disorder symptomatology was compared with general variables. Results: The obtained version included 18 items, grouped into four factors that explained 70.78 percent of the total variance. Also, an acceptable fit was obtained [x2/gl=1.54; NFI and CFI=0.99; SRMR=0.052; RMSEA=0.036 (90 percent CI: 0.26-0.46)]. The items discriminate satisfactorily, as does the scale according to sex, marital status and those with a family member who died from COVID-19. Internal consistency was adequate for the global scale (ω = 0.924) and its dimensions (EDA=0.740; IEAN = 0.882; A=0.786 and CE=0.811). Conclusion: The new Peruvian version of the instrument has acceptable metric properties; therefore, its use is recommended for assessing posttraumatic stress disorder and validation studies(AU)

Análise do transtorno do estresse pós-traumático em profissionais emergencistas / Análisis del trastorno del estrés postraumático en profesionales de emergencias / Analysis of post-traumatic stress disorder in emergency professionals

Resumo Objetivo Analisar a prevalência estimada do Transtorno do Estresse Pós-Traumático em profissionais emergencistas e seus fatores relacionados. Métodos Estudo analítico, transversal, exploratório com abordagem quantitativa, realizado em serviços de referência no atendimento a urgências e emergências em saúde e em serviços de segurança e proteção pública com condutores socorristas, enfermeiros, técnicos/auxiliares de enfermagem, médicos, policiais e bombeiros militares. Foram analisados dados provenientes de dois instrumentos. As classificações da Escala do Impacto do Evento - Revisada foram relacionadas com as variáveis sociodemográficas, profissionais e de aspectos relativos ao evento potencialmente traumático coletadas na amostra, e foi levantada a prevalência dos eventos potencialmente traumáticos. Resultados Participaram 338 profissionais, 31,07% apresentaram escores compatíveis com provável diagnóstico da psicopatologia. Apresentaram escores correspondentes ao agravo 39,67% dos profissionais de segurança e 20,78% dos de saúde. Os profissionais de segurança tiveram prevalência 48% superior na apresentação de escores compatíveis com o diagnóstico do transtorno. Como fatores relacionados, foram identificados os eventos potencialmente traumáticos prevalentes na amostra, usualmente relativos a situações com risco de morte, e estratégias de enfrentamento, que apontaram relação significativa com os escores do transtorno, como o afastamento de situações semelhantes, o suporte psicológico e reavaliação das situações. Conclusão O risco encontrado foi relativamente alto quando comparado a outros estudos brasileiros; situações envolvendo risco à vida foram prevalentes e as estratégias de enfrentamento com relações significativas se encontraram nos participantes que optaram pelo afastamento, suporte psicológico e reavaliação das situações potencialmente traumáticas.

Resumen Objetivo Analizar la prevalencia estimada del trastorno del estrés postraumático en profesionales de emergencias y los factores relacionados. Métodos Estudio analítico, transversal, exploratorio con enfoque cuantitativo, realizado en servicios de referencia en la atención a urgencias y emergencias de salud y en servicios de seguridad y protección pública con conductores socorristas, enfermeros, técnicos/auxiliares de enfermería, médicos, policías y bomberos militares. Se analizaron los datos provenientes de dos instrumentos. Se relacionaron las clasificaciones de la Escala del Impacto del Evento - Revisada con las variables sociodemográficas, profesionales y de aspectos relativos al evento potencialmente traumático recopiladas en la muestra. Además, se estudió la prevalencia de los eventos potencialmente traumáticos. Resultados Participaron 338 profesionales, el 31,07 % presentó puntuación compatible con un probable diagnóstico de la psicopatología. El 39,67 % de los profesionales de seguridad y el 20,78 % de los de salud presentaron puntuación que correspondía al empeoramiento. Los profesionales de seguridad tuvieron una prevalencia 48 % superior en la presentación de puntuación compatible con el diagnóstico del trastorno. Como factores relacionados, se identificaron los eventos potencialmente traumáticos prevalentes en la muestra, normalmente relativos a situaciones con riesgo de muerte, y las estrategias de afrontamiento que indicaron una relación significativa con la puntuación del trastorno, como el evitar situaciones semejantes, el apoyo psicológico y la revaluación de las situaciones. Conclusión El riesgo encontrado fue relativamente alto en comparación con otros estudios brasileños. Las situaciones con riesgo de vida fueron prevalentes. Se observaron estrategias de afrontamiento con relaciones significativas en participantes que optaron por el distanciamiento, el apoyo psicológico y la revaluación de las situaciones potencialmente traumáticas.

Abstract Objective To analyze the estimated prevalence of Post-Traumatic Stress Disorder in emergency professionals and its related factors. Methods Analytical, cross-sectional, exploratory, quantitative study performed in reference services in urgent and emergency care in health and services of public safety and protection with emergency service drivers, nurses, nursing technicians/assistants, physicians, police officers and firefighters. Data from two instruments were analyzed. The classifications of the Event Impact Scale - Revised were related to sociodemographic and professional variables and to those of aspects related to the potentially traumatic event collected in the sample. The prevalence of potentially traumatic events was estimated. Results Participation of 338 professionals, of which 31.07% had compatible scores with a probable diagnosis of the psychopathology, and 39.67% of security professionals and 20.78% of health professionals had scores corresponding to the disorder. Security professionals had a 48% higher prevalence of compatible scores with diagnosis of the disorder. The potentially traumatic events prevalent in the sample were identified as related factors, usually the situations with risk of death and coping strategies, which showed a significant relationship with scores of the disorder, such as distancing from similar situations, psychological support and reassessment of situations. Conclusion The risk was relatively high when compared to other Brazilian studies; situations involving risk to life were prevalent and the coping strategies with significant relationships were found in participants who chose distancing, psychological support and reassessment of potentially traumatic situations.

Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge

Objective: Sepsis survivors present a wide range of sequelae; few studies have evaluated psychiatric disorders after sepsis. The objective of this study was to define the prevalence of and risk factors for anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in sepsis survivors. Method: Anxiety, depression and post-traumatic stress symptoms in severe sepsis and septic shock survivors 24 h and 1 year after intensive care unit (ICU) discharge were assessed using the Beck Anxiety/Depression Inventories and the PTSD Checklist-Civilian Version. Differences in psychiatric symptoms over time and the influence of variables on these symptoms were calculated with marginal models. Results: A total of 33 patients were enrolled in the study. The frequencies of anxiety, depression and PTSD 24 h after ICU discharge were 67%, 49%, and 46%, respectively and, among patients re-evaluated 1 year after ICU discharge, the frequencies were 38%, 50%, and 31%, respectively. Factors associated with PTSD included serum S100B level, age, and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score. Factors associated with depression included patient age and cumulative dose of dobutamine. IQCODE score and cumulative dose of haloperidol in the ICU were associated with anxiety after ICU discharge. Conclusion: Patients who survive sepsis have high levels of psychiatric symptoms. Sepsis and associated treatment-related exposures may have a role in increasing the risk of subsequent depression, anxiety, and PTSD.

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.

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.

The impact of the COVID-19 pandemic on the mental health of young people: A comparison between China and the United Kingdom / 中华创伤杂志(英文版)

PURPOSE@#As COVID-19 spreads globally and affects people's health, there are concerns that the pandemic and control policies may have psychological effects on young people (age from 17 to 35 years). This psychological impact might vary in different countries, and thus we compared the prevalence of self-reported psychological distress, loneliness and posttraumatic stress symptoms (PTSS) among young people in the United Kingdom (UK) and China at the beginning of the COVID-19 pandemic.@*METHODS@#Data of this study came from two sources. One source was the first wave of COVID-19 study in Understanding Society, a special wave of the UK household longitudinal study, which provided the high-quality, national-wide representative panel data. The sample comprised 1054 young people. The other source was an online survey on the mental health of 1003 young people from Shanghai, a highly developed area in China. The questionnaire included questions on the prevalence of common mental disorders (cut-off score ≥ 4), loneliness and potential PTSS (cut-off ≥ 33). Univariable analyses were conducted to test the differences in the self-reported prevalence of psychological distress and loneliness between the two groups. Multivariable logistic regression analyses were run to explore the predictors of psychological distress and loneliness among all the young people from England and Shanghai.@*RESULTS@#Among the samples with self-reported psychological distress, the UK sample accounted for 34.4% (n=1054) and the Chinese sample accounted for 14.1% (n=1003). The difference between the two groups was statistically significant (p < 0.001). Additionally, 57.1% of people in the UK and 46.7% in China reported that they sometimes or often felt lonely, of which the difference is statistically significant (p < 0.001). Regression analysis of the entire samples showed that nationality, gender, psychotherapy and loneliness were significant predictors of 12-item General Health Questionnaire scores, while the variables of age and living alone were not. Significant predictors of self-reported loneliness were the nationality, gender, age, living alone and psychotherapy. In China, 123 (12.3%) young people, 49 men (11.3%) and 74 women (13.0%), met the criteria of PTSS symptoms (cut-off scores ≥ 33). These scores were only collected in China.@*CONCLUSION@#This evidence suggests that mental health and loneliness reported by young people were lower in China than that in the UK during the studied period. More research is needed to understand these differences. If the differential negative psychological impacts are confirmed, country-specific measures of prevention and intervention should be adopted to improve the mental health of young people under the ongoing impact of the pandemic.

Estilo de vida y estrés postraumático en mujeres desplazadas víctimas de abuso sexual en Santa Marta, Colombia / Lifestyle and post-traumatic stress disorder in displaced women victims of sexual abuse in Santa Marta, Colombia

Introducción: El fenómeno del desplazamiento forzoso en Colombia es una consecuencia de la violencia ejercida por diversos actores armados ilegales que afectan la estabilidad de un determinado sector de la población y del país. Objetivo: Identificar la relación entre estilo de vida y estrés postraumático en un grupo de mujeres desplazadas víctimas de abuso sexual. Métodos: Investigación descriptiva correlacional, con diseño transversal y muestreo intencional. Población constituida por 100 mujeres desplazadas víctimas de abuso sexual, de la que se tomó muestra intencional de 20 mujeres, de entre 20 y 55 años de edad, que aceptaron participar y otras 20 mujeres desplazadas. Se aplicó el Cuestionario fantástico de estilo de vida y la Escala de gravedad de síntomas del trastorno de estrés postraumático. Para el análisis estadístico se hicieron análisis descriptivos, se aplicó la prueba T de student para diferencia de medias y Rho de Spearman para determinar la intensidad de la correlación entre las dos variables estudiadas. Resultados: Luego de un tiempo de reexperimentación de 1 a 5 años, el 80 por ciento de las mujeres desplazadas víctimas de abuso sexual se encontraban en nivel crónico grave de estrés postraumático, a diferencia del 35 por ciento de mujeres desplazadas no víctimas. El 40 por ciento de las mujeres desplazadas víctimas de abuso sexual presentaron un estilo de vida inadecuado, a diferencia del 15 por ciento de las mujeres desplazadas no víctimas. Conclusiones: El impacto negativo del trastorno de estrés postraumático perdura más en las mujeres que han sufrido una doble victimización que aquellas que solo sufrieron desplazamiento forzoso. Esta difícil situación afecta indudablemente la salud y el estilo de vida de esta población, aunque en el presente estudio no se comprobó correlación entre estilo de vida y estrés postraumático(AU)

Introduction: The phenomenon of forced displacement in Colombia is a consequence of the violence perpetrated by various illegal armed actors affecting the stability of a particular sector of the population and the country. Objective: To identify the relationship between lifestyle and post-traumatic stress disorder in a group of displaced women who were victims of sexual abuse. Methods: Descriptive correlational research with cross-sectional design and intentional sampling. Population constituted by 100 displaced women victims of sexual abuse, in which it was taken an intentional sample of 20 women, between 20 and 55 years old who accepted to participate, and other 20 displaced women. It was applied the Fantastic questionnaire of lifestyle and the Post-traumatic stress disorder´s symptoms severity scale. For the statistical analysis, descriptive analyzes were made, it was applied the student's T test for difference of means, and Spearman's Rho to determine the intensity of the correlation between the two variables studied. Results: After a 1 to 5 years´ time of re-experiencing, 80 percent of displaced women victims of sexual abuse were in severe chronic level of post-traumatic stress disorder, unlike the 35 percent of non-victim displaced women. The 40 percent of the displaced women victims of sexual abuse presented an inadequate lifestyle, unlike the 15 percent of the non-victims displaced women. Conclusions: The negative impact of post-traumatic stress disorder lasts more in women who have suffered a double victimization than in those who only suffered forced displacement. This difficult situation undoubtedly affects the health and lifestyle of this population, although in the present study there was no evidence of correlation between lifestyle and post-traumatic stress disorder(AU)

Attachment styles of People Living with HIV/AIDS / Estilos de Apego de Pessoas vivendo com HIV/AIDS

Abstract Factors that involve the dynamics in interpersonal relationships and may have consequences in health are still little explored in people living with HIV/AIDS. The aim was to identify the evidences of literature regarding adult attachment style and HIV. It is an Integrative literature review. Seven databases were explored, using the combination of key words and Boolean connectors: "Attachment Style OR Object Attachment AND HIV". A reasonable number of articles addressed attachment among people with HIV as a mediator to post-traumatic stress disorder, depression and stress. The prevalence of insecure attachment in this group was high. Evidence was also found in relation to the attachment as an important factor to adaptation to the diagnosis of HIV, attachment and behavior in interpersonal relationships, and emphasize the possibility of changing the attachment style.

Resumo Fatores que envolvem a dinâmica nos relacionados interpessoais e podem ter consequências na saúde ainda são pouco explorados em Pessoas vivendo com HIV/AIDS. O objetivo desse estudo é identificar as evidências na literatura relacionando estilo de apego e HIV em adultos. Trata-se de uma revisão integrativa de literatura. Sete bases de dados foram exploradas, usando a combinação das palavras-chave e dos seguintes conectores booleanos em inglês: "Attachment Style OR Object Attachment AND HIV". Um número razoável de artigos abordou o vínculo entre pessoas com HIV como mediador de transtorno de estresse pós-traumático, depressão e estresse. A prevalência de apego inseguro nesse grupo foi alta. Evidências mostram ainda a relação entre apego e a adaptação ao diagnóstico de HIV, apego e estilos de comportamento nos relacionamentos, e destacam ainda a possibilidade de modificação do tipo de apego.

Long-term posttraumatic stress disorder in mine workers after a coalmining disaster

Abstract Background A coalmine disaster has occurred in Turkey on 13 May 2014, which caused the death of 301 miners. Objective This study aimed to determine the prevalence of posttraumatic stress disorder (PTSD) symptoms and the risk factors for PTSD among mine workers, 2 years after the coalmining disaster. Methods This was a cross-sectional survey conducted between June 2016 and July 2016 among mine workers who were the employees of either the mine where the accident occurred or three other mines in the same area. Sociodemographic data form and PTSD Symptom-Scale Self-Report (PSS-SR) were used to collect data. Results 672 mine workers participated in the study. At the time of the accident, 23.7% (n = 159) of them were in the mine where the accident occurred. The mean score on total PSS-SR was 4.27 (SD: ±4.49). Eighteen (2.7%) participants screened positive for PTSD. Logistic regression analysis revealed the significant risk factors for PTSD are: being single/divorced/widowed, having a chronic disease, having a family history of psychiatric illness and previously experiencing traumatic events more than one. Discussion Coalmining workers have considerably high prevalence rate of PTSD symptoms after a coalmining disaster. Assessing PTSD and associated risks is important for preventive mental health services.

Tentativa de suicídio, transtorno de estresse pós-traumático e fatores associados em mulheres do Recife / Suicide attempt, Post-traumatic stress disorder and associated factors in women of Recife

RESUMO: Objetivo: Investigar a associação da tentativa de suicídio (TS) com o transtorno de estresse pós-traumático (TEPT), a violência por parceiro íntimo (VPI) e variáveis relacionadas aos aspectos socioeconômicos e demográficos em uma coorte de mulheres cadastradas na Estratégia Saúde da Família do Recife. Métodos: Foi realizado um estudo transversal, aninhado em um estudo de coorte prospectivo, com 644 mulheres de 18 a 49 anos, cadastradas na Estratégia Saúde da Família do Distrito Sanitário II da cidade do Recife (PE), entre julho de 2013 e dezembro de 2014. A TS foi avaliada pela pergunta "Já tentou pôr fim à sua vida?", e o TEPT, diagnosticado por meio do Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). Foram realizadas uma modelagem hierarquizada, a aplicação do teste χ2 e a análise de resíduos padronizados. A associação das variáveis independentes com a TS foi estimada por meio de regressão logística simples e ajustada. Resultados: A prevalência da TS foi de 10,9%, e a frequência de TEPT, de 16%. As mulheres que tinham TEPT e também as que não possuíam religião tiveram maior chance de tentar o suicídio (odds ratio - OR = 5,11, intervalo de confiança de 95% - IC95% 2,9 - 8,7; OR = 1,76, IC95% 1,0 - 2,9, respectivamente). Conclusões: Houve maior risco de TS nas mulheres que tiveram TEPT e baixa adesão a uma religião. Sendo assim, compreendeu-se que o enfrentamento do TEPT se dá prevenindo esse transtorno, tratando dele e promovendo mais conhecimentos sobre ele, além do efeito agregador e protetor social que a religiosidade promove, que também podem ser estratégias de redução e prevenção da TS.

ABSTRACT: Objective: To investigate the association of suicide attempt (SA) with Post-Traumatic Stress Disorder (PSTD), Intimate Partner Violence (IPV) and variables related to socioeconomic and demographic aspects in a cohort of women enrolled in the Family Health Strategy in Recife. Methods: A cross-sectional study was carried out, nested in a prospective cohort study with 644 women aged 18 to 49 enrolled in the Family Health Strategy of the Sanitary District II of Recife, PE, between July 2013 and December 2014. The SA was evaluated by the question "Have you ever tried to end your life?" PTSD was diagnosed through the Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). A hierarchical modeling was performed, applying the χ2 test and Standardized Waste Analysis. The association of the independent variables with SA was estimated through simple and adjusted Logistic Regression. Results: The prevalence of SA was 10.9%, and the frequency of PSTD was 16%. Women who had PTSD and those who did not have a religion showed higher risk for suicide (odds ratio - OR = 5.11, 95%CI 2.9 - 8.7, OR = 1.76, 95%CI 1.0 - 2.9 respectively). Conclusions: There was a higher risk of SA in women who had PTSD and low adherence to a religion. Thus, it was understood that coping with PTSD comes from preventing, treating and promoting greater knowledge about this disorder, in addition to aggregating and social protective effect promoted by religiosity, which can be a strategy for the reduction and prevention of SA.

Post-traumatic Stress Disorder,Social Support,and Quality of Life in Patients with Spinal Cord Injury / 中国医学科学院学报

Objective To explore the relationship among post-traumatic stress disorder(PTSD),social support and quality of life in patients with spinal cord injury(SCI)after a long recovery in China and investigate the factors influencing the quality of life. Methods In this cross-sectional study,206 SCI patients who were hospitalized in 9 hospitals were enrolled.Data collection was performed using general information,the Post-Traumatic Stress Disorder Checklist-Civilian version,the social support scales,and the World Health Organization Quality of Life-Abbreviated version.The data were statistically analyzed using

Female crack cocaine users under treatment at therapeutic communities in southern Brazil: characteristics, pattern of consumption, and psychiatric comorbidities / Mulheres usuárias de crack-cocaína em tratamento em comunidades terapêuticas no sul do Brasil: características, padrão de consumo e comorbidades psiquiátricas

Abstract Objective To explore and describe sociodemographic characteristics, crack consumption patterns, and psychiatric comorbidities of female crack users receiving treatment at therapeutic communities. Methods This was a cross-sectional, descriptive, quantitative study. Forty-six women who abstained from crack use were assessed using a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and a profile of crack use questionnaire. Descriptive statistical analyses were conducted. Results Participants had a mean age of 31.02 years (standard deviation [SD] = 7.73), most were single (76.1%), white (67.4%) and had complete or incomplete elementary education (43.5%). Before treatment, 65.2% of the women reported using crack every day; 46.3% smoked between 10 to 30 crack rocks per week. Mean treatment time was 63.56 days (SD = 75.85), with a mean of 80.41 days of abstinence (SD = 74.52) and 3.37 previous treatments (SD = 5.49). Mean age upon crack use initiation was 22.61 years (SD = 8.06), and the most frequent motivation to start using crack was curiosity (78.3%). The mean lifetime duration of crack use was 82.26 months (SD = 74.76), and the physical complications most frequently reported were weight loss (93.5%), followed by sleep problems (87%). In this study, the most prevalent psychiatric diagnoses were major depressive episode (60.87%), followed by post-traumatic stress disorder (52.17%) and generalized anxiety disorder (13.07%). Conclusions Overall, a pattern of high consumption of crack was observed. The results show a high frequency of mood and anxiety disorders, with the highest frequencies found for major depressive episode and post-traumatic stress disorder.

Resumo Objetivo Explorar e descrever características sociodemográficas, padrão de consumo e comorbidades psiquiátricas em mulheres usuárias de crack recebendo tratamento em comunidades terapêuticas. Método Estudo transversal, descritivo e quantitativo. Quarenta e seis mulheres abstinentes de crack responderam a um questionário sociodemográfico, ao Mini-Exame do Estado Mental (MEEM), à Entrevista Estruturada do DSM-IV para Transtornos do Eixo I (SCID-I) e a um questionário sobre padrão de consumo de crack. Foram realizadas análises estatísticas descritivas dos dados. Resultados As participantes tinham média de 31,02 anos [desvio padrão (DP) = 7,73], eram na maioria solteiras (76,1%), brancas (67,4%) e tinham ensino fundamental completo ou incompleto (43,5%). Antes do tratamento, 65,2% das mulheres relataram usar crack todos os dias; 46,3% fumavam entre 10 e 30 pedras de crack por semana. O tempo médio de tratamento foi de 63,56 dias (DP = 75,85), com média de 80,41 dias em abstinência (DP = 74,52) e 3,37 (DP = 5,49) tratamentos anteriores. A idade média de início do uso de crack foi de 22,61 anos (DP = 8,06), e a motivação mais frequente para iniciar o uso de crack foi a curiosidade (78,3%). A duração média de uso de crack na vida foi de 82,26 meses (DP = 74,76), e as complicações físicas mais frequentemente relatadas foram perda de peso (93,5%), seguida por problemas de sono (87%). Neste estudo, os diagnósticos mais prevalentes foram episódio depressivo maior (60,87%), seguido por transtorno de estresse pós-traumático (52,17%) e transtorno de ansiedade generalizada (13,07%). Conclusões Em geral, observamos um padrão de alto consumo de crack. Os resultados mostram alta frequência de transtornos de humor e ansiedade, com maiores frequências para episódio depressivo maior e transtorno de estresse pós-traumático.

PTSD in mental health outpatient settings: highly prevalent and under-recognized

Objectives: To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training. Methods: We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records. Results: Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals. Conclusions: These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.

Psychoactive substance abuse and dependence and its association with anxiety disorders: a population-based study of young adults in Brazil

Objective: To evaluate the association between abuse of and dependence on different psychoactive substances and the presence of anxiety disorders in a sample of young adults from a city in southern Brazil. Methods: Between 2007 and 2009, we carried out a cross-sectional, population-based study of individuals aged 18-24 years who lived in Pelotas, a city in southern Brazil. We evaluated anxiety disorders using the Mini International Neuropsychiatric Interview 5.0 (MINI), and use of psychoactive substances with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST 2.0/0MS). We used Fisher's exact test for univariate analysis, and Poisson regression models with robust variance for multivariable analysis. Results: The sample consisted of 1,560 young adults. The overall prevalence of abuse/dependence was 26.9% for alcohol, 24.9% for tobacco, and 7.3% for illicit substances. Individuals with agoraphobia had a 32% higher prevalence of tobacco abuse/dependence (prevalence ratio [PR] = 1.32 [95%CI 1.01-1.74]). Individuals with posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD) had a 2.41-fold (95%CI 1.22-4.77) and 1.76-fold (95%CI 1.00-3.11) higher prevalence of illicit substance abuse/dependence, respectively. Conclusion: In this population-based sample, we found associations between GAD, PTSD, and increased prevalence of illicit substance abuse/dependence. In addition, individuals with agoraphobia seem to have increased tobacco abuse/dependence.

Suicide risk and childhood trauma in individuals diagnosed with posttraumatic stress disorder / Risco de suicídio e trauma na infância em indivíduos diagnosticados com transtorno de estresse pós-traumático

Abstract Introduction Posttraumatic stress disorder (PTSD) develops after exposure to a potentially traumatic event. Its clinical condition may lead to the development of risk behaviors, and its early detection is a relevant aspect to be considered. The aim of this study was to assess the association between childhood trauma and suicide risk in individuals with PTSD. Method This was a cross-sectional study conducted with individuals aged 18 to 60 years who were evaluated at a mental health research outpatient clinic. PTSD diagnosis and suicide risk identification were performed using specific modules of the Mini International Neuropsychiatric Interview (MINI-Plus). The Childhood Trauma Questionnaire (CTQ) was used to evaluate traumatic events in childhood. Results Of the 917 individuals evaluated, 55 were diagnosed with PTSD. The suicide risk prevalence in individuals with PTSD was 63.6%. Emotional neglect and emotional abuse scores tended to be higher in the suicide risk group (p<0.2). Conclusion Our findings showed a higher prevalence of suicide risk in individuals with PTSD and support the hypothesis that the investigation of childhood traumatic experiences, especially emotional neglect and abuse, may help in the early detection of suicide risk in individuals with PTSD.

Resumo Introdução O transtorno de estresse pós-traumático (TEPT) desenvolve-se após exposição a evento traumático grave. É uma condição clínica que pode levar ao desenvolvimento de comportamentos de risco, e sua detecção precoce é um aspecto relevante a ser considerado. O objetivo deste estudo foi verificar a associação entre trauma na infância e risco de suicídio em indivíduos com TEPT. Método Este foi um estudo transversal conduzido com indivíduos de 18 a 60 anos de idade avaliados em um ambulatório de pesquisa e extensão em saúde mental. O diagnóstico do TEPT e a identificação do risco de suicídio foram realizados através dos módulos específicos da Mini International Neuropsychiatric Interview (MINI-Plus). O Childhood Trauma Questionnaire (CTQ) foi utilizado para avaliar eventos traumáticos na infância. Resultados Dos 917 indivíduos avaliados, 55 foram diagnosticados com TEPT. A prevalência de risco de suicídio em indivíduos com TEPT foi de 63,6%. Os escores de negligência emocional e abuso emocional mostraram tendência a estarem mais elevados no grupo com risco de suicídio (p<0,2). Conclusão Nossos achados mostram a alta prevalência de risco de suicídio em indivíduos com TEPT e suportam a hipótese de que a investigação de experiências traumáticas na infância, especialmente a negligência e o abuso emocionais, poderá auxiliar na identificação precoce do risco de suicídio em indivíduos com TEPT.

Influência do sexo e condição de cônjuge nos sintomas de ansiedade, depressão e transtorno de estresse pós-traumático em pacientes admitidos à unidade de terapia intensiva e em seus respectivos cônjuges / Sex and spouse conditions influence symptoms of anxiety, depression, and posttraumatic stress disorder in both patients admitted to intensive care units and their spouses

RESUMO Objetivo: Avaliar os efeitos do sexo e da condição de cônjuge nos sintomas de ansiedade, depressão e transtorno de estresse pós-traumático em pacientes admitidos à unidade de terapia intensiva e em seus respectivos cônjuges. Métodos: Estudo prospectivo conduzido em uma unidade de terapia intensiva mista com 22 leitos em um hospital terciário, localizado na capital do Estado de São Paulo. Os pacientes e respectivos cônjuges foram inscritos 2 dias após a admissão à unidade de terapia intensiva. Foram entrevistados durante a permanência na unidade com utilização da ferramenta Escala Hospitalar de Ansiedade e Depressão. Após 30 e 90 dias da alta da unidade de terapia intensiva, os participantes foram avaliados em entrevista realizada por telefone com utilização das ferramentas Escala do Impacto do Evento e Escala Hospitalar de Ansiedade e Depressão. Resultados: No período compreendido entre março de 2011 e março de 2013, avaliamos 118 pacientes e seus respectivos cônjuges. O sexo feminino se associou com pontuações mais elevadas que a dos homens na subescala de ansiedade (p = 0,032) e de depressão (p = 0,034). Não se observou associação entre o sexo e sintomas de transtorno de estresse pós-traumático. No entanto, os cônjuges tiveram pontuações mais elevadas do que os pacientes (p = 0,001). Conclusão: O sexo feminino se associou com ansiedade e depressão, enquanto os cônjuges foram mais vulneráveis que os pacientes aos sintomas de transtorno de estresse pós-traumático. Idade mais avançada e avaliações mais tardias também se associaram com pontuações mais baixas na Escala do Impacto do Evento.

ABSTRACT Objectives: To assess the effect of sex and spouse condition on symptoms of anxiety, depression and posttraumatic stress symptoms in patients and their spouses. Methods: A prospective study conducted in a 22-bed adult mixed intensive care unit in a tertiary hospital in São Paulo, Brazil. Patients and their spouses were enrolled 2 days after intensive care unit admission. They were interviewed while in the intensive care unit using the Hospital Anxiety and Depression Scale. At 30 and 90 days after intensive care unit discharge, they completed the Impact of Event Scale and Hospital Anxiety and Depression Scale by phone. Results: From March 2011 to March 2013, we analyzed 118 patients and their spouses. We observed that female sex was associated with higher scores than male sex was in terms of the anxiety Hospital Anxiety and Depression Scale - subscale (p = 0.032) and depression (p = 0.034). There was no association between sex and posttraumatic stress disorder symptoms. However, spouses had higher Impact of Event Scale points compared with patients (p = 0.001). Conclusions: Female sex was associated with anxiety and depression, and spouses were more vulnerable to post-traumatic stress symptoms than the patients were. Increasing age and a later time of assessment were also associated with lower scores on the Impact of Event Scale.

Prevalência do transtorno de estresse pós-traumático em mães de recém-nascidos prematuros: atualização / Prevalence of post traumatic stress disorder in preterm infants's mothers: update

O Transtorno do Estresse Pós-Traumático (TEPT) é um agravo mental que pode ocorrer em resposta a eventos traumáticos na vida do indivíduo. Alguns estudos apontam que há relação do transtorno do estresse pós-traumático após o parto, quando este é considerado como parto de risco. O objetivo deste artigo é fornecer uma atualização da literatura sobre a prevalência do Transtorno de Estresse Pós-Traumático em mulheres que tiveram parto pré-termo. Para a identificação dos estudos, foram consultadas as bases de dados PubMed/Medline, Ibecs e Lilacs. Para os resultados da busca, a seleção inicial ocorreu pela leitura dos títulos encontrados, sendo descartados aqueles não tinham relação com o tema e período selecionados. O total de 18 estudos cumpriu com os critérios de inclusão deste artigo. A prevalência encontrada do Transtorno do Estresse Pós-Traumático após o parto foi entre 1,3% e 12,5%, e de 28% nos grupos de risco, como as mães de prematuros. O presente artigo de atualização aponta que há possível correlação entre o Transtorno do Estresse Pós-Traumático e o nascimento prematuro.(AU)

The Post-traumatic stress disorder (PTSD) is a mental illness that can occur in response to traumatic events in an individual's life. Some studies indicate that there is a relationship between PTSD after childbirth, when it is considered as risk childbirth. The aim of this article is to provide an update of the literature about the prevalence of Post Traumatic Stress Disorder and Prematurity. To identify the studies, the PubMed / Medline, Ibecs and Lilacs databases were consulted. For the search results, the initial selection occurred by reading the titles found, being discarded those that had no relation with the theme and period selected. In the total 18 studies met the inclusion criteria of this article. The prevalence of posttraumatic stress disorder after childbirth was between 1,3 and 12.5%, and 28% in the risk groups, such as mothers of premature infants. The present update article points out that there is a possible correlation between posttraumatic stress disorder and premature birth.(AU)

Post-Traumatic Stress Disorder and severe maternal morbidity: is there an association?

OBJECTIVE: To evaluate the occurrence of Post-Traumatic Stress Disorder among women experiencing a severe maternal morbidity event and associated factors in comparison with those without maternal morbidity. METHODS: In a retrospective cohort study, 803 women with or without severe maternal morbidity were evaluated at 6 months to 5 years postpartum for the presence of Post-Traumatic Stress Disorder. Interviews were conducted by telephone and electronic data was stored. Data analysis was carried out by using χ2, Fisher's Exact test, and logistic regression analysis. RESULTS: There was no significant change in the prevalence of Post-Traumatic Stress Disorder related to a previous severe maternal morbidity experience. There were also no differences in diagnostic criteria for severe maternal morbidity (hypertensive syndromes, hemorrhage, surgical intervention or intensive care unit admission required, among other management criteria). Low parity (2.5-fold risk) and increasing age were factors associated with Post-Traumatic Stress Disorder. CONCLUSIONS: A severe maternal morbidity episode is not associated with Post-Traumatic Stress Disorder symptoms within five years of the severe maternal morbidity event and birth. However, a more advanced maternal age and primiparity increased the risk of Post-Traumatic Stress Disorder. This does not imply that women who had experienced a severe maternal morbidity event did not suffer or need differentiated care.

Eventos potencialmente traumáticos y sintomatología postraumática en estudiantes de preparatoria / Potentially traumatic events and post-traumatic symptomatology in high school students

Resumen: Objetivo: Describir la ocurrencia de eventos potencialmente traumáticos (EPT) en estudiantes de preparatoria, medir la sintomatología postraumática subumbral en quienes aún sufren repercusiones de un EPT y asociar la sintomatología con variables sociodemográficas y características del EPT. Material y métodos: Estudio transversal analítico realizado en un muestra por conveniencia de 1000 estudiantes de tres preparatorias del Estado de México. Se aplicó la Escala para Estrés Postraumático en Universitarios Mexicanos. Se evaluó la presencia de síntomas y su frecuencia; la asociación con variables explicativas se realizó con modelos de regresión logística y cuantílica, respectivamente. Resultados: 80% reportó un EPT. De éstos, 79% aún sufría repercusiones actuales y casi la mitad de ellos presentó sintomatología. El sexo, número de eventos y características del EPT (cambios percibidos y gravedad) se encontraron asociados. Conclusiones: Los resultados sugieren intervenir tempranamente para disminuir el riesgo de desarrollar un trastorno.

Abstract: Objective: Describe the occurrence of potentially traumatic events (PTE) in high-school students, measure subthreshold post-traumatic symptomatology in those who still experience PTE repercussions and associate the symptomatology with sociodemographic and PTE characteristics. Materials and methods: Analytic transversal study carried out in a convenience sample of one thousand students from three high schools in the State of Mexico. The Scale for Post Traumatic Stress in University Students was applied. The presence of symptoms, their frequency and their association with explanatory variables was assessed by means of logistic and quantile logistic regression models, respectively. Results: 80% reported PTE. Of this, 79% still experienced current repercussions and almost a half presented symptomatology. Gender, number of events, and PTE characteristics (perceived and grave symptoms) were associated. Conclusions: Results suggest to intervene early to reduce the risk of developing a disorder.