It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder (PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.

BackgroundWithout effective treatment, PTSD and depression can cause persistent disability in disaster-affected populations.MethodsOur objective was to test the efficacy of Interpersonal Psychotherapy (IPT) delivered by trained local personnel compared with treatment as usual (TAU) for Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) among adults affected by the Sichuan 2008 earthquake. A small randomized controlled trial of IPT + TAU versus TAU alone was delivered by local mental health personnel in Shifang, China. Between July 2011 and January 2012, 49 adults ≥ 18 years with PTSD, MDD or both were enrolled and randomized to 12 weekly sessions of IPT + TAU (27) or TAU (22) alone x 12 weeks. IPT was then offered to the TAU group. Unblinded follow up assessments were conducted at three and six months. IPT was a 12 session, weekly one hour treatment delivered by local personnel who were trained and supervised in IPT. TAU was continuation of prescribed psychotropic medication (if applicable) and crisis counseling, as needed.Main Outcome(s) and Measures (s): Clinician Administered PTSD Scale (CAPS) PTSD diagnosis; Structured Clinical Interview for DSM-IV (SCID) for MDD diagnosis. Secondary measures included PTSD/depression symptoms, interpersonal conflict/anger, social support, self-efficacy and functioning.ResultsUsing an intent-to-treat analysis, 22 IPT + TAU and 19 TAU participants were compared at three months post-baseline. A significantly greater reduction of PTSD and MDD diagnoses was found in the IPT group (51.9%, 30.1%, respectively) versus the TAU group (3.4%, 3.4%, respectively). Despite the small sample, the estimates for time-by-condition analyses of target outcomes (2.37 for PTSD (p = .018) and 1.91 for MDD (p = .056)) indicate the improvement was better in the IPT + TAU condition versus the TAU group. Treatment gains were maintained at 6 months for the IPT group. A similar treatment response was observed in the TAU group upon receipt of IPT.ConclusionsThis initial study shows that IPT is a promising treatment for reducing PTSD and depression, the two major mental health disorders affecting populations surviving natural disaster, using a design that builds local mental health care capacity.Trial RegistrationClinicalTrials.Gov number, NCT01624935.

IntroductionIt has been reported that posttraumatic stress disorder (PTSD) is associated with secondary spouse/partner (S/P) emotional distress and relationship violence.ObjectiveTo investigate the relationships between PTSD, S/P emotional distress and relationship violence among police recruits using a prospective design.MethodsTwo hypotheses were tested in 71 S/Ps: (1) Police officer reports of greater PTSD symptoms after 12 months of police service will be associated with greater secondary trauma symptoms among S/Ps; (2) Greater secondary trauma symptoms among S/Ps at 12 months will be associated with S/P reports of greater relationship violence.Methods71 police recruits and their S/Ps were assessed at baseline and 12 months after the start of police officer duty. Using linear and logistic regression, we analyzed explanatory variables for 12 month S/P secondary traumatic stress symptoms and couple violence, including baseline S/P variables and couple violence, as well as exposure and PTSD reports from both S/P and officer.ResultsS/P perception of officer PTSD symptoms predicted S/P secondary traumatic stress. OS/P secondary trauma was significantly associated with both total couple violence (.34, p = .004) and S/P to officer violence (.35, p = .003).ConclusionsAlthough results from this relatively small study of young police officers and their S/Ps must be confirmed by larger studies in general populations, findings suggest that S/P perception of PTSD symptoms may play a key role in the spread of traumatic stress symptoms across intimate partner relationships and intimate partner violence in the context of PTSD.

Approximately one third of a population exposed to mass violence develops posttraumatic stress disorder (PTSD) and approximately half develops depression, yet little is known about how to effectively treat these populations. This study's objective was to examine the impact of interpersonal psychotherapy (IPT) on Sudanese refugees living in Cairo, Egypt, who had symptoms of PTSD. A randomized controlled trial (April-August 2008) with 22 Sudanese refugees in Cairo, Egypt, tested two hypotheses: (1) After IPT, participants will have fewer symptoms of depression and PTSD compared with waitlist controls. (2) After IPT, participants will have less interpersonal violence compared with waitlist controls. Participants were randomly assigned to either 6 sessions of IPT delivered by Sudanese community therapists without previous mental health training or a waitlist control group. Measures taken at baseline and trial conclusion included the Harvard Trauma Questionnaire, the Beck Depression Index-II, the Conflict Tactics Scale, and the State-Trait Anger Inventory, all translated and adapted for local use. The effect sizes of IPT treatment for PTSD symptoms, depression, state anger, trait anger, and Conflict Tactics Scale-Violence Toward Household were Ϫ2.52, Ϫ2.38, Ϫ1.21, Ϫ1.43, and Ϫ0.84, respectively. IPT predicted a significant decrease in symptoms of PTSD, state anger, and depression using a conservative intent-to-treat analysis. This study represents the first randomized controlled trial of IPT to address PTSD, depression, and interpersonal violence in a refugee population. The study's preliminary success has positive implications for development of effective and sustainable mental health interventions to support the recovery of traumatized populations.