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Neylan TC, Muratore LA, Williams CL, Schmitz M, Valdez CV, Maguen S, O'Donovan A, Kelley DP, Metzler TJ, Cohen BE, West AC, Phan JDV, Antonetti V, Mayzel O, Hlavin JA, Chesney MA, Mehling WE. Group integrated exercise versus recovery class for veterans with posttraumatic stress disorder: a randomized clinical trial. BMC Psychiatry 2025; 25:185. [PMID: 40021975 PMCID: PMC11871828 DOI: 10.1186/s12888-025-06638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 02/20/2025] [Indexed: 03/03/2025] Open
Abstract
There are no reported randomized trials testing exercise versus an active comparator for Posttraumatic Stress Disorder (PTSD). This randomized clinical trial assessed the effectiveness of group exercise versus psychoeducation to improve quality of life and reduces symptomatic severity in Veterans with PTSD. Veterans who met criteria for current PTSD (DSM-5) and/or endorsed moderate levels of PTSD symptoms (CAPS 5 score ≥ 23) were randomly assigned to treatment. Integrative Exercise (IE) combines fitness exercises (aerobics, resistance training, stretching) with mindful body/breath awareness versus Recovery Class (REC) psychoeducation control condition. A total of 84 participants were enrolled of which 41 participants were randomized to IE and 43 participants to REC. There were no significant pre-post differences in change in the WHOQOL Psychological Domain in either group. There was a modest reduction in the total CAPS-5 score in both groups (IE: -8.2 (9.9), p < .001: REC: -7.8 (2.0), p < .001) but no differences across the two conditions. In the IE subsample that was remote, there was a greater improvement in PTSD symptom severity (F[1, 50] = 4.62, p = .036) and in in the WHOQOL Psychological Domain (F(1, 47) = 6.46, p = .014) in those who attended more sessions. Trial registration ClinicalTrials.gov Identifier: NCT02856412 (registration date: February 27, 2017).
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Affiliation(s)
- Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA.
- Northern California Institute for Research and Education, San Francisco, CA, USA.
- Department of Neurology, University of California, San Francisco, USA.
- San Francisco VA Health Care System (116-P), University of California, San Francisco, 4150 Clement St., San Francisco, CA, 94121, USA.
| | - Laura A Muratore
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Chanda L Williams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Osher Center for Integrative Health, University of California, San Francisco, USA
| | - Martha Schmitz
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Courtney V Valdez
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Aoife O'Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - D Parker Kelley
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Beth E Cohen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, USA
| | - Anna C West
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Jordan D V Phan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Victor Antonetti
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Olga Mayzel
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Jennifer A Hlavin
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Margaret A Chesney
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
- Department of Medicine, University of California, San Francisco, USA
| | - Wolf E Mehling
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Osher Center for Integrative Health, University of California, San Francisco, USA
- Department of Family and Community Medicine, University of California, San Francisco, USA
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2
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Jansen van Vuren E, van den Heuvel LL, Hemmings SM, Seedat S. Cardiovascular risk and allostatic load in PTSD: The role of cumulative trauma and resilience in affected and trauma-exposed adults. J Psychiatr Res 2025; 182:338-346. [PMID: 39848101 DOI: 10.1016/j.jpsychires.2025.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 01/15/2025] [Accepted: 01/16/2025] [Indexed: 01/25/2025]
Abstract
BACKGROUND The pathophysiology of posttraumatic stress disorder (PTSD) involves dysregulation of stress-sensitive biological systems due to repeated trauma exposure, predisposing individuals to the development of cardiovascular disease (CVD). Allostatic load (AL), an indicator of maladaptive stress responses, could shed light on the underlying biological mechanisms. We determined whether CVD risk and AL were associated with trauma load and resilience in women with PTSD and trauma-exposed controls (TEC). METHODS Adults with PTSD N = 114 and TEC N = 95 were administered the Clinician Administered Posttraumatic Stress Disorder Scale for DSM-5, to assess for current PTSD diagnosis and severity, the Life Events Checklist for DSM-5 for lifetime exposure to potentially traumatic events (cumulative trauma) and the Connor-Davidson Resilience Scale. An AL score was calculated as a sum of dichotomous variables from four physiological systems (neuroendocrine, metabolic, cardiovascular, and inflammatory). CVD risk was assessed with the South African Framingham risk score. RESULTS In patients with PTSD, cumulative trauma was associated with higher AL (p = 0.04) and CVD risk (p = 0.02). In TEC, AL was inversely associated with resilience (p = 0.04). There was a significant interaction between cumulative trauma and resilience on AL (p = 0.009) in PTSD cases, with a stronger association between cumulative trauma and AL in those with higher resilience. CONCLUSIONS Resilience may have differential detrimental and protective effects on AL in individuals with PTSD and TEC. Cumulative trauma exposure may, independently, increase the likelihood of high AL and CVD risk in PTSD, with resilience moderating this effect. Remaining resilient while experiencing PTSD symptoms may impose a biological strain that could have long-term harmful effects.
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Affiliation(s)
- Esmé Jansen van Vuren
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X1290, Potchefstroom, South Africa; South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Sian Mj Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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3
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Zuschlag ZD, Lord B, Smith T, Lengerich A, Tindall B, Leonard K, Guereca Y, Panaite V, Kumar A, Norred MA, Milsom VA. The Management of Depression and Anxiety in Primary Care: Examining Predictors of Adherence to a Psychopharmacological Collaborative Care Management Program for Veterans. J Behav Health Serv Res 2025; 52:19-31. [PMID: 39179923 DOI: 10.1007/s11414-024-09904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/26/2024]
Abstract
Collaborative care management (CoCM) is an evidenced based approach to psychiatric treatment in primary care, yet literature examining factors associated with program adherence is lacking. This study analyzed predictors of adherence to a CoCM model of psychopharmacological treatment of depression and anxiety in primary care by conducting a retrospective cohort analysis on Veterans referred to a large VA Medical Center's CoCM program over an 18-month period. Baseline characteristics, symptomatic assessments, and covariates of interest were collected. For the primary outcome, the association between covariates and programmatic completion were analyzed. Secondary analyses assessed improvements in psychiatric symptoms. A total of 757 Veterans with depressive or anxiety disorders were included, and 256 completed the CoCM program. Baseline covariates associated with differences in completion rates included the following: age, contact with psychology prior to referral, baseline PHQ-9, baseline GAD-7, and a number of comorbid psychiatric/substance abuse covariates. After controlling for baseline differences, age remained a significant positive predictor of completion (OR 1.019, 95% CI 1.008‒1.030) and cannabis use a significant negative predictor (OR 0.507, 95% CI 0.275‒0.934). Both early improvement in PHQ-9 (OR 1.864, 95% CI 1.210‒2.872) and GAD-7 (OR 1.762, 95% CI 1.154‒2.691) scores were positive predictors. Secondary analyses showed that programmatic completion was associated with greater reductions in psychiatric symptoms. Results identified a number of modifiable parameters associated with differences in completion rates and greater symptomatic reduction for those who complete the program. Additional studies should be conducted examining interventions to optimize CoCM programs by supporting positive predictors while minimizing negative predictors.
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Affiliation(s)
- Zachary D Zuschlag
- James A. Haley Veterans Hospital, Tampa, FL, USA.
- University of South Florida, Tampa, FL, USA.
| | | | | | | | | | - Kaitlin Leonard
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | | | - Vanessa Panaite
- James A. Haley Veterans Hospital, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| | | | - Michael A Norred
- James A. Haley Veterans Hospital, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
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4
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Katrinli S, Wani AH, Maihofer AX, Ratanatharathorn A, Daskalakis NP, Montalvo-Ortiz J, Núñez-Ríos DL, Zannas AS, Zhao X, Aiello AE, Ashley-Koch AE, Avetyan D, Baker DG, Beckham JC, Boks MP, Brick LA, Bromet E, Champagne FA, Chen CY, Dalvie S, Dennis MF, Fatumo S, Fortier C, Galea S, Garrett ME, Geuze E, Grant G, Hauser MA, Hayes JP, Hemmings SMJ, Huber BR, Jajoo A, Jansen S, Kessler RC, Kimbrel NA, King AP, Kleinman JE, Koen N, Koenen KC, Kuan PF, Liberzon I, Linnstaedt SD, Lori A, Luft BJ, Luykx JJ, Marx CE, McLean SA, Mehta D, Milberg W, Miller MW, Mufford MS, Musanabaganwa C, Mutabaruka J, Mutesa L, Nemeroff CB, Nugent NR, Orcutt HK, Qin XJ, Rauch SAM, Ressler KJ, Risbrough VB, Rutembesa E, Rutten BPF, Seedat S, Stein DJ, Stein MB, Toikumo S, Ursano RJ, Uwineza A, Verfaellie MH, Vermetten E, Vinkers CH, Ware EB, Wildman DE, Wolf EJ, Young RM, Zhao Y, van den Heuvel LL, Uddin M, Nievergelt CM, Smith AK, Logue MW. Epigenome-wide association studies identify novel DNA methylation sites associated with PTSD: a meta-analysis of 23 military and civilian cohorts. Genome Med 2024; 16:147. [PMID: 39696436 DOI: 10.1186/s13073-024-01417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 11/29/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND The occurrence of post-traumatic stress disorder (PTSD) following a traumatic event is associated with biological differences that can represent the susceptibility to PTSD, the impact of trauma, or the sequelae of PTSD itself. These effects include differences in DNA methylation (DNAm), an important form of epigenetic gene regulation, at multiple CpG loci across the genome. Moreover, these effects can be shared or specific to both central and peripheral tissues. Here, we aim to identify blood DNAm differences associated with PTSD and characterize the underlying biological mechanisms by examining the extent to which they mirror associations across multiple brain regions. METHODS As the Psychiatric Genomics Consortium (PGC) PTSD Epigenetics Workgroup, we conducted the largest cross-sectional meta-analysis of epigenome-wide association studies (EWASs) of PTSD to date, involving 5077 participants (2156 PTSD cases and 2921 trauma-exposed controls) from 23 civilian and military studies. PTSD diagnosis assessments were harmonized following the standardized guidelines established by the PGC-PTSD Workgroup. DNAm was assayed from blood using Illumina HumanMethylation450 or MethylationEPIC (850 K) BeadChips. Within each cohort, DNA methylation was regressed on PTSD, sex (if applicable), age, blood cell proportions, and ancestry. An inverse variance-weighted meta-analysis was performed. We conducted replication analyses in tissue from multiple brain regions, neuronal nuclei, and a cellular model of prolonged stress. RESULTS We identified 11 CpG sites associated with PTSD in the overall meta-analysis (1.44e - 09 < p < 5.30e - 08), as well as 14 associated in analyses of specific strata (military vs civilian cohort, sex, and ancestry), including CpGs in AHRR and CDC42BPB. Many of these loci exhibit blood-brain correlation in methylation levels and cross-tissue associations with PTSD in multiple brain regions. Out of 9 CpGs annotated to a gene expressed in blood, methylation levels at 5 CpGs showed significant correlations with the expression levels of their respective annotated genes. CONCLUSIONS This study identifies 11 PTSD-associated CpGs and leverages data from postmortem brain samples, GWAS, and genome-wide expression data to interpret the biology underlying these associations and prioritize genes whose regulation differs in those with PTSD.
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Affiliation(s)
- Seyma Katrinli
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Agaz H Wani
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, San Diego, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Columbia University Mailmain School of Public Health, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nikolaos P Daskalakis
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center of Excellence in Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Janitza Montalvo-Ortiz
- U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Diana L Núñez-Ríos
- U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Anthony S Zannas
- Carolina Stress Initiative, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
- Department of Genetics, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Xiang Zhao
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Allison E Aiello
- Robert N. Butler Columbia Aging Center, Department of Epidemiology, Columbia University, New York, NY, USA
| | - Allison E Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Diana Avetyan
- Department of Psychiatry, University of California San Diego, La Jolla, CA, San Diego, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, La Jolla, CA, San Diego, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham VA Health Care System, Researcg, Durham, NC, USA
- Genetics Research Laboratory, VA Mid-Atlantic Mental Illness Research Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Marco P Boks
- Department of Psychiatry, Brain Center University Medical Center Utrecht, Utrecht, UT, NL, Netherlands
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Evelyn Bromet
- Epidemiology Research Group, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Frances A Champagne
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Chia-Yen Chen
- Biogen Inc, Translational Sciences, Cambridge, MA, USA
| | - Shareefa Dalvie
- Department of Pathology, University of Cape Town, Western Province, Cape Town, ZA, South Africa
- Division of Human Genetics, University of Cape Town, Western Province, Cape Town, ZA, South Africa
| | - Michelle F Dennis
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham VA Health Care System, Researcg, Durham, NC, USA
- Genetics Research Laboratory, VA Mid-Atlantic Mental Illness Research Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Segun Fatumo
- MRC/UVRI and London School of Hygiene and Tropical Medicine, The African Computational Genomics (TACG) Research Group, Entebbe, Wakiso, Uganda
| | - Catherine Fortier
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS)/Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Elbert Geuze
- Brain Research and Innovation Centre, Netherlands Ministry of Defence, Utrecht, UT, NL, Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center Rudolf Magnus, Utrecht, UT, Netherlands
| | - Gerald Grant
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Michael A Hauser
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jasmeet P Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
- SAMRC Genomics of Brain Disorders Research Unit, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
| | - Bertrand Russel Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Aarti Jajoo
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Stefan Jansen
- College of Medicine and Health Sciences, University of Rwanda, Kigali, RW, Rwanda
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Genetics Research Laboratory, VA Mid-Atlantic Mental Illness Research Education, and Clinical Center (MIRECC), Durham, NC, USA
- Mental Health Service Line, Durham VA Health Care System, Durham, NC, USA
| | - Anthony P King
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
- Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joel E Kleinman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Nastassja Koen
- Department of Psychiatry & Mental Health, University of Cape Town, Western Province, Cape Town, ZA, South Africa
- Neuroscience Institute, University of Cape Town, Western Province, Cape Town, ZA, South Africa
- SA MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Western Province, Cape Town, ZA, South Africa
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Massachusetts General Hospital, Boston, MA, USA
| | - Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences, Texas A&M University College of Medicine, Bryan, TX, USA
| | - Sarah D Linnstaedt
- Department of Anesthesiology, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
- UNC Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jurjen J Luykx
- Amsterdam Neuroscience Research Institute Stress & Sleep Program, Amsterdam University Medical Center, Amsterdam, NH, Netherlands
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam University Medical Center, Amsterdam, NH, Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, NH, Netherlands
| | - Christine E Marx
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Samuel A McLean
- Department of Psychiatry, UNC Institute for Trauma Recovery, NC, Chapel Hill, USA
| | - Divya Mehta
- Centre for Genomics and Personalised Health, Queensland University of Technology, Kelvin Grove, QLD, AU, Brisbane, Australia
- School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, AU, Brisbane, Australia
| | | | - Mark W Miller
- Biomedical Genetics & Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Mary S Mufford
- Department of Psychiatry and Mental Health, University of Cape Town, Western Province, Cape Town, ZA, South Africa
| | - Clarisse Musanabaganwa
- Research Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
- Center of Human Genetics, University of Rwanda, Kigali, RW, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, University of Rwanda, Huye, RW, Rwanda
| | - Leon Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, RW, Rwanda
- Center for Human Genetics, University of Rwanda, Kigali, RW, Rwanda
| | - Charles B Nemeroff
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Nicole R Nugent
- Department of Emergency Medicine, Alpert Brown Medical School, Providence, RI, USA
- Department of Pediatrics, Alpert Brown Medical School, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Brown Medical School, Providence, RI, USA
| | - Holly K Orcutt
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Xue-Jun Qin
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - Sheila A M Rauch
- Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
- Joseph Maxwell Cleland Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Victoria B Risbrough
- Department of Psychiatry, University of California San Diego, La Jolla, CA, San Diego, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht Universitair Medisch Centrum, Maastricht, Limburg, NL, Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
- SA MRC Extramural Genomics of Brain Disorders Research Unit, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
| | - Dan J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Western Province, Cape Town, ZA, South Africa
- Neuroscience Institute, University of Cape Town, Western Province, Cape Town, ZA, South Africa
- SA MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Western Province, Cape Town, ZA, South Africa
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, San Diego, USA
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- School of Public Health, University of California San Diego, CA, La Jolla, USA
| | - Sylvanus Toikumo
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
- SA MRC Genomics of Brain Disorders Research Unit, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD, USA
| | - Annette Uwineza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Mieke H Verfaellie
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Memory Disorders Research Center, VA Boston Healthcare System, Boston, MA, USA
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, ZH, NL, Netherlands
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Christiaan H Vinkers
- Department of Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Holland, Netherlands
- Department of Psychiatry, Amsterdam, UMC Location Vrije Universiteit Amsterdam, Amsterdam, Holland, Netherlands
- Amsterdam University Medical Center, Amsterdam Neuroscience Research Institute, Stress & Sleep Program, MoodPsychosisAmsterdam, Holland, AnxietyNL, Netherlands
| | - Erin B Ware
- Survey Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Derek E Wildman
- College of Public Health, University of South Florida, Tampa, FL, USA
- Genomics Program, University of South Florida, Tampa, FL, USA
| | - Erika J Wolf
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ross McD Young
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, QLD, AU, Brisbane, Australia
- University of the Sunshine Coast, The Chancellory Sippy Downs, QLD, AU, Buderim, Australia
| | - Ying Zhao
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
- Department of Anesthesiology, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
- SA MRC Extramural Genomics of Brain Disorders Research Unit, Stellenbosch University, Western Cape, Cape Town, ZA, South Africa
| | - Monica Uddin
- University of South Florida College of Public Health, Genomics Program, Tampa, FL, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, San Diego, USA
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Mark W Logue
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
- Biomedical Genetics & Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
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5
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Almuwaqqat Z, Liu C, Ko YA, Elon L, Moazzami K, Wang M, Murrah N, Shallenberger L, Lewis TT, Shah AJ, Raggi P, Bremner JD, Quyyumi AA, Vaccarino V. Posttraumatic Stress Disorder and the Risk of Heart Failure Hospitalizations Among Individuals With Coronary Artery Disease. Circ Cardiovasc Qual Outcomes 2024; 17:e011040. [PMID: 39564654 PMCID: PMC11652216 DOI: 10.1161/circoutcomes.124.011040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 10/15/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with maladaptive dysregulation of stress response systems, which could lead to an increased risk of heart failure. We investigated whether PTSD was independently associated with first and recurrent heart failure hospitalizations in the setting of coronary artery disease. METHODS Individuals with stable coronary artery disease and without heart failure at baseline were enrolled in 2 parallel prospective cohort studies in metropolitan Atlanta, GA. Participants underwent a structured clinical interview to assess their lifetime history of PTSD. Current PTSD symptoms were assessed using the PTSD symptom checklist. Participants were followed up for a median time of 4.9 years. The primary end point was first or recurrent hospitalization for heart failure. Secondary end points included cardiovascular death and nonfatal myocardial infarction with and without hospitalization for heart failure. Survival analysis for repeated events was used to assess the association of PTSD with adverse events. RESULTS We studied 736 individuals with a mean age of 60±10 years; 36% were Black, and 35% were women. In total, 69 (9.4%) patients met the criteria for PTSD. Having a PTSD diagnosis was associated with the primary end point of first or recurrent heart failure hospitalizations, with a hazard ratio of 4.4 (95% CI, 2.6-7.3). The results were minimally attenuated after adjusting for demographic and clinical factors (hazard ratio, 3.7 [95% CI, 2.1-6.3]). Similarly, a 10-point increase in the PTSD symptom checklist score was associated with a 30% (95% CI, 10%-50%) increase in heart failure hospitalizations. PTSD was not associated with an end point of cardiovascular death or nonfatal myocardial infarction, which excluded hospitalizations due to heart failure. CONCLUSIONS Among patients with coronary artery disease, PTSD is associated with incident and recurrent heart failure hospitalizations. Future research is needed to investigate whether PTSD management can reduce the risk of heart failure.
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Affiliation(s)
- Zakaria Almuwaqqat
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Chang Liu
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology (C.L., N.M, L.S., T.T.L., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yi-An Ko
- Biostatistics and Bioinformatics (Y.-A.K., L.E.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lisa Elon
- Biostatistics and Bioinformatics (Y.-A.K., L.E.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kasra Moazzami
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Maggie Wang
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Nancy Murrah
- Department of Epidemiology (C.L., N.M, L.S., T.T.L., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lucy Shallenberger
- Department of Epidemiology (C.L., N.M, L.S., T.T.L., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Tené T Lewis
- Department of Epidemiology (C.L., N.M, L.S., T.T.L., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology (C.L., N.M, L.S., T.T.L., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA (A.J.S., J.D.B.)
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (P.R.)
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA
- Department of Radiology and Imaging Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA (A.J.S., J.D.B.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine (Z.A., C.L., K.M., M.W., A.J.S., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology (C.L., N.M, L.S., T.T.L., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
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6
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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024; 18:649-680. [PMID: 38711288 PMCID: PMC11538387 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M. Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E. Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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7
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Strange TA, Clark HL, Dixon LJ. Potentially traumatic events, posttraumatic stress symptoms, and skin-related quality of life among adults with self-reported skin disease symptoms. Arch Dermatol Res 2024; 317:19. [PMID: 39546010 PMCID: PMC11568012 DOI: 10.1007/s00403-024-03451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/20/2024] [Accepted: 10/08/2024] [Indexed: 11/17/2024]
Abstract
The connection between stress and skin disease has been extensively documented; however, there are no empirical studies investigating the incidence of traumatic event exposure and posttraumatic stress (PTS) symptoms among dermatology patients. To address this gap in the literature and begin to understand the associations between PTS symptoms and skin disease symptoms, this study used a sample of adults with self-reported skin disease symptoms to examine: (1) rates of potentially traumatic event (PTE) exposure and PTS symptoms; and (2) the association between PTS symptoms and skin-related quality of life, controlling for relevant covariates. Data were collected online through Cloud Research, and participants completed a battery of self-report measures. The sample included 310 participants (68.4% female) who endorsed current skin disease symptoms. Results indicated that 47.1% of participants endorsed clinical levels of PTS symptoms. Consistent with hypotheses, greater levels of PTS symptoms were associated with worse skin-related quality of life, and this association was particularly robust for arousal-related symptoms. Results shed light on the occurrence of trauma-related experiences among individuals with self-reported skin disease and indicate a link between PTS symptoms and the perceived burden of skin disease symptoms on daily living. However, this study was cross-sectional and relied on self-report measures; therefore, findings should be interpreted with caution, particularly since diagnoses could not be verified. Replication of this work in dermatology patients is needed to further understand these connections.
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Affiliation(s)
- Taylor A Strange
- Department of Psychology, University of Mississippi, P.O. Box 1848, Mississippi, 38655-1848, USA
| | - Heather L Clark
- Department of Psychology, University of Mississippi, P.O. Box 1848, Mississippi, 38655-1848, USA
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, Mississippi, 38655-1848, USA.
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8
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Gnall KE, Sacco SJ, Sinnott SM, Park CL, Mazure CM, Hoff RA. Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans. J Health Psychol 2024; 29:1576-1589. [PMID: 38400566 DOI: 10.1177/13591053241233380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Given the importance of physical activity (PA) for both physical and mental health, the present study characterizes post-9/11 veterans' leisure-time PA engagement over time. Further, this study examines the relationship between PA and posttraumatic stress symptoms (PTSS), as well as whether this relation differs by gender and time since military discharge. This study was a secondary analysis of a 12-month longitudinal observational investigation of 410 (39.5% female) post-9/11 veterans. Participants completed self-report questionnaires at baseline and 12 months. Over a third of post-9/11 veterans were not engaging in any weekly leisure-time PA at study baseline and PA engagement significantly decreased in the subsequent year. The longitudinal relationship between PA and PTSS depended on both gender and time since military discharge. These results underscore the importance of considering both gender and time since discharge when tailoring interventions to support leisure-time PA as a key health habit in post-9/11 veterans.
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Affiliation(s)
| | | | | | | | | | - Rani A Hoff
- Yale School of Medicine, USA
- Northeast Program Evaluation Center (NEPEC), USA
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9
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Pierce SK, Reynolds KA, Sommer JL, El-Gabalawy R, Pietrzak RH, Sumner JA, Mota N. Maladaptive health factors as potential mediators for the association between posttraumatic stress disorder and cardiovascular disease: A sex-stratified analysis in the U.S. adult population. J Psychiatr Res 2024; 177:102-108. [PMID: 39002531 DOI: 10.1016/j.jpsychires.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES This study examined sex differences for health risk factors as potential mediators in the association between posttraumatic stress disorder (PTSD) and cardiovascular disease (CVD). METHODS Secondary data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave 3 was used. This cross-sectional survey contains a nationally representative sample of 36,309 U.S. adults (nfemales = 20,447, Mage = 47.16, 95% CI = [46.74, 47,57]; nmales = 15,682, Mage = 45.88, 95% CI = [45.42, 46.34]). Natural effect models and logistic regression analyses were conducted to evaluate health risk factors (smoking, substance use, low physical activity, high body mass index [BMI], binge eating, and multiple health risk factors) as potential mediators for the PTSD-CVD relationship in females and males. RESULTS High BMI (indirect AOR = 1.05, 95% CI = [1.02, 1.07]) and substance use (indirect AOR = 0.93, 95% CI = [0.88, 0.98], p = 0.005) were potential mediators in females and males respectively. Binge eating, smoking, and low physical activity were not mediators in either sex. The number of health risk factors was also a potential mediator in females (indirect AOR = 1.12, 95% CI = [1.07, 1.19], p = <0.001) though not males (indirect AOR = 1.09, 95% CI = [1.00, 1.19], p = .059). CONCLUSIONS The results inform prevention strategies, such as screening for health risk factors to mitigate the adverse effect of PTSD on CVD risk. Findings also inform important directions for future longitudinal research to establish causal pathways.
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Affiliation(s)
- S K Pierce
- Department of Psychology, University of Manitoba, MB, Canada
| | - K A Reynolds
- Department of Psychology, University of Manitoba, MB, Canada; Department of Psychiatry, University of Manitoba, MB, Canada
| | - J L Sommer
- Department of Psychology, University of Manitoba, MB, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, MB, Canada
| | - R El-Gabalawy
- Department of Psychology, University of Manitoba, MB, Canada; Department of Psychiatry, University of Manitoba, MB, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, MB, Canada; Department of Clinical Health Psychology, University of Manitoba, MB, Canada
| | - R H Pietrzak
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - J A Sumner
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - N Mota
- Department of Psychiatry, University of Manitoba, MB, Canada; Department of Clinical Health Psychology, University of Manitoba, MB, Canada.
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10
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McBain SA, Cordova MJ. Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings. J Clin Psychol Med Settings 2024; 31:501-512. [PMID: 39095585 DOI: 10.1007/s10880-024-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 08/04/2024]
Abstract
Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry and Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA, 94304, USA
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11
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Katrinli S, Wani AH, Maihofer AX, Ratanatharathorn A, Daskalakis NP, Montalvo-Ortiz J, Núñez-Ríos DL, Zannas AS, Zhao X, Aiello AE, Ashley-Koch AE, Avetyan D, Baker DG, Beckham JC, Boks MP, Brick LA, Bromet E, Champagne FA, Chen CY, Dalvie S, Dennis MF, Fatumo S, Fortier C, Galea S, Garrett ME, Geuze E, Grant G, Michael A Hauser, Hayes JP, Hemmings SM, Huber BR, Jajoo A, Jansen S, Kessler RC, Kimbrel NA, King AP, Kleinman JE, Koen N, Koenen KC, Kuan PF, Liberzon I, Linnstaedt SD, Lori A, Luft BJ, Luykx JJ, Marx CE, McLean SA, Mehta D, Milberg W, Miller MW, Mufford MS, Musanabaganwa C, Mutabaruka J, Mutesa L, Nemeroff CB, Nugent NR, Orcutt HK, Qin XJ, Rauch SAM, Ressler KJ, Risbrough VB, Rutembesa E, Rutten BPF, Seedat S, Stein DJ, Stein MB, Toikumo S, Ursano RJ, Uwineza A, Verfaellie MH, Vermetten E, Vinkers CH, Ware EB, Wildman DE, Wolf EJ, Young RM, Zhao Y, van den Heuvel LL, Uddin M, Nievergelt CM, Smith AK, Logue MW. Epigenome-wide association studies identify novel DNA methylation sites associated with PTSD: A meta-analysis of 23 military and civilian cohorts. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.15.24310422. [PMID: 39072012 PMCID: PMC11275670 DOI: 10.1101/2024.07.15.24310422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background The occurrence of post-traumatic stress disorder (PTSD) following a traumatic event is associated with biological differences that can represent the susceptibility to PTSD, the impact of trauma, or the sequelae of PTSD itself. These effects include differences in DNA methylation (DNAm), an important form of epigenetic gene regulation, at multiple CpG loci across the genome. Moreover, these effects can be shared or specific to both central and peripheral tissues. Here, we aim to identify blood DNAm differences associated with PTSD and characterize the underlying biological mechanisms by examining the extent to which they mirror associations across multiple brain regions. Methods As the Psychiatric Genomics Consortium (PGC) PTSD Epigenetics Workgroup, we conducted the largest cross-sectional meta-analysis of epigenome-wide association studies (EWASs) of PTSD to date, involving 5077 participants (2156 PTSD cases and 2921 trauma-exposed controls) from 23 civilian and military studies. PTSD diagnosis assessments were harmonized following the standardized guidelines established by the PGC-PTSD Workgroup. DNAm was assayed from blood using either Illumina HumanMethylation450 or MethylationEPIC (850K) BeadChips. A common QC pipeline was applied. Within each cohort, DNA methylation was regressed on PTSD, sex (if applicable), age, blood cell proportions, and ancestry. An inverse variance-weighted meta-analysis was performed. We conducted replication analyses in tissue from multiple brain regions, neuronal nuclei, and a cellular model of prolonged stress. Results We identified 11 CpG sites associated with PTSD in the overall meta-analysis (1.44e-09 < p < 5.30e-08), as well as 14 associated in analyses of specific strata (military vs civilian cohort, sex, and ancestry), including CpGs in AHRR and CDC42BPB. Many of these loci exhibit blood-brain correlation in methylation levels and cross-tissue associations with PTSD in multiple brain regions. Methylation at most CpGs correlated with their annotated gene expression levels. Conclusions This study identifies 11 PTSD-associated CpGs, also leverages data from postmortem brain samples, GWAS, and genome-wide expression data to interpret the biology underlying these associations and prioritize genes whose regulation differs in those with PTSD.
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Affiliation(s)
- Seyma Katrinli
- Emory University, Department of Gynecology and Obstetrics, Atlanta, GA, US
| | - Agaz H Wani
- University of South Florida, Genomics Program, College of Public Health, Tampa, FL, US
| | - Adam X Maihofer
- University of California San Diego, Department of Psychiatry, La Jolla, CA, US
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, US
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, US
| | - Andrew Ratanatharathorn
- Columbia University Mailmain School of Public Health, Department of Epidemiology, New York, NY, US
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, US
| | - Nikolaos P Daskalakis
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, US
- Harvard Medical School, Department of Psychiatry, Boston, MA, US
- McLean Hospital, Center of Excellence in Depression and Anxiety Disorders, Belmont, MA, US
| | - Janitza Montalvo-Ortiz
- U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, CT, US
- VA Connecticut Healthcare System, West Haven, CT, US
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, US
| | - Diana L Núñez-Ríos
- U.S. Department of Veterans Affairs National Center of Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, CT, US
- VA Connecticut Healthcare System, West Haven, CT, US
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, US
| | - Anthony S Zannas
- University of North Carolina at Chapel Hill, Carolina Stress Initiative, Chapel Hill, NC, US
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, NC, US
- University of North Carolina at Chapel Hill, Department of Psychiatry, Chapel Hill, NC, US
- University of North Carolina at Chapel Hill, Institute for Trauma Recovery, Chapel Hill, NC, US
| | - Xiang Zhao
- Boston University School of Public Health, Department of Biostatistics, Boston, MA, US
| | - Allison E Aiello
- Columbia University, Robert N Butler Columbia Aging Center, Department of Epidemiology, New York, NY, US
| | | | - Diana Avetyan
- University of California San Diego, Department of Psychiatry, La Jolla, CA, US
| | - Dewleen G Baker
- University of California San Diego, Department of Psychiatry, La Jolla, CA, US
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, US
- Veterans Affairs San Diego Healthcare System, Psychiatry Service, San Diego, CA, US
| | - Jean C Beckham
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, US
- Durham VA Health Care System, Research, Durham, NC, US
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, US
| | - Marco P Boks
- Brain Center University Medical Center Utrecht, Department of Psychiatry, Utrecht, UT, NL
| | - Leslie A Brick
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, US
| | - Evelyn Bromet
- State University of New York at Stony Brook, Epidemiology Research Group, Stony Brook, NY, US
| | | | - Chia-Yen Chen
- Biogen Inc., Translational Sciences, Cambridge, MA, US
| | - Shareefa Dalvie
- University of Cape Town, Department of Pathology, Cape Town, Western Province, ZA
- University of Cape Town, Division of Human Genetics, Cape Town, Western Province, ZA
| | - Michelle F Dennis
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, US
- Durham VA Health Care System, Research, Durham, NC, US
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, US
| | - Segun Fatumo
- MRC/UVRI and London School of Hygiene and Tropical Medicine, The African Computational Genomics (TACG) Research Group, Entebbe, Wakiso, Uganda
| | - Catherine Fortier
- Harvard Medical School, Department of Psychiatry, Boston, MA, US
- VA Boston Healthcare System, TRACTS/GRECC, Boston, MA, US
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, US
| | - Melanie E Garrett
- Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, US
| | - Elbert Geuze
- Netherlands Ministry of Defence, Brain Research and Innovation Centre, Utrecht, UT, NL
- UMC Utrecht Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht, UT, NL
| | - Gerald Grant
- Duke University School of Medicine, Department of Neurosurgery, Durham, NC, US
| | - Michael A Hauser
- Duke University School of Medicine, Department of Medicine, Durham, NC, US
| | - Jasmeet P Hayes
- The Ohio State University, Department of Psychology, Columbus, OH, US
| | - Sian Mj Hemmings
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA
- Stellenbosch University, SAMRC Genomics of Brain Disorders Research Unit, Cape Town, Western Cape, ZA
| | - Bertrand Russel Huber
- Boston University School of Medicine, Department of Neurology, Boston, MA, US
- VA Boston Healthcare System, Pathology and Laboratory Medicine, Boston, MA, US
| | - Aarti Jajoo
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, US
- Harvard Medical School, Department of Psychiatry, Boston, MA, US
- McLean Hospital, Belmont, MA, US
| | - Stefan Jansen
- University of Rwanda, College of Medicine and Health Sciences, Kigali, RW
| | - Ronald C Kessler
- Harvard Medical School, Department of Health Care Policy, Boston, MA, US
| | - Nathan A Kimbrel
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, US
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, US
- Durham VA Health Care System, Mental Health Service Line, Durham, NC, US
| | - Anthony P King
- The Ohio State University, College of Medicine, Institute for Behavioral Medicine Research, Columbus, OH, US
- The Ohio State University, College of Medicine, Psychiatry & Behavioral Health, Columbus, OH, US
| | - Joel E Kleinman
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, US
- Lieber Institute for Brain Development, Baltimore, MD, US
| | - Nastassja Koen
- University of Cape Town, Department of Psychiatry & Mental Health, Cape Town, Western Province, ZA
- University of Cape Town, Neuroscience Institute, Cape Town, Western Province, ZA
- University of Cape Town, SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, Western Province, ZA
| | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, US
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, US
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA, US
| | - Pei-Fen Kuan
- Stony Brook University, Department of Applied Mathematics and Statistics, Stony Brook, NY, US
| | - Israel Liberzon
- Texas A&M University College of Medicine, Department of Psychiatry and Behavioral Sciences, Bryan, TX, US
| | - Sarah D Linnstaedt
- University of North Carolina at Chapel Hill, Department of Anesthesiology, Chapel Hill, NC, US
- University of North Carolina at Chapel Hill, UNC Institute for Trauma Recovery, Chapel Hill, NC, US
| | - Adriana Lori
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, US
| | - Benjamin J Luft
- Stony Brook University, Department of Medicine, Stony Brook, NY, US
| | - Jurjen J Luykx
- Amsterdam University Medical Center, Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress & Sleep Program, Amsterdam, NH, NL
- Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, NH, NL
- Amsterdam University Medical Center, Department of Psychiatry, Amsterdam, NH, NL
| | - Christine E Marx
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, US
- Durham VA Health Care System, Durham, NC, US
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, US
| | - Samuel A McLean
- UNC Institute for Trauma Recovery, Department of Psychiatry, Chapel Hill, NC, US
| | - Divya Mehta
- Queensland University of Technology, Centre for Genomics and Personalised Health, Kelvin Grove, QLD, AU
- Queensland University of Technology, School of Biomedical Sciences, Kelvin Grove, QLD, AU
| | | | - Mark W Miller
- Boston University School of Medicine, Psychiatry, Biomedical Genetics, Boston, MA, US
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, US
| | - Mary S Mufford
- University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, Western Province, ZA
| | - Clarisse Musanabaganwa
- Rwanda Biomedical Center, Research Innovation and Data Science Division, Kigali, RW
- University of Rwanda, Center of Human Genetics, Kigali, RW
| | - Jean Mutabaruka
- University of Rwanda, Department of Clinical Psychology, Huye, RW
| | - Leon Mutesa
- University of Rwanda, College of Medicine and Health Sciences, Kigali, RW
- University of Rwanda, Center for Human Genetics, Kigali, RW
| | - Charles B Nemeroff
- The University of Texas at Austin, Department of Psychology, Austin, TX, US
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, Austin, TX, US
| | - Nicole R Nugent
- Alpert Brown Medical School, Department of Emergency Medicine, Providence, RI, US
- Alpert Brown Medical School, Department of Pediatrics, Providence, RI, US
- Alpert Brown Medical School, Department of Psychiatry and Human Behavior, Providence, RI, US
| | - Holly K Orcutt
- Northern Illinois University, Department of Psychology, DeKalb, IL, US
| | - Xue-Jun Qin
- Duke University, Duke Molecular Physiology Institute, Durham, NC, US
| | - Sheila A M Rauch
- Emory University, Department of Psychiatry & Behavioral Sciences, Atlanta, GA, US
- Joseph Maxwell Cleland Atlanta Veterans Affairs Healthcare System, Atlanta, GA, US
| | - Kerry J Ressler
- Harvard Medical School, Department of Psychiatry, Boston, MA, US
- McLean Hospital, Belmont, MA, US
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, US
| | - Victoria B Risbrough
- University of California San Diego, Department of Psychiatry, La Jolla, CA, US
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, US
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, US
| | | | - Bart P F Rutten
- Maastricht Universitair Medisch Centrum, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, Limburg, NL
| | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA
- Stellenbosch University, SA MRC Extramural Genomics of Brain Disorders Research Unit, Cape Town, Western Cape, ZA
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry & Mental Health, Cape Town, Western Province, ZA
- University of Cape Town, Neuroscience Institute, Cape Town, Western Province, ZA
- University of Cape Town, SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, Western Province, ZA
| | - Murray B Stein
- University of California San Diego, Department of Psychiatry, La Jolla, CA, US
- Veterans Affairs San Diego Healthcare System, Psychiatry Service, San Diego, CA, US
- University of California San Diego, School of Public Health, La Jolla, CA, US
| | - Sylvanus Toikumo
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA
- Stellenbosch University, SA MRC Genomics of Brain Disorders Research Unit, Cape Town, Western Cape, ZA
| | - Robert J Ursano
- Uniformed Services University, Center for the Study of Traumatic Stress, Department of Psychiatry, Bethesda, Maryland, US
| | - Annette Uwineza
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Mieke H Verfaellie
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, US
- VA Boston Healthcare System, Memory Disorders Research Center, Boston, MA, US
| | - Eric Vermetten
- Leiden University Medical Center, Department of Psychiatry, Leiden, ZH, NL
- New York University School of Medicine, Department of Psychiatry, New York, NY, US
| | - Christiaan H Vinkers
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, Holland, NL
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam, Holland, NL
- Amsterdam University Medical Center, Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress & Sleep Program, Amsterdam, Holland, NL
| | - Erin B Ware
- University of Michigan, Survey Research Center, Ann Arbor, MI, US
| | - Derek E Wildman
- University of South Florida, College of Public Health, Tampa, FL, US
- University of South Florida, Genomics Program, Tampa, FL, US
| | - Erika J Wolf
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, US
- Boston University Chobanian & Avedisian School of Medicine, Department of Psychiatry, Boston, MA, US
| | - Ross McD Young
- Queensland University of Technology, School of Clinical Sciences, Kelvin Grove, QLD, AU
- University of the Sunshine Coast, The Chancellory, Sippy Downs, QLD, AU
| | - Ying Zhao
- University of North Carolina at Chapel Hill, Institute for Trauma Recovery, Chapel Hill, NC, US
- University of North Carolina at Chapel Hill, Department of Anesthesiology, Chapel Hill, NC, US
| | - Leigh L van den Heuvel
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA
- Stellenbosch University, SA MRC Extramural Genomics of Brain Disorders Research Unit, Cape Town, Western Cape, ZA
| | - Monica Uddin
- University of South Florida College of Public Health, Genomics Program, Tampa, FL, US
| | - Caroline M Nievergelt
- University of California San Diego, Department of Psychiatry, La Jolla, CA, US
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, US
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, US
| | - Alicia K Smith
- Emory University, Department of Gynecology and Obstetrics, Atlanta, GA, US
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, US
- Emory University, Department of Human Genetics, Atlanta, GA, US
| | - Mark W Logue
- Boston University School of Public Health, Department of Biostatistics, Boston, MA, US
- Boston University School of Medicine, Psychiatry, Biomedical Genetics, Boston, MA, US
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, US
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12
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Bourassa KJ, Sbarra DA. Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory. Transl Psychiatry 2024; 14:285. [PMID: 38997260 PMCID: PMC11245531 DOI: 10.1038/s41398-024-03004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
Although stress and adversity are largely universal experiences, people exposed to greater hardship are at increased risk for negative health consequences. Recent studies identify accelerated biological aging as a mechanism that could explain how trauma and adversity gives rise to poor health, and advances in this area of study coincide with technological innovations in the measurement of biological aging, particularly epigenetic profiles consistent with accelerated aging derived from DNA methylation. In this review, we provide an overview of the current literature examining how adversity might accelerate biological aging, with a specific focus on social and health behaviors. The most extensive evidence in this area suggests that health-compromising behaviors, particularly smoking, may partially explain the association between adversity and accelerated aging. Although there is relatively less published support for the role of social behaviors, emerging evidence points to the importance of social connection as a mechanism for future study. Our review highlights the need to determine the extent to which the associations from adversity to accelerated aging are consistent with causal processes. As we consider these questions, the review emphasizes methodological approaches from the causal inference literature that can help deepen our understanding of how stress and trauma might result in poor health. The use of these methodologies will help provide evidence as to which behavioral interventions might slow aging and improve health, particularly among populations that more often experience adversity and trauma.
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Affiliation(s)
- Kyle J Bourassa
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
- Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA.
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
| | - David A Sbarra
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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13
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Filippou K, Knappe F, Hatzigeorgiadis A, Morres ID, Tzormpatzakis E, Havas E, Pühse U, Theodorakis Y, Gerber M. Self-Reported Physical Activity and Mental Health Among Asylum Seekers in a Refugee Camp. J Phys Act Health 2024; 21:657-667. [PMID: 38621670 DOI: 10.1123/jpah.2023-0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/22/2024] [Accepted: 02/29/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers. METHODS Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being. RESULTS High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect. CONCLUSIONS The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.
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Affiliation(s)
- Konstantinia Filippou
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Florian Knappe
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Ioannis D Morres
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | | | - Elsa Havas
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Yannis Theodorakis
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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14
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Glass IV, Frankenburg FR, Zanarini MC. Longitudinal description and prediction of physical inactivity among patients with borderline personality disorder and personality-disordered comparison subjects. Borderline Personal Disord Emot Dysregul 2024; 11:11. [PMID: 38845011 PMCID: PMC11157732 DOI: 10.1186/s40479-024-00253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The physical and psychological benefits of physical activity are well-known, and physical activity has been proven to be a helpful adjunct to psychotherapeutic treatment for many symptomatic disorders, including mood and anxiety disorders. The current study explores physical inactivity levels in patients with borderline personality disorder (BPD). The first aim of this study is to describe the 12-year course of physical inactivity in patients with BPD. The second aim is to examine predictors of physical inactivity, including adversity experiences, comorbid symptomatic (formerly axis I) disorders, medical disorders, and demographic factors. METHODS Two hundred and forty-five patients with BPD were interviewed seven times over 12-years of prospective follow-up as part of the McLean Study of Adult Development (MSAD). Patients were categorized as ever-recovered (i.e., patient had experienced a symptomatic and psychosocial recovery from BPD) or never-recovered. At each follow-up, patients reported physical activity levels (minutes of exercise per week) via a semi-structured interview- the Medical History and Services Utilization Interview (MHSUI). Data was collected from June 1992 to December 2018. RESULTS Never-recovered patients with BPD were significantly more inactive than their ever-recovered counterparts (p < 0.001). These rates of inactivity remained stable over time for both groups. Two significant multivariate predictors of inactivity were found: obesity (p = 0.003) and PTSD (p < 0.001). CONCLUSIONS Non-recovered BPD patients are more likely to be inactive than patients who have recovered. Both clinical and medical factors appear to contribute to inactivity levels in patients with BPD.
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Affiliation(s)
- Isabel V Glass
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA
| | - Frances R Frankenburg
- Boston University School of Medicine, Boston, MA, USA
- Edith Nourse Rogers Veterans Administration Medical Center, Bedford, MA, USA
| | - Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA.
- Harvard Medical School, Boston, MA, USA.
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15
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Puljiz Z, Kumric M, Borovina Marasovic T, Mastelic T, Rakusic M, Pavela G, Beg A, Glavina T, Mornar M, Supe Domic D, Vilovic M, Zucko J, Ticinovic Kurir T, Bozic J. Mediterranean Diet Adherence, Physical Activity, and Advanced Glycation End Products in Complex PTSD: A Comprehensive Examination of Lifestyle and Cardiovascular Risk in War Veterans. Nutrients 2024; 16:1791. [PMID: 38892723 PMCID: PMC11174454 DOI: 10.3390/nu16111791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
As accumulated evidence suggests that individuals with post-traumatic stress disorder (PTSD) encounter earlier and more frequent occurrences of cardiovascular diseases, the aim of this study was to ascertain the differences in lifestyle and cardiovascular risk between PTSD and complex PTSD patients. We enrolled 137 male war veterans with PTSD (89 had complex PTSD). The diagnosis was established based on 11th revision of International Classification of Diseases (ICD-11), and cardiovascular risk was estimated by the measurement of advanced glycation end products. Adherence to Mediterranean diet (MD) was lower in the complex PTSD group (2.2% vs. 12.5%, p = 0.015). Accordingly, patients with complex PTSD had lower healthy lifestyle scores in comparison to PTSD counterparts (50.6 ± 9.7 vs. 59.6 ± 10.1, p < 0.001), and a positive association was noted between MD adherence and a healthy lifestyle (r = 0.183, p = 0.022). On the other hand, differences were not noted in terms of physical activity (p = 0.424), fat % (p = 0.571) or cardiovascular risk (p = 0.573). Although complex PTSD patients exhibit worse adherence to MD and lower healthy lifestyle scores, these differences do not seem to impact physical activity, body composition, or estimated cardiovascular risk. More research is needed to clarify if this lack of association accurately reflects the state of the PTSD population or results from insufficient statistical power.
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Affiliation(s)
- Zivana Puljiz
- Laboratory for Bioinformatics, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (Z.P.); (J.Z.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Laboratory for Cardiometabolic Research, University of Split School of Medicine, 21000 Split, Croatia
| | - Tonka Borovina Marasovic
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Tonci Mastelic
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Mihaela Rakusic
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Goran Pavela
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Andelko Beg
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Trpimir Glavina
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
- Department of Psychiatry, University of Split School of Medicine, 21000 Split, Croatia
| | - Marin Mornar
- Department of Pharmacology, University of Split School of Medicine, 21000 Split, Croatia;
| | - Daniela Supe Domic
- Department of Health Studies, University of Split, 21000 Split, Croatia;
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Laboratory for Cardiometabolic Research, University of Split School of Medicine, 21000 Split, Croatia
| | - Jurica Zucko
- Laboratory for Bioinformatics, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (Z.P.); (J.Z.)
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Department of Endocrinology, Diabetes and Metabolic Disorders, University Hospital of Split, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Laboratory for Cardiometabolic Research, University of Split School of Medicine, 21000 Split, Croatia
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16
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Deng H, Shepler LJ, Chacon KL, Tenney D, Ni P, Stewart BT, Carrougher GJ, Kowalske K, Wolf SE, Slavin MD, Kazis LE, Ryan CM, Schneider JC. Predictors at 6 and 12 Months for Social Participation Outcome at 24 Months in the Adult Burn Injury Population: A Burn Model System National Database Study. Arch Phys Med Rehabil 2024; 105:235-242. [PMID: 37392780 PMCID: PMC10756920 DOI: 10.1016/j.apmr.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury. DESIGN A prospective cohort study based on Burn Model System National Database. SETTING Burn Model System centers. PARTICIPANTS 181 adult participants less than 2 years after burn injury (N=181). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and injury variables were collected at discharge. Predictor variables were assessed at 6 and 12 months: Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Sleep Disturbance, Fatigue, and Pain Interference short forms, and self-reported Heat Intolerance. Social participation was measured at 24 months using the Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities short forms. RESULTS Linear and multivariable regression models were used to examine predictor variables for social participation outcomes, controlling for demographic and injury variables. For LIBRE Social Interactions, significant predictors included the PCL-C total score at 6 months (β=-0.27, P<.001) and 12 months (β=-0.39, P<.001), and PROMIS-29 Pain Interference at 6 months (β=-0.20, P<.01). For LIBRE Social Activities, significant predictors consisted of the PROMIS-29 Depression at 6 months (β=-0.37, P<.001) and 12 months (β=-0.37, P<.001), PROMIS-29 Pain Interference at 6 months (β=-0.40, P<.001) and 12 months (β=-0.37, P<.001), and Heat Intolerance at 12 months (β=-4.55, P<.01). CONCLUSIONS Post-traumatic stress and pain predicted social interactions outcomes, while depression, pain and heat intolerance predicted social activities outcomes in people with burn injury.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Kaitlyn L Chacon
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | | | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
| | - Barclay T Stewart
- The University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA
| | | | - Karen Kowalske
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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17
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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: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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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18
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Kinsman LM, Norrie HJ, Rachor GS, Asmundson GJG. Exercise and PTSD. Curr Top Behav Neurosci 2024; 67:241-262. [PMID: 39112812 DOI: 10.1007/7854_2024_500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2024]
Abstract
Evidence indicating that exercise benefits mental health symptoms across a range of mental health diagnoses spans decades of scientific literature; however, fewer studies have examined the impact of exercise on posttraumatic stress disorder (PTSD). Exercise is an accessible, cost-effective, and scalable treatment option that has the potential to improve both physiological and psychological symptoms among individuals with PTSD. The purpose of this chapter is to review empirical literature on the role of exercise in the treatment of PTSD. Researchers have demonstrated that exercise improves PTSD symptoms as both a stand-alone treatment and as an adjunct to cognitive behavioral and trauma-focused therapies. Additional research is needed to clarify mechanisms that account for the impacts of exercise on PTSD and to identify which components of exercise (e.g., type of exercise, dose, intensity, frequency) are the most beneficial.
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Affiliation(s)
- Laura M Kinsman
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Holden J Norrie
- Department of Psychology, University of Regina, Regina, SK, Canada
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Wiseman M, Hinks M, Hallett D, Blundell J, Sweeney E, Thorpe CM, Walling SG, Swift-Gallant A. Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder. J Psychiatr Res 2023; 168:213-220. [PMID: 37918034 DOI: 10.1016/j.jpsychires.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow's Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis.
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Affiliation(s)
- Megan Wiseman
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Meagan Hinks
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Darcy Hallett
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ellen Sweeney
- Atlantic PATH, Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Christina M Thorpe
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Susan G Walling
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ashlyn Swift-Gallant
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada.
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Humbert A, Kohls E, Baldofski S, Epple C, Rummel-Kluge C. Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic. Front Psychiatry 2023; 14:1271702. [PMID: 37953932 PMCID: PMC10634536 DOI: 10.3389/fpsyt.2023.1271702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool. Objective The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany. Methods The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers. Results In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05). Conclusion A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients. Clinical trial registration https://clinicaltrials.gov/, DRKS00027911.
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Affiliation(s)
- Annika Humbert
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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21
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Kim G, Kim H, Park J, Kang HS, Kim S, Kim S. A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A Quasi-Experimental Pilot Study. J Korean Acad Nurs 2023; 53:500-513. [PMID: 37977561 DOI: 10.4040/jkan.22120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. METHODS This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. RESULTS The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p =.004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. CONCLUSION This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.
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Affiliation(s)
- Goun Kim
- College of Nursing and Research Institute of Nursing Science, Pusan National University, Yangsan, Korea
- Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Heejung Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Jeongok Park
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Soojin Kim
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Sunah Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea.
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22
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Young-McCaughan S, Straud CL, Bumstead S, Pruiksma KE, Taylor DJ, Jacoby VM, Yarvis JS, Peterson AL. Aerobic exercise improves sleep in U. S. active duty service members following brief treatment for posttraumatic stress disorder symptoms. Front Psychol 2023; 14:1249543. [PMID: 37794901 PMCID: PMC10546873 DOI: 10.3389/fpsyg.2023.1249543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Physical exercise is a lifestyle intervention that can positively impact aspects of physical and psychological health. There is a growing body of evidence suggesting that physical exercise, sleep, and PTSD are interrelated. This study investigated possible relationships. Three research questions were posed: (1) Did randomization to an aerobic exercise intervention reduce insomnia more than being randomized to an intervention without exercise, (2) Did change in sleep predict change in PTSD symptoms, and (3) Did change in sleep impact the relationship between exercise and PTSD symptom reductions? Methods Data were collected from 69 treatment-seeking active duty service members with PTSD symptoms randomized into one of four conditions; two conditions included aerobic exercise, and two conditions did not include exercise. Participants in the exercise groups exercised five times per week keeping their heart rate > 60% of their heart rate reserve for 20-25 min. Results At baseline, 58% of participants reported moderate or severe insomnia. PTSD symptom severity decreased following treatment for all groups (p < 0.001). Participants randomized to exercise reported greater reductions in insomnia compared to those in the no exercise group (p = 0.47). However, change in insomnia did not predict change in PTSD symptoms nor did it significantly impact the relationship between exercise and PTSD symptom reductions. Discussion Adding exercise to evidence-based treatments for PTSD could reduce sleep disturbance, a characteristic of PTSD not directly addressed with behavioral therapies. A better understanding of exercise as a lifestyle intervention that can reduce PTSD symptoms and insomnia is warranted.
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Affiliation(s)
- Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Susannah Bumstead
- Institute for Studies of Religion, Baylor University, Waco, TX, United States
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Vanessa M. Jacoby
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Killeen, TX, United States
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, United States
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23
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Campbell AA, Taylor KA, Augustine AV, Sherwood A, Wu JQ, Beckham JC, Hoerle JM, Ulmer CS. Nightmares: an independent risk factor for cardiovascular disease? Sleep 2023; 46:zsad089. [PMID: 36996027 DOI: 10.1093/sleep/zsad089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
STUDY OBJECTIVES Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. METHODS Participants were veterans (N = 3468; 77% male) serving since September 11, 2001, aged 38 years (SD = 10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity were assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. RESULTS Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. CONCLUSIONS Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.
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Affiliation(s)
| | - Kenneth A Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Ann V Augustine
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jade Q Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Jeffrey M Hoerle
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Christi S Ulmer
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA
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24
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Malhotra D, Boyle SH, Gifford EJ, Sullivan BA, Nguyen Wenker TH, Abs ND, Ahmed ST, Upchurch J, Vahey J, Stafford C, Efird JT, Hunt SC, Bradford A, Sims KJ, Hauser ER, Helmer DA, Williams CD. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterol Motil 2023; 35:e14548. [PMID: 36942766 DOI: 10.1111/nmo.14548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans. METHODS Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). KEY RESULTS The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aORIBS = 3.12, 95% CI: 1.93-5.05; aORGERD = 2.04, 95% CI: 1.44-2.90; aORCP = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aORIBS = 4.38, 95% CI: 1.55-12.36; aORGERD = 2.51 95% CI: 1.63-3.87; aORCP = 2.57, 95% CI: 1.53-4.32). CONCLUSIONS & INFERENCES GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.
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Affiliation(s)
- D Malhotra
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - S H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - B A Sullivan
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - T H Nguyen Wenker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Nono-Djotsa Abs
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, Washington, USA
| | - S T Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - J Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J Vahey
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Stafford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J T Efird
- VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA
- Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - S C Hunt
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - A Bradford
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - K J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | - D A Helmer
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - C D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
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Sumner JA, Cleveland S, Chen T, Gradus JL. Psychological and biological mechanisms linking trauma with cardiovascular disease risk. Transl Psychiatry 2023; 13:25. [PMID: 36707505 PMCID: PMC9883529 DOI: 10.1038/s41398-023-02330-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, and experiences of psychological trauma have been associated with subsequent CVD onset. Identifying key pathways connecting trauma with CVD has the potential to inform more targeted screening and intervention efforts to offset elevated cardiovascular risk. In this narrative review, we summarize the evidence for key psychological and biological mechanisms linking experiences of trauma with CVD risk. Additionally, we describe various methodologies for measuring these mechanisms in an effort to inform future research related to potential pathways. With regard to mechanisms involving posttraumatic psychopathology, the vast majority of research on psychological distress after trauma and CVD has focused on posttraumatic stress disorder (PTSD), even though posttraumatic psychopathology can manifest in other ways as well. Substantial evidence suggests that PTSD predicts the onset of a range of cardiovascular outcomes in trauma-exposed men and women, yet more research is needed to better understand posttraumatic psychopathology more comprehensively and how it may relate to CVD. Further, dysregulation of numerous biological systems may occur after trauma and in the presence of posttraumatic psychopathology; these processes of immune system dysregulation and elevated inflammation, oxidative stress, mitochondrial dysfunction, renin-angiotensin system dysregulation, and accelerated biological aging may all contribute to subsequent cardiovascular risk, although more research on these pathways in the context of traumatic stress is needed. Given that many of these mechanisms are closely intertwined, future research using a systems biology approach may prove fruitful for elucidating how processes unfold to contribute to CVD after trauma.
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Affiliation(s)
- Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Shiloh Cleveland
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tiffany Chen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Baker S, Gilhen-Baker M, Roviello GN. The Role of Nutrition and Forest-Bathing in the Physical Rehabilitation of Physically Inactive Patients: From the Molecular Aspects to New Nature-Inspired Techniques. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:793. [PMID: 36613115 PMCID: PMC9819495 DOI: 10.3390/ijerph20010793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 05/07/2023]
Abstract
Physical rehabilitation plays a fundamental role in the management of individuals with disabilities associated with age-related muscle loss or affected by catastrophic conditions such as trauma, surgery, cancer or other severe pathologies. These events have in common an extended period of physical inactivity. Patients who undergo prolonged bed rest often present with a number of complications; for example, muscle loss that can exacerbate existing conditions determined by sarcopenia, which in turn greatly limits physical functions. The main scope of this work is to summarize certain key strategies for the physiotherapeutic management of physically inactive patients, regardless of the reason behind their prolonged bed rest, with a particular focus on physical rehabilitation, nutrition and forest-bathing. The importance of correct nutrition in counter-acting the loss of muscle mass and consequent function is explored alongside a description of the main nutrients that are needed for muscle regeneration. From a biomolecular perspective, some specific molecular mechanisms associated with physical rehabilitation are also reported not only in the context of physical therapy, but also within nature-inspired techniques, such as forest-bathing as well as body self-healing. Combining a targeted physiotherapeutic approach with an appropriate diet as well as nature-based therapy could thus help with the recovery of bed ridden patients.
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Affiliation(s)
- Steven Baker
- Compete Physiotherapy and Rehabilitation Centre, Unit 1 Bridge Mill—Cowan Bridge, Carnforth LA6 2HS, UK
| | | | - Giovanni N. Roviello
- Institute of Biostructures and Bioimaging, Italian National Council for Research (IBB-CNR), Area di Ricerca Site and Headquarters, Via Pietro Castellino 111, 80131 Naples, Italy
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27
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Analysis of the bidirectional relationships between posttraumatic stress and depression symptoms with physical health functioning in post-9/11 veteran men and women deployed to a war zone. J Psychosom Res 2022; 162:111034. [PMID: 36099750 DOI: 10.1016/j.jpsychores.2022.111034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Many war-zone deployed post-9/11 veterans report negative mental health symptoms related to their military service, which can have consequences for physical health symptoms and the impact of physical health on functioning. The current study examined the longitudinal, bidirectional relationships between mental health symptoms and physical health functioning in veteran men and women, allowing for exploration of gender differences. METHODS A sample of 1032 post-9/11 veterans (women: n = 554; men: n = 478) who recently returned from a war-zone deployment completed self-report measures of posttraumatic stress disorder (PTSD) symptoms, depression symptoms, and physical health functioning at 3 time points spanning approximately 7 years. Gender-stratified longitudinal cross-lagged panel analyses were used to examine bidirectional relationships. RESULTS PTSD symptom severity was negatively associated with physical health functioning across time. For women, associations were reciprocal, such that those reporting poorer physical health functioning reported more severe PTSD symptoms at later time points. Men with greater PTSD symptom severity reported poorer physical health functioning at later time points, but there was no evidence of bidirectionality. Men and women with more severe depression symptoms reported worse later physical health functioning, which further exacerbated depression symptoms across time. CONCLUSIONS Findings showed that individual differences in mental health symptoms both set the stage for and were impacted by physical health functioning in post-9/11 veterans. Although additional research is needed, the current study suggests that healthcare approaches that consider the whole person, such as through integration of mental and physical health treatments, may be particularly relevant for post-9/11 veterans.
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28
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Meinhausen C, Prather AA, Sumner JA. Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review. Health Psychol 2022; 41:663-673. [PMID: 35007121 PMCID: PMC9271141 DOI: 10.1037/hea0001143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Growing longitudinal research has demonstrated that posttraumatic stress disorder (PTSD) precedes and predicts the onset of cardiovascular disease (CVD), and a number of physiological (e.g., dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, chronic systemic inflammation) and behavioral (e.g., physical inactivity, smoking, poor diet) factors might underlie this association. In this narrative review, we focus on sleep as a modifiable risk factor linking PTSD with CVD. METHOD We summarize the evidence for sleep disturbance after trauma exposure and the potential cardiotoxic effects of poor sleep, with an emphasis on mechanisms. In addition, we review the literature that has examined sleep in the context of the PTSD-CVD risk relation. RESULTS Although sleep disturbance is a hallmark symptom of PTSD and a well-established risk factor for the development of CVD, the role of sleep in the association between PTSD and CVD has been largely unexamined in the extant literature. However, such work has the potential to improve our understanding of mechanisms of risk and inform intervention efforts to offset elevated CVD risk after trauma. CONCLUSIONS We outline several recommendations for future research and behavioral medicine models in order to help define and address the role of sleep behavior in the development of CVD among trauma-exposed individuals with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Corinne Meinhausen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Tian F, Shen Q, Hu Y, Ye W, Valdimarsdóttir UA, Song H, Fang F. Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study. Lancet Reg Health Eur 2022; 18:100402. [PMID: 35663363 PMCID: PMC9160321 DOI: 10.1016/j.lanepe.2022.100402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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Collin LJ, Veres K, Gradus JL, Ahern TP, Lash TL, Sørensen HT. Preexisting stress-related diagnoses and mortality: A Danish cancer cohort study. Cancer 2022; 128:1312-1320. [PMID: 34797563 PMCID: PMC8882160 DOI: 10.1002/cncr.34036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study evaluated the association between preexisting stress-related diagnoses and mortality in a Danish population-based cancer cohort. METHODS This study included Danish patients with cancer diagnosed in 1995-2011 who had a stress-related diagnosis before their cancer diagnosis. Cancer patients without a prior stress-related diagnosis were matched 5:1 to the stress disorder cohort by cancer site, age group, calendar period, and sex. The 5-year cumulative incidence of cancer-specific and all-cause mortality was computed by stress-related diagnosis category. Hazard ratios and 95% confidence intervals (CIs) associating stress-related diagnoses with mortality were computed by follow-up time, stress-related diagnosis category, stage, comorbidity status, and cancer type. RESULTS This study identified 4437 cancer patients with a preexisting stress-related diagnosis and 22,060 matched cancer cohort members. The 5-year cumulative risk of cancer-specific mortality was 33% (95% CI, 32%-35%) for those with a preexisting stress-related diagnosis and 29% (95% CI, 28%-29%) for those without a prior stress-related diagnosis. Cancer patients with a preexisting stress-related diagnosis had a 1.3 times higher cancer-specific mortality rate than the comparison cohort members (95% CI, 1.2-1.5). This increase persisted across categories of stress-related diagnosis. The association varied by stage and cancer type, with more pronounced associations found among those with a late stage at diagnosis and hematological malignancies. CONCLUSIONS Cancer patients with preexisting stress-related diagnoses had increased rates of cancer-specific and all-cause mortality. The results suggest that psychiatric comorbidities may be an important consideration for cancer prognosis, and cancer treatment informed by a patient's history may improve outcomes.
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Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts
| | - Thomas P Ahern
- Department of Surgery, Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont.,Department of Biochemistry, Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts
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Riley ED, Delucchi K, Rubin S, Weiser SD, Vijayaraghavan M, Lynch K, Tsoh JY. Ongoing tobacco use in women who experience homelessness and unstable housing: A prospective study to inform tobacco cessation interventions and policies. Addict Behav 2022; 125:107125. [PMID: 34673360 DOI: 10.1016/j.addbeh.2021.107125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tobacco use is common in people who experience homelessness. However, despite biological differences in use by sex and lower quit rates in women, research in homeless and unstably housed (HUH) women is sparse. We identified correlates of use specific to this population, with the goal of informing tobacco cessation programs tailored for HUH women. METHODS We conducted a prospective study among HUH women recruited from San Francisco homeless shelters, street encampments, free meal programs and low-income hotels. Between June 2016 and January 2019, study participants completed six monthly interviews to examine factors associated with tobacco use, defined as urinary cotinine >10 pg/mL or self-reported prior 30-day use. RESULTS Among 245 participants, 40% were Black, the median age was 53, 75% currently used tobacco and 89% had ≥one 24-hour quit attempt in the prior year. Tobacco use was more common in women with PTSD (66% vs. 48%) and depression (54% vs. 35%) compared to women without these conditions. Adjusted odds of tobacco use decreased significantly with increasing age (OR/5 yrs: 0.81; 95% CI:0.68, 0.96) and increased with an increasing number of additional substances used (OR: 2.52; 95% CI: 1.88, 3.39). CONCLUSION Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.
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Defining the importance of stress reduction in managing cardiovascular disease - the role of exercise. Prog Cardiovasc Dis 2022; 70:84-93. [DOI: 10.1016/j.pcad.2022.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
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Stellman JM, Stellman SD, Spiro A, Pless Kaiser A, Smith BN. Impact of Military Service in Vietnam on Coping and Health Behaviors of Aging Veterans During the COVID-19 Pandemic. Front Public Health 2022; 9:809357. [PMID: 35111722 PMCID: PMC8802994 DOI: 10.3389/fpubh.2021.809357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Many Vietnam War veterans who experienced military trauma still exhibit PTSD symptomatology. Little is known about how new stressful situations, like the COVID-19 pandemic, affect previously traumatized people or whether they will react differently to them. We explore whether military combat experiences in Vietnam affect veterans' perceived abilities to cope with COVID-19 and whether current PTSD symptoms and later-adulthood reengagement with trauma memories are related to coping. We examine the extent that current PTSD symptoms and trauma reengagement relate to preventive practices. Participants were part of a randomly sampled cohort of American Legionnaires who responded to two previous surveys (1984, 1998), were born 1945-1953 and deployed to Vietnam 1963-1973, thus representing an aging veteran population. A survey supplement assessed coping with the pandemic and adherence to public health guidelines. The response rate was 74% (N = 507); 422 (61.6%) completed the COVID-19 supplement. Military experiences were found to affect coping with 41.4% reporting they affected ability to cope with COVID-19. Medium- and high-combat veterans were more likely to report that military experience affected coping than low-combat (OR 2.4, 95% CI 1.51–3.96; 2.6, 95% CI 1.41–4.61, respectively). Those with high PTSD scores had 7.7-fold (95% CI 4.3–13.17) increased likelihood of reporting that their coping was affected, compared to low-PTSD scorers. Few adopted social distancing (4%), staying at home (17%), or ceasing usual activities (32%); high-combat veterans were least likely to stay home. Veterans who practiced handwashing, sanitizer use, mask-wearing, and surface disinfection had significantly higher PTSD scores than those who did not. Veterans with higher scores on the LOSS-SF scale associated more reengagement with trauma memories and were more likely to engage in personal preventive strategies. Analysis of open-ended responses supported these findings. We conclude that fifty years after returning from Vietnam, PTSD scores were high for high-combat veterans, suggestive of PTSD diagnosis. Military experiences affected coping with COVID both positively and negatively, and may have helped instill useful personal health behaviors. Veterans, especially those with PTSD symptomatology, may have special needs during stressful times, like the COVID-19 pandemic, affecting compliance with recommended practices, as well as their overall health and well-being.
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Affiliation(s)
- Jeanne M. Stellman
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Jeanne M. Stellman
| | - Steven D. Stellman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System and Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, MA, United States
| | - Anica Pless Kaiser
- National Center for PTSD Behavioral Science Division at VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Brian N. Smith
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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Popovic D, Lavie C. Stress, cardiovascular diseases and exercise – A narrative review. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bourassa KJ, Rasmussen LJH, Danese A, Eugen-Olsen J, Harrington H, Houts R, Poulton R, Ramrakha S, Sugden K, Williams B, Moffitt TE, Caspi A. Linking stressful life events and chronic inflammation using suPAR (soluble urokinase plasminogen activator receptor). Brain Behav Immun 2021; 97:79-88. [PMID: 34224821 PMCID: PMC8453112 DOI: 10.1016/j.bbi.2021.06.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022] Open
Abstract
Stressful life events have been linked to declining health, and inflammation has been proposed as a physiological mechanism that might explain this association. Using 828 participants from the Dunedin Longitudinal Study, we tested whether people who experienced more stressful life events during adulthood would show elevated systemic inflammation when followed up in midlife, at age 45. We studied three inflammatory biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), and a newer biomarker, soluble urokinase plasminogen activator receptor (suPAR), which is thought to index systemic chronic inflammation. Stressful life events were not associated with CRP or IL-6. However, people who experienced more stressful life events from age 38 to 44 had elevated suPAR at age 45, and had significantly greater increases in suPAR from baseline to follow-up across the same period. When examining stressful life events across the lifespan, both adverse childhood experiences (ACEs) and adult stressful life events were independently associated with suPAR at age 45. ACEs moderated the association of adult stressful life events and suPAR at age 45-children with more ACEs showed higher suPAR levels after experiencing stressful life events as adults. The results suggest systemic chronic inflammation is one physiological mechanism that could link stressful life events and health, and support the use of suPAR as a useful biomarker for such research.
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Affiliation(s)
- Kyle J. Bourassa
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC,Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Line J. H. Rasmussen
- Department of Psychology & Neuroscience, Duke University, Durham, NC,Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Andrea Danese
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, King’s College London, London, United Kingdom,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,National and Specialist Child and Adolescent Mental Health Services Trauma, Anxiety, and Depression Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | - Renate Houts
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Richie Poulton
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Karen Sugden
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Ben Williams
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Terrie E. Moffitt
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC,Department of Psychology & Neuroscience, Duke University, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC,Center for Genomic and Computational Biology, Duke University, Durham, NC
| | - Avshalom Caspi
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC,Department of Psychology & Neuroscience, Duke University, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC,Center for Genomic and Computational Biology, Duke University, Durham, NC
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Duan-Porter W, Nelson DB, Ensrud KE, Spoont MR. Physical functioning and mental health treatment initiation and retention for veterans with posttraumatic stress disorder: a prospective cohort study. BMC Health Serv Res 2021; 21:1005. [PMID: 34551770 PMCID: PMC8457897 DOI: 10.1186/s12913-021-07035-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Most US adults with posttraumatic stress disorder (PTSD) do not initiate mental health treatment within a year of diagnosis. Increasing treatment uptake can improve health and quality of life for those with PTSD. Individuals with PTSD are more likely to report poor physical functioning, which may contribute to difficulty with treatment initiation and retention. We sought to determine the effects of poor physical functioning on mental health treatment initiation and retention for individuals with PTSD. METHODS We used data for a national cohort of veterans in VA care; diagnosed with PTSD in June 2008-July 2009; with no mental health treatment in the prior year; and who responded to baseline surveys on physical functioning and PTSD symptoms (n = 6,765). Physical functioning was assessed using Veterans RAND 12-item Short Form Health Survey, and encoded as limitations in physical functioning and role limitations due to physical health. Treatment initiation (within 6 months of diagnosis) was determined using VA data and categorized as none (reference), only medications, only psychotherapy, or both. Treatment retention was defined as having ≥ 4 months of appropriate antidepressant or ≥ 8 psychotherapy encounters. RESULTS In multinomial models, greater limitations in physical functioning were associated with lower odds of initiating only psychotherapy (OR 0.82 [95 % CI 0.68, 0.97] for limited a little and OR 0.74 [0.61, 0.90] for limited a lot, compared to reference "Not limited at all"). However, it was not associated with initiation of medications alone (OR 1.04 [0.85, 1.28] for limited a little and OR 1.07 [0.86, 1.34] for limited a lot) or combined with psychotherapy (OR 1.03 [0.85, 1.25] for limited a little and OR 0.95 [0.78, 1.17] for limited a lot). Greater limitations in physical functioning were also associated with lower odds of psychotherapy retention (OR 0.69 [0.53, 0.89] for limited a lot) but not for medications (e.g., OR 0.96 [0.79, 1.17] for limited a lot). Role limitations was only associated with initiation of both medications and psychotherapy, but there was no effect gradient (OR 1.38 [1.03, 1.86] for limitations a little or some of the time, and OR 1.18 [0.63, 1.06] for most or all of the time, compared to reference "None of the time"). Accounting for chronic physical health conditions did not attenuate associations between limitations in physical functioning (or role limitations) and PTSD treatment; having more chronic conditions was associated with lower odds of both initiation and retention for all treatments (e.g., for 2 + conditions OR 0.53 [0.41, 0.67] for initiation of psychotherapy). CONCLUSIONS Greater limitations in physical functioning may be a barrier to psychotherapy initiation and retention. Future interventions addressing physical functioning may enhance uptake of psychotherapy.
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Affiliation(s)
- Wei Duan-Porter
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, One Veterans Dr, MN, 55417, Minneapolis, United States.
- University of Minnesota Medical School, MN, Minneapolis, USA.
| | - David B Nelson
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, One Veterans Dr, MN, 55417, Minneapolis, United States
- University of Minnesota Medical School, MN, Minneapolis, USA
| | - Kristine E Ensrud
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, One Veterans Dr, MN, 55417, Minneapolis, United States
- University of Minnesota Medical School, MN, Minneapolis, USA
- School of Public Health, University of Minnesota, MN, Minneapolis, USA
| | - Michele R Spoont
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, One Veterans Dr, MN, 55417, Minneapolis, United States
- University of Minnesota Medical School, MN, Minneapolis, USA
- National Center for PTSD, Department of Veterans Affairs, Minneapolis, USA
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Nilsson H, Gustavsson C, Gottvall M, Saboonchi F. Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden: a cross-sectional study. BMC Psychiatry 2021; 21:452. [PMID: 34530806 PMCID: PMC8444359 DOI: 10.1186/s12888-021-03461-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden. METHODS A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture. RESULTS About half of the participants (53.3, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001). CONCLUSIONS Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants' health.
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Affiliation(s)
- Henrik Nilsson
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- The Swedish Red Cross Treatment Center for Persons Affected by War and Torture, PO Box 166, SE-201 21 Malmö, Sweden
| | - Catharina Gustavsson
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, SE-791 82 Falun, Sweden
| | - Maria Gottvall
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Clinical Psychology in Health Care, Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Thomas CL, Nieh C, Hooper TI, Gackstetter GD, LeardMann CA, Porter B, Blazer DG. Sexual Harassment, Sexual Assault, and Physical Activity Among U.S. Military Service Members in the Millennium Cohort Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7043-7066. [PMID: 30827142 DOI: 10.1177/0886260519832904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sexual harassment (SH) and sexual assault (SA) continue to be a focus of prevention efforts in the U.S. military because of the prevalence and potential to affect the health and readiness of service members. Limited research exists on the association of SH and SA with coping behaviors, such as physical activity, within the military. Data including self-reported SA, SH, and physical activity were obtained from the Millennium Cohort Study, a longitudinal cohort study designed to examine the impact of military service on the health and well-being of service members. A hierarchical regression approach was applied to examine the association between SH or SA and subsequent physical activity levels. Hierarchical regression showed that, among those self-reporting recent SA, the odds of medium-high (300-449 min/week) and high physical activity levels (≥450 min/week) were significantly increased. Although the magnitude of these associations was attenuated with an increasing amount of adjustment, the odds of high physical activity levels remained statistically significant in the fully adjusted model (medium-high: odds ratio [OR] = 1.72, 95% confidence interval [CI] = [1.08, 2.73]; high: OR = 1.58, 95% CI = [1.02, 2.44]). We observed statistically significant negative associations between recent SH and medium-high physical activity levels in adjusted models (OR = 0.70, 95% CI = [0.54, 0.91]). The current results demonstrate that SA is generally associated with increased levels of physical activity among military service members. Analyzing the relationship between sexual trauma and physical activity is valuable because of the high prevalence of SH and SA in the military, long-term health implications including physical and emotional well-being, and potential impact on military readiness.
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Affiliation(s)
- Connie L Thomas
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Chiping Nieh
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Tomoko I Hooper
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Cynthia A LeardMann
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Ben Porter
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
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Presciutti A, Shaffer J, Sumner JA, Elkind MSV, Roh DJ, Park S, Claassen J, Edmondson D, Agarwal S. Hyperarousal Symptoms in Survivors of Cardiac Arrest Are Associated With 13 Month Risk of Major Adverse Cardiovascular Events and All-Cause Mortality. Ann Behav Med 2021; 54:413-422. [PMID: 32043140 DOI: 10.1093/abm/kaz058] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Key dimensions of cardiac arrest-induced posttraumatic stress disorder (PTSD) symptoms include reexperiencing, avoidance, numbing, and hyperarousal. It remains unknown which dimensions are most predictive of outcome. PURPOSE To determine which dimensions of cardiac arrest-induced PTSD are predictive of clinical outcome within 13 months posthospital discharge. METHODS PTSD symptoms were assessed in survivors of cardiac arrest who were able to complete psychological screening measures at hospital discharge via the PTSD Checklist-Specific scale, which queries for 17 symptoms using five levels of severity. Responses on items for each symptom dimension of the four-factor numbing model (reexperiencing, avoidance, numbing, and hyperarousal) were converted to Z-scores and treated as continuous predictors. The combined primary endpoint was all-cause mortality (ACM) or major adverse cardiovascular events (MACE; hospitalization for myocardial infarction, unstable angina, heart failure, emergency coronary revascularization, or urgent defibrillator/pacemaker placements) within 13 months postdischarge. Four bivariate Cox proportional hazards survival models evaluated associations between individual symptom dimensions and ACM/MACE. A multivariable model then evaluated whether significant bivariate predictors remained independent predictors of the primary outcome after adjusting for age, sex, comorbidities, premorbid psychiatric diagnoses, and initial cardiac rhythm. RESULTS A total of 114 patients (59.6% men, 52.6% white, mean age: 54.6 ± 13 years) were included. In bivariate analyses, only hyperarousal was significantly associated with ACM/MACE. In a fully adjusted model, 1 standard deviation increase in hyperarousal symptoms corresponded to a two-times increased risk of experiencing ACM/MACE. CONCLUSIONS Greater level of hyperarousal symptoms was associated with a higher risk of ACM/MACE within 13 months postcardiac arrest. This initial evidence should be further investigated in a larger sample.
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Affiliation(s)
- Alex Presciutti
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Jonathan Shaffer
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - David J Roh
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Soojin Park
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Sreenivasan J, Khan MS, Khan SU, Hooda U, Aronow WS, Panza JA, Levine GN, Commodore-Mensah Y, Blumenthal RS, Michos ED. Mental health disorders among patients with acute myocardial infarction in the United States. Am J Prev Cardiol 2021; 5:100133. [PMID: 34327485 PMCID: PMC8315415 DOI: 10.1016/j.ajpc.2020.100133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the prevalence, temporal trends and sex- and racial/ethnic differences in the burden of mental health disorders (MHD) and outcomes among patients with myocardial infarction (MI) in the United States. METHODS Using the National Inpatient Sample Database, we evaluated a contemporary cohort of patients hospitalized for acute MI in the United States over 10 years period from 2008 to 2017. We used multivariable logistic regression analysis for in-hospital outcomes, yearly trends and estimated annual percent change (APC) in odds of MHD among MI patients. RESULTS We included a total sample of 6,117,804 hospitalizations for MI (ST elevation MI in 30.4%), with a mean age of 67.2 ± 0.04 years and 39% females. Major depression (6.2%) and anxiety disorders (6.0%) were the most common MHD, followed by bipolar disorder (0.9%), schizophrenia/psychotic disorders (0.8%) and post-traumatic stress disorder (PTSD) (0.3%). Between 2008 and 2017, the prevalences significantly increased for major depression (4.7%-7.4%, APC +6.2%, p < .001), anxiety disorders (3.2%-8.9%, APC +13.5%, p < .001), PTSD (0.2%-0.6%, +12.5%, p < .001) and bipolar disorder (0.7%-1.0%, APC +4.0%, p < .001). Significant sex- and racial/ethnic-differences were also noted. Major depression, bipolar disorder or schizophrenia/psychotic disorders were associated with a lower likelihood of coronary revascularization. CONCLUSION MHD are common among patients with acute MI and there was a concerning increase in the prevalence of major depression, bipolar disorder, anxiety disorders and PTSD over this 10-year period. Focused mental health interventions are warranted to address the increasing burden of comorbid MHD among acute MI.
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Affiliation(s)
- Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | | | - Safi U. Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Urvashi Hooda
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Julio A. Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Glenn N. Levine
- Division of Cardiology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Vanderheyden WM, Kehoe M, Vanini G, Britton SL, Koch LG. Rat models for low and high adaptive response to exercise differ for stress-related memory and anxiety. Physiol Rep 2021; 9:e14716. [PMID: 33619911 PMCID: PMC7900769 DOI: 10.14814/phy2.14716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
Physical exercise and fitness may serve as resilience factors to stress exposure. However, the extreme range in human exercise performance suggests that genetic variation for exercise capacity could be a confounding feature to understanding the connection between exercise and stress exposure. To test this idea, we use laboratory rat models selectively bred for a low and high gain in aerobic running capacity in response to training to examine whether an inherent capacity to respond to physical exercise reflects how stress changes neurobiological functioning and regulates fear-associated memory processing. Utilization of this contrasting rat model system of low and high responders has the potential to guide the interpretation of the reported association with exercise involvement and the reduction of stress-induced anxiety disorders. Our data show that aerobic fitness may be linked to the ability to regulate fear-associated memories. We also show that acquired exercise capacity may play a key role in regulating responses to an acute stressor. Exercise sensitivity plays a significant role in the activation of the plasticity-associated molecule extracellular signal-regulated kinase, changes in stress hormone activity, and anatomical modifications to the noradrenergic locus coeruleus. These data identify a unique operational mechanism that may serve as translational targets for lessening symptoms of stress and anxiety.
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Affiliation(s)
| | - Michaela Kehoe
- Department of AnesthesiologyUniversity of MichiganAnn ArborMIUSA
| | - Giancarlo Vanini
- Department of AnesthesiologyUniversity of MichiganAnn ArborMIUSA
| | - Steven L. Britton
- Department of AnesthesiologyUniversity of MichiganAnn ArborMIUSA
- Department of Physiology and PharmacologyThe University of Toledo College of Medicine and Life SciencesToledoOHUSA
| | - Lauren Gerard Koch
- Department of Physiology and PharmacologyThe University of Toledo College of Medicine and Life SciencesToledoOHUSA
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Pedowitz E, Derby L, Cruz GJ, Trainor A, Edmondson D, Cornelius T. Relationship between NIH stroke symptoms and post-traumatic stress disorder in patients evaluated for transient ischemic attack/stroke. Gen Hosp Psychiatry 2021; 70:98-102. [PMID: 33774490 PMCID: PMC8127400 DOI: 10.1016/j.genhosppsych.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) can develop after a life-threatening medical event. According to the enduring somatic treat (EST) model, internal somatic cues (e.g., rapid heart rate) may contribute to symptoms of stroke/TIA-induced PTSD. To address this possibility, the present study tested the association of stroke-induced disability with PTSD symptoms in patients treated for stroke or transient ischemic attack (TIA). METHOD Participants (n = 300) were drawn from an observational cohort study examining PTSD symptoms in patients admitted to the NewYork Presbyterian Hospital between 2015 and 2017 for a stroke/TIA. Patients self-reported acute stress symptoms in-person approximately 3 days post-stroke/TIA and PTSD symptoms via telephone one month later. Severity of stroke symptoms (i.e., stroke disability) was evaluated using the NIH Stroke Scale prior to hospital discharge. RESULTS Stroke disability had a significant, positive association with acute stress symptoms early post-stroke/TIA, B = 0.46, se = 0.15, p = .002, and with PTSD symptoms one month later, B = 0.56, se = 0.19, p = .003. CONCLUSIONS Stroke disability is positively associated with both acute distress and PTSD symptoms one month later following a stroke/TIA, supporting the hypothesis that internal somatic symptoms contribute to the development stroke/TIA-induced PTSD symptoms.
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Affiliation(s)
- Emily Pedowitz
- NYU Grossman School of Medicine, Department of Psychiatry, 1 Park Avenue, 8th Avenue, 10016, United States.
| | - Lilly Derby
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Gaspar J. Cruz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Alison Trainor
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
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Broken Heartstrings—Post-Traumatic Stress Disorder and Psychological Burden after Acute Mitral Regurgitation Due to Chordae Tendineae Rupture. J Clin Med 2020; 9:jcm9124048. [PMID: 33333785 PMCID: PMC7765219 DOI: 10.3390/jcm9124048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
Chordae tendineae rupture (CTR) is a potentially life-threatening cardiac event often resulting in Acute mitral regurgitation (AMR). We assessed Post-traumatic stress disorder (PTSD), depression, and anxiety symptoms in n=21 CTR patients with AMR (age 82.3 ± 4.2 years; 66.7% men) and compared them to n=23 CTR patients with Chronic mitral regurgitation (CMR) and n=35 Myocardial infraction (MI) patients. Regression analyses revealed that PTSD scores were significantly higher in CTR patients with AMR than in CTR patients with CMR or MI patients. CTR patients with CMR had the lowest levels of PTSD-symptoms. Depression and anxiety scores were elevated across all three groups. Our results suggest that psychosocial factors need to be considered in CTR patients’ care.
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Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters. J Psychosom Res 2020; 139:110269. [PMID: 33039951 DOI: 10.1016/j.jpsychores.2020.110269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters. METHODS Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk. RESULTS A structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = -0.18, p < .01) and depression symptoms (β = -0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01). CONCLUSIONS High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.
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Theal R, Kerin JL, Romaniuk M. Psychosocial Outcomes of Australian Male and Female Veterans Following Participation in Peer-Led Adventure-Based Therapy. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Gurel NZ, Jiao Y, Wittbrodt MT, Ko YA, Hankus A, Driggers EG, Ladd SL, Shallenberger L, Murrah N, Huang M, Haffar A, Alkhalaf M, Levantsevych O, Nye JA, Vaccarino V, Shah AJ, Inan OT, Bremner JD, Pearce BD. Effect of transcutaneous cervical vagus nerve stimulation on the pituitary adenylate cyclase-activating polypeptide (PACAP) response to stress: A randomized, sham controlled, double blind pilot study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2020; 4:100012. [PMID: 35755625 PMCID: PMC9216713 DOI: 10.1016/j.cpnec.2020.100012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 10/15/2020] [Indexed: 12/24/2022] Open
Abstract
Pituitary adenylate cyclase-activating peptide (PACAP) is a neuropeptide that plays a key role in the neurobiology of the stress response, and prior studies suggest that its function is dysregulated in post-traumatic stress disorder (PTSD). Transcutaneous cervical vagus nerve stimulation (tcVNS) acts through PACAP and other neurobiological systems to modulate stress responses and/or symptoms of PTSD. In this pilot study, we examined the effects of tcVNS on PACAP in a three day chronic stress laboratory paradigm involving serial traumatic and mental stress exposures in healthy individuals with a history of exposure to psychological trauma (n = 18) and patients with PTSD (n = 12). Methods A total of 30 subjects with a history of exposure to psychological trauma experience were recruited (12 with PTSD diagnosis) for a three-day randomized double-blinded study of tcVNS or sham stimulation. Subjects underwent a protocol that included both personalized trauma recall and non-personalized mental stressors (public speaking, mental arithmetic) paired to tcVNS or sham stimulation over three days. Blood was collected at baseline and multiple time points after exposure to stressors. Linear mixed-effects models were used to assess changes in PACAP over time (in response to stressors) and its relation to active tcVNS or sham stimulation. Results PACAP blood levels increased over the course of three days for both active tcVNS and sham groups. This increase was statistically-significant in the sham group at the end of the second (Cohen's drm = 0.35, p = 0.04), and third days (drm = 0.41, p = 0.04), but not in the active tcVNS group (drm = 0.21, drm = 0.18, and p > 0.20). Conclusion These pilot findings suggest tcVNS may attenuate this neurobiological stress-response. Larger studies are needed to investigate gender and interaction effects.
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Affiliation(s)
- Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yunshen Jiao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Allison Hankus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Emily G. Driggers
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
| | - Stacy L. Ladd
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
- Department of Radiology, Emory School of Medicine, Atlanta, GA, USA
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Oleksiy Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathon A. Nye
- Department of Radiology, Emory School of Medicine, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory School of Medicine, Atlanta, GA, USA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Coulter Department of Bioengineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
- Department of Radiology, Emory School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Bradley D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Angosta AD, Reyes AT, Cross C, Pollom T, Sood K. Cardiovascular disease knowledge, risk factors, and resilience among US veterans with and without post-traumatic stress disorder. J Am Assoc Nurse Pract 2020; 33:947-958. [PMID: 32976251 DOI: 10.1097/jxx.0000000000000507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in the United States and the leading cause of hospitalization and disability among the US veterans. Information about CVD knowledge and risk factors, and connection between psychological health and CVD among veterans transitioning from the military are limited. PURPOSE We examined the existing knowledge of CVD and its risk factors among the US veterans with and without post-traumatic stress disorder (PTSD), and the relationship between knowledge, risk factors, resilience, and PTSD. METHODS A total of 104 veterans participated in our study by responding to the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Heart Disease Fact Questionnaire (HDFQ) knowledge scale, and Connor-Davidson Resilience Scale 10. Data were extracted from the online Qualtrics survey software into SPSS (v. 25) for analysis. RESULTS Mean age was 52.3 years, mostly males (85.6%), married (72.1%), employed (54.8%), and with college education. Most were in the Navy or Air Force (72.1%) and served in a war (68.0%). Hypertension, high cholesterol, and obesity were the most common CVD risk factors reported. Average CVD knowledge score was 85%. Marines scored higher on resilience than other branches of the military. Seventeen percent reported having PTSD. The Connor-Davidson Resilience Scale 10 was significantly correlated with the HDFQ in the probable PTSD group (r = .589, p = .013). IMPLICATIONS FOR PRACTICE Our study provides information about the knowledge and risk factors of CVD among veterans and insights about interventions needed to improve CV health. Nurse practitioners should assess the CV and psychological health of veterans and screen for PTSD to provide appropriate care and referral.
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Affiliation(s)
- Alona D Angosta
- University of Nevada, Las Vegas School of Nursing, Las Vegas, Nevada
| | | | - Chad Cross
- University of Nevada, Las Vegas Schools of Medicine and Public Health, Las Vegas, Nevada
| | - Trevor Pollom
- Department of Anthropology, University of Nevada, Las Vegas, Las Vegas, Nevada
| | - Komal Sood
- University of Nevada, Las Vegas Schools of Medicine and Public Health, Las Vegas, Nevada
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Hinojosa R. Sex, Age, Race/Ethnicity, Veteran Status, and the Likelihood of Reporting Cardiovascular Conditions in the National Health Interview Survey. J Cardiovasc Nurs 2020; 34:215-221. [PMID: 30973492 DOI: 10.1097/jcn.0000000000000561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study explores the likelihood of reporting the presence of cardiovascular health conditions in the National Health Interview Survey, with a focus on the moderating effects of veteran status, race/ethnicity, age, sex, and functional status. METHOD Data from the 2012-2015 National Health Interview Survey examine 5 cardiovascular health conditions/risk factors (hypertension, coronary heart disease, heart conditions, stroke, and heart attack). RESULTS Age, sex, and functional status moderate the relationship between veteran status and cardiovascular conditions. Veterans who are younger (veteran × age) have a higher risk of reporting 1 cardiovascular condition compared with veterans who are older (relative risk [RR], 0.99; 95% confidence interval [CI], 0.99-0.99). Veterans with functional limitations (veteran × functional status) are at a lower risk of reporting 3 or more cardiovascular conditions compared with veterans with no functional limitations (RR, 0.73; 95% CI, 0.56-0.95). Interaction variables in the model (veteran × sex) show that female veterans had a higher risk than did female non-veterans of reporting 3 or more cardiovascular conditions compared with male veterans versus male non-veterans (RR, 0.71; 95% CI, 0.53-0.95). Race/ethnicity does not moderate the likelihood of reporting cardiovascular disease conditions in this sample. CONCLUSION This study demonstrates that previous military service is linked to the reporting of cardiovascular disease conditions by using nationally representative data to examine the moderating effects of veteran status on the relationship between race/ethnicity, sex, functional status, and age and cardiovascular disease for veterans living in the general US population. The findings suggest a waning healthy soldier effect for the youngest American veterans and indicate that female veterans' cardiovascular health is at greatest risk.
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Affiliation(s)
- Ramon Hinojosa
- Ramon Hinojosa, PhD Assistant Professor, University of Central Florida, Department of Sociology, Orlando
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Wittbrodt MT, Moazzami K, Shah AJ, Lima BB, Hammadah M, Mehta PK, Quyyumi AA, Vaccarino V, Nye JA, Bremner JD. Neural responses during acute mental stress are associated with angina pectoris. J Psychosom Res 2020; 134:110110. [PMID: 32345456 PMCID: PMC8082434 DOI: 10.1016/j.jpsychores.2020.110110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/31/2022]
Abstract
UNLABELLED Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD. OBJECTIVE Examine brain correlates of mental stress in patients with CAD with and without a history of angina. METHODS Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina. RESULTS Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history. CONCLUSIONS Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.
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Affiliation(s)
- Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Corresponding author at: 1821 Clifton Rd, Room 214, Atlanta, GA 30307, United States of America. (M.T. Wittbrodt)
| | - Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
| | - Bruno B. Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Muhammad Hammadah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jonathon A. Nye
- Department of Radiology, Emory University School of Medicine, United States of America
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Department of Radiology, Emory University School of Medicine, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
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Chronic stress as a mediator of the relationship between socioeconomic status and pharmacological adherence in hypertensive patients. ACTA ACUST UNITED AC 2020; 40:243-256. [PMID: 32673454 PMCID: PMC7505514 DOI: 10.7705/biomedica.4780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 12/12/2022]
Abstract
Introducción. La hipertensión arterial sistémica es un problema de salud pública en el mundo. En Colombia, su prevalencia es del 25 % y la mortalidad es alta. Los factores psicosociales que afectan el cumplimiento del tratamiento farmacológico no han sido estudiados suficientemente. En otros países, se ha estudiado el papel del estrés crónico en la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo. Objetivo. Examinar el papel del estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico, en pacientes hipertensos de 45 a 70 años en el 2015 y el 2016. Materiales y métodos. Se hizo un estudio transversal de una población de pacientes hipertensos. Los datos provienen de la muestra seleccionada para el programa “De todo corazón” en Bogotá, Medellín y Quibdó. El análisis estadístico de los datos se hizo mediante análisis factorial y regresiones multivariadas. Resultados. Los resultados confirmaron una asociación positiva entre la posición socioeconómica y el grado de cumplimiento del tratamiento farmacológico, y una relación negativa entre la primera y el estrés crónico. Además, se evidenció que el estrés tiene una asociación negativa con el grado de cumplimiento. Conclusiones. Los resultados sugieren que el estrés no es un mediador entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo en Colombia. Se requieren estudios adicionales para confirmar estas relaciones con una muestra más amplia.
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