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The taking : a novel
\"On the morning that marks the end of the world they have known, Molly and Neil Sloan awaken to the drumbeat of rain on their roof. A luminous silvery downpour is drenching their small California mountain town. It has haunted their sleep, invaded their dreams, and now, in the moody purple dawn, the young couple cannot shake the sense of something terribly wrong. As the hours pass, Molly and Neil listen to disturbing news of extreme weather phenomena across the globe...\"--P. [4] of cover.
Book
How to talk about death? A cross-sectional survey on patients’, informal caregivers’ and health care professionals’ views in the setting of allogenic hematopoietic stem cell transplantation
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment, which carries a high risk of complications and mortality, highlighting the necessity of discussions about life threat. This study explores the perspectives of patients, informal caregivers (ICs), and healthcare professionals (HCPs) regarding the timing, content, and challenges of these discussions. Multicenter cross-sectional survey in comprehensive care centers across Germany, involving patients with allo-HSCT, ICs, and HCPs. Questionnaires assessed perceived concerns about life threat, communication needs, and attitudes toward death. Statistical analyses included descriptive statistics, group comparisons, and multivariate logistic regressions. A total of 61 patients, 31 ICs and 125 HCPs participated in this study. Patients and ICs had a high need for discussion about life threat at diagnosis, which was corroborated by HCPs. At further time points in the transplant trajectory, there were more discrepancies between patients‘/ICs‘ and HCPs’ perceptions towards conversations about life threat. While 61.7% of patients preferred having their ICs present during discussions, ICs often felt overlooked, with only 50% finding conversations with HCPs helpful. HCPs’ avoidance of death was associated with a reduced likelihood of reporting a need for conversation in patients in the event of severe complications. These findings highlight a discrepancy between patients’ and ICs’ preferred timing for conversations about life threat and HCPs’ perceptions of when patients actually express such a need. To bridge this gap, earlier and ongoing conversations are essential. Training programs should address HCPs’ discomfort in discussing prognosis and improve interdisciplinary teamwork to standardize end-of-life communication.
Trial registration number
: DRKS00027290 (German Clinical Trials Register) on 10.01.2022.
Journal Article
The birthday party
\"Buried deep in rural France, little remains of the isolated hamlet of the Three Lone Girls, save a few houses and a curiously assembled quartet: Patrice Bergogne, inheritor of his family's farm; his wife, Marion; their daughter, Ida; and their neighbor, Christine, an artist. While Patrice plans a surprise for his wife's fortieth birthday, inexplicable events start to disrupt the hamlet's quiet existence: anonymous, menacing letters, an unfamiliar car rolling up the driveway. And as night falls, strangers stalk the houses, unleashing a nightmarish chain of events. Told in rhythmic, propulsive prose that weaves seamlessly from one consciousness to the next over the course of a day, Laurent Mauvignier's The Birthday Party is a deft unraveling of the stories we hide from others and from ourselves, a gripping tale of the violent irruptions of the past into the present, written by a major contemporary French writer.\"-- Provided by publisher.
Book
An evidence-based approach to forensic life-threat assessments using spleen injuries as an example
During the judicial process of addressing violent crime, a forensic practitioner may need to assess whether an inflicted injury should be considered life-threatening. This could be important for the classification of the crime. To some extent, these assessments are arbitrary since the natural course of an injury might not be completely known. To guide the assessment, a quantitative and transparent method based on rates of mortality and acute interventions is suggested, using spleen injuries as an example.
The electronic database PubMed was searched using the term “spleen injuries” for articles reporting on rates of mortality and interventions such as surgery and angioembolization in spleen injuries. By combining these different rates, a method for a transparent and quantitative assessment of the risk to life across the natural course of spleen injuries is presented.
A total of 301 articles were identified, and 33 of these were included in the study. The mortality rate of spleen injuries, as reported in studies, varied between 0% and 2.9% in children, and between 0% and 15.4% in adults. However, when combining the rates of acute interventions and the mortality rates, the risk of death across the natural course of spleen injuries was estimated as 9.7% in children, and 46.4% in adults.
The calculated risk of death across the natural course of spleen injuries in adults was considerable higher than the observed mortality. A similar but smaller effect was observed in children. The forensic assessment of life-threat in cases involving spleen injury needs further research; however, the applied method is a step towards an evidence-based practice for forensic life-threat assessments.
•Introducing an evidence-based practice in assessing the threat to life that an injury carries in a judicial context.•In the natural course of spleen injuries the observed mortality rate underestimates the risk to life.•The risk to life in a judicial setting is estimated by adding the rates of mortality and acute interventions.
Journal Article
Facing life-threat during youth: a qualitative study on challenges, coping, and needs among adolescents and young adults with cancer
Purpose
While the unique situation of adolescents and young adults with cancer (AYAs) has become the focus of research and clinical practice, little is known about how they deal with the threat to life at a curative stage. The aim of this study was to obtain insight into the challenges, coping strategies, and needs of AYAs regarding the life-threatening nature of their diseases.
Methods
Face-to-face in-depth interviews were conducted with patients who were 18–39 years old at diagnosis. The interviews took place 2–5 years after their diagnosis. Patients who were still undergoing treatment or who were suspected of recurrence were excluded. Interviews were transcribed verbatim and analyzed using qualitative content analysis.
Results
Fifteen patients (mean age 27.33 years, nine females) were interviewed in a large comprehensive cancer center in Germany. Before diagnosis, AYAs had not faced their own mortality and had little experience with cancer. The sudden confrontation with a life-threatening disease and therapy, as well as experiencing the death of other AYAs, challenged them. Fear, particularly regarding recurrence and death, and the loss of trust in their own bodies were the major emotions that continued to limit them even after the end of treatment. For mothers, concern of leaving their young children alone was paramount. Coping strategies frequently mentioned were hope, avoidance, self-soothing, and valuing the experience as a chance. Health care professionals were expected to be reassuring, motivating, and open and to provide honest information based on individual and current needs.
Conclusion
AYAs appear to cope with life-threats similarly to older patients but have additional unique challenges, including inexperience with life-threatening diseases and responsibility for young children. More research is needed in this area, although it is already evident that AYAs need honest and reassuring communication regarding the life-threat during any curable phases of their disease.
Trial registration number
DRKS00030277; September 27, 2022 (German Clinical Trials Register).
Journal Article
Time perspective and psychological hardiness mediate a COVID-19 related life threat
IntroductionUnpredictable risks of COVID-19 morbidity and mortality make people suffer from threats and fears. Are there any psychological personality traits that correlate with a decrement in such feelings?ObjectivesTo specify the relationship between psychological characteristics of time perspective, hardiness and COVID-19-related life threat.MethodsWe used Zimbardo Time Perspective Inventory, Maddi Hardiness Scale and a 17-point Attitude towards COVID-19 Questionnaire to question 327 Russian university students on social networks. The survey was carried out in the second half of May 2020 in the period of increasing COVID-19 morbidity and mortality rates. The mean age of the respondents was 21.24±2.84; most of them were females (61.16%).ResultsThe survey showed that every fifth respondent had a high level of COVID-19-related life threat (21.10 %). At the same time, every tenth of the respondents (10.09%) saw no threat to their life in the situation of a fast spreading dangerous novel coronavirus infection. According to the correlation analysis, decrement in feeling personal threat related to the spread of COVID-19 was directly associated (p<0.05) with low indicators on the scales of Negative Past (r=0.16), Hedonistic Present (r=0.13) and Fatalistic Present (r=0.17). Certain inverse relation was found between the level of COVID-19 related life threat and such indicators as psychological hardiness – commitment (r=-0.16), and challenge (r=-0.23).ConclusionsDispositional orientation to the present and future, as well as psychological characteristics of hardiness may mediate COVID-19 related life threat; therefore, these may be used as a possible basis for preventing stress and mental disorders in population.
Journal Article
Perceived life threat in children during the COVID-19 pandemic: associations with posttraumatic stress, anxiety, and depressive symptoms
Defining children’s “trauma exposure” in the context of the COVID-19 pandemic has been a source of debate. Children were exposed to threatening messaging about COVID-19 but might interpret this information differently than adults. Perceived life threat (PLT), the belief that one’s life is in danger, has been identified as a robust predictor of posttraumatic stress symptoms (PTSS), and may be a better predictor of PTSS than actual life threat (ALT). This study investigated parent reports of children’s self-PLT (belief that they might die from COVID-19) and family-PLT (belief that a family member might die from COVID-19). The aims were to compare PLT to ALT, evaluate their associations with children’s psychological functioning, and identify risk factors associated with PLT. We hypothesized an association between PLT and children’s psychological functioning in the context of the COVID-19 pandemic. Parents (N = 140) reported on their child’s (
M
age = 9.81 years, 47% female) pandemic experiences, psychological functioning, and both self-PLT and family-PLT. Results revealed self-PLT for 10% of the children and family-PLT for 43% of the children, yet only 6% experienced ALT (i.e., they or their parent tested positive for COVID-19). Children with reported self- or family-PLT had higher PTSS, depressive symptoms, anxiety symptoms, and functional impairment compared to children without these reported beliefs. PLT, but not ALT, was associated with psychological outcomes. Children with only PLT had greater PTSS and impairment than children with ALT. There were differences in parental functioning and pandemic-related information/media exposure between children with and without PLT. Children’s perceptions, rather than objective experiences, may be more central to their psychological functioning. This has implications for screening for pandemic-related symptomatology in children as traditional trauma exposure measures may not adequately identify distressed children.
Journal Article
Are Peritraumatic Perceptions of Fear/Life Threat and Posttraumatic Negative Self-Conscious Appraisals/Emotions Differentially Associated with PTSD Symptoms?
In light of revisions to the diagnostic classification and criteria of PTSD in the DSM-5 that underscore a range of negative self-related appraisals and emotions beyond fear/anxiety, the current study examined the relative associations of peritraumatic perceptions of fear/life threat and posttraumatic negative self-conscious appraisals and emotions (shame, guilt, negative beliefs about the self, self-blame) with specific PTSD symptom clusters: re-experiencing, avoidance, numbing, and hyperarousal. The sample included 257 female survivors of intimate partner violence. Structural equation modeling analyses revealed that peritraumatic perceptions of fear/life threat and posttraumatic negative self-conscious appraisals/emotions significantly correlated with each of the PTSD symptom clusters. Findings support the conceptualization of PTSD as involving concurrent fear- and self-related cognitive/emotional factors.
Journal Article
Psychological Toll of the COVID-19 Pandemic: An In-Depth Exploration of Anxiety, Depression, and Insomnia and the Influence of Quarantine Measures on Daily Life
The COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19’s role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts.
Journal Article
Prevalence and course of posttraumatic stress disorder symptoms in partners of burn survivors
Background: Partners of burn survivors may develop posttraumatic stress disorder (PTSD) symptoms in response to the potential life threatening nature of the burn event and the burn survivor's medical treatment.
Objective: This longitudinal study examined the prevalence, course and potential predictors of partners' PTSD symptoms up to 18 months post-burn.
Methods: Participants were 111 partners of adult burn survivors. In a multi-centre study, PTSD symptoms were assessed with the Impact of Event Scale-Revised during the acute phase and subsequently at 3, 6, 12 and 18 months post-burn. Partners' appraisal of life threat, anger, guilt and level of rumination were assessed as potential predictors of PTSD symptoms in an exploratory piecewise latent growth model.
Results: Acute PTSD symptoms in the clinical range were reported by 30% of the partners, which decreased to 4% at 18 months post-burn. Higher acute PTSD symptoms were related to perceived life threat and higher levels of anger, guilt, and rumination. Over time, mean symptom levels decreased, especially in partners with high levels of acute PTSD symptoms, perceived life threat and rumination. From three months onward, PTSD symptoms decreased less in partners of more severely burned survivors. At 18 months post-burn, higher levels of PTSD symptoms were related to higher acute PTSD symptoms and more severe burns.
Conclusions: One in three partners reported clinical levels of acute PTSD symptoms, of which the majority recovered over time. Perceived life threat, feelings of anger and guilt, and rumination may indicate the presence of acute PTSD symptoms, whereas more severe burns predict long-term PTSD symptom levels. The results highlight the need to screen for acute PTSD symptoms and offer psychological help to partners to alleviate acute elevated stress levels if indicated.
One in three partners reported clinical levels of acute PTSD symptoms, which decreased to 4% at 18 months post-burn.
Perceived life threat and higher levels of anger, guilt and rumination predicted higher acute PTSD symptoms.
Over time, PTSD symptoms decreased less in partners of more severely burn survivors.
Journal Article