Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Although the association between post-traumatic stress disorder (PTSD) and social support is well documented, few studies have tested the causal pathways explaining this association at several points in the acute post-trauma recovery period or examined whether the association varies for different sources of social support. To address these gaps, 151 community individuals (mean age = 37.20 years, 69.5% women) exposed to trauma within the previous 6 months were recruited to complete measures of PTSD and social support from intimate partners, friends, and relatives four times in 1 year. In line with recent recommendations for research on social support and PTSD symptoms, random intercept cross-lagged panel modeling (RI-CLPM) was used to examine dynamic changes between PTSD severity and social support over time. The pattern of RI-CLPM cross-lagged coefficients indicated that positive deviations from one’s expected stable level of total social support (across all sources) sped up the recovery of PTSD symptoms at the end of the post-trauma year, and more severe PTSD symptoms than expected based on one’s expected stable level of PTSD started eroding social support midway through the assessment year. When specific sources of social support were analyzed separately, the association between within-person increases in social support from friends at any given time point accelerated the recovery from PTSD across the entire year. Among participants with intimate partners (n = 53), intimate partner support did not predict PTSD symptoms, but more severe PTSD symptoms at any given time point predicted less support at the following time point. Results from this longitudinal study provide additional support for the bidirectional relationship between PTSD and social support over time and suggest that perceived social support from friends may be especially helpful during trauma recovery.

Background: On average older adults experiencing TBI are hospitalized four times as often, have longer hospital stays, and experience slower recovery trajectories and worse functional outcomes compared to younger populations with the same injury severity. A standard measure of Qol for older adults with TBI would facilitate accurate and reliable data across the individual patient care continuum and across clinical care settings, as well as support more rigorous research studies of metadata. Purpose: The aim of this systematic review was to investigate patient reported Qol measures in studies with older adults post TBI. Method: A systematic review was carried out focusing on the various tools to measure Qol in older adults, ≥ 65 years of age with a diagnosis of TBI. Data bases searched included Medline, Embase, PubMed, CINAHL, and PsychInfo from date of inception to September 25, 2017. Results: A total of 20 articles met the inclusion criteria. Nine different tools were identified. Conclusions: Findings based on the comparison of reliability and construct validity of the Qol measures reported in this review suggest that no single instrument is superior to all others for our study population. Future research in this field should include the enrollment of larger study samples of older adults. Without these future efforts, the ability to detect an optimal Qol measure will be hindered.

To examine the combined and individual utility of 2 screening tools in prediction of depression and PTSD one-month post traumatic injury. 484 Level I Trauma Center patients were administered the Peritraumatic Distress Inventory (PDI) and Injured Trauma Survivor Screen (ITSS). Approximately 30 days post-injury, patients completed the Posttraumatic Stress Disorder Checklist for DSM–5 (PCL-5) and Patient Health Questionnaire (PHQ-8). Receiver operating characteristic curve (ROC) curves for the PDI suggested a cutoff score of 17.5 predicting PTSD (Sensitivity = 70%; Specificity = 62%) and depression (Sensitivity = 74%; Specificity = 64%). For the ITSS, ROC curves suggested a cutoff score of 1.5 to predict PTSD (Sensitivity = 72%; Specificity = 60%) and depression (Sensitivity = 67%; Specificity = 62%). Inclusion of both instruments in regression analyses accounted for 2.4%-6.8% greater variance than 1 measure alone in predicting PCL-5 and PHQ-8 scores. The ITSS and PDI each demonstrated significant clinical utility in practice. Use of both measures, versus either alone, likely does not produce sufficient added clinical benefit. Follow-up screening and/or ongoing symptom monitoring is recommended as an adjunct to brief bedside screening.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Over 75% of individuals are exposed to a traumatic event, and a substantial minority will go on to experience mental health problems that can be chronic and pernicious in their lifetime. Early interventions show promise for preventing posttrauma psychopathology; yet, face-to-face intervention can be costly and there are many barriers to accessing this format of care. Objective: This paper systematically reviewed studies of Internet-delivered early interventions for trauma-exposed individuals. Methods: A literature search was conducted in PsycINFO and Pubmed/Medline for papers published between 1991 and 2017. Papers were included if the following criteria were met: 1) an Internet-based intervention was described and applied to individuals exposed to a traumatic event; 2) The authors stated that the intervention was intended to be applied early posttrauma exposure or as a preventive intervention; and 3) data on mental health symptoms at pre-and post- intervention were described (regardless of whether these were primary outcomes). Methodological quality of included studies was assessed using the Downs and Blacks Checklist. Results: The interventions in the seven studies identified were categorized as “selected” (i.e., delivered to an entire sample following trauma regardless of psychopathology symptoms), or “indicated” (i.e., delivered to those endorsing some level of posttraumatic distress). Selected interventions did not produce significant symptom improvement compared with treatment-as-usual or no intervention control groups. However, indicated interventions yielded significant improvements over other active control conditions on mental health outcomes. Conclusions: Consistent with the notion that many experience natural recovery posttrauma, results imply that indicated early Internet-delivered interventions hold the most promise in future prevention efforts. More studies that use rigorous methods and clearly defined outcomes are needed to evaluate the efficacy of early Internet-delivered interventions. Moreover, basic research on risk and resilience factors following trauma exposure is necessary to inform indicated Internet-delivered interventions.