Browsing by Subject "PTSD"

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  • Suomalainen, L.; Haravuori, H.; Berg, N.; Kiviruusu, O.; Marttunen, M. (2011)
    Background: In November 2007, a student shot eight people and himself at Jokela High School, Finland. This study aims to evaluate the long-term effects of exposure to a school shooting among adolescents. Method: Associations between psychological outcomes and background factors were analysed and compared with "comparison students" four months after the incident. A questionnaire including Impact of Event Scale (IES) and General Health Questionnaire (GHQ-36) was used. Results: Half of the females and a third of the males suffered from posttraumatic distress. High level of posttraumatic distress (IES >= 35), predicting PTSD, was observed in 27% of the females and 7% of the males. The odds ratio was 6.4 (95% confidence interval 3.5-10.5) for having high levels of posttraumatic distress. Severe or extreme exposure and female gender were found to increase the risk. Forty-two percent of the females and 16% of the males had psychiatric disturbance (GHQ >= 9). Severe or extreme exposure, older age and female gender increased the risk. Perceived support from family and friends was found to be protective. Conclusions: The observed risk and protective factors were similar to earlier studies. Follow-up will be essential in identifying factors predicting persisting trauma-related symptoms in adolescence. (C) 2010 Elsevier Masson SAS. All rights reserved.
  • Kangaslampi, Samuli; Garoff, Ferdinand; Golden, Shannon; Peltonen, Kirsi (2021)
    We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.
  • Haravuori, Henna; Kiviruusu, Olli; Suomalainen, Laura; Marttunen, Mauri (2016)
    Background: The proposed posttraumatic stress disorder (PTSD) criteria for the International Classification of Diseases (ICD) 11th revision are simpler than the criteria in ICD-10, DSM-IV or DSM-5. The aim of this study was to evaluate the ICD-11 PTSD factor structure in samples of young people, and to compare PTSD prevalence rates and diagnostic agreement between the different diagnostic systems. Possible differences in clinical characteristics of the PTSD cases identified by ICD-11, ICD-10 and DSM-IV are explored. Methods: Two samples of adolescents and young adults were followed after exposure to similar mass shooting incidents in their schools. Semi-structured diagnostic interviews were performed to assess psychiatric diagnoses and PTSD symptom scores (N = 228, mean age 17.6 years). PTSD symptom item scores were used to compose diagnoses according to the different classification systems. Results: Confirmatory factor analyses indicated that the proposed ICD-11 PTSD symptoms represented two rather than three factors; re-experiencing and avoidance symptoms comprised one factor and hyperarousal symptoms the other factor. In the studied samples, the three-factor ICD-11 criteria identified 51 (22.4 %) PTSD cases, the two-factor ICD-11 identified 56 (24.6 %) cases and the DSM-IV identified 43 (18.9 %) cases, while the number of cases identified by ICD-10 was larger, being 85 (37.3 %) cases. Diagnostic agreement of the ICD-11 PTSD criteria with ICD-10 and DSM-IV was moderate, yet the diagnostic agreement turned to be good when an impairment criterion was imposed on ICD-10. Compared to ICD-11, ICD-10 identified cases with less severe trauma exposure and posttraumatic symptoms and DSM-IV identified cases with less severe trauma exposure. Conclusions: The findings suggest that the two-factor model of ICD-11 PTSD is preferable to the three-factor model. The proposed ICD-11 criteria are more restrictive compared to the ICD-10 criteria. There were some differences in the clinical characteristics of the PTSD cases identified by ICD-11, when compared to ICD-10 and DSM-IV.
  • Diniz, Cassiano R.A.F.; Casarotto, Plinio C.; Resstel, Leonardo; Samia, R.L. Joca (2018)
    Depression and posttraumatic stress disorder are assumed to be maladaptive responses to stress and antidepressants are thought to counteract such responses by increasing BDNF (brain-derived neurotrophic factor) levels. BDNF acts through TrkB (tropomyosin-related receptor kinase B) and plays a central role in neuroplasticity. In contrast, both precursor proBDNF and BDNF propeptide (another metabolic product from proBDNF cleavage) have a high affinity to p75 receptor (p75R) and usually convey apoptosis and neuronal shrinkage. Although BDNF and proBDNF/propeptide apparently act in opposite ways, neuronal turnover and remodeling might be a final common way that both act to promote more effective neuronal networking, avoiding neuronal redundancy and the misleading effects of environmental contingencies. This review aims to provide a brief overview about the BDNF functional role in antidepressant action and about p75R and TrkB signaling to introduce the "continuum-sorting hypothesis." The resulting hypothesis suggests that both BDNF/proBDNF and BDNF/propeptide act as protagonists to fine-tune antidepressant-dependent neuroplasticity in crucial brain structures to modulate behavioral responses to stress.
  • Tuisku, Katinka; Sandman, Nils; Partinen, Markku; Paunio, Tiina (2020)
  • Sarasjärvi, Kiira (Helsingin yliopisto, 2018)
    Objective: In the present study we investigated neuronal synchronization in post-traumatic stress disorder (PTSD) during real-time fMRI neurofeedback (rt-fMRI NF). We a used inter-subject covariance (ISC) -based method to discover model-free stimulus-response patterns that conventional GLM-analysis is not able to detect. So far, ISC has never been implemented in block-design nor rt-fMRI NF experiments, and only two studies have applied the method in a clinical sample. However, we hoped to find some distinct patterns that could disclose some new information regarding the psychopathology of PTSD and effects of neurofeedback. Methods: The study combined three previously conducted studies that focus on teaching participants to self-regulate anterior cingulate cortex (ACC) activity (HC=24, PTSD=9). The participants lay in the fMRI scanner whilst ACC activity was controlled with the help of a social avatar. The participants were measured three times within one week to examine the effect of neurofeedback. The analyses were completed by using ISC to detect the model-free brain activity. A 2x4 repeated ANOVA was used to investigate the group and neurofeedback effects. The ACC was chosen as a region of interest to investigate synchrony in the target region. An additional 3x4 repeated ANOVA was completed to examine the within and between-group ISC differences during the task. Results: We discovered a higher ISC in the PTSD group in respect to healthy controls, along with a linear decrease of ISC in both groups throughout the experiment. The same pattern was also detected in the ROI-analysis. The additional 3x4 ANOVA revealed a cluster in the orbitofrontal cortex showing a higher ISC within the groups, in respect to between the group ISC. Conclusions: ISC-analyses demonstrate a new type of information regarding the brain mechanisms and connections in respect to the conventional brain analyses. Our results indicate a stronger ISC in PTSD-groups and during the start of the experiment. Moreover, the results are reversed with comparison to the conventional GLM-method – demonstrating a new type of information regarding the brain synchrony. These results could further solidify the importance of the individual strategy used during the experiment. Furthermore, the additional analysis argues for disorder-specific synchrony in PTSD patients that could be meaningful in the psychopathology of PTSD. The thesis proves the feasibility of the ISC-method to discover direct stimulus-response relationship patterns that conventional GLM-analysis are not capable of revealing. Furthermore, it creates new research questions that have not previously existed and therefore it can be applied to neuroimaging.
  • Parviainen, Anni (Helsingin yliopisto, 2020)
    Tausta: Suuri osa ihmisistä kokee psyykkisesti traumaattisen tapahtuman jo ennen aikuisikää. Nuorena koettu trauma ja nuoruusiän psyykkinen kehitys vaikuttavat toisiinsa, minkä vuoksi traumaattisten tapahtumien seurauksia on tärkeää tutkia erikseen tässä ikäryhmässä. Traumatapahtumalle annetun merkityksen on todettu vaikuttavan traumasta toipumiseen ja toisaalta traumaperäiseen kasvuun. Tässä tutkimuksessa selvitettiin merkityksen anto -prosessin vaikutusta psyykkisestä traumasta toipumiseen. Menetelmä: Tutkittavat olivat kahden vuoden seurantatutkimukseen osallistuneita kouluampumistapahtumille 2007 tai 2008 altistuneita alle 30-vuotiaita oppilaita ja opiskelijoita sekä verrokkeja (N=865). Ensimmäisessä kyselyssä tutkittavat vastasivat avoimeen kysymykseen tapahtumalle antamastaan selityksestä. Selitykset luokiteltiin aineistolähtöisesti. Traumaperäisiä stressioireita mitattiin Impact of Event Scale (IES) ja traumaperäistä kasvua Post Traumatic Growth Inventory (PTGI) -kyselyillä. Tulokset: Tutkimushenkilöiden traumatapahtumalle antamat selitykset jakautuivat seitsemään ryhmään, joista suurin muodostui tekijään liittyvistä selityksistä. Kymmenesosa vastaajista ei pystynyt selittämään tapahtumaa itselleen lainkaan. Heillä oli kaikkina seuranta-ajankohtina merkittävästi enemmän traumaperäisiä stressioireita tapahtuman itselleen selittämään pystyneisiin verrattuna. Kykenemättömyys selittää tapahtumaa lainkaan oli traumaperäisen oireilun merkittävä riskitekijä myös useita muita traumasta toipumiseen vaikuttavia tekijöitä huomioivassa monimuuttujamallissa. Muuten erilaisten selitysryhmien välillä ei ollut eroja psyykkisestä traumasta toipumisessa. Traumatapahtumalle annettu selitys ei juuri vaikuttanut kokemuksiin traumaperäisestä kasvusta. Pohdinta: Jonkin selityksen antaminen psyykkisesti traumaattiselle tapahtumalle on yhteydessä parempaan traumasta toipumiseen verrattuna niihin, jotka eivät pysty lainkaan selittämään tapahtumaa itselleen. Kykenemättömyys selittää tapahtumaa voi kertoa vaikeuksista trauman psyykkisessä käsittelyssä. Merkityksen anto -prosessin käynnistymisen epäonnistuminen altistaa pitkittyneelle traumaperäiselle oireilulle.
  • Kangaslampi, Samuli; Garoff, Ferdinand; Peltonen, Kirsi (2015)
    Background: Millions of children worldwide suffer from posttraumatic stress disorder (PTSD) symptoms and other mental health problems due to repeated exposure to war or organized violence. Forms of cognitive-behavioral therapy (CBT) are the most commonly used treatment for PTSD and appear to be effective for children as well, but little is known about the mechanisms of change through which they achieve their effectiveness. Here we present the study protocol of a randomized controlled trial (RCT) studying the effectiveness and mechanisms of change of Narrative Exposure Therapy (NET), a CBT-based, manualized, short-term intervention for PTSD symptoms resulting from repeated traumatization, in immigrant children traumatized by war. Methods/Design: We are conducting a multicentre, pragmatic RCT in a usual care setting. Up to 80 9-17-year-old immigrant children who have experienced war and suffer from PTSD symptoms will be randomized into intervention (NET) and control (treatment as usual, TAU) groups of equal sizes. The effectiveness of NET treatment will be compared to both a waiting list and the parallel TAU positive control group, on the primary outcomes of PTSD and depressive symptoms, psychological distress, resilience, and level of cognitive performance. The effects of the intervention on traumatic memories and posttraumatic cognitions will be studied as potential mechanisms of change mediating overall treatment effectiveness. The possible moderating effects of peritraumatic dissociation, level of cognitive performance, and gender on treatment effectiveness will also be considered. We hypothesize that NET will be more effective than a waitlist condition or TAU in reducing PTSD and other symptoms and improving resilience, and that these effects will be mediated by changes in traumatic memories and posttraumatic cognitions. Discussion: The results of this trial will provide evidence for the effectiveness of NET in treating trauma-related symptoms in immigrant children affected by war. The trial will also generate insights into the complex relationships between PTSD, memory functions, posttraumatic cognitions and cognitive performance in children, and help guide the future development and implementation of therapeutic interventions for PTSD in children.
  • Kieseppä, Valentina J; Jokela, Markus; Holm, Minna; Suvisaari, Jaana; Gissler, Mika; Lehti, Venla (2021)
    The aim of this study was to compare differences in comorbidity between immigrants and Finnish-born controls, and to examine the treatment received by immigrants with PTSD. Our original data included all the immigrants living in Finland by the end of 2010 and matched controls. For this study, we selected individuals who had received a diagnosis of PTSD during 2010-2015 (immigrants: n = 754, Finnish-born controls: n = 311). We compared the frequency of different comorbid conditions between immigrants and natives. Multinomial logistic regression was used to predict categorized treatment intensity with the region of origin and length of residence among the immigrants. Psychiatric comorbidity was much more extensive among the Finnish-born controls than among immigrants. Immigrants from Africa and the Middle East more often received treatment of low intensity compared with immigrants from Western countries. The length of residence was associated with more frequent treatment. The important differences in comorbidity and background characteristics between immigrants and natives should be taken into account in planning treatment guidelines for PTSD. The disparities in treatment intensity across different immigrant groups indicate a need to improve the services for immigrants with PTSD.
  • Chung, Man Cheung; AlQarni, Nowf; AlMazrouei, Mariam; Al Muhairi, Shamsa; Shakra, Mudar; Mitchell, Britt; Al Mazrouei, Sara; Al Hashimi, Shurooq (2018)
    It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults' sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.
  • Lyytinen, Nina (Helsingfors universitet, 2010)
    Objectives. School personnel who are exposed to school violence are at risk in developing post traumatic stress disorder (PTSD). In Finland there have been two such events in recent years, Jokela school shooting on 7.11.2007 and Kauhajoki school shooting about a year later. The aim of the present study was to examine the presence and change in PTSD symptoms during the first year after the Jokela school shooting. A second aim was to study how the initial exposure and treatment affects the symptom levels of PTSD. There were four hypotheses: 1) The PTSD symptoms are higher for the people who were exposed to the school shooting than for the people who did not face the stressor. 2) The PTSD symptoms increase in the follow up for the people at the school which was not attacked because of the second incident brought up the memories from the Jokela school shooting. 3) Those who have greater exposure to the shooting will have higher level of PTSD symptoms at both 4 and 11 months after the shooting than those who were not directly exposed to the shooting. 4) The PTSD symptoms are reduced more in the group that starts treatment right after the traumatic event than in other groups. Methods. A sample of 24 members of Jokela school personnel were examined four months after the incident and 16 were reassessed 11 month after the incident. To study the change and level of symptoms in other schools during the same period, a group with no exposure to the shooting was used as a control group (n=22). The assessment included Post Traumatic Stress Disorder Checklist Specific (PCL-S) and a social and professional support questionnaire. In addition questions about timing of support and experiences of psychological debriefing were asked. Results and conclusions. Most participants in the study group experienced some symptoms of PTSD at both 4 and 11 months. In both measures three participants from the study group fulfilled the diagnostic criteria for PTSD. The study group and control group differed significantly in overall symptom levels. The study group had more PTSD symptoms in the first measure but in the follow-up the study group's PTSD symptoms decreased and the control group's increased. There was a significant change in the study groups PTSD symptom level for those who started treatment right after the traumatic event. The results from this study showed that an exposure to school shooting has long-term effects on school personnel. The findings suggest that it is crucial to plan a comprehensive and long-term treatment for school personnel in the aftermath of school shooting.
  • Radun, Igor; Radun, Jenni; Kaistinen, Jyrki; Parkkari, Inkeri; Kecklund, Göran; Olivier, Jake; Theorell, Töres (2020)
    Train and heavy vehicle drivers can experience a traumatic event caused by people attempting suicide by crashing into their vehicles or jumping in front of them. While there are a number of studies on train drivers showing the negative consequences these events can have on their well-being, there are no studies on heavy vehicle drivers involved in these types of crashes. In the current study, we surveyed Finnish heavy vehicle drivers(N = 15) involved in a suicide crash in the year 2017 regarding their experiences and coping approximately one month (T1) and one year (T2) after the crash. Ten of these drivers reported one or various combinations of measurable consequences such as minor physical injuries, shorter or longer sickness absences, significant posttraumatic stress symptoms(measured using the Impact of Events Scale-Revised) and requiring psychological help. Posttraumatic stress symptoms decreased over time; however, three out of the four drivers who had a high IES-R score at T1 were still around the IES-R cut-off score at T2. This research raises questions whether and what kind of support heavy vehicle drivers who have been involved in a suicide crash should be given
  • Häkli, Eveliina (Helsingin yliopisto, 2019)
    Tavoitteet. Vaikka oikeusviranomaiset kohtaavat työssään monia mahdollisesti traumatisoituneita henkilöitä, tällä hetkellä ei tiettävästi ole tutkimustietoa siitä, millaisia näkemyksiä oikeusviranomaisilla on traumatisoitumisen vaikutuksista oikeuden kuulemistilanteessa käyttäytymiseen ja siellä annetun kertomuksen sisältöön traumaattisista tapahtumista kerrottaessa. Traumapsykologista tutkimustietoa koskevan tietoisuuden ja ymmärryksen lisääminen uhrien kanssa toimivien oikeusviranomaisten keskuudessa voi edistää rikosprosessien sujumista ja asianosaisten oikeusturvaa. Tässä tutkimuksessa tarkasteltiin oikeusviranomaisten näkemyksiä siitä, millä tavalla traumatisoituminen ilmenee oikeudessa kuultavan käyttäytymisessä ja kertomuksen sisällössä kerrottaessa traumaattisista kokemuksista. Näkemyksiä tarkasteltiin suhteessa traumapsykoterapeuttien näkemyksiin, traumapsykologiseen tutkimustietoon sekä korkeimman oikeuden asettamiin kertomuksen arvioinnin luotettavuuskriteereihin. Menetelmät. Oikeusviranomaiset (n=83) ja traumapsykoterapeutit (n=34) vastasivat verkossa jaettuun E-lomake –kyselyyn. Kyselylomakkeessa oli mukana 72 käyttäytymisen ja kerronnan piirrettä. Kunkin piirteen kohdalla vastaajan tehtävänä oli arvioida, miten traumatisoituminen on siihen yhteydessä tuomioistuimen kuulemistilanteessa, jossa henkilöä kuullaan siitä kokemuksesta, jonka vaikutuksesta hän mahdollisesti on traumatisoitunut. Aineistolle tehtiin klusterianalyysi sen selvittämiseksi, millaisia näkemyksiä traumatisoituneita kohtaavilla henkilöillä on traumatisoitumisen ilmenemisestä käyttäytymisessä ja kerronnassa. Tulokset ja johtopäätökset. Oikeusviranomaisten ja traumapsykoterapeuttien keskuudesta nousi esiin neljä traumanäkemystä: varovaisesti kantaaottava (36.1 % oikeusviranomaisista ja 17.6 % terapeuteista), konservatiivinen (28.9 % oikeusviranomaisista ja 2.9 % terapeuteista), ei-kantaaottava (19.3 % oikeusviranomaisista ja 8.8 % terapeuteista), ja kantaaottava (15.7 % oikeusviranomaisista ja 70.6 % terapeuteista) näkemys. Vaikka osa tutkimukseen osallistuneista oikeusviranomaisista oli varsin yhdenmukaisia traumatutkimuskirjallisuuden ja traumapsykoterapeuttien kanssa, kokonaisuudessaan vaikuttaa kuitenkin siltä, että vielä suurempi osa oikeusviranomaisista joko yhdistää traumatisoitumisen vain ulkoisesti havaittaviin, psyykkiseen kuormittumiseen viittaaviin käyttäytymispiirteisiin, tai on hyvin epävarmoja traumatisoitumisen vaikutusten arvioinnin suhteen.