The relationship between attachment and posttraumatic stress in children and adolescents: A meta-analytic review.

The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies (N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS (r = -.16) and a positive correlation between insecure attachment (r = .20), avoidant attachment (r = .20), anxious attachment (r = .32), and disorganized attachment (r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.

The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis.

Background: Healthcare workers (HCWs) are considered at elevated risk of experiencing mental health disorders in working with patients with COVID-19. Objective: To estimate the prevalence of common mental health disorders in HCWs based in hospitals where pandemic-affected patients were treated. Method: Databases were searched for studies published before 30 March 2020. Quantitative synthesis was used to obtain estimates of the prevalence of mental health disorders in four time windows, determined a priori (the acute phase, i.e. during and up to 1.5 months post-pandemic; 1.5-5.9 months; 6-11.9 months; 12 months and later). Results: Nineteen studies met the review criteria. They predominantly addressed the acute phase of the SARS outbreak in Asia. The most studied outcomes were clinically significant post-traumatic stress symptoms (PTSS) and general psychiatric caseness. For clinically significant PTSS in the acute phase, the prevalence estimate was 23.4% (95% CI 16.3, 31.2; N = 4147; I2 = 96.2%); in the 12 months plus window, the estimate was 11.9% (8.4, 15.8; N = 1136; I2 = 74.3%). For general psychiatric caseness, prevalence estimates were acute phase, 34.1% (18.7, 51.4; N = 3971; I2 = 99.1%); 6-12 months, 17.9% (13.1, 23.2; N = 223; I2 = 0.0%); 12 months plus, 29.3% (6.0, 61.0; N = 710; I2 = 97.8%). No differences between doctors and nurses with respective to PTSS and general psychiatric caseness were apparent in the acute phase. Conclusions: Mental health disorders are particularly common in HCWs working with pandemic-afflicted patients immediately following a pandemic, but the course of disorders following this period is poorly understood. There was considerable heterogeneity between studies, likely linked to methodological differences. More extended follow up of HCWs is needed.

Antecedentes: Se considera que los trabajadores de la salud (TS) tienen un riesgo elevado de experimentar trastornos de salud mental al trabajar con pacientes con COVID-19.Objetivo: Estimar la prevalencia de trastornos de salud mental comunes en los TS de los hospitales donde se trataron a pacientes afectados por una pandemia.Método: Se realizaron búsquedas en las bases de datos para estudios publicados antes del 30 de marzo de 2020. Se utilizó una síntesis cuantitativa para obtener estimaciones de la prevalencia de trastornos de salud mental en cuatro ventanas de tiempo, determinadas a priori (la fase aguda, es decir, durante y hasta 1,5 meses después de la pandemia; 1.5-5.9 meses; 6-11.9 meses; y después de 12 meses).Resultados: Diecinueve estudios cumplieron los criterios de esta revisión. Principalmente abordaron la fase aguda del brote de SARS en Asia. Los resultados más estudiados fueron los síntomas de estrés postraumático clínicamente significativos (SEPT) y casuística psiquiátrica general. Para los SEPT clínicamente significativo en la fase aguda, la estimación de prevalencia fue del 23,4% (IC del 95%: 16,3, 31,2; N = 4147; I2 = 96,2%); en los 12 meses adicionales, la estimación fue del 11,9% (8,4, 15,8; N = 1136; I2 = 74,3%). Para los casos de psiquiatría general, las estimaciones de prevalencia fueron: fase aguda, 34.1% (18.7, 51.4; N = 3971; I2 = 99.1%); 6-12 meses, 17.9% (13.1, 23.2; N = 223; I2 = 0.0%); después de 12 meses, 29.3% (6.0, 61.0; N = 710; I2 = 97.8%). No se observaron diferencias entre los médicos y las enfermeras con SEPT y casuística psiquiátrica general en la fase aguda.Conclusiones: Los trastornos de salud mental son particularmente comunes en los TS que trabajan con pacientes afectados inmediatamente después de la pandemia, pero el curso de los trastornos después de este período es poco conocido. Hubo una considerable heterogeneidad entre los estudios, probablemente vinculada a diferencias metodológicas. Se necesita un seguimiento más extenso de los TS.

Treating Acute Insomnia: A Randomized Controlled Trial of a "Single-Shot" of Cognitive Behavioral Therapy for Insomnia.

STUDY OBJECTIVES: Despite considerable evidence supporting cognitive behavioral therapy for insomnia (CBT-I) for chronic insomnia, it remains untested within the context of acute insomnia. This study examined the efficacy of a single session of CBT-I, with an accompanying self-help pamphlet, for individuals with acute insomnia. DESIGN: A pragmatic parallel group randomized controlled trial. SETTING: Community. PARTICIPANTS: Forty adults (mean age 32.9 ± 13.72 y) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defined insomnia disorder, except a self-reported duration of less than 3 mo (i.e., acute insomnia), who reported no previous exposure to CBT-I and were not currently taking medication for sleep. INTERVENTIONS: A single 60- to 70-min session of CBT-I (n = 20), with an accompanying self-help pamphlet, or wait list control group (n = 20). All subjects were offered a full individual course of CBT-I on completion of the study, regardless of group allocation. MEASUREMENTS AND RESULTS: Subjects completed sleep diaries and the Insomnia Severity Index (ISI) pretreatment and 1 mo following treatment. There were no between-group differences on baseline ISI scores or subjective sleep continuity. The intervention group reported significantly lower ISI scores than controls (t(38) 2.24, P < 0.05) at follow-up. Further, using proposed ISI scores for identifying insomnia caseness (i.e., ≥ 10), 60% of those in the CBT-I group had remitted by 1 mo compared to 15% of those in the control group. CONCLUSIONS: This single session of cognitive behavioral therapy for insomnia (CBT-I) is sufficiently efficacious for a significant proportion of those with acute insomnia. The results are discussed in terms of integrating this brief form of CBT-I into the "stepped care" model of insomnia. TRIAL REGISTRATION: Testing the efficacy of an early intervention for acute insomnia (SRCTN05891695) http://www.controlled-trials.com/ISRCTN05891695.