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Abstract
Individuals with post-traumatic stress disorder avoid trauma-related stimuli and exhibit blunted hypothalamic-pituitary-adrenal axis response at the time of trauma. Our laboratory uses predator odor (i.e. bobcat urine) stress to divide adult Wistar rats into groups that exhibit high (avoiders) or low (nonavoiders) avoidance of a predator odor-paired context, modeling the fact that not all humans exposed to traumatic events develop psychiatric conditions. Male avoiders exhibit lower body weight gain after stress, as well as extinction-resistant avoidance that persists after a second stress exposure. These animals also show attenuated hypothalamic-pituitary-adrenal axis response to predator odor that predicts subsequent avoidance of the odor-paired context. Avoiders exhibit unique brain activation profiles relative to nonavoiders and controls (as measured by Fos immunoreactivity), and higher corticotropin-releasing factor levels in multiple brain regions. Furthermore, avoider rats exhibit escalated and compulsive-like alcohol self-administration after traumatic stress. Here, we review the predator odor avoidance model of post-traumatic stress disorder and its utility for tracking behavior and measuring biological outcomes predicted by avoidance. The major strengths of this model are (i) etiological validity with exposure to a single intense stressor, (ii) established approach distinguishing individual differences in stress reactivity, and (iii) robust behavioral and biological phenotypes during and after trauma.
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2
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Bremer-Landau JD, Caskie GIL. Gender as Potential Moderator of Associations Among Trauma Exposure, Posttraumatic Stress Disorder Symptoms, and Alcohol Use Disorder Symptoms in Young Adults. J Trauma Stress 2019; 32:586-594. [PMID: 31291486 DOI: 10.1002/jts.22419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 01/19/2019] [Accepted: 01/30/2019] [Indexed: 11/11/2022]
Abstract
Traumatic events (TEs), posttraumatic stress disorder (PTSD) symptoms, and alcohol use disorder (AUD) symptoms can significantly impair functioning, yet little is known about whether associations among these variables differ between men and women within young adult samples. The current study conducted a path analysis of archival, longitudinal data from the Drug Use Trajectories: Ethnic/Racial Comparisons 1998-2002 (DUT) study (Turner, 2011) to examine gender differences as a possible moderator of the relations between TEs, PTSD symptoms, and AUD symptoms among 1,076 young adults (aged 18-23 years) residing in South Florida. The sample included 580 male (53.9%) and 496 female (46.1%) participants, whose ethnicity was self-reported as African American (n = 280, 26.0%), non-Hispanic White (n = 268, 24.9%), other Hispanic (n = 267, 24.8%), and Cuban (n = 261, 24.3%). Significant positive associations were found between TEs and PTSD symptoms, βs = .08-.30; PTSD and AUD symptoms, βs = .09 - .10; PTSD symptoms over time, β = .52; and AUD symptoms over time, β = .46. In addition, for male but not female participants, a higher frequency of PTSD symptoms at Wave I was related to more AUD symptoms at Wave II, β = .09. Findings build upon existing research to further elucidate the role of gender as a potential moderator of the associations among TEs, PTSD symptoms, and AUD symptoms for young adults and provide important implications for future research and clinical practice, including informing mental health prevention and treatment efforts.
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Affiliation(s)
- Jodi D Bremer-Landau
- Department of Education and Human Services, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Grace I L Caskie
- Department of Education and Human Services, Lehigh University, Bethlehem, Pennsylvania, USA
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Taylor E, Timko C, Harris AHS, Yu M, Finlay AK. Receipt of pharmacotherapy for alcohol use disorder by justice-involved women in the Veterans Health Administration. Addict Sci Clin Pract 2019; 14:1. [PMID: 30602392 PMCID: PMC6317204 DOI: 10.1186/s13722-018-0129-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/18/2018] [Indexed: 01/30/2023] Open
Abstract
Background Alcohol use disorder (AUD) and unhealthy drinking are prevalent among women involved in the criminal justice system and women military veterans. Pharmacotherapy—including naltrexone, topiramate, acamprosate, and disulfiram—for AUD is one form of effective treatment that is associated with better health and criminal justice outcomes. The current study examined the association of justice involvement with receipt of pharmacotherapy for AUD, as well as other patient factors that may explain variation in receipt of pharmacotherapy for AUD among women veterans who receive care at Veterans Health Administration (VHA) facilities.
Methods Using national VHA clinical records, we examined all women VHA patients who received an AUD diagnosis during an outpatient or inpatient visit in fiscal years (FY) 2014–2017. We compared patient characteristics by justice status, defined as contact with one of the VHA’s justice outreach programs, and used a mixed-effects logistic regression model to test whether justice involvement was independently associated with odds of receiving pharmacotherapy for AUD. Results Of 10,511 women veterans diagnosed with AUD in FY2017, 852 (8%) met our definition of justice-involved. Since FY2014, the percentage of women veterans who received pharmacotherapy for AUD increased (14–21%). Women justice-involved veterans and those who were homeless had higher odds of receiving pharmacotherapy for AUD (OR 1.29, CI 1.15–1.45; OR 1.35, CI 1.25–1.47). Women veterans age 55 or older or who were African-American had lower odds of receiving pharmacotherapy (OR 0.74, CI 0.67–0.82; OR 0.73, CI 0.68–0.79). Conclusions While women involved in the criminal justice system face many barriers to accessing health and social services, women justice-involved veterans had higher odds of receiving pharmacotherapy for AUD at VHA facilities compared to women veterans with no justice involvement. Legal mandates and supportive programming directed towards veterans in the criminal justice system may explain the higher rate of receipt of pharmacotherapy observed among justice-involved women veterans. Women veterans who are homeless may also have more opportunities to access and use pharmacotherapy for AUD compared to their housed counterparts.
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Affiliation(s)
- Emmeline Taylor
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA. .,, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
| | - Christine Timko
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Alex H S Harris
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mengfei Yu
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA
| | - Andrea K Finlay
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, 94025, USA
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Lin X, Liu J, Fu P, Zeng X, Qin J, Tang Z, Wu J. Associations Between Gene Polymorphisms and Psychological Stress in the Guangxi Minority Region of China. Med Sci Monit 2018; 24:6680-6687. [PMID: 30242809 PMCID: PMC6166522 DOI: 10.12659/msm.910432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022] Open
Abstract
To investigate whether there is an association between gene polymorphisms, genetic and environmental interactions, and psychological stress reactivity in Chinese subjects living in the Guangxi minority region. This cross-sectional study enrolled subjects older than 18 years, living in Nandan county, Guangxi minority region, China for at least 1 year. All participants were healthy, without any mental diseases, and were able to communicate. Eligible participants were randomly selected. The Life Event Scale Questionnaire, Simplified Coping Style Questionnaire, and Social Support Rating Scale were used to measure the physiological stress, coping style, and social support, respectively, in individuals. A total of 600 participants were recruited. A decreased risk of psychological stress was only found in TT of NPSR1 (rs324981): A allele carriers vs. TT genotype (OR 1.64, 95% CI 1.11, 2.42), and AT genotype vs. TT genotype (OR 1.76, 95% CI 1.17, 2.65). The overall coping style was positively associated with psychological stress, and no significant interactions between genetics and environment were found. We found that the NPSR1 (rs324981) T/T genotype decreased the risk of psychological stress, while the overall coping style was a risk factor for psychological stress. However, there was no interactive effects of genes and environment on psychological stress. Our findings will improve understanding of the biological basis underlying psychological stress if the results can be replicated in further research.
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Affiliation(s)
- Xiujin Lin
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jianbo Liu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
- Mental Health Institute of The Second Xiangya Hospital and Key Laboratory of Psychiatry and Mental Health of Hunan Province, The Central South University, Changsha, Hunan, P.R. China
| | - Peipei Fu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Xuan Zeng
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jian Qin
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Zhenghua Tang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Junduan Wu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
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Hingray C, Donné C, Martini H, Cohn A, El Hage W, Schwan R, Paille F. Description of type of trauma in alcohol-dependent women. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Impact of trauma on addiction and psychopathology profile in alcohol-dependent women. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee RS, Oswald LM, Wand GS. Early Life Stress as a Predictor of Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder. Alcohol Res 2018; 39:147-159. [PMID: 31198654 PMCID: PMC6561395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
During the critical developmental periods of childhood when neural plasticity is high, exposure to early life stress (ELS) or trauma may lead to enduring changes in physiological stress systems and enhanced vulnerability for psychopathological conditions such as post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) in adulthood. Clinical and preclinical studies have sought to understand the possible mechanisms linking ELS, PTSD, and AUD. Preclinical studies have employed animal models of stress to recapitulate PTSD-like behavioral deficits and alcohol dependence, providing a basic framework for identifying common physiological mechanisms that may underlie these disorders. Clinical studies have documented ELS-related endocrine dysregulation and genetic variations associated with PTSD and AUD, as well as disruption in crucial neural circuitry throughout the corticomesolimbic region. Despite limitations and challenges, both types of studies have implicated three interrelated mechanisms: hypothalamic pituitary adrenal (HPA) axis and glucocorticoid signaling dysregulation, genetics, and epigenetics. ELS exposure leads to disruption of HPA axis function and glucocorticoid signaling, both of which affect homeostatic cortisol levels. However, individual response to ELS depends on genetic variations at specific genes that moderate HPA axis and brain function, thus influencing susceptibility or resilience to psychopathologies. Epigenetic-influenced pathways also are emerging as a powerful force in helping to create the PTSD and AUD phenotypes. Dysregulation of the HPA axis has an epigenetic effect on genes that regulate the HPA axis itself, as well as on brain-specific processes such as neurodevelopment and neurotransmitter regulation. These studies are only beginning to elucidate the underpinnings of ELS, PTSD, and AUD. Larger human cohorts, identification of additional genetic determinants, and better animal models capable of recapitulating the symptoms of PTSD and AUD are needed.
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Hutton H, Lesko CR, Chander G, Lau B, Wand GS, McCaul ME. Differential effects of perceived stress on alcohol consumption in moderate versus heavy drinking HIV-infected women. Drug Alcohol Depend 2017; 178:380-385. [PMID: 28704766 PMCID: PMC5604751 DOI: 10.1016/j.drugalcdep.2017.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the association between perceived stress and subsequent alcohol use in women living with HIV. METHODS Women (n=338) receiving HIV care between April 2006 and July 2010 who enrolled in either a brief intervention for hazardous drinking or a cohort of non-hazardous drinkers completed a 90-day drinking and drug use history, and completed stress, depression and anxiety measures at 0, 6, and 12 months. We examined the association between perceived stress at months 0 or 6 and measures of quantity and frequency of alcohol use in months 3-6 and 9-12, respectively. RESULTS The association between perceived stress and subsequent alcohol use depended on whether women were heavy or moderate drinkers at index visit. Among women reporting ≥7 drinks/week at index visit, high levels of perceived stress were associated with subsequent increased alcohol intake. However, among women reporting >0 but <7 drinks/week at index visit, high levels of perceived stress were associated with a subsequent reduction in drinking. CONCLUSIONS Baseline drinking status moderates the relationship between perceived stress and subsequent alcohol use. Perceived stress is an important therapeutic target in women who are heavy drinkers.
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Affiliation(s)
- Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, John Hopkins School of Medicine, United States.
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Gary S Wand
- Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, John Hopkins School of Medicine, United States
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Addiction severity and comorbidity among women with alcohol use disorders: A hospital-based study from India. Asian J Psychiatr 2017; 28:67-72. [PMID: 28784400 DOI: 10.1016/j.ajp.2017.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 11/23/2022]
Abstract
AIM To examine the addiction severity, comorbid psychiatric disorder and their temporal relationship among women seeking treatment for Alcohol Use Disorders (AUDs). MATERIALS AND METHODS The sample comprised of 35 women with AUDs, with or without psychiatric disorders, recruited from the outpatient and inpatient settings of a tertiary-care hospital. Their mean age was 38.51 years (S.D=7.42). Patients were assessed using Clinical Data Sheet (CDS), Mini-International Neuropsychiatric Interview (MINI), Structured Clinical Interview for DSM-IV Personality disorders (SCIDII), Addiction Severity Index (ASI)-Alcohol subscale and Fagerstrom Test for Nicotine Dependence (FTND). RESULTS Findings of the study indicated that on average patients initiated alcohol use in their early twenties and developed dependence by the age of 29.66 years (S.D=7.60). The average duration of alcohol dependence was less than a decade before seeking treatment. The mean composite score on ASI was 0.71 (S.D=0.18) and on FTND was 5.16 (S.D=2.59), indicating a high level of alcohol and moderate level of nicotine dependence respectively. On MINI, 57.14% of the patients met the criteria for co-occurring Axis I psychiatric disorders such as major depression disorder and dysthymia. In the majority of the cases, comorbid Axis I disorders were secondary to AUDs. On SCID-II, 17% met the criteria for borderline personality disorder. CONCLUSION Examining and understanding the substance use and clinical profile of patients with AUDs are crucial for planning intensity, settings and focus of treatment for women with AUDs.
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Langdon KJ, Rubin A, Brief DJ, Enggasser JL, Roy M, Solhan M, Helmuth E, Rosenbloom D, Keane TM. Sexual Traumatic Event Exposure, Posttraumatic Stress Symptomatology, and Alcohol Misuse Among Women: A Critical Review of the Empirical Literature. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kirsten J. Langdon
- National Center for PTSD; Women's Health Sciences Division; VA Boston Healthcare System; Boston University School of Medicine
| | - Amy Rubin
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | - Deborah J. Brief
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | | | - Monica Roy
- VA Boston Healthcare System; Boston University School of Medicine
| | - Marika Solhan
- VA Boston Healthcare System; Boston University School of Medicine
| | - Eric Helmuth
- National Center for PTSD; Boston University School of Public Health
| | - David Rosenbloom
- National Center for PTSD; Boston University School of Public Health
| | - Terence M. Keane
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
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11
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Werner KB, Sartor CE, McCutcheon VV, Grant JD, Nelson EC, Heath AC, Bucholz KK. Association of Specific Traumatic Experiences With Alcohol Initiation and Transitions to Problem Use in European American and African American Women. Alcohol Clin Exp Res 2016; 40:2401-2408. [PMID: 27656844 DOI: 10.1111/acer.13220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/18/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aims of this study were to (i) characterize racial differences in alcohol involvement and (ii) examine the risk conferred by specific trauma exposures and posttraumatic stress disorder (PTSD) for different stages of alcohol involvement in European American (EA) and African American (AA) women. METHODS Data are from the Missouri Adolescent Female Twins Study (N = 3,787, 14.6% AA; mean age at most recent interview = 24.5 [SD 2.8]). Trauma exposures (e.g., sexual abuse [SA], physical abuse [PA], witnessing another person being killed or injured, experiencing an accident, and experiencing a disaster) were modeled as time-varying predictors of alcohol initiation, transition to first alcohol use disorder (AUD) symptom, and transition to AUD diagnosis using Cox proportional hazards regression while taking into account other substance involvement, parental characteristics, and commonly co-occurring psychiatric disorders. RESULTS In EA women only, SA was associated with alcohol initiation prior to the age of 14, PA predicted transition from initiation to first AUD symptom, and PA, witnessing injury or death, and SA predicted transition to AUD diagnosis. No association was discovered between trauma exposures or PTSD for any stage of alcohol involvement in AA women. CONCLUSIONS Results reveal trauma experiences as important contributors to all stages of alcohol involvement in EA women only, with different trauma types conferring risk for each stage of alcohol involvement. PTSD was not revealed as a significant predictor of AUD in EA or AA women, suggesting trauma, independent of PTSD, directly contributes to alcohol involvement. Findings highlight the importance of considering racial differences when developing etiologic models of the association of traumatic experiences with alcohol involvement.
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Affiliation(s)
- Kimberly B Werner
- George Warren Brown School of Social Work, Washington University, St. Louis, Missouri.
| | - Carolyn E Sartor
- Alcohol Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Vivia V McCutcheon
- Alcohol Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Julia D Grant
- Alcohol Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Elliot C Nelson
- Alcohol Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew C Heath
- Alcohol Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Kathleen K Bucholz
- Alcohol Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Jacobson NC. Current evolutionary adaptiveness of psychiatric disorders: Fertility rates, parent-child relationship quality, and psychiatric disorders across the lifespan. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:824-39. [PMID: 27362490 DOI: 10.1037/abn0000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study sought to evaluate the current evolutionary adaptiveness of psychopathology by examining whether these disorders impact the quantity of offspring or the quality of the parent-child relationship across the life span. Using the National Comorbidity Survey, this study examined whether DSM-III-R anxiety, posttraumatic stress, depressive, bipolar, substance use, antisocial, and psychosis disorders predicted later fertility and the quality of parent-child relationships across the life span in a national sample (N = 8,098). Using latent variable and varying coefficient models, the results suggested that anxiety in males and bipolar pathology in males and females were associated with increased fertility at younger ages. The results suggested almost all other psychopathology was associated with decreased fertility in middle to late adulthood. The results further suggested that all types of psychopathology had negative impacts on the parent-child relationship quality (except for antisocial pathology in males). Nevertheless, for all disorders, the impact of psychopathology on both fertility and the parent-child relationship quality was affected by the age of the participant. The results also showed that anxiety pathology is associated with a high-quantity, low-quality parenting strategy followed by a low-quantity, low-quality parenting strategy. Further, the results suggest that bipolar pathology is associated with an early high-quantity and a continued low-quality parenting strategy. Posttraumatic stress, depression, substance use, antisocial personality, and psychosis pathology are each associated with a low-quantity, low-quality parenting strategy, particularly in mid to late adulthood. These findings suggest that the evolutionary impact of psychopathology depends on the developmental context. (PsycINFO Database Record
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Barrault S, Hegbe KG, Bertsch I, Courtois R. Relation entre les événements de vie traumatiques de l’enfance, le trouble de personnalité borderline et les conduites cybersexuelles problématiques. ACTA ACUST UNITED AC 2016. [DOI: 10.3917/psyt.223.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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14
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Müller M, Vandeleur C, Rodgers S, Rössler W, Castelao E, Preisig M, Ajdacic-Gross V. Childhood adversities as specific contributors to the co-occurrence of posttraumatic stress and alcohol use disorders. Psychiatry Res 2015; 228:251-6. [PMID: 26163721 DOI: 10.1016/j.psychres.2015.06.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 11/18/2022]
Abstract
There is much evidence that alcohol use disorders (AUD) often co-occur with posttraumatic stress disorders (PTSD), and that the comorbid condition is associated with a more severe clinical profile than that of PTSD without AUD. However, little is known about the role of childhood adversities as specific risk factors for the development of AUD in individuals presenting with PTSD. The aim of the study was to explore whether specific stressors from the spectrum of trauma and childhood adversities contribute to the development of AUD among subjects with PTSD. From a large community sample, of N=140 individuals with PTSD, N=24 (17.14%) received an additional diagnosis of AUD with an onset after the onset of PTSD. Those with comorbid PTSD/AUD and those with PTSD only were compared regarding type and features of their trauma, childhood adversities and psychiatric comorbidity. Compared to PTSD alone, PTSD/AUD was associated with higher levels of stress in terms of childhood adversities; in particular, sexual abuse below the age of 16, but also with having been brought up in a foster home. PTSD/AUD was also associated with an earlier age of adverse events. Treatment of AUD should include standardized assessments of trauma, especially of trauma experienced during childhood.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland.
| | | | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
| | - Wulf Rössler
- Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
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Hall S, Hynan M, Phillips R, Press J, Kenner C, Ryan DJ. Development of Program Standards for Psychosocial Support of Parents of Infants Admitted to a Neonatal Intensive Care Unit: A National Interdisciplinary Consensus Model. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Myers US, Browne KC, Norman SB. Treatment Engagement: Female Survivors of Intimate Partner Violence in Treatment for PTSD and Alcohol Use Disorder. J Dual Diagn 2015; 11:238-47. [PMID: 26515712 PMCID: PMC4915366 DOI: 10.1080/15504263.2015.1113762] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Treatment engagement rates are low for individuals with comorbid posttraumatic stress disorder (PTSD) and alcohol use disorders across available interventions and treatment modalities. A better understanding of who does and does not engage in treatment can help improve retention, completion, and subsequent treatment outcomes. METHODS Forty female survivors of intimate partner violence with PTSD and alcohol use disorder participated in a randomized controlled trial comparing twenty-five 90-minute sessions of either modified Seeking Safety or Facilitated Twelve-Step in a community-based outpatient clinic. This study examined differences in demographics and pre-treatment PTSD symptoms and alcohol use between participants who engaged in treatment (attended ≥ 6 sessions, n = 18) and those who dropped out (n = 22). RESULTS There were no significant differences in PTSD or alcohol use disorder symptoms between treatment conditions. Women who engaged in therapy versus those who did not were significantly older (M = 46.2, SD = 9.14 vs. M = 38.95, SD = 10.49, respectively; p =.027), and had fewer dependents (M =.17, SD =.38, range = 0-1 vs. M =.95, SD = 1.66, range = 1-7, respectively; p =.046). Greater avoidance/numbing PTSD symptoms (OR = 1.13, p =.028, 95% CI [1.02-1.25]) and more years of heavy drinking (OR = 1.04, p =.03, 95% CI [1.00-1.07]) were also significantly associated with treatment engagement. CONCLUSIONS This study replicates previous findings suggesting a need for additional retention strategies for younger women with dependents in comorbid PTSD and alcohol use disorder treatment. This is an analysis of data collected as part of a clinical trial registered as NCT00607412, at www.clinicaltrials.gov.
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Affiliation(s)
- Ursula S Myers
- a San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology , San Diego , California , USA.,b VA San Diego Healthcare System , San Diego , California , USA
| | - Kendall C Browne
- a San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology , San Diego , California , USA.,b VA San Diego Healthcare System , San Diego , California , USA
| | - Sonya B Norman
- b VA San Diego Healthcare System , San Diego , California , USA.,c National Center for PTSD, White River Junction , USA.,d University of California, San Diego , San Diego , California , USA.,e VA Center of Excellence for Stress and Mental Health , San Diego , California , USA
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Trautmann S, Schönfeld S, Behrendt S, Schäfer J, Höfler M, Zimmermann P, Wittchen HU. Associations between lifetime PTSD symptoms and current substance use disorders using a five-factor model of PTSD. J Anxiety Disord 2015; 29:93-100. [PMID: 25527901 DOI: 10.1016/j.janxdis.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
This paper aimed to extend the existing knowledge on the association between PTSD symptoms, alcohol use disorders (AUD) and nicotine dependence (ND) by distinguishing between anxious and dysphoric arousal PTSD symptoms and by considering the putative contribution of additional comorbidity. Data stem from a cross-sectional study in a stratified, representative sample of 1483 recently deployed soldiers using standardized diagnostic interviews. All lifetime PTSD symptom clusters (occurrence of any symptom and number of symptoms) were associated with current AUD and ND in crude models except that anxious arousal was not related to AUD. Associations were reduced in magnitude when controlling for comorbidity. Current ND was related to the occurrence of any emotional numbing and to the number of re-experiencing symptoms above the contribution of other symptom clusters and comorbidity. In conclusion, associations between PTSD symptoms, AUD and ND may be partially attributable to additional comorbidity. Findings also yield further evidence for a role of emotional numbing and re-experiencing symptoms in the comorbidity between PTSD and ND and for a distinction between dysphoric and anxious arousal PTSD symptoms.
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Affiliation(s)
- S Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - S Schönfeld
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - S Behrendt
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Schäfer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - P Zimmermann
- Centre for Psychiatry and Posttraumatic Stress, Federal Armed Forces Hospital Berlin, Berlin, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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18
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Kachadourian LK, Pilver CE, Potenza MN. Trauma, PTSD, and binge and hazardous drinking among women and men: findings from a national study. J Psychiatr Res 2014; 55:35-43. [PMID: 24838049 PMCID: PMC4094352 DOI: 10.1016/j.jpsychires.2014.04.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether trauma and posttraumatic stress disorder (PTSD) are differentially associated with binge and hazardous patterns of drinking among women and men. METHODS Secondary analysis of the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); the analytic sample included 31,487 respondents (54.6% female) without past-year alcohol abuse/dependence. Participants' trauma-exposure/PTSD status was characterized as: no exposure to trauma in lifetime (reference), lifetime trauma exposure, PTSD before past-year, or past-year PTSD. Past-year binge and hazardous drinking were examined with multinomial logistic regression models (past-year abstinence was modeled as the non-event); models included the main effects of trauma-exposure/PTSD status and gender, the trauma-exposure/PTSD status-by-gender interaction, psychiatric comorbidity, and socio-demographic covariates. RESULTS The gender-specific effects of trauma, before past-year PTSD, and past-year PTSD were significantly elevated for all drinking behaviors in women (range of odds ratios (ORs) = 1.8-4.8), and for some drinking behaviors in men (range of ORs = 1.3-2.0), relative to no trauma exposure. Trauma exposure was more strongly associated with high-frequency binge drinking, low-frequency binge drinking, and non-binge drinking among women as compared to men. Past-year PTSD was also more strongly associated with low-frequency binge drinking and non-binge drinking among women compared to men. Findings for hazardous drinking followed a similar pattern, with significant gender-related differences in ORs for hazardous drinking and non-hazardous drinking observed with respect to trauma exposure and past-year PTSD.. CONCLUSION Mental health practitioners should be mindful of the extent to which trauma-exposed individuals both with and without PTSD engage in binge and hazardous drinking, given the negative consequences associated with these patterns of drinking..
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Affiliation(s)
- Lorig K. Kachadourian
- National Center for PTSD, VA Connecticut Healthcare System,Yale University School of Medicine
| | - Corey E. Pilver
- Yale University School of Medicine,Yale School of Public Health
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19
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Kaysen D, Atkins DC, Simpson TL, Stappenbeck CA, Blayney JA, Lee CM, Larimer ME. Proximal relationships between PTSD symptoms and drinking among female college students: results from a daily monitoring study. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:62-73. [PMID: 23915369 PMCID: PMC3825767 DOI: 10.1037/a0033588] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Self-medication has been theorized to explain comorbidity between posttraumatic stress disorder (PTSD) and drinking, whereupon problem drinking develops in order to modulate negative affect and ameliorate PTSD symptoms. Daily monitoring methodologies may help refine our understanding of proximal relations between PTSD, affect, and alcohol use. One hundred thirty-six female college drinkers with a past history of sexual victimization and 38 female college drinkers with no past trauma history completed electronic monitoring of PTSD symptoms, affect, alcohol use, and alcohol cravings, daily for 4 weeks. A two-part mixed hurdle model was used to examine likelihood of drinking and amount of alcohol consumed on drinking days. We found significant relationships between daily PTSD symptoms, affect, and drinking. On days women experienced more intrusive and behavioral avoidance symptoms of PTSD, they experienced stronger urges to drink and were more likely to drink on that day. On days in which women experienced more negative affect than their average, they experienced stronger urges to drink, whereas on days in which women experienced more of the dysphoric symptoms associated with PTSD than their average, they drank less. On days with higher positive affect, women reported stronger urges to drink and were more likely to drink. Results suggest the need to examine both aspects of affect and specific PTSD symptoms as they may differentially predict drinking behavior. Differences in the ways in which PTSD symptoms and affect influence drinking suggest that interventions more specifically address the function of drinking behaviors in reducing alcohol use among college women.
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Affiliation(s)
- Debra Kaysen
- Department of Psychiatry and Behavioral Sciences
| | | | - Tracy L Simpson
- Center of Excellence in Substance Abuse Treatment and Education
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20
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McHugh RK, Hu MC, Campbell ANC, Hilario EY, Weiss RD, Hien DA. Changes in sleep disruption in the treatment of co-occurring posttraumatic stress disorder and substance use disorders. J Trauma Stress 2014; 27:82-9. [PMID: 24473926 PMCID: PMC4096867 DOI: 10.1002/jts.21878] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sleep disruption appears not only to reflect a symptom of posttraumatic stress disorder (PTSD), but also a unique vulnerability for its development and maintenance. Studies examining the impact of psychosocial treatments for PTSD on sleep symptoms are few and no studies to date of which we are aware have examined this question in samples with co-occurring substance use disorders. The current study is a secondary analysis of a large clinical trial comparing 2 psychological treatments for co-occurring PTSD and substance use disorders. Women (N = 353) completed measures of PTSD at baseline, end of treatment, and 3-, 6-, and 12-month follow-ups. Results indicated that the prevalence of insomnia, but not nightmares, decreased during treatment, and that 63.8% of participants reported at least 1 clinical-level sleep symptom at the end of treatment. Improvement in sleep symptoms during treatment was associated with better overall PTSD outcomes over time, χ(2) (1) = 33.81, p < .001. These results extend the existing literature to suggest that residual sleep disruption following PTSD treatment is common in women with co-occurring PTSD and substance use disorders. Research on the benefits of adding sleep-specific intervention for those with residual sleep disruption in this population may be a promising future direction.
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Affiliation(s)
- R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Aimee N. C. Campbell
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA,Department of Psychiatry and Behavioral Health, St. Luke’s Roosevelt Hospital Center, New York, New York, USA
| | - E. Yvette Hilario
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise A. Hien
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA,Department of Psychology, City College of the City University of New York, New York, New York, USA
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21
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Wilsnack SC, Wilsnack RW. Focus on: women and the costs of alcohol use. Alcohol Res 2014; 35:219-28. [PMID: 24881330 PMCID: PMC3908713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although light-to-moderate drinking among women is associated with reduced risks of some cardiovascular problems, strokes, and weakening of bones, such levels of drinking also are associated with increased risks of breast cancer and liver problems, and heavy drinking increases risks of hypertension and bone fractures and injuries. Women's heavy-drinking patterns and alcohol use disorders are associated with increased likelihood of many psychiatric problems, including depression, posttraumatic stress disorder, eating disorders, and suicidality, as well as increased risks of intimate partner violence and sexual assault, although causality in the associations of drinking with psychiatric disorders and with violence remains unclear. It is important for women to be aware of the risks associated with alcohol use, especially because gaps between U.S. men's and women's drinking may have narrowed. However, analyses of health risks and benefits need mprovement to avoid giving women oversimplified advice about drinking.
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22
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Roltsch EA, Baynes BB, Mayeux JP, Whitaker AM, Baiamonte BA, Gilpin NW. Predator odor stress alters corticotropin-releasing factor-1 receptor (CRF1R)-dependent behaviors in rats. Neuropharmacology 2013; 79:83-9. [PMID: 24269607 DOI: 10.1016/j.neuropharm.2013.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 12/22/2022]
Abstract
Humans with stress-related anxiety disorders exhibit increases in arousal and alcohol drinking, as well as altered pain processing. Our lab has developed a predator odor stress model that produces reliable and lasting increases in alcohol drinking. Here, we utilize this predator odor stress model to examine stress-induced increases in arousal, nociceptive processing, and alcohol self-administration by rats, and also to determine the effects of corticotropin-releasing factor-1 receptors (CRF1Rs) in mediating these behavioral changes. In a series of separate experiments, rats were exposed to predator odor stress, then tested over subsequent days for thermal nociception in the Hargreaves test, acoustic startle reactivity, or operant alcohol self-administration. In each experiment, rats were systemically injected with R121919, a CRF1R antagonist, and/or vehicle. Predator odor stress increased thermal nociception (i.e., hyperalgesia) and acoustic startle reactivity. Systemic administration of R121919 reduced thermal nociception and hyperarousal in stressed rats but not unstressed controls, and reduced operant alcohol responding over days. Stressed rats exhibited increased sensitivity to the behavioral effects of R121919 in all three tests, suggesting up-regulation of brain CRF1Rs number and/or function in stressed rats. These results suggest that post-stress alcohol drinking may be driven by a high-nociception high-arousal state, and that brain CRF1R signaling mediates these stress effects.
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Affiliation(s)
- Emily A Roltsch
- Department of Physiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Brittni B Baynes
- Department of Physiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Jacques P Mayeux
- Department of Physiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Annie M Whitaker
- Department of Physiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Brandon A Baiamonte
- Department of Physiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Nicholas W Gilpin
- Department of Physiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
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23
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La Flair LN, Bradshaw CP, Storr CL, Green KM, Alvanzo AAH, Crum RM. Intimate partner violence and patterns of alcohol abuse and dependence criteria among women: a latent class analysis. J Stud Alcohol Drugs 2012; 73:351-60. [PMID: 22456240 DOI: 10.15288/jsad.2012.73.351] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Intimate partner violence (IPV) is a major public health issue, yet little is known about the association between IPV victimization and problem drinking among women. Study objectives were to (a) identify subtypes of problem drinking among women according to abuse and dependence criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV); (b) examine the association between recent IPV and the problem drinking classes; and (c) evaluate major depressive disorder (MDD) as a mediator of the IPV-alcohol relationship. METHOD Data come from a cohort of 11,782 female current drinkers participating in Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analysis was used to group participants into problem drinking classes according to 11 DSM-IV abuse and dependence criteria. The IPV measure was derived from six questions regarding abusive behaviors perpetrated by a romantic partner in the past year. Past-year MDD was assessed according to DSM-IV criteria. Latent class regression was used to test the association between drinking class and IPV. RESULTS Three classes of problem drinkers were identified: Severe (Class 1: 1.9%; n = 224), moderate (Class 2: 14.2%; n = 1,676), and nonsymptomatic (Class 3: 83.9%; n = 9,882). Past-year IPV was associated with severe and moderate classes (severe: adjusted odds ratio [aOR] = 5.70, 95% CI [3.70, 8.77]; moderate: aOR = 1.92, 95% CI [1.43, 2.57]). Past-year MDD was a possible mediator of the IPV-drinking class relationship. CONCLUSIONS Results indicate a strong association between recent IPV and problem drinking class membership. This study offers preliminary evidence that programs aimed at preventing problem drinking among women should take IPV and MDD into consideration.
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Affiliation(s)
- Lareina N La Flair
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. llafl
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24
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Sartor CE, Grant JD, Lynskey MT, McCutcheon VV, Waldron M, Statham DJ, Bucholz KK, Madden PAF, Heath AC, Martin NG, Nelson EC. Common heritable contributions to low-risk trauma, high-risk trauma, posttraumatic stress disorder, and major depression. ACTA ACUST UNITED AC 2012; 69:293-9. [PMID: 22393221 DOI: 10.1001/archgenpsychiatry.2011.1385] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Understanding the relative contributions of genetic and environmental factors to trauma exposure, posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) is critical to developing etiologic models of these conditions and their co-occurrence. OBJECTIVES To quantify heritable influences on low-risk trauma, high-risk trauma, PTSD, and MDD and to estimate the degree of overlap between genetic and environmental sources of variance in these 4 phenotypes. DESIGN Adult twins and their siblings were ascertained from a large population-based sample of female and male twin pairs on the basis of screening items for childhood sexual abuse and physical abuse obtained in a previous assessment of this cohort. SETTING Structured psychiatric telephone interviews. PARTICIPANTS Total sample size of 2591: 996 female and 536 male twins; 625 female and 434 male nontwin siblings. MAIN OUTCOME MEASURE Lifetime low- and high-risk trauma exposure, PTSD, and MDD. RESULTS In the best-fitting genetic model, 47% of the variance in low-risk trauma exposure and 60% of the variance in high-risk trauma exposure was attributable to additive genetic factors. Heritable influences accounted for 46% of the variance in PTSD and 27% of the variance in MDD. An extremely high degree of genetic overlap was observed between high-risk trauma exposure and both PTSD (r = 0.89; 95% CI, 0.78-0.99) and MDD (r = 0.89; 95% CI, 0.77-0.98). Complete correlation of genetic factors contributing to PTSD and to MDD (r = 1.00) was observed. CONCLUSIONS The evidence suggests that almost all the heritable influences on high-risk trauma exposure, PTSD, and MDD, can be traced to the same sources; that is, genetic risk is not disorder specific. Individuals with a positive family history of either PTSD or MDD are at elevated risk for both disorders and should be closely monitored after a traumatic experience for symptoms of PTSD and MDD.
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Affiliation(s)
- Carolyn E Sartor
- Department of Psychiatry, Yale School of Medicine, VA Connecticut Healthcare System, USA.
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25
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Abstract
Stress has long been suggested to be an important correlate of uncontrolled drinking and relapse. An important hormonal response system to stress-the hypothalamic-pituitary-adrenal (HPA) axis-may be involved in this process, particularly stress hormones known as glucocorticoids and primarily cortisol. The actions of this hormone system normally are tightly regulated to ensure that the body can respond quickly to stressful events and return to a normal state just as rapidly. The main determinants of HPA axis activity are genetic background, early-life environment, and current life stress. Alterations in HPA axis regulation are associated with problematic alcohol use and dependence; however, the nature of this dysregulation appears to vary with respect to stage of alcohol dependence. Much of this research has focused specifically on the role of cortisol in the risk for, development of, and relapse to chronic alcohol use. These studies found that cortisol can interact with the brain's reward system, which may contribute to alcohol's reinforcing effects. Cortisol also can influence a person's cognitive processes, promoting habit-based learning, which may contribute to habit formation and risk of relapse. Finally, cortisol levels during abstinence may be useful clinical indicators of relapse vulnerability in alcohol-dependent people.
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26
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Brady KT. Childhood trauma, posttraumatic stress disorder, and alcohol dependence. Alcohol Res 2012; 34:408-13. [PMID: 23584107 PMCID: PMC3860395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Early-childhood trauma is strongly associated with developing mental health problems, including alcohol dependence, later in life. People with early-life trauma may use alcohol to help cope with trauma-related symptoms. This article reviews the prevalence of early-childhood trauma and its robust association with the development of alcohol use disorders and posttraumatic stress disorder. It also examines the potential biological mechanisms by which early adverse experiences can result in long-lasting changes in neurobiology underlying this vulnerability, as well as pharmacological and behavioral interventions. Recent investigations highlight the importance of assessing trauma among patients with alcohol use disorders and the positive benefits associated with the application of integrative psychosocial interventions that target both trauma-related symptoms and alcohol dependence.
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