Isabel Kreis

Objective: To clarify the longitudinal, directional relationship between event centrality and post-traumatic stress symptoms (PTSS), this study examined their cross-lagged associations over time in a sample of sexual assault survivors.Method: In total, 423 participants who had experienced a sexual assault were included in this study (98% female, age M = 26.68). PTSS and event centrality were assessed 3-, 6-, and 12-months post-study inclusion. A cross-lagged panel model (CLPM) and a random intercept CLPM (RI-CLPM) were fitted to the data across the three time points to capture both between- and within-person effects. Results: Significant cross-lagged effects were observed only from PTSS to centrality and not vice versa, both in the CLPM (β = 0.12, 95% CI [0.05,0.18]) and the RI-CLPM (β = 0.23, 95% CI [0.04,0.42]). That is, higher early levels of PTSS were predictive of higher subsequent levels of event centrality both at the between- and within-person level. Exploratory findings tentatively suggest that the cross-lagged dynamics between centrality and PTSS may vary as a function of the temporal distance from the index trauma, though results were not statistically significant. Generalizability of the findings is limited by the low diversity of the sample regarding demographic characteristics.Conclusions: These findings indicate that the longitudinal association between post-traumatic stress and event centrality is predominantly symptom-driven, with centrality functioning primarily as a consequence and not a driving force of ongoing distress. Exploratory results suggest a potential temporal dependence of these dynamics, highlighting the need for research with early-recruited cohorts.

Peritraumatic reactions during sexual assault are central to societal rape stereotypes and may play a role in post-trauma mental health. Nevertheless, existing research is limited. In this cross-sectional study, we explored a broad spectrum of emotional, cognitive, and behavioural peritraumatic reactions and investigated their associations with assault characteristics, sexual assault history, and symptoms of post-traumatic stress and depression/anxiety. Recent sexual assault victims (N = 425, 96% female, M = 26.20 years old) completed a 23-item peritraumatic reactions questionnaire developed in collaboration with lived-experience experts. Exploratory factor analysis (EFA) was employed to identify latent peritraumatic reaction factors. Associations between factor scores, various assault characteristics, history of sexual assault, and current symptoms of post-traumatic stress and depression/anxiety were assessed with t-tests, ANOVA, correlations and linear regressions. EFA revealed six factors: Dissociation & freeze, Cognitive strategies & thought processes, Active defense behaviour, Negative emotions, Perceived life threat, and Reactive surrender. Feelings of helplessness and non-active behavioural responses, captured by the Dissociation & freeze and the Reactive surrender factors, were much more pronounced than active resistance. Perpetrator strategies involving threats and physical violence were related to higher levels of most peritraumatic reactions, apart from Dissociation & freeze. A closer victim-perpetrator relationship was associated with lower perceived life threat, whereas a history of sexual assault was associated with higher levels of Reactive surrender. All factors except Cognitive strategies & thought processes and active defense behaviour were positively correlated with post-traumatic stress and depression/anxiety symptoms, even when controlling for assault characteristics and sexual assault history. These findings highlight the heterogeneity of peritraumatic responses and challenge rape stereotypes of the actively resisting victim by identifying reactive surrender as a common survival strategy. The robust associations between diverse peritraumatic reactions and post-trauma mental health propose these acute responses as vital clinical indicators for post-trauma adjustment.

Background: Peritraumatic reactions during sexual assault are central to societal rape stereotypes and may play a role for post-trauma mental health. Nevertheless, existing research is limited. In this cross-sectional study, we explored a broad spectrum of emotional, cognitive, and behavioral peritraumatic reactions and investigated their associations with assault characteristics, sexual assault history, and symptoms of post-traumatic stress and depression/anxiety.Methods: Recent sexual assault victims (N=425, 96% female, M = 26.20 years old) completed a 23-item peritraumatic reactions questionnaire developed in collaboration with lived-experience experts. Exploratory factor analysis (EFA) was employed to identify latent peritraumatic reaction factors. Associations between factor scores, various assault characteristics, history of sexual assault, and current symptoms of posttraumatic stress and depression/anxiety were assessed with t-tests, ANOVA, correlations and linear regressions.Results: EFA revealed six factors: Dissociation & freeze, Cognitive strategies & thought processes, Active defense behavior, Negative emotions, Perceived life threat, and Reactive surrender. Feelings of helplessness and nonactive behavioral responses, captured by the Dissociation & freeze and the Reactive surrender factors, were much more pronounced than active resistance. Perpetrator strategies involving threats and physical violence were related to higher levels of most peritraumatic reactions, apart from Dissociation & freeze. A closer victim-perpetrator relationship was associated with lower Perceived life threat, whereas a history of sexual assault was associated with higher levels of Reactive surrender. All factors except Cognitive strategies & thought processes and Active defense behavior were positively correlated with post-traumatic stress and depression/anxiety symptoms, even when controlling for assault characteristics and sexual assault history.Conclusions: These findings highlight the heterogeneity of peritraumatic responses and challenge rape stereotypes of the actively resisting victim by identifying reactive surrender as a common survival strategy. The robust associations between diverse peritraumatic reactions and post-trauma mental health propose these acute responses as vital clinical indicators for post-trauma adjustment.

Background: People with severe mental disorders (SMDs) have about 15 years shorter life expectancy than the general population. Cardiovascular disease (CVD) is among the leading causes of premature mortality and shares genetic underpinnings with SMDs. We investigated the link between clinical traits in SMDs and time to the first CVD diagnosis. Methods: The study included 1,627 well-characterized participants with schizophrenia spectrum (SCZ, N = 998) and bipolar spectrum disorders (BDs, N = 629), and a reference group of 1,201 healthy controls. CVD diagnoses were obtained from two Norwegian national registries (covering both primary and specialist health care) for the period of 2006–2020. Applying Cox proportional hazard models, we investigated associations between SMD clinical traits and time to first CVD diagnosis in SMD participants, adjusting for age, sex, diagnosis, and tobacco use. Results: Among individuals with SMD, recurring self-harming behavior (SHB) was associated with a shorter time to first CVD diagnosis (p = .029) relative to those without SHB. In the subgroup with SHB and a history of attempted suicide(s), more suicide attempts were associated with shorter time to first CVD diagnosis (p = .041). Significant associations of time to first CVD diagnosis with age at SMD onset and comorbid substance use disorder were not demonstrated. Conclusions: SHB and a history of suicide attempts in individuals with SMD seem to be associated with earlier CVD onset, and may improve the prediction of CVD, in addition to standard cardiovascular risk factors.

Aberrant levels of blood markers reflecting inflammation and immune system activation have been implicated in psychotic disorders and linked to psychotic symptom severity. However, their predictive value for the long-term course of psychotic symptoms as well as the potential confounding and moderating role of cannabis use remain underexplored. We tested if baseline levels of immune markers previously linked to psychotic symptoms or treatment response (CRP, IL-1RA, sIL-2R, sTNFR1, sgp130) predicted 10-year outcomes in a first-episode psychosis sample (N = 320), and whether associations were moderated by baseline cannabis use. We assessed psychiatric (re)admissions and number of psychotic episodes during each year of the follow-up period, as well as change in positive psychotic symptom severity from baseline. Apart from sTNFR1, none of the immune markers significantly predicted psychosis outcomes independently of cannabis use. Baseline sTNFR1 was linked to lower risk of both (re)admissions and psychotic episodes, with an increasingly negative association over time. The statistical effects of CRP, IL-1RA, and sgp130 were all dependent on cannabis use. Specifically, negative (CRP, IL-1RA) or positive associations (sgp130) with psychiatric (re)admission risk or psychotic episode risk were observed in cannabis users only. Similarly, sgp130 was negatively associated with symptom change in cannabis users only. Some of these associations varied by follow-up year of the measured outcome (sgp130, IL-1RA). These findings challenge the prognostic and etiological significance of baseline immune markers for the course of positive psychotic symptoms and emphasize the importance of accounting for cannabis use.

Aberrant levels of blood markers reflecting inflammation and immune system activation have been implicated in psychotic disorders and linked to psychotic symptom severity. However, their predictive value for the long-term course of psychotic symptoms as well as the potential confounding and moderating role of cannabis use remain underexplored. We tested if baseline levels of immune markers previously linked to psychotic symptoms or treatment response (CRP, IL-1RA, sIL-2R, sTNFR1, sgp130) predicted 10-year outcomes in a first-episode psychosis sample (N = 320), and whether associations were moderated by baseline cannabis use. We assessed psychiatric (re)admissions and number of psychotic episodes during each year of the follow-up period, as well as change in positive psychotic symptom severity from baseline. Apart from sTNFR1, none of the immune markers significantly predicted psychosis outcomes independently of cannabis use. Baseline sTNFR1 was linked to lower risk of both (re)admissions and psychotic episodes, with an increasingly negative association over time. The statistical effects of CRP, IL-1RA, and sgp130 were all dependent on cannabis use. Specifically, negative (CRP, IL-1RA) or positive associations (sgp130) with psychiatric (re)admission risk or psychotic episode risk were observed in cannabis users only. Similarly, sgp130 was negatively associated with symptom change in cannabis users only. Some of these associations varied by follow-up year of the measured outcome (sgp130, IL-1RA). These findings challenge the prognostic and etiological significance of baseline immune markers for the course of positive psychotic symptoms and emphasize the importance of accounting for cannabis use.

Illness trajectories in people with first-episode psychosis (FEP) vary significantly over time. Identifying early-course parameters predicting outcomes is essential, but long-term data still needs to be provided. We conducted a 10-year follow-up study of a comprehensive first-episode psychosis (FEP) cohort investigating the prevalence of clinical recovery (CR) and treatment resistance (TR) after ten years, as well as clinical, demographic, and pre-illness predictors of long-term outcomes. 102 participants with FEP DSM-IV Schizophrenia spectrum disorders were recruited within their first year of treatment. The Treatment Response and Resistance in Psychosis Working Group (TRRIP) and the Remission in Schizophrenia Working Group (RSWG) criteria were used to define TR and CR, respectively. At 10-year follow-up, 29 (29%) of the participants were classified as in CR, while 32 (31%) were classified as TR. We also identified a larger middle group (n = 41, 40%) consisting of participants in partial recovery. 7% of all participants had tried Clozapine at the 10-year follow-up. Logistic regression analyses identified insidious onset (OR = 4.16) and baseline disorganized symptoms (OR = 2.96) as significantly associated with an increased risk of developing TR. Good premorbid academic adjustment (OR = 1.60) and acute onset (OR = 3.40) were associated with an increased chance of CR. We identified three long-term outcome groups by using recent consensus definitions. We also identified the potential importance of assessing baseline disorganized symptoms and monitoring patients with insidious onset more closely. Further, the findings suggest that clinicians should pay close attention to early-course parameters and provide adequate treatment to improve long-term outcomes of FEP.