@article{antonioLatentClassesProximal2026,

title = {Latent Classes of Proximal Traumatic Exposure Among Portuguese Police and Security Professionals: Associations with PTSD Symptoms and Psychological Distress},

author = {H. António and S. Albuquerque and M. Vieira de Castro and S. Bouchard and P. Gamito and R. J. Pinto},

url = {https://www.scopus.com/pages/publications/105048524559?origin=resultslist},

doi = {10.3390/psychiatryint7040173},

issn = {26735318 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Psychiatry International},

volume = {7},

number = {4},

publisher = {Multidisciplinary Digital Publishing Institute (MDPI)},

abstract = {Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered. © 2026 by the authors.},

keywords = {adult, Anxiety, article, cross-sectional study, decision making, Depression, DSM-5, female, Global Severity Index, hostility, human, human experiment, Latent Class Analysis, LEC-5, major clinical study, male, paranoia, phobia, police, Positive symptom distress index, Positive symptom total, posttraumatic stress disorder, posttraumatic stress disorder checklist, Proximal Traumatic Exposure, psychological distress, psychosis, PTSD, questionnaire, receiver operating characteristic, Security, security professionals, self report, sociodemographics, trauma exposure},

pubstate = {published},

tppubtype = {article}

}

@article{antonio_posttraumatic_2025,

title = {Posttraumatic stress disorder and Physiological Response in First Responders During Virtual Reality Exposure},

author = {H. António and C. Barros and M. Vieira de Castro and J. Oliveira and P. Gamito and S. Bouchard and R. J. Pinto},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105023876769&doi=10.1177%2F21522715251394917&partnerID=40&md5=c3c071b02ee24bd37789dfd06a936fbd},

doi = {10.1177/21522715251394917},

issn = {21522715 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Cyberpsychology, Behavior, and Social Networking},

abstract = {First responders (FRs) are routinely exposed to traumatic events, increasing risk for posttraumatic stress disorder (PTSD). This study compared heart rate variability (HRV) and skin conductance level (SCL) between FRs with and without probable PTSD at baseline and during a virtual reality (VR) task. Eighty-four FRs completed questionnaires and physiological assessments. Participants with probable PTSD showed significantly lower baseline HRV, indicating reduced parasympathetic modulation. No group differences emerged for HRV during VR or for SCL at either point. The results confirm reduced HRV at rest in PTSD, but further work is needed to clarify why this difference was not observed during the task and why SCL showed no group effects. To advance understanding of these results, future studies should include larger samples, longer baselines, recovery phases, and clinical interviews. © 2025 Mary Ann Liebert, (NY) LLC.},

keywords = {adult, electrodermal response, Emergency Responders, female, first responders, Galvanic Skin Response, Heart Rate, human, Humans, male, Middle Aged, pathophysiology, physiological response, physiology, Post-Traumatic, posttraumatic stress disorder, posttraumatic stress disorder (PTSD), psychology, questionnaire, rescue personnel, skin conductance, Stress Disorders, Surveys and Questionnaires, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{antonioPosttraumaticStressDisorder2025,

title = {Posttraumatic Stress Disorder and Physiological Response in First Responders During Virtual Reality Exposure},

author = {H. António and C. Barros and M. Vieira de Castro and J. Oliveira and P. Gamito and S. Bouchard and R. J. Pinto},

url = {https://www.scopus.com/pages/publications/105023876769?origin=resultslist},

doi = {10.1177/21522715251394917},

issn = {21522715 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Cyberpsychology, Behavior, and Social Networking},

volume = {28},

number = {12},

pages = {787–793},

publisher = {SAGE Publications Ltd},

abstract = {First responders (FRs) are routinely exposed to traumatic events, increasing risk for posttraumatic stress disorder (PTSD). This study compared heart rate variability (HRV) and skin conductance level (SCL) between FRs with and without probable PTSD at baseline and during a virtual reality (VR) task. Eighty-four FRs completed questionnaires and physiological assessments. Participants with probable PTSD showed significantly lower baseline HRV, indicating reduced parasympathetic modulation. No group differences emerged for HRV during VR or for SCL at either point. The results confirm reduced HRV at rest in PTSD, but further work is needed to clarify why this difference was not observed during the task and why SCL showed no group effects. To advance understanding of these results, future studies should include larger samples, longer baselines, recovery phases, and clinical interviews. © 2025 SAGE Publications.},

keywords = {adult, electrodermal response, Emergency Responders, female, first responders, Galvanic Skin Response, Heart Rate, human, Humans, male, Middle Aged, pathophysiology, physiological response, physiology, Post-Traumatic, posttraumatic stress disorder, posttraumatic stress disorder (PTSD), psychology, questionnaire, rescue personnel, skin conductance, Stress Disorders, Surveys and Questionnaires, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{antonioPosttraumaticStressDisorder2025a,

title = {Posttraumatic stress disorder and Physiological Response in First Responders During Virtual Reality Exposure},

author = {H. António and C. Barros and M. Vieira de Castro and J. Oliveira and P. Gamito and S. Bouchard and R. J. Pinto},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105023876769&doi=10.1177%2F21522715251394917&partnerID=40&md5=c3c071b02ee24bd37789dfd06a936fbd},

doi = {10.1177/21522715251394917},

issn = {21522715 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Cyberpsychology, Behavior, and Social Networking},

abstract = {First responders (FRs) are routinely exposed to traumatic events, increasing risk for posttraumatic stress disorder (PTSD). This study compared heart rate variability (HRV) and skin conductance level (SCL) between FRs with and without probable PTSD at baseline and during a virtual reality (VR) task. Eighty-four FRs completed questionnaires and physiological assessments. Participants with probable PTSD showed significantly lower baseline HRV, indicating reduced parasympathetic modulation. No group differences emerged for HRV during VR or for SCL at either point. The results confirm reduced HRV at rest in PTSD, but further work is needed to clarify why this difference was not observed during the task and why SCL showed no group effects. To advance understanding of these results, future studies should include larger samples, longer baselines, recovery phases, and clinical interviews. © 2025 Mary Ann Liebert, (NY) LLC.},

keywords = {adult, electrodermal response, Emergency Responders, female, first responders, Galvanic Skin Response, Heart Rate, human, Humans, male, Middle Aged, pathophysiology, physiological response, physiology, Post-Traumatic, posttraumatic stress disorder, posttraumatic stress disorder (PTSD), psychology, questionnaire, rescue personnel, skin conductance, Stress Disorders, Surveys and Questionnaires, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{belleville_efficacy_2023,

title = {Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial},

author = {G. Belleville and M. -C. Ouellet and V. Békés and J. Lebel and C. M. Morin and S. Bouchard and S. Guay and N. Bergeron and S. Ghosh and T. Campbell and F. P. Macmaster},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140981202&doi=10.1016%2fj.beth.2022.08.004&partnerID=40&md5=261383919bbdaa149ac0eeb6d3317fc0},

doi = {10.1016/j.beth.2022.08.004},

issn = {00057894 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Behavior Therapy},

volume = {54},

number = {2},

pages = {230–246},

publisher = {Elsevier Inc.},

abstract = {This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires. One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128},

note = {Publisher: Elsevier Inc.},

keywords = {adult, Anxiety, article, clinical effectiveness, clinical feature, cognitive behavioral therapy, controlled study, Depression, disaster, Disasters, disease severity, e-mental health, female, human, Humans, insomnia, Internet-Based Intervention, major clinical study, male, Middle Aged, natural disaster, physical disability, Post-Traumatic, posttraumatic stress disorder, psychotherapist, PTSD, randomized controlled trial, risk factor, Sleep Initiation and Maintenance Disorders, Stress Disorders, telepsychotherapy, treatment outcome, wildfire},

pubstate = {published},

tppubtype = {article}

}

@article{bellevilleEfficacyTherapistAssistedSelfHelp2023,

title = {Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial},

author = {G. Belleville and M. -C. Ouellet and V. Békés and J. Lebel and C. M. Morin and S. Bouchard and S. Guay and N. Bergeron and S. Ghosh and T. Campbell and F. P. Macmaster},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140981202&doi=10.1016%2fj.beth.2022.08.004&partnerID=40&md5=261383919bbdaa149ac0eeb6d3317fc0},

doi = {10.1016/j.beth.2022.08.004},

issn = {00057894 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Behavior Therapy},

volume = {54},

number = {2},

pages = {230–246},

publisher = {Elsevier Inc.},

abstract = {This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires. One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128},

keywords = {adult, Anxiety, article, clinical effectiveness, clinical feature, cognitive behavioral therapy, controlled study, Depression, disaster, Disasters, disease severity, e-mental health, female, human, Humans, insomnia, Internet-Based Intervention, major clinical study, male, Middle Aged, natural disaster, physical disability, Post-Traumatic, posttraumatic stress disorder, psychotherapist, PTSD, randomized controlled trial, risk factor, Sleep Initiation and Maintenance Disorders, Stress Disorders, telepsychotherapy, treatment outcome, wildfire},

pubstate = {published},

tppubtype = {article}

}

@article{bekes_trainee_2022,

title = {Trainee Therapists’ Perceptions of a Blended Intervention to Promote Resilience after a Natural Disaster: A Qualitative Case Study},

author = {V. Békés and G. Belleville and J. Lebel and M. -C. Ouellet and Z. Chen and C. M. Morin and N. Bergeron and T. S. Campbell and S. Ghosh and S. Bouchard and S. Guay and F. P. MacMaster},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136961448&doi=10.3390%2fjcm11154361&partnerID=40&md5=9705da30150789ca11a9c7719d221dac},

doi = {10.3390/jcm11154361},

issn = {20770383},

year  = {2022},

date = {2022-01-01},

journal = {Journal of Clinical Medicine},

volume = {11},

number = {15},

publisher = {MDPI},

abstract = {Background: Natural disasters happen in an increased frequency, and telemental health interventions could offer easily accessible help to reduce mental health symptoms experienced by survivors. However, there are very few programs offered to natural disaster survivors, and no research exists on therapists’ experiences with providing blended interventions for natural disaster survivors. Aims: Our qualitative case study aims to describe psychologists’ experiences with an online, therapist-assisted blended intervention for survivors of the Fort McMurray wildfires in Alberta, Canada. Method: The RESILIENT intervention was developed in the frames of a randomized controlled trial to promote resilience after the Fort McMurray wildfires by providing survivors free access to a 12-module, therapist-assisted intervention, aiming to improve post-traumatic stress, insomnia, and depression symptoms. A focus group design was used to collect data from the therapists, and emerging common themes were identified by thematic analysis. Results: Therapists felt they could build strong alliances and communicate emotions and empathy effectively, although the lack of nonverbal cues posed some challenges. The intervention, according to participating therapists, was less suitable for participants in high-stress situations and in case of discrepancy between client expectations and the intervention content. Moreover, the therapists perceived specific interventions as easy-to-use or as more challenging based on their complexity and on the therapist support needed for executing them. Client engagement in the program emerged as an underlying theme that had fundamental impact on alliance, communication, and ultimately, treatment efficiency. Therapist training and supervision was perceived as crucial for the success of the program delivery. Conclusions: Our findings provided several implications for the optimalization of blended interventions for natural disaster survivors from our therapists’ perspective. © 2022 by the authors.},

note = {Publisher: MDPI},

keywords = {adult, Alberta, article, case study, Depression, emotion, Empathy, expectation, female, human, insomnia, natural disaster, perception, personal experience, posttraumatic stress disorder, psychological resilience, psychotherapist, qualitative analysis, survivor, thematic analysis, therapeutic alliance, wildfire, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{binet_portrait_2021,

title = {A Portrait of Mental Health Services Utilization and Perceived Barriers to Care in Men and Women Evacuated During the 2016 Fort McMurray Wildfires},

author = {É. Binet and M. -C. Ouellet and J. Lebel and V. Békés and C. M. Morin and N. Bergeron and T. Campbell and S. Ghosh and S. Bouchard and S. Guay and F. P. MacMaster and G. Belleville},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85101819468&doi=10.1007%2fs10488-021-01114-w&partnerID=40&md5=4130f3aeaaf2d3894820e7fce46e67f0},

doi = {10.1007/s10488-021-01114-w},

issn = {0894587X (ISSN)},

year  = {2021},

date = {2021-01-01},

journal = {Administration and Policy in Mental Health and Mental Health Services Research},

volume = {48},

number = {6},

pages = {1006–1018},

publisher = {Springer},

abstract = {This study examines the influence of gender on mental health services utilization and on perceived barriers to treatment one year after the 2016 Fort McMurray wildfires. Data was collected through a phone survey from May to July 2017 (N = 1510). Participants were English-speaking evacuees aged 18 and older. Mental health services utilization and barriers to mental health care were assessed with the Perceived Need for Care questionnaire. Probable diagnoses of posttraumatic stress disorder, depression and insomnia were assessed with validated self-report questionnaires. Multiple logistic regressions confirmed that gender was a significant predictor of services utilization, after controlling for associated sociodemographic variables and presence of probable diagnoses. Women were respectively 1.50, 1.55 and 1.86 times more likely than men to receive information, medication and psychological help. Self-reliance was the most frequently reported reason for not receiving help, and motivational barriers, such as pessimism and stigma, were reported in a higher proportion than structural barriers, including nonresponse and finance. No significant gender differences were found in the types of perceived barriers to services. Among the Fort McMurray fire evacuees, mental health services utilization was similar to other studies on natural disaster victims, and higher in women than in men. Efforts to increase services utilization in natural disaster victims should focus on motivational barriers and offering treatments fostering people’s autonomy, such as online treatments. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.},

note = {Publisher: Springer},

keywords = {Depression, female, Gender, health care delivery, Health Services Accessibility, human, Humans, insomnia, male, mental health service, Mental Health Services, Mental health services utilization, natural disaster, Patient Acceptance of Health Care, patient attitude, Post-Traumatic, posttraumatic stress disorder, Stress Disorders, wildfire, Wildfires},

pubstate = {published},

tppubtype = {article}

}