Impact of Military Service in Vietnam on Coping and Health Behaviors of Aging Veterans During the COVID-19 Pandemic

Many Vietnam War veterans who experienced military trauma still exhibit PTSD symptomatology. Little is known about how new stressful situations, like the COVID-19 pandemic, affect previously traumatized people or whether they will react differently to them. We explore whether military combat experiences in Vietnam affect veterans' perceived abilities to cope with COVID-19 and whether current PTSD symptoms and later-adulthood reengagement with trauma memories are related to coping. We examine the extent that current PTSD symptoms and trauma reengagement relate to preventive practices. Participants were part of a randomly sampled cohort of American Legionnaires who responded to two previous surveys (1984, 1998), were born 1945-1953 and deployed to Vietnam 1963-1973, thus representing an aging veteran population. A survey supplement assessed coping with the pandemic and adherence to public health guidelines. The response rate was 74% (N = 507); 422 (61.6%) completed the COVID-19 supplement. Military experiences were found to affect coping with 41.4% reporting they affected ability to cope with COVID-19. Medium- and high-combat veterans were more likely to report that military experience affected coping than low-combat (OR 2.4, 95% CI 1.51–3.96; 2.6, 95% CI 1.41–4.61, respectively). Those with high PTSD scores had 7.7-fold (95% CI 4.3–13.17) increased likelihood of reporting that their coping was affected, compared to low-PTSD scorers. Few adopted social distancing (4%), staying at home (17%), or ceasing usual activities (32%); high-combat veterans were least likely to stay home. Veterans who practiced handwashing, sanitizer use, mask-wearing, and surface disinfection had significantly higher PTSD scores than those who did not. Veterans with higher scores on the LOSS-SF scale associated more reengagement with trauma memories and were more likely to engage in personal preventive strategies. Analysis of open-ended responses supported these findings. We conclude that fifty years after returning from Vietnam, PTSD scores were high for high-combat veterans, suggestive of PTSD diagnosis. Military experiences affected coping with COVID both positively and negatively, and may have helped instill useful personal health behaviors. Veterans, especially those with PTSD symptomatology, may have special needs during stressful times, like the COVID-19 pandemic, affecting compliance with recommended practices, as well as their overall health and well-being.

Quarantine-related traumatic stress, views, and experiences during the first wave of Coronavirus pandemic: A mixed-methods study among adults in Saudi Arabia

Purpose Mental health is a significant problem following exposure to a traumatic event. This study aimed to examine quarantine-related experiences, traumatic stress, and coping strategies among adults quarantined in Saudi Arabia due to coronavirus disease 2019 (COVID-19) exposure or travel history. Methods Individuals aged ≥ 18 years who were quarantined in Saudi Arabia due to COVID-19 exposure or travel history were included. We used a sequential mixed methods design, using an online survey followed by in-depth individual telephonic interviews. The Impact of Event Scale-Revised (IES–R) was used to measure post-traumatic stress disorder (PTSD) symptoms after the quarantine. To identify factors associated with significant symptoms (IES–R score ≥ 33), prevalence ratios (PR) with 95% confidence intervals were computed using Poisson regression with robust error variance. In the next phase, a subset of the participants (n = 26) were interviewed to elicit their quarantine-related experiences and coping responses. Major themes and subthemes were identified. Results Of the 111 adults who completed the survey, 32 (28.8% [95% CI, 21.1–38.0%]) had significant PTSD symptoms (IES–R score ≥ 33) and 27 (24.3% [95% CI, 17.2–33.3%]) had severe symptoms (IES–R score > 37). Marital status was the only variable that was significantly associated with significant PTSD symptoms (P = 0.028). Significant symptoms were twice as prevalent in married adults than among other marital groups (PR 2.00, 95% CI, 1.08–3.72). Participants reported negative emotions such as overwhelming fear, helplessness, anxiety, and disgust. Participants utilized both problem-centered coping (e.g., use of social support) and emotion-centered coping (e.g., use of positive diversionary activities) during the quarantine period. Conclusion PTSD symptoms were present in one out of every four quarantined persons. The quarantine experience is viewed negatively. These findings highlight the need for increased awareness about stress-related disorders among quarantined individuals. Efforts are needed to detect and manage these symptoms early while making the quarantine experience more satisfying for the involved individuals and groups.

Post-traumatic stress symptoms in cancer patients during the COVID-19 pandemic: a one-year longitudinal study

Background: Cancer patients may be particularly vulnerable to psychological consequences of the COVID-19 pandemic and successive lockdowns. We studied the prevalence and evolution of post-traumatic stress disorder (PTSD) symptoms in cancer patients during the pandemic waves, and investigated factors associated with high symptoms. Methods: COVIPACT is a one-year longitudinal prospective study of French patients with solid/hematologic malignancy receiving treatment during the first nationwide lockdown. PTSD symptoms were measured every 3 months from April 2020 using the Impact of Event Scale-Revised. Patients also completed validated questionnaires on quality of life (QoL), cognitive complaints and insomnia, and a survey on their COVID-19 lockdown experience. Results: Longitudinal analyses involved 386 patients with at least one PTSD assessment after baseline (median age 63, 76% female). Among them, 21.5% had moderate/severe PTSD symptoms during the first lockdown. The rate of patients reporting PTSD symptoms decreased at lockdown release (13.6%), increased again at second lockdown (23.2%), and slightly declined from the second release period (22.7%) to the third lockdown (17.5%). Patients were grouped into three trajectories of evolution. Most patients had stable low symptoms throughout the period, 6% had high baseline symptoms slowly decreasing over time, and 17.6% had moderate symptoms worsening during second lockdown. Female sex, feeling socially isolated, worrying about COVID-19 infection, and using psychotropic drugs were associated with PTSD symptoms. PTSD symptoms were associated with impaired QoL, sleep and cognition. Conclusions: Around a quarter of cancer patients presented high and persistent PTSD symptoms over the first year of the COVID-19 pandemic and may benefit from psychological support.

Kintsugi mind: clinicians can emerge from the pandemic whole

The Japanese practice an ancient art called Kintsugi. A craftsperson repairs broken pottery with gold or silver rendering it more beautiful than in its original state. Can clinicians engage in “Kintsugi Mind” and thereby emerge from this pandemic integrated and whole? Yuan et al. (2021) conducted a meta-analysis including 88 studies of post-traumatic stress disorder (PTSD) following earlier pandemics and COVID-19. Health care professionals had the highest prevalence (26.9%) compared to infected cases and the public. Another type of trauma is called secondary or vicarious; it occurs when a person bears witness to suffering and death but remains powerless to change it; countless clinicians have experienced this over the past year. It manifests as emotional depletion, anxiety, insomnia, and impaired interpersonal relationships. How can clinicians heal from their exposure to the pandemic? Post-traumatic growth (PTG) is defined as positive psychological changes following trauma. PTG manifests in five areas: appreciation of life, relating to others, personal strength, recognizing new possibilities, and spiritual change. A transformation in the person’s world view and their place in it ensues. For health care professionals who are experiencing emotional distress, insomnia, or manifest PTSD symptoms they may heal by engaging in the six “Rs.” These are: relating, resourcing, repatterning, reprocessing, reflecting, and rituals. Both PTG and these six practices may contribute to Kintsugi Mind. While this appears to place the onus on individuals, it is crucial that leaders in the health care system implement programs enabling HCPs to be restored, rather than broken by this crisis.

Sex differences in the severity and natural recovery of child PTSD symptoms: a longitudinal analysis of children exposed to acute trauma

Background Higher levels of PTSD symptoms are present among trauma-exposed females v. males in adulthood; however, much less is known about the emergence of this sex difference during development. Methods In a multi-study sample of 7–18-year-olds (n = 3397), we examined the effect of sex and age on the severity of PTSD symptoms after a single incident trauma at 1 month (T1), and on symptom change after a natural recovery period of 3 (T2) and 6 months (T3). PTSD scores were harmonised across measurement types, and linear regressions were used to determine sex and age effects, adjusting for study level variance and trauma type. Results A sex × age interaction was observed at T1 (p < 0.001) demonstrating that older age was associated with greater PTSD symptom severity in females (β = 0.008, p = 0.047), but less severe symptoms in males (β = −0.011, p = 0.014). The same pattern was observed at T2 and T3, with sex differences beginning to emerge by age 12 years. PTSD symptoms decreased naturally by ~25% at T2 with little further improvement by T3. Further, females showed a greater reduction in symptoms at T3 than males, although the same effect was not observed at T2. Conclusions Sex differences in PTSD symptoms become apparent during adolescence, due to opposing changes in susceptibility occurring in females and males with age. Understanding the factors contributing to these findings is likely to provide wider insight into sex-specific psychological vulnerability to trauma-related psychopathology.

Longitudinal PTSD network structure: Measuring PTSD symptom networks over a five year period

Background: Network modeling has been applied in a range of trauma exposed samples, yet results are limited by an over reliance on cross-sectional data. The current analyses used posttraumatic stress disorder (PTSD) symptom data collected over a five-year period to estimate a more robust between-subject network and an associated symptom change network. Methods: A PTSD symptom network is measured in a sample of military veterans across four time points (Ns = 1254, 1231, 1106, 925). The repeated measures permits isolating between-subject associations by limiting effects of within-subject variability. The result is a highly reliable PTSD symptom network. A symptom slope network depicting covariation of symptom change over time is also estimated. Results: Negative trauma-related emotions had particularly strong associations with the network. Trauma-related amnesia, sleep disturbance, and self-destructive behavior had weaker overall associations with other PTSD symptoms. Conclusions: PTSD’s network structure appears stable over time. There is no single “most important” node or node cluster. The relevance of self-destructive behavior, sleep disturbance, and trauma-related amnesia to the PTSD construct may deserve additional consideration.

Quality of Life After Myocardial Infarction as a Function of Temperamental Traits, Stress Coping Styles, and Posttraumatic Stress Disorder Symptoms

The presented study aims to explore the relationship between quality of life after myocardial infarction and factors such as temperamental traits, stress coping, and posttraumatic stress disorder (PTSD) symptoms. Ninety-six participants, including 51 females and 45 males aged 24–85 years, who have survived ST-elevation myocardial infarction were asked to complete the Formal Characteristics of Behavior—Temperament Inventory, Coping Inventory for Stressful Situations, PTSD Inventory, and Quality of Life SF-36 questionnaire. According to the obtained results, a lower level of briskness and sensory sensitivity, as well as a higher level of perseverance and endurance, correlates with a higher level of emotion-oriented coping, whereas a higher level of perseverance, endurance, and activity correlates with a higher level of avoidant-distracted coping. Moreover, a higher level of briskness and activity is correlated with a higher level of avoidant-social coping. A higher level of emotion-oriented and avoidant-distracted coping is, in turn, associated with a higher intensity of PTSD symptoms, whereas a higher level of avoidant-social coping correlates with lower intensity of PTSD symptoms. Furthermore, a higher level of avoidant-distracted coping is correlated to a better physical quality of life, whereas higher levels of endurance and activity are associated with a better emotional quality of life. Also, the more severe the PTSD symptoms, the lower quality of life in general. Contrastingly, higher sensory sensitivity and briskness correlate with better quality of life. The meaning of other temperamental traits, however, is more ambiguous. Nevertheless, the findings support the model of psychological processes in which the subsequent stages are temperament, coping, PTSD, and quality of life.

Post-traumatic Stress Disorder Symptoms and Its Predictors Among Healthcare Workers Following COVID-19 Pandemic in Southern Ethiopia: A Cross-Sectional Study

Background: COVID-19 causes immense psychological pressure on communities in addition to physical misery. There is currently a scarcity of data on the psychological impact of the COVID-19 epidemic on Ethiopian healthcare workers (HCWs). Therefore, this study was aimed to assess the post-traumatic stress disorder (PTSD) symptoms and its predictors following COVID-19 pandemic among healthcare workers (HCWs) in southern Ethiopia.Methods: A hospital based cross-sectional study design was used among 387 randomly selected HCWs between September 25 and October 25, 2020 at four selected public hospitals in Sidama National Regional State, southern Ethiopia. Impact of Event Scale-Revised (IES-R) was used to collect data post-traumatic stress disorder (PTSD) symptoms. Logistic regression analyses with 95% CI were used to examine the relationship between independent and outcome variables.Result: The prevalence of PTSD symptoms was found in 56.8% of participants. Significant factors that increase risk of PTSD symptoms were being female (AOR = 1.91, 95% CI = 1.19, 3.05), married (AOR = 1.87, 95% CI = 1.12, 3.14) and nurses (AOR = 3.31, 95% CI = 1.66, 6.63). On the other hand, HCWs working other than emergency unit such as inpatients/wards (AOR = 0.43, 95% CI = 0.24, 0.75), OPD (AOR = 0.48, 95% CI = 0.24, 0.97) and other units (AOR = 0.49, 95% CI = 0.25, 0.96) less likely to be affected by PTSD symptoms.Conclusion: The current study showed high levels of PTSD symptoms as psychological challenges for HCWs. Sex, age, marital status, type of profession and working environment were significant factors for PTSD symptoms in HCWs during the pandemic. HCWs require mental health support during and after the pandemic.

Rumination, Posttraumatic Stress Disorder Symptoms, and Posttraumatic Growth Among Wenchuan Earthquake Adult Survivors: A Developmental Perspective

This study examined the long-term effects of the Wenchuan earthquake among adult survivors. Specifically, it explored the role of perceived social support (PSS) in the relationship between rumination and posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD) symptoms. Data were collected from March to July 2020 using a youth survivor sample (n = 476) of the 2008 Wenchuan earthquake. Participants were divided into three groups depending on their age when the quake occurred: 6–11 years (n = 227), 12–15 years (n = 83), 16–19 years (n = 166). The results indicated that long-term PTG and PTSD symptom levels varied by age group. Both intrusive and deliberate ruminations had a significant effect on PTG as well as PTSD symptoms. PSS played a mediating role between rumination and PTG, and the mediation mechanisms varied by age group (developmental stages). Moderated analyses revealed that PSS from significant others significantly buffered the indirect effect of rumination on PTSD symptoms. Our findings demonstrated the universal nature of traumatic events encountered during childhood and adolescence development and underscore the importance of examining the developmental context of PTG in investigations on traumatic experiences and their consequences.