Transtorno de Estresse Pós-traumático e funções executivas em adultos: uma revisão sistemática / Posttraumatic Stress Disorder and executive functions in adults: a systematic review / Trastorno de Estrés Postraumático y funciones ejecutivas en adultos: una revisión sistemática

O Transtorno do Estresse Pós-traumático (TEPT) é caracterizado por apresentar sintomas de desconforto e medo diante de situações diretas e/ou imaginadas em relação a experiências que ameaçam a integridade pessoal. As Funções Executivas (FE) são processos responsáveis pela análise de uma situação, tomada de decisão e ações voltadas à resolução de problemas. Sabe-se que o TEPT está associado a prejuízos em diferentes dimensões das FE. Deste modo, o presente estudo investigou a produção científica sobre o tema feita nos últimos 12 anos. Duzentos e três registros foram identificados e 18 deles cumpriram os critérios de inclusão. A avaliação das pesquisas incluídas nesta revisão apontou o comprometimento das funções executivas e a reabilitação neuropsicológica mostrou-se eficiente como estratégia de intervenção para adultos diagnosticados com TEPT. A ausência de informações sobre a intensidade dos sintomas presentes no TEPT foi uma limitação comum aos estudos encontrados nesta pesquisa.(AU)

Posttraumatic Stress Disorder (PTSD) is characterized by symptoms of uneasiness and fear when faced with direct and/or imagined situations related to experiences that threaten personal integrity. Executive Functions (EF) are processes defined by situational analysis, making decisions and taking actions to solve problems. It is known that PTSD is associated with dysfunctions in different dimensions of EF. Accordingly, the present study investigated the scientific production on the subject considering the last 12 years. A total of203 records were identified, with 18 of them meeting the inclusion criteria. The evaluation of the studies included in this review showed the impairment of EF and that neuropsychological rehabilitation has proven to be an efficient intervention strategy for adults diagnosed with PTSD. The absence of information about the intensity of symptoms present in PTSD was a common limitation of the studies found in this review.(AU)

El Trastorno de Estrés Postraumático (TEPT) se caracteriza por presentar síntomas de malestar y miedo ante situaciones directas y/o imaginadas en relación con experiencias que amenazan la integridad personal. Las Funciones Ejecutivas (FE) son procesos definidos por el análisis de una situación, toma de decisiones y acciones encaminadas a la resolución de problemas. Se sabe que el TEPT está asociado con disfunciones en diferentes dimensiones de la FE. De esta manera, el presente estudio investigó la producción científica sobre el tema en los últimos 12 años. Se identificaron 203 registros y 18 de ellos cumplieron los criterios de inclusión. La evaluación de los estudios incluidos en esta revisión mostró que el compromiso de las funciones ejecutivas, y la rehabilitación neuropsicológica, demostró ser eficiente como estrategia de intervención para adultos diagnosticados con TEPT. La ausencia de información sobre la intensidad de los síntomas presentes en el TEPT fue una limitación común de los estudios encontrados en esta investigación.(AU)

Propriedades psicométricas da Impact of Event Scale no contexto da COVID-19 / Psychometric properties of the Impact of Event Scale in the COVID-19 context / Propiedades psicométricas de la Impact of Event Scale en el contexto del COVID-19

A pandemia da COVID -19 tornou-se um dos eventos de vida mais impactantes da experiência humana contemporânea. Este estudo examinou as propriedades psicométricas de uma versão da Impact of Event Scale, medida de sofrimento subjetivo relacionada aos eventos estressantes de vida, adaptada ad hoc ao contexto pandêmico. Participaram 318 moradores do Rio de Janeiro/RJ, que foram divididos aleatoriamente em duas amostras. Os escores do primeiro grupo foram submetidos à Análise Fatorial Exploratória, que extraiu uma solução de dois fatores: Pensamentos Intrusivos e Evitativos. No segundo, foi testado um modelo de dois fatores oblíquos, por meio de Análise Fatorial Confirmatória, que apresentou um bom ajuste aos dados. Os resultados também indicaram evidências de validade convergente, validade discriminativa e consistência interna as duas dimensões da escala. Uma Análise de Regressão indicou os Pensamentos Intrusivos da IES como principal preditor de Afetividade Negativa, evidência de validade de critério. Foram encontradas evidências suficientes de validade e fidedignidade para a IES adaptada ao contexto da COVID-19.(AU)

The COVID-19 pandemic has become one of the most impactful life events in recent human experience. This study examined the psychometric properties of a version of the Impact of Event Scale, a measure of subjective suffering related to stressful life events, adapted ad hoc to the pandemic context. A total of 318 residents of Rio de Janeiro / RJ took part in the study, and were randomly divided into two samples. The scores of the first group were submitted to Exploratory Factor Analysis, which extracted a solution of two factors: Intrusive Thoughts and Avoidant Thoughts. In the second, a model of two oblique factors was tested, through Confirmatory Factor Analysis, which presented a good fit to the data, evidence of convergent validity, discriminative validity and internal consistency for the two dimensions of the scale. Regression Analysis indicated the IES's Intrusive Thoughts as the main predictor of Negative Affectivity, providing evidence of criterion validity. Sufficient evidence of validity and reliability was found for the IES adapted to the context of COVID-19.(AU)

La pandemia de COVID-19 se ha convertido en uno de los eventos de vida más impactantes en la experiencia humana contemporánea. Este estudio examinó las propiedades psicométricas de una versión de la Impact of Event Scale, una medida del sufrimiento subjetivo relacionado con eventos vitales estresantes, adaptada ad hoc al contexto de la pandemia. Participaron 318 habitantes de la ciudad de Rio de Janeiro, que fueron divididos aleatoriamente en dos muestras. Las puntuaciones del primer grupo se sometieron al Análisis Factorial Exploratorio, que extrajo una solución de dos factores: Pensamientos Intrusivos y Evitativos. En el segundo, se probó un modelo bifactorial oblicuo, mediante Análisis Factorial Confirmatorio, que presentó un buen ajuste a los datos. Los resultados también indicaron evidencias de validez convergentes, validez discriminativa y consistencia interna en las dos dimensiones de la escala. Un Análisis de Regresión indicó que los Pensamientos Intrusivos son el principal predictor de Afectividad Negativa, evidencia de validez de criterio. Se encontró evidencias suficientes de validez y fiabilidad para la IES adaptada al contexto del COVID-19.(AU)

Terapia Cognitivo Conductual en pacientes con trauma infantil diverso: Evidencia de reducción de síntomas. Artículo de Revisión / Cognitive Behavioral Therapy in patients with diverse childhood trauma: Evidence of symptom reduction. Review article

La presentación de un evento traumático único o sistemático en la infancia, puede afectar el curso normal del desarrollo psíquico del infante en sus etapas evolutivas si no es abordado oportuna y adecuadamente. Métodos: Se realizó una búsqueda de artículos, de los últimos 5 años, que abordasen el efecto de la Terapia Cognitivo Conductual Centrada en el Trauma (TCC-CT) en niños y adolescentes. Resultados: Las experiencias de trauma en la primera infancia son un problema real y no infrecuentes, con efecto sobre varios dominios del desarrollo y salud del infante, por ello, es de gran importancia un tratamiento oportuno basado en la evidencia. Esta terapia es un tratamiento efectivo y ampliamente utilizado para abordar el trauma infantil. Discusión: Los artículos revisados, respaldan la TCCCT como un tratamiento efectivo y ampliamente utilizado para abordar el trauma infantil, con vasta evidencia.

The presentation of a single or systematic traumatic event in childhood can affect the normal course of the infant's psychic development in its evolutionary stages if it is not approached in a timely and adequate manner. Methods. A search was carried out for articles, from the last 5 years, that addressed the effect of Trauma-Focused Cognitive Behavioral Therapy (CBT-CT) in children and adolescents. Results. The experiences of trauma in early childhood are a real problem and not infrequent, with an effect on several domains of development and health of the infant, therefore, the great importance of a timely treatment based on evidence. This therapy is an effective and widely used treatment to address childhood trauma. Discussion. The revised articles support CBT-CT as an effective and used treatment to address childhood trauma, with ample evidence.

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.

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)

COVID-19: médicos, gastroenterología y emociones / COVID-19: doctors, gastroenterology and emotions

La enfermedad por coronavirus (COVID-19) se convirtió en una pandemia con implicaciones clínicas y emo-cionales, a veces invisibles para los gastroenterólogos. Aunque morir es parte de la vida, el riesgo para algunos médicos puede ser mayor. Específicamente, los gastroenterólogos nos vemos afectados por el temor a reiniciar nuestras consultas y procedimientos endoscópicos. En medio de un mar de información ­incluso con contradicciones entre diferentes expertos­, seguir los lineamientos de las Asociaciones Colombianas del Aparato Digestivo podría ayudar a tranquilizar a los médicos y pacientes. Aunque las patologías seguirán apareciendo, el miedo de la población a contagiarse puede generar consecuencias como el retraso en el tratamiento de un cáncer de vías digestivas. El autocuidado físico mediante estrategias de protección y el cuidado emocional son clave para ayudar a nuestro sistema inmunológico. Adaptarnos a funcionar en medio de la pandemia por medio de la teleorientación en plataformas digitales es una forma creativa de disminuir la angustia colectiva.(AU)

COVID-19 is a pandemic with clinical and emotional implications, sometimes invisible to gastroenterologists. Although dying is part of life, the risk for some doctors may be greater. Specifically, gastroenterologists are affected by the fear of restarting medical check-ups and endoscopic procedures. Amid a sea of information ­even with contradictions between different experts­ following the guidelines of the Colombian Associations of the Digestive Tract could help reassure doctors and patients. Although the pathologies will continue to appear, the fear of the population to be infected can generate consequences such as delaying the treatment of digestive tract cancers. Physical self-care through protection strategies and the emotional care, are important to help our immune system. Adapting to function during the pandemic, using tele-orientation through digital platforms, is a creative way to reduce collective anxiety.(AU)

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.

Disability and post-trauma stress in the population over 15 years old in Kashan, Iran: A population-based study / 中华创伤杂志(英文版)

PURPOSE@#One of the consequences of trauma-related injuries is disability. There are more than one billion people with disabilities worldwide. Disability in people reduces their quality of life. The goal of this study was to determine the rate of post-trauma stress and disability related to trauma in the population over 15 years old in Kashan during a solar year of 2018-2019.@*METHODS@#This is a cross-sectional population-based study. A cluster sampling method was used in the city of Kashan, and 3880 persons were interviewed with individuals randomly selected in each household. If a person had trauma during one year ago, the World Health Organization Disability Assessment Schedule 2.0 and Post Trauma Stress Disorder (PTSD) Checklist were applied for further interview. Data were analyzed using Chi-square test or t-test.@*RESULTS@#Among the 3880 participants residing in Kashan, 274 (7.1%) reported a history of traumatic injury during one year ago in 2018-2019. Incidence of all injuries was estimated to be 70.61 (62.60-78.70) per 1000 people. For the trauma population, 213 (77.7%) were male and 75.1% were married. About half of them (50.3%, 138/274) aged 21-39 years. The most common cause of injuries was related to traffic accidents: 140 (51.1%). Of the 274 trauma participants, 47 (17.2%) reported PTSD; 244 (89.1%) had a mild disability, and 30 (10.9%) reported moderate disability.@*CONCLUSION@#One of the main causes of disability in the human community is the traumatic injuries. According to the results of this study, 89.1% of trauma participants have sustained at last mild disability following trauma. These people require follow-up and post-treatment support. It should be noted that psychological complications such as PTSD are as significant as physical symptoms.

Predictores de sintomatología postraumática aguda y crecimiento post-estrés tras un accidente laboral reciente / Predictors of Acute Posttraumatic Symptoms and Post- Stress Growth After a Recent Work Accident

Resumen El propósito de este estudio fue evaluar un modelo predictivo de sintomatología postraumática aguda (SPT) y de crecimiento post-estrés (CPE) en trabajadores que sufrieron un accidente laboral reciente. Se encuestaron 246 trabajadores (23.2% mujeres) entre los 18 y los 73 años. Se encontró que los principales predictores de la SPT son: severidad subjetiva del evento, afrontamiento religioso negativo, reinterpretación positiva y rumiación de tipos intrusiva, negativa y deliberada. A su vez, los principales predictores de CPE fueron: rumiación deliberada y afrontamiento religioso positivo. Se realizó un análisis de sendero para evaluar un modelo en el cual la rumiación intrusiva y la deliberada cumplen una función mediadora, obteniendo adecuados índices de ajuste. Se plantea la necesidad de contar con un método de evaluación temprana de las respuestas psicológicas tras un accidente.

Abstract The aim of this study is to evaluate a predictive model of acute posttraumatic symptomatology (PTS) and post-stress growth (PSG) in workers who suffered a recent work accident. To this end, 246 workers (23.2% women) were surveyed, aged between 18 and 73 years. The main predictors of PTS were subjective severity of event, negative religious coping, positive reinterpretation, and intrusive, brooding and deliberate rumination. At the same time, the main predictors of PSG were deliberate rumination and positive religious coping. A path analysis was performed to evaluate a model in which intrusive and deliberate rumination fulfill a mediating function, obtaining adequate goodness-of-fix indices. The need to have a method of early evaluation of psychological responses after an accident is proposed.

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.

Revictimization as a high-risk factor for development of posttraumatic stress disorder: a systematic review of the literature

Objective: Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PTSD). Methods: Electronic searches were conducted in five databases (MEDLINE/PubMed, Cochrane Library, Campbell Library, PsycINFO, and LILACS), using the terms PTSD, posttraumatic stress disorder, child abuse, and rape. Results: We identified nine articles that established a connection among childhood sexual abuse (CSA), sexual revictimization in adulthood, and development of PTSD. Eight of the nine papers included were classified as having strong methodological quality (grade VI). One was classified as IV, with an average quality-of-evidence rating. The mean methodological quality score of the articles was 5.5, and the quality of evidence was deemed strong. Conclusion: In the included studies, PTSD symptoms were most prevalent in the CSA + adult sexual assault groups, providing further evidence for the revictimization hypothesis.

Moral Distress Assessment in the Nursing Team of a Hematology-Oncology Sector / Evaluación del Sufrimiento Moral en el equipo de enfermería de un sector de Hemato-Oncología / Avaliação do Sofrimento Moral na equipe de enfermagem de um setor de Hemato-Oncologia

ABSTRACT Objective: To identify the frequency and intensity of Moral Distress, and to analyze the associations between Moral Distress and sociodemographic and labor characteristics of the nursing team of a Hematology-Oncology. Method: A cross-sectional study was carried out with 46 nursing professionals from a Hematology-Oncology sector of a hospital institution in Rio Grande do Sul State, Brazil, through the application of the Moral Distress Scale - Brazilian version. In the data analysis, descriptive statistics and nonparametric association tests were used. Results: Mortal Distress intensity of 3.27 (SD= 1.79) and frequency of 1.72 (SD= 1.02) were found in this team. The Moral Distress of greater intensity and frequency were related to the denial of the role of Nursing as a patient's advocate and the disrespect to the patient's autonomy, respectively. Conclusion: It is suggested a greater space for discussion among professionals, multiprofessional team and managers, so that adequate conditions of action and communication are provided.

RESUMEN Objetivo: Identificar la frecuencia e intensidad del Sufrimiento Moral y analizar las asociaciones entre el Sufrimiento Moral y las características sociodemográficas y laborales del equipo de enfermería de un sector de Hemato-Oncología. Método: Estudio transversal, realizado con 46 profesionales de enfermería de un sector de Hemato-Oncología de una institución hospitalaria de Rio Grande do Sul, por medio de la aplicación de la escala Moral Distress Scale - Versión brasileña. Se empleó, en el análisis de los datos, estadística descriptiva y pruebas de asociación no paramétricas. Resultados: Se verificó una media de intensidad del Sufrimiento Moral de 3,27 (DP = 1,79) y la frecuencia de 1,72 (DP = 1,02) en ese equipo. El Sufrimiento Moral de mayor intensidad y frecuencia fueron referentes a la negación del papel de la enfermería como abogada del paciente y el irrespeto a la autonomía del paciente, respectivamente. Conclusión: Se sugiere mayor espacio de discusión entre profesionales, equipo multiprofesional y jefaturas, para que sean proporcionadas adecuadas condiciones de actuación y comunicación.

RESUMO Objetivo: Identificar a frequência e intensidade do Sofrimento Moral, e analisar as associações entre Sofrimento Moral e características sociodemográficas e laborais da equipe de enfermagem de um setor de Hemato-Oncologia. Método: Estudo transversal, realizado com 46 profissionais de enfermagem de um setor de Hemato-Oncologia de uma instituição hospitalar do Rio Grande do Sul, por meio da aplicação da escala Moral Distress Scale - Versão brasileira. Empregou-se, na análise dos dados, estatística descritiva e testes de associação não paramétricos. Resultados: Verificou-se média de intensidade do Sofrimento Moral de 3,27 (DP = 1,79) e frequência de 1,72 (DP = 1,02) nessa equipe. O Sofrimento Moral de maior intensidade e frequência foram referentes à negação do papel da Enfermagem como advogada do paciente e o desrespeito à autonomia do paciente, respectivamente. Conclusões: Sugere-se maior espaço de discussão entre profissionais, equipe multiprofissional e chefias, para que sejam proporcionadas adequadas condições de atuação e comunicação.

Moral sensitivity components identified among nurses from Intensive Care Units / Componentes de la sensibilidad moral identificados entre enfermeros de Unidades de Cuidado Intensivo / Componentes da sensibilidade moral identificados entre enfermeiros de Unidades de Terapia Intensiva

ABSTRACT Objective: to identify ethical problems from the components of moral sensitivity among nurses of Intensive Care Units. Method: qualitative, exploratory-descriptive study developed in a hospital in the South of Brazil with 19 nurses working in intensive care units through semi-structured interviews that were analyzed through discursive textual analysis. Results: ethical education, dialogue, relationships with other health team members, professional autonomy, knowledge, personal values, effective communication, leadership and patients' positive outcomes were identified as important components of nurses' moral sensitivity, and comprise the domains of moral consciousness, benevolent motivation, and spontaneous moral perception. Final considerations: the components of moral sensitivity identified in this study facilitate nurses' instrumentalization in the face of decision making and ethical problems in the intensive care setting.

RESUMEN Objetivo: identificar los problemas éticos a partir de los componentes de la sensibilidad moral entre enfermeros de Unidades de Cuidado Intensivo. Método: investigación cualitativa, del tipo exploratorio-descriptivo, desarrollada en institución hospitalaria del sur de Brasil con 19 enfermeros actuantes en unidades de cuidado intensivo, por medio de entrevistas semiestructuradas y analizadas mediante el análisis textual discursivo. Resultados: la educación ética, el diálogo, la relación con los demás miembros del equipo de salud, la autonomía profesional, el conocimiento, los valores personales, la comunicación efectiva, el liderazgo y los resultados positivos presentados por los pacientes fueron identificados como importantes componentes de la sensibilidad moral de los enfermeros, que comprende los dominios de la conciencia moral, motivación benévola y percepción moral espontánea. Consideraciones finales: los componentes de la sensibilidad moral identificados en este estudio facilitan la instrumentalización de los enfermeros delante de las tomas de decisión y los problemas éticos en el ambiente de cuidado intensivo.

RESUMO Objetivo: identificar, entre enfermeiros de Unidades de Terapia Intensiva, problemas éticos com base nos componentes da sensibilidade moral. Método: pesquisa qualitativa, do tipo exploratório-descritiva, desenvolvida em instituição hospitalar do Sul do Brasil, com 19 enfermeiros atuantes em unidades de terapia intensiva. Dados foram coletados por meio de entrevistas semiestruturadas e analisados mediante análise textual discursiva. Resultados: a educação ética, o diálogo, a relação com os demais membros da equipe de saúde, a autonomia profissional, o conhecimento, os valores pessoais, a comunicação efetiva, a liderança e os resultados positivos apresentados pelos pacientes constituem importantes componentes da sensibilidade moral dos enfermeiros, compreendendo os domínios da consciência moral, motivação benevolente e percepção moral espontânea. Considerações finais: os componentes da sensibilidade moral identificados neste estudo facilitam a instrumentalização dos enfermeiros diante das tomadas de decisões e de problemas éticos no ambiente de terapia intensiva.

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.

Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review

Objective: There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. Methods: The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. Results: Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. Conclusions: Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.

Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C

Objective: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. Methods: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. Results: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). Conclusion: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.

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.