Cezar Giosan

High-K Strategy Scale: A Measure of the High-K Independent Criterion of Fitness

The present study aimed at testing whether factors documented in the literature as being indicators of a high-K reproductive strategy have effects on fitness in extant humans. A 26-item High-K Strategy Scale comprising these factors was developed and tested on 250 respondents. Items tapping into health and attractiveness, upward mobility, social capital and risks consideration, were included in the scale. As expected, the scale showed a significant correlation with perceived offspring quality and a weak, but significant association with actual number of children. The scale had a high reliability coefficient (Cronbachs Alpha = .92). Expected correlations were found between the scale and number of medical diagnoses, education, perceived social support, and number of previous marriages, strengthening the scales construct validity. Implications of the results are discussed.

Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the world trade center following the attacks of September 11, 2001.

Background: Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The goal of this study was to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11. Methods: Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self‐report measures. PTSD symptoms were assessed by the CAPS and the PCL; co‐morbid disorders were also assessed. 2,960 individuals with complete CAPS and PCL data were included in the analyses. Results: Eight percent of participants had symptoms consistent with full PTSD, 9.3% with subthreshold PTSD, 6% with MDD, 3.5% with GAD, and 2.5% with panic disorder. Although risk factors included psychiatric and trauma history, 51% of individuals with probable PTSD had neither; subjective perception of threat to ones life was the best predictor of probable PTSD. Extent of exposure predicted 89% of PTSD cases in those without a psychiatric or trauma history, but only 67% of cases among those with both. Conclusions: Nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers. Depression and Anxiety 28:210–217, 2011.  © 2010 Wiley‐Liss, Inc.

The application of virtual reality to the treatment of PTSD following the WTC attack

Abstract:  Recent research suggests that virtual reality (VR) enhanced exposure therapy may enhance the efficacy of treatment through increasing patient engagement in the exposure. This study evaluated the use of VR in the treatment of PTSD following the WTC attack of September 11, 2001. Individuals in a 14 session VR‐enhanced treatment (n=9) were compared to a waitlist (WL) control group (n=8). ANOVA showed a significant interaction of time by group (p<.01) with a large effect size of 1.53. The VR group showed significantly greater post‐treatment decline in CAPS scores compared to the WL. Our preliminary data suggests that VR is an effective tool for enhancing exposure therapy for both civilians and disaster workers who suffer from PTSD.

The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th

This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed.

The Lay Concept of ‘Mental Disorder’: A Cross-Cultural Study:

Lay concepts of ‘mental disorder’ were investigated in three countries (U.S.A., Romania and Brazil). Participants judged whether a sample of conditions – some falling inside and some outside the borders defined by DSM-IV – were mental disorders, and rated them on features invoked in professional understandings of ‘mental disorder.’ The concept of mental disorder was considerably more inclusive and convergent with the DSM-IV in the American sample than in the Brazilian sample, and disorder judgments showed only moderate agreement across cultures. Several features of the concept were culturally distinctive, amounting to a more ‘internalist’ or intrapsychic understanding in the American sample.

Numbing symptoms as predictors of unremitting posttraumatic stress disorder

This prospective longitudinal study examined the ability of re-experiencing, avoidance, numbing, and hyperarousal symptoms to predict persistence of posttraumatic stress disorder (PTSD) in disaster workers followed for 2 years. Cluster analyses suggested that overall severity was the best predictor of PTSD at follow up, but for groups with PTSD of moderate severity, numbing symptoms were also associated with PTSD at the 2-year follow up. Regression analyses with all four symptom groups as independent variables found that only numbing and re-experiencing symptoms predicted PTSD at the 1 year follow up, and only numbing symptoms predicted PTSD at the 2-year follow up. Findings suggest that numbing symptom severity could be used as a risk index of very chronic PTSD, especially when the overall PTSD severity falls in the moderate range.

Anger and Posttraumatic Stress Disorder in Disaster Relief Workers Exposed to the September 11, 2001 World Trade Center Disaster : One-Year Follow-Up Study

Although anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 (Evans et al., 2006) indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a 1-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.

Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers

The present study examined the relationships between memories for a single incident traumatic event - the 9/11 attack on the World Trade Center (WTC)--and posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that, of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.

Disability and posttraumatic stress disorder in disaster relief workers responding to september 11, 2001 World Trade Center Disaster

Empirical evidence suggests that social and occupational disability plays a significant role in posttraumatic stress disorder (PTSD). The purpose of this study was to assess the role of social/occupational disability and to identify predictors of the development of PTSD in a group of disaster relief workers (DRWs) who had been deployed to the World Trade Center (WTC) following September 11, 2001. Eight hundred forty-two utility workers completed a battery of comprehensive tests measuring PTSD and social occupational functioning. Results indicated a significant association between PTSD symptoms and impaired social/occupational functioning. Symptomatic workers were also more likely to have a history of trauma, panic disorder, and depression. Those with a history of trauma, depression, generalized anxiety disorder or panic reported significantly more disability than those without a psychiatric history. Careful screening of PTSD and social/occupational functioning in DRWs following a disaster is warranted so that early treatment can be undertaken to prevent a chronic and disabling course.

Internet‐Based Psychotherapy for Adult Depression: What About the Mechanisms of Change?

INTRODUCTION Internet-based cognitive behavioral therapy for depression (iCBT) has been advanced as a valuable alternative treatment option, generating promising results. However, little is known about its underlying mechanisms of change. OBJECTIVE We aimed to provide an overview of the state of the art regarding the mechanisms of iCBT for adult depression, in the context of iCBT efficacy. METHOD We conducted a systematic qualitative review of 37 randomized clinical trials, assessed the risk of bias in the included studies, and used a systematic evaluative framework to establish the scientific status of iCBT, based on evidence regarding clinical efficacy and mechanisms of change. RESULTS Findings indicated that iCBT mechanisms of change are clearly underinvestigated, although iCBT is relatively efficacious, at least in the short term. The quality of iCBT randomized clinical trials proved to be suboptimal. CONCLUSIONS The iCBT theory should be clearly specified and adequately investigated to design and implement highly efficacious therapeutic packages. Without considering the iCBT mechanisms of change along with iCBT efficacy, the extent to which iCBT is an empirically validated treatment remains questionable.