Unpredictability in the child’s environment has recently emerged as a significant and unique form of early life adversity (ELA). Cross-sectional studies have linked childhood unpredictability with increased post-traumatic stress disorder (PTSD) symptoms in adults; however, no prospective studies have tested the link between childhood unpredictability and PTSD risk in later life, nor what processes, such as increased anhedonia symptoms, might mediate such risk. Here, we leveraged three distinct prospective, longitudinal cohorts to test the hypothesis that unpredictability during childhood contributes to adult PTSD via worsening anhedonia symptoms.

Participants were male service members (n=314), adult females (n=170), and adolescents (n=137) recruited for separate longitudinal investigations. All completed dimensional assessments of anhedonia symptoms and PTSD; childhood trauma and childhood unpredictability were measured by the Questionnaire for Unpredictability in Childhood (QUIC). Pearson correlations tested relations between QUIC, anhedonia symptoms, and PTSD symptoms. Mediational models tested whether the link between childhood unpredictability and PTSD is mediated by increased anhedonia symptoms by estimating indirect effects via bootstrapped path analysis.

Childhood unpredictability was associated with increased adult PTSD symptoms in all three cohorts (rs>.19, ps<.016). Further, in all three cohorts, the relationship was partially mediated by higher anhedonia symptoms (bs>0.046, 95% confidence intervals = 0.01–0.12). All effects remained significant when controlling for levels of childhood trauma and removing anhedonia-related PTSD items.

Unpredictability during childhood may confer risk for adult PTSD, and this increased risk may occur via alterations in anhedonia symptoms. Efforts to increase predictability during childhood could enhance resilience to later traumatic events.

Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.

We used Taiwan’s National Health Insurance Research Database (2000–2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).

Over a mean follow-up of 8 years, PTSD was associated with excess all-cause mortality (AHR = 1.32, 95% CI 1.24–1.41) driven by markedly increased unnatural deaths (AHR = 5.93, 5.13–6.85), especially suicide (AHR = 10.36, 8.41–12.76) and accidental deaths (AHR = 2.18, 1.67–2.86). Natural-cause mortality showed no consistent increase (AHR = 0.91, 0.85–0.98). In sibling analyses, excess risks persisted for all-cause (AHR = 2.48, 2.04–3.01), unnatural deaths (AHR = 4.76, 3.58–6.34) and suicide mortality (AHR = 7.90, 5.21–11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.

PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.

Journalists covering war are exposed to grave risk which can cause mental health difficulties.

To determine the long-term psychiatric health of journalists who covered wars in Afghanistan and the Middle East between September 2001 (following 9/11) and 2013 (waning of the Arab Spring uprisings).

Observational, qualitative study involving journalists from CNN, The New York Times, the Washington Post, the Associated Press and National Public Radio. Data collected via study website and Zoom interviews. Of 324 journalists identified, 202 (62.3%) were traceable. Of these, 16 (4.9%) were deceased, 156/186 (83.9%) consented and 30/186 (16.1%) declined participation. Of 156 journalists who provided psychometric data, 99 (63.4%) agreed to interview. Duration of exposure to and severity of risk were recorded. Psychometric data included the General Anxiety Disorder seven-item scale, the nine-item Patient Health Questionnaire, the PTSD Checklist for DSM-5 and the Structured Clinical Interview Schedule for DSM-5 to elicit 12-month and lifetime prevalence of psychiatric diagnoses.

One hundred and twelve (71.8%) were male, mean age was 57.0 (s.d. = 9.75) years and 77/156 (49.4%) spent more than 3 years in war zones. Time in a war zone correlated with risk severity (r = 0.476, p < 0.001). Lifetime and 12-month prevalence of post-traumatic stress disorder (PTSD) 27%/6%; major depression 34%/8%; any anxiety disorder 28%/11%; alcohol use disorder 34%/4%; acute stress disorder 6%/0%; dissociative disorder 2%/0%. Severity of risk predicted lifetime PTSD only (odds ratio 2.55, 95% CI: 1.27–5.14, p = 0.009). Counselling was available to 63/156 (40.4%) journalists while covering conflict.

Journalists who covered wars in Afghanistan, Iraq and elsewhere that began after 9/11 have a high lifetime prevalence of PTSD, major depression, any anxiety disorder and alcohol use disorder; 12-month prevalence for PTSD and any anxiety disorder remains elevated, albeit less so. War journalism is hazardous, and risk severity predicts PTSD, highlighting the importance of therapy availability.

This longitudinal study examines the psychometric validity of the Subjective Traumatic Outlook (STO) questionnaire by evaluating its structural consistency and diagnostic performance in a conflict-affected context. The STO was used to measure trauma-related subjective distress at two time points following the terrorist attacks in Israel on 7 October 2023.

The primary aim of this study was to evaluate the STO as a concise and reliable assessment tool for populations affected by armed conflict.

A nationally representative sample of 4097 participants responded at T1, of whom 2005 completed the study at T2. Data were collected during the ongoing war in Israel. Participants completed the STO alongside validated measures of post-traumatic stress disorder (PTSD (PTSD Checklist for DSM-5) and International Trauma Questionnaire), depression, anxiety and adjustment disorder. Exploratory factor analyses were used to estimate one- to three-factor solutions using robust maximum likelihood estimation. Convergent validity was assessed through bivariate correlations with trauma- related measures. Receiver operating characteristic analyses were conducted to evaluate diagnostic utility for PTSD and complex PTSD per the ICD-11.

Exploratory factor analysis supported a stable two-factor structure across both waves. The STO demonstrated strong internal consistency and stable convergent validity over time. Receiver operating characteristic analyses indicated that the four-item version matched or slightly outperformed the five-item version, suggesting improved parsimony without loss of diagnostic accuracy.

The stable factor structure of the STO and its strong psychometric properties across both waves within a wartime context support its utility for large-scale screening and early detection of trauma-related distress.

Machine learning (ML) models show promise in predicting post-traumatic stress disorder (PTSD) treatment outcomes, but it is unknown how their predictions compare to those of clinicians. This study directly compared the accuracy of clinicians’ predictions of patient treatment outcomes with those of three ML models.

Twenty clinicians providing cognitive processing therapy repeatedly predicted outcomes for 194 veterans. We compared their accuracy against three ML models on two key endpoints: clinically meaningful symptom reduction (≥10-point PCL-5 decrease) and posttreatment severity (final PCL-5 < 33). Clinician predictions were compared against a recurrent neural network, a mixed-effects random forest, and a generalized linear mixed-effects model. We analyzed prediction accuracy and the association between clinician confidence and accuracy using logistic mixed-effects models.

ML models were significantly more accurate than clinicians at predicting whether a patient’s posttreatment PCL-5 score would be below 33 (p < .001). However, no significant difference in accuracy was found for predicting a ≥10-point symptom reduction (p = .734). Clinician confidence increased throughout treatment and was significantly associated with greater prediction accuracy for both outcomes (ORs = 1.06, ps < .001).

ML models can outperform clinicians in predicting posttreatment symptom severity, particularly early in treatment, suggesting they could be a useful tool for identifying patients at risk for suboptimal outcomes. However, ML models were not superior in predicting symptom reduction, where clinicians also performed at a high level. Findings support the selective use of ML to enhance, rather than replace, clinical judgment in PTSD treatment.

The January 2025 Los Angeles wildland-urban interface wildfires represent a significant environmental disaster, resulting in widespread evacuations. Beyond the immediate physical and economic devastation, wildfires can have profound and lasting impacts on the mental well-being of affected populations. This study compared mental health outcomes between Southern California residents who evacuated due to the fires and those who did not evacuate.

Southern California residents (N = 739) were surveyed 2-3 months after the January 2025 wildfires. Logistic regression models assessed the association of evacuation status with depression, anxiety, and PTSD, adjusting for demographics and baseline pre-fire levels of depression and anxiety.

Evacuating was significantly associated with higher odds of depression (AOR = 1.75 [1.08-2.85]) and PTSD (AOR = 2.44 [1.36-4.35]), after controlling for pre-fire mental health status and other demographic covariates. Evacuation status was not associated with anxiety.

These findings support previous research linking wildfire exposure to adverse mental health outcomes and highlight the importance of targeted mental health screening and support for wildfire evacuees, who are at increased risk for depression and PTSD.

1. (1) To outline potential impacts of trafficking-related experiences on mental health.

2. (2) To increase clinicians’ confidence in engaging survivors of trafficking in assessment and evidence-based CBT interventions.

3. (3) To apply a phased model framework to planning and delivering effective interventions where there may be additional or complex psychosocial needs.

Major depressive episodes (MDEs) are highly recurrent in clinical samples. However, the course of MDEs and predictors of their endurance are unclear in the general youth population.

We investigated prospective factors associated with enduring MDE (the presence of 12-month DSM-IV MDE at baseline and 1 year using the Composite International Diagnostic Interview–Screening Scales) in 1,833 participants of a 1-year epidemiological youth cohort study in Hong Kong. Multivariable logistic regression models were used to examine the influences of a range of personal and environmental factors.

At baseline, 13.7% participants had MDEs, among whom 21.1% presented enduring MDEs. More severe symptoms of post-traumatic stress disorder (adjusted odds ratio [aOR] = 5.54, confidence interval [CI] = 2.14–14.38), depression (aOR = 3.92, CI = 1.79–8.62), and generalized anxiety (aOR = 2.27, CI = 1.21–4.25) at baseline were among the strongest associated factors for enduring MDE, with trends of associations observed for psychotic-like experiences (aOR = 1.98, CI = 0.98–4.02) and eating disorder symptoms (aOR = 1.88, CI = 0.90–3.95). Among various types of stressors, only dependent stressors at follow-up showed a clear association with enduring MDE (aOR = 4.22, CI = 1.81–9.83). Those with enduring MDE showed poorer functioning and mental health-related quality of life at follow-up, with only 35.6% having sought any psychiatric/psychological help during the past year.

Detecting comorbid symptoms in those with prior MDEs and reducing the impact of dependent stressors may help reduce their long-term implications. Enhancing the accessibility and acceptability of youth-targeted mental health services would also be crucial to improve help-seeking.

Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress–diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.

The INTERSECT cross-sectional survey (April 2021–January 2024) included 11,302 women at 6–12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant-related factors. All models were adjusted for country-level variation as a random effect.

Models explained substantial variance across all outcomes (conditional R2 = 0.53–0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80–0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41–1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29–2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21–0.29). Other predictors reached significance but showed small effects.

Findings support a stress–diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women’s appraisals of birth.

Bilateral sensory stimulation (BLS), such as eye movements or alternating tactile stimulation, is a key component of Eye Movement Desensitisation and Reprocessing (EMDR), a recommended treatment for post-traumatic stress disorder (PTSD). However, the neurophysiological mechanisms underlying BLS remain poorly understood.

This study examined the physiological effects of visual and tactile BLS on frontal electroencephalography (EEG) activity and autonomic arousal in patients with PTSD and healthy controls, by varying the type of stimulation in different emotional stimuli.

Twenty female PTSD patients and twenty matched healthy controls participated in a counterbalanced, within-subjects design. Participants recalled a subjectively stressful or neutral event while receiving visual or tactile BLS. Frontal EEG and peripheral psychophysiological measures were recorded before and after stimulation. Data were analysed using mixed model analysis to examine the effects of stimulation type, memory condition and group.

Both visual and tactile BLS significantly increased the total power of frontal EEG and decreased spectral edge frequency and peripheral physiological activation. These effects were consistent between the groups and memory conditions.

BLS, regardless of visual or tactile modality or emotional memory content, is associated with increased frontal EEG activity and reduced autonomic arousal. These findings support the hypothesis that BLS facilitates top-down cortical regulation, potentially aiding emotional processing in EMDR by using an inherent mechanism to promote psychological recovery. More research is needed to clarify the neural mechanisms and clinical implications.

Impaired maternal sensitivity may be a risk pathway linking maternal posttraumatic stress symptoms (PTSS) to adverse child outcomes. Respiratory sinus arrhythmia (RSA), a psychophysiological marker of emotion dysregulation, may be a key factor in how PTSS influence maternal sensitivity. Yet, these associations remain untested in early infancy. The current study tested maternal resting RSA and RSA reactivity to caregiving as moderators of the association between maternal PTSS and maternal sensitivity in trauma-exposed mothers.

Seventy-seven mother–infant dyads (maternal Mage = 30.06 years, infant Mage = 9.53 weeks) were recruited from the community and an urban public hospital setting. Mothers reported on PTSS and engaged in a caregiving task; maternal sensitivity was coded. RSA was measured at rest and in response to the task. Generalized linear models for ordinal outcomes analyses examined the moderating effect of resting RSA and RSA reactivity (decrease in RSA) on the association between PTSS and maternal sensitivity.

The association between maternal PTSS and sensitivity was significantly moderated by resting RSA (B(SE) = 0.03(0.01), p = .033, and RSA reactivity, B(SE) = 0.03(0.01), p = .022.

Maternal PTSS was negatively associated with maternal sensitivity only among mothers with higher resting RSA (+1SD above mean), B(SE) = −0.05(0.02), p = .030, and with greater RSA reactivity (−1SD below mean RSA reactivity scores), B(SE) = −0.06 (0.02), p = 0.021.

A tendency toward autonomic overregulation and heightened physiological reactivity may serve as relevant factors influencing how PTSS leads to maladaptive parenting behavior in early postpartum.