Depression and post-traumatic stress disorder (PTSD) are highly prevalent and frequently co-occur in conflict-affected populations, yet the complex relationships among their symptoms remain poorly understood. This study applied psychological network analysis and Bayesian network modelling to examine symptom associations and exploratory directional dependencies among participants living in Cox’s Bazar and neighbouring Bandarban, Bangladesh.

Baseline data were obtained from 9,397 participants, including forcibly displaced Rohingya refugees and host-community members. Depression symptoms (Patient Health Questionnaire-9) and PTSD symptoms (Harvard Trauma Questionnaire-16) were analysed using regularized partial correlation networks and directed acyclic graphs. Symptom centrality, bridge centrality, predictability and network stability were assessed, alongside sensitivity analyses by settlement status and sex.

Distinct yet interconnected clusters of depression and PTSD symptoms emerged. Guilt, anhedonia, recurrent traumatic thoughts, emotional detachment, hopelessness about the future and rumination emerged as the most central symptoms. Bridge-strength analyses identified guilt and physical health problems as the most prominent bridge symptoms linking depression and PTSD symptom communities. Bayesian network analysis identified several highly stable exploratory directional dependencies involving anhedonia, guilt, rumination, recurrent traumatic thoughts and emotional detachment. The network demonstrated excellent stability (correlation stability = 0.75), while symptom-level classification accuracy ranged from 0.542 to 0.791. Sensitivity analyses indicated that network structure differed across settlement settings, whereas no significant difference in overall network structure was detected between sexes.

These findings provide a nuanced understanding of symptom interrelationships between depression and PTSD in a major humanitarian setting. Symptoms such as guilt, rumination, recurrent traumatic thoughts and physical health problems warrant further interventions as potential intervention targets, potentially informing more focused and culturally sensitive mental health strategies for conflict-affected populations.

Intrusive trauma memories – vivid, distressing recollections that occur involuntarily and may feel present – is a defining symptom of post-traumatic stress disorder (PTSD). While traditional models emphasize dysregulation within limbic-prefrontal circuits, emerging evidence implicates visual sensory systems in the formation of trauma-memory intrusions. However, direct causal evidence remains lacking.

We combined functional MRI with repetitive transcranial magnetic stimulation (rTMS) to examine the causal role of visual sensory cortices in intrusive memory formation. Healthy participants underwent a trauma-film paradigm, followed by fMRI scanning during memory encoding and a post-encoding resting phase during which spontaneous intrusions were recorded. One group received 1-Hz rTMS targeting early visual cortex (V1/V2); a control group received stimulation at the Vertex. Intrusive memories were recorded over the subsequent 7 days.

rTMS to V1/V2 significantly reduced the frequency, vividness, and emotional intensity of intrusive memories, while preserving recognition of episodic gist. fMRI analyses showed that intrusive episodes were associated with heightened activation and stable neural representations within the occipital visual cortex (OVC). Functional and effective connectivity analyses further revealed that the occurrence of intrusions was predicted by interactions between the middle frontal gyrus (MFG) and OVC. Dynamic causal modeling confirmed direct, bidirectional MFG-OVC interactions that coexisted with, but tracked the intrusion dynamics more closely than, the traditional prefrontal-limbic circuits.

These findings provide the first causal evidence for the direct involvement of the early visual cortex in trauma-memory intrusions. They highlight the visual system as a novel neuromodulation target for therapeutic intervention on PTSD.

Existing research on post-traumatic stress disorder (PTSD) development over time covers brief periods predominantly among military personnel, rather than civilians, and baseline measurements from before traumatic experiences are rarely available. This longitudinal study examined PTSD trajectories among Israeli civilians before and after the October 7, 2023, terror attack, exploring their associations with current and previous trauma.

Data included 1,231 Israeli Jewish adults from a quasi-representative sample surveyed at four time points: January 2018, April 2022, December 2023, and March 2024. Participants completed self-report measures, including the PTSD Checklist for DSM-5 (PCL-5), exposure to the October 7 attack and subsequent war, and trauma in childhood and adulthood. Latent growth mixture modeling identified PTSD trajectories.

Four trajectories were identified: resilience (70.4%), trauma recovery (9.4%), trauma vulnerability (16.8%), and chronic PTSD (3.5%). The chronic PTSD group exhibited persistently high symptoms, associated with greater childhood trauma and war-related exposure. The trauma vulnerability group showed low-medium pre-attack PTSD levels that escalated post-attack, associated with higher war-related stressors. The trauma recovery group had high pre-attack PTSD severity related to high trauma exposure, but showed significant symptom reduction post-attack.

This study, the first to examine PTSD trajectories in civilians after large-scale trauma, highlights diverse impacts. Most participants demonstrated resilience, while some exhibited chronic symptoms. Two trajectories – trauma vulnerability and trauma recovery – were event-responsive, suggesting that collective trauma can both exacerbate and paradoxically alleviate symptoms. Findings emphasize the need for targeted interventions and suggest future research using machine learning to refine PTSD trajectory prediction.

Little is known about the interrelationships among adverse childhood experiences (ACEs), post-traumatic stress disorder (PTSD), dissociative disorders, depression, and dementia risk. We sought to investigate associations of ACEs, PTSD, dissociative disorders, and depression with incident dementia and explore whether these associations may be interrelated through mediation.

This prospective cohort study used population-based UK Biobank data, including 502 355 participants recruited at 22 assessment centres who completed questionnaires, an interview, and physical assessments at baseline (2006–2010). Data are linked to participants’ electronic health records from primary care, hospital admissions, and death registers through November 30, 2022, and to the results of the UK Biobank online mental health survey (2016–2017). Cox regression and g-formula-based mediation analyses were used to examine associations between self-reported ACEs, self-reported PTSD symptoms, diagnosed PTSD, dissociative disorders, depression, and dementia.

In the final sample (n = 434 215, mean (SD) age 56.58 (8.07) years), ACEs (hazard ratio (HR)1point: 1.10; 95% CI 1.02–1.20), diagnosed PTSD (HR: 2.09; 95% CI 1.38–3.18), dissociative disorders (HR: 3.96; 95% CI 2.55–6.15), depression (HR: 2.17; 95% CI 2.05–2.30), and self-reported PTSD symptoms (HR1point: 1.09; 95% CI 1.06–1.11) were associated with increased dementia risk, after adjusting for sociodemographic characteristics. Self-reported PTSD symptoms explained 75.26% (P < .001) of the excess dementia risk associated with ACEs. Depression explained 4.51% (P = .02) of the ACEs-dementia link, 8.42% (P < .001) of the diagnosed PTSD-dementia link, and 10.29% (P < .001) of the dissociative disorders-dementia link.

Individuals with ACEs, PTSD, dissociative disorders, or depression appear to be at increased risk of dementia, potentially through both shared and unique associations. However, these findings should be interpreted with caution due to potential limitations in statistical power.

This experimental study investigated whether the trait factors of world assumptions and cognitive flexibility were predictive of levels of attentional bias to threat stimuli, memory integration, and data-driven processing.

An opportunity sample of 74 participants took part in the investigation. Participants viewed a virtual reality film to induce mild distress to mimic processes that can occur in individuals when experiencing a traumatic event. A prospective experimental design was conducted involving measurements at pre-trauma exposure (Time 1), post-exposure (Time 2) and one-week follow-up (Time 3). Self-report measures of world assumptions, cognitive flexibility, and cognitive processing were administered. Eye-tracking equipment was used to assess attentional bias towards threat images, and a free recall task to assess memory integration.

A mixed effects linear model found increased cognitive bias towards trauma-related threat images pre/post-exposure, specifically for a maintenance attentional bias. Significantly greater data-driven processing was observed post-exposure, with greater conceptually driven processing observed at one-week follow-up. No significant findings were observed for memory integration. World assumptions were predictive of increased data-driven processing; the relative use of data-driven to conceptually driven processing; and trait anxiety. Cognitive flexibility was predictive of state anxiety.

These results provide additional support for the role of maintained attention, data-driven processing, and conceptually driven processing in post-trauma reactions as per established cognitive theories of post-traumatic stress disorder. More research is required to fully explore the roles of core beliefs, assumptions and cognitive flexibility in this area.

Cognitive behavioural therapists and practitioners often feel uncertain about how to treat post-traumatic stress disorder (PTSD) following rape and sexual assault. There are many myths and rumours about what you should and should not do. All too frequently, this uncertainty results in therapists avoiding doing trauma-focused work with these clients. Whilst understandable, this means that the survivor continues to re-experience the rape as flashbacks and/or nightmares. This article outlines an evidence-based cognitive behavioural therapy (CBT) approach to treating PTSD following a rape in adulthood. It aims to be a practical, ‘how to’ guide for therapists, drawing on the authors’ decades of experience in this area. We have included film links to demonstrate how to undertake each step of the treatment pathway. Our aim is for CBT practitioners to feel more confident in delivering effective trauma-focused therapy to this client group. We consider how to assess and formulate PTSD following a rape in adulthood, then how to deliver cognitive therapy for PTSD (CT-PTSD; Ehlers and Clark, 2000). We will cover both client and therapist factors when working with memories of rape, as well as legal, social, cultural and interpersonal considerations.

1. To understand the importance of providing effective, trauma-focused therapy for survivors of rape in adulthood who are experiencing symptoms of PTSD.

2. To be able to assess, formulate and treat PTSD following a rape in adulthood.

3. How to manage the dissociation common in this client group.

4. To be able to select and choose appropriate cognitive, behavioural and imagery techniques to help with feelings of shame, responsibility, anger, disgust, contamination and mistrust.

5. For therapists to learn how best to support their own ability to cope with working in a trauma-focused way with survivors of rape and sexual violence.

Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders.

We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference.

The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment.

Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.

Although both psychological resilience and social support are widely believed to be effective in alleviating post-traumatic psychiatric symptoms in individuals with traumatic events, there has been a lack of comparative analysis of their intervention effects on different post-traumatic psychiatric symptoms. Furthermore, previous studies have mostly failed to control for potential confounding effects caused by different traumatic events.

We used the novel network analysis approach to examine the differential moderating effects of psychological resilience and social support on post-traumatic psychiatric symptoms, controlling for the confounding effects of traumatic events.

We recruited 264 front-line rescuers who experienced the same traumatic event. Quantified edge weights and bridge expected influence (BEI) were applied to compare the alleviating effects of psychological resilience and social support.

Our study revealed distinct correlations in a sample of front-line rescuers: social support negatively correlates more with psychosomatic symptoms, notably fatigue in depressive networks and sleep disturbance in post-traumatic stress disorder (PTSD) networks, whereas psychological resilience shows fewer such correlations. Quantitative analysis using BEI indicated that psychological resilience more effectively suppresses depressive and anxiety symptom networks, whereas social support more significantly inhibits PTSD symptom networks.

The current study represents the first attempt to examine the differential effects of psychological resilience and social support on post-traumatic outcomes in real-world emergency rescuers, controlling for the confounding effect of traumatic events. Our results can act as the theoretical reference for future precise and efficient post-trauma psychological interventions.

1. (1) To understand why feelings of guilt may arise following experiences of trauma or adversity.

2. (2) To be able to assess and formulate feelings of guilt.

3. (3) To be able to choose an appropriate cognitive technique, based on the reason for the feeling of guilt/responsibility, and work through this with a client.

4. (4) To be able to use imagery techniques to support cognitive interventions with feelings of guilt.

The coronavirus disease 2019 (COVID-19) pandemic is likely to lead to a significant increase in mental health disorders among healthcare workers (HCW).

We evaluated the rates of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a population of HCW in the UK.

An electronic survey was conducted between the 5 June 2020 and 31 July 2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: the 4-item Patient Health Questionnaire(PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations between 24 independent variables and anxiety, depressive or PTSD symptoms.

There were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 years, interquartile range: 32–51). The rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5%, respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio (OR) = 2.3, 95% CI 1.9–2.7, P < 0.001), depression (OR = 2.5, 95% CI 2.1–3.0, P < 0.001) and PTSD (OR = 2.1, 95% CI 1.7–2.5, P < 0.001). The availability of adequate personal protective equipment (PPE), well-being support and lower exposure to moral dilemmas at work demonstrated significant negative associations with these symptoms (P ≤ 0.001).

We report higher rates of clinically significant mental health symptoms among hospital HCW following the initial COVID-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to well-being support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.

Increasing evidence confirms a strict relationship between mental disorders and physical health. Particularly, stressful life events and post-traumatic stress disorder (PTSD) have been closely correlated with various physical disorders and somatic symptoms, such as chronic pain, gastrointestinal disorders, and headaches. The aim of this study was to investigate the emergence of somatic symptoms in a sample of young adult survivors 21 months after exposure to the L’Aquila 2009 earthquake, with particular attention to PTSD and gender impact.

Four hundred and fifty high-school senior students (253 male and 197 female) exposed to the 2009 L’Aquila earthquake, 21 months earlier, were enrolled and evaluated by the Trauma and Loss Spectrum Self-Report (TALS-SR), for symptomatological PTSD, and the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR) “rhythmicity and vegetative functions” domain, for somatic symptoms.

Significantly higher rates of endorsement of the MOODS-SR somatic symptoms emerged in survivors with PTSD compared to those without. Females reported higher rates of endorsement of at least one MOODS-SR somatic symptom compared to males; however, a Decision Tree model and a two-way analysis of variance model confirmed a significant effect of PTSD only. A multivariate logistical regression showed a significant association between the presence of at least one MOOD-SR somatic symptom and re-experiencing and maladaptive coping TALS-SR domains.

This study corroborates a relevant impact of symptomatological PTSD, across both the genders, on somatic symptoms occurring in young adults after months from exposure to a massive earthquake.