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Nilaweera D, Phyo AZZ, Teshale AB, Htun HL, Wrigglesworth J, Gurvich C, Freak-Poli R, Ryan J. Lifetime posttraumatic stress disorder as a predictor of mortality: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:229. [PMID: 37032341 PMCID: PMC10084620 DOI: 10.1186/s12888-023-04716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) could potentially increase the risk of mortality, and there is a need for a meta-analysis to quantify this association. This study aims to determine the extent to which PTSD is a predictor of mortality. METHODS EMBASE, MEDLINE, and PsycINFO were searched systematically on 12th February 2020, with updated searches conducted in July 2021, and December 2022 (PROSPERO CRD42019142971). Studies involving community-dwelling participants with a diagnosis of PTSD or PTSD symptoms, and a comparator group of individuals without PTSD, and which assessed mortality risk, were included. A random-effects meta-analysis was conducted on studies reporting Odds Ratio (OR), Hazard Ratio (HR), and Risk Ratio (RR), and subgroup analysis was also performed by age, sex, type of trauma experienced, PTSD diagnosis, and cause of death. RESULTS A total of 30 eligible studies of mostly good methodological quality were identified, with a total of more than 2.1 million participants with PTSD. The majority of studies involved male-dominated, veteran populations. PTSD was associated with a 47% (95% CI: 1.06-2.04) greater risk of mortality across six studies that reported OR/RR, and a 32% increased risk across 18 studies which reported time to death (HR: 1.32, 95% CI: 1.10-1.59). There was very high study heterogeneity (I2 > 94%) and this was not explained by the prespecified subgroup analysis. CONCLUSION PTSD is associated with increased mortality risk, however further research is required amongst civilians, involving women, and in individuals from underdeveloped countries.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Achamyeleh Birhanu Teshale
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Htet Lin Htun
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Caroline Gurvich
- Department of Psychiatry, Central Clinical School, Alfred Hospital and Monash University, Melbourne, VIC, 2004, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia.
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2
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Shields GS, Fassett-Carman A, Gray ZJ, Gonzales JE, Snyder HR, Slavich GM. Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses. Stress Health 2023; 39:87-102. [PMID: 35599238 PMCID: PMC10243213 DOI: 10.1002/smi.3165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/19/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Subjective stress severity appraisals have consistently emerged as better predictors of poor health than stressor exposure, but the reason for this is unclear. Subjective stress may better predict poor health for one of at least two reasons. First, because stressor exposure measures consider all stressors as equal, stress severity measures-which "weight" stressors by self-reported severity-might better predict poor health simply by not treating all stressors as being equally impactful. Second, subjective stress appraisals may index important individual differences in stress vulnerability. We tested these two possibilities in this preregistered, two-study manuscript. Across these two different studies, subjective stress severity was a better predictor of poor health than independently weighted stress severity or stressor exposure. These results demonstrate that, beyond weighting of stressful experiences, subjective stress severity indexes health-relevant individual differences. Moreover, the results suggest that subjective stress severity may be the preferred stress summary metric even when derived from imprecise stress assessment instruments.
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Affiliation(s)
| | | | - Zach J. Gray
- Department of Psychological Science, University of Arkansas
| | - Joseph E. Gonzales
- Department of Psychology and Center for Women and Work, University of Massachusetts Lowell
| | - Hannah R. Snyder
- Department of Psychology and Neuroscience Program, Brandeis University
| | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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3
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Strain MM, Tongkhuya S, Wienandt N, Alsadoon F, Chavez R, Daniels J, Garza T, Trevino AV, Wells K, Stark T, Clifford J, Sosanya NM. Exploring combat stress exposure effects on burn pain in a female rodent model. BMC Neurosci 2022; 23:73. [PMID: 36474149 PMCID: PMC9724288 DOI: 10.1186/s12868-022-00759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/27/2022] [Indexed: 12/12/2022] Open
Abstract
In the military, constant physiological and psychological stress encountered by Soldiers can lead to development of the combat and operational stress reaction (COSR), which can effect pain management. Similar effects are seen in other populations subjected to high levels of stress. Using a model of COSR, our lab recently showed that four weeks of stress prior to an injury increases pain sensitivity in male rats. With the roles of women in the military expanding and recent studies indicating sex differences in stress and pain processing, this study sought to investigate how different amounts of prior stress exposure affects thermal injury-induced mechanosensitivity in a female rat model of COSR. Adult female Sprague Dawley rats were exposed to the unpredictable combat stress (UPCS) procedure for either 2 or 4 weeks. The UPCS procedure included exposure to one stressor each day for four days. The stressors include: (1) sound stress for 30 min, (2) restraint stress for 4 h, (3) cold stress for 4 h, and (4) forced swim stress for 15 min. The order of stressors was randomized weekly. Mechanical and thermal sensitivity was tested twice weekly. After the UPCS procedure, a sub-set of rats received a thermal injury while under anesthesia. The development of mechanical allodynia and thermal hyperalgesia was examined for 14 days post-burn. UPCS exposure increased mechanosensitivity after two weeks. Interestingly, with more stress exposure, females seemed to habituate to the stress, causing the stress-induced changes in mechanosensitivity to decrease by week three of UPCS. If thermal injury induction occurred during peak stress-induced mechanosensitivity, after two weeks, this resulted in increased mechanical allodynia in the injured hind paw compared to thermal injury alone. This data indicates a susceptibility to increased nociceptive sensitization when injury is sustained at peak stress reactivity. Additionally, this data indicates a sex difference in the timing of peak stress. Post-mortem examination of the prefrontal cortex (PFC) showed altered expression of p-TrkB in 4-week stressed animals given a thermal injury, suggesting a compensatory mechanism. Future work will examine treatment options for preventing stress-induced pain to maintain the effectiveness and readiness of the Warfighter.
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Affiliation(s)
- Misty M. Strain
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Sirima Tongkhuya
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Nathan Wienandt
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Farah Alsadoon
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Roger Chavez
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Jamar Daniels
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Thomas Garza
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Alex V. Trevino
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Kenney Wells
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Thomas Stark
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - John Clifford
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Natasha M. Sosanya
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
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4
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Levert-Levitt E, Shapira G, Sragovich S, Shomron N, Lam JCK, Li VOK, Heimesaat MM, Bereswill S, Yehuda AB, Sagi-Schwartz A, Solomon Z, Gozes I. Oral microbiota signatures in post-traumatic stress disorder (PTSD) veterans. Mol Psychiatry 2022; 27:4590-4598. [PMID: 35864319 DOI: 10.1038/s41380-022-01704-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) represents a global public health concern, affecting about 1 in 20 individuals. The symptoms of PTSD include intrusiveness (involuntary nightmares or flashbacks), avoidance of traumatic memories, negative alterations in cognition and mood (such as negative beliefs about oneself or social detachment), increased arousal and reactivity with irritable reckless behavior, concentration problems, and sleep disturbances. PTSD is also highly comorbid with anxiety, depression, and substance abuse. To advance the field from subjective, self-reported psychological measurements to objective molecular biomarkers while considering environmental influences, we examined a unique cohort of Israeli veterans who participated in the 1982 Lebanon war. Non-invasive oral 16S RNA sequencing was correlated with psychological phenotyping. Thus, a microbiota signature (i.e., decreased levels of the bacteria sp_HMT_914, 332 and 871 and Noxia) was correlated with PTSD severity, as exemplified by intrusiveness, arousal, and reactivity, as well as additional psychopathological symptoms, including anxiety, hostility, memory difficulties, and idiopathic pain. In contrast, education duration correlated with significantly increased levels of sp_HMT_871 and decreased levels of Bacteroidetes and Firmicutes, and presented an inverted correlation with adverse psychopathological measures. Air pollution was positively correlated with PTSD symptoms, psychopathological symptoms, and microbiota composition. Arousal and reactivity symptoms were correlated with reductions in transaldolase, an enzyme controlling a major cellular energy pathway, that potentially accelerates aging. In conclusion, the newly discovered bacterial signature, whether an outcome or a consequence of PTSD, could allow for objective soldier deployment and stratification according to decreases in sp_HMT_914, 332, 871, and Noxia levels, coupled with increases in Bacteroidetes levels. These findings also raise the possibility of microbiota pathway-related non-intrusive treatments for PTSD.
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Affiliation(s)
- Ella Levert-Levitt
- School of Psychological Sciences, Center for the Study of Child Development, University of Haifa, 6035 Rabin Building, Haifa, 3190501, Israel
| | - Guy Shapira
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Shlomo Sragovich
- Elton Laboratory for Molecular Neuroendocrinology, Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Adams Super Center for Brain Studies and Sagol School of Neuroscience, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Noam Shomron
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Jacqueline C K Lam
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China
| | - Victor O K Li
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China
| | - Markus M Heimesaat
- Institute for Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Bereswill
- Institute for Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ariel Ben Yehuda
- Department of Health and Well-being, Medical Corps, Israel Defense Forces (IDF), Ramat Gan, Israel.,'Shalvata' Mental Health Center, Clalit Health Services, Hod Hasharon, 4534708, Israel
| | - Abraham Sagi-Schwartz
- School of Psychological Sciences, Center for the Study of Child Development, University of Haifa, 6035 Rabin Building, Haifa, 3190501, Israel
| | - Zahava Solomon
- Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Illana Gozes
- Elton Laboratory for Molecular Neuroendocrinology, Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Adams Super Center for Brain Studies and Sagol School of Neuroscience, Tel Aviv University, 69978, Tel Aviv, Israel.
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5
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Holman EA, Thompson RR, Garfin DR, Silver RC. The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States. SCIENCE ADVANCES 2020; 6:sciadv.abd5390. [PMID: 32948511 PMCID: PMC7556755 DOI: 10.1126/sciadv.abd5390] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/27/2020] [Indexed: 05/07/2023]
Abstract
The COVID-19 (coronavirus disease 2019) pandemic is a collective stressor unfolding over time; yet, rigorous empirical studies addressing its mental health consequences among large probability-based national samples are rare. Between 18 March and 18 April 2020, as illness and death escalated in the United States, we assessed acute stress, depressive symptoms, and direct, community, and media-based exposures to COVID-19 in three consecutive representative samples from the U.S. probability-based nationally representative NORC AmeriSpeak panel across three 10-day periods (total N = 6514). Acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the United States. Preexisting mental and physical health diagnoses, daily COVID-19-related media exposure, conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. Results have implications for targeting public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time.
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Affiliation(s)
- E Alison Holman
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, USA.
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Rebecca R Thompson
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Dana Rose Garfin
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, USA
| | - Roxane Cohen Silver
- Departments of Psychological Science and Medicine and Program in Public Health, University of California, Irvine, Irvine, CA, USA.
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6
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Solomon Z. From the Frontline to the Homefront: The Experience of Israeli Veterans. Front Psychiatry 2020; 11:589391. [PMID: 33192737 PMCID: PMC7655530 DOI: 10.3389/fpsyt.2020.589391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
In 1948, the state of Israel was created as a homeland for the Jewish people after 2,000 years of persecution and deportations in the diaspora. During the past 72 years, its inhabitants have experienced several wars and numerous terrorist attacks. Therefore, the issue of trauma goes beyond academic study, it is part of daily life. These circumstances have, unfortunately, turned Israel into a natural stress laboratory, which has enabled the systematic research of the biopsychosocial effects of traumatic stress on soldiers and civilians. This article reviews the findings of a series of studies that examine (a) the short- and long-term mental health effects of war on combat veterans; (b) the effects of repeated exposure to war on veterans; (c) trajectories of PTSD; and, specifically, (d) reactivation and (e) delayed-onset PTSD. We present the findings of two decades of systematic trauma research, which have followed the ongoing psychopathological effect of war on veterans. In understanding the ripple effects of trauma, it can be seen that veterans do not leave the events of the war behind once they are home; rather, it is with them wherever they go. Consequently, the trauma has a ripple effect that may carry over to veterans' spouses and offspring. The multiple manifestations and trajectories of both acute and chronic trauma will be presented. Clinical ramifications and implications will also be discussed.
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Affiliation(s)
- Zahava Solomon
- Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel.,I-Core Research Center for Mass Trauma, Tel-Aviv University, Tel-Aviv, Israel
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