Tonic immobility triggered by COVID-19-related trauma is associated with long-term PTSD symptoms.

During the COVID-19 pandemic healthcare workers were repeatedly exposed to traumatic experiences. Facing life-threatening events and repeated exposure to traumatic duty-related situations may cause posttraumatic stress disorder (PTSD). While tonic immobility has been considered a key vulnerability factor for PTSD, little is known about this relationship in the long term. In this study, we aimed to determine whether peritraumatic tonic immobility triggered by COVID-19-related trauma predicts PTSD symptom severity six to twelve months later. We conducted an online longitudinal survey using the PTSD Checklist for the DSM-5 (PCL-5) and the Tonic Immobility Scale to assess PTSD symptoms and the tonic immobility response, respectively. Multivariate regression models revealed a significant association between tonic immobility and PTSD symptoms. Each one-unit increase in the tonic immobility score was associated with a 1.5 % increase in the average PTSD symptom score six to twelve months after the traumatic event that triggered the tonic immobility. Furthermore, participants who showed significant or extreme levels of tonic immobility were 3.5 times or 7.3 times more likely to have a probable PTSD diagnosis, respectively. Hence, peritraumatic tonic immobility seems to have a lasting deleterious effect on mental health. Psychological treatment for health care professionals is urgent, and psychoeducation about the involuntary, biological nature of tonic immobility is essential to reduce suffering.

Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma.

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.

The invisible scars of emotional abuse: a common and highly harmful form of childhood maltreatment.

BACKGROUND: Childhood maltreatment (CM) is unfortunately widespread globally and has been linked with an increased risk of a variety of psychiatric disorders in adults, including posttraumatic stress disorder (PTSD). These associations are well established in the literature for some maltreatment forms, such as sexual and physical abuse. However, the effects of emotional maltreatment are much less explored, even though this type figures among the most common forms of childhood maltreatment. Thus, the present study aims to investigate the impact of each type of childhood maltreatment, both individually and conjointly, on revictimization and PTSD symptom severity using a nonclinical college student sample. METHODS: Five hundred and two graduate and undergraduate students participated in the study by completing questionnaires assessing lifetime traumatic experiences in general, maltreatment during childhood and PTSD symptoms. Bivariate and multivariate negative binomial regressions were applied to examine the associations among childhood maltreatment, revictimization, and PTSD symptom severity. RESULTS: Our results showed that using bivariate models, all types of CM were significantly associated with revictimization and PTSD symptom severity. Multivariate models showed that emotional abuse was the type of maltreatment associated with the highest incidence rates of revictimization and PTSD symptom severity. CONCLUSIONS: These data provide additional evidence of the harmful effects of childhood maltreatment and its long-term consequences for individuals' mental health. Notably, the findings highlight the importance of studying the impacts of emotional abuse, which seems to be a highly prevalent, understudied, and chronic form of maltreatment that is as toxic as other maltreatment forms.

Evaluation of family caregiver satisfaction with a mental health inpatient service / Avaliação da satisfação dos familiares com um serviço de internação em saúde mental

Abstract Objective To evaluate the satisfaction of family caregivers with a mental health inpatient service in Brazil. Methods This was a cross-sectional study with a quantitative approach. A sample of 80 caretaking family members answered the abbreviated version of the Brazilian Mental Health Services' Family Satisfaction scale (SATIS-BR) and a sociodemographic questionnaire. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations. Interactions among variables and indexes of the scale were analyzed using the Student's t test, Pearson correlation coefficient and analysis of variance. Results The results showed a high mean overall satisfaction score when considering the categorization of the items of the scale, with higher satisfaction indexes in the 'Treatment results' subscale and lower ones in the 'Reception and competence of staff' and 'Privacy and confidentiality' subscales. In the comparison of the samples studied, greater scores were observed in general satisfaction and in factors in the medical residency care model than in the attending psychiatrist model. There were no significant differences in terms of family member satisfaction in relation to sociodemographic variables. Conclusion Family member satisfaction was high. The need for improvement in aspects related to the infrastructure of services was evident. This paper underlines the importance of continuous and regular evaluations of the services provided, focusing on the satisfaction of users and family members in order to better understand the factors that contribute towards the quality of care provided.

Resumo Objetivo Avaliar a satisfação de familiares cuidadores com um serviço de internação em saúde mental no Brasil. Métodos Trata-se de um estudo transversal, com abordagem quantitativa. Uma amostra de 80 familiares cuidadores respondeu à Escala de Avaliação da Satisfação de Familiares com os Serviços de Saúde Mental (SATIS-BR), além de questionário sociodemográfico. As variáveis categóricas foram expressas como freqüências e porcentagens, e as variáveis quantitativas, como médias e desvios padrão. As interações entre variáveis e índices da escala foram analisadas utilizando o test t de Student, correlação de Pearson e análise de variância. Resultados Os resultados indicaram escore médio de satisfação geral elevado quando considerada a categorização dos itens da escala, tendo ocorrido maiores índices de satisfação no fator 'Resultados do tratamento' e menores índices nos fatores 'Acolhida e competência da equipe' e 'Privacidade e confidencialidade'. Na comparação das amostras estudadas, foram observados maiores escores de satisfação geral e por fator no modelo de atendimento residência médica em relação ao modelo psiquiatra assistente. Não houve diferenças significativas quanto à satisfação dos familiares em relação às variáveis sociodemográficas. Conclusão A satisfação dos familiares foi elevada. Foram evidenciadas necessidades de melhoria nos aspectos relacionados à infraestrutura dos serviços. Esta pesquisa aponta para a importância de serem realizadas avaliações contínuas e regulares dos serviços, tendo como foco a satisfação dos usuários e familiares para uma melhor compreensão dos fatores que contribuem para a qualidade do atendimento.

Evaluation of family caregiver satisfaction with a mental health inpatient service.

OBJECTIVE: To evaluate the satisfaction of family caregivers with a mental health inpatient service in Brazil. METHODS: This was a cross-sectional study with a quantitative approach. A sample of 80 caretaking family members answered the abbreviated version of the Brazilian Mental Health Services' Family Satisfaction scale (SATIS-BR) and a sociodemographic questionnaire. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations. Interactions among variables and indexes of the scale were analyzed using the Student's t test, Pearson correlation coefficient and analysis of variance. RESULTS: The results showed a high mean overall satisfaction score when considering the categorization of the items of the scale, with higher satisfaction indexes in the 'Treatment results' subscale and lower ones in the 'Reception and competence of staff' and 'Privacy and confidentiality' subscales. In the comparison of the samples studied, greater scores were observed in general satisfaction and in factors in the medical residency care model than in the attending psychiatrist model. There were no significant differences in terms of family member satisfaction in relation to sociodemographic variables. CONCLUSION: Family member satisfaction was high. The need for improvement in aspects related to the infrastructure of services was evident. This paper underlines the importance of continuous and regular evaluations of the services provided, focusing on the satisfaction of users and family members in order to better understand the factors that contribute towards the quality of care provided.

Efficiency of electron transfer initiated chemiluminescence.

Although the mechanisms of many chemiluminescence (CL) reactions have been intensively studied, no general model has been suggested to rationalize the efficiency of these transformations. To contribute to this task, we report here quantum yields for some well-characterized CL reactions, concentrating on recent reports of efficient transformations. Initially, a short review on the most important general CL mechanisms is given, including unimolecular peroxide decomposition, electrogenerated CL, as well as the intermolecular and intramolecular catalyzed decomposition of peroxides. Thereafter, quantum yield values for several CL transformations are compiled, including the unimolecular decomposition of 1,2-dioxetanes and 1,2-dioxetanones, the catalyzed decomposition of appropriate peroxides and the induced decomposition of properly substituted 1,2-dioxetane derivatives. Finally, some representative examples of quantum yields for complex CL transformations, like luminol oxidation and the peroxyoxalate reaction, in different experimental conditions are given. This quantum yield compilation indicates that CL transformations involving electron transfer steps can occur with high efficiency in general only if the electron transfer is of intramolecular nature, with the intermolecular processes being commonly inefficient. A notable exception to this general rule is the peroxyoxalate reaction which, also constituting an example of an intermolecular electron transfer system, possesses very high quantum yields.