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Holzman JB, Valentiner DP, Hannan SM, Wallace DG, Orcutt HK. High dose alcohol consumption predicts less reduction in post-traumatic stress symptoms after a campus mass shooting. Anxiety Stress Coping 2017; 30:609-618. [PMID: 28697628 DOI: 10.1080/10615806.2017.1348297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recognizing that alcohol might affect subsequent processing of trauma-related information, this study examined whether high dose alcohol consumption (HDAC) following a campus mass shooting affected the relation between shooting exposure and post-traumatic stress symptoms (PTSS). METHODS Female participants (N = 691) recorded levels of physical exposure to the shooting event, alcohol use, and PTSS 1 month following the shooting event and 8 months later. RESULTS No evidence was found to suggest that pre-shooting HDAC moderated the relationship between trauma exposure and PTSS 1 month following the shooting. HDAC in the month following the shooting predicted less resolution of PTSS 8 months later. Specifically, at higher (but not lower) levels of HDAC, shooting exposure was associated with less reduction in PTSS from 1 to 8 months post-trauma. Several alternate explanations were ruled out. CONCLUSIONS Less reduction in PTSS seems to occur at high levels of both shooting exposure and HDAC. Theoretical implications and directions for future research are discussed.
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Affiliation(s)
- Jacob B Holzman
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - David P Valentiner
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - Susan M Hannan
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - Douglas G Wallace
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
| | - Holly K Orcutt
- a Department of Psychology , Northern Illinois University , DeKalb , IL , USA
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Orcutt HK, Hannan SM, Seligowski AV, Jovanovic T, Norrholm SD, Ressler KJ, McCanne T. Fear-Potentiated Startle and Fear Extinction in a Sample of Undergraduate Women Exposed to a Campus Mass Shooting. Front Psychol 2017; 7:2031. [PMID: 28111559 PMCID: PMC5216047 DOI: 10.3389/fpsyg.2016.02031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a common psychological disorder that affects a substantial minority of individuals. Previous research has suggested that PTSD can be partially explained as a disorder of impaired fear inhibition. The current study utilized a previously validated fear acquisition and extinction paradigm in a sample of 75 undergraduate women who were exposed to a campus mass shooting that occurred in 2008. We used a protocol in which conditioned fear was first acquired through the presentation of one colored shape (reinforced conditioned stimulus, CS+) that was paired with an aversive airblast to the larynx (unconditioned stimulus, US) and a different colored shape that was not paired with the airblast (non-reinforced conditioned stimulus, CS-). Fear was extinguished 10 min later through repeated presentations of the CSs without reinforcement. Number of clinically significant posttraumatic stress symptoms (PTSS) immediately following the mass shooting were positively associated with fear-potentiated startle (FPS) to the CS+ and CS- during late periods of acquisition. During early periods of fear extinction, PTSS was positively associated with FPS to the CS+. Results from the current study suggest that PTSS is related to altered fear inhibition and extinction during an FPS paradigm. In line with similar research, women with greater PTSS demonstrated a greater “fear load,” suggesting that these women experienced elevated fear to the CS+ during extinction after conditioned fear was acquired.
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Affiliation(s)
- Holly K Orcutt
- Department of Psychology, Northern Illinois University, DeKalb IL, USA
| | - Susan M Hannan
- Department of Psychology, Northern Illinois University, DeKalb IL, USA
| | | | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, AtlantaGA, USA; Trauma Recovery Program, Atlanta Veteran Affairs Medical Center, DecaturGA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, AtlantaGA, USA; Howard Hughes Medical Institute, Chevy ChaseMD, USA; Program in Neuroscience, Department of Psychiatry, Harvard Medical School, BostonMA, USA
| | - Thomas McCanne
- Department of Psychology, Northern Illinois University, DeKalb IL, USA
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Abstract
PURPOSE The purpose of this paper is to assess the reliability and validity of the Spanish version of the Davidson trauma scale (DTS-S) and to determine the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms in a non-clinical random sample of prison inmates. DESIGN/METHODOLOGY/APPROACH Probabilistic samples of 1,179 inmates from 26 penal institutions in Puerto Rico were selected using a multistage sampling design. Population estimates and correlations were obtained for PTSD, generalized anxiety and depression. The reliability, factor structure, and convergent validity of the DTS-S were assessed. Cross-validation was employed to confirm the results of the factor analyses. FINDINGS Using the cut-offs adopted by the scale's author, 136 (13.4 percent) of the inmates are likely to have current PTSD and 117 (11.6 percent) reach the cut-off for sub-threshold PTSD. Confirmatory factor analysis generated two factors explaining 53 percent of the variance. High reliabilities were obtained for the total scale (α=0.95) and for the frequency and severity scales (α=0.90 and 0.91). Significantly higher DTS-S scores were found for females (t=2.26, p<0.025), for inmates diagnosed with depression or anxiety (t=2.02, p<0.05), and those reporting suicide attempts (t=4.47, p<0.0001). ORIGINALITY/VALUE Findings support that the DTS-S is a reliable and valid measure to assess PTSD symptoms in Latino inmate populations and to identify individuals at risk for the disorder that require confirmatory diagnosis and clinical interventions.
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Affiliation(s)
- José N Caraballo
- Professor, based at Department of Mathematics-Physics, University of Puerto Rico, Cayey, Puerto Rico
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Mercer KB, Orcutt HK, Quinn JF, Fitzgerald CA, Conneely KN, Barfield RT, Gillespie CF, Ressler KJ. Acute and posttraumatic stress symptoms in a prospective gene x environment study of a university campus shooting. ACTA ACUST UNITED AC 2011; 69:89-97. [PMID: 21893641 DOI: 10.1001/archgenpsychiatry.2011.109] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT The serotonin transporter (SLC6A4) has been associated with several stress-related syndromes including posttraumatic stress disorder (PTSD). The ability to detect meaningful associations is largely dependent on reliable measures of preexisting trauma. OBJECTIVE To study the association of genetic variants within SLC6A4 with acute and posttraumatic stress symptoms in a civilian cohort with known levels of preexisting trauma and PTSD symptoms collected prior to a shared index traumatic event. DESIGN Ongoing longitudinal study. SETTING On February 14, 2008, a lone gunman shot multiple people on the campus of Northern Illinois University in DeKalb, Illinois, killing 5 and wounding 21. As part of an ongoing longitudinal study on that campus, a cohort of female undergraduate students, interviewed prior to the shooting, completed follow-up trauma-related measures including PTSD symptom severity (follow-up survey was launched 17 days postshooting; n = 691). To obtain DNA, salivary samples were collected from a subset of the original study population based on willingness to participate (n = 276). PARTICIPANTS Two hundred four undergraduate women. MAIN OUTCOME MEASURES SLC6A4 polymorphisms STin2, 5-HTTLPR, and rs25531 were genotyped in 235 individuals. RESULTS We found that although the STin2 variant and 5-HTTLPR alone did not associate with increased PTSD symptoms, rs25531 and the 5-HTTLPR multimarker genotype (combined 5-HTTLPR and rs25531) were associated with significantly increased acute stress disorder symptoms at 2 to 4 weeks postshooting (n = 161; P < .05). This association remained significant when controlling for race and for level of shooting exposure (n = 123; P < .007). The association was most robust with the 5-HTTLPR multimarker genotype and avoidance symptoms (P = .003). CONCLUSION These data suggest that differential function of the serotonin transporter may mediate differential response to a severe trauma. When examined in a relatively homogenous sample with shared trauma and known prior levels of child and adult trauma, the 5-HTTLPR multimarker genotype may serve as a useful predictor of risk for PTSD-related symptoms in the weeks and months following the trauma.
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Gill JM, Szanton S, Taylor TJ, Page GG, Campbell JC. Medical conditions and symptoms associated with posttraumatic stress disorder in low-income urban women. J Womens Health (Larchmt) 2009; 18:261-7. [PMID: 19183098 DOI: 10.1089/jwh.2008.0914] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epidemiological studies have consistently reported rates of posttraumatic stress disorder (PTSD) in women that are twice that of men. In men and women, PTSD has been associated with comorbid medical conditions, medical symptoms and lower self-rating of health. In low-income urban women, rates of PTSD are even more elevated than in suburban women and may be related to observed health disparities. METHODS In this study, 250 women seeking healthcare at an urban clinic were interviewed for a PTSD diagnosis, major depressive disorder (MDD), the experience of traumatic events, the experience of current and past common medical conditions and symptoms, and subjective rating of health. A chart review was used to assess healthcare use in the past year. RESULTS More current (5.2 vs. 3.8, p < 0.05) and past medical conditions (4.6 vs. 3.3, p < 0.05) were reported by women with a lifetime history of PTSD than by women without this history, after controlling for demographics and current depression. Women with lifetime PTSD also had more annual clinic appointments (5.9 vs. 3.8 p < 0.03) and were 2.4 times (p < 0.05) more likely to report lower appraisal of their physical health. CONCLUSIONS These findings suggest that urban health-seeking women with PTSD experience health impairments that may cause increased morbidity and that healthcare providers should consider the health ramifications of PTSD when providing medical care to women.
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Affiliation(s)
- Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892-1506, USA.
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Gill JM, Page GG, Sharps P, Campbell JC. Experiences of traumatic events and associations with PTSD and depression development in urban health care-seeking women. J Urban Health 2008; 85:693-706. [PMID: 18581238 PMCID: PMC2527434 DOI: 10.1007/s11524-008-9290-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 05/14/2008] [Indexed: 10/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.
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Affiliation(s)
- Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, 10 Center Drive, 10/CRC 2-1339, Bethesda, MD 20892-1506, USA.
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Lincoln AK, Liebschutz JM, Chernoff M, Nguyen D, Amaro H. Brief screening for co-occurring disorders among women entering substance abuse treatment. Subst Abuse Treat Prev Policy 2006; 1:26. [PMID: 16959041 PMCID: PMC1570455 DOI: 10.1186/1747-597x-1-26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 09/07/2006] [Indexed: 11/12/2022]
Abstract
Background Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374). Results Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness. Conclusion Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment
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Affiliation(s)
- Alisa K Lincoln
- Department of Social and Behavioral Sciences, Boston University School of Public Health, Department of Psychiatry, Boston University School of Medicine, 715 Albany Street, T246W, Boston, MA, 02118, USA
| | - Jane M Liebschutz
- Department of Social and Behavioral Sciences, Boston University School of Public Health, Department of Psychiatry, Boston University School of Medicine, 715 Albany Street, T246W, Boston, MA, 02118, USA
- Section of General Internal Medicine (Clinical Addiction Research and Education Unit), Department of Medicine, Boston University School of Medicine, Department of Social and Behavioral Sciences, Boston University School of Public Health,, and Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA, 02118, USA
| | - Miriam Chernoff
- Institute on Urban Health Research, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Stearns Suite 503, Boston, MA, 02115, USA
| | - Dana Nguyen
- Potkin Research Division, Bldg,3, Rt.88, Rm 305, University of California – Irvine, Irvine, CA, 92697, USA
| | - Hortensia Amaro
- Institute on Urban Health Research, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Stearns Suite 503, Boston, MA, 02115, USA
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Iribarren J, Prolo P, Neagos N, Chiappelli F. Post-traumatic stress disorder: evidence-based research for the third millennium. Evid Based Complement Alternat Med 2005; 2:503-12. [PMID: 16322808 PMCID: PMC1297500 DOI: 10.1093/ecam/neh127] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 09/12/2005] [Indexed: 11/29/2022]
Abstract
The stress that results from traumatic events precipitates a spectrum of psycho-emotional and physiopathological outcomes. Post-traumatic stress disorder (PTSD) is a psychiatric disorder that results from the experience or witnessing of traumatic or life-threatening events. PTSD has profound psychobiological correlates, which can impair the person's daily life and be life threatening. In light of current events (e.g. extended combat, terrorism, exposure to certain environmental toxins), a sharp rise in patients with PTSD diagnosis is expected in the next decade. PTSD is a serious public health concern, which compels the search for novel paradigms and theoretical models to deepen the understanding of the condition and to develop new and improved modes of treatment intervention. We review the current knowledge of PTSD and introduce the role of allostasis as a new perspective in fundamental PTSD research. We discuss the domain of evidence-based research in medicine, particularly in the context of complementary medical intervention for patients with PTSD. We present arguments in support of the notion that the future of clinical and translational research in PTSD lies in the systematic evaluation of the research evidence in treatment intervention in order to insure the most effective and efficacious treatment for the benefit of the patient.
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Affiliation(s)
| | - Paolo Prolo
- UCLA School of DentistryLos Angeles, CA, USA
- Psychoneuroimmunology Group, Inc.Los Angeles, CA, USA
| | | | - Francesco Chiappelli
- UCLA School of DentistryLos Angeles, CA, USA
- Psychoneuroimmunology Group, Inc.Los Angeles, CA, USA
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