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Chiba I, Nakaya N, Kogure M, Hatanaka R, Nakaya K, Tokioka S, Nakamura T, Nagaie S, Fuse N, Obara T, Kotozaki Y, Tanno K, Kuriyama S, Hozawa A. Associations between housing and psychological damage by earthquake and modifiable risk factors for dementia in general older adults: Tohoku Medical Megabank community-based cohort study. Geriatr Gerontol Int 2024; 24:509-516. [PMID: 38700081 DOI: 10.1111/ggi.14867] [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: 12/18/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 05/05/2024]
Abstract
AIM To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults. METHODS This cross-sectional study enrolled 29 039 community-dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster-related damage (by complete or not complete housing damage) and psychological damage (by post-traumatic stress reaction [PTSR]) after the GEJE using a self-report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster-related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables. RESULTS Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19-0.27) and PTSR (β = 0.60; 95% CI: 0.53-0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR. CONCLUSIONS Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; 24: 509-516.
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Affiliation(s)
- Ippei Chiba
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Mana Kogure
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Rieko Hatanaka
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kumi Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Sayuri Tokioka
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
- Faculty of Data Science, Kyoto Women's University, Kyoto, Japan
| | - Satoshi Nagaie
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Nobuo Fuse
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yuka Kotozaki
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Morioka, Japan
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kozo Tanno
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Morioka, Japan
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Atsushi Hozawa
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
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Wen FH, Prigerson HG, Chou WC, Huang CC, Hu TH, Chiang MC, Chuang LP, Tang ST. How symptoms of prolonged grief disorder, posttraumatic stress disorder, and depression relate to each other for grieving ICU families during the first two years of bereavement. Crit Care 2022; 26:336. [PMID: 36320037 PMCID: PMC9628049 DOI: 10.1186/s13054-022-04216-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background Bereaved ICU family surrogates are at risk of comorbid prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Knowledge about temporal relationships between PGD, PTSD, and depression is limited by a lack of relevant studies and diverse or inappropriate assessment time frames given the duration criterion for PGD. We aimed to determine the temporal reciprocal relationships between PGD, PTSD, and depressive symptoms among ICU decedents’ family surrogates during their first 2 bereavement years with an assessment time frame reflecting the PGD duration criterion. Methods This prospective, longitudinal, observational study examined PGD, PTSD, and depressive symptoms among 303 family surrogates of ICU decedents from two academic hospitals using 11 items of the Prolonged Grief Disorder-13, the Impact of Event Scale—Revised, and the depression subscale of the Hospital Anxiety and Depression Scale, respectively, at 6, 13, 18, and 24 months post-loss. Cross-lagged panel modeling was conducted: autoregressive coefficients indicate variable stability, and cross-lagged coefficients indicate the strength of reciprocal relationships among variables between time points. Results Symptoms (autoregressive coefficients) of PGD (0.570–0.673), PTSD (0.375–0.687), and depression (0.591–0.655) were stable over time. Cross-lagged standardized coefficients showed that depressive symptoms measured at 6 months post-loss predicted subsequent symptoms of PGD (0.146) and PTSD (0.208) at 13 months post-loss. PGD symptoms did not predict depressive symptoms. PTSD symptoms predicted subsequent depressive symptoms in the second bereavement year (0.175–0.278). PGD symptoms consistently predicted subsequent PTSD symptoms in the first 2 bereavement years (0.180–0.263), whereas PTSD symptoms predicted subsequent PGD symptoms in the second bereavement year only (0.190–0.214). PGD and PTSD symptoms are bidirectionally related in the second bereavement year. Conclusions PGD, PTSD, and depressive symptoms can persist for 2 bereavement years. Higher PGD symptoms at 6 months post-loss contributed to the exacerbation of PTSD symptoms over time, whereas long-lasting PTSD symptoms were associated with prolonged depression and PGD symptoms beyond the first bereavement year. Identification and alleviation of depression and PGD symptoms as early as 6 months post-loss enables bereaved surrogates to grieve effectively and avoid the evolution of those symptoms into long-lasting PGD, PTSD, and depression. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04216-5.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, R.O.C
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, R.O.C
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.,Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, R.O.C
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R.O.C
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R.O.C
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.. .,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R.O.C.. .,School of Nursing, Medical College, Chang Gung University, 259 Wen-Hwa 1St Road, Kwei-Shan, Tao-Yuan, 333, Taiwan, R.O.C.. .,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R.O.C..
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Levis M, Ludmer DJ, Cornelius S, Scott R, Watts BV, Shiner B. An implementation and effectiveness study evaluating Conflict Analysis in VA residential substance abuse services: Whole Health informed self-guided online care. Explore (NY) 2022; 18:688-697. [DOI: 10.1016/j.explore.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
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Bachem R, Zhou X, Levin Y, Solomon Z. Trajectories of depression in aging veterans and former prisoners-of-war: The role of social support and hardiness. J Clin Psychol 2021; 77:2203-2215. [PMID: 34000063 DOI: 10.1002/jclp.23168] [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: 12/27/2019] [Revised: 01/14/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Depression is a prevalent outcome of traumatic experiences, such as combat and war captivity. This study explores the heterogeneity of changes over time and assesses the contribution of trauma exposure (combat vs. war captivity), hardiness, and social support for depression trajectories. METHODS Two groups of Israeli veterans were assessed in 1991, 2003, 2008, and 2015: 149 former prisoners-of-war (ex-POWs) and 107 combat veterans. Protective factors were evaluated in 1991. Group-based trajectory modeling was conducted to identify latent trajectories of change. RESULTS Four trajectories of "resiliency" (62.8%), "delayed onset" (25.1%), "exacerbation" (6.2%), and "chronicity" (5.9%) were found. The majority of the resilient group were combat veterans whereas the clinical groups consisted primarily of ex-POWs. Lower hardiness and social support were related to more deleterious trajectories. CONCLUSIONS Spirals of loss involving hardiness and social support, normative experiences, and contextual factors may present explanations for the various depression trajectories.
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Affiliation(s)
- Rahel Bachem
- I-Core Research Center for Mass Trauma, Tel Aviv University, Tel Aviv, Israel.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.,Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Xiao Zhou
- I-Core Research Center for Mass Trauma, Tel Aviv University, Tel Aviv, Israel.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.,Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yafit Levin
- I-Core Research Center for Mass Trauma, Tel Aviv University, Tel Aviv, Israel.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.,Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Tel Aviv University, Tel Aviv, Israel.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Kumar RG, Jayasinghe N, Walker RL, Gibbons LE, Power MC, Larson EB, Crane PK, Dams-O'Connor K. Association of remote traumatic brain injury and military employment with late-life trajectories of depressive symptom severity. J Affect Disord 2021; 281:376-383. [PMID: 33348181 PMCID: PMC8887889 DOI: 10.1016/j.jad.2020.12.003] [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: 08/04/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) and military service are common lifetime exposures among current older adults that may affect late-life mental health. The objective of the present study was to evaluate the association between TBI with loss of consciousness (LOC) and military employment and late-life depressive symptom severity trajectory. METHODS 1445 males and 2096 females adults at least 65 years old without dementia or recent TBI were enrolled and followed biennially for up to 10 years in the Adult Changes in Thought study from Kaiser Permanente Washington in Seattle, Washington. RESULTS Using group-based trajectory modeling, we documented four distinct depressive symptom severity trajectories that followed a similar course in males and females (Minimal, Decreasing, Increasing, and Persistent). In multinomial regression analyses, TBI with LOC in males was associated with greater likelihood of Persistent versus Minimal depressive symptom severity compared to individuals without TBI (OR = 1.51, 95% CI: 1.01, 2.27; p=0.046). Males reporting past military employment had greater likelihood of Decreasing versus Minimal depressive symptom severity compared to individuals without past military employment (OR = 1.54, 95% CI: 1.03, 2.31; p=0.035). There was no association between TBI or military employment and depression trajectories in females, and no evidence of effect modification by age or between exposures. LIMITATIONS Lifetime history of TBI was ascertained retrospectively and may be subject to recall bias. Also, past military employment does not presuppose combat exposure. CONCLUSIONS Remote TBI and past military employment are relevant to late-life trajectories of depressive symptom severity in dementia-free older males.
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Affiliation(s)
- Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Nimali Jayasinghe
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai; Department of Psychiatry, Weill Cornell Medicine
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute
| | | | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
| | - Eric B Larson
- Department of Medicine, University of Washington; Kaiser Permanente Washington Health Research Institute
| | - Paul K Crane
- Department of Medicine, University of Washington
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai; Department of Neurology, Icahn School of Medicine at Mount Sinai. kristen.dams-o'
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Kwon A, Lee HS, Lee SH. The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD. Front Psychiatry 2021; 12:613735. [PMID: 33841200 PMCID: PMC8032896 DOI: 10.3389/fpsyt.2021.613735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis. Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide. Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression. Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.
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Affiliation(s)
- Aeran Kwon
- Department of Social Welfare and Counseling, Chodang University, Muan, South Korea
| | - Hyun Seo Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, South Korea
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Cheng J, Liang Y, Fu L, Liu Z. The relationship between PTSD and depressive symptoms among children after a natural disaster: A 2-year longitudinal study. Psychiatry Res 2020; 292:113296. [PMID: 32688133 DOI: 10.1016/j.psychres.2020.113296] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
This study examined the relationship between posttraumatic stress disorder (PTSD) and depressive symptoms among children who survived the Lushan earthquake. Three hundred thirty-three children (154 males, 179 females) were assessed for acute stress disorder (ASD) and depressive symptoms at 2 weeks (T1), and their PTSD and depressive symptoms were recorded at 1.5 (T2), 6 (T3), 12 (T4) and 24 (T5) months after the earthquake. The results showed that ASD predicted PTSD and depressive symptoms from T1 to T2, and PTSD symptoms predicted depressive symptoms from T2 to T5, but not vice versa. Depressive symptoms predicted avoidance from T1 to T5; in turn, avoidance predicted depressive symptoms from T3 to T5. Hyperarousal and intrusive symptoms had an effect on depressive symptoms between T1 and T2, and depressive symptoms predicted hyperarousal and intrusion from T2 to T3; after 12 months they did not significantly predict each other. The results suggest that PTSD symptoms generally precede depressive symptoms, and that hyperarousal and intrusive symptoms are major symptoms of PTSD soon after trauma events, while avoidance symptoms are major symptoms of PTSD late after trauma events. The relationship between PTSD and depressive symptoms mostly fits the interactive model.
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Affiliation(s)
- Jin Cheng
- School of Psychology, Beijing Sport University, Beijing 100084, China; CAS Key Laboratory of Mental Health, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing 100101, China
| | - Yiming Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing 100101, China.
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Pathways of Internalizing and Posttraumatic Stress Symptoms Across Childhood and Adolescence. Res Child Adolesc Psychopathol 2020; 49:103-116. [PMID: 32979128 DOI: 10.1007/s10802-020-00701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Research in adult populations has suggested a number of possible explanations for the high co-morbidity between posttraumatic stress symptoms (PTSS) and internalizing symptoms, including shared risk factors and reciprocal causation. Little research has examined these hypotheses in children or has considered the separation of between- and within-person effects. The objective of this study was to examine pathways between PTSS and internalizing symptoms using two samples drawn from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN, n = 1221) and the first National Survey of Child and Adolescent Well-Being (NSCAW-I, n = 309). Each sample included three waves of data (LONGSCAN: ages 8, 12, and 16; NSCAW: ages 8, 11, 15). It was hypothesized: (1) PTSS would predict future internalizing symptoms; (2) the strength of the relationship between internalizing symptoms and PTSS would increase over time; and (3) childhood trauma would be associated with higher levels of internalizing symptoms and PTSS. The hypotheses were examined using traditional cross-lagged panel models (CLPMs) as well as a CLPM with random intercepts (RI-CLPM), which has the advantage of separating within-person effects from between-person stability in symptoms. Results from both CLPMs and RI-CLPM support rising symptom comorbidity from late childhood to mid-adolescence. Results between the models, however, suggest that the reciprocal influence between symptom complexes over time may not hold after separating between- and within-persons effects, lending stronger support to the shared risk factors hypothesis and highlighting the need for future research to explore other possible explanatory mechanisms for the rising comorbidity of these symptom complexes over development.
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Resnik LJ, Borgia ML, Clark MA. A National Survey of Prosthesis Use in Veterans with Major Upper Limb Amputation: Comparisons by Gender. PM R 2020; 12:1086-1098. [PMID: 32103626 DOI: 10.1002/pmrj.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND A better understanding of women veterans with upper limb amputation is needed. OBJECTIVE To compare prosthetic use and outcomes of female and male veterans with upper limb amputation. DESIGN Cross-sectional survey: Amputation characteristics, prosthesis use, and quality of life outcomes were compared by gender. Separate logistic regression models examined association of gender with prosthesis use and receipt of training to use a prosthesis. Separate linear regression models examined the relationship between gender and health-related quality of life (HRQoL) outcomes. PARTICIPANTS Participants were veterans with major upper limb amputation who received care at the Department of Veterans Affairs (VA) in 2010-2015, identified from VA data sources. A total of 808 individuals (755 men, 21 women) were surveyed by telephone. MAIN OUTCOME MEASURES Disabilities of the Arm, Shoulder and Hand (QuickDASH), VR-12 Physical Component Summary (PCS) and VR-12 Mental Component Summary (MCS), Trinity Amputation and Prosthetic Experience Scale satisfaction scale, Orthotics and Prosthetic User's Survey client satisfaction with devices scale. SETTING Telephone survey of community dwelling participants. INTERVENTIONS Not applicable. RESULTS Survey response rate was 47.3% for men and 62.8% for women. Women were less likely to have ever used a prosthesis (adjusted odds ratio [aOR] = 0.26; confidence interval [CI] 0.08-0.88), have received training for an initial prosthesis (aOR: 0.24; CI 0.08-0.70), be current users (aOR = 0.34; CI 0.12-1.01), and have received training for a current prosthesis (aOR: 0.15; 0.03-0.87). A greater proportion of women used cosmetic and a smaller proportion used body-powered devices compared to men (P < .05). Device heaviness or fatigue was the most common reason for abandonment. There were no significant differences in outcome measures by gender. CONCLUSIONS Women were less likely than men to have ever used and currently use prostheses or to have received prosthetic training, more likely to use cosmetic devices, and less likely to use body-powered devices. Efforts to develop prostheses that are cosmetically acceptable, yet lightweight and functional, are needed.
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Affiliation(s)
- Linda J Resnik
- Research Department, Providence VA Medical Center, Providence, RI, USA.,Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Matthew L Borgia
- Research Department, Providence VA Medical Center, Providence, RI, USA
| | - Melissa A Clark
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
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Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander VA, LeardMann CA. Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry 2019; 19:396. [PMID: 31836015 PMCID: PMC6911296 DOI: 10.1186/s12888-019-2375-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/27/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, particularly major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD. METHODS Eligible participants (n = 1704) for the Millennium Cohort Study included those who screened positive at baseline for both PTSD (PTSD Checklist-Civilian Version) and MDD (Patient Health Questionnaire). Between 2001 and 2016, participants completed a baseline assessment and up to 4 follow-up assessments approximately every 3 years. Mixture modeling simultaneously determined trajectories of comorbid PTSD and MDD symptoms. Multinomial regression determined factors associated with latent class membership. RESULTS Four distinct classes (chronic, relapse, gradual recovery, and rapid recovery) described symptom trajectories of PTSD/MDD. Membership in the chronic class was associated with older age, service branch, deployment with combat, anxiety, physical assault, disabling injury/illness, bodily pain, high levels of somatic symptoms, and less social support. CONCLUSIONS Comorbid PTSD/MDD symptoms tend to move in tandem, and, although the largest class remitted symptoms, almost 25% of participants reported chronic comorbid symptoms across all time points. Results highlight the need to assess comorbid conditions in the context of PTSD. Future research should further evaluate the chronicity of comorbid symptoms over time.
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Affiliation(s)
- Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA.
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA.
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA.
| | - Kristen H Walter
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, 92106-3521, USA
| | - Toni Rose Geronimo-Hara
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Ben Porter
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Cynthia A LeardMann
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
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11
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Examining reciprocal influence between posttraumatic stress and depressive symptoms among natural disaster survivors. J Affect Disord 2019; 257:345-351. [PMID: 31302524 DOI: 10.1016/j.jad.2019.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/03/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The current study examined reciprocal effects of symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) among individuals affected by Hurricane Ike, which made landfall on September 13, 2008 METHODS: Participants were 658 survivors, who participated in the Galveston Bay Recovery Study (GBRS; National Center for Disaster Mental Health Research, Galea, and Norris, 2016). Assessment was conducted at 3, 6, and 15 months after the disaster. Bivariate latent change score modeling was conducted to examine the nature of the time-sequential associations between symptoms of PTSD and MDD RESULTS: Results revealed a unidirectional coupling effect from depression to change in PTSD, but unidirectional coupling effect from PTSD to change in depression was not supported. LIMITATIONS Only linear relations of within-individual change and time-sequential associations between PTSD and depression were examined, and therefore, it precludes potential nonlinear relations between these constructs. Also, the results of the current study are limited to the studied timespan (i.e., 3 to 15 months). Lastly, other factors that could be confounding the change in PTSD symptoms were not examined, leaving a possibility of other constructs that may influence the change in future PTSD symptoms CONCLUSIONS: The current study suggests that disaster survivors with higher symptoms of depression may be at higher risk of experiencing increased PTSD symptoms even after one year, raising an importance of tailoring a treatment to alleviate depressive symptoms and to mitigate the risk of future symptoms of PTSD.
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The relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer. J Anxiety Disord 2019; 61:82-88. [PMID: 29580634 DOI: 10.1016/j.janxdis.2018.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022]
Abstract
Two studies suggest that reductions in posttraumatic symptoms (Aderka et al., 2013) and cognitions (Zalta et al., 2014) precede reductions in depressive symptoms during prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) in female assault survivors. The present study explored the temporal relationship between posttraumatic and depressive symptoms in a randomized trial of D-Cycloserine (DCS) versus placebo augmented virtual reality exposure (VRE) therapy for chronic World Trade Center-related PTSD following the September 11, 2001 terrorist attacks. Twenty-five male and female participants were randomly assigned to receive either 100 mg DCS (N = 13) or placebo (N = 12) 90 min before 12 weekly VRE sessions. Participants contributed a total of 280 weekly PTSD Checklist (PCL; Weathers et al., 1993) and Beck Depression Inventory-second edition (BDI-II; Beck et al., 1996) symptom scores. Two sets of mediation analyses for longitudinal mixed models assessed the effects of 1) lagged PCL on BDI-II (Model 1), and 2) lagged BDI-II on PCL (Model 2) in the VRE-DCS and VRE-Placebo treatment groups, respectively. Results revealed reciprocal relations between posttraumatic and depressive symptoms during VRE treatment, although reductions in posttraumatic symptoms led to subsequent reductions in depressive symptoms to a greater extent than the converse. These effects were stronger in the DCS-enhanced group. Findings suggest that VRE primarily decreases posttraumatic symptoms, which in turn leads to decreased depressive symptoms, and that DCS may strengthen these effects.
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Changes in posttraumatic stress symptoms, cognitions, and depression during treatment of traumatized youth. Behav Res Ther 2018; 111:119-126. [DOI: 10.1016/j.brat.2018.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/05/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022]
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Cheng J, Liang Y, Fu L, Liu Z. Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake. Eur J Psychotraumatol 2018; 9:1472992. [PMID: 29805782 PMCID: PMC5965039 DOI: 10.1080/20008198.2018.1472992] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/18/2018] [Indexed: 11/05/2022] Open
Abstract
Background: Many studies have reported the comorbidity of posttraumatic stress disorder (PTSD) and depression in children. However, the underlying relationship between PTSD and depression remains unclear. Objective: This study examines the relationship between PTSD and depressive symptoms in children who survived the Wenchuan earthquake in China. Methods: In total, 301 children were assessed at four months and then followed up at 29, 40 and 52 months after the disaster. The ages of the children ranged from 9.6-14.6 years old, and the sample included 157 males and 144 females. The children were assessed by using the University of California at Los Angeles PTSD reaction index for DSM-IV for PTSD symptoms and the Children's Depression Inventory for depressive symptoms. Results: Comorbid PTSD and depressive symptoms were prevalent in 4.0, 3.3, 3.7 and 5.1% of the participants at times 1, 2, 3 and 4, respectively. The cross-lagged analysis indicated that PTSD symptoms at time 1 predicted depressive symptoms at time 2; depressive symptoms at time 1 predicted PTSD symptoms at time 2; depressive symptoms at time 2 predicted PTSD symptoms at time 3; and depressive symptoms at time 3 predicted PTSD symptoms at time 4. The findings also showed that being female, poor parental relationships and trauma exposure were risk factors for PTSD or depressive symptoms. Conclusions: The results suggest that the causal relationship between PTSD and depressive symptoms changes over time; the effects of PTSD symptoms tend to decrease, while those of depressive symptoms tend to increase. Two stages of the relationship between PTSD and depressive symptoms were observed, namely, that PTSD and depressive symptoms first influenced each other and then that depressive symptoms predicted PTSD. The results of our study also suggest that females with poor parental relationships and a high degree of trauma exposure are more likely to require intervention.
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Affiliation(s)
- Jin Cheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - YiMing Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - ZhengKui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
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Ben Barnes J, Hayes AM, Contractor AA, Nash WP, Litz BT. The structure of co-occurring PTSD and depression symptoms in a cohort of Marines pre- and post-deployment. Psychiatry Res 2018; 259:442-449. [PMID: 29131993 DOI: 10.1016/j.psychres.2017.10.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 10/03/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
Symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder are the most frequently co-occurring problems following potentially traumatic events. It is unclear whether these comorbidities represent two correlated but distinct disorders or a common post-event response. We sought to inform this question by examining the distinctiveness of PTSD and depression symptoms at four cross-sectional time points, using data from a parent prospective longitudinal study of 858 Marines evaluated before deployment and approximately 1, 5, and 8 months after returning from the Afghanistan war. We conducted a series of cross-sectional confirmatory factor analyses of PTSD and depression symptoms at each time point, using the Posttraumatic Stress Disorder Checklist IV and the Beck Depression Inventory II. Analyses indicated that across all four assessments, self-reported symptoms on the measures were best explained by distinct but correlated subclusters of symptoms within each measure. This structure was supported by the data both before and after deployment, even with increases in average PTSD symptoms after deployment. These findings suggest that despite shared method variance and some symptom overlap, self-reports of PTSD and depression symptoms across a stressful combat deployment show distinct symptom subclusters rather than a general common trauma reaction in this sample of Marines.
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Affiliation(s)
- J Ben Barnes
- Department of Psychological and Brain Sciences, University of Delaware, Wolf Hall 108, 105 The Green, Newark, DE 19716, United States.
| | - Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, Wolf Hall 108, 105 The Green, Newark, DE 19716, United States
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, United States
| | - William P Nash
- Headquarters, United States Marine Corps, Arlington, VA, United States
| | - Brett T Litz
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA, United States; Boston University, Boston, MA, United States
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Searle AK, Van Hooff M, McFarlane AC, Davies CE, Tran T, Hodson SE, Benassi HP, Steele NM. Screening for Depression and Psychological Distress in a Currently Serving Military Population: The Diagnostic Accuracy of the K10 and the PHQ9. Assessment 2017; 26:1411-1426. [PMID: 29192508 DOI: 10.1177/1073191117745124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study is the first to examine the diagnostic accuracy of two depression screening scales-the Kessler Psychological Distress Scale (K10) and the Patient Health Questionnaire (PHQ)-in an entire regular-serving military population. Currently serving Australian Defence Force personnel (n = 24,481) completed the K10 and PHQ9. Then a targeted subsample (i.e., the analysis sample, n = 1,730) completed a diagnostic interview to identify DSM-IV 30-day disorder. Weighted results represented the entire population (N = 50,049). Both scales similarly showed a good ability to discriminate between personnel with and without depressive disorders. Optimal cutoffs (19 for K10, 6 for PHQ9) showed high sensitivity and good specificity, and were similar to though slightly lower than those recommended in civilian populations. Both scales appear to be valid screens for depressive disorder in the military, using the cutoffs identified. As both performed similarly, scale choice may depend on other factors (e.g., availability of norms).
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Affiliation(s)
- Amelia K Searle
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Thao Tran
- University of Adelaide, Adelaide, South Australia, Australia.,Department of Health, Queensland Government, Brisbane, Queensland, Australia
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Mousavi B, Khateri S, Soroush M, Ganjparvar Z. Sulfur mustard exposure and mental health in survivors of Iran–Iraq war with severe lung injuries. TOXIN REV 2017. [DOI: 10.1080/15569543.2017.1303779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Batool Mousavi
- Janbazan Medical and Engineering Research Center, Tehran, Iran
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McLean CP, Su YJ, Carpenter JK, Foa EB. Changes in PTSD and Depression During Prolonged Exposure and Client-Centered Therapy for PTSD in Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 46:500-510. [PMID: 25751238 PMCID: PMC4564358 DOI: 10.1080/15374416.2015.1012722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Depressive symptoms are common among individuals with posttraumatic stress disorder (PTSD). Prolonged exposure therapy (PE) for PTSD has been found to alleviate both PTSD and depressive symptoms, but relatively little is known about the pattern of PTSD and depressive symptom change during treatment. This study aimed to investigate the relationship between changes in PTSD and depression during PE for adolescent (PE-A) and client-centered therapy (CCT). The moderating role of PE-A versus CCT and the possible differences across symptom clusters of PTSD were also examined. Participants were 61 female adolescents with sexual-assault-related PTSD randomized to PE-A (n = 31) or CCT (n = 30). Participants completed the Beck Depression Inventory and the Child PTSD Symptom Scale at pre-, mid-, and posttreatment and before each treatment session. Multilevel mediation analysis indicated a reciprocal but asymmetrical relationship between changes in PTSD and depression during treatment in the overall sample. Moderated mediation analysis showed that the reciprocal relation was observed only during PE-A. Reductions in PTSD led to reductions in depression to a greater extent (48.7%), 95% confidence interval [30.2, 67.2], than vice versa (22.0%), [10.6, 33.4]. For participants receiving CCT, reduction in PTSD led to reductions in depression (31.6%), [11.8, 51.4], but not vice versa (7.4%), [-7.1, 21.9]. The reciprocal relationship between PTSD and depression was also observed across different symptoms clusters of PTSD. Our findings suggest that changes in PTSD led to changes in depressive symptoms to a greater extent than vice versa across PE-A and CCT.
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Affiliation(s)
| | - Yi-Jen Su
- b Graduate Institute of Behavioral Sciences , Chang Gung University
| | | | - Edna B Foa
- a Department of Psychiatry , University of Pennsylvania
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Abstract
The first part of the series of three articles on posttraumatic stress disorder (PTSD) in Court to appear in the journal reviews the history of the construct of PTSD and its presentation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013) and the ICD-11 (International Classification of Diseases, 11th Edition; World Health Organization, 2018). There are 20 symptoms of PTSD in the DSM-5. PTSD symptoms are arranged into a four-cluster model, which has received partial support in the literature. Other four-factor models have been found that fit the data even better than that of the DSM-5. There is a five-factor dysphoria model and two six-factor models that have been found to fit better the DSM-5 PTSD symptoms. Finally, research is providing support for a hybrid seven-factor model. An eighth factor on dissociation seems applicable to the minority of people who express the dissociative subtype. At the epidemiological level, individuals can expect trauma exposure to take place about 70% over one's lifetime. Also, traumatic exposure leads to traumatic reactions in about 10% of cases, with PTSD being a primary diagnosis for trauma. Once initiated, PTSD becomes prolonged in about 10% of cases. Polytrauma and comorbidities complicate these prevalence statistics. Moreover, the possibility of malingered PTSD presents confounds. However, the estimate for malingered PTSD varies extensively, from 1 to 50%, so that the estimate is too imprecise for use in court without further research. This first article in the series of three articles appearing in the journal on PTSD in Court concludes with discussion of complications related to comorbidities and heterogeneities, in particular. For example, PTSD and its comorbidities can be expressed in over one quintillion ways. This complexity in its current structure in the DSM-5 speaks to the individual differences involved in its expression.
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Affiliation(s)
- Gerald Young
- Glendon Campus, York University, Toronto, Ontario, Canada.
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Yennu A, Tian F, Smith-Osborne A, J Gatchel R, Woon FL, Liu H. Prefrontal responses to Stroop tasks in subjects with post-traumatic stress disorder assessed by functional near infrared spectroscopy. Sci Rep 2016; 6:30157. [PMID: 27452397 PMCID: PMC4995363 DOI: 10.1038/srep30157] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Abstract
Studies on posttraumatic stress disorder (PTSD) showing attentional deficits have implicated abnormal activities in the frontal lobe. In this study, we utilized multichannel functional near-infrared spectroscopy (fNIRS) to investigate selective attention-related hemodynamic activity in the prefrontal cortex among 15 combat-exposed war-zone veterans with PTSD and 13 age- and gender-matched healthy controls. While performing the incongruent Stroop task, healthy controls showed significant activations in the left lateral prefrontal cortex (LPFC) compared to baseline readings. This observation is consistent with previously reported results. In comparison, subjects with PTSD failed to activate left LPFC during the same Stroop task. Our observations may implicate that subjects with PTSD experienced difficulty in overcoming Stroop interference. We also observed significant negative correlation between task reaction times and hemodynamic responses from left LPFC during the incongruent Stroop task in the PTSD group. Regarding the methodology used in this study, we have learned that an appropriate design of Stroop paradigms is important for meeting an optimal cognitive load which can lead to better brain image contrasts in response to Stroop interference between healthy versus PTSD subjects. Overall, the feasibility of fNIRS for studying and mapping neural correlates of selective attention and interference in subjects with PTSD is reported.
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Affiliation(s)
- Amarnath Yennu
- The University of Texas at Arlington, Department of Bioengineering, Arlington, TX 76019, USA
| | - Fenghua Tian
- The University of Texas at Arlington, Department of Bioengineering, Arlington, TX 76019, USA
| | - Alexa Smith-Osborne
- The University of Texas at Arlington, School of Social Work, Arlington, TX 76019, USA
| | - Robert J Gatchel
- The University of Texas at Arlington, Department of Psychology, Arlington, TX 76019, USA
| | - Fu Lye Woon
- The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hanli Liu
- The University of Texas at Arlington, Department of Bioengineering, Arlington, TX 76019, USA
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Cohen P, Kasen S, Bifulco A, Andrews H, Gordon K. The accuracy of adult narrative reports of developmental trajectories. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016. [DOI: 10.1177/01650250500147709] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This methodological investigation examines the accuracy of narrative-based scaled ratings covering several post high school years. Guided narratives by young adults described developmentally relevant behaviour and context for each month between ages 17 and the mid-20s. “Prospective” narratives covered shorter time periods in three interviews separated by about 1 year each. A fourth “retrospective” interview included the entire period covered in the previous narratives and took place 1 year after the last prospective interview. Study variables were reliable ratings of data from these carefully conducted and blindly repeated narratives. Aspects of the study design expected to maximise reliability and validity of these data are provided. Prospective–retrospective (test–retest) correlation of ratings based on data from 149 participants covering an average of 64 studied months each on role-related, qualitative, and social variables are reported. The high consistency of many developmental variables based on these reports suggests that retrospective narratives can produce reliable and valid scaled measures covering a substantial period of time.
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Affiliation(s)
| | - Stephanie Kasen
- New York State Psychiatric Institute and Columbia University, USA
| | | | - Howard Andrews
- New York State Psychiatric Institute and Columbia University, USA
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Cao X, Wang L, Cao C, Zhang J, Liu P, Zhang B, Wu Q, Zhang H, Zhao Z, Fan G, Elhai JD. Patterns of DSM-5 posttraumatic stress disorder and depression symptoms in an epidemiological sample of Chinese earthquake survivors: A latent profile analysis. J Affect Disord 2015; 186:58-65. [PMID: 26231442 DOI: 10.1016/j.jad.2015.06.058] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps. METHODS LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors. RESULTS A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment. LIMITATIONS A sample exposed to specific traumatic events was assessed by self-report measures. CONCLUSIONS The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations.
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Affiliation(s)
- Xing Cao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | - Chengqi Cao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China
| | - Jianxin Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China; People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Biao Zhang
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Qi Wu
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Hong Zhang
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Zhihong Zhao
- Hanwang People's Hospital, Deyang, Sichuan, China
| | - Gaolin Fan
- Hanwang People's Hospital, Deyang, Sichuan, China
| | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, Toledo, USA
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Armour C, Contractor A, Elhai JD, Stringer M, Lyle G, Forbes D, Richardson JD. Identifying latent profiles of posttraumatic stress and major depression symptoms in Canadian veterans: Exploring differences across profiles in health related functioning. Psychiatry Res 2015; 228:1-7. [PMID: 25936834 DOI: 10.1016/j.psychres.2015.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/29/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been consistently reported as being highly comorbid with major depressive disorder (MDD) and as being associated with health related functional impairment (HRF). We used archival data from 283 previously war-zone deployed Canadian veterans. Latent profile analysis (LPA) was used to uncover patterns of PTSD and MDD comorbidity as measured via the PTSD Checklist-Military version (PCL-M) and the Patient Health Questionnaire-9 (PHQ-9). Individual membership of latent classes was used in a series of one-way ANOVAs to ascertain group differences related to HRF as measured via the Short-Form-36 Health Survey (SF-36). LPA resulted in three discrete patterns of PTSD and MDD comorbidity which were characterized by high symptoms of PTSD and MDD, moderate symptoms, and low symptoms. All ANOVAs comparing class membership on the SF-36 subscales were statistically significant demonstrating group differences across levels of HRF. The group with the highest symptoms reported the worst HRF followed by the medium and low symptom groups. These findings are clinically relevant as they demonstrate the need for continual assessment and targeted treatment of co-occurring PTSD and MDD.
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Affiliation(s)
- Cherie Armour
- School of Psychology, University of Ulster at Coleraine Campus, Coleraine, Northern Ireland, UK.
| | | | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Maurice Stringer
- School of Psychology, University of Ulster at Coleraine Campus, Coleraine, Northern Ireland, UK
| | - Gary Lyle
- Psychology Department, Northern Ireland Prison Service, HMP Magilligan, Limavady, Northern Ireland, UK
| | - David Forbes
- Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - J Don Richardson
- Parkwood Operational Stress Injury Clinic, St. Joseph׳s Health Care London - Parkwood Hospital, University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, University of Western Ontario, London, Ontario, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada
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Sumner JA, Kubzansky LD, Elkind MSV, Roberts AL, Agnew-Blais J, Chen Q, Cerdá M, Rexrode KM, Rich-Edwards JW, Spiegelman D, Suglia SF, Rimm EB, Koenen KC. Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women. Circulation 2015; 132:251-9. [PMID: 26124186 PMCID: PMC4519406 DOI: 10.1161/circulationaha.114.014492] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 05/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. METHODS AND RESULTS We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49 978 women in the Nurses' Health Study II. Proportional hazards models estimated hazard ratios and 95% confidence intervals for CVD events confirmed by additional information or medical record review (n=548, including myocardial infarction [n=277] and stroke [n=271]). Trauma exposure and PTSD symptoms were assessed by using the Brief Trauma Questionnaire and a PTSD screen. In comparison with no trauma exposure, endorsing ≥4 PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (hazard ratio,1.60; 95% confidence interval, 1.20-2.13). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (hazard ratio, 1.45; 95% confidence interval, 1.15-1.83), although being trauma-exposed and endorsing 1 to 3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. CONCLUSION Trauma exposure and elevated PTSD symptoms may increase the risk of CVD in this population of women. These findings suggest that screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention.
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Affiliation(s)
- Jennifer A Sumner
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
| | - Laura D Kubzansky
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Mitchell S V Elkind
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Andrea L Roberts
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Jessica Agnew-Blais
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Qixuan Chen
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Magdalena Cerdá
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Kathryn M Rexrode
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Janet W Rich-Edwards
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Donna Spiegelman
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Shakira F Suglia
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Eric B Rimm
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
| | - Karestan C Koenen
- From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.)
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Puetz TW, Youngstedt SD, Herring MP. Effects of Pharmacotherapy on Combat-Related PTSD, Anxiety, and Depression: A Systematic Review and Meta-Regression Analysis. PLoS One 2015; 10:e0126529. [PMID: 26020791 PMCID: PMC4447407 DOI: 10.1371/journal.pone.0126529] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/02/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To estimate the effect of pharmacotherapy on PTSD, anxiety, and depression among combat veterans; to determine whether the effects varied according to patient and intervention characteristics; and to examine differential effects of pharmacotherapy on outcomes. MATERIALS AND METHODS Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science databases were searched through November 2014. Searches resulted in eighteen double-blind, placebo controlled trials of 773 combat veterans diagnosed with PTSD and included only validated pre- and post-intervention PTSD and anxiety or depression measures. Authors extracted data on effect sizes, moderators, and study quality. Hedges' d effect sizes were computed and random effects models estimated sampling error and population variance. The Johnson-Neyman procedure identified the critical points in significant interactions to define regions of significance. RESULTS Pharmacotherapy significantly reduced (Δ, 95%CI) PTSD (0.38, 0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52, 0.35-0.70). The effects of SSRIs and tricyclic antidepressants on PTSD were greater than other medications independent of treatment duration. The effect of SSRIs and tricyclic antidepressants were greater than other medications up to 5.2 and 13.6 weeks for anxiety and depression, respectively. The magnitude of the effect of pharmacotherapy on concurrently-measured PTSD, anxiety, and depression did not significantly differ. CONCLUSIONS Pharmacotherapy reduced PTSD, anxiety, and depressive symptoms in combat veterans. The effects of SSRIs and tricyclic antidepressants were greater for PTSD and occurred quicker for anxiety and depression than other medications.
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Affiliation(s)
- Timothy W. Puetz
- Office of the Director, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Shawn D. Youngstedt
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona, United States of America
- Phoenix VA Health Care System, Phoenix, Arizona, United States of America
| | - Matthew P. Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Albright DL, Weiss EL, Nedjat-Haiem FR. Introduction to the aging military veterans special section. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2015; 58:382-385. [PMID: 25970538 DOI: 10.1080/01634372.2015.1042301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- David L Albright
- a School of Social Work , University of Missouri , Columbia , Missouri , USA
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Tracy M, Morgenstern H, Zivin K, Aiello AE, Galea S. Traumatic event exposure and depression severity over time: results from a prospective cohort study in an urban area. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1769-82. [PMID: 24816599 PMCID: PMC6684030 DOI: 10.1007/s00127-014-0884-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/14/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE A substantial proportion of adults experience traumatic events each year, yet little is known about the effects of different types of traumatic events on depression severity over time. We prospectively assessed the effects of traumatic event exposure during a 1-year period on changes in depression severity during that period among a representative sample of adults living in Detroit, Michigan in the United States. METHODS We used data from 1,054 participants in the first two waves of the Detroit Neighborhood Health Study (2008-2010). Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Negative binomial regression was used to estimate the effect of traumatic event exposure on depression severity at Wave 2, adjusting for Wave 1 PHQ-9 score and potential confounders. RESULTS The mean depression severity score at Wave 2 among those exposed to at least one traumatic event during follow-up was 1.71 times higher than among those with no traumatic event exposure [95 % confidence interval (CI) 1.27-2.29]. Also positively associated with depression severity at Wave 2 (vs. no traumatic events) were assaultive violence (mean ratio 2.49, 95 % CI 1.41-4.38), injuries and other directly experienced shocking events (mean ratio 2.59, 95 % CI 1.62-3.82), and three or more traumatic events (mean ratio 2.58, 95 % CI 1.62-4.09). CONCLUSIONS Violence, injuries, and other directly experienced traumatic events increase depression severity and may be useful targets for interventions to alleviate the burden of depression in urban areas.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Room 515, New York, NY, 10032, USA,
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA,Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA,Department of Urology, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kara Zivin
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA,Department of Veterans Affairs, Ann Arbor, MI 48113, USA
| | - Allison E. Aiello
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Room 515, New York, NY 10032, USA
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Dekel S, Solomon Z, Horesh D, Ein-Dor T. Posttraumatic stress disorder and depressive symptoms: joined or independent sequelae of trauma? J Psychiatr Res 2014; 54:64-9. [PMID: 24703578 DOI: 10.1016/j.jpsychires.2014.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The nature of co-morbidity between posttraumatic stress disorder (PTSD) and depression has been the subject of much controversy. This study addresses this issue by investigating associations between probable PTSD and depressive symptoms in a prospective, longitudinal sample of combat veterans. METHOD Symptoms of PTSD and depression were assessed at 3 points of time (i.e., 1991, 2003, 2008) over a period of 17 years utilizing the PTSD Inventory and the SCL-90 (Derogatis, 1977). Two groups of combat veterans, 275 former prisoners of war (ex-POWs) and 219 matched combatants (controls), were assessed. Data were analyzed using descriptive statistics, latent variable modeling, and confirmatory factor analysis. RESULTS A series of χ(2) tests revealed that the prevalence proportions of depressive symptoms and probable PTSD were higher among ex-POWs compared to controls at all time points. The prevalence of depressive symptoms was higher than the prevalence of PTSD symptoms in both groups at the each of the times. Latent Trajectories Modeling (LTM) indicated that while ex-POWs' PTSD symptom severity increased over time, the severity of symptoms remained stable among controls. Parallel Process Latent Growth Modeling (PLGM) revealed a positive bi-directional relationship whereby PTSD symptoms mediated the affect of captivity on depressive symptoms and depressive symptoms mediated the affect of captivity on PTSD symptoms over time. Utilizing Confirmatory Factor Analysis (CFA), a single factor model emerged for depressive and PTSD symptoms. CONCLUSION The findings suggest that while depression and PTSD seem to be different long-term manifestations of traumatic stress, accounted for in part by the severity of the trauma, they both may be parts of a common general traumatic stress construct. Clinical and theoretical implications of these findings are discussed.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Danny Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University, NY, USA
| | - Tsachi Ein-Dor
- School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
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Trajectory and predictors of depressive symptoms among adolescent survivors following the Wenchuan earthquake in China: a cohort study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:943-52. [PMID: 24429727 DOI: 10.1007/s00127-014-0821-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the trajectory of depressive symptoms among adolescents exposed to the Wenchuan earthquake as well as predictors after the earthquake. METHODS A cohort of students (N = 1,573) in the 7th and 10th grades from Dujiangyan city was followed-up periodically for 2 years. Participants were assessed at 6, 12, 18, and 24 months after the earthquake. Adolescents completed the Depression Self-rating Scale for Children, Adolescent Self-Rating Life Event Checklist, Resilience Scale, and earthquake exposure questionnaire. RESULTS The prevalence rates of depressive symptoms at 6, 12, 18 and 24 months were 27.4, 41, 31.9, and 38.3 %, respectively. The number of adolescents who kept no depressive symptoms and persistent depressive symptoms at each stage was stable, accounted for almost 50 and 20 % of the total, respectively. Adolescents turning no depressive symptoms to depressive symptoms were mostly in 6-12 months, followed by 18-24 months. Additionally, girls (OR 1.24-1.37), post-disaster negative life events (OR for high vs. low = 5.54-15.06), resilience (OR for low vs. high = 9.40-13.69), and depressive symptoms at previous stage (OR 4.96-6.03) had a long-term effect on depressive symptoms, while the impact of earthquake exposure diminished with the passage of time and could not predict depressive symptoms after one and a half years after the earthquake. CONCLUSIONS Among adolescent survivors, the resistance and persistence of depressive symptoms were common. Moreover, depressive symptoms tended to outbreak close to the anniversary date, showing the anniversary reaction. Adolescent girls, adolescents who encountered high levels of life events, had low levels of resilience and a history of depressive symptoms should be provided with psychological intervention.
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Tian F, Yennu A, Smith-Osborne A, Gonzalez-Lima F, North CS, Liu H. Prefrontal responses to digit span memory phases in patients with post-traumatic stress disorder (PTSD): a functional near infrared spectroscopy study. Neuroimage Clin 2014; 4:808-19. [PMID: 24936431 PMCID: PMC4055895 DOI: 10.1016/j.nicl.2014.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/08/2014] [Accepted: 05/11/2014] [Indexed: 11/16/2022]
Abstract
Neuroimaging studies of post-traumatic stress disorder (PTSD)-related memory impairments have consistently implicated abnormal activities in the frontal and parietal lobes. However, most studies have used block designs and could not dissociate the multiple phases of working memory. In this study, the involvement of the prefrontal cortex in working memory phases was assessed among veterans with PTSD and age-/gender-matched healthy controls. Multichannel functional near infrared spectroscopy (fNIRS) was utilized to measure prefrontal cortex hemodynamic activations during memory of neutral (i.e., not trauma-related) forward and backward digit span tasks. An event-related experimental design was utilized to dissociate the different phases (i.e., encoding, maintenance and retrieval) of working memory. The healthy controls showed robust hemodynamic activations during the encoding and retrieval processes. In contrast, the veterans with PTSD were found to have activations during the encoding process, but followed by distinct deactivations during the retrieval process. The PTSD participants, but not the controls, appeared to suppress prefrontal activity during memory retrieval. This deactivation was more pronounced in the right dorsolateral prefrontal cortex during the retrieval phase. These deactivations in PTSD patients might implicate an active inhibition of dorsolateral prefrontal neural activity during retrieval of working memory.
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Affiliation(s)
- Fenghua Tian
- Department of Bioengineering, The University of Texas at Arlington, Arlington, USA
| | - Amarnath Yennu
- Department of Bioengineering, The University of Texas at Arlington, Arlington, USA
| | | | - F. Gonzalez-Lima
- Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Carol S. North
- VA North Texas Health Care System, Dallas, TX, USA
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanli Liu
- Department of Bioengineering, The University of Texas at Arlington, Arlington, USA
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Lockwood E, Forbes D. Posttraumatic Stress Disorder and Comorbidity: Untangling the Gordian Knot. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9189-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Young G, Lareau C, Pierre B. One Quintillion Ways to Have PTSD Comorbidity: Recommendations for the Disordered DSM-5. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9186-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Keyes KM, Shmulewitz D, Greenstein E, McLaughlin K, Wall M, Aharonovich E, Weizman A, Frisch A, Spivak B, Grant BF, Hasin D. Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: the moderating role of childhood maltreatment. Drug Alcohol Depend 2014; 134:296-303. [PMID: 24262650 PMCID: PMC3884580 DOI: 10.1016/j.drugalcdep.2013.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history. METHODS Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region. RESULTS Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01-27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25-1.01); test for interaction: X(2)=5.28, df=1, P=0.02. CONCLUSIONS Experiencing a fateful stressor outside the control of study participants, civilian exposure to the 2006 Lebanon War, is associated with a heightened the risk of alcohol disorders among those with early adverse childhood experiences. Results suggest that early life experiences may sensitize individuals to adverse health responses later in life.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA,Corresponding author at: Department of Epidemiology, Columbia University Department of Epidemiology, 722 West 168th Street, Suite 503, New York, NY 10032, USA. Tel.: +1 212 304 5652; fax: +1 212 543 5913. (K.M. Keyes)
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Eliana Greenstein
- New York State Psychiatric Institute, New York, NY 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Kate McLaughlin
- Division of General Pediatrics, Children’s Hospital Boston, Harvard Medical School, Boston, MA 02115-6092, USA
| | - Melanie Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Efrat Aharonovich
- New York State Psychiatric Institute, New York, NY 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Abraham Weizman
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Amos Frisch
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Baruch Spivak
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA,New York State Psychiatric Institute, New York, NY 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clin Psychol Rev 2013; 34:87-98. [PMID: 24486520 DOI: 10.1016/j.cpr.2013.12.002] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.
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Nickerson A, Steenkamp M, Aerka IM, Salters-Pedneault K, Carper TL, Barnes JB, Litz BT. Prospective investigation of mental health following sexual assault. Depress Anxiety 2013; 30:444-50. [PMID: 23165889 DOI: 10.1002/da.22023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/30/2012] [Accepted: 10/16/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Comorbidity in psychological disorders is common following exposure to a traumatic event. Relatively little is known about the manner in which changes in the symptoms of a given type of psychological disorder in the acute period following a trauma impact changes in symptoms of another disorder. This study investigated the relationship between changes in posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the first 12 weeks following sexual assault. METHODS Participants were 126 women who had been sexually assaulted in the previous 4 weeks. RESULTS Lower level mediation analyses revealed that changes in PTSD symptoms had a greater impact on changes in depression and anxiety than vice versa. CONCLUSIONS The finding highlights the role of PTSD symptoms in influencing subsequent change in other psychological symptoms. These findings are discussed in the context of models detailing the trajectory of psychological disorders following trauma, and clinical implications are considered.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia.
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Abstract
Experiences of 17 female Iraq War veterans were explored to understand the challenges of reintegrating into civilian life and the impact on mental health. All respondents completed preliminary electronic surveys and participated in one of two focus groups. High levels of distress exist among veterans who are caught between military and civilian cultures, coping with war experiences, feeling alienated from family and friends, and attempting to negotiate gender and identity. Narrative is identified as a means of resolution. Recommendations include development of social support and transition groups; military cultural competence training for therapists, social workers, and college counselors; and further research to identify appropriate military response and paths to successful reintegration into society.
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Aderka IM, Foa EB, Applebaum E, Shafran N, Gilboa-Schechtman E. Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents. J Consult Clin Psychol 2012; 79:421-5. [PMID: 21480695 DOI: 10.1037/a0023318] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our objective in the present study was to examine the temporal sequencing of posttraumatic and depressive symptoms during prolonged exposure therapy for posttraumatic stress disorder (PTSD) among children and adolescents. METHOD Participants were 73 children and adolescents (56.2% female) between the ages of 8 and 18. Participants completed self-report measures of posttraumatic stress and depression prior to every session. Measures included the Child PTSD Symptom Scale, Beck Depression Inventory, and Children's Depression Inventory. RESULTS Multilevel mediational analyses indicated reciprocal relations during treatment: Changes in posttraumatic symptoms led to changes in depressive symptoms and vice versa. Posttraumatic symptoms accounted for 64.1% of the changes in depression, whereas depressive symptoms accounted for 11.0% of the changes in posttraumatic stress. CONCLUSIONS Prolonged exposure therapy may work primarily by reducing posttraumatic stress, which in turn reduces depression.
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Affiliation(s)
- Idan M Aderka
- Department of Psychology, Boston University, 648 Beacon St., Boston, MA 02215, USA.
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Smid GE, Lensvelt-Mulders GJLM, Knipscheer JW, Gersons BPR, Kleber RJ. Late-onset PTSD in unaccompanied refugee minors: exploring the predictive utility of depression and anxiety symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 40:742-55. [PMID: 21916692 DOI: 10.1080/15374416.2011.597083] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Following resettlement in Western countries, unaccompanied refugee minors (URM) are at risk of developing posttraumatic stress disorder (PTSD). It is unclear to what extent PTSD in this group may become manifest at later stages following resettlement and which factors are associated with late onset. We examined data from URM collected 1 (T1) and 2 years (T2) following resettlement for differences between groups with no PTSD, PTSD at T1, and late-onset PTSD (at T2 only) using multinomial regression and path analysis. Of the children and adolescents (ages 12-18) completing both assessments (N = 554), 223 (40%) met criteria for PTSD at T1, and 88 (16%) endorsed late-onset PTSD. Late-onset PTSD was associated with traumatic event exposure, older age, and low education. In the late-onset PTSD group, the predictive effects of traumatic event exposure on symptom severity at T2 were fully mediated by depression and anxiety symptoms at T1. These results suggest that late-onset PTSD is a clinically relevant problem among URM that may be heralded by early depression and anxiety symptoms.
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Affiliation(s)
- Geert E Smid
- Foundation Centrum '45, Diemen, The Netherlands.
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Pérez Benítez CI, Zlotnick C, Stout RI, Lou F, Dyck I, Weisberg R, Keller M. A 5-year longitudinal study of posttraumatic stress disorder in primary care patients. Psychopathology 2012; 45:286-93. [PMID: 22797509 DOI: 10.1159/000331595] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 08/05/2011] [Indexed: 11/19/2022]
Abstract
Little is known about the clinical course of posttraumatic stress disorder (PTSD) and the clinical predictors of its recovery in primary care patients. We examined 5 years of follow-up of PTSD symptoms using rates of recovery and recurrence, and the predictive value of comorbid mental disorders, treatment participation and psychosocial functioning, on PTSD recovery. We examined 199 participants with PTSD diagnoses, from the Primary Care Anxiety Disorder Project. We found that the course of PTSD in a sample of primary care patients is chronic. Survival analysis revealed that the likelihood of PTSD recovery was 38.0% and of recurrence it was 29.5%. Cox regression analyses indicated that baseline clinical variables did not have a significant relationship with probability of PTSD recovery. However, time-varying models showed that the course of psychosocial impairment was a significant predictor of the likelihood of recovery from PTSD. Findings provide initial empirical support for treatment approaches that focus on psychosocial functioning to reduce PTSD symptoms.
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Affiliation(s)
- Carlos I Pérez Benítez
- Department of Educational and Psychological Studies, University of Miami, 5202 University Drive, 312 Merrick Building, Coral Gables, FL 33146, USA.
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Sayer NA, Spoont M, Murdoch M, Parker LE, Hintz S, Rosenheck R. A qualitative study of U.S. veterans' reasons for seeking Department of Veterans Affairs disability benefits for posttraumatic stress disorder. J Trauma Stress 2011; 24:699-707. [PMID: 22109077 DOI: 10.1002/jts.20693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is the most prevalent compensable mental disorder within the U.S. Department of Veterans Affairs disability system and the number of veterans with PTSD service-connected disability has increased steadily over the past decade. An understanding of the reasons veterans apply for PTSD disability status may inform interpretation of this increase and policies and interventions to assist veterans with military-related PTSD. The authors conducted an exploratory qualitative study to describe the reasons veterans seek PTSD disability benefits and explored differences between those who served in different military service eras. They gathered data through in-depth interviews with 44 purposefully selected U.S. veterans, and conducted content analysis of transcribed interviews using inductive and deductive analysis with constant comparison. Participants described 5 interrelated categories of reasons for seeking PTSD disability benefits, including 3 internal factors (tangible need, need for problem identification or clarification, beliefs that justify/legitimize PTSD disability status) and 2 external factors (encouragement from trusted others and professional assistance). There were no major differences by service era. Findings may help policy makers, providers, and researchers understand what veterans hope to achieve through PTSD disability and the instrumental role of social networks and government systems in promoting the pursuit of PTSD disability status.
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Affiliation(s)
- Nina A Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, Minnesota 55417, USA.
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41
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Stanley EA, Schaldach JM, Kiyonaga A, Jha AP. Mindfulness-based Mind Fitness Training: A Case Study of a High-Stress Predeployment Military Cohort. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.08.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Measurement of Military Combat Exposure Among Women: Analysis and Implications. Womens Health Issues 2011; 21:S160-8. [DOI: 10.1016/j.whi.2011.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 04/19/2011] [Accepted: 04/20/2011] [Indexed: 11/21/2022]
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Haynes PL, Parthasarathy S, Kersh B, Bootzin RR. Examination of insomnia and insomnia treatment in psychiatric inpatients. Int J Ment Health Nurs 2011; 20:130-6. [PMID: 21371228 DOI: 10.1111/j.1447-0349.2010.00711.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite the high comorbidity of insomnia with psychiatric illness, few studies have examined insomnia or insomnia treatments in psychiatric inpatients. The present study had two overall goals. First, we sought to describe insomnia symptoms in 76 US veterans hospitalized for a wide-range of psychiatric illnesses. Next, we sought to examine whether participation in one session of group therapy for insomnia was associated with improvement in Insomnia Severity Index (ISI) scores for a subset of these inpatients (n = 19). Data were extracted from the clinical charts of 140 inpatients admitted into the 26-bed psychiatric ward at the New Mexico VA Healthcare System. The majority of the veterans had clinical insomnia in the moderate-to-severe range, and only 18% of the sample reported no clinically-significant insomnia. There was a significant reduction in ISI scores approximately 1 week after attendance at the group therapy session, which appears to be unrelated to the length of hospitalization, but might be related to psychiatric stabilization. This is the first study to examine insomnia symptoms in a mixed, psychiatric inpatient population. Group therapy for insomnia might be a particularly useful treatment option given polypharmacy and substance dependency issues often arising in this population.
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Affiliation(s)
- Patricia L Haynes
- Southern Arizona VA Health Care System, University of Arizona, Department of Psychiatry, Tucson, Arizona 85724-5002, USA.
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44
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Temporal relationships between Gulf War deployment and subsequent psychological disorders in Royal Australian Navy Gulf War veterans. Soc Psychiatry Psychiatr Epidemiol 2010; 45:843-52. [PMID: 19763364 DOI: 10.1007/s00127-009-0134-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 08/21/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although much has been published on the effects of the 1990/1991 Gulf War on the psychological health of veterans, few studies have addressed the pattern and timing of post-war development of psychological disorders. Our study aims to identify the most common psychological disorders that first appeared post-Gulf War, the period of peak prevalence and the sequence of multiple psychological disorders. METHODS The temporal progression of psychological disorders in male Australian naval Gulf War veterans with no prior psychological disorders was calculated across each year of the post-Gulf War period. DSM-IV diagnoses were obtained using the Composite International Diagnostic Interview. RESULTS Psychological disorder rates peaked in the first 2 years (1991-1992) following the Gulf War. Alcohol use disorders were the most likely to appear first. Classification and regression tree analysis found that risk of disorder was exacerbated if veterans had been exposed to a high number of potential psychological stressors during their military service. Lower military rank was associated with increased risk of alcohol disorders, particularly during the first 2 years post-Gulf War. In veterans with two or more disorders, anxiety disorders and alcohol disorders tended to appear before affective disorders. CONCLUSIONS Our study found that psychological disorders occur in sequence following Gulf War deployment. Our findings may help clinicians to anticipate, and better manage, multiple symptomatology. The findings may also assist veteran and defence organisations in planning effective mental health screening, management and prevention policy.
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Pietrzak RH, Goldstein MB, Malley JC, Rivers AJ, Southwick SM. Structure of posttraumatic stress disorder symptoms and psychosocial functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatry Res 2010; 178:323-9. [PMID: 20546925 DOI: 10.1016/j.psychres.2010.04.039] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 04/11/2010] [Accepted: 04/25/2010] [Indexed: 10/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is one of the most prevalent psychiatric conditions in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF), but little is known about the structure of PTSD symptoms, and associations between PTSD symptom clusters and psychosocial functioning in this population. A total of 272 OEF-OIF Veterans in Connecticut completed a mail survey containing measures of psychopathology, resilience, and psychosocial functioning. Confirmatory factor analyses revealed that the 4-factor dysphoria model, which is comprised of separate re-experiencing, avoidance, dysphoria, and hyperarousal symptom clusters, provided the best representation of PTSD symptom structure in this sample. Dysphoria symptoms were independently associated with a broad range of psychosocial measures, even after controlling for age, combat exposure, and other PTSD symptom clusters. Re-experiencing symptoms were associated with alcohol use problems, and avoidance symptoms were associated with increased psychosocial difficulties and decreased perceptions of postdeployment social support. These results suggest that dysphoria symptoms were strongly related to a broad range of psychosocial measures in this sample of OEF-OIF Veterans. Dysphoria symptoms may deserve special attention in the assessment and treatment of symptomatic OEF-OIF Veterans.
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Affiliation(s)
- Robert H Pietrzak
- National Center for Posttraumatic Stress Disorder, Resilience Laboratory, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
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Cougle JR, Resnick H, Kilpatrick DG. PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women. Depress Anxiety 2010; 26:1151-7. [PMID: 19842171 DOI: 10.1002/da.20621] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A growing body of literature implicates major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) as risk factors for suicidal ideation (SI) and suicide attempts (SA), though research has not adequately examined their differential contributions to increasing suicide risk prospectively or cross-sectionally. METHODS The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women (N=3,085) and covarying for trauma history, substance abuse, and demographic variables. RESULTS Cross-sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone; prevalence of SI was elevated and comparable for PTSD and MDD only. Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only. Lastly, a 2-year prospective analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only, though comorbid diagnosis did not differ from either PTSD only or MDD only. CONCLUSIONS PTSD appears to be a particularly strong predictor of SI and SA. Overall, only 16% of women with lifetime SA did not have a history of MDD or PTSD, highlighting the importance of assessing these variables when assessing suicide risk.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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47
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Wells TS, LeardMann CA, Fortuna SO, Smith B, Smith TC, Ryan MAK, Boyko EJ, Blazer D. A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. Am J Public Health 2010; 100:90-9. [PMID: 19910353 DOI: 10.2105/ajph.2008.155432] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan. METHODS We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria for depression at follow-up, but not at baseline. RESULTS Deployed men and women with combat exposures had the highest onset of depression, followed by those not deployed and those deployed without combat exposures. Combat-deployed men and women were at increased risk for new-onset depression compared with nondeployed men and women (men: adjusted odds ratio [AOR]=1.32; 95% confidence interval [CI]=1.13, 1.54; women: AOR=2.13; 95% CI=1.70, 2.65). Conversely, deployment without combat exposures led to decreased risk for new-onset depression compared with those who did not deploy (men: AOR=0.66; 95% CI=0.53, 0.83; women: AOR=0.65; 95% CI=0.47, 0.89). CONCLUSIONS Deployment with combat exposures is a risk factor for new-onset depression among US service members. Post-deployment screening may be beneficial for US service members exposed to combat.
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Affiliation(s)
- Timothy S Wells
- US Air Force Research Laboratory, 711th HPW/RHPA, Building 824 Room 206, 2800 Q St, Wright-Patterson AFB, OH 45433-7947, USA.
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King LA, King DW, Vogt DS, Knight J, Samper RE. Deployment Risk and Resilience Inventory: A Collection of Measures for Studying Deployment-Related Experiences of Military Personnel and Veterans. MILITARY PSYCHOLOGY 2009. [DOI: 10.1207/s15327876mp1802_1] [Citation(s) in RCA: 362] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lynda A. King
- Women's Health Sciences Division, National Center for PTSD and Departments of Psychology and Psychiatry, Boston University
| | - Daniel W. King
- Behavioral Science Division, National Center for PTSD and Departments of Psychology and Psychiatry, Boston University
| | - Dawne S. Vogt
- Women's Health Sciences Division, National Center for PTSD and Department of Psychiatry, Boston University School of Medicine
| | - Jeffrey Knight
- Behavioral Science Division, National Center for PTSD and Department of Psychiatry, Boston University School of Medicine
| | - Rita E. Samper
- Women's Health Sciences Division, National Center for PTSD
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49
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King DW, King LA, McArdle JJ, Shalev AY, Doron-LaMarca S. Sequential Temporal Dependencies in Associations Between Symptoms of Depression and Posttraumatic Stress Disorder: An Application of Bivariate Latent Difference Score Structural Equation Modeling. MULTIVARIATE BEHAVIORAL RESEARCH 2009; 44:437-464. [PMID: 26735592 DOI: 10.1080/00273170903103308] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Depression and posttraumatic stress disorder (PTSD) are highly comorbid conditions that may arise following exposure to psychological trauma. This study examined their temporal sequencing and mutual influence using bivariate latent difference score structural equation modeling. Longitudinal data from 182 emergency room patients revealed level of depression symptom severity to be positively associated with changes in PTSD intrusion, avoidance, and hyperarousal over 3 time intervals, beginning shortly after the traumatic event. Higher scores on depression anticipated increases (or worsening) in PTSD symptom severity. The pattern of influence from PTSD symptom severity to change in depression symptom severity simply followed the general trend toward health and well-being. Results are discussed in terms of the dynamic interplay and associated mechanisms of posttrauma depression and PTSD symptom severity.
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Affiliation(s)
| | - Lynda A King
- a Boston University and VA Boston Healthcare System
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Kashdan TB, Morina N, Priebe S. Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: experiential avoidance as a contributor to distress and quality of life. J Anxiety Disord 2009; 23:185-96. [PMID: 18676121 PMCID: PMC2667796 DOI: 10.1016/j.janxdis.2008.06.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 06/22/2008] [Accepted: 06/23/2008] [Indexed: 10/21/2022]
Abstract
Few studies have been conducted on psychological disorders other than post-traumatic stress disorder (PTSD) in war survivors. The aim of this study was to examine PTSD, social anxiety disorder (SAD), and major depressive disorder (MDD) and their associations with distress and quality of life in 174 Albanian civilian survivors of the Kosovo War. This included testing of conceptual models suggesting that experiential avoidance might influence associations between anxiety and mood disorders with psychological functioning. Each of the three psychiatric disorders was associated with greater experiential avoidance and psychological distress, and lower quality of life. Being a refugee was associated with a higher likelihood of having SAD and MDD. We found evidence for experiential avoidance as a partial mediator of the respective effects of SAD and PTSD on quality of life; experiential avoidance did not mediate the effects of disorders on global distress. We also found support for a moderation model showing that only war survivors without SAD and low experiential avoidance reported elevated quality of life; people with either SAD or excessive reliance on experiential avoidance reported compromised, low quality of life. This is the third independent study, each using a different methodology, to find empirical support for this moderation model [Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: a prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1-12; Kashdan, T. B., & Steger, M. F. (2006). Expanding the topography of social anxiety: an experience sampling assessment of positive emotions and events, and emotion suppression. Psychological Science, 17, 120-128]. Overall, we provided initial evidence for the importance of addressing PTSD, SAD, MDD, and experiential avoidance in primarily civilian war survivors.
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