Suchergebnisse

La pandemia COVID-19 ha puesto en emergencia a casi todos los países del mundo, con impactos sin precedentes y hoy constituye un gran desafío a la salud mental y la seguridad psicosocial del personal de salud, estudios científicos revelan cifras preocupantes de consecuencias psicosociales a nivel individual y en grupos familiares, desde el inicio de la pandemia y se mantiene en la actualidad, las múltiples alteraciones psicológicas asociadas que van desde síntomas menores hasta síntomas complejos, como la ansiedad y la depresión. Es imprescindible que las entidades gubernamentales apliquen estrategias capaces de minimizar estos efectos en el personal de primera línea. La presente investigación tuvo como objetivo determinar los efectos psicosociales de la pandemia COVID-19 en el entorno familiar del personal de enfermería en el hospital general del Instituto Ecuatoriano de Seguridad Social (I.E.S.S) Portoviejo. Para lo cual se hizo una encuesta en línea con 53 trabajadores de salud, los resultados se lo proceso utilizando la estadística descriptiva, y se aplicó la prueba paramétrica de la Chi-cuadrada para determinar la relación de variables. Se ha podido determinar varios aspectos relevantes, tales como el alto grado de ansiedad que presentan el personal de enfermería, especialmente en el sexo femenino. Así también se demuestra que al estar en constante riesgo, han tenido problemas de sentirse irritado o enfadado con facilidad.PALABRAS CLAVE: Efecto psicosocial; Reacciones de estrés; Enfermedades psiquiátricas; Crisis psicosociales.PSYCHOSOCIAL EFFECT OF THE 2019 CORONAVIRUS PANDEMIC (COVID-19) IN THE FAMILY ENVIRONMENT OF NURSING STAFFABSTRACTABSTRACTThe COVID-19 pandemic has put almost every country in the world in emergency, with unprecedented impacts and today constitutes a great challenge to the mental health and psychosocial safety of health personnel, scientific studies reveal worrying figures of psychosocial consequences at the level individual and in family groups, since the beginning of the pandemic and is maintained today, the multiple associated psychological alterations ranging from minor symptoms to complex symptoms, such as anxiety and depression. It is essential that government entities apply strategies capable of minimizing these effects on frontline personnel. The present research aimed to determine the psychosocial effects of the COVID-19 pandemic in the family environment of the nursing staff in the general hospital of the Ecuadorian Social Security Institute (I.E.S.S) Portoviejo. For which an online survey was made with 53 health workers, the results were processed using descriptive statistics, and the parametric Chi-square test was applied to determine the relationship of variables. It has been possible to determine several relevant aspects, such as the high degree of anxiety presented by the nursing staff, especially in the female sex. This also shows that being in constant risk, they have had problems feeling irritated or angry easily.KEYWORDS: Psychosocial effect; Stress reactions; Psychiatric illnesses; Psychosocial crisis.

На основе впервые вводимых в научный оборот данных рассматривается появление почтовой службы в Горном Алтае. Проанализированы основные направления деятельности почты в исследуемый период. ; The need to get news from other districts and countries goes back to an high antiquity. Post service a component of the nation-wide communication system, one of economy branches. It satisfies requirements of the industry, agriculture, management personnel for information interchange both in the country, and with other states, and also some cultural and community requirements of the population. On the all-Russian materials the theme of history of post service is rather well investigated. On materials of Gorny Altai the designated problem hadn"t become the object of complex and special studying: tendencies, features and specificity of creation and functioning of post service at various historical stages aren"t characterized. In Gorny Altai (Gorny Altai was a part of Biysk district of Tomsk province) it is formally possible to consider as date of creation of mail the year of 1904, when in village Ongudai the Altay Gorny district of Tomsk province the post-cable branch has been formed. By 1916 the territory of Gorny Altai was served by five post-cable branches and five post-cable agencies. The main activity of post workers was delivery of letters and the documentation, parcels and material assets. However, being in department of the Ministry of Internal Affairs, and closely cooperating with the Ministry of Finance, post workers often had to be engaged in gathering of statistical data. The collected data concerned number of a livestock of cattle, quantity of crops and grain stocks. They were also engaged in drawing up of lists of government agencies, the officials evacuated on military circumstances from areas of operations in other points. The data about the former military ranks that left service in connection with wound, and arrived on service in post-cable branches. There were also data about the geographical position and the population of province, the factory and factory industry, trade, taxes and duties, state buildings. It also contained the information about national morals, about number of prisoners, an amount of fires, hospitals, the working medical personnel, quantity of drugstores, maternity homes, psychiatric hospitals, ambulance stations, shelters, about smallpox vaccination, epidemics, about number of violent deaths, etc. All these data were used in the annual report to the emperor and published in «Reviews of Tomsk province». The formation and development of post service was favorable to all categories of the population in the region. Among them officials of different level, peasants, dealers, travelers etc. Thanks to occurrence of such service the region population had an opportunity in rather short terms to carry out sending and reception of correspondence, parcels, transfers, etc. Actually in 1904-1915 the foundation for development of post service and its infrastructure in the region was laid down.

For most psychol'al tests, expense, administration time, & personnel training requirements have prevented wide use in large-scale surveys. Also many R's become defensive thus jeopardizing the survey. Cattell's approach to 'selective- answer projective techniques' embodying a multiple-choice answer format suggests a means of developing a short form disguised projective test which was used in an attempt to measure the variable of `pessimism' or the `anxious att.' The criteria for the Disguised Anxiety Scale (DAS) were that it (a) be well disguised, (b) be short, (c) be easy to comprehend, (d) be easy to administer & score, (e) have objectively ascertainable reliability & validity, & (f) elicit true projections of underlying feelings. The DAS which is modeled on the TAT, satisfies all the foregoing criteria. Each of the 12 pictures is accompanied by a set of four multiple-choice statements ranging in tone from great optimism to great pessimism. Statements are scored by the Likert scaling method & 11 items were found to discriminate well between the upper & lower 27% of the 1 score distribution. Splithalf reliabilities for samples of adult educ & undergraduate sociol students were 0.64 in each case. For validation, scores of the DAS were r'ed with scores obtained from the Taylor Scale of Manifest Anxiety (TSMA) & the K Scale of the MMPI which is a measure of defensiveness. Initial r 's were unsatisfactory but a revised DAS was administered to sociol undergraduates (normals) & new admissions at 2 psychiatric outpatient clinics. After the K factor had been partialed out the DAS-TSMA r 's were 0.27 for the normals & 0.46 for the outpatients. But, while the out-patients had higher (mean - average) scores than the normals on the Taylor scale, the (mean - average) scores of the 2 groups were reversed on the DAS. It may be that this unexpected reversal arises because the TSMA (symptom) scale measures intensity of anxiety while the DAS (picture) measures extensity of anxiety. This hypothesis was partially supported by is between clinicians, ratings of extensity & intensity of anxiety of outpatients and DAS scores. Further validation is needed. M. C. Coughenour.

BackgroundEpigenetic mechanisms have been suggested to play a role in the development of post-traumatic stress disorder (PTSD). Here, blood-derived DNA methylation data (HumanMethylation450 BeadChip) collected prior to and following combat exposure in three cohorts of male military members were analyzed to assess whether DNA methylation profiles are associated with the development of PTSD. A total of 123 PTSD cases and 143 trauma-exposed controls were included in the analyses. The Psychiatric Genomics Consortium (PGC) PTSD EWAS QC pipeline was used on all cohorts, and results were combined using a sample size weighted meta-analysis in a two-stage design. In stage one, we jointly analyzed data of two new cohorts (N = 126 and 78) for gene discovery, and sought to replicate significant findings in a third, previously published cohort (N = 62) to assess the robustness of our results. In stage 2, we aimed at maximizing power for gene discovery by combining all three cohorts in a meta-analysis.ResultsStage 1 analyses identified four CpG sites in which, conditional on pre-deployment DNA methylation, post-deployment DNA methylation was significantly associated with PTSD status after epigenome-wide adjustment for multiple comparisons. The most significant (intergenic) CpG cg05656210 (p = 1.0 × 10-08) was located on 5q31 and significantly replicated in the third cohort. In addition, 19 differentially methylated regions (DMRs) were identified, but failed replication. Stage 2 analyses identified three epigenome-wide significant CpGs, the intergenic CpG cg05656210 and two additional CpGs located in MAD1L1 (cg12169700) and HEXDC (cg20756026). Interestingly, cg12169700 had an underlying single nucleotide polymorphism (SNP) which was located within the same LD block as a recently identified PTSD-associated SNP in MAD1L1. Stage 2 analyses further identified 12 significant differential methylated regions (DMRs), 1 of which was located in MAD1L1 and 4 were situated in the human leukocyte antigen (HLA) region.ConclusionsThis study suggests that the development of combat-related PTSD is associated with distinct methylation patterns in several genomic positions and regions. Our most prominent findings suggest the involvement of the immune system through the HLA region and HEXDC, and MAD1L1 which was previously associated with PTSD.

ImportanceWhether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples.ObjectiveTo examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms.Design, setting, and participantsAs part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66).Main outcomes and measuresThe primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment.ResultsAt the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms.Conclusions and relevanceEven when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.

BackgroundEpigenetic mechanisms have been suggested to play a role in the development of post-traumatic stress disorder (PTSD). Here, blood-derived DNA methylation data (HumanMethylation450 BeadChip) collected prior to and following combat exposure in three cohorts of male military members were analyzed to assess whether DNA methylation profiles are associated with the development of PTSD. A total of 123 PTSD cases and 143 trauma-exposed controls were included in the analyses. The Psychiatric Genomics Consortium (PGC) PTSD EWAS QC pipeline was used on all cohorts, and results were combined using a sample size weighted meta-analysis in a two-stage design. In stage one, we jointly analyzed data of two new cohorts (N = 126 and 78) for gene discovery, and sought to replicate significant findings in a third, previously published cohort (N = 62) to assess the robustness of our results. In stage 2, we aimed at maximizing power for gene discovery by combining all three cohorts in a meta-analysis.ResultsStage 1 analyses identified four CpG sites in which, conditional on pre-deployment DNA methylation, post-deployment DNA methylation was significantly associated with PTSD status after epigenome-wide adjustment for multiple comparisons. The most significant (intergenic) CpG cg05656210 (p = 1.0 × 10-08) was located on 5q31 and significantly replicated in the third cohort. In addition, 19 differentially methylated regions (DMRs) were identified, but failed replication. Stage 2 analyses identified three epigenome-wide significant CpGs, the intergenic CpG cg05656210 and two additional CpGs located in MAD1L1 (cg12169700) and HEXDC (cg20756026). Interestingly, cg12169700 had an underlying single nucleotide polymorphism (SNP) which was located within the same LD block as a recently identified PTSD-associated SNP in MAD1L1. Stage 2 analyses further identified 12 significant differential methylated regions (DMRs), 1 of which was located in MAD1L1 and 4 were situated in the human leukocyte antigen (HLA) region.ConclusionsThis study ...

Objective: To investigate suicide and mortality risk in deployed military veterans versus non-deployed comparators who had gone through military conscription testing. Design: Population-based matched cohort study. Setting: Sweden. Participants: Participants were identified from the Military Service Conscription Register and deployment status from the Swedish Military Information Personnel Register. Of 1.9 million conscripts, 21 721 had deployed at some time between 1990 and 2013 (deployed military veterans). Non-deployed comparators were matched to deployed military veterans in two ways: (1) by cognitive ability, psychological assessment, mental health, body mass index, sex, birth-year and conscription-year (carefully matched), with further adjustment for exercise capacity and suicide attempt history; and (2) by sex, birth-year and conscription-year (age-and sex-matched). Main outcome: Suicide retrieved from the Swedish National Patient and Causes of Death Register until 31 December 2013. Results: During a median follow-up of 12 years, 39 and 211 deaths by suicide occurred in deployed military veterans (n=21 627) and carefully matched non-deployed comparators (n=107 284), respectively (15 vs 16/100 000 person-years; adjusted HR (aHR) 1.07; 95% CI 0.75 to 1.52; p=0.72) and 329 in age-and sex-matched non-deployed comparators (n=108 140; 25/100 000 person-years; aHR 0.59; 95% CI 0.42 to 0.82; p=0.002). There were 284 and 1444 deaths by suicide or attempted suicides in deployed military veterans and carefully matched non-deployed comparators, respectively (109 vs 112; aHR 0.99; 95% CI 0.88 to 1.13; p=0.93) and 2061 in age-and sex-matched non-deployed comparators (158; aHR 0.69; 95% CI 0.61 to 0.79; p<0.001). The corresponding figures for all-cause mortality for carefully matched non-deployed comparators were 159 and 820 (61 vs 63/100 000 person-years; aHR 0.97; 95% CI 0.82 to 1.15; p=0.71) and 1289 for age-and sex-matched non-deployed comparators (98/100 000 person-years; aHR 0.62; 95% CI 0.52 to 0.73; p<0.001). Conclusion: Deployed military veterans had similar suicide and mortality risk as non-deployed comparators after accounting for psychological, psychiatric and physical factors. Studies of mental health in deployed veterans need to adjust for more factors than age and sex for comparisons to be meaningful. ; Funding: Research reported in this publication was supported by Kungafonden (the Royal Fund). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Royal Fund.

At once a classic account of the ravages of mental illness and a major American autobiography, A Mind That Found Itself tells the story of a young man who is gradually enveloped by a psychosis. His well-meaning family commits him to a series of mental hospitals, but he is brutalized by the treatment, and his moments of fleeting sanity become fewer and fewer. His ultimate recovery is a triumph of the human spirit. The publication of A Mind That Found Itself did for the American mental health movement what Thomas Paineís Common Sense did for the American Revolution. Moreover, it grips the ima

ObjectiveHeart rate variability (HRV), thought to reflect autonomic nervous system function, is lowered under conditions such as posttraumatic stress disorder (PTSD). The potential confounding effects of traumatic brain injury (TBI) and depression in the relationship between HRV and PTSD have not been elucidated in a large cohort of military service members. Here we describe HRV associations with stress disorder symptoms in a large study of Marines while accounting for well-known covariates of HRV and PTSD including TBI and depression.MethodsFour battalions of male active-duty Marines (n = 2430) were assessed 1 to 2 months before a combat deployment. HRV was measured during a 5-minute rest. Depression and PTSD were assessed using the Beck Depression Inventory and Clinician-Administered PTSD Scale, respectively.ResultsWhen adjusting for covariates, including TBI, regression analyses showed that lower levels of high-frequency HRV were associated with a diagnosis of PTSD (β = -0.20, p = .035). Depression and PTSD severity were correlated (r = 0.49, p < .001); however, participants with PTSD but relatively low depression scores exhibited reduced high frequency compared with controls (p = .012). Marines with deployment experience (n = 1254) had lower HRV than did those with no experience (p = .033).ConclusionsThis cross-sectional analysis of a large cohort supports associations between PTSD and reduced HRV when accounting for TBI and depression symptoms. Future postdeployment assessments will be used to determine whether predeployment HRV can predict vulnerability and resilience to the serious psychological and physiological consequences of combat exposure.

В статье прослеживается эволюция концепции эффективности в психологической практике с особым акцентом на проблемы валидности центров оценки. Ранние методы и процедуры центров оценки возникли и были развиты в военно-психологических и военно-психиатрических службах некоторых стран Европы и Америки перед Второй мировой войной и во время ведения боевых действий. Первые исследования эффективности центров оценки были начаты уже после окончания войны. Проводились измерения надежности и валидности. Центр оценки в его современном виде оформился в результате проведения исследований профессиональной карьеры в телекоммуникационной корпорации AT&T. Тогда же развернулись широкомасштабные исследования валидности центров оценки. Это было время господства тринитарной доктрины валидности (а именно, комплекса, состоящего из содержательной, критериальной и конструктной валидности). Как правило, при проведении центров оценки обеспечивались высокие показатели содержательной и критериальной валидности. Проблема была в том, что не удавалось получить веских доказательств наличия конструктной валидности. Исследования раз за разом обнаруживали, что поведенческие индикаторы разных компетенций в одних и тех же упражнениях более сильно коррелируют между собой в отдельных упражнениях (эффект упражнений), чем поведенческие показатели одних и тех же компетенций в разных упражнениях (эффект измеряемых параметров). Этот феномен получил название парадокса конструктной валидности центров оценки. В настоящее время тринитарную доктрину сменяет концепция унитарной валидности, что открывает возможности для переформатирования данной проблемы с целью создания более эффективных центров оценки. Далее проводится анализ намечающихся тенденций решения сходных методологических проблем в других областях психологической практики, таких как качественные исследования и исследования действием. Рассматриваются пути повышения валидности, справедливости, приемлемости и действенности центров оценки для подбора и развития персонала ; The article reviews the evolution of the concept of effectiveness in the psychological practice, with a particular emphasis on assessment centers (AC) validity. Early AC-methods and processes were originated and developed by military psychological and psychiatric services in Europe and America before and during the WW2. The first studies of AC effectiveness were initialized after the war. There were some attempt to measure AC reliability and validity. The assessment center method, in its modern form, came into existence as a result of the AT&T Management Progress Study. At that time large-scale investigations of AC-validity were successfully developed. The trinitarian view of validity (namely content, criterion-related, and construct) has dominated psychology for almost a second half of the XX century. ACs have traditionally demonstrated strong content and criterion-related validity. However, researchers have been puzzled with the lack of evidence concerning construct validity. Researchers have consistently revealed that different behavioral ratings within simulations are more strongly related to one another (exercise effects) than the same dimension rating across simulations (dimension effects). This phenomenon was named as the AC construct-related validity paradox. Now the trinitarian doctrine has been replaced by the unitarian validity concept and we have the opportunity to reformate the problem for creating more effective ACs. Further, we examine some emerging trends in resolving similar methodological problems by other branches of the psychological practice, such as qualitative investigations and action researches. Conclusions about the validity, fairness, acceptability and efficacy of ACs for personnel selection and development are offered.

Computerized physician order entry and unit-dose automation participate in decreasing drug iatrogenic, priority of health's politics. Based on the French legislative decree of 6th, April 2011 for quality management of the medication circuit and drugs in hospitals, quality's objectives of this circuit and the different involved process (prescription, dispensation, transport and administration) must have follow-up indicators. That's why; it seems to us important to definite the most pertinent indicators for the setting up of the project, the development and the follow up of the unit-dose automation at Charles Perrens' hospital. Our psychiatric hospital is composed of 523 full-time intramuros beds, 365 extramuros beds and a nursing home for heavy disabled persons of 50 beds. First of all, the legislative context and indicators' notion will be reminded, and then we will present the automation project and its progress with the proposition of structure's, activity's, process' and results' indicators. They will allow us to delimitate the automation's perimeter with the determination of the eligible health units, which material and personal resources are needed and the impact of this new activity on the process of the medication circuit. This work allowed us to evaluate different indicators based on several criteria: easiness to follow, acceptability, reliability, relevance and feasibility. We chose to follow in routine 9 structure's, 10 activity's, 6 process' and 3 results' indicators. ; L'informatisation de la prescription, la mise en place de la dispensation individuelle nominative (DIN) et son automatisation concourent à diminuer la iatrogénie médicamenteuse, priorité de santé publique. Selon l'arrêté du 6 avril 2011 relatif au management de la qualité de la prise en charge médicamenteuse et aux médicaments dans les établissements de santé, les objectifs de la qualité de cette prise en charge et des différents processus impliqués (prescription, dispensation, transport, administration) doivent être assortis d'indicateurs de suivi. C'est pourquoi il nous a paru intéressant de définir les indicateurs les plus pertinents pour la mise en place du projet, la montée en charge et le suivi en routine de la DIN automatisée au Centre Hospitalier Charles Perrens. Notre établissement psychiatrique présente la configuration suivante : 523 lits d'hospitalisation complète intramuros, 365 places extramuros et une MAS de 50 lits. Dans un premier temps, il sera rappelé le contexte réglementaire et la notion d'indicateurs, puis nous présenterons le projet d'automatisation et son état d'avancement assortis d'une proposition d'indicateurs de structure, d'activités, de processus, et de résultats. Ces indicateurs devraient nous permettre de délimiter le périmètre de l'automatisation en déterminant quelles unités de soins sont éligibles à la DIN, quelles ressources matérielles et personnelles doivent être mises en place, ainsi que l'impact de cette nouvelle activité sur les processus de la prise en charge médicamenteuse. Ce travail nous a permis d'évaluer plusieurs indicateurs selon différents critères : simplicité à suivre, acceptabilité auprès du personnel, fiabilité, pertinence, faisabilité. Il a été fait le choix de retenir 9 indicateurs de structure, 10 d'activité, 6 de processus, 3 de résultats qui composeront un tableau de bord suivi en routine par le service pharmacie.

This book aims to provide a series of informative descriptions of key elements of health emergency preparedness and response that are underpinned by real-life examples. The book is divided into 17 chapters, as follows: introduction on the need to prepare for health emergencies; the planning process; risk assessment; writing an emergency plan; emergency planning and response, and working in partnership; interprofessional working and understanding some emotional barriers and unconscious processes that might influence practice in group and team work; command, control and communication; communications during a health emergency; psychosocial and mental health care before, during and after emergencies, disasters and major incidents; business continuity; training and exercising for emergency preparedness, resilience and response; post-incident follow-up; mass casualty incidents; preparedness and response to pandemics and other infectious disease emergencies; chemical, biological, radiological and nuclear incidents; a military case study; and, health and emergencies in Canterbury, New Zealand, from pandemics to earthquakes.

ObjectiveHeart rate variability (HRV), thought to reflect autonomic nervous system function, is lowered under conditions such as posttraumatic stress disorder (PTSD). The potential confounding effects of traumatic brain injury (TBI) and depression in the relationship between HRV and PTSD have not been elucidated in a large cohort of military service members. Here we describe HRV associations with stress disorder symptoms in a large study of Marines while accounting for well-known covariates of HRV and PTSD including TBI and depression.MethodsFour battalions of male active-duty Marines (n = 2430) were assessed 1 to 2 months before a combat deployment. HRV was measured during a 5-minute rest. Depression and PTSD were assessed using the Beck Depression Inventory and Clinician-Administered PTSD Scale, respectively.ResultsWhen adjusting for covariates, including TBI, regression analyses showed that lower levels of high-frequency HRV were associated with a diagnosis of PTSD (β = -0.20, p = .035). Depression and PTSD severity were correlated (r = 0.49, p < .001); however, participants with PTSD but relatively low depression scores exhibited reduced high frequency compared with controls (p = .012). Marines with deployment experience (n = 1254) had lower HRV than did those with no experience (p = .033).ConclusionsThis cross-sectional analysis of a large cohort supports associations between PTSD and reduced HRV when accounting for TBI and depression symptoms. Future postdeployment assessments will be used to determine whether predeployment HRV can predict vulnerability and resilience to the serious psychological and physiological consequences of combat exposure.

A year has passed, and the COVID-19 pandemic continues to spread around the world. Apart from its direct devastating health consequences, voices have been raised about decreasing mental health. The introduction of social distancing measures and lockdown to prevent the spread of COVID-19 led to a sudden change of routine, a drastic change of the physical and social environment (e.g., reduced social contacts and connection), a change of working conditions and economic losses, all are known to be important drivers for mental health and mental disorders. Evidence from previous studies that have examined the psychological impact of disaster and outbreaks, shows that such health emergencies have its toll on mental health. In Hong-Kong, for example, suicide rates rose sharply during the 2003 SARS epidemic. Given that measures taken during the SARS epidemic interfered much less with normal life and for a shorter period, it is not far-fetched to assume that the COVID-19 pandemic, in one way or another, will affect mental health. In fact, surveys conducted so far, using contemporary data from national surveys, show that since the start of the pandemic, mental health has deteriorated. Current research suggests that poorer mental health is associated with increased fear of illness, social distancing policies and social adversities (e.g. loss of employment), housing conditions as well as loss of support from health and other services. As a consequence of the lockdown and social distancing measures, psychosocial services as well as in- and out-patient mental health care facilities greatly interrupted, reduced and changed their services. Many services switched from face-to-face to digital services and check-in phone calls. However, due to lack of access or ability to use technology and a lack of privacy, remote care is not always considered sufficient. Additionally, people at risk, might feel stigmatized due to the perceptions of being a burden to society. The epidemic may shatter personal goals and way of living and undermine a sense of meaning in life and trust in others. Meaning making, however, is a predictor of resilience and mental health. Resilience is a multidimensional concept which can be defined as being able to adapt to stressful (e.g., family and relationship problems, workplace and financial stressors) and extraordinary threatening events, such as a pandemic. The factors, which contribute to resilience, are manifold, including individual, interpersonal and community factors. At the individual level, very recent research suggests that healthcare personnel, youth and older individuals, and those with a current or past medical history, especially a history of mental illness, are at risk. Additionally, we learnt from other disasters that at the interpersonal level, social isolation, and lack of trusting relationships and at the society level lack of trust in the government might put people at risk. While evidence about the effects of COVID-19 on resilience and mental health is emerging, at this point, no accurate assumptions about the extent of the pandemic on mental health can be made. Furthermore, the mental health responses to the pandemic and the trajectories of mental health and resilience remain unknown. Approaches to mental health and psychiatric care in such outbreaks remain poorly understood, outlined or covered by existing research and there is virtually no substantial knowledge of the mental health impact of rapidly spreading outbreaks of infectious diseases. International cooperation is essential for building appropriate mental health prevention and promotion strategies. Identifying factors that may contribute to better mental health and greater psychological resilience at an international level and sharing experiences and information is of utmost importance. Therefore, a comprehensive assessment of the prevalence, risk and protective factors, of mental health is necessary. For that reasons the international Public Mental Health Section of the European Public Health Association (EUPHA) initiated this study and worked together with the consortium members to set up the Coping with COVID-19 with Resilience (COPERS) study. The consortium includes members of 10 countries all over Europe. COPERS aims to grasp longitudinally the extent of mental health and resilience across Europe, to identify mental health, and resilience trajectories of adults aged 18 years and older and to detect factors that potentially influence mental health and resilience in the different countries. The researchers also aim to conduct a living mapping review to identify, analyze, and present mental health policy responses to the COVID-19 pandemic and contribute to better knowledge on how to support personal and community resilience in times of a pandemic.

The introduction of the new concept of complex post-traumatic stress disorder (cPTSD) in the International Classification of Diseases of the 11th Edition deserves attention in a country where active fighting is taking place. The increase in the number of PTSD sufferers among military personnel and civilians on the territory of hostilities increases the likelihood of PTSD occurring among the contingent. At present, we have no experience in the diagnosis of cPTSD. The objective of our study, along with the diagnosis of PTSD symptoms, is to use a quality of life questionnaire to evaluate the symptoms of cPTSD. The result revealed that the level of community and service support was below average, indicating the need to improve community social support. The self-realization of the combatants has a low average level, which further influences the level of adaptation after the end of the service. Physical and psychological well-being are also low, and this indicator to the need for psychological and physical rehabilitation of demobilized soldiers. At the same time, communication with friends and family, performance were at a high enough level, and these are positive factors that influence the adaptation to civilian life. Summarizing the research, we suggest that in order to organize the help of the combatants more effectively, it is necessary to evaluate, along with a purely psychiatric diagnosis of PTSD, the level of social and physical adaptation of patients with PTSD. ; Введение нового понятия, как комплексный посттравматическое стрессовое расстройство (кПТСР) в Международной классификации болезней 11-го пересмотра заслуживает внимания в стране, где проходят активные боевые действия. Увеличение количества страдающих ПТСР среди военнослужащих и гражданского населения находящихся на территории боевых действий, повышает вероятность возникновения кПТСР среди данного контингента. На сегодняшний день, мы не имеем опыта диагностики кПТСР. Задачей нашего исследования наряду с диагностикой симптомов ПТСР применять опросник оценки качества жизни, для оценки симптомов кПТСР. Результатом работы выявлено - уровень общественной и служебной поддержки был ниже среднего уровня, что указывает на необходимость улучшать социальную поддержку общины. Самореализация бывших участников боевых действий имеет низкий средний уровень, в дальнейшем негативно влияет на уровень адаптации после окончания службы. Физическое и психологическое благополучие также имеют низкий уровень, а это уже говорит о необходимости психологической и физической реабилитации демобилизованных воинов. В то же время, общение с друзьями и в семье, работоспособность были на достаточно высоком уровне, а это положительные факторы, влияющие на адаптацию к гражданской жизни. Предлагаем для более эффективной организации помощи, бывшим участникам боевых действий необходимо, наряду с определением чисто психиатрического диагноза ПТСР, оценивать уровень социальной, физической адаптации пациентов с ПТСР. ; Введення нового поняття, як комплексний посттравматичний стресовий розлад (кПТСР) у Міжнародній класифікації хвороб 11-го перегляду заслуговує на увагу в країні, де проходять активні бойові дії. Збільшення кількості страждаючих на ПТСР серед військовослужбовців та цивільного населення що знаходяться на території бойових дій, підвищує вірогідність виникнення кПТСР серед даного контингенту. На сьогодні, ми не маємо досвіду діагностики кПТСР. Задачею нашого пілотного дослідження поряд з діагностикою симптомів ПТСР застосовувати опитувальник оцінки якості життя, для оцінки симптомів кПТСР. Група пацієнтів – 26 чоловік, колишніх учасників бойових дій (КУБД) чоловічої статі, які мали виражені симптоми ПТСР включили у дослідження. Середній вік хворих складав 41,3 роки, середня тривалість перебування у армії - 19,4 місяці (максимальний строк служби складав 48 місяців, мінімальний - 8 міс), тривалість перебування у зоні бойових дій - 8,2 міс. Переважали хворі зі середньо спеціальною освітою - 18 чоловіків (69,3%), безробітні - 16 чоловік (61,6%) та не перебували у шлюбі 17 чол. (65,4%). У 12 (662%) не було дітей, а кількість КУБД з однією або двома дітьми була однаковою – по 7 осіб (26,9%). Тільки 7 чоловіків, а це становить 26,9%, мешкали зі своєю сім'єю, решта – 9 осіб. (34,6%) мешкали самостійно, 10 чоловік (48,5%) мешкали з батьками. Рівень свого матеріальне забезпечення досліджувані оцінювали як низький рівень 15 осіб. (57,7%) , або середній рівень 11 осіб. (42,3%). Фіксувалось відсутність обтяження спадковості психічними розладами у 23 осіб. (88,5%), у решти хворих – 3 осіб. (11,5%) серед родичів були психічні розлади. У 11 осіб (42,3%) в анамнезі психологічна травма дитинства. Левова більшість мали досвід строкової військової служби перед участю у бойових діях (18 хворих - 69,3%). Результатом роботи виявлено - рівень громадської та службової підтримки був нижче середнього рівня, що вказує на необхідність покращувати соціальну підтримку громади. Самореалізація колишнього учасника бойових дій має низький рівень, що в подальшому впливає на рівень адаптації після закінчення служби. Фізичне та психологічне благополуччя також мають низький рівень, а це вже говорить про потребу психологічної та фізичної реабілітації демобілізованих воїнів. У той же час, спілкування з друзями та у сім'ї, працездатність були на достатньо високому рівні, а це позитивні фактори, що впливають на адаптацію до цивільного життя. Підсумовуючи дослідження, пропонуємо для більш ефективної організації допомоги колишнім учасникам бойових дій необхідно, поряд з суто психіатричним діагнозом ПТСР, оцінювати рівень соціальної, фізичної адаптації пацієнтів з ПТСР.