The effects of psychotherapies for posttraumatic stress disorder on quality of life in the civilian population: A meta-analysis of RCTs.

Objective: Posttraumatic stress disorder (PTSD) has been shown to significantly impair quality of life (QOL), although no meta-analysis has evaluated the effect of psychotherapies for PTSD on QOL in the civilian population. The current meta-analysis aimed to assess these effects in the adult civilian population. Method: An exhaustive search of 13 databases revealed 9 studies of moderate to strong methodological quality evaluating mainly cognitive-behavioral therapy (8 of 9 studies). A total of 421 participants were allocated to a psychotherapy condition, 174 to a waitlist control group, and 203 were allocated to an active control group. Waitlist and active-controlled random effects of psychotherapies on QOL were computed. Risk of bias was assessed using multiple indices. Results: Pre-post treatment pooled effect sizes were small to moderate for QOL (active-controlled: Hedges' g = 0.37, 95% confidence interval [CI;0.14, 0.59]; waitlist-controlled: g = 0.63, CI [0.44, 0.83]) and were both large (waitlist-controlled: g = -1.36, CI [-1.85, -0.88]) and small (active-controlled: g = -0.40, CI [-0.57, -0.23]) for PTSD. Risk of bias analyses support robust and conservative results. Conclusions: The results, mainly with respect to cognitive-behavioral therapy, suggest that psychotherapies for PTSD improve QOL. More research is required to determine whether improvements are adequate in restoring QOL to a clinically acceptable level. Future studies should evaluate the effects of psychotherapies on the different dimensions of QOL as well as the specific effects of additional QOL-focused interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Quality of Life After Violent Crime: The Impact of Acute Stress Disorder, Posttraumatic Stress Disorder, and Other Consequences.

Victims of violent crime (VVC) are at risk of developing acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD). In addition, VVC are more likely to have low social support due to stigmatization and victim-blaming, and PTSD is frequently associated with depression, anxiety, and impaired quality of life (QoL). The present study aimed to determine the impact of ASD, PTSD, depressive symptoms, anxiety symptoms, and perceived social support in relation to four domains of QoL among VVC. Individuals were recruited as part of a longitudinal study assessing the efficacy of a brief cognitive behavioral treatment for ASD. Participants (N = 127) were interviewed and completed self-report measures within 30 days of experiencing a violent crime (T0 ) and at assessments 2 months (T1 ) and 6 months (T2 ) after the event. Depressive symptoms, ASD, and PTSD were found to be associated with lower QoL ratings in all four domains. Anxiety symptoms were found to be associated with lower ratings in the physical health and psychological QoL domains. Perceived social support was found to be associated with higher QoL ratings in all domains. The proportions of QoL variance explained by the combined fixed and random effects combined ranged from 70% to 79%. Future research considerations include an examination of how early interventions for VVC could prevent QoL deterioration by targeting ASD and PTSD development, depressive and anxiety symptoms, and social support.

Identifying Trajectories and Predictors of Response to Psychotherapy for Post-Traumatic Stress Disorder in Adults: A Systematic Review of Literature.

OBJECTIVE: There exists considerable individual variability in the development and progression of pathological stress reactions after experiencing trauma, as well as in individuals' response to psychological interventions. Yet until recently, such individual differences had not been considered when evaluating the efficacy of therapeutic interventions for post-traumatic stress disorder (PTSD). This systematic review aims to examine the emerging literature on this subject and, specifically, to identify trajectories and predictors of psychotherapeutic response in adults with PTSD. METHOD: Four databases were searched using specific keywords without date or language restrictions. For each study, independent reviewers systematically evaluated whether it met eligibility criteria and assessed risk of bias. For included studies, reviewers completed data extraction using standard formats. Those examining how subgroups of adults respond to therapy for clinical PTSD using trajectory modeling were deemed eligible. Demographic, PTSD, clinical, and trauma-related factors associated to particular trajectories were also examined. RESULTS: Of the 1,727 papers identified, 11 were included in this analysis. Of these studies, six focused on military-related traumas and five on civilian ones. Although studies found between two and five trajectories, most supported a three-trajectory model of response categorized as responders, nonresponders, and subclinical participants. Over 22 predictors of treatment trajectories were examined. Comorbid depression, anxiety, and alcohol abuse were the strongest predictors of poor therapeutic response. Age, combat exposure, social support, and hyperarousal were moderate predictors. CONCLUSION: This review provides valuable insight into the treatment of PTSD, as it supports the heterogeneous trajectories of psychotherapeutic responses and provides avenues for the development of interventions that consider individual-level factors in treatment response.

Gender Differences in the Prediction of Acute Stress Disorder From Peritraumatic Dissociation and Distress Among Victims of Violent Crimes.

Peritraumatic dissociation and distress are strong predictors of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) development. However, there is limited data concerning gender differences in these relations, particularly among victims of violent crimes (VVC). The objective of this study is to examine whether peritraumatic dissociation and distress predict the number of ASD symptoms differently for men and women VVC. In all, 162 adults (97 women, M age = 39.6 years), 63% of whom experienced physical assaults, completed the Acute Stress Disorder Interview, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Analyses included t tests and multiple hierarchical regressions models controlling for known PTSD risk factors. The regression model showed dissociation and distress to be significant predictors of ASD for both men and women (ß = .349 and ß =.312 respectively; all p < .001). A significant three-way interaction was also observed between peritraumatic distress (PDI), past potentially traumatic experiences, and gender. In simple slopes analyses, the combination of high levels of PDI and of a high number of past potentially traumatic events were associated with greater risk of ASD in men only (b = 3.78, p < .001). However, women experienced greater PDI, t(157) = 5.844, p = .005, than men, and elevated distress was associated with more ASD symptoms independently of past traumatic events. Gender differences were revealed as a function of past potentially traumatic experiences. There is a cumulative impact of past potential traumas and current distress that predicts ASD in men, while in women, it contributes to ASD via increased distress.

Identifying crime victims vulnerable to persistent depressive symptoms: Results from a secondary analysis.

BACKGROUND: Although depression has been extensively studied in relations to Intimate Partner Violence (IPV) and Childhood Maltreatment (CM), we still know little about its relationship with other types of violent crimes (e.g., physical assault, mugging) or how symptoms evolve over time. METHODS: Using a clinical sample of 132 crime victims, this study sought to map out group-based symptoms trajectories using Latent Growth Curve Analysis (LCGA) over the course of one year. RESULTS: Less than one month after having been assaulted, 30% of the sample reached the severe depression threshold. Symptoms tended to improve over time, with only 8% of participants reporting severe depression one year later. Analyses indicate the presence of three distinct profiles: one marked by severe and stable symptomatology over time (17%), the second characterized by a moderate level of symptoms that decreases exponentially over time (57%) and a third one describing a pattern of minimal depression throughout the year. People who suffered from persistent depression reported significantly lower levels of social support, scored higher on the ASDI and were also more likely to report some type of maltreatment in childhood but not IPV in adulthood, and appeared non-responsive to treatment. LIMITATIONS: Results must be nuanced by the size (i.e., LCGA requirements and attrition) and nature of the sample (i.e., help-seeking victims only). CONCLUSIONS: Although violence is a risk factor for depression, some individuals, especially those with a history of CM, appear to be more vulnerable to severe, persistent and treatment-resistant depression than others.

Développement et validation de la version canadienne-française de l'échelle de Satisfaction des Adolescents de la gestion de la Douleur postopératoire - Scoliose idiopathique (SAD-S).

Background: Spinal fusion for scoliosis generates moderate to severe pain intensity. There are currently no instruments available to measure adolescents' satisfaction regarding post-spinal fusion pain management. Aims: To develop and validate a scale on satisfaction of adolescents regarding pain management following spinal fusion for scoliosis. Methods: A methodological design was used to develop and validate the French-Canadian scale "Satisfaction des Adolescents de la gestion de la Douleur postopératoire - Scoliose idiopathique (SAD-S)". A modified Delphi method, with seven healthcare professionals and 10 adolescents, was used to establish content validity of the SAD-S. A pre-test of the scale was conducted with 10 adolescents post-spinal fusion. The final version of the scale was validated through a pilot study with 98 adolescents following their surgery. Results: The SAD-S scale includes a total of 13 items. Principal component analysis yielded a two-factor structure (2 subscales): 1) Pain management education and 2) Education regarding medication. These two factors explained 47,8% of the total variance for satisfaction. A Cronbach's alpha of 0,84 was obtained for internal consistency. Conclusion: Validation of the SAD-S scale showed that it has good psychometric properties with this population. Further validation is required with a larger sample to pursue its validation.

Introduction: La chirurgie correctrice de la scoliose génère de la douleur postopératoire d'intensité modérée à sévère. Il n'existe pas d'instruments sur la satisfaction d'adolescents ayant eu recours à ce type de chirurgie quant à la gestion de leur douleur.Objectifs: Développement et validation d'une échelle pour mesurer la satisfaction d'adolescents ayant subi une chirurgie correctrice de la scoliose quant à la gestion de leur douleur postopératoire.Méthodes: Un devis méthodologique a été utilisé pour développer l'Échelle de Satisfaction des Adolescents de la gestion de la Douleur postopératoire ­ Scoliose idiopathique (SAD-S). La validité de contenu du SAD-S a été évaluée selon la méthode Delphi modifiée avec sept professionnels de la santé et 10 adolescents. Un pré-test de l'instrument a été effectué auprès de 10 autres adolescents ayant subi cette chirurgie. Une étude de validation a ensuite été menée auprès de 98 adolescents en phase postopératoire.Résultats: Le SAD-S comprend 13 énoncés. L'analyse en composantes principales a permis de déterminer une structure à deux facteurs (sous-échelles): 1) enseignement sur la gestion de la douleur et 2) enseignement sur la médication. Ces facteurs permettent d'expliquer 47,8 % de la variance totale pour la satisfaction. Un alpha de Cronbach de 0,84 a été obtenu pour la consistance interne de l'échelle.Conclusion: Le SAD-S possède de bonnes propriétés psychométriques pour la mesure de la satisfaction auprès de cette clientèle. La validation de cet instrument devra être poursuivie à l'aide d'un échantillon plus grand.

Efficacy of an ibuprofen/codeine combination for pain management in children presenting to the emergency department with a limb injury: a pilot study.

BACKGROUND: Fractures and severe sprains generate moderate to severe pain (>3/10). Despite this fact, pain management in children presenting to the Emergency Department (ED) with a musculoskeletal trauma is still suboptimal. Few studies have focused on the efficacy of a combination of an opioid with an anti-inflammatory drug to relieve this type of pain. STUDY OBJECTIVE: To compare the efficacy of a combination of codeine with ibuprofen to ibuprofen alone on the intensity of pain experienced by children presenting to the ED with a musculoskeletal trauma to a limb. METHODS: This randomized, double-blind, placebo-controlled trial included patients aged 6 to 18 years. After triage, subjects were randomized to either ibuprofen (10 mg/kg, max 600 mg) and codeine (1 mg/kg, max 60 mg) orally, or ibuprofen (10 mg/kg, max 600 mg) and a placebo orally. Pain was assessed with the visual analog scale (0 to 10) at triage, and at 60, 90, and 120 min after medication administration. Differences on mean pain scores were compared between groups over time. RESULTS: We recruited 81 patients, 40 in the experimental group and 41 in the control group. No significant differences were observed in mean pain scores between groups at any time point. Mean pain scores were moderate at 90 min in both experimental and control groups (4.0 ± 2.4 vs. 4.1 ± 2.0, respectively). Side effects were minimal. CONCLUSION: The addition of codeine to ibuprofen did not significantly improve pain management in children with musculoskeletal trauma to a limb. Pain control provided by the medications remained suboptimal for most patients.

Pain management interventions with parents in the emergency department: a randomized trial.

AIM: This paper is a report of the efficacy of a parental educational intervention on children's pain intensity and experience of pain-related unpleasantness at 24 hours post-discharge from the emergency department, and on parents' beliefs about pain. BACKGROUND: Parents' misbeliefs about pain management may inhibit them from managing their child's pain appropriately. Educating parents about pain management may increase their knowledge, dispel myths and help decrease children's pain intensity and unpleasantness related to pain following a visit to an emergency department. METHOD: A randomized design was adopted with samples of parent/child dyads. The experimental group received a bookmark, booklet on pain management and pain scale. The control group only received a pain scale. Pain intensity and unpleasantness were measured at triage and 24 hours after discharge from the emergency department. Parents' beliefs were measured with the Pain Belief Questionnaire. Data were collected from November 2005 to May 2006. RESULTS: Samples of 98 (experimental) and 97 (control) children/parents were recruited. No statistically significant differences were found between both groups regarding pain intensity and unpleasantness, at triage and 24 hours post-discharge. Results for the Pain Belief Questionnaire were similar between the groups (t = 1·751, P = 0·082). CONCLUSION: The interventions were not effective to reduce pain and unpleasantness related to pain, as well as to improve pain beliefs of parents. Other interventions, such as having parents participate actively in their child's pain management, might be more effective than a passive educational intervention.

Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study: interventions with nurses.

BACKGROUND AND AIM: Children's pain in emergency departments (EDs) is poorly managed by nurses, despite evidence that pain is one of the most commonly presenting complaints of children attending the ED. Our objectives were 2-fold: to verify if tailored educational interventions with emergency pediatric nurses would improve nurses' knowledge of pain management and nurses' pain management practices (documentation of pain, administration of analgesics, nonpharmacological interventions). METHODS: This intervention study with a pre-post design (baseline, immediately after the intervention [T-2], and 6 months after intervention [T-3]) used a sample of nurses (N = 50) and retrospective chart reviews of children (N = 450; 150 charts reviewed each at baseline, T-2, and T-3) who presented themselves in the ED with a diagnosis known to generate moderate to severe pain (burns, acute abdominal pain, deep lacerations, fracture, sprain). Principal outcomes: nurses' knowledge of pain management (Pediatric Nurses Knowledge and Attitudes Survey [PNKAS] on pain) and nurses' clinical practices of pain management (Pain Management Experience Evaluation [PMEE]). RESULTS: Response rate on the PNKAS was 84% (42/50) at baseline and 50% (21/42) at T-2. Mean scores on PNKAS were 28.2 (SD, 4.9; max, 42.0) at baseline and 31.0 (SD, 4.6) at T-2. Results from paired t test showed significant difference between both times (t = -3.129, P = 0.005). Nurses who participated in the capsules improved their documentation of pain from baseline (59.3%) to T-2 (80.8%; chi = 12.993, P < 0.001) as well as from baseline (59.3%) to T-3 (89.1%; chi = 29.436, P < 0.001). In addition, nurses increased their nonpharmacological interventions from baseline (16.7%) to T-3 (31.9%; chi = 8.623, P = 0.003). Finally, we obtained significant differences on pain documentation between the group of nurses who attended at least 1 capsule and the group of nurses who did not attend any capsule at both times (T-2 and T-3; chi = 20.424, P < 0.001; chi = 33.333, P < 0.001, respectively). CONCLUSIONS: The interventions contributed to the improvement of the nurses' knowledge of pain management and some of the practices over time. We believe that an intervention tailored to nurses' needs and schedule has more impact than just passive diffusion of educational content.

Detection of exercise-induced myocardial ischemia from symptomatology experienced during testing in men and women.

BACKGROUND AND OBJECTIVES: To examine the capacity of angina and related symptoms experienced during exercise-stress testing to detect the presence of ischemia, controlling for other clinical factors. METHOD: The authors undertook a prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging. One hundred forty-six women and 127 men reported chest pain, and of these, 25% of women and 66% of men had myocardial perfusion imaging evidence of ischemia during testing. The present article focuses on patients with chest pain during testing. MAIN OUTCOME MEASURES: Outcome measures included chest pain localization, extension, intensity and quality, as well as the presence of various nonpain-related symptoms. Backward logistical regression analyses were performed separately on men and women who had experienced chest pain during testing. RESULTS: Men who described their chest pain as 'heavy' were 4.6 times more likely to experience ischemia during testing (P=0.039) compared with other men, but this pain descriptor only slightly improved accuracy of prediction beyond that provided by control variables. In women, several symptoms added to the sensitivity of the prediction, such as a numb feeling in the face or neck region (OR 4.5; P=0.048), a numb feeling in the chest area (OR 14.6; P=0.003), muscle tension (OR 5.2; P=0.013), and chest pain that was described as hot or burning (OR 4.3; P=0.014). CONCLUSIONS: A more refined evaluation of symptoms experienced during testing was particularly helpful in improving detection of ischemia in women, but not in men. Attention to these symptoms may favour timely diagnosis of myocardial perfusion defects in women.

Angina symptoms in men and women with stable coronary artery disease and evidence of exercise-induced myocardial perfusion defects.

BACKGROUND: To examine sex differences in pain and associated symptoms in patients with exercise-related ischemia, as well as the independence of these findings from other clinical factors. METHODS: Prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging (MPI). Analyses were performed on 38 women and 94 men with both angina and MPI evidence of ischemia during exercise. MEASURES: Chest pain localization, extension, intensity, quality, and presence of various non-pain-related symptoms. RESULTS: Women rated their pain as more intense, used different words to describe it, and reported more non-pain-related symptoms than men (P < .05). They experienced pain and other sensations in the neck area more frequently (P < .05). Most of these differences remained after controlling for clinical or psychological variables, with the exception of pain intensity measures. CONCLUSIONS: Sex differences in the experience of symptoms associated with MPI evidence of myocardial ischemia may complicate timely and accurate diagnosis of ischemia in women.