PURPOSE OF REVIEW: This paper highlights the topic of combat-related acute stress reactions (ASRs) in service members. Specifically, we contrast ASRs with related psychiatric conditions, report the estimated prevalence of ASRs for soldiers deployed to combat, and discuss how team members can effectively respond to these reactions. RECENT FINDINGS: Although not regarded as a clinical disorder, ASRs can have a significant impact on high-risk occupations like the military in which impaired functioning can imperil team members and others. Based on self-report, 17.2% of soldiers who have deployed to combat report having experienced a possible ASR. To our knowledge, this is the first such prevalence estimate. SUMMARY: The prevalence of ASRs underscores the need for improved prevention, management, and recovery strategies. Peer-based intervention protocols such as iCOVER may provide a useful starting point to address ASRs in team members.
Researchers and counsellors have observed a range of stress reactions in emergency service workers even after extreme and putatively traumatic incidents. Various studies have sought to delineate characteristics of incidents or of individuals which account for differences in appraisal and stress reactions. Few studies have examined expectations of stress and stressors in recruits to emergency work. Looks at such expectations in firefighter recruits, measured at the beginning and end of their training program, and compares their predictions with actual ratings from a group of experienced firefighters in the same organization. Most of the recruits already had some familiarity with the emergency environment. Stress ratings for items dealing with other people in the emergency work context increased over training. Discusses the relationships between predictions of stress, training, and task performance.
In this study we developed a scale to provide a tool for accurate assessment of acute stress response (ASR). We determined the dimensions and symptom clusters of ASR according to a review of the literature and through interviews with psychologists, and then compiled corresponding items, using these to compose the Acute Stress Response Scale (ASRS). We also investigated the construct validity, concurrent validity, test-retest reliability, and internal consistency reliability of this scale. The final version of the scale included 6 dimensions and 25 symptom clusters with comparatively satisfactory indices of validity and reliability, indicating that the ASRS can lay the foundation for the detection and objective and accurate assessment of ASR.
Background Relevance of the topic and the necessity for scientific investigation Robberies at the bank branches are potentially traumatic events. Many bank employees experiencing a robbery in their workplace suffer important negative consequences as numerous clinical symptoms of post-traumatic stress, worse physical health, impaired productivity and intention to leave their job, both immediately and up to six months after bank robbery. Despite decreasing in frequency, there is an ongoing risk in the bank branches: such events are difficult to predict, and primary intervention strategies may not completely eliminate the risk. Motives for choosing a particular topic Although bank robberies are potentially traumatic event, little is known about the psychological sequelae of those involved. Post-traumatic stress disorder (PTSD) literature has largely focused on victims of specific traumas, such as sexual violence, natural disaster, and military combat. PTSD in the occupational context is still under-investigated, and research mainly concerns specific occupational groups as emergency service personnel, police officers, firefighters, and health care workers. Studies concerning the psychological consequences of bank robberies are limited, mostly based on convenience samples, and vary in outcomes measures and design substantially, thus making comparisons difficult. Research problem and why it is worthwhile studying Since only a minority of subjects experiencing such event in the workplace develop long-term clinically important symptoms and functional impairment, understanding the antecedents of occupational PTSD is a key goal of research. A better understanding of risk factors associated to post-traumatic stress reactions may improve early treatment and preventive intervention, thus reducing PTSD onset and worsening of symptoms. Research objectives The study has three main objectives. The first aim is to evaluate the impact of bank robbery on employees psychological well-being, thus investigating post-traumatic stress reactions. The second one is to better understand risk factors associated to the onset of post-traumatic symptomatology. Consequently, the third aim is to inform the development of new interventions and risk management strategies. Research methodology Nine hundred twenty-four employees of a primary Italian bank group, victims of 238 different robberies, voluntarily joined an employer-sponsored post-robbery support program: - a structured and collective support interview (i.e. psychological debriefing) was conducted with robbery victims within 7-15 days after the event (T1) at the bank branch. A self-reported questionnaire collected socio-demographic information, number of bank robberies occurred during participants' working life, detailed description of the last robbery with closed and open-ended questions, assessment of post-traumatic stress reaction (Impact of Event Scale); - a follow-up psychological assessment (through structured individual interviews) was conducted 45 days after the first session (T2). Interview investigated victims' general health conditions and self-reported trajectory of post-traumatic symptoms after robbery, victims' evaluation of the intervention, assessment of post-traumatic stress reaction (Impact of Event Scale). To accomplish with our objectives, the following statistical analysis were adopted: - Absolute and relative frequencies or means and standard deviations, χ2 and one-way ANOVA for categorical or continuous variables respectively. - Logistic and linear multilevel regression to estimate the impact of predictive values on post-traumatic symptoms: random intercept mixed-effect regression models to account for subjects' clustering within robberies. Three hierarchical models were adopted (Model 1: pre-trauma risk factors; Model 2: peri-trauma risk factors; Model 3: subjective perception and reaction to robberies). - Residual pseudo-likelihood test (H0: σ 2 = 0) to assess the significance of unmeasured robbery- related factors; latent variable threshold model approach for the calculation of the variance partition coefficient. Results The final sample consisted in 595 subjects, victims of 238 different robberies. Correlates of early post-robbery reactions were age, being female, being cashier, geographical region, perception of robbers as out of control; after including feelings of fear, terror and hopelessness during the robbery, all the other variables lost statistical significance. IES scores decreased during the follow-up (∆T1-T2=15.76; p34, a cut-off suggestive of Post-traumatic stress disorder (PTSD). In the multivariable model, age, being female, being cashier, presence of arms, being injured, were associated with PTSD diagnosis. After including early subjective reaction, IES score at T1 was the strongest predictor. Unmeasured robbery-related factors explained a significant portion (24%) of IES variance at T1 after excluding small groups (number of colleagues <5). Limitations Possible selection bias due to the voluntary participation into the intervention program cannot be excluded. Information on non-occupational traumatic events occurred in subjects' life time and pre-existent psychiatric disorders, as well as perceived support after the event, could not be collected. Assessment of post-traumatic stress symptoms relied on self-report measure without a thorough clinical examination; thus, Impact of Event Scale did not include all criteria for Post-traumatic stress disorder stated by recent DSM-V. Originality of the study The study gives an original contribution to the existing literature of psychological sequelae following bank robbery: to date, this is the longitudinal study with the largest sample assessing prevalence and predictors of post-traumatic stress symptoms; logistic and linear multilevel regression provided a valuable understanding of risk factors; furthermore, no studies had previous investigated the role of group factor in the aftermath of post-traumatic reaction following bank robbery or acute stress at work. Conclusion/Practical implication Our findings showed that bank robbery is a potential traumatizing event associated with both immediate and long-term posttraumatic stress symptoms. Results suggested the weight of subjective variables, such as personal perception of robbery severity and early emotional reaction, in identifying persons at higher risk to develop PTSD. Our findings may help management and prevention of acute stress and trauma in the banking sector, contributing to post-traumatic stress literature. Finally, group factors, an often overlooked dimension in post-traumatic stress literature, might affect the risk of PTSD, thus encouraging further research.
In: Alcohol and alcoholism: the international journal of the Medical Council on Alcoholism (MCA) and the journal of the European Society for Biomedical Research on Alcoholism (ESBRA), Band 50, Heft 2, S. 213-218
Background: Female hormones fluctuate with the phases of menstrual cycle. Estrogen, which has attributes in cardio-protection, is secreted less during luteal phase. In post-ovulatory phase, days 1-2 before menstruation has minimal female hormone influence due to less secretion. Mental stress subjected at this phase might enhance sympathetic activation which in long run may precipitate cardiovascular diseases. Hence, to explore the autonomic activity to mental stress during this phase of menstrual cycle the study was undertaken.Methods: Thirty apparently healthy young postovulatory female medical students of B. P. Koirala Institute of Health Sciences, Nepal of age 19.93 (± 0.91) years with BMI of 20.70 kg/m2 (± 2.49) kg/m2 were recruited for the present study. Their short term heart rate variability (HRV) of 5 min was recorded during rest at sitting position. Then each subject was given a mental stress (nine questions selected from MENSA workout questionnaire) for 5 min. During the stress, HRV was recorded simultaneously. Data was statistically analyzed using Friedman test followed by multiple comparisons. The p<0.005 was considered statistically significant.Results: Mental stress significantly decreased RMSSD (p= 0.001), NN50 (p= 0.001) and PNN50 (p=0.001) in time domain and HF nu (p=0.012) in frequency domain parameters of HRV.Conclusions: Young healthy post ovulatory females responded to acute mental stress by withdrawing cardiac parasympathetic activity.Keywords: Female; HRV; mental stress
The concept of involuntary displacement inside the country is growing day by day. Globally, researchers have suggested that due to prolonged internal displacement the Internally Displaced Persons (IDPs) usually suffer from mental health issues. The current study was carried out with the purpose of investigating the psychosocial reactions of trauma in IDPs, who were subjected to displacement due to the military operation in the region, with no concurrent aim of diagnosing them with Post-traumatic Stress Disorder (PTSD). It was a cross-sectional study and 104 (M= 31.20, SD=9.32) IDPs were sampled for it. Post-traumatic Stress Diagnostic Scale (PDS) was administered on IDPs. The findings revealed that around 17% of them showed severe symptoms. The women were at more risk for PTSD as compared to men. Although no significant differences were found in both genders when it was about impairment in daily life functioning and both were equally affected. The satisfaction of life was decreased; too, on many symptoms results were significant. It was revealed that symptom severity decreased when the duration of displacement increased. The results were described according to cultural manifestation.
