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.     

Teaching the Bible in the schools of the Labor and the Kibbutz Movements, 1921–1953

How the challenge of teaching the Bible was met by educators who were members of the Kibbutz and Labor movements during the years before the establishment of the Israeli State is the subject of the following essay. Years ago, Jacobus Schoneveld, (1976), recently followed by Asher Shkedi (2004) proposed dividing educators of the Labor and Kibbutz movements into three types: those who wished to stress “national reconstruction,” those directed toward teaching a “universal humanism” and those seeking to awaken “moral dialogue” and achieve “personal growth.” In fact, such clear-cut lines of demarcation did not exist. The goals were these, but approaches themselves were always mixed. One distinguishes educational goals better by a more simple division into the questions of what is to be taught (religious versus Secular materials) and through which ancillary disciplines. Doing so has the virtue of highlighting how these educators were animated by their quest after how best to teach Biblical morality with the aim of “shaping” the student or achieving “emulation,” especially by generating a “dialogue” between the pupil and the biblical text, leading to “personal growth.” These emphases tell us much about the pre-State educational mentality and pedagogical ideals.     

The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears

There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic "bull's eye" disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology.     

Virtue and Continence

John McDowell argued that the virtuous person (VP) knows no temptation: her perception of a situation silences all competing motivations – be it fear in the face of danger or a strong desire. The VP cannot recognize any reason to act non-virtuously as a reason, and is never inclined to act non-virtuously. This view rests on the requirement that the VP rationally respond, and not merely react, to the environment – it rests on the requirement that the relation between the VP and the world (ethical requirements) must rule out the possibility that the VP is a brain in a vat. I will argue that the opposite is true: virtue requires a sensitivity to temptation. The VP, as such, must be able to recognize reasons for performing non-virtuous actions as reasons, and be inclined to perform them. She must find nothing human alien. This is so because the VP must possess the ability to understand non-virtuous agents, and understanding necessarily involves vulnerability to temptation. Otherwise, it will be argued, the VP views the actions of others as determined from outside the space of reasons. But the VP, like any other person, must have the ability to view the actions of others as rational responses to the environment, not only as reactions to it. Put differently, the VP’s view of others must rule out the possibility that they are brains in a vat – the possibility that their actions are merely caused, rather than justified, by the facts. Finally, it will be suggested that an amended conception of the VP can meet both requirements: view others as rationally responsive to the world, without relinquishing its relation to the facts.

Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity

There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N = 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N = 447) used cross-sectional data collected 2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both cross-sectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology.     

The Al Qaeda 9/11 instructions: a study in the construction of religious martyrdom

A growing global concern about suicide attacks has led to attempts from various disciplines to understand the psychological profiles of persons willing to commit suicide terrorist attacks. Recent reports have suggested that more powerful explanatory models might be discovered using social psychological concepts, with a shift of focus from the individual to the group within which the individual acts and by which the individual is influenced. This paper attempts to do so by presenting an analysis of the Al Qaeda ‘final instructions’ document, which sheds light on the way members of this group were mobilised towards conducting one of the most devastating assaults in modern history. We discuss the use of religious doctrine and rhetorical devices as a psychological strategy employed by this group to inspire, control and mobilise its members before and during the September 11, 2001, attacks.     

Changes in positive and negative affect as predictors of change in felt age: Results from the Health and Retirement Study

The present study aimed to examine how changes in positive and negative affect and their interaction predict changes in felt age in a longitudinal design of two waves drawn from the Health and Retirement Study (HRS). Participants (n = 4174) at an average age of 67.97 completed the 2008 and 2012 left behind questionnaire of the HRS. Our results showed that an increase in positive affect and a decrease in negative affect from Wave 1 to Wave 2 predicted an accelerated decrease in felt age. There was an interaction effect showing that for those with an increase in negative affect, a higher change in positive affect predicted reduced odds for accelerated increase in felt age. To conclude, improving favorable change in the combination between positive and negative affect might in turn relate to the individual’s self-perceptions of aging, in the second half of life.     

ABCs of principal–agent interactions: Accurate predictions,biased processes,and contrasts between working and delegating

We experimentally investigate people’s evaluations of incentive pay contracts and people’s predictions of others’ evaluations of incentive pay contracts. We emphasize that the construction of evaluations and predictions often includes two substeps, involving likelihood judgment and likelihood weighting. Predictors appear to be biased at both substeps but in opposing directions. Accurate overall predictions thus sometimes reflect two errors that are of the same magnitude and thereby offset. Moreover, predictions can become more inaccurate if one step is debiased but the other is left untouched. Importantly, principals deciding whether to delegate a task are susceptible to just one of the biases. Delegation assessments are thus often flawed, reflecting a single error that is not offset.