Search Results (814)

Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered. Full article

The intensification of armed conflicts has forced thousands of women to seek refuge in other countries, exposing them to conditions of heightened vulnerability, characterized by inequality, violence, and mental health challenges. Despite these adversities, refugee women demonstrate resilience through diverse coping strategies. However, qualitative research centring women’s experiences within gender-sensitive and intersectional frameworks remains limited. This study aims to characterize the experiences of forced migration among refugee women in Portugal and to explore the coping strategies they have developed. Semi-structured interviews were conducted with six refugee women residing in Portugal. Based on thematic analysis, the data revealed a trajectory marked by material and symbolic losses, disruption of social bonds, and symptoms consistent with post-traumatic stress. Motherhood emerged both as motivation and as an obstacle to social and professional integration. Participants reported various coping strategies, including social support, self-efficacy, optimism, emotional regulation, religious coping, and contemplative practices. These findings indicate that coping strategies among refugee women are shaped not only by trauma exposure, but also by gendered structural conditions in the host context. These results highlight the need for gender-sensitive and trauma-informed public policies, as well as community-based interventions to promote social integration and well-being. Full article

(1) Background: Prehospital emergency workers frequently experience workplace violence and trauma, raising their risk of post-traumatic stress disorder (PTSD) symptoms and burnout, yet their link to quiet quitting remains poorly understood. We tested whether the PTSD–quiet quitting association is statistically patterned through perceived occupational stress and emotional exhaustion. (2) Methods: In a cross-sectional online survey, prehospital emergency professionals in Türkiye who reported workplace violence within the previous six months completed the PTSD-Short Scale, Perceived Occupational Stress Scale, Job-Related Emotional Exhaustion Scale, and Quiet Quitting Scale. Serial mediation was tested with PROCESS Model 6 (5000 bootstrap resamples), with an age- and gender-adjusted sensitivity analysis, and reporting followed the STROBE checklist. (3) Results: Of 327 respondents, 305 were analysed. PTSD symptoms were associated with quiet quitting (β = 0.460, p < 0.001). With both mediators entered, the direct path was non-significant (β = 0.105, p = 0.071), indicating full statistical mediation. The serial route through stress and exhaustion was the largest indirect pathway (B = 0.155, 95% CI [0.091, 0.217]), and the model explained 42.1% of the variance. Self-reported, single-session data mean the indirect effects are best treated as upper-bound estimates. (4) Conclusions: PTSD symptoms were indirectly related to quiet quitting through occupational stress and emotional exhaustion. The high correlation between the two mediators suggests one broad strain process rather than two distinct stages. Because the design is cross-sectional, it precludes causal ordering; longitudinal studies are needed. Clinically, the findings highlight reducing workplace violence and monitoring stress and exhaustion to limit disengagement among prehospital staff. Full article

Post-traumatic stress disorder (PTSD) is a severe condition triggered by traumatic exposure, characterized by symptoms like trauma re-experiencing, avoidance, mood alterations, hypervigilance, and sleep disturbances. While its exact mechanisms remain uncertain, PTSD involves dysregulation across neurobiological systems underlying fear conditioning, threat appraisal, executive control, and stress response. Although research highlights the sympathetic–adreno–medullary (SAM) system and the hypothalamic–pituitary–adrenal (HPA) axis, findings on stress-related mediators remain inconsistent regarding their precise contributions over time. To address this, we propose a hypothetical model viewing PTSD as a multistable system shifting from physiological to pathological steady states. We assume that intense, repeated emotional stress triggers spike activation in the amygdala, driving an amygdala–locus coeruleus loop into a high-activation state via reciprocal excitation, mediated by corticotropin-releasing hormone (CRH) and noradrenaline. This sequentially alters amygdala–hippocampus and prefrontal cortex loops, reinforcing fear expression and impairing extinction. This model is consistent with key features of PTSD, including its higher prevalence among females, increased glucocorticoid receptor sensitivity, the frequently observed hypocortisolism, and the partial efficacy of serotonin and norepinephrine reuptake inhibitor (SNRI) and CRH receptor antagonists. While requiring experimental validation, this framework connects molecular, circuit, and behavioral data to help identify novel interventions for restoring adaptive stress-response dynamics. Full article

Background/Objectives: Perinatal loss is a profoundly distressing life event associated with grief, depression, anxiety, post-traumatic stress symptoms, and long-term psychosocial challenges among bereaved parents who experience miscarriage, stillbirth, or neonatal death. Although psychotherapeutic interventions are increasingly used to address these adverse outcomes, there is limited synthesis on how characteristics consistent with a patient-centered care perspective are reflected in such interventions and how they may relate to psychosocial well-being. This umbrella review aimed to synthesize evidence on psychotherapeutic interventions following perinatal loss and to examine patient-centered care–related dimensions reported across the included reviews, including therapeutic communication, patient engagement, therapeutic relationships, emotional validation, and meaning-making processes. Methods: An umbrella review was conducted in accordance with the Joanna Briggs Institute methodological guidance. Systematic reviews and meta-analyses published between 2019 and 2025 were identified through searches of PubMed, CINAHL, PsycINFO, and the Cochrane Library from database inception to 31 May 2026. Eligible reviews examined psychotherapeutic, psychosocial, and psychological support interventions designed to improve grief, depression, anxiety, post-traumatic stress symptoms, psychological distress, coping, and psychosocial well-being among bereaved parents following perinatal loss. In accordance with the predefined secondary exploratory objective, a secondary interpretive synthesis examined patient-centered care–related dimensions described within the included reviews. Results: Five systematic reviews and meta-analyses met the inclusion criteria. Interventions included cognitive behavioral therapy, mindfulness-based approaches, bereavement counseling, psychosocial support programs, narrative interventions, supportive counseling, and digitally delivered psychological therapies. Across reviews, psychotherapeutic interventions were generally associated with beneficial effects on grief, depression, anxiety, post-traumatic stress symptoms, and broader indicators of psychosocial well-being. Communication-, support-, and engagement-related characteristics consistent with a patient-centered care perspective, including empathy, therapeutic alliance, individualized support, emotional validation, and continuity of communication, were identified through secondary interpretive synthesis as recurring features of beneficial interventions. Digital modalities, such as internet-based cognitive behavioral therapy and telephone-delivered counseling, were consistently described as supporting accessibility, engagement, and continuity of care. Conclusions: Psychotherapeutic interventions following perinatal loss appear to improve a range of psychosocial outcomes. A patient-centered care perspective may help interpret how communication, emotional validation, patient engagement, and supportive therapeutic relationships are described in relation to psychological adaptation after loss. These dimensions should be understood as interpretive characteristics identified across the included reviews rather than as directly measured mechanisms of intervention effectiveness. Future research should examine communication processes, therapeutic alliance, and patient engagement using validated measures, assess how these factors relate to intervention effectiveness, and support the development of integrated, patient-centered models of perinatal bereavement care. Full article

Background: Adolescents exposed to large-scale natural disasters are at increased risk for psychological distress, yet individual psychological characteristics associated with stress and trauma responses remain insufficiently explored. Self-compassion has been suggested as a relevant factor in stress regulation and emotional adjustment. This study aimed to examine the associations between self-compassion, perceived stress, and trauma-related reactions in adolescents exposed to an earthquake. Methods: The sample consisted of 3362 adolescents (57.3% female) aged 14–17 years (mean age = 15.01 ± 0.97 years) who were exposed to the 2020 Elazığ–Sivrice earthquake. Participants completed the Perceived Stress Scale (PSS), the Self-Compassion Scale–Short Form (SCS-SF), and the Child Post-Traumatic Stress Reaction Index (CPTS-RI). Group comparisons and correlation analyses were conducted to examine relationships among the study variables and earthquake-related characteristics. Results: Adolescents residing in severely and moderately damaged areas reported significantly higher perceived stress and lower self-compassion compared to those in mildly damaged areas. Self-compassion was negatively correlated with trauma-related symptoms, whereas perceived stress showed a positive association with trauma reactions. Female adolescents reported higher perceived stress and trauma-related symptoms and lower self-compassion than males. Conclusions: The findings underscore the relevance of self-compassion in understanding adolescents’ psychological responses to earthquake-related stress and trauma and suggest that self-compassion may be considered in post-disaster psychological support efforts. Full article

Background and Objectives: Cardiac implantable electronic devices (CIEDs), including permanent pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are increasingly used in an aging population characterized by multimorbidity and a high prevalence of psychiatric and cognitive disorders. Depression, anxiety, post-traumatic stress disorder (PTSD), mild cognitive impairment, and dementia may affect informed consent, adherence to therapy, quality of life, and long-term cardiovascular outcomes in patients undergoing CIED implantation. The aim of this review was to summarize the prevalence and clinical significance of psychiatric and cognitive disorders in patients undergoing CIED implantation and to discuss practical strategies for their assessment in routine cardiology practice. Materials and Methods: This narrative review was based on a literature search of PubMed, Web of Science, and the National Health Library database covering the literature from 2010 to 2025, including a broad search strategy. Original studies and review articles were included, having confirmed their definite association with the subject. Results: Psychiatric disorders and cognitive impairment were highly prevalent among patients with CIEDs and were associated with impaired adherence, reduced participation in rehabilitation, lower quality of life, and worse cardiovascular outcomes. ICD therapies, particularly inappropriate therapies, were strongly associated with anxiety, depressive symptoms, and PTSD-related distress. Cognitive impairment may compromise informed consent, recognition of complications, and compliance with post-implantation recommendations. Several validated screening tools, including MMSE, MoCA, HADS, BDI-II, STAI, and FSAS, may facilitate early identification of high-risk patients, and their most appropriate use in various clinical scenarios, including pre- and post-CIED implantation was described. Conclusions: Psychiatric disorders and cognitive impairment are common and clinically relevant in patients undergoing CIED implantation. Routine psychological and cognitive assessment before and after implantation should be considered an important component of modern multidisciplinary cardiac care, potentially affecting the decision to implant the device, and likely influencing the type of the implanted device. Full article

Burn injuries are increasingly recognized as chronic conditions with enduring physical, psychological and social consequences that extend beyond acute survival. This narrative review synthesizes and interpretatively discusses recent evidence on health-related quality of life (HRQoL) in adult burn survivors, focusing on recovery patterns following discharge. Persistent physical sequelae—particularly chronic pain, pruritus, contractures and scarring—remain major determinants of reduced HRQoL, mainly mediated by functional limitation and self-perception. Psychological morbidity is common, with high rates of depression, anxiety and post-traumatic stress disorder, particularly early after injury, although post-traumatic growth may also emerge. Social reintegration, including return to work, is often delayed or incomplete and is influenced by injury severity, mental health status and social support. Recovery trajectories are nonlinear: the greatest improvements occur within the first six months, followed by slower gains up to 18–24 months, after which many patients fail to reach population norms. Pain and psychological symptoms may persist for years. Overall, these findings support a multidisciplinary, longitudinal approach to burn care, emphasizing early risk stratification and rehabilitation to optimize individualized recovery. In this narrative review, we aim to outline the main dimensions of long-term quality of life, with a particular focus on the temporal dynamics of recovery patterns. Full article

This study aimed to examine the relationship between post-traumatic stress symptoms following cryptocurrency loss and early maladaptive schemas in physicians. This cross-sectional study was conducted using a relational screening model and included 94 physicians across Türkiye who reported financial loss in cryptocurrency markets between 15 April and 15 July 2022. Data were collected online using a sociodemographic information form, the Young Schema Questionnaire–Short Form 3, and the Impact of Event Scale-Revised. Participants with an Impact of Event Scale–Revised total score of 33 or higher were classified as having elevated IES-R symptoms, reflecting elevated event-related distress according to a screening cutoff rather than a clinical diagnosis of PTSD. Eighteen participants (19.1%) were classified into this group. While no significant differences were found in age, marital status, employment status, or investment duration, the proportion of savings allocated to crypto was higher among participants with elevated IES-R symptoms. The elevated IES-R symptom group had higher scores in Failure, Pessimism, Dependence/Enmeshment, Punitiveness, Defectiveness, and Vulnerability to Harm, and additional correlation analyses showed that the IES-R total score was positively associated with Pessimism, Punitiveness, Dependence/Enmeshment, and Failure after false discovery rate correction. However, in the exploratory logistic regression analysis, none of these variables independently predicted elevated IES-R symptom status. These findings suggest that cryptocurrency loss may represent not only a financial stressor but also a significant experience associated with post-traumatic stress symptoms and maladaptive schema patterns in physicians. Full article

Post-Traumatic Stress Disorder (PTSD) is a prevalent and costly mental health condition characterized by symptoms such as hyperarousal, avoidance, and re-experiencing. While machine learning (ML) approaches have shown promise in detecting PTSD-related physiological patterns, most validation efforts rely on computational metrics rather than real-world user perceptions. This study evaluates the perceived precision of a smartwatch-based ML tool designed to detect PTSD hyperarousal events using heart rate and activity data. The tool, previously developed using XGBoost 1.0.0, was deployed in a 21-day naturalistic study with 12 participants diagnosed with PTSD. Quantitative results showed a median perceived precision of 65.27%, with substantial variability across participants. A Mann–Kendall trend analysis revealed a significant increase in perceived precision over time for most participants, suggesting calibration of trust. Qualitative findings indicated high usability, general trust in the system, and acceptance of false positives, though concerns about notification design and battery life were noted. The results highlight the importance of incorporating user-centered, real-world validation into the evaluation of ML-based mental health monitoring tools. This work provides preliminary evidence supporting the feasibility of wearable-based PTSD monitoring and underscores the role of perceived precision in technology adoption and sustained use. Full article

Background and Objectives: This study aimed to examine the level of depression in children who had undergone pediatric liver transplantation and to evaluate the potential role of liver enzymes as biomarkers of depression. Materials and Methods: The study was conducted with 50 pediatric liver transplant recipients followed at the Liver Transplantation Institute of İnönü University, and data were collected through face-to-face interviews. The Personal and Transplant Information Form, Child Revised Impact of Event Scale, and Patient Health Questionnaire–Depression were used as data collection tools. In addition to descriptive statistics, Student’s t-test, Mann–Whitney U test, correlation analyses, and regression analyses were performed. Results: The median PHQ-9 score was 1.00 (Q1–Q3: 0.00–5.00), indicating generally low levels of depression. A significant positive correlation was found between CRIES and PHQ-9 scores (r = 0.414, p < 0.01). In contrast, no consistent significant associations were observed between liver enzyme levels and depression scores in multivariate analyses, although bilirubin showed a modest negative correlation with PHQ-9 scores. In the multivariate analysis, although the overall regression model was not statistically significant, the CRIES score showed an individual association with PHQ-9 scores within the model (B = 0.117, p = 0.037). Conclusions: Liver enzymes cannot be considered strong biomarkers of depression in pediatric liver transplant recipients; however, post-traumatic stress symptoms may be an important clinical indicator for assessing psychological adjustment. Full article

Post-traumatic stress disorder (PTSD) remains inadequately treated by existing pharmacological and psychological interventions, prompting growing interest in psychedelic-assisted psychotherapy. Although randomised controlled trials have evaluated several psychedelic agents for PTSD, to our knowledge, no prior PTSD-specific synthesis has quantitatively examined multiple agent classes within a single review framework. This systematic review and meta-analysis searched PsycINFO, CINAHL, Embase, MEDLINE, and clinical trial registries to identify RCTs of psychedelic-assisted psychotherapy for PTSD. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and random-effects meta-analyses were conducted for efficacy outcomes; safety and therapeutic protocols were synthesised narratively. Eleven RCTs involving 358 participants met inclusion criteria, evaluating MDMA, ketamine, and cannabidiol, of which eight contributed to meta-analyses. MDMA-assisted psychotherapy demonstrated a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity, and participants were significantly more likely to achieve clinical response and loss of PTSD diagnosis. The pooled effect for ketamine was small and non-significant, and a single cannabidiol trial showed no clear benefit. All agents were generally well tolerated. MDMA-assisted psychotherapy showed a promising efficacy signal for PTSD symptom reduction, although safety data were heterogenous and remain insufficient for strong comparative conclusions. Evidence for ketamine and cannabidiol remains too limited to support clinical implementation and it is noted that the current evidence base is dominated by MDMA trials. Further adequately powered trials with standardised outcomes and direct comparative studies across agents are needed. Full article

Background/Objectives: Clinical childbirth in high-income countries is increasingly shaped by standardised routines that do not always accommodate individual preferences. In Germany, approximately one in eight pregnant persons experiences clinically significant childbirth-related post-traumatic stress disorder symptoms, with pregnant persons facing language or health-literacy barriers being at particular risk of inadequate preference integration. Methods: This paper presents the conceptual foundation and proposed study design for FAIR-Birth, an interdisciplinary initiative to develop and feasibility-test a mobile application supporting Advance Birth Planning (ABP) embedded within midwifery-led antenatal care. The intervention combines four elements: transfer of the Advance Care Planning concept to antenatal care, a domain-restricted Large Language Model (LLM) supporting multilingual preference articulation, integration of the resulting ABP document into midwifery-led continuity of care, and iterative adaptation. Following the updated MRC framework, this study will employ a sequential mixed-methods design encompassing systematic review, participatory instrument development, Delphi consensus on the knowledge base, iterative technical development with usability testing, and a feasibility study across two perinatal centres in Bavaria. Results/Conclusions: FAIR-Birth is expected to generate a content-validated ABP instrument, a domain-restricted multilingual LLM dialogue system, and an evaluated application prototype. The work corresponds to the development and feasibility phases of the MRC framework; effectiveness questions are reserved for a planned subsequent randomised controlled trial. Full article

Background/Objectives: Extant data suggest that the Stellate Ganglion Block (SGB) is effective for posttraumatic stress disorder (PTSD). Clinical data from a large healthcare system are lacking. We report data from a clinical project in the Veterans Health Administration. Methods: Retrospective data of PTSD and anxiety for 579 patients who received one or more SGBs were analyzed on the full sample and on those who had complete data using general linear models. Results: Receiving the first SGB provided a 36% and 30% reduction in PTSD symptom scores at 1-week and 1-month post-SGB, respectively. Those who received 2–4+ SGBs showed lower pre-SGB PTSD symptom scores and trends for lower scores at 1-week and 1-month post-SGB. Overall, 78% and 71% of patients had a reliable (Δ ≥ −5 points) change and 68% and 60% had a clinically meaningful (Δ ≥ −10 points) change in PTSD symptom scores from pre-SGB to 1-week and 1-month post-SGB, respectively. There were clinically meaningful reductions for anxiety in 51.5% and 48.3% at 1-week and 1-month post-SGB, respectively. Conclusions: These data corroborate existing data about the benefit of SGB for PTSD and anxiety and are unique in showing an association between repeat SGBs and lower PTSD symptoms at subsequent baseline. Full article

Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine which symptom clusters carry the greatest impact on health-related quality of life (HRQOL). Materials and Methods: Fifty liver transplant recipients between the ages of 8 and 18 were enrolled at a single center. Children and their parents completed four psychiatric measures—the CBCL, CDI, SCARED, and CRIES-13—alongside the parent-proxy PedsQL to capture HRQOL across physical, emotional, social, and school functioning domains. Correlations between instruments were calculated, and linear regression was used to determine which psychiatric variables independently predicted PedsQL Total scores. Results: Across all psychiatric measures, higher symptom scores were associated with lower HRQOL, with school functioning recording the lowest absolute PedsQL domain score, while emotional functioning demonstrated the strongest and most consistent inverse correlations with all psychiatric symptom measures across instruments. CBCL Total (r = −0.607), SCARED Total (r = −0.557), and CRIES-13 Total (r = −0.548) scores all correlated meaningfully with overall HRQOL. When entered into multivariable analysis, anxiety symptoms measured by the SCARED (β = −0.295, p = 0.032) and post-traumatic stress symptoms measured by the CRIES-13 (β = −0.400, p = 0.004) stood out as the two independent predictors of worse PedsQL Total scores. Conclusions: Even in medically stable recipients, anxiety and post-traumatic stress symptoms were independently associated with lower daily functioning scores and overall quality of life. These findings suggest that routine psychosocial screening and trauma-informed approaches may warrant integration into post-transplant care protocols, and that prospective, adequately powered studies are needed to confirm and extend these associations. Full article