The Relationship Between Perceived Social Support and PTSD Symptoms After Exposure to Physical Assault: An 8 Years Longitudinal Study.

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time (p < .001); PSS were significantly correlated only between T1 and T2 (p < .001), T1 and T3 (p < .05), and between T2 and T3 (p < .05). Cross-lagged analyses showed an inverse relationship between prior PSS and later PTSD symptoms across all time points (ps < .05); not proved between prior PTSD symptoms and later PSS (ps > .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions.

The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross-Sectional Study.

OBJECTIVES: To assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation. DESIGN AND SETTING: This is a cross-sectional study. The population were all patients discharged (2008-2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited. MAIN OUTCOME MEASURES: Symptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life. RESULTS: Symptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function. CONCLUSION: Patients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.

A planned but vulnerable pathway towards self-management following day surgery. Orthopaedic patients' experiences.

INTRODUCTION: An increasing share of surgical activity is organised as day surgery, thus giving more responsibility for care to patients and their next of kin. PURPOSE: To obtain increased understanding of orthopaedic day surgery patients' experiences with self-management. METHODS: A descriptive interview study. Eleven men and five women aged 18-78 years, who had undergone arthroscopic knee surgery in rural Norway participated in qualitative individual interviews during autumn 2018. Systematic text condensation was used as analysis strategy. RESULTS: The main theme a planned but vulnerable pathway towards self-management and five subthemes were highlighted. The interviewees were satisfied with most aspects of the day surgery. However, challenges in adapting oral and written information to self-management postdischarge, a need for further self-management support at home, and strenuous travel increased the strain. CONCLUSION: The written and oral information and support that was planned and provided by the hospital did not meet the patients' needs for self-management support postdischarge. The day surgery care pathway seemed to lack effective educational interventions for strengthening the patients' self-efficacy and control and to have potential for improvements.

Longitudinal Relationship between Self-efficacy and Posttraumatic Stress Symptoms 8 Years after a Violent Assault: An Autoregressive Cross-Lagged Model.

Self-efficacy is assumed to promote posttraumatic adaption, and several cross-sectional studies support this notion. However, there is a lack of prospective longitudinal studies to further illuminate the temporal relationship between self-efficacy and posttraumatic stress symptoms. Thus, an important unresolved research question is whether posttraumatic stress disorder (PTSD) symptoms affect the level of self-efficacy or vice versa or whether they mutually influence each other. The present prospective longitudinal study investigated the reciprocal relationship between general self-efficacy (GSE) and posttraumatic stress symptoms in 143 physical assault victims. We used an autoregressive cross-lagged model across four assessment waves: within 4 months after the assault (T1) and then 3 months (T2), 12 months (T3) and 8 years (T4) after the first assessment. Stress symptoms at T1 and T2 predicted subsequent self-efficacy, while self-efficacy at T1 and T2 was not related to subsequent stress symptoms. These relationships were reversed after T3; higher levels of self-efficacy at T3 predicted lower levels of posttraumatic stress symptoms at T4, while posttraumatic tress symptoms at T3 did not predict self-efficacy at T4. In conclusion, posttraumatic stress symptoms may have a deteriorating effect on self-efficacy in the early phase after physical assault, whereas self-efficacy may promote recovery from posttraumatic stress symptoms over the long term.

Prevalence, comorbidity and stability of post-traumatic stress disorder and anxiety and depression symptoms after exposure to physical assault: an 8-year prospective longitudinal study.

BACKGROUND: There is a lack of prospective longitudinal studies focusing specifically on the victims exposed to physical violence by a perpetrator other than a family member. AIMS: To assess the prevalence and comorbidity of post-traumatic stress disorder (PTSD) and anxiety and depression symptoms and the stability of symptoms, in a population of victims of non-domestic physical violence through 8 years. METHOD: This study had a single group longitudinal design with four repeated measures-the first as soon as possible after the exposure (n = 143 at T1), the second 3 months later (n = 94 at T2), the third after 1 year (n = 73 at T3) and the fourth after 8 years (n = 47 at T4). Questionnaires used were Impact of Event Scale-15 and 22 (IES-15 and 22), Post Traumatic Symptom Scale-10 (PTSS-10) and the Hopkins Symptoms Check List (HSCL-25). RESULTS: Probable PTSD cases measured with IES-15 were 33.6% at T1, 30.9 at T2, 30.1% at T3 (12 months) and 19.1% at T4 (8 years), while probable anxiety and depression cases measured with HSCL-25 were 42.3% at T1, 35.5% at T2, 35.6% at T3 and 23.4% at T4. The estimated probability of recovery from PTSD symptoms during the 8 years is 52%, whereas the corresponding finding concerning anxiety and depression is 43%. CONCLUSION: The consequences of exposure to physical assault by strangers need to be given more attention as a severe risk of chronic mental health problems.

Post-disaster psychosocial services across Europe: the TENTS project.

At present post-disaster activities and plans seem to vary widely. An adequate estimation of the availability of post-disaster psychosocial services across Europe is needed in order to compare them with recently developed evidence-informed psychosocial care guidelines. Here we report on the results of a cross-sectional web-based survey completed in 2008 by two hundred and eighty-six representatives of organizations involved in psychosocial responses to trauma and disaster from thirty-three different countries across Europe. The survey addressed planning and delivery of psychosocial care after disaster, methods of screening and diagnosis, types of interventions used, and other aspects of psychosocial care after trauma. The findings showed that planning and delivery of psychosocial care was inconsistent across Europe. Countries in East Europe seemed to have less central coordination of the post-disaster psychosocial response and fewer post-disaster guidelines that were integrated into specific disaster or contingency plans. Several forms of psychological debriefing, for which there is no evidence of efficacy to date, were still used in several areas particularly in North Europe. East European countries delivered evidence-based interventions for PTSD less frequently, whilst in South- and South-Eastern European countries anxiety suppressing medication such as benzodiazepines were prescribed more frequently to disaster victims than in other areas. Countries across Europe are currently providing sub-optimal psychosocial care for disaster victims. This short report shows that there is an urgent need for some countries to abandon non-effective interventions and others to develop more evidence based and effective services to facilitate the care of those involved in future disasters.

Brief measure of posttraumatic stress reactions: impact of Event Scale-6.

BACKGROUND: The Impact of Event Scale-revised (IES-R) is one of the most widely used measures of posttraumatic stress reactions. However, for some purposes, such as large epidemiological studies, there is a need for briefer instruments. The aim of this study was to develop and validate an abbreviated version of the IES-R that could capture the three current symptom clusters of posttraumatic stress disorder (PTSD). METHODS: Stepwise multiple regression was applied to abbreviate the IES-R in one sample. The abbreviated version was then tested in three separate samples of individuals exposed to different kinds of potentially traumatic events. Agreement with a reference measure of PTSD, the PTSD checklist (PCL), was calculated for the abbreviated and the full-scale versions of IES. RESULTS: The abbreviation procedure resulted in a subset of six items (the IES-6), which correlated highly (pooled correlation = 0.95) with the IES-R across samples. Correlations between the IES-6 and IES-R subscales were somewhat lower (r = 0.78-0.94). Both the IES-6 and IES-R were in high agreement with the PCL. CONCLUSION: The IES-6 appears to be a robust brief measure of posttraumatic stress reactions. It may be useful for research in epidemiological studies, and it may also have a role as a screening instrument in clinical practice.

Assaulted victims of nondomestic violence in Norway--injury, crime characteristics and emotions during the assault.

Violence is a negative and depressing part of human relationships, whereas consequences related to interpersonal violence cause a number of health problems in the world. The aim of this paper is to describe socio-demographic characteristics, injury, crime characteristics and emotions during the event in assault victims of nondomestic violence, and further evaluate possible associations between these factors. Data were collected from 149 victims by questionnaires and semi-structured interviews. Our results show that most of the victims were young men assaulted by unknown attackers in public places. The educational levels and the levels of employment in the present sample are high compared with those of other studies. Seventy-six per cent of the participants suffered injuries to the head, face or eyes. About one-third of the sample had serious injuries that required specialist treatment. Anxiety was the most frequent emotion felt during the assault, followed by aggression. Female victims were more likely to experience shock (p < 0.01) and anxiety (p < 0.01) during the incident than men. Nineteen per cent of the participants reported feeling shocked and frightened simultaneously. About 60% experienced a combination of subjective factors, such as fear of serious injury, being killed during the assault and actual physical injury. It is reasonable to expect a high occurrence of future psychopathology among our participants.

Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence. A longitudinal study.

BACKGROUND: Victims of violent assault experience diverse post-event emotional problems such as post-traumatic stress disorder (PTSD), and they may have multiple emotional problems. The aim of the present study was to evaluate the prevalence and predictors of PTSD in a longitudinal design. METHODS: The levels of physical injury, perceived life threat, prior experience of violence, peritraumatic dissociation (PD), acute PTSD, perceived self-efficacy and perceived social support are considered possible predictors. This study had a single group (N = 70), longitudinal design with three repeated measures over a period of 12 months. Questionnaires used were: Impact of Event Scale-15 and 22 (IES-15 and 22), Post-Traumatic Symptom Scale-10 (PTSS-10), Peritraumatic Dissociation (PD) 7-item self-report measure, Social Provisions Scale (SPS) and Generalized Self-Efficacy scale (GSE). RESULTS: Results showed a high prevalence and severity of PTSD on all outcomes, for instance 31% scored as probable PTSD-cases and 14% as risk level cases by IES-15 at T3. Either injury severity or prior experience of being a victim of violence predicted PTSD in this study. Early PTSD predicted subsequent PTSD, and perceived life threat was a predictor of PD. Furthermore, lack of perceived social support was a predictor of PTSD symptoms at T3. In addition, low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1. CONCLUSIONS: Our results showed that experience of non-domestic violence may cause serious chronic emotional problems, and therefore it is important to be aware of early symptoms indicating needs for special follow-ups.

The predictive value of post-traumatic stress disorder symptoms for quality of life: a longitudinal study of physically injured victims of non-domestic violence.

BACKGROUND: Little is known about longitudinal associations between post-traumatic stress disorder (PTSD) and quality of life (QoL) after exposure to violence. The aims of the current study were to examine quality of life (QoL) and the predictive value of post-traumatic stress disorder (PTSD) for QoL in victims of non-domestic violence over a period of 12 months. METHODS: A single-group (n = 70) longitudinal design with three repeated measures over a period of 12 months were used. Posttraumatic psychological symptoms were assessed by using the Impact of Event Scale, a 15-item self-rating questionnaire comprising two subscales (intrusion and avoidance) as a screening instrument for PTSD. The questionnaire WHOQOL-Bref was used to assess QoL. The WHOQOL-BREF instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. Results of the analysis were summarized by fitting Structural Equation Modelling (SEM). RESULTS: For each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOL-Bref subscales (the four domains and the two single items) were stable across time of assessment. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. In addition, the two items examining perception of overall quality of life and perception of overall health in WHOQOL showed the same results according to PTSD symptoms such as QoL domains. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3. CONCLUSION: The presence of PTSD symptoms predicted lower QoL, both from an acute and prolonged perspective, in victims of non-domestic violence. Focusing on the individual's perception of his/her QoL in addition to the illness may increase the treatment priorities and efforts.

Acute psychological reactions in assault victims of non-domestic violence: peritraumatic dissociation, post-traumatic stress disorder, anxiety and depression.

The aims of this study were to investigate acute and subacute post-traumatic reactions in victims of physical non-domestic violence. A Norwegian sample of 138 physically assaulted victims was interviewed and a questionnaire was completed. The following areas were examined: the frequency and intensity of acute and subacute psychological reactions such as peritraumatic dissociation (PD), post-traumatic stress disorder (PTSD) and anxiety and depression; the relationship between several psychological reactions; the relationship between psychological reactions and level of physical injury, perceived life threat, and potential of severe physical injury, and the relationship between psychological reactions and socio-demographic variables. The following distress reactions were measured retrospectively: PD, PTSD, and anxiety and depression. Thirty-three per cent of the victims scored as probable PTSD cases according to the Post Traumatic Symptoms Scale 10 (PTSS-10); the corresponding Impact of Event Scale-15 (IES-15) score identified prevalence of 34% respectively. Forty-four per cent scored as cases with probable anxiety and depression, according to the Hopkins Symptom Check List 25 (HSCL-25). Severity of perceived threat predicted higher scores on all measures of psychological reactions. There were no statistically significant differences between acute and subacute groups on PD, PTSS-10, IES-15, IES-22 and HSCL-25 according to measured means (and standard deviations) and occurrence of probable cases and risk level cases. The results showed no connection between severity of physical injury and caseness. The acute psychological impairment that results from assault violence may have a deleterious effect on the mental health of victims.