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Lovett SM, Orta OR, Boynton-Jarrett R, Wesselink AK, Ncube CN, Nillni YI, Hatch EE, Wise LA. Childhood adversity and time-to-pregnancy in a preconception cohort. Am J Epidemiol 2024:kwae085. [PMID: 38794905 DOI: 10.1093/aje/kwae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
We examined the association between childhood adversity and fecundability (the per-cycle probability of conception), and the extent to which childhood social support modified this association. We used data from 6,318 female participants aged 21-45 years in Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study (2013-2022). Participants completed a baseline questionnaire, bimonthly follow-up questionnaires (until pregnancy or a censoring event), and a supplemental questionnaire on experiences across the life course including adverse childhood experiences (ACE) and social support (using the modified Berkman-Syme Social Network Index [SNI]). We used proportional probabilities regression models to compute fecundability ratios (FR) and 95% confidence intervals (CI), adjusting for potential confounders and precision variables. Adjusted FRs for ACE scores 1-3 and ≥4 vs. 0 were 0.91 (95% CI: 0.85, 0.97) and 0.84 (95% CI: 0.77, 0.91), respectively. FRs for ACE scores ≥4 vs. 0 were 0.86 (95% CI: 0.78, 0.94) among participants reporting high childhood social support (SNI ≥4) and 0.78 (95% CI: 0.56, 1.07) among participants reporting low childhood social support (SNI <4). Our findings confirm results from two previous studies and indicate that high childhood social support slightly buffered the effects of childhood adversity on fecundability.
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Affiliation(s)
- Sharonda M Lovett
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Olivia R Orta
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Renée Boynton-Jarrett
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, United States
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Collette N Ncube
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, United States
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
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Nillni YI, Fox AB, Fernando M, Perez J, Galovski TE. Ethnoracial Disparities in Perinatal Outcomes among Women Veterans. J Womens Health (Larchmt) 2024. [PMID: 38639054 DOI: 10.1089/jwh.2023.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Objective: Non-Hispanic Black women have increased rates of preterm birth and low infant birth weight. However, we do not know if these disparities replicate in women veterans, a population that may be at further risk for poor perinatal outcomes. This study sought to examine ethnoracial differences in preterm birth and low infant birth weight in veterans. Methods: A national sample of randomly chosen women veterans (i.e., oversampled for residency in high crime neighborhoods) reported information about all pregnancies they have had in their life, demographic characteristics, and history of childhood trauma exposures. The analytic sample was limited to individuals who identified as Hispanic/Latinx, Black, or White (n = 972). Mixed-effects regression models were used to examine ethnoracial differences in gestational age at delivery and infant birth weight, controlling for age at pregnancy, childhood trauma exposure, pregnancy during military service, income, and education. Results: Both Black and Hispanic/Latinx veterans were significantly more likely to have an infant born at lower gestational age (B = -1.04 and B = -1.11, respectively) and lower infant birth weight (B = -195.83 and B = -144.27, respectively) as compared with White veterans in covariate-adjusted models. Black (odds ratio = 3.24, confidence interval = 1.16, 9.09) veterans were more likely to meet the clinical definition of preterm birth as compared with White veterans. Conclusions: Results align with what is seen in the general population regarding ethnoracial disparities in gestational age at delivery and infant birth weight. Findings highlight the critical need for more research on mechanisms and prevention efforts for ethnoracial disparities in perinatal outcomes.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Annie B Fox
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA, USA
| | - Michelle Fernando
- National Center for PTSD, Behavioral Sciences Division at VA Boston Healthcare System, Boston, MA, USA
| | | | - Tara E Galovski
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Valentine SE, Godfrey LB, Gellatly R, Paul E, Clark C, Giovannini K, Saia KA, Nillni YI. Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States. SSM Ment Health 2023; 4:100256. [PMID: 38645900 PMCID: PMC11027481 DOI: 10.1016/j.ssmmh.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.
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Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Laura B. Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Resham Gellatly
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Caitlin Clark
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Karissa Giovannini
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Kelley A. Saia
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
- Department of Obstetrics & Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Yael I. Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
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Fox AB, Baier AL, Alpert E, Nillni YI, Galovski TE. Psychosocial and Economic Impacts of the COVID-19 Pandemic on the Mental Health of Veteran Men and Women. J Womens Health (Larchmt) 2023; 32:1041-1051. [PMID: 37610854 DOI: 10.1089/jwh.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Purpose: The psychosocial impacts of the coronavirus disease-2019 (COVID-19) pandemic on women Veterans' mental health compared to men are understudied, with few studies examining the differential impact of COVID-19 stressors on depression and post-traumatic stress disorder (PTSD). Furthermore, little is known about whether social support may buffer against adverse pandemic-related outcomes for this population. In the present study, we examined (1) gender differences in the impact of the COVID-19 pandemic on numerous life domains, including economic, work, home, social, and health; (2) how pandemic impacts in these domains were associated with depression and PTSD symptoms; and (3) whether social support buffered against worse mental health outcomes. Materials and Methods: Data from 1530 Veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study were analyzed using descriptive statistics and multiple groups' path analyses. Results: Women reported higher pandemic impact scores across life domains. For both men and women, higher health impacts were associated with increased PTSD symptoms; differential findings emerged for depressive symptoms. Home and economic impacts were associated with increased depression for both men and women, social and health impacts were associated with depression for women, and work impacts were associated with depression for men. Higher social support was associated with decreased depressive symptoms for both men and women; however, social support moderated the relationship between pandemic impacts and both PTSD and depressive symptoms for women only. Conclusions: Findings highlight the value of social support in mitigating effects of pandemic-related stress, particularly for women Veterans.
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Affiliation(s)
- Annie B Fox
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Allison L Baier
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth Alpert
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Yael I Nillni
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tara E Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Nillni YI, Horenstein A, McClendon J, Duke CC, Sawdy M, Galovski TE. The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans. PLoS One 2023; 18:e0291965. [PMID: 37751447 PMCID: PMC10521990 DOI: 10.1371/journal.pone.0291965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Black and Hispanic/Latinx individuals experience a greater burden of mental health symptoms as compared to White individuals in the general population. Examination of ethnoracial disparities and mechanisms explaining these disparities among veterans is still in its nascence. The current study examined perceived everyday discrimination and income as parallel mediators of the association between race/ethnicity and PTSD, depression, and general anxiety symptoms in a sample of White, Black, and Hispanic/Latinx veterans stratified by gender. METHODS A random sample of 3,060 veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey. Veterans completed self-report measures of perceived discrimination via the Everyday Discrimination Scale, PTSD symptoms via the Posttraumatic Stress Disorder Checklist-5, depressive symptoms via the Patient Health Questionnaire, and anxiety symptoms via the Generalized Anxiety Disorder Questionnaire. RESULTS Models comparing Black vs. White veterans found that the significant effect of race on PTSD, depression, and anxiety symptoms was mediated by both perceived discrimination and income for both male and female veterans. Results were less consistent in models comparing Hispanic/Latinx vs. White veterans. Income, but not perceived discrimination, mediated the relationship between ethnicity/race and depression and anxiety symptoms, but only among women. CONCLUSIONS Results suggest that discrimination and socioeconomic status are important mechanisms through which marginalized social status negatively impacts mental health.
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Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Juliette McClendon
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Molly Sawdy
- Suffolk University, Boston, MA, United States of America
| | - Tara E. Galovski
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
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Valentine SE, Alshabani N, Godfrey LB, Paul E, Clark C, Giovannini K, Nillni YI. Considerations for the provision of PTSD treatment among pregnant women with substance use histories: A clinical conceptual model based on case consultation field notes. Gen Hosp Psychiatry 2023; 84:3-11. [PMID: 37270989 PMCID: PMC10527811 DOI: 10.1016/j.genhosppsych.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Increasing prevalence of substance use in pregnancy presents a public health crisis that is compounded by posttraumatic stress disorder (PTSD) comorbidity. We aimed to detail the clinical complexities of PTSD treatment provision among pregnant women with substance use histories. METHODS We conducted a qualitative study using clinical case consultation field notes (N = 47 meetings) which were gathered during a hybrid effectiveness-implementation pilot study of Written Exposure Therapy (WET) for PTSD among pregnant women seen in an obstetrics-SUD clinic [2019-2021]. Patient baseline survey data (N = 25) were used to characterize the sample and contextualize engagement. RESULTS Participants were exposed to a high number of trauma/adversity event types. There was no association between number of trauma/adversity event types and treatment response or dropout. Qualitative findings revealed clinical features relevant to PTSD treatment, including multi-system involvement; parental trauma and substance use; relevance of substance use to trauma context and posttraumatic cognitions, emotions, and behaviors; impact of trauma on experiences of pregnancy, attachment, and child rearing; limited social networks placing women at risk of ongoing violence; and experiences of substance use discrimination. CONCLUSION PTSD treatment among pregnant women with substance use histories is highly important to maternal-child health.
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Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine Boston MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Nuha Alshabani
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Caitlin Clark
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Karissa Giovannini
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yael I Nillni
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine Boston MA, USA; National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
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Nillni YI, Baul TD, Paul E, Godfrey LB, Sloan DM, Valentine SE. Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness. Gen Hosp Psychiatry 2023; 83:66-74. [PMID: 37119780 PMCID: PMC10587907 DOI: 10.1016/j.genhosppsych.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This pilot open trial examined the feasibility, acceptability, and preliminary effectiveness of Written Exposure Therapy (WET), a 5-session evidence-based intervention for posttraumatic stress disorder (PTSD) during pregnancy. Participants were pregnant women with comorbid PTSD and substance use disorder (SUD) receiving prenatal care in a high risk obstetrics-addictions clinic. METHODS A total of 18 participants with probable PTSD engaged in the intervention, and 10 completed the intervention and were included in outcome analyses. Wilcoxon's Signed-Rank analyses were used to evaluate PTSD and depression symptoms and craving at pre-intervention to post-intervention and pre-intervention to the 6-month postpartum follow-up. Engagement and retention in WET and therapist fidelity to the intervention manual were used to assess feasibility. Quantitative and qualitative measures of patient satisfaction were used to assess acceptability. RESULTS PTSD symptoms significantly decreased from pre-intervention to post-intervention (S = 26.6, p = 0.006), which sustained at the 6-month postpartum follow-up (S = 10.5, p = 0.031). Participant satisfaction at post-intervention was high. Therapists demonstrated high adherence to the intervention and excellent competence. CONCLUSIONS WET was a feasible and acceptable treatment for PTSD in this sample. Randomized clinical trial studies with a general group of pregnant women are needed to expand upon these findings and perform a full-scale test of effectiveness of this intervention.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Tithi D Baul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; College of Liberal Arts and Sciences, St. John's University, Queens, NY, USA.
| | - Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Denise M Sloan
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division at VA Boston Healthcare System, Boston, MA, USA.
| | - Sarah E Valentine
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
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Galovski TE, Rossi FS, Fox AB, Vogt D, Duke CC, Nillni YI. Relationship of perceived neighborhood danger with depression and PTSD among veterans: The moderating role of social support and neighborhood cohesion. Am J Community Psychol 2023; 71:395-409. [PMID: 36661400 DOI: 10.1002/ajcp.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/06/2023]
Abstract
Little is known about the impact of perceived neighborhood danger on military veterans' mental health, a population potentially at higher risk for this experience, or whether interpersonal social support and neighborhood cohesion can help buffer against poor mental health. This study examined: (1) the impact of perceived neighborhood danger on depression and posttraumatic stress disorder (PTSD) among veterans; (2) whether interpersonal social support and neighborhood cohesion can mitigate these effects; and (3) how prior trauma history may interact with these factors. Six moderation models were examined using data from 3049 veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma study, a mail-based survey that oversampled for veterans in high crime neighborhoods. Most notably, results indicated that perceived neighborhood danger was associated with increased depression and PTSD (all p < .001). Interpersonal social support or neighborhood cohesion mitigated the effect of perceived neighborhood danger on veterans' depression, but, only for those without prior trauma (all p < .011). For trauma-exposed veterans, interpersonal social support was more effective in mitigating the effect of perceived neighborhood danger on depression than neighborhood cohesion (p = .006). Findings help inform interventions to improve the mental health of veterans living in high crime neighborhoods.
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Affiliation(s)
- Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Chobanian and Avedesian School of Medicine at Boston University, Boston, Massachusetts, USA
| | - Fernanda S Rossi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Annie B Fox
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Chobanian and Avedesian School of Medicine at Boston University, Boston, Massachusetts, USA
| | | | - Yael I Nillni
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Chobanian and Avedesian School of Medicine at Boston University, Boston, Massachusetts, USA
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Harper KL, Vogt D, Fox A, Nillni YI, Galovski T. The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use. Psychol Trauma 2023; 15:690-696. [PMID: 36174158 DOI: 10.1037/tra0001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED [Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on Nov 07 2022 (see record 2023-15574-001). In the original article, the second affiliation of Dawne Vogt was changed from "MGH Institute of Health Professionals, Boston, Massachusetts, United States" to "Department of Psychiatry, Boston University School of Medicine." In addition, the following sentence was deleted from the author note: "The study was funded by the National Center for PTSD." All versions of this article have been corrected.] Objective: Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female veterans and examine the impact of different types of trauma exposure on this association. METHOD Using data from a longitudinal study, we examined whether intimate relationship functioning mediated the association between posttraumatic stress disorder (PTSD) symptom severity and mental health service use (0 = no mental health services, 1 = any mental health services) in male and female veterans (N = 1,200). We used multiple groups path analysis to examine whether intimate relationship functioning mediated the association between PTSD symptom severity and mental health service use for male and female veterans. RESULTS For male veterans, greater PTSD symptom severity was related to poorer intimate relationship functioning, which in turn explained increased likelihood of mental health service use (R² = .18). This mediation effect was not significant for female veterans. CONCLUSIONS Our findings suggest that targeting intimate relationship functioning in treatment for male veterans may be beneficial because difficulties in these relationships appear to be a motivating factor for treatment seeking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Kelly L Harper
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
| | - Annie Fox
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
| | - Yael I Nillni
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
| | - Tara Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
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Galovski TE, McSweeney LB, Woolley MG, Alpert E, Nillni YI. The Relative Impact of Different Types of Military Sexual Trauma on Long-Term PTSD, Depression, and Suicidality. J Interpers Violence 2023:8862605231168823. [PMID: 37102588 DOI: 10.1177/08862605231168823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sexual assault and harassment in the U.S. military are very common. Military sexual trauma (MST) is defined as sexual assault or harassment experienced during military service; yet, the relative impact of sexual assault, harassment, and their combination is not well understood. Given the extent and potential severity of the long-term outcomes of MST, it is critical to evaluate the relative impacts of these types of MST on long-term mental health outcomes. Veterans (n = 2,590; 55% female) completed self-report measures of experiences of sexual assault and harassment perpetrated by coworkers during military service, posttraumatic stress disorder (PTSD), depression, and suicidality. Controlling for combat exposure, all types of MST experiences (Harassment Only, Assault Only, or Both) compared to No MST predicted greater severity of PTSD, depression, and suicidality after military service. Compared to Veterans with No MST, those who experienced Both Assault and Harassment reported significantly more severe PTSD, depression, and suicidality followed by Harassment Only, and then Assault Only. Data suggest that different types of MST experiences have an impact on long-term mental health outcomes, and the combination of Both sexual Assault and Harassment is particularly deleterious.
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Affiliation(s)
- Tara E Galovski
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | | | - Elizabeth Alpert
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Yael I Nillni
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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11
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Harper KL, Vogt D, Fox A, Nillni YI, Galovski T. "The role of PTSD symptom severity and relationship functioning in male and female veterans’ mental health service use": Correction. Psychological Trauma: Theory, Research, Practice, and Policy 2022; 15:696. [PMID: 36342430 DOI: 10.1037/tra0001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reports an error in "The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use" by Kelly L. Harper, Dawne Vogt, Annie Fox, Yael I. Nillni and Tara Galovski (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Sep 29, 2022, np). In the original article, the second affiliation of Dawne Vogt was changed from "MGH Institute of Health Professionals, Boston, Massachusetts, United States" to "Department of Psychiatry, Boston University School of Medicine." In addition, the following sentence was deleted from the author note: "The study was funded by the National Center for PTSD." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2023-05302-001). OBJECTIVE Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female veterans and examine the impact of different types of trauma exposure on this association. METHOD Using data from a longitudinal study, we examined whether intimate relationship functioning mediated the association between posttraumatic stress disorder (PTSD) symptom severity and mental health service use (0 = no mental health services, 1 = any mental health services) in male and female veterans (N = 1,200). We used multiple groups path analysis to examine whether intimate relationship functioning mediated the association between PTSD symptom severity and mental health service use for male and female veterans. RESULTS For male veterans, greater PTSD symptom severity was related to poorer intimate relationship functioning, which in turn explained increased likelihood of mental health service use (R² = .18). This mediation effect was not significant for female veterans. CONCLUSIONS Our findings suggest that targeting intimate relationship functioning in treatment for male veterans may be beneficial because difficulties in these relationships appear to be a motivating factor for treatment seeking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Nillni YI, Crowe HM, Yland JJ, Wesselink AK, Wise LA. The association between time-to-pregnancy and postpartum depressive symptoms in a North American prospective cohort study. Ann Epidemiol 2022; 74:51-57. [PMID: 35902064 PMCID: PMC9743161 DOI: 10.1016/j.annepidem.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively examine the association between time-to-pregnancy (TTP) and postpartum depression (PPD) and determine whether perceived stress during early pregnancy mediated this association. METHODS In Pregnancy Study Online, an internet-based preconception cohort study of pregnancy planners, participants completed questionnaires every 8 weeks for up to 12 months or conception, during pregnancy, and at postpartum. A total of 2643 women provided information on sociodemographic factors, reproductive history, and stress (i.e., Perceived Stress Scale [PSS]) during preconception and early pregnancy (completed at ∼4-12 weeks' gestation) and on postpartum depressive symptoms (i.e., Edinburgh Postnatal Depression Scale [EPDS]) at ∼6 months postpartum. We used multivariable modified Poisson regression models to estimate risk ratios and 95% confidence intervals (CIs) for the association between TTP (<3, 3-5, 6-11, ≥12 menstrual cycles) and PPD (EPDS score ≥13). Causal mediation analyses assessed the mediating role of early pregnancy PSS scores. RESULTS 10.6% of women had EPDS scores indicating possible PPD (≥13). Compared with women who took less than 3 cycles to conceive, risk ratios for those who took 3-5, 6-11, and greater than or equal to 12 were 1.06 (95% CI: 0.77, 1.45), 1.24 (95% CI: 0.90, 1.70), and 1.31 (95% CI: 0.87, 1.99), respectively. Approximately 30% of the association between infertility (TTP ≥ 12) and PPD was mediated by early pregnancy PSS. CONCLUSIONS There was a modest positive dose-response association between delayed conception and PPD. Perceived stress in early pregnancy explained a small proportion of this association. However, given the width of the CIs, chance cannot be ruled out as an explanation for the observed association.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA.
| | - Holly M Crowe
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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Iverson KM, Rossi FS, Nillni YI, Fox AB, Galovski TE. PTSD and Depression Symptoms Increase Women's Risk for Experiencing Future Intimate Partner Violence. Int J Environ Res Public Health 2022; 19:12217. [PMID: 36231518 PMCID: PMC9566456 DOI: 10.3390/ijerph191912217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Psychological distress may impact women's risk for future intimate partner violence (IPV). Yet, limited research has utilized longitudinal research designs and there is a scarcity of research looking at the three most commonly implicated mental health factors-posttraumatic stress disorder (PTSD), depression, and alcohol use-within the same study. Research is especially scarce for women veterans, who experience substantial risk for these mental health concerns and experiencing IPV. This study examined the role of PTSD symptoms, depression symptoms, and alcohol use in increasing risk for experiencing future IPV while simultaneously accounting for the impact of recent IPV experience on subsequent mental health. This study included a sample of 1921 women veterans (Mage = 36.5), who were asked to complete three mail surveys over the course of 8 months as part of a larger longitudinal survey study of US veterans' health and well-being. The survey assessed experiences of IPV, PTSD symptoms (PCL-5), depression symptoms (PHQ-9), and alcohol use (AUDIT-C) at each of the three time points. Results from separate path analysis models provided support for the role of PTSD symptoms and depression symptoms (but not alcohol use) in increasing risk for IPV experience over time. However, the path analysis models provided little support, with the exception of PTSD, for the impact of IPV experience on subsequent mental health symptoms. Findings point to the importance of better understanding the mechanisms by which PTSD and depression symptoms can increase risk for IPV to inform theory and prevention and treatment efforts. Detection and treatment of PTSD and depression symptoms among women may help reduce risk for future violence in intimate relationships.
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Affiliation(s)
- Katherine M. Iverson
- Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Fernanda S. Rossi
- Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
- Center for Primary Care and Outcomes Research (PCOR), Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yael I. Nillni
- Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Annie B. Fox
- Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- School of Healthcare Leadership, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA
| | - Tara E. Galovski
- Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
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Lovett SM, Fox MP, Gradus JL, Wesselink AK, Boynton-Jarrett R, Nillni YI, Wise LA. Bias analysis of childhood trauma and probable post-traumatic stress disorder. Ann Epidemiol 2022. [DOI: 10.1016/j.annepidem.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yland JJ, McKinnon CJ, Hatch EE, Eisenberg ML, Nillni YI, Rothman KJ, Wise LA. A Prospective Study of Male Depression, Psychotropic Medication Use, and Fecundability. Am J Mens Health 2022; 16:15579883221075520. [PMID: 35144505 PMCID: PMC8841933 DOI: 10.1177/15579883221075520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined the associations of male depression and psychotropic medication use with fecundability in a North American preconception cohort study (2013–2020). Men aged ≥21 years completed a baseline questionnaire with questions on history of diagnosed depression, the Major Depression Inventory (MDI), and psychotropic medication use. Pregnancy status was updated via bimonthly female follow-up questionnaires until pregnancy or 12 menstrual cycles, whichever occurred first. Analyses were restricted to 2,398 couples attempting conception for ≤6 menstrual cycles at entry. We fit proportional probabilities models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for age (male and female), education, (male and female), race/ethnicity, physical activity, alcohol intake, body mass index, smoking, and having previously impregnated a partner. Nearly 12% of participants reported a depression diagnosis; 90.6% had low depressive symptoms (MDI <20), 3.5% had mild symptoms (MDI: 20–24), 2.7% had moderate symptoms (MDI: 25–29), and 3.3% had severe symptoms (MDI: ≥30). A total of 8.8% of participants reported current use of psychotropic medications. History of depression was associated with slightly reduced fecundability, although this result was also reasonably compatible with chance (FR = 0.89; 95% CI: [0.76, 1.04]). FRs for mild, moderate, and severe compared with low depressive symptoms were 0.89 (95% CI: [0.66, 1.21]), 0.90 (95% CI: [0.62, 1.31]), and 0.88 (95% CI: [0.65, 1.20]), respectively. This indicates little evidence of a dose–response relationship for depressive symptoms with fecundability, although estimates were imprecise. Current psychotropic medication use mediated 44% of the association between depressive symptoms and fecundability.
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Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Craig J McKinnon
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Eisenberg
- Department of Urology and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,RTI International, Research Triangle Park, NC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Franz MR, Sanders W, Nillni YI, Vogt D, Matteo R, Galovski T. PTSD and parental functioning: The protective role of neighborhood cohesion among Black and White veterans. Psychol Trauma 2021; 14:S4-S12. [PMID: 34591535 DOI: 10.1037/tra0001123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Caregivers with a history of trauma exposure may struggle to parent effectively, particularly when symptoms of PTSD are prominent. Consequently, identifying factors that buffer associations between PTSD and poor parental functioning is critical to help trauma-exposed families thrive. One important source of resilience may spring from being part of a socially cohesive neighborhood that offers positive social connections and resources. The purpose of this study was to examine whether greater neighborhood cohesion buffers associations between PTSD and perceived parental functioning. METHOD A diverse national sample of 563 Black and White veterans raising children in single or dual parent households completed questionnaires assessing PTSD symptoms and neighborhood cohesion at baseline, as well as parental functioning four months later. RESULTS Multigroup moderation analyses that controlled for crime index, income, and sex revealed that among single Black veterans, but not other groups, the relationship between higher PTSD and poorer parental functioning was weakened for veterans who reported higher neighborhood cohesion. CONCLUSIONS Findings suggest that PTSD symptoms and neighborhood cohesion affect parenting differently across racial and family makeup configurations, and that higher neighborhood cohesion might be particularly useful in buffering the association between PTSD and parenting among single Black veterans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Haviland MJ, Nillni YI, Cabral HJ, Fox MP, Wise LA, Burris HH, Hacker MR. Adverse psychosocial factors in pregnancy and preterm delivery. Paediatr Perinat Epidemiol 2021; 35:519-529. [PMID: 33666948 PMCID: PMC8380636 DOI: 10.1111/ppe.12756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental health symptoms, stress, and low psychosocial resources are associated with preterm delivery. It is unknown if there are groups of women who experience similar patterns of these adverse psychosocial factors during pregnancy and if the risk of preterm delivery differs among these groups. OBJECTIVE To identify groups of women with similar patterns of adverse psychosocial factors during pregnancy and determine whether the risk of preterm delivery differs among these groups. METHODS Spontaneous Prematurity and Epigenetics of the Cervix (SPEC) is a prospective cohort study of pregnant women, aged 18 and older. In this analysis, we included women who enrolled after 24 August 2014 and delivered by 20 January 2019. As women could enrol more than once, our cohort included 774 women with 787 pregnancies. We conducted a latent class analysis to identify groups of women with similar patterns of adverse psychosocial factors during pregnancy based on their responses to measures assessing depression, perceived stress, anxiety (pregnancy-related and generalised), stressful life events, resilience, and social support (partner and friend/family). After identifying the latent classes, we used log-binomial regression to compare the incidence of preterm delivery among the classes. RESULTS The median age among participants was 33.2 years (interquartile range 30.3-36.3), and the majority were non-Hispanic white (56.9%). We identified three classes of adverse psychosocial factors (few, some, and many factors). In total, 63 (8.0%) pregnancies resulted in a preterm delivery. Compared to participants with few factors, the risk of preterm delivery was no different among participants with some (RR 1.23, 95% CI 0.68, 2.25) and many adverse factors (RR 1.62, 95% CI 0.73, 3.62). CONCLUSIONS We identified three groups of pregnant women with similar patterns of adverse psychosocial factors. We did not observe a difference in the risk of preterm delivery among the classes.
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Affiliation(s)
- Miriam J. Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Yael I. Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Matthew P. Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michele R. Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Nillni YI, Fox AB, Cox K, Paul E, Vogt D, Galovski TE. The impact of military sexual trauma and warfare exposure on women veterans' perinatal outcomes. Psychol Trauma 2021; 14:730-737. [PMID: 34410813 DOI: 10.1037/tra0001095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the general population, history of trauma is associated with a range of adverse perinatal outcomes, which have long-term negative consequences for both mother and child. Research examining the impact of trauma, particularly trauma occurring during military service, on perinatal outcomes among women veterans is still in its nascence. The current study examined if warfare exposure and military sexual trauma (MST) contributed unique variance to the prediction of a broad range of adverse perinatal outcomes (i.e., preterm birth, full-term birth, infant birth weight, postpartum depression and/or anxiety). METHOD Women veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey, and reported information about all pregnancies that occurred since enlistment in the military. They also reported on warfare exposure and MST using the Deployment Risk and Resilience Inventory. RESULTS A total of 911 women reported on 1,752 unique pregnancies. Results revealed that MST, but not warfare exposure, was associated with having a lower infant birth weight (B = -17.30, SE = 5.41), a slight decrease in the likelihood of having a full-term birth (OR = .97, 95% CI [.93, 1.00]), and an increased likelihood of experiencing postpartum depression and/or anxiety (OR = 1.09, 95% CI [1.10, 1.14]) above and beyond age at pregnancy, racial/ethnic minority status, childhood violence exposure, and warfare exposure. CONCLUSIONS Findings highlight the importance of screening for MST during pregnancy and trauma-informed obstetric care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Zelkowitz RL, Mitchell KS, Grossman SL, Nillni YI, Gradus JL, Galovski TE. Latent Class Analysis of Self-directed Violence and Indirect Self-harm Behaviors: Gender Differences and Associations With Mental Health Symptoms. Med Care 2021; 59:S51-S57. [PMID: 33438883 DOI: 10.1097/mlr.0000000000001476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to (1) examine whether the latent class structure of individuals engaging in self-directed violence and indirect self-harm behaviors (eg, substance use, disordered eating) varied by gender in a sample of US veterans, and (2) test the associations of posttraumatic stress disorder (PTSD) and depressive symptoms with the resulting classes. STUDY DESIGN Cross-sectional data from 3581 veterans, ages 18-50 (51.9% identified as women) were analyzed. Veterans self-reported histories of self-directed violence, substance use, and disordered eating. Latent class analysis and latent class regression were used to explore class structure by gender and examine association of class membership with PTSD and depressive symptoms. RESULTS A 4-class model was supported in the sample. Class 1 (20.0%) was characterized by substance use and self-directed violent thoughts and behaviors. Class 2 (8.3%) was characterized by substance use, disordered eating, and self-directed violent thoughts and behaviors. Class 3 (12.6%) was distinguished by indirect self-harm behaviors (substance use and disordered eating). Class 4 (59.6%) reflected low likelihood of behavioral dysregulation. Classes were partially invariant across gender; endorsement of substance use behaviors was generally higher for men in each class. Comorbid clinically significant depressive and PTSD symptoms were associated with the class characterized by highest behavioral dysregulation. CONCLUSIONS Self-directed violent thoughts and behaviors present comorbidly with indirect self-harm in men and women veterans, although patterns of indirect self-harm behaviors differ slightly by gender. Such comorbidity may be associated with more severe presentations of psychiatric concerns.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
| | - Karen S Mitchell
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
| | - Stephanie L Grossman
- Behavioral Medicine, VA Boston Healthcare System
- Department of Psychiatry, Harvard Medical School
| | - Yael I Nillni
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
| | - Jaimie L Gradus
- Department of Psychiatry, Boston University School of Medicine
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
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Haviland MJ, Murphy LA, Modest AM, Fox MP, Wise LA, Nillni YI, Sakkas D, Hacker MR. Comparison of pregnancy outcomes following preimplantation genetic testing for aneuploidy using a matched propensity score design. Hum Reprod 2020; 35:2356-2364. [DOI: 10.1093/humrep/deaa161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Does preimplantation genetic testing for aneuploidy (PGT-A) increase the likelihood of live birth among women undergoing autologous IVF who have fertilized embryos?
SUMMARY ANSWER
PGT-A is associated with a greater probability of live birth among women 35 years old and older who are undergoing IVF.
WHAT IS KNOWN ALREADY
Previous studies evaluating the association between PGT-A and the incidence of live birth may be prone to confounding by indication, as women whose embryos undergo PGT-A may have a lower probability of live birth due to other factors associated with their increased risk of aneuploidy (e.g. advancing age, history of miscarriage). Propensity score matching can reduce bias where strong confounding by indication is expected.
STUDY DESIGN, SIZE, DURATION
We conducted a retrospective cohort study utilizing data from women who underwent autologous IVF treatment, had their first oocyte retrieval at our institution from 1 January 2011 through 31 October 2017 and had fertilized embryos from this retrieval. If a woman elected to use PGT-A, all good quality embryos (defined as an embryo between Stages 3 and 6 with Grade A or B inner or outer cell mass) were tested. We only evaluated cycles associated with the first oocyte retrieval in this analysis.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Our analytic cohort included 8227 women. We used multivariable logistic regression to calculate a propensity score for PGT-A based on relevant demographic and clinical factors available to the IVF provider at the time of PGT-A or embryo transfer. We used the propensity score to match women who did and did not utilize PGT-A in a 1:1 ratio. We then used log-binomial regression to compare the cumulative incidence of embryo transfer, clinical pregnancy, miscarriage and live birth between women who did and did not utilize PGT-A. Because the risk of aneuploidy increases with age, we repeated these analyses among women <35, 35–37 and ≥38 years old based on the Society for Assisted Reproductive Technology’s standards.
MAIN RESULTS AND THE ROLE OF CHANCE
Overall, women with fertilized embryos who used PGT-A were significantly less likely to have an embryo transfer (risk ratios (RR): 0.78; 95% CI: 0.73, 0.82) but were more likely to have a cycle that resulted in a clinical pregnancy (RR: 1.15; 95% CI: 1.04, 1.28) and live birth (RR: 1.21; 95% CI: 1.08, 1.35) than women who did not use PGT-A. Among women aged ≥38 years, those who used PGT-A were 67% (RR: 1.67; 95% CI: 1.31, 2.13) more likely to have a live birth than women who did not use PGT-A. Among women aged 35–37 years, those who used PGT-A were also more likely to have a live birth (RR: 1.27; 95% CI: 1.05, 1.54) than women who did not use PGT-A. In contrast, women <35 years old who used PGT-A were as likely to have a live birth (RR: 0.91; 95% CI: 0.78, 1.06) as women <35 years old who did not use PGT-A.
LIMITATIONS, REASONS FOR CAUTION
We were unable to abstract several potential confounding variables from patients’ records (e.g. anti-Mullerian hormone levels and prior IVF treatment), which may have resulted in residual confounding. Additionally, by restricting our analyses to cycles associated with the first oocyte retrieval, we were unable to estimate the cumulative incidence of live birth over multiple oocyte retrieval cycles.
WIDER IMPLICATIONS OF THE FINDINGS
Women aged 35 years or older are likely to benefit from PGT-A. Larger studies might identify additional subgroups of women who might benefit from PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
No funding was received for this study. D.S. reports that he is a member of the Cooper Surgical Advisory Board. The other authors report no conflicts of interest.
TRIAL REGISTRATION NUMBER
N/A.
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Affiliation(s)
- Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lauren A Murphy
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Haviland MJ, Nillni YI, Fox MP, Savitz DA, Hatch EE, Rothman KJ, Hacker MR, Wang TR, Wise LA. Psychotropic medication use during pregnancy and gestational age at delivery. Ann Epidemiol 2020; 53:34-41.e2. [PMID: 32835770 DOI: 10.1016/j.annepidem.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the association between psychotropic medication use during pregnancy and gestational age at delivery, after adjusting for depressive symptom and perceived stress severity. METHODS We analyzed data on singleton live births from 2914 female Pregnancy Study Online participants, aged 21 to 45, with a reported conception from 6/2013 to 6/2018. Women reported psychotropic medication use at 8 to 12 weeks' and ~32 weeks' gestation. We measured depressive symptoms using the Major Depressive Inventory and perceived stress using the 10-item Perceived Stress Scale. Data on gestational age at delivery were based on self-reports and/or birth certificates. We used restricted mean survival time models, stratifying by severity of depressive symptoms (Major Depression Inventory <25 vs. ≥25) and perceived stress (Perceived Stress Scale <20 vs. ≥20). RESULTS Two hundred and ten (7.2%) participants reported using psychotropic medications during pregnancy. Mean gestational age at delivery among women who never used psychotropic medications was 38.2 weeks (95% confidence interval: 37.7, 38.7), whereas it was 37.3 weeks (95% confidence interval: 36.7, 37.9) among women who used psychotropic medications during pregnancy. Results were similar across strata of depressive symptoms and perceived stress. CONCLUSIONS Our data indicate that the association between psychotropic medication use and gestational age at delivery is not confounded by indication.
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Affiliation(s)
- Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA; National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; RTI International, Research Triangle Park, NC
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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Nillni YI, Shayani DR, Finley E, Copeland LA, Perkins DF, Vogt D. The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans' Perinatal Outcomes Following Separation From Military Service. J Trauma Stress 2020; 33:248-256. [PMID: 32291816 PMCID: PMC7864116 DOI: 10.1002/jts.22509] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 01/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period.
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Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Danielle R. Shayani
- Department of Psychiatry, Boston University School of Medicine,Northeastern University
| | - Erin Finley
- Veterans Evidence-based Research Dissemination and Implementation Center, South Texas Veterans Health Care System,Departments of Medicine and Psychiatry, UT Health San Antonio
| | - Laurel A. Copeland
- VA Central Western Massachusetts Healthcare System,Department of Population and Quantitative Health Science, University of Massachusetts Medical School
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness, and Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University
| | - Dawne Vogt
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
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23
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Pineles SL, Nillni YI, Pinna G, Webb A, Arditte Hall KA, Fonda JR, Irvine J, King MW, Hauger RL, Resick PA, Orr SP, Rasmusson AM. Associations between PTSD-Related extinction retention deficits in women and plasma steroids that modulate brain GABA A and NMDA receptor activity. Neurobiol Stress 2020; 13:100225. [PMID: 32490055 PMCID: PMC7256058 DOI: 10.1016/j.ynstr.2020.100225] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/14/2020] [Accepted: 04/25/2020] [Indexed: 12/25/2022] Open
Abstract
Several studies have demonstrated poor retention of extinction learning among individuals with posttraumatic stress disorder (PTSD). Gonadal hormone signaling in brain appears to influence the retention of extinction learning differently in women with and without PTSD. Women with PTSD, compared to trauma-exposed women without PTSD, show relative deficits in extinction retention during the mid-luteal phase (mLP) of the menstrual cycle, compared to the early follicular phase (eFP). A PTSD-related reduction in conversion of progesterone to its GABAergic metabolites allopregnanolone (Allo) and pregnanolone (PA) may contribute to these findings. The current study in trauma-exposed women with (n = 9) and without (n = 9) PTSD investigated associations between extinction retention and plasma Allo + PA levels, as well as the ratio of Allo + PA to 5α-dihydroprogesterone (5α-DHP), the immediate steroid precursor for Allo. The study also investigated the relationship between extinction retention and the ratio of Allo + PA to dehydroepiandrosterone (DHEA), an adrenally-derived GABAA receptor antagonist. Study participants completed differential fear-conditioning during both the eFP and mLP of the menstrual cycle. Analyses revealed a strong positive relationship between resting plasma Allo + PA levels and extinction retention during the mLP in the women with, but not without, PTSD (e.g., diagnosis X Allo + PA interaction controlling for early extinction: β = −.0008, p = .003). A similar pattern emerged for the Allo + PA to 5α-DHP ratio (β = -.165, p = .071), consistent with a PTSD-related block in production of Allo and PA at the enzyme 3α-hydroxysteroid dehydrogenase. The ratio of Allo + PA to DHEA appeared to influence extinction retention only during the eFP when Allo + PA and DHEA levels are comparable and thus may compete for effects on GABAA receptor function. This study aligns with male rodent PTSD models linking experimental reductions in brain Allo levels to deficits in extinction retention and suggests that targeting PTSD-related deficits in GABAergic neurosteroid synthesis may be therapeutic.
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Affiliation(s)
- Suzanne L Pineles
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Yael I Nillni
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Andrea Webb
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | | | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System Boston, MA, 02130, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John Irvine
- The MITRE Corporation, Bedford, MA, 01730, USA
| | - Matthew W King
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, CA, 9216, USA.,Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA
| | - Scott P Orr
- Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ann M Rasmusson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
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24
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Copeland LA, Finley EP, Vogt D, Perkins DF, Nillni YI. Gender differences in newly separated veterans' use of healthcare. Am J Manag Care 2020; 26:97-104. [PMID: 32181624 DOI: 10.37765/ajmc.2020.42633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The Veterans Health Administration (VHA) is adapting to a new model of care in the wake of the Veterans Choice Act of 2014. A longitudinal study, The Veterans Metrics Initiative, captured multiple domains of psychosocial health and healthcare use as veterans moved through the first 15 months of transition from military to civilian life. This study examined gender differences and clinical, social, and lifestyle correlates in healthcare use. STUDY DESIGN The multiwave web-based survey collected self-reported measures from a national sample of newly separated military veterans. METHODS Multivariable analysis weighted to represent the sampling frame and account for attrition at follow-up examined the association between gender and self-reported healthcare utilization overall and in the VHA. RESULTS In fall 2016, veterans within approximately 90 days post military separation provided baseline data and completed a follow-up survey a year later, representing a cohort of 49,865. Sleep problems, anxiety, and depression were associated with healthcare use for both men and women following transition. Women were twice as likely as men to use healthcare in general but equally likely to use VHA care. For women veterans, unstable housing at separation was associated with less healthcare use a year later, especially for the subgroup with mental/behavioral health issues. CONCLUSIONS US veterans separating from military service need expert care, both in the VHA and elsewhere, for anxiety, depression, and sleep disturbance. Women veterans may be underserved by the VHA and may benefit from housing assistance programs to enable ongoing healthcare use.
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Affiliation(s)
- Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, 421 N Main St, Leeds, MA 01053.
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25
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Katon JG, Gerber MR, Nillni YI, Patton EW. Consequences of Military Sexual Trauma for Perinatal Mental Health: How Do We Improve Care for Pregnant Veterans with a History of Sexual Trauma? J Womens Health (Larchmt) 2019; 29:5-6. [PMID: 31738642 DOI: 10.1089/jwh.2019.8154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jodie G Katon
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Value-Driven and Veteran-Centered Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Megan R Gerber
- Women's Health, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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26
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Nillni YI, Arditte Hall KA, Langdon KJ, Pineles SL. Examination of the stability of the anxiety sensitivity index across the menstrual cycle in trauma-exposed women with and without PTSD. Anxiety Stress Coping 2019; 33:115-121. [PMID: 31455152 DOI: 10.1080/10615806.2019.1660322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and Objectives: Anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index (ASI), has consistently been studied as a trait-level predictor of a variety of emotional and physical health conditions, including premenstrual symptoms. The menstrual cycle influences symptom expression and stress reactivity among anxiety and stress-related disorders. However, research has yet to directly evaluate the stability of AS across the various phases of the menstrual cycle, particularly in clinical populations with high levels of AS and with documented menstrual cycle differences in symptoms such as women with posttraumatic stress disorder (PTSD).Design and Methods: The current study examined whether AS fluctuates as a function of menstrual cycle phase among a community sample of trauma-exposed women (N = 48) with and without PTSD. Participants completed the ASI, including subscales assessing sensitivity to physical, cognitive, and social symptoms of anxiety, during early follicular and mid-luteal menstrual cycle phases.Results: Results revealed that ASI scores remained relatively stable across the different phases of the menstrual cycle assessed; evidence for stability was particularly strong for the subscale assessing sensitivity to physical symptoms of anxiety.Conclusion: This study provides additional support for the conceptualization of AS as a stable, trait-like, cognitive risk factor.
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Affiliation(s)
- Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
| | - Kim A Arditte Hall
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
| | - Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Suzanne L Pineles
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
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27
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Rohan KJ, Meyerhoff J, Ho SY, Roecklein KA, Nillni YI, Hillhouse JJ, DeSarno MJ, Vacek PM. A measure of cognitions specific to seasonal depression: Development and validation of the Seasonal Beliefs Questionnaire. Psychol Assess 2019; 31:925-938. [PMID: 30920245 PMCID: PMC7988399 DOI: 10.1037/pas0000715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We introduce the Seasonal Beliefs Questionnaire (SBQ), a self-report inventory of maladaptive thoughts about the seasons, light availability, and weather conditions, proposed to constitute a unique cognitive vulnerability to winter seasonal affective disorder (SAD; Rohan, Roecklein, & Haaga, 2009). Potential items were derived from a qualitative analysis of self-reported thoughts during SAD-tailored cognitive-behavioral therapy (CBT-SAD) and subsequently refined based on qualitative feedback from 48 SAD patients. In the psychometric study (N = 536 college students), exploratory and confirmatory factor analyses pruned the items to a 26-item scale with a 5-factor solution, demonstrating good internal consistency, convergent and divergent validity, and 2-week test-retest reliability. In a known groups comparison, the SBQ discriminated SAD patients (n = 86) from both nonseasonal major depressive disorder (MDD) patients (n = 30) and healthy controls (n = 110), whereas a generic measure of depressogenic cognitive vulnerability (the Dysfunctional Attitudes Scale [DAS]) discriminated MDD patients from the other groups. In a randomized clinical trial comparing CBT-SAD with light therapy (N = 177), SBQ scores improved at twice the rate in CBT-SAD than in light therapy. Greater change in SBQ scores during CBT-SAD, but not during light therapy, was associated with a lower risk of depression recurrence 2 winters later. In contrast, DAS scores improved comparably during CBT-SAD and light therapy, and DAS change was unrelated to recurrence following either treatment. These results support using the SBQ as a brief assessment tool for a SAD-specific cognitive vulnerability and as a treatment target in CBT-SAD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division, Veterans Affairs Boston Healthcare System
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University
| | - Michael J DeSarno
- Medical Biostatistics Unit, University of Vermont College of Medicine
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine
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28
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Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW. Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017. Semin Reprod Med 2019; 36:315-322. [PMID: 31003246 DOI: 10.1055/s-0039-1678750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.
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Affiliation(s)
- Jodie G Katon
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Laurie Zephyrin
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia.,Department of Obstetrics and Gynecology, VA Harbor Medical Center, New York City, New York.,Department of Obstetrics and Gynecology, New York School of Medicine, New York, NY
| | - Anne Meoli
- VHA, SimLEARN National Simulation Center, Orlando, Florida
| | - Avanthi Hulugalle
- New York University College of Global Public Health, New York City, New York
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California
| | - Lisa Callegari
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ileana V Galvan
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Kristen E Gray
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Kristin O Haeger
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Claire Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Medical Center, Miami, Florida
| | - Erica W Ma
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | | | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Suzanne L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shivani M Reddy
- VA Boston Healthcare System, Boston, Massachusetts.,Center for Advanced Methods Development, RTI International, Waltham, Massachusetts
| | - David A Savitz
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California.,Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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29
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Vogt D, Taverna EC, Nillni YI, Booth B, Perkins DF, Copeland LA, Finley EP, Tyrell FA, Gilman CL. Development and Validation of a Tool to Assess Military Veterans' Status, Functioning, and Satisfaction with Key Aspects of their Lives. Appl Psychol Health Well Being 2019; 11:328-349. [PMID: 30963703 DOI: 10.1111/aphw.12161] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We developed and validated the Well-Being Inventory (WBI) to address the need for a tool that can provide a comprehensive assessment of key aspects of military veterans' lives. This multidimensional instrument assesses status, functioning, and satisfaction with regard to vocation, finances, health, and social relationships. METHODS Two large multi-phase studies (Study 1 Ns = 301, 286; Study 2 Ns = 9,566, 7,342) were conducted to develop and validate this tool among military veterans. RESULTS Confirmatory factor analyses supported the proposed factor structure, with separate factors observed for all scales except the health functioning scale, which was best represented as three factors rather than a single factor. Cronbach's alphas were satisfactory, with an average alpha of 0.86. Most WBI measures discriminated among individuals with and without mental health conditions and demonstrated expected declines among those with a new mental health condition. CONCLUSIONS This study provides initial evidence for the reliability, validity, and sensitivity to change of the WBI. This tool can be used to provide insight into areas in which military veterans would benefit from additional support and inform efforts to promote the well-being of this population. Given its broad focus, it may also prove useful with other civilian populations.
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Affiliation(s)
- Dawne Vogt
- National Center for PTSD, VA Boston Healthcare System, USA.,Boston University School of Medicine, USA
| | | | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, USA.,Boston University School of Medicine, USA
| | | | | | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, USA.,UT Health San Antonio, USA
| | - Erin P Finley
- UT Health San Antonio, USA.,South Texas Veterans Health Care System, USA
| | | | - Cynthia L Gilman
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), USA
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30
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Rasmusson AM, King MW, Valovski I, Gregor K, Scioli-Salter E, Pineles SL, Hamouda M, Nillni YI, Anderson GM, Pinna G. Relationships between cerebrospinal fluid GABAergic neurosteroid levels and symptom severity in men with PTSD. Psychoneuroendocrinology 2019; 102:95-104. [PMID: 30529908 PMCID: PMC6584957 DOI: 10.1016/j.psyneuen.2018.11.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/02/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
Allopregnanolone and pregnanolone (together termed allo + pregnan) are neurosteroid metabolites of progesterone that equipotently facilitate the action of gamma-amino-butyric acid (GABA) at GABAA receptors. The adrenal steroid dehydroepiandrosterone (DHEA) allosterically antagonizes GABAA receptors and facilitates N-methyl-D-aspartate (NMDA) receptor function. In prior research, premenopausal women with posttraumatic stress disorder (PTSD) displayed low cerebrospinal fluid (CSF) levels of allo + pregnan [undifferentiated by the gas chromatography-mass spectrometry (GC-MS) method used] that correlated strongly and negatively with PTSD reexperiencing and negative mood symptoms. A PTSD-related decrease in the ratio of allo + pregnan to 5α-dihydroprogesterone (5α-DHP: immediate precursor for allopregnanolone) suggested a block in synthesis of these neurosteroids at 3α-hydroxysteroid dehydrogenase (3α-HSD). In the current study, CSF was collected from unmedicated, tobacco-free men with PTSD (n = 13) and trauma-exposed healthy controls (n = 17) after an overnight fast. Individual CSF steroids were quantified separately by GC-MS. In the men with PTSD, allo + pregnan correlated negatively with Clinician-Administered PTSD Scale (CAPS-IV) total (ρ=-0.74, p = 0.006) and CAPS-IV derived Simms dysphoria cluster (ρ=-0.71, p = 0.01) scores. The allo+pregnan to DHEA ratio also was negatively correlated with total CAPS (ρ=-0.74, p = 0.006) and dysphoria cluster (ρ=-0.79, p = 0.002) scores. A PTSD-related decrease in the 5α-DHP to progesterone ratio indicated a block in allopregnanolone synthesis at 5α-reductase. This study suggests that CSF allo + pregnan levels correlate negatively with PTSD and negative mood symptoms in both men and women, but that the enzyme blocks in synthesis of these neurosteroids may be sex-specific. Consideration of sex, PTSD severity, and function of 5α-reductase and 3α-HSD thus may enable better targeting of neurosteroid-based PTSD treatments.
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Affiliation(s)
- Ann M Rasmusson
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States.
| | - Matthew W King
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Ivan Valovski
- VA Boston Healthcare System, Boston, MA, 02130, United States; Harvard Medical School, Boston, MA, 02115, United States
| | - Kristin Gregor
- VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Erica Scioli-Salter
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Suzanne L Pineles
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Mohamed Hamouda
- VA Boston Healthcare System, Boston, MA, 02130, United States; Harvard Medical School, Boston, MA, 02115, United States
| | - Yael I Nillni
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - George M Anderson
- Child Study Center and Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Graziano Pinna
- The Psychiatric Institute, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, United States
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31
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Affiliation(s)
- Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Women's Health Sciences Division at Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA.
| | - Cassidy A Gutner
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Women's Health Sciences Division at Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
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32
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Nillni YI, Wesselink AK, Hatch EE, Mikkelsen EM, Gradus JL, Rothman KJ, Wise LA. Mental health, psychotropic medication use, and menstrual cycle characteristics. Clin Epidemiol 2018; 10:1073-1082. [PMID: 30214312 PMCID: PMC6118267 DOI: 10.2147/clep.s152131] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the influence of depressive symptoms, perceived stress, and psychotropic medication use on prospectively assessed menstrual cycle regularity and length. Participants and methods Data were obtained from Pregnancy Study Online, a prospective cohort study of pregnancy planners from North America. At baseline, women reported information on demographics, anthropometrics, lifestyle, and medical history, including their use of psychotropic medications. They also completed the Major Depression Inventory and the Perceived Stress Scale. Every 8 weeks for up to 12 months or until conception, women completed follow-up questionnaires to assess changes in psychotropic medication use, perceived stress, and menstrual cycle characteristics (ie, cycle regularity and length). Women who completed at least one follow-up questionnaire from 2013 to 2018 (n=3,346) were included in the primary analyses. A total of 5,439 women were included in secondary analyses utilizing baseline data only. Primary analyses estimated prevalence ratios (PR) and 95% CIs using log-binomial regression models. Results Women with severe depressive symptoms at baseline, regardless of psychotropic medication use, had an 80% greater prevalence of irregular cycles during follow-up than women with no or low depressive symptoms (PR =1.80, 95% CI =1.48–2.19). Perceived stress was also associated with the prevalence of irregular cycles during follow-up (PR =1.33, 95% CI =1.14–1.55). Psychotropic medication use was not appreciably associated with menstrual characteristics after controlling for history of diagnosed depression and/or anxiety. Depressive symptoms, perceived stress, and psychotropic medication use showed little association with menstrual cycle length. Conclusion Higher levels of depressive symptoms and perceived stress were associated with irregular menstrual cycles, but not appreciably associated with menstrual cycle length. Use of psychotropic medications was not meaningfully associated with cycle regularity or length.
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Affiliation(s)
- Yael I Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA, .,National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA,
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA, .,National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA, .,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,RTI Health Solutions, Research Triangle, NC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Pineles SL, Nillni YI, Pinna G, Irvine J, Webb A, Arditte Hall KA, Hauger R, Miller MW, Resick PA, Orr SP, Rasmusson AM. PTSD in women is associated with a block in conversion of progesterone to the GABAergic neurosteroids allopregnanolone and pregnanolone measured in plasma. Psychoneuroendocrinology 2018; 93:133-141. [PMID: 29727810 DOI: 10.1016/j.psyneuen.2018.04.024] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/28/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022]
Abstract
There is a need to identify new and more effective treatments for posttraumatic stress disorder (PTSD). Allopregnanolone and its stereoisomer pregnanolone (together termed ALLO) are metabolites of progesterone that positively and allosterically modulate GABA effects at GABAA receptors, thereby reducing anxiety and depression. Previous research revealed that women with PTSD had low cerebrospinal fluid (CSF) ALLO levels and a low ratio of ALLO to the allopregnanolone precursor 5α-DHP, consistent with deficient activity of the ALLO synthetic enzyme 3α-hydroxysteroid dehydrogenase (3α-HSD). The current study examined ALLO and the ratio of ALLO to 5α-DHP in plasma at rest and in response to psychophysiological stressors in trauma-exposed, medication-free women with and without PTSD. Participants were examined twice in random order during the early follicular phase (eFP) and mid-luteal phase (mLP) of the menstrual cycle. Plasma neurosteroids were measured using gas chromatography-mass spectrometry. Results indicate that the ALLO to 5α-DHP ratio in plasma increases between the eFP and mLP. In addition, women with PTSD have a lower ratio of ALLO to 5α-DHP than trauma-exposed healthy women, as well as blunted increases in this ratio in response to a moderately stressful laboratory procedure, i.e., differential fear conditioning, across the menstrual cycle. Clinically feasible testing for 3α-HSD dysfunction is critical to translating this line of research into clinical care. Measurement of this ratio in plasma could facilitate patient stratification in clinical treatment trials, as well as precision medicine targeting of treatments that address ALLO synthesis deficits in women with PTSD.
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Affiliation(s)
- S L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.
| | - Y I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - G Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - J Irvine
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | - A Webb
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | - K A Arditte Hall
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - R Hauger
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, CA, 9216, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - M W Miller
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - P A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA
| | - S P Orr
- Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - A M Rasmusson
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
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Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clin Psychol Rev 2018; 66:136-148. [PMID: 29935979 DOI: 10.1016/j.cpr.2018.06.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | | | - Laura Mayer
- Department of Psychiatry, Boston University School of Medicine, United States
| | - Snezana Milanovic
- Department of Psychiatry, Boston University School of Medicine, United States
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Rasmusson AM, Marx CE, Pineles SL, Locci A, Scioli-Salter ER, Nillni YI, Liang JJ, Pinna G. Neuroactive steroids and PTSD treatment. Neurosci Lett 2017; 649:156-163. [PMID: 28215878 DOI: 10.1016/j.neulet.2017.01.054] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 01/08/2023]
Abstract
This review highlights early efforts to translate pre-clinical and clinical findings regarding the role of neuroactive steroids in stress adaptation and PTSD into new therapeutics for PTSD. Numerous studies have demonstrated PTSD-related alterations in resting levels or the reactivity of neuroactive steroids and their targets. These studies also have demonstrated substantial variability in the dysfunction of specific neuroactive steroid systems among PTSD subpopulations. These variabilities have been related to the developmental timing of trauma, severity and type of trauma, genetic background, sex, reproductive state, lifestyle influences such as substance use and exercise, and the presence of comorbid conditions such as depression and chronic pain. Nevertheless, large naturalistic studies and a small placebo-controlled interventional study have revealed generally positive effects of glucocorticoid administration in preventing PTSD after trauma, possibly mediated by glucocorticoid receptor-mediated effects on other targets that impact PTSD risk, including other neuroactive steroid systems. In addition, clinical and preclinical studies show that administration of glucocorticoids, 17β-estradiol, and GABAergic neuroactive steroids or agents that enhance their synthesis can facilitate extinction and extinction retention, depending on dose and timing of dose in relation to these complex PTSD-relevant recovery processes. This suggests that clinical trials designed to test neuroactive steroid therapeutics in PTSD may benefit from such considerations; typical continuous dosing regimens may not be optimal. In addition, validated and clinically accessible methods for identifying specific neuroactive steroid system abnormalities at the individual level are needed to optimize both clinical trial design and precision medicine based treatment targeting.
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Affiliation(s)
- Ann M Rasmusson
- National Center for PTSD, Women's Health Science Division, Department of Veterans Affairs 150 South Huntington Avenue, Boston, MA 02135, USA; VA Boston Healthcare System 150 South Huntington Avenue, Boston, MA 02135, USA; Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA.
| | - Christine E Marx
- Durham VA Medical Center, VA Mid-Atlantic MIRECC,and Duke University Medical Center, 508 Fulton Street, Durham, NC 27705, USA
| | - Suzanne L Pineles
- National Center for PTSD, Women's Health Science Division, Department of Veterans Affairs 150 South Huntington Avenue, Boston, MA 02135, USA; Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
| | - Andrea Locci
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Str., Chicago, IL 60612, USA
| | - Erica R Scioli-Salter
- VA Boston Healthcare System 150 South Huntington Avenue, Boston, MA 02135, USA; Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
| | - Yael I Nillni
- National Center for PTSD, Women's Health Science Division, Department of Veterans Affairs 150 South Huntington Avenue, Boston, MA 02135, USA; Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
| | - Jennifer J Liang
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Str., Chicago, IL 60612, USA
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Manikandan S, Nillni YI, Zvolensky MJ, Rohan KJ, Carkeek KR, Leyro TM. The role of emotion regulation in the experience of menstrual symptoms and perceived control over anxiety-related events across the menstrual cycle. Arch Womens Ment Health 2016; 19:1109-1117. [PMID: 27562823 PMCID: PMC6730650 DOI: 10.1007/s00737-016-0661-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/12/2016] [Indexed: 02/06/2023]
Abstract
Hormonal variation throughout the menstrual cycle is posited to impact various physical and mental health symptoms; however, this is not observed in all women and mechanisms are not well understood. Difficulty in emotion regulation may elucidate differences that women experience in physical and mental health functioning between menstrual phases. We examined the moderating role of difficulty in emotion regulation in the relation between menstrual phase and menstrual symptom severity and perceived control over anxiety-related events, in healthy, regularly menstruating women. The participants were 37 women (Mage = 26.5, SD = 9.6). A series of regression analyses were used to examine whether individual differences in emotion regulation difficulties moderate the relation between menstrual phase and our outcomes, severity of menstrual symptoms and perceived control over anxiety-related events, using a within-subjects design. The analyses revealed that difficulty in emotion regulation significantly moderated the relation between menstrual phase and perceived control over anxiety-related events (β = -0.42, p < .05), but not menstrual symptom severity. Women who reported higher emotion regulation difficulty experienced greater differences in perceived control over anxiety-related events between menstrual phases. Specifically, women with lower difficulty in emotion regulation report greater increase in control over anxiety during the late luteal phase compared to women with higher emotion regulation difficulty. Difficulty in emotion regulation may play an important role in understanding differences in menstrual phase-associated impairments, thereby informing the development of targeted interventions for vulnerable women.
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Affiliation(s)
| | - Yael I. Nillni
- National Center for PTSD Women’s Health Sciences Division at VA Boston Healthcare system, Boston, USA,Boston University School of Medicine, Boston, USA
| | | | | | | | - Teresa M. Leyro
- Rutgers, The State University of New Jersey, New Brunsick, USA
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Nillni YI, Wesselink AK, Gradus JL, Hatch EE, Rothman KJ, Mikkelsen EM, Wise LA. Depression, anxiety, and psychotropic medication use and fecundability. Am J Obstet Gynecol 2016; 215:453.e1-8. [PMID: 27131586 PMCID: PMC11064128 DOI: 10.1016/j.ajog.2016.04.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/09/2016] [Accepted: 04/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The literature regarding the associations between depression, anxiety, and fecundity is inconsistent. While cross-sectional studies suggest that depression and/or anxiety may adversely affect fecundity, the sole cohort study showed only a small association. OBJECTIVE We sought to evaluate the association of self-reported depressive symptoms, self-reported diagnoses of depression and anxiety, and psychotropic medication use with fecundability in a prospective cohort study. STUDY DESIGN Data were derived from Pregnancy Study Online (PRESTO), an Internet-based preconception cohort study of couples attempting to conceive in the United States and Canada. At baseline, female participants completed a survey that assessed demographic information, history of physician-diagnosed depression and anxiety, self-reported depressive symptoms (assessed by the Major Depression Inventory), and use of psychotropic medications. Women completed follow-up surveys every 8 weeks for up to 12 months or until reported conception to assess changes in exposures and pregnancy status. We estimated fecundability ratios and 95% confidence intervals using proportional probabilities regression models. The analysis was restricted to 2146 women who had been attempting to conceive for ≤6 cycles at study entry. RESULTS Severe depressive symptoms at baseline, regardless of treatment, were associated with decreased fecundability compared with no or low depressive symptoms (fecundability ratio, 0.62; 95% confidence interval, 0.43-0.91). The fecundability ratio associated with a 10-unit increase in Major Depression Inventory score was 0.90 (95% confidence interval, 0.83-0.97). Women who reported moderate to severe depressive symptoms and had never received psychotropic medications (fecundability ratio, 0.69; 95% confidence interval, 0.48-0.99) or who were currently being treated with psychotropic medications (fecundability ratio, 0.72; 95% confidence interval, 0.44-1.20) had decreased fecundability relative to women who had no/mild depressive symptoms and had never used psychotropic medications. Former users of psychotropic medications had increased fecundability regardless of the presence of no/mild depressive symptoms (fecundability ratio, 1.22; 95% confidence interval, 1.06-1.39) or moderate to severe depressive symptoms (fecundability ratio, 1.18; 95% confidence interval, 0.80-1.76). CONCLUSION We found an inverse association between depressive symptoms and fecundability, independent of psychotropic medication use. Use of psychotropic medications did not appear to harm fecundability.
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Affiliation(s)
- Yael I Nillni
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA.
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jaimie L Gradus
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; RTI Health Solutions, Durham, NC
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Slone Epidemiology Center, Boston University, Boston, MA
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Nillni YI, Pineles SL, Rohan KJ, Zvolensky MJ, Rasmusson AM. The influence of the menstrual cycle on reactivity to a CO 2 challenge among women with and without premenstrual symptoms. Cogn Behav Ther 2016; 46:239-249. [PMID: 27687294 DOI: 10.1080/16506073.2016.1236286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clinically significant premenstrual symptoms (PMS) is conceptualized as a depressive disorder in DSM-5, however, it may share pathophysiological processes with anxiety- and fear-related disorders. Specifically, women with PMS panic at higher rates during biological challenge procedures. It is unclear if this increased interoceptive sensitivity is a general vulnerability or specific to the premenstrual phase. The current study examined the role of menstrual cycle phase on reactivity to a CO2 challenge among women with (n = 11) and without (n = 26) clinically significant PMS (N = 37). During the late follicular phase (days 6-12), women with and without PMS responded similarly to the CO2 challenge, whereas during the premenstrual phase (within 5 days before menses), women with PMS reported significantly more intense panic symptoms in response to the challenge than women without PMS. Vulnerability to panic in women with PMS may be specific to the premenstrual phase. Potential psychological and neurobiological mechanisms underlying this phenomenon are discussed.
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Affiliation(s)
- Yael I Nillni
- a Women's Health Sciences Division, National Center for PTSD , VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Suzanne L Pineles
- a Women's Health Sciences Division, National Center for PTSD , VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | | | - Michael J Zvolensky
- d University of Houston , Houston , TX , USA.,e The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ann M Rasmusson
- a Women's Health Sciences Division, National Center for PTSD , VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
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Pineles SL, Blumenthal TD, Curreri AJ, Nillni YI, Putnam KM, Resick PA, Rasmusson AM, Orr SP. Prepulse inhibition deficits in women with PTSD. Psychophysiology 2016; 53:1377-85. [PMID: 27237725 DOI: 10.1111/psyp.12679] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Prepulse inhibition (PPI) is an automatic and preattentive process, whereby a weak stimulus attenuates responding to a sudden and intense startle stimulus. PPI is a measure of sensorimotor filtering, which is conceptualized as a mechanism that facilitates processing of an initial stimulus and is protective from interruption by a later response. Impaired PPI has been found in (a) healthy women during the luteal phase of the menstrual cycle, and (b) individuals with types of psychopathology characterized by difficulty suppressing and filtering sensory, motor, or cognitive information. In the current study, 47 trauma-exposed women with or without posttraumatic stress disorder (PTSD) completed a PPI session during two different phases of the menstrual cycle: the early follicular phase, when estradiol and progesterone are both low, and the midluteal phase, when estradiol and progesterone are both high. Startle stimuli were 100 dB white noise bursts presented for 50 ms, and prepulses were 70 dB white noise bursts presented for 20 ms that preceded the startle stimuli by 120 ms. Women with PTSD showed deficits in PPI relative to the healthy trauma-exposed participants. Menstrual phase had no effect on PPI. These results provide empirical support for individuals with PTSD having difficulty with sensorimotor filtering. The potential utility of PPI as a Research Domain Criteria (RDoC) phenotype is discussed.
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Affiliation(s)
- Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Terry D Blumenthal
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Andrew J Curreri
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine M Putnam
- Department of Psychology, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Ann M Rasmusson
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Mahon JN, Rohan KJ, Nillni YI, Zvolensky MJ. The role of perceived control over anxiety in prospective symptom reports across the menstrual cycle. Arch Womens Ment Health 2015; 18:239-246. [PMID: 25269759 PMCID: PMC9074117 DOI: 10.1007/s00737-014-0456-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Abstract
The present investigation tested the role of psychological vulnerabilities to anxiety in reported menstrual symptom severity. Specifically, the current study tested the incremental validity of perceived control over anxiety-related events in predicting menstrual symptom severity, controlling for the effect of anxiety sensitivity, a documented contributor to menstrual distress. It was expected that women with lower perceived control over anxiety-related events would report greater menstrual symptom severity, particularly in the premenstrual phase. A sample of 49 normally menstruating women, aged 18-47 years, each prospectively tracked their menstrual symptoms for one cycle and completed the Anxiety Control Questionnaire (Rapee, Craske, Brown, & Barlow Behav Ther 27:279-293. doi: 10.1016/S0005-7894(96)80018-9 , 1996) in their follicular and premenstrual phases. A mixed model analysis revealed perceived control over anxiety-related events was a more prominent predictor of menstrual symptom severity than anxiety sensitivity, regardless of the current cycle phase. This finding provides preliminary evidence that perceived control over anxiety-related events is associated with the perceived intensity of menstrual symptoms. This finding highlights the role of psychological vulnerabilities in menstrual distress. Future research should examine whether psychological interventions that target cognitive vulnerabilities to anxiety may help reduce severe menstrual distress.
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Affiliation(s)
- Jennifer N. Mahon
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - Kelly J. Rohan
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - Yael I. Nillni
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA; National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA 02130-4817, USA; Boston University School of Medicine, Boston, MA, USA
| | - Michael J. Zvolensky
- University of Houston, Heyne Building Room 129, 4800 Calhoun Road, Houston, TX 77004-5022, USA; MD Anderson Cancer Center, Department of Behavioral Science, The University of Texas, Austin, TX, USA
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Abstract
The menstrual cycle has been implicated as a sex-specific biological process influencing psychological symptoms across a variety of disorders. Limited research exists regarding the role of the menstrual cycle in psychological symptoms among women with posttraumatic stress disorder (PTSD). The current study examined the severity of a broad range of psychological symptoms in both the early follicular (Days 2-6) and midluteal (6-10 days postlutenizing hormone surge) phases of the menstrual cycle in a sample of trauma-exposed women with and without PTSD (N = 49). In the sample overall, total psychological symptoms (d = 0.63), as well as depression (d = 0.81) and phobic anxiety (d = 0.81) symptoms, specifically, were increased in the early follicular compared to midluteal phase. The impact of menstrual cycle phase on phobic anxiety was modified by a significant PTSD × Menstrual Phase interaction (d = 0.63). Women with PTSD reported more severe phobic anxiety during the early follicular versus midluteal phase, whereas phobic anxiety did not differ across the menstrual cycle in women without PTSD. Thus, the menstrual cycle appears to impact fear-related symptoms in women with PTSD. The clinical implications of the findings and future research directions are discussed.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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Nillni YI, Gradus JL, Gutner CA, Luciano MT, Shipherd JC, Street AE. Deployment stressors and physical health among OEF/OIF veterans: the role of PTSD. Health Psychol 2014; 33:1281-7. [PMID: 25020154 DOI: 10.1037/hea0000084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is a large body of literature documenting the relationship between traumatic stress and deleterious physical health outcomes. Although posttraumatic stress disorder (PTSD) symptoms have been proposed to explain this relationship, previous research has produced inconsistent results when moderating variables such as gender or type of traumatic stressor are considered. Within a large sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, the current study examined if deployment stressors (i.e., combat stress, harassment stress) contributed unique variance to the prediction of physical health symptoms (i.e., pain, nonpain) beyond the effects of PTSD symptoms. METHODS A total of 2,332 OEF/OIF Veterans, with equal representation of women and men, completed a series of self-report measures assessing deployment stressors, PTSD symptoms, and physical health symptoms. RESULTS RESULTS revealed that harassment, but not combat stress, added unique variance in the prediction of pain and nonpain symptoms after accounting for PTSD symptoms. CONCLUSIONS This study extends the existing literature by demonstrating the unique influence of harassment stress on physical health outcomes. Specifically, the relationship between combat stress and physical health symptoms appears to be explained mainly by an individual's experience of PTSD symptoms, whereas the relationship between harassment stress and physical health symptoms is not fully explained by PTSD symptoms, suggesting that other variables may be involved in the pathway from harassment stress to physical health symptoms.
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Nillni YI, Berenz EC, Pineles SL, Coffey SF, Zvolensky MJ. Anxiety Sensitivity as a Moderator of the Association Between Premenstrual Symptoms and Posttraumatic Stress Disorder Symptom Severity. Psychol Trauma 2014; 6:167-175. [PMID: 26973758 DOI: 10.1037/a0032087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Experience of premenstrual symptoms may be an important factor involved in understanding posttraumatic stress disorder (PTSD) symptom vulnerability. Correlations between PTSD and premenstrual dysphoric disorder (PMDD) have been identified in epidemiological studies, however, the nature of this relation is not clear. The current study examined the incremental validity of premenstrual symptoms, as well as their interaction with anxiety sensitivity, in the prediction of PTSD symptom severity above and beyond other theoretically relevant covariates. A community sample of trauma-exposed women (N = 63) completed questionnaires assessing premenstrual symptoms, anxiety sensitivity, and neuroticism and were administered the Clinician-Administered PTSD Scale to assess PTSD symptom severity. A series of hierarchical linear regressions revealed that premenstrual symptoms uniquely predicted PTSD total, reexperiencing, avoidance, and hyperarousal symptoms above and beyond other theoretically relevant covariates (i.e., number of potentially traumatic events, neuroticism, panic attack history, and anxiety sensitivity). Additionally, anxiety sensitivity emerged as a moderator of the association between premenstrual symptoms and PTSD symptom severity such that greater premenstrual symptoms were associated with greater PTSD total, reexperiencing, and numbing symptom severity for individuals high, but not low, in anxiety sensitivity. Experience of premenstrual symptoms may be an important sex-specific mechanism involved in increasing vulnerability for PTSD symptoms, particularly among women high in anxiety sensitivity.
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Affiliation(s)
- Yael I Nillni
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Erin C Berenz
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts and Boston University School of Medicine
| | - Scott F Coffey
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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Nillni YI, Rohan KJ, Mahon JN, Pineles SL, Zvolensky MJ. The role of anxiety sensitivity in the experience of menstrual-related symptoms reported via daily diary. Psychiatry Res 2013; 210:564-9. [PMID: 23910240 PMCID: PMC6605776 DOI: 10.1016/j.psychres.2013.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
The current study examined the interactive effects of Anxiety Sensitivity (AS) and menstrual cycle phase in the experience of menstrual-related symptoms. Participants were 55 community women who completed prospective tracking of menstrual-related symptoms across at least one full menstrual cycle using the Daily Record of Severity of Problems (DRSP) and completed the Menstrual Distress Questionnaire (MDQ) once in their premenstrual and follicular cycle phases. Results revealed that women with higher levels of AS reported greater menstrual-related symptoms, regardless of cycle phase, as compared to women with lower levels of AS. These findings suggest that AS may be an important psychological factor involved in the experience of psychological and somatic symptoms across the menstrual cycle. Results are consistent with previous literature documenting the role of AS in menstrual-related symptoms as well as in other physical health conditions.
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Affiliation(s)
- Yael I. Nillni
- University of Vermont, Burlington, VT, USA,National Center for PTSD, Women′s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA,Correspondence to: National Center for PTSD, Women′s Health Sciences Division, Veteran′s Affairs Boston Healthcare System, 150 South Huntington Ave.(116B-3), Boston, MA 02130, USA. Tel.: +1 857 364 4637; fax: +1 857 364 4515., , (Y.I.Nillni)
| | | | | | - Suzanne L. Pineles
- National Center for PTSD, Women′s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| | - Michael J. Zvolensky
- University of Houston, Houston, TX, USA,MD Anderson Cancer Center, Houston, TX, USA
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Sitnikov L, Rohan KJ, Evans M, Mahon JN, Nillni YI. Cognitive predictors and moderators of winter depression treatment outcomes in cognitive-behavioral therapy vs. light therapy. Behav Res Ther 2013; 51:872-81. [PMID: 24211338 DOI: 10.1016/j.brat.2013.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 09/21/2013] [Accepted: 09/30/2013] [Indexed: 11/30/2022]
Abstract
There is no empirical basis for determining which seasonal affective disorder (SAD) patients are best suited for what type of treatment. Using data from a parent clinical trial comparing light therapy (LT), cognitive-behavioral therapy (CBT), and their combination (CBT + LT) for SAD, we constructed hierarchical linear regression models to explore baseline cognitive vulnerability constructs (i.e., dysfunctional attitudes, negative automatic thoughts, response styles) as prognostic and prescriptive factors of acute and next winter depression outcomes. Cognitive constructs did not predict or moderate acute treatment outcomes. Baseline dysfunctional attitudes and negative automatic thoughts were prescriptive of next winter treatment outcomes. Participants with higher baseline levels of dysfunctional attitudes and negative automatic thoughts had less severe depression the next winter if treated with CBT than if treated with LT. In addition, participants randomized to solo LT who scored at or above the sample mean on these cognitive measures at baseline had more severe depressive symptoms the next winter relative to those who scored below the mean. Baseline dysfunctional attitudes and negative automatic thoughts did not predict treatment outcomes in participants assigned to solo CBT or CBT + LT. Therefore, SAD patients with extremely rigid cognitions did not fare as well in the subsequent winter if treated initially with solo LT. Such patients may be better suited for initial treatment with CBT, which directly targets cognitive vulnerability processes.
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Affiliation(s)
- Lilya Sitnikov
- University of Vermont, Department of Psychology, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, United States.
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Nillni YI, Nosen E, Williams PA, Tracy M, Coffey SF, Galea S. Unique and related predictors of major depressive disorder, posttraumatic stress disorder, and their comorbidity after Hurricane Katrina. J Nerv Ment Dis 2013; 201:841-7. [PMID: 24080670 PMCID: PMC6554025 DOI: 10.1097/nmd.0b013e3182a430a0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current study examined demographic and psychosocial factors that predict major depressive disorder (MDD) and comorbid MDD/posttraumatic stress disorder (MDD/PTSD) diagnostic status after Hurricane Katrina, one of the deadliest and costliest hurricanes in the history of the United States. This study expanded on the findings published in the article by Galea, Tracy, Norris, and Coffey (J Trauma Stress 21:357-368, 2008), which examined the same predictors for PTSD, to better understand related and unique predictors of MDD, PTSD, and MDD/PTSD comorbidity. A total of 810 individuals representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina were interviewed. Ongoing hurricane-related stressors, low social support, and hurricane-related financial loss were common predictors of MDD, PTSD, and MDD/PTSD, whereas educational and marital status emerged as unique predictors of MDD. Implications for postdisaster relief efforts that address the risk for both MDD and PTSD are discussed.
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Affiliation(s)
- Yael I. Nillni
- University of Mississippi Medical Center, Jackson, MS, USA,University of Vermont, Burlington, VT, USA,Corresponding author: Yael I. Nillni is now at the National Center for PTSD, Women’s Health Sciences Division, Veteran’s Affairs Boston Healthcare System, 150 South Huntington Ave. (116B-3), Boston, MA 02130.
| | - Elizabeth Nosen
- University of Mississippi Medical Center, Jackson, MS, USA,University of British Columbia, Vancouver, B.C., Canada
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Gutner CA, Nillni YI, Suvak M, Wiltsey-Stirman S, Resick PA. Longitudinal course of anxiety sensitivity and PTSD symptoms in cognitive-behavioral therapies for PTSD. J Anxiety Disord 2013; 27:728-34. [PMID: 24176804 PMCID: PMC3860054 DOI: 10.1016/j.janxdis.2013.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
Anxiety sensitivity (AS) has been conceptualized as trait-like vulnerability and maintenance factor for PTSD. Although recent literature has demonstrated its malleability during treatment, few have examined its influence on and effect from PTSD treatment. Using multilevel regression analyses we examined: (a) changes in AS during treatment and (b) whether pre-treatment AS predicted PTSD treatment response, in sample of female victims of interpersonal trauma receiving one of three treatments (cognitive processing therapy, cognitive processing therapy-cognitive, and written accounts). Participants exhibited reductions in total ASI scores from pre- to post-treatment. Growth curve modeling revealed slightly different trajectories of PTSD symptoms as a function of pre-treatment AS, and overall decreases in PTSD symptoms during treatment were not associated with pretreatment AS. Pretreatment AS dimensions impacted PTSD total scores and symptoms clusters differentially. Clinical and theoretical implications for these results are discussed.
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Affiliation(s)
- Cassidy A. Gutner
- Department of Psychiatry, Boston University School of Medicine,National Center for Posttraumatic Stress Disorder, Women’s Health Sciences Division, VA, Boston Healthcare System
| | - Yael I. Nillni
- Department of Psychiatry, Boston University School of Medicine,National Center for Posttraumatic Stress Disorder, Women’s Health Sciences Division, VA, Boston Healthcare System
| | - Michael Suvak
- Department of Psychiatry, Boston University School of Medicine,Department of Psychology, Suffolk University
| | - Shannon Wiltsey-Stirman
- Department of Psychiatry, Boston University School of Medicine,National Center for Posttraumatic Stress Disorder, Women’s Health Sciences Division, VA, Boston Healthcare System
| | - Patricia A. Resick
- Department of Psychiatry, Boston University School of Medicine,National Center for Posttraumatic Stress Disorder, Women’s Health Sciences Division, VA, Boston Healthcare System
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Evans M, Rohan KJ, Sitnikov L, Mahon JN, Nillni YI, Lindsey KT, Vacek PM. Cognitive Change across Cognitive-Behavioral and Light Therapy Treatments for Seasonal Affective Disorder: What Accounts for Clinical Status the Next Winter? Cognit Ther Res 2013; 37. [PMID: 24415812 DOI: 10.1007/s10608-013-9561-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Efficacious treatments for seasonal affective disorder include light therapy and a seasonal affective disorder-tailored form of cognitive-behavioral therapy. Using data from a parent clinical trial, these secondary analyses examined the relationship between cognitive change over treatment with cognitive-behavioral therapy, light therapy, or combination treatment and mood outcomes the next winter. Sixty-nine participants were randomly assigned to 6-weeks of cognitive-behavioral therapy, light therapy, or combination treatment. Cognitive constructs (i.e., dysfunctional attitudes, negative automatic thoughts, and rumination) were assessed at pre- and post-treatment. Dysfunctional attitudes, negative automatic thoughts, and rumination improved over acute treatment, regardless of modality; however, in participants randomized to solo cognitive-behavioral therapy, a greater degree of improvement in dysfunctional attitudes and automatic thoughts was uniquely associated with less severe depressive symptoms the next winter. Change in maladaptive thoughts during acute treatment appears mechanistic of solo cognitive-behavioral therapy's enduring effects the next winter, but is simply a consequence of diminished depression in light therapy and combination treatment.
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Affiliation(s)
- Maggie Evans
- University of Vermont, Department of Psychology, Burlington, VT
| | - Kelly J Rohan
- University of Vermont, Department of Psychology, Burlington, VT
| | - Lilya Sitnikov
- University of Vermont, Department of Psychology, Burlington, VT
| | | | - Yael I Nillni
- University of Vermont, Department of Psychology, Burlington, VT
| | | | - Pamela M Vacek
- University of Vermont College of Medicine, Medical Biostatistics, Burlington, VT
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Rohan KJ, Evans M, Mahon JN, Sitnikov L, Ho SY, Nillni YI, Postolache TT, Vacek PM. Cognitive-behavioral therapy vs. light therapy for preventing winter depression recurrence: study protocol for a randomized controlled trial. Trials 2013; 14:82. [PMID: 23514124 PMCID: PMC3652773 DOI: 10.1186/1745-6215-14-82] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a subtype of recurrent depression involving major depressive episodes during the fall and/or winter months that remit in the spring. The central public health challenge in the management of SAD is prevention of winter depression recurrence. Light therapy (LT) is the established and best available acute SAD treatment. However, long-term compliance with daily LT from first symptom through spontaneous springtime remission every fall/winter season is poor. Time-limited alternative treatments with effects that endure beyond the cessation of acute treatment are needed to prevent the annual recurrence of SAD. METHODS/DESIGN This is an NIMH-funded R01-level randomized clinical trial to test the efficacy of a novel, SAD-tailored cognitive-behavioral group therapy (CBT) against LT in a head-to-head comparison on next winter outcomes. This project is designed to test for a clinically meaningful difference between CBT and LT on depression recurrence in the next winter (the primary outcome). This is a concurrent two-arm study that will randomize 160 currently symptomatic community adults with major depression, recurrent with seasonal pattern, to CBT or LT. After 6 weeks of treatment in the initial winter, participants are followed in the subsequent summer, the next winter, and two winters later. Key methodological issues surround timing study procedures for a predictably recurrent and time-limited disorder with a focus on long-term outcomes. DISCUSSION The chosen design answers the primary question of whether prior exposure to CBT is associated with a substantially lower likelihood of depression recurrence the next winter than LT. This design does not test the relative contributions of the cognitive-behavioral treatment components vs. nonspecific factors to CBT's outcomes and is not adequately powered to test for differences or equivalence between cells at treatment endpoint. Alternative designs addressing these limitations would have required more patients, increased costs, and reduced power to detect a difference in the primary outcome. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01714050.
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Affiliation(s)
- Kelly J Rohan
- Department of Psychology, University of Vermont, John Dewey Hall, Burlington, VT 05405-0134, USA.
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Nosen E, Nillni YI, Berenz EC, Schumacher JA, Stasiewicz PR, Coffey SF. Cue-elicited affect and craving: advancement of the conceptualization of craving in co-occurring posttraumatic stress disorder and alcohol dependence. Behav Modif 2012; 36:808-33. [PMID: 22619397 DOI: 10.1177/0145445512446741] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol dependence (AD) and negatively affects treatment outcomes. Trauma-related negative affect enhances substance craving in laboratory cue-reactivity studies of AD individuals, but the role of positive affect has not been established. In this study, 108 AD treatment-seeking adults with current PTSD and AD were presented with four counterbalanced trials consisting of an audio cue (personalized trauma or neutral script) followed by a beverage cue (alcohol or water). Results revealed alcohol cues increased positive and negative affect, and positive affective responses explained significant incremental variance in self-reported craving and salivation, but only when cues were accompanied by neutral not trauma imagery. Ambivalent (high negative and positive) responses were associated with strongest craving. Findings advance the conceptualization of craving in individuals with PTSD-AD and highlight the importance of independently assessing positive and negative affective responses to cues in individuals with co-occurring PTSD-AD.
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