Psychiatry - Research Publications
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ItemPredicting posttraumatic stress disorder symptoms and pain intensity following severe injury: the role of catastrophizing(TAYLOR & FRANCIS LTD, 2011)BACKGROUND: A number of theories have proposed possible mechanisms that may explain the high rates of comorbidity between posttraumatic stress disorder (PTSD) and persistent pain; however, there has been limited research investigating these factors. OBJECTIVE: The present study sought to prospectively examine whether catastrophizing predicted the development of PTSD symptoms and persistent pain following physical injury. DESIGN: Participants (N=208) completed measures of PTSD symptomatology, pain intensity and catastrophizing during hospitalization following severe injury, and 3 and 12 months postinjury. Cross-lagged path analysis explored the longitudinal relationship between these variables. RESULTS: Acute catastrophizing significantly predicted PTSD symptoms but not pain intensity 3 months postinjury. In turn, 3-month catastrophizing predicted pain intensity, but not PTSD symptoms 12 months postinjury. Indirect relations were also found between acute catastrophizing and 12-month PTSD symptoms and pain intensity. Relations were mediated via 3-month PTSD symptoms and 3-month catastrophizing, respectively. Acute symptoms did not predict 3-month catastrophizing and catastrophizing did not fully account for the relationship between PTSD symptoms and pain intensity. CONCLUSIONS: Findings partially support theories that propose a role for catastrophizing processes in understanding vulnerability to pain and posttrauma symptomatology and, thus, a possible mechanism for comorbidity between these conditions.
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ItemOlfactory identification dysfunction, aggression and impulsivity in war veterans with post-traumatic stress disorder(CAMBRIDGE UNIV PRESS, 2008-04)BACKGROUND: Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population. METHOD: Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity. RESULTS: War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety, depression and alcohol misuse, and were significant predictors of aggression and impulsivity. CONCLUSIONS: This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.
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ItemA multi-level framework to guide mental health response following a natural disaster(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2012)
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ItemThe Relationship Between Deployment and Turnover in Australian Navy Personnel(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2009)
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ItemThe latent structure of the Peritraumatic Dissociative Experiences Questionnaire.(Wiley, 2009-04)This paper has been retracted due to a publisher's error: the order of the authors was incorrect. The Editor and Publisher of the Journal of Traumatic Stress apologize to the authors and our readership. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven individuals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.
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ItemDistant Memories: A Prospective Study of Vantage Point of Trauma Memories(SAGE PUBLICATIONS INC, 2009-09)Adopting an observer perspective to recall trauma memories may function as a form of avoidance that maintains posttraumatic stress disorder (PTSD). We conducted a prospective study to analyze the relationship between memory vantage point and PTSD symptoms. Participants (N= 947) identified the vantage point of their trauma memory and reported PTSD symptoms within 4 weeks of the trauma; 730 participants repeated this process 12 months later. Initially recalling the trauma from an observer vantage point was related to more severe PTSD symptoms at that time and 12 months later. Shifting from a field to an observer perspective a year after trauma was associated with greater PTSD severity at 12 months. These results suggest that remembering trauma from an observer vantage point is related to both immediate and ongoing PTSD symptoms.
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ItemPrior Trauma and Psychiatric History as Risk Factors for Intentional and Unintentional Injury in Australia(LIPPINCOTT WILLIAMS & WILKINS, 2009-02)BACKGROUND: Preliminary evidence suggests that injury survivors are at increased risk for having experienced traumatic events before their injury or having a lifetime psychiatric history. We aimed to extend the previous research by examining in the same sample whether trauma history or lifetime psychiatric history represented risk pathways to injury for intentional or unintentional injury survivors. We also aimed to describe the co-occurrence between trauma history and psychiatric history in unintentionally injured survivors. METHODS: In this multisited study, randomly selected injury survivors admitted to five trauma services in three states of Australia (April 2004 to February 2006) completed two structured clinical interviews that assessed their history of traumatic life events and lifetime psychiatric disorder (n = 1,167). chi analyses were conducted to compare the lifetime prevalence of traumatic events and psychiatric history for intentional and unintentional injury with population norms. RESULTS: Both intentional and unintentional injury survivors were at increased risk for reporting all types of trauma and reporting all measured psychiatric diagnoses compared with population norms. The majority of unintentional injury survivors with a psychiatric history were likely to have a trauma history. CONCLUSIONS: In this study, we identified that prior trauma or prior psychiatric illness may represent risk for injury in both intentionally and unintentionally injured survivors. The results highlight the need for injury-care services to address mental health issues in injury patients as part of routine care.
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ItemPost-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury(CAMBRIDGE UNIV PRESS, 2009-11)The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for PTSD 3 months later (N = 920). At the follow-up assessment, 90 (9.4%) patients met criteria for PTSD (MTBI: 50, 11.8%; No-TBI: 40, 7.5%); MTBI patients were more likely to develop PTSD than no-TBI patients, after controlling for injury severity (adjusted odds ratio: 1.86; 95% confidence interval, 1.78-2.94). Longer post-traumatic amnesia was associated with less severe intrusive memories at the acute assessment. These findings indicate that PTSD may be more likely following MTBI, however, longer post-traumatic amnesia appears to be protective against selected re-experiencing symptoms.
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ItemThe role of post-traumatic stress disorder and depression in predicting disability after injury(AUSTRALASIAN MED PUBL CO LTD, 2009-04-06)OBJECTIVES: To examine the relationship between psychological response to injury at 1 week and 3 months, and disability at 12 months. DESIGN: Multisite, longitudinal study. PARTICIPANTS AND SETTING: 802 adult patients admitted to trauma services at four Australian hospitals from 13 March 2004 to 21 February 2006 were assessed before discharge and followed up at 3 and 12 months. MAIN OUTCOME MEASURE: Disability, measured with the 12-item version of the World Health Organization Disability Assessment Schedule II. RESULTS: Logistic regression identified the degree to which high levels of depression and post-traumatic stress disorder (PTSD) at 1 week and at 3 months predicted disability at 12 months. After controlling for demographic variables and characteristics of the injury, patients with PTSD or subsyndromal PTSD at 1 week were 2.4 times more likely, and those with depression at 1 week were 1.9 times more likely to have high disability levels at 12 months. PTSD at 3 months was associated with 3.7 times, and depression at 3 months with 3.4 times the risk of high disability at 12 months. CONCLUSIONS: PTSD and depression at 1 week and at 3 months after injury significantly increased the risk of disability at 12 months. Routine assessment of symptoms of depression and PTSD in patients who have been physically injured may facilitate triage to evidence-based treatments, leading to improvement in both physical and psychological outcomes.
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ItemEarly Stage Assessment and Course of Acute Stress Disorder After Mild Traumatic Brain Injury(LIPPINCOTT WILLIAMS & WILKINS, 2009-03)Although it has been established that acute stress disorder (ASD) and posttraumatic stress disorder occur after mild traumatic brain injury (MTBI) the qualitative differences in symptom presentation between injury survivors with and without a MTBI have not been explored in depth. This study aimed to compare the ASD and posttraumatic stress disorder symptom presentation of injury survivors with and without MTBI. One thousand one hundred sixteen participants between the ages of 17 to 65 years (mean age: 38.97 years, SD: 14.23) were assessed in the acute hospital after a traumatic injury. Four hundred seventy-five individuals met the criteria for MTBI. Results showed a trend toward higher levels of ASD in the MTBI group compared with the non-MTBI group. Those with a MTBI and ASD had longer hospital admissions and higher levels of distress associated with their symptoms. Although many of the ASD symptoms that the MTBI group scored significantly higher were also part of a postconcussive syndrome, higher levels of avoidance symptoms may suggest that this group is at risk for longer term poor psychological adjustment. Mild TBI patients may represent a injury group at risk for poor psychological adjustment after traumatic injury.