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Lim A, Pasini M, Yun S, Gill J, Koirala B. Genetic association between post-traumatic stress disorder and cardiovascular disease: A scoping review. J Psychiatr Res 2024; 178:331-348. [PMID: 39191203 DOI: 10.1016/j.jpsychires.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/05/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a complex psychiatric disorder associated with adverse long-term health outcomes, including cardiovascular disease (CVD). Despite growing evidence that PTSD is positively associated with CVD, the biological mechanisms underlying this association are poorly understood. This review provides an overview of the current state of science on the genetic association between PTSD and CVD. MATERIAL AND METHODS This scoping review identified studies from Pubmed, Embase, PsycINFO, and Web of Science. The search terms were a combination of PTSD, CVD/CVD-related traits, and a set of genetic molecules and related terms. This review followed the PRISMA Extension for Scoping Reviews guidelines. Eligible criteria included original studies that have genetic factors related to PTSD or CVD, conducted in humans, written in English, and published between 2003 and 2023 in peer-reviewed journals. RESULTS A total of twenty-three studies were included; PTSD correlated with genetic variants in CVD-related traits and gene expression in regulatory pathways contributing to CVD development. Common CVD-related traits involved in genetic associations with PTSD were inflammation, cellular aging, increased blood pressure, hypothalamus-pituitary-adrenal axis dysregulation, metabolic syndrome, and oxidative stress. These traits may explain potential underlying mechanisms between PTSD and CVD. Evidence of a causal relationship between the two diseases was insufficient. DISCUSSION PTSD and CVD/CVD-related traits are genetically associated. Further research is needed to comprehensively explore gene-environment interactions and the cumulative impact of behavioral and psychological factors on the pathophysiological mechanisms between PTSD and CVD.
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Affiliation(s)
- Arum Lim
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA.
| | - Mia Pasini
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Sijung Yun
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Jessica Gill
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Binu Koirala
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
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Dyball D, Bennett AN, Schofield S, Cullinan P, Boos CJ, Bull AM, Stevelink SA, Fear NT. The underlying mechanisms by which Post-Traumatic Growth is associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study. J Health Psychol 2024:13591053241240196. [PMID: 38605584 DOI: 10.1177/13591053241240196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Post-Traumatic Growth (PTG) is associated with good cardiovascular health, but the mechanisms of this are poorly understood. This cross-sectional analysis assessed whether factors of PTG (Appreciation of Life (AOL), New Possibilities (NP), Personal Strength (PS), Relating to Others (RTO) and Spiritual Change (SC)) are associated with cardiovascular health in a cohort of 1006 male UK military personnel (median age 34). The findings suggest AOL, PS and RTO are associated with better cardiovascular health through cardiometabolic effects (lower levels of triglycerides, and total cholesterol) and haemodynamic functioning (lower diastolic blood pressure), but not inflammation. However, NP and SC were associated with poorer cardiovascular health through cardiometabolic effects (lower levels of high-density lipoproteins and higher levels of total cholesterol) and AOL had a non-linear association with low-density lipoproteins. These findings suggest that the relationship between PTG and cardiovascular functioning is complex and in need of further scrutiny.
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Pokeerbux MR, Mavingui P, Gérardin P, Agrinier N, Gokalsing E, Meilhac O, Cournot M. A Holistic Approach to Cardiometabolic and Infectious Health in the General Population of Reunion Island: The REUNION Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00221-9. [PMID: 38564109 DOI: 10.1007/s44197-024-00221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Reunion Island is a French overseas department in the South West Indian Ocean with a unique multi-ethnic population. Cardiovascular diseases are the most common chronic conditions with higher prevalences of hypertension and diabetes compared to mainland France. Moreover, Reunion Island is particularly exposed to vector-borne diseases such as chikungunya and dengue. Our objective is to describe the prevalence of cardiometabolic and infectious diseases in Reunion Island and explore causal mechanisms linking these diseases. METHODS The REUNION study is an ongoing French prospective study. From January 2022, 2,000 consenting participants (18-68 years old) are being recruited from the general population according to polling lists and random generation of cellphone number. Baseline examination consists of (i) general health examination, assessment of cardiovascular risk factors, markers of subclinical atherosclerosis, bronchial obstruction, neuropathic and autonomic dysfunction, (ii) questionnaires to determine sociodemographic characteristics, diet, exposure to vector-borne diseases, mental health and cognitive functions, social inequalities in health and ethnic origins, (iii) biological sampling for determination of cardiovascular risk factors, seroprevalence of infectious diseases, innovative lipid biomarkers, advanced omics, composition of intestinal, periodontal and skin microbiota, and biobanking. CONCLUSIONS The REUNION study should provide new insights into the prevalence of cardiometabolic and infectious diseases, as well as their potential associations through the examination of various environmental pathways and a wide range of health aspects.
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Affiliation(s)
- Mohammad Ryadh Pokeerbux
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, La Réunion, 97410, France.
| | - Patrick Mavingui
- Université de La Réunion, UMR Processus Infectieux en Milieu Insulaire et Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Sainte-Clotilde, La Réunion, 97490, France
| | - Patrick Gérardin
- Plateforme de Recherche Clinique et Translationnelle, INSERM CIC1410, CHU de La Réunion, Saint-Pierre, La Réunion, 97400, France
| | - Nelly Agrinier
- CHRU-Nancy, Université de Lorraine, CIC, Epidémiologie clinique, Inserm, Nancy, F-54000, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, F-54000, France
| | - Erick Gokalsing
- Etablissement Public de Santé Mentale de La Réunion, 42 chemin du Grand Pourpier, 97866, Saint-Paul Cedex, France
- Laboratoire IRISSE (IngéniéRIe de la Santé, du Sport et de l'Environnement), Université de La Réunion, UFR SHE, Saint Pierre, EA, 4075, France
| | - Olivier Meilhac
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, La Réunion, 97410, France
- Plateforme de Recherche Clinique et Translationnelle, INSERM CIC1410, CHU de La Réunion, Saint-Pierre, La Réunion, 97400, France
| | - Maxime Cournot
- Université de La Réunion, UMR Diabète Athérothrombose Réunion Océan Indien (DéTROI), INSERM U1188, Saint-Pierre, La Réunion, 97410, France
- Groupe de santé Clinifutur, Clinique Les Orchidées, Le Port, La Réunion, 97420, France
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Miron RJ, Estrin NE, Sculean A, Zhang Y. Understanding exosomes: Part 2-Emerging leaders in regenerative medicine. Periodontol 2000 2024; 94:257-414. [PMID: 38591622 DOI: 10.1111/prd.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024]
Abstract
Exosomes are the smallest subset of extracellular signaling vesicles secreted by most cells with the ability to communicate with other tissues and cell types over long distances. Their use in regenerative medicine has gained tremendous momentum recently due to their ability to be utilized as therapeutic options for a wide array of diseases/conditions. Over 5000 publications are currently being published yearly on this topic, and this number is only expected to dramatically increase as novel therapeutic strategies continue to be developed. Today exosomes have been applied in numerous contexts including neurodegenerative disorders (Alzheimer's disease, central nervous system, depression, multiple sclerosis, Parkinson's disease, post-traumatic stress disorders, traumatic brain injury, peripheral nerve injury), damaged organs (heart, kidney, liver, stroke, myocardial infarctions, myocardial infarctions, ovaries), degenerative processes (atherosclerosis, diabetes, hematology disorders, musculoskeletal degeneration, osteoradionecrosis, respiratory disease), infectious diseases (COVID-19, hepatitis), regenerative procedures (antiaging, bone regeneration, cartilage/joint regeneration, osteoarthritis, cutaneous wounds, dental regeneration, dermatology/skin regeneration, erectile dysfunction, hair regrowth, intervertebral disc repair, spinal cord injury, vascular regeneration), and cancer therapy (breast, colorectal, gastric cancer and osteosarcomas), immune function (allergy, autoimmune disorders, immune regulation, inflammatory diseases, lupus, rheumatoid arthritis). This scoping review is a first of its kind aimed at summarizing the extensive regenerative potential of exosomes over a broad range of diseases and disorders.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Nathan E Estrin
- Advanced PRF Education, Venice, Florida, USA
- School of Dental Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
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Liu J, Roberts AL, Lawn RB, Jha SC, Sampson L, Sumner JA, Kang JH, Rimm EB, Grodstein F, Liang L, Haneuse S, Kubzansky LD, Koenen KC, Chibnik LB. Post-traumatic stress disorder symptom remission and cognition in a large cohort of civilian women. Psychol Med 2024; 54:419-430. [PMID: 37577959 PMCID: PMC10947504 DOI: 10.1017/s0033291723001915] [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] [Indexed: 08/15/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit. METHODS Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively. RESULTS Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression. CONCLUSION Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms.
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Affiliation(s)
- Jiaxuan Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea L. Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca B. Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaili C. Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, CA, Los Angeles, CA, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston MA, USA
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Ahmed ST, Li R, Richardson P, Ghosh S, Steele L, White DL, Djotsa AN, Sims K, Gifford E, Hauser ER, Virani SS, Morgan R, Delclos G, Helmer DA. Association of Atherosclerotic Cardiovascular Disease, Hypertension, Diabetes, and Hyperlipidemia With Gulf War Illness Among Gulf War Veterans. J Am Heart Assoc 2023; 12:e029575. [PMID: 37772504 PMCID: PMC10727258 DOI: 10.1161/jaha.123.029575] [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: 01/20/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Approximately 30% of the 700 000 Gulf War veterans report a chronic symptom-based illness of varying severity referred to as Gulf War illness (GWI). Toxic deployment-related exposures have been implicated in the cause of GWI, some of which contribute to metabolic dysregulation and lipid abnormalities. As this cohort ages, the relationship between GWI and atherosclerotic cardiovascular disease (ASCVD) is a growing concern. We evaluated associations between GWI and ASCVD, diabetes, hyperlipidemia, and hypertension in veterans of the Gulf War (1990-1991). METHODS AND RESULTS Analysis of survey data collected in 2014 to 2016 from a national sample of deployed Gulf War veterans (n=942) and Veterans Health Administration electronic health record data (n=669). Multivariable logistic regression models tested for associations of GWI with self-reported ASCVD, diabetes, hyperlipidemia, and hypertension, controlling for confounding factors. Separate models tested for GWI associations with ASCVD and risk factors documented in the electronic health record. GWI was associated with self-reported hypertension (adjusted odds ratio [aOR], 1.67 [95% CI, 1.18-2.36]), hyperlipidemia (aOR, 1.46 [95% CI, 1.03-2.05]), and ASCVD (aOR, 2.65 [95% CI, 1.56-4.51]). In the subset of veterans with electronic health record data, GWI was associated with documented diabetes (aOR, 2.34 [95% CI, 1.43-3.82]) and hypertension (aOR, 2.84 [95% CI, 1.92-4.20]). Hyperlipidemia and hypertension served as partial mediators of the association between GWI and self-reported ASCVD. CONCLUSIONS Gulf War veterans with GWI had higher odds of hyperlipidemia, hypertension, diabetes, and ASCVD compared with Gulf War veterans without GWI. Further examination of the mechanisms underlying this association, including a possible shared exposure-related mechanism, is necessary.
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Affiliation(s)
- Sarah T. Ahmed
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Ruosha Li
- Department of Biostatistics and Data Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Peter Richardson
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Saurendro Ghosh
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Lea Steele
- Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTX
| | - Donna L. White
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Alice Nono Djotsa
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Kellie Sims
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
| | - Elizabeth Gifford
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
- Duke Molecular Physiology Institute and Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamNC
| | - Salim S. Virani
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Cardiology and Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiology, Department of MedicineMichael E. DeBakey VA Medical CenterHoustonTX
| | - Robert Morgan
- Department of Management, Policy and Community Health, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - George Delclos
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
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Hunter LD, Boer T, Saltzman LY. The Intersectionality of Sex and Race in the Relationship Between Posttraumatic Stress Disorder and Cardiovascular Disease: A Scoping Review. Public Health Rev 2023; 44:1605302. [PMID: 37441026 PMCID: PMC10333493 DOI: 10.3389/phrs.2023.1605302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives: Posttraumatic stress disorder (PTSD) has been linked with cardiovascular disease (CVD), suggesting a risk for negative health outcomes among individuals with PTSD. This review synthesizes the temporal relationship between PTSD and CVD and highlights the intersection of sex and race. Methods: Covidence was used to systematically review the literature published between 1980 and 2020. Results: 176 studies were extracted. 68 (38.64%) of the studies were a predominantly male sample. 31 studies (17.61%) were a predominantly female sample. Most reported participants of both sexes (n = 72; 40.91%) and only 5 (2.84%) did not report respondent sex. No studies reported transgender participants. 110 (62.5%) studies reported racial and ethnic diversity in their study population, 18 (10.22%) described a completely or predominantly white sample, and 48 (27.27%) did not report race or ethnicity of their study population. Conclusion: A compelling number of studies did not identify sex differences in the link between PTSD and CVD or failed to report race and ethnicity. Investigating sex, race, ethnicity, and the temporal relationship between PTSD and CVD are promising avenues for future research.
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Affiliation(s)
- Lauren D. Hunter
- Tulane Center for Aging and Department of Medicine, Tulane University, New Orleans, LA, United States
| | - Tara Boer
- Tulane School of Social Work, Tulane University, New Orleans, LA, United States
| | - Leia Y. Saltzman
- Tulane School of Social Work, Tulane University, New Orleans, LA, United States
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Campbell AA, Taylor KA, Augustine AV, Sherwood A, Wu JQ, Beckham JC, Hoerle JM, Ulmer CS. Nightmares: an independent risk factor for cardiovascular disease? Sleep 2023; 46:zsad089. [PMID: 36996027 DOI: 10.1093/sleep/zsad089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
STUDY OBJECTIVES Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. METHODS Participants were veterans (N = 3468; 77% male) serving since September 11, 2001, aged 38 years (SD = 10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity were assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. RESULTS Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. CONCLUSIONS Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.
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Affiliation(s)
| | - Kenneth A Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Ann V Augustine
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jade Q Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Jeffrey M Hoerle
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Christi S Ulmer
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA
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Dyball D, Bennett AN, Schofield S, Cullinan P, Boos CJ, Bull AMJ, Stevelink SA, Fear NT. The underlying mechanisms by which PTSD symptoms are associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study. J Psychiatr Res 2023; 159:87-96. [PMID: 36696788 DOI: 10.1016/j.jpsychires.2023.01.010] [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: 10/30/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) has been identified as an independent risk factor for cardiovascular disease, but the mechanisms of this relationship are not well understood. This study investigates the associations between PTSD symptom clusters (hyperarousal, intrusive thoughts, avoidance behaviours and emotional numbing) and mechanisms of cardiovascular disease including cardiometabolic effects, inflammation, and haemodynamic functioning. In the ADVANCE study cohort of UK male military personnel, 1111 participants were assessed for PTSD via questionnaire and cardiovascular risk via venous blood sampling, pulse wave analysis and dual energy x-ray absorptiometry between 2015 and 2020. Variable selection procedures were conducted to assess which of the symptom clusters if any were associated with cardiovascular risk outcomes. Associations were confirmed via robust regression modelling. Avoidance behaviours were associated with greater systolic Blood Pressure (BP) (Adjusted Coefficient (AC) 0.640 (95% Confidence Interval (CI) 0.065, 1.149). Emotional numbing was associated with greater estimated glucose disposal rate (AC -0.021 (95%CI -0.036, -0.005). Hyperarousal was associated with greater levels of (log)triglycerides (exponentiated-AC 1.009 (95%CI 1.002, 1.017). Intrusive thoughts were associated with greater visceral adipose tissue (AC 0.574 (95%CI 0.020, 1.250). Nonlinear relationships were observed between emotional numbing with heart rate and intrusive thoughts with systolic BP. Limited evidence is present for symptom associations with lipoproteins and pulse wave velocity. No associations were observed between PTSD symptom clusters and high sensitivity c-reactive protein, diastolic BP, total cholesterol, or haemoglobin fasting glucose. In conclusion, symptom clusters of PTSD were associated with increased cardiovascular risk via cardiometabolic and haemodynamic functioning mechanisms, but not inflammation.
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Affiliation(s)
- Daniel Dyball
- King's Centre for Military Health Research, King's College London, SE5 9RJ, UK.
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, Nottinghamshire, LE12 5BL, UK
| | - Susie Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, SW3 6LR, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, SW3 6LR, UK
| | - Christopher J Boos
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BH1 3LT, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, SW7 2AZ, UK
| | - Sharon Am Stevelink
- King's Centre for Military Health Research, King's College London, SE5 9RJ, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, SE5 9RJ, UK; Academic Department of Military Mental Health, King's College London, SE5 9RJ, UK
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Seung HB, Leem J, Kwak HY, Kwon CY, Kim SH. Acupuncture for military veterans with posttraumatic stress disorder and related symptoms after combat exposure: Protocol for a scoping review of clinical studies. PLoS One 2023; 18:e0273131. [PMID: 37083860 PMCID: PMC10120924 DOI: 10.1371/journal.pone.0273131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/26/2022] [Indexed: 04/22/2023] Open
Abstract
Posttraumatic stress disorder is caused by traumatic events such as death, serious injury, and sexual violence. Military personnel and veterans are at high risk for posttraumatic stress disorder. Conventional posttraumatic stress disorder treatments have certain limitations. Complementary and integrative medicine treatments, especially acupuncture, are potential novel first-line treatments that may overcome these limitations. We aim to investigate the current status of the available clinical evidence related to acupuncture treatment for posttraumatic stress disorder in war veterans. We will follow the scoping review process as previously described. The study question is as follows: "Which types of clinical research designs, study types, study durations, adverse events, and clinical outcomes have been reported regarding acupuncture therapy for posttraumatic stress disorder in military veterans?" We will perform a comprehensive search of Medline, Excerpta Medica dataBASE, Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycArticles databases, as well as Chinese, Korean, and Japanese databases, from inception to June 2022. Data from the included studies will be collected and descriptively analyzed in relation to our research question. The extracted data will be collated, synthesized, and summarized according to the analytical framework of a scoping review. The protocol of this study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to ensure the clarity and completeness of our reporting in all phases of this scoping review (Protocol registration: https://osf.io/t723f/). The findings of this scoping review will provide fundamental data that will help researchers identify appropriate research questions and design further studies on the use of acupuncture for PTSD management in military veterans. These results will be helpful for developing disaster site-specific research protocols for future clinical trials on this topic.
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Affiliation(s)
- Hye-Bin Seung
- College of Korean Medicine, Daegu Haany University, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Jungtae Leem
- College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Hui-Yong Kwak
- Republic of Korea Army, Capital Defense Command, Gwacheon-daero, Gwanak-gu, Seoul, Republic of Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, Korea
| | - Sang-Ho Kim
- Department of Neuropsychiatry of Korean Medicine, Pohang Korean Medicine Hospital Affiliated to Daegu Haany University, Pohang-si, Gyeongsangbuk-do, Republic of Korea
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11
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Hanafi A. A Case Report of Home-Based Cognitive-Behavioural Treatment for Late-Onset Post-Traumatic Stress Disorder, Triggered by Mask-Wearing in the Context of the COVID-19 Pandemic. Clin Case Stud 2022; 21:588-605. [PMID: 38603092 PMCID: PMC9118003 DOI: 10.1177/15346501221102915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
A small but clinically significant number of people experience delayed-onset Post-traumatic stress disorder (PTSD); symptoms of trauma years after the events which are now being re-experienced. The following case report describes the use of the cognitive-behavioural treatment for PTSD with a woman experiencing flashbacks to domestic abuse endured more than 20 years ago. Mask-wearing mandated as a result of the COVID-19 pandemic triggered non-contextualised memories of life-threatening physical violence by an abuser who covered his face. She had been managing her flashbacks and intrusive thoughts with both behavioural and experiential forms of avoidance. An 18-session intervention was provided in her own home due to physical health difficulties. Treatment focused on managing hyper-arousal, reducing thought suppression, in-vivo exposure, stimulus-discrimination and re-contextualising traumatic memories. Regular outcome measurements were kept and results are presented as a single-case experimental design in 'AB' format (i.e. baseline period pre intervention). Symptoms of trauma fell to levels non-indicative of PTSD and speak to the evidence base for this modality, even when applied to delayed-onset difficulties in a non-traditional therapy setting. This conclusion is lent extra credence by an experimental design with good internal validity.
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Affiliation(s)
- Adham Hanafi
- University of Bath and NHS Somerset Foundation Trust, UK
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12
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Stewart IJ, Amuan ME, Wang CP, Kennedy E, Kenney K, Werner JK, Carlson KF, Tate DF, Pogoda TK, Dismuke-Greer CE, Wright WS, Wilde EA, Pugh MJ. Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11-Era Veterans. JAMA Neurol 2022; 79:1122-1129. [PMID: 36066882 PMCID: PMC9449870 DOI: 10.1001/jamaneurol.2022.2682] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Question What is the association of a traumatic brain injury (TBI) with the subsequent risk of cardiovascular disease in veterans of the recent conflicts in Iraq and Afghanistan? Findings In this cohort study of 1 559 928 participants, TBI was associated with the development of a composite end point for cardiovascular disease (coronary artery disease, stroke, and peripheral artery disease). TBI was also associated with the individual components of this composite end point. Meaning Traumatic brain injury is a potentially novel risk factor for cardiovascular disease in veterans. Importance Traumatic brain injury (TBI) was common among US service members deployed to Iraq and Afghanistan. Although there is some evidence to suggest that TBI increases the risk of cardiovascular disease (CVD), prior reports were predominantly limited to cerebrovascular outcomes. The potential association of TBI with CVD has not been comprehensively examined in post-9/11–era veterans. Objective To determine the association between TBI and subsequent CVD in post-9/11–era veterans. Design, Setting, and Participants This was a retrospective cohort study conducted from October 1, 1999, to September 30, 2016. Participants were followed up until December 31, 2018. Included in the study were administrative data from the US Department of Veterans Affairs and the Department of Defense from the Long-term Impact of Military-Relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium. Participants were excluded if dates did not overlap with the study period. Data analysis was conducted between November 22, 2021, and June 28, 2022. Exposures History of TBI as measured by diagnosis in health care records. Main Outcomes and Measures Composite end point of CVD: coronary artery disease, stroke, peripheral artery disease, and cardiovascular death. Results Of the 2 530 875 veterans from the consortium, after exclusions, a total of 1 559 928 veterans were included in the analysis. A total of 301 169 veterans (19.3%; median [IQR] age, 27 [23-34] years; 265 217 male participants [88.1]) with a TBI history and 1 258 759 veterans (80.7%; median [IQR] age, 29 [24-39] years; 1 012 159 male participants [80.4%]) without a TBI history were included for analysis. Participants were predominately young (1 058 054 [67.8%] <35 years at index date) and male (1 277 376 [81.9%]). Compared with participants without a history of TBI, diagnoses of mild TBI (hazard ratio [HR], 1.62; 95% CI, 1.58-1.66; P < .001), moderate to severe TBI (HR, 2.63; 95% CI, 2.51-2.76; P < .001), and penetrating TBI (HR, 4.60; 95% CI, 4.26-4.96; P < .001) were associated with CVD in adjusted models. In analyses of secondary outcomes, all severities of TBI were associated with the individual components of the composite outcome except penetrating TBI and CVD death. Conclusions and Relevance Results of this cohort study suggest that US veterans with a TBI history were more likely to develop CVD compared with veterans without a TBI history. Given the relatively young age of the cohort, these results suggest that there may be an increased burden of CVD as these veterans age and develop other CVD risk factors. Future studies are needed to determine if the increased risk associated with TBI is modifiable.
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Affiliation(s)
- Ian J Stewart
- Department of Medicine, Uniformed Services University, Bethesda, Maryland.,Military Cardiovascular Outcomes Research Program, Bethesda, Maryland
| | - Megan E Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Chen-Pin Wang
- University of Texas Health San Antonio, Department of Population Health Sciences, San Antonio
| | - Eamonn Kennedy
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Neurology, Uniformed Services University, Bethesda, Maryland
| | - J Kent Werner
- Department of Neurology, Uniformed Services University, Bethesda, Maryland
| | - Kathleen F Carlson
- VA Portland Health Care System and Oregon Health and Science University, School of Public Health, Portland
| | - David F Tate
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Terri K Pogoda
- VA Boston Healthcare System, Boston University School of Public Health, Boston, Massachusetts
| | - Clara E Dismuke-Greer
- VA Palo Alto Healthcare System, Health Economics Resource Center, Palo Alto, California
| | - W Shea Wright
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Elisabeth A Wilde
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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13
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Health-Related Quality of Life by Gulf War Illness Case Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084425. [PMID: 35457293 PMCID: PMC9026791 DOI: 10.3390/ijerph19084425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
This study examines how health-related quality of life (HRQOL) and related indices vary by Gulf War illness (GWI) case status. The study population included veterans from the Gulf War Era Cohort and Biorepository (n = 1116). Outcomes were physical and mental health from the Veterans RAND 12 and depression, post-traumatic stress (PTSD), sleep disturbance, and pain. Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions were used. Kansas GWI derived subtypes included GWI (met symptom criteria; no exclusionary conditions (KS GWI: Sym+/Dx−)) and those without GWI: KS noncase (1): Sym+/Dx+, KS noncase (2): Sym−/Dx+, and noncase (3): Sym−/Dx−. CDC-derived subtypes included CDC GWI severe, CDC GWI mild-to-moderate and CDC noncases. Case status and outcomes were examined using multivariable regression adjusted for sociodemographic and military-related characteristics. Logistic regression analysis was used to examine associations between GWI case status and binary measures for depression, PTSD, and severe pain. The KS GWI: Sym+/Dx− and KS noncase (1): Sym+/Dx+ groups had worse mental and physical HRQOL outcomes than veterans in the KS noncase (2): Sym−/Dx+ and KS noncase (3): Sym−/Dx− groups (ps < 0.001). Individuals who met the CDC GWI severe criteria had worse mental and physical HRQOL outcomes than those meeting the CDC GWI mild-to-moderate or CDC noncases (ps < 0.001). For other outcomes, results followed a similar pattern. Relative to the less symptomatic comparison subtypes, veterans who met the Kansas symptom criteria, regardless of exclusionary conditions, and those who met the CDC GWI severe criteria experienced lower HRQOL and higher rates of depression, PTSD, and severe pain.
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14
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Sommer JL, Mota N, Thompson JM, Asmundson GJ, Sareen J, Bernstein CN, Marrie RA, El-Gabalawy R. Associations between courses of posttraumatic stress disorder and physical health conditions among Canadian military personnel. J Anxiety Disord 2022; 87:102543. [PMID: 35168002 DOI: 10.1016/j.janxdis.2022.102543] [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: 05/11/2021] [Revised: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel. METHOD We analyzed data from the 2002 Canadian Community Health Survey-Mental Health and Well-being-Canadian Forces supplement (CCHS-CF) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS; N = 2941). Multivariable logistic regressions examined associations between PTSD courses (reference = no PTSD) and physical health conditions. RESULTS In general, physical health conditions were more prevalent among symptomatic PTSD courses compared to no PTSD. After adjustment, new onset PTSD was associated with increased odds of all physical health conditions with the exception of ulcers and cancer (AOR range: 1.41-2.31) and remitted PTSD was associated with increased odds of diabetes (AOR = 2.31). CONCLUSION Results suggest that new onset PTSD may be most strongly associated with physical health conditions. Findings may inform targeted screening and intervention methods among military personnel with PTSD and physical health conditions.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - James M Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Gordon Jg Asmundson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2 Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - Charles N Bernstein
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9 Canada.
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15
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Levi P, Moss J. Intensive Care Unit Nurses' Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients. Workplace Health Saf 2022; 70:358-367. [PMID: 35112605 DOI: 10.1177/21650799211064262] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive care unit (ICU) nurses are enduring unprecedented burden caring for COVID-19 patients. Few studies have reported types of work-related events that lead to occupational stress and post-traumatic stress disorder (PTSD). METHODS ICU nurses were recruited at an academic health science center to explore their experiences of caring for COVID-19 patients. Participants were interviewed for 1 hour using open-ended questions. Symptoms of PTSD were assessed using the PTSD Checklist, job satisfaction with a Likert-type scale, and intention to leave their job with a "yes or no" question. Semi-structured interviews were transcribed and analyzed using NVivo software; quantitative data were analyzed using frequencies and means with R 4.0.5. FINDINGS The ICU nurse sample comprised nine females and one male, all Caucasian, with a mean age of 26.6 years. Analysis of interview transcripts revealed six recurring themes: Change in Practice, Emotion, Patient's Family, Isolation, Job Satisfaction, and Public Reaction. Quantitative findings revealed 7 of 10 met diagnostic criteria for PTSD. Most participants (7/10) were "somewhat satisfied" with their job. Five of 10 considered leaving their job in the last 6 months. CONCLUSION/IMPLICATIONS FOR PRACTICE Understanding the impact stressful pandemic-related patient care has on ICU nurses provides evidence that new policies are needed. Furthermore, qualitative findings provide insight into the best design and deployment of interventions to reduce stress and prevent development of PTSD. More research is needed to understand long-term effects of PTSD and to evaluate strategies to prevent PTSD during stressful emergency surges in intensive care.
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16
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Gran-Ruaz SM, Taylor RJ, Jacob G, Williams MT. Lifetime Trauma Exposure and Posttraumatic Stress Disorder Among African Americans and Black Caribbeans by Sex and Ethnicity. Front Psychiatry 2022; 13:889060. [PMID: 35800025 PMCID: PMC9253828 DOI: 10.3389/fpsyt.2022.889060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a debilitating disorder requiring timely diagnosis and treatment, with special attention needed for Black populations in the U.S. Yet, stakeholders often fail to recognize Black communities' heterogeneous ethnic composition, thus not allowing diverse sociocultural realities to inform PTSD interventions. This study aims to characterize sex and ethnic differences in lifetime trauma exposure, lifetime PTSD diagnosis and symptoms, and help-seeking among the African Americans and Black Caribbeans in the U.S. METHOD This study relied on data from the National Survey of American Life 2001-2003 (NSAL) to investigate the lifetime exposure to traumatic events and prevalence of a clinical PTSD diagnosis based on the DSM-IV among African American (n = 3,570) and Black Caribbean (n = 1,623) adults. 44.5% of respondents were men and 55.5% were women. Logistic regression was utilized to investigate the impact of traumatic events on PTSD. RESULTS Several ethnic and sex differences in exposure to potentially traumatic events were identified. African American respondents were more likely to experience spousal abuse and toxin exposure than their Black Caribbean counterparts. Black Caribbeans reported higher lifetime exposure to muggings, natural disasters, harsh parental discipline, being a civilian living in terror and/or being a refugee than African American respondents. Specific to sex, Black men reported more events of combat, a peacekeeper/relief worker, being mugged, toxin exposure, seeing atrocities, and/or injuring someone. Black women were more likely to have been rape/sexual assault and/or intimate partner violence victims. The assaultive violence trauma type was most predictive of lifetime PTSD diagnosis among Black Americans. African American women were more likely to report PTSD symptoms than men, with almost no significant differences in Black Caribbean men and women. Approximately half of Black Americans sought help for their worst traumatic event, commonly engaging family/friends, psychiatrists, and mental health professionals. Further, there were almost no ethnic and sex differences related to professional and non-professional help sought. CONCLUSION Future PTSD-related research should aim to characterize the heterogenous experiences of potentially traumatic events within different Black communities. Clinicians working with Black clients should strive to understand the limitations within their tools/interventions in meeting the needs of diverse groups.
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Affiliation(s)
| | | | - Grace Jacob
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Monnica T Williams
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,School of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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17
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Stanislawski MA, Stamper CE, Stearns-Yoder KA, Hoisington AJ, Brostow DP, Forster JE, Postolache TT, Lowry CA, Brenner LA. Characterization of the gut microbiota among Veterans with unique military-related exposures and high prevalence of chronic health conditions: A United States-Veteran Microbiome Project (US-VMP) study. Brain Behav Immun Health 2021; 18:100346. [PMID: 34988495 PMCID: PMC8710413 DOI: 10.1016/j.bbih.2021.100346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/06/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
The gut microbiome is impacted by environmental exposures and has been implicated in many physical and mental health conditions, including anxiety disorders, affective disorders, and trauma- and stressor-related disorders such as posttraumatic stress disorder (PTSD). United States (US) military Veterans are a unique population in that their military-related exposures can have consequences for both physical and mental health, but the gut microbiome of this population has been understudied. In this publication, we describe exposures, health conditions, and medication use of Veterans in the US Veteran Microbiome Project (US-VMP) and examine the associations between these characteristics and the gut microbiota. This cohort included 331 US Veterans seeking healthcare with the Veterans Health Administration who were 83% male with an average (±SD) age of 47.6 ± 13.4 years. The cohort displayed a high prevalence of PTSD (49.8%) and history of traumatic brain injuries (76.1%), and high current use of prescription medications (74.9%) to treat various acute and chronic conditions. We observed significant associations between the gut microbiota composition and gastroenteritis, peripheral vascular disease (PVD), bipolar disorders, symptoms of severe depression based on the Beck Depression Inventory, stimulant and opioid use disorders, beta-blockers, serotonin and norepinephrine reuptake inhibitor antidepressants, diabetes medications, and proton pump inhibitors. Many of the Veteran characteristics examined were associated with altered relative abundances of specific taxa. We found that PVD and cardiovascular disease were associated with lower microbiota diversity in the gut (i.e., α-diversity), while supplemental vitamin use was associated with higher α-diversity. Our study contributes novel insights as to whether the unique exposures of Veterans in this cohort correlate with gut microbiota characteristics and, in line with previous findings with other population-level studies of the microbiome, confirms associations between numerous health conditions and medications with the gut microbiome.
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Affiliation(s)
- Maggie A. Stanislawski
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
| | - Christopher E. Stamper
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly A. Stearns-Yoder
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew J. Hoisington
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Systems Engineering & Management, Air Force Institute of Technology, Wright-Patterson AFB, OH, USA
| | - Diana P. Brostow
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeri E. Forster
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Teodor T. Postolache
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- VISN 5 MIRECC, Department of Veterans Affairs, Baltimore, MD, USA
| | - Christopher A. Lowry
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa A. Brenner
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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18
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Gupta S, Guleria RS, Szabo YZ. MicroRNAs as biomarker and novel therapeutic target for posttraumatic stress disorder in Veterans. Psychiatry Res 2021; 305:114252. [PMID: 34739954 PMCID: PMC8857765 DOI: 10.1016/j.psychres.2021.114252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 10/23/2021] [Indexed: 12/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder for military Veterans, characterized by hyperarousal, intrusive thoughts, flashbacks, hypervigilance, and distress after experiencing traumatic events. Some of the known physiological effects of PTSD include hypothalamic-pituitary-adrenal (HPA)-axis imbalance, a cortical function resulting in neuronal deficit and changes in behavior. Moreover, excessive discharge of inflammatory molecules and a dysregulated immune system are implicated in the pathophysiology of PTSD. Due to complex nature of this disorder, the biological underpinnings of PTSD remain inexplicable. Investigating novel biomarkers to understanding the pathogenesis of PTSD may reflect the underlying molecular network for therapeutic use and treatment. Circulatory microRNAs (miRNAs) and exosomes are evolving biomarkers that have shown a key role in psychiatric and neurological disorders including PTSD. Given the unique nature of combat trauma, as well as evidence that a large portion of Veterans do not benefit from frontline treatments, focus on veterans specifically is warranted. In the present review, we delineate the identification and role of several miRNAs in PTSD among veterans. An association of miRNA with HPA-axis regulation through FKBP5, a key modulator in PTSD is discussed as an emerging molecule in psychiatric diseases. We conclude that miRNAs may be used as circulatory biomarker detection in Veterans with PTSD.
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Affiliation(s)
- Sudhiranjan Gupta
- VISN 17 Center of Excellence for Research on Returning War Veterans, Biomarkers & Genetics Core, Central Texas Veterans Health Care System, 4800 Memorial Drive (151C), Waco, TX, 76711, USA.
| | - Rakeshwar S. Guleria
- VISN 17 Center of Excellence for Research on Returning War Veterans, Biomarkers & Genetics Core, Central Texas Veterans Health Care System, 4800 Memorial Drive (151C), Waco, Texas, 76711
| | - Yvette Z. Szabo
- VISN 17 Center of Excellence for Research on Returning War Veterans, Biomarkers & Genetics Core, Central Texas Veterans Health Care System, 4800 Memorial Drive (151C), Waco, Texas, 76711
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19
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Walker LE, Watrous J, Poltavskiy E, Howard JT, Janak JC, Pettey WBP, Zarzabal LA, Sim A, Gundlapalli A, Stewart IJ. Longitudinal mental health outcomes of combat-injured service members. Brain Behav 2021; 11:e02088. [PMID: 33662185 PMCID: PMC8119815 DOI: 10.1002/brb3.2088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post-traumatic stress disorder (PTSD), depression, and anxiety. METHODS Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat-injured United States service members matched 1:1 to combat-deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. RESULTS Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person-years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat-injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68-3.17), depression (HR 1.47, 95%CI 1.36-1.58), and anxiety (HR 1.34, 95%CI 1.24-1.45). CONCLUSIONS Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.
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Affiliation(s)
| | | | | | | | | | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lee Ann Zarzabal
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Alan Sim
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Adi Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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20
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Li H, Flynn DM, Highland KB, Barr PK, Langford DJ, Doorenbos AZ. Relationship between Post-Traumatic Stress Disorder Symptoms and Chronic Pain Related Symptom Domains among Military Active Duty Service Members. PAIN MEDICINE 2021; 22:2876-2883. [PMID: 33690851 DOI: 10.1093/pm/pnab087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examined the relationships between symptom domains relevant to PTSD diagnosis, PTSD screening, and chronic pain-related symptoms (pain intensity, pain interference, physical function, fatigue, depression, anxiety, anger, satisfaction with social roles) experienced by active duty military service members with chronic pain. DESIGN Cross-sectional study. SETTING The Interdisciplinary Pain Management Center (IPMC) at Madigan Army Medical Center between 2014 and 2018. SUBJECTS Active duty service members receiving care at IPMC (N = 2,745). METHODS Independent sample t test was conducted to compare pain intensity and pain-related measures of physical, emotional and social functioning among patients with and without a PTSD diagnosis or PTSD positive screen (≥3 symptoms). Relative weight analysis was used to identify the relative importance of each PTSD symptom cluster (e.g., intrusion, avoidance, hyperarousal, emotional numbness) to pain and related domains. RESULTS Approximately 27.9% patients had a positive screen for PTSD, and 30.5% of the patients had a PTSD diagnosis. Patients with PTSD diagnosis and positive screening had higher Pain Interference and lower Physical Function and Social Satisfaction scores (P < 0.001), and had increased Anger, Anxiety, Fatigue, and Depression scores (P < 0.001). Emotional numbness accounted for the largest proportion of variance in average pain intensity, pain interference, and psychological functioning; while avoidance accounted for the largest proportion of variance in physical function. CONCLUSION To improve treatment effectiveness and overall functioning for active duty military patients, integrated treatment and therapies targeted to reducing chronic pain, and PTSD symptoms (focus on emotional numbness and avoidance) are recommended.
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Affiliation(s)
- Hongjin Li
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago.,University of Illinois Cancer Center, Chicago
| | - Diane M Flynn
- Department of Rehabilitative Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland.,Henry M. Jackson Foundation, Rockville, Maryland
| | - Patricia K Barr
- Department of Rehabilitative Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Dale J Langford
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago.,University of Illinois Cancer Center, Chicago
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21
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Khalsa SS, Clausen AN, Shahabi L, Sorg J, Gonzalez SE, Naliboff B, Shivkumar K, Ajijola OA. Cardiac sympathetic denervation and mental health. Auton Neurosci 2021; 232:102787. [PMID: 33631539 DOI: 10.1016/j.autneu.2021.102787] [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: 03/06/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. METHODS 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. RESULTS A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. CONCLUSION The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America.
| | - Ashley N Clausen
- Department of Behavioral Health, Kansas City VA Medical Center, Kansas City, MO, United States of America; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Julie Sorg
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah E Gonzalez
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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22
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Lewis ME, Volpert-Esmond HI, Deen JF, Modde E, Warne D. Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1821. [PMID: 33668461 PMCID: PMC7918141 DOI: 10.3390/ijerph18041821] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Indigenous people experience the greatest cardiometabolic disease disparity in the Unites States, yet high cardiometabolic disease risk factors do not fully explain the extent of the cardiometabolic disease disparity for Indigenous people. Stress, trauma, and racism occur at high rates within Indigenous communities and have not been well explored as significant contributors to cardiometabolic disease disparities despite emerging literature, and therefore will be described here. METHODS This descriptive study explores the relationship between cardiometabolic disease risks and Indigenous-specific stressors (e.g., early childhood stress and trauma, adulthood stress and trauma, and historical and intergenerational trauma) using current literature. Indigenous-specific protective factors against cardiometabolic disease are also reviewed. RESULTS Increasing research indicates that there is a relationship between Indigenous-specific stressful and traumatic life experiences and increased cardiometabolic disease risk. Mental health and psychophysiology play an important role in this relationship. Effective interventions to reduce cardiometabolic disease risk in Indigenous communities focus on ameliorating the negative effects of these stressors through the use of culturally specific health behaviors and activities. CONCLUSIONS There is increasing evidence that cultural connection and enculturation are protective factors for cardiometabolic disease, and may be galvanized through Indigenous-led training, research, and policy change.
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Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | | | - Jason F. Deen
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA;
| | - Elizabeth Modde
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Donald Warne
- Family & Community Medicine Department, University of North Dakota, Grand Forks, ND 58202, USA;
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23
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Spitzer C, Klinger-König J, Frenzel S, Schminke U, Völzke H, Lübke L, Grabe HJ. Association of traumatic stress and posttraumatic stress disorder with carotid atherosclerosis: findings from the general population. Eur J Psychotraumatol 2020; 11:1815280. [PMID: 33244360 PMCID: PMC7678678 DOI: 10.1080/20008198.2020.1815280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Cumulative evidence suggests that both traumatic stress and posttraumatic stress disorder (PTSD) are cross-sectionally and prospectively linked to cardiovascular disease (CVD). However, their association with proxy markers of atherosclerosis has hardly been investigated. Objective: The objective of this general population study was to relate traumatic stress and PTSD to carotid plaque and intima-media thickness (cIMT). Methods: 3119 adults from the general population were assessed regarding their traditional cardiovascular risk factors, and an ultrasound of the carotid arteries was performed in each participant. Based on a PTSD interview, every participant was assigned to one of three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. The sample was stratified into five age groups. Results: Trauma exposure was reported by 54.5% of the sample and 2.0% had PTSD. Traumatized participants had increased odds of self-reported CVD events compared to those without trauma exposure, even when accounted for CVD risk factors and other covariates (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.03-2.22). This association was driven by those aged 70 years or older. Only in those aged 40 to 49 years, there was an association between cIMT and PTSD. There were no further associations between carotid plaque or cIMT and traumatic stress or PTSD. Conclusions: Our findings in concert with prior research suggest that the association between traumatic stress, PTSD and atherosclerosis as well as its clinical endpoints is complex and remains inconclusive.
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Affiliation(s)
- Carsten Spitzer
- Department of Psychosomatic Medicine, University Medical Center Rostock, Rostock, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Laura Lübke
- Department of Psychosomatic Medicine, University Medical Center Rostock, Rostock, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
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GPER-Deficient Rats Exhibit Lower Serum Corticosterone Level and Increased Anxiety-Like Behavior. Neural Plast 2020; 2020:8866187. [PMID: 32908490 PMCID: PMC7474769 DOI: 10.1155/2020/8866187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 01/02/2023] Open
Abstract
Ample evidence suggests that estrogens have strong influences on the occurrence of stress-related mood disorders, but the underlying mechanisms remain poorly understood. Through multiple approaches, we demonstrate that the G protein-coupled estrogen receptor (GPER) is widely distributed along the HPA axis and in brain structures critically involved in mood control. Genetic ablation of GPER in the rat resulted in significantly lower basal serum corticosterone level but enhanced ACTH release in response to acute restraint stress, especially in the female. GPER−/− rats of either sex displayed increased anxiety-like behaviors and deficits in learning and memory. Additionally, GPER deficiency led to aggravation of anxiety-like behaviors following single-prolonged stress (SPS). SPS caused significant decreases in serum corticosterone in WT but not in GPER-deficient rats. The results highlight an important role of GPER at multiple sites in regulation of the HPA axis and mood.
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Liu M, Xie J, Sun Y. TLR4/MyD88/NF-κB-Mediated Inflammation Contributes to Cardiac Dysfunction in Rats of PTSD. Cell Mol Neurobiol 2020; 40:1029-1035. [PMID: 31939007 DOI: 10.1007/s10571-020-00791-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is related with myocardial injury and cardiac dysfunction, while the molecular mechanism has not been clear. This study investigated whether TLR4/MyD88/NF-κB-mediated inflammation involved in myocardial injury of PTSD. Adult male Wistar rats were exposed to single-prolonged stress (SPS), which was used broadly as a animal model of PTSD. Morris Water Maze (MWM) test and forced swimming test (FST) was carried out for behavioral testing. The protein expression of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the left ventricular of heart and TLR4/MyD88/NF-κB-mediated inflammation were examined. Our results showed that there were obvious increased in the protein expression of ANP and BNP in heart after exposure to SPS, SPS also significantly enhanced the serum level of IL-1β and TNF-α, and meanwhile, the TLR4/MyD88/NF-κB pathway were activated. These results demonstrated that the TLR4/MyD88/NF-κB pathway were involved in the myocardial injury of PTSD, which might be one of possible molecular mechanism contributed to the pathogenesis of cardiac dysfunction in PTSD.
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Affiliation(s)
- Moujie Liu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Juhua Xie
- Department of Histology and Embryology, Basic Medical Sciences College, Shenyang Medical College, Shenyang, 110034, People's Republic of China.
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
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The Relationship between Military Combat and Cardiovascular Risk: A Systematic Review and Meta-Analysis. Int J Vasc Med 2019; 2019:9849465. [PMID: 31934451 PMCID: PMC6942813 DOI: 10.1155/2019/9849465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives Cardiovascular disease (CVD) is a leading cause of death among military veterans with several reports suggesting a link between combat and related traumatic injury (TI) to an increased CVD risk. The aim of this paper is to conduct a widespread systematic review and meta-analysis of the relationship between military combat ± TI to CVD and its associated risk factors. Methods PubMed, EmbaseProQuest, Cinahl databases and Cochrane Reviews were examined for all published observational studies (any language) reporting on CVD risk and outcomes, following military combat exposure ± TI versus a comparative nonexposed control population. Two investigators independently extracted data. Data quality was rated and rated using the 20-item AXIS Critical Appraisal Tool. The risk of bias (ROB using the ROBANS 6 item tool) and strength of evidence (SOE) were also critically appraised. Results From 4499 citations, 26 studies (14 cross sectional and 12 cohort; 78–100% male) met the inclusion criteria. The follow up period ranged from 1 to 43.6 years with a sample size ranging from 19 to 621901 participants in the combat group. Combat-related TI was associated with a significantly increased risk for CVD (RR 1.80: 95% CI 1.24–2.62; I2 = 59%, p = 0.002) and coronary heart disease (CHD)-related death (risk ratio 1.57: 95% CI 1.35–1.83; I2 = 0%, p = 0.77: p < 0.0001), although the SOE was low. Military combat (without TI) was linked to a marginal, yet significantly lower pooled risk (low SOE) of cardiovascular death in the active combat versus control population (RR 0.90: CI 0.83–0.98; I2 = 47%, p = 0.02). There was insufficient evidence linking combat ± TI to any other cardiovascular outcomes or risk factors. Conclusion There is low SOE to support a link between combat-related TI and both cardiovascular and CHD-related mortality. There is insufficient evidence to support a positive association between military combat ± any other adverse cardiovascular outcomes or risk factors. Data from well conducted prospective cohort studies following combat are needed.
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