Background The posttraumatic stress disorder (PTSD) Checklist for DSM-5 (PCL-5) is among few validated measures of PTSD severity in line with the DSM-5. Validation efforts among veteran samples have recommended cut scores of 33 and 38 to indicate PTSD; cut scores vary across populations depending on factors such as trauma type. The purpose of this study was to evaluate the diagnostic utility of and identify optimal cut scores for the PCL-5 in relation to the gold standard Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) among traumatically injured individuals 6 months after discharge from a level I trauma center. Methods A total of 251 participants completed the PCL-5 and CAPS-5 6 months after discharge from a level I trauma center following traumatic injury. Receiver operating characteristic curve analyses detailed diagnostic accuracy of the PCL-5 and identified the optimal cut score via Youden's J index. Cut scores were also broken down by intentional versus nonintentional injury. Results The PCL-5 produces satisfactory diagnostic accuracy, with adequate sensitivity and specificity, in a traumatically injured population. Estimates indicate the optimal cut score as >30; the optimal cut score for intentional injuries was >34 and >22 for nonintentional injuries. Conclusions This investigation provides support for the PCL-5 in detection of PTSD among injured individuals 6 months after discharge from a level I trauma center. PCL-5 specificity and sensitivity suggest clinicians working with this population can feel confident in using this measure over more onerous structured interviews (e.g., CAPS-5). This study signifies a move toward ensuring those experiencing mental health difficulties after traumatic injury are identified and connected to resources.

/pdf/detecting-ptsd-in-a-traumatically-injured-population-the-12tmpvrkf1.pdf

Detecting PTSD in a traumatically injured population: The diagnostic utility of the PTSD Checklist for DSM-5.

Background: There is growing evidence of the important role played by socio-interpersonal variables on the maintenance of PTSD. Many World War II survivors in Poland could, as a result of political...

https://www.tandfonline.com/doi/pdf/10.1080/20008198.2018.1423831

Posttraumatic stress symptoms among Polish World War II survivors: the role of social acknowledgement.

Background The research on the psychological consequences of World War II (WWII) trauma has predominantly focused on concentration camp and Holocaust survivors. Only a few studies have been undertaken among civilian survivors of WWII. Objectives The purpose of this study was to examine the association between perceived social acknowledgment of WWII trauma and the level of post-traumatic stress disorder (PTSD) and depressive symptoms among Polish survivors of WWII by employing a mixed-methods design (i.e., a quantitative analysis supported by qualitative interviews). Method In the quantitative part, 123 participants filled out: the list of WWII-related traumatic events, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), the shortened version of the Geriatric Depression Scale (GDS), and the Social Acknowledgment Questionnaire (SAQ). In the qualitative part, an interpretative phenomenological analysis (IPA) of participants' reminiscences of WWII was examined. Results Although we observed a direct positive association between the number of WWII-related traumatic events and the intensity of PTSD and depressive symptoms, these relationships changed when we entered the social acknowledgment construct into the model. Specifically, we found that perceived social acknowledgment (general disapproval) was a mediator of the relationship between the number of WWII traumatic events and the intensity of PTSD symptoms only, and not of depressive symptoms. In the qualitative part, three themes relating to traumatic reminiscences emerged among the participants: parental efficacy, parental betrayal, and support from the invader. Conclusion Our study showed the significance of the general social acknowledgment in the long-term mental consequences of the WWII trauma in Poland. In addition, the results of our study may be an adjunct to the discussion on the long-term impact of WWII trauma in Poland and the factors that hindered its social recognition.

/pdf/long-term-psychological-consequences-of-world-war-ii-trauma-1sj0fvy2kf.pdf

Long-Term Psychological Consequences of World War II Trauma Among Polish Survivors: A Mixed-Methods Study on the Role of Social Acknowledgment.

Objectives: Survivors of the Holocaust have reached an age during which it is common for them to look back on their lives. Previous research has shown that reminiscence can take on either adaptive ...

From fragments to identity: reminiscence, life review and well-being of holocaust survivors. An integrative review.

. We investigated the efficacy of reminiscence therapy (RT) on symptoms of depression in patients with mild to moderate dementia. Out of 227 patients with mild to moderate dementia from a specialized physician’s office, 27 pairs (N = 54; mean age 79.04 ± 6.16 years) who had either received treatment as usual (TAU) or TAU combined with RT, were matched retrospectively according to age as well as cognitive and depressive symptom scores. After controlling for age and sex, symptoms of depression significantly decreased over time in the RT group compared to TAU (F1,52 = 4.36; p < .05). RT is a promising option for the treatment of depression in mild to moderate dementia. Larger randomized-controlled trials are needed.

Reminiscence therapy for depression in dementia: An observational study with matched pairs.

Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25; Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, dwithin = 0.46-0.60, dbetween = 0.53-0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.

Effect of Life Review Therapy for Holocaust Survivors: A randomized controlled trial.

The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events. The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20–25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included). Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples. ISRCTN, ISRCTN12823306. Registered 31 March 2018 – Retrospectively registered (first participant 22 December 2017).

/pdf/life-review-therapy-for-holocaust-survivors-lrt-hs-study-3tmhrm80ao.pdf

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial.

https://www.zora.uzh.ch/id/eprint/97745/1/Forstmeier%20et%20al.%20Lebensru%CC%88ckblick%20Holocaust-U%CC%88berlebenden.pdf

Die Methode des therapeutischen Lebensrückblicks bei Holocaust-Überlebenden

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Effect of Life Review Therapy for Holocaust Survivors: A randomized controlled trial.

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial.

Die Methode des therapeutischen Lebensrückblicks bei Holocaust-Überlebenden