Psychological models of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) make predictions about the role of unhelpful coping strategies in maintaining difficulties by blocking ...self-correction of negative appraisals and memory integration following stressful life events like bereavement. However, few studies have tested these predictions directly.
We used counterfactually based causal mediation to assess whether unhelpful coping strategies mediated the relationship between (1) loss-related memory characteristics and/or (2) negative grief-related appraisals and symptoms of PGD, PTSD and depression using a three-wave longitudinal sample (
= 275). Appraisals and memory characteristics were measured at time point 1, unhelpful coping strategies at T2, and symptom variables at T3. Additionally, multiple mediation analyses within a structural equation modelling (SEM) framework assessed which types of coping strategies differentially mediated symptoms of PGD, PTSD and depression.
Coping strategies mediated the relationship between negative appraisals and memory characteristics and symptoms of PGD, PTSD and depression after adjusting for demographics and loss characteristics. Sensitivity analyses suggested that these results were most robust for PGD, followed by PTSD and then depression. Multiple mediation analyses suggested that all four subscales (avoidance, proximity seeking, loss rumination and injustice rumination) individually mediated the effect of memory characteristics and appraisals on PGD.
These results suggest that core predictions of the cognitive model for PTSD and the cognitive behavioural model of PGD are useful in predicting symptoms of post-loss mental health problems in the first 12-18 months after loss. Targeting unhelpful coping strategies is likely to reduce symptoms of PGD, PTSD and depression.
Cognitive behavioural correlates to bereavement-related mental health problems such a Prolonged Grief Disorder (PGD) and Posttraumatic Stress Disorder (PTSD) are of theoretical and clinical ...importance.
Individuals bereaved at least six months (N = 647) completed measures of loss-related cognitions and behaviours (i.e., loss-related memory characteristics, negative appraisals, coping strategies, grief resilience, and perceived social disconnection) and measures of PGD and PTSD symptoms. Individuals were assigned to one of four groups depending on probable clinical diagnoses (No-PGD/PTSD, PTSD, PGD, PGD+PTSD).
Results indicated that higher loss-related memory characteristics and lower grief resilience increased the likelihood of a clinical problem. The PGD and PGD+PTSD groups reported significantly higher loss-related memory characteristics and appraisals compared to the PTSD group. Social disconnection increased the likelihood of comorbid PGD+PTSD in comparison to any other group.
Results indicate cognitive differences between loss-related cognitions, memory characteristics and coping strategies between PGD and PTSD, and points to distinct cognitive correlates to psychopathology following loss.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: The identification of modifiable cognitive antecedents of trajectories of grief is of clinical and theoretical interest. Method: The study gathered 3-wave data on 275 bereaved adults in ...the first 12-18 months postloss (T1 = 0-6 months, T2 = 6-12 months, T3 = 12-18 months). Participants completed measures of grief severity, cognitive factors (loss-related memory characteristics, negative appraisals, unhelpful coping strategies, and grief resilience), as well as measures of interpersonal individual differences (attachment and dependency). Latent growth mixture modeling was used to identify classes of grief trajectories. Predictors of class membership were identified using multinomial logistic regression and multigroup structural equation modeling. Results: Four latent classes were identified: 3 high grief classes (Stable, Low Adaptation, and High Adaptation) and a low grief class (Low Grief). When considered separately, variance in all four cognitive factors predicted membership of the high grief classes. When considered together, membership of the high grief classes was predicted by higher mean scores on memory characteristics. More negative appraisals predicted low or no adaptation from high grief severity. Losing a child also predicted membership to the stable class. Fast adaptation of high grief was predicted by a pattern of high memory characteristics but low engagement with unhelpful coping strategies. Conclusions: The findings have implications for clinical practice and point to early cognitive predictors of adaptation patterns in grief. Findings are consistent with cognitive models highlighting the importance of characteristics of memory, negative appraisals, and unhelpful coping strategies in the adaptation to highly negative life events.
What is the public health significance of this article?
The study identifies a number of modifiable cognitive predictors that are linked to grief severity and maintenance in the first months of loss. Targeting these cognitive predictors in the first 6 months of loss may prove helpful in facilitating grief adaptation.
•The type of coping strategy utilised in the early months of loss has a significant impact on later symptoms of prolonged grief disorder (PGD).•Use of avoidant strategies, proximity seeking ...strategies, and rumination measured at 6–12 months all significantly predict prospective symptoms of prolonged grief disorder at 12–18 months.•Use of avoidant coping strategies in the early months after loss (0–6 months) did not predict elevated PGD 6 months later.
Research indicates that post-bereavement coping strategies can be adaptive or maladaptive. Understanding which strategies lead to poorer outcomes is an important clinical and theoretical question with the potential to guide intervention.
The Oxford Grief – Coping Strategies scale was developed from interviews with bereaved people with and without prolonged grief disorder (PGD) to assess the frequency of maladaptive cognitive and behavioural strategies after bereavement. Factorial and psychometric validity were assessed using exploratory and confirmatory factor analysis (N = 676). A three-wave cross-lagged panel model (N = 275) was used to assess the predictive validity of the tool in explaining symptoms of PGD.
Results supported a four-factor solution (Avoidance, Proximity Seeking, Loss Rumination, Injustice Rumination) with good psychometric properties. The OG-CS predicted prospective symptoms of PGD in the short-term (6–12 months) and long term (12–18 months), controlling for baseline symptoms and autocorrelations. Subscale analyses demonstrated that the use of coping strategies predicted ICD-11 PGD in both the short-term and the long-term. However, avoidance was not predictive of outcomes early in the grieving process. At 6–12 months, avoidance predicted PGD at 12–18 months.
Social Networks and Health Smith, Kirsten P.; Christakis, Nicholas A.
Annual review of sociology,
01/2008, Letnik:
34, Številka:
1
Journal Article
Recenzirano
People are interconnected, and so their health is interconnected. In recognition of this social fact, there has been growing conceptual and empirical attention over the past decade to the impact of ...social networks on health. This article reviews prominent findings from this literature. After drawing a distinction between social network studies and social support studies, we explore current research on dyadic and supradyadic network influences on health, highlighting findings from both egocentric and sociocentric analyses. We then discuss the policy implications of this body of work, as well as future research directions. We conclude that the existence of social networks means that people's health is interdependent and that health and health care can transcend the individual in ways that patients, doctors, policy makers, and researchers should care about.
•Kratom was often used to self-treat opioid withdrawal or as an opioid substitute.•Polydrug use that included kratom and at least one other substance was common.•Kratom was perceived as lifesaving, ...but also potentially addictive.•Kratom dependence and withdrawal symptoms were described in detail.•Most used kratom for pragmatic health reasons, rather than to achieve euphoria.
Mitragyna speciosa, referred to as “kratom”, is increasingly used in the United States for self-treating pain, psychiatric, and substance use disorder symptoms. It is used by some to attenuate opioid withdrawal and as a longer-term drug substitute. Most self-report data have come from online surveys, small in-person surveys, and case reports. These may not be representative of the broader kratom-using population.
Analyze user-generated social media posts to determine if independent, descriptive accounts are generally consistent with prior U.S. kratom survey findings and gain a more nuanced understanding of kratom use patterns.
Reddit posts mentioning kratom from 42 subreddits between June 2019–July 2020 were coded by two independent raters.
Relevant posts (number of comments, upvotes, and downvotes) from 1274 posts comprised the final sample (n = 280). Of the 1521 codes applied, 1273 (83.69%) were concordant. Desirable kratom effects were described among a majority, but so too were adverse effects. Reports of kratom as acute self-treatment for opioid withdrawal were more prominent compared to longer-term opioid substitution. Quantitative analysis found higher kratom doses associated (p < .001) with greater odds of reported kratom addiction (OR = 3.56) or withdrawal (OR = 5.88), with slightly lower odds of desirable effects (OR = 0.53, p = .014). Despite perceived therapeutic benefits, kratom was characterized by some in terms of addiction that, in some cases, appeared dose-dependent. Polydrug use was also prominently discussed.
Results validated many prior survey findings while illustrating complexities of kratom use that are not being fully captured and require continued investigation.
Evidence suggests that veterans with posttraumatic stress disorder (PTSD) have a poorer treatment response than nonveterans. In this study, we explored heterogeneity in treatment response for 960 ...veterans in the United Kingdom with PTSD who had been offered a residential intervention consisting of a mixture of group sessions and individual trauma‐focused cognitive behavioral therapy (TF–CBT). The primary outcome was PTSD score on the Impact of Event Scale–Revised (IES–R). Covariates included depression, anxiety, anger, alcohol misuse, functional impairment, and sociodemographic characteristics. Follow‐up occurred posttreatment at set time points for 12 months. We present predictors of PTSD severity at posttreatment and follow‐up obtained using a latent class growth analysis to identify different treatment trajectories. Multinomial logistic regression models were used to identify covariates predicting class membership, and five classes were identified. Of participants, 71.3% belonged to three classes showing positive treatment responses, and 1.2% showed initial improvement but later relapsed. Additionally, 27.5% of participants were identified within a treatment‐resistant class that showed little change in severity of presentation. Depression, anxiety, and having had a combat role during military service increased the likelihood of membership in the treatment‐resistant class, odds ratios (ORs) = 1.12–1.53, 1.16–1.32, and 2.89, respectively. Additionally, participants in the treatment‐resistant class had higher pretreatment PTSD scores for reexperiencing, avoidance, and hyperarousal symptoms, ORs = 5.24, 2.62, and 3.86, respectively. Findings suggest the importance of triaging individuals and offering interventions tailored to severity of presentation.
Resumen
Spanish s by Asociación Chilena de Estrés Traumático (ACET)
La Eficacia del Tratamiento para Veteranos del Reino Unido con Trastorno de Estrés Postraumático: Trayectorias de la Clase Latente de la Respuesta al Tratamiento y sus Predictores
TRAYECTORIAS DE TRATAMIENTO PARA LOS VETERANOS DEL REINO UNIDO CON TEPT
La evidencia sugiere que los veteranos con trastorno de estrés postraumático (TEPT) tienen una respuesta al tratamiento más pobre que aquellos que no son veteranos. En este estudio, exploramos la heterogeneidad en la respuesta al tratamiento de 960 veteranos del Reino Unido que presentaban TEPT y a quienes se les había ofrecido una intervención residencial consistente en una mezcla de sesiones grupales y terapia cognitivo‐conductual individual centrada en el trauma (TF‐CBT, en su sigla en inglés). El resultado principal fue el puntaje de TEPT en la Escala Revisada de Impacto de Eventos (IES–R, en su sigla en inglés). Las covariables incluyeron la depresión, la ansiedad, la ira, el abuso de alcohol, la discapacidad funcional, y las características sociodemográficas. El seguimiento ocurrió de forma posterior al termino del tratamiento en periodos específicos por 12 meses. Presentamos predictores de la severidad del TEPT al término el tratamiento y al seguimiento obtenidos por medio de un análisis de crecimiento de clases latentes para identificar las diferentes trayectorias de tratamiento. Modelos de regresión logística multinominales fueron usados para identificar las covariables predictoras de pertenencia a una clase, y así cinco clases fueron identificadas; de los participantes, un 71.3% perteneció a tres clases mostrando respuestas positivas al tratamiento y un 1.2% mostro una mejoría inicial pero posterior recaída. Adicionalmente, el 27.5% de los participantes fueron identificados dentro de una clase resistente al tratamiento, ya que mostraron pocos cambios en la severidad de la presentación. La depresión, odds ratios (ORs, en su sigla en inglés) = 1.12 ‐ 1.53; la ansiedad, ORs = 1.16 ‐ 1.32; y tener un rol de combate durante el servicio militar, OR = 2.89, incrementaron la probabilidad de pertenecer a la clase resistente al tratamiento. Adicionalmente, los participantes en la clase resistente al tratamiento mostraron tener puntajes de más altos de TEPT antes del tratamiento, particularmente reexperimentación, OR = 5.24; evitación, OR = 2.62; y síntomas de hiperactivación, OR = 3.86. Los hallazgos pueden sugerir la importancia de clasificar a los individuos y ofrecer intervenciones a la medida de la severidad de la presentación.
抽象
Traditional and Simplified Chinese s by the Asian Society for Traumatic Stress Studies (AsianSTSS)
簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯
Treatment efficacy for UK veterans with post‐traumatic stress disorder: latent class trajectories of treatment response and their predictors.
Traditional Chinese
標題: 患創傷後壓力症的英國退役軍人的治療成效:治療反應的潛在類別軌跡及其預測變量
撮要: 過往數據證明, 患創傷後壓力症(PTSD)的退役軍人比非退役軍人的治療成效較差。本研究透過960名患PTSD的英國退役軍人, 探索治療成效的異質性。樣本接受住院干預治療, 當中包含組別治療節段和個人的創傷聚焦認知行為治療(TF–CBT)。我們檢視的主要治療成效為於事件影響測量表(修訂版)(IES–R)的PTSD分數。共變量包括抑鬱症、焦慮症、憤怒、濫用酒精、功能性損傷和社會人口特徵。我們在樣本完成治療12個月後作跟進。我們利用潛在類別成長分析, 找出不同的治療軌跡, 並找到於完成治療及跟進期的PTSD嚴重度預測變量。多項邏輯迴歸模型用以找出可預測類別的共變量, 並得出5個類別。71.3%的樣本屬於3個正向治療成效的類別, 1.2%起初展現改善但又回復故態。27.5%的樣本屬於抗拒治療類別, 症狀嚴重度只有少量改變。以下能提升樣本屬抗拒治療類別的可能性:抑鬱症(勝算比 (ORs) = 1.12–1.53)、焦慮症(ORs = 1.16–1.32)、服役時曾參與戰鬥(OR = 2.89)。屬抗拒治療類別的樣本,
治療前以下方面的PTSD分數都較高:再體驗(OR = 5.24)、迴避(OR = 2.62)、過激反應症狀(OR = 3.86)。結果反映把患者分類, 並因應患者的嚴重度調校干預治療的重要性。
Simplified Chinese
标题: 患创伤后压力症的英国退役军人的治疗成效:治疗反应的潜在类别轨迹及其预测变量
撮要: 过往数据证明, 患创伤后压力症(PTSD)的退役军人比非退役军人的治疗成效较差。本研究透过960名患PTSD的英国退役军人, 探索治疗成效的异质性。样本接受住院干预治疗, 当中包含组别治疗节段和个人的创伤聚焦认知行为治疗(TF–CBT)。我们检视的主要治疗成效为于事件影响测量表(修订版)(IES–R)的PTSD分数。共变量包括抑郁症、焦虑症、愤怒、滥用酒精、功能性损伤和社会人口特征。我们在样本完成治疗12个月后作跟进。我们利用潜在类别成长分析, 找出不同的治疗轨迹, 并找到于完成治疗及跟进期的PTSD严重度预测变量。多项逻辑回归模型用以找出可预测类别的共变量, 并得出5个类别。71.3%的样本属于3个正向治疗成效的类别, 1.2%起初展现改善但又回复故态。27.5%的样本属于抗拒治疗类别, 症状严重度只有少量改变。以下能提升样本属抗拒治疗类别的可能性:抑郁症(胜算比 (ORs) = 1.12–1.53)、焦虑症(ORs = 1.16–1.32)、服役时曾参与战斗(OR = 2.89)。属抗拒治疗类别的样本,
治疗前以下方面的PTSD分数都较高:再体验(OR = 5.24)、回避(OR = 2.62)、过激反应症状(OR = 3.86)。结果反映把患者分类, 并因应患者的严重度调校干预治疗的重要性。
•Kratom is a Southeast Asian plant with opioid-receptor mediated effects.•Kratom has recently emerged as a substance of abuse, with limited available data.•Kratom is being used by White, middle-aged ...Americans for pain, anxiety, depression.•Users also report using kratom to decrease opioid use, withdrawal, and craving.•Additional research on kratom epidemiology and pharmacology is necessary.
Kratom, a Southeast Asian plant with opioid-receptor mediated effects, has emerged as a potential substance of abuse, with limited data on its use and effects. This study characterized kratom user demographics, use patterns, and perceived drug effects.
A cross-sectional, anonymous online survey was conducted between January and December 2017.
2,798 kratom users – mean age 40 (SD = 12); predominantly White (90 %), female (61 %), and located in the US (97 %) – completed the survey. Kratom was primarily taken orally in doses of 1−3 g (49 %), with daily use (59 %) being most common. Kratom was used for pain (91 %), anxiety (67 %), and depression (65 %), with high ratings of effectiveness. 1,144 (41 %) used kratom to stop or reduce prescription or illicit opioid use, citing decreased opioid withdrawal and craving related to kratom use, with 411 reporting >1-year continuous abstinence from opioids attributed to kratom use. Roughly one-third of respondents reported adverse effects of kratom, largely rated as mild in severity and lasting ≤24 h. Seventeen participants (0.6 %) sought treatment for adverse effects. Fifty-six individuals (2 %) met DSM-5 criteria for a past-year moderate or severe kratom-related substance use disorder (SUD). When asked how troubled they felt regarding their kratom use, the mean (SD) rating was 3.2 (9.8) on a scale from 0 to 100.
Kratom is used among White, middle-aged Americans for symptoms of pain, anxiety, depression, and opioid withdrawal. Although regular use was typical, kratom-related SUD and serious adverse effects were uncommon. Additional research on kratom epidemiology and pharmacology is imperative in light of the present opioid epidemic.
Summary
Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have ...been proposed as an innovative solution.
Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways.
A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services.
The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery.
Where evaluated, young people report having benefited from and being highly satisfied with these services.
Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care.
Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.
Objective: The study aimed to explore the content and features of loss-related memories in a sample of individuals bereaved by cancer with and without a probable diagnosis of prolonged grief ...disorder/persistent complex bereavement disorder (PGD/PCBD).
Methods: Semi-structured interviews with 28 bereaved adults (PGD/PCBD = 12, NoPGD/PCBD = 16) were analysed using thematic analysis.
Results: Three superordinate themes were identified: (1) intrusive imagery, (2) qualities of memory, and (3) triggers. Results showed that individuals suffering from probable PGD/PCBD reported a predominance of negative and upsetting memories, happy memories triggering pain and more negative intrusive imagery than those without PGD/PCBD.
Conclusions: Bereavement by cancer can result in troubling intrusive memories that overshadow positive memories. Sufferers of PGD/PCBD are more likely to experience loss-related memories as negative and upsetting. Clinical approaches that utilise memory processing may be of particular relevance in this group.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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