Prevalence,Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review

Research suggests that posttraumatic stress disorder (PTSD) is common, debilitating and frequently associated with comorbid health conditions, including poor functioning, and increased health care utilization. This article systematically reviewed the empirical literature on PTSD in primary care settings, focusing on prevalence, detection and correlates. Twenty-seven studies were identified for inclusion. Current PTSD prevalence in primary care patients ranged widely between 2 % to 39 %, with significant heterogeneity in estimates explained by samples with different levels of trauma exposure. Six studies found detection of PTSD by primary care physicians (PCPs) ranged from 0 % to 52 %. Studies examining associations between PTSD and sociodemographic variables yielded equivocal results. High comorbidity was reported between PTSD and other psychiatric disorders including depression and anxiety, and PTSD was associated with functional impairment or disability. Exposure to multiple types of trauma also raised the risk of PTSD. While some studies indicated that primary care patients with PTSD report higher levels of substance and alcohol abuse, somatic symptoms, pain, health complaints, and healthcare utilization, other studies did not find these associations. This review proposes that primary care settings are important for the early detection of PTSD, which can be improved through indicated screening and PCP education.     

How some dyads “fail”: A qualitative analysis with implications for nursing practice

Videotapes of 20 mentally ill and 20 matched well mothers with their three month through 36-month-old-children were analyzed in a two-part study. Part I tested the usefulness of the Maternal Sensitivity Scale and the Maternal Effectiveness Scale in discriminating mentally ill and well mother-child dyads. Part II analyzed the interactions of those dyads that were rated low on the scales in Part I (n = 13) to explore maladaptive patterns of behavior which may explain how the insensitivity and ineffectiveness unfolded. Seven characteristics that were observed to contribute to the interactive disorganization in these 13 dyads are described and discussed.     

Bottom-Up and Top-Down Processes in Emotion Generation: Common and Distinct Neural Mechanisms

ABSTRACT— Emotions are generally thought to arise through the interaction of bottom-up and top-down processes. However, prior work has not delineated their relative contributions. In a sample of 20 females, we used functional magnetic resonance imaging to compare the neural correlates of negative emotions generated by the bottom-up perception of aversive images and by the top-down interpretation of neutral images as aversive. We found that (a) both types of responses activated the amygdala, although bottom-up responses did so more strongly; (b) bottom-up responses activated systems for attending to and encoding perceptual and affective stimulus properties, whereas top-down responses activated prefrontal regions that represent high-level cognitive interpretations; and (c) self-reported affect correlated with activity in the amygdala during bottom-up responding and with activity in the medial prefrontal cortex during top-down responding. These findings provide a neural foundation for emotion theories that posit multiple kinds of appraisal processes and help to clarify mechanisms underlying clinically relevant forms of emotion dysregulation.     

Signaling threat: how situational cues affect women in math, science, and engineering settings

This study examined the cues hypothesis, which holds that situational cues, such as a setting's features and organization, can make potential targets vulnerable to social identity threat. Objective and subjective measures of identity threat were collected from male and female math, science, and engineering (MSE) majors who watched an MSE conference video depicting either an unbalanced ratio of men to women or a balanced ratio. Women who viewed the unbalanced video exhibited more cognitive and physiological vigilance, and reported a lower sense of belonging and less desire to participate in the conference, than did women who viewed the gender-balanced video. Men were unaffected by this situational cue. The implications for understanding vulnerability to social identity threat, particularly among women in MSE settings, are discussed.     

A note on the sociological eye and the discovery of a new Durkheim text

The text consisting of recently discovered student notes taken during Émile Durkheim's 1883–1884 lycée lectures on philosophy bears few signs of the social realist perspective with which Durkheim's later work has been identified. Though some scholars have argued that Durkheim's thought was sociological almost from the start, the lectures suggest that Durkheim's sociological eye did not develop until well after the completion of his schooling at the École Normale Supérieure in 1882. This finding is consistent with accounts of Durkheim's intellectual development that stress the importance of his exposure to German scholarship, as well as his consideration of the work of Comte and Rousseau, in the years following 1885. However, these accounts have generally failed to distinguish between the development of Durkheim's philosophy of social realism and the unfolding of the practical worldview that constituted his sociological perspective. This failure is not unique to Durkheimian scholarship, as there exists no general theory of the sociological eye on which historians of ideas can draw. This short essay makes the case that Durkheim's lycée lectures should be used to help develop such a theory. © 1996 John Wiley & Sons, Inc.     

Framing Emotional Response

Framing studies typically are concerned with how people's opinions are affected by opposing ways of presenting, or framing, an issue or event. This paper investigates whether different frames also lead to different patterns of emotional response. Cognitive appraisal models of emotion suggest that frames can alter emotional reactions. An experiment compared students' emotional responses to versions of a newspaper article that emphasized underlying social conditions as the cause of the 1992 Los Angeles riots (situational frame) or emphasized irresponsibility and criminality on the part of the rioters (dispositional frame). Few systematic framing effects were found when examining whether respondents reported experiencing a particular emotion. However, consistent with recent work showing that predispositions mediate the effect of frames on opinion, frames altered the relationship between predispositions and emotion. Patterns suggestive of framing effects also emerged in an examination of the content of people's emotional reactions. The findings are consistent with the claim that framing affects emotional responses, reinforce the claim that framing effects depend on individual predispositions, and underscore the importance of accounting for the content of people's emotional responses in the study of emotion.     

Reappraising faces: effects on accountability appraisals,self-reported valence,and pupil diameter

Many of our emotions arise in social contexts, as we interact with and learn about others. What is not yet clear, however, is how such emotions unfold when we either react to others or attempt to regulate our emotions. To address this issue, 30 healthy volunteers reacted to or reappraised positive or negative information that was paired with neutral faces. While they were doing this task, we assessed pupillary responses. We also asked participants to provide ratings of accountability and experienced emotion. Findings indicated that appraised accountability increased in response to emotional information, and changes in accountability were associated with commensurate changes in valence reports and increased pupil diameter. During reappraisal, accountability and emotion decreased, but pupil diameter increased. The findings highlight the importance of accountability appraisals during the generation and regulation of emotional reactions to others, while also documenting pupillary increases during emotional reactivity and regulation.