1
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Shih CH, Thalla PR, Elhai JD, Mathews J, Brickman KR, Redfern RE, Xie H, Wang X. Preliminary study examining the mediational link between mild traumatic brain injury, acute stress, and post-traumatic stress symptoms following trauma. Eur J Psychotraumatol 2020; 11:1815279. [PMID: 33133419 PMCID: PMC7580736 DOI: 10.1080/20008198.2020.1815279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The presence of mild traumatic brain injury (mTBI) increases post-traumatic stress disorder (PTSD) symptoms in the months following injury. However, factors that link mTBI and PTSD development are still unclear. Acute stress responses after trauma have been associated with PTSD development. mTBI may impair cognitive functions and increase anxiety immediately after trauma. Objective: This research aimed to test the possibility that mTBI increases acute stress symptoms rapidly, which in turn results in PTSD development in the subsequent months. Method: Fifty-nine patients were recruited from the emergency rooms of local hospitals. Post-mTBI, acute stress, and PTSD symptom severity were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Acute Stress Disorder Scale (ASDS), and PTSD Checklist for DSM-5 (PCL-5), respectively. Results: Moderated mediation analysis indicated that ASDS, at 2 weeks post-trauma, mediated the relationship between RPQ scores at 2 weeks and PCL-5 scores at 3 months post-trauma, only for patients who met mTBI diagnostic criteria. Conclusions: These findings present preliminary evidence suggesting that acute stress disorder symptoms may be one of the mechanisms involved in the development of PTSD among trauma survivors who have experienced mTBI, which provides a theoretical basis for early intervention of PTSD prevention after mTBI.
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Affiliation(s)
- Chia-Hao Shih
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | | | - Jon D Elhai
- Department of Psychiatry, University of Toledo, Toledo, OH, USA.,Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Jeremy Mathews
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | | | | | - Hong Xie
- Department of Neurosciences, University of Toledo, Toledo, OH, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA.,Department of Neurosciences, University of Toledo, Toledo, OH, USA
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2
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Gordon K, Burnell K, Wilson C. Outside the Military "Bubble": Life After Service for UK Ex-armed Forces Personnel. Front Public Health 2020; 8:50. [PMID: 32195216 PMCID: PMC7062665 DOI: 10.3389/fpubh.2020.00050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/11/2020] [Indexed: 11/25/2022] Open
Abstract
Military personnel who have seen active service can be affected by their experiences. Much of the literature on the mental and physical health battles faced by men and women who leave the Armed Forces is dominated by research in the United States (US) (1), and is particularly focused on exposure to deployment, combat conditions, and effects on mental health. Research in the United Kingdom (UK) tends to focus on depression or alcohol misuse and the impact these issues have on currently serving personnel. This study aimed to present UK veterans' first-hand experiences related to military service, access to and use of mental healthcare and interventions, and the impact of transition on the military family. Semi-structured interviews explored experiences of 30 participants (27 male, 3 female). Participants ranged in age from 26 to 92 years (M = 53.33), and across multiple war cohorts (from WWII to Iraq and Afghanistan). Data were analyzed using Thematic Analysis and Narrative Analysis. Findings show meaning-making from experiences of transition across veteran cohorts. Main themes were reasons for leaving Armed Forces, life outside the military, and mental health concerns after service. Subordinate themes additionally focused on evaluation of identity and mental health service provision. Future clinical research should include the experiences of UK serving personnel and the effects of pre-and post-military adversity, alongside the impact of deployment experiences. Interventions designed to address transition into life after service are discussed.
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Affiliation(s)
- Kim Gordon
- School of Life Sciences and Education, Clinical Psychology, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Karen Burnell
- School of Sport, Health and Social Sciences, Solent University, Southampton, United Kingdom
| | - Clare Wilson
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
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3
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German A, Hochberg Z. Sexual Dimorphism of Size Ontogeny and Life History. Front Pediatr 2020; 8:387. [PMID: 32793524 PMCID: PMC7394004 DOI: 10.3389/fped.2020.00387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Ecological and physiological factors and social and economic constraints affect sex-specific body size. Here, we used the male/female (M/F) height ratio as an indicator of the combined effect of genetic and sex characteristics. We hypothesized that (1) sexual dimorphism in body size will be established during infancy and adolescence when growth velocity is maximal, (2) living standards and health are important factors which can affect sexual dimorphism in body size, (3) variations in sexual dimorphism in body size are due to the differential response of boys and girls to environmental cues, and (4) sexual dimorphism in body size will be more pronounced in those populations whose average height and weight are the greatest. Methods: To study the ontogeny of sexual dimorphism from birth until the age of 18 years, we used the 2000 CDC growth data. Data on height by country, life expectancy, and gross domestic product (GDP) per capita based on purchasing power parity were extracted from the national accounts data of NCD Risk Factor Collaboration, the World Bank, Eurostat: Demographic Statistics, Secretariat of the Pacific Community: Statistics and Demography Program, and the US Census Bureau. Results: We found that sexual dimorphism in body size starts at age 1 month, peaks at age 3 months, and diminishes by age 24 months. During childhood, there is no sexual difference in body size, and it is gradually established when the boys enter puberty. The M/F height ratio correlates positively with the average male and female height and weight by country. Conclusion: Sexual dimorphism in body size occurs when (a) the growth velocity is maximal during infancy and adolescence, (b) living standards are high, and health correlate positively with male/female height ratio. Anthropological studies and our results emphasize mostly the female resiliency hypothesis: shorter male heights in times of environmental stress lead to smaller sexual dimorphism in body size.
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Affiliation(s)
- Alina German
- Pediatric Department, Bnei-Zion Medical Center, Clalit HMO, Haifa, Israel.,Rappaport Family Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ze'ev Hochberg
- Rappaport Family Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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4
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Marini CM, Fiori KL, Wilmoth JM, Pless Kaiser A, Martire LM. Psychological Adjustment of Aging Vietnam Veterans: The Role of Social Network Ties in Reengaging with Wartime Memories. Gerontology 2019; 66:138-148. [PMID: 32079014 PMCID: PMC7056538 DOI: 10.1159/000502340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in -helping - or hindering - aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts.
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Affiliation(s)
- Christina M Marini
- Department of Psychology, The Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA,
| | - Katherine L Fiori
- Department of Psychology, The Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Janet M Wilmoth
- Department of Sociology, Aging Studies Institute, Syracuse University, Syracuse, New York, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lynn M Martire
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, Pennsylvania, USA
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5
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Sippel LM, Watkins LE, Pietrzak RH, Hoff R, Harpaz-Rotem I. Heterogeneity of posttraumatic stress symptomatology and social connectedness in treatment-seeking military veterans: a longitudinal examination. Eur J Psychotraumatol 2019; 10:1646091. [PMID: 31489133 PMCID: PMC6713134 DOI: 10.1080/20008198.2019.1646091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022] Open
Abstract
Elucidating whether PTSD symptoms predict poorer social connectedness over time (i.e. social erosion) and/or that poor social connectedness contributes to maintenance of PTSD (i.e. social causation) has implications for PTSD treatment and relapse prevention. Most extant research has been cross-sectional and examined overall PTSD symptoms. Evidence of longitudinal associations among heterogeneous PTSD symptom clusters and social connectedness could provide insight into more nuanced targets for intervention. Using data from 1,491 U.S. military veterans in residential treatment for PTSD at 35 Department of Veterans Affairs facilities, we evaluated a two-wave cross-lagged panel model including a five-factor model of PTSD and two aspects of social connectedness. PTSD, quality of connectedness (i.e. degree of distress related to interpersonal conflict), and structural social support (i.e. number of days of contact with supportive loved ones) in the past 30 days were assessed at baseline and 4 months after discharge. The largest effect was greater severity of PTSD dysphoric arousal symptoms (i.e. irritability/anger, poor concentration, and sleep problems) at baseline predicting more conflict-related distress at follow-up (β = 0.43). Post-hoc symptom-level analyses indicated that irritability/anger drove this association. In addition, conflict-related distress predicted greater PTSD symptom severity across all five clusters (β's = 0.10 to 0.14, p's < 0.01). More days of contact predicted lower severity of avoidance and numbing symptoms (β's = -.05 and -.07, p's < 0.01), along with individual symptoms within these clusters, plus flashbacks. Results support both social erosion and social causation models. Engaging loved ones in veterans' treatment and targeting dysphoric arousal symptoms, particularly anger and irritability, may improve long-term PTSD and relationship outcomes, respectively.
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Affiliation(s)
- Lauren M Sippel
- National Center for PTSD Executive Division, White River Junction, VT, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Laura E Watkins
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert H Pietrzak
- National Center for PTSD Clinical Neurosciences Division, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rani Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,National Center for PTSD Evaluation Division, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- National Center for PTSD Clinical Neurosciences Division, West Haven, CT, USA.,National Center for PTSD Evaluation Division, West Haven, CT, USA
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6
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Fernandez CA, Vicente B, Marshall BD, Koenen KC, Arheart KL, Kohn R, Saldivia S, Buka SL. Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors. Int J Epidemiol 2018; 46:440-452. [PMID: 27283159 DOI: 10.1093/ije/dyw094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 11/14/2022] Open
Abstract
Background With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that pre-existing psychopathology plays in developing PTSD after a disaster. Methods This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres ( N = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD. Results The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65). Conclusions This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.
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Affiliation(s)
- Cristina A Fernandez
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Benjamin Vicente
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Brandon Dl Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Karestan C Koenen
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Kohn
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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7
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DeFraia GS. Workplace Disruption following Psychological Trauma: Influence of Incident Severity Level on Organizations' Post-Incident Response Planning and Execution. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2017; 7:75-86. [PMID: 27112716 PMCID: PMC6816515 DOI: 10.15171/ijoem.2016.746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/08/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychologically traumatic workplace events (known as critical incidents), which occur globally, are increasing in prevalence within the USA. Assisting employers in their response is a growing practice area for occupational medicine, occupational social work, industrial psychology and other occupational health professions. Traumatic workplace events vary greatly in their level of organizational disruption. OBJECTIVE To explore whether extent of workplace disruption influences organizations' decisions for post-incident response planning and plan execution. METHODS Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring extent of workplace disruption associated with organizational decisions regarding post-incident response. RESULTS The more severe and disruptive the incident, the more likely organizations planned for and followed through to deliver on-site interventions. Following more severe incidents, organizations were also more likely to deliver group sessions and to complete follow-up consultations to ensure ongoing worker recovery. CONCLUSION Increasing occupational health practitioners' knowledge of varying levels of organizational disruption and familiarity with a range of organizational response strategies improves incident assessment, consultation and planning, and ensures interventions delivered are consistent with the level of assistance needed on both worker and organizational levels.
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Affiliation(s)
- G S DeFraia
- Adjunct Professor, Adelphi University, New York, USA.
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8
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Finley EP, Pugh MJ, Palmer RF. Validation of a Measure of Family Resilience among Iraq and Afghanistan Veterans. MILITARY BEHAVIORAL HEALTH 2017; 4:205-219. [PMID: 28168094 DOI: 10.1080/21635781.2016.1153530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although interactions within veterans' families may support or inhibit resilient coping to stress and trauma across the deployment cycle, research on family resilience has been hampered by the lack of a brief assessment. Using a three-stage mixed-method study, we developed and conducted preliminary validation of a measure of family resilience tailored for Iraq and Afghanistan veterans (IAV), the Family Resilience Scale for Veterans (FRS-V), which was field-tested using a survey of 151 IAV. Our findings indicate the resulting 6-item measure shows strong initial reliability and validity and support the application of existing models of family resilience in this population.
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Affiliation(s)
- Erin P Finley
- South Texas Veterans Health Care System, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary Jo Pugh
- South Texas Veterans Health Care System, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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9
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McAndrew LM, Markowitz S, Lu SE, Borders A, Rothman D, Quigley KS. Resilience during war: Better unit cohesion and reductions in avoidant coping are associated with better mental health function after combat deployment. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2017; 9:52-61. [PMID: 27455138 PMCID: PMC6549499 DOI: 10.1037/tra0000152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The majority of individuals who endure traumatic events are resilient; however, we do not yet understand why some individuals are more resilient than others. We used data from a prospective longitudinal study Army National Guard and Reserve personnel to examine how unit cohesion (military-specific social support) and avoidant coping relate to resilience over the first year after return from deployment. METHOD Soldiers (N = 767) were assessed at 4 phases: predeployment (P1), immediately postdeployment (P2), 3 months' postdeployment (P3), and 1-year postdeployment (P4). RESULTS After controlling for predeployment avoidant coping and overall social support, higher unit cohesion was associated with a reduction in avoidant coping (from P1 to P3). This reduction in avoidant coping (from P1 to P3) mediated the relationship between unit cohesion (P2) and improvement in mental health function (from P1 to P3). CONCLUSIONS The results are consistent with the hypothesis that higher unit cohesion may mitigate increases in avoidant coping in military personnel after a combat deployment and in turn may improve mental health function. (PsycINFO Database Record
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Affiliation(s)
- Lisa M McAndrew
- NJ War Related Illness & Injury Study Center, Department of Veterans Affairs
| | | | - Shou-En Lu
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center
| | - Ashley Borders
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center
| | - David Rothman
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center
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10
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Schure MB, Katon JG, Wong E, Liu CF. Food and housing insecurity and health status among U.S. adults with and without prior military service. SSM Popul Health 2016; 2:244-248. [PMID: 29349144 PMCID: PMC5757928 DOI: 10.1016/j.ssmph.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022] Open
Abstract
Food and housing insecurity may contribute to poorer mental and physical health. It is unclear as to whether those with prior military service, compared to those without, are more vulnerable to these current stressors. The objective of this study was to use U.S. population-based data to determine whether prior military service moderates the association of food and housing insecurity with poor mental and physical health. We analyzed data from nine states administering the Social Context module from the 2011 and 2012 Behavioral Risk Factor Surveillance System. Multivariable logistic regression was used to examine the associations of housing and food insecurity with poor mental and physical health and potential modification by military service. Compared with those with a history of military service, those without had higher prevalence of food insecurity (23.1% versus 13.7%) and housing insecurity (36.0% versus 22.5%). Food insecurity was associated with poor mental and physical health (mental health: odds ratio (OR)=3.47, 95% confidence interval (CI)=[3.18-3.77]; physical health: OR=3.21, 95% CI=[2.92-3.53]). Similar associations were observed between housing insecurity and poor mental and physical health. Prior military service was significantly associated with poor physical health. Interaction terms of prior military service with food and housing were not statistically significant. Food and housing insecurity does not appear to differentially impact mental and physical health among those with and without military service.
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Affiliation(s)
- Marc B Schure
- Montana State University, Department of Health & Human Development, Bozeman, MT, United States
| | - Jodie G Katon
- Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, WA, United States
- VA Office of Patient Care Services, Office of Women's Health Services, Department of Veterans Affairs, Washington, DC, United States
- University of Washington, School of Public Health, Department of Health Services, Seattle, WA, United States
| | - Edwin Wong
- Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, WA, United States
- University of Washington, School of Public Health, Department of Health Services, Seattle, WA, United States
| | - Chuan-Fen Liu
- Health Services Research and Development (HSR&D), VA Puget Sound Health Care System, Seattle, WA, United States
- University of Washington, School of Public Health, Department of Health Services, Seattle, WA, United States
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11
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Smith BN, Wang JM, Vaughn-Coaxum RA, Di Leone BAL, Vogt D. The role of postdeployment social factors in linking deployment experiences and current posttraumatic stress disorder symptomatology among male and female veterans. ANXIETY STRESS AND COPING 2016; 30:39-51. [DOI: 10.1080/10615806.2016.1188201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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De Schryver M, Vindevogel S, Rasmussen AE, Cramer AOJ. Unpacking Constructs: A Network Approach for Studying War Exposure, Daily Stressors and Post-Traumatic Stress Disorder. Front Psychol 2015; 6:1896. [PMID: 26733901 PMCID: PMC4679872 DOI: 10.3389/fpsyg.2015.01896] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/24/2015] [Indexed: 11/13/2022] Open
Abstract
Conflict-affected populations are exposed to stressful events during and after war, and it is well established that both take a substantial toll on individuals’ mental health. Exactly how exposure to events during and after war affect mental health is a topic of considerable debate. Various hypotheses have been put forward on the relation between stressful war exposure (SWE), daily stressors (DS) and the development of post-traumatic stress disorder (PTSD). This paper seeks to contribute to this debate by critically reflecting upon conventional modeling approaches and by advancing an alternative model to studying interrelationships between SWE, DS, and PTSD variables. The network model is proposed as an innovative and comprehensive modeling approach in the field of mental health in the context of war. It involves a conceptualization and representation of variables and relationships that better approach reality, hence improving methodological rigor. It also promises utility in programming and delivering mental health support for war-affected populations.
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Affiliation(s)
- Maarten De Schryver
- Department of Experimental-Clinical and Health Psychology, Ghent University Ghent, Belgium
| | - Sofie Vindevogel
- Department of Experimental-Clinical and Health Psychology, Ghent UniversityGhent, Belgium; Department of Orthopedagogy, Department of Orthopedagogics and Ghent University College, Ghent UniversityGhent, Belgium
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13
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Helitzer D, Graeber D, LaNoue M, Newbill S. Don't Step on the Tiger's Tail: A Mixed Methods Study of the Relationship Between Adult Impact of Childhood Adversity and Use of Coping Strategies. Community Ment Health J 2015; 51:768-74. [PMID: 25536941 PMCID: PMC4480186 DOI: 10.1007/s10597-014-9815-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
A mixed methods study examined the relationship between childhood adversity (ACE) and coping among individuals grouped by perceived impact of ACE in adulthood. Groups did not differ on mean total ACE scores and total ACE score was not associated with any coping strategy. Differences between groups were found in 6 of 14 coping strategies. Planning and active coping were endorsed the most by both groups, despite their being used in significantly different amounts and in different ways. How individuals with ACE rate its impact in their current lives is a significant factor in the use and meaning of coping strategies.
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Affiliation(s)
- Deborah Helitzer
- Department of Family and Community Medicine, School of Medicine, MSC 09-5040, University of New Mexico, Albuquerque, NM, 87121-0001, USA.
| | - David Graeber
- Department of Psychiatry, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Marnie LaNoue
- Department of Family and Community Medicine, Jefferson Medical College, Philadelphia, PA, USA
| | - Sharon Newbill
- Department of Family and Community Medicine, School of Medicine, MSC 09-5040, University of New Mexico, Albuquerque, NM, 87121-0001, USA
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14
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DeFraia GS. Psychological Trauma in the Workplace: Variation of Incident Severity among Industry Settings and between Recurring vs Isolated Incidents. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2015; 6:155-68. [PMID: 26174992 PMCID: PMC6977051 DOI: 10.15171/ijoem.2015.545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 05/03/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychologically traumatic workplace events (known as critical incidents) occur within various work environments, with workgroups in certain industries vulnerable to multiple incidents. With the increasing prevalence of incidents in the USA, incident response is a growing practice area within occupational medicine, industrial psychology, occupational social work and other occupational health professions. OBJECTIVE To analyze a measure of incident severity based on level of disruption to the workplace and explore whether incident severity varied among different industry settings or between workgroups experiencing multiple vs single traumatic incidents. METHODS Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring incident severity level varied among industry settings or between workgroups impacted by multiple vs isolated events. RESULTS Incident severity level differed among various industry settings. Banks, retail stores and fast food restaurants accounted for the most severe incidents, while industrial and manufacturing sites reported less severe incidents. Workgroups experiencing multiple incidents reported more severe incidents than workgroups experiencing a single incident. CONCLUSION Occupational health practitioners should be alert to industry differences in several areas: pre-incident resiliency training, the content of business recovery plans, assessing worker characteristics, strategies to assist continuous operations and assisting workgroups impacted by multiple or severe incidents.
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Gaher RM, Simons JS, Hahn AM, Hofman NL, Hansen J, Buchkoski J. An experience sampling study of PTSD and alcohol-related problems. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1013-25. [PMID: 25134021 DOI: 10.1037/a0037257] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) represents a debilitating psychiatric condition that is affecting the lives of many returning veterans. PTSD and alcohol use and dependence are highly comorbid. The purpose of this study was to understand the functional mechanisms between PTSD and alcohol use and problems. Specifically, the role of negative urgency and emotional intelligence were investigated as vulnerability and resiliency factors, respectively. This study utilized experience sampling to test associations between PTSD symptoms and alcohol use and related problems in a sample of 90 OIF/OEF veterans. Participants completed 8 brief questionnaires daily for 2 weeks on palmtop computers. Elevations in PTSD symptoms during the day were associated with subsequent increases in alcohol use and associated problems that night. PTSD symptoms were associated with greater problems above and beyond the effect of drinking level at both the within- and between- person level. Emotional intelligence was associated with lower negative urgency, fewer PTSD symptoms, and less alcohol use and associated problems. The effects of emotional intelligence were primarily indirect via negative urgency and the effects of negative urgency on alcohol use and problems were indirect via its positive association with PTSD symptoms. Hypothesized cross-level effects of emotional intelligence and negative urgency were not supported. The findings suggest a functional association between PTSD symptoms and alcohol consumption. The association between PTSD symptoms and alcohol consumption is consistent with a self-medication model. However, the significant associations between PTSD symptoms and alcohol problems, after controlling for use level, suggest a broader role of dysregulation.
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Affiliation(s)
| | | | - Austin M Hahn
- Department of Psychology, University of South Dakota
| | | | - Jamie Hansen
- Department of Psychology, University of South Dakota
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Residential treatment for combat-related posttraumatic stress disorder: identifying trajectories of change and predictors of treatment response. PLoS One 2014; 9:e101741. [PMID: 25058403 PMCID: PMC4109915 DOI: 10.1371/journal.pone.0101741] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Combat-related posttraumatic stress disorder (PTSD) can be a difficult condition to treat and has been associated with serious medical and economic issues among U.S. military veterans. Distinguishing between treatment responders vs. non-responders in this population has become an important public health priority. This study was conducted to identify pre-treatment characteristics of U.S. veterans with combat-related PTSD that might contribute to favorable and unfavorable responses to high value treatments for this condition. METHOD This study focused on 805 patients who completed a VHA PTSD residential program between 2000 and 2007. These patients completed the PTSD Clinical Checklist at pre-treatment, post-treatment, and a four-month follow-up assessment. Latent growth curve analysis (LCGA) was incorporated to determine trajectories of changes in PTSD across these assessments and whether several key clinical concerns for this population were associated with their treatment responses. STUDY FINDINGS LCGA indicated three distinct trajectories in PTSD outcomes and identified several clinical factors that were prospectively linked with changes in veterans' posttraumatic symptomatology. When compared to a group with high PTSD symptom severity that decreased over the program but relapsed at follow-up (41%), the near half (48.8%) of the sample with an improving trajectory had less combat exposure and superior physical/mental health. However, when compared to a minority (10.2%) with relatively low symptomatology that also remained somewhat stable, patients in the improving group were younger and also reported greater combat exposure, poorer physical/mental health status, and more problems with substance abuse before the start of treatment. CONCLUSIONS Findings suggest that veterans are most likely to benefit from residential treatment in an intermediate range of symptoms and risk factors, including PTSD symptom severity, history of combat exposure, and comorbid issues with physical/mental health. Addressing these factors in an integrative manner could help to optimize the effectiveness of treatments of combat-related PTSD in many cases.
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Smith BN, Vaughn RA, Vogt D, King DW, King LA, Shipherd JC. Main and interactive effects of social support in predicting mental health symptoms in men and women following military stressor exposure. ANXIETY STRESS AND COPING 2013; 26:52-69. [DOI: 10.1080/10615806.2011.634001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Nicdao EG, Noel LT, Ai AL, Plummer C, Groff S. Post disaster resilience: Racially different correlates of depression symptoms among hurricane Katrina-Rita volunteers. DISASTER HEALTH 2013; 1:45-53. [PMID: 28228986 PMCID: PMC5314885 DOI: 10.4161/dish.23077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/30/2012] [Indexed: 11/19/2022]
Abstract
The present analyses examined the differential risks of and protective factors against depressive symptoms of African American and Non-Hispanic White American student volunteers, respectively after Hurricanes Katrina and Rita (H-KR). A total sample of 554 student volunteers were recruited from mental health professional programs at five universities located in the Deep South, namely areas severely impacted by H-KR during fall semester 2005. The response rate was 91% (n = 505). African American respondents (n = 299) and Non-Hispanic White Americans (n = 206) completed the survey questionnaires. Respondents retrospectively provided information on peritraumatic emotional reactions and previous trauma that were recalled by H-KR and H-KR stressors. African American respondents reported higher levels of depressive symptoms (65.2%) than their Non-Hispanic White counterparts (34.8%). Hierarchical regression analyses revealed that disaster related stressors affected African Americans (p < 0.001), but not Non-Hispanic Whites. However, African Americans who experienced peritraumatic positive emotions had lower depression levels. Lower rates of recollection of prior traumas during H-KR were reported by African American respondents, whereas previous trauma recollections predicted symptoms among Non-Hispanic White Americans (p < 0.05). Exhibiting more optimism had lower depression levels among Non-Hispanic White Americans. Peritraumatic negative emotion was the only shared risk for depressive symptoms of both groups. Findings underscore racially different levels of depressive symptoms that may contribute to varying degrees of resilience among student volunteers. Future research and practice may address these racial differences by understanding the risk factors for depressive symptoms to develop appropriate interventions for racial groups, and cultivating the protective factors that contribute to resilience from traumatic experiences.
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Affiliation(s)
- Ethel G Nicdao
- Department of Sociology; University of the Pacific; Stockton, CA USA
| | - La Tonya Noel
- College of Social Work; Florida State University; Tallahassee, FL USA
| | - Amy L Ai
- College of Social Work; Florida State University; Tallahassee, FL USA
| | - Carol Plummer
- School of Social Work; University of Hawaii; Honolulu, HI USA
| | - Sara Groff
- College of Social Work; Florida State University; Tallahassee, FL USA
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Ruff RL, Riechers RG, Wang XF, Piero T, Ruff SS. A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI. BMJ Open 2012; 2:e000312. [PMID: 22431700 PMCID: PMC3312078 DOI: 10.1136/bmjopen-2011-000312] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown. OBJECTIVE To evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan. METHODS This was a case-control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians. RESULTS Among combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was >90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS). CONCLUSIONS Impaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.
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Affiliation(s)
- Robert Louis Ruff
- Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Ronald George Riechers
- Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Xiao-Feng Wang
- Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Traci Piero
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Suzanne Smith Ruff
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Psychology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
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Betancourt TS, Borisova II, Williams TP, Brennan RT, Whitfield TH, de la Soudiere M, Williamson J, Gilman SE. Sierra Leone's former child soldiers: a follow-up study of psychosocial adjustment and community reintegration. Child Dev 2010; 81:1077-95. [PMID: 20636683 PMCID: PMC2921972 DOI: 10.1111/j.1467-8624.2010.01455.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This is the first prospective study to investigate psychosocial adjustment in male and female former child soldiers (ages 10-18; n = 156, 12% female). The study began in Sierra Leone in 2002 and was designed to examine both risk and protective factors in psychosocial adjustment. Over the 2-year period of follow-up, youth who had wounded or killed others during the war demonstrated increases in hostility. Youth who survived rape not only had higher levels of anxiety and hostility but also demonstrated greater confidence and prosocial attitudes at follow-up. Of the potential protective resources examined, improved community acceptance was associated with reduced depression at follow-up and improved confidence and prosocial attitudes regardless of levels of violence exposure. Retention in school was also associated with greater prosocial attitudes.
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Affiliation(s)
| | | | - Timothy Philip Williams
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health,
| | - Robert T. Brennan
- Department of Global Health and Social Medicine, Harvard Medical School,
| | | | | | - John Williamson
- Senior Technical Advisor for Displaced Children and Orphans Fund of USAID,
| | - Stephen E. Gilman
- Departments of Society, Human Development & Health and Epidemiology, Harvard School of Public Health,
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[The relationship between social support, psychological stress and the risk of developing anxiety disorders in men and women: results of a national study]. Canadian Journal of Public Health 2009. [PMID: 19839294 DOI: 10.1007/bf03405526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Investigate the links between different types of social support, psychological well-being and distress among individuals with anxiety disorders. METHODS Data were drawn from the Canadian Community Health Survey (CCHS cycle 1.2) which had 36,984 participants, 1,803 of whom presented with anxiety disorders. Classical linear regression analyses were conducted to examine the links between different social support dimensions and psychological well-being on one hand, and psychological distress on the other hand. RESULTS Women reported perceiving significantly higher levels of affective, emotional/informational, tangible support and positive social interactions than men. After controlling for potentially confounding variables (socio-demographic variables and the presence of a major depressive disorder), three types of social supports appeared to be predictors for the psychological well-being of women with anxiety disorders: positive social interactions, emotional/informational support, and affective support. For men, none of the social support variables were significantly associated with psychological well-being or distress. The comparisons of Beta coefficients do not show any significant difference between the sexes. CONCLUSION Social support appears to be a positive predictor for psychological well-being among women with an anxiety disorder. No associations were found between social support variables and the psychological distress perceived by men and women. The results of this study therefore confirm the importance of teaching appropriate support strategies adapted for anxiety disorders. Future studies should assess negative social interactions in addition to social support.
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Wagner KD, Brief DJ, Vielhauer MJ, Sussman S, Keane TM, Malow R. The potential for PTSD, substance use, and HIV risk behavior among adolescents exposed to Hurricane Katrina. Subst Use Misuse 2009; 44:1749-67. [PMID: 19895305 PMCID: PMC4181568 DOI: 10.3109/10826080902963472] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adverse psychosocial outcomes can be anticipated among youth exposed to Hurricane Katrina. Adolescents are particularly vulnerable to the consequences of this natural disaster and may suffer lasting consequences in the form of psychological morbidity and the development of negative health behaviors due to their exposure. We review existing literature on the effects of exposure to natural disasters and similar traumas on youth and, where data on youth are unavailable, on adults. The effect of natural disasters is discussed in terms of risk for three negative health outcomes that are of particular concern due to their potential to cause long-term morbidity: post-traumatic stress disorder, substance use disorder, and HIV-risk behavior. Where available, data from studies of the effects of Hurricane Katrina are included.
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Affiliation(s)
- Karla D Wagner
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Alhambra, California, USA
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Goldzweig CL, Balekian TM, Rolón C, Yano EM, Shekelle PG. The state of women veterans' health research. Results of a systematic literature review. J Gen Intern Med 2006; 21 Suppl 3:S82-92. [PMID: 16637952 PMCID: PMC1513165 DOI: 10.1111/j.1525-1497.2006.00380.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Assess the state of women veterans' health research. DESIGN Systematic review of studies that pertained specifically to or included explicit information about women veterans. A narrative synthesis of studies in 4 domains/topics was conducted: Stress of military life; Health and performance of military/VA women; Health services research/quality of care; and Psychiatric conditions. MEASUREMENTS AND MAIN RESULTS We identified 182 studies. Of these, 2 were randomized-controlled trials (RCTs) and the remainder used observational designs. Forty-five percent of studies were VA funded. We identified 77 studies pertaining to the stress of military life, of which 21 reported on sexual harassment or assault. Rates of harassment ranged from 55% to 79% and rates of sexual assault from 4.2% to 7.3% in active duty military women and 11% to 48% among women veterans. Forty-two studies concerned the health and performance of military/VA women, with 21 studies evaluating sexual assault and posttraumatic stress disorder (PTSD) and their effect on health. Fifty-nine studies assessed various aspects of health services research. Eight studies assessed quality of care and 5, patient satisfaction. Twenty-five studies assessed utilization and health care organization, and findings include that women veterans use the VA less than men, that gender-specific reasons for seeking care were common among female military and veteran personnel, that provision of gender-specific care increased women veterans' use of VA, and that virtually all VAs have available on-site basic women's health services. Fifty studies were classified as psychiatric; 31 of these were about the risk, prevalence, and treatment of PTSD. CONCLUSIONS Most research on VA women's health is descriptive in nature and has concerned PTSD, sexual harassment and assault, the utilization and organization of care, and various psychiatric conditions. Experimental studies and studies of the quality of care are rare.
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Affiliation(s)
- Caroline L Goldzweig
- Southern California Evidence-Based Practice Center, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
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Pizarro J, Silver RC, Prause J. Physical and mental health costs of traumatic war experiences among Civil War veterans. ARCHIVES OF GENERAL PSYCHIATRY 2006; 63:193-200. [PMID: 16461863 PMCID: PMC1586122 DOI: 10.1001/archpsyc.63.2.193] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health effects of traumatic war experiences have not been adequately assessed across the lifetime of these veterans. OBJECTIVE To identify the role of traumatic war experiences in predicting postwar nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War. DESIGN An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded. SETTING AND PARTICIPANTS The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records. MAIN OUTCOME MEASURES Signs of physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease; number of unique ailments within each disease; and mortality. RESULTS Military trauma was related to signs of disease and mortality. A greater percentage of company killed was associated with signs of postwar cardiac and gastrointestinal disease (incidence risk ratio [IRR], 1.34; P < .02), comorbid nervous and physical disease (IRR, 1.51; P < .005), and more unique ailments within each disease (IRR, 1.14; P < .005). Younger soldiers (<18 years), compared with older enlistees (>30 years), showed a higher mortality risk (hazard ratio, 1.52), signs of comorbid nervous and physical disease (IRR, 1.93), and more unique ailments within each disease (IRR, 1.32) (P < .005 for all), controlling for time lived and other covariates. CONCLUSIONS Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans. Physiological mechanisms by which trauma might result in disease are discussed.
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Affiliation(s)
- Judith Pizarro
- Department of Psychology and Social Behavior (Ms. Pizarro, Dr. Silver and Dr. Prause); Department of Medicine (Dr. Silver), University of California, Irvine
| | - Roxane Cohen Silver
- Department of Psychology and Social Behavior (Ms. Pizarro, Dr. Silver and Dr. Prause); Department of Medicine (Dr. Silver), University of California, Irvine
| | - JoAnn Prause
- Department of Psychology and Social Behavior (Ms. Pizarro, Dr. Silver and Dr. Prause); Department of Medicine (Dr. Silver), University of California, Irvine
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Aber JL, Gershoff ET, Ware A, Kotler JA. Estimating the Effects of September 11th and Other Forms of Violence on the Mental Health and Social Development of New York City's Youth: A Matter of Context. APPLIED DEVELOPMENTAL SCIENCE 2004. [DOI: 10.1207/s1532480xads0803_2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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26
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Gray MJ, Elhai JD, Frueh BC. Enhancing patient satisfaction and increasing treatment compliance: patient education as a fundamental component of PTSD treatment. Psychiatr Q 2004; 75:321-32. [PMID: 15563050 DOI: 10.1023/b:psaq.0000043508.52428.6e] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) is the modal mental health problem afflicting combat veterans. In addition to the significant distress resulting from the disorder itself, PTSD has been associated with significant medical comorbidity and increased utilization of medical services. Interventions have historically focused on targeting symptoms directly, with comparatively little attention to systematically educating patients about the etiology and maintenance of the disorder and associated features and treatment issues. This descriptive study summarizes an eight-week PTSD patient education and orientation group. Seventeen patients admitted consecutively to the PTSD Clinic at a large VA hospital completed surveys of patient satisfaction with services and motivation to comply with treatment regimens upon completion of the group. Participants reported very high satisfaction with services, increased awareness of PTSD treatment options, greater optimism and symptom improvement and enhanced motivation to continue with treatment as a result of attending the group.
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Affiliation(s)
- Matt J Gray
- Department of Psychology, University of Wyoming, Laramie, WY 82071-3415, USA.
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Falsetti SA, Erwin BA, Resnick HS, Davis J, Combs-Lane AM. Multiple Channel Exposure Therapy of PTSD: Impact of Treatment on Functioning and Resources. J Cogn Psychother 2003. [DOI: 10.1891/jcop.17.2.133.57439] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significant impairment in functioning. Although improvement in PTSD symptoms following cognitive-behavioral treatment of PTSD has been demonstrated in numerous studies, improvement in functioning has yet to be fully explored. In addition to measures of PTSD, measures of functioning may help to identify more reliably broad-based change following cognitive-behavioral treatment of PTSD. A few studies have demonstrated short-term improvement in functioning following pharmacotherapy of PTSD. The current study is the first investigation to examine short- and long-term changes in adjustment and resources following cognitive-behavioral treatment of PTSD. Findings from this study suggest that, immediately following Multiple Channel Exposure Therapy (MCET), female trauma victims with PTSD and comorbid panic attacks reported improvement in work, marital, economic, and overall adjustment. In addition, 3 and 6 months following MCET, patients continued to experience improvement in work, marital, economic, parental, and overall adjustment. Future directions and clinical implications are discussed.
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