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The replicability of ICD-11 complex post-traumatic stress disorder symptom networks in adults
- Matthias Knefel, Thanos Karatzias, Menachem Ben-Ezra, Marylene Cloitre, Brigitte Lueger-Schuster, Andreas Maercker
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 6 / June 2019
- Published online by Cambridge University Press:
- 09 January 2019, pp. 361-368
- Print publication:
- June 2019
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Background
The ICD-11 includes a new disorder, complex post-traumatic stress disorder (CPTSD). A network approach to CPTSD will enable investigation of the structure of the disorder at the symptom level, which may inform the development of treatments that target specific symptoms to accelerate clinical outcomes.
AimsWe aimed to test whether similar networks of ICD-11 CPTSD replicate across culturally different samples and to investigate possible differences, using a network analysis.
MethodWe investigated the network models of four nationally representative, community-based cross-sectional samples drawn from Germany, Israel, the UK, and the USA (total N = 6417). CPTSD symptoms were assessed with the International Trauma Questionnaire in all samples. Only those participants who reported significant functional impairment by CPTSD symptoms were included (N = 1591 included in analysis; mean age 43.55 years, s.d. 15.10, range 14–99, 67.7% women). Regularised partial correlation networks were estimated for each sample and the resulting networks were compared.
ResultsDespite differences in traumatic experiences, symptom severity and symptom profiles, the networks were very similar across the four countries. The symptoms within dimensions were strongly associated with each other in all networks, except for the two symptom indicators assessing aspects of affective dysregulation. The most central symptoms were ‘feelings of worthlessness’ and ‘exaggerated startle response’.
ConclusionsThe structure of CPTSD symptoms appears very similar across countries. Addressing symptoms with the strongest associations in the network, such as negative self-worth and startle reactivity, will likely result in rapid treatment response.
Declaration of interestA.M. and M.C. were members of the World Health Organization (WHO) ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The views expressed in this article are those of the authors and do not represent the official policies or positions of the International Advisory Group or the WHO.
International Standards and Guidelines on Education and Training for the Multi-disciplinary Health Response to Major Events that Threaten the Health Status of a Community*
- Education Committee Working Group World Association for Disaster and Emergency Medicine, Geert Seynaeve, Frank Archer, Judith Fisher, Brigitte Lueger-Schuster, Alison Rowlands, Phillip Sellwood, Karel Vandevelde, Anastasia Zigoura
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- Journal:
- Prehospital and Disaster Medicine / Volume 19 / Issue S2 / 04-06 2004
- Published online by Cambridge University Press:
- 17 February 2017, pp. s17-s24
- Print publication:
- 04-06 2004
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The 13th World Congress on Disaster and Emergency Medicine, convened in Melbourne, Australia in May 2003, requested the World Association for Disaster and Emergency Medicine (WADEM) to lead the development of “International Standards and Guidelines on Education and Training for “Disaster Medicine”. This Paper has been developed by a Working Group of the WADEM Education Committee (“the Working Group”) in response to that request from the international “Disaster Medicine” and emergency health community. The main focus of the Working Group is to develop standards and guidelines for education and training in the multi-disciplinary health response to major events that threaten the health status of a community. The contemporary view is that of a multi-disciplinary health response to major events which threaten the health status of a community, including the prevention and mitigation of future events, and taking account of the broader context in which these events occur.
It is the vision of the Working Group that evidence-based standards and guidelines for education and training must be developed in a broad sense, for all members of the healthcare community. Rather than purely describing isolated performance indicators, the Working Group agreed that priority be given to explaining the general approach, presenting the conceptual framework, clarifying important principles, and describing the educational needs and training requirements for situations for which there exist a major threat to the health status of a community.
It is not the intent to produce an updated educational curriculum for special courses in “Disaster Medicine” by listing levels of theoretical knowledge and clinical skills required for medical doctors, nurses, and paramedics. Nor, does the Working Group think it is useful to repeat requirements and learning outcomes that are part of the normal basic education and training for the various health professionals.
The purpose of this Issues Paper is to present an initial summary of current issues relating to an international perspective of “Disaster Medicine” education and training. This summary has been prepared following discussions within the Working Group of the WADEM Education Committee. The paper aims to stimulate debate and form the basis of further of discussion at an international meeting scheduled to be held in Brussels (Belgium) on 29–31 October 2004.
The Working Group has structured this Issues Paper into five parts and has identified several key issues for discussion.
Part 1: Understanding the contemporary interpretation of the multi-disciplinary health response to major events that threaten the health status of a community
Issue 1: Definitions and terminology in “Disaster Medicine”;
Issue 2: Getting to grips with the contemporary concepts and international trends in “Disaster Medicine”; and,
Issue 3: Valuing personal attributes in “Disaster Medicine” practitioners.
Part 2: Developing an underlying scientific framework for linking theory to practice in “Disaster Medicine”
Issue 4: Creating a scientific framework(s) for “Disaster Medicine”.
Part 3: Defining a conceptual framework and general principals to develop “International Standards and Guidelines on Education and Training for the Multi-disciplinary Health Response to Major Events that Threaten the Health Status of a Community”
Issue 5: Where are we now? Getting to grips with the contemporary concepts and international trends in “Disaster Medicine” education and training.
Issue 6: Where do we want to get to? Identifying contemporary, evidence-based education and training standards and guidelines for “Disaster Medicine” education and training programs.
Issue 7: How do we get there? Overcoming barriers to introducing the International Standards and Guidelines.
Part 4: Maintaining the momentum—improving international collaboration
Issue 8: Exploring the feasibility of an ongoing, international, collaborative network of “Centres of Excellence” in “Disaster Medicine” research and/or education.
Part 5: Additional input
Issue 9: What other issues would you like to bring to the attention of the Working Group?
Conclusions:The results of the consultation will lead to the development of international standards and guidelines that will be presented and consensus sought during the 14th World Congress on Disaster and Emergency Medicine (WCDEM-14) to be convened in Edinburgh in May, 2005.
The influence of sense of coherence and mindfulness on PTSD symptoms and posttraumatic cognitions in a sample of elderly Austrian survivors of World War II
- Tobias M. Glück, Ulrich S. Tran, Simone Raninger, Brigitte Lueger-Schuster
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- Journal:
- International Psychogeriatrics / Volume 28 / Issue 3 / March 2016
- Published online by Cambridge University Press:
- 14 September 2015, pp. 435-441
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Background:
Sense of Coherence (SOC) and mindfulness are known protective factors against psychopathology, also in older age. We set out to investigate the influence of SOC and mindfulness on posttraumatic symptoms and cognitions in the context of lifetime trauma in elderly persons with a history of childhood war-experiences.
Methods:Elderly Austrians (N = 97) filled in questionnaires on traumatic lifetime experiences and posttraumatic symptoms (ETI), posttraumatic cognitions (PTCI), SOC (SOC-13) and mindfulness (FFMQ). We expected the influence of SOC scores on posttraumatic symptoms and cognitions to be on one hand influenced by mindfulness. On the other hand, we expected that both aspects would uniquely explain fewer posttraumatic symptoms and cognitions.
Results:Participants reported various lifetime traumas (M = 2.42), including experiences during World War II (WWII) as children and adolescents. Mindfulness partially mediated the association of SOC scores with posttraumatic cognitions, but not with posttraumatic symptoms. However, in a two-stage mediation model, mindfulness significantly predicted posttraumatic symptoms via its effects on posttraumatic cognitions.
Conclusion:Although SOC was the strongest predictor of posttraumatic symptoms, mindfulness influenced the severity of posttraumatic symptoms via its effects on posttraumatic cognitions. We discuss implications for mindfulness-based interventions on trauma-related cognitions in the elderly.
Sexual violence by occupational forces during and after World War II: influence of experiencing and witnessing of sexual violence on current mental health in a sample of elderly Austrians
- Brigitte Lueger-Schuster, Tobias M. Glück, Ulrich S. Tran, Elisabeth L. Zeilinger
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- Journal:
- International Psychogeriatrics / Volume 24 / Issue 8 / August 2012
- Published online by Cambridge University Press:
- 21 March 2012, pp. 1354-1358
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Background: Wartime rape is an atrocity with long-lasting impacts not only on victims but whole societies. In this brief report, we present data on experience and witness of sexual violence during World War II (WWII) and subsequent time of occupation and on indicators of mental health in a sample of elderly Austrians.
Methods: Interviews of 298 elderly Austrians from a larger epidemiological study on WWII traumatization were analyzed for the impact of experience and witness of sexual violence during the wartime committed by occupational forces. Interviews comprised a biographical/historical section and psychological measures (BSI, TLEQ, PCL–C). Participants were recruited in all nine provinces of Austria with respect to former zones of occupation (Western Allied/Soviet).
Results: Twelve persons reported direct experience of sexual violence, 33 persons witnessed such atrocities. One third of the victims and 18.2% of the witnesses reported post-traumatic stress disorder (PTSD full/subthreshold). Sexual violence occurred more often in the former Soviet zone. Victims and witnesses displayed higher odds of post-traumatic symptoms and symptoms of depression and phobic fear than non-victims. Furthermore, witnesses displayed higher levels of aggression compared to victims and non-witnesses.
Conclusions: Our results corroborate previous findings that wartime rape has long-lasting effects over decades on current mental health and post-traumatic distress in victims and witnesses. We recommend integration of psychotraumatological knowledge on consequences of sexual violence on mental health into geriatric care and the education of dedicated personnel.