ACPMH articles 1994 to 2011
ACPMH Publications
Please note, in this list of publications, the ACPMH authors have been emphasised.
In Press
Forbes, D., Elhai, J. D., Lockwood, E., Creamer, M., Frueh, B. C., & Magruder, K. M. (2011 In press). The structure of posttraumatic psychopathology in veterans attending primary care. Journal of Anxiety Disorders. doi: 10.1016/j.janxdis.2011.09.004
Forbes, D., Fletcher, S., Parslow, P., Phelps, A. J., O’Donnell, M., Creamer, M., et al. (2011 In press). Trauma at the hands of another: Differences in the PTSD symptom profile following interpersonal compared with non-interpersonal trauma. Journal of Clinical Psychiatry.
Gleeson, J. F. M., Cotton, S. M., Alvarez-Jimenez, M., Wade, D., Gee, D., Crisp, K., ... McGorry, P. (2011 In press). A randomized controlled trial of relapse prevention therapy for first-episode psychosis patients: Outcome at 30-months follow up. Schizophrenia Bulletin.
McHugh, T., Forbes, D., Bates, G., Hopwood, M., & Creamer, M. (2011 In press). Anger in PTSD: Is there a need for a concept of PTSD-related posttraumatic anger? Clinical Psychology Review.
O’Donnell, M., Lau, W., Tipping, S., Holmes, A., Ellen, S., Judson, R., et al. (2011 In press). Stepped early psychological intervention for posttraumatic stress disorder, other anxiety disorders and depression and following serious injury. Journal of Traumatic Stress.
Varker, T., & Devilly, G. J. (2011 In press). Proof of concept: An analogue trial of inoculation/resilience training for emergency services personnel. Journal of Anxiety Disorders.
Wade, D., Varker, T., O’Donnell, M., & Forbes, D. (2011 In press). Examination of the latent factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in two independent trauma patient groups using Confirmatory Factor Analysis. Journal of Substance Abuse Treatment.
2011
Bryant, R. A., Brooks, R., Silove, D., Creamer, M., O’Donnell, M., & McFarlane, A. C. (2011). Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder. Behaviour Research and Therapy, 346-351. doi:10.1016/j.brat.2011.03.003
Click to read abstract
Although peritraumatic dissociation predicts subsequent posttraumatic stress disorder (PTSD), little is understood about the mechanism of this relationship. This study examines the role of panic during trauma in the relationship between peritraumatic dissociation and subsequent PTSD. Randomized eligible admissions to 4 major trauma hospitals across Australia (n = 244) were assessed during hospital admission and within one month of trauma exposure for panic, peritraumatic dissociation and PTSD symptoms, and subsequently re-assessed for PTSD three months after the initial assessment (n = 208). Twenty (9.6%) patients met criteria for PTSD at 3-months post injury. Structural equation modeling supported the proposition that peritraumatic derealization (a subset of dissociation) mediated the effect of panic reactions during trauma and subsequent PTSD symptoms. The mediation model indicated that panic reactions are linked to severity of subsequent PTSD via derealization, indicating a significant indirect relationship. Whereas peritraumatic derealization is associated with chronic PTSD symptoms, this relationship is influenced by initial acute panic responses.
Bryant, R. A., Creamer, M., O’Donnell, M., Silove, D., & McFarlane, A. C. (2011). Heart rate after trauma and the specificity of fear circuitry disorders. Psychological Medicine, 41, 2573-2580. doi:10.1017/S0033291711000948
Click to read abstract
Background: Fear circuitry disorders purportedly include post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia and specific phobia. It is proposed that these disorders represent a cluster of anxiety disorders triggered by stressful events and lead to fear conditioning. Elevated heart rate (HR) at the time of an aversive event may reflect strength of the unconditioned response, which may contribute to fear circuitry disorders. Method: This prospective cohort study assessed HR within 48 h of hospital admission in 602 traumatically injured patients, who were assessed during hospital admission and within 1 month of trauma exposure for lifetime psychiatric diagnosis. At 3 months after the initial assessment, 526 patients (87%) were reassessed for PTSD, major depressive disorder, panic disorder, agoraphobia, social phobia, obsessive compulsive disorder and generalized anxiety disorder. Results. At the 3-month assessment there were 77 (15%) new cases of fear circuitry disorder and 87 new cases of non-fear circuitry disorder (17%). After controlling for gender, age, type of injury and injury severity, patients with elevated HR (defined as o96 beats per min) at the time of injury were more likely to develop PTSD [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.32–14.43], panic disorder (OR 3.46, 95% CI 1.16–10.34), agoraphobia (OR 3.90, 95% CI 1.76–8.61) and social phobia (OR 3.98, 95% CI 1.42–11.14). Elevated HR also predicted new fear circuitry disorders that were not co-morbid with a non-fear circuitry disorder (OR 7.28, 95% CI 2.14–24.79). Conclusions: These data provide tentative evidence of a common mechanism underpinning the onset of fear circuitry disorders.
Bryant, R. A., Felmingham, K. L., Silove, D., Creamer, M., O’Donnell, M., & McFarlane, A. C. (2011). The association between menstrual cycle and traumatic memories. Journal of Affective Disorders, 131, 398-401. doi:10.1016/j.jad.2010.10.049
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Background: Women in the mid-luteal phase of the menstrual cycle have been shown to have stronger emotional memories than other women. We investigated the extent to which experiencing a traumatic event during the luteal phase of the menstrual cycle is associated with stronger traumatic flashback memories. Methods: Consecutive female patients admitted to hospital after traumatic injury (n = 138) were assessed for days since last menstruation, as well as assessment of flashbacks. Twenty three (17%) women were in the mid-luteal phase (18-24) days at the time of trauma exposure and 29 (21%) were in the mid-luteal phase at the time of assessment. Results: Women were more likely to experience flashback memories if they were in the luteal phase during the trauma (22% vs. 9%), adjusted OR: 3.64 [95%CI: 0.99-13.29] after controlling for injury severity, age, trauma type, and mild traumatic brain injury. Women in the luteal phase at assessment were 4.89 times more likely to have flashbacks. Adjusted OR: 4.89 [95%CI: 1.39-17.86]. Conclusions: Increased glucocorticoid release associated with the luteal phase of the menstrual cycle may facilitate consolidation of trauma memories.
Carty, J., O’Donnell, M., Evans, L., Kazantzis, N., & Creamer, M. (2011). Predicting posttraumatic stress disorder symptoms and pain intensity following severe injury: The role of catastrophizing. European Journal of Pscyhotraumatology, 2. Advanced online publication. doi:10.3402/ejpt.v2i0.5652
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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.
Couineau, A.-L. & Forbes, D. (2011). Using predictive models of behaviour change to promote evidence-based treatment for PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 266-275. doi: 10.1037/a0024980
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While there is a strong evidence base regarding effective treatment of Posttraumatic Stress Disorder (PTSD), and an increased number of treatment guidelines available internationally, research indicates that there is significant variation in clinical practice. This study aimed to identify effective ways to promote adoption of trauma-focused interventions in community services offering mental health care to people who have experienced trauma. The study sought to do so by identifying factors influencing the uptake of evidence-based practice at both an individual and organizational level, and trialing competency training and support strategies based on these factors across 6 community trauma services. The effectiveness of the training and support strategies was investigated using self-report surveys and prospective recording of clinicians’ treatment planning for PTSD clients. The study found that while lack of skills and confidence were identified as significant barriers to the uptake of trauma-focused interventions, expectations about treatment outcomes and organizational factors also influenced clinical behavior. This finding highlighted the importance of considering factors other than knowledge and skills when developing training and other interventions to support the implementation of evidence-based practice. Furthermore, it was found that a training and implementation process tailored to organizational and individual barriers, and based on currently recognized theories of behavior change, led to a significant increase in the use of imaginal exposure in the treatment plans of clients assessed as having PTSD. This change was maintained 6 months following training.
Creamer, M., Wade, D., Fletcher, S., & Forbes, D. (2011). PTSD among military personnel. International Review of Psychiatry, 23, 160-165. doi:10.3109/09540261.2011.559456
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Although symptoms characteristic of post-traumatic stress disorder (PTSD) have been noted in military personnel for many centuries, it was not until 1980 that the disorder was formally recognized and became the focus of legitimate study. This paper reviews our current state of knowledge regarding the prevalence and course of this complex condition in past and present members of the defence forces. Although rates vary across conflicts and countries, there is no doubt that PTSD affects substantial numbers of personnel and results in considerable impairment in functioning and quality of life. The paper goes on to discuss recent attempts to build resilience and to promote adjustment following deployment, noting that there is little evidence at this stage upon which to draw firm conclusions. Finally, effective treatment for PTSD is reviewed, with particular reference to the challenges posed by this population in a treatment setting.
Elhai, J. D., Contractor, A. A., Palmieri, P. A., Forbes, D., & Richardson, J. D. (2011). Exploring the relationship between underlying dimensions of posttraumatic stress disorder and depression in a national trauma exposed military sample. Journal of Affective Disorders, 133, 477-480. doi:10.1016/j.jad.2011.04.035
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Background: Posttraumatic stress disorder (PTSD) and depression are highly comorbid and intercorrelated. Yet little research has examined the underlying processes explaining their interrelationship. Method: In the present survey study, the investigators assessed the combined symptom structure of PTSD and depression symptoms, to examine shared, underlying psychopathological processes. Participants included 740 Canadian military veterans from a national, epidemiological survey, previously deployed on peacekeeping missions and administered the PTSD Checklist and Center for Epidemiological Studies-Depression Scale (CES-D). Results: An eight-factor PTSD/depression model fit adequately. In analyses validating the structure, PTSD's dysphoria factor was more related to depressive affect than to several other PTSD and depression factors. Somatic problems were more related to dysphoria than to other PTSD factors. Limitations: Only military veterans were sampled, and without the use of structured diagnostic interviews. Conclusions: Results highlight a set of interrelationships that PTSD's dysphoria factor shares with specific depression factors, shedding light on the underlying psychopathology of PTSD that emphasizes dysphoric mood.
Elhai, J. D., Naifeh, J. A., Forbes, D., Ractliffe, K., C., & Tamburrino, M. (2011). Heterogeneity in posttraumatic stress disorder’s clinical presentations among medical patients: Testing factor structure variation using factor mixture modeling. Journal of Traumatic Stress, 24, 435-443. doi:10.1002/jts.20653
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The present study used factor mixture modeling to explore empirically defined subgroups of psychological trauma victims based on confirmatory factor analysis (CFA) and latent class analysis of posttraumatic stress disorder (PTSD) symptoms. We sampled 310 medical patients with a history of trauma exposure. Confirmatory factor analysis revealed that the 4-factor emotional numbing PTSD model yielded the best model fit. Using latent factor means derived from this model and the 4-factor dysphoria PTSD model (indexing severity on PTSD factors), 3 latent classes of participants were identified using factor mixture modeling. The 3-class model fit the data very well and was validated against external measures of anxiety and rumination.
Forbes, D. & Creamer, M. (2011). Psychological support and treatment for victims of the floods. InPsych: The Bulletin of the Australian Psychological Society Ltd, February, 24-25. Retrieved from http://www.psychology.org.au/publications/inpsych/2011/feb/forbes/
Click to read abstract
The floods across the Eastern States, particularly in areas such as Toowoomba and the Lockyer Valley in Queensland–with their heavy toll on life and property–will leave thousands deeply affected. The extent of devastation has been such that, for many, it will be a long time before lives return to normal. Lessons from the Black Saturday Victorian bushfires and the 1974 floods indicate that re-establishing a sense of normality and rebuilding after such events can continue for years afterward. For those who lost loved ones, the experience of traumatic grief will have an additional major impact on their lives. The loss of homes and communities, and the security that they provide, will make the recovery process longer and more difficult. How organisations and health services support those affected by the floods may have a lasting impact on individuals’ ability to cope. While much attention in the early stages will focus on broad community interventions designed to enhance cohesion and support, there is also an important place for individual assistance.
Forbes, D., Fletcher, S., Lockwood, E., O’Donnell, M., Creamer, M., Bryant, R. A. . . . Silove, D. (2011). Requiring both avoidance and emotional numbing in DSM-V PTSD: Will it help? Journal of Affective Disorders, 130, 483-486. doi:10.1016/j/jad.2010.10.032
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Objective: The proposed DSM-V criteria for posttraumatic stress disorder (PTSD) specifically require both active avoidance and emotional numbing symptoms for a diagnosis. In DSM-IV, since both are included in the same cluster, active avoidance is not essential. Numbing symptoms overlap with depression, which may result in spurious comorbidity or overdiagnosis of PTSD. This paper investigated the impact of requiring both active avoidance and emotional numbing on the rates of PTSD diagnosis and comorbidity with depression. Method: We investigated PTSD and depression in 835 traumatic injury survivors at 3 and 12months post-injury. We used the DSM-IV criteria but explored the potential impact of DSM-IV and DSM-V approaches to avoidance and numbing using comparison of proportion analyses. Results: The DSM-V requirement of both active avoidance and emotional numbing resulted in significant reductions in PTSD caseness compared with DSM-IV of 22% and 26% respectively at 3 and 12months posttrauma. By 12months, the rates of comorbid PTSD in those with depression were significantly lower (44% vs. 34%) using the new criteria, primarily due to the lack of avoidance symptoms. Conclusion: These preliminary data suggest that requiring both active avoidance and numbing as separate clusters offers a useful refinement of the PTSD diagnosis. Requiring active avoidance may help to define the unique aspects of PTSD and reduce spurious diagnoses of PTSD in those with depression.
Forbes, D., Lewis, V., Varker, T., Phelps, A., O’Donnell, M., Wade, D., ... Creamer, M. (2011). Psychological first aid following trauma: Implementation and evaluation framework for high-risk organizations. Psychiatry: interpersonal and biological processes.74, 224-239. doi:10.1521/psyc.2011.74.3.224
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International clinical practice guidelines for the management of psychological trauma recommend Psychological First Aid (PFA) as an early intervention for survivors of potentially traumatic events. These recommendations are consensus-based, and there is little published evidence assessing the effectiveness of PFA. This is not surprising given the nature of the intervention and the complicating factors involved in any evaluation of PFA. There is, nevertheless, an urgent need for stronger evidence evaluating its effectiveness. The current paper posits that the implementation and evaluation of PFA within high risk organizational settings is an ideal place to start. The paper provides a framework for a phasic approach to implementing PFA within such settings and presents a model for evaluating its effectiveness using a logic- or theory-based approach which considers both pre-event and post-event factors. Phases 1 and 2 of the PFA model are pre-event actions, and phases 3 and 4 are post-event actions. It is hoped that by using the Phased PFA model and evaluation method proposed in this paper, future researchers will begin to undertake the important task of building the evidence about the most effective approach to providing PFA in high risk organizational and community disaster settings.
Forbes, D., Lockwood, E., Elhai, J. D., Creamer, M., O’Donnell, M., Bryant, R.A.,. . . Silove, D. (2011). An examination of the structure of posttraumatic stress disorder in relation to the anxiety and depressive disorders. Journal of Affective Disorders, 132, 165-172. doi:10.1016/j.jad.2011.02.011.
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The nature and structure of posttraumatic stress disorder (PTSD) has been the subject of much interest in recent times. This research has been represented by two streams, the first representing a substantive body of work which focuses specifically on the factor structure of PTSD and the second exploring PTSD's relationship with other mood and anxiety disorders. The present study attempted to bring these two streams together by examining structural models of PTSD and their relationship with dimensions underlying other mood and anxiety disorders. PTSD, anxiety and mood disorder data from 989 injury survivors interviewed 3-months following their injury were analyzed using a series of confirmatory factor analyses (CFA) to identify the optimal structural model. CFA analyses indicated that the best fitting model included PTSD's re-experiencing (B1–5), active avoidance (C1–2), and hypervigilance and startle (D4–5) loading onto a Fear factor (represented by panic disorder, agoraphobia and social phobia) and the PTSD dysphoria symptoms (numbing symptoms C3–7 and hyperarousal symptoms D1–3) loading onto an Anxious Misery/Distress factor (represented by depression, generalized anxiety disorder and obsessive compulsive disorder). The findings have implications for informing potential revisions to the structure of the diagnosis of PTSD and the diagnostic algorithm to be applied, with the aim of enhancing diagnostic specificity.
Hanley, F. T., Matthews, L. R., & Lewis, V. J. (2011). Exploring the meaning of best practice: A discussion on the way client-centred psychosocial rehabilitation services might address the needs of Australian veterans in the future. International Journal of Disability Management, 6, 10-21. doi: 10.1375/jdmr.6.1.10
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This article presents a summary of 10 priorities for the delivery of best practices in psychosocial rehabilitation relevant to the Australian veteran population. The first section interrogates the empirical principles characteristically identified with best practices before presenting an alternative, heuristic framework organised by three reference points and informed by principles of efficacy, external validity, and the meaning of efficacy in the context of parity. The article presents the strategy used in reviewing the literature, before presenting the findings according to 10 key priorities. The 10 priorities are described in the context of the literature informing them and are set out with regard to the centrality of the client-centred service model in the design and delivery of pertinent and effective services into the future.
Shultz, J. M., Kelly, F., Forbes, D., Verdeli, H., Rosen., A., & Neria, Y. (2011). Triple Threat Trauma: Evidence-based mental health response for the 2011 Japan disaster. Prehospital and Disaster Medicine, 26, 141-145. doi:10.1017/S1049023X11006364
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On March 11, 2011, a Richter Magnitude 9.0 earthquake occurred in the ocean along a seismically-active tectonic plate boundary 120 km east of Japan’s main island, Honshu. The earthquake launched a tsunami of immense magnitude, surging toward the Japanese coastline with limited time to warn coastal residents. As the tsunami crashed ashore, several nuclear power plants were seriously damaged, precipitating a succession of explosions and subsequently, containment structure leaks that sent significant amounts of radioactive material drifting over major population centers and later discharging into the Pacific Ocean.
Phelps, A. J., Forbes, D., Hopwood, M., & Creamer, M. (2011). Trauma related dreams of Australian veterans with PTSD: Content, affect and phenomenology. Australian and New Zealand Journal of Psychiatry, 45, 853-860. doi: 10.3109/00048674.2011.599314
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Objective: Consensus on the parameters of trauma-related dreams required to meet criteria for post-traumatic stress disorder (PTSD) is critical when: (i) the diagnosis requires a single re-experiencing symptom; and (ii) trauma dreams are prevalent in survivors without PTSD. Method: This study investigated the phenomenology of PTSD dreams in 40 veterans,
using structured interview and self-report measures. Results: Dream content varied between replay, non-replay, and mixed, but affect was largely the same as that experienced at the time of trauma across all dream types. ANOVA indicated no difference between dream types on PTSD severity or nightmare distress. Conclusions: The findings provide preliminary support for non-replay dreams to satisfy the DSM B2 diagnostic criterion when the affect associated with those dreams is the same as that experienced at the time of the traumatic event.
2010
Bryant, R. A., Creamer, M., O’Donnell, M., Silove, D., & McFarlane, A. C. (2010). Sleep disturbance immediately prior to trauma predicts subsequent psychiatric disorder. Sleep, 33, 69-74. Retrieved from http://www.journalsleep.org/ViewAbstract.aspx?pid=27675
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Study Objectives: This study investigated the extent to which sleep disturbance in the period immediately prior to a traumatic event predicted development of subsequent psychiatric disorder. Design: Prospective design cohort study. Setting: Four major trauma hospitals across Australia. Patients: A total of 1033 traumatically injured patients were initially assessed during hospital admission and followed up at 3 months (898) after injury. Measures: Lifetime psychiatric disorder was assessed in hospital with the Mini-International Neuropsychiatric Interview. Sleep disturbance in the 2 weeks prior to injury was also assessed using the Sleep Impairment Index. The prevalence of psychiatric disorder was assessed 3 months after traumatic injury. Results: There were 255 (28%) patients with a psychiatric disorder at 3 months. Patients who displayed sleep disturbance prior to the injury were more likely to develop a psychiatric disorder at 3 months (odds ratio: 2.44, 95% CI: 1.62–3.69). In terms of patients who had never experienced a prior disorder (n = 324), 96 patients (30%) had a psychiatric disorder at 3 months, and these patients were more likely to develop disorder if they displayed prior sleep disturbance (odds ratio: 3.16, 95% CI: 1.59–4.75). Conclusions: These findings provide evidence that sleep disturbance prior to a traumatic event is a risk factor for development of posttraumatic psychiatric disorder.
Bryant, R. A., O’Donnell, M. L., Creamer, M., McFarlane, A. C., Clark, R. C., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167, 312-320. doi:10.1176/appi.ajp.2009.09050617
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Objective: Traumatic injury affects millions of people each year. There is little understanding of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury (TBI) on psychiatric illness. The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status. Method: In this prospective cohort study, patients were drawn from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months (N = 932, 86%) and 12 months (N = 817, 75%) after injury. Lifetime psychiatric diagnoses were assessed in hospital. The prevalence of psychiatric disorders, levels of quality of life, and mental health service use were assessed at the follow-ups. The main outcome measures were 3- and 12-month prevalence of axis I psychiatric disorders, levels of quality of life, and mental health service use and lifetime axis I psychiatric disorders. Results: Twelve months after injury, 31% of patients reported a psychiatric disorder, and 22% developed a psychiatric disorder that they had never experienced before. The most common new psychiatric disorders were depression (9%), generalized anxiety disorder (9%), posttraumatic stress disorder (6%), and agoraphobia (6%). Patients were more likely to develop posttraumatic stress disorder (odds ratio=1.92, 95% CI=1.08-3.40), panic disorder (odds ratio=2.01, 95% CI=1.03-4.14), social phobia (odds ratio=2.07, 95% CI=1.03-4.16), and agoraphobia (odds ratio=1.94, 95% CI=1.11-3.39) if they had sustained a mild TBI. Functional impairment, rather than mild TBI, was associated with psychiatric illness. Conclusions: A significant range of psychiatric disorders occur after traumatic injury. The identification and treatment of a range of psychiatric disorders are important for optimal adaptation after traumatic injury.
Bryant, R. A., O’Donnell, M. L., Creamer, M., McFarlane, A. C., & Silove, D. (2010). Posttraumatic intrusive symptoms across psychiatric disorders. Journal of Psychiatric Research, 45, 842-847. doi:10.1016/j.jpsychires.2010.11.012
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Reexperiencing symptoms are a key feature of posttraumatic stress disorder (PTSD). This study investigated the pattern of reexperiencing symptoms in non-PTSD posttraumatic disorders. This study recruited 1084 traumatically injured patients during hospital admission and conducted follow-up assessment 12 months later (N = 817, 75%). Twelve months after injury, 22% of patients reported a psychiatric disorder they had never experienced prior to the traumatic injury. One-third of patients with a non-PTSD disorder satisfied the PTSD reexperiencing criteria. Whereas patients with a non-PTSD disorder were more likely to experience intrusive memories, nightmares, psychological distress and physiological reactivity to reminders, only patients with PTSD were likely to experience flashback memories (OR: 11.41, 95% CI: 6.17–21.09). The only other symptom that was distinctive to PTSD was dissociative amnesia (OR: 4.50, 95% CI: 2.09–9.71). Whereas intrusive memories and reactions are common across posttraumatic disorders, flashbacks and dissociative amnesia are distinctive to PTSD.
Cook, J. M., Harb, G. C., Gehrman, P. R., Cary, M. S., Gamble, G. M., Forbes, D., & Ross, R. J. (2010). Imagery Rehearsal for Posttraumatic Nightmares: A Randomized Controlled Trial. Journal of Traumatic Stress, 23, 553-563. doi:10.1002/jts.20569
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One hundred twenty-four male Vietnam War veterans with chronic, severe posttraumatic stress disorder (PTSD) were randomly assigned to imagery rehearsal (n = 61) or a credible active comparison condition (n = 63) for the treatment of combat-related nightmares. There was pre-post change in overall sleep quality and PTSD symptoms for both groups, but not in nightmare frequency. Intent-to-treat analyses showed that veterans who received imagery rehearsal had not improved significantly more than veterans in the comparison condition for the primary outcomes (nightmare frequency and sleep quality), or for a number of secondary outcomes, including PTSD. Six sessions of imagery rehearsal delivered in group format did not produce substantive improvement in Vietnam War veterans with chronic, severe PTSD. Possible explanations for findings are discussed.
Ehlers, A., Bisson, J., Clark, D. M., Creamer, M., Pilling, S., Richards, D., . . . Yule, W. (2010). Do all psychological treatments really work the same in posttraumatic stress disorder? Clinical Psychology Review, 30, 269-276. doi:10.1016/j.cpr.2009.12.001
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A recent meta-analysis by Benish, Imel, and Wampold (2008, Clinical Psychology Review, 28, 746–758) concluded that all bona fide treatments are equally effective in posttraumatic stress disorder (PTSD). In contrast, seven other meta-analyses or systematic reviews concluded that there is good evidence that trauma-focused psychological treatments (trauma-focused cognitive behavior therapy and eye movement desensitization and reprocessing) are effective in PTSD; but that treatments that do not focus on the patients' trauma memories or their meanings are either less effective or not yet sufficiently studied. International treatment guidelines therefore recommend trauma-focused psychological treatments as first-line treatments for PTSD. We examine possible reasons for the discrepant conclusions and argue that (1) the selection procedure of the available evidence used in Benish et al.'s (2008) meta-analysis introduces bias, and (2) the analysis and conclusions fail to take into account the need to demonstrate that treatments for PTSD are more effective than natural recovery. Furthermore, significant increases in effect sizes of trauma-focused cognitive behavior therapies over the past two decades contradict the conclusion that content of treatment does not matter. To advance understanding of the optimal treatment for PTSD, we recommend further research into the active mechanisms of therapeutic change, including treatment elements commonly considered to be non-specific. We also recommend transparency in reporting exclusions in meta-analyses and suggest that bona fide treatments should be defined on empirical and theoretical grounds rather than by judgments of the investigators' intent.
Evans, L., Cowlishaw, S., Forbes, D., Parslow, R., & Lewis, V. (2010). Longitudinal analyses of family functioning in veterans and their partners across treatment. Journal of Consulting & Clinical Psychology, 78, 611-622. doi:10.1037/a0020457
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Objective: This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Method: Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Results: Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Conclusion: Family functioning may play a role in treatment for veterans.
Fletcher, S., Creamer, M., & Forbes, D. (2010). Preventing posttraumatic stress disorder: Are drugs the answer? Australian and New Zealand Journal of Psychiatry, 44, 1064-1071. doi:10.3109/00048674.2010.509858
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In the field of traumatic stress, chemoprophylaxis is a term that is often used but rarely well understood. There has been no shortage of debate on the issue, but few rigorous studies to ground the discussion. The purpose of the current paper is to explore the issues surrounding this contentious area. Databases including PubMed, PsychArticles and Web of Knowledge were searched using the key words chemo or pharmaco, prevention or prophylaxis, and PTSD or post-traumatic stress. Relevant journals and reference lists of the papers obtained through this search were scanned for additional references. Studies that investigated the use of pharmacotherapy to prevent the onset of post-traumatic stress disorder were considered for this paper. Studies that examined the treatment of established PTSD were excluded. A total of 15 empirical studies were included in the review (including five randomized controlled trials), and twice as many non-data-driven papers. Evidence for the prophylactic use of alcohol, morphine, propranolol, and hydrocortisone is presented, followed by a discussion of the many challenges of using pharmacological interventions in this context. While attention to this issue has increased in recent times, the dearth of empirical data has done little to further the field. Larger studies are indicated following small trials with medications such as propranolol and hydrocortisone. There remain a number of ethical and practical questions to be answered before the widespread use of chemoprophylaxis can be recommended.
Forbes, D., Creamer, M., Bisson, J. I., Cohen, J. A., Crow, B. E., Foa, E. B., . . . Ursano, R. J. (2010). A guide to guidelines for the treatment of PTSD and related conditions. Journal of Traumatic Stress, 23, 537-552. doi:10.1002/jts.20565
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In recent years, several practice guidelines have appeared to inform clinical work in the assessment and treatment of posttraumatic stress disorder. Although there is a high level of consensus across these documents, there are also areas of apparent difference that may lead to confusion among those to whom the guidelines are targeted— providers, consumers, and purchasers of mental health services for people affected by trauma. The authors have been responsible for developing guidelines across three continents (North America, Europe, and Australia). The aim of this article is to examine the various guidelines and to compare and contrast their methodologies and recommendations to aid clinicians in making decisions about their use.
Forbes, D., Elhai, J. D., Miller, M. W., & Creamer, M. (2010). Internalizing and externalizing classes in posttraumatic stress disorder: A latent class analysis. Journal of Traumatic Stress, 23, 340-349. doi:10.1002/jts.20526
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Using latent class analysis (LCA) the typology of personality profiles of veterans with posttraumatic stress disorder (PTSD) was examined based on internalizing/externalizing dimensions of psychopathology. Latent class analysis on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Personality Psychopathology-5 (PSY-5) scale data from 299 Australian combat veterans with PTSD supported the model, identifying an optimal 4-class solution, with PTSD externalizing class defined by aggressiveness and disconstraint, high and moderate internalizing classes differentiated on the extent of elevations in introversion and negative emotionality and elevation of psychoticism in the high internalizing class and a simple PTSD class with normal range scores. The model was validated using external self-report and psychiatric-interview-derived diagnoses. A second exploratory LCA using broader comorbidity indicators (MMPI-2 Restructured Clinical scales) demonstrated some support for, although limitations in, using nonpersonality measures to identify these classes directly.
Forbes, D., Fletcher, S., Wolfgang, B., Varker, T., Creamer, M., Brymer, M. J., . . . Bryant, R.A. (2010). Practitioner perceptions of Skills for Psychological Recovery: A training program for health practitioners in the aftermath of the Victorian bushfires. Australian and New Zealand Journal of Psychiatry, 44, 1105-1111. doi:10.3109/00048674.2010.513674
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Objective: Following the February 2009 Victorian bushfires, Australia’s worst natural disaster, the Australian Centre for Posttraumatic Mental Health, in collaboration with key trauma experts, developed a three-tiered approach to psychological recovery initiatives for survivors with training specifi cally designed for each level. The middle level intervention, designed for delivery by allied health and primary care practitioners for survivors with ongoing mild-moderate distress, involved a protocol still in draft form called Skills for Psychological Recovery (SPR). SPR was developed by the US National Center for PTSD and US National Child Traumatic Stress Network. This study examined health practitioner perceptions of the training in, and usefulness of SPR.
Forbes, D., Parslow, R., Creamer, M., O’Donnell, M., Byrant, R., McFarlane, A., . . . Shalev, A. (2010). A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with fear and anxious-misery disorders: Implications for DSM-V. Journal of Affective Disorders, 127, 147-152. doi:10.1016/j/jad.2010.05.005
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This paper examined the hypothesis that PTSD-unique symptom clusters of re-experiencing, active avoidance and hyperarousal were more related to the fear/phobic disorders, while shared PTSD symptoms of dysphoria were more closely related to Anxious-Misery disorders (MDD/GAD). Confirmatory factor and correlation analyses examining PTSD, anxiety and mood disorder data from 714 injury survivors interviewed 3, 12 and 24-months following their injury supported this hypothesis with these relationships remaining robust from 3–24 months posttrauma. Of the nine unique fear-oriented PTSD symptoms, only one is currently required for a DSM-IV diagnosis. Increasing emphasis on PTSD fear symptoms in DSM-V, such as proposed DSM-V changes to mandate active avoidance, is critical to improve specificity, ensure inclusion of dimensionally distinct features and facilitate tailoring of treatment.
Forbes, D., Parslow, R., Fletcher, S. McHugh, T., & Creamer, M. (2010). Attachment style in the prediction of recovery following group treatment in combat veterans with post-traumatic stress disorder. Journal of Nervous & Mental Disease, 198, 881-884. doi:10.1097/NMD.0b013e3181fe73fa
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Post-traumatic stress disorder (PTSD) can be difficult to treat, with gains often particularly modest in combat veterans. Although group-based treatments are commonly delivered for veterans, little is known about factors influencing their outcomes. Attachment style is known to be associated with psychopathology after trauma and is critical to group-based interventions, but has not yet been investigated in relation to treatment outcome. A better understanding of factors that influence outcome is critical in optimizing the effectiveness of such interventions. This study investigated attachment style as a predictor of outcome for 103 veterans attending group-based treatment for combat-related PTSD. Measures included the Clinician Administered PTSD Scale, PTSD Checklist, and Relationship Styles Questionnaire. Path analyses indicated preoccupied attachment style strongly negatively predicted outcome following treatment. The preoccupied attachment style impedes recovery in group-based treatment for veterans with PTSD. Potential mechanisms underlying this finding are discussed. The results suggest that greater attention should be paid at initial assessment to attachment style of veterans before entering PTSD treatment, particularly group-based interventions.
Holmes, A., Williamson, O., Hogg, M., Arnold, C., Prosser, A., Clements, J., . . . O’Donnell, M. L. (2010). Predictors of pain 12 months after serious injury. Pain Medicine, 11, 1599-1611.
doi:10.1111/j.1526-4637.2010.00955.x
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Objective: The majority of patients will report pain 12 months after a serious injury. Determining the independent risk factors for pain after serious injury will establish the degree to which high-risk patients can be detected in the acute setting and the viability of early triage to specialist pain services. Design: A prospective cohort study of patients following serious injury was conducted. The initial assessment comprised a comprehensive battery of known and possible risk factors for persistent pain. Patients were assessed at 12 months for pain severity and for the presence of chronic pain. Results: Two hundred ninety patients underwent an initial assessment of whom 238 (82%) were followed up at 12 months. At 12 months, 171 (72%) patients reported some pain over the past 24 hours. Thirty five patients (14.7%) reported chronic pain. Five factors independently predicted the 24-hour pain severity: preinjury physical role function, preinjury employment status, initial 24 hours pain score, higher beliefs in the need for medication, and compensable injury (R2 = 0.21, P < 0.0001). Four factors predicted the presence of chronic pain at 12 months: not working prior to injury, total Abbreviated Injury Scale, initial pain severity, and initial pain control attitudes (pseudo R2 = 0.24, P = 0.0001). Conclusions: Factors present at the time of injury can allocate patients into high- or low-risk groups.The majority of cases of chronic pain emerging from the high-risk group warrant more intense clinical attention. We recommend recording these factors in discharge documentation as indicators of persistent pain.
Holmes, A., Williamson, O., Hogg, M., Arnold, C., Prosser, A., Clements, J., . . . O'Donnell, M. (2010). Predictors of pain severity 3 months after serious injury. Pain Medicine, 11, 990-1000.
doi: 10.1111/j.1526-4637.2010.00890.x
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Objective: Injury is a common initiating event for persistent pain. The presentation of injured patients to hospital represents an opportunity to identify patients at high risk of persistent pain and triage them to early intervention. Although a range of physical, psychological, and social risk factors have been implicated in the transition from acute to persistent pain, these factors have not been tested concurrently in a prospective study. This study aimed to determine the degree to which pain severity at 3 months can be predicted at the time of injury and which independent factors predicted pain severity. Design: A large prospective cohort study was conducted recruiting patients from two trauma hospitals during their acute admission. Patients were assessed with a comprehensive battery of known and possible risk factors for persistent pain. Patients were assessed for pain severity on a visual analog scale over the past 24 hours at 3 months. Results: Two hundred ninety patients were recruited, and 242 were followed up at 3 months. Older age, female gender, past alcohol dependence, lower physical role function, pain severity, amount of morphine equivalents administered on the day of assessment, and pain control attitudes predicted pain severity at 3 months. The variance attributed to these factors was 22%. Conclusions: Injured patients with a number of these factors may warrant increased monitoring and early triage to specialist pain services.
Ikin, J. F., Creamer, M. C., Sim, M. R., & McKenzie, D. P. (2010). Comorbidity of PTSD and depression in Korean War veterans: Prevalence, predictors, and impairment. Journal of Affective Disorders, 125, 279-286. doi:10.1016/j.jad.2009.12.005
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Background: Rates of PTSD and depression are high in Korean War veterans. The prevalence and impact of the two disorders occurring comorbidly, however, has not been investigated. This paper aims to investigate the extent to which PTSD and depression co-occur in Australian veterans of the Korean War, the symptom severity characteristics of comorbidity, the impact on life satisfaction and quality, and the association with war-related predictors. Methods: Veterans (N = 5352) completed self-report questionnaires including the Posttraumatic Stress Disorder Checklist, the Hospital Anxiety and Depression Scale, the Life Satisfaction Scale, the brief World Health Organisation Quality of Life questionnaire and the Combat Exposure Scale. Results: Seventeen percent of veterans met criteria for comorbid PTSD and depression, 15% had PTSD without depression, and a further 6% had depression without PTSD. Compared with either disorder alone, comorbidity was associated with impaired life satisfaction, reduced quality of life, and greater symptomseverity. Several war-related factorswere associated with comorbidity and with PTSD alone, but not with depression alone. Limitations: The reliance on self-reportedmeasures and the necessity for retrospective assessment of some deployment-related factors renders some study data vulnerable to recall bias. Conclusions: Comorbid PTSD and depression, and PTSD alone, are prevalent among Korean War veterans, are both associated with war-related factors 50 years after the Korean War, and may represent a single traumatic stress construct. The results have important implications for understanding complex psychopathology following trauma.
McKenzie, D. P., Creamer, M., Kelsall, H. L., Forbes, A. B., Ikin, J. F., Sim, M. R., McFarlane, A.C. (2010). Temporal relationships between Gulf War deployment and subsequent psychological disorders in Royal Australian Navy Gulf War veterans. Social Psychiatry and Psychiatric Epidemiology, 45, 843-852. doi:10.1007/s00127-009-0134-1
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Background: Although much has been published on the effects of the 1990/1991 Gulf War on the psychological health of veterans, few studies have addressed the pattern and timing of post-war development of psychological disorders. Our study aims to identify the most common psychological disorders that first appeared post-Gulf War, the period of peak prevalence and the sequence of multiple psychological disorders. Methods: The temporal progression of psychological disorders in male Australian naval Gulf War veterans with no prior psychological disorders was calculated across each year of the post-Gulf War period. DSM-IV diagnoses were obtained using the Composite International Diagnostic Interview. Results Psychological disorder rates peaked in the first 2 years (1991–1992) following the Gulf War. Alcohol use disorders were the most likely to appear first. Classification and regression tree analysis found that risk of disorder was exacerbated if veterans had been exposed to a high number of potential psychological stressors during their military service. Lower military rank was associated with increased risk of alcohol disorders, particularly during the first 2 years post-Gulf War. In veterans with two or more disorders, anxiety disorders and alcohol disorders tended to appear before affective disorders. Conclusions: Our study found that psychological disorders occur in sequence following Gulf War deployment. Our findings may help clinicians to anticipate, and better manage, multiple symptomatology. The findings may also assist veteran and defence organisations in planning effective mental health screening, management and prevention policy.
O’Connor, D. W. & Parslow, R. A. (2010). Mental health scales and psychiatric diagnoses: Responses to GHQ-12, K-10 and CIDI across the lifespan. Journal of Affective Disorders, 121, 263-267.
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Background: Surveys based on complex interviews like CIDI report very low rates of affective disorder in older people, perhaps because the lengthy, convoluted questions present a special challenge to aged respondents. By contrast, mental health scales like the GHQ-12 and K-10 show much less change in score with age. Before concluding that scales present a fairer picture of aged mental health, it is important to check if scores are inflated by items that might reflect normal involutional changes in cognition, energy and social role. Methods: Secondary analysis of an Australian national survey of 10,641 adults. Results: GHQ-12 and K-10 scores declined with age to a relatively minor degree. When scores were bisected, the proportion of respondents scoring above the cutpoints fell with age but to a lesser degree than with ICD-10 diagnoses. Scores on GHQ-12 and K-10 items relating to cognition, energy and social role rose with age but, on factor analysis, these items loaded similarly in a two-factor model. Conclusion: No evidence emerged of age-related bias in either GHQ-12 or K-10. Items concerning cognition, energy and social role were associated with affect in older people, just as they were in younger ones. It seems unlikely therefore that the different trajectories over the lifespan of CIDI diagnoses and scores on GHQ-12 and K-10 are due to limitations within the scales. The possibility that CIDI minimizes affective disorder in older age-groups cannot be discounted. Limitations: Residents of aged care facilities and those with low cognitive scores were excluded.
O’Donnell, M. L., Creamer, M., & Cooper, J. (2010). Criterion A: Controversies and Clinical Implications. In G. M. Rosen & B. C. Frueh (Eds.), Clinician's Guide to Posttraumatic Stress Disorder. New Jersey: John Wiley & Sons.
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The diagnosis of PTSD requires that a person experience a traumatic event. In DSM-IV, it is Criterion A that defines a traumatic stressor for the purpose of a diagnosis. Defining what constitutes a traumatic event, however, is not an easy task and much heated debate has revolved around criterion A and its role in the genesis of PTSD. With the development of DSM-V, due for release in 2013, the question of defining trauma in PTSD has been reignited and several excellent papers have appeared in recent years discussing the many complex issues associated with Criterion A (e.g., Long & Elhai, 2009; North, Suris, Davis, & Smith, 2009; Weathers & Keane, 2007). This chapter aims to distill the key issues raised by other commentators, so as to help the clinician negotiate the complex debates over what constitutes a traumatic stressor. We will return to our case examples at the end of the chapter to help clinicians understand the application of these issues in their own practice.
O'Donnell, M. L., Creamer, M., Holmes, A. C. N., Ellen, S., McFarlane, A. C., Judson, R., . . . Bryant, R.A. (2010). Posttraumatic stress disorder after injury: Does admission to Intensive Care Unit increase risk? Journal of Trauma-Injury, Infection and Critical Care, 69, 627-632. doi:10.1097/TA.0b013e3181bc0923
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This study aimed to index the prevalence of posttraumatic stress disorder (PTSD) after injury requiring intensive care unit (ICU) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission. Methods: A two-group (those admitted to the ICU vs. those not admitted to ICU), prospective, cohort study of 829 randomly selected injury patients from five major trauma hospitals across Australia. We collected information on factors that may increase risk for PTSD including demographic variables (gender, age, income, education, and marital status), preinjury mental health status (prior trauma, psychiatric history, and prior social support), and injury characteristics (mild traumatic brain injury, injury severity, length of hospital admission, discharge destination, pain, and perceived threat). PTSD was measured at 12 months by structured clinical interview. Results: ICU patients were significantly more likely to have PTSD at 12 months than trauma controls (17% vs. 7%). Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic, preinjury mental health status, and injury characteristic variables. Conclusions: Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given we controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.
O'Donnell, M. L., Creamer, M. C., McFarlane, A. C., Silove, D., & Bryant, R. A. (2010). Does access to compensation impact on recovery outcomes after injury? Medical Journal of Australia, 192, 328-333. Retrieved from http://www.mja.com.au/public/issues/192_06_150310/odo11364_fm.pdf
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Objective: To conduct a descriptive study investigating the effect of access to motor vehicle accident (MVA) compensation on recovery outcomes at 24 months after injury. Design and setting: Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria, Australia. Participants were 391 randomly selected injury patients with moderate-to-severe injuries. Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes. Main outcome measures: Health outcomes at 24 months, including anxiety and depression severity, quality of life and disability. Results: Medical records identified two groups of compensation patients: MVA-compensable and non-compensable patients. After controlling for baseline variables, the MVA-compensable patients, at 24 months, had higher levels of post-traumatic stress disorder, anxiety and depression, and were less likely to have returned to their pre-injury number of work hours. However, some patients in the non-compensable group had accessed other forms of compensation (eg, private health care or compensation for victims of crime). When these were removed from the non-compensable group, the differences between MVA-compensable and non-compensable groups all but disappeared. Conclusion: Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes. The relationship between access to compensation and health outcomes is complex, and more high-level research is required.
O'Donnell, M. L., Creamer, M., McFarlane, A. C., Silove, D., & Bryant, R. A. (2010). Should A2 be a diagnostic requirement for posttraumatic stress disorder in DSM-V? Psychiatry Research, 176, 257-260. doi:10.1016/j.psychres.2009.05.012
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The requirement that trauma survivors experience fear, helplessness or horror (Criterion A2) as a part of their posttraumatic stress disorder (PTSD) diagnosis was introduced into DSM-IV. The imminent re-definition of PTSD in DSM-V highlights the need for empirical studies to validate the utility of the A2 requirement. We aimed to identify (i) how often A2 was associated with PTSD (B-F criteria) at 3 months after trauma and (ii) what was the peritraumatic emotional experience for those who met PTSD criteria but were A2 negative. In a prospective design cohort study we assessed the peritraumatic emotional experience of 535 injury patients in four Australian hospitals. These patients were followed up 3 months later and assessed for PTSD using a structured clinical interview. The majority of those who developed PTSD (B-F criterion) at 3 months met A2 criteria. A substantial minority, however (23%), did not meet A2 criteria. Those PTSD patients who were A2 negative fell into three groups: (i) those who experienced subthreshold levels of A2; (ii) those who experienced intense peritrauma emotional responses other than fear, helplessness or horror; and (iii) those who were amnesic to their peritrauma emotional experience. These findings do not support the inclusion of A2 as diagnostic requirement for DSM-V.
2009
Australian Centre for Posttraumatic Mental Health (ACPMH). (2009). Skills for Psychological Recovery (SPR): Australian Adaptation Brochure. Melbourne: ACPMH. Retrieved from www.psid.org.au/Assets/Files/ACPMH-Quick-Guide-SPR.pdf
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About this brochure: This brochure is a brief reference guide to Skills for Psychological Recovery (SPR). It provides an overview of the various components of SPR and describes for whom they may be useful. Traumatic Events: Events are those that (a) involve actual or threatened death or serious injury (real or perceived) to self or others (e.g., accidents, assault, natural disasters and wars); and (b) evoke feelings of fear, helplessness or horror. Certain events (e.g., interpersonal violence, direct life threat and events of prolonged duration) are more likely to result in a traumatic response. Reactions to Traumatic Events: Most people recover after a traumatic event without serious problems. Some develop more severe and persistent symptoms like PTSD, depression and substance abuse. Stepped Care: The stepped care model is a non-pathologising approach. It begins with a period of monitoring followed by the use of increasingly intensive treatments as the need for such interventions is determined. This model is resource efficient as it provides best practice care only to those who need it. It also promotes the normal recovery process.
Brooks, R., Bryant, R. A., Silove, D., Creamer, M., O'Donnell, M., McFarlane, A. C., & Marmar, C. R. (2009). The latent structure of the Peritraumatic Dissociative Experiences Questionnaire. Journal of Traumatic Stress, 22, 153-157. doi:10.1002/jts.20414
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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.
Broomhall, L. G., Clark, C. R., McFarlane, A. C., O'Donnell, M., Bryant, R., Creamer, M., & Silove, D. (2009). Early stage assessment and course of acute stress disorder after mild traumatic brain Injury. Journal of Nervous & Mental Disease, 197, 178-181. doi:10.1097/NMD.0b013e318199fe7f
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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.
Bryant, R. A., Creamer, M., O'Donnell, M., Silove, D., Clark, R. C., & McFarlane, A. C. (2009). Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic injury. Journal of the International Neuropsychological Society, 15, 862-867. doi:10.1017/S1355617709990671
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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.
Bryant, R. A., Creamer, M., O’Donnell, M., Silove, D., & McFarlane, A. C. (2009). A study of the protective function of acute morphine administration on subsequent posttraumatic stress disorder. Biological Psychiatry, 65, 438-440. doi:10.1016/j.biopsych.2008.10.032
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Background:To index the extent to which acute administration of morphine is protective against development of posttraumatic stress disorder (PTSD). Methods: Consecutive patients admitted to hospital after traumatic injury (n = 155) were assessed for current psychiatric disorder, pain, and morphine dose in the initial week after injury and were reassessed for PTSD and other psychiatric disorders 3 months later (n = 120). Results: Seventeen patients (14%) met criteria for PTSD at 3 months. Patients who met criteria for PTSD received significantly less morphine than those who did not develop PTSD; there was no difference in morphine levels in those who did and did not develop major depressive episode or another anxiety disorder. Hierarchical regression analysis indicated that PTSD severity at 3 months was significantly predicted by acute pain, mild traumatic brain injury, and elevated morphine dose in the initial 48 hours after trauma, after controlling for injury severity, gender, age, and type of injury. Conclusions: Acute administration of morphine may limit fear conditioning in the aftermath of traumatic injury and may serve as a secondary prevention strategy to reduce PTSD development.
Carboon, I., Creamer, M., Forbes, A. B., McKenzie, D. P., McFarlane, A. C., & Kelsall, H. L. (2009). The relationship between deployment and turnover in Australian Navy personnel. Military Psychology, 21, 233-240. doi:10.1080/08995600802574647
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Increases in the frequency of operations tempo have focused attention on the relationship between deployment and separation from military service. This retrospective study explored the association between deployment and turnover over a 10-year period in Royal Australian Navy (RAN) personnel. Participants were 2355 males who served in the RAN during the period of the 1991 Gulf War (August 1990-September 1991); approximately half had been deployed to that conflict. Data were collected 10 years later as part of the Australian Gulf War Veterans' Health Study. During that 10-year period, 61% of participants left the RAN. The likelihood of separation decreased as number of deployments increased even when controlling for age, rank, and length of service. Personnel deployed to the 1991 Gulf conflict did not have a significantly higher risk of separation. The results provide evidence that deployment is not necessarily a risk factor for separation.
Cook, F., Ciorciari, J., Varker, T., & Devilly, G. J. (2009). Changes in long term neural connectivity following psychological trauma. Clinical Neurophysiology, 120, 309-314. doi:10.1016/j.clinph.2008.11.021
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Objective: Neural connectivity differences between adults reporting childhood, adulthood or no history of trauma were examined. Methods: A total of 39 participants completed the Post-traumatic Stress Diagnostic Scale (PDS; Foa EB. Post-traumatic Stress Diagnostic Scale (PDS) Manual. Minneapolis, MN: National Computer Systems, 1995), a Word Memory Task (WMT; [McNally RJ, Metzger LJ, Lasko NB, Clancy SA, Pitman RK. Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without post-traumatic stress disorder. J Abnorm Psychol 1998, 107: 596–601]) and EEG analysis. Intelligence was not assessed during the study. Results: As predicted, those with childhood trauma had significantly higher EEG coherence than those with either adulthood trauma or no past trauma. Conclusions: Significant differences were observed over frontal, central, temporal and parietal areas. Evidence was found suggesting that childhood psychological trauma may have a lasting impact on neuronal connectivity. Significance: This is the first study to demonstrate the suspected long term effect of trauma over central, temporal and parietal areas. Longterm neural correlates of childhood and adult trauma appear to suggest information processing differences – differences that may, eventually, lead to better interventions following trauma.
Creamer, M., O’Donnell, M. L., Carboon, I., Lewis, V., Densley, K., McFarlane, A., . . . Bryant, R. A. (2009). Evaluation of the Dispositional Hope Scale in injury survivors. Journal of Research in Personality, 43, 613-617. doi:10.1016/j.jrp.2009.03.002
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Hope is a higher-order cognitive construct that encompasses the belief in one’s ability to accomplish personal goals. Hope has been conceptualised as consisting of two constructs – Pathways (the individual’s perceived means available to achieve goals) and Agency (belief in one’s ability to succeed in using the identified Pathways). This study aimed to validate a measure of hope, the Dispositional Hope Scale (DHS: [Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigman, S. T., et al. (1991). The will and the ways: Development and validation of an individual differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585]) in a large sample of traumatic injury survivors (N = 1025). The findings support the psychometric properties of the scale, as well as the two-factor structure of Agency and Pathways, in this population. This study provides support for the use of the DHS as a measure of hope in traumatised populations.
Devilly, G. J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress or simply burnout? The effect of trauma therapy on mental health professionals. The Australian and New Zealand Journal of Psychiatry, 43, 375-387. doi:10.1080/00048670902721079
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Objectives: The aim of the present study was to perform an assessment for secondary traumatic stress (STS), vicarious trauma (VT) and workplace burnout for Australian mental health professionals involved in clinical practice. Methods: Recruited directly by mail, randomly selected participants were invited to submit a questionnaire by post or online. Of the 480 participants contacted, 152 mental health professionals completed the questionnaire, which contained measures of STS, VT and burnout. Results: Exposure to patients’ traumatic material did not affect STS, VT or burnout, contradicting the theory of the originators of STS and VT. Rather, it was found that work-related stressors best predicted therapist distress. Conclusions: These findings have significant implications for the direction of research and theory development in traumatic stress studies, calling into question the existence of secondary trauma-related phenomena and enterprises aimed at treating the consultants.
Forbes, D., Wolfgang, B., Cooper, J., Creamer, M., & Barton, D. (2009). Post-traumatic stress disorder: Best practice GP guidelines. Australian Family Physician, 38, 106-111. Retrieved from the ProQuest Central database.
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Approximately 50-65% of Australians are exposed to a traumatic event during their lifetime. Approximately 250 000 Australians suffer from post-traumatic stress disorder (PTSD) at any given time, making it one of the most common anxiety disorders. In May 2007, the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder was published. In order to facilitate translation of evidence regarding PTSD into busy clinical practice, and particularly for general practitioners, a more succinct version of the guidelines has been developed. This article describes a brief algorithm based on the Australian guidelines and outlines key recommendations. General practitioners are often the first point of contact with the health care system for someone who has experienced a traumatic event. Patients experiencing trauma within the past 2 weeks require psychological first aid, and monitoring and assessment for the development of acute stress disorder and symptoms of PTSD. If the patient wishes to talk about the event with you, support them in doing so. However, it is important not to push those who prefer not to talk about the event. Trauma focused psychological treatment is the first line of treatment for PTSD, although antidepressant medication may have an adjuvant role in some patients or in those with comorbidities.
Kenny, L. M., Bryant, R. A., Silove, D., Creamer, M., O’Donnell, M., & McFarlane, A. C. (2009). Distant memories: A prospective study of vantage point of trauma memories. Psychological Science, 20, 1049-1052. doi:10.1111/j.1467-9280.2009.02393.x
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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.
Lewis, V., Creamer, M., & Failla, S. (2009). Is poor sleep in veterans a function of post-traumatic stress disorder? Military Medicine, 174, 948-951. Retrieved from the EBSCO database.
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Substantial research has demonstrated an association between post-traumatic stress disorder (PTSD) and quality of sleep, particularly in veteran populations. The exact nature of this relationship, however, is not clear. The possibility that poor sleep is a more general experience among veterans has not been explored to date, with most studies focusing only on veteran populations with PTSD. This pilot study aimed to explore whether sleep disturbance is common to veterans generally or simply those with PTSD. Data were collected from a community sample of 152 Australian Vietnam war veterans, 87 of whom did not meet criteria for PTSD. All those with PTSD and 90% of those without PTSD reported clinically significant sleep disturbance, indicating that serious sleep problems are common across the veteran population. Despite the limitations of this initial study, these results highlight the importance of ensuring that research into sleep disorders in veterans with PTSD pays attention to the potential etiological role of other military factors, including deployments.
Liedl, A., O’Donnell, M., Creamer, M., McFarlane, A., Knaevelsrud, C., & Bryant, R. A. (2009). Support for the mutual maintenance of pain and post-traumatic stress symptoms. Psychological Medicine, 40, 1215-1223. doi:10.1017/S0033291709991310
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Background: Pain and post-traumatic stress disorder (PTSD) are frequently co-morbid in the aftermath of a traumatic event. Although several models attempt to explain the relationship between these two disorders, the mechanisms underlying the relationship remain unclear. The aim of this study was to investigate the relationship between each PTSD symptom cluster and pain over the course of post-traumatic adjustment. Method: In a longitudinal study, injury patients (n = 824) were assessed within 1 week post-injury, and then at 3 and 12 months. Pain was measured using a 100-mm Visual Analogue Scale (VAS). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Structural equation modelling (SEM) was used to identify causal relationships between pain and PTSD. Results: In a saturated model we found that the relationship between acute pain and 12-month pain was mediated by arousal symptoms at 3 months. We also found that the relationship between baseline arousal and re-experiencing symptoms, and later 12-month arousal and re-experiencing symptoms, was mediated by 3-month pain levels. The final model showed a good fit [χ2=16.97, df=12, p>0.05, Comparative Fit Index (CFI)=0.999, root mean square error of approximation (RMSEA)=0.022]. Conclusions: These findings provide evidence of mutual maintenance between pain and PTSD.
McFarlane, A. C., Browne, D., Bryant, R. A., O’Donnell, M., Silove, D., Creamer, M., & Horsley, K. (2009). A longitudinal analysis of alcohol consumption and the risk of posttraumatic symptoms. Journal of Affective Disorders, 118, 166-172. doi:10.1016/j.jad.2009.01.017
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Background: Previous studies investigating the impact of alcohol ingestion on the emergence of posttraumatic psychological symptoms have generated contradictory findings. Methods: One thousand forty-five patients, admitted to hospital following traumatic injury were assessed during hospitalisation for patterns of alcohol consumption prior to the injury and also during the month prior to reassessment at 3 months. Anxiety, depression and posttraumatic stress disorder (PTSD) were assessed post accident and at 3 months. In a sub sample (n = 167), blood alcohol levels were measured at the time of admission to emergency departments. Results: Moderate alcohol consumption prior to and following the accident predicted lower levels of psychological distress at 1 week and 3 months. No significant relationship was found between the blood alcohol level and psychiatric outcomes. PTSD predicted the emergence of alcohol abuse following the accident, suggesting self-medication in a subgroup of survivors. Limitations: The impact of alcohol consumption upon injury severity and the nature of injury was not controlled for and some non-participation may have been related to patterns of alcohol consumption. We relied on retrospective reports of alcohol use obtained shortly after the traumatic injury to index prior alcohol use and these reports may have been influenced by mood states at the time of recall. Our follow-up was limited to 3 months and there is a need for longer-term assessment of the relationship between prior alcohol use and subsequent posttraumatic adjustment. Conclusion: Given the potential impact of alcohol use on traumatic injury and post-injury recovery, we advocate active screening and early intervention strategies that focus on moderate alcohol usage.
McKenzie, D. P., Creamer, M., Kensall, H. L., Forbes, A. B., Ikin, J. F., Sim, M. R., & McFarlane, A. C. (2009). Temporal relationships between Gulf War deployment and subsequent psychological disorders in Royal Australian Navy Gulf War veterans. Social Psychiatry and Psychiatric Epidemiology, 45, 843-852. doi:10.1007/s00127-009-0134-1
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Background: Although much has been published on the effects of the 1990/1991 gulf war on the psychological health of veterans, few studies have addressed the pattern and timing of post-war development of psychological disorders. Our study aims to identify the most common psychological disorders that first appeared post-gulf war, the period of peak prevalence and the sequence of multiple psychological disorders. Methods: The temporal progression of psychological disorders in male Australian Naval gulf war veterans with no prior psychological disorders was calculated across each year of the post-gulf war period. DSM-IV diagnoses were obtained using the composite international diagnostic interview. Results: Psychological disorder rates peaked in the first 2 years (1991-1992) following the gulf war. Alcohol use disorders were the most likely to appear first. Classification and regression tree analysis found that risk of disorder was exacerbated if veterans had been exposed to a high number of potential psychological stressors during their military service. Lower military rank was associated with increased risk of alcohol disorders, particularly during the first 2 years post-gulf war. In veterans with two or more disorders, anxiety disorders and alcohol disorders tended to appear before affective disorders. Conclusions: Our study found that psychological disorders occur in sequence following gulf war deployment. Our findings may help clinicians to anticipate, and better manage, multiple symptomatology. The findings may also assist veteran and defence organisations in planning effective mental health screening, management and prevention policy.
O'Connor, D. W. & Parslow, R. A. (2009). Different responses to K-10 and CIDI suggest that complex structured psychiatric interviews underestimate rates of mental disorder in old people. Psychological Medicine, 39, 1527-1531. doi:10.1017/S0033291708004728
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Background: Epidemiological surveys based on complex diagnostic interviews, such as the Composite International Diagnostic Interview (CIDI), report very low rates of anxiety and depressive disorders in older age groups. Mental health checklists show much less change over the lifespan. This paper explores the possibility that complex interviews present a special challenge to older respondents and thereby exaggerate the decline in mental disorder with age. Method: Analysis of data from an Australian national mental health survey with 10,641 community-resident adult respondents. Measures of interest included ICD-10 anxiety and depression diagnoses, scores on the Kessler Psychological Distress Scale (K-10), agreement between K-10 and CIDI anxiety and depressive questions, and changes in agreement with age. Results: Levels of inconsistency between simple and complex questions about anxiety and depression rose with age. Conclusions: Older people may have difficulty attending to and processing lengthy, complex questionnaires. When in doubt, their preferred response may be to deny having experienced symptoms, thus deflating rates of diagnosed mental disorder. We recommend that simple mental health scales be included in epidemiological studies involving older age groups.
O'Donnell, M. L., Creamer, M., Elliott, P., Bryant, R., McFarlane, A., & Silove, D. (2009). Prior trauma and psychiatric history as risk factors for intentional and unintentional injury. Journal of Trauma-Injury Infection & Critical Care, 66, 470-476. doi:10.1097/TA.0b013e31815d965e
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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]2 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.
O'Donnell, M. L., Holmes, A. C., Creamer, M. C., Ellen, S., Judson, R., McFarlane, A. C., . . . Bryant, R. A. (2009). The role of post-traumatic stress disorder and depression in predicting disability after injury. Medical Journal of Australia, 190, s71-s74. Retrieved from http://www.mja.com.au/public/issues/190_07_060409/odo10883_fm.pdf
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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.
Phelps, A., Lloyd, D., Creamer, M., & Forbes, D. (2009). Caring for carers in the aftermath of trauma. Journal of Aggression, Maltreatment & Trauma, 18, 313-330. doi:10.1080/10926770902835899
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The potential impact on psychological well-being of working in the caring professions in the aftermath of trauma and disaster has been recognized for many years, with terms such as burnout, compassion fatigue, and vicarious traumatization coined to describe stress-related conditions. Although prevalent, these conditions do not affect all workers in the field. Various studies have investigated potential risk and protective factors. It is argued that the outcomes of this research should be used to guide practical interventions in the workplace designed to minimize stress-related problems. A framework that incorporates interventions at the primary, secondary, and tertiary prevention levels is outlined, and research investigating the efficacy of interventions at each of these levels is recommended.
2008
Australian Centre for Posttraumatic Mental Health. (2008). Acute Stress Disorder and Posttraumatic Stress Disorder brochure [Clinical Algorithm]. ACPMH: Melbourne, Australia.
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Australia’s first treatment guidelines for acute stress disorder and posttraumatic stress disorder (ASD and PTSD) are now available. They will help policy makers and health practitioners make decisions about the best approaches to screening, assessment and treatment of posttraumatic mental health problems. They will also help people affected by trauma make informed choices about their care. The Australian Centre for Posttraumatic Mental Health developed the Guidelines in consultation with trauma experts from a range of disciplines, as well as people affected by trauma. Endorsed by the National Health and Medical Research Council, the Guidelines provide practical recommendations applicable in all healthcare settings.
Brooks, R., Silove, D., Bryant, R., O’Donnell, M., Creamer, M., & McFarlane, A. (2008). A confirmatory factor analysis of the acute stress disorder interview. Journal of Traumatic Stress, 21, 352-355. doi:10.1002/jts.20333
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Acute stress disorder (ASD) was introduced in 1994 to describe posttraumatic stress reactions that occur in the initial month after trauma exposure. Although it comprises the distinct symptom clusters of dissociation, reexperiencing, avoidance, and arousal, there have been no confirmatory factor analyses of the construct. In this study, 587 individuals admitted to five major hospitals after traumatic injury, were administered the Acute Stress Disorder Interview. Forty-four participants met criteria for ASD. Confirmatory factor analysis based on the four symptom clusters described the Acute Stress Disorder Interview responses. These data provide the first confirmatory factor analysis of the ASD symptoms, and are discussed in terms of the 4-factor models repeatedly found in samples of chronic posttraumatic stress disorder.
Bryant, R. A., Creamer, M., O’Donnell, M., Silove, D., & McFarlane, A. C. (2008). A multisite study of initial respiration rate and heart rate as predictors of posttraumatic stress disorder. Journal of Clinical Psychiatry, 69, 1694-1701. doi:10.4088/JCP.v69n1104
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Objective:Fear-conditioning models posit that increased arousal at the time of trauma predicts subsequent posttraumatic stress disorder (PTSD). This multisite study evaluated the extent to which acute heart rate and respiration rate predict subsequent chronic PTSD. Method:Traumatically injured patients admitted to 4 hospitals across Australia between April 2004 and February 2006 were initially assessed during hospital admission (N = 1105) and were reassessed 3 months later for PTSD by using the Clinician-Administered PTSD Scale-IV and for major depressive disorder (MDD) by using the Mini-International Neuropsychiatric Interview (English version 5.0.0) (N = 955). Heart rate, respiration rate, and blood pressure were assessed on the initial day of traumatic injury. Results:Ninety patients (10%) met criteria for PTSD and 159 patients (17%) met criteria for MDD at the 3-month assessment. Patients with PTSD compared to those without PTSD had higher heart rate (90.16 ± 18.66 vs. 84.84 ± 17.41, t = 2.74, p < .01) and respiration rate (20.24 ± 5.16 vs. 18.58 ± 4.29, t = 3.43, p < .001) immediately after injury. There were no heart rate or respiration rate differences between patients who did and did not develop MDD. Patients were more likely to develop PTSD at 3 months if they had a heart rate of at least 96 beats per minute (15% vs. 8%, OR = 2.12, 95% CI = 1.34 to 3.33) or respiration rate of at least 22 breaths per minute (18% vs. 8%, OR = 2.42, 95% CI = 1.48 to 3.94). Conclusions:Elevated heart rate and respiration rate are predictors of subsequent PTSD. These data underscore the need for future research into secondary prevention strategies that reduce acute arousal immediately after trauma and may limit PTSD development in some individuals.
Bryant, R. A., Creamer, M., O'Donnell, M. L., Silove, D., & McFarlane, A. C. (2008). A multisite study of the capacity of acute stress disorder diagnosis to predict posttraumatic stress disorder. Journal of Clinical Psychiatry, 69, 923-929. doi:10.4088/JCP.v69n0606
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Objective: Previous studies investigating the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) have reported mixed findings and have been flawed by small sample sizes and single sites. This study addresses these limitations by conducting a large-scale and multisite study to evaluate the extent to which ASD predicts subsequent PTSD. Method: Between April 2004 and April 2005, patients admitted consecutively to 4 major trauma hospitals across Australia (N = 597) were randomly selected and assessed for ASD (DSM-IV criteria) during hospital admission (within 1 month of trauma exposure) and were subsequently reassessed for PTSD 3 months after the initial assessment (N = 507). Results: Thirty-three patients (6%) met criteria for ASD, and 49 patients (10%) met criteria for PTSD at the 3-month follow-up assessment. Fifteen patients (45%) diagnosed with ASD and 34 patients (7%) not diagnosed with ASD subsequently met criteria for PTSD. The positive predictive power of PTSD criteria in the acute phase (0.60) was a better predictor of chronic PTSD than the positive predictive power of ASD (0.46). Conclusions: The majority of people who develop PTSD do not initially meet criteria for ASD. These data challenge the proposition that the ASD diagnosis is an adequate tool to predict chronic PTSD.
Bryant, R. A., Mastrodomenico, J., Felmingham, K. L., Hopwood, S., Kenny, L., Kandris, E., . . . Creamer, M. (2008). Treatment of acute stress disorder: A randomized controlled trial. Archives General Psychiatry, 65, 659-667. doi:10.1001/archpsyc.65.6.659
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Context: Recent trauma survivors with acute stress disorder (ASD) are likely to subsequently develop chronic posttraumatic stress disorder (PTSD). Cognitive behavioral therapy for ASD may prevent PTSD, but trauma survivors may not tolerate exposure-based therapy in the acute phase. There is a need to compare nonexposure therapy techniques with prolonged exposure for ASD. Objective: To determine the efficacy of exposure therapy or trauma-focused cognitive restructuring in preventing chronic PTSD relative to a wait-list control group. Design, Setting, and Participants: A randomized controlled trial of civilians who experienced trauma and who met the diagnostic criteria for ASD (N = 90) seen at an outpatient clinic between March 1, 2002, and June 30, 2006. Intervention: Patients were randomly assigned to receive 5 weekly 90-minute sessions of either imaginal and in vivo exposure (n = 30) or cognitive restructuring (n = 30), or assessment at baseline and after 6 weeks (wait-list group; n = 30). Main Outcome Measures: Measures of PTSD at the 6-month follow-up visit by clinical interview and self-report assessments of PTSD, depression, anxiety, and trauma-related cognition. Results: Intent-to-treat analyses indicated that at posttreatment, fewer patients in the exposure group had PTSD than those in the cognitive restructuring or wait-list groups (33% vs 63% vs 77%; P = .002). At follow-up, patients who underwent exposure therapy were more likely to not meet diagnostic criteria for PTSD than those who underwent cognitive restructuring (37% vs 63%; odds ratio, 2.10; 95% confidence interval, 1.12-3.94; P = .05) and to achieve full remission (47% vs 13%; odds ratio, 2.78; 95% confidence interval, 1.14-6.83; P = .005). On assessments of PTSD, depression, and anxiety, exposure resulted in markedly larger effect sizes at posttreatment and follow-up than cognitive restructuring. Conclusions: Exposure-based therapy leads to greater reduction in subsequent PTSD symptoms in patients with ASD when compared with cognitive restructuring. Exposure should be used in early intervention for people who are at high risk for developing PTSD.
Bryant, R. A., Moulds, M. L., Guthrie, R. M., Dang, S. T., Mastrodomenico, J., Nixon, R. D., . . . Creamer, M. (2008). A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder. Journal of Consulting & Clinical Psychology, 76, 695-703. doi:10.1037/a0012616
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Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients.
Creamer, M., & O’Donnell, M. (2008). The pros and cons of psychoeducation following trauma: Too early to judge? Psychiatry: Interpersonal and biological processes, 71, 319-321. doi:10.1521/psyc.2008.71.4.319
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The paper by Wessely and colleagues raises interesting and important questions about the use of psychoeducation in the context of traumatic exposure. Psychoeducation is now so routinely used in the aftermath of large scale disaster and trauma that the public health implications of these questions are enormous. Since psychoeducation can be offered at several timepoints (before the experience for those likely to be exposed, immediately after the event for all those exposed, or later for those who develop problems), it is important to clarify what we mean by the term. Falvo (1994) defined patient education as a planned educational activity designed to produce changes in knowledge, attitudes, and skills to improve health outcomes. Wehn such education is targeted at psychological health, it is often referred to as psychoeducation (Pekkala & Merinder, 2002). Psychoeducation (in both written and verbal forms) is routinely used as a component of successful interventions for psychiatric conditions such as posttraumatic stress disorder (PTSD) (e.g., Foa & Rothbaum, 1998; Resick & Schnicke, 1993). It has demonstrated some efficacy as a standalone treatment of high prevalence disorders such as depression (Christensen, Griffiths, & Jorm, 1994).
Creamer, M., & Parslow, R. (2008). Trauma exposure and posttraumatic stress disorder in the elderly: A community prevalence study. American Journal of Geriatric Psychiatry, 16, 853-856. doi:10.1097/01.JGP.0000310785.36837.85
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Objective: Little prevalence data exist on trauma exposure and posttraumatic stress disorder (PTSD) in the elderly. The authors examined lifetime exposure to trauma and 12-month PTSD in a large community sample. Method: Data were drawn from the Australian National Survey of Mental Health. Of the total 10,641 participants, 1,792 were over the age of 65. The Composite International Diagnostic Interview provided trauma exposure and diagnostic status. Results: A curvilinear pattern of lifetime exposure to trauma across the lifespan was obtained for women, whereas men showed a linear increase. This difference was explained by combat exposure. PTSD prevalence reduced with age and participants over 65 reported negligible rates. Around 10% of the elderly reported reexperiencing symptoms. Conclusions: PTSD rates are lower in older age cohorts, although reasons for this are unclear. With 10% reporting reexperiencing symptoms associated with past events, however, greater awareness of treatments that target traumatic memories may be beneficial.
Dileo, J., Brewer, W., Hopwood, M., Anderson, V., & Creamer, M. (2008). Olfactory identification dysfunction, aggression and impulsivity in war veterans with posttraumatic stress disorder. Psychological Medicine, 38, 523-531. doi:10.1017/S0033291707001456
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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, SD = 2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean = 56.84 years, SD = 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.
Elhai, J. D., Grubaugh, A. L., Richardson, J. D., Egede, L. E., & Creamer, M. (2008). Outpatient medical and mental healthcare utilization models among military veterans: Results from the 2001 National Survey of Veterans. Journal of Psychiatric Research, 42, 858-867. doi:10.1016/j.psychires.2007.09.006
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Using Andersen's (1995) [Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 1995;36:1-10] behavioral model of healthcare use as our theoretical framework, we examined predisposing (i.e., sociodemographic), enabling (i.e., access resources), and need (i.e., illness) models of outpatient medical and mental healthcare utilization among a national sample of US veterans. Participants were 20,048 nationally representative participants completing the 2001 National Survey of Veterans. Outcomes were healthcare use variables for the past year, including the number of Veterans Affairs (VA) and non-VA outpatient healthcare visits, and whether VA and non-VA mental health treatment was used. Univariate results demonstrated that numerous predisposing, enabling and need variables predicted both VA and non-VA healthcare use intensity and mental healthcare use. In multivariate analyses, predisposing, enabling and need variables demonstrated significant associations with both types of healthcare use, but accounted for more variance in mental healthcare use. Need variables provided an additive effect over predisposing and enabling variables in accounting for medical and mental healthcare use, and accounted for some of the strongest effects. The results demonstrate that need remains an important factor that drives healthcare use among veterans and does not seem to be overshadowed by socioeconomic factors that may create unfair disparities in treatment access.
Forbes, D. (2008). Minnesota Multiphasic Personality Inventory-2. In G. Reyes, J. D. Elhai & J. D. Ford (Eds.), The Encyclopedia of Psychological Trauma (pp. 430-433). Hoboken, NJ: John Wiley Press.
Forbes, D., Lewis, V., Parslow, R., Hawthorne, G., & Creamer, M. (2008). A naturalistic comparison of models of programmatic interventions for combat-related post-traumatic stress disorder. The Australian and New Zealand Journal of Psychiatry, 42, 1051-1059. doi:10.1080/00048670802512024
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Objectives: Post-traumatic stress disorder (PTSD) is a difficult-to-treat sequel of combat. Data on effectiveness of alternate treatment structures are important for planning veterans' psychiatric services. The present study compared clinical presentations and treatment outcomes for Australian veterans with PTSD who participated in a range of models of group-based treatment. Method: Participants consisted of 4339 veterans with combat-related PTSD who participated in one of five types of group-based cognitive behavioural programmes of different intensities and settings. Data were gathered at baseline (intake), as well as at 3 and 9 month follow up, on measures of PTSD, anxiety, depression and alcohol misuse. Analyses of variance and effect size analyses were used to investigate differences at intake and over time by programme type. Results: Small baseline differences by programme intensity were identified. Although significant improvements in symptoms were evident over time for each programme type, no significant differences in outcome were evident between programmes. When PTSD severity was considered, veterans with severe PTSD performed less well in the low-intensity programmes than in the moderate- or high-intensity programmes. Veterans with mild PTSD improved less in high-intensity programmes than in moderate- or low-intensity programmes. Conclusion: Comparable outcomes are evident across programme types. Outcomes may be maximized when veterans participate in programme intensity types that match their level of PTSD severity. When such matching is not feasible, moderate-intensity programmes appear to offer the most consistent outcomes. For regionally based veterans, delivering treatment in their local environment does not detract from, and may even enhance, outcomes. These findings have implications for the planning and purchasing of mental health services for sufferers of PTSD, particularly for veterans of more recent combat or peacekeeping deployments.
Forbes, D., Parslow, R., Creamer, M., Allen, N., McHugh, T., & Hopwood. M. (2008). Mechanisms of anger and treatment outcome in combat veterans with Posttraumatic Stress Disorder. Journal of Traumatic Stress, 21, 142-149. doi:10.1002/jts.20315
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Research has identified anger as prominent in, and an influence on, treatment outcome for military veterans with posttraumatic stress disorder (PTSD). This study examined factors influencing the relationship between anger and outcome to improve treatment effectiveness. Participants comprised 103 veterans attending PTSD treatment. Measures of PTSD and comorbidity were obtained at intake and 9-month follow-up. Measures also included potential mediators of therapeutic alliance, social support, problematic/undermining relationships and fear of emotion. Path analyses supported anger as a predictor of treatment outcome, with only fear of anger and alcohol comorbidity accounting for the variance between anger and outcome. To improve treatment effectiveness, clinicians need to assess veterans' anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors.
Hawthorne, G., Konstancja, D., Pallant, J. F., Mortimer, D., & Segal, L. (2008). Deriving utility scores from the SF-36 health instrument using Rasch analysis. Quality of Life Research, 17, 1183-1193. doi:10.1007/s11136-008-9395-5
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Background: Utility scores for use in cost-utility analysis may be imputed from the SF-36 health instrument using various techniques, typically regression analysis. This paper explored imputation using partial credit Rasch analysis. Method: Data from the Assessment of Quality of Life (AQoL) instrument validation study were re-analysed (n = 996 inpatients, outpatients and a community sample). For each AQoL item, factor analysis identified those SF-36 items forming a unidimensional scale. Rasch analysis located scale logit scores for these SF-36 items. The logit scores were used to assign AQoL item scores. The standard AQoL scoring algorithm was then applied to obtain the utility scores. Results: Many SF-36 items were limited predictors of AQoL items; some items from both instruments obtained disordered thresholds. All imputed scores were consistent with the AQoL model and fell within AQoL score boundaries. The explained variance between imputed and true AQoL scores was 61%. Discussion: Rasch-imputed mapping, unlike many regression-based algorithms, produced results consistent with the axioms of utility measurement, while the proportion of explained variance was similar to regression-based modelling. Item properties on both instruments implied that some items should be revised using Rasch analysis. The methods and results may be used by researchers needing to impute utility scores from SF-36 health scores.
Higgins, R. O., Murphy, B. M., Goble, A. J., Le Grande, M. R., Elliott, P. C., & Worcester, M. U. C. (2008). Cardiac rehabilitation program attendance after coronary artery bypass surgery: Overcoming the barriers. The Medical Journal of Australia, 188, 712-714. Retrieved from http://www.mja.com.au/public/issues/188_12_160608/hig10391_fm.html
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Objective: To investigate rates and predictors of cardiac rehabilitation (CR) attendance after coronary artery bypass graft surgery (CABGS) at Royal Melbourne Hospital (RMH), Victoria, where current best practice referral and recruitment strategies have been adopted. Design, setting and participants: Prospective cohort study of 184 patients who underwent CABGS at RMH between July 2001 and April 2004. Patients completed questionnaires pre-operatively, and 170 patients (92%) had their CR attendance tracked after referral to CR either at RMH or elsewhere. Main outcome measures: Rates of CR attendance among RMH patients referred to CR either at RMH or elsewhere; sociodemographic, medical, cognitive, psychosocial and geographical predictors of CR non-attendance. Results: The CR attendance rate was 72%. Patients referred to CR at RMH were more than four times more likely to attend than patients referred elsewhere (odds ratio [OR], 4.36; P=0.024). Travel time significantly predicted CR attendance (OR, 0.86; P=0.039). Conclusions: CR attendance rates were found to be higher than previously reported for CABGS patients, suggesting that best practice referral and recruitment procedures minimise common barriers to CR attendance.
Killackey, E., Jorm, A., Alvarez-Jimenez, M., McCann, T. V., Hides, L., & Couineau, A. L. (2008). Do we do what we know works, and if not why not? Australian and New Zealand Journal of Psychiatry, 42, 439-444. doi:10.1080.00048670802050652
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There have always been a range of treatments for mental illness. Evidence exists of ancient trepanning, and through the ages other techniques have been used such as blood letting, exorcism, confinement, dietary interventions, environmental interventions, talking therapies of various modalities, industrial therapies, insulin comas, and ice baths among many others. In the past the view was held that physicians were people of such sober judgement and fine knowledge that ‘all remedies whatever are at the disposal of practitioners to reject or employ them under the sole guidance of their own judgment’. But in more recent times, for reasons of efficacy and economics, there has been greater concern with using treatments for which there is the best evidence of a positive outcome.
Le Grande, M. R., Elliott, P. C., Worcester, M. U. C., Murphy, B. M., & Goble, A. J. (2008). An evaluation of self-report physical activity instruments used in studies involving cardiac patients. Journal of Cardiopulmonary Rehabilitation and Prevention, 28, 358-369. doi:10.1097/HCR.0b013e318181c3d90
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Given the importance of physical activity (PA) in cardiac rehabilitation and prevention, measuring it in a valid and reliable manner is a practical challenge. Measuring self-reported PA in elderly cardiac patients can be problematic because of the need to assess many activities of short duration that may occur as part of routine daily functions. The primary purpose of this article was to identify and evaluate instruments that have been used over the last 15 years in studies of cardiac patients. A comprehensive MEDLINE search was carried out to identify articles from studies undertaken to assess PA in cardiac patients. The self-report PA instruments were subjected to evaluation concerning suitability for use with cardiac patients. The initial electronic and hand searches yielded 203 articles. After removing articles that did not meet the inclusion criteria, a total of 86 articles were selected. Twenty-three self-report instruments were identified for evaluation. Most of the instruments had problems associated with inadequate validation methods or suitability for cardiac patients. Many of the instruments failed to demonstrate adequate validity or reliability, particularly when measuring low-intensity PA. Some instruments are more suited to epidemiologic research than to clinical interventions where responsiveness to interventions is crucial. Recommendations for the constituents of an acceptable self-report PA instrument for cardiac patients are presented and the most suitable existing instruments are identified.
Murphy, B. M.,
Elliott, P. C., Higgins, R. O., Le Grande, M. R., Worcester M. U. C., Goble, A. J., & Tatoulis, J. (2008). Anxiety and depression after coronary artery bypass graft surgery: Most get better, some get worse.
European Journal of Cardiovascular Prevention and Rehabilitation, 15, 434-440. doi:10.1097/HJR.0b013e3282fbc945
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Background: To target interventions, patients at risk for poor outcomes after a cardiac event need to be identified. We investigated trajectories of anxiety and depression after coronary artery bypass graft surgery (CABGS) and identified patients at risk of persistent or worsening anxiety and depression. Methods: A consecutive sample of 184 patients on the waiting list for CABGS at The Royal Melbourne Hospital completed self-report questionnaires before surgery, and at 2 and 6 months postsurgery. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Growth mixture modelling identified trajectories of anxiety and depression. Results: Two possible trajectories emerged for anxiety, whereas three trajectories emerged for depression. Most patients (92%) followed a trajectory of minor presurgical anxiety that remitted in 6 months after CABGS, with the remainder (8%) following a trajectory of major anxiety that remitted in the same period. Minor remitted depression was also common (72% patients). Two less common depression trajectories indicated worsening or unresolved depression. One trajectory began with major presurgical depression that partially remitted by 6 months (14% patients) and the other began with minor presurgical depression that worsened by 6 months (14% patients). Unpartnered patients, smokers, those with presurgical anxiety, high cholesterol, angina, more severe disease or having repeat CABGS were at increased risk for a poor depression trajectory. Conclusion: Although initial anxiety and depression resolved or lessened for most patients, some patients experienced persistent or worsening depression after CABGS. Interventions can be targeted toward ‘at risk’ patients.
Murphy, B. M., Elliott, P. C., Le Grande, M. R., Higgins, R. O., Ernest, C. S., Goblea, A. J., . . . Worcester, M. U. C. (2008). Living alone predicts 30-day hospital readmission after coronary artery bypass graft surgery. European Journal of Cardiovascular Prevention and Rehabilitation, 15, 210-215. doi:10.1097/HJR.0b013e3282f2dc4e
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Background: Earlier studies show that medical factors and disease severity predict early readmission to hospital after coronary artery bypass graft surgery (CABGS). Few studies have investigated psychosocial predictors. This study investigated medical, sociodemographic and psychosocial predictors of 30-day hospital readmission. Methods: A consecutive sample of 181 patients wait-listed for CABGS completed self-report questionnaires before surgery, and at 2 and 6 months after surgery. Results: Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t = 2.12, df = 179, P = 0.035), and more likely to be unmarried (χ2 = 5.80, df = 1, P = 0.016), live alone (χ2 = 8.33, df = 1, P = 0.004), have a history of hypertension (χ2 = 2.731, df = 1, P = 0.098) and have higher anxiety before surgery (t = 1.67, df = 175, P = 0.097). When these variables were entered into a backward stepwise logistic regression, the only significant unique predictor of 30-day readmission was living alone (Wald = 7.08, odds ratio = 3.42, P = 0.008). Patients living alone were over three times more likely than those living with others to be readmitted to hospital. Disease severity and other medical factors were not associated with readmission. Conclusion: Living alone was identified as the single most important risk factor for early readmission after CABGS. Patients who live alone may benefit from additional support during early convalescence. Intervention studies could explore support options for these patients.
Murphy, B. M., Elliott, P. C., Worcester, C., Higgins, R. O., Le Grande, M. R., Roberts, S. B., & Goble, A. J. (2008). Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event. British Journal of Health Psychology, 13, 135-153. doi:10.1348/135910707X173312
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Objectives: Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. Method: A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. Results: Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. Conclusion: Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
O’Donnell, M. L., Bryant, R. A., Creamer, M., & Carty, J. (2008). Mental health following traumatic injury: Toward a health system model of early psychological intervention. Clinical Psychology Review, 28, 387-406. doi:10.1016/j.cpr.2007.07.008
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In 2005, over 2 million people in the United States of America were hospitalised following non-fatal injuries. The frequency with which severe injury occurs renders it a leading cause of posttraumatic stress disorder and other trauma-related psychopathology. In order to develop a health system model of early psychological intervention for this population, we review the literature that pertains to mental health early intervention. The relevant domains include prevalence of psychopathology following traumatic injury, the course of symptoms, screening, and early intervention strategies. On the basis of available evidence, we propose a health system model of early psychological intervention following traumatic injury. The model involves screening for vulnerability within the hospital setting, follow-up screening for persistent symptoms at one month posttrauma, and early psychological intervention for those who are experiencing clinical impairment. Recommendations are made to facilitate tailoring early intervention psychological therapies to the special needs of the injury population.
O'Donnell, M., & Creamer, M. (2008). Motor vehicle collisions. In G. Reyes, J. D. Elhai & J. D. Ford (Eds.), The Encyclopedia of Psychological Trauma. Hoboken, NJ: John Wiley Press.
O'Donnell, M. L., Creamer, M., & Ludwig, G. (2008). PTSD and associated mental health consequences of motor vehicle collisions. In M. Duckworth, T. Iezzi & W. O'Donohue (Eds.), Motor Vehicle Collisions: Medical, Psychosocial, and Legal Consequences (pp. 345-363). New York: Elsevier Inc. doi:10.1016/B978-0-08-045048-3.00013-0
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Motor vehicle collisions (MVCs) are frequently experienced as a traumatic event. Breslau et al. (1991), for example, found that 42% of people reported experiencing a serious motor vehicle crash at some time in their lives, making MVC the second most frequent traumatic event. This has been replicated in a number of epidemiological studies both in the USA (Kessler et al., 1995) and other western countries (Erkonigg et al., 2000; Creamer et al., 2001). In this chapter, we will review the literature on the psychological consequences of MVCs using a posttraumatic mental health paradigm. This paradigm focuses on the experience of an MVC as a potentially traumatic event.
O’Donnell, M. L., Creamer, M. C., Parslow, R., Elliott, P., Holmes, A. C. N., Ellen, S., . . . Bryant, R. A. (2008). A predictive screening index for posttraumatic stress disorder and depression following traumatic injury. Journal of Consulting and Clinical Psychology, 76, 923-932. doi:10.1037/a0012918
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Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.
Pead, J., Fletcher, S., & Creamer, M. (2008). Ten challenges in posttraumatic mental health. Australian and New Zealand Journal of Occupational Health and Safety, 24, 531-539.
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The mental health effects of trauma following workplace injury have been the focus of increasing awareness for OHS professionals and insurers. Employers and third party insurers have a responsibility to ensure that the consequences of such events are managed according to agreed best practices, which are driven by the available research evidence. This article outlines 10 challenges associated with managing mental health issues following traumatic events. Three relate to people’s needs, including causation, recovery and early problem recognition. Four relate to best practice interventions, including psychological debriefing and other immediate responses, evidence-based treatment, finding effective health practitioners, and maintaining quality of care. The final challenges relate to outcomes, emphasising physical, social and occupational goals in the context of, rather than separate to, mental health treatment. Solutions for each of these key challenges, together with evidence for each, are described.
Phelps, A., Forbes, D., & Creamer, M. (2008). Understanding posttraumatic nightmares: An empirical and conceptual Review. Clinical Psychology Review, 28, 339-356. doi:10.1016/j.cpr.2007.06.001
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Posttraumatic nightmares (PTNMs) are a highly prevalent and distressing symptom of posttraumatic stress disorder (PTSD), yet have been subject to limited phenomenological investigation. As a result, the parameters of the symptom required to meet diagnostic criterion for PTSD are unclear and their relationship with normal dreams following trauma is not known. A categorical distinction between PTNMs and normal dreams has been assumed, explicitly within dreaming theories and perhaps implicitly within the PTSD field, but lacks empirical support. This paper reviews the current understanding of PTNMs and normal dreams following trauma within the PTSD and dreaming fields respectively. It is argued that models of PTSD can readily account for repetitive PTNMs that accurately replay the traumatic event, but not those that are symbolic of the traumatic event. On the other hand, theories of dreaming that propose a psychologically adaptive function of dreams can account for both replay and symbolic nightmares that evolve over time, but not those that are stuck in repetition. It is concluded that there is no adequate explanation for the range of dreams following trauma including the PTNM of PTSD that is both symbolic and repetitive. Three alternate explanatory models are proposed that draw on existing knowledge within both the PTSD and dreaming fields to explain the full range of nightmares following trauma.
2007
Australian Centre for Posttraumatic Mental Health (ACPMH). (2007). Australian Guidelines for the treatment of adults with Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne: ACPMH. Retrieved from http://www.acpmh.unimelb.edu.au/resources/resources-guidelines.html
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Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are psychological reactions that develop in some people following the experience of traumatic events such as major disaster, war, sexual or physical assault, motor vehicle accidents, and torture. Exposure to a traumatic event is not an uncommon experience. Large community surveys in Australia and overseas reveal that 50–65 per cent of people report at least one traumatic event in their lives. Most people will have some kind of psychological reaction to trauma—feelings of fear, sadness, guilt and anger are common. However, the majority recover over time with only a small proportion developing ASD or PTSD. It is estimated that 1.3 per cent of Australians have experienced PTSD in the last year, and that between 5 and 10 per cent of people have had PTSD at some point in their lives.
Creamer, M. (2007). Posttraumatic Syndromes: Disorders or Symptoms? In D. Castle, S. Hood & M. Kyrios (Eds.), Anxiety Disorders: Current Controversies, Future Directions. Melbourne: Australian Postgraduate Medicine.
Ernest, C. S., Elliott, P. C., Murphy, B. M., Le Grande, M. R., Goble, A. J., Higgins, R. O., . . . Tatoulis, J. (2007). Predictors of cognitive function in candidates for coronary artery bypass graft surgery. Journal of the International Neurolopsychological Society, 13, 257-266. doi:10.1017/S1355617707070282
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Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.
Cooper, J., Forbes, D., Pead, J., & Phelps, A. (2007). Mental Health Advice Book for practitioners helping veterans with common mental health problems. Canberra: Department of Veterans’ Affairs. Retrieved from http://at-ease.dva.gov.au/resources/documents/Mental_Health_Advice_Booklet_-_DVA_July_2007.pdf
Click to read abstract
Veterans’ mental health problems are as varied as the conflicts in which our ex-servicemen and women have served. Health practitioners may treat an ex-prisoner of war from World War II, a Vietnam veteran or a woman in her thirties who served in Rwanda and East Timor. While their problems and the treatment they receive may be unique, veterans share a common military culture. Although it has certainly changed over the years, an understanding of this culture will greatly assist health practitioners to provide the most appropriate treatment for veterans. At the same time, practitioners can be reassured that they can help veterans with mental health problems with much the same approach as they use to help the general community. Society’s understanding and acceptance of mental health problems has improved dramatically since the men and women who served in World War I returned home to the care of dedicated repatriation hospitals. Views about where to provide mental health treatment have changed considerably since then. Like all of us, veterans benefit from being treated in the community, close to family and friends, with as little disruption as possible to their daily routines This book provides information and advice to practitioners in all health services in recognising, assessing and treating veterans’ common mental health problems. It will also increase practitioners’ awareness and knowledge of more specialist mental health advice, services and referral options.
Forbes, D., Creamer, M., Phelps, A., Bryant, R., McFarlane, A., Devilly, G., . . . Newton, S. (2007). The Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder. Australian and New Zealand Journal of Psychiatry, 41, 637-648. Retrieved from http://www.devilly.org/Publications/Tx_Guidelines_ANZJP.pdf
Forbes, D., Creamer, M. C., Phelps, A. J., Couineau, A. L., Cooper, J. A., Bryant, R. A, . . . Raphael, B. (2007). Treating adults with acute stress disorder and posttraumatic stress disorder in general practice: A clinical update. Medical Journal of Australia, 187, 120-123. Retrieved from http://www.mja.com.au/public/issues/187_02_160707/for10467_fm.pdf
Goldney, R., Fisher, L., Dal Grande, E., & Hawthorne, G. (2007). Have education and publicity about depression made a difference? A comparison of prevalence, service use and excess costs in South Australia: 1998 and 2004. Australian and New Zealand Journal of Psychiatry, 41, 38-53. doi:10.1080/00048670601050465
O'Donnell, M. L., Creamer, M., Elliott, P., & Bryant, R. (2007). Tonic and phasic heart rate as predictors of posttraumatic stress disorder. Psychosomatic Medicine, 69, 256-261. doi:10.1097/PSY.0b013e3180417d04
O'Donnell, M. L., Elliott, P., Lau, W., & Creamer, M. (2007). PTSD symptom trajectories: From acute to chronic response. Behaviour Research and Therapy, 45, 601-606. doi:10.1016/j.brat.2006.03.015
O'Donnell, M. L., Elliott, P., Wolfgang, B. J., & Creamer, M. (2007). Posttraumatic appraisals in the development and persistence of posttraumatic stress symptoms. Journal of Traumatic Stress, 20, 173-182. doi:10.1002/jts.20198
Rushford, N., Murphy, B. M., Worcester, M. U. C., Goble, A. J., Higgins, R. O., Le Grande, M. R., . . . Elliot, P. C. (2007). Recall of information received in hospital by female cardiac patients. European Journal of Cardiovascular Prevention & Rehabilitation, 14, 463–469. doi: 10.1097/HJR.0b013e3280ac1507
Worcester, M. U. C., Murphy, B. M., Elliot, P. C., Le Grande, M. R., Higgins, R. O., Goble, A., J., & Roberts, S. B. (2007). Trajectories of recovery of quality of life in women after an acute cardiac event. British Journal of Health Psychology, 12, 1-15. doi: 10.1348/135910705X90127
2006
Bowden, S. C., Weiss, L. G.,Holdnack, J. A., & Lloyd, D. (2006). Age-related invariance of abilities measured with the Wechsler Adult Intelligence Scale–III. Psychological Assessment, 18, 334-339. doi:10.1037/1040-3590.18.3.334
Carty, J., O'Donnell, M. L., & Creamer, M. (2006). Delayed-onset PTSD: A prospective study of injury survivors. Journal of Affective Disorders, 90, 257-261. doi:10.1016/j.jad.2005.11.011
Cooper, J. A., Creamer, M. C., & Forbes, D. (2006). Mental health initiatives for veterans and serving personnel. The Medical Journal of Australia, 185, 453. Retrieved from http://www.mja.com.au/public/issues/185_08_161006/coo10523_fm.pdf
Creamer, M. (2006). Acute psychological intervention for law enforcement personnel following trauma exposure: What is current best practice? The Law Enforcement Executive Forum, 6, 135-150. Retrieved from http://www.iletsbei.com/forum/articledetail.php?recordID=545
Creamer, M., Carboon, I., Forbes, A. B., McKenzie, D. P., McFarlane, A. C., Kelsall, H. L., & Sim, M. R. (2006). Psychiatric disorder and separation from military service: A 10 year retrospective study. American Journal of Psychiatry, 163, 733-734. doi:10.1176/appi.ajp.163.4.733
Creamer, M., & Carty, J. (2006). Posttraumatic Stress Disorder. In M. C. McNulty (Ed.), Handbook of Adult Clinical Psychology: An Evidence Based Practice Approach (pp. 523-557). London: Brunner Routledge.
Creamer, M., & Carty, J. (2006). Posttraumatic stress disorder in women. In D. Castle, J. Kulkarni, K. M. Abel, & Goldstein, J. (Eds.), Mood and Anxiety in Women (pp. 75-91). Cambridge: Cambridge University Press. doi:10.1017/CBO9780511543647
Creamer, M., Elliott, P., Forbes, D., Biddle, D., & Hawthorne, G. (2006). Treatment for combat-related posttraumatic stress disorder: Two year follow-up. Journal of Traumatic Stress, 19, 675-685. doi:10.1002/jts.20155
Forbes, D., & Creamer, M. (2006). The treatment of chronic posttraumatic stress disorder. In G. Kearney, M. Creamer, R. Marshall & A. Goyne (Eds.), Military stress and performance (pp. 206-218). Melbourne: Melbourne University Press.
Forbes, D., Carty, J., Elliott, P., Creamer, M., McHugh, T., Hopwood, M., & Chemtob, C. M. (2006). Is mixed handedness a marker of treatment response in posttraumatic stress disorder?: A pilot study. Journal of Traumatic Stress, 19, 961-966. doi:10.1002/jts.20160
Hawthorne, G. (2006). Measuring social isolation in older adults: Development and initial validation of the Friendship Scale. Social Indicators Research, 77, 521 - 548. doi:10.1007/s11205-005-7746-y
Hawthorne, G., Herrman, H., & Murphy, B. (2006). Interpreting the WHOQOL-Brèf: Preliminary population norms and effect sizes. Social Indicators Research, 77, 37 - 59.
doi:10.1007/s11205-005-5552-1
Hawthorne, G., Mouthaan, J., Forbes, D., & Novaco, R. W. (2006). Response categories and anger measurement: Do fewer categories result in poorer measurement?: Development of the DAR5. Social Psychiatry and Psychiatric Epidemiology, 41, 164-172. doi:10.1007/s00127-005-0986-y
Le Grande, M. R., Elliott, P. C., Murphy, B. M., Worcester, M. U. C., Higgins, R. O., Ernest, C. S., & Goble, A. J. (2006). Health related quality of life trajectories and predictors following coronary artery bypass surgery. Health and Quality of Life Outcomes, 4, 49. doi:10.1186/1477-7525-4-49
McFarlane, A. C., & Creamer, M. (2006). Current knowledge about psychological trauma: A response to Milton. ADF Health,7, 78-82. Retrieved from http://www.defence.gov.au/health/infocentre/journals/ADFHJ_oct06/ADFHealth_7_2_78.pdf
McKenzie, D. P., McFarlane, A. C., Creamer, M., Ikin, J. F., Forbes, A. B., Kelsall, H. L., . . . Sim, M. R. (2006). Hazardous or harmful alcohol use in Royal Australian Navy veterans of the 1991 Gulf War: Identification of high risk subgroups. Addictive Behaviors, 31, 1683-1694. doi:10.1016/j.addbeh.2005.12.027
O'Donnell, M. L., Creamer, M., Bryant, R. A., Schnyder, U., & Shalev, A. (2006). Posttraumatic Stress Disorder following injury: Assessment and other methodological considerations. In G. Young, A. Kane, & K. Nicholson (Eds.), Psychological Knowledge In Court: PTSD, Pain, and TBI (pp.70-84). New York: Springer Publishing Co. doi:10.1007/0-387-25610-5_4
Scott, C. K., Sonis, J., Creamer, M., & Dennis, M. L. (2006). Maximizing follow-up in longitudinal studies of traumatized populations. Journal of Traumatic Stress, 19, 757-769. doi:10.1002/jts.20186
2005
Biddle, D., Hawthorne, G., Forbes, D., & Coman, G. (2005). Problem gambling in Australian PTSD treatment-seeking veterans. Journal of Traumatic Stress, 18, 759-767. doi:10.1002/jts.20084
Carboon, I., Anderson, V. A., Pollard, A., Szer, J., & Seymour, J. F. (2005). Posttraumatic growth following a cancer diagnosis: Do world assumptions contribute? Traumatology, 11, 269-283. doi:10.1177/153476560501100406
Coman, G. J., Evans, B. J., & Burrows, G. D. (2005). An innovative cognitive strategy to assist problem gamblers. British Journal of Guidance and Counselling, 33, 129-140. doi:10.1080/03069880412331335867
Cooper, J., Carty, J., & Creamer, M. (2005). Pharmacotherapy for posttraumatic stress disorder: Empirical review and clinical recommendations. Australian and New Zealand Journal of Psychiatry, 39, 674-682. doi: 10.1111/j.1440-1614.2005.01651.x
Creamer, M., McFarlane, A. C., & Burgess, P. (2005). Psychopathology following trauma: The role of subjective experience. Journal of Affective Disorders, 86, 175-182. doi:10.1016/j.jad.2005.01.15
Creamer, M., O'Donnell, M. L., & Pattison, P. (2005). Amnesia, traumatic brain injury, and posttraumatic stress disorder: A methodological enquiry. Behaviour Research and Therapy, 43, 1383-1389. doi:10.1016/j.brat.2004.11.001
Elliott, P., Biddle, D., Hawthorne, G., Forbes, D., & Creamer, M. (2005). Patterns of treatment response in chronic posttraumatic stress disorder: An application of latent variable growth mixture modeling. Journal of Traumatic Stress, 18,303-311. doi:10.1002/jts.20041
Elliott, P. & Hawthorne, G. (2005). Imputing missing repeated measures data: How should we proceed? Australian & New Zealand Journal of Psychiatry, 39, 575-582.
doi:10.1111/j.1440-1614.2005.01629.x
Forbes, D., Bennett, N., Biddle, D., Crompton, D., McHugh, T., Elliott, P., & Creamer, M. C. (2005). Clinical presentations and treatment outcome for peacekeeper veterans with PTSD: Preliminary findings. American Journal of Psychiatry, 162, 2188-2190. doi:10.1176/appi.ajp.162.11.2188
Forbes, D., Haslam, N., Williams, B. J., & Creamer, M. (2005). Testing the latent structure of posttraumatic stress disorder: A taxometric study of combat veterans. Journal of Traumatic Stress, 18,647-656. doi:10.1002/jts.20073
Hawthorne, G., & Elliott, P. (2005). Imputing cross-sectional missing data: A comparison of common techniques. Australian & New Zealand Journal of Psychiatry, 39, 583-590.
doi:10.1111/j.1440-1614.2005.01630.x
Hawthorne, G., & Osborne, R. (2005). Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure. Australian and New Zealand Journal of Public Health, 29, 136-142. doi: 10.1111/j.1467-842X.2005.tb00063.x
Ikin, J. F., McKenzie, D. P., Creamer, M. C., McFarlane, A. C., Kelsall, H. L., Glass, D. C., Forbes, A. B., Horsley, K. W. A., Harrex, W. K., & Sim, M. R. (2005). War zone stress without direct combat: The Australian naval experience of the Gulf War. Journal of Traumatic Stress, 18, 193-204. doi:10.1002/jts.20028
O'Donnell, M. L., & Creamer, M. (2005). Letter to the Editor - Drs. O'Donnell and Creamer Reply. American Journal of Psychiatry, 162, 630 - 631. Retrieved from http://ajp.psychiatryonline.org/cgi/reprint/162/3/630
O'Donnell, M. L., Creamer, M., Elliott, P., & Atkin, C. (2005). Health costs following motor vehicle accidents: The role of posttraumatic stress disorder. Journal of Traumatic Stress, 18, 557-561. doi:10.1002/jts.20064
O'Donnell, M. L., Creamer, M. C., Elliott, P., Atkins, C., & Kossmann, T. (2005). Determinants of quality of life and role-related disability after injury: Impact of acute psychological responses. Journal of Trauma-Injury Infection & Critical Care, 59, 1328-1335. doi:10.1097/01.ta.0000197621.94561.4e
2004
Creamer, M., & Forbes, D. (2004). Military Populations. In S. Taylor (Ed.), Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-Behavioral Perspectives (pp. 153-174). New York: Springer.
Creamer, M., & Forbes, D. (2004). Treatment of posttraumatic stress disorder in military and veteran populations. Psychotherapy: Theory, Research, Practice, Training, 41, 388-398.
doi:10.1037/0033-3204.41.4.388
Creamer, M., O'Donnell, M. L., & Pattison, P. (2004). The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors. Behaviour Research and Therapy, 42, 315-328. doi:10.1016/S0005-7967(03)00141-4
Forbes, D., Hawthorne, G., Elliott, P., McHugh, T., Biddle, D., Creamer, M., & Novaco, R. W. (2004). A concise measure of anger in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 17, 249-256. doi:10.1023/B:JOTS.0000029268.22161.bd
Goldney, R., Hawthorne, G., & Fisher, L. (2004). Is the Australian National Survey of Mental Health a reliable guide for health planners? A methodological note on the prevalence of depression. Australian & New Zealand Journal of Psychiatry, 38, 635-638. doi:10.1111/j.1440-1614.2004.01425.x
Hawthorne, G. E., Hayes, L. M., Kelly, C., & Creamer, M. C. (2004). Pathways to care in veterans recently compensated for a mental health condition. Canberra: Department of Veterans’ Affairs.
Ikin, J. F., Sim, M. R., Creamer, M. C., Forbes, A. B., McKenzie, D. P., Kelsall, H. L., . . . Schwarz, H. (2004). War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War. The British Journal of Psychiatry, 185, 116-126. doi:10.1192/bjp.185.2.116
McKenzie, D. P., Ikin, J. F., McFarlane, A. C., Creamer, M., Forbes, A. B., Kelsall, H. L., . . . Sim, M. R. (2004). Psychological health of Australian veterans of the 1991 Gulf War: An assessment using the SF-12, GHQ-12 and PCL-S. Psychological Medicine, 34, 1419-1430. doi:10.1017/S0033291704002818
O'Donnell, M. (2004). Early intervention for trauma and traumatic loss. Behaviour Change, 21, 283-285. Retrieved from the ProQuest database.
O'Donnell, M. L., Creamer, M., & Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: Understanding comorbidity. American Journal of Psychiatry, 161, 1390-1396. doi:10.1176/appi.ajp.161.8.1390
O'Donnell, M. L., Creamer, M., Pattison, P., & Atkin, C. (2004). Psychiatric morbidity following injury. American Journal of Psychiatry, 161, 507-514. doi:10.1176/appi.ajp.161.3.507
2003
Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., & Page, A. (2003). The treatment of anxiety disorders: Clinician guides and patient manuals (2nd ed.). Cambridge: Cambridge University Press.
Coman, G. J., Evans, B. J., & Burrows, G. D. (2003). Gambling counselling in Australia: Focus on cognitive counselling techniques. British Journal of Guidance & Counselling, 31, 163-175. doi:10.1080/0306988031000102342
Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the Impact of Event Scale−Revised. Behaviour Research and Therapy, 41, 1489-1496.
Creamer, M., & Forbes, D. (2003). The long term effects of traumatic stress. In G. Kearney, M. Creamer, R. Marshall & A. Goyne (Eds.), Military Stress and Performance: The Australian Defence Force Experience. Melbourne: Melbourne University Press.
Creamer, M., & Singh, B. (2003). An integrated approach to veteran and military mental health: An overview of the Australian Centre for Posttraumatic Mental Health. Australasian Psychiatry, 11, 225-227. doi:10.1046/j.1039-8562.2003.00514.x
Elhai, J. D., Forbes, D., Creamer, M., McHugh, T. F., & Frueh, C. B. (2003). Clinical symptomatology of posttraumatic stress disorder-diagnosed Australian and United States Vietnam combat veterans: An MMPI-2 comparison. The Journal of Nervous and Mental Disease, 191, 458-464. doi:10.1097/01.NMD.0000081614.30361.3D
Evans, B. J., & Coman, G. J. (2003). Hypnosis with treatment for the anxiety disorders. Australian Journal of Clinical and Experimental Hypnosis, 31, 1-31.
Forbes, D., Cooper, J., & Creamer, M. (2003). Posttraumatic Stress: Presentation and management in General Practice. GP Review, 7, 22-23.
Forbes, D., & Creamer, M. (2003). The treatment of chronic posttraumatic stress disorder. In G. Kearney, M. Creamer, R. Marshall & A. Goyne (Eds.), Military Stress and Performance: The Australian Defence Force Experience (pp. 206-220). Melbourne: Melbourne University Press.
Forbes, D., Creamer, M., Allen, N., Elliott, P., McHugh, T., Debenham, P., & Hopwood, M. (2003). MMPI-2 based subgroups of veterans with combat-related PTSD: Differential patterns of symptom change after treatment. Journal of Nervous and Mental Disease, 191, 531-537. doi:10.1097/01.nmd.0000082181.79051.83
Forbes, D., Creamer, M., Allen, N., McHugh, T., Debenham, P., & Hopwood, M. (2003). MMPI-2 as a predictor of change in PTSD symptom clusters: A further analysis of the Forbes et al. (2002) data set. Journal of Personality Assessment, 81, 183-186. doi:10.1207/S15327752JPA8102_10
Forbes, D., Creamer, M., Hawthorne, G., Allen, N., & McHugh, T. (2003). Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder. The Journal of Nervous and Mental Disease, 191, 93-99. doi:10.1097/01.NMD.0000051903.60517.98
Forbes, D., Phelps, A. J., McHugh, A. F., Debenham, P., Hopwood, M., & Creamer, M. (2003). Imagery rehearsal in the treatment of posttraumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data. Journal of Traumatic Stress, 16, 509-513. doi:10.1023/A:1025718830026
Hawthorne, G. (2003). The effect of different methods of collecting data: Mail, telephone and filter data collection issues in utility measurement. Quality of Life Research, 12, 1081-1088. doi:10.1023/A:1026103511161
Hawthorne, G., Cheok, F., Goldney, R., & Fisher, L. (2003). The excess cost of depression in South Australia: A population-based study. Australian and New Zealand Journal of Psychiatry, 37, 362-373. doi:10.1046/j.1440-1614.2003.01189.x
Hawthorne, G., Osborne, R. H., & Elliott, P. (2003). Commentary on: A psychometric analysis of the measurement level of the rating scale, time-trade off and standard gamble, by Cook et al. Social Science & Medicine, 56, 895-897. doi:10.1016/S0277-9536(02)00077-1
Kearney, G., Creamer, M., Marshall, R., & Goyne, A. (Eds.), (2003). Military Stress and Performance: The Australian Defence Force Experience. Melbourne: Melbourne University Press.
O'Donnell, M. L., Creamer, M., Bryant, R. A., Schnyder, U., & Shalev, A. (2003). Posttraumatic disorders following injury: An empirical and methodological review. Clinical Psychology Review, 23, 587-603. doi:10.1016/S0272-7358(03)00036-9
Osborne, R. H., Hawthorne, G., Lew, E. A., & Gray, L. C. (2003). Quality of Life assessment in the community-dwelling elderly: Validation of the Assessment of Quality of Life (AQoL) Instrument and comparison with the SF-36. Journal of Clinical Epidemiology, 56, 138-147.
doi:10.1016/S0895-4356(02)00601-7
Sim, M., Abramson, M., Forbes, A., Glass, D., Ikin, J., . . . Creamer, M. C., & Fritischi, L. (2003). Australian Gulf War veteran’s health study, 1-3. Melbourne: Monash University Publishing.
Steindl, S. R., Young, R. M., Creamer, M., & Crompton, D. (2003). Hazardous alcohol use and treatment outcome in male combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 16, 27-34. doi:10.1023/A:1022055110238
2002
Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., & Page, A. (2002). The Treatment of Anxiety Disorders (2nd Ed.) New York: Cambridge University Press.
Biddle, D., Elliott, P., Creamer, M., Forbes, D., & Devilly, G. J. (2002). Self-reported problems: A comparison between PTSD-diagnosed veterans, their spouses, and clinicians. Behaviour Research and Therapy, 40, 853-865. doi:10.1016/S0005-7967(01)00084-5
Coman, G. J., Evans, B. J., & Burrows, G. D. (2002). Group counselling for problem gambling. British Journal of Guidance & Counselling, 30,145-158. doi:10.1080/03069880220128029
Creamer, M., Forbes, D., Biddle, D., & Elliott, P. (2002). Inpatient versus day hospital treatment for chronic, combat-related posttraumatic stress disorder: A naturalistic comparison. Journal of Nervous and Mental Disease, 190, 183-189. doi:10.1097/00005053-200203000-00007
Creamer, M., & O'Donnell, M. (2002). Post-traumatic stress disorder. Current Opinion in Psychiatry, 15, 163-168. Retrieved from the Ovid database.
Forbes, D., Creamer, M., Allen, N., Elliott, P., McHugh, T., Debenham, P., & Hopwood, M. (2002). The MMPI-2 as a predictor of symptom change following treatment for posttraumatic stress disorder. Journal of Personality Assessment,79, 321-336. doi:10.1207/S15327752JPA7902_13
Herrman, H., Hawthorne, G., & Thomas, R. (2002). Quality of life assessment in people living with psychosis. Social Psychiatry and Psychiatric Epidemiology, 37, 510-518.
doi:10.1007/s00127-002-0587-y
2001
Cobelas, C., Cooper, C., Ell, M., Hawthorne, G., Kennedy, M., & Leach, D. (2001). Quality management and the Emergency Services Enhancement Program. Journal of Quality in Clinical Practice, 21, 80-85. doi:10.1046/j.1440-1762.2001.00408.x
Creamer, M., Burgess, P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-Being. Psychological Medicine, 31, 1237-1247. doi:10.1017/S0033291701004287
Forbes, D., Creamer, M., & Biddle, D. (2001). The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behaviour Research and Therapy, 39,977-986. doi:10.1016/S0005-7967(00)00084-X
Forbes, D., Phelps, A., & McHugh, T. (2001). Treatment of combat-related nightmares using imagery rehearsal: a pilot study. Journal of Traumatic Stress, 14, 433-442. doi:10.1023/A:1011133422340
Hawthorne, G., & Richardson, J. (2001). Measuring the value of program outcomes: A review of multiattribute utility measures. Expert Review of Pharmacoeconomics & Outcomes Research, 1, 215-228. doi:10.1586/14737167.1.2.215
Hodgins, G., Creamer, M., & Bell, R. (2001). Risk factors for posttrauma reactions in police officers: A longitudinal study. Journal of Nervous and Mental Disease, 189, 541-547.
doi:10.1097/00005053-200108000-00007
Kearney , G., Creamer, M., Marshall, R., & Goyne, A. (Eds.), (2001). The Management of Stress in the Australian Defence Force: Human factors, families, and the welfare of military personnel away from the combat zone. Canberra: Defence Publishing Service.
O’Donnell, M. (2001). Getting over it: coping with serious injury. A guide for injury survivors and their families. Melbourne: Australian Centre for Posttraumatic Mental Health.
2000
Creamer, M. (2000). Posttraumatic stress disorder following violence and aggression. Aggression and Violent Behavior, 5,431-449. 
doi:10.1016/S1359-1789(98)00017-2
1999
Creamer, M., & McFarlane, A. C. (1999). Posttraumatic stress disorder. Australian Prescriber, 22, 32-36. Retrieved from http://www.australianprescriber.com/magazine/22/2/32/4
Creamer, M., Morris, P., Biddle, D., & Elliott, P. (1999). Treatment outcome in Australian veterans with combat-related posttraumatic stress disorder: A cause for cautious optimism? Journal of Traumatic Stress, 12, 545-558. doi:10.1023/A:1024702931164
Forbes, D., Creamer, M., & McHugh, T. (1999). MMPI-2 data for Australian Vietnam veterans with combat-related PTSD. Journal of Traumatic Stress, 12, 371-378. doi:10.1023/A:1024740929231
1998
Coman, G. J. & Burrows, G. D. (1998). Your Guide to Responsible Gambling. Richmond, Vic: Options Project; Mental Health Foundation of Victoria.
Creamer, M., & Manning, C. (1998). Acute stress disorder following an industrial accident. Australian Psychologist, 33, 125-129. doi:10.1080/00050069808257393
1997
Creamer, M., & Kelly, J. (1997). Information processing in combat veterans: The role of avoidance. In
J. D. Read & D. Lindsay (Eds.), Recollections Of Trauma: Scientific Evidence And Clinical Practice (pp. 441-447). NATO Advanced Institute series (Life Sciences, Vol. 291). New York: Plenum Press.
Morris, P., & Creamer, M. (1997). Cormorbid posttraumatic stress disorder and depressive illness. Depression Awareness Journal, 2, 3-4.
1996
Creamer, M. (1996). Posttraumatic stress disorder: nature and treatment. Psychotherapy In Australia, 3, 8-15. Retrieved from
http://search.informit.com.au.ezp.lib.unimelb.edu.au/ documentSummary;dn=551896643500780;res=IELHEA
Creamer, M. (1996). The prevention of posttraumatic stress. In P. Cotton & H. J. Jackson (Eds.), Early intervention and prevention in mental health (pp. 229-246). Melbourne: Australian Psychological Society.
Creamer, M. (1996).The nature and treatment of posttraumatic reactions. In B. Hawyward & A. Lowe (Eds.), Applied Aviation Psychology: Achievement, Change and Challenge (pp. 299-307). Aldershot: Ashgate Publishing.
Creamer, M. (1996). Treatment interventions for posttraumatic stress. In D. Paton & N. Long (Eds.), Psychological Aspects of Disaster: Impact, Coping, And Intervention (pp. 177-192). Palmerston: Dunmore Press.
Creamer, M., Jackson, A., & Ball, A. (1996). A profile of help-seeking Australian Veterans. Journal of Traumatic Stress, 9, 569-575. doi:10.1002/jts.2490090312
1995
Creamer, M., Foran, J., & Bell, R. (1995). The Beck Anxiety Inventory in a non-clinical sample. Behaviour Research and Theory, 33, 477-485. doi:10.1016/0005-7967(94)00082-U
1994
Creamer, M. (1994). Community recovery from trauma. In Watts, R. & Horne, D. J. (Eds.) Coping with trauma: The victim and the helper (pp. 37-51). Bowen Hills: Australian Academic Press.
Forbes, D., Creamer, M., & Rycroft, P. (1994). Eye movement desensitization and reprocessing in posttraumatic stress disorder: A pilot study using assessment measures. Journal of Behavior Therapy and Experimental Psychiatry, 25, 113-120. doi:10.1016/0005-7916(94)90003-5
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