Associations between PTSD and temporal discounting: The role of future thinking.

BACKGROUND AND OBJECTIVES: Despite documented alterations in future thinking in posttraumatic stress disorder (PTSD), our understanding of how individuals with PTSD make future-oriented decisions is limited. We tested the hypothesis that increased discounting in association with PTSD reflects failure to spontaneously envision future rewarding situations. METHODS: Thirty-seven trauma exposed war-zone veterans completed a standard temporal discounting task as well as a temporal discounting task accompanied by episodic future thinking cues. RESULTS: Severity of PTSD symptoms was associated with preference for sooner, smaller rewards in the standard task. Consistent with our hypothesis, when participants engaged in future thinking, greater PTSD symptom severity was no longer associated with steeper discounting. Moreover, difficulty anticipating future events, as measured contemporaneously in a separate task (Verfaellie et al., 2024), mediated the relationship between PTSD symptom severity and degree of discounting in the standard task. Among PTSD symptom clusters, the severity of avoidance and negative alterations in cognition and mood was related to steeper discounting. Measures of depression and alcohol use were not associated with discounting. LIMITATIONS: The sample included mostly male, predominantly White veterans who experienced primarily combat-related trauma. CONCLUSIONS: PTSD-associated alterations in temporal discounting reflect failure to spontaneously imagine future positive events. Two common correlates of PTSD, depression and alcohol use, could not account for the observed associations between PTSD and future-oriented decisions.

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.

Heparin as a Potential Therapeutic Substance for Post-Traumatic Stress Disorder.

In sexually mature male Wistar rats with modeled post-traumatic stress disorder, personalized characteristics of neurobiological reactions in the population of predator-induced stress-resilient and stress-susceptible heparinized animals were determined. Characteristics of the systemic response of immune mechanisms, hypothalamic-pituitary-adrenal axis, behavioral manifestations, as well as basic properties of the CNS (excitation/inhibition) are presented. The study demonstrated encouraging positive results of the course administration of unfractionated heparin at a dose below the therapeutic and prophylactic doses. The inclusion of heparin drugs into the clinical practice for the treatment of post-traumatic stress disorder will not require large-scale clinical trials, because many effects of heparin as a nonspecific adaptogen are well studied. Moreover, these properties were confirmed at a higher technological level during the COVID-19 pandemic.

Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives.

The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.

Corrigendum: Artemisinin reduces PTSD-like symptoms, improves synaptic plasticity, and inhibits apoptosis in rats subjected to single prolonged stress.

[This corrects the article DOI: 10.3389/fphar.2024.1303123.].

Case report: "Scared to deaf": medical-legal evaluation of a suspected post -traumatic stress disorder".

The case concerns the alleged failure by the resisting administration to fulfill obligations arising from the contract and employment relationship, as well as the violation of safety regulations leading to the workplace accident reported by an Airforce Sergeant. Following the accident, the soldier complains of developing barotraumatic hearing loss with tinnitus and reactive post-traumatic stress disorder to the traumatic event. The case provides an opportunity to analyze the relevance of forensic medical assessment and its integration with psychodiagnostic examination for the correct nosographic classification aimed at evaluating and quantifying biological damage.

Multiple Stressors Induce Amygdalohippocampal Volume Reduction in Adult Male Rats as Detected by Longitudinal Structural Magnetic Resonance Imaging.

Background: Traumatic events can cause long-lasting and uncontrollable fear and anxiety. Posttraumatic stress disorder is an intractable mental disorder, and neurobiological mechanisms using animal models are expected to help development of posttraumatic stress disorder treatment. In this study, we combined multiple stress (MS) and longitudinal in vivo magnetic resonance imaging to reveal the effects of long-lasting anxiety-like behaviors on adult male rat brains. Methods: Twelve male Wistar rats (8 weeks old) were exposed to the MS of 1-mA footshocks and forced swimming, while 12 control rats were placed in a plastic cage. Contextual fear conditioning with 0.1-mA footshocks in a context different from the MS was conducted 15 days after the MS for both groups. Three retention tests were administered after 24 hours and 9 and 16 days. Two magnetic resonance imaging scans were conducted, one on the day before MS induction and one the day after the third retention test, with a 32-day interval. Results: The MS group showed greater freezing responses than the control group in all retention tests. Whole-brain voxel-based morphometry analyses revealed reduced gray matter volume in the anterior amygdalohippocampal area in MS group rats compared with control rats. These volume changes were negatively associated with freezing time in the third retention test in the MS group. Conclusions: These results suggest that individual variability in the amygdalohippocampal area may be related to long-lasting fear responses after severe stress.

Traumatic events can cause long-lasting and uncontrollable fear and anxiety. In this study, we combined multiple stress (MS) and longitudinal in vivo magnetic resonance imaging to reveal the effects of long-lasting anxiety-like behaviors on adult male rat brains. The MS group showed greater freezing responses than the control group in all retention tests. Brain morphometry analyses revealed reduced gray matter volume in the anterior amygdalohippocampal area in MS group rats compared with control rats. These results suggest that individual variability in the amygdalohippocampal area may be related to long-lasting fear responses after severe stress.

[Poor sleep quality contributes to occurrence of posttraumatic stress disorder in trauma patients].

OBJECTIVE: To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder (PTSD) in trauma patients. METHODS: We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October, 2021 to November, 2022, and 226 of the participants completed the PTSD survey and assessment. The patients' sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index (PSQI), and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring; the PTSD Checklist-Civilian Version (PCL-C) was used to detect the occurrence of PTSD during the follow-up. RESULTS: The detection rate of PTSD in the patients was 19.47% at 1 month and 17.61% at 3 months after trauma. The patients who developed PTSD had poorer sleep quality before the trauma, as shown by significantly higher PSQI scale scores (P < 0.001), than those without PTSD, and they showed a sleep abnormality rate as high as 72.73% prior to PTSD onset. Within 7 days after admission, the patients developing PTSD had lower sleep quality scores with more frequent night awakenings (P < 0.05). A 1 month and 3 months after trauma, the patients with PTSD had significantly higher PSQI scores than those without PTSD (P < 0.05). CONCLUSION: PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.

Genetic Variation and Stroke Recovery: The STRONG Study.

BACKGROUND: Genetic association studies can reveal biology and treatment targets but have received limited attention for stroke recovery. STRONG (Stroke, Stress, Rehabilitation, and Genetics) was a prospective, longitudinal (1-year), genetic study in adults with stroke at 28 US stroke centers. The primary aim was to examine the association that candidate genetic variants have with (1) motor/functional outcomes and (2) stress-related outcomes. METHODS: For motor/functional end points, 3 candidate gene variants (ApoE ε4, BDNF [brain-derived neurotrophic factor], and a dopamine polygenic score) were analyzed for associations with change in grip strength (3 months-baseline), function (3-month Stroke Impact Scale-Activities of Daily Living), mood (3-month Patient Health Questionnaire-8), and cognition (12-month telephone-Montreal Cognitive Assessment). For stress-related outcomes, 7 variants (serotonin transporter gene-linked promoter region, ACE [angiotensin-converting enzyme], oxytocin receptor, FKBP5 [FKBP prolyl isomerase 5], FAAH [fatty acid amide hydrolase], BDNF, and COMT [catechol-O-methyltransferase]) were assessed for associations with posttraumatic stress disorder ([PTSD]; PTSD Primary Care Scale) and depression (Patient Health Questionnaire-8) at 6 and 12 months; stress-related genes were examined as a function of poststroke stress level. Statistical models (linear, negative binomial, or Poisson regression) were based on response variable distribution; all included stroke severity, age, sex, and ancestry as covariates. Stroke subtype was explored secondarily. Data were Holm-Bonferroni corrected. A secondary replication analysis tested whether the rs1842681 polymorphism (identified in the GISCOME study [Genetics of Ischaemic Stroke Functional Outcome]) was related to 3-month modified Rankin Scale score in STRONG. RESULTS: The 763 enrollees were 63.1±14.9 (mean±SD) years of age, with a median initial National Institutes of Health Stroke Scale score of 4 (interquartile range, 2-9); outcome data were available in n=515 at 3 months, n=500 at 6 months, and n=489 at 12 months. At 1 year poststroke, the rs6265 (BDNF) variant was associated with poorer cognition (0.9-point lower telephone-Montreal Cognitive Assessment score, P=1×10-5). For stress-related outcomes, rs4291 (ACE) and rs324420 (FAAH) were risk factors linking increased poststroke stress with higher 1-year depression and PTSD symptoms (P<0.05), while rs4680 (COMT) linked poststroke stress with lower 1-year depression and PTSD. Findings were unchanged when considering stroke subtype. STRONG replicated GISCOME: rs1842681 was associated with lower 3-month modified Rankin Scale score (P=3.2×10-5). CONCLUSIONS: This study identified genetic associations with cognitive function, depression, and PTSD 1 year poststroke. Genetic susceptibility to PTSD and depressive symptoms varied according to the amount of poststroke stress, underscoring the critical role of lived experiences in recovery. Together, the results suggest that genetic association studies provide insights into the biology of stroke recovery in humans.

Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach.

Background: Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce. Methods: We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance. Results: Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78. Conclusion: In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.

Changes in Service Use After Participation in an Intensive Outpatient Program Among Adults With Posttraumatic Stress Disorder.

INTRODUCTION: Intensive outpatient programs (IOPs) have been shown to reduce posttraumatic stress disorder (PTSD) symptoms in veteran populations. The aim of this study was to examine the association between IOP participation and inpatient psychiatric and mental health-related emergency department (ED) encounters among patients with PTSD. METHODS: This is a retrospective cohort study among 258 adults with PTSD who participated in the IOP at Kaiser Permanente Oakland Medical Center between January 1, 2017, and December 31, 2018. The authors compared changes in inpatient psychiatric hospitalizations and mental health-related ED encounters from the year before vs after the first IOP engagement. Bivariate analyses comparing ED and inpatient utilization pre- and post-IOP engagement, stratified by sociodemographic variables were conducted using paired t-tests and McNemar's test. Conditional multivariable logistic regression was performed to assess the odds of psychiatric utilization. RESULTS: Participants were more likely to have ≥ 1 inpatient psychiatric encounter (28.7% vs 15.9%; p < 0.01) and ≥ 1 mental health-related ED encounter (24.8% vs 18.2%; p = 0.04) pre-IOP vs post-IOP. The authors' multivariable analysis demonstrated that patients experienced a 56% reduction in the odds of inpatient psychiatric encounters (adjusted odds ratio = 0.42, 95% confidence interval: 0.26-0.68, p < 0.01) and a 35% reduction in mental health-related ED encounters (adjusted odds ratio = 0.63, 95% confidence interval: 0.40-1.00, p = 0.05) post-IOP vs pre-IOP. DISCUSSION: This study demonstrated a significant reduction in inpatient psychiatric hospitalizations and mental health-related ED visits among patients with PTSD in the year following participation in an IOP. CONCLUSION: These findings support the use of IOPs for patients with PTSD to reduce the likelihood of intensive service use.

Cardiac disease-induced trauma and stress-related disorders.

OBJECTIVE: This review aims to present an updated overview of cardiac disease-induced trauma and stress-related disorders such as acute stress disorder (ASD), adjustment disorder (AjD), and posttraumatic stress disorder (PTSD). First, the prevalence of these disorders, their diagnostic criteria, and their differences from other trauma-related disorders are described. Special challenges in diagnosis and treatment are identified, with various screening tools being evaluated for symptom assessment. Additionally, the risk factors studied so far for the development of symptoms of cardiac-induced posttraumatic stress disorder and the bidirectional relationship between posttraumatic stress disorder and cardiovascular diseases are summarized. Various therapeutic interventions, including pharmacological approaches, are also discussed. Finally, various areas for future research are outlined. BACKGROUND: Experiencing a cardiovascular disease, particularly a life-threatening cardiac event, can potentially lead to stress-related disorders such as ASD, AjD, and cardiac disease-induced PTSD (CDI-PTSD). If left untreated, these disorders are associated with a worsening cardiac prognosis and higher mortality rates. Approaching treatment through a trauma-focused lens may be beneficial for managing CDI-PTSD and stress-related disorders. CONCLUSION: Future research should explore treatment options for both the patients and the caregivers as well as investigate the long-term effects of trauma-focused interventions on physical and mental health outcomes.

Adjunctive electroconvulsive therapy in the treatment of a patient with comorbid major depressive disorder, posttraumatic stress disorder, and anorexia nervosa - a case report.

Purpose: Posttraumatic stress disorder (PTSD) is still-underdiagnosed and often accompanied by other psychiatric disorders affecting treatment and outcomes. Case description: Here we present a case report of a 28-year-old female patient with comorbid PTSD, major depressive disorder (MDD), and anorexia nervosa (AN). The patient had been treated with various medications and attended trauma-focused psychotherapy. Because none of these treatments yielded satisfying improvement, the patient was referred for electroconvulsive therapy (ECT). We had to overcome challenges such as the patient's false assumptions about ECT, the simultaneous use of benzodiazepines and the management of the side effects of ECT. The symptoms of MDD and PTSD improved after 12 treatment sessions. Comment: Our report suggests that ECT may be a safe and effective method for treating patients with PTSD and comorbid MDD and AN.

Advancing Late-Life Trauma-Informed Care Education: Development and Evaluation of an Educational Podcast.

Posttraumatic stress disorder (PTSD) may emerge in late life in the context of illness, role changes, and life review, leading to complications in disease management. The "Talking Later" podcast was developed as an accessible educational product to improve knowledge about late-life PTSD. We describe the process of systematically developing a ten-episode podcast following Kern's six-step curricular model. Following release, the podcast was evaluated via listenership analytics, external clinician feedback survey (N = 45), and internal team survey (N = 9). In 22 months since release, the podcast was played or downloaded 10,124 times across 45 countries. In the external survey, 97% of clinician experts reported the episodes as engaging and informational; 87% stated that no more than general knowledge of PTSD was required to enjoy the podcast. Qualitative analysis of open-ended feedback items found that participants were interested in learning about additional comorbidities and diversity issues related to late-life trauma reengagement. Both the external and internal survey identified discrete elements for improvement. Results suggest the podcast was engaging and informational to a diverse clinical audience. Podcasts represent a relatively new way to deliver educational content. Further consideration of their pedagogical value and limits is warranted.

Intergenerational associations between childhood maltreatment, post-traumatic stress symptoms, and chronic pain in young adult offspring and their parents.

Findings have revealed a strong link between exposure to child maltreatment (CM) and later chronic pain. Concurrently, other findings have been grounded in the understanding that CM consequences may not end with the exposed individual, rather, they extend to their offspring. However, little is known regarding the possible intergenerational transmission of chronic pain following CM. This study examines whether chronic pain among parents and their young adult offspring may be associated with parental exposure to CM. Three hundred ninety-three parent-offspring dyads (parents' mean age = 58, SD = 5.91 years; offspring's mean age = 27, SD = 3.91 years) completed self-report questionnaires, assessing CM (CTQ), posttraumatic stress (PTS) and disturbances in self-organisation (DSO) symptoms (ITQ), and chronic pain. CM was associated with chronic pain mediated by DSO symptoms among parents (indirect effect = 0.77; p = 0.007) and PTS symptoms among offspring (indirect effect = 0.285; p = 0.005). Offspring chronic pain was significantly associated with parental CM through two intergenerational paths: the mediation of parents' DSO symptoms and chronic pain (indirect effect = 0.298; p = 0.011), and through parents' PTS symptoms and offspring's PTS symptoms (indirect effect = 0.077; p = 0.004). This study's findings support the relevance of the intergenerational transmission of chronic pain following parental exposure to CM. Furthermore, the findings reveal complex PTS symptoms as a possible underlying mechanism for the intergenerational associations of chronic pain following CM.

Posttraumatic stress disorder in the aftermath of the Turkey earthquake: exploring the role of demographics, level of exposure, and personality traits.

BACKGROUND AND OBJECTIVES: Post-Traumatic Stress Disorder (PTSD) is an important mental disorder that can develop after mass traumas such as earthquakes. In our study, we aimed to investigate the development of PTSD after the Turkey earthquake (6 February 2023) and its association with some demographic variables, personality traits, and psychological vulnerability. METHOD: 547 participants completed assessments of personality, disaster exposure, and PTSD symptoms. Multiple regression analyses were used to identify predictors of PTSD symptoms. RESULTS: PTSD scores were higher in women, single people, those with low educational level, those who witnessed someone else's injury or death, those who were injured, and those whose homes were destroyed. Physical injury, conscientiousness, marital status, income, and agreeableness predicted PTSD. Among these variables, physical injury was the strongest predictor of PTSD. CONCLUSIONS: Psychological vulnerability, conscientiousness, physical injury, employment, witnessing someone else's injury, gender, and emotional stability predicted PTSD score in a significant way. Physical injury, conscientiousness, marital status, income, agreeableness predicted PTSD in a significant way.

Symptomatology of posttraumatic stress and burnout associated with aggressions suffered by primary care health professionals. A transversal study.

Objective: To know the incidence of aggressions in Primary Care, and to determine the psychological symptoms that may accompany these experiences. A transversal study was carried out in North-Eastern Spain, in 2022. Methods: 207 participants (60.9% women, mean age 48.8 years), primary care professionals (nurses and doctors), responded to Questionnaire of Sociodemographic and Occupational variables, List of Aggressions, General Health Questionnaire, Posttraumatic Stress Disorder Checklist, and Maslach Burnout Inventory. Results: 57.49% had suffered aggressions in the last year (44.4% threats, 55.1% insults and 18.4% physical aggressions). They showed more psychological symptoms than those who had not been assaulted: re-experiencing, avoidance, distancing, emotional or cognitive disturbances and hypervigilance, as well as to emotional exhaustion, depersonalization and low personal realization. Although no statistically significant differences were found in terms of the number of victims with respect to gender, men showed more symptoms of trauma. Conclusion: The data show the increase of violent episodes in Primary Care. Although the attacks perpetrated in this sector do not usually present the magnitude required for the diagnosis of post-traumatic stress, many of its symptoms were manifested in those who had suffered violence. Likewise, a relationship was found between aggression and burnout. The need to have post-incident protocols is evident, raising awareness among professionals about the importance of reporting episodes, as well as designing and implementing prevention plans. The damage generated by these behaviors does not only affect nurses and doctors, but, indirectly, all users of the health system.

Psychological distress mediates the association between COVID-19-related discrimination and subsequent PTSD symptom severity in healthcare workers: a two-year follow-up study.

BACKGROUND: Past research has suggested a cross-sectional association between COVID-19-related discrimination and PTSD symptom severity. However, no cohort study has examined the longitudinal association that better supports causal interpretation. Also, even if such an association genuinely exists, the specific pathway remains unclear. METHODS: We conducted a two-year follow-up study, obtaining data from healthcare workers in a hospital setting. We first evaluated how COVID-19-related discrimination in 2021 was associated with subsequent PTSD symptom severity in 2023. Thereafter, we conducted causal mediation analysis to examine how this association was mediated by psychological distress in 2022, accounting for exposure-mediator interaction. Missing data were handled using random forest imputation. RESULTS: A total of 660 hospital staff were included. The fully adjusted model showed greater PTSD symptom severity in individuals who experienced any COVID-19-related discrimination compared with those without such experiences (ß, 0.44; 95% CI, 0.04-0.90). Regarding each type of discrimination, perceived discrimination was associated with greater PTSD symptom severity (ß, 0.52; 95% CI, 0.08-0.96), whereas verbal discrimination did not reach statistical significance. Psychological distress mediated 28.1%-38.8% of the observed associations. CONCLUSIONS: COVID-19-related discrimination is associated with subsequent PTSD symptom severity in healthcare workers. Psychological distress may serve as an important mediator, underscoring the potential need for interventions targeting this factor.

Analysis of risk factors and construction of a prediction model for posttraumatic stress disorder among Chinese college students during the COVID-19 pandemic.

BACKGROUND: To explore the risk factors of post-traumatic stress disorder (PTSD) among Chinese college students during the COVID-19 pandemic and the construction and validation of risk prediction models. METHODS: A total of 10,705 university students were selected for the study. The questionnaire included the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), PTSD Checklist for DSM-5 (PCL-5), and self-designed questionnaire. These assessments were conducted to facilitate the survey, construct the predictive model and validate the model's validity. RESULTS: Sex, left-behind experience, poverty status, anxiety score, and depression score were identified as independent risk factors influencing psychological trauma among Chinese college students during the COVID-19 pandemic, while COVID-19 infection emerged as a protective factor against psychological trauma. A column chart was constructed to visualize the six independent risk factors derived from logistic regression analysis. The Hosmer-Lemeshow test results (χ2 = 13.021, P = 0.111) indicated that the risk prediction model fitted well. The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.864 in the model group and 0.855 in the validation group. The calibration curves of the model closely resembled the ideal curve. Decision curve analysis (DCA) revealed that the model provided net benefit and demonstrated good clinical utility. LIMITATIONS: The validation of the model is currently restricted to internal assessments. However, further confirmation through larger sample sizes, multicenter investigations, and prospective studies is necessary. CONCLUSIONS: The model effectively predicted PTSD risk among Chinese college students during the COVID-19 pandemic, indicating strong clinical applicability.

Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms.

Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

Youth often lack access to evidence-based care after trauma. This study assessed the feasibility of a trauma-focused internet- and mobile-based intervention with therapist guidance.The intervention was accepted by youths, and the preliminary evaluation of participant responses suggests its efficacy.Future studies should examine strategies to improve adherence and the IMI's efficacy in a RCT.