Mapping PTSD, depression, and anxiety: A network analysis of co-occurring symptoms in treatment-seeking first responders.

First responders are at high risk for a range of co-occurring mental health conditions due to their repeated exposure to traumatic events. When first responders present for treatment, their complex presentation of symptoms including posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) can prove challenging to differentiate for clinical purposes. Network analysis provides a means to identify the nuanced associations between the symptoms of these conditions and to identify groups of related symptoms. In this study, a treatment-seeking sample of first responders (N = 432) completed self-report measures of PTSD, depression, and GAD. Network analysis was used to identify symptom clusters within the sample. Our cross-sectional data yielded six empirically distinct communities: depression symptoms, GAD symptoms, and four communities comprising PTSD symptoms - intrusion and avoidance; irritability and aggression; negative affect; and arousal and sleep. Network associations underscore the heterogeneity of PTSD and also highlight overlapping and diverging symptoms of depression and GAD. These findings are discussed within the context of existing research on first responders, and recommendations for further study and treatment interventions are provided.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of Veterans.

OBJECTIVE: Veterans can present at nongovernment (Department of Defense, Department of Veterans Affairs) mental health agencies with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no veteran study has validated these measures on a treatment-seeking sample of veterans outside the DoD and VA. METHODS: We used a treatment-seeking sample of veterans ( N = 493) to validate measures that assess these constructs (PTSD Checklist 5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7). RESULTS: The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting model of the depression measure was a two-factor structure, cognitive-affective, and somatic depression. The measure of generalized anxiety was a unidimensional model. LIMITATIONS: Follow-up studies should validate these measures on nontreatment-seeking discharged veterans. CONCLUSIONS: We interpret these findings within the veteran scholarship and explore clinical implications for providers.

Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes.

OBJECTIVE: To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs). METHODS: We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide. RESULTS: Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs. LIMITATIONS: These data are cross-sectional and should be modeled longitudinally over the course of treatment. CONCLUSION: Separate constructs influence suicide for LEOs and FFs/EMTs.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of First Responders.

OBJECTIVE: First responders (FRs) commonly present for treatment with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no FR study has validated these measures on a treatment-seeking sample. METHODS: Confirmatory factor analysis was utilized to validate measures that assess these constructs (Posttraumatic Stress Disorder Checklist for DSM-5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7) on a treatment-seeking sample of FRs ( N = 390). RESULTS: The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting factor model of the depression measure was a two-factor structure, cognitive-affective and somatic depression. Lastly, generalized anxiety was a unidimensional construct. LIMITATIONS: Follow-up studies should validate these measures on each FR subtype. CONCLUSION: We position these findings within the FR literature, review clinical implications for providers, and offer recommendations for future research.

Differences in Resilience and Mental Health Symptoms Among US First Responders With Secure and Insecure Attachment.

OBJECTIVE: This observational study aimed to determine whether attachment style predicted first responders' mental health and resilience. METHOD: Data were from a treatment-seeking sample of first responders ( N = 237). Each participant completed six assessments measuring attachment, resilience, generalized anxiety, depression, suicidality, and posttraumatic stress disorder. RESULTS: On the attachment assessment, 25.3% were categorized as secure, 19.0% as dismissive, 25.3% as preoccupied, and 30.4% as fearfully attached. As predicted, securely attached participants had the lowest scores for generalized anxiety, depression, suicidality, and posttraumatic stress disorder and the highest scores on the resiliency measure, followed by dismissive, preoccupied, and fearfully attached participants. LIMITATIONS: These data are cross-sectional and causality cannot be inferred. CONCLUSIONS: Results highlight the importance of the study of attachment to psychotherapy and mental health treatment with first responders.

Affective Depression Mediates PTSD to Suicide in a Sample of Treatment-Seeking First Responders.

OBJECTIVE: The aim of this study was to examine the associations of comorbid posttraumatic stress disorder (PTSD), affective or somatic depression, and suicide among first responders (FRs). METHOD: We used baseline data from FRs ( N = 232) who sought services at a nonprofit mental health agency specializing in treating trauma exposed FRs. We conducted two PROCESS simple mediation models with PTSD as the predictor, affective depression and somatic depression as the mediators, and suicidality as the dependent variable. RESULTS: Affective depression significantly mediated the relationship between PTSD and suicidality, whereas somatic depression did not. The direct effect of PTSD on suicidality was not significant. LIMITATIONS: These data are cross-sectional and should be followed up with longitudinal analyses across the course of treatment. CONCLUSIONS: To reduce suicide risk, it is recommended that clinicians target affective depression instead of PTSD symptoms.

Differences in Suicidality in Non-Treatment-Seeking and Treatment-Seeking Law Enforcement Officers: A Cross-sectional Study.

OBJECTIVE: Law enforcement officers (LEOs) are exposed to high levels of occupational trauma and face added stress from heightened public scrutiny and COVID-19, which may result in suicide. It is crucial to understand differences between LEOs who seek treatment and those who do not. METHOD: We compared LEOs from the same greater metropolitan area who sought treatment with those who did not. Participants completed validated measures assessing posttraumatic stress disorder, generalized anxiety, depression, and suicidality. RESULTS: The treatment-seeking sample scores were higher on all standardized assessments. Bivariate logistic regression results indicated that the non-treatment-seeking sample's odds of experiencing suicidality were 1.76 times the odds for the treatment seeking sample. Conclusions: This suggests that many LEOs experiencing suicidality may not be seeking treatment and highlights the role that posttraumatic stress disorder may play in determining whether LEOs seek treatment or not.

Southwestern Assessment of Processing Speed (SWAPS): A new brief test with demographically-corrected norms in an ethnically and educationally diverse population.

Objective. Neuropsychological measures of processing speed have long been used as sensitive indices of cognitive functioning. Most of these commonly used tests are proprietary, and there is a need for brief, freely available tools that can be used in diverse clinical and research settings. The Southwestern Assessment of Processing Speed (SWAPS) is a 60-second digit-symbol transcription task developed as a brief alternative to commercially available coding tests. Demographically-corrected normative data are presented along with reliability and sensitivity/specificity values in older adults with and without cognitive impairment.Method. SWAPS data from 915 healthy aging individuals (NC) and 858 subjects with clinical diagnoses of mild cognitive impairment (MCI; n = 430) and Alzheimer's disease clinical syndrome (ADCS; n = 428) were obtained from the Texas Alzheimer's Research and Care Consortium (TARCC). TARCC participants represent ethnically and educationally diverse community-dwelling individuals age 50+.Results. SWAPS scores showed the expected associations with age, sex, and education, and the interaction between age and education were significant predictors of SWAPS scores. Test-retest reliability in NC was good, and the SWAPS distinguished impaired and non-impaired groups with adequate to excellent sensitivity and specificity for the primary analyses, with optimal cut-off points provided. Raw score- to uncorrected normalized T-scores and demographically-corrected SWAPS T-scores using regression-based norms are presented along with scoring programs for the calculation of each.Conclusions. The SWAPS is a brief, free, easily administered test with demographically-corrected regression-based norms and promising utility for detection of cognitive impairment and efficient assessment of processing speed.

Correlation between the Bicycle Drawing Task and neuropsychological variables in patients referred for a dementia evaluation.

The objective of this study was to examine the relationship between the Bicycle Drawing Task and a number of neuropsychological variables, including the Repeatable Battery for the Assessment of Neuropsychological Status, in a heterogeneous group of older adults referred for a dementia evaluation. The sample consisted of 91 participants with a mean age of 77.0 yr. (SD = 6.4). The correlations between scores on the Bicycle Drawing Task and the Repeatable Battery for the Assessment of Neuropsychological Status and supplemental cognitive measures were generally in the moderate range. The Bicycle Drawing Task was not significantly related to premorbid IQ or education. As a neuropsychological measure, the task is brief, easily explained, easily scored, and well-tolerated by patients. Results suggest the Bicycle Drawing Task may be a useful screening procedure for cognitive impairment that is not significantly related to education or premorbid ability.