1
|
Finch AJ, Dickerman AL. PTSD and lower respiratory symptoms: A systematic review of longitudinal associations in early 9/11 World Trade Center responders. J Psychiatr Res 2024; 169:318-327. [PMID: 38070472 DOI: 10.1016/j.jpsychires.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The objective of this systematic review is to examine longitudinal associations between post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) specifically among responders present at the World Trade Center (WTC) site on September 11, 2001 (9/11). This group, which we refer to as "9/11 early responders," appears to have particularly high rates of both mental and physical illness relative to other 9/11-exposed populations. METHODS We performed a systematic literature review to examine associations between PTSD and LRS among 9/11 early responders in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. After a structured search of Pubmed and the Fire Department of New York (FDNY) WTC bibliography for relevant articles, we identified 4 articles commenting on associations between PTSD and LRS in this population; all 4 passed quality review and were included in our primary analysis. 10 other articles we found in our research discussed rates of PTSD and LRS, but not associations between them, in the population in question; we commented on these in a secondary analysis. RESULTS The data demonstrate that there are significant associations between PTSD and LRS among 9/11 early responders. The data also suggest that both of these phenomena are more prevalent among 9/11 early responders relative to other 9/11-exposed populations. CONCLUSIONS These findings are relevant for optimizing care for the population in question, as well as for other survivors of past and future disasters with both psychiatric and medical sequelae.
Collapse
Affiliation(s)
- Anthony J Finch
- New York Presbyterian Hospital - Weill Cornell Medicine Department of Psychiatry, 525 East 68th Street, New York, NY, USA, 10065; Duke University Hospital - Duke Department of Psychiatry and Behavioral Sciences, 3643 N Roxboro St #6, Durham, NC, USA, 27704.
| | - Anna L Dickerman
- New York Presbyterian Hospital - Weill Cornell Medicine Department of Psychiatry, 525 East 68th Street, New York, NY, USA, 10065
| |
Collapse
|
2
|
Yrondi A, Colineaux H, Claudet I, Sales de Gauzy J, Huo S, Taib S, Bui E, Birmes P. Prevalence and prediction of PTSD and depression in mothers of children surviving a motor vehicle crash. Eur J Psychotraumatol 2022; 13:2121014. [PMID: 36212115 PMCID: PMC9543172 DOI: 10.1080/20008066.2022.2121014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Few studies have examined the psychopathological consequences for parents of children who were survivors of a motor vehicle crash (MVC). This study assessed the impact of dissociation and peritraumatic distress on the severity of PTSD and post-traumatic major depressive episode (MDE) symptoms in mothers during the first years after the MVC and the role that cortisol response might play in this association. Methods: 125 mothers were included. Peritraumatic distress and dissociation were assessed. Morning salivary cortisol was tested at the baseline. Participants were assessed for a probable diagnosis of PTSD and MDE at 5 weeks, 6 months and 12 months. Results: At 5 weeks, 12 (13.6%) mothers exhibited probable PTSD. During the first year, the PCL score was higher when the (i) Peritraumatic Distress Inventory (PDI) score increased and (ii) the Peritraumatic Dissociation Experience Questionnaire (PDEQ) score increased. Cortisol levels were lower when the PDI score increased. Conclusion: This is the first study to assess the mothers of MVC survivors for one year following the trauma. We confirm that peritraumatic responses are useful for predicting the severity of PTSD symptoms. These results could encourage the implementation of follow-up programmes not only for survivors but also for their mothers. HIGHLIGHTS Mothers of children involved in motor vehicle accident are at risk for developing PTSD.Peritraumatic responses (distress and dissociation) are associated to the severity of PTSD symptoms.Low salivary cortisol levels were associated with high peritraumatic distress.
Collapse
Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hopital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Hélène Colineaux
- UMR1027, Université Toulouse III, Inserm, Toulouse, France.,Département d'Epidemiologie, CHU Toulouse, Toulouse, France
| | - Isabelle Claudet
- Département des Urgences Pédiatriques, CHU Toulouse, Toulouse, France
| | - Jérome Sales de Gauzy
- Département de chirurgie orthopédique, Hopital des enfants, CHU Toulouse, Toulouse, France
| | - Samantha Huo
- Département d'Epidemiologie, CHU Toulouse, Toulouse, France
| | - Simon Taib
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Eric Bui
- Université de Caen Normandie et CHU Caen, Caen, France.,Massachusetts General Hospital, Boston
| | - Philippe Birmes
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
| |
Collapse
|
3
|
Beresford T, Wahlberg L, Hipp D, Ronan PJ. Psychological Adaptive Mechanism Maturity Predicts Good Outcomes in Treatment for Refractory PTSD. Front Psychol 2021; 12:718451. [PMID: 34659030 PMCID: PMC8514622 DOI: 10.3389/fpsyg.2021.718451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/04/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Post-traumatic Stress Disorder (PTSD) severity follows a bell-shaped curve ranging from mild to severe. Those in the severe range often receive the most intensive treatments, including targeted residential rehabilitation stays. These are expensive and welcome ways to improve their effectiveness. We hypothesized that positive change among subjects treated in a 45-day residential rehabilitation format would be associated with the maturity levels of measurable Psychological Adaptive Mechanisms (PAMs), alternately ego defense mechanisms. Methods: In this association study, adult male patients (N = 115) with a history of combat related PTSD treated in a residential rehabilitation setting completed the Defense Style Questionnaire (DSQ) on admission, as well as the Post-Traumatic Stress Disorder Checklist-Military Version (PCL-M) and the Mississippi Scale for Combat-Related Post-traumatic Stress Disorder (M-PTSD) on admission and again at discharge. This allowed prospectively calculated change scores on each of the PTSD measures for each patient. The change scores allowed association testing with averaged admission DSQ scores using Pearson's correlation probability with significance held at p < 0.05. Results: As hypothesized, averaged individual Mature scores on the DSQ were associated with improved change scores on both the PCL-M (p = 0.03) and the M-PTSD (p = 0.04). By contrast neither averaged DSQ Neurotic or Immature scores associated significantly with either PTSD scale change scores. Conclusion: These results, the first of their kind to our knowledge, suggest that patients presenting with predominantly Mature level PAMs are likely to benefit from residential rehabilitation treatment of PTSD. By contrast, those presenting with Neurotic or Immature PAMs predominantly are less likely to encounter positive change in this type of treatment. Although residential treatment is often reserved for the most refractory PTSD cases, it appears that those endorsing Mature level PAMs will make use of residential treatment whereas other forms of treatment may be better suited to those with Neurotic and Immature adjustment mechanisms.
Collapse
Affiliation(s)
- Thomas Beresford
- Rocky Mountain Regional Veteran Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Lawrence Wahlberg
- Rocky Mountain Regional Veteran Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Daniel Hipp
- Rocky Mountain Regional Veteran Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Patrick J Ronan
- Sioux Falls VA Health Care System, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States
| |
Collapse
|
4
|
Van Der Merwe J, Brook S, Fear C, Benjamin MJ, Libby G, Williams ACDC, Baranowski AP. Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme. Scand J Pain 2021; 21:560-568. [PMID: 32338637 DOI: 10.1515/sjpain-2019-0182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/31/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS There is very little published evaluation of the treatment of military veterans with chronic pain, with or without post-traumatic stress disorder. Few clinical services offer integrated treatment for veterans with chronic pain and PTSD. Such veterans experience difficulty in accessing treatment for either condition: services may consider each condition as a contraindication to treatment of the other. Veterans are therefore often passed from one specialist service to another without adequate treatment. The veteran pain management programme (PMP) in the UK was established to meet the needs of veterans suffering from chronic pain with or without PTSD; this is the first evaluation. METHODS The PMP was advertised online via veteran charities. Veterans self-referred with accompanying information from General Practitioners. Veterans were then invited for an inter-disciplinary assessment and if appropriate invited onto the next PMP. Exclusion criteria included; current severe PTSD, severe depression with active suicidal ideation, moderate to severe personality disorder, or who were unable to self-care in the accommodation available. Treatment was by a team of experienced pain management clinicians: clinical psychologist, physiotherapist, nurse, medical consultant and psychiatrist. The PMP was delivered over 10 days: five residential days then five single days over the subsequent 6 months. The PMP combines cognitive behavioural treatment, which has the strongest evidence base, with more recent developments from mindfulness-based CBT for pain and compassion-focused therapy. Standard pain management strategies were adapted to meet the specific needs of the population, recognising the tendency to use demanding activity to manage post-traumatic stress symptoms. Domains of outcome were pain, mood, function, confidence and changes in medication use. RESULTS One hundred and sixty four military veterans started treatment in 19 programmes, and 158 completed. Results from those with high and low PTSD were compared; overall improvements in all domains were statistically significant: mood, self-efficacy and confidence, and those with PTSD showed a reduction (4.3/24 points on the IES-6). At the end of the programme the data showed that 17% reduced opioid medication and 25% stopped all opioid use. CONCLUSIONS Veterans made clinically and statistically significant improvements, including those with co-existing PTSD, who also reduced their symptom level. This serves to demonstrate the feasibility of treating veterans with both chronic pain and PTSD using a PMP model of care. IMPLICATIONS Military veterans experiencing both chronic pain and PTSD can be treated in a PMP adapted for their specific needs by an experienced clinical team.
Collapse
Affiliation(s)
- Jannie Van Der Merwe
- Consultant Clinical Psychologist, King Edward VII's Hospital, Centre of Veterans' Health, Charterhouse, 56 Weymouth Street, London W1G 6NX, UK
| | | | | | | | - Gerald Libby
- King Edward VII's Hospital, Barts and London School of Medicine and Dentistry, London, UK
| | | | - Andrew P Baranowski
- King Edward VII's Hospital, University College London Hospital and University College London, London, UK
| |
Collapse
|
5
|
Gross GM, Bastian LA, Smith NB, Harpaz-Rotem I, Hoff R. Sex Differences in Associations Between Depression and Posttraumatic Stress Disorder Symptoms and Tobacco Use Among Veterans of Recent Conflicts. J Womens Health (Larchmt) 2020; 29:677-685. [PMID: 31934813 DOI: 10.1089/jwh.2019.8082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Georgina M. Gross
- Pain, Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Northeast Program Evaluation Center, West Haven, Connecticut
| | - Lori A. Bastian
- Pain, Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Noelle B. Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Northeast Program Evaluation Center, West Haven, Connecticut
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Northeast Program Evaluation Center, West Haven, Connecticut
| | - Rani Hoff
- Pain, Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Northeast Program Evaluation Center, West Haven, Connecticut
| |
Collapse
|
6
|
Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. J Trauma Acute Care Surg 2020; 87:440-450. [PMID: 31348404 DOI: 10.1097/ta.0000000000002370] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic injury affects over 2.6 million U.S. adults annually and elevates risk for a number of negative health consequences. This includes substantial psychological harm, the most prominent being posttraumatic stress disorder (PTSD), with approximately 21% of traumatic injury survivors developing the disorder within the first year after injury. Posttraumatic stress disorder is associated with deficits in physical recovery, social functioning, and quality of life. Depression is diagnosed in approximately 6% in the year after injury and is also a predictor of poor quality of life. The American College of Surgeons Committee on Trauma suggests screening for and treatment of PTSD and depression, reflecting a growing awareness of the critical need to address patients' mental health needs after trauma. While some trauma centers have implemented screening and treatment or referral for treatment programs, the majority are evaluating how to best address this recommendation, and no standard approach for screening and treatment currently exists. Further, guidelines are not yet available with respect to resources that may be used to effectively screen and treat these disorders in trauma survivors, as well as who is going to bear the costs. The purpose of this review is: (1) to evaluate the current state of the literature regarding evidence-based screens for PTSD and depression in the hospitalized trauma patient and (2) summarize the literature to date regarding the treatments that have empirical support in treating PTSD and depression acutely after injury. This review also includes structural and funding information regarding existing postinjury mental health programs. Screening of injured patients and timely intervention to prevent or treat PTSD and depression could substantially improve health outcomes and improve quality of life for this high-risk population. LEVEL OF EVIDENCE: Review, level IV.
Collapse
|
7
|
Gross GM, Laws H, Park CL, Hoff R, Hoffmire CA. Meaning in life following deployment sexual trauma: Prediction of posttraumatic stress symptoms, depressive symptoms, and suicidal ideation. Psychiatry Res 2019; 278:78-85. [PMID: 31158725 DOI: 10.1016/j.psychres.2019.05.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
Deployment sexual trauma (DST; i.e., sexual harassment or assault during deployment in the military) is associated with physical and mental health consequences, including posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI). Less attention has been placed on factors that may offer protection from deleterious mental health outcomes following DST. Global meaning in life (i.e., purpose, beliefs, goals, and subjective feelings) has been shown to be a protective factor against PTSD, depression, and SI following combat trauma; however, the extent to which meaning in life may affect outcomes following DST has not been investigated. Cross-sectional associations and Hayes mediation models were examined using baseline interview data from the Survey of Experiences of Returning Veterans sample (SERV; 850 recently returned veterans, 352 women). DST was associated with post-deployment posttraumatic stress symptoms (PTSS), depressive symptoms, and SI severity, and with decreased sense of meaning in life. Further, meaning in life was a significant mediator between DST and each of the three outcomes, even after controlling for demographic variables and combat experiences. The mediation models did not differ by gender. Findings suggest meaning in life may be an important clinical factor, both for the identification of risk and as a point of intervention.
Collapse
Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Holly Laws
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA; University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Rani Hoff
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
8
|
Guillen A, Curot J, Birmes PJ, Denuelle M, Garès V, Taib S, Valton L, Yrondi A. Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in Epileptic Patients: A Multidimensional Comparison of the Psychiatric Profile of Patients Suffering From Epilepsy and Patients Suffering From Psychogenic Nonepileptic Seizures. Front Psychiatry 2019; 10:303. [PMID: 31130885 PMCID: PMC6509224 DOI: 10.3389/fpsyt.2019.00303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Patients with psychogenic nonepileptic seizures (PNESs) have often been exposed to traumatic events, which is a risk factor for suicidal behavior. This would suggest that the severity of suicidal ideation is greater in PNES than in patients suffering only from epileptic seizures (ESs). However, these psychiatric symptoms may be underestimated in the ES population. The specific features or similarities between the psychiatric clinical profiles of these two groups should be elaborated to improve therapeutic management. Our study is the first to compare suicidal ideation, suicide risk, posttraumatic stress disorder (PTSD), and depression disorder simultaneously in both groups, in a tertiary care epilepsy center. Material and methods: We prospectively enrolled patients hospitalized for video-electroencephalography (EEG) monitoring to assess repeated seizures before an ES or a PNES diagnosis was made. During the psychiatric consultation that accompanied the video EEG, we rated the severity of suicidal ideation and depressive symptoms, suicidal risk, traumatic exposure history, and PTSD symptoms. Results: Eighteen subjects were enrolled and diagnosed with PNES, and 42, with ES. The PNES group reported more exposures to traumatic events and more intense PTSD symptoms (median: 17 vs. 27; p = 0.001). The severity of suicidal ideation did not differ significantly between the two groups. Conclusion: It is the severity of PTSD symptoms in PNES patients that differentiates them from ES patients, although exposure to traumatic events is also frequent in ES patients. We demonstrated that suicidal ideation and suicide risk are equally high in the ES and PNES groups. Therefore, both groups require extreme vigilance in terms of suicidal risk.
Collapse
Affiliation(s)
- Abel Guillen
- Explorations Neurophysiologiques (Neurophysiological Investigations), Hôpital Pierre Paul Riquet, CHU Purpan (Toulouse University Hospital), Toulouse, France
| | - Jonathan Curot
- Explorations Neurophysiologiques (Neurophysiological Investigations), Hôpital Pierre Paul Riquet, CHU Purpan (Toulouse University Hospital), Toulouse, France
- Centre de Recherche Cerveau et Cognition (Brain and Cognition Research Centre), University of Toulouse, Toulouse, France
- Centre National de la Recherche Scientifique CerCo (CerCo National Scientific Research Centre), Toulouse, France
| | - Philippe Jean Birmes
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Marie Denuelle
- Explorations Neurophysiologiques (Neurophysiological Investigations), Hôpital Pierre Paul Riquet, CHU Purpan (Toulouse University Hospital), Toulouse, France
| | - Valérie Garès
- University of Rennes, INSA, CNRS, IRMAR-UMR 6625, Rennes, France
| | - Simon Taib
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
- Service de Psychiatrie et Psychologie Médicale (Department of Psychiatry and Medical Psychology), CHU de Toulouse (Toulouse University Hospital), Toulouse, France
| | - Luc Valton
- Explorations Neurophysiologiques (Neurophysiological Investigations), Hôpital Pierre Paul Riquet, CHU Purpan (Toulouse University Hospital), Toulouse, France
- Centre de Recherche Cerveau et Cognition (Brain and Cognition Research Centre), University of Toulouse, Toulouse, France
- Centre National de la Recherche Scientifique CerCo (CerCo National Scientific Research Centre), Toulouse, France
| | - Antoine Yrondi
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
- Service de Psychiatrie et Psychologie Médicale (Department of Psychiatry and Medical Psychology), CHU de Toulouse (Toulouse University Hospital), Toulouse, France
| |
Collapse
|
9
|
Lenane Z, Peacock E, Joyce C, Frohlich ED, Re RN, Muntner P, Krousel-Wood M. Association of Post-Traumatic Stress Disorder Symptoms Following Hurricane Katrina With Incident Cardiovascular Disease Events Among Older Adults With Hypertension. Am J Geriatr Psychiatry 2019; 27:310-321. [PMID: 30581139 PMCID: PMC6476543 DOI: 10.1016/j.jagp.2018.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/10/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association of post-traumatic stress disorder (PTSD) symptoms following Hurricane Katrina with incident cardiovascular disease (CVD) events in older, hypertensive, community-dwelling adults both overall and stratified by age, sex, and race. METHODS This was a prospective cohort study performed in Southeastern Louisiana 12-24 months following Hurricane Katrina through February 2011. Participants were community-dwelling older adults (n = 2,073) enrolled in the Cohort Study of Medication Adherence Among Older Adults with no known history of CVD events. PTSD symptoms were assessed via telephone interview 12-24 months following Hurricane Katrina using the PTSD CheckList-Specific Version. The presence of PTSD symptoms was defined by scores greater than or equal to 37. Incident CVD events (stroke, myocardial infarction, hospitalization for congestive heart failure, or CVD death) were identified and adjudicated over a median 3.8-year follow-up period. RESULTS Overall, 8.6% of participants screened positive for PTSD symptoms, and 11.6% had an incident CVD event during follow-up. PTSD symptoms were associated with an adjusted hazard ratio (aHR) for CVD events of 1.7 (95% confidence interval [CI], 1.1, 2.6). The association was present among blacks (aHR, 3.3, 95% CI, 1.7, 6.3) but not whites (aHR, 0.9, 95% CI, 0.4, 1.9); the interaction of PTSD symptoms and race on CVD events was statistically significant. CONCLUSION PTSD symptoms following Hurricane Katrina were associated with a higher risk of incident CVD in older adults with hypertension, with a stronger association in blacks compared with whites.
Collapse
Affiliation(s)
- Zachary Lenane
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Cara Joyce
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Edward D Frohlich
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Richard N Re
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Paul Muntner
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine (ZL, EP, MK), New Orleans; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (ZL, MK), New Orleans; San Mateo County Behavioral Health and Recovery Services (ZL), San Mateo, CA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University (CJ), Chicago; Ochsner Clinic Foundation (EDF, RNR, MK), New Orleans; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (PM), Birmingham, AL.
| |
Collapse
|
10
|
Bunnell BE, Davidson TM, Ruggiero KJ. The Peritraumatic Distress Inventory: Factor structure and predictive validity in traumatically injured patients admitted through a Level I trauma center. J Anxiety Disord 2018; 55:8-13. [PMID: 29549879 PMCID: PMC5879025 DOI: 10.1016/j.janxdis.2018.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/16/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Peritraumatic distress is defined as the emotional and physiological distress experienced during and/or immediately after a traumatic event and is associated with the development and severity of posttraumatic stress disorder (PTSD) and related psychological difficulties. The Peritraumatic Distress Inventory (PDI) is a widely-used self-report measure for which psychometric evaluation has been limited. This study sought to assess the factor structure and predictive validity of the PDI with a clinical sample of 600 traumatically injured patients admitted to a Level I trauma center, 271 of whom completed a phone-based PTSD screening ∼30-days post-injury. The results confirmed previously proposed one- and two-factor solutions for the PDI. PDI scores predicted PTSD severity and positive PTSD screens (i.e., clinically elevated vs. non-elevated). Data suggested an optimal cutoff score of 23 (sensitivity = 71%; specificity = 73%) for predicting clinically elevated PTSD 30-days post-injury. This study provides further evidence supporting the PDI as a valid and reliable measure of peritraumatic distress and a useful clinical tool with significant prognostic value.
Collapse
Affiliation(s)
- Brian E. Bunnell
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, 135 Cannon St., Ste. 405, MSC 200, Charleston, SC 29425
| | - Tatiana M. Davidson
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St., MSC 160, Charleston, SC, 29425
| | - Kenneth J. Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St., MSC 160, Charleston, SC, 29425
| |
Collapse
|
11
|
Feeley N, Hayton B, Gold I, Zelkowitz P. A comparative prospective cohort study of women following childbirth: Mothers of low birthweight infants at risk for elevated PTSD symptoms. J Psychosom Res 2017; 101:24-30. [PMID: 28867420 DOI: 10.1016/j.jpsychores.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
| | - Barbara Hayton
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ian Gold
- Department of Psychiatry, McGill University, Montreal, Canada; Department of Philosophy, McGill University, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| |
Collapse
|
12
|
Mucka LE, Dayton CJ, Lawler J, Kirk R, Alfafara E, Schuster MM, Miller N, Ribaudo J, Rosenblum KL, Muzik M. MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM. Infant Ment Health J 2017; 38:536-550. [PMID: 28665536 DOI: 10.1002/imhj.21652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.
Collapse
|
13
|
Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord 2017; 208:634-645. [PMID: 27865585 DOI: 10.1016/j.jad.2016.10.009] [Citation(s) in RCA: 337] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/04/2016] [Accepted: 10/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. METHODS PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. RESULTS 59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum. LIMITATIONS Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters. CONCLUSIONS PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
Collapse
Affiliation(s)
- Pelin Dikmen Yildiz
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Louise Phillips
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| |
Collapse
|
14
|
Rosellini AJ, Stein MB, Colpe LJ, Heeringa SG, Petukhova MV, Sampson NA, Schoenbaum M, Ursano RJ, Kessler RC. APPROXIMATING A DSM-5 DIAGNOSIS OF PTSD USING DSM-IV CRITERIA. Depress Anxiety 2015; 32:493-501. [PMID: 25845710 PMCID: PMC4490033 DOI: 10.1002/da.22364] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Diagnostic criteria for DSM-5 posttraumatic stress disorder (PTSD) are in many ways similar to DSM-IV criteria, raising the possibility that it might be possible to closely approximate DSM-5 diagnoses using DSM-IV symptoms. If so, the resulting transformation rules could be used to pool research data based on the two criteria sets. METHODS The pre-post deployment study (PPDS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) administered a blended 30-day DSM-IV and DSM-5 PTSD symptom assessment based on the civilian PTSD Checklist for DSM-IV (PCL-C) and the PTSD Checklist for DSM-5 (PCL-5). This assessment was completed by 9,193 soldiers from three US Army Brigade Combat Teams approximately 3 months after returning from Afghanistan. PCL-C items were used to operationalize conservative and broad approximations of DSM-5 PTSD diagnoses. The operating characteristics of these approximations were examined compared to diagnoses based on actual DSM-5 criteria. RESULTS The estimated 30-day prevalence of DSM-5 PTSD based on conservative (4.3%) and broad (4.7%) approximations of DSM-5 criteria using DSM-IV symptom assessments were similar to estimates based on actual DSM-5 criteria (4.6%). Both approximations had excellent sensitivity (92.6-95.5%), specificity (99.6-99.9%), total classification accuracy (99.4-99.6%), and area under the receiver operating characteristic curve (0.96-0.98). CONCLUSIONS DSM-IV symptoms can be used to approximate DSM-5 diagnoses of PTSD among recently deployed soldiers, making it possible to recode symptom-level data from earlier DSM-IV studies to draw inferences about DSM-5 PTSD. However, replication is needed in broader trauma-exposed samples to evaluate the external validity of this finding.
Collapse
Affiliation(s)
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California,VA San Diego Healthcare System, San Diego, California
| | - Lisa J. Colpe
- National Institute of Mental Health, Bethesda, Maryland
| | - Steven G. Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts,Correspondence to: Ronald C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston MA 02115. Tel. (617) 432-3587, Fax (617) 432-3588,
| | | |
Collapse
|
15
|
Adams ZW, Danielson CK, Sumner JA, McCauley JL, Cohen JR, Ruggiero KJ. Comorbidity of PTSD, Major Depression, and Substance Use Disorder among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri. Psychiatry 2015; 78:170-85. [PMID: 26168094 PMCID: PMC4503377 DOI: 10.1080/00332747.2015.1051448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE The purpose of this study was twofold: (1) to estimate the prevalence of comorbid posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance use disorder (SUD); and (2) to identify risk factors for patterns of comorbidity among adolescents affected by disasters. METHOD A population-based sample of 2,000 adolescents (51% female; 71% Caucasian, 26% African American) aged 12 to 17 years (M = 14.5, SD = 1.7) and their parents was recruited from communities affected by the spring 2011 tornadoes in Alabama and Joplin, Missouri. Participants completed structured telephone interviews assessing demographic characteristics, impact of disaster, prior trauma history, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), symptoms of posttraumatic stress disorder (PTSD) and major depressive episode (MDE), and substance use disorder (SUD) symptoms. Prevalence estimates were calculated for PTSD + MDE, PTSD + SUD, MDE + SUD, and PTSD + MDE + SUD. Hierarchical logistic regression was used to identify risk factors for each comorbidity profile. RESULTS Overall prevalence since the tornado was 3.7% for PTSD + MDE, 1.1% for PTSD + SUD, 1.0% for MDE + SUD, and 0.7% for PTSD + MDE + SUD. Girls were significantly more likely than boys to meet criteria for PTSD + MDE and MDE + SUD (ps < .05). Female gender, exposure to prior traumatic events, and persistent loss of services were significant risk factors for patterns of comorbidity. Parental injury was associated with elevated risk for PTSD + MDE. Adolescents should be evaluated for comorbid problems, including SUD, following disasters so that appropriate referrals to evidence-based treatments can be made. CONCLUSIONS Results suggest that screening procedures to identify adolescents at risk for comorbid disorders should assess demographic characteristics (gender), impact of the disaster on the family, and adolescents' prior history of stressful events.
Collapse
Affiliation(s)
- Zachary W. Adams
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla Kmett Danielson
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer A. Sumner
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jenna L. McCauley
- Clinical Neurosciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph R. Cohen
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| |
Collapse
|
16
|
Finley EP. EMPOWERING VETERANS WITH PTSD IN THE RECOVERY ERA: ADVANCING DIALOGUE AND INTEGRATING SERVICES. ANNALS OF ANTHROPOLOGICAL PRACTICE 2014. [DOI: 10.1111/napa.12028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Winters LE, Karow A, Reimer J, Fricke S, Kuhnigk O, Schäfer I. Psychometric Properties of the Posttraumatic Diagnostic Scale (PDS) in Alcohol-Dependent Patients. Subst Abus 2014; 35:262-7. [DOI: 10.1080/08897077.2014.891555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
18
|
Perroud N, Rutembesa E, Paoloni-Giacobino A, Mutabaruka J, Mutesa L, Stenz L, Malafosse A, Karege F. The Tutsi genocide and transgenerational transmission of maternal stress: epigenetics and biology of the HPA axis. World J Biol Psychiatry 2014; 15:334-45. [PMID: 24690014 DOI: 10.3109/15622975.2013.866693] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Transmission of parental post-traumatic stress disorder (PTSD) to offspring might be explained by transmission of epigenetic processes such as methylation status of the glucocorticoid receptor (GR) gene (NR3C1). METHODS We investigated PTSD and depression severity, plasma cortisol, GR and mineralocorticoid receptor (MR) levels, and methylation status of NR3C1 and NR3C2 promoter regions in 25 women exposed to the Tutsi genocide during pregnancy and their children, and 25 women from the same ethnicity, pregnant during the same period but not exposed to the genocide, and their children. RESULTS Transmission of PTSD to the offspring was associated with transmission of biological alterations of the HPA axis. Mothers exposed to the genocide as well as their children had lower cortisol and GR levels and higher MR levels than non-exposed mothers and their children. Moreover, exposed mothers and their children had higher methylation of the NR3C1 exon 1F than non-exposed groups. Finally, exposed mothers showed higher methylation of CpGs located within the NR3C2 coding sequence than non-exposed mothers. CONCLUSIONS PTSD was associated with NR3C1 epigenetic modifications that were similarly found in the mothers and their offspring, modifications that may underlie the possible transmission of biological alterations of the HPA axis.
Collapse
Affiliation(s)
- Nader Perroud
- University Hospitals of Geneva, Department of Mental Health and Psychiatry , Geneva , Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Social capital and chronic post-traumatic stress disorder among survivors of the 2007 earthquake in Pisco, Peru. Soc Sci Med 2013; 101:9-17. [PMID: 24560219 DOI: 10.1016/j.socscimed.2013.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 10/16/2013] [Accepted: 11/01/2013] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the association between chronic Post-Traumatic Stress Disorder (PTSD) and both structural and cognitive social capital in adult survivors of the 2007 earthquake in Pisco, Peru. Cognitive social capital measures trust, sense of belonging and interpersonal relationships in the community and structural social capital measures group membership, support from community groups and individuals, and involvement in citizenship activities. We conducted a population-based cross-sectional study in five counties in Pisco, selecting 1012 adults through complex, multi-stage random sampling. All participants completed socio-demographic questions and validated Spanish-language versions of the Adapted Social Capital Assessment Tool (SASCAT) and the civilian PTSD checklist (PCL-C). After performing descriptive and bivariate analyses, we carried out prevalence ratio (PR) regression. The overall prevalence of chronic PTSD was 15.9% (95% CI: 12.3, 19.8), much higher than anticipated based on existing evidence. Cognitive social capital was found to be negatively associated with chronic PTSD, while no significant association was found for structural social capital. Specifically, those with high cognitive social capital had an almost two times lower prevalence of chronic PTSD (PR = 1.83, 95% CI: 1.50, 2.22) compared with those with low cognitive social capital. No independent association between structural social capital and chronic PTSD was found (PR = 1.44, 95% CI: 0.70, 2.97). In conclusion, cognitive social capital, but not structural social capital, has a protective influence on the occurrence of chronic PTSD in survivors of natural disasters. These results may have public health implications. For example, pre- and post-disaster community-based interventions that catalyze and foster dimensions of cognitive social capital may aid in ameliorating the effect of earthquakes and other natural disasters on populations with high vulnerability to such events and poor access to mental health and other support services.
Collapse
|
20
|
White S, Acierno R, Ruggiero KJ, Koenen KC, Kilpatrick DG, Galea S, Gelernter J, Williamson V, McMichael O, Vladimirov VI, Amstadter AB. Association of CRHR1 variants and posttraumatic stress symptoms in hurricane exposed adults. J Anxiety Disord 2013; 27:678-83. [PMID: 24077033 PMCID: PMC4182958 DOI: 10.1016/j.janxdis.2013.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 12/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a moderately heritable anxiety disorder that may develop after exposure to trauma. However, only few genetic variants that relate to PTSD have been studied. This study examined the relationship between 12 single nucleotide polymorphisms (SNPs) in the corticotropin-releasing hormone receptor 1 gene (CRHR1) and post-disaster PTSD symptoms and diagnosis in adults exposed to 2004 Florida hurricanes. CRHR1 regulates the hypothalamic-pituitary-adrenal (HPA) axis; dysregulation of the HPA axis is characteristic of stress phenotypes. Final analyses were conducted in the European-American (EA) subsample (n=564) due to population stratification. After correction for multiple testing, rs12938031 and rs4792887 remained associated with post-hurricane PTSD symptoms. Additionally, rs12938031 was associated with post-hurricane diagnosis of PTSD. This study is the first to examine CRHR1 in relation to PTSD in adults, and provides evidence for the importance of CRHR1 variation in the etiology of PTSD. Although results are preliminary and require replication, they justify follow-up efforts to characterize how this gene relates to PTSD.
Collapse
Affiliation(s)
- Simone White
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Ron Acierno
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sandro Galea
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Joel Gelernter
- Division of Human Genetics in Psychiatry, Yale University School of Medicine, New Haven, CT, USA
,VA National Center for PTSD Research
| | - Vernell Williamson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Omari McMichael
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Vladimir I. Vladimirov
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
21
|
Davidson TM, Price M, McCauley JL, Ruggiero KJ. Disaster impact across cultural groups: comparison of Whites, African Americans, and Latinos. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:97-105. [PMID: 23709270 PMCID: PMC4386718 DOI: 10.1007/s10464-013-9579-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The current study extends knowledge regarding the differential impact of natural disasters among White, African American, and Latino survivors of Hurricane Ike through its use of a large, regional sample recruited via representative sampling procedures to examine the associations between cultural identification and disaster impact, including loss, damage, and negative mental health outcomes. Consistent with previous research, results indicated disparities between cultural groups with regard to disaster exposure. Additionally, type of disaster impact was differentially associated with PTSD and depression status dependent on cultural group. Specifically, the extent of personal disaster exposure, property damage, and loss of services made significant contributions to PTSD status among White survivors. African-Americans were more likely than White and Latino Ike survivors to endorse post-disaster PTSD and depression and endorsement of depression was predicted by severity of property damage. With respect to Latino respondents, only the extent of personal disaster exposure significantly contributed to both PTSD and depression status. Implications of the current findings are discussed with regard to future disaster preparedness and response efforts and the implementation and evaluation of community-based disaster resources.
Collapse
Affiliation(s)
- Tatiana M Davidson
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street IOP 2 South, MSC 861, Charleston, SC 29425, USA.
| | | | | | | |
Collapse
|
22
|
Rapp PE, Rosenberg BM, Keyser DO, Nathan D, Toruno KM, Cellucci CJ, Albano AM, Wylie SA, Gibson D, Gilpin AMK, Bashore TR. Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders. Front Neurol 2013; 4:91. [PMID: 23885250 PMCID: PMC3717660 DOI: 10.3389/fneur.2013.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/26/2013] [Indexed: 12/20/2022] Open
Abstract
Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant's clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.
Collapse
Affiliation(s)
- Paul E. Rapp
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Brenna M. Rosenberg
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - David O. Keyser
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Dominic Nathan
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Kevin M. Toruno
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | | | | | - Scott A. Wylie
- Neurology Department, Vanderbilt UniversityNashville, TN, USA
| | - Douglas Gibson
- Combat Casualty Care Directorate, Army Medical Research and Materiel CommandFort Detrick, MD, USA
| | - Adele M. K. Gilpin
- Arnold and Porter, LLPWashington, DC, USA
- Department of Epidemiology and Preventive Medicine, University of MarylandCollege Park, MD, USA
| | | |
Collapse
|
23
|
Aoki Y, Malcolm E, Yamaguchi S, Thornicroft G, Henderson C. Mental illness among journalists: a systematic review. Int J Soc Psychiatry 2013; 59:377-90. [PMID: 22408118 DOI: 10.1177/0020764012437676] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mass media depictions of people with mental illness have a strong influence on public attitudes, to the extent that changes in these depictions can reduce public stigmatization of people with such illness. Journalists' mental health may influence their depiction of those with mental illness, but little is known about this. AIMS To investigate mental illness among journalists in five key areas: (1) journalists' mental health status; (2) journalists' personal attitudes towards mental illness; (3) attitudes and support journalists expect or have experienced from colleagues when they have a mental health problem; (4) effect of journalism's professional culture on the course of mental illness; and (5) effect of journalism's professional culture on mass media depictions of people with mental illness. METHODS We performed a systematic screening of MEDLINE, PsycINFO, EMBASE, Web of Science and the Cochrane Library regarding the study aims. RESULTS We identified 19, 12, seven and four studies for aims 1, 2, 3, and 4, respectively. No articles were found for aim 5. CONCLUSIONS The prevalence of post-traumatic stress disorder (PTSD) among journalists is higher than that among the general population. Journalists have positive personal attitudes towards mental illness, but there are perceived workplace disincentives to disclose mental health problems.
Collapse
Affiliation(s)
- Yuta Aoki
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
| | | | | | | | | |
Collapse
|
24
|
Edmondson D, Gamboa C, Cohen A, Anderson AH, Kutner N, Kronish I, Mills MA, Muntner P. Association of posttraumatic stress disorder and depression with all-cause and cardiovascular disease mortality and hospitalization among Hurricane Katrina survivors with end-stage renal disease. Am J Public Health 2013; 103:e130-7. [PMID: 23409901 DOI: 10.2105/ajph.2012.301146] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the association of psychiatric symptoms in the year after Hurricane Katrina with subsequent hospitalization and mortality in end-stage renal disease (ESRD) patients. METHODS A prospective cohort of ESRD patients (n = 391) treated at 9 hemodialysis centers in the New Orleans, Louisiana, area in the weeks before Hurricane Katrina were assessed for posttraumatic stress disorder (PTSD) and depression symptoms via telephone interview 9 to 15 months later. Two combined outcomes through August 2009 (maximum 3.5-year follow-up) were analyzed: (1) all-cause and (2) cardiovascular-related hospitalization and mortality. RESULTS Twenty-four percent of participants screened positive for PTSD and 46% for depression; 158 participants died (79 cardiovascular deaths), and 280 participants were hospitalized (167 for cardiovascular-related causes). Positive depression screening was associated with 33% higher risk of all-cause (hazard ratio [HR] = 1.33; 95% confidence interval [CI] = 1.06, 1.66) and cardiovascular-related hospitalization and mortality (HR = 1.33; 95% CI = 1.01, 1.76). PTSD was not significantly associated with either outcome. CONCLUSIONS Depression in the year after Hurricane Katrina was associated with increased risk of hospitalization and mortality in ESRD patients, underscoring the long-term consequences of natural disasters for vulnerable populations.
Collapse
Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Mutabaruka J, Séjourné N, Bui E, Birmes P, Chabrol H. Traumatic grief and traumatic stress in survivors 12 years after the genocide in Rwanda. Stress Health 2012; 28:289-96. [PMID: 22282057 DOI: 10.1002/smi.1429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 07/25/2011] [Accepted: 08/31/2011] [Indexed: 11/10/2022]
Abstract
The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B=0.06, R=0.6, R(2) =0.36 and ß=0.6, t=7.54, p=0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one.
Collapse
Affiliation(s)
- Jean Mutabaruka
- Centre d'Etudes et de Recherches en Psychopathologie, Université de Toulouse, Toulouse, France
| | | | | | | | | |
Collapse
|
26
|
McCart MR, Zajac K, Kofler MJ, Smith DW, Saunders BE, Kilpatrick DG. Longitudinal examination of PTSD symptoms and problematic alcohol use as risk factors for adolescent victimization. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:822-36. [PMID: 22963207 DOI: 10.1080/15374416.2012.717872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The current study examined associations between posttraumatic stress disorder (PTSD) symptoms and future interpersonal victimization among adolescents, after accounting for the impact of early victimization exposure, gender, ethnicity, and household income. In addition, problematic alcohol use was tested as a mediator of the relation between PTSD symptoms and subsequent victimization. Participants included a national longitudinal sample of adolescents (N = 3,604) who were ages 12 to 17 at the initial assessment: 50% were male, and 67% were White, 16% African American, and 12% Hispanic. Cohort-sequential latent growth curve modeling was used to examine associations among the study variables. Baseline PTSD symptoms significantly predicted age-related increases in interpersonal victimization, even after accounting for the effects of earlier victimization experiences. In addition, alcohol problems emerged as a partial mediator of this relation, such that one fourth to one third of the effect of PTSD symptoms on future victimization was attributable to the impact of PTSD symptoms on alcohol problems (which, in turn, predicted additional victimization risk). Collectively, the full model accounted for more than half of the variance in age-related increases in interpersonal victimization among youth. Results indicate that PTSD symptoms serve as a risk factor for subsequent victimization among adolescents, over and above the risk conferred by prior victimization. This increased risk occurred both independently and through the impact of PTSD symptoms on problematic alcohol use. Based on these findings, it is hypothesized that the likelihood of repeated victimization among youth might be reduced through early detection and treatment of these clinical problems.
Collapse
Affiliation(s)
- Michael R McCart
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Rheingold AA, Zinzow H, Hawkins A, Saunders BE, Kilpatrick DG. Prevalence and mental health outcomes of homicide survivors in a representative US sample of adolescents: data from the 2005 National Survey of Adolescents. J Child Psychol Psychiatry 2012; 53:687-94. [PMID: 22211367 PMCID: PMC3326225 DOI: 10.1111/j.1469-7610.2011.02491.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Each homicide leaves behind several friends and family members, or homicide survivors. However, limited information is available on the impact of homicide on adolescent survivors. The purpose of the current study was to identify the prevalence of homicide survivorship and to determine mental health outcomes within a sample of US adolescent survivors. METHODS A nationally representative sample of American adolescents (N = 3,614) between the ages of 12 and 17 completed structured telephone interviews assessing homicide survivorship and mental health consequences including posttraumatic stress disorder (PTSD), depression, drug use, and alcohol abuse. RESULTS Reported prevalence within this sample of losing a loved one to criminal homicide was 9%, losing a loved one to vehicular homicide was 7%, and losing a loved one to both types of homicide was 2%. Logistic regression analyses found that adolescents who reported being homicide survivors were significantly more likely to report depression, drug use, and alcohol abuse after controlling for demographic factors and other violence exposure. CONCLUSIONS If the results from this study are generalizable to the US population, roughly 1 in 5 American adolescents may be impacted by homicide. Further, adolescents exposed to such a loss are at increased risk for mental health sequelae. Results suggest that greater attention needs to be paid to address the needs of these often underserved victims.
Collapse
Affiliation(s)
- Alyssa A Rheingold
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street,Charleston, SC29425, USA.
| | | | | | | | | |
Collapse
|
28
|
Cisler JM, Begle AM, Amstadter AB, Resnick HS, Danielson CK, Saunders BE, Kilpatrick DG. Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: data from the NSA-R. J Trauma Stress 2012; 25:33-40. [PMID: 22354506 PMCID: PMC4090767 DOI: 10.1002/jts.21672] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Interpersonal violence (IPV) is associated with a range of subsequent negative outcomes; however, research has yet to test whether IPV operates as a specific risk factor for separate psychopathology outcomes, such as posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, delinquent acts, or binge drinking. To address this, cumulative exposure to IPV and non-IPV-related traumatic events, PTSD symptoms, depressive symptoms, delinquent acts, and binge drinking were measured 3 times over approximately 3 years among a nationally representative sample of adolescents aged 12-17 (N = 3,614 at Wave 1). Results demonstrated that cumulative IPV exposure predicted subsequent PTSD, depression, delinquency, and binge drinking (βs = .07, .12, .10, and .09, respectively; all ps < .01) when all cross-relationships (e.g., the effect of delinquency on future binge drinking) were in the model. Exposure to non-IPV traumatic events generally did not confer vulnerability to subsequent psychopathology outcomes. Overall, findings from this study advance the literature in this area by exploring consequences for adolescents following cumulative IPV exposure.
Collapse
Affiliation(s)
- Josh M. Cisler
- Brain Imaging Research Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Angela M. Begle
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ananda B. Amstadter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Heidi S. Resnick
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carla Kmett Danielson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin E. Saunders
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dean G. Kilpatrick
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
29
|
Ruggiero KJ, Resnick HS, Paul LA, Gros K, McCauley JL, Acierno R, Morgan M, Galea S. Randomized controlled trial of an internet-based intervention using random-digit-dial recruitment: the Disaster Recovery Web project. Contemp Clin Trials 2012; 33:237-46. [PMID: 22008248 PMCID: PMC3253875 DOI: 10.1016/j.cct.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
Disasters occur with high frequency throughout the world and increase risk for development of mental health problems in affected populations. Research focused on the development and evaluation of secondary prevention interventions addressing post-disaster mental health has high potential public-health impact. Toward this end, internet-based interventions (IBIs) are particularly attractive in that they: (1) offer a low-cost means of delivering standardized, targeted, personalized intervention content to a broad audience; and (2) are easily integrated within a stepped care approach to screening and service delivery. We describe a unique study design intended to evaluate an IBI with a disaster-affected population-based sample. Description and rationale are provided for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this intervention include the use of a population-based sample, telephone and internet-based assessments, and development of a highly individualized web-based intervention. Challenges related to the development and large-scale evaluation of IBIs targeting post-disaster mental health problems, as well as implications for future research and practice are discussed.
Collapse
Affiliation(s)
- Kenneth J Ruggiero
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC861, Charleston, SC 29425, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Vásquez DA, de Arellano MA, Reid-Quiñones K, Bridges AJ, Rheingold AA, Stocker RPJ, Danielson CK. Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino youth: results from the Hispanic family study. J Trauma Dissociation 2012; 13:509-25. [PMID: 22989240 PMCID: PMC4769641 DOI: 10.1080/15299732.2012.678471] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This is the 1st study to examine peritraumatic dissociation and peritraumatic emotions as they predict symptoms and diagnosis of posttraumatic stress disorder (PTSD) in Latino youth. Our aim was to test the hypothesis that the degree of peritraumatic dissociation would predict the number of PTSD symptoms and PTSD clinical diagnosis when the influences of other salient factors were statistically controlled. We also explored the possible contributions of peritraumatic emotional responses to PTSD symptomatology and PTSD diagnosis. We expected that peritraumatic dissociation would emerge as a significant predictor of PTSD. A total of 204 Latino youth (mean age = 12.37 years) completed semistructured individual clinical interviews with bilingual research assistants. These interviews assessed trauma exposure, peritraumatic responses, and current psychopathology. A linear regression analysis demonstrated significant relationships between lifetime number of traumatic events, peritraumatic dissociation, shame, and number of PTSD symptoms endorsed. Significant inverse (protective) relationships were demonstrated between anger and guilt and current PTSD symptomatology. Logistic regression analysis demonstrated significant relationships between peritraumatic dissociation, shame, lifetime number of traumatic events experienced, and PTSD diagnosis. The analyses examined both the number of PTSD symptoms as well as diagnosis of PTSD while simultaneously controlling for age, lifetime exposure to traumatic events, time residing in the United States, and gender. These results support an increasingly robust body of empirical literature suggesting that the peritraumatic dissociative and emotional responses to trauma are important predictors of future PTSD diagnosis. Possible cultural factors contributing to the dissociative responses in Latino youth and clinical implications are discussed.
Collapse
Affiliation(s)
- Desi Alonzo Vásquez
- Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Walsh K, Danielson CK, McCauley J, Hanson RF, Smith DW, Resnick HS, Saunders BE, Kilpatrick DG. Longitudinal trajectories of posttraumatic stress disorder symptoms and binge drinking among adolescent girls: the role of sexual victimization. J Adolesc Health 2012; 50:54-9. [PMID: 22188834 PMCID: PMC3245642 DOI: 10.1016/j.jadohealth.2011.05.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/22/2011] [Accepted: 05/26/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE Many studies have documented associations among sexual victimization (SV), posttraumatic stress disorder (PTSD) symptoms, and alcohol use; however, few have examined these associations longitudinally among adolescents. The present study evaluated the effect of SV on the longitudinal trajectory of PTSD symptoms and binge drinking (BD) among adolescent girls, a population known to have high rates of SV and alcohol use. METHODS Participants (N = 1,808 at wave 1) completed interviews regarding PTSD symptoms, BD, and SV experiences over approximately 3 years. RESULTS Multilevel modeling revealed decreases in PTSD symptoms over the course of the study; however, compared with nonvictims, adolescents who were sexually victimized reported greater PTSD symptoms at wave 1 and maintained higher levels of PTSD symptoms over the course of the study after controlling for age. SV reported during the study also predicted an acute increase in PTSD symptoms at that occasion. BD increased significantly over the course of the study; however, SV did not predict initial BD or increases over time. SV reported during the study was associated with acute increases in BD at that occasion, although this effect diminished when participants reporting substance-involved rape were excluded. CONCLUSIONS SV was associated with immediate and long-lasting elevations in PTSD symptoms, but not with initial or lasting elevations in BD over time, suggesting that adolescent victims have yet to develop problematic patterns of alcohol use to cope with SV. However, SV was associated with acute increases in PTSD symptoms and BD, suggesting a need for BD interventions to reduce alcohol-related SV.
Collapse
Affiliation(s)
- Kate Walsh
- Medical University of South Carolina, Department of Psychiatry, Charleston, South Carolina 29455, USA.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Cisler JM, Amstadter AB, Begle AM, Resnick HS, Danielson CK, Saunders BE, Kilpatrick DG. PTSD symptoms, potentially traumatic event exposure, and binge drinking: a prospective study with a national sample of adolescents. J Anxiety Disord 2011; 25:978-87. [PMID: 21783340 PMCID: PMC3546501 DOI: 10.1016/j.janxdis.2011.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 06/13/2011] [Accepted: 06/16/2011] [Indexed: 12/21/2022]
Abstract
Research demonstrates substantial comorbidity between PTSD and alcohol use disorders. Evidence for functional relationships between PTSD and problematic alcohol use has not always been consistent, and there have been few investigations with adolescent samples. Further, research has not consistently controlled for cumulative potentially traumatic event (PTE) exposure when examining prospective relationships between PTSD and problematic alcohol use (i.e., binge drinking). This study examines the prospective relationships between PTSD symptoms, problematic alcohol use, and cumulative PTE exposure measured at three time points over approximately three years among a nationally representative sample of adolescents exposed to at least one PTE (n=2399 and age range=12-17 at Wave 1). Results from parallel process latent growth curve models demonstrated that increases in cumulative PTE exposure over time positively predicted increases in both PTSD symptoms and binge drinking, whereas increases in PTSD symptoms and increases in binge drinking were not related when controlling for the effect of cumulative PTE exposure. Further analyses suggested that these relationships are specific to assaultive PTEs and are not found with non-assaultive PTEs. Theoretical implications are discussed.
Collapse
Affiliation(s)
- Josh M Cisler
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham #554, Little Rock, AR 72205, United States.
| | | | | | | | | | | | | |
Collapse
|
33
|
Tagay S, Repic N, Senf W. Traumafolgestörungen bei Erwachsenen, Kindern und Jugendlichen. PSYCHOTHERAPEUT 2011. [DOI: 10.1007/s00278-011-0847-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Wilkins KC, Lang AJ, Norman SB. Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety 2011; 28:596-606. [PMID: 21681864 PMCID: PMC3128669 DOI: 10.1002/da.20837] [Citation(s) in RCA: 617] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/27/2011] [Accepted: 04/27/2011] [Indexed: 12/18/2022] Open
Abstract
The posttraumatic stress disorder checklist is a commonly used measure, with military (PCL-M), civilian (PCL-C), and specific trauma (PCL-S) versions. This synthesis of the psychometric properties of all three versions found the PCL to be a well-validated measure. The PCL shows good temporal stability, internal consistency, test-retest reliability, and convergent validity. The majority of structural validity studies support four factor models. Little is available on discriminant validity and sensitivity to change. Strengths, limitations, and future research directions are discussed. Understanding the PCL's psychometric properties, strengths (e.g., items map on to DSM-IV diagnostic criteria), and limitations (e.g., may overestimate PTSD prevalence) will help clinicians and researchers make educated decisions regarding the appropriate use of this measure in their particular setting.
Collapse
Affiliation(s)
- Kendall C. Wilkins
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; 6363 Alvarado Court, Suite 103, San Diego, CA, 92120;
| | - Ariel J. Lang
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; 6363 Alvarado Court, Suite 103, San Diego, CA, 92120; ,University of California, San Diego, VA San Diego Healthcare System and VA Center of Excellence in Stress and Mental Health; 3350 La Jolla Village Drive, MC: 116B, San Diego, CA 92161; ;
| | - Sonya B. Norman
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; 6363 Alvarado Court, Suite 103, San Diego, CA, 92120; ,University of California, San Diego, VA San Diego Healthcare System and VA Center of Excellence in Stress and Mental Health; 3350 La Jolla Village Drive, MC: 116B, San Diego, CA 92161; ;
| |
Collapse
|
35
|
Ayer LA, Cisler JM, Danielson CK, Amstadter AB, Saunders BE, Kilpatrick DG. Adolescent posttraumatic stress disorder: an examination of factor structure reliability in two national samples. J Anxiety Disord 2011; 25:411-21. [PMID: 21131171 PMCID: PMC3051035 DOI: 10.1016/j.janxdis.2010.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 10/18/2010] [Accepted: 11/08/2010] [Indexed: 11/25/2022]
Abstract
A four-factor structure of posttraumatic stress disorder (PTSD) has been proposed for DSM-V based on empirical evidence that it is superior to the three-factor DSM-IV structure. However, most studies reveal multiple structures fit the data well in adolescent samples, and high factor correlations have been reported. Within two national samples of adolescents, we tested eight PTSD factor structures, which have never been compared in a single study. Confirmatory factor analyses (CFA) of PTSD symptoms were conducted in two national samples of adolescents: the National Survey of Adolescents (NSA; N = 4023) and the NSA-Replication (NSA-R; N = 3614). CFA revealed that all models provided very good fit to both samples (RMSEAs = .021-.039), though the one-factor model can be rejected, and correlations between factors were high (rs = .80-1.0). Potential interpretations of these findings include: (1) the indicators (i.e., symptoms) need refinement; or (2) relevant symptoms have yet to be identified.
Collapse
Affiliation(s)
- Lynsay A. Ayer
- Vermont Center for Children, Youth, & Families, Department of Psychiatry, University of Vermont,Corresponding Author: Vermont Center for Children, Youth, & Families, Department of Psychiatry, University of Vermont, St. Joseph, Room 3213, 1 South Prospect Street, Burlington, VT 05401, PHONE (802) 656-2124, FAX (802) 656-0987,
| | - Josh M. Cisler
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences
| | - Carla Kmett Danielson
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric & Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| | - Benjamin E. Saunders
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Dean G. Kilpatrick
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| |
Collapse
|
36
|
Ayer L, Danielson CK, Amstadter AB, Ruggiero K, Saunders B, Kilpatrick D. Latent classes of adolescent posttraumatic stress disorder predict functioning and disorder after 1 year. J Am Acad Child Adolesc Psychiatry 2011; 50:364-75. [PMID: 21421176 PMCID: PMC3115531 DOI: 10.1016/j.jaac.2011.01.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 01/03/2011] [Accepted: 01/06/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify latent classes of posttraumatic stress disorder (PTSD) symptoms in a national sample of adolescents, and to test their associations with PTSD and functional impairment 1 year later. METHOD A total of 1,119 trauma-exposed youth aged 12 through 17 years (mean = 14.99 years, 51% female and 49% male) participating in the National Survey of Adolescents-Replication were included in this study. Telephone interviews were conducted to assess PTSD symptoms and functional impairment at Waves 1 and 2. RESULTS Latent Class Analysis revealed three classes of adolescent PTSD at each time point: pervasive disturbance, intermediate disturbance, and no disturbance. Three numbing and two hyperarousal symptoms best distinguished the pervasive and intermediate disturbance classes at Wave 1. Three re-experiencing, one avoidance, and one hyperarousal symptom best distinguished these classes at Wave 2. The Wave 1 intermediate disturbance class was less likely to have a PTSD diagnosis, belong to the Wave 2 pervasive disturbance class, and report functional impairment 1 year later compared with the Wave 1 pervasive disturbance class. The Wave 1 no disturbance class was least likely to have PTSD, belong to the pervasive disturbance class, and report functional impairment at Wave 2. CONCLUSIONS This study suggests that PTSD severity-distinguishing symptoms change substantially in adolescence and are not characterized by the numbing cluster, contrary to studies in adult samples. These results may help to explain inconsistent factor analytic findings on the structure and diagnosis of PTSD, and emphasize that developmental context is critical to consider in both research and clinical work in PTSD assessment and diagnosis.
Collapse
Affiliation(s)
- Lynsay Ayer
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, St. Joseph, Room 3213, 1 South Prospect Street, Burlington, VT 05401, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Gewirtz AH, Polusny MA, DeGarmo DS, Khaylis A, Erbes CR. Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: associations with parenting behaviors and couple adjustment. J Consult Clin Psychol 2011; 78:599-610. [PMID: 20873896 DOI: 10.1037/a0020571] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this article, we report findings from a 1-year longitudinal study examining the impact of change in posttraumatic stress disorder (PTSD) symptoms following combat deployment on National Guard soldiers' perceived parenting and couple adjustment 1 year following return from Iraq. METHOD Participants were 468 Army National Guard fathers from a brigade combat team (mean age = 36 years; median deployment length = 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey 1 month before returning home from Operation Iraqi Freedom deployment (Time 1) and again 1 year postdeployment (Time 2). The PTSD Checklist-Military Version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and 2 items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire-Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale-7; Sharpley & Rogers, 1984; Spanier, 1976), parent-child relationship quality (4 items from the Social Adjustment Scale-Self-Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. RESULTS Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p < .001). Furthermore, PTSD symptoms predicted parenting challenges independent of their impact on couple adjustment. CONCLUSIONS Findings highlight the importance of investigating and intervening to support parenting and couple adjustment among combat-affected National Guard families.
Collapse
Affiliation(s)
- Abigail H Gewirtz
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Avenue, St. Paul, MN 55108, USA.
| | | | | | | | | |
Collapse
|
38
|
Zatzick DF, Rivara FP, Jurkovich GJ, Hoge CW, Wang J, Fan MY, Russo J, Trusz SG, Nathens A, Mackenzie EJ. Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. ACTA ACUST UNITED AC 2011; 67:1291-300. [PMID: 21135329 DOI: 10.1001/archgenpsychiatry.2010.158] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). OBJECTIVES To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. DESIGN Multisite US prospective cohort study. SETTING Eighteen level I trauma centers and 51 non-trauma center hospitals. PATIENTS A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. MAIN OUTCOME MEASURES Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. RESULTS At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. CONCLUSIONS More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.
Collapse
Affiliation(s)
- Douglas F Zatzick
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, 98104, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Wolitzky-Taylor KB, Ruggiero KJ, McCart MR, Smith DW, Hanson RF, Resnick HS, de Arellano MA, Saunders BE, Kilpatrick DG. Has adolescent suicidality decreased in the United States? Data from two national samples of adolescents interviewed in 1995 and 2005. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2010; 39:64-76. [PMID: 20390799 DOI: 10.1080/15374410903401146] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We compared the prevalence and correlates of adolescent suicidal ideation and attempts in two nationally representative probability samples of adolescents interviewed in 1995 (National Survey of Adolescents; N = 4,023) and 2005 (National Survey of Adolescents-Replication; N = 3,614). Participants in both samples completed a telephone survey that assessed major depressive episode (MDE), post-traumatic stress disorder, suicidal ideation and attempts, violence exposure, and substance use. Results demonstrated that the lifetime prevalence of suicidal ideation among adolescents was lower in 2005 than 1995, whereas the prevalence of suicide attempts remained stable. MDE was the strongest predictor of suicidality in both samples. In addition, several demographic, substance use, and violence exposure variables were significantly associated with increased risk of suicidal ideation and attempts in both samples, with female gender, nonexperimental drug use, and direct violence exposure being consistent risk factors in both samples.
Collapse
Affiliation(s)
- Kate B Wolitzky-Taylor
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Allenou C, Olliac B, Bourdet-Loubère S, Brunet A, David AC, Claudet I, Lecoules N, Roullet P, Bui E, Birmes P. Symptoms of traumatic stress in mothers of children victims of a motor vehicle accident. Depress Anxiety 2010; 27:652-7. [PMID: 20013986 DOI: 10.1002/da.20650] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Motor vehicle accidents (MVAs) are the main cause of Posttraumatic stress disorder (PTSD) in industrialized countries. This includes the frequently occurring but understudied situation of parents learning that their children were injured. However, unlike in other types of trauma survivors, little is known about the predictors of PTSD symptoms in mothers whose child has suffered an MVA. METHODS A group of 72 mothers and 28 fathers were prospectively assessed for peritraumatic distress, peritraumatic dissociation, and PTSD symptoms 1 and 5 weeks after their child had suffered an MVA. RESULTS Levels of peritraumatic distress and dissociation were comparable to other trauma victims, 18% of the mothers were considered to be suffering from probable PTSD. In mothers, significant positive correlations were found between PTSD symptoms and peritraumatic distress (r=.34) and dissociation (r=.37), whereas mothers' PTSD symptoms were associated with decreased peritraumatic dissociation in fathers (r=-.37). Even after controlling for covictim/witness status, peritraumatic distress was a predictor of mothers' PTSD symptoms, explaining 14% of the variance. CONCLUSIONS Peritraumatic response and PTSD symptoms should be routinely assessed among parents whose child has experienced a traumatic event.
Collapse
Affiliation(s)
- Charlotte Allenou
- Université de Toulouse et CHU de Toulouse, Hôpital Casselardit, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
McCauley JL, Danielson CK, Amstadter AB, Ruggiero KJ, Resnick HS, Hanson RF, Smith DW, Saunders BE, Kilpatrick DG. The role of traumatic event history in non-medical use of prescription drugs among a nationally representative sample of US adolescents. J Child Psychol Psychiatry 2010; 51:84-93. [PMID: 19674194 PMCID: PMC2826795 DOI: 10.1111/j.1469-7610.2009.02134.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Building on previous research with adolescents that examined demographic variables and other forms of substance abuse in relation to non-medical use of prescription drugs (NMUPD), the current study examined potentially traumatic events, depression, posttraumatic stress disorder (PTSD), other substance use, and delinquent behavior as potential correlates of past-year non-medical use of prescription drugs. METHOD A nationally representative sample of 3,614 non-institutionalized, civilian, English-speaking adolescents (aged 12-17 years) residing in households with a telephone was selected. Demographic characteristics, traumatic event history, mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had used a prescription drug in a non-medical manner. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set were then entered into a final multivariable logistic regression to determine significant predictors of past-year NMUPD. RESULTS NMUPD was endorsed by 6.7% of the sample (n = 242). The final multivariable model showed that lifetime history of delinquent behavior, other forms of substance use/abuse, history of witnessed violence, and lifetime history of PTSD were significantly associated with increased likelihood of NMUPD. CONCLUSIONS Risk reduction efforts targeting NMUPD among adolescents who have witnessed significant violence, endorsed abuse of other substances and delinquent behavior, and/or endorsed PTSD are warranted. Interventions for adolescents with history of violence exposure or PTSD, or those adjudicated for delinquent behavior, should include treatment or prevention modules that specifically address NMUPD.
Collapse
Affiliation(s)
- Jenna L. McCauley
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Carla Kmett Danielson
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Ananda B. Amstadter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Kenneth J. Ruggiero
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences,Ralph H. Johnson VA Medical Center
| | - Heidi S. Resnick
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Rochelle F. Hanson
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Daniel W. Smith
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Benjamin E. Saunders
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Dean G. Kilpatrick
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| |
Collapse
|
42
|
Abstract
The aim of the present study was to provide a critical review of prevalence estimates of combat-related post-traumatic stress disorder (PTSD) among military personnel and veterans, and of the relevant factors that may account for the variability of estimates within and across cohorts, including methodological and conceptual factors accounting for differences in prevalence rates across nations, conflicts/wars, and studies. MEDLINE and PsycINFO databases were examined for literature on combat-related PTSD. The following terms were used independently and in combinations in this search: PTSD, combat, veterans, military, epidemiology, prevalence. The point prevalence of combat-related PTSD in US military veterans since the Vietnam War ranged from approximately 2% to 17%. Studies of recent conflicts suggest that combat-related PTSD afflicts between 4% and 17% of US Iraq War veterans, but only 3-6% of returning UK Iraq War veterans. Thus, the prevalence range is narrower and tends to have a lower ceiling among combat veterans of non-US Western nations. Variability in prevalence is likely due to differences in sampling strategies; measurement strategies; inclusion and measurement of the DSM-IV clinically significant impairment criterion; timing and latency of assessment and potential for recall bias; and combat experiences. Prevalence rates are also likely affected by issues related to PTSD course, chronicity, and comorbidity; symptom overlap with other psychiatric disorders; and sociopolitical and cultural factors that may vary over time and by nation. The disorder represents a significant and costly illness to veterans, their families, and society as a whole. Further carefully conceptualized research, however, is needed to advance our understanding of disorder prevalence, as well as associated information on course, phenomenology, protective factors, treatment, and economic costs.
Collapse
Affiliation(s)
| | - B. Christopher Frueh
- The Menninger Clinic and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ronald Acierno
- Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
43
|
Boals A, Hathaway LM. The importance of the DSM-IV E and F criteria in self-report assessments of PTSD. J Anxiety Disord 2010; 24:161-6. [PMID: 19913383 DOI: 10.1016/j.janxdis.2009.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 10/08/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
The purpose of the current study was to examine the DSM-IV E and F criteria when using self-report measures of Posttraumatic Stress Disorder (PTSD). According to DSM-IV there are six core criteria required for a PTSD diagnosis including specific trauma characteristics, re-experiencing, avoidance, hyperarousal, duration, and impairment level. The Impact of Events Scale (IES) is a widely used self-report measure designed to measure PTSD symptoms. It has recently been suggested that the IES may produce misleading results, making emotional reactions to obviously non-traumatic events look like PTSD. In two separate studies, when duration (E criterion) and subjective impairment (F criterion) were included, the rates of those meeting PTSD criteria dropped from 20% to 3%. In addition, only 30% of events identified by a trauma history questionnaire met the DSM-IV definition of a traumatic event. The results have implications for the use of self-report measures in the assessment of PTSD.
Collapse
Affiliation(s)
- Adriel Boals
- University of North Texas, Denton, TX 76203, United States.
| | | |
Collapse
|
44
|
Abstract
Despite the use of quantitative and qualitative data in trauma research and therapy, mixed methods studies in this field have not been analyzed to help researchers designing investigations. This discussion begins by reviewing four core characteristics of mixed methods research in the social and human sciences. Combining these characteristics, the authors focus on four select mixed methods designs that are applicable in trauma research. These designs are defined and their essential elements noted. Applying these designs to trauma research, a search was conducted to locate mixed methods trauma studies. From this search, one sample study was selected, and its characteristics of mixed methods procedures noted. Finally, drawing on other mixed methods designs available, several follow-up mixed methods studies were described for this sample study, enabling trauma researchers to view design options for applying mixed methods research in trauma investigations.
Collapse
Affiliation(s)
- John W Creswell
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE 68502, USA.
| | | |
Collapse
|
45
|
Birmes P, Raynaud JP, Daubisse L, Brunet A, Arbus C, Klein R, Cailhol L, Allenou C, Hazane F, Grandjean H, Schmitt L. Children's enduring PTSD symptoms are related to their family's adaptability and cohesion. Community Ment Health J 2009; 45:290-9. [PMID: 19621258 DOI: 10.1007/s10597-008-9166-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 09/19/2008] [Indexed: 11/30/2022]
Abstract
This study compared, 18-24 months after an industrial disaster, in two groups of children (those with clinically relevant PTSD symptoms versus those with low PTSD symptoms), the child's perception of family cohesion and adaptability, the child's experience of the explosion, and parental characteristics. Enmeshed family cohesion or rigid family adaptability were more frequently found in children with low PTSD symptoms. PTSD symptoms in the mother, living in a family of 3 or more children, and being female were significantly associated with PTSD symptoms in the children. The assessment of traumatized children should include assessment of family's adaptability and cohesion.
Collapse
Affiliation(s)
- Philippe Birmes
- Laboratoire du Stress Traumatique (JE 2511) Services Universitaires de Psychiatrie Hôpital Casselardit-CHU de Toulouse, 170 av. de Casselardit, Toulouse Cedex 9, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Broman-Fulks JJ, Ruggiero KJ, Green BA, Smith DW, Hanson RF, Kilpatrick DG, Saunders BE. The latent structure of posttraumatic stress disorder among adolescents. J Trauma Stress 2009; 22:146-52. [PMID: 19319918 DOI: 10.1002/jts.20399] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Debate has arisen over whether posttraumatic stress disorder (PTSD) is most accurately conceptualized as representing a discrete clinical syndrome or an extreme reaction to traumatic life events. Recent taxometric research using predominantly adult samples appears to support a dimensional model of PTSD, raising questions about the utility of current psychiatric nosology which depicts PTSD as a distinct entity. The present study sought to use taxometric procedures to examine the latent structure of posttraumatic stress reactions among a national epidemiologic sample of 2,885 adolescents. Results were consistent with previous taxometric studies in supporting a dimensional model of posttraumatic stress reactions. The implications of these findings for public policy, as well as the etiology and assessment of posttraumatic stress reactions, are discussed.
Collapse
|
47
|
Amstadter AB, Koenen KC, Ruggiero KJ, Acierno R, Galea S, Kilpatrick DG, Gelernter J. Variant in RGS2 moderates posttraumatic stress symptoms following potentially traumatic event exposure. J Anxiety Disord 2009; 23:369-73. [PMID: 19162436 PMCID: PMC2735848 DOI: 10.1016/j.janxdis.2008.12.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 11/21/2008] [Accepted: 12/09/2008] [Indexed: 12/25/2022]
Abstract
Polymorphisms in the RGS2 (regulator of G-protein signaling 2) gene were found to be associated with anxious behavior in mice and anxiety in humans. We examined whether rs4606, a single nucleotide polymorphism (SNP) of RGS2, and social support moderated risk for PTSD in an epidemiologic sample. The study examines 607 adults from the 2004 Florida Hurricanes study who returned buccal DNA samples via mail. rs4606 was associated with increased symptoms of posthurricane PTSD symptoms under conditions of high hurricane exposure and low social support (P<.05). Further, this polymorphism was associated with lifetime PTSD symptoms under conditions of lifetime exposure to a potentially traumatic event, and low social support (P<.001). These gene by environment interactions remained significant after adjustment for sex, ancestry, and age. RGS2 rs4606 modifies risk of postdisaster and lifetime PTSD symptoms under conditions of high stressor exposure. This is the first demonstration of gene-environment interaction for this locus.
Collapse
Affiliation(s)
- Ananda B Amstadter
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Danielson CK, Amstadter AB, Dangelmaier RE, Resnick HS, Saunders BE, Kilpatrick DG. Trauma-related risk factors for substance abuse among male versus female young adults. Addict Behav 2009; 34:395-9. [PMID: 19110381 DOI: 10.1016/j.addbeh.2008.11.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/09/2008] [Accepted: 11/14/2008] [Indexed: 11/18/2022]
Abstract
Clinical efforts to reduce risk for Substance Use Disorders (SUDs) among young adults rely on the empirical identification of risk factors for addictive behaviors in this population. Exposure to traumatic events and Posttraumatic Stress Disorder (PTSD) have been linked with SUDs in various populations. Emerging data, particularly from adolescent samples, suggest that traumatic event exposure increases risk for SUDs for young women, but not young men. The purpose of the current study was to examine trauma-related risk factors for alcohol and drug abuse among a national sample of young adults and compare such risk factors between men and women. Participants were 1753 young adults who participated in the 7-8 year follow-up telephone-based survey to the original National Survey of Adolescents. In the full sample, 29.1% met criteria for substance abuse. Trauma-related risk factors for alcohol and drug abuse differed for men and women. Clinical implications of these results are discussed.
Collapse
Affiliation(s)
- Carla Kmett Danielson
- National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston, SC 29425,United States.
| | | | | | | | | | | |
Collapse
|
49
|
Zinzow HM, Ruggiero KJ, Resnick H, Hanson R, Smith D, Saunders B, Kilpatrick D. Prevalence and mental health correlates of witnessed parental and community violence in a national sample of adolescents. J Child Psychol Psychiatry 2009; 50:441-50. [PMID: 19220624 PMCID: PMC3485065 DOI: 10.1111/j.1469-7610.2008.02004.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although research suggests that witnessed violence is linked to adverse mental health outcomes among adolescents, little is known about its prevalence or its significance in predicting psychiatric symptoms beyond the contribution of co-occurring risk factors. The purpose of this study was to identify the national prevalence of witnessed parental and community violence and to examine these life stressors as independent risk factors for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among adolescents. A secondary aim was to determine which characteristics of witnessed violence were associated with mental health outcomes. METHOD Participants were 3,614 adolescents recruited from a 2005 US national household probability sample who completed structured telephone interviews assessing witnessed violence and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for PTSD and MDE. RESULTS National prevalence of witnessed parental violence and witnessed community violence was estimated to be 9% and 38%, respectively. Both forms of witnessed violence predicted PTSD and MDE beyond variance accounted for by age, gender, race/ethnicity, income, and other traumatic event history. Perceptions of threat, repeated violence exposure, location of the violence, and relationship to the victim were associated with psychiatric diagnoses. CONCLUSIONS Findings suggest that witnessed violence represents a significant public health burden with implications for psychological assessment and prevention efforts.
Collapse
|
50
|
Koenen KC, Aiello AE, Bakshis E, Amstadter AB, Ruggiero KJ, Acierno R, Kilpatrick DG, Gelernter J, Galea S. Modification of the association between serotonin transporter genotype and risk of posttraumatic stress disorder in adults by county-level social environment. Am J Epidemiol 2009; 169:704-11. [PMID: 19228812 DOI: 10.1093/aje/kwn397] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although both genetic factors and features of the social environment are important predictors of posttraumatic stress disorder (PTSD), there are few data examining gene-social environment interactions in studies of PTSD. The authors examined whether features of the social environment (county-level crime rate and unemployment) modified the association between the serotonin protein gene (SLC6A4) promoter variant (5-HTTLPR) and risk of current PTSD in a sample of 590 participants from the 2004 Florida Hurricane Study. Interviews conducted in 2005 were used to obtain individual-level risk factor measures and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PTSD diagnoses. DNA was extracted from salivary samples. County-level crime and unemployment rates were assessed from Federal Bureau of Investigation and US Census data, respectively. There was a significant interaction between 5-HTTLPR genotype and both crime rate (odds ratio = 2.68, 95% confidence interval: 1.09, 6.57) and unemployment rate (odds ratio = 3.67, 95% confidence interval: 1.42, 9.50) in logistic regression models predicting PTSD risk, after adjustment for individual-level determinants of PTSD. Stratified analyses indicated that the "s" allele of the 5-HTTLPR polymorphism was associated with decreased risk of PTSD in low-risk environments (low crime/unemployment rates) but increased risk of PTSD in high-risk environments. These results suggest that social environment modifies the effect of 5-HTTLPR genotype on PTSD risk.
Collapse
Affiliation(s)
- Karestan C Koenen
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|