Comorbid depressive symptoms in treatment-seeking PTSD outpatients affect multiple domains of quality of life.

PURPOSE: No study has examined the impact of the comorbid Axis I conditions on the quality of life (QoL) of patients with a primary diagnosis of PTSD. Our goal was to investigate the influence of comorbid disorders on the QoL of treatment-seeking outpatients with PTSD. METHODS: The diagnoses of PTSD and of the comorbid disorders were established using the SCID-I. The 54 volunteers also completed the Posttraumatic Stress Disorder Checklist - Civilian Version, the BDI, the BAI, the Trauma History Questionnaire, and a socio-demographic questionnaire. Quality of life was assessed by means of the WHOQOL-BREF, a 26-item self-administered scale that measures four domains of QoL: psychological, physical, social, and environmental. Multiple linear regression models were fitted to investigate the relationship between the severity of post-traumatic, mood, and anxiety symptoms; the presence of specific current comorbid disorders and of psychotic symptoms, the number of current comorbid conditions, and a history of child abuse for each of the four domains of QoL, after adjusting for the effect of socio-demographic characteristics. RESULTS: The severity of PTSD symptoms impacted negatively on the psychological and physical domains. The severity of depressive symptoms correlated negatively with QoL in all domains, independently of sex, age, occupation, and marital status. The psychotic symptoms impacted negatively on the environmental domain. A history of child abuse was negatively associated with the psychological and the social domains. CONCLUSIONS: The severity of comorbid depressive symptoms is one of the most important factors in the determination of the QoL in patients with PTSD.

Os pacientes invisíveis: transtorno de estresse pós-traumático em pais de pacientes com fibrose cística / The invisible patients: posttraumatic stress disorder in parents of individuals with cystic fibrosis

CONTEXTO: Apesar do crescente reconhecimento da relevância do transtorno de estresse pós-traumático (TEPT) secundário a doenças médicas, ainda não existem estudos em fibrose cística. OBJETIVO: Verificar a prevalência de TEPT e dos três grupos de sintomas de estresse pós-traumático em pais de pacientes com fibrose cística. MÉTODOS: Pais de pacientes com fibrose cística (idade média: 2 a 33 anos) foram recrutados da Associação Carioca de Mucoviscidose. Neste estudo transversal, os pais preencheram um questionário sociodemográfico e foram entrevistados por meio do módulo de TEPT do Structured Clinical Interview for DSM-IV. RESULTADOS: A amostra era composta de 62 indivíduos (46 mães e 16 pais). A prevalência atual de TEPT foi 6,5 por cento e de TEPT parcial, de 19,4 por cento. Os pais com e sem sintomas de TEPT diferiram significativamente em dois aspectos psicossociais: os primeiros relataram mais problemas emocionais (p = 0,001) e reconheceram mais frequentemente a necessidade de tratamento psiquiátrico ou psicológico (p = 0,002) que os últimos. Entretanto, somente 6,3 por cento dos pais com sintomas de TEPT estavam em tratamento psiquiátrico/psicológico. CONCLUSÕES: Este estudo preliminar demonstrou que a frequência dos sintomas de TEPT é bem elevada em pais de pacientes com fibrose cística e, apesar de esses pais reconheceram que tem problemas emocionais e precisam de tratamento psiquiátrico/psicológico, seu sofrimento permanece invisível para o sistema médico, levando ao subdiagnóstico e ao subtratamento.

BACKGROUND: Besides the growing acknowledgment of the relevance of posttraumatic stress disorder (PTSD) related to medical illness, there is no study in cystic fibrosis yet. OBJECTIVE: To assess the prevalence of PTSD and the three clusters of posttraumatic stress symptoms (PTSS) in parents of patients with cystic fibrosis. METHODS: Parents of patients with cystic fibrosis (age range: 2 to 33 years) were drawn from the Cystic Fibrosis Association of the city of Rio de Janeiro. In this cross-sectional study, parents were asked to fulfill a questionnaire for social and demographic characteristics and were interviewed by means of the PTSD module of the Structured Clinical Interview for DSM-IV. RESULTS: The sample comprised 62 subjects (46 mothers and 16 fathers). Current prevalence for full PTSD was 6.5 percent and that for partial PTSD was 19.4 percent. Parents with and without PTSS differed significantly in two psychosocial aspects: the former reported more emotional problems (p = 0.001); and acknowledged more often the need for psychological or psychiatric interventions (p = 0.002) than the latter. However, only 6.3 percent of the parents with PTSS were in psychological/psychiatric treatment. DISCUSSION: This preliminary study showed that the frequency of PTSD symptoms is fairly high among parents of patients with cystic fibrosis, and although these parents recognize they have emotional problems and need psychological/psychiatric treatment, their suffering remains "invisible" to the medical system, leading to underdiagnosis and undertreatment.

Posttraumatic stress disorder in parents of children with chronic illnesses: a meta-analysis.

OBJECTIVE: To estimate PTSD prevalence in parents of children with chronic illnesses or undergoing invasive procedures, and its association with higher risk of PTSD among parents. METHODS: Sixteen studies reporting prevalence of PTSD in parents of children with chronic illnesses were identified through a systematic review in Pubmed, Web of Science, Pilots and PsycINFO databases. MAIN OUTCOME MEASURES: Pooled current PTSD prevalence was calculated for parents from these studies. Pooled PTSD prevalence ratios were obtained by comparing parents of children with chronic diseases with parents of healthy children. Meta-regression was used to identify variables that could account for the lack of homogeneity. RESULTS: Pooled PTSD prevalence was 19.6% in mothers, 11.6% in fathers, and 22.8% in parents in general (p < .001). Pooled prevalence ratio for the four studies reporting on mothers and comparison healthy groups was 4.2 (p < .001). CONCLUSIONS: The high prevalence of PTSD found in this population highlights the importance of promptly assessing and treating post-traumatic symptoms in parents of children with chronic diseases as a key step to prevent the negative consequences of PTSD and preserve their competency as caregivers.

The increasing internationalization of mainstream posttraumatic stress disorder research: a bibliometric study.

The aim of this study was to quantify changes in the national contributions to research related to posttraumatic stress disorder (PTSD) from 1983 through 2002. Using the Web of Science database (Thomson Scientific, Philadelphia, PA), we classified articles according to the year of publication and the country of the authors. The number of publishing countries increased from 7 between 1983 and 1987 to 39 between 1998 and 2002. Meanwhile, the U.S. output share declined from 87.6% in the first period to 62.4%. Although the number of countries publishing on PTSD has steadily increased, research is still dominated qualitatively and quantitatively by developed countries. These findings suggest a growing international acceptance of this diagnostic category. However, the immaturity of PTSD research is demonstrated by the concentration of publications in a few countries.

A comparison of publication trends on avoidant personality disorder and social phobia.

The objective of this study was to ascertain the number of articles published per annum on the topics of avoidant personality disorder (APD) and social phobia (SP) in the period from 1973 to 2001. We hypothesized that while annual publication rates on SP would exhibit a sound growth, the number of scientific articles on APD published per annum would present a stagnant or declining trend. We performed a comprehensive literature review on APD and SP using the three largest existing databases for medical and psychological journals: MEDLINE, PsycINFO, and Web of Science. The references were gathered by means of the Reference Manager version 9.5 software and transferred to an SPSS version 10 database for statistical analysis. The data were then input into regression models with the goal of predicting future growth of the scientific literature in these areas. The number of journal articles published annually on SP has steadily increased in the period from 1973 (1 article) to 2001 (118 articles). In contrast, the production of scientific literature on APD peaked in 1986 (5 articles) and subsequently declined. During the last decade reviewed, an average of fewer than two articles on APD was published per annum. Given the declining trend identified in this study, we believe that it is unlikely that the publication of scientific articles on APD will provide the empirical evidence required to validate this disorder in a foreseeable future. The permanence of APD on the rolls of the personality disorders should therefore be reassessed.

The cross-cultural adaptation to Portuguese of the Trauma History Questionnaire to identify traumatic experiences.

BACKGROUND: Despite the high prevalence of exposure to traumatic events in Brazil, there are few studies on trauma and post-traumatic stress disorder. This paper presents the cross-cultural adaptation to Portuguese of the Trauma History Questionnaire. METHODS: Two translations and their respective back-translations were made, as well as the evaluation of the semantic equivalence, the preparation of the synthesis version, the pre-testing in the target population and the definition of the final version. DISCUSSION: Similar levels of referential meaning between the two back-translations and the original instrument were observed. Priority was given to the first translation in the decision process for the elaboration of the synthesis version. The pre-testing of this version in the target population confirmed the goal to achieve the semantic and the operational equivalence criteria. This work offers the first adaptation of a specific instrument to detect traumatic experiences in the Brazilian context.

The cross-cultural adaptation to Portuguese of the Trauma History Questionnaire to identify traumatic experiences

INTRODUÇAO: Apesar da prevalência elevada de exposição a eventos traumáticos no Brasil, há poucos estudos sobre trauma e transtorno de estresse pós-traumático. Este artigo apresenta a adaptação transcultural para o português do Trauma History Questionnaire. MÉTODOS: Foram feitas duas traduções e suas respectivas retraduções, avaliação da equivalência semântica, elaboração da versão síntese, pré-teste na população-alvo e realização da versão final. DISCUSSAO: Observaram-se níveis semelhantes de significado referencial das duas retraduções em relação ao instrumento original. Deu-se primazia à primeira tradução no processo de decisão para a elaboração da versão síntese. O pré-teste na população-alvo confirmou o objetivo de atingir os critérios de equivalência semântica e equivalência operacional. Este trabalho torna disponível a primeira adaptação para o contexto brasileiro de um instrumento específico para a detecção de experiências traumáticas.

A adaptação transcultural para o português do instrumento dissociative experiences scale para rastrear e quantificar os fenômenos dissociativos / The cross-cultural adaptation to Portuguese of the Dissociative Experiences Scale for screening and quantifying dissociative phenomena

OBJETIVO: Este artigo apresenta a adaptação transcultural para o português da Dissociative Experiences Scale, o questionário mais utilizado mundialmente para rastrear e quantificar os fenômenos dissociativos. MÉTODOS: Fizeram-se duas traduções e suas respectivas retraduções, avaliação da equivalência semântica, elaboração da versão síntese, pré-teste na população-alvo, realização da versão final e segundo pré-teste na população-alvo. RESULTADOS: Observou-se um grau elevado de equivalência semântica entre o instrumento original e os dois pares de traduções-retraduções, da perspectiva dos significados referencial e geral. Os pré-testes na população-alvo conduziram a modificações para confirmar a realização dos critérios de equivalência semântica e de equivalência operacional. CONCLUSÃO: Este trabalho torna disponível a primeira adaptação para o contexto brasileiro de um instrumento específico para a detecção e a quantificação de sintomas dissociativos.

[The cross-cultural adaptation to Portuguese of the Dissociative Experiences Scale for screening and quantifying dissociative phenomena]. / A adaptação transcultural para o português do instrumento Dissociative Experiences Scale para rastrear e quantificar os fenômenos dissociativos.

OBJECTIVE: This paper presents the cross-cultural adaptation to Portuguese of the Dissociative Experiences Scale, the worldwide most employed questionnaire for screening and quantifying dissociative phenomena. METHODS: Two translations and their respective back-translations were performed, as well as the evaluation of the semantic equivalence, the preparation of the synthetic version, the pre-testing on the target population, the definition of the final version and a second pre-testing on the target population. RESULTS: A high level of semantic equivalence between the original instrument and the two pairs of translations and back-translations was observed regarding the referential and general meanings. The two pre-testing in the target population led to alterations in order to achieve the semantic and operational equivalence criteria. CONCLUSION: This work provides the first adaptation of a specific instrument to detect and quantify dissociative symptoms in the Brazilian context.