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Do somatic symptoms relate to PTSD and gender after earthquake exposure? A cross-sectional study on young adult survivors in Italy. CNS Spectr 2021; 26:268-274. [PMID: 32248878 DOI: 10.1017/s1092852920000097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Increasing evidence confirms a strict relationship between mental disorders and physical health. Particularly, stressful life events and post-traumatic stress disorder (PTSD) have been closely correlated with various physical disorders and somatic symptoms, such as chronic pain, gastrointestinal disorders, and headaches. The aim of this study was to investigate the emergence of somatic symptoms in a sample of young adult survivors 21 months after exposure to the L'Aquila 2009 earthquake, with particular attention to PTSD and gender impact. METHODS Four hundred and fifty high-school senior students (253 male and 197 female) exposed to the 2009 L'Aquila earthquake, 21 months earlier, were enrolled and evaluated by the Trauma and Loss Spectrum Self-Report (TALS-SR), for symptomatological PTSD, and the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR) "rhythmicity and vegetative functions" domain, for somatic symptoms. RESULTS Significantly higher rates of endorsement of the MOODS-SR somatic symptoms emerged in survivors with PTSD compared to those without. Females reported higher rates of endorsement of at least one MOODS-SR somatic symptom compared to males; however, a Decision Tree model and a two-way analysis of variance model confirmed a significant effect of PTSD only. A multivariate logistical regression showed a significant association between the presence of at least one MOOD-SR somatic symptom and re-experiencing and maladaptive coping TALS-SR domains. CONCLUSION This study corroborates a relevant impact of symptomatological PTSD, across both the genders, on somatic symptoms occurring in young adults after months from exposure to a massive earthquake.
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Schwetlik SN, Baldock KL, Hill CL, Ferrar K. Chronic stress and arthritis: a scoping review. Arthritis Care Res (Hoboken) 2020; 74:982-996. [PMID: 33278062 DOI: 10.1002/acr.24528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/02/2020] [Accepted: 12/01/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Emerging research supports the role of chronic stress in chronic disease development. This scoping review aimed to map the field of research exploring relationships between chronic stress and the development of arthritis in adult populations. METHODS Five electronic databases were systematically searched without publication limits based on three key concepts: stress, arthritis and adults. Eligible qualitative studies investigated individuals' perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by two independent reviewers and data were narratively synthesised. RESULTS Of 1819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods and 45 used quantitative methods. Studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorised as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self-reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development. CONCLUSION Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease aetiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiological framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions.
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Affiliation(s)
- Sarah N Schwetlik
- UniSA: Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Katherine L Baldock
- UniSA: Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Catherine L Hill
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
| | - Katia Ferrar
- UniSA: Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
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3
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Rehman Y, Sadeghirad B, Guyatt GH, McKinnon MC, McCabe RE, Lanius RA, Richardson DJ, Couban R, Sousa-Dias H, Busse JW. Management of post-traumatic stress disorder: A protocol for a multiple treatment comparison meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17064. [PMID: 31574805 PMCID: PMC6775348 DOI: 10.1097/md.0000000000017064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Most systematic reviews have explored the efficacy of treatments on symptoms associated with post-traumatic stress disorder (PTSD), which is a chronic and often disabling condition. Previous network meta-analysis (NMA) had limitations such as focusing on pharmacological or psychotherapies. Our review is aims to explore the relative effectiveness of both pharmacological and psychotherapies and we will establish the differential efficacy of interventions for PTSD in consideration of both symptom reduction and functional recovery. METHODS We will conduct a network meta-analysis of randomized controlled trials evaluating treatment interventions for PTSD. We will systematically search Medline, PILOT, Embase, CINHAL, AMED, Psychinfo, Health Star, DARE and CENTRAL to identify trials that: (1) enroll adult patients with PTSD, and (2) randomize them to alternative interventions or an intervention and a placebo/sham arm. Independent reviewers will screen trials for eligibility, assess risk of bias using a modified Cochrane instrument, and extract data. Our outcomes of interest include PTSD symptom reduction, quality of life, functional recovery, social and occupational impairment, return to work and all-cause drop outs. RESULTS We will conduct frequentist random-effects network meta-analysis to assess relative effects of competing interventions. We will use a priori hypotheses to explore heterogeneity between studies, and assess the certainty of evidence using the GRADE approach. CONCLUSION This network meta-analysis will determine the comparative effectiveness of therapeutic options for PTSD on both symptom reduction and functional recovery. Our results will be helpful to clinicians and patients with PTSD, by providing a high-quality evidence synthesis to guide shared-care decision making.
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Affiliation(s)
- Yasir Rehman
- Department of Health Research Methods, Evidence, and Impact (HEI)
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
- Canadian Academy of Osteopathy (CAO)
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (HEI)
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence, and Impact (HEI)
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioral Neurosciences, McMaster University
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton
- Homewood Research Institute, Guelph
| | - Randi E. McCabe
- Department of Psychiatry and Behavioral Neurosciences, McMaster University
- Anxiety Treatment & Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton
| | - Ruth A. Lanius
- Homewood Research Institute, Guelph
- Imaging Division, Lawson Health Research Institute
- Department of Psychiatry and Neurosciences Western University
| | - Donald J. Richardson
- MacDonald/Franklin OSI Research Centre, Western University
- Lawson Health Research Institute
- Parkwood Hospital Operational Stress Injury Clinic, St. Joseph's Health Care London
- Department of Psychiatry and Neurosciences Western University, London
| | - Rachel Couban
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
| | | | - Jason W. Busse
- Department of Health Research Methods, Evidence, and Impact (HEI)
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
- Department of Anesthesia
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
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Zhou B, Boyer R, Guay S. Dangers on the road: A longitudinal examination of passenger-initiated violence against bus drivers. Stress Health 2018; 34:253-265. [PMID: 28913926 DOI: 10.1002/smi.2779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 05/18/2017] [Accepted: 07/07/2017] [Indexed: 11/11/2022]
Abstract
This study examined the impact of workplace violence against 109 bus drivers over a 1-year span. Workplace violence is related to both psychological and work-related consequences. Our findings showed that bus drivers experienced a wide range of violence at work and the psychological consequences were devastating: Half of the participants met the diagnostic criteria for acute stress disorder within the first month following the index event. Majority of them experienced at least moderate levels of post-traumatic stress disorder (PTSD) problems over the 1-year span. About 9.3% of participants showed a delayed onset of PTSD 6 months after. Furthermore, counter-supportive behaviours and reexposure to violence played important roles in the maintenance of PTSD symptoms over time. Even though PTSD symptoms per se did not relate to bus driver's confidence in coping with aggressive passengers, the immediate post-traumatic reaction-symptoms of acute stress disorder-showed a significant long-term negative effect on bus drivers' confidence in dealing with aggressive passengers 12 months after. This study provided empirical evidence of the changing nature of PTSD symptoms over time among bus drivers.
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Affiliation(s)
- Biru Zhou
- Centre for Research on Children and Families, McGill University and Trauma Studies Centre, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
| | - Richard Boyer
- Department of Psychiatry, Université de Montréal and Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
| | - Stéphane Guay
- School of Criminology, Université de Montréal and Trauma Studies Centre, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
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Gradus JL, Farkas DK, Svensson E, Ehrenstein V, Lash TL, Toft Sørensen H. Posttraumatic Stress Disorder and Gastrointestinal Disorders in the Danish Population. Epidemiology 2018; 28:354-360. [PMID: 28099266 DOI: 10.1097/ede.0000000000000622] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence for the association between posttraumatic stress disorder (PTSD) and gastrointestinal (GI) disorders is mixed, owing in part to methodologic differences across studies. Furthermore, studies which have combined GI disorders or symptoms for examination as one overall category may potentially obscure associations between PTSD and individual GI diagnoses. METHODS This nationwide cohort study examined the incidence of all major nonmalignant GI disorders in patients with a prior PTSD diagnosis (n = 4,076), compared with the general population incidence from 1995 to 2013, using Danish medical registry data. We examined differences by sex, age, marital status, psychiatric and somatic comorbidity, and follow-up time. Risks, standardized incidence rates (SIRs), and confidence intervals (95% CIs) were calculated. RESULTS Risk of any GI disorder among PTSD patients was 25% (95% CI: 21%, 29%); the SIR for any GI disorder was 1.8 (95% CI: 1.7, 2.0). Risk and SIRs varied by disorder (e.g., no association with diverticula of the intestines [SIR: 1.1, 95% CI: 0.83, 1.5]; stronger association with peptic ulcer, site unspecified [SIR: 3.3, 95% CI: 1.8, 5.5]). Stratified analyses revealed that some associations were stronger for persons ages 16-39 or unmarried at PTSD diagnosis, persons with comorbid psychiatric diagnoses, and in the year following PTSD diagnosis. CONCLUSIONS This study documents associations between clinician-diagnosed PTSD and all major nonmalignant GI disorders in an unselected nationwide cohort with long follow-up. Differences in associations across GI disorders and important modifiers may account for previous conflicting research findings.
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Affiliation(s)
- Jaimie L Gradus
- From the aNational Center for PTSD, VA Boston Healthcare System, Boston, MA; bDepartments of Psychiatry and Epidemiology, Boston University, Boston, MA; cDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; and dDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Guay S, Fortin C, Fikretoglu D, Poundja J, Brunet A. Validation of the WHOQOL-BREF in a Sample of Male Treatment-Seeking Veterans. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stéphane Guay
- Trauma Studies Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada, and School of Criminology, Université de Montréal
| | - Christophe Fortin
- Trauma Studies Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada, and School of Criminology, Université de Montréal
| | | | | | - Alain Brunet
- Department of Psychiatry, McGill University, and Douglas Mental Health University Institute
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Siqveland J, Ruud T, Hauff E. Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain. Eur J Psychotraumatol 2017; 8:1375337. [PMID: 29038680 PMCID: PMC5632777 DOI: 10.1080/20008198.2017.1375337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Trauma exposure and post-traumatic stress disorder (PTSD) are risk factors for chronic pain. Objective: This study investigated how exposure to intentional and non-intentional traumatic events and PTSD are related to pain severity and outcome of treatment in chronic pain patients. Methods: We assessed exposure to potentially traumatizing events, psychiatric diagnosis with structured clinical interview, and pain severity in 63 patients at a secondary multidisciplinary pain clinic at the beginning of treatment, and assessed level of pain at follow up. Exposure to potentially traumatizing events and PTSD were regressed on pain severity at the initial session and at follow up in a set of multiple regression analysis. Results: The participants reported exposure to an average of four potentially traumatizing events, and 32% had PTSD. Exposure to intentional traumatic events and PTSD were significantly associated with more severe pain, and PTSD significantly moderated the relationship between trauma exposure and pain (all p < .05). The treatment programme reduced pain moderately, an effect that was unrelated to trauma exposure and PTSD. Conclusions: Trauma exposure is related to chronic pain in the same pattern as to mental disorders, with intentional trauma being most strongly related to pain severity. PTSD moderated the relationship between trauma exposure and pain. While pain patients with PTSD initially report more pain, they responded equally to specialist pain treatment as persons without PTSD.
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Affiliation(s)
- J Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Regional Center of Violence, Traumatic Stress and Suicide Prevention, Oslo, Norway
| | - T Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E Hauff
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway
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Atwoli L, Platt JM, Basu A, Williams DR, Stein DJ, Koenen KC. Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study. BMC Psychiatry 2016; 16:214. [PMID: 27389090 PMCID: PMC4936266 DOI: 10.1186/s12888-016-0929-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/20/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important. METHODS Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions. RESULTS After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06-2.07) for arthritis and 2.07 (95 % CI: 1.57-2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions. CONCLUSIONS Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors.
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Affiliation(s)
- Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, PO Box 1493, Eldoret, 30100, Kenya. .,Department of Psychiatry and Mental Health, MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Cape Town, South Africa.
| | - Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Cape Town, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA ,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA USA
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9
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Associations between lifetime traumatic events and subsequent chronic physical conditions: a cross-national, cross-sectional study. PLoS One 2013; 8:e80573. [PMID: 24348911 PMCID: PMC3864645 DOI: 10.1371/journal.pone.0080573] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022] Open
Abstract
Background Associations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries. Methods Cross-sectional, face-to-face household surveys of adults (18+) were conducted in 14 countries (n = 38, 051). The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders. Findings A dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 [95% CI: 1.4–1.5] for 1 LTE; 2.1 [2.0–2.3] for 5+ LTEs), independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience), nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 [1.2–1.5] to 1.7 [1.4–2.0]) and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 [1.3–2.4] to 3.6 [2.0–6.5]), the exceptions being cancer and stroke. Conclusions Traumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.
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Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord 2013; 27:33-46. [PMID: 23247200 DOI: 10.1016/j.janxdis.2012.08.004] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/23/2012] [Accepted: 08/26/2012] [Indexed: 01/09/2023]
Abstract
The present meta-analysis systematically examined associations between physical health and posttraumatic stress disorder (PTSD)/PTSD symptoms (PTSS), as well as moderators of this relationship. Literature searches yielded 62 studies examining the impact of PTSD/PTSS on physical health-related quality of life (HR-QOL), general health symptoms, general medical conditions, musculoskeletal pain, cardio-respiratory (CR) symptoms, and gastrointestinal (GI) health. Sample-specific and methodological moderators were also examined. Results revealed significantly greater general health symptoms, general medical conditions, and poorer HR-QOL for PTSD and high PTSS individuals. PTSD/PTSS was also associated with greater frequency and severity of pain, CR, and GI complaints. Results of moderation analyses were mixed. However, consistent relationships emerged regarding PTSD assessment method, such that effect sizes were largest for self-reported PTSD/PTSS and all but one health outcome. Results highlight the need for prospective longitudinal examination of physical health shortly following trauma, and suggest variables to consider in the design of such studies.
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Affiliation(s)
- Maria L Pacella
- Department of Psychology, Kent State University, Kent, OH 44242, USA
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Hobfoll SE, Hall BJ, Canetti D. Political violence, psychological distress, and perceived health: A longitudinal investigation in the Palestinian Authority. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2012; 4:9-21. [PMID: 22328960 PMCID: PMC3275891 DOI: 10.1037/a0018743] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One thousand one hundred and ninety six Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem were interviewed beginning in September 2007 and again at 6- and 12-month intervals. Using structural equation modeling, we focused on the effects of exposure to political violence, psychosocial and economic resource loss, and social support, on psychological distress, and the association of each of these variables on subjective health. Our proposed mediation model was partially supported. Exposure to political violence, psychosocial resource loss, and social support were related to subjective health, fully mediated by their relationship with psychological distress. Female sex and being older were also directly related to poorer subjective health and partially mediated via psychological distress. Greater economic resource loss, lower income, and poorer education were directly related to poor subjective health. An alternative model exploring subjective health as a mediator of psychological distress revealed that subjective health partially mediated the relationship between resource loss and psychological distress. The associate between female sex, education, income, and age on psychological distress were fully mediated by subjective health. Social support and exposure to political violence were directly related to psychological distress. These results were discussed in terms of the importance of resource loss on both mental and physical health in regions of chronic political violence and potential intervention strategies.
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FARCOMENI ALESSIO. Generalized Augmentation to Control the False Discovery Exceedance in Multiple Testing. Scand Stat Theory Appl 2009. [DOI: 10.1111/j.1467-9469.2008.00633.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Eadie EM, Runtz MG, Spencer-Rodgers J. Posttraumatic stress symptoms as a mediator between sexual assault and adverse health outcomes in undergraduate women. J Trauma Stress 2008; 21:540-7. [PMID: 19107722 DOI: 10.1002/jts.20369] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study investigated the links between sexual assault experiences, posttraumatic stress symptoms, and adverse physical health outcomes among undergraduate women. Existing research has demonstrated that posttraumatic stress disorder mediates the relationship between trauma exposure and physical health in general, but this has yet to be tested for sexual assault specifically. Using structural equation modeling, support was found for a model in which posttraumatic stress symptom severity partially mediates the association between sexual assault severity and self-reported health outcomes. An alternative model using depression symptoms did not meet the criteria for mediation. Implications for the physical health of sexual assault survivors are discussed.
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Affiliation(s)
- Erin M Eadie
- Department of Psychology, University of Victoria, Victoria, BC, Canada.
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Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med 2008; 31:341-9. [PMID: 18553129 DOI: 10.1007/s10865-008-9158-3] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 04/29/2008] [Indexed: 11/24/2022]
Abstract
The present study sought to extend prior research by using data from the National Comorbidity Survey-Replication (NCS-R) to examine the relationship between number of lifetime traumas, posttraumatic stress disorder (PTSD) and 15 self-reported chronic medical conditions. The goal was to determine whether the commonly found relationship between PTSD symptomatology and physical health were better explained by the number of lifetime traumas experienced. The NCS-R is a representative US household survey that assessed lifetime experience of a variety of traumas, lifetime diagnosis of PTSD and 15 chronic medical conditions (e.g. pain conditions, cardiovascular disorders, etc.). Two major findings emerged: (1) there was a graded relationship between trauma exposure, PTSD, and the majority of chronic medical conditions where individuals with PTSD had the highest likelihood of chronic medical condition and non-traumatized individuals had the lowest risk and; (2) with the exception of headaches, the relationship between PTSD and chronic medical conditions was explained by the number of lifetime traumas experienced when analyses were subset to traumatized individuals. The present study supports prior research suggesting that multiple traumas have a cumulative effect on physical health. The impact of trauma on health may be independent of PTSD symptomatology.
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Affiliation(s)
- Eve M Sledjeski
- Department of Psychology, Wesleyan University, Middletown, CT 06459, USA.
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15
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Friedberg JP, Adonis MN, Suchday S. The Effects of Indirect Exposure to September 11th–Related Trauma on Cardiovascular Reactivity. JOURNAL OF LOSS & TRAUMA 2007. [DOI: 10.1080/15325020701441481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Poundja J, Fikretoglu D, Brunet A. The co-occurrence of posttraumatic stress disorder symptoms and pain: is depression a mediator? J Trauma Stress 2006; 19:747-51. [PMID: 17075919 DOI: 10.1002/jts.20151] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although recent studies suggest that posttraumatic stress disorder (PTSD) symptoms and pain may be related, the possible mediational role of depression in this relationship has not been examined. This study sought to examine this question in a sample of 130 male veterans seeking assessment or treatment for deployment-related PTSD. Results suggest that PTSD and pain are moderately related (r = .29) but that this relationship is fully mediated by depression. Our findings have important clinical implications: Treatment of PTSD and pain in veteran populations should include careful assessment and regular monitoring of depression.
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Affiliation(s)
- Joaquin Poundja
- Department of Psychology-Université de Montréal and Douglas Hospital Research Center, Montréal, Canada
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Gillock KL, Zayfert C, Hegel MT, Ferguson RJ. Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization. Gen Hosp Psychiatry 2005; 27:392-9. [PMID: 16271653 DOI: 10.1016/j.genhosppsych.2005.06.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Revised: 05/23/2005] [Accepted: 06/01/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study estimates the prevalence of posttraumatic stress disorder (PTSD) and describes the relationships among PTSD status and health indices in a civilian primary care patient sample. METHODS Participants (N = 232) completed a paper-and-pencil survey of life events, PTSD symptoms, physical symptoms and health functioning. Utilization was assessed from medical records. RESULTS Nine percent of the participants met the criteria for full PTSD (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and another 25% were defined as partial PTSD. The full-PTSD group evidenced higher rates of medical utilization, more intense physical symptoms and poorer health functioning than the no-PTSD group. The partial-PTSD group more closely resembled the full-PTSD group. CONCLUSIONS This study, although limited by sample size and diagnosis by questionnaire vs. diagnostic interview, suggests research directions for enhancing our understanding of PTSD among civilian primary care patients and for developing appropriate interventions that can be conducted in the primary care setting.
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Affiliation(s)
- Karen L Gillock
- Department of Psychiatry, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001, USA. karen.l.gillock@dart
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