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Miller ML, Laifer LM, Thomas EBK, Grekin R, O'Hara MW, Brock RL. From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women. J Affect Disord 2024; 357:11-22. [PMID: 38663559 DOI: 10.1016/j.jad.2024.04.079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. METHODS Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. RESULTS Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LIMITATIONS Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. CONCLUSIONS Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Department of Psychiatry, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St., Indianapolis, IN 46202, United States of America; University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America.
| | - Lauren M Laifer
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
| | - Emily B K Thomas
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca Grekin
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Michael W O'Hara
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca L Brock
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
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Borst B, Jovanovic T, House SL, Bruce SE, Harnett NG, Roeckner AR, Ely TD, Lebois LAM, Young D, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Harte SE, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Stevens JS, van Rooij SJH. Sex differences in response inhibition-related neural predictors of PTSD in recent trauma-exposed civilians. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00080-6. [PMID: 38522649 DOI: 10.1016/j.bpsc.2024.03.002] [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] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Females are more likely to develop posttraumatic stress disorder (PTSD) than males. Impaired inhibition has been identified as mechanism for PTSD development, but studies on the potential sex differences of this neurobiological mechanism and how it relates to PTSD severity and progression are sparse. Here we examined sex differences in neural activation during response inhibition and PTSD following recent trauma. METHODS Participants (N= 205, 138 female sex assigned at birth) were recruited from emergency departments within 72 hours of a traumatic event. PTSD symptoms were assessed 2-weeks and 6-months post-trauma. A Go/NoGo task was performed 2-weeks post-trauma in a 3T MRI scanner to measure neural activity during response inhibition in the ventromedial prefrontal cortex (vmPFC), right inferior frontal gyrus (rIFG), and the bilateral hippocampus. General Linear models were used to examine the interaction effect of sex on the relationship between our regions of interest (ROIs) and the whole brain, and PTSD symptoms at 6-months, and symptom progression between 2-weeks and 6-months. RESULTS Lower response-inhibition-related vmPFC activation 2-weeks post-trauma predicted more PTSD symptoms at 6-months in females but not in males, while greater response-inhibition-related rIFG activation predicted lower PTSD symptom progression in males but not females. Whole brain interaction effects were observed in the medial temporal gyrus and left precentral gyrus. CONCLUSIONS There are sex differences in the relationship between inhibition-related brain activation and PTSD symptom severity and progression. These findings suggest that sex differences should be assessed in future PTSD studies and reveal potential targets for sex-specific interventions.
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Affiliation(s)
- Bibian Borst
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alyssa R Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Dmitri Young
- University of California San Francisco, San Francisco, CA, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA; Department of Emergency Medicine, Brown University, Providence, RI
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; The Many Brains Project, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Ohio State University College of Nursing, Columbus, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Jefferson Einstein hospital, Jefferson Health, Philadelphia, PA, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Affiliation(s)
- Diane Roston
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, and West Central Behavioral Health, Lebanon, New Hampshire
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Williamson ES, Arentsen TJ, Roper BL, Pedersen HA, Shultz LA, Crouse EM. The Importance of the Morel Emotional Numbing Test Instructions: A Diagnosis Threat Induction Study. Arch Clin Neuropsychol 2024; 39:35-50. [PMID: 37449530 DOI: 10.1093/arclin/acad048] [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] [Accepted: 05/07/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Marketed as a validity test that detects feigning of posttraumatic stress disorder (PTSD), the Morel Emotional Numbing Test for PTSD (MENT) instructs examinees that PTSD may negatively affect performance on the measure. This study explored the potential that MENT performance depends on inclusion of "PTSD" in its instructions and the nature of the MENT as a performance validity versus a symptom validity test (PVT/SVT). METHOD 358 participants completed the MENT as a part of a clinical neuropsychological evaluation. Participants were either administered the MENT with the standard instructions (SIs) that referenced "PTSD" or revised instructions (RIs) that did not. Others were administered instructions that referenced "ADHD" rather than PTSD (AI). Comparisons were conducted on those who presented with concerns for potential traumatic-stress related symptoms (SI vs. RI-1) or attention deficit (AI vs. RI-2). RESULTS Participants in either the SI or AI condition produced more MENT errors than those in their respective RI conditions. The relationship between MENT errors and other S/PVTs was significantly stronger in the SI: RI-1 comparison, such that errors correlated with self-reported trauma-related symptoms in the SI but not RI-1 condition. MENT failure also predicted PVT failure at nearly four times the rate of SVT failure. CONCLUSIONS Findings suggest that the MENT relies on overt reference to PTSD in its instructions, which is linked to the growing body of literature on "diagnosis threat" effects. The MENT may be considered a measure of suggestibility. Ethical considerations are discussed, as are the construct(s) measured by PVTs versus SVTs.
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Affiliation(s)
- Emily S Williamson
- Department of Veterans Affairs, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, TN, USA
| | - Timothy J Arentsen
- Department of Veterans Affairs, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, TN, USA
- Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brad L Roper
- Department of Veterans Affairs, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, TN, USA
- Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Heather A Pedersen
- Department of Veterans Affairs, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, TN, USA
| | - Laura A Shultz
- Department of Veterans Affairs, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, TN, USA
| | - Ellen M Crouse
- Department of Veterans Affairs, Lt. Col. Luke Weathers, Jr. VA Medical Center, Memphis, TN, USA
- Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN, USA
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Patas K, Baker DG, Chrousos GP, Agorastos A. Inflammation in Posttraumatic Stress Disorder: Dysregulation or Recalibration? Curr Neuropharmacol 2024; 22:524-542. [PMID: 37550908 PMCID: PMC10845099 DOI: 10.2174/1570159x21666230807152051] [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] [Received: 11/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 08/09/2023] Open
Abstract
Despite ample experimental data indicating a role of inflammatory mediators in the behavioral and neurobiological manifestations elicited by exposure to physical and psychologic stressors, causative associations between systemic low-grade inflammation and central nervous system inflammatory processes in posttraumatic stress disorder (PTSD) patients remain largely conceptual. As in other stress-related disorders, pro-inflammatory activity may play an equivocal role in PTSD pathophysiology, one that renders indiscriminate employment of anti-inflammatory agents of questionable relevance. In fact, as several pieces of preclinical and clinical research convergingly suggest, timely and targeted potentiation rather than inhibition of inflammatory responses may actually be beneficial in patients who are characterized by suppressed microglia function in the face of systemic low-grade inflammation. The deleterious impact of chronic stress-associated inflammation on the systemic level may, thus, need to be held in context with the - often not readily apparent - adaptive payoffs of low-grade inflammation at the tissue level.
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Affiliation(s)
- Kostas Patas
- Department of Biopathology and Laboratory Medicine, Eginition University Hospital, Athens, Greece
| | - Dewleen G. Baker
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, San Diego, CA, USA
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - Agorastos Agorastos
- VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, San Diego, CA, USA
- Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
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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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Wood HJ, Babusci C, Bendall S, Sarpal DK, Jones N. Trauma and Trauma-Informed Care in Early Intervention in Psychosis: State of Implementation and Provider Views on Challenges. Psychiatr Serv 2023; 74:1240-1246. [PMID: 37194314 DOI: 10.1176/appi.ps.20220624] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Although trauma is increasingly recognized as a major risk factor for psychosis and for its link to treatment outcomes, the landscape of trauma-related practices in specialized early psychosis services in the United States and other countries remains only poorly characterized. Research documenting the perspectives of frontline providers is also lacking. The primary goals of this study were to document the state of trauma-related policy implementation in early intervention in psychosis (EIP) programs and to gather provider perspectives. METHODS This was a mixed-methods project involving an international EIP provider survey, followed by in-depth provider interviews. The survey was disseminated in Australia, Canada, Chile, the United Kingdom, and the United States. In total, 164 providers, representing 110 unique sites, completed the survey. Frequencies were calculated for responses to survey items, and open-ended responses were analyzed with a systematic content analysis. RESULTS The survey findings suggested low implementation rates for a variety of assessment and support practices related to trauma and trauma-informed care. Coding of open-ended responses revealed numerous concerns and uncertainties among providers regarding the relationship between trauma and psychosis and the state of the EIP field. CONCLUSIONS An expansion of research and service development aimed at better meeting the trauma-related needs of young people with psychosis is essential, with implications for EIP outcomes and service user and staff experiences.
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Affiliation(s)
- Helen J Wood
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Christina Babusci
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Sarah Bendall
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Deepak K Sarpal
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
| | - Nev Jones
- Services for the Treatment of Early Psychosis, UPMC Western Psychiatric Hospital, Pittsburgh (Wood, Sarpal); School of Social Work (Babusci, Jones) and Department of Psychiatry (Sarpal), University of Pittsburgh, Pittsburgh; Centre for Youth Mental Health, University of Melbourne, and Orygen, Melbourne (Bendall)
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Sorjonen K, Melin B. Prospective associations between social support and posttraumatic stress disorder may be spurious: A re-meta-analysis of longitudinal studies and a simulation. J Affect Disord 2023; 340:174-180. [PMID: 37557992 DOI: 10.1016/j.jad.2023.08.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
A recent meta-analysis concluded to have found proof for both a social causation model, according to which social support protects against posttraumatic stress disorder (PTSD), and a social selection model, which claims that PTSD erodes social support. However, the prospective cross-lagged effects were estimated while adjusting for a prior measurement of the outcome and this method is vulnerable for spurious findings due to correlations with residuals and regression toward the mean. The present re-analyses of the meta-analytic effects indicated that depending on used model one can choose to claim that social support has either a decreasing, an increasing, or no prospective effect on subsequent change in PTSD symptom severity, and vice versa. Therefore, claims over and above a negative cross-sectional correlation between social support and PTSD, including the social causation and social selection models, can be questioned. The findings were validated by analyses of simulated data, which indicated that prospective effects were not necessary for the observed meta-analytic associations.
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Affiliation(s)
- Kimmo Sorjonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Bo Melin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Langeslag SJE, Posey ZW. Factors that contribute to an inability to remember an important aspect of a traumatic event. Memory 2023; 31:1402-1411. [PMID: 37870905 DOI: 10.1080/09658211.2023.2268304] [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] [Received: 05/25/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
Dissociative amnesia is controversial. We tested other factors that could contribute to an inability to remember an important aspect of a traumatic event: how traumatic the event was, organic amnesia, dissociative state, childhood amnesia, expression suppression, sleep disturbance, repeated experiences, and ordinary forgetting. Trauma survivors who reported an inability to remember an important aspect of a traumatic event rated the event as traumatic as trauma survivors who reported no such inability to remember. Moreover, all cases of an inability to remember an important aspect of the traumatic event could be explained by at least one factor other than dissociative amnesia. These findings are contrary to dissociative amnesia. Compared to participants who reported no inability to remember an important aspect of the traumatic event, participants who did report an inability to remember were more likely to (1) have felt disconnected from their body during the traumatic event, which may have altered memory encoding, (2) have experienced sleep problems in the year after the traumatic event, which may have reduced memory consolidation, and (3) have experienced the traumatic event repeatedly, which may have led to less detailed memories. These findings have implications for the inclusion of dissociative amnesia in the DSM.
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Affiliation(s)
- Sandra J E Langeslag
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Zachary W Posey
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
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Janssen E, Spauwen P, Rijnen S, Ponds R. Exploration of eye movement desensitization and reprocessing in treating posttraumatic stress-disorder in patients with acquired brain injury: a retrospective case series. Eur J Psychotraumatol 2023; 14:2264117. [PMID: 37860867 PMCID: PMC10591538 DOI: 10.1080/20008066.2023.2264117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/10/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is prevalent in people with acquired brain injury (ABI). Despite the established efficacy of eye movement desensitization and reprocessing (EMDR) for PTSD in general, evaluation studies on EMDR in ABI patients with PTSD are limited.Objective: The aim of this study is to explore clinical features, treatment characteristics, feasibility and first indications of efficacy of EMDR in adult ABI patients with PTSD.Method: This retrospective consecutive case series included ABI patients, who received at least one session of EMDR for PTSD between January 2013 and September 2020. PTSD symptoms were measured using the Impact of Event Scale (IES) pre- and post-treatment. Affective distress was measured using the Subjective Units of Distress (SUD) pre- and post-treatment of the first target.Results: Sixteen ABI patients (median age 46 years, 50% males), with predominantly moderate or severe TBI (50%) or stroke (25%) were included. Treatment duration was a median of seven sessions. Post-treatment IES scores were significantly lower than pre-treatment scores (p < .001). In 81% of the cases there was an individual statistically and clinically relevant change in IES score. Mean SUD scores of the first target were significantly lower at the end of treatment compared to scores at the start of treatment (p < .001). In 88% of the patients full desensitization to a SUD of 0-1 of the first target was accomplished. Only few adjustments to the standard EMDR protocol were necessary.Conclusions: Findings suggest that EMDR is a feasible, well tolerated and potentially effective treatment for PTSD in ABI patients. For clinical practice in working with ABI patients, it is advised to consider EMDR as a treatment option.
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Affiliation(s)
- E.P.J. Janssen
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands
- Limburg Brain Injury Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - P.J.J. Spauwen
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
| | - S.J.M. Rijnen
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands
- Limburg Brain Injury Center, Maastricht, the Netherlands
| | - R.W.H.M. Ponds
- Limburg Brain Injury Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centre location Vrije Universiteit, Amsterdam, the Netherlands
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Benfer N, Howell MK, Lucksted A, Romero EG, Drapalski AL. Self-Stigma and PTSD: Conceptualization and Implications for Research and Treatment. Psychiatr Serv 2023; 74:1081-1083. [PMID: 36935625 DOI: 10.1176/appi.ps.20220397] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Preliminary empirical evidence suggests that self-stigma may be a significant problem for those with posttraumatic stress disorder (PTSD). Although research on self-stigma for persons with PTSD is limited, some PTSD symptoms, such as negative thoughts about oneself, feelings of shame, and avoidance-particularly of social interactions-may be conceptually related to self-stigma, potentially explaining the co-occurrence and relevance of self-stigma in PTSD. This Open Forum reviews how the social cognitive model may explain the co-occurrence of self-stigma and PTSD, considers how this model may inform treatment approaches for self-stigma in PTSD, and identifies next steps to empirically test the proposed theory.
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Affiliation(s)
- Natasha Benfer
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston (Benfer) VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore (Howell, Lucksted, Romero, Drapalski); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Lucksted, Romero, Drapalski)
| | - Mary Katherine Howell
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston (Benfer) VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore (Howell, Lucksted, Romero, Drapalski); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Lucksted, Romero, Drapalski)
| | - Alicia Lucksted
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston (Benfer) VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore (Howell, Lucksted, Romero, Drapalski); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Lucksted, Romero, Drapalski)
| | - Erin G Romero
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston (Benfer) VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore (Howell, Lucksted, Romero, Drapalski); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Lucksted, Romero, Drapalski)
| | - Amy L Drapalski
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston (Benfer) VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore (Howell, Lucksted, Romero, Drapalski); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Lucksted, Romero, Drapalski)
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12
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Sala-Hamrick KJ, Braciszewski JM, Yeh HH, Zelenak L, Westphal J, Beebani G, Frank C, Simon GE, Owen-Smith AA, Rossom RC, Lynch F, Lu CY, Waring SC, Harry ML, Beck A, Daida YG, Ahmedani BK. Diagnosed Posttraumatic Stress Disorder and Other Trauma-Associated Stress Disorders and Risk for Suicide Mortality. Psychiatr Serv 2023; 74:936-942. [PMID: 37143334 PMCID: PMC10497061 DOI: 10.1176/appi.ps.202100244] [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] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Strong evidence exists for posttraumatic stress disorder (PTSD) as a risk factor for suicidal thoughts and behaviors across diverse populations. However, few empirical studies have examined PTSD and other trauma-associated stress disorders as risk factors for suicide mortality among health system populations. This study aimed to assess trauma-associated stress diagnoses as risk factors for suicide mortality in a U.S. health system population. METHODS This case-control, matched-design study examined individuals who died by suicide between 2000 and 2015 and had received care from nine U.S. health systems affiliated with the Mental Health Research Network (N=3,330). Individuals who died by suicide were matched with individuals from the general health system population (N=333,000): 120 individuals with PTSD who died by suicide were matched with 1,592 control group members, 84 with acute reaction to stress were matched with 2,218 control individuals, and 331 with other stress reactions were matched with 8,174 control individuals. RESULTS After analyses were adjusted for age and sex, individuals with any trauma-associated stress condition were more likely to have died by suicide. Risk was highest among individuals with PTSD (adjusted OR [AOR]=10.10, 95% CI=8.31-12.27), followed by those with other stress reactions (AOR=5.38, 95% CI=4.78-6.06) and those with acute reaction to stress (AOR=4.49, 95% CI=3.58-5.62). Patterns of risk remained the same when the analyses were adjusted for any comorbid psychiatric condition. CONCLUSIONS All trauma-associated stress disorders are risk factors for suicide mortality, highlighting the importance of health system suicide prevention protocols that consider the full spectrum of traumatic stress diagnoses.
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Affiliation(s)
- Kelsey J Sala-Hamrick
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Logan Zelenak
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ganj Beebani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances Lynch
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa L Harry
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
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Morales T, Stamper C, Brenner L. High molar ratios of tumor necrosis factor α (TNF α) soluble receptors I and II to the TNF ligand in human plasma from male veterans with comorbid posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Eur J Psychiatry 2023; 37:141-148. [PMID: 37577070 PMCID: PMC10421642 DOI: 10.1016/j.ejpsy.2023.03.003] [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] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background and Objectives Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with chronic inflammation, as inferred from increased, but variable, peripheral levels of cytokines. We sought proof of concept for the notion that peripheral cytokine binding proteins and/or soluble receptors can confound measures of cytokines in those with a history of physical and psychological traumatic exposures. Efforts were focused on one of the major cytokines involved in inflammation, tumor necrosis factor-α (TNF-α). Methods We examined blood plasma concentrations of TNF-α, its soluble receptors (TNF-soluble receptors (sR) I and TNFsRII), and C-reactive protein (CRP-1) in a cohort of US Veterans. In a previous study, CRP-1 was shown to be reduced by probiotic anti-inflammatory treatment in this patient cohort. All participants (n = 22) were diagnosed with PTSD and had a history of mild TBI with persistent post-concussive symptoms. Exclusion criteria included medications directly targeting inflammation. Results Molar concentrations of soluble TNFsRI and II exceeded concentrations of the TNF-α ligand. TNFsRI, but not TNFsRII, was significantly associated with CRP-1 (Spearman Rho correlations = 0.518; p=.016 and 0.365; p = .104, respectively). Conclusions TNF soluble receptors may bind to and sequester free TNF-α, suggesting that only measuring ligand concentrations may not provide a fully comprehensive view of inflammation, and potentially lead to inaccurate conclusions. TNFsRI concentration may provide a better estimate of inflammation than TNF-α for those with PTSD and post-acute mTBI with post-concussive symptoms, a hypothesis that invites further testing in larger studies.
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Affiliation(s)
- T.I Morales
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO 80045-8020, USA
- Departments of Psychiatry, University of Colorado, Anschutz Medical Campus Aurora, CO 80045, USA
| | - C.E Stamper
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO 80045-8020, USA
- Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus Aurora, CO 80045, USA
| | - L.A Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO 80045-8020, USA
- Departments of Psychiatry, University of Colorado, Anschutz Medical Campus Aurora, CO 80045, USA
- Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus Aurora, CO 80045, USA
- Neurology, University of Colorado, Anschutz Medical Campus Aurora, CO 80045, USA
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14
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Mäkelä T, Saisto T, Salmela-Aro K, Miettinen J, Sintonen H, Rouhe H. Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study. BMC Pregnancy Childbirth 2023; 23:468. [PMID: 37349712 DOI: 10.1186/s12884-023-05790-4] [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: 11/26/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples. METHODS In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument. RESULTS PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women's mean 15D score was lower than partners' and that of age- and gender-standardized general population, while partners' mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively). CONCLUSIONS PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.
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Affiliation(s)
- Tia Mäkelä
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland.
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland.
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
| | - Katariina Salmela-Aro
- Department of Educational Sciences, University of Helsinki, PO BOX 9, Helsinki, 00014, Finland
| | - Jenny Miettinen
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
- Espoo Health Care Center, City of Espoo, PO BOX 1, Espoo, 02070, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO BOX 20, Helsinki, 00014, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
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Richerson JT, Wagner TH. Service Dogs for Veterans With PTSD. Psychiatr Serv 2023; 74:668-669. [PMID: 37259586 DOI: 10.1176/appi.ps.20230164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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16
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Princip M, Ledermann K, von Känel R. Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Curr Cardiol Rep 2023; 25:455-465. [PMID: 37129760 DOI: 10.1007/s11886-023-01870-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. RECENT FINDINGS A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Veraart J, van Westenbrugge M, van Wulfften Palthe J, van der Meij A, Schoevers R, de Jong J. Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder. Heliyon 2023; 9:e15883. [PMID: 37223704 PMCID: PMC10200841 DOI: 10.1016/j.heliyon.2023.e15883] [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: 01/02/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Ketamine and its S-enantiomer esketamine are novel pharmacotherapeutic options for treatment resistant depression (TRD). There is growing evidence on the efficacy for other psychiatric disorders, including posttraumatic stress disorder (PTSD). It is hypothesized that psychotherapy may further potentiate the effects of (es)ketamine in psychiatric disorders. Methods Repeated oral esketamine was prescribed once or twice weekly in five patients suffering from TRD and comorbid PTSD. We describe the clinical effects of esketamine and report data from psychometric instruments and patients' perspectives. Results Esketamine treatment duration ranged from six weeks to a year. In four patients, we observed improvement in depressive symptoms, increased resilience and more receptiveness to psychotherapy. One patient experienced symptom worsening in response to a threatening situation during esketamine treatment, highlighting the need for a safe setting. Discussion (Es)ketamine treatment within a psychotherapeutic framework appears promising in patients with treatment resistant symptoms of depression and PTSD. Controlled trials are warranted to validate these results and to elucidate the optimal treatment methods.
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Affiliation(s)
- J.K.E. Veraart
- PsyQ Depression Treatment Centre, Parnassia Psychiatric Institute, The Hague, the Netherlands
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - M. van Westenbrugge
- Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | - A. van der Meij
- Pro Persona Mental Health Care, Depression Expertise Centre, Nijmegen, the Netherlands
| | - R.A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - J. de Jong
- PsyQ Psychotrauma Department, The Hague, the Netherlands
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18
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Brown LA, Zhu Y, Coon H, Young-McCaughan S, Fina BA, Dondanville KA, Hernandez AM, Litz BT, Mintz J, Maurer DM, Kelly KM, Peterson AL, Bryan CJ, Williamson DE. Phenotypic predictors of suicide subtypes from pre-to postdeployment in active duty military personnel. J Psychiatr Res 2023; 160:163-170. [PMID: 36804111 DOI: 10.1016/j.jpsychires.2023.02.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023]
Abstract
Military service members are at increased risk for suicide, but there are few strategies for detecting those who are at highest risk after a deployment. Using all available data collected from 4119 Military service members before and after their deployment to Iraq for Operation Iraqi Freedom, we tested whether predeployment characteristics clustered together to predict postdeployment suicidal risk. Latent class analysis showed that three classes best characterized the sample at predeployment. Class 1 had significantly higher scores on PTSD severity pre- and postdeployment than Classes 2 and 3 (Ps < .001). At postdeployment, Class 1 also had a greater proportion of endorsement of lifetime and past year suicidal ideation than Classes 2 and 3 (Ps < .05) and a greater proportion of lifetime suicide attempts than Class 3 (P < .001). Class 1 also had a greater proportion of endorsement of past-30-days intention to act on suicidal thoughts than Classes 2 and 3 (Ps < .05) and past-30-days specific plan for suicide than Classes 2 and 3 (Ps < .05). The study showed that based only on predeployment data, it is possible to determine which service members might be at highest risk for suicidal ideation and behavior at postdeployment.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Yiqin Zhu
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Hillary Coon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Brooke A Fina
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ann Marie Hernandez
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Valiant Mental Health, San Antonio, TX, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Douglas M Maurer
- Department of Family and Community Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA; Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA
| | - Kevin M Kelly
- Department of Family and Community Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA; Office of Consultants to the Army Surgeon General, Washington, DC, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Douglas E Williamson
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
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19
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results. J Eat Disord 2023; 11:48. [PMID: 36973828 PMCID: PMC10044735 DOI: 10.1186/s40337-023-00773-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION We studied whether provisional posttraumatic stress disorder (PTSD) moderated discharge (DC) and 6-month follow-up (FU) outcomes of multi-modal, integrated eating disorder (ED) residential treatment (RT) based upon principles of cognitive processing therapy (CPT). METHODS ED patients [N = 609; 96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD completed validated assessments at admission (ADM), DC and 6-month FU to measure severity of ED, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life (EDQOL). We tested whether PTSD moderated the course of symptom change using mixed models analyses and if ED diagnosis, ADM BMI, age of ED onset and LGBTQ + orientation were significant covariates of change. Number of days between ADM and FU was used as a weighting measure. RESULTS Despite sustained improvements with RT in the total group, the PTSD group had significantly higher scores on all measures at all time points (p ≤ .001). Patients with (n = 261) and without PTSD (n = 348) showed similar symptom improvements from ADM to DC and outcomes remained statistically improved at 6-month FU compared to ADM. The only significant worsening observed between DC and FU was with MDD symptoms, yet all measures remained significantly lower than ADM at FU (p ≤ .001). There were no significant PTSD by time interactions for any of the measures. Age of ED onset was a significant covariate in the EDI-2, PHQ-9, STAI-T, and EDQOL models such that an earlier age of ED onset was associated with a worse outcome. ADM BMI was also a significant covariate in the EDE-Q, EDI-2, and EDQOL models, such that higher ADM BMI was associated with a worse ED and quality of life outcome. CONCLUSIONS Integrated treatment approaches that address PTSD comorbidity can be successfully delivered in RT and are associated with sustained improvements at FU. Improving strategies to prevent post-DC recurrence of MDD symptoms is an important and challenging area of future work.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Timothy D. Brewerton, MD, LLC, Mount Pleasant, SC, USA.
- Monte Nido and Affiliates, Miami, FL, USA.
| | | | | | - Molly M Perlman
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, FL, USA
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20
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Sun L, Shang Z, Wu L, Pan X, Sun L, Ouyang H, Huang H, Zhan J, Jia Y, Zhou Y, Bai Y, Xie W, Liu W. One-quarter of COVID-19 patients developed PTSD symptoms: A one-year longitudinal study. Psychiatry Res 2023; 323:115161. [PMID: 36934469 PMCID: PMC10011031 DOI: 10.1016/j.psychres.2023.115161] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
This study investigated the longitudinal development of PTSD symptoms and respiratory sequelae among COVID-19 patients one year after hospital discharge. The cumulative occurrence of probable PTSD in COVID-19 survivors (n = 329) was 26.7%, which significantly decreased over the 12-month period (23.1% to 4.3%). Non-severe patients showed marked improvement in all four clusters of PTSD symptoms at 12 months compared to 3 months, while severe patients only showed improvements in re-experiencing and numbing symptoms. Moreover, being female and having respiratory sequelae increased the risk for chronic PTSD. Psychological interventions are required for COVID-19 patients during long-term convalescence.
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Affiliation(s)
- Luna Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Zhilei Shang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Lili Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Xiao Pan
- Department of Medical Psychology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - LiangLiang Sun
- Department of Endocrinology and Metabolism, Changzheng Hospital, Naval Medical University, Shanghai, China; Optical Valley Branch of Maternal and Child Hospital of Hubei Province, Wuhan, China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Hai Huang
- Optical Valley Branch of Maternal and Child Hospital of Hubei Province, Wuhan, China; Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jingye Zhan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Yanpu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Yaoguang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Yonghai Bai
- Department of Medical Psychology, Changzheng Hospital, Naval Medical University, Shanghai, China; Optical Valley Branch of Maternal and Child Hospital of Hubei Province, Wuhan, China.
| | - Weifen Xie
- Optical Valley Branch of Maternal and Child Hospital of Hubei Province, Wuhan, China; Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China.
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China.
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21
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Li Y, Li N, Zhang L, Liu Y, Zhang T, Li D, Bai D, Liu X, Li L. Predicting PTSD symptoms in firefighters using a fear-potentiated startle paradigm and machine learning. J Affect Disord 2022; 319:294-299. [PMID: 36162659 DOI: 10.1016/j.jad.2022.09.094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
This study develops a fear-potentiated startle paradigm (FPS) and a machine learning approach to accurately predict PTSD symptoms using electrogram data. A three-phase fear-potentiated startle paradigm was designed to assess the conditioning, generalization, and extinction of fear. Electrooculogram and electrocardiogram signals were collected during the FPS. A total of 1107 Chinese firefighters participated in the study. The Chinese version PCL-C was administered to all subjects. A cutoff of 38 or higher is used to indicate PTSD symptoms. Electrogram features were extracted and selected to build a machine learning model to classify individuals. The machine learning model was 5-fold cross validated. The importance of the selected features was calculated. Classification performance metrics were evaluated for the machine learning model. The machine learning model can identify firefighters with a PCL-C score of 38 or above with sensitivity and specificity both above 0.85 when 5-fold cross validated on a 1107-person sample. The area under the receiver operating characteristic curve of the model is 0.93. Features related to fear generalization are found to be the most important. The proposed fear-potentiated startle paradigm and machine learning approach can accurately predict PTSD symptoms in Chinese firefighters, which can improve the screening and diagnosis of PTSD.
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Affiliation(s)
- Yuanhui Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Nan Li
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Liqun Zhang
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Yanru Liu
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | | | - Dai Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | | | - Xiang Liu
- Department of Industrial Engineering, Tsinghua University, Beijing, China.
| | - Lingjiang Li
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, China.
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22
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Gianoli MO, Meisler AW, Rosen MI. Proposed Changes to the Department of Veterans Affairs Disability Rating Rubric for Mental Disorders. Psychiatr Serv 2022:appips20220377. [PMID: 36510762 DOI: 10.1176/appi.ps.20220377] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The U.S. Department of Veterans Affairs (VA) provides disability benefits for general medical and mental health conditions related to military service. Despite advances in conceptualization, assessment, and diagnosis of mental disorders, the current rating rubric used to determine the award amounts received by veterans with posttraumatic stress disorder and other mental disorders has not been substantively revised since 1996. The VA recently proposed sweeping changes to the rating rubric for mental disorders, shifting the focus from a symptom-based algorithm to one based on functional impairment and bringing the rubric more in line with existing disability systems and guidelines. METHODS The authors examined the VA's current symptom-based rating rubric and reviewed and analyzed the proposed changes, including a comparison with other rating systems used for mental disorders. Research on the relationship between psychiatric symptoms and functional impairment is also discussed. RESULTS Bringing examination procedures in line with the new function-based rating schedule will require significant changes to current standard practice for both examiners and Veterans Benefits Administration raters. The new rubric requires more specific definitions, anchors, and operationalization of the domains of function in the rating schedule to improve reliability and validity. CONCLUSIONS The new system reflects an overdue shift away from a symptom-based formula toward real-world functioning. Concept study data suggest that the system may increase ratings for veterans awarded compensation, but the actual impact remains unknown. The authors discuss the implications of the new method for disability determination and offer suggestions for maximizing effective and fair implementation of the new rubric.
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Affiliation(s)
- Mayumi O Gianoli
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven
| | - Andrew W Meisler
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven
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23
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Zhu Y, Jha SC, Shutta KH, Huang T, Balasubramanian R, Clish CB, Hankinson SE, Kubzansky LD. Psychological distress and metabolomic markers: A systematic review of posttraumatic stress disorder, anxiety, and subclinical distress. Neurosci Biobehav Rev 2022; 143:104954. [PMID: 36368524 PMCID: PMC9729460 DOI: 10.1016/j.neubiorev.2022.104954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/12/2022] [Revised: 08/30/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Psychological distress can be conceptualized as an umbrella term encompassing symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), or stress more generally. A systematic review of metabolomic markers associated with distress has the potential to reveal underlying molecular mechanisms linking distress to adverse health outcomes. The current systematic review extends prior reviews of clinical depressive disorders by synthesizing 39 existing studies that examined metabolomic markers for PTSD, anxiety disorders, and subclinical psychological distress in biological specimens. Most studies were based on small sets of pre-selected candidate metabolites, with few metabolites overlapping between studies. Vast heterogeneity was observed in study design and inconsistent patterns of association emerged between distress and metabolites. To gain a more robust understanding of distress and its metabolomic signatures, future research should include 1) large, population-based samples and longitudinal assessments, 2) replication and validation in diverse populations, 3) and agnostic metabolomic strategies profiling hundreds of targeted and nontargeted metabolites. Addressing these research priorities will improve the scope and reproducibility of future metabolomic studies of psychological distress.
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Affiliation(s)
- Yiwen Zhu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Shaili C Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Katherine H Shutta
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Raji Balasubramanian
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Clary B Clish
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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24
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Jordan N, Stroupe KT, Richman J, Pogoda TK, Cao L, Kertesz S, Kyriakides TC, Bond GR, Davis LL. Comparing Service Use and Costs of Individual Placement and Support With Usual Vocational Services for Veterans With PTSD. Psychiatr Serv 2022; 73:1109-1116. [PMID: 35538744 DOI: 10.1176/appi.ps.202100197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Among veterans with posttraumatic stress disorder (PTSD), supported employment that utilizes the individual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs. METHODS A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Comparisons were also made to an 18-month postintervention period. RESULTS The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity services. Annual per-person costs of health services were approximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher utilization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to nonsignificant differences. The mean annual per-person vocational service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period. CONCLUSIONS In keeping with IPS’s intensive case management approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should examine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.
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Affiliation(s)
- Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Joshua Richman
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Terri K Pogoda
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Stefan Kertesz
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Tassos C Kyriakides
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Gary R Bond
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lori L Davis
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
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Suo X, Zuo C, Lan H, Li W, Li L, Kemp GJ, Wang S, Gong Q. Multilayer Network Analysis of Dynamic Network Reconfiguration in Adults With Posttraumatic Stress Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 8:452-461. [PMID: 36152949 DOI: 10.1016/j.bpsc.2022.09.003] [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] [Received: 04/26/2022] [Revised: 08/20/2022] [Accepted: 09/12/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Brain functional network abnormalities are reported in posttraumatic stress disorder (PTSD). Most resting-state functional magnetic resonance imaging studies have assumed that the functional networks remain static during the scans. How these might change dynamically in PTSD remains unclear. METHODS Resting-state functional magnetic resonance imaging data were collected from 71 noncomorbid, treatment-naïve patients with PTSD and 70 demographically matched, trauma-exposed non-PTSD control subjects. Network switching rate was used to characterize dynamic changes of individual resting-state functional networks. Results were analyzed by comparing switching rates between the PTSD and trauma-exposed non-PTSD groups, testing for diagnosis × sex interactions, and examining correlations with PTSD symptom severity. RESULTS At the global level, the PTSD group showed significantly lower network switching rates than the trauma-exposed non-PTSD group. These were observed mainly in the frontoparietal, default mode, and limbic networks at the subnetwork level and in the frontal and temporal regions at the nodal level. These network switching rate alterations were correlated with PTSD symptom severity. There were no significant effects of sex. CONCLUSIONS These disruptions of dynamic functional network stability, reflected by lower network switching rates in the resting state, are a feature of PTSD and suggest that the frontoparietal, default mode, and limbic networks may play a critical role in the underlying neural mechanisms.
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Affiliation(s)
- Xueling Suo
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chao Zuo
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Huan Lan
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Wenbin Li
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lingjiang Li
- Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Song Wang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Qiyong Gong
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China.
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26
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Romaniuk M, Xia Y, Fisher G, Pannek K, Fripp J, Evans J, Rose S. The relationship between chronic PTSD, cortical volumetry and white matter microstructure among Australian combat veterans. Mil Med Res 2022; 9:50. [PMID: 36114591 PMCID: PMC9482182 DOI: 10.1186/s40779-022-00413-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been associated with volumetric and white matter microstructural changes among general and veteran populations. However, regions implicated have greatly varied and often conflict between studies, potentially due to confounding comorbidities within samples. This study compared grey matter volume and white matter microstructure among Australian combat veterans with and without a lifetime diagnosis of PTSD, in a homogenous sample assessed for known confounding comorbidities. METHODS Sixty-eight male trauma-exposed veterans (16 PTSD-diagnosed; mean age 69 years) completed a battery of psychometric assessments and underwent magnetic resonance and diffusion tensor imaging. Analyses included tract-based spatial statistics, voxel-wise analyses, diffusion connectome-based group-wise analysis, and volumetric analysis. RESULTS Significantly smaller grey matter volumes were observed in the left prefrontal cortex (P = 0.026), bilateral middle frontal gyrus (P = 0.021), and left anterior insula (P = 0.048) in the PTSD group compared to controls. Significant negative correlations were found between PTSD symptom severity and fractional anisotropy values in the left corticospinal tract (R2 = 0.34, P = 0.024) and left inferior cerebellar peduncle (R2 = 0.62, P = 0.016). No connectome-based differences in white matter properties were observed. CONCLUSIONS Findings from this study reinforce reports of white matter alterations, as indicated by reduced fractional anisotropy values, in relation to PTSD symptom severity, as well as patterns of reduced volume in the prefrontal cortex. These results contribute to the developing profile of neuroanatomical differences uniquely attributable to veterans who suffer from chronic PTSD.
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Affiliation(s)
- Madeline Romaniuk
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, 4120, Australia. .,Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, 4067, Australia.
| | - Ying Xia
- The Australian E-Health Research Centre, CSIRO Health and Biosecurity, Herston, 4029, Australia
| | - Gina Fisher
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, 4120, Australia
| | - Kerstin Pannek
- The Australian E-Health Research Centre, CSIRO Health and Biosecurity, Herston, 4029, Australia
| | - Jurgen Fripp
- The Australian E-Health Research Centre, CSIRO Health and Biosecurity, Herston, 4029, Australia
| | - Justine Evans
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, 4120, Australia
| | - Stephen Rose
- The Australian E-Health Research Centre, CSIRO Health and Biosecurity, Herston, 4029, Australia
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27
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Spitzer C, Lübke L, Müller S, Lindstädt T, Gallinat C. Childhood maltreatment, traumatic experiences, and posttraumatic stress disorder in pathological skin picking: An online case-control study. Gen Hosp Psychiatry 2022; 78:9-13. [PMID: 35752025 DOI: 10.1016/j.genhosppsych.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although traumatic stress including childhood maltreatment (CM) has a profound impact on mental health, its relation to pathological skin picking (PSP) has been understudied and results remain inconclusive. Likewise, posttraumatic stress disorder (PTSD) as the most typical sequelae of traumatic stress has hardly been investigated in those with PSP. The objective of our online case-control study was to shed further light on this issue. METHODS Using an anonymous online survey, 325 adult participants with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7 were administered the Childhood Trauma Questionnaire (CTQ), the Short Screening Scale for DSM-IV PTSD (PTSD-7) including a list of traumatic events, and a brief measure of psychopathological distress. They were compared to an age-, sex-, and education-matched control group recruited online by means of analyses of variance (ANOVA). RESULTS The PSP sample scored significantly higher on the CTQ dimensions of sexual and emotional abuse as well as emotional neglect with small to moderate effect sizes (d between 0.27 and 0.49). Accounting for psychological distress, the only significant difference related to emotional abuse with a small effect (d = 0.23). Participants with PSP reported significantly more traumatic experiences in adulthood than the control group (59.1% vs. 38.2%; χ2(1; N=638) = 28.02, p < .001). Among those with PSP, a probable diagnosis of PTSD was found in 44 (13.5%) compared to zero cases in the control group. CONCLUSIONS Our findings indicate that emotional abuse in childhood may be of relevance in skin picking. Since exposure to traumatic events in adulthood as well as PTSD seem to be more frequent in those with PSP compared to a control group, it might be worthwhile to consider these factors in the assessment of patients with skin picking.
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Tabb LP, Rich JA, Waite D, Alberto C, Harris E, Gardner J, Gentile N, Corbin TJ. Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence. J Urban Health 2022; 99:669-679. [PMID: 35699886 PMCID: PMC9360210 DOI: 10.1007/s11524-022-00628-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 01/31/2023]
Abstract
Our study examines the association between Adverse Childhood Experience (ACE) exposure and posttraumatic stress disorder (PTSD) symptoms among survivors of violence. In this cross-sectional study, an ACE questionnaire and PTSD Checklist for DSM-5 (PCL-5) were completed by 147 participants ≤ 3 months after presenting to a Philadelphia, PA emergency department between 2014 and 2019 with a violent injury. This study treated ACEs, both separate and cumulative, as exposures and PTSD symptom severity as the outcome. Most participants (63.3%) met criteria for provisional PTSD, 90% reported experiencing ≥ 1 ACE, and 39% reported experiencing ≥ 6 ACEs. Specific ACEs were associated with increasing PCL-5 scores and increased risk for provisional PTSD. Additionally, as participants' cumulative ACE scores increased, their PCL-5 scores worsened (b = 0.16; p < 0.05), and incremental ACE score increases predicted increased odds for a positive provisional PTSD screen. Results provide further evidence that ACEs exacerbate the development of PTSD in young survivors of violence. Future research should explore targeted interventions to treat PTSD among survivors of interpersonal violence.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - John A Rich
- Center for Nonviolence & Social Justice, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Daria Waite
- Center for Nonviolence & Social Justice, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Cinthya Alberto
- Department of Health Management & Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Erica Harris
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - James Gardner
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Nina Gentile
- Department of Emergency Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Theodore J Corbin
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, 60612, USA.
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Ryklief Z, Suliman S, Hemmings SMJ, van den Heuvel LL, Seedat S. Rates of and factors associated with atopy and allergies in posttraumatic stress disorder as compared to controls. J Psychosom Res 2022; 158:110938. [PMID: 35580455 DOI: 10.1016/j.jpsychores.2022.110938] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/25/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years, SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017. METHODS Self-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma. RESULTS Rates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD. CONCLUSIONS Rates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.
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Affiliation(s)
- Zulfa Ryklief
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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Benzakour L, Kakoraiti E, Perrin A, Cereghetti S, Assal F. Psychiatric reaction of an intensive care unit survivor in the context of coronavirus disease 2019: a case report. J Med Case Rep 2022; 16:263. [PMID: 35739582 PMCID: PMC9218700 DOI: 10.1186/s13256-022-03450-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The coronavirus disease 2019 pandemic has had a serious impact on global mental health, particularly in intensive care unit survivors. Given the lethal potential and unpredictability of coronavirus disease 2019, a high risk of posttraumatic stress disorder was identified in the beginning of the crisis. There are insufficient details in current literature and no official guidelines available for the treatment and follow-up of acute stress disorder and the prevention of posttraumatic stress disorder for intensive care unit survivors in the context of coronavirus disease 2019. Case presentation We hereby describe a 67-year-old Swiss patient presenting a psychiatric reaction in the context of coronavirus disease 2019. He was admitted to the intensive care unit due to severe acute respiratory distress syndrome from severe acute respiratory syndrome coronavirus 2 and intubated for 13 days. Afterwards, there was a severe worsening of acute renal failure prompting hemodialysis, and he developed delirium. Psychiatric liaison was requested 4 days post-intubation because the patient presented residual symptoms of delirium, false memories about the real context of his medical care, and ideas of persecution toward medical caregivers. He suffered from a very strong peritraumatic reaction, then developed an acute stress disorder linked with his care on the intensive care unit. We looked for strategies to prevent progression from acute stress disorder to posttraumatic stress disorder. We proceeded to the following therapeutic interventions: intensive psychiatric follow-up, intensive care unit diary, and low-dose antipsychotic treatment. The aim of our psychotherapeutic approach was to allow him to increase his feeling of security and to cope with the reality of his traumatic experience. He showed clinical improvement in his mental state after 3 months, despite several predictive factors of evolution to post-intensive care unit posttraumatic stress disorder. Conclusion This case report illustrates how a delusional clinical presentation after intensive care in the context of coronavirus disease 2019 can hide psychotraumatic symptoms. It is important to highlight that the intensive care unit diary completed by the intensive care team and the follow-up by the psychiatric liaison team helped the patient reconstruct an appropriate and coherent account. Further studies are needed to determine the psychiatric effects of coronavirus disease 2019 and to assess early and appropriate psychiatric intervention for patients hospitalized for coronavirus disease 2019 to prevent posttraumatic stress disorder.
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Affiliation(s)
- Lamyae Benzakour
- Department of Psychiatry, Liaison Psychiatry Unit, University Hospitals of Geneva, 4, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.
| | - Emmanouela Kakoraiti
- Department of Psychiatry, Liaison Psychiatry Unit, University Hospitals of Geneva, 4, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Alexandre Perrin
- Department of Psychiatry, Liaison Psychiatry Unit, University Hospitals of Geneva, 4, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Sara Cereghetti
- Dpartment of Medicine, Intensive Care Service, University Hospitals of Geneva, 4, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
| | - Frédéric Assal
- Department of Neurosciences, Service of Neurology, University Hospital of Geneva, 4, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
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31
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Bountress KE, Brick LA, Sheerin C, Grotzinger A, Bustamante D, Hawn SE, Gillespie N, Kirkpatrick RM, Kranzler H, Morey R, Edenberg HJ, Maihofer AX, Disner S, Ashley-Koch A, Peterson R, Lori A, Stein DJ, Kimbrel N, Nievergelt C, Andreassen OA, Luykx J, Javanbakht A, Youssef NA, Amstadter AB. Alcohol use and alcohol use disorder differ in their genetic relationships with PTSD: A genomic structural equation modelling approach. Drug Alcohol Depend 2022; 234:109430. [PMID: 35367939 PMCID: PMC9018560 DOI: 10.1016/j.drugalcdep.2022.109430] [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: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Posttraumatic Stress Disorder (PTSD) is associated with increased alcohol use and alcohol use disorder (AUD), which are all moderately heritable. Studies suggest the genetic association between PTSD and alcohol use differs from that of PTSD and AUD, but further analysis is needed. BASIC PROCEDURES We used genomic Structural Equation Modeling (genomicSEM) to analyze summary statistics from large-scale genome-wide association studies (GWAS) of European Ancestry participants to investigate the genetic relationships between PTSD (both diagnosis and re-experiencing symptom severity) and a range of alcohol use and AUD phenotypes. MAIN FINDINGS When we differentiated genetic factors for alcohol use and AUD we observed improved model fit relative to models with all alcohol-related indicators loading onto a single factor. The genetic correlations (rG) of PTSD were quite discrepant for the alcohol use and AUD factors. This was true when modeled as a three-correlated-factor model (PTSD-AUD rG:.36, p < .001; PTSD-alcohol use rG: -0.17, p < .001) and as a Bifactor model, in which the common and unique portions of alcohol phenotypes were pulled out into an AUD-specific factor (rG with PTSD:.40, p < .001), AU-specific factor (rG with PTSD: -0.57, p < .001), and a common alcohol factor (rG with PTSD:.16, NS). PRINCIPAL CONCLUSIONS These results indicate the genetic architecture of alcohol use and AUD are differentially associated with PTSD. When the portions of variance unique to alcohol use and AUD are extracted, their genetic associations with PTSD vary substantially, suggesting different genetic architectures of alcohol phenotypes in people with PTSD.
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Affiliation(s)
- Kaitlin E Bountress
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA.
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Quantitative Sciences Program, Alpert Medical School at Brown University, USA
| | - Christina Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Andrew Grotzinger
- Behavioral, Psychiatric, and Statistical Genetics, Institute for Behavior Genetics, University of Colorado Boulder, USA
| | - Daniel Bustamante
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA; Integrative Life Sciences Doctoral Program, Virginia Commonwealth University, USA
| | - Sage E Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Nathan Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Robert M Kirkpatrick
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Henry Kranzler
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Rajendra Morey
- VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham VAMC, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California, San Diego, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Seth Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Allison Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Roseann Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University, USA
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nathan Kimbrel
- VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham VAMC, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Caroline Nievergelt
- Department of Psychiatry, University of California, San Diego, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jurjen Luykx
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Department of Psychiatry and Neuropsychology Maastricht, The Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Department of Psychiatry Utrecht, University, Utrecht, The Netherlands; Outpatient second opinion clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic (STARC), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Nagy A Youssef
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
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Al Yacoub ON, Awwad HO, Zhang Y, Standifer KM. Therapeutic potential of nociceptin/orphanin FQ peptide (NOP) receptor modulators for treatment of traumatic brain injury, traumatic stress, and their co-morbidities. Pharmacol Ther 2022; 231:107982. [PMID: 34480968 DOI: 10.1016/j.pharmthera.2021.107982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 06/01/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
The nociceptin/orphanin FQ (N/OFQ) peptide (NOP) receptor is a member of the opioid receptor superfamily with N/OFQ as its endogenous agonist. Wide expression of the NOP receptor and N/OFQ, both centrally and peripherally, and their ability to modulate several biological functions has led to development of NOP receptor modulators by pharmaceutical companies as therapeutics, based upon their efficacy in preclinical models of pain, anxiety, depression, Parkinson's disease, and substance abuse. Both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are debilitating conditions that significantly affect the quality of life of millions of people around the world. PTSD is often a consequence of TBI, and, especially for those deployed to, working and/or living in a war zone or are first responders, they are comorbid. PTSD and TBI share common symptoms, and negatively influence outcomes as comorbidities of the other. Unfortunately, a lack of effective therapies or therapeutic agents limits the long term quality of life for either TBI or PTSD patients. Ours, and other groups, demonstrated that PTSD and TBI preclinical models elicit changes in the N/OFQ-NOP receptor system, and that administration of NOP receptor ligands alleviated some of the neurobiological and behavioral changes induced by brain injury and/or traumatic stress exposure. Here we review the past and most recent progress on understanding the role of the N/OFQ-NOP receptor system in PTSD and TBI neurological and behavioral sequelae. There is still more to understand about this neuropeptide system in both PTSD and TBI, but current findings warrant further examination of the potential utility of NOP modulators as therapeutics for these disorders and their co-morbidities. We advocate the development of standards for common data elements (CDE) reporting for preclinical PTSD studies, similar to current preclinical TBI CDEs. That would provide for more standardized data collection and reporting to improve reproducibility, interpretation and data sharing across studies.
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Affiliation(s)
- Omar N Al Yacoub
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America
| | - Hibah O Awwad
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America
| | - Yong Zhang
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America
| | - Kelly M Standifer
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America.
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Hunt AD, Adams LM. Health Care Access Alone Falling Short of Health Care Equity. Psychiatr Serv 2022; 73:210-211. [PMID: 34470503 DOI: 10.1176/appi.ps.202100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron D Hunt
- Department of Psychology (Hunt, Adams) and Women and Gender Studies Program (Adams), George Mason University, Fairfax, Virginia
| | - Leah M Adams
- Department of Psychology (Hunt, Adams) and Women and Gender Studies Program (Adams), George Mason University, Fairfax, Virginia
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Fitzgerald JM, Webb EK, Weis CN, Huggins AA, Bennett KP, Miskovich TA, Krukowski JL, deRoon-Cassini TA, Larson CL. Hippocampal Resting-State Functional Connectivity Forecasts Individual Posttraumatic Stress Disorder Symptoms: A Data-Driven Approach. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:139-149. [PMID: 34478884 PMCID: PMC8825698 DOI: 10.1016/j.bpsc.2021.08.007] [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] [Received: 03/14/2021] [Revised: 07/18/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a debilitating disorder, and there is no current accurate prediction of who develops it after trauma. Neurobiologically, individuals with chronic PTSD exhibit aberrant resting-state functional connectivity (rsFC) between the hippocampus and other brain regions (e.g., amygdala, prefrontal cortex, posterior cingulate), and these aberrations correlate with severity of illness. Previous small-scale research (n < 25) has also shown that hippocampal rsFC measured acutely after trauma is predictive of future severity using a region-of-interest-based approach. While this is a promising biomarker, to date, no study has used a data-driven approach to test whole-brain hippocampal FC patterns in forecasting the development of PTSD symptoms. METHODS A total of 98 adults at risk of PTSD were recruited from the emergency department after traumatic injury and completed resting-state functional magnetic resonance imaging (8 min) within 1 month; 6 months later, they completed the Clinician-Administered PTSD Scale for DSM-5 for assessment of PTSD symptom severity. Whole-brain rsFC values with bilateral hippocampi were extracted (using CONN) and used in a machine learning kernel ridge regression analysis (PRoNTo); a k-folds (k = 10) and 70/30 testing versus training split approach were used for cross-validation (1000 iterations to bootstrap confidence intervals for significance values). RESULTS Acute hippocampal rsFC significantly predicted Clinician-Administered PTSD Scale for DSM-5 scores at 6 months (r = 0.30, p = .006; mean squared error = 120.58, p = .006; R2 = 0.09, p = .025). In post hoc analyses, hippocampal rsFC remained significant after controlling for demographics, PTSD symptoms at baseline, and depression, anxiety, and stress severity at 6 months (B = 0.59, SE = 0.20, p = .003). CONCLUSIONS Findings suggest that functional connectivity of the hippocampus across the brain acutely after traumatic injury is associated with prospective PTSD symptom severity.
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Affiliation(s)
| | - Elisabeth Kate Webb
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Carissa N. Weis
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Ashley A. Huggins
- Medical University of South Carolina, Department of Psychiatry, Charleston, SC, USA
| | | | | | | | - Terri A. deRoon-Cassini
- Medical College of Wisconsin, Department of Surgery, Division of Trauma & Acute Care Surgery, Milwaukee, WI, USA
| | - Christine L. Larson
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI, USA
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Romero-Sanchiz P, Mahu IT, Barrett SP, Salmon JP, Al-Hamdani M, Swansburg JE, Stewart SH. Craving and emotional responses to trauma and cannabis cues in trauma-exposed cannabis users: Influence of PTSD symptom severity. Addict Behav 2022; 125:107126. [PMID: 34655908 DOI: 10.1016/j.addbeh.2021.107126] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 01/25/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022]
Abstract
Conditioned craving to trauma cues and avoidance learning have both been implicated in the high concurrence of trauma-related distress and substance misuse. Using a cue-exposure paradigm involving personalized trauma, cannabis, and neutral cues, we examined if conditioned craving and/or elevated negative affect to trauma cues are mechanisms linking PTSD and cannabis use disorder. Fifty-one trauma-exposed cannabis users were randomly presented the three cue types. Craving and emotional responses were evaluated after each cue using the Marijuana Craving Questionnaire-Short Form (Heishman et al., 2001) and the Positive and Negative Affect Schedule (Watson et al., 1988). Relief cannabis craving (compulsivity and emotionality) was significantly higher after trauma than cannabis and neutral cues (p's < 0.001) and was also higher among those with more severe PTSD symptoms (p's < 0.05). The relationship between PTSD symptom severity and cannabis craving was stronger after trauma than cannabis cues for the compulsivity component of craving (p < .05). Relief craving was also higher after the cannabis cue than after the neutral cue (expectancy and purposefulness; p < .001). Negative affect was significantly higher: after trauma than cannabis and neutral cues (p's < 0.001); and among those with more severe PTSD symptoms (p < . 005). Positive affect was significantly lower after trauma than cannabis cues (p < .05). Trauma cue exposure might promote cannabis misuse through conditioned craving as well as the desire to relieve negative affect. Conditioned cannabis craving involving an uncontrollable compulsion to use cannabis in response to trauma reminders appears particularly likely among cannabis users with more severe PTSD symptoms.
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Affiliation(s)
- Pablo Romero-Sanchiz
- University of Roehampton, School of Psychology, Whitelands College, SW15 4JD, Holybourne Ave, London, United Kingdom; Dalhousie University, Department of Psychology and Neuroscience, Life Sciences Centre, 1355 Oxford Street, PO Box 15000, B3H 4J1 Halifax, Nova Scotia, Canada.
| | - Ioan T Mahu
- Dalhousie University, Department of Psychology and Neuroscience, Life Sciences Centre, 1355 Oxford Street, PO Box 15000, B3H 4J1 Halifax, Nova Scotia, Canada
| | - Sean P Barrett
- Dalhousie University, Department of Psychology and Neuroscience, Life Sciences Centre, 1355 Oxford Street, PO Box 15000, B3H 4J1 Halifax, Nova Scotia, Canada
| | - Joshua P Salmon
- Dalhousie University, Department of Psychology and Neuroscience, Life Sciences Centre, 1355 Oxford Street, PO Box 15000, B3H 4J1 Halifax, Nova Scotia, Canada
| | - Mohammed Al-Hamdani
- Department of Psychology, Saint Mary's University, 923 Robie Street, B3H3C3, Nova Scotia, Canada
| | - Jennifer E Swansburg
- Dalhousie University, Department of Psychology and Neuroscience, Life Sciences Centre, 1355 Oxford Street, PO Box 15000, B3H 4J1 Halifax, Nova Scotia, Canada
| | - Sherry H Stewart
- Dalhousie University, Department of Psychology and Neuroscience, Life Sciences Centre, 1355 Oxford Street, PO Box 15000, B3H 4J1 Halifax, Nova Scotia, Canada; Dalhousie University, Department of Psychiatry, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, B3H 2E2 Halifax, Nova Scotia, Canada
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Dashorst P, Huntjens R, Mooren TM, Kleber RJ, de Jong PJ. Personal characteristics of World War Two survivor offspring related to the presence of indirect intrusions. Eur J Psychotraumatol 2022; 13:2101349. [PMID: 35928522 PMCID: PMC9344957 DOI: 10.1080/20008198.2022.2101349] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Background: A substantial proportion of clinical World War Two survivor offspring reports intrusions about war events they did not experience themselves. Objective: To help identify factors that contribute to the development of such indirect intrusions (i.e. intrusions about non-self-experienced traumatic events), we examined the personal characteristics of survivor offspring that were related to the presence of indirect intrusions. To explore the specificity of these relationships, we compared characteristics related to the presence of indirect and direct intrusions (i.e. intrusions about self-experienced traumatic events). Methods: Participants (N = 98) were post-war offspring of World War Two survivors in treatment in one of two clinics specialized in mental health services for war victims. We assessed the presence of indirect and direct intrusions as well as the following personal characteristics: gender, education level, trait dissociation, affect intensity, attentional control, mental imagery, fantasy proneness, and current psychopathology. Results: Reports of indirect intrusions were more frequent in individuals high in fantasy proneness, trait dissociation, and current psychopathology. Reports of direct intrusions were more frequent in women, individuals scoring high on trait dissociation, affect intensity, and current psychopathology. Fantasy proneness was a unique correlate of indirect intrusions. Conclusions: These findings are consistent with the idea that intrusions are the result of (re)constructive processes affected by several factors including personal characteristics. HIGHLIGHTS Offspring of World War Two survivors often experience indirect intrusions.We examined personal characteristics related to indirect and direct intrusions.Fantasy proneness was the best predictor of indirect intrusions.Gender was the best predictor of direct intrusions.
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Affiliation(s)
- P Dashorst
- ARQ Centrum'45, Diemen/Oegstgeest, the Netherlands
| | - R Huntjens
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - T M Mooren
- ARQ Centrum'45, Diemen/Oegstgeest, the Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - R J Kleber
- ARQ Centrum'45, Diemen/Oegstgeest, the Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - P J de Jong
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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37
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Dvir Y. Childhood Trauma and Psychosis: A Brief Updated Review and Case Study. Child Adolesc Psychiatr Clin N Am 2022; 31:91-98. [PMID: 34801157 DOI: 10.1016/j.chc.2021.08.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Significant evidence suggests strong links between childhood trauma and psychosis, with childhood trauma considered a significant risk factor for psychosis, causing a more severe presentation of psychotic illness with a dose-response effect. The relationship between anxiety, mood, posttraumatic stress disorder, and childhood trauma and psychosis and the difficulties distinguishing between overlapping symptoms require careful attention of the treating clinician considering the presentation and treatment course. Finally, there also appears to be a link between childhood trauma and violent behavior in individuals with psychotic illness. More research is needed into the effectiveness and safety of trauma-focused psychotherapeutic interventions.
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Affiliation(s)
- Yael Dvir
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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38
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Diamond RM, Colaianni A. The impact of perinatal healthcare changes on birth trauma during COVID-19. Women Birth 2021; 35:503-510. [PMID: 34924337 PMCID: PMC8678623 DOI: 10.1016/j.wombi.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
Abstract
Background Since the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience. Aim Research has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic. Methods 269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms. Findings 5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD. Conclusion The present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.
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Affiliation(s)
- Rachel M Diamond
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA.
| | - Allison Colaianni
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA
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Lahav Y. Painful bonds: Identification with the aggressor and distress among IPV survivors. J Psychiatr Res 2021; 144:26-31. [PMID: 34592508 DOI: 10.1016/j.jpsychires.2021.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/05/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022]
Abstract
Intimate partner violence (IPV) is a global health problem that often results in a variety of mental health detriments, including trauma-related distress and depressive symptoms. According to the trauma literature, IPV victims may develop strong bonds with their perpetrators - a phenomenon known as identification with the aggressor (IWA) - in order to survive the abuse. Yet, this defensive reaction may endure after the abuse has ended, and may adversely affect victims' mental health. Nevertheless, research exploring these suppositions is lacking. Filling this void, this study investigated IWA in light of current versus past IPV as well as the relations between IWA, trauma-related distress, and depressive symptoms among a convenience sample of 297 women. Of them, 68 and 229 participants reported being subjected to IPV at present or in the past, respectively. Results indicated that whereas participants who reported current IPV had elevated trauma-related distress and depressive symptoms compared to participants who reported past IPV, no differences were found in IWA levels between the groups. Identification with the aggressor was related to trauma-related distress and depressive symptoms. Furthermore, IWA had a unique contribution in explaining trauma-related distress and depressive symptoms above and beyond background characteristics and IPV features. The findings of the current study suggest that IWA may mirror the unique relational dynamics that characterize IPV, which continue to exist even after the abuse ends, and may be implicated in IPV survivors' psychological distress.
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Archibald PC. Factors Influencing the Relationship Between Work-Related Stress and Posttraumatic Stress Disorder Among Working Black Adults in the United States. Yale J Biol Med 2021; 94:383-394. [PMID: 34602878 PMCID: PMC8461583] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Work-related stress (WRS) and posttraumatic disorder (PTSD) is higher among Black adults relative to their White counterparts. Trauma exposure is not the only connection to increased risk for PTSD as WRS is highly associated with risk for PTSD. However, the factors that link WRS and PTSD among working Black adults is not well understood. Materials and Methods: Cross-sectional data from the National Survey of American Life was used to examine the relationship between WRS and PTSD among 2,139 working Black adults and to determine whether there are influencing factors. Results: Logistic regression analyses revealed that working Black adults who reported experiencing WRS was associated with higher odds of PTSD than those who reported no WRS (OR: 1.24, 95% CI: 1.04-1.48). The relationship was attenuated when depression, alcohol abuse, and major discrimination were added to the model (OR: 1.09, 95% CI: 0.87-1.36). Mediation analyses show that the average indirect effect of WRS on PTSD were 0.09 ± 0.04 for alcohol abuse, 0.14 ± 0.06 for depression, and 0.35 ± 0.10 for major discrimination. Conclusion: The results underscore the need for culturally responsive trauma-informed public health interventions for working Black adults. Public health practitioners should be alerted to the relationship between WRS and PTSD among working Black adults and the potential contributing factors (alcohol abuse, depression, and major discrimination). Special attention should be given to working Black females with their worse PTSD status and major discrimination experiences which demonstrated greater effect on the relationship between WRS and PTSD.
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Affiliation(s)
- Paul C. Archibald
- To whom all correspondence should be addressed:
Paul C. Archibald, College of Staten Island, City University of New York, School
of Health Sciences, Department of Social Work, Johns Hopkins University Program
for Research on Men’s Health, Hopkins Center for Health Disparities Solutions;
Tel: 718-982-2174; ; ORCID iD:
https://orcid.org/0000-0002-2826-5292
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Ostacher MJ, Fischer E, Bowen ER, Lyu J, Robbins DJ, Suppes T. Investigation of a Capnometry Guided Respiratory Intervention in the Treatment of Posttraumatic Stress Disorder. Appl Psychophysiol Biofeedback 2021; 46:367-76. [PMID: 34468913 DOI: 10.1007/s10484-021-09521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence‐based treatments for posttraumatic stress disorder (PTSD), including psychotherapies and medications, have high dropout and nonresponse rates, suggesting that more acceptable and effective treatments for PTSD are needed. Capnometry Guided Respiratory Intervention (CGRI) is a digital therapeutic effective in panic disorder that measures and displays end-tidal carbon dioxide (EtCO2) and respiratory rate (RR) in real-time within a structured breathing protocol and may have benefit in PTSD by moderating breathing and EtCO2 levels. We conducted a single-arm study of a CGRI system, Freespira®, to treat symptoms of PTSD. Participants with PTSD (n = 55) were treated for four weeks with twice-daily, 17-min at-home CGRI sessions using a sensor and tablet with pre-loaded software. PTSD and associated symptoms were assessed at baseline, end-of treatment, 2-months and 6-months post-treatment. Primary efficacy outcome was 50% of participants having ≥ 6-point decrease in Clinician Administered PTSD Scale (CAPS-5) score at 2-month follow up. Tolerability, usability, safety, adherence and patient satisfaction were assessed. CGRI was well tolerated, with 88% [95% CI 74–96%] having ≥ 6-point decrease in CAPS-5 scores at 2-months post-treatment follow up. Mean CAPS-5 scores decreased from 49.5 [s.d. = 9.2] at baseline to 27.1 [s.d. = 17.8] at 2-months post-treatment follow up. Respiratory rate decreased and EtCO2 levels increased. Associated mental and physical health symptoms also improved. This CGRI intervention was safe, acceptable, and well-tolerated in improving symptoms in this study in PTSD. Further study against an appropriate comparator is warranted. Trial registration Clinicaltrials.gov NCT#03039231.
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Ellenberg E, Yakir A, Bar-On Z, Sasson Y, Taragin M, Luft-Afik D, Cohen O, Lavenda O, Mahat-Shamir M, Hamama-Raz Y, Ben Ezra M, Frueh BC, Ostfeld I. Naturalistic Study of Posttraumatic Stress Disorder Among Israeli Civilians Exposed to Wartime Attacks. Psychiatr Serv 2021; 72:1026-1030. [PMID: 33882689 DOI: 10.1176/appi.ps.201900313] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Civilians who survive wartime attacks commonly experience substantial psychological distress, including acute stress reactions (ASRs) and posttraumatic stress disorder (PTSD). The authors sought to determine the level of Israeli civilian exposure to wartime attacks, prevalence of posttraumatic stress disorder (PTSD) and physical injuries, and associated medical costs over a 7-year period. METHODS Data from the National Insurance Institute of Israel on civilian survivors of wartime attacks in the 2009-2015 period were retrospectively examined. RESULTS Overall, 11,476 civilians were affected by 243 wartime attacks during the study period. Of these individuals, 7,561 (65.9%) received early intervention (EI) psychological treatment for ASRs, 1,332 (11.6%) were subsequently adjudicated as having a disability (all causes), and 519 (4.5%) were adjudicated as disabled by PTSD through the end of 2016. Individuals who received immediate ASR treatment were less likely to be disabled by PTSD (p=0.001). Among those without physical injuries, the EI was associated with decreased PTSD disability (2.6% of those receiving the EI developed PTSD, whereas 7.2% of those who did not receive the EI developed PTSD); however, for those with physical injuries, the PTSD rate was higher among those who received the EI (30.4%) than among those who did not receive the EI (5.2%). Individuals having a disability other than PTSD incurred higher medical costs ($7,153 in 2016 U.S. dollars) than individuals with PTSD ($1,960). CONCLUSIONS An approach of providing case management, medical care, behavioral health screening, and EI for ASRs in the wake of wartime attacks on civilians minimized long-term PTSD-related disability.
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Affiliation(s)
- Eytan Ellenberg
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Avi Yakir
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Zvia Bar-On
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Yehuda Sasson
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Mark Taragin
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Danielle Luft-Afik
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Osnat Cohen
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Osnat Lavenda
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Michal Mahat-Shamir
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Yaira Hamama-Raz
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Menahem Ben Ezra
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - B Christopher Frueh
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Ishay Ostfeld
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
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43
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Shively SB, Priemer DS, Stein MB, Perl DP. Pathophysiology of Traumatic Brain Injury, Chronic Traumatic Encephalopathy, and Neuropsychiatric Clinical Expression. Psychiatr Clin North Am 2021; 44:443-458. [PMID: 34373000 DOI: 10.1016/j.psc.2021.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/27/2022]
Abstract
This article focuses on neuropsychiatric clinical expression and neuropathology associated with chronic traumatic encephalopathy (CTE), which is thought to develop years after traumatic brain injury. The incidence, prevalence, additional risk factors, and pathophysiology remain largely unknown. CTE is considered a tauopathy because the endogenous brain protein tau, in its hyperphosphorylated state (p-tau), defines the predominant neuropathological findings and may underlie aspects of cell toxicity, synapse and circuit dysfunction, and clinical signs and symptoms. We discuss pathophysiological mechanisms possibly affecting p-tau accumulation. Finally, we interweave how clinical features and neuroanatomical sites associated with CTE potentially intersect with posttraumatic stress disorder.
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Affiliation(s)
| | - David S Priemer
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Murray B Stein
- University of California San Diego, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Daniel P Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room B-3138, Bethesda, MD 20814, USA.
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44
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Pickover A, Lowell A, Lazarov A, Lopez-Yianilos A, Sanchez-Lacay A, Ryba M, Such S, Arnon S, Amsalem D, Neria Y, Markowitz JC. Interpersonal Psychotherapy of Posttraumatic Stress Disorder for Veterans and Family Members: An Open Trial. Psychiatr Serv 2021; 72:866-873. [PMID: 33557597 PMCID: PMC8328866 DOI: 10.1176/appi.ps.202000355] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Military service members and veterans have high rates of posttraumatic stress disorder (PTSD), as do military family members. Exposure-based, cognitive-behavioral approaches have received ample research, but other PTSD therapies require further empirical attention. Interpersonal psychotherapy (IPT) targets affective awareness, life circumstances, and social support. IPT has shown efficacy for civilians with PTSD but awaits rigorous testing among military personnel; only two small military pilot studies and two case reports have been published. Military family members have received minimal attention from clinical outcomes research. Addressing these gaps, this open trial examined IPT for PTSD among veterans, service members, and family members, including a patient subset with comorbid PTSD and depression. METHODS Fifty U.S. military service members, veterans, and family members (age ≥18 years) were offered 14 sessions of IPT for PTSD. Individuals with psychosis, bipolar disorder, moderate or severe substance use disorders, or high suicide risk were excluded. PTSD and depressive symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. RESULTS Clinician-assessed PTSD (Clinician-Administered PTSD Scale) and depression (Hamilton Depression Rating Scale) symptoms decreased over time in the full sample and the comorbid PTSD/depression subset (p<0.05). Service members, veterans, and family members had similar treatment responses. CONCLUSIONS Patients receiving IPT showed reductions in PTSD and depressive symptoms. These open trial findings provide preliminary support for the utility of IPT in reducing PTSD symptoms among veterans and family members. This largest IPT trial to date for PTSD in military patients also bolsters the literature on treating military family members.
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Affiliation(s)
- Alison Pickover
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Ari Lowell
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center, NY
- School of Psychological Sciences, Tel Aviv University, Israel
| | | | - Arturo Sanchez-Lacay
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Matthew Ryba
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Weill-Cornell Medical Center, NY
| | - Sara Such
- New York State Psychiatric Institute, NY
| | - Shay Arnon
- New York State Psychiatric Institute, NY
| | - Doron Amsalem
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - Yuval Neria
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
| | - John C. Markowitz
- New York State Psychiatric Institute, NY
- Department of Psychiatry, Columbia University Irving Medical Center, NY
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45
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Hardardottir H, Aspelund T, Zhu J, Fall K, Hauksdottir A, Fang F, Lu D, Janson C, Jonsson S, Valdimarsdottir H, Valdimarsdottir UA. Optimal communication associated with lower risk of acute traumatic stress after lung cancer diagnosis. Support Care Cancer 2021; 30:259-269. [PMID: 34273032 DOI: 10.1007/s00520-021-06138-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to assess the role of the patient's background and perceived healthcare-related factors in symptoms of acute stress after lung cancer diagnosis. METHODS The study population consisted of 89 individuals referred for diagnostic work-up at Landspitali National University Hospital in Iceland and subsequently diagnosed with lung cancer. Before diagnosis, the patients completed questionnaires on sociodemographic characteristics, pre-diagnostic distress (Hospital Anxiety and Depression Scale), social support, and resilience. At a median of 16 days after diagnosis, the patients reported symptoms of acute stress on the Impact of Event Scale-Revised (IES-R) and experience of communication and support from healthcare professionals and family during the diagnostic period. RESULTS Patients were on average 68 years and 52% reported high levels of post-diagnostic acute stress (IES-R > 23) while 24% reported symptoms suggestive of clinical significance (IES-R > 32). Prior history of cancer (β = 6.7, 95% CI: 0.1 to 13.3) and pre-diagnostic distress were associated with higher levels of post-diagnostic acute stress (β = 8.8, 95% CI: 2.7 to 14.9), while high educational level (β = - 7.9, 95% CI: - 14.8 to - 1.1) was associated with lower levels. Controlling for the abovementioned factors, the patients' perception of optimal doctor-patient (β = - 9.1, 95% CI: - 14.9 to - 3.3) and family communication (β = - 8.6, 95% CI: - 14.3 to - 2.9) was inversely associated with levels of post-diagnostic acute stress after lung cancer diagnosis. CONCLUSIONS A high proportion of patients with newly diagnosed lung cancer experience high levels of acute traumatic stress of potential clinical significance. Efforts to improve doctor-patient and family communication may mitigate the risk of these adverse symptoms.
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Affiliation(s)
- Hronn Hardardottir
- Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland. .,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jianwei Zhu
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Arna Hauksdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Donghao Lu
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christer Janson
- Respiratory, Allergy and Sleep Research, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Steinn Jonsson
- Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland.,Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Heiddis Valdimarsdottir
- Department of Psychology, Reykjavík University, Reykjavik, Iceland.,Mount Sinai School of Medicine, New York, NY, USA
| | - Unnur A Valdimarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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46
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An S, Wang J, Zhang X, Duan Y, Xu Y, Lv J, Wang D, Zhang H, Richter-Levin G, Klavir O, Yu B, Cao X. αCaMKII in the lateral amygdala mediates PTSD-Like behaviors and NMDAR-Dependent LTD. Neurobiol Stress 2021; 15:100359. [PMID: 34258335 PMCID: PMC8252123 DOI: 10.1016/j.ynstr.2021.100359] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/06/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that afflicts many individuals. However, its molecular and cellular mechanisms remain largely unexplored. Here, we found PTSD susceptible mice exhibited significant up-regulation of alpha-Ca2+/calmodulin-dependent kinase II (αCaMKII) in the lateral amygdala (LA). Consistently, increasing αCaMKII in the LA not only caused PTSD-like behaviors such as impaired fear extinction and anxiety-like behaviors, but also attenuated N-methyl-D-aspartate receptor (NMDAR)-dependent long-term depression (LTD) at thalamo-lateral amygdala (T-LA) synapses, and reduced GluA1-Ser845/Ser831 dephosphorylation and a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) internalization. Suppressing the elevated αCaMKII to normal levels completely rescued both PTSD-like behaviors and the impairments in LTD, GluA1-Ser845/Ser831 dephosphorylation, and AMPAR internalization. Intriguingly, deficits in GluA1-Ser845/Ser831 dephosphorylation and AMPAR internalization were detected not only after impaired fear extinction, but also after attenuated LTD. Our results suggest that αCaMKII in the LA may be a potential molecular determinant of PTSD. We further demonstrate for the first time that GluA1-Ser845/Ser831 dephosphorylation and AMPAR internalization are molecular links between fear extinction and LTD.
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Affiliation(s)
- Shuming An
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Jiayue Wang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Xuliang Zhang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Yanhong Duan
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Yiqiong Xu
- Department of Anesthesiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Junyan Lv
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Dasheng Wang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Huan Zhang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Gal Richter-Levin
- “Sagol” Department of Neurobiology, University of Haifa, Haifa, 31905, Israel
| | - Oded Klavir
- Department of Psychology, Brain and Psychopathology Division, University of Haifa, Haifa, 31905, Israel
| | - Buwei Yu
- Department of Anesthesiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
- Corresponding author.
| | - Xiaohua Cao
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
- Corresponding author.
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47
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van Rooij SJH, Ravi M, Ely TD, Michopoulos V, Winters SJ, Shin J, Marin MF, Milad MR, Rothbaum BO, Ressler KJ, Jovanovic T, Stevens JS. Hippocampal activation during contextual fear inhibition related to resilience in the early aftermath of trauma. Behav Brain Res 2021; 408:113282. [PMID: 33819532 PMCID: PMC8128041 DOI: 10.1016/j.bbr.2021.113282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/09/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Impaired contextual fear inhibition is often associated with posttraumatic stress disorder (PTSD). Our previous work has demonstrated that more hippocampal activation during a response inhibition task after trauma exposure was related to greater resilience and fewer future PTSD symptoms. In the current study, we sought to extend our previous findings by employing a contextual fear conditioning and extinction paradigm to further determine the role of the hippocampus in resilience and PTSD in the early aftermath of trauma. METHODS Participants (N = 28) were recruited in the Emergency Department shortly after experiencing a traumatic event. A contextual fear inhibition task was conducted in a 3 T MRI scanner approximately two months post-trauma. Measures of resilience (CD-RISC) at time of scan and PTSD symptoms three months post-trauma were collected. The associations between hippocampal activation during fear conditioning and during the effect of context during extinction, and post-trauma resilience and PTSD symptoms at three-months were assessed. RESULTS During fear conditioning, activation of the bilateral hippocampal region of interest (ROI) correlated positively with resilience (r = 0.48, p = 0.01). During the effect of context during extinction, greater bilateral hippocampal activation correlated with lower PTSD symptoms three months post-trauma after controlling for baseline PTSD symptoms, age and gender (r=-0.59, p=0.009). CONCLUSIONS Greater hippocampal activation was related to post-trauma resilience and lower PTSD symptoms three months post-trauma. The current study supports and strengthens prior findings suggesting the importance of hippocampus-dependent context processing as a mechanism for resilience versus PTSD risk, which could be a potential mechanistic target for novel early interventions.
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Affiliation(s)
- Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Meghna Ravi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sterling J Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jaemin Shin
- MR Applied Science Lab, GE Healthcare, New York, NY, USA
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Quebec, Canada
| | - Mohammed R Milad
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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48
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Postel C, Mary A, Dayan J, Fraisse F, Vallée T, Guillery-Girard B, Viader F, Sayette VDL, Peschanski D, Eustache F, Gagnepain P. Variations in response to trauma and hippocampal subfield changes. Neurobiol Stress 2021; 15:100346. [PMID: 34113695 PMCID: PMC8170416 DOI: 10.1016/j.ynstr.2021.100346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/08/2020] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/01/2023] Open
Abstract
Models of posttraumatic stress disorder (PTSD) suggest that the hippocampus is key to the persistence of traumatic memory. Yet very little is known about the precise changes that take place in this structure, nor their relation with PTSD symptoms. Previous studies have mostly used magnetic resonance imaging (MRI) at low resolutions, making it impossible to identify sensitive anatomical landmarks, or compared groups often unequally matched in terms of traumatic exposure. The present cross-sectional study included 92 individuals who had all been exposed to the terrorist attacks in Paris on November 13, 2015 (53 of whom subsequently developed PTSD) and 56 individuals who had not been exposed. Hippocampal subfield volumes were estimated using cross-validated automatic segmentation of high-resolution MRI images. Results revealed changes in CA1 and CA2-3/dentate gyrus (DG) volumes in individuals with PTSD, but not in resilient (i.e., exposed but without PTSD) individuals, after controlling for potential nuisance variables such as previous traumatic exposure and substance abuse. In line with current models of hippocampal subfield functions, CA1 changes were linked to the uncontrollable re-experiencing of intrusive memories, while CA2-3/DG changes, potentially exacerbated by comorbid depression, fostered the overgeneralization of fear linked to avoidance and hypervigilance behaviors. Additional analyses revealed that CA1 integrity was linked to optimum functioning of the memory control network in resilient individuals. These findings shed new light on potential pathophysiological mechanisms in the hippocampus subtending the development of PTSD and the failure to recover from trauma.
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Affiliation(s)
- Charlotte Postel
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Alison Mary
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Centre for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, 1050, Brussels, Belgium
| | - Jacques Dayan
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Florence Fraisse
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Thomas Vallée
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Bérengère Guillery-Girard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Fausto Viader
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Vincent de la Sayette
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Denis Peschanski
- Université Paris I Panthéon Sorbonne, HESAM Université, EHESS, CNRS, UMR8209, Paris, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Pierre Gagnepain
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
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49
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Fox R, McHugh Power J, Coogan AN, Beekman ATF, van Tilburg TG, Hyland P. Posttraumatic stress disorder and loneliness are associated over time: A longitudinal study on PTSD symptoms and loneliness, among older adults. Psychiatry Res 2021; 299:113846. [PMID: 33706195 DOI: 10.1016/j.psychres.2021.113846] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/07/2020] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
Loneliness has a pernicious effect on mental health in later life and is likely to have a bidirectional relationship with psychopathology. However, longitudinal research examining loneliness and posttraumatic stress symptoms among older adults is scarce. This study aimed to examine the longitudinal relationship between different types of loneliness (social and emotional) and posttraumatic stress symptoms. Using two waves of an older adult sample (n = 1,276) from the Longitudinal Aging Study Amsterdam (LASA), this longitudinal relationship was examined using a multivariate two wave-latent change score (2W-LCS) model. There were significant, however, very small increases in both posttraumatic stress symptoms and emotional loneliness over time, whereas, average social loneliness scores did not significantly increase/decrease over time. Changes in both social (β = .16) and emotional loneliness (β = .15) were associated with small changes in posttraumatic stress symptoms, consistent with the existence of a longitudinal association between the constructs, net of covariate effects. Results provide evidence of the existence of a longitudinal association between subtypes of loneliness and posttraumatic stress symptoms, among older adults. Results have implications for clinicians who should identify individuals at risk of developing posttraumatic stress symptoms, and for the theory of both posttraumatic stress disorder and loneliness.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland; Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin.
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland; UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; GGZ inGeest, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
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50
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McGuire A, Huffhines L, Jackson Y. The trajectory of PTSD among youth in foster care: A survival analysis examining maltreatment experiences prior to entry into care. Child Abuse Negl 2021; 115:105026. [PMID: 33721660 PMCID: PMC8052914 DOI: 10.1016/j.chiabu.2021.105026] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 12/24/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Youth in foster care are more likely than non-foster care youth to experience posttraumatic stress disorder (PTSD). While research has identified maltreatment as a risk factor for PTSD, this research remains limited because it tends to only (a) examine a single type or dimension of maltreatment and ignore the polyvictimization and heterogeneity in exposure, and (b) study this relation across a short period time or retrospectively at the end of care. OBJECTIVE The current study used survival analysis to simultaneously examine the influence of maltreatment characteristics on the risk of receiving a PTSD diagnosis at any time in care following entry into care. PARTICIPANTS/SETTING 291 youth (Mean age at entry = 9.71; 53 % female; 49 % Black) in foster care and their primary caregivers from a large, Midwestern county. METHODS Information on PTSD diagnosis was extracted from Medicaid records, and information on maltreatment and time in care was extracted from case files. Survival analysis was then used to determine the association between maltreatment and risk of PTSD diagnosis. RESULTS When examined independently, each dimension (frequency, severity) of the four maltreatment types was significantly associated with PTSD diagnosis risk (all hazard ratio's [HR] > 1.00), except sexual abuse frequency. In the comprehensive model with all dimensions examined simultaneously, only neglect frequency for youth entering care in adolescence (HR: 1.13[1.03-1.23]), and neglect severity (HR: 1.27[1.05-1.52]) and emotional abuse frequency (HR: 1.24[1.00-1.53]) for youth entering care pre-adolescence, were associated with PTSD diagnosis risk. Additionally, age of entry into care was associated with PTSD diagnosis risk (HR: 2.34[1.88-2.92]), as adolescents tended to spend fewer days in care before receiving a diagnosis. CONCLUSIONS Results suggest that researchers who study PTSD in youth in foster care should consider the entirety of youth's maltreatment exposure and the context of care to more accurately determine what aspects of youth's history contributes to receiving a PTSD diagnosis.
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Affiliation(s)
- Austen McGuire
- Clinical Child Psychology Program, University of Kansas, Dole Human Development Building, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA.
| | - Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA; Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, Providence, RI, USA
| | - Yo Jackson
- Department of Psychology, The Pennsylvania State University, University Park, PA, 16802, USA
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