Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-27T19:26:23.244Z Has data issue: false hasContentIssue false
  • English
  • Français

Post-traumatic stress disorder in train crash survivors in Italy: the role of mood spectrum dysregulations and intrusiveness

Published online by Cambridge University Press:  27 April 2020

Mario Miniati Open the ORCID record for Mario Miniati [Opens in a new window] ,
Laura Palagini ,
Danila Caruso ,
Mauro Mauri ,
Donatella Marazziti Open the ORCID record for Donatella Marazziti [Opens in a new window]  and
Liliana Dell’Osso
Mario Miniati*
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
Laura Palagini
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
Danila Caruso
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
Mauro Mauri
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
Donatella Marazziti
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
Liliana Dell’Osso
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
*
Mario Miniati, MD, PhD Email: mario.miniati@med.unipi.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

To explore relationships among post-traumatic stress disorder (PTSD), depressive spectrum symptoms, and intrusiveness in subjects who survived the crash of a train derailed carrying liquefied petroleum gas and exploded causing a fire.

Methods

A sample of 111 subjects was enrolled in Viareggio, Italy. AMOS version 21 (IBM Corp, 2012) was utilized for a structural equation model-path analysis to model the direct and indirect links between the exposure to the traumatic event, the occurrence of depressive symptoms, and intrusiveness. Subjects were administered with the SCID-IV (Structured Clinical Interview for DSM-IV), the Questionnaire for Mood Spectrum (MOODS-SR)-Last Month version, the Trauma and Loss Spectrum Questionnaire (TALS-SR), and the Impact of Event Scale-Revised version (IES-R).

Results

Sixty-six (66/111; 59.4%) subjects met SCID-IV criteria for PTSD. Indices of goodness of fit were as followed: χ2/df = 0.2 P = .6; comparative fit index = 1 and root mean square error of approximation = 0.0001. A significant path coefficient for direct effect of potential traumatic events on depressive symptoms (β = 0.25; P < .04) and from depressive symptoms to intrusiveness (β = 0.34; P < .003) was found. An indirect effect was also observed: standardized value of potential traumatic events on intrusiveness was 0.86. The mediating factor of this indirect effect path was represented by depressive symptoms. Potential traumatic events explained 6.2% of the variance of depressive symptoms; 11.8% of the variance of intrusiveness was accounted for traumatic event and depressive symptoms.

Conclusions

Path analysis led us to speculate that depression symptoms might have mediated the relationship between the exposure to potential traumatic events and intrusiveness for the onset of PTSD.

Keywords

PTSDmood spectrumpath analysisintrusivenessrail crash
Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 1 , February 2021 , pp. 71 - 76
Copyright
© The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atwoli, L, Stein, DJ, Koenen, KC, et al. Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Curr Opin Psychiatry. 2015;28(4):307–311.CrossRefGoogle ScholarPubMed
Kessler, RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61(5):4–12.Google Scholar
Faravelli, C, Abrardi, L, Bartolozzi, D, et al. The Sesto Fiorentino study: background, methods and preliminary results. Lifetime prevalence of psychiatric disorders in an Italian community sample using clinical interviewers. Psychother Psychosom. 2004;73(4):216–225.CrossRefGoogle Scholar
Bobo, WV, Warner, CH, Warner, CM. The management of post-traumatic stress disorder (PTSD) in the primary care setting. South Med J. 2007;100(8):797–802.CrossRefGoogle ScholarPubMed
Wafa, MH, Viprey, M, Magaud, L, et al. Identification of biopsychosocial factors predictive of post-traumatic stress disorder in patients admitted to the Emergency department after a trauma (ISSUE): protocol for a multicenter prospective study. BMC Psychiatry. 2019;19(1):163.CrossRefGoogle ScholarPubMed
Galea, S, Ahern, J, Resnick, H, et al. Psychological sequelae of the September 11 terrorist attacks in New York city. N Eng J Med. 2002;346(13):982–987.CrossRefGoogle ScholarPubMed
Thavichachart, N, Tangwongchai, S, Worakul, S, et al. Post-traumatic stress disorder of the Tsunami survivors in Thailand. J Med Assoc Thai. 2009;92(3):420–429.Google ScholarPubMed
Dell’Osso, L, Carmassi, C, Massimetti, G, et al. Impact of traumatic loss on post-traumatic spectrum symptoms in high school students after the L’Aquila 2009 earthquake in Italy. J Affect Disord. 2011;134(1–3):59–64.CrossRefGoogle ScholarPubMed
Mauri, M, Petracca, A, Miniati, M, et al. Estimates of prevalence and criteria comparison in DSM-5 versus DSM-IV-TR post-traumatic stress disorder in 111 survivors to the 2009 railway accident in Viareggio-Italy. Int J Emerg Ment Health. 2015;17(3):609–615.CrossRefGoogle Scholar
Reich, J, Lyons, M, Cai, B. Familial vulnerability factors to post-traumatic stress disorder in male military veterans. Acta Psychiatr Scand. 1996;93(2):105–112.CrossRefGoogle ScholarPubMed
Blanchard, EB, Hickling, EJ, Taylor, AE, et al. Who develops PTSD from motor vehicle accidents? Behav Res Ther. 1996;34(1):1–10.CrossRefGoogle ScholarPubMed
Vranceanu, A-M, Hobfoll, SE, Johnson, RJ. Child multi-type maltreatment and associated depression and PTSD symptoms: the role of social support and stress. Child Abuse Negl. 2007;31(1):71–84.CrossRefGoogle ScholarPubMed
Haagsma, JA, Ringburg, AN, van Lieshout, EM, et al. Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: a prospective cohort study. BMC Psychiatry. 2012;12:236.CrossRefGoogle ScholarPubMed
Landolt, MA, Vollrath, M, Timm, K, et al. Predicting posttraumatic stress symptoms in children after road traffic accidents. J Am Acad Child Adolesc Psychiatry. 2005;44(12):1276–1283.CrossRefGoogle ScholarPubMed
Bui, E, Brunet, A, Allenou, C, et al. Peritraumatic reactions and posttraumatic stress symptoms in school-aged children victims of road traffic accident. Gen Hosp Psychiatry. 2010;32(3):330–333.CrossRefGoogle ScholarPubMed
Ehring, T, Ehlers, A, Cleare, AJ, et al. Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression? Psychiatry Res. 2008;161(1):67–75.CrossRefGoogle ScholarPubMed
Creamer, M, O’Donnell, ML, Pattison, P. The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors. Behav Res Ther. 2004;42(3):315–328.CrossRefGoogle ScholarPubMed
McFarlane, AC, Barton, CA, Yehuda, R, et al. Cortisol response to acute trauma and risk of posttraumatic stress disorder. Psychoneuroendocrinology. 2011;36(5):720–727.CrossRefGoogle ScholarPubMed
El-Jawahri, AR, Vandusen, HB, Traeger, LN, et al. Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer. 2016;122(5):806–812.CrossRefGoogle ScholarPubMed
Forbes, D, Creamer, M, Phelps, A, et al. Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder. Aust N Z J Psychiatry. 2007;41(8):637–648.CrossRefGoogle ScholarPubMed
Bomyea, J, Risbrough, V, Lang, AJ. A consideration of select pre-trauma factors as key vulnerabilities in PTSD. Clin Psychol Rev. 2012;32(7):630–641.CrossRefGoogle ScholarPubMed
Di Gangi, JA, Gomez, D, Mendoza, L, et al. Pretrauma risk factors for posttraumatic stress disorder: a systematic review of the literature. Clin Psychol Rev. 2013;33(6):728–744.CrossRefGoogle Scholar
Reynolds, M, Brewin, CR. Intrusive memories in depression and posttraumatic stress disorder. Behav Res Ther. 1999;37(3):201–215.CrossRefGoogle ScholarPubMed
Williams, JMG, Watts, FN, MacLeod, C, et al. Cogntive Psychology and Emotional Disorders. 2nd ed. Chichester, UK: Wiley; 1997.Google Scholar
Kim, JI, Park, H, Kim, JH. The mediation effect of PTSD, perceived job stress and resilience on the relationship between trauma exposure and the development of depression and alcohol use problems in Korean firefighters: a cross-sectional study. J Affect Disord. 2018;15:450–455.CrossRefGoogle Scholar
Brewin, CR, Hunter, E, Carroll, F, Tata, P. Intrusive memories in depression: an index of schema activation? Psychol Med. 1996;26(6):1271–1276.CrossRefGoogle ScholarPubMed
Miniati, M, Petracca, A, Carmassi, C, et al. Risk of post-traumatic stress disorder in 111 survivors the 2009 Viareggio (Italy) Rail Crash: the role of mood spectrum comorbidity. J Psychopathol. 2017;23(1):12–18.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, et al. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York, NY: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
Weiss, DS, Marmar, CR. The impact of event scale-revised. In: Wilson, JP, Keane, TM, eds. Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook. New York, NY: Guilford Press; 1997:399–411.Google Scholar
Dell’Osso, L, Armani, A, Rucci, P, et al. Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002;43(1):69–73.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Carmassi, C, Rucci, P, et al. A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR). Compr Psychiatry. 2009;50(5):485–490.CrossRefGoogle Scholar
Horowitz, M, Wilner, M, Alvarez, W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979;41(3):209–218.CrossRefGoogle ScholarPubMed
Sundin, EC, Horowitz, MJ. Impact of Event Scale: psychometric properties. Br J Psychiatry. 2002;180(3):205–209.CrossRefGoogle ScholarPubMed
Cassano, GB, Benvenuti, A, Miniati, M, et al. The factor structure of lifetime depressive spectrum in patients with unipolar depression. J Affect Disord. 2009;115(1–2):87–99.10.1016/j.jad.2008.09.006CrossRefGoogle ScholarPubMed
Cassano, GB, Mula, M, Rucci, P, et al. The structure of lifetime manic-hypomanic spectrum. J Affect Disord. 2009;112(1–3):59–70.CrossRefGoogle ScholarPubMed
Tate, CU. On the overuse and misuse of mediation analysis: it may be a matter of timing. Basic Appl Soc Psych. 2015;37(4):235–246.CrossRefGoogle Scholar
Cassano, GB, Dell’Osso, L, Frank, E, et al. The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord. 1999;54(3):319–328.CrossRefGoogle Scholar
Cassano, GB, Frank, E, Miniati, M, et al. Conceptual underpinnings and empirical support for the mood spectrum. Psychiatr Clin North Am. 2002;25(4):699–712.CrossRefGoogle ScholarPubMed
Miniati, M, Palagini, L, Maglio, A, et al. Can sleep disturbance be a cue of mood spectrum comorbidity? A preliminary study in panic disorder. CNS Spectr. 2019;11:1–6.Google Scholar
Benvenuti, A, Miniati, M, Callari, A, et al. Mood spectrum model: evidence reconsidered in the light of DSM-5. World J Psychiatry. 2015;5(1):126–137.CrossRefGoogle ScholarPubMed
Miniati, M, Benvenuti, A, Bologna, E, et al. Mood spectrum comorbidity in patients with anorexia and bulimia nervosa. Eat Weight Disord. 2018;23(3):305–311.CrossRefGoogle ScholarPubMed
Pollack, MH, Simon, NM, Fagiolini, A, et al. Persistent post-traumatic stress disorder following September 11 in patients with bipolar disorder. J Clin Psychiatry. 2006;67(3):394–349.CrossRefGoogle ScholarPubMed
Shackelford, JL, Smith, LS, Farrell, CT, et al. Interrelationships among resilience, posttraumatic stress disorder, traumatic brain injury, depression, and academic outcomes in student military veterans. J Psychosoc Nurs Ment Health Serv. 2019;57(2):35–43.CrossRefGoogle ScholarPubMed
Tinland, A, Boyer, L, Loubiere, S, et al. Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life. Neuropsychiatr Dis Treat. 2018;14:2269–2279.CrossRefGoogle ScholarPubMed
Thompson, CT, Vidgen, A, Roberts, NP. Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: a systematic review and meta-analysis. Clin Psychol Rev. 2018;63(7):66–79.CrossRefGoogle ScholarPubMed
Kim, JE, Dager, SR, Jeong, HS, et al. Firefighters, posttraumatic stress disorder, and barriers to treatment: results from a nationwide total population survey. PLoS ONE. 2018;13(1):e0190630.CrossRefGoogle ScholarPubMed
Green, BL, Lindy, D, Grace, MC. Posttraumatic stress disorder: towards DSM-IV. J. Nerv Mental Dis. 1985;173(7):406–411.CrossRefGoogle Scholar
Davidson, JRT, Hughes, D, Blazer, DG, et al. Posttraumatic stress disorder in the community: an epidemiological study. Psychol Med. 1991;21(3):713–721.CrossRefGoogle Scholar
Davidson, RT, Foa, EB. Diagnostic issues in posttraumatic stress disorder: consideration for the DSM-IV. J Abnorm Psychol. 1991;100(3):346–355.CrossRefGoogle Scholar
Too, LS, Milner, A, Bugeja, L, McClure, R. The socio-environmental determinants of railway suicide: a systematic review. BMC Public Health. 2014;10(1):14–20.Google Scholar
Boyd, JE, Protopopescu, A, O’Connor, C, et al. Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD. Eur J Psychotraumatol. 2018;9(1):1463794.CrossRefGoogle Scholar
Hashemian, F, Khoshnood, K, Desai, MM, et al. Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare. JAMA. 2006;296(5):560–566.CrossRefGoogle ScholarPubMed
Moring, JC, Nason, E, Hale, WJ, et al. Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members. J Affect Disord. 2019;256(1):541–549.CrossRefGoogle ScholarPubMed
Wortmann, JH, Jordan, AH, Weathers, FW, et al. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess. 2016;28(11):1392–1403.CrossRefGoogle Scholar
Birrer, E, Michael, T, Munsch, S. Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: a cross-sectional clinical study. Behav Res Ther. 2007;45(9):2053–2065.CrossRefGoogle ScholarPubMed
Starr, S, Moulds, ML. The role of negative interpretations of intrusive memories in depression. J Affect Disord. 2006;93(1–3):125–132.CrossRefGoogle ScholarPubMed