Posttraumatic stress disorder in urban women

Urbanicity and anxiety disorders: current evidence and quo vadis?

PURPOSE OF REVIEW

There are few studies investigating the effects of urbanization on various anxiety-related conditions in specific population subgroups. This review aims to examine the effects of urbanization through the lens of population subgroups as well as anxiety disorder subtypes.

RECENT FINDINGS

There was more consistent evidence suggesting that those of a younger age group and from disadvantaged backgrounds (such as lower socioeconomic status, refugee status) may be more vulnerable to posttraumatic stress disorder (PTSD). When we examined the relationship between urbanization and anxiety disorder subtype, the results were largely mixed, with some evidence for the positive association between urbanization and PTSD. Many of the recent studies had been conducted in the context of the recent coronavirus disease 2019 (COVID-19) pandemic.

SUMMARY

The association between urbanicity and anxiety-related disorders in the various subgroups can be influenced by socio-demographic factors. Interventions and policies that aim to ameliorate the effects of urbanicity would need to identify vulnerable individuals early based on social or environmental factors. Given that the short and long-term psychological sequelae of the recent COVID-19 pandemic are still being evaluated, the inter-relationships between urbanization, external factors and specific anxiety disorders await further delineation.

The PAC1 receptor risk genotype does not influence fear acquisition, extinction, or generalization in women with no trauma/low trauma

Women are known to have twice as much lifetime prevalence of post-traumatic stress disorder (PTSD) as men do. It has been reported that the risk genotype (CC) of a single nucleotide polymorphism (SNP) (rs2267735) in the pituitary adenylate cyclase-activating polypeptide (PACAP-PAC1R) system is associated with PTSD risk and altered fear conditioning and fear extinction in women. Surprisingly, no previous work has studied the effect of this SNP on fear conditioning, extinction, or generalization in non-traumatized/low trauma load women. Here, two separate groups of women underwent either a two-day fear conditioning and fear extinction paradigm, or a one-day fear conditioning and fear generalization paradigm. Results showed no significant differences between genotypes in conditioned stimulus discrimination, during fear acquisition, extinction, or generalization. These findings suggest that the previously reported fear processing impairments in traumatized CC women are not a consequence of this genotype alone, but likely dependent on the interaction between this genetic risk and the exposure to traumatic stressors.

Challenges in the use of animal models and perspectives for a translational view of stress and psychopathologies

The neurobiology and development of treatments for stress-related neuropsychiatric disorders rely heavily on animal models. However, the complexity of these disorders makes it difficult to model them entirely, so only specific features of human psychopathology are emulated and these models should be used with great caution. Importantly, the effects of stress depend on multiple factors, like duration, context of exposure, and individual variability. Here we present a review on pre-clinical studies of stress-related disorders, especially those developed to model posttraumatic stress disorder, major depression, and anxiety. Animal models provide relevant evidence of the underpinnings of these disorders, as long as face, construct, and predictive validities are fulfilled. The translational challenges faced by scholars include reductionism and anthropomorphic/anthropocentric interpretation of the results instead of a more naturalistic and evolutionary understanding of animal behavior that must be overcome to offer a meaningful model. Other limitations are low statistical power of analysis, poor evaluation of individual variability, sex differences, and possible conflicting effects of stressors depending on specific windows in the lifespan.

C-L Case Conference: Psychiatric Evaluation and Management Following Gunshot Injury

We present the case of a 23-year-old female presenting to CL Psychiatry after admission for multiple gunshot wounds. Top experts in the CL field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include risk factors for gun violence victimization, assessment of psychiatric diagnoses associated with gunshot injury, and management challenges including access to psychiatric care. Specifically, we highlight the high prevalence of trauma-related disorders, substance use disorders, and functional impairment after gunshot injury. We also provide practical guidance on issues of lethality assessment, trauma-informed care, psychiatric management, and community resources that support recovery.

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW’s COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW’s MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.

Brainstem Quadruple Aberrant Hyperphosphorylated Tau, Beta-Amyloid, Alpha-Synuclein and TDP-43 Pathology, Stress and Sleep Behavior Disorders

Quadruple aberrant hyperphosphorylated tau (p-τ), amyloid-β peptide, alpha-synuclein and TDP-43 brainstem and supratentorial pathology are documented in forensic ≤40y autopsies in Metropolitan Mexico City (MMC), and p-τ is the major aberrant protein. Post-traumatic stress disorder (PTSD) is associated with an elevated risk of subsequent dementia, and rapid eye movement sleep behavior disorder (RBD) is documented in PD, AD, Lewy body dementia and ALS. This study aimed to identify an association between PTSD and potential pRBD in Mexico. An anonymous online survey of 4502 urban college-educated adults, 29.3 ± 10.3 years; MMC, n = 1865; non-MMC, n = 2637, measured PTSD symptoms using the Impact of Event Scale-Revised (IES-R) and pRBD symptoms using the RBD Single-Question. Over 50% of the participants had IES-R scores ≥33 indicating probable PTSD. pRBD was identified in 22.6% of the participants across Mexico and 32.7% in MMC residents with PTSD. MMC subjects with PTSD had an OR 2.6218 [2.5348, 2.7117] of answering yes to the pRBD. PTSD and pRBD were more common in women. This study showed an association between PTSD and pRBD, strengthening the possibility of a connection with misfolded proteinopathies in young urbanites. We need to confirm the RBD diagnosis using an overnight polysomnogram. Mexican women are at high risk for stress and sleep disorders.

Mental health problems among healthcare workers involved with the COVID-19 outbreak

OBJECTIVE

The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems.

METHODS

A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19.

RESULTS

The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001).

CONCLUSION

The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.