1
|
Morawej Z, Misra S, Ametaj AA, Stevenson A, Kyebuzibwa J, Gelaye B, Akena D. Experiences of trauma and psychometric properties of the Life Events Checklist among adults in Uganda. PLoS One 2024; 19:e0298385. [PMID: 38687810 PMCID: PMC11060541 DOI: 10.1371/journal.pone.0298385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/23/2024] [Indexed: 05/02/2024] Open
Abstract
Exposure to potentially traumatic events (PTE) is common and increases an individual's risk of developing post-traumatic stress disorder (PTSD) and other psychiatric disorders. PTEs can be screened with the Life Events Checklist for DSM 5 (LEC-5). However, the psychometric properties of the LEC-5 have never been assessed in Uganda. We aimed to estimate the prevalence of PTEs and evaluate the factor structure of the LEC-5 in a sample of N = 4,479 Ugandan adults between February 2018 -March 2020. We used the phenotyping data from a case-control study (NeuroGAP-Psychosis) in Uganda investigating the genetic and environmental risk factors for psychosis spectrum disorders with 4,479 participants (2,375 cases and 2,104 controls). Prevalence for PTEs was determined for all participants and by case-control status. The factor structure of the LEC-5 was assessed using an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The overall prevalence of exposure to one or more types of PTEs was 60.5%. Cases reported more frequency of exposure to PTEs than controls (64.2% vs 55.4%; p<0.001). The most frequently endorsed traumatic event was physical assault (22.8%), while exposure to toxic substances was the least endorsed (1.7%). There were several differences among the types of events experienced between cases and controls, including cases reporting more experiences of physical (28.6% vs. 16.2%, p<0.001) and sexual assault (11.5% vs. 5.0%, p<0.001) than controls. The EFA yielded a six-factor model that explained 49.8% of the total variance. The CFA showed that a theoretical seven-factor model based on the South African Stress and Health survey was a better fitting model (CFI = 0.935; TLI = 0.908; RMSEA = 0.026) than the EFA. This study revealed a high prevalence of PTEs among cases and controls, and the LEC-5 was found to have good psychometric properties among Ugandan adults.
Collapse
Affiliation(s)
- Zahra Morawej
- Department of Psychiatry, Faculty of Medicine, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, United States of America
| | - Amantia A. Ametaj
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Joseph Kyebuzibwa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Dickens Akena
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
2
|
Ross DC, McCallum N, Truuvert AK, Butt A, Behdinan T, Rojas D, Soklaridis S, Vigod S. The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma. J Ment Health 2024:1-10. [PMID: 38572918 DOI: 10.1080/09638237.2024.2332797] [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: 03/10/2023] [Accepted: 08/05/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population. AIMS To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program. METHODS Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted. RESULTS Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming. CONCLUSIONS Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.
Collapse
Affiliation(s)
- Dana C Ross
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McCallum
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie K Truuvert
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Aysha Butt
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Tina Behdinan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Rojas
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Manuel J, Rudolph L, Beissner F, Neubert TA, Dusch M, Karst M. Traumatic Events, Posttraumatic Stress Disorder, and Central Sensitization in Chronic Pain Patients of a German University Outpatient Pain Clinic. Psychosom Med 2023; 85:351-357. [PMID: 36825929 PMCID: PMC10171308 DOI: 10.1097/psy.0000000000001181] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/02/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and traumatic life events are often coupled to chronic pain, possibly linked by central sensitization. We wanted to assess the prevalence of traumatic events and PTSD in chronic pain patients of a German university hospital outpatient pain clinic. Moreover, we evaluated the extent of indicators and co-occurring traits of central sensitization in comorbid patients. METHODS We retrospectively divided 914 chronic pain patients into four groups depending on their trauma severity: no trauma, accidental trauma, interpersonal trauma, and PTSD. We collected electronic pain drawings focusing on pain area and widespreadness, as well as information about pain intensity, sleep impairment, disability, stress, anxiety, depression, and somatization. Differences between groups were calculated using Kruskal-Wallis with post-hoc Mann-Whitney tests. RESULTS Of 914 patients, 231 (25%) had no trauma, 210 (23%) had accidental traumas, 283 (31%) had interpersonal traumas, 99 (11%) had PTSD, and 91 (10%) could not be classified. We observed statistically significant differences between groups in pain area and widespreadness, as well as maximal pain, sleep impairment, disability, stress, anxiety, depression, and somatization. The severity of symptoms increased with trauma severity. CONCLUSIONS Traumatic life events and PTSD are frequent in chronic pain patients. The increased pain area and widespreadness, as well as the increased negative impact on co-occurring traits of sensory sensitivity (anxiety, depression, somatization), are compatible with central sensitization in comorbid patients. Therefore, a heightened awareness of the comorbidity between traumatic experiences and chronic pain is recommended.
Collapse
|
4
|
Sumner JA, Cleveland S, Chen T, Gradus JL. Psychological and biological mechanisms linking trauma with cardiovascular disease risk. Transl Psychiatry 2023; 13:25. [PMID: 36707505 PMCID: PMC9883529 DOI: 10.1038/s41398-023-02330-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, and experiences of psychological trauma have been associated with subsequent CVD onset. Identifying key pathways connecting trauma with CVD has the potential to inform more targeted screening and intervention efforts to offset elevated cardiovascular risk. In this narrative review, we summarize the evidence for key psychological and biological mechanisms linking experiences of trauma with CVD risk. Additionally, we describe various methodologies for measuring these mechanisms in an effort to inform future research related to potential pathways. With regard to mechanisms involving posttraumatic psychopathology, the vast majority of research on psychological distress after trauma and CVD has focused on posttraumatic stress disorder (PTSD), even though posttraumatic psychopathology can manifest in other ways as well. Substantial evidence suggests that PTSD predicts the onset of a range of cardiovascular outcomes in trauma-exposed men and women, yet more research is needed to better understand posttraumatic psychopathology more comprehensively and how it may relate to CVD. Further, dysregulation of numerous biological systems may occur after trauma and in the presence of posttraumatic psychopathology; these processes of immune system dysregulation and elevated inflammation, oxidative stress, mitochondrial dysfunction, renin-angiotensin system dysregulation, and accelerated biological aging may all contribute to subsequent cardiovascular risk, although more research on these pathways in the context of traumatic stress is needed. Given that many of these mechanisms are closely intertwined, future research using a systems biology approach may prove fruitful for elucidating how processes unfold to contribute to CVD after trauma.
Collapse
Affiliation(s)
- Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Shiloh Cleveland
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tiffany Chen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
5
|
Friedberg R, Baiocchi M, Rosenman E, Amuyunzu-Nyamongo M, Nyairo G, Sarnquist C. Mental health and gender-based violence: An exploration of depression, PTSD, and anxiety among adolescents in Kenyan informal settlements participating in an empowerment intervention. PLoS One 2023; 18:e0281800. [PMID: 36989329 PMCID: PMC10057741 DOI: 10.1371/journal.pone.0281800] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE This study examines the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) among adolescents attending schools in several informal settlements of Nairobi, Kenya. Primary aims were estimating prevalence of these mental health conditions, understanding their relationship to gender-based violence (GBV), and assessing changes in response to an empowerment intervention. METHODS Mental health measures were added to the final data collection point of a two-year randomized controlled trial (RCT) evaluating an empowerment self-defense intervention. Statistical models evaluated how past sexual violence, access to money to pay for a needed hospital visit, alcohol use, and self-efficacy affect both mental health outcomes as well as how the intervention affected female students' mental health. FINDINGS Population prevalence of mental health conditions for combined male and female adolescents was estimated as: PTSD 12.2% (95% confidence interval 10.5-15.4), depression 9.2% (95% confidence interval 6.6-10.1) and anxiety 17.6% (95% confidence interval 11.2% - 18.7%). Female students who reported rape before and during the study-period reported significantly higher incidence of all mental health outcomes than the study population. No significant differences in outcomes were found between female students in the intervention and standard-of-care (SOC) groups. Prior rape and low ability to pay for a needed hospital visit were associated with higher prevalence of mental health conditions. The female students whose log-PTSD scores were most lowered by the intervention (effects between -0.23 and -0.07) were characterized by high ability to pay for a hospital visit, low agreement with gender normative statements, larger homes, and lower academic self-efficacy. CONCLUSION These data illustrate a need for research and interventions related to (1) mental health conditions among the young urban poor in low-income settings, and (2) sexual violence as a driver of poor mental health, leading to a myriad of negative long-term outcomes.
Collapse
Affiliation(s)
- Rina Friedberg
- LinkedIn, Data Science and Applied Research (all work completed while at Department of Statistics, Stanford University), Stanford, CA, United States of America
| | - Michael Baiocchi
- Stanford Prevention Research Center, Stanford, CA, United States of America
- Department of Statistics, Stanford University, Stanford, CA, United States of America
| | - Evan Rosenman
- Harvard Data Science Initiative, Cambridge, MA, United States of America
| | | | - Gavin Nyairo
- African Institute for Health and Development, Nairobi, Kenya
| | - Clea Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| |
Collapse
|
6
|
Boyas JF, Moore D, Duran MY, Fuentes J, Woodiwiss J, McCoy L, Cirino A. Exploring the health of child protection workers: A call to action. Health Promot Perspect 2022; 12:381-390. [PMID: 36852203 PMCID: PMC9958233 DOI: 10.34172/hpp.2022.50] [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: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 02/22/2023] Open
Abstract
Background: This exploratory study determined if a relationship exists between secondary traumatic stress (STS) related to health status, health outcomes, and health practices among child protection workers in a Southern state. Methods: This study used a cross-sectional survey research design that included a non-probability sample of child protection workers (N=196). Data were collected face-to-face and online between April 2018 and November 2019 from multiple county agencies. A self-administered questionnaire was completed focused on various health behaviors, outcomes, and workplace perceptions. Results: Results of the zero-order correlations suggest that higher levels of STS were significantly associated with not having visited a doctor for a routine checkup (r=-0.17, P=0.04), more trips to see a doctor (r=0.16, P=0.01), and increased number of visits to emergency room (ER) (r=0.20, P=0.01). Lower levels of STS were associated with better self-rated health (SRH) (r=-0.32, P≤0.001), higher perceptions of health promotion at work (r=-0.29, P≤0.001), frequent exercise (r=-0.21, P=0.01), and by avoiding salt (r=-0.20, P≤0.031). T-test results suggest that workers who did not have children (µ=45.85, SD=14.02, P=0.01) and non-Hispanic white workers (µ=51.79, SD=11.62, P≤0.001) reported significantly higher STS levels than workers who had children (µ=39.73, SD=14.58) and self-identified as Black (µ=39.01, SD=14.38). Conclusion: Findings show that increased interpersonal trauma was linked to unhealthy eating, general physical health problems, and health care utilization. If not addressed, both STS and poor health and health outcomes can have unfavorable employee outcomes, such as poor service delivery.
Collapse
Affiliation(s)
- Javier F. Boyas
- Troy University, School of Social Work and Human Services, 112A Wright Hall, Troy, AL, 36082, USA,Corresponding Author: Javier F. Boyas,
| | - Debra Moore
- Troy University, School of Social Work and Human Services, 112A Wright Hall, Troy, AL, 36082, USA
| | - Maritza Y. Duran
- University of Georgia, School of Social Work, 279 Williams St., Athens, GA, 30602, USA
| | - Jacqueline Fuentes
- University of Georgia, School of Social Work, 279 Williams St., Athens, GA, 30602, USA
| | - Jana Woodiwiss
- University of Georgia, School of Social Work, 279 Williams St., Athens, GA, 30602, USA
| | - Leah McCoy
- University of Georgia, School of Social Work, 279 Williams St., Athens, GA, 30602, USA
| | - Antonella Cirino
- University of Georgia, School of Social Work, 279 Williams St., Athens, GA, 30602, USA
| |
Collapse
|
7
|
Bahji A, Di Nota PM, Groll D, Carleton RN, Anderson GS. Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis. Syst Rev 2022; 11:255. [PMID: 36434683 PMCID: PMC9701019 DOI: 10.1186/s13643-022-02112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear. OBJECTIVES The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs. METHODS A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I2, and publication bias was evaluated using Egger's test. RESULTS The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I2 = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I2 = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I2 = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions. CONCLUSIONS There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019133534.
Collapse
Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Paula M Di Nota
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, Vancouver, BC, Canada
| | - Dianne Groll
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | | | | |
Collapse
|
8
|
Girma E, Ametaj A, Alemayehu M, Milkias B, Yared M, Misra S, Stevenson A, Koenen KC, Gelaye B, Teferra S. Measuring traumatic experiences in a sample of Ethiopian adults: Psychometric properties of the life events checklist-5. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022; 6. [DOI: 10.1016/j.ejtd.2022.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
9
|
Alper HE, Feliciano L, Millien L, Pollari C, Locke S. Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9737. [PMID: 35955093 PMCID: PMC9368472 DOI: 10.3390/ijerph19159737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.
Collapse
Affiliation(s)
- Howard E. Alper
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| | - Leen Feliciano
- Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Lucie Millien
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| | - Cristina Pollari
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| | - Sean Locke
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| |
Collapse
|
10
|
Magee LA, Dennis Fortenberry J, Aalsma MC, Gharbi S, Wiehe SE. Healthcare utilization and mental health outcomes among nonfatal shooting assault victims. Prev Med Rep 2022; 27:101824. [PMID: 35656226 PMCID: PMC9152773 DOI: 10.1016/j.pmedr.2022.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Victims of nonfatal shooting (NFS) assaults suffer from emotional and physical trauma; however, little is understood about clinical care utilization patterns among victims. This study examines the healthcare utilization and mental health outcomes before and after an index NFS victimization. A longitudinal dataset of police and clinical data were linked at the individual level to define a cohort of NFS victims with one or more clinical encounter in the 24-months preceding an index NFS injury (N = 2,681) in Indianapolis, Indiana between 2005 and 2018. Mental health was defined using ICD diagnosis codes from any emergency department, inpatient, or outpatient encounter and clinical care utilization was the number of unique encounters within the 24-months preceding and following an index NFS injury. Multivariable logistic regression was conducted to examine factors associated with a mental health diagnosis in the post injury period. Analyses were conducted in October 2021-March 2022. Overall clinical care utilization (Mean: pre = 277.7 (SD 235.3) vs. post = 333.9 (SD 255.1), p < 0.001) and mental health prevalence (14.4% pre vs. 18.8% post, p < 0.001) increased in the 24-months following an index NFS compared to the prior 24-months. Preinjury mental health utilization increased the odds of receiving a mental health diagnosis in the 24-months following an index NFS injury - particularly for Black victims (Odds Ratio 1.69, 95% CI 1.01, 2.85). The findings indicate missed opportunities within the healthcare system to connect NFS victims with needed mental health services, as well as the importance of premorbid connection to mental health care.
Collapse
Affiliation(s)
- Lauren A. Magee
- O’Neill School of Public and Environmental Affairs, Indiana University Purdue University – Indianapolis, 801 W. Michigan Street, Indianapolis, IN 46204, USA
| | - J. Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Matthew C. Aalsma
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Sami Gharbi
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| |
Collapse
|
11
|
Johnson BN, McKernan LC, Bruehl S. A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury. Curr Pain Headache Rep 2022; 26:405-414. [PMID: 35380406 DOI: 10.1007/s11916-022-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Individuals with chronic pain are significantly more likely to have experienced overwhelming trauma early and often in key developmental years. There is increasing acknowledgment that childhood trauma disrupts how individuals process and cope with both physical and emotional pain. Emerging studies acknowledge elevated rates of non-suicidal self-injury (NSSI) in chronic pain populations. This review provides a theoretical framework to understand the relationship between NSSI behavior and pain experience in persons with chronic pain and childhood trauma histories. We discuss how NSSI may act to regulate neurobiological (e.g., endogenous opioid systems) and psychological (e.g., heightened negative affect and emotion dysregulation) systems affected by childhood trauma, leading to temporary pain relief and a cycle of negative reinforcement perpetuating NSSI. As these concepts are greatly understudied in pain populations, this review focuses on key areas relevant to chronic pain that may provide a testable, conceptual framework to support hypothesis generation, future empirical investigation, and intervention efforts. RECENT FINDINGS See Fig. 1. See Fig. 1.
Collapse
|
12
|
Kozina RM, Lear MK, Stacy S, Kern S, Ripley A, Clapp J. Moderating effects of brooding on the link between functional impairment and interpersonal needs in survivors of serious trauma. J Clin Psychol 2022; 78:1839-1850. [PMID: 35150129 DOI: 10.1002/jclp.23327] [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: 07/08/2021] [Revised: 12/12/2021] [Accepted: 01/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Trauma and resulting functional limitations demonstrate associations with perceived burdensomeness and thwarted belongingness, factors contributing to elevated risk for suicidal ideation. However, survivors display differential risk in response to impairment, highlighting the need for research on exacerbating factors. The current study examined the impact of brooding on the association of functional impairment with burdensomeness and belongingness among trauma-exposed undergraduates (N = 262). METHOD Trauma was assessed via clinical interview with questionnaires for study variables. Regression models examined the unique and interactive effects of physical impairment, emotional impairment, and brooding on burdensomeness and thwarted belongingness. RESULTS An interaction of brooding and impairment due to emotional difficulties was observed for burdensomeness with impairment linked to elevated burdensomeness at high (β = -0.46; p < 0.001), but not low (β = -0.07; p = 0.476) brooding. Impairment due to emotional difficulties (β = -0.38; p < 0.001) and brooding (β = 0.25; p < 0.001) were associated with belongingness. CONCLUSIONS Findings identify brooding as a potential target for assessment and intervention in trauma-exposed individuals.
Collapse
Affiliation(s)
- Ryan M Kozina
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - M Kati Lear
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Stephanie Stacy
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Shira Kern
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Adam Ripley
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Joshua Clapp
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| |
Collapse
|
13
|
Co-Occurring Trauma and Non-Suicidal Self-Injury Among People With Chronic Pain: A Systematic Review. Curr Pain Headache Rep 2021; 25:70. [PMID: 34766192 DOI: 10.1007/s11916-021-00984-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Trauma and posttraumatic stress are common among individuals with chronic pain and contribute to increased morbidity and impairment. Individuals with trauma and chronic pain may be prone to non-suicidal self-injury, a relatively common yet risky self-regulatory behavior. There is a dearth of research on the intersection of trauma, chronic pain, and non-suicidal self-injury (NSSI). We conducted a systematic review of the extant literature. RECENT FINDINGS Five quantitative and eight case reports were identified. Only one quantitative study reported specifically on NSSI. Self-harm rates varied across studies, though appeared elevated among patients with chronic pain. Childhood trauma was linked to this co-occurrence. Causal links between trauma, NSSI, and pain are proposed, highlighting the need for a comprehensive theoretical model. We recommend assessing for childhood trauma when treating patients with chronic pain and querying regarding NSSI when patients present with indicators of NSSI risk and to treat or refer such patients to specialized treatment.
Collapse
|
14
|
Jakubowski KP, Murray V, Stokes N, Thurston RC. Sexual violence and cardiovascular disease risk: A systematic review and meta-analysis. Maturitas 2021; 153:48-60. [PMID: 34654528 DOI: 10.1016/j.maturitas.2021.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of death among adults. Over 35% of women worldwide report lifetime exposure to sexual violence. While psychosocial factors broadly have been linked to CVD risk, it is unclear if a history of sexual violence is associated with increased risk for CVD. This study employed quantitative meta-analysis to investigate the association between sexual violence and CVD risk. METHODS PubMed and PsycINFO databases were searched through March 1, 2021. Included articles had a measure of sexual violence and at least one cardiovascular outcome (i.e., clinical CVD, subclinical CVD, select CVD risk factors) in women and men aged 18 years or older. Data were expressed as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI) extracted from fully-adjusted models. OR and HR effects were pooled separately, given the inability to statistically harmonize these effects and differences in interpretation, using random effects meta-analysis. Heterogeneity of effects was tested using Cochran's Q test. RESULTS Overall, 45 articles based on 830,579 adults (77.1% women) were included (113 individual effects expressed as OR and 9 individual effects expressed as HR). Results indicated that sexual violence was related to adult CVD risk (OR [95%CI] = 1.25 [1.11-1.40]; HR [95%CI] = 1.17 [1.05-1.31]). Results varied by outcome type and measurement, and timing of violence. CONCLUSIONS Adults with a history of sexual violence demonstrate greater CVD risk relative to those without this history. The results highlight the importance of addressing sexual violence in CVD risk reduction efforts.
Collapse
Affiliation(s)
- Karen P Jakubowski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Vanessa Murray
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Natalie Stokes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
15
|
Platt JM, Pozen J, Ntaganira J, Sezibera V, Neugebauer R. Gender Differences in Traumatic Experiences and Posttraumatic Stress Symptoms After the Rwandan Genocide Against the Tutsi. J Trauma Stress 2021; 34:799-807. [PMID: 34118164 PMCID: PMC9059246 DOI: 10.1002/jts.22693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
The effects of the 1994 Rwandan Genocide against the Tutsi are widespread and long-lasting, but little is known about how posttraumatic consequences differ regarding gender. In the present study, we estimated the associations between trauma exposure and posttraumatic stress symptoms (PTSS) in a Rwandan community sample and examined whether the associations differed by gender. The sample comprised 498 adults (75.2% women) living in Rwanda's Huye District in 2011. We used a validated self-report checklist to assess the eight most frequent traumatic experiences during the Genocide. The PTSD Checklist-Civilian version (PCL-C) was used to assess PTSS. Associations between trauma exposure and PTSS were estimated using structural equation modeling (SEM), with additional SEMs stratified by gender. The prevalence of exposure to each traumatic event ranged from 15.1% to 64.5%, with more severe PTSS among individuals who reported personal physical injury, β = .76, 95% CI [0.54, 0.98]; witnessing sexual/physical violence against a loved one, β = .51, 95% CI [0.20, 0.81]; a close relative/friend's death, β = .54, 95% CI [0.24, 0.83]; property destruction, β = .35, 95% CI [0.048, 0.51]; or a family member's death due to illness, β = .21, 95% CI [0.00, 0.41]. Men who saw people killed and women who witnessed sexual/physical violence against a close family member reported elevated PTSS. The psychiatric impact of the Rwandan Genocide continues into the 21st century. Increased attention should be paid to the long-term and demographic patterns of distress and disorder, especially in the absence of widespread clinical mental health services.
Collapse
Affiliation(s)
- Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health at Columbia University, 722 W 168th st, New York, 10032, USA
| | - Joanna Pozen
- New York University College of Global Public Health, New York, New York, USA
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, University of Rwanda School of Public Health, Kigali, Rwanda
| | - Vincent Sezibera
- Department of Clinical Psychology, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Richard Neugebauer
- Department of Epidemiology, Mailman School of Public Health at Columbia University, 722 W 168th st, New York, 10032, USA
- Division of Epidemiology, Department of Child & Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Departement of Psychiatry, Faculty of Medicine, Columbia University
| |
Collapse
|
16
|
Cano MT, Pennington DL, Reyes S, Pineda BS, Llamas JA, Periyakoil VS, Muñoz RF. Factors associated with smoking in low-income persons with and without chronic illness. Tob Induc Dis 2021; 19:59. [PMID: 34305505 PMCID: PMC8280622 DOI: 10.18332/tid/138241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking. METHODS Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables. RESULTS The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p<0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p<0.01]. Both depression (Spearman’s rho=0.39; p<0.01) and anxiety (Spearman’s rho=0.29; p<0.05) were associated with total number of CIL categories. CONCLUSIONS Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking.
Collapse
Affiliation(s)
- Monique T Cano
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, United States.,Research Service, San Francisco VA Health Care System, San Francisco, United States
| | - David L Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, United States.,Research Service, San Francisco VA Health Care System, San Francisco, United States
| | - Sara Reyes
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, United States
| | - Blanca S Pineda
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, United States
| | - Jazmin A Llamas
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, United States
| | | | - Ricardo F Muñoz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, United States.,Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, United States
| |
Collapse
|
17
|
Saltzman LY, Lesen AE, Henry V, Hansel TC, Bordnick PS. COVID-19 Mental Health Disparities. Health Secur 2021; 19:S5-S13. [PMID: 34014118 DOI: 10.1089/hs.2021.0017] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Communities of color in the United States have been disproportionately impacted by the COVID-19 pandemic. Studies exploring the mental health implications of these disparities have only just begun to emerge. The purpose of this study is to better understand mental health concerns and test whether social determinants of health and COVID-19-related experiences influence these concerns. In April 2020, we launched a community-based survey for adults across the United States. A total of 341 respondents completed the survey, which included questions about demographics, depression, social isolation, work environment, and preexisting mental health conditions. We generated matched controls by adding county data from the Robert Wood Johnson Foundation to our survey. Chi square, Pearson product-moment correlation, point biserial correlation, and logistic regression were estimated. Our analysis revealed that respondents who identified as Latinx, Latin@, or Hispanic were 10 times more likely to meet the threshold score for depression. Similarly, individuals with prior mental health conditions and those who expressed feelings of social isolation due to COVID-19 were 3 times more likely to meet the threshold score for depression. These results confirm our hypothesis that communities of color will likely experience disproportionate mental health impacts of COVID-19-specifically, the mental health sequela that emerge from exposure, cumulative burden, and social isolation. We discuss the implications for expanding access and quality of health and mental health services to address current inequities.
Collapse
Affiliation(s)
- Leia Y Saltzman
- Leia Y. Saltzman, LMSW, PhD, is an Assistant Professor; Veronica Henry, MSW, is a Graduate Student; Tonya C. Hansel, PhD, LMSW, is an Associate Professor; and Patrick S. Bordnick, PhD, is Dean; all at the School of Social Work, Tulane University, New Orleans, LA. Amy E. Lesen, PhD, is an Associate Professor, Minority Health and Health Disparities Research Center, Biology Department, Dillard University, New Orleans, LA
| | - Amy E Lesen
- Leia Y. Saltzman, LMSW, PhD, is an Assistant Professor; Veronica Henry, MSW, is a Graduate Student; Tonya C. Hansel, PhD, LMSW, is an Associate Professor; and Patrick S. Bordnick, PhD, is Dean; all at the School of Social Work, Tulane University, New Orleans, LA. Amy E. Lesen, PhD, is an Associate Professor, Minority Health and Health Disparities Research Center, Biology Department, Dillard University, New Orleans, LA
| | - Veronica Henry
- Leia Y. Saltzman, LMSW, PhD, is an Assistant Professor; Veronica Henry, MSW, is a Graduate Student; Tonya C. Hansel, PhD, LMSW, is an Associate Professor; and Patrick S. Bordnick, PhD, is Dean; all at the School of Social Work, Tulane University, New Orleans, LA. Amy E. Lesen, PhD, is an Associate Professor, Minority Health and Health Disparities Research Center, Biology Department, Dillard University, New Orleans, LA
| | - Tonya C Hansel
- Leia Y. Saltzman, LMSW, PhD, is an Assistant Professor; Veronica Henry, MSW, is a Graduate Student; Tonya C. Hansel, PhD, LMSW, is an Associate Professor; and Patrick S. Bordnick, PhD, is Dean; all at the School of Social Work, Tulane University, New Orleans, LA. Amy E. Lesen, PhD, is an Associate Professor, Minority Health and Health Disparities Research Center, Biology Department, Dillard University, New Orleans, LA
| | - Patrick S Bordnick
- Leia Y. Saltzman, LMSW, PhD, is an Assistant Professor; Veronica Henry, MSW, is a Graduate Student; Tonya C. Hansel, PhD, LMSW, is an Associate Professor; and Patrick S. Bordnick, PhD, is Dean; all at the School of Social Work, Tulane University, New Orleans, LA. Amy E. Lesen, PhD, is an Associate Professor, Minority Health and Health Disparities Research Center, Biology Department, Dillard University, New Orleans, LA
| |
Collapse
|
18
|
Cleveland S, Reed K, Thomas JL, Ajijola OA, Ebrahimi R, Hsiai T, Lazarov A, Montoya AK, Neria Y, Shimbo D, Wolitzky-Taylor K, Sumner JA. Key dimensions of post-traumatic stress disorder and endothelial dysfunction: a protocol for a mechanism-focused cohort study. BMJ Open 2021; 11:e043060. [PMID: 33952541 PMCID: PMC8103395 DOI: 10.1136/bmjopen-2020-043060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Both trauma exposure and post-traumatic stress disorder (PTSD) are associated with increased risk of cardiovascular disease (CVD), the leading cause of death in the USA. Endothelial dysfunction, a modifiable, early marker of CVD risk, may represent a physiological mechanism underlying this association. This mechanism-focused cohort study aims to investigate the relationship between PTSD (both in terms of diagnosis and underlying symptom dimensions) and endothelial dysfunction in a diverse, community-based sample of adult men and women. METHODS AND ANALYSIS Using a cohort design, 160 trauma-exposed participants without a history of CVD are designated to the PTSD group (n=80) or trauma-exposed matched control group (n=80) after a baseline diagnostic interview assessment. Participants in the PTSD group have a current (past month) diagnosis of PTSD, whereas those in the control group have a history of trauma but no current or past psychiatric diagnoses. Endothelial dysfunction is assessed via flow-mediated vasodilation of the brachial artery and circulating levels of endothelial cell-derived microparticles. Two higher order symptom dimensions of PTSD-fear and dysphoria-are measured objectively with a fear conditioning paradigm and attention allocation task, respectively. Autonomic imbalance, inflammation, and oxidative stress are additionally assessed and will be examined as potential pathway variables linking PTSD and its dimensions with endothelial dysfunction. Participants are invited to return for a 2-year follow-up visit to reassess PTSD and its dimensions and endothelial dysfunction in order to investigate longitudinal associations. ETHICS AND DISSEMINATION This study is conducted in compliance with the Helsinki Declaration and University of California, Los Angeles Institutional Review Board. The results of this study will be disseminated via articles in peer-reviewed journals and presentations at academic conferences and to community partners. TRIAL REGISTRATION NUMBER NCT03778307; pre-results.
Collapse
Affiliation(s)
- Shiloh Cleveland
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Kristina Reed
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Jordan L Thomas
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, California, USA
| | - Ramin Ebrahimi
- Medicine, University of California Los Angeles, Los Angeles, California, USA
- Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angleles, California, USA
| | - Tzung Hsiai
- Medicine, University of California Los Angeles, Los Angeles, California, USA
- Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amanda K Montoya
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Yuval Neria
- Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Daichi Shimbo
- Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kate Wolitzky-Taylor
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Jennifer A Sumner
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
19
|
Abd El Fatah SA. Multifarious experiences of women drivers post-car accidents: An urban community experience. WOMENS STUDIES INTERNATIONAL FORUM 2021. [DOI: 10.1016/j.wsif.2021.102449] [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]
|
20
|
Sommer JL, Reynolds K, El-Gabalawy R, Pietrzak RH, Mackenzie CS, Ceccarelli L, Mota N, Sareen J. Associations between physical health conditions and posttraumatic stress disorder according to age. Aging Ment Health 2021; 25:234-242. [PMID: 31769298 DOI: 10.1080/13607863.2019.1693969] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories. METHODS We analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed past-year DSM-5 PTSD. Multiple regression analyses examined associations between PTSD (reference = no PTSD) with number and type of physical health conditions in each age category (18-34: "younger adults," 35-49: "middle-aged adults," 50-64: "young-old adults," 65+: "older adults"). RESULTS The prevalence of nearly all physical health conditions increased according to age, whereas the prevalence of PTSD tended to decrease with age. After adjustment, PTSD was associated with a greater number of physical health conditions among all age categories (b range: 0.62-1.29). Regardless of age category, PTSD was associated with increased odds of cardiovascular and musculoskeletal conditions (AOR range: 1.54-2.34). PTSD was also associated with increased odds of gastrointestinal, hepatobiliary, endocrine/metabolic, respiratory, neurologic conditions, cancer, sleep disorders, and anemia among select age categories (AOR range: 1.70-3.31). For most physical health conditions, the largest effect sizes emerged for younger and middle-aged adults. CONCLUSIONS PTSD is associated with many physical health conditions across the age spectrum, particularly among younger and middle-aged adults. Results may inform targeted screening and intervention strategies to mitigate risk of physical health conditions among adults with PTSD.
Collapse
Affiliation(s)
- Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,U.S. Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Laura Ceccarelli
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
21
|
Sommer JL, El-Gabalawy R, Taillieu T, Afifi TO, Carleton RN. Associations between Trauma Exposure and Physical Conditions among Public Safety Personnel: Associations entre l'exposition à un traumatisme et les problèmes physiques chez le personnel de la santé publique. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:548-558. [PMID: 32275461 PMCID: PMC7361655 DOI: 10.1177/0706743720919278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Trauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of physical conditions according to PSP category (e.g., police, paramedic) and index trauma type (e.g., serious accident, physical assault) in a large Canadian sample of PSP. METHODS PSP completed an online survey between September 2016 and January 2017. Multivariable logistic regressions examined associations between context of index trauma exposure (i.e., part of job vs. other) and physical condition categories. Cross-tabulations with chi-square analyses examined whether the prevalence of physical conditions significantly differed according to PSP category and index trauma type. RESULTS There were 5,267 PSP included in the current study. Results from the most stringent model of logistic regressions demonstrated that, compared to PSP who experienced their index trauma in any other context, PSP who experienced it as part of their job had reduced odds of "other" physical conditions (adjusted odds ratio = 0.73, 95% confidence interval, 0.57 to 0.94, P < 0.05). Results also revealed significant differences in the prevalence of physical conditions across all PSP categories and select index trauma types. CONCLUSION Results highlight the relevance of trauma exposure outside of an occupational context among PSP and may have implications for the positive impact of stress inoculation and resiliency training programs for PSP.
Collapse
Affiliation(s)
- Jordana L. Sommer
- Department of Psychology, University of Manitoba, Winnipeg,
Canada
- Department of Anesthesiology, Perioperative and Pain Medicine,
University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg,
Canada
- Department of Anesthesiology, Perioperative and Pain Medicine,
University of Manitoba, Winnipeg, Canada
- Department of Clinical Health Psychology, University of Manitoba,
Winnipeg, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg,
Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba,
Winnipeg, Canada
| | - Tracie O. Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg,
Canada
- Department of Community Health Sciences, University of Manitoba,
Winnipeg, Canada
| | | |
Collapse
|
22
|
Payne CF, Mall S, Kobayashi L, Kahn K, Berkman L. Life-Course Trauma and Later Life Mental, Physical, and Cognitive Health in a Postapartheid South African Population: Findings From the HAALSI study. J Aging Health 2020; 32:1244-1257. [PMID: 32207348 DOI: 10.1177/0898264320913450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the relationships between exposure to life-course traumatic events (TEs) and later life mental, physical, and cognitive health outcomes in the older population of a rural South African community. Method: Data were from baseline interviews with 2,473 adults aged ≥40 years in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study, conducted in 2015. We assessed exposure to 16 TEs, and used logistic regression models to estimate associations with depression, post-traumatic stress disorder (PTSD), activities of daily living disability, and cognitive impairment. Results: Participants reported an average of 5 (SD = 2.4) TEs over their lifetimes. Exposure was ubiquitous across sociodemographic and socioeconomic groups. Trauma exposure was associated with higher odds of depression, PTSD, and disability, but not with cognitive health. Discussion: Results suggest that TEs experienced in earlier life continue to reverberate today in terms of mental health and physical disability outcomes in an older population in rural South Africa.
Collapse
Affiliation(s)
| | - Sumaya Mall
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kathy Kahn
- University of the Witwatersrand, Johannesburg, South Africa.,Umeå University, Sweden
| | - Lisa Berkman
- University of the Witwatersrand, Johannesburg, South Africa.,Harvard T.H. Chan School of Public Health, Cambridge, USA
| |
Collapse
|
23
|
Karrasch S, Hitzler M, Gumpp A, Karabatsiakis A, Kolassa IT. Molekulartoxische Folgen von chronischem und traumatischem Stress und deren Reversibilität durch entspannungs- und achtsamkeitsbasierte Interventionen. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000505380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
24
|
Sommer JL, El-Gabalawy R, Mota N. Understanding the association between posttraumatic stress disorder characteristics and physical health conditions: A population-based study. J Psychosom Res 2019; 126:109776. [PMID: 31327594 DOI: 10.1016/j.jpsychores.2019.109776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) is commonly comorbid with a range of physical health conditions. The aim of this study was to examine the association between index trauma and PTSD symptom clusters with physical health conditions, among individuals with PTSD in a population-based sample. Data were analyzed from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). Past-year PTSD (n = 1779) was assessed using a clinical interview in accordance with DSM-5 criteria. Multiple logistic regression models examined the associations between PTSD symptom clusters and index trauma with physical health conditions. Results of the most stringent model, adjusting for sociodemographics, other psychiatric conditions, and other PTSD symptom clusters, indicated re-experiencing symptoms were associated with cardiovascular and endocrine/metabolic conditions (adjusted odds ratio (AOR) range: 1.18-1.33) and negative alterations in mood and cognition symptoms were associated with sleep disorder (AOR = 1.16, 95% confidence interval (CI) [1.04-1.30], p = .009). Results also demonstrated significant associations between life-threatening illness with cancer, digestive, and neurologic conditions (AOR range: 2.10-3.42) and life-threatening injury with musculoskeletal and neurologic conditions (AOR range: 1.76-2.04). Finally, significant associations emerged between psychological trauma with musculoskeletal and neurologic conditions (AOR range: 0.48-0.66), and other trauma with digestive conditions and anemia (AOR range: 0.38-0.47). Results suggest PTSD symptomatology and index trauma play a differential role in their association with variable physical health conditions. Results may inform screening practices and targeted interventions to mitigate risk of PTSD and physical health conditions.
Collapse
Affiliation(s)
- Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
| |
Collapse
|
25
|
Tran ST, Koven ML, Castro AS, Goya Arce AB, Carter JS. Sociodemographic and Environmental Factors are Associated with Adolescents' Pain and Longitudinal Health Outcomes. THE JOURNAL OF PAIN 2019; 21:170-181. [PMID: 31255798 DOI: 10.1016/j.jpain.2019.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 02/04/2023]
Abstract
Research in adult populations indicates that several sociodemographic and environmental variables increase risk for pain and poor outcomes. There is little research exploring the impact of household income, health insurance coverage, barriers to health care, neighborhood and school safety, violence experienced, and neighborhood isolation on pediatric chronic pain. Data from the Add Health Study, a longitudinal examination of a nationally-representative adolescent sample were analyzed. The relationships between demographic variables, risk factors, chronic pain, and long-term health outcomes were examined. Adolescents with chronic pain had lower income, more health care barriers, greater safety concerns, and experienced more violence compared to those without pain. In a model together, female sex, White race/ethnicity, and greater health care barriers, safety concerns, and violence exposure conferred significant risk for chronic pain. Additional analyses revealed nuances in the strength of risk factors between racial/ethnic groups. Systemic health care barriers were significantly associated with chronic pain and may delay symptom alleviation and return to functioning. Considering access to care is necessary in prevention efforts. Among adolescents with chronic pain, greater safety concerns predicted poor mental health outcomes, particularly for White females. The cumulative stress of environmental concerns, such as safety, and managing chronic pain may worsen functioning. PERSPECTIVE: Adolescents with chronic pain had lower income, and more health care barriers, safety concerns, and violence exposure compared to those without chronic pain. Access to care is a significant problem in youth with chronic pain. The relationships between race/ethnicity, risk factors, and health outcomes are complex and require additional research.
Collapse
Affiliation(s)
- Susan T Tran
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois.
| | - Marissa L Koven
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| | - Ashley S Castro
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| | - Ana B Goya Arce
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| | - Jocelyn S Carter
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| |
Collapse
|
26
|
Nacak Y, Morawa E, Tuffner D, Erim Y. Insecure attachment style and cumulative traumatic life events in patients with somatoform pain disorder: A cross-sectional study. J Psychosom Res 2017; 103:77-82. [PMID: 29167050 DOI: 10.1016/j.jpsychores.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/30/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Current models assume somatoform pain disorder (SPD) to be the result of a complex interaction between bio- and psychosocial factors, but the etiology is still not well understood. This study aimed to investigate the distribution of attachment style and the frequency of traumatic life events, especially childhood adversities, in patients with SPD compared to healthy controls. METHODS We compared 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) to 65 age- and gender-matched healthy controls. The following questionnaires were employed: Relationship Scale Questionnaire (RSQ), Essen Trauma Inventory (ETI), Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-15). A logistic regression analysis was used to identify the association between SPD and psychological factors. RESULTS Insecure attachment was significantly more prevalent (60%) in patients with SPD compared to healthy subjects (14%; p<0.001). Overall, 70.4% of patients with SPD reported three or more traumatic events in their life, compared with healthy subjects who reported predominantly one (40%). Patients with SPD scored significantly higher in all CTQ subscales compared to the healthy controls. The factor most strongly related with SPD was the insecure attachment style (OR=11.20, 95% CI: 1.32-94.86). Other significant predictive factors were depression (OR=3.35, 95% CI: 1.84-6.11) and number of traumatic events (OR=2.04, 95% CI: 1.06-3.92). Insecure attachment, depression symptoms and the number of traumatic events explained 86.2% of the variance. CONCLUSIONS The high predictive value of insecure attachment style and cumulative traumatic events emphasize their importance as risk factors of SPD.
Collapse
Affiliation(s)
- Yeliz Nacak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Daniela Tuffner
- Multidisciplinary Pain Center, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| |
Collapse
|
27
|
Sandifer PA, Knapp LC, Collier TK, Jones AL, Juster R, Kelble CR, Kwok RK, Miglarese JV, Palinkas LA, Porter DE, Scott GI, Smith LM, Sullivan WC, Sutton‐Grier AE. A Conceptual Model to Assess Stress-Associated Health Effects of Multiple Ecosystem Services Degraded by Disaster Events in the Gulf of Mexico and Elsewhere. GEOHEALTH 2017; 1:17-36. [PMID: 30596189 PMCID: PMC6309401 DOI: 10.1002/2016gh000038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 05/28/2023]
Abstract
Few conceptual frameworks attempt to connect disaster-associated environmental injuries to impacts on ecosystem services (the benefits humans derive from nature) and thence to both psychological and physiological human health effects. To our knowledge, this study is one of the first, if not the first, to develop a detailed conceptual model of how degraded ecosystem services affect cumulative stress impacts on the health of individual humans and communities. Our comprehensive Disaster-Pressure State-Ecosystem Services-Response-Health (DPSERH) model demonstrates that oil spills, hurricanes, and other disasters can change key ecosystem components resulting in reductions in individual and multiple ecosystem services that support people's livelihoods, health, and way of life. Further, the model elucidates how damage to ecosystem services produces acute, chronic, and cumulative stress in humans which increases risk of adverse psychological and physiological health outcomes. While developed and initially applied within the context of the Gulf of Mexico, it should work equally well in other geographies and for many disasters that cause impairment of ecosystem services. Use of this new tool will improve planning for responses to future disasters and help society more fully account for the costs and benefits of potential management responses. The model also can be used to help direct investments in improving response capabilities of the public health community, biomedical researchers, and environmental scientists. Finally, the model illustrates why the broad range of potential human health effects of disasters should receive equal attention to that accorded environmental damages in assessing restoration and recovery costs and time frames.
Collapse
Affiliation(s)
- Paul A. Sandifer
- School of Sciences and MathematicsCollege of CharlestonCharlestonSouth CarolinaUSA
| | - Landon C. Knapp
- Master's in Environmental StudiesCollege of CharlestonCharlestonSouth CarolinaUSA
| | | | - Amanda L. Jones
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | | | | | - Richard K. Kwok
- Epidemiology BranchNational Institute of Environmental Health ScienceResearch Triangle ParkNorth CarolinaUSA
| | - John V. Miglarese
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Lawrence A. Palinkas
- Department of Children, Youth and FamiliesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Dwayne E. Porter
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Geoffrey I. Scott
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Lisa M. Smith
- Office of Research and DevelopmentU.S. Environmental Protection AgencyGulf BreezeFloridaUSA
| | - William C. Sullivan
- Department of Landscape ArchitectureUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Ariana E. Sutton‐Grier
- Earth System Science Interdisciplinary CenterUniversity of Maryland and National Oceanic and Atmospheric AdministrationSilver SpringMarylandUSA
| |
Collapse
|