1
|
Weggen JB, Darling AM, Autler AS, Hogwood AC, Decker KP, Richardson J, Tuzzolo G, Garten RS. Lower vascular conductance responses to handgrip exercise are improved following acute antioxidant supplementation in young individuals with post-traumatic stress disorder. Exp Physiol 2024; 109:992-1003. [PMID: 38711207 PMCID: PMC11140166 DOI: 10.1113/ep091762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
Young individuals with post-traumatic stress disorder (PTSD) display peripheral vascular and autonomic nervous system dysfunction, two factors potentially stemming from a redox imbalance. It is currently unclear if these aforementioned factors, observed at rest, alter peripheral haemodynamic responses to exercise in this population. This study examined haemodynamic responses to handgrip exercise in young individuals with PTSD following acute antioxidant (AO) supplementation. Thirteen young individuals with PTSD (age 23 ± 3 years), and 13 age- and sex-matched controls (CTRL) participated in the study. Exercise-induced changes to arm blood flow (BF), mean arterial pressure (MAP) and vascular conductance (VC) were evaluated across two workloads of rhythmic handgrip exercise (3 and 6 kg). The PTSD group participated in two visits, consuming either a placebo (PL) or AO prior to their visits. The PTSD group demonstrated significantly lower VC (P = 0.04) across all exercise workloads (vs. CTRL), which was significantly improved following AO supplementation. In the PTSD group, AO supplementation improved VC in participants possessing the lowest VC responses to handgrip exercise, with AO supplementation significantly improving VC responses (3 and 6 kg: P < 0.01) by blunting elevated exercise-induced MAP responses (3 kg: P = 0.01; 6 kg: P < 0.01). Lower VC responses during handgrip exercise were improved following AO supplementation in young individuals with PTSD. AO supplementation was associated with a blunting of exercise-induced MAP responses in individuals with PTSD displaying elevated MAP responses. This study revealed that young individuals with PTSD exhibit abnormal, peripherally mediated exercise responses that may be linked to a redox imbalance.
Collapse
Affiliation(s)
- Jennifer B. Weggen
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ashley M. Darling
- Department of KinesiologyUniversity of Texas at ArlingtonArlingtonTexasUSA
| | - Aaron S. Autler
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Austin C. Hogwood
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Kevin P. Decker
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Jacob Richardson
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Gina Tuzzolo
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ryan S. Garten
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| |
Collapse
|
2
|
Pokeerbux MR, Mavingui P, Gérardin P, Agrinier N, Gokalsing E, Meilhac O, Cournot M. A Holistic Approach to Cardiometabolic and Infectious Health in the General Population of Reunion Island: The REUNION Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00221-9. [PMID: 38564109 DOI: 10.1007/s44197-024-00221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Reunion Island is a French overseas department in the South West Indian Ocean with a unique multi-ethnic population. Cardiovascular diseases are the most common chronic conditions with higher prevalences of hypertension and diabetes compared to mainland France. Moreover, Reunion Island is particularly exposed to vector-borne diseases such as chikungunya and dengue. Our objective is to describe the prevalence of cardiometabolic and infectious diseases in Reunion Island and explore causal mechanisms linking these diseases. METHODS The REUNION study is an ongoing French prospective study. From January 2022, 2,000 consenting participants (18-68 years old) are being recruited from the general population according to polling lists and random generation of cellphone number. Baseline examination consists of (i) general health examination, assessment of cardiovascular risk factors, markers of subclinical atherosclerosis, bronchial obstruction, neuropathic and autonomic dysfunction, (ii) questionnaires to determine sociodemographic characteristics, diet, exposure to vector-borne diseases, mental health and cognitive functions, social inequalities in health and ethnic origins, (iii) biological sampling for determination of cardiovascular risk factors, seroprevalence of infectious diseases, innovative lipid biomarkers, advanced omics, composition of intestinal, periodontal and skin microbiota, and biobanking. CONCLUSIONS The REUNION study should provide new insights into the prevalence of cardiometabolic and infectious diseases, as well as their potential associations through the examination of various environmental pathways and a wide range of health aspects.
Collapse
Affiliation(s)
- Mohammad Ryadh Pokeerbux
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, La Réunion, 97410, France.
| | - Patrick Mavingui
- Université de La Réunion, UMR Processus Infectieux en Milieu Insulaire et Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Sainte-Clotilde, La Réunion, 97490, France
| | - Patrick Gérardin
- Plateforme de Recherche Clinique et Translationnelle, INSERM CIC1410, CHU de La Réunion, Saint-Pierre, La Réunion, 97400, France
| | - Nelly Agrinier
- CHRU-Nancy, Université de Lorraine, CIC, Epidémiologie clinique, Inserm, Nancy, F-54000, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, F-54000, France
| | - Erick Gokalsing
- Etablissement Public de Santé Mentale de La Réunion, 42 chemin du Grand Pourpier, 97866, Saint-Paul Cedex, France
- Laboratoire IRISSE (IngéniéRIe de la Santé, du Sport et de l'Environnement), Université de La Réunion, UFR SHE, Saint Pierre, EA, 4075, France
| | - Olivier Meilhac
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, La Réunion, 97410, France
- Plateforme de Recherche Clinique et Translationnelle, INSERM CIC1410, CHU de La Réunion, Saint-Pierre, La Réunion, 97400, France
| | - Maxime Cournot
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, La Réunion, 97410, France
- Groupe de santé Clinifutur, Clinique Les Orchidées, Le Port, La Réunion, 97420, France
| |
Collapse
|
3
|
Salas J, Wang W, Schnurr PP, Cohen BE, Freedland KE, Jaffe AS, Lustman PJ, Friedman M, Scherrer JF. Severity of posttraumatic stress disorder, type 2 diabetes outcomes and all-cause mortality: A retrospective cohort study. J Psychosom Res 2023; 175:111510. [PMID: 37827022 PMCID: PMC10842322 DOI: 10.1016/j.jpsychores.2023.111510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Some evidence suggests patients with comorbid PTSD and type 2 diabetes (T2D) have worse T2D outcomes than those with T2D alone. However, there is no evidence regarding PTSD severity and risk for starting insulin, hyperglycemia, microvascular complications, and all-cause mortality. METHODS In this retrospective cohort study, Veterans Health Affairs (VHA) medical record data from fiscal year (FY) 2012 to FY2022 were used to identify eligible patients (n = 23,161) who had a PTSD diagnosis, ≥1 PTSD Checklist score, controlled T2D (HbA1c ≤ 7.5) without microvascular complications at baseline. PTSD Checklist for DSM-5 (PCL-5) scores defined mild, moderate, and severe PTSD. Competing risk and survival models estimated the association between PTSD severity and T2D outcomes before and after controlling for confounding. RESULTS Most (70%) patients were ≥ 50 years of age, 88% were male, 64.2% were of white race and 17.1% had mild, 67.4% moderate and 15.5% severe PTSD. After control for confounding, as compared to mild PTSD, moderate (HR = 1.05; 95% CI:1.01-1.11) and severe PTSD (HR = 1.15; 95%CI:1.07-1.23) were significantly associated with increased risk for microvascular complication. Hyperarousal was associated with a 42% lower risk of starting insulin. Negative mood was associated with a 16% increased risk for any microvascular complication. Severe PTSD was associated with a lower risk for all-cause mortality (HR = 0.76; 95%CI:0.63-0.91). CONCLUSIONS Patients with comorbid PTSD and T2D have an increased risk for microvascular complications. However, they have lower mortality risk perhaps due to more health care use and earlier chronic disease detection. PTSD screening among patients with T2D may be warranted.
Collapse
Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Wenjin Wang
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Paula P Schnurr
- National Center for PTSD, White River Junction, VT, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Beth E Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, San Francisco, CA, United States
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Allan S Jaffe
- Department of Cardiovascular Medicine and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew Friedman
- National Center for PTSD, White River Junction, VT, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Saint Louis University, St. Louis, MO, United States.
| |
Collapse
|
4
|
Roer GE, Lien L, Bolstad I, Aaseth JO, Abebe DS. The impact of PTSD on risk of cardiometabolic diseases: a national patient cohort study in Norway. BMC Psychiatry 2023; 23:349. [PMID: 37210523 PMCID: PMC10200052 DOI: 10.1186/s12888-023-04866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/13/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with cardiometabolic diseases, concurrent anxiety, alcohol use disorder and depression. The relationship between PTSD and cardiometabolic diseases are still unclear, and less is known about the effects of socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression. The study, therefore, aims to examine the risk of developing cardiometabolic diseases including type 2 diabetes mellitus over time in PTSD patients, and to what extent socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression attenuate associations between PTSD and risk of developing cardiometabolic diseases. METHOD A retrospective, register-based cohort study with 6-years follow-up of adult (> 18 years) PTSD patients (N = 7 852) compared with the general population (N = 4 041 366), was performed. Data were acquired from the Norwegian Patient Registry and Statistic Norway. Cox proportional regression models were applied to estimate hazard ratios (HRs) (99% confidence intervals) of cardiometabolic diseases among PTSD patients. RESULTS Significantly (p < 0.001) higher age and gender adjusted HRs were disclosed for all cardiometabolic diseases among PTSD patients compared to the population without PTSD, with a variation in HR from 3.5 (99% CI 3.1-3.9) for hypertensive diseases to HR = 6.5 (5.7-7.5) for obesity. When adjusted for socioeconomic status and comorbid mental disorders, reductions were observed, especially for comorbid depression, for which the adjustment resulted in HR reduction of about 48.6% for hypertensive diseases and 67.7% for obesity. CONCLUSIONS PTSD was associated with increased risk of developing cardiometabolic diseases, though attenuated by socioeconomic status and comorbid mental disorders. Health care professionals should be attentive towards the burden and increased risk that low socioeconomic status and comorbid mental disorders may represent for PTSD patients' cardiometabolic health.
Collapse
Affiliation(s)
- Grethe Emilie Roer
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway.
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130, Oslo, Norway.
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, NO-2418, Elverum, Norway
| | - Ingeborg Bolstad
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, NO-2418, Elverum, Norway
| | - Jan O Aaseth
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, NO-2418, Elverum, Norway
- Research Department, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway
| | - Dawit Shawel Abebe
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130, Oslo, Norway
| |
Collapse
|
5
|
Melin EO, Wanby P, Neumark T, Holmberg S, Neumark ASN, Johansson K, Landin-Olsson M, Thulesius H, Hillman M, Thunander M. Depression was associated with younger age, female sex, obesity, smoking, and physical inactivity, in 1027 patients with newly diagnosed type 2 diabetes: a Swedish multicentre cross-sectional study. BMC Endocr Disord 2022; 22:273. [PMID: 36348470 PMCID: PMC9644465 DOI: 10.1186/s12902-022-01184-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. METHODS Multicentre, cross-sectional study. INCLUSION CRITERIA adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m2), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. RESULTS In 1027 T2D patients, aged 18-94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m2 (OR 1.7), BMI ≥ 40 kg/m2 (OR 2.3), smoking (OR 1.9), physical inactivity (OR 1.8), and women (OR 1.6) (all p ≤ 0.013). Younger women (n = 113), ≤ 59 years, compared to younger men (n = 217) had higher prevalence of current depression (31% vs 12%), previous depression (43 vs 19%), anxiety (42% vs 25%), antidepressant use (37% vs 12%), BMI ≥ 30 kg/m2 (73% vs 60%) and BMI ≥ 40 kg/m2) (18% vs 9%), and smoking (26% vs 16%) (all p ≤ 0.029). Older women (n = 297), ≥ 60 years, compared to older men (n = 400) had higher prevalence of previous depression (45% vs 12%), anxiety (18% vs 10%), antidepressant use (20% vs 8%), BMI ≥ 30 kg/m2 (55% vs 47%), BMI ≥ 40 kg/m2 (7% vs 3%) (all p ≤ 0.048), but not of current depression (both 9%). Compared to the Swedish general population (depression (women 11.2%, men 12.3%) and antidepressant use (women 9.8%, men 5.3%)), the younger women had higher prevalence of current depression, and all patients had higher prevalence of antidepressant use. CONCLUSIONS In patients with newly diagnosed T2D, the younger women had the highest prevalence of depression, anxiety, and obesity. The prevalence of depression in young women and antidepressant use in all patients were higher than in the Swedish general population. Three risk factors for CVD, obesity, smoking, and physical inactivity, were associated with depression.
Collapse
Affiliation(s)
- Eva O Melin
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden.
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden.
- Region Kronoberg, Primary Care, Växjö, Sweden.
| | - Pär Wanby
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
- Department of Internal Medicine, Endocrinology, Kalmar County Hospital, Region Kalmar, Sweden
| | - Thomas Neumark
- Regional Executive Office - Coordination of Health Care, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Karin Johansson
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Region Kronoberg, Primary Care, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden
- Department of Diabetology and Endocrinology, Skane University Hospital, Lund, Sweden
| | - Hans Thulesius
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Region Kronoberg, Primary Care, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Clinical Sciences, Division of Family Medicine, Lund University, Malmö, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden
| | - Maria Thunander
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Department of Internal Medicine, Endocrinology and Diabetes, Växjö Central Hospital, Region Kronoberg, Växjö, Sweden
| |
Collapse
|
6
|
Hoffman SJ, Shannon PJ, Horn TL, Letts JP, Kondes Z, Mathiason MA. Associations between gender, torture, and health: A 5-year retrospective cohort analysis. JOURNAL OF LOSS & TRAUMA 2022; 28:191-205. [PMID: 37305587 PMCID: PMC10254698 DOI: 10.1080/15325024.2022.2092317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort. Findings have implications for how primary care and public health providers implement war trauma screening tools and timelines, targeted healthcare services, and community resources to promote health and prevent disease in populations that have trauma from torture or war.
Collapse
Affiliation(s)
| | - Patricia J Shannon
- University of Minnesota School of Social Work, Center for Victims of Torture
| | | | | | - Zoë Kondes
- Abbott Northwestern Hospital and an alumnus of the University of Minnesota School of Nursing
| | | |
Collapse
|
7
|
Bergman BP, Mackay D, Pell JP. Type 2 diabetes in Scottish military veterans: a retrospective cohort study. BMJ Open 2022; 12:e057431. [PMID: 35115360 PMCID: PMC8814809 DOI: 10.1136/bmjopen-2021-057431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Type 2 diabetes is an important public health problem but the risk in UK military veterans is unknown. We used data from the Trends in Scottish Veterans' Health study to investigate the risk in comparison with people with no record of service. DESIGN Retrospective cohort study of a large national sample in Scotland, with up to 37 years follow-up. SETTING Pseudoanonymised extract of computerised Scottish National Health Service records, including a disease register and national vital records. PARTICIPANTS 78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence. OUTCOME MEASURES Cox proportional HRs for first record of type 2 diabetes in veterans compared with non-veterans, overall and by sex and birth cohort. Long-term trend, comorbidity with specific mental health outcomes and risk of limb loss. RESULTS Overall, 7.2% of veterans were diagnosed with type 2 diabetes, and were at slightly increased risk compared with non-veterans, Cox proportional HR 1.08, 95%CIs 1.04 to 1.11, p<0.001. The increased risk was confined to men, and to veterans born prior to 1960. There has been no change in HR over the last 25 years. Among veterans with post-traumatic stress disorder (PTSD), 12.1% had been diagnosed with type 2 diabetes, compared with 9.4% of non-veterans with PTSD. The difference was statistically significant, OR 1.29, 95% CI 1.04 to 1.59, p=0.021. Risk of limb loss was increased among the oldest veterans. CONCLUSIONS Older veterans in Scotland have an increased risk of type 2 diabetes in comparison with non-veterans, but there is no difference in respect of younger veterans, and the pattern of risk shows no evidence that it is changing. There is a positive association between type 2 diabetes and PTSD, especially in the presence of comorbid mood disorder, an important finding which should be noted by care providers.
Collapse
Affiliation(s)
- Beverly P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
8
|
Boakye MD, Miyamoto S, Greenwood D. What Individuals Want to Hear at the Point of Type 2 Diabetes Diagnosis. Clin Diabetes 2022; 41:110-119. [PMID: 36714250 PMCID: PMC9845082 DOI: 10.2337/cd21-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent studies have shown that the time of diagnosis with type 2 diabetes is often not a teachable moment because of heightened emotions. Yet, research also shows that individuals who are newly diagnosed with type 2 diabetes need reassurance and a clear pathway to obtain the education and support needed to self-manage the condition. This article reports on qualitative research exploring the experiences of individuals with type 2 diabetes at the time of diagnosis, including information they wanted to hear and learn at diagnosis. The findings suggest that initial communication should offer reassurance and establish a partnership between the diagnosed individual and the health care provider to identify next steps toward self-management success.
Collapse
Affiliation(s)
- Michelle D.S. Boakye
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA
- Corresponding author: Michelle D.S. Boakye, or
| | - Sheridan Miyamoto
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA
| | | |
Collapse
|
9
|
Kohut AO, Chaban OS, Dolynskyi RG, Sandal OS, Bursa AI, Bobryk MI, Vertel AV. THE FEATURES OF POSTTRAUMATIC STRESS DISORDER DEVELOPMENT IN PATIENTS WITH DIABETES MELLITUS 2 TYPE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1903-1907. [PMID: 36089877 DOI: 10.36740/wlek202208115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: The revealing of the development of stress-related disorders in patients with type 2 diabetes mellitus (DM 2) to: identify the prevalence of stress-related disorders, particularly, posttraumatic stress disorder (PTSD); study the influence of psychosocial factors on the occurrence and course of stress-related disorders and increase the effectiveness of treatment in DM 2. PATIENTS AND METHODS Materials and methods: Research papers have been found by searching the PubMed database using the keywords ``ptsd and diabetes 2 type" with the result of 74 studies. Totally 25 of selected publications were analysed based on our criteria about the mechanisms through which the influence of psychosocial factors, permanent stressful or traumatic events on the probable risk of PTSD development and their analysis and relationships for the improvement of treatment effectiveness in DM 2 patients who have not been the veterans. CONCLUSION Conclusions: Given the complex neurophysiological relationships between the long-term stress and pathophysiological mechanisms of DM 2 - this group of patients has the higher risk of developing stress-related disorders, including PTSD.
Collapse
Affiliation(s)
- Anna O Kohut
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | - Oleg S Chaban
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | | | - Olha S Sandal
- KOSTIUK INSTITUTE OF PSYCHOLOGY OF NATIONAL ACADEMY OF EDUCATIONAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | | | - Anton V Vertel
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A.S. MAKARENKO, SUMY, UKRAINE
| |
Collapse
|
10
|
[Mental health research opportunities in the MONICA-KORA study]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2020; 66:324-336. [PMID: 33284064 DOI: 10.13109/zptm.2020.66.4.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mental health research opportunities in the MONICA-KORA study Goal: Initially, part of the worldwide MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Project of the World Health Organization (WHO), the project was pursued 1996 as KORA (Cooperative Health Research in the Region Augsburg) Study, which now substantially expands the former focus on cardiovascular medicine. Major research questions within the mental health focus emphasize the prognostic impact of psychosocial stress on the incidence of somatic endpoints and the gender-driven crosstalk of psycho-neuro- immunological conditions with somatic diseases. Methods: Three independent representative population-based MONICA/KORA surveys (S1 to S3) starting in 1984/85 and performed in 5-years intervals, constitute the backbone of the psychosocial MONICA sub study. An extensive set of psychosocial baseline data captured in the S1 to S3 surveys are available for a total of approximately 13000 participants in the age range of 25 to 75 years. Here, data allow estimates of work-stress conditions, social isolation, social network, life satisfaction and the Type A Behavior Pattern. The Follow-up studies (F3, F4, FFF4) allow for prospective, time-dependent analyses. In the follow-up (F) surveys, psychosomatic research was strengthened with the inclusion of standardized assessments of depression, anxiety, Type D personality and (in F4) for Posttraumatic Stress Disorder (PTSD), psychosocial stress and life satisfaction. Combined analyses with genetic, epigenetic and metabolomic datasets are feasible. Results: The initial S1 to S3 surveys provided psychosocial baseline data for approximately 13000 participants in the age range of 25 to75 years. The Follow-up studies (F3, F4, FFF4) each included approximately 3000 participants with validated datasets with a median of 9 to 15 years of follow-up period from baseline. An increasing number of co-operations dealing with sophisticated basic research tools are currently ongoing. Conclusions: Prospective assessments of psychosocial stress conditions on the onset of somatic disease conditions and research on the interaction with autonomic, endocrine and inflammatory pathways result in new insights of established disease conditions and may contribute as a game-changer in the current disease understanding.
Collapse
|
11
|
Marseille E, Kahn JG, Yazar-Klosinski B, Doblin R. The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PLoS One 2020; 15:e0239997. [PMID: 33052965 PMCID: PMC7556534 DOI: 10.1371/journal.pone.0239997] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic posttraumatic stress disorder (PTSD) is a disabling condition that generates considerable morbidity, mortality, and both medical and indirect social costs. Treatment options are limited. A novel therapy using 3,4-methylenedioxymethamphetamine (MDMA) has shown efficacy in six phase 2 trials. Its cost-effectiveness is unknown. METHODS AND FINDINGS To assess the cost-effectiveness of MDMA-assisted psychotherapy (MAP) from the health care payer's perspective, we constructed a decision-analytic Markov model to portray the costs and health benefits of treating patients with chronic, severe, or extreme, treatment-resistant PTSD with MAP. In six double-blind phase 2 trials, MAP consisted of a mean of 2.5 90-minute trauma-focused psychotherapy sessions before two 8-hour sessions with MDMA (mean dose of 125 mg), followed by a mean of 3.5 integration sessions for each active session. The control group received an inactive placebo or 25-40 mg. of MDMA, and otherwise followed the same regimen. Our model calculates net medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Efficacy was based on the pooled results of six randomized controlled phase 2 trials with 105 subjects; and a four-year follow-up of 19 subjects. Other inputs were based on published literature and on assumptions when data were unavailable. We modeled results over a 30-year analytic horizon and conducted extensive sensitivity analyses. Our model calculates expected medical costs, mortality, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Future costs and QALYs were discounted at 3% per year. For 1,000 individuals, MAP generates discounted net savings of $103.2 million over 30 years while accruing 5,553 discounted QALYs, compared to continued standard of care. MAP breaks even on cost at 3.1 years while delivering 918 QALYs. Making the conservative assumption that benefits cease after one year, MAP would accrue net costs of $7.6 million while generating 288 QALYS, or $26,427 per QALY gained. CONCLUSION MAP provided to patients with severe or extreme, chronic PTSD appears to be cost-saving while delivering substantial clinical benefit. Third-party payers are likely to save money within three years by covering this form of therapy.
Collapse
Affiliation(s)
- Elliot Marseille
- Health Strategies International, Oakland, California, United States of America
- University of California, San Francisco, California, United States of America
- * E-mail:
| | - James G. Kahn
- University of California, San Francisco, California, United States of America
| | - Berra Yazar-Klosinski
- Multidisciplinary Association for Psychedelic Studies (MAPS), Santa Cruz, California, United States of America
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), Santa Cruz, California, United States of America
| |
Collapse
|
12
|
Jiang L, Atasoy S, Johar H, Herder C, Peters A, Kruse J, Ladwig KH. Anxiety boosts progression of prediabetes to type 2 diabetes: findings from the prospective Cooperative Health Research in the Region of Augsburg F4 and FF4 studies. Diabet Med 2020; 37:1737-1741. [PMID: 31943340 DOI: 10.1111/dme.14232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 01/14/2023]
Abstract
AIM To investigate the association between anxiety symptoms and the progression from prediabetes to type 2 diabetes. METHODS A sample of 1708 participants aged 31-82 years from the population-based Cooperative Health Research in the Region of Augsburg F4 and the follow-up Cooperative Health Research in the Region of Augsburg FF4 studies was included. Prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance, and anxiety status was measured by the generalized anxiety disorder-7 questionnaire. Newly diagnosed type 2 diabetes cases were identified after 6.5 years (11 102 person-years) and confirmed by medical records. Multivariate logistic regression analyses were employed to estimate the effect of prediabetes and anxiety on the incidence of type 2 diabetes with different levels of adjustments for potential confounders. The population attributable risk of type 2 diabetes in participants with prediabetes and anxiety was estimated. RESULTS Prediabetes at baseline was prevalent in 247 participants, of whom 77 developed diabetes after follow-up, accounting for a progression rate of 31%. In participants with prediabetes, high anxiety was associated with a 3-fold increased risk of progression to type 2 diabetes in comparison with low anxiety, even after accounting for socio-demographic, lifestyle and metabolic risk factors (OR = 2.82, 95% CI = 0.95-8.37, P = 0.06). A significant proportion of incident type 2 diabetes was attributed to having anxiety in addition to prediabetes (attributable risk proportion: 0.52; 95% CI = 0.004-1.04, P = 0.05). CONCLUSIONS Anxiety symptoms independently increase the progression risk of prediabetes to type 2 diabetes and should be routinely considered alongside the traditional risk factors in people with prediabetes.
Collapse
Affiliation(s)
- L Jiang
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - S Atasoy
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - H Johar
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - C Herder
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - A Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - J Kruse
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - K-H Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| |
Collapse
|
13
|
Perna L, Zhang Y, Matias-Garcia PR, Ladwig KH, Wiechmann T, Wild B, Waldenberger M, Schöttker B, Mons U, Ihle A, Kliegel M, Schwettmann L, Peters A, Brenner H. Subjective mental health, incidence of depressive symptoms in later life, and the role of epigenetics: results from two longitudinal cohort studies. Transl Psychiatry 2020; 10:323. [PMID: 32958748 PMCID: PMC7506005 DOI: 10.1038/s41398-020-00997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
The role of self-perceived general health in predicting morbidity and mortality among older people is established. The predictive value of self-perceived mental health and of its possible biological underpinnings for future depressive symptoms is unexplored. This study aimed to assess the role of mental health-related quality of life (HRQOL) and of its epigenetic markers in predicting depressive symptoms among older people without lifetime history of depression. Data were based on a subgroup (n = 1 492) of participants of the longitudinal ESTHER study. An epigenome-wide association study (EWAS) of mental HRQOL was conducted using DNA from baseline whole blood samples and logistic regression analyses were performed to assess the predictive value of methylation beta values of EWAS identified CpGs for incidence of depressive symptoms in later life. The methylation analyses were replicated in the independent KORA cohort (n = 890) and a meta-analysis of the two studies was conducted. Results of the meta-analysis showed that participants with beta values of cg27115863 within quartile 1 (Q1) had nearly a two-fold increased risk of developing depressive symptoms compared to participants with beta values within Q4 (ORQ1vsQ4 = 1.80; CI 1.25-2.61). In the ESTHER study the predictive value of subjective mental health for future depressive symptoms was also assessed and for 10-unit increase in mental HRQOL scores the odds for incident depressive symptoms were reduced by 54% (OR 0.46; CI 0.40-0.54). These findings suggest that subjective mental health and hypomethylation at cg27115863 are predictive of depressive symptoms, possibly through the activation of inflammatory signaling pathway.
Collapse
Affiliation(s)
- Laura Perna
- German Cancer Research Center (DKFZ) - Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany. .,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804, Munich, Germany.
| | - Yan Zhang
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ) – Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Pamela R. Matias-Garcia
- grid.6936.a0000000123222966Technical University of Munich, TUM School of Medicine, Ismaninger Straße 22, 81675 München, Germany ,Helmholtz Zentrum München – Research Unit Molecular Epidemiology – Ingolstädter, Landstraße 1, 85764 Neuherberg, Germany ,Helmholtz Zentrum München – Institute of Epidemiology, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Helmholtz Zentrum München – Institute of Epidemiology, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ,Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Langerstraße 3, 81675 München, Germany
| | - Tobias Wiechmann
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804 Munich, Germany
| | - Beate Wild
- grid.5253.10000 0001 0328 4908University of Heidelberg – Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Melanie Waldenberger
- Helmholtz Zentrum München – Research Unit Molecular Epidemiology – Ingolstädter, Landstraße 1, 85764 Neuherberg, Germany
| | - Ben Schöttker
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ) – Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373University of Heidelberg – Network Aging Research (NAR), Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Ute Mons
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ) – Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ) – Cancer Prevention Unit, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andreas Ihle
- grid.8591.50000 0001 2322 4988University of Geneva – Department of Psychology, Boulevard du pont d’ Arve 40, 1211 Geneva, Switzerland ,grid.8591.50000 0001 2322 4988University of Geneva – Center for the Interdisciplinary Study of Gerontology and Vulnerability, Boulevard du pont d’ Arve 40, 1205 Geneva, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne – Swiss National Centre of Competence in Research LIVES – Overcoming vulnerability: Life course perspectives, Géopolis Building, 1015 Lausanne, Switzerland
| | - Matthias Kliegel
- grid.8591.50000 0001 2322 4988University of Geneva – Department of Psychology, Boulevard du pont d’ Arve 40, 1211 Geneva, Switzerland ,grid.8591.50000 0001 2322 4988University of Geneva – Center for the Interdisciplinary Study of Gerontology and Vulnerability, Boulevard du pont d’ Arve 40, 1205 Geneva, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne – Swiss National Centre of Competence in Research LIVES – Overcoming vulnerability: Life course perspectives, Géopolis Building, 1015 Lausanne, Switzerland
| | - Lars Schwettmann
- Helmholtz Zentrum München – German Research Center for Enviromental Health (GmbH) – Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ,grid.9018.00000 0001 0679 2801Department of Economics, Martin Luther University, Halle Wittenberg, 06099 Halle, (Saale) Germany
| | - Annette Peters
- Helmholtz Zentrum München – Institute of Epidemiology, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany ,grid.5252.00000 0004 1936 973XInstitute for Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians Universität, Marchioninistr. 15, 81377 Munich, Germany
| | - Hermann Brenner
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ) – Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany ,grid.5253.10000 0001 0328 4908University of Heidelberg – Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| |
Collapse
|
14
|
Stingl M, Knipper M, Hetzger B, Richards J, Yazgan B, Gallhofer B, Hanewald B. Assessing the special need for protection of vulnerable refugees: testing the applicability of a screening method (RHS-15) to detect traumatic disorders in a refugee sample in Germany. ETHNICITY & HEALTH 2019; 24:897-908. [PMID: 29081242 DOI: 10.1080/13557858.2017.1379598] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Although EU member states are obligated to take special account of the situation of particularly vulnerable refugees, appropriate and specific measures to detect affected asylum seekers are not yet available. This study tries to pave the way for the implementation of an adequate instrument which at the same time assesses these needs of suffering people whilst responding to the need for mental health assessments specifically designed for refugees. This was done by testing the implementation of a screening method (Refugee Health Screener RHS-15) for trauma related mental health problems in refugees. Design: Two refugee samples in Germany (differing in arrival time: 126 applicants for asylum residing in the initial reception center and 116 living in long term communal accommodations) were assessed with the culturally sensitive Refugee Health Screener (RHS-15) to detect the incidence of mental health problems amongst them. Test fairness, reasonableness, susceptibility, transparency, acceptance, external design, utility and economy of the instrument were examined to check the applicability of the RHS-15 standardization test. Results: The RHS-15 indicates a good practical feasibility as the examination of the focused psychometric characteristics suggests. It became apparent, that implementing a screening procedure depends on political, legal and medical context factors that need to be considered. 2/3 of the participants had a positive screening result, which needs further diagnostic clarification in a second step. Conclusion: The RHS-15 seems to be practicable, economical, and rapidly deployable for the widespread detection of traumatic disorders in refugees living in Europe. The tool proved useful to aid diagnostic assessments and provide treatment to individuals in need, however the time of examination (resp. the duration of staying in the target land) influences the results.
Collapse
Affiliation(s)
- Markus Stingl
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Michael Knipper
- Institute for the History of Medicine, Justus-Liebig-University , Giessen , Germany
| | - Björge Hetzger
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Jessica Richards
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Bülent Yazgan
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Bernd Gallhofer
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Bernd Hanewald
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| |
Collapse
|
15
|
Somvanshi PR, Mellon SH, Flory JD, Abu-Amara D, Wolkowitz OM, Yehuda R, Jett M, Hood L, Marmar C, Doyle FJ. Mechanistic inferences on metabolic dysfunction in posttraumatic stress disorder from an integrated model and multiomic analysis: role of glucocorticoid receptor sensitivity. Am J Physiol Endocrinol Metab 2019; 317:E879-E898. [PMID: 31322414 PMCID: PMC6879860 DOI: 10.1152/ajpendo.00065.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 02/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with neuroendocrine alterations and metabolic abnormalities; however, how metabolism is affected by neuroendocrine disturbances is unclear. The data from combat-exposed veterans with PTSD show increased glycolysis to lactate flux, reduced TCA cycle flux, impaired amino acid and lipid metabolism, insulin resistance, inflammation, and hypersensitive hypothalamic-pituitary-adrenal (HPA) axis. To analyze whether the co-occurrence of multiple metabolic abnormalities is independent or arises from an underlying regulatory defect, we employed a systems biological approach using an integrated mathematical model and multiomic analysis. The models for hepatic metabolism, HPA axis, inflammation, and regulatory signaling were integrated to perform metabolic control analysis (MCA) with respect to the observations from our clinical data. We combined the metabolomics, neuroendocrine, clinical laboratory, and cytokine data from combat-exposed veterans with and without PTSD to characterize the differences in regulatory effects. MCA revealed mechanistic association of the HPA axis and inflammation with metabolic dysfunction consistent with PTSD. This was supported by the data using correlational and causal analysis that revealed significant associations between cortisol suppression, high-sensitivity C-reactive protein, homeostatic model assessment of insulin resistance, γ-glutamyltransferase, hypoxanthine, and several metabolites. Causal mediation analysis indicates that the effects of enhanced glucocorticoid receptor sensitivity (GRS) on glycolytic pathway, gluconeogenic and branched-chain amino acids, triglycerides, and hepatic function are jointly mediated by inflammation, insulin resistance, oxidative stress, and energy deficit. Our analysis suggests that the interventions to normalize GRS and inflammation may help to manage features of metabolic dysfunction in PTSD.
Collapse
Affiliation(s)
- Pramod R Somvanshi
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California
| | - Janine D Flory
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Duna Abu-Amara
- Department of Psychiatry, New York Langone Medical School, New York, New York
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco, California
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marti Jett
- Integrative Systems Biology, US Army Medical Research and Materiel Command, US Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland
| | - Leroy Hood
- Institute for Systems Biology, Seattle, Washington
| | - Charles Marmar
- Department of Psychiatry, New York Langone Medical School, New York, New York
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| |
Collapse
|
16
|
Katrinli S, Lori A, Kilaru V, Carter S, Powers A, Gillespie CF, Wingo AP, Michopoulos V, Jovanovic T, Ressler KJ, Smith AK. Association of HLA locus alleles with posttraumatic stress disorder. Brain Behav Immun 2019; 81:655-658. [PMID: 31310798 PMCID: PMC6754776 DOI: 10.1016/j.bbi.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Immune dysregulation has been widely observed in those with posttraumatic stress disorder (PTSD). An individual's immune response is shaped, in part, by the highly polymorphic Human Leukocyte Antigen (HLA) locus that is associated with major psychiatric disorders such as schizophrenia, major depression and bipolar disorder. The aim of the current study was to investigate the association between common HLA alleles and PTSD. METHODS Genome-wide association data was used to predict alleles of 7 classical polymorphic HLA genes (A, B, C, DRB1, DQA1, DQB1, DPB1) in 403 lifetime PTSD cases and 369 trauma exposed controls of African ancestry. Association of HLA allelic variations with lifetime PTSD was analyzed using logistic regression, controlling for ancestry, sex and multiple comparisons. The effect of HLA alleles on gene expression was assessed by weighted correlation network analysis (WGCNA), using 353 subjects with available expression data. Enrichment analysis was performed using anRichment to identify associated pathways of each module. RESULTS HLA-B*58:01 (p = 0.035), HLA-C*07:01 (p = 0.035), HLA-DQA1*01:01 (p = 0.003), HLA-DQB1*05:01 (p = 0.009) and HLA-DPB1*17:01 (p = 0.017) were more common in PTSD cases, while HLA-A*02:01 (p = 0.026), HLA-DQA1*05:05 (p = 0.011) and HLA-DRB1*11:01 (p < 0.001) were more frequent in controls. WGCNA was used to explore expression patterns of the PTSD related alleles. Gene expression modules of PTSD-related HLA alleles were enriched in various pathways, including pathways related to immune and neural activity. CONCLUSIONS To the best of our knowledge, this is the first study to report an association of HLA alleles with PTSD. Altogether, our results support the link between the immune system, brain and PTSD.
Collapse
Affiliation(s)
- Seyma Katrinli
- Emory University, Department of Gynecology and Obstetrics, Atlanta, Georgia, USA
| | - Adriana Lori
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA
| | - Varun Kilaru
- Emory University, Department of Gynecology and Obstetrics, Atlanta, Georgia, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Abigail Powers
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA
| | - Charles F. Gillespie
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA
| | - Aliza P. Wingo
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA,Division of Mental Health, Atlanta VA Medical Center, Decatur, GA, USA
| | - Vasiliki Michopoulos
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA
| | - Tanja Jovanovic
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA
| | - Kerry J. Ressler
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA,Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Alicia K. Smith
- Emory University, Department of Gynecology and Obstetrics, Atlanta, Georgia, USA,Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, USA,Corresponding author: Dr Alicia K Smith,
| |
Collapse
|
17
|
Alhaboby ZA, Barnes J, Evans H, Short E. Cyber-Victimization of People With Chronic Conditions and Disabilities: A Systematic Review of Scope and Impact. TRAUMA, VIOLENCE & ABUSE 2019; 20:398-415. [PMID: 29333943 DOI: 10.1177/1524838017717743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The victimization of individuals with chronic conditions or disabilities is prevalent with severe impact at psychological and physiological levels. With the increasing use of technology these experiences were further reshaped. This systematic review aimed at scoping the experiences of cyber-victimization of people living with chronic conditions or disabilities and examine the documented impact on them. Following a four-stage search strategy in several databases including MEDLINE, Embase, PsychINFO, CINAHL, Cochrane and snowballing of references, a total of 2,922 studies were scanned and 10 studies were eventually included. Quality assessment was done in two phases using tools specific to observational studies and cyber-victimization research. A narrative synthesis of reported results covered a total of 3,070 people. Sample size ranged between 42 and 823 participants, and the age range was 6-71 years with a majority of White ethnic backgrounds. Most studies (n=9) were cross sectional. The prevalence range of cyber-victimization was 2%-41.7% based on variable definitions, duration and methods. Targeted conditions included physical impairments, intellectual disabilities and specific chronic diseases. The most common documented impact was psychological/psychiatric, mainly depression followed by anxiety and distress. Somatic health complaints and self-harm were also reported. We concluded that people with chronic conditions and disabilities were consistently at higher risk of victimization with devastating health complications. Research gaps were identified such as the need to address more conditions and acknowledge differences between heterogeneous health conditions. Other recommendations include allowing flexibility and accountability to patients/victims in research design, education on victimization and health consequences, and improving primary care.
Collapse
Affiliation(s)
- Zhraa A Alhaboby
- 1 Institute for Health Research, University of Bedfordshire, Bedfordshire, United Kingdom
| | - James Barnes
- 2 National Centre for Cyberstalking Research, University of Bedfordshire, Bedfordshire, United Kingdom
| | - Hala Evans
- 1 Institute for Health Research, University of Bedfordshire, Bedfordshire, United Kingdom
| | - Emma Short
- 2 National Centre for Cyberstalking Research, University of Bedfordshire, Bedfordshire, United Kingdom
| |
Collapse
|
18
|
Impact of Length of Residence in the United States on Risk of Diabetes and Hypertension in Resettled Refugees. J Immigr Minor Health 2019; 20:296-306. [PMID: 28852919 DOI: 10.1007/s10903-017-0636-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The relationship between resettlement and development of chronic disease has yet to be elucidated in refugees. We aimed to assess the relationship between length of residence in the US and development of diabetes and hypertension utilizing multivariable logistic regression models in a sample of former refugee patients seeking primary care services. Multivariable logistic regression models adjusting for age, gender, and country of origin showed significantly increasing odds of type 2 diabetes (OR 1.12, 95% CI 1.03-1.22, p < 0.01) and hypertension (OR 1.07, 95% CI 1.00-1.14) with increasing length of stay in the US for resettled refugee adults. A significant proportion of diabetes (26.7%) and hypertension (36.9%) diagnoses were made within one year of arrival, highlighting the critical role of focusing diagnosis and prevention of chronic disease in newly resettled refugees, and continuing this focus throughout follow-up as these patients acculturate to their new homeland.
Collapse
|
19
|
Abstract
Although some studies have been conducted on the association between diabetes and anxiety symptoms, the data on this association remain controversial. The purpose of this meta-analysis was to examine the association between diabetes and anxiety symptoms. The authors systematically searched PubMed, Scopus, and Google Scholar databases until July 2018. After the screening process, 23 studies were included in the meta-analysis. Stata-14 was used for meta-analyzing. Forest plot was calculated for the whole 23 studies and subgroups, and publication bias was also examined. Overall, diabetes was positively associated with anxiety; pooled odds ratio was equal to1.48; 95% confidence interval was 1 .27-1.74. In cross-sectional study, the result was odds ratio = 1.50; 95% confidence interval = 1.26-1.77, and in prospective-cohort study, the result was odds ratio = 1.34; 95% confidence interval = 1.21-1.49. There was small evidence of publication bias. Overall, our findings indicate that diabetes is a risk factor for anxiety symptoms. Therefore, having a healthy medical condition can be an anxiety prevention agent.
Collapse
|
20
|
Posttraumatic Stress Disorder Augments Plasma Triglycerides in TT Homozygotes of rs495225 at Growth Hormone Secretagogue Receptor Gene. Biochem Genet 2018; 57:273-288. [PMID: 30269201 DOI: 10.1007/s10528-018-9890-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) and growth hormone secretagogue receptor (GHSR) were reported to be associated with plasma lipid and glucose levels. However, interplays of PTSD with GHSR on plasma lipid and glucose levels have not been explored yet. This study was to investigate the interplays of PTSD and GHSR rs495225 on plasma glucose and lipid profiles. A total of 709 high school students were recruited at 6 months after the 2008 Wenchuan earthquake. Variants of GHSR rs495225 were identified by polymerase chain reaction-restriction fragment length polymorphism analyses and verified by DNA sequencing. The PTSD Checklist Civilian Version (PCL-C) was used to assess PTSD. There was no significant difference of PTSD prevalence between the TT homozygotes and the C allele carriers. However, the students with PTSD had significantly lower levels of glucose, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) than the students without PTSD in the C allele carriers of GHSR rs495225 after the adjustment for age, gender and body mass index (BMI), but higher levels of TG and TG/HDL-C in the TT homozygotes. Meanwhile, the TT homozygotes had lower levels of HDL-C than the C allele carriers in the students without PTSD, but higher levels of insulin and HOMA-IR in the subjects with PTSD. After the adjustment of age and gender, and additional adjustment for BMI, the results were not changed except the difference of insulin was only a tendency (p = 0.054) after the additional adjustment for BMI. PTSD may augment TG levels and the related lipid ratio TG/HDL-C in the TT homozygotes of GHSR rs495225 but decrease the levels of glucose, insulin and HOMA-IR in the C allele carriers.
Collapse
|
21
|
Jacob L, Haro JM, Koyanagi A. Post-traumatic stress symptoms are associated with physical multimorbidity: Findings from the Adult Psychiatric Morbidity Survey 2007. J Affect Disord 2018. [PMID: 29522958 DOI: 10.1016/j.jad.2018.02.063] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Studies on the association between symptoms of post-traumatic stress disorder (PTSD) and physical multimorbidity (i.e., ≥2 chronic conditions) are lacking. Thus, we assessed the association between PTSD symptoms and physical multimorbidity using nationally representative, community-based data of the UK adult population. METHODS Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed. PTSD symptoms were assessed using the 10-item Trauma Screening Questionnaire (TSQ). A total score of ≥6 points indicated a probable PTSD. Information was collected on 20 doctor/other health professional diagnosed physical health conditions that were present in the past 12 months. Multimorbidity was defined as ≥2 physical diseases. Multivariable logistic regression and mediation analyses were conducted to analyze the association between PTSD and physical multimorbidity, and the influence of behavioral and psychological factors in this association. RESULTS Among 7403 individuals aged ≥16 years [mean age (SD) = 46.3 (18.6) years; 51.5% females], the prevalence of PTSD increased from 2.1% in individuals with no physical conditions to 5.4% in those with ≥4 physical conditions. After adjustment for sociodemographic factors and lifetime occurrence of a traumatic event, PTSD was associated with higher odds for physical multimorbidity (Odds Ratio [OR] = 2.47; 95% Confidence Interval [CI]: 1.71-3.56). Anxiety, depression, and disordered eating explained 35%, 21%, and 8% of the PTSD-multimorbidity association, respectively. LIMITATIONS Causality or temporal associations cannot be established due to the cross-sectional nature of the study. In addition, PTSD and physical conditions were assessed using self-reports. CONCLUSIONS PTSD symptoms may be risk factors for physical multimorbidity. Anxiety and depressive symptoms might play an important role in this association. Screening for chronic physical conditions among individuals with PTSD and treating them simultaneously may lead to better clinical outcomes.
Collapse
Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, 15 rue de l'École de Médecine, Paris 75006, France.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| |
Collapse
|
22
|
Jiang C. Posttraumatic stress disorder after a first-ever intracerebral hemorrhage in the Chinese population: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:1-8. [PMID: 29617165 DOI: 10.1080/23279095.2018.1451334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Che Jiang
- Department of Neurology, Guangzhou Military General Hospital, Guangzhou, China
| |
Collapse
|
23
|
Arigo D, Juth V, Trief P, Wallston K, Ulbrecht J, Smyth JM. Unique relations between post-traumatic stress disorder symptoms and patient functioning in type 2 diabetes. J Health Psychol 2017; 25:652-664. [PMID: 28859527 DOI: 10.1177/1359105317727839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study examined reported post-traumatic stress disorder symptoms in adults with poorly controlled type 2 diabetes who had no history of psychiatric diagnosis or treatment (n = 184, MHbA1c = 9.13%, standard deviation = 1.68). Participants reported moderate to severe intensity of post-traumatic stress disorder symptoms (M = 19.17, SD = 17.58). Together, depressive and post-traumatic stress disorder symptoms accounted for 10-40 percent of the variance in type 2 diabetes outcomes; post-traumatic stress disorder symptoms were associated with elevated diabetes distress and more frequent exercise and self-blood glucose testing (unique R2 ~ 3%). Post-traumatic stress disorder symptoms may be overlooked in type 2 diabetes among patients without formal psychiatric diagnoses, and warrant increased attention.
Collapse
|
24
|
Surya M, Jaff D, Stilwell B, Schubert J. The Importance of Mental Well-Being for Health Professionals During Complex Emergencies: It Is Time We Take It Seriously. GLOBAL HEALTH, SCIENCE AND PRACTICE 2017; 5:188-196. [PMID: 28655798 PMCID: PMC5487082 DOI: 10.9745/ghsp-d-17-00017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/23/2017] [Indexed: 12/20/2022]
Abstract
We call on humanitarian aid organizations to integrate proven mental health strategies to protect the mental health of their workforce and improve staff capacity to provide care for vulnerable populations. Such strategies could include: Pre-deployment training Art therapy Team building Physical exercise Mindfulness or contemplative techniques Mind-body exercises Narrative Exposure Therapy Eye movement desensitization and reprocessing
Collapse
Affiliation(s)
- Mary Surya
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA.
| | - Dilshad Jaff
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Johanna Schubert
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| |
Collapse
|
25
|
Aronson BD, Palombi LC, Walls ML. Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes. J Behav Med 2016; 39:694-703. [PMID: 27001254 PMCID: PMC4945379 DOI: 10.1007/s10865-016-9733-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.
Collapse
Affiliation(s)
- Benjamin D Aronson
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812, USA.
| | - Laura C Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812, USA
| | - Melissa L Walls
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| |
Collapse
|
26
|
Stein MB, Chen CY, Ursano RJ, Cai T, Gelernter J, Heeringa S, Jain S, Jensen KP, Maihofer A, Mitchell C, Nievergelt CM, Nock MK, Neale BM, Polimanti R, Ripke S, Sun X, Thomas ML, Wang Q, Ware EB, Borja S, Kessler RC, Smoller JW. Genome-wide Association Studies of Posttraumatic Stress Disorder in 2 Cohorts of US Army Soldiers. JAMA Psychiatry 2016; 73:695-704. [PMID: 27167565 PMCID: PMC4936936 DOI: 10.1001/jamapsychiatry.2016.0350] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is a prevalent, serious public health concern, particularly in the military. The identification of genetic risk factors for PTSD may provide important insights into the biological foundation of vulnerability and comorbidity. OBJECTIVE To discover genetic loci associated with the lifetime risk for PTSD in 2 cohorts from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). DESIGN, SETTING, AND PARTICIPANTS Two coordinated genome-wide association studies of mental health in the US military contributed participants. The New Soldier Study (NSS) included 3167 unique participants with PTSD and 4607 trauma-exposed control individuals; the Pre/Post Deployment Study (PPDS) included 947 unique participants with PTSD and 4969 trauma-exposed controls. The NSS data were collected from February 1, 2011, to November 30, 2012; the PDDS data, from January 9 to April 30, 2012. The primary analysis compared lifetime DSM-IV PTSD cases with trauma-exposed controls without lifetime PTSD. Data were analyzed from March 18 to December 27, 2015. MAIN OUTCOMES AND MEASURES Association analyses for PTSD used logistic regression models within each of 3 ancestral groups (European, African, and Latino American) by study, followed by meta-analysis. Heritability and genetic correlation and pleiotropy with other psychiatric and immune-related disorders were estimated. RESULTS The NSS population was 80.7% male (6277 of 7774 participants; mean [SD] age, 20.9 [3.3] years); the PPDS population, 94.4% male (5583 of 5916 participants; mean [SD] age, 26.5 [6.0] years). A genome-wide significant locus was found in ANKRD55 on chromosome 5 (rs159572; odds ratio [OR], 1.62; 95% CI, 1.37-1.92; P = 2.34 × 10-8) and persisted after adjustment for cumulative trauma exposure (adjusted OR, 1.64; 95% CI, 1.39-1.95; P = 1.18 × 10-8) in the African American samples from the NSS. A genome-wide significant locus was also found in or near ZNF626 on chromosome 19 (rs11085374; OR, 0.77; 95% CI, 0.70-0.85; P = 4.59 × 10-8) in the European American samples from the NSS. Similar results were not found for either single-nucleotide polymorphism in the corresponding ancestry group from the PPDS sample, in other ancestral groups, or in transancestral meta-analyses. Single-nucleotide polymorphism-based heritability was nonsignificant, and no significant genetic correlations were observed between PTSD and 6 mental disorders or 9 immune-related disorders. Significant evidence of pleiotropy was observed between PTSD and rheumatoid arthritis and, to a lesser extent, psoriasis. CONCLUSIONS AND RELEVANCE In the largest genome-wide association study of PTSD to date, involving a US military sample, limited evidence of association for specific loci was found. Further efforts are needed to replicate the genome-wide significant association with ANKRD55-associated in prior research with several autoimmune and inflammatory disorders-and to clarify the nature of the genetic overlap observed between PTSD and rheumatoid arthritis and psoriasis.
Collapse
Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Department of Family Medicine and Public Health, UCSD, La Jolla, CA,VA San Diego Healthcare System, San Diego, CA
| | - Chia-Yen Chen
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Robert J. Ursano
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Tianxi Cai
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Joel Gelernter
- Departments of Psychiatry, Genetics, and Neurobiology, Yale University, New Haven, CT
| | - Steven Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Sonia Jain
- Department of Family Medicine and Public Health, UCSD, La Jolla, CA
| | - Kevin P. Jensen
- Departments of Psychiatry, Genetics, and Neurobiology, Yale University, New Haven, CT
| | - Adam Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | | | | | - Benjamin M. Neale
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Renato Polimanti
- Departments of Psychiatry, Genetics, and Neurobiology, Yale University, New Haven, CT
| | - Stephan Ripke
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Department of Psychology, Harvard University, Cambridge, MA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, UCSD, La Jolla, CA
| | - Michael L. Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Qian Wang
- Departments of Psychiatry, Genetics, and Neurobiology, Yale University, New Haven, CT
| | - Erin B. Ware
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Susan Borja
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | | |
Collapse
|
27
|
Nobles CJ, Valentine SE, Borba CPC, Gerber MW, Shtasel DL, Marques L. Black-white disparities in the association between posttraumatic stress disorder and chronic illness. J Psychosom Res 2016; 85:19-25. [PMID: 27212665 PMCID: PMC4879687 DOI: 10.1016/j.jpsychores.2016.03.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD. METHODS We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales. RESULTS The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI -0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p=0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p=0.051). CONCLUSION A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela.
Collapse
Affiliation(s)
- Carrie J Nobles
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
| | - Sarah E Valentine
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Christina P C Borba
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Monica W Gerber
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA
| | - Derri L Shtasel
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| |
Collapse
|
28
|
Abstract
Exposure to adversity in childhood (adverse childhood experiences [ACEs]) is linked to a number of chronic diseases in adulthood, yet there is limited research examining the impact of ACEs on diabetes. The current review sought to examine the association between ACEs, other trauma exposure or posttraumatic stress disorder (PTSD) diagnosis, and risk for diabetes. Thirty-eight studies are reviewed. Unlike in other diseases, several studies in diabetes show a threshold-response versus a dose-response relation, while other studies show a relation between greater abuse severity and diabetes risk. There were mixed results for studies examining abuse type and frequency. Chronic or comorbid PTSD was also related to increased diabetes risk among veterans, but in community samples, only trauma exposure predicted diabetes risk. While the research is still limited, diabetes researchers and clinicians should consider screening for ACEs and examine severity and frequency across abuse type as a predictor of both diabetes and poor diabetes outcomes.
Collapse
Affiliation(s)
- Lindsay Huffhines
- University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA
- Center for Children's Healthy Lifestyles and Development, 610 E. 22nd Street, Kansas City, MO, 64108, USA
| | - Amy Noser
- University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA
- Center for Children's Healthy Lifestyles and Development, 610 E. 22nd Street, Kansas City, MO, 64108, USA
| | - Susana R Patton
- Center for Children's Healthy Lifestyles and Development, 610 E. 22nd Street, Kansas City, MO, 64108, USA.
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| |
Collapse
|
29
|
Abstract
OBJECTIVE To clarify the prevalence and predictors of Type 2 diabetes mellitus (T2DM) in people with posttraumatic stress disorder (PTSD) and where possible compare this to healthy controls. METHODS We searched major electronic databases until May 2015 for studies reporting T2DM prevalence in people with PTSD. Two independent authors extracted data and completed methodological quality appraisal. A random-effects meta-analysis was used. RESULTS From 1171 candidate publications after exclusions, nine publications were included (n = 23,396; 28.6% male; mean age = 35-60 years). The overall prevalence of T2DM was 10.0% (95% confidence interval [CI] = 8.1%-12.0%). Subgroup analysis demonstrated that war veterans experience higher prevalence of T2DM (16.3%; 95% CI = 5.2%-31.8%; n studies = 3, n = 473) compared with mixed samples (11.8%; 95% CI = 6.34-18.7, p < .001; n studies = 4, n = 2753). Increasing age (β = 0.0593, 95% CI = 0.010-0.109, z = 2.34, p = .019), median year of publication (β = -0.08, 95% CI = -0.14 to -0.03, z = -3.09, p = .002), and a lower percentage of white participants (β = -3.21, 95% CI = -5.12 to -1.29, z = -2.28, p = .001) predicted prevalence of T2DM. A relative risk meta-analysis comparing controls (n = 125,723) against those with PTSD (n = 23,203) demonstrated a significantly increased risk of T2DM (n studies = 5, relative risk = 1.49, 95% CI = 1.17-1.89, p = .001). CONCLUSIONS People with PTSD are at a high risk for developing T2DM. The current findings should, however, be interpreted with caution because most studies were based on self-report data.
Collapse
|
30
|
Telomere length and telomere repeating factors: Cellular markers for post-traumatic stress disorder-like model. J Affect Disord 2016; 195:156-62. [PMID: 26896808 DOI: 10.1016/j.jad.2016.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/08/2015] [Accepted: 02/07/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the present study was to explore the telomere length of peripheral blood leukocytes from a rat model of post-traumatic stress disorder (PTSD), as well as the expression level of telomere-binding protein in the hippocampal CA1 region. METHODS The PTSD model was established with 42 adult male Wistar rats. The relative telomere length of the leukocytes was measured by real-time fluorescence quantitative polymerase chain reaction, and the expression levels of telomere repeating factor 1 (TRF1) and telomere repeating factor 2 (TRF2) in the hippocampal CA1 region of the PTSD rat model were determined by immunofluorescence technology. The covariance analysis of repeated measurements by the mixed model approach was used for the telomere length analysis. The comparison of averaged data among groups was performed using least significant difference and analysis of variance. The Student's t test or the Mann-Whitney U test was used for intragroup comparison. The association study among groups was conducted using the Spearman test. RESULTS The shortening speed of telomere length significantly accelerated in rats after Single Prolonged Stress (SPS) stimulation (P<0.05). The expression levels of TRF1 and TRF2 increased with the progress of PTSD, and the expression peak was shown in day 14, which was significantly different from the control group (P<0.05). CONCLUSION The shortening speed of the telomere length of peripheral blood leukocytes accelerated in PTSD rats, and the expression levels of TRF1 and TRF2 increased in hippocampus, both of which were closely associated with the pathological progress of the PTSD-like model and unfavorable prognosis.
Collapse
|
31
|
Malan-Müller S, Fairbairn L, Daniels WMU, Dashti MJS, Oakeley EJ, Altorfer M, Kidd M, Seedat S, Gamieldien J, Hemmings SMJ. Molecular mechanisms of D-cycloserine in facilitating fear extinction: insights from RNAseq. Metab Brain Dis 2016; 31:135-56. [PMID: 26400817 DOI: 10.1007/s11011-015-9727-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/02/2015] [Indexed: 01/24/2023]
Abstract
D-cycloserine (DCS) has been shown to be effective in facilitating fear extinction in animal and human studies, however the precise mechanisms whereby the co-administration of DCS and behavioural fear extinction reduce fear are still unclear. This study investigated the molecular mechanisms of intrahippocampally administered D-cycloserine in facilitating fear extinction in a contextual fear conditioning animal model. Male Sprague Dawley rats (n = 120) were grouped into four experimental groups (n = 30) based on fear conditioning and intrahippocampal administration of either DCS or saline. The light/dark avoidance test was used to differentiate maladapted (MA) (anxious) from well-adapted (WA) (not anxious) subgroups. RNA extracted from the left dorsal hippocampus was used for RNA sequencing and gene expression data was compared between six fear-conditioned + saline MA (FEAR + SALINE MA) and six fear-conditioned + DCS WA (FEAR + DCS WA) animals. Of the 424 significantly downregulated and 25 significantly upregulated genes identified in the FEAR + DCS WA group compared to the FEAR + SALINE MA group, 121 downregulated and nine upregulated genes were predicted to be relevant to fear conditioning and anxiety and stress-related disorders. The majority of downregulated genes transcribed immune, proinflammatory and oxidative stress systems molecules. These molecules mediate neuroinflammation and cause neuronal damage. DCS also regulated genes involved in learning and memory processes, and genes associated with anxiety, stress-related disorders and co-occurring diseases (e.g., cardiovascular diseases, digestive system diseases and nervous system diseases). Identifying the molecular underpinnings of DCS-mediated fear extinction brings us closer to understanding the process of fear extinction.
Collapse
Affiliation(s)
- Stefanie Malan-Müller
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Lorren Fairbairn
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Willie M U Daniels
- Department of Human Physiology, University of KwaZulu-Natal, Durban, South Africa
| | | | - Edward J Oakeley
- Novartis Institutes for BioMedical Research, Biomarker Development - Human Genetics and Genomics, Genome Technologies, Basel, Switzerland
| | - Marc Altorfer
- Novartis Institutes for BioMedical Research, Biomarker Development - Human Genetics and Genomics, Genome Technologies, Basel, Switzerland
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Junaid Gamieldien
- University of the Western Cape, South African National Bioinformatics Institute, Cape Town, South Africa
| | - Sîan Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
32
|
Altevers J, Lukaschek K, Baumert J, Kruse J, Meisinger C, Emeny RT, Ladwig KH. Poor structural social support is associated with an increased risk of Type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study. Diabet Med 2016; 33:47-54. [PMID: 26331457 DOI: 10.1111/dme.12951] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 12/31/2022]
Abstract
AIMS Several psychosocial factors have been shown to increase the risk of Type 2 diabetes mellitus. This study investigated the association between structural social support and incidence of Type 2 diabetes mellitus in men and women. METHODS Data were derived from three population-based MONICA/KORA surveys conducted in 1984-1995 in the Augsburg region (southern Germany) and followed up by 2009. The study population comprised 8952 participants (4669 men/4283 women) aged 30-74 years without diabetes at baseline. Structural social support was assessed using the Social Network Index. Sex-specific hazard ratios were estimated from Cox proportional hazard models. RESULTS Within follow-up, 904 incident Type 2 diabetes mellitus cases (558 men, 346 women) were observed. Crude incidence rates for Type 2 diabetes mellitus per 10 000 person-years were substantially higher in poor compared with good structural social support (men: 94 vs. 69, women: 58 vs. 43). After adjustment for age, survey, parental history of diabetes, smoking status, alcohol intake, physical activity, hypertension, dyslipidaemia, BMI, education, sleep complaints and depressed mood, risk of Type 2 diabetes mellitus for participants with poor compared with good structural social support was 1.31 [95% confidence interval (CI) = 1.11-1.55] in men and 1.10 (95% CI = 0.88-1.37) in women. Stratified analyses revealed a hazard ratio of 1.50 (95% CI = 1.23-1.83) in men with a low level of education and 0.87 (95% CI = 0.62-1.22) in men with a high level of education (P for interaction: 0.0082). CONCLUSIONS Poor structural social support is associated with Type 2 diabetes mellitus in men. This association is independent of risk factors at baseline and is particularly pronounced in men with a low level of education.
Collapse
Affiliation(s)
- J Altevers
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - K Lukaschek
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - J Baumert
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), partner site Munich, Germany
| | - J Kruse
- German Center for Diabetes Research (DZD), partner site Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Augsburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Marburg, Augsburg, Germany
| | - C Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
| | - R T Emeny
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - K H Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), partner site Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| |
Collapse
|
33
|
Hasan SS, Clavarino AM, Dingle K, Mamun AA, Kairuz T. Diabetes Mellitus and the Risk of Depressive and Anxiety Disorders in Australian Women: A Longitudinal Study. J Womens Health (Larchmt) 2015; 24:889-98. [DOI: 10.1089/jwh.2015.5210] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Syed Shahzad Hasan
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | | | - Kaeleen Dingle
- Queensland University of Technology, Queensland, Australia
| | - Abdullah A. Mamun
- School of Population Health, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Therese Kairuz
- Department of Pharmacy, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
34
|
Trauma- und Gewaltfolgen – psychische Auswirkungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:28-34. [DOI: 10.1007/s00103-015-2259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
35
|
Miller-Graff LE, Cater ÅK, Howell KH, Graham-Bermann SA. Victimization in childhood: General and specific associations with physical health problems in young adulthood. J Psychosom Res 2015. [PMID: 26208402 DOI: 10.1016/j.jpsychores.2015.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The goal of the current study was to examine the direct relationship between diverse types of childhood victimization and physical health problems in early adulthood, controlling for other common factors that contribute to physical health problems, including psychopathology and health risk behaviors. The associations between types of victimization (e.g., physical assault) and specific health problems (e.g., pain) were also examined. METHODS 2500 Swedish young adults reported on their exposure to victimization in childhood and their current mental and physical health as adults. RESULTS Using multiple regression, results indicated that the amount of childhood victimization was a significant predictor of health problems in adulthood, controlling for the significant negative effects of health risk behaviors and mental health problems on physical health. Logistic regressions indicated that physical assaults and sexual abuse were associated with all types of health problems assessed. Sleep problems were associated with almost all types of victimization history. CONCLUSIONS The long-term effects of childhood victimization on physical health in adulthood are serious and warrant significant attention. Primary care providers should include assessments of past victimization as one way of screening for health risk. Health providers should also consider multiple points of intervention that may help to reduce physical illness. For example, providing a mental health intervention or social service support related to victimization experiences may not only address these difficulties, but also more broadly impact physical health as well.
Collapse
Affiliation(s)
- Laura E Miller-Graff
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, 107 Haggar Hall, Notre Dame, IN 46556, United States.
| | - Åsa Källström Cater
- School of Law, Psychology and Social Work, Örebro University, 701 82 Örebro, Sweden
| | - Kathryn H Howell
- Department of Psychology, University of Memphis, 202 Psychology Building, Memphis, TN 38152, United States
| | - Sandra A Graham-Bermann
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109-1043, United States
| |
Collapse
|
36
|
Lohr JB, Palmer BW, Eidt CA, Aailaboyina S, Mausbach BT, Wolkowitz OM, Thorp SR, Jeste DV. Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature. Am J Geriatr Psychiatry 2015; 23:709-25. [PMID: 25959921 PMCID: PMC4568841 DOI: 10.1016/j.jagp.2015.04.001] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) has major public health significance. Evidence that PTSD may be associated with premature senescence (early or accelerated aging) would have major implications for quality of life and healthcare policy. We conducted a comprehensive review of published empirical studies relevant to early aging in PTSD. METHOD Our search included the PubMed, PsycINFO, and PILOTS databases for empirical reports published since the year 2000 relevant to early senescence and PTSD, including: 1) biomarkers of senescence (leukocyte telomere length [LTL] and pro-inflammatory markers), 2) prevalence of senescence-associated medical conditions, and 3) mortality rates. RESULTS All six studies examining LTL indicated reduced LTL in PTSD (pooled Cohen's d = 0.76). We also found consistent evidence of increased pro-inflammatory markers in PTSD (mean Cohen's ds), including C-reactive protein = 0.18, Interleukin-1 beta = 0.44, Interleukin-6 = 0.78, and tumor necrosis factor alpha = 0.81. The majority of reviewed studies also indicated increased medical comorbidity among several targeted conditions known to be associated with normal aging, including cardiovascular disease, type 2 diabetes mellitus, gastrointestinal ulcer disease, and dementia. We also found seven of 10 studies indicated PTSD to be associated with earlier mortality (average hazard ratio: 1.29). CONCLUSION In short, evidence from multiple lines of investigation suggests that PTSD may be associated with a phenotype of accelerated senescence. Further research is critical to understand the nature of this association. There may be a need to re-conceptualize PTSD beyond the boundaries of mental illness, and instead as a full systemic disorder.
Collapse
Affiliation(s)
- James B. Lohr
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Barton W. Palmer
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Carolyn A. Eidt
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Smitha Aailaboyina
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Brent T. Mausbach
- University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | | | - Steven R. Thorp
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Dilip V. Jeste
- University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| |
Collapse
|
37
|
Ciocca G, Carosa E, Stornelli M, Limoncin E, Gravina GL, Iannarelli R, Sperandio A, Di Sante S, Lenzi A, Lauro D, Jannini EA. Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L'Aquila earthquake. Acta Diabetol 2015; 52:513-21. [PMID: 25408297 DOI: 10.1007/s00592-014-0686-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
AIM After natural and collective catastrophes, many behavioral phenomena can occur through psychobiological responses that involve also the diabetic condition.The aim of this study was to investigate post-traumatic stress disorder (PTSD) and coping strategies in type 2 diabetic patients after L'Aquila earthquake, with a particular attention to the newly diagnosed patients and to the gender differences. METHODS Among the local diabetic population, we recruited 100 diabetic patients (46 women and 54 men). Sixty of these had diabetes before the earthquake (pre-quake patients), and other 40 received diabetes diagnosis after the earthquake (post-quake patients). A psychometric protocol composed by Davidson Trauma Scale for PTSD and Brief-COPE for coping strategies was administered. RESULTS We found significant differences in the levels of PTSD when comparing both post-quake with pre-quake patients (post-quake = 51.72 ± 26.05 vs. pre-quake = 31.65 ± 22.59; p < 0.05) and the female patients with males (women = 53.50 ± 27.01 vs. men = 31.65 ± 23.06; p < 0.05) and also in the prevalence [post-quake = 27/40 (67.5 %) vs. pre-quake = 20/60 (33.3 %); p < 0.05], [women = 27/46 (58.69 %) vs. men = 16/54 (29.62 %); p < 0.05]. Moreover, maladaptive coping was a predictive factor for PTSD in the post-quake group only (OR 1.682; 95 % CI 1.155-2.450; p = 0.006). CONCLUSIONS Our results revealed that PTSD may be considered an important comorbidity factor in newly diagnosed patients and in diabetic women. Hence, a psychological support seems particularly important in these patients after a collective traumatic event to help them react to both PTSD and diabetes and to help them improve their coping skills.
Collapse
Affiliation(s)
- Giacomo Ciocca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Pile V, Barnhofer T, Wild J. Updating versus Exposure to Prevent Consolidation of Conditioned Fear. PLoS One 2015; 10:e0122971. [PMID: 25902141 PMCID: PMC4406712 DOI: 10.1371/journal.pone.0122971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 02/17/2015] [Indexed: 11/23/2022] Open
Abstract
Targeting the consolidation of fear memories following trauma may offer a promising method for preventing the development of flashbacks and other unwanted re-experiencing symptoms that characterise Posttraumatic Stress Disorder (PTSD). Research has demonstrated that performing visuo-spatial tasks after analogue trauma can block the consolidation of fear memory and reduce the frequency of flashbacks. However, no research has yet used verbal techniques to alter memories during the consolidation window. This is surprising given that the most effective treatments for PTSD are verbally-based with exposure therapy and trauma-focused cognitive behavioural therapy gaining the most evidence of efficacy. Psychological therapies aim to reduce the conditioned fear response, which is in keeping with the preliminary finding that an increased propensity for fear conditioning may be a vulnerability factor for PTSD. Our research had two aims. We investigated the degree to which individual differences in fear conditioning predict the development of PTSD symptoms. We also compared the preventative effects of two clinically informed psychological techniques administered during the consolidation window: exposure to the trauma memory and updating the meaning of the trauma. 115 healthy participants underwent a fear conditioning paradigm in which traumatic film stimuli (unconditioned stimuli) were paired with neutral stimuli (conditioned stimuli). Participants were randomly allocated to an updating, exposure or control group to compare the effects on the conditioned fear response and on PTSD symptomatology. The results showed that stronger conditioned responses at acquisition significantly predicted the development of PTSD symptoms. The updating group, who verbally devalued the unconditioned stimulus within the consolidation window, experienced significantly lower levels of PTSD symptoms during follow-up than the exposure and control groups. These findings are consistent with clinical interventions for chronic PTSD and have important implications for identifying those at risk as well as for designing novel early interventions to prevent the development of PTSD.
Collapse
Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Thorsten Barnhofer
- Department of Psychology, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
39
|
Chen MH, Pan TL, Li CT, Lin WC, Chen YS, Lee YC, Tsai SJ, Hsu JW, Huang KL, Tsai CF, Chang WH, Chen TJ, Su TP, Bai YM. Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study. Br J Psychiatry 2015; 206:302-7. [PMID: 25698764 DOI: 10.1192/bjp.bp.113.143610] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 09/19/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous evidence has shown positive associations between post-traumatic stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes mellitus, which are all risk factors for stroke, but the role of PTSD in the subsequent development of stroke is still unknown. AIMS To investigate the temporal association between PTSD and the development of stroke. METHOD Identified from the Taiwan National Health Insurance Research Database, 5217 individuals aged ≥18 years, with PTSD but with no history of stroke, and 20 868 age- and gender-matched controls were enrolled between 2002 and 2009, and followed up until the end of 2011 to identify the development of stroke. RESULTS Individuals with PTSD had an increased risk of developing any stroke (hazard ratio (HR) 3.37, 95% CI 2.44-4.67) and ischaemic stroke (HR = 3.47, 95% CI 2.23-5.39) after adjusting for demographic data and medical comorbidities. Sensitivity tests showed consistent findings (any stroke HR = 3.02, 95% CI 2.13-4.28; ischaemic stroke HR = 2.89, 95% CI 1.79-4.66) after excluding the first year of observation. CONCLUSIONS Individuals with PTSD have an increased risk of developing any stroke and ischaemic stroke. Further studies are required to investigate the underlying mechanisms.
Collapse
Affiliation(s)
- Mu-Hong Chen
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Long Pan
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Ta Li
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chen Lin
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Sheue Chen
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chiao Lee
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lin Huang
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Fen Tsai
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Han Chang
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
40
|
Sibener L, Zaganjor I, Snyder HM, Bain LJ, Egge R, Carrillo MC. Alzheimer's Disease prevalence, costs, and prevention for military personnel and veterans. Alzheimers Dement 2015; 10:S105-10. [PMID: 24924663 DOI: 10.1016/j.jalz.2014.04.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
By 2050, more than 13 million Americans of all ages are estimated to be living with Alzheimer's disease (AD), and the aggregate costs of care will swell to approximately $1.2 trillion. The rapidly climbing number of those affected with AD includes a growing population of aging military veterans affected who may have an added risk for the disease as a consequence of traumatic brain injury, posttraumatic stress disorder, and/or service-related injuries. The increasing number of individuals, the long duration of disability, and the rising cost of care for AD and other dementia to our society are important public health challenges facing many older adults. These challenges are further compounded by a burgeoning military veteran population that is much younger, with an increased risk of AD and other dementia, and who may experience decades-long periods of disability and care. This outlook underscores the critical need for investments in research at the federal and international levels to accelerate the pace of progress in developing breakthrough discoveries that will change the trajectory of AD and related dementia.
Collapse
Affiliation(s)
- Leslie Sibener
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA
| | - Ibrahim Zaganjor
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA
| | - Heather M Snyder
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA
| | - Lisa J Bain
- Independent Science Writer, Philadelphia, PA, USA
| | - Robert Egge
- Public Policy and Advocacy Division, Alzheimer's Association, Washington, DC, USA
| | - Maria C Carrillo
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA.
| |
Collapse
|
41
|
Baumert J, Meisinger C, Lukaschek K, Emeny RT, Rückert IM, Kruse J, Ladwig KH. A pattern of unspecific somatic symptoms as long-term premonitory signs of type 2 diabetes: findings from the population-based MONICA/KORA cohort study, 1984-2009. BMC Endocr Disord 2014; 14:87. [PMID: 25416641 PMCID: PMC4247721 DOI: 10.1186/1472-6823-14-87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unspecific symptoms often proceed a serious chronic disease condition long before the onset of the disease. The role of an unspecific premonitory symptom (UPMS) pattern as premonitory signs of subsequent type 2 diabetes mellitus (T2DM) diagnosis independent of established cardio-metabolic risk factors is unclear and therefore was examined in the present study. METHODS The study population consisted of 10,566 participants aged 25-74 years at baseline drawn from the population-based MONICA/KORA Cohort Study conducted in 1984-2009 in the Augsburg region (Germany). Unspecific premonitory symptoms were assessed following the Somatic Symptom Scale-8 (SSS-8). The impact of the score on T2DM risk within a mean follow-up time of 16 years was estimated by Cox regression. RESULTS Within follow-up, 974 newly diagnosed T2DM cases were observed. The risk for T2DM increased by a hazard ratio (HR) of 1.03 (95% CI 1.01-1.04, p value < 0.001) for a one unit increase of the UPMS score in a Cox model adjusted for age, sex and survey. Additional adjustment for cardio-metabolic risk factors attenuated this effect (HR = 1.02) but significance remained (p value = 0.01). CONCLUSIONS Suffering from an elevated burden of unspecific somatic symptoms is associated with T2DM long before the onset and independent of established cardio-metabolic risk factors. Further research is needed to obtain insight in potential underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Jens Baumert
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Christa Meisinger
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
- />Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
| | - Karoline Lukaschek
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Rebecca Thwing Emeny
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Ina-Maria Rückert
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Johannes Kruse
- />Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Giessen, Germany
- />Department of Psychosomatic Medicine and Psychotherapy, University of Marburg, Marburg, Germany
| | - Karl-Heinz Ladwig
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
- />Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| |
Collapse
|
42
|
Rao MN, Chau A, Madden E, Inslicht S, Talbot L, Richards A, O’Donovan A, Ruoff L, Grunfeld C, Neylan TC. Hyperinsulinemic response to oral glucose challenge in individuals with posttraumatic stress disorder. Psychoneuroendocrinology 2014; 49:171-81. [PMID: 25108160 PMCID: PMC4165697 DOI: 10.1016/j.psyneuen.2014.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/23/2014] [Accepted: 07/08/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with a 2-4 fold increased risk of developing Type 2 diabetes mellitus. However, detailed assessments of glucose metabolism and insulin secretion in a study designed to minimize confounders are lacking. Furthermore, few studies examine potential mechanisms involved. We analyzed data from a case-control study of medically healthy, medication-free adults to determine whether individuals with PTSD had abnormal glucose or insulin response to oral glucose tolerance test (OGTT) compared to controls. Secondarily, we assessed potential mediators such as sleep, cortisol and adiponectin. METHODS Data was analyzed from 92 age and gender-matched subjects (44 PTSD, 48 controls). Chronic PTSD was diagnosed using the Structured Clinical Interview for DSM-IV and Clinician Administered PTSD Scale. Subjects underwent 75-g OGTT, actigraphy and sleep diary (to quantify sleep duration), polysomnography (to assess slow wave sleep [SWS] and delta power), and overnight blood sampling (for cortisol and adiponectin). RESULTS At baseline, individuals with PTSD had mildly increased insulin levels (by 19%, compared to controls, p=0.048) that was mediated primarily by weight. In response to OGTT, the PTSD group had higher levels of insulin at 120 min (by 44%, p=0.03) and insulin AUC (by 43%, p=0.015) compared to controls, after adjusting for confounders. Glucose levels were similar in the two groups. Although self-reported sleep duration, SWS, and delta power differed between PTSD subjects and controls, they did not mediate the effects of PTSD status on insulin response. CONCLUSION In this case-control study, individuals with PTSD had a hyperinsulinemic response to oral glucose challenge compared to controls, suggestive of insulin resistance.
Collapse
Affiliation(s)
- Madhu N. Rao
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, U.S.A,Corresponding Author: Madhu N. Rao, MD, San Francisco VA Medical Center (111F), 4150 Clement Street, San Francisco, CA 94121, , Ph: 415-750-2005, Fax: 415-476-4918
| | - Alanna Chau
- Albert Einstein College of Medicine, New York, NY, U.S.A
| | - Erin Madden
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Northern California Institute for Research and Education, San Francisco, CA, U.S.A
| | - Sabra Inslicht
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Lisa Talbot
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Anne Richards
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Aoife O’Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Leslie Ruoff
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A
| | - Carl Grunfeld
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| |
Collapse
|
43
|
Vaccarino V, Goldberg J, Magruder KM, Forsberg CW, Friedman MJ, Litz BT, Heagerty PJ, Huang GD, Gleason TC, Smith NL. Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study. J Psychiatr Res 2014; 56:158-64. [PMID: 24950602 PMCID: PMC4086302 DOI: 10.1016/j.jpsychires.2014.05.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Growing evidence has linked posttraumatic stress disorder (PTSD) to insulin resistance and type-2 diabetes, but most previous studies were cross-sectional. We examined the association between PTSD and incidence of diabetes in a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Lifetime PTSD was diagnosed at baseline with the Diagnostic Interview Schedule (DIS) according to DSM-III-R criteria. Subthreshold PTSD was defined by meeting some, but not all, criteria for PTSD. A total of 4340 respondents without self-reported diabetes at baseline were included. Of these, 658 reported a new diagnosis of treated diabetes over a median of 19.4 years of follow-up. At baseline, twins with PTSD showed more behavioral and metabolic risk factors such as overweight and hypertension. The age-adjusted cumulative incidence of diabetes was significantly higher in twins with PTSD (18.9%) than those without PTSD (14.4%), [odds ratio (OR) = 1.4, 95% confidence interval (CI) 1.03-1.8], and intermediate in those with subthreshold PTSD (16.4%) (OR = 1.2, 95% CI 0.9-1.5, p for trend = 0.03). Adjustment for military, lifestyle and metabolic factors diminished the association. No significant association was found comparing twin pairs discordant for PTSD. In conclusion, PTSD was prospectively associated with a 40% increased risk of new-onset type-2 diabetes which was partially explained by a cluster of metabolic and behavioral risk factors known to influence insulin resistance. Shared biological or behavioral precursors which occur within families may lead to both PTSD and insulin resistance/diabetes. Thus, PTSD could be a marker of neuroendocrine and metabolic dysregulation which may lead to type-2 diabetes.
Collapse
Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta, GA, United States.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Miller-Archie SA, Jordan HT, Ruff RR, Chamany S, Cone JE, Brackbill RM, Kong J, Ortega F, Stellman SD. Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster. Prev Med 2014; 66:34-8. [PMID: 24879890 DOI: 10.1016/j.ypmed.2014.05.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the temporal relationship between 9/11-related posttraumatic stress disorder (PTSD) and new-onset diabetes in World Trade Center (WTC) survivors up to 11 years after the attack in 2001. METHODS Three waves of surveys (conducted from 2003 to 2012) from the WTC Health Registry cohort collected data on physical and mental health status, sociodemographic characteristics, and 9/11-related exposures. Diabetes was defined as self-reported, physician-diagnosed diabetes reported after enrollment. After excluding prevalent cases, there were 36,899 eligible adult enrollees. Logistic regression and generalized multilevel growth models were used to assess the association between PTSD measured at enrollment and subsequent diabetes. RESULTS We identified 2143 cases of diabetes. After adjustment, we observed a significant association between PTSD and diabetes in the logistic model [adjusted odds ratio (AOR) 1.28, 95% confidence interval (CI) 1.14-1.44]. Results from the growth model were similar (AOR 1.37, 95% CI 1.23-1.52). CONCLUSION This exploratory study found that PTSD, a common 9/11-related health outcome, was a risk factor for self-reported diabetes. Clinicians treating survivors of both the WTC attacks and other disasters should be aware that diabetes may be a long-term consequence.
Collapse
Affiliation(s)
- Sara A Miller-Archie
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
| | - Hannah T Jordan
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Ryan R Ruff
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Shadi Chamany
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Joanne Kong
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Felix Ortega
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Steven D Stellman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| |
Collapse
|
45
|
Job strain as a risk factor for the onset of type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study. Psychosom Med 2014; 76:562-8. [PMID: 25102002 DOI: 10.1097/psy.0000000000000084] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine whether job strain is associated with an increased risk of subsequent Type 2 diabetes mellitus (T2DM) development in a population-based study of men and women. METHODS Data were derived from the prospective MONICA/KORA Augsburg study. We investigated 5337 working participants aged 29 to 66 years without diabetes at one of the three baseline surveys. Job strain was measured by the Karasek job content questionnaire. High job strain was defined by the quadrant approach, where high job demands combined with low job control were classified as high job strain. Continuous job strain (quotient of job demands divided by job control) was additionally analyzed as sensitivity analysis. Hazard ratios (HRs) were estimated using multivariable Cox proportional hazards models with adjustment for age, sex, survey, socioeconomic and life-style variables, parental history of diabetes, and body mass index. RESULTS During a median follow-up of 12.7 years, 291 incident cases of T2DM were observed. The participants with high job strain at baseline had a 45% higher fully adjusted risk to develop T2DM than did those with low job strain (HR = 1.45 [95% confidence interval = 1.00-2.10], p = .048). On the continuous scale, more severe job strain in the magnitude of 1 standard deviation corresponded to a 12% increased fully adjusted T2DM risk (HR = 1.12 [95% confidence interval = 1.00-1.25], p = .045). CONCLUSIONS Men and women who experience high job strain are at higher risk for developing T2DM independently of traditional risk factors. Preventive strategies to combat the globally increasing T2DM epidemic should take into consideration the adverse effects of high strain in the work environment.
Collapse
|
46
|
Richter K, Breitner S, Webb AR, Huth C, Thorand B, Kift R, Linseisen J, Schuh A, Kratzsch J, Mielck A, Weidinger S, Peters A, Schneider A. Influence of external, intrinsic and individual behaviour variables on serum 25(OH)D in a German survey. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2014; 140:120-9. [PMID: 25116947 DOI: 10.1016/j.jphotobiol.2014.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
Abstract
The objective of the present study was to identify external, intrinsic or behavioural factors that significantly influenced serum 25-hydroxyvitamin D (25(OH)D) concentrations in a German survey. Data from 3061 participants in the Cooperative Health Research in the Region of Augsburg, Germany (KORA) F4 survey were used to relate potential determinants to measured mean serum 25(OH)D concentrations using multivariable regression models. The factors significantly associated with hypovitaminosis D (defined as 25(OH)D<25 nmolL(-1)) were season (winter, spring and autumn), urban environment and high body mass index. In contrast, times spent in sunny regions, hours per day spent outdoors in the summer as well as additional oral intake were associated with higher 25(OH)D concentrations. These results suggest that mainly ambient UV exposure but also individual behaviour are the most important determinants for personal 25(OH)D concentrations. The analyses further showed that in winter 43% of subjects were vitamin D deficient and 42% insufficient. Even in summer over half the population has insufficient vitamin D status with 8% deficient and 47% insufficient. Therefore measures to mitigate widespread vitamin D insufficiency such as regular short-term sun exposure and/or improved dietary intake/supplementation recommendations by public health bodies need to be considered.
Collapse
Affiliation(s)
- Katja Richter
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Susanne Breitner
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Ann R Webb
- School of Earth Atmospheric and Environmental Sciences, University of Manchester, Manchester, UK
| | - Cornelia Huth
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Richard Kift
- School of Earth Atmospheric and Environmental Sciences, University of Manchester, Manchester, UK
| | - Jakob Linseisen
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Angela Schuh
- Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Germany
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Leipzig, Germany
| | - Andreas Mielck
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephan Weidinger
- Department of Dermatology, Allergology, and Venereology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Alexandra Schneider
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | | |
Collapse
|
47
|
Wilson CB, Ebenezer PJ, McLaughlin LD, Francis J. Predator exposure/psychosocial stress animal model of post-traumatic stress disorder modulates neurotransmitters in the rat hippocampus and prefrontal cortex. PLoS One 2014; 9:e89104. [PMID: 24551226 PMCID: PMC3925189 DOI: 10.1371/journal.pone.0089104] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/20/2014] [Indexed: 12/31/2022] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) can develop in response to a traumatic event involving a threat to life. To date, no diagnostic biomarkers have been identified for PTSD. Recent research points toward physiological abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis, sympathoadrenal medullary and immune system that may be implicated in the disorder. The modulation of neurotransmitters is another possible mechanism, but their role in the progression of PTSD is poorly understood. Low serotonin (5-HT) may be a factor, but it may not be the only neurotransmitter affected as modulation affects levels of other neurotransmitters. In this study, we hypothesized the predator exposure/psychosocial stress rodent model of PTSD may alter levels of 5-HT and other neurotransmitters in the rat hippocampus and prefrontal cortex (PFC). Male Sprague-Dawley rats were used in this experiment. We induced PTSD via a predator exposure/psychosocial stress model, whereby rats were placed in a cage with a cat for 1 hour on days 1 and 11 of the 31-day experiment. Rats also received psychosocial stress via daily cage cohort changes. On day 32, the rats were sacrificed and the brains dissected to remove the hippocampus and PFC. Norepinephrine (NE), 5-Hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), dopamine (DA), and 3,4-Dihydroxyphenylacetic acid (DOPAC), and 5-HT levels in the hippocampus and PFC were measured with high-performance liquid chromatography (HPLC). In the hippocampus, 5-HT and HVA were lower, while NE and DOPAC were higher, in the PTSD group vs. controls. In the PFC, only 5-HT was lower, while NE, DA, and DOPAC were higher, in the PTSD group vs. controls. The rate limiting enzymes tyrosine hydroxylase and tryptophan hydroxylase were also examined and confirmed our findings. These results demonstrate that the predator exposure/psychosocial stress model of PTSD produces neurotransmitter changes similar to those seen in human patients and may cause a heightened noradrenergic response.
Collapse
Affiliation(s)
- C. Brad Wilson
- Comparative Biomedical Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, Louisiana, United States of America
| | - Philip J. Ebenezer
- Comparative Biomedical Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, Louisiana, United States of America
| | - Leslie D. McLaughlin
- Pathobiological Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, Louisiana, United States of America
- * E-mail: (LDM); (JF)
| | - Joseph Francis
- Comparative Biomedical Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, Louisiana, United States of America
- * E-mail: (LDM); (JF)
| |
Collapse
|
48
|
Depression among patients with diabetes attending a safety-net primary care clinic: relationship with disease control. PSYCHOSOMATICS 2014; 55:548-54. [PMID: 25016357 DOI: 10.1016/j.psym.2014.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Depression and diabetes are highly comorbid, with depression increasing risk of diabetes-related complications and mortality. Few studies have examined the relationship between depression and diabetes in safety-net populations with high rates of trauma exposure, anxiety, and substance use disorders. METHODS Using a cross-sectional survey of 261 patients with diabetes attending safety-net clinics, associations between depression and key diabetes control parameters were examined in bivariate and multivariable analyses adjusting for relevant confounders and significant interactions. RESULTS Among the participants, 57% were men, 51% were white, and the average age was 57 years. Most respondents were unemployed (81%) and earned less than $10,000 per year (51%). Overall, 28% screened positive for depression, with a high overlap of posttraumatic stress (58%) and generalized anxiety (77%) symptoms. After adjustment for socioeconomic and clinical variables, depression was associated with higher mean body mass index (p = 0.01), severe obesity (body mass index ≥ 35kg/m(2)) (odds ratio = 2.34, 95% CI: 1.09-5.04, p = 0.03) and uncontrolled diastolic blood pressure (odds ratio = 2.49, 95% CI: 1.15-5.39, p = 0.02). There was a nonsignificant trend for those with depression to have worse control of blood glucose. Associations with depression and diabetes clinical outcomes were not significantly worsened in the presence of comorbid anxiety disorders. CONCLUSIONS Within a highly comorbid safety-net population, significant associations between depression and key diabetes outcomes remained after accounting for relevant covariates. Further research will help elucidate the relationship between depression and diabetes control measures in safety-net populations.
Collapse
|
49
|
Wilson CB, McLaughlin LD, Nair A, Ebenezer PJ, Dange R, Francis J. Inflammation and oxidative stress are elevated in the brain, blood, and adrenal glands during the progression of post-traumatic stress disorder in a predator exposure animal model. PLoS One 2013; 8:e76146. [PMID: 24130763 PMCID: PMC3794007 DOI: 10.1371/journal.pone.0076146] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/19/2013] [Indexed: 12/13/2022] Open
Abstract
This study sought to analyze specific pathophysiological mechanisms involved in the progression of post-traumatic stress disorder (PTSD) by utilizing an animal model. To examine PTSD pathophysiology, we measured damaging reactive oxygen species and inflammatory cytokines to determine if oxidative stress and inflammation in the brain, adrenal glands, and systemic circulation were upregulated in response to constant stress. Pre-clinical PTSD was induced in naïve, male Sprague-Dawley rats via a predator exposure/psychosocial stress regimen. PTSD group rats were secured in Plexiglas cylinders and placed in a cage with a cat for one hour on days 1 and 11 of a 31-day stress regimen. In addition, PTSD group rats were subjected to psychosocial stress whereby their cage cohort was changed daily. This model has been shown to cause heightened anxiety, exaggerated startle response, impaired cognition, and increased cardiovascular reactivity, all of which are common symptoms seen in humans with PTSD. At the conclusion of the predator exposure/psychosocial stress regimen, the rats were euthanized and their brains were dissected to remove the hippocampus, amygdala, and pre-frontal cortex (PFC), the three areas commonly associated with PTSD development. The adrenal glands and whole blood were also collected to assess systemic oxidative stress. Analysis of the whole blood, adrenal glands, and brain regions revealed oxidative stress increased during PTSD progression. In addition, examination of pro-inflammatory cytokine (PIC) mRNA and protein demonstrated neurological inflammatory molecules were significantly upregulated in the PTSD group vs. controls. These results indicate oxidative stress and inflammation in the brain, adrenal glands, and systemic circulation may play a critical role in the development and further exacerbation of PTSD. Thus, PTSD may not be solely a neurological pathology but may progress as a systemic condition involving multiple organ systems.
Collapse
Affiliation(s)
- C. Brad Wilson
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail: (CW)
| | - Leslie D. McLaughlin
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Anand Nair
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Philip J. Ebenezer
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Rahul Dange
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Joseph Francis
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail: (CW)
| |
Collapse
|
50
|
Posttraumatic stress disorder and not depression is associated with shorter leukocyte telomere length: findings from 3,000 participants in the population-based KORA F4 study. PLoS One 2013; 8:e64762. [PMID: 23843935 PMCID: PMC3700974 DOI: 10.1371/journal.pone.0064762] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background A link between severe mental stress and shorter telomere length (TL) has been suggested. We analysed the impact of Posttraumatic Stress Disorder (PTSD) on TL in the general population and postulated a dose-dependent TL association in subjects suffering from partial PTSD compared to full PTSD. Methods Data are derived from the population-based KORA F4 study (2006–2008), located in southern Germany including 3,000 individuals (1,449 men and 1,551 women) with valid and complete TL data. Leukocyte TL was measured using a quantitative PCR-based technique. PTSD was assessed in a structured interview and by applying the Posttraumatic Diagnostic Scale (PDS) and the Impact of Event Scale (IES). A total of 262 (8.7%) subjects qualified for having partial PTSD and 51 (1.7%) for full PTSD. To assess the association of PTSD with the average TL, linear regression analyses with adjustments for potential confounding factors were performed. Results The multiple model revealed a significant association between partial PTSD and TL (beta = −0.051, p = 0.009) as well as between full PTSD and shorter TL (beta = −0.103, p = 0.014) indicating shorter TL on average for partial and full PTSD. An additional adjustment for depression and depressed mood/exhaustion gave comparable beta estimations. Conclusions Participants with partial and full PTSD had significantly shorter leukocyte TL than participants without PTSD. The dose-dependent variation in TL of subjects with partial and full PTSD exceeded the chronological age effect, and was equivalent to an estimated 5 years in partial and 10 years in full PTSD of premature aging.
Collapse
|