Machine learning (ML) models show promise in predicting post-traumatic stress disorder (PTSD) treatment outcomes, but it is unknown how their predictions compare to those of clinicians. This study directly compared the accuracy of clinicians’ predictions of patient treatment outcomes with those of three ML models.

Twenty clinicians providing cognitive processing therapy repeatedly predicted outcomes for 194 veterans. We compared their accuracy against three ML models on two key endpoints: clinically meaningful symptom reduction (≥10-point PCL-5 decrease) and posttreatment severity (final PCL-5 < 33). Clinician predictions were compared against a recurrent neural network, a mixed-effects random forest, and a generalized linear mixed-effects model. We analyzed prediction accuracy and the association between clinician confidence and accuracy using logistic mixed-effects models.

ML models were significantly more accurate than clinicians at predicting whether a patient’s posttreatment PCL-5 score would be below 33 (p < .001). However, no significant difference in accuracy was found for predicting a ≥10-point symptom reduction (p = .734). Clinician confidence increased throughout treatment and was significantly associated with greater prediction accuracy for both outcomes (ORs = 1.06, ps < .001).

ML models can outperform clinicians in predicting posttreatment symptom severity, particularly early in treatment, suggesting they could be a useful tool for identifying patients at risk for suboptimal outcomes. However, ML models were not superior in predicting symptom reduction, where clinicians also performed at a high level. Findings support the selective use of ML to enhance, rather than replace, clinical judgment in PTSD treatment.

The January 2025 Los Angeles wildland-urban interface wildfires represent a significant environmental disaster, resulting in widespread evacuations. Beyond the immediate physical and economic devastation, wildfires can have profound and lasting impacts on the mental well-being of affected populations. This study compared mental health outcomes between Southern California residents who evacuated due to the fires and those who did not evacuate.

Southern California residents (N = 739) were surveyed 2-3 months after the January 2025 wildfires. Logistic regression models assessed the association of evacuation status with depression, anxiety, and PTSD, adjusting for demographics and baseline pre-fire levels of depression and anxiety.

Evacuating was significantly associated with higher odds of depression (AOR = 1.75 [1.08-2.85]) and PTSD (AOR = 2.44 [1.36-4.35]), after controlling for pre-fire mental health status and other demographic covariates. Evacuation status was not associated with anxiety.

These findings support previous research linking wildfire exposure to adverse mental health outcomes and highlight the importance of targeted mental health screening and support for wildfire evacuees, who are at increased risk for depression and PTSD.

1. (1) To outline potential impacts of trafficking-related experiences on mental health.

2. (2) To increase clinicians’ confidence in engaging survivors of trafficking in assessment and evidence-based CBT interventions.

3. (3) To apply a phased model framework to planning and delivering effective interventions where there may be additional or complex psychosocial needs.

Major depressive episodes (MDEs) are highly recurrent in clinical samples. However, the course of MDEs and predictors of their endurance are unclear in the general youth population.

We investigated prospective factors associated with enduring MDE (the presence of 12-month DSM-IV MDE at baseline and 1 year using the Composite International Diagnostic Interview–Screening Scales) in 1,833 participants of a 1-year epidemiological youth cohort study in Hong Kong. Multivariable logistic regression models were used to examine the influences of a range of personal and environmental factors.

At baseline, 13.7% participants had MDEs, among whom 21.1% presented enduring MDEs. More severe symptoms of post-traumatic stress disorder (adjusted odds ratio [aOR] = 5.54, confidence interval [CI] = 2.14–14.38), depression (aOR = 3.92, CI = 1.79–8.62), and generalized anxiety (aOR = 2.27, CI = 1.21–4.25) at baseline were among the strongest associated factors for enduring MDE, with trends of associations observed for psychotic-like experiences (aOR = 1.98, CI = 0.98–4.02) and eating disorder symptoms (aOR = 1.88, CI = 0.90–3.95). Among various types of stressors, only dependent stressors at follow-up showed a clear association with enduring MDE (aOR = 4.22, CI = 1.81–9.83). Those with enduring MDE showed poorer functioning and mental health-related quality of life at follow-up, with only 35.6% having sought any psychiatric/psychological help during the past year.

Detecting comorbid symptoms in those with prior MDEs and reducing the impact of dependent stressors may help reduce their long-term implications. Enhancing the accessibility and acceptability of youth-targeted mental health services would also be crucial to improve help-seeking.

Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress–diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.

The INTERSECT cross-sectional survey (April 2021–January 2024) included 11,302 women at 6–12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant-related factors. All models were adjusted for country-level variation as a random effect.

Models explained substantial variance across all outcomes (conditional R2 = 0.53–0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80–0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41–1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29–2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21–0.29). Other predictors reached significance but showed small effects.

Findings support a stress–diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women’s appraisals of birth.

Bilateral sensory stimulation (BLS), such as eye movements or alternating tactile stimulation, is a key component of Eye Movement Desensitisation and Reprocessing (EMDR), a recommended treatment for post-traumatic stress disorder (PTSD). However, the neurophysiological mechanisms underlying BLS remain poorly understood.

This study examined the physiological effects of visual and tactile BLS on frontal electroencephalography (EEG) activity and autonomic arousal in patients with PTSD and healthy controls, by varying the type of stimulation in different emotional stimuli.

Twenty female PTSD patients and twenty matched healthy controls participated in a counterbalanced, within-subjects design. Participants recalled a subjectively stressful or neutral event while receiving visual or tactile BLS. Frontal EEG and peripheral psychophysiological measures were recorded before and after stimulation. Data were analysed using mixed model analysis to examine the effects of stimulation type, memory condition and group.

Both visual and tactile BLS significantly increased the total power of frontal EEG and decreased spectral edge frequency and peripheral physiological activation. These effects were consistent between the groups and memory conditions.

BLS, regardless of visual or tactile modality or emotional memory content, is associated with increased frontal EEG activity and reduced autonomic arousal. These findings support the hypothesis that BLS facilitates top-down cortical regulation, potentially aiding emotional processing in EMDR by using an inherent mechanism to promote psychological recovery. More research is needed to clarify the neural mechanisms and clinical implications.

Impaired maternal sensitivity may be a risk pathway linking maternal posttraumatic stress symptoms (PTSS) to adverse child outcomes. Respiratory sinus arrhythmia (RSA), a psychophysiological marker of emotion dysregulation, may be a key factor in how PTSS influence maternal sensitivity. Yet, these associations remain untested in early infancy. The current study tested maternal resting RSA and RSA reactivity to caregiving as moderators of the association between maternal PTSS and maternal sensitivity in trauma-exposed mothers.

Seventy-seven mother–infant dyads (maternal Mage = 30.06 years, infant Mage = 9.53 weeks) were recruited from the community and an urban public hospital setting. Mothers reported on PTSS and engaged in a caregiving task; maternal sensitivity was coded. RSA was measured at rest and in response to the task. Generalized linear models for ordinal outcomes analyses examined the moderating effect of resting RSA and RSA reactivity (decrease in RSA) on the association between PTSS and maternal sensitivity.

The association between maternal PTSS and sensitivity was significantly moderated by resting RSA (B(SE) = 0.03(0.01), p = .033, and RSA reactivity, B(SE) = 0.03(0.01), p = .022.

Maternal PTSS was negatively associated with maternal sensitivity only among mothers with higher resting RSA (+1SD above mean), B(SE) = −0.05(0.02), p = .030, and with greater RSA reactivity (−1SD below mean RSA reactivity scores), B(SE) = −0.06 (0.02), p = 0.021.

A tendency toward autonomic overregulation and heightened physiological reactivity may serve as relevant factors influencing how PTSS leads to maladaptive parenting behavior in early postpartum.

Intrusive re-experiencing of traumatic events is a cornerstone of post-traumatic stress disorder (PTSD). Clinicians notice that clients also experience intrusive mental images of what they think might happen during a traumatic event. As mental imagery has a powerful impact on emotion, imagination-based imagery may be implicated in the peaks of distress (‘hotspots’) during a trauma.

A data-only study was undertaken of cognitive therapy for PTSD ‘hotspot’ charts used by Grenfell Health and Wellbeing Service clinicians after the Grenfell fire disaster. The aim was to establish the prevalence and nature of peri-traumatic ‘imagination-based hotspots’ in this sample.

Hotspots are described as the worst moments within a trauma. Two clinicians independently rated anonymised hotspot charts (N=26) for the presence and content of ‘imagination-based hotspots’, defined as ‘a peak of emotion during a traumatic event that is related to something imagined “in the mind’s eye” as opposed to directly perceived with the senses’.

81% (N=21) of individuals reported an imagination-based hotspot; 38% of all hotspots (n=159) contained an imagination-based component. The most common was an image in which the person watching the fire imagined themselves in the ‘shoes’ of a tower resident.

Imagination-based mental imagery appears to be linked to the ‘hotspots’ of a high proportion of people experiencing PTSD in this sample. Results underline the importance of enquiring about the presence of mental imagery during PTSD treatment. The presence of peri-traumatic mental images has implications for effective updating of ‘hotspots’ in PTSD treatment.

The medical profession is associated with high demands and occupational stressors – including confrontation with illness and death, extended work hours, and high workload – which may increase the risk of traumatization and posttraumatic stress disorder (PTSD). This systematic review aimed to synthesize evidence on prevalence of PTSD among physicians and examine potential moderators, including the COVID-19 pandemic, specialties, and geographic regions.

A systematic search was conducted in PubMed, Web of Science, PsychINFO, and PubPsych up to April 2025. Included studies were English-language, peer-reviewed, observational studies, reporting PTSD prevalence in physicians, using validated instruments. Studies focusing on preselected PTSD cases or mixed healthcare samples were excluded. Data extraction included study methodology, measurement tools, geographic region, specialty, and survey timing (pre-/“post”-COVID). Risk of bias was assessed using the JBI critical appraisal checklist for prevalence studies. Quantitative synthesis and moderator analyses were performed. The review was registered with PROSPERO (ID CRD42023401984).

Based on 81 studies (N = 41,051), the pooled PTSD prevalence using a random-effects model was 14.9% (95% CI [0.132–0.168]). Prevalence estimates were lower in high-income (13.6%) compared to middle-income countries (21.1%) (p < 0.036). Studies employing brief screening tools (≤10 items) yielded significantly lower prevalence estimates (10.2%) than those using longer instruments (16.4%) (p < 0.027). No other significant moderators were identified.

PTSD prevalence among physicians is elevated relative to the general population, with notable variation across regions and measurement approaches. Future research should address gaps in representativeness and geographic coverage to improve prevalence estimates and guide prevention strategies.

Depression, anxiety and post-traumatic stress disorder (PTSD) are prevalent among healthcare workers (HCWs), including those from sub-Saharan Africa (SSA). However, there are limited summary data on the burden and factors associated with these disorders in this region. We conducted this systematic review (registration no. CRD42022349136) to fill this gap.

The aim of this review was to systematically summarise the available evidence on the prevalence and factors associated with depression, anxiety and PTSD, or their symptoms, among HCWs from SSA.

We searched African Index Medicus, African Journals Online, CINAHL, PsycINFO and PubMed for articles published, from database inception to 15 February 2024. The keywords used in the search were ‘depression/anxiety/PTSD’, ‘healthcare workers’, ‘SSA’ and their variations.

Sixty-nine studies met our inclusion criteria, most of which (n = 55, 79.7%) focused on the burden of these disorders during the COVID-19 pandemic. Across studies, wide-ranging prevalence estimates of depressive (2.1–75.7%), anxiety (4.8–96.5%) and PTSD symptoms (11.7–78.3%) were reported. These disorders appear to have been heightened during the COVID-19 pandemic. Several sociodemographic, health-related, COVID-19-related and work-related factors were reported to either increase or lower the risk of these disorders among HCWs from SSA.

The burden of depression, anxiety and PTSD among HCWs from SSA is high and appears to have been worsened by the COVID-19 pandemic. The correlates of these disorders among HCWs from this region are multifactorial. A multi-component intervention could contribute to addressing the burden of mental disorders among HCWs from this region.

This study aimed to investigate the association between the experience of rescue activities in the 2024 Noto Peninsula earthquake and posttraumatic stress symptoms (PTSS) and psychological distress among medical rescue workers (MRWs).

MRWs were recruited from March 8 to March 31, 2024. Outcomes were psychological distress and PTSS. Independent variables were the experiences of rescue activities in the Noto Peninsula earthquake and peritraumatic distress assessed by the Peritraumatic Distress Inventory (PDI).

1085 MRWs completed all questions. Multiple linear regression analyses showed that experiences of being overwhelmed by the tragic situation in the disaster area (B = 0.61, p < 0.01), experience of disagreement and conflict among rescuers during rescue activities (B = 0.51, p < 0.01) and PDI (B = 0.33, p < 0.01) were significantly associated with psychological distress, and experience of disagreement and conflict among rescuers during rescue activities (B = 1.70, p < 0.01) and PDI (B = 0.65, p < 0.01) were significantly associated with PTSS.

This study showed factors associated with PTSS and psychological distress among MRWs during the Noto Peninsula earthquake, which was an important finding for future research on the mental health of MRWs.

The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) and International Classification of Diseases – 11th Revision (ICD-11) employ different post-traumatic stress disorder (PTSD) criteria, necessitating updated prevalence estimates. Most of the existing evidence is still based on ICD-Tenth Revision and DSM-Fourth Edition criteria, leading to varied estimates across populations. This study provides current PTSD prevalence rates in the German general population, comparing DSM-5 and ICD-11 criteria and examines variations by age and gender.

In a 2016 cross-sectional survey of 2404 adults (18–94 years) representative of the German general population, participants completed the Life-Events-Checklist for DSM-5 (LEC-5) for trauma exposure and the PTSD Checklist for DSM-5 (PCL-5) for PTSD symptoms. Probable PTSD diagnoses were based on DSM-5-, ICD-11-algorithms and suggested cut-off scores. Chi-square and McNemar’s tests were used to test differences in prevalence rates by diagnostic framework, age and gender.

Of the total sample, 47.2% (n = 1135) reported experiencing at least one lifetime traumatic event (TE), with transportation accidents (7.3%) and life-threatening injuries (4.9%) being most common. Probable PTSD prevalence was 4.7% under both DSM-5 and ICD-11 criteria, and 2.6% based on a conservative cut-off normed for prevalence estimation. Gender and age were not significantly associated with TE exposure or PTSD prevalence, though trauma types varied: female participants more often reported sexual violence and severe suffering, while more male participants reported physical assaults and various types of accidents. DSM-5 and ICD-11 diagnostic algorithms had substantial yet not perfect agreement (κ = 0.62). Particularly within the re-experiencing symptoms, cluster agreement was only moderate (κ = 0.57). The cut-off method aligned more closely with DSM-5 (κ = 0.60) than ICD-11 algorithm (κ = 0.42).

This study provides updated PTSD prevalence estimates for the German general population and underscores differences between DSM-5 and ICD-11 in identifying cases, particularly with respect to re-experiencing symptoms. These findings emphasize that while overall PTSD prevalence rates under DSM-5 and ICD-11 criteria are similar, the diagnostic frameworks identify partially distinct cases, reflecting differences in symptom definitions. This highlights the need to carefully consider the impact of evolving diagnostic criteria when interpreting prevalence estimates and comparing results across studies.

Post-traumatic stress disorder (PTSD) and depression are highly comorbid. A comprehensive meta-analysis on the efficacy of PTSD-specific psychotherapies in reducing comorbid depression is lacking.

To examine the short-, mid- and long-term efficacy of PTSD-specific psychotherapies in reducing comorbid depression.

We performed a preregistered (Prospero-ID: CRD42023479224) meta-analysis and followed PRISMA guidelines. PsycINFO, MEDLINE, Web of Science and PTSDpubs were searched. Randomised controlled trials (RCTs) examining psychotherapies for PTSD in samples with ≥70% PTSD diagnosis rate, mean age of sample ≥18 years, ≥10 participants per group and reporting of depression outcome data were included in the meta-analysis.

In total, 136 RCTs (N = 8868) assessed depression. Most data concerned trauma-focused cognitive behaviour therapy (TF-CBT), followed by eye movement desensitisation and reprocessing and non-trauma-focused and other trauma-focused interventions. At post-treatment, TF-CBT was associated with large reductions in depression relative to passive controls (Hedges’ g = 0.97, 95% CI 0.80–1.14, k = 46 trials) and moderate reductions relative to active controls (Hedges’ g = 0.50, 95% CI 0.35–0.65, k = 29). Effects relative to control conditions were similar across the other interventions. Response rates for comorbid depression were three times higher in psychological interventions relative to passive controls (odds ratio 3.07, 95% CI 1.18–7.94, k = 4). In head-to-head comparisons, there was evidence for TF-CBT producing higher short-, mid- and long-term reductions in depression than non-trauma-focused interventions. Results at mid- and long term were generally similar to those at treatment end-point.

PTSD-specific psychotherapies are effective in reducing depression. TF-CBT presented with the highest certainty of results. More long-term data for other interventions are needed. Results are encouraging for clinical practice.

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.