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      Prevalence and prediction of PTSD and depression in mothers of children surviving a motor vehicle crash Translated title: Trastorno de estrés postraumático y trastorno depresivo mayor en madres de niños sobrevivientes de un accidente automovilístico Translated title: 车祸幸存儿童母亲的创伤后应激障碍和重性抑郁障碍

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          ABSTRACT

          Introduction: Few studies have examined the psychopathological consequences for parents of children who were survivors of a motor vehicle crash (MVC). This study assessed the impact of dissociation and peritraumatic distress on the severity of PTSD and post-traumatic major depressive episode (MDE) symptoms in mothers during the first years after the MVC and the role that cortisol response might play in this association.

          Methods: 125 mothers were included. Peritraumatic distress and dissociation were assessed. Morning salivary cortisol was tested at the baseline. Participants were assessed for a probable diagnosis of PTSD and MDE at 5 weeks, 6 months and 12 months.

          Results: At 5 weeks, 12 (13.6%) mothers exhibited probable PTSD. During the first year, the PCL score was higher when the (i) Peritraumatic Distress Inventory (PDI) score increased and (ii) the Peritraumatic Dissociation Experience Questionnaire (PDEQ) score increased. Cortisol levels were lower when the PDI score increased.

          Conclusion: This is the first study to assess the mothers of MVC survivors for one year following the trauma. We confirm that peritraumatic responses are useful for predicting the severity of PTSD symptoms. These results could encourage the implementation of follow-up programmes not only for survivors but also for their mothers.

          HIGHLIGHTS

          • Mothers of children involved in motor vehicle accident are at risk for developing PTSD.

          • Peritraumatic responses (distress and dissociation) are associated to the severity of PTSD symptoms.

          • Low salivary cortisol levels were associated with high peritraumatic distress.

          Translated abstract

          Antecedentes: Pocos estudios han examinado las consecuencias psicopatológicas para los padres de niños que fueron sobrevivientes de un accidente automovilístico (MVC, por sus siglas en inglés).

          Objetivo: Este estudio evaluó el impacto de la disociación y la angustia peritraumática en la gravedad del TEPT y los síntomas del episodio depresivo mayor (EDM) postraumático en las madres durante los primeros años después del MVC y el papel que podría desempeñar la respuesta del cortisol en esta asociación.

          Métodos: Se incluyeron 125 madres. Se evaluó la angustia peritraumática y la disociación. El cortisol salival matutino se analizó al inicio del estudio. Los participantes fueron evaluados para un diagnóstico probable de TEPT y EDM a las 5 semanas, 6 meses y 12 meses.

          Resultados: A las 5 semanas, 12 (13,6%) madres exhibieron TEPT probable. Durante el primer año, la puntuación PCL (lista de chequeo para TEPT) fue mayor cuando i) aumentó la puntuación del Inventario de angustia peritraumática (PDI, por sus siglas en inglés) y ii) aumentó la puntuación del Cuestionario de experiencias de disociación peritraumática (PDEQ, por sus siglas en inglés). Los niveles de cortisol fueron más bajos cuando aumentó la puntuación PDI.

          Conclusión: Este es el primer estudio que evalúa a las madres de sobrevivientes de MVC un año después del trauma. Confirmamos que las respuestas peritraumáticas son útiles para predecir la gravedad de los síntomas del TEPT. Estos resultados podrían incentivar la implementación de programas de seguimiento no solo para las sobrevivientes sino también para sus madres.

          Translated abstract

          背景: 很少有研究考查车祸 (MVC) 幸存者儿童父母的精神病理学结果。

          目的: 本研究评估了 MVC 后第一年母亲分离和创伤期精神痛苦对 PTSD 严重程度和创伤后重性抑郁发作 (MDE) 症状的影响,以及皮质醇反应在这种关联中可能的作用。

          方法: 纳入了 125 名母亲。评估了创伤期精神痛苦和分离。在基线检测了早晨唾液皮质醇。在第 5 周、第 6 个月和第 12 个月时,对参与者进行了可能的 PTSD 和 MDE 诊断评估。

          结果: 在 5 周时,12 名 (13.6%) 母亲表现出可能的 PTSD。在第一年,当 i) 创伤期精神痛苦量表 (PDI) 得分增加和 ii) 创伤期分离经历问卷 (PDEQ) 得分增加时,PCL 得分较高。当 PDI 评分增加时,皮质醇水平较低。

          结论: 这是第一项评估 MVC 幸存者母亲在创伤后一年内的研究。我们确认创伤期反应有助于预测 PTSD 症状的严重程度。这些结果可以促进对于不仅幸存者且对其母亲随访计划的实施。

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          Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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              Recognition that inflammation may represent a common mechanism of disease has been extended to include neuropsychiatric disorders including major depression. Patients with major depression have been found to exhibit increased peripheral blood inflammatory biomarkers, including inflammatory cytokines, which have been shown to access the brain and interact with virtually every pathophysiologic domain known to be involved in depression, including neurotransmitter metabolism, neuroendocrine function, and neural plasticity. Indeed, activation of inflammatory pathways within the brain is believed to contribute to a confluence of decreased neurotrophic support and altered glutamate release/reuptake, as well as oxidative stress, leading to excitotoxicity and loss of glial elements, consistent with neuropathologic findings that characterize depressive disorders. Further instantiating the link between inflammation and depression are data demonstrating that psychosocial stress, a well-known precipitant of mood disorders, is capable of stimulating inflammatory signaling molecules, including nuclear factor kappa B, in part, through activation of sympathetic nervous system outflow pathways. Interestingly, depressed patients with increased inflammatory biomarkers have been found to be more likely to exhibit treatment resistance, and in several studies, antidepressant therapy has been associated with decreased inflammatory responses. Finally, preliminary data from patients with inflammatory disorders, as well as medically healthy depressed patients, suggest that inhibiting proinflammatory cytokines or their signaling pathways may improve depressed mood and increase treatment response to conventional antidepressant medication. Translational implications of these findings include the unique opportunity to identify relevant patient populations, apply immune-targeted therapies, and monitor therapeutic efficacy at the level of the immune system in addition to behavior.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                27 September 2022
                2022
                27 September 2022
                : 13
                : 2
                : 2121014
                Affiliations
                [a ]Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hopital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS , Toulouse, France
                [b ]UMR1027, Université Toulouse III, Inserm , Toulouse, France
                [c ]Département d’Epidemiologie, CHU Toulouse , Toulouse, France
                [d ]Département des Urgences Pédiatriques, CHU Toulouse , Toulouse, France
                [e ]Département de chirurgie orthopédique, Hopital des enfants, CHU Toulouse , Toulouse, France
                [f ]Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS , Toulouse, France
                [g ]Université de Caen Normandie et CHU Caen , Caen, France
                [h ]Massachusetts General Hospital , Boston
                Author notes
                [CONTACT ] Antoine Yrondi antoineyrondi@ 123456gmail.com Antoine Yrondi, 330 de Grande Bretagne, CHU Toulouse Purpan, Bâtiment de psychiatrie , 31000, Toulouse, France
                Author information
                https://orcid.org/0000-0002-2650-6080
                Article
                2121014
                10.1080/20008066.2022.2121014
                9543172
                6a8bb501-72c7-4301-987f-62fbd970517f
                © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 6, Equations: 0, References: 79, Pages: 13
                Categories
                Clinical Research Article
                Research Article

                Clinical Psychology & Psychiatry
                motor vehicle crash,peritraumatic,cortisol,mothers,ptsd,accidente automovilístico,peritraumático,madres,tept,车祸,创伤期,皮质醇,母亲

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