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Abstract
Cannabidiol (CBD), a Cannabis sativa constituent, is a pharmacologically broad-spectrum drug that in recent years has drawn increasing interest as a treatment for a range of neuropsychiatric disorders. The purpose of the current review is to determine CBD's potential as a treatment for anxiety-related disorders, by assessing evidence from preclinical, human experimental, clinical, and epidemiological studies. We found that existing preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder when administered acutely; however, few studies have investigated chronic CBD dosing. Likewise, evidence from human studies supports an anxiolytic role of CBD, but is currently limited to acute dosing, also with few studies in clinical populations. Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with need for further study of chronic and therapeutic effects in relevant clinical populations.
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Affiliation(s)
| | | | - Jorge Manzanares
- New York University School of Medicine, New York, NY, USA
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández and Consejo Superior de Investigaciones Científicas, Alicante, Spain
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Marmar CR, Schlenger W, Henn-Haase C, Qian M, Purchia E, Li M, Corry N, Williams CS, Ho CL, Horesh D, Karstoft KI, Shalev A, Kulka RA. Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry 2015. [PMID: 26201054 DOI: 10.1001/jamapsychiatry.2015.0803] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). OBJECTIVE To determine the prevalence, course, and comorbidities of war-zone posttraumatic stress disorder (PTSD) across a 25-year interval. DESIGN, SETTING, AND PARTICIPANTS The NVVLS survey consisted of a self-report health questionnaire (n = 1409), a computer-assisted telephone survey health interview (n = 1279), and a telephone clinical interview (n = 400) in a representative national sample of veterans who served in the Vietnam theater of operations (theater veterans) from July 3, 2012, through May 17, 2013. Of 2348 NVVRS participants, 1920 were alive at the outset of the NVVLS, and 81 died during recruitment; 1450 of the remaining 1839 (78.8%) participated in at least 1 NVVLS study phase. Data analysis was performed from May 18, 2013, through January 9, 2015, with further analyses continued through April 13, 2015. MAIN OUTCOMES AND MEASURES Study instruments included the Mississippi Scale for Combat-Related PTSD, PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and Structured Clinical Interview for DSM-IV, Nonpatient Version. RESULTS Among male theater veterans, we estimated a prevalence (95% CI) of 4.5% (1.7%-7.3%) based on CAPS-5 criteria for a current PTSD diagnosis; 10.8% (6.5%-15.1%) based on CAPS-5 full plus subthreshold PTSD; and 11.2% (8.3%-14.2%) based on PCL-5+ criteria for current war-zone PTSD. Among female veterans, estimates were 6.1% (1.8%-10.3%), 8.7% (3.8%-13.6%), and 6.6% (3.5%-9.6%), respectively. The PCL-5+ prevalence (95% CI) of current non-war-zone PTSD was 4.6% (2.6%-6.6%) in male and 5.1% (2.3%-8.0%) in female theater veterans. Comorbid major depression occurred in 36.7% (95% CI, 6.2%-67.2%) of veterans with current war-zone PTSD. With regard to the course of PTSD, 16.0% of theater veterans reported an increase and 7.6% reported a decrease of greater than 20 points in Mississippi Scale for Combat-Related PTSD symptoms. The prevalence (95% CI) of current PCL-5+-derived PTSD in study respondents was 1.2% (0.0%-3.0%) for male and 3.9% (0.0%-8.1%) for female Vietnam veterans. CONCLUSIONS AND RELEVANCE Approximately 271,000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms.
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Affiliation(s)
- Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | | | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Meng Qian
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Emily Purchia
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Meng Li
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Nida Corry
- Abt Associates Inc, Durham, North Carolina
| | | | | | - Danny Horesh
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York3Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Karen-Inge Karstoft
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York4Department of Psychology, University of Southern Denmark, Odense
| | - Arieh Shalev
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York3Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Richard A Kulka
- currently an independent consultant, Raleigh, North Carolina
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Schlenger WE, Corry NH, Kulka RA, Williams CS, Henn-Haase C, Marmar CR. Design and methods of the national Vietnam veterans longitudinal study. Int J Methods Psychiatr Res 2015; 24:186-203. [PMID: 26096554 PMCID: PMC6878456 DOI: 10.1002/mpr.1469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/20/2014] [Accepted: 06/27/2014] [Indexed: 11/06/2022] Open
Abstract
The National Vietnam Veterans Longitudinal Study (NVVLS) is the second assessment of a representative cohort of US veterans who served during the Vietnam War era, either in Vietnam or elsewhere. The cohort was initially surveyed in the National Vietnam Veterans Readjustment Study (NVVRS) from 1984 to 1988 to assess the prevalence, incidence, and effects of post-traumatic stress disorder (PTSD) and other post-war problems. The NVVLS sought to re-interview the cohort to assess the long-term course of PTSD. NVVLS data collection began July 3, 2012 and ended May 17, 2013, comprising three components: a mailed health questionnaire, a telephone health survey interview, and, for a probability sample of theater Veterans, a clinical diagnostic telephone interview administered by licensed psychologists. Excluding decedents, 78.8% completed the questionnaire and/or telephone survey, and 55.0% of selected living veterans participated in the clinical interview. This report provides a description of the NVVLS design and methods. Together, the NVVRS and NVVLS constitute a nationally representative longitudinal study of Vietnam veterans, and extend the NVVRS as a critical resource for scientific and policy analyses for Vietnam veterans, with policy relevance for Iraq and Afghanistan veterans.
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Affiliation(s)
| | | | | | | | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
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Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of "trauma-focused" psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects. OBJECTIVE To examine the effectiveness of psychotherapies for PTSD in military and veteran populations. EVIDENCE REVIEW PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included. FINDINGS Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions. CONCLUSIONS AND RELEVANCE In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused.
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Affiliation(s)
- Maria M Steenkamp
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, New York
| | - Brett T Litz
- VA Boston Healthcare System, Massachusetts Veterans Epidemiological Research and Information Center (MAVERIC), Boston University School of Medicine, Boston
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, New York
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Flory JD, Henn-Haase C, Bierer LM, Lehrner A, Makotkine I, Marmar CR, Yehuda R. Glucocorticoid functioning in male combat veterans with posttraumatic stress disorder and mild traumatic brain injury. Biol Psychiatry 2015; 78:e5-6. [PMID: 25796472 DOI: 10.1016/j.biopsych.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Janine D Flory
- James J. Peters Veterans Affairs Medical Center, Bronx; Departments of Psychiatry, Icahn School of Medicine at Mount Sinai.
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Linda M Bierer
- James J. Peters Veterans Affairs Medical Center, Bronx; Departments of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Amy Lehrner
- James J. Peters Veterans Affairs Medical Center, Bronx; Departments of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Iouri Makotkine
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx; Departments of Psychiatry, Icahn School of Medicine at Mount Sinai; Departments of Neuroscience, Icahn School of Medicine at Mount Sinai
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Almli LM, Stevens JS, Smith AK, Kilaru V, Meng Q, Flory J, Abu-Amara D, Hammamieh R, Yang R, Mercer KB, Binder EB, Bradley B, Hamilton S, Jett M, Yehuda R, Marmar CR, Ressler KJ. A genome-wide identified risk variant for PTSD is a methylation quantitative trait locus and confers decreased cortical activation to fearful faces. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:327-36. [PMID: 25988933 PMCID: PMC4844461 DOI: 10.1002/ajmg.b.32315] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/06/2015] [Indexed: 12/13/2022]
Abstract
Genetic factors appear to be highly relevant to predicting differential risk for the development of post-traumatic stress disorder (PTSD). In a discovery sample, we conducted a genome-wide association study (GWAS) for PTSD using a small military cohort (Systems Biology PTSD Biomarkers Consortium; SBPBC, N = 147) that was designed as a case-controlled sample of highly exposed, recently returning veterans with and without combat-related PTSD. A genome-wide significant single nucleotide polymorphism (SNP), rs717947, at chromosome 4p15 (N = 147, β = 31.34, P = 1.28 × 10(-8) ) was found to associate with the gold-standard diagnostic measure for PTSD (the Clinician Administered PTSD Scale). We conducted replication and follow-up studies in an external sample, a larger urban community cohort (Grady Trauma Project, GTP, N = 2006), to determine the robustness and putative functionality of this risk variant. In the GTP replication sample, SNP rs717947 associated with PTSD diagnosis in females (N = 2006, P = 0.005), but not males. SNP rs717947 was also found to be a methylation quantitative trait locus (meQTL) in the GTP replication sample (N = 157, P = 0.002). Further, the risk allele of rs717947 was associated with decreased medial and dorsolateral cortical activation to fearful faces (N = 53, P < 0.05) in the GTP replication sample. These data identify a genome-wide significant polymorphism conferring risk for PTSD, which was associated with differential epigenetic regulation and with differential cortical responses to fear in a replication sample. These results may provide new insight into understanding genetic and epigenetic regulation of PTSD and intermediate phenotypes that contribute to this disorder.
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Affiliation(s)
- Lynn M. Almli
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Varun Kilaru
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Qian Meng
- Department of Psychiatry, University Medical Center, New York, New York
| | - Janine Flory
- Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York/Traumatic Stress Studies Division, New York, New York
| | - Duna Abu-Amara
- Department of Psychiatry, New York University, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, New York
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Center for Environmental Health Research, Fort Detrick, Maryland
| | - Ruoting Yang
- Advanced Biomedical Computing Center, Frederick National Laboratory for Cancer Research/SAIC-Frederick Inc., Frederick, Maryland
| | - Kristina B. Mercer
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Elizabeth B. Binder
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,Department of Veterans Affairs Medical Center, Clinical Psychologist, Mental Health Service Line, Atlanta, Georgia
| | - Steven Hamilton
- Department of Psychiatry, University of California, San Francisco, California
| | - Marti Jett
- Integrative Systems Biology, US Army Center for Environmental Health Research, Fort Detrick, Maryland
| | - Rachel Yehuda
- Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York/Traumatic Stress Studies Division, New York, New York
| | - Charles R. Marmar
- Department of Psychiatry, New York University, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, New York
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,Howard Hughes Medical Institute, Chevy Chase, Maryland,Correspondence to: Kerry J. Ressler, M.D., Ph.D., Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia.
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57
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Yan X, Lazar M, Shalev AY, Neylan TC, Wolkowitz OM, Brown AD, Henn-Haase C, Yehuda R, Flory JD, Abu-Amara D, Sodickson DK, Marmar CR. WITHDRAWN: Precuneal and amygdala spontaneous activity and functional connectivity in war-zone-related PTSD. Psychiatry Res 2014:S0925-4927(14)00328-X. [PMID: 25561375 DOI: 10.1016/j.pscychresns.2014.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 11/13/2014] [Accepted: 12/04/2014] [Indexed: 11/23/2022]
Abstract
This article has been withdrawn at the request of the author. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Xiaodan Yan
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
| | - Mariana Lazar
- Bernard and Irene Schwartz Center for Biomedical Imaging, NYU School of Medicine, New York, NY, USA
| | - Arieh Y Shalev
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Adam D Brown
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA; Department of Psychology, Sarah Lawrence College, Bronxville, NY, USA
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Janine D Flory
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Daniel K Sodickson
- Bernard and Irene Schwartz Center for Biomedical Imaging, NYU School of Medicine, New York, NY, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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58
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Lindqvist D, Wolkowitz OM, Mellon S, Yehuda R, Flory JD, Henn-Haase C, Bierer LM, Abu-Amara D, Coy M, Neylan TC, Makotkine I, Reus VI, Yan X, Taylor NM, Marmar CR, Dhabhar FS. Proinflammatory milieu in combat-related PTSD is independent of depression and early life stress. Brain Behav Immun 2014; 42:81-8. [PMID: 24929195 DOI: 10.1016/j.bbi.2014.06.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/20/2014] [Accepted: 06/02/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic inflammation may be involved in combat-related post-traumatic stress disorder (PTSD) and may help explain comorbid physical diseases. However, the extent to which combat exposure per se, depression, or early life trauma, all of which are associated with combat PTSD, may confound the relationship between PTSD and inflammation is unclear. METHODS We quantified interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and C-reactive protein (CRP) in 51 combat-exposed males with PTSD and 51 combat-exposed males without PTSD, and assessed PTSD and depression severity as well as history of early life trauma. To decrease the possibility of Type I errors, we summed standardized scores of IL-1β, IL-6, TNFα, IFNγ and CRP into a total "pro-inflammatory score". PTSD symptom severity was assessed with the Clinician Administered PTSD Scale (CAPS) rating scale. RESULTS Subjects with PTSD had significantly higher pro-inflammatory scores compared to combat-exposed subjects without PTSD (p=0.006), and even after controlling for early life trauma, depression diagnosis and severity, body mass index, ethnicity, education, asthma/allergies, time since combat and the use of possibly confounding medications (p=0.002). Within the PTSD group, the pro-inflammatory score was not significantly correlated with depressive symptom severity, CAPS total score, or with the number of early life traumas. CONCLUSIONS Combat-related PTSD in males is associated with higher levels of pro-inflammatory cytokines, even after accounting for depression and early life trauma. These results, from one of the largest studies of inflammatory cytokines in PTSD to date, suggest that immune activation may be a core element of PTSD pathophysiology more so than a signature of combat exposure alone.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States.
| | - Synthia Mellon
- Department of OB/GYN and Reproductive Sciences, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Rachel Yehuda
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Janine D Flory
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Linda M Bierer
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Michelle Coy
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Xiaodan Yan
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Nicole M Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States.
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Galatzer-Levy IR, Steenkamp MM, Qian M, Inslicht S, Henn-Haase C, Otte C, Yehuda R, Neylan TC, Marmar CR, Marmar CR. Cortisol response to an experimental stress paradigm prospectively predicts long-term distress and resilience trajectories in response to active police service. J Psychiatr Res 2014; 56:36-42. [PMID: 24952936 PMCID: PMC5759781 DOI: 10.1016/j.jpsychires.2014.04.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/25/2014] [Accepted: 04/24/2014] [Indexed: 11/24/2022]
Abstract
Heterogeneity in glucocorticoid response to experimental stress conditions has shown to differentiate individuals with healthy from maladaptive real-life stress responses in a number of distinct domains. However, it is not known if this heterogeneity influences the risk for developing stress related disorders or if it is a biological consequence of the stress response itself. Determining if glucocorticoid response to stress induction prospectively predicts psychological vulnerability to significant real life stressors can adjudicate this issue. To test this relationship, salivary cortisol as well as catecholamine responses to a laboratory stressor during academy training were examined as predictors of empirically identified distress trajectories through the subsequent 4 years of active duty among urban police officers routinely exposed to potentially traumatic events and routine life stressors (N = 234). During training, officers were exposed to a video vignette of police officers exposed to real-life trauma. Changes in salivary 3-methoxy-4-hydroxyphenylglycol (MHPG) and cortisol in response to this video challenge were examined as predictors of trajectory membership while controlling for age, gender, and baseline neuroendocrine levels. Officers who followed trajectories of resilience and recovery over 4 years mounted significant increases in cortisol in response to the experimental stressor, while those following a trajectory of chronic increasing distress had no significant cortisol change in response to the challenge. MHPG responses were not associated with distress trajectories. Cortisol response prospectively differentiated trajectories of distress response suggesting that a blunted cortisol response to a laboratory stressor is a risk factor for later vulnerability to distress following significant life stressors.
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Affiliation(s)
- Isaac R. Galatzer-Levy
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine,Corresponding Author: Isaac R. Galatzer-Levy, Ph.D., NYU School of Medicine, 1 Park Ave. New York, NY, 10028, 847-420-2527,
| | - Maria M. Steenkamp
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine
| | - Meng Qian
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury
| | - Sabra Inslicht
- San Francisco Veterans Affairs,University of California San Francisco
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine
| | | | | | - Thomas C. Neylan
- San Francisco Veterans Affairs,University of California San Francisco
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury,New York University School of Medicine
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, United States; New York University School of Medicine, United States
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60
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Meffert SM, Henn-Haase C, Metzler TJ, Qian M, Best S, Hirschfeld A, McCaslin S, Inslicht S, Neylan TC, Marmar CR. Prospective study of police officer spouse/partners: a new pathway to secondary trauma and relationship violence? PLoS One 2014; 9:e100663. [PMID: 24987848 PMCID: PMC4079247 DOI: 10.1371/journal.pone.0100663] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 05/29/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION It has been reported that posttraumatic stress disorder (PTSD) is associated with secondary spouse/partner (S/P) emotional distress and relationship violence. OBJECTIVE To investigate the relationships between PTSD, S/P emotional distress and relationship violence among police recruits using a prospective design. METHODS Two hypotheses were tested in 71 S/Ps: (1) Police officer reports of greater PTSD symptoms after 12 months of police service will be associated with greater secondary trauma symptoms among S/Ps; (2) Greater secondary trauma symptoms among S/Ps at 12 months will be associated with S/P reports of greater relationship violence. METHODS 71 police recruits and their S/Ps were assessed at baseline and 12 months after the start of police officer duty. Using linear and logistic regression, we analyzed explanatory variables for 12 month S/P secondary traumatic stress symptoms and couple violence, including baseline S/P variables and couple violence, as well as exposure and PTSD reports from both S/P and officer. RESULTS S/P perception of officer PTSD symptoms predicted S/P secondary traumatic stress. OS/P secondary trauma was significantly associated with both total couple violence (.34, p = .004) and S/P to officer violence (.35, p = .003). CONCLUSIONS Although results from this relatively small study of young police officers and their S/Ps must be confirmed by larger studies in general populations, findings suggest that S/P perception of PTSD symptoms may play a key role in the spread of traumatic stress symptoms across intimate partner relationships and intimate partner violence in the context of PTSD.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Clare Henn-Haase
- Department of Psychiatry, New York University, New York, New York, United States of America
| | - Thomas J. Metzler
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Meng Qian
- Department of Psychiatry, New York University, New York, New York, United States of America
| | - Suzanne Best
- Graduate School of Education and Counseling, Lewis and Clark College, Portland, Oregon, United States of America
| | - Ayelet Hirschfeld
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Shannon McCaslin
- Dissemination and Training Division, National Center for PTSD, Palo Alto, California, United States of America
| | - Sabra Inslicht
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Thomas C. Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Charles R. Marmar
- Department of Psychiatry, New York University, New York, New York, United States of America
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Mosconi L, Murray J, Davies M, Williams S, Pirraglia E, Spector N, Tsui WH, Li Y, Butler T, Osorio RS, Glodzik L, Vallabhajosula S, McHugh P, Marmar CR, de Leon MJ. Nutrient intake and brain biomarkers of Alzheimer's disease in at-risk cognitively normal individuals: a cross-sectional neuroimaging pilot study. BMJ Open 2014; 4:e004850. [PMID: 24961717 PMCID: PMC4078781 DOI: 10.1136/bmjopen-2014-004850] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There is increasing evidence to suggest that diet, one of the most important modifiable environmental factors, may play a role in preventing or delaying cognitive decline and Alzheimer's disease (AD). This study examines the relationship between dietary nutrients and brain biomarkers of AD in cognitively normal individuals (NL) with and without AD risk factors. DESIGN As part of an ongoing brain imaging study, participants received clinical and laboratory examinations, a neurocognitive test battery, positron emission tomography (PET) with (11)C-Pittsburgh Compound-B (PiB; a measure of amyloid-β (Aβ) load) and (18)F-fluorodeoxyglucose (FDG; a proxy of neuronal activity), and completed semiquantitative food frequency questionnaires. SETTING Research centre affiliated with the Alzheimer's disease Core Center at New York University School of Medicine. PARTICIPANTS 49 NL individuals (age 25-72 years, 69% women) with dietary information, (11)C-PiB and (18)F-FDG PET scans were examined. RESULTS Controlling for age and total caloric intake, higher intake of vitamin B12, vitamin D and ω-3 polyunsaturated fatty acid (PUFA) was associated with lower Aβ load in AD regions on PiB-PET, while higher intake of β-carotene and folate was associated with higher glucose metabolism on FDG-PET. β-carotene and folate were associated with reduced glucose metabolism for women, apolipoprotein E epsilon 4 (APOE4) carriers and participants with positive AD family history, but not for their risk-free counterparts. The associations of vitamin B12, vitamin D and ω-3 PUFA with PiB retention were independent of gender, APOE and family history. The identified nutrient combination was associated with higher intake of vegetables, fruit, whole grains, fish and legumes, and lower intake of high-fat dairies, meat and sweets. CONCLUSIONS Our data provide a potential pathophysiological mechanism for epidemiological findings showing that dietary interventions may play a role in the prevention of AD. Longitudinal studies are needed to determine whether there is a direct link between nutrient intake, brain biomarkers and risk of AD.
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Affiliation(s)
- Lisa Mosconi
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - John Murray
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Michelle Davies
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Schantel Williams
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Elizabeth Pirraglia
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Nicole Spector
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Wai H Tsui
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Yi Li
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Tracy Butler
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Ricardo S Osorio
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Lidia Glodzik
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Shankar Vallabhajosula
- Department of Radiology, Citigroup Biomedical Imaging Center (CBIC), Weill Cornell Medical College, New York, New York, USA
| | - Pauline McHugh
- Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University School of Medicine, New York, USA
- Steven and Alexandra Cohen Veterans Center for PTSD and TBI, New York, New York, USA
| | - Mony J de Leon
- Department of Psychiatry, New York University School of Medicine, New York, USA
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Bruno D, Brown AD, Kapucu A, Marmar CR, Pomara N. Cognitive Reserve and Emotional Stimuli in Older Individuals: Level of Education Moderates the Age-Related Positivity Effect. Exp Aging Res 2014; 40:208-23. [DOI: 10.1080/0361073x.2014.882212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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63
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Meffert SM, Abdo AO, Alla OAA, Elmakki YOM, Omer AA, Yousif S, Metzler TJ, Marmar CR. A pilot randomized controlled trial of interpersonal psychotherapy for Sudanese refugees in Cairo, Egypt. ACTA ACUST UNITED AC 2014. [DOI: 10.1037/a0023540] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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64
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Komarovskaya I, Brown AD, Galatzer-Levy IR, Madan A, Henn-Haase C, Teater J, Clarke BH, Marmar CR, Chemtob CM. Early physical victimization is a risk factor for posttraumatic stress disorder symptoms among Mississippi police and firefighter first responders to Hurricane Katrina. ACTA ACUST UNITED AC 2014. [DOI: 10.1037/a0031600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Brown AD, Addis DR, Romano TA, Marmar CR, Bryant RA, Hirst W, Schacter DL. Episodic and semantic components of autobiographical memories and imagined future events in post-traumatic stress disorder. Memory 2013; 22:595-604. [PMID: 24712772 DOI: 10.1080/09658211.2013.807842] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Individuals with post-traumatic stress disorder (PTSD) tend to retrieve autobiographical memories with less episodic specificity, referred to as overgeneralised autobiographical memory. In line with evidence that autobiographical memory overlaps with one's capacity to imagine the future, recent work has also shown that individuals with PTSD also imagine themselves in the future with less episodic specificity. To date most studies quantify episodic specificity by the presence of a distinct event. However, this method does not distinguish between the numbers of internal (episodic) and external (semantic) details, which can provide additional insights into remembering the past and imagining the future. This study employed the Autobiographical Interview (AI) coding scheme to the autobiographical memory and imagined future event narratives generated by combat veterans with and without PTSD. Responses were coded for the number of internal and external details. Compared to combat veterans without PTSD, those with PTSD generated more external than internal details when recalling past or imagining future events, and fewer internal details were associated with greater symptom severity. The potential mechanisms underlying these bidirectional deficits and clinical implications are discussed.
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Affiliation(s)
- Adam D Brown
- a Department of Psychiatry , New York University School of Medicine , USA
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66
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Yan X, Brown AD, Lazar M, Cressman VL, Henn-Haase C, Neylan TC, Shalev A, Wolkowitz OM, Hamilton SP, Yehuda R, Sodickson DK, Weiner MW, Marmar CR. Spontaneous brain activity in combat related PTSD. Neurosci Lett 2013; 547:1-5. [PMID: 23643995 DOI: 10.1016/j.neulet.2013.04.032] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 04/13/2013] [Accepted: 04/25/2013] [Indexed: 12/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder, especially in combat veterans. Existing functional neuroimaging studies have provided important insights into the neural mechanisms of PTSD using various experimental paradigms involving trauma recollection or other forms of emotion provocation. However it is not clear whether the abnormal brain activity is specific to the mental processes related to the experimental tasks or reflects general patterns across different brain states. Thus, studying intrinsic spontaneous brain activity without the influence of external tasks may provide valuable alternative perspectives to further understand the neural characteristics of PTSD. The present study evaluated the magnitudes of spontaneous brain activity of male US veterans with or without PTSD, with the two groups matched on age, gender, and ethnicity. Amplitudes of low frequency fluctuation (ALFF), a data driven analysis method, were calculated on each voxel of the resting state fMRI data to measure the magnitudes of spontaneous brain activity. Results revealed that PTSD subjects showed increased spontaneous activity in the amygdala, ventral anterior cingulate cortex, insula, and orbital frontal cortex, as well as decreased spontaneous activity in the precuneus, dorsal lateral prefrontal cortex and thalamus. Within the PTSD group, larger magnitudes of spontaneous activity in the thalamus, precuneus and dorsal lateral prefrontal cortex were associated with lower re-experiencing symptoms. Comparing our results with previous functional neuroimaging findings, increased activity of the amygdala and anterior insula and decreased activity of the thalamus are consistent patterns across emotion provocation states and the resting state.
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Affiliation(s)
- Xiaodan Yan
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
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67
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Galatzer-Levy IR, Nickerson A, Litz BT, Marmar CR. Patterns of lifetime PTSD comorbidity: a latent class analysis. Depress Anxiety 2013; 30:489-96. [PMID: 23281049 DOI: 10.1002/da.22048] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/01/2012] [Accepted: 12/02/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with high rates of psychiatric comorbidity, most notably substance use disorders, major depression, and other anxiety disorders. However, little is known about how these disorders cluster together among people with PTSD, if disorder clusters have distinct etiologies in terms of trauma type, and if they confer greater burden over and above PTSD alone. METHOD Utilizing Latent Class Analysis, we tested for discrete patterns of lifetime comorbidity with PTSD following trauma exposure (n = 409). Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID). Next, we examined if gender, trauma type, symptom frequency, severity, and interference with everyday life were associated with the latent classes. RESULTS Three patterns of lifetime comorbidity with PTSD emerged: a class characterized by predominantly comorbid mood and anxiety disorders; a class characterized by predominantly comorbid mood, anxiety, and substance dependence; and a relatively pure low-comorbidity PTSD class. Individuals in both high comorbid classes had nearly two and a half times the rates of suicidal ideation, endorsed more PTSD symptom severity, and demonstrated a greater likelihood of intimate partner abuse compared to the low comorbidity class. Men were most likely to fall into the substance dependent class. CONCLUSION PTSD comorbidity clusters into a small number of common patterns. These patterns may represent an important area of study, as they confer distinct differences in risk and possibly etiology. Implications for research and treatment are discussed.
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68
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Maguen S, Madden E, Bosch J, Galatzer-Levy I, Knight SJ, Litz BT, Marmar CR, McCaslin SE. Killing and latent classes of PTSD symptoms in Iraq and Afghanistan veterans. J Affect Disord 2013; 145:344-8. [PMID: 22959679 DOI: 10.1016/j.jad.2012.08.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Our goal was to better understand distinct PTSD symptom presentations in Iraq and Afghanistan Veterans (N=227) and to determine whether those who killed in war were at risk for being in the most symptomatic class. METHODS We used latent class analysis of responses to the PTSD checklist and logistic regression of most symptomatic class. RESULTS We found that a four-class solution best fit the data, with the following profiles emerging: High Symptom (34% of participants), Intermediate Symptom (41%), Intermediate Symptom with Low Emotional Numbing (10%), and Low Symptom (15%). The largest group of individuals who reported killing (45%) was in the High Symptom class, and those who killed had twice the odds of being in the most symptomatic PTSD class, compared to those who did not kill. Those who endorsed killing a non-combatant (OR=4.56, 95% CI [1.77, 11.7], p<0.01) or killing in the context of anger or revenge (OR=4.63, 95% CI=[1.89, 11.4], p<0.001) were more likely to belong to the most symptomatic PTSD class, compared to those who did not kill. LIMITATIONS The study was retrospective and cross-sectional. The results may not generalize to veterans of other wars. CONCLUSIONS Killing in war may be an important indicator of risk for developing frequent and severe PTSD symptoms. This has implications for the mental healthcare of veterans, providing evidence that a comprehensive evaluation of returning veterans should include an assessment of killing experiences and reactions to killing.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center and University of California, San Francisco, CA 94121, USA.
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69
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Galatzer-Levy IR, Brown AD, Henn-Haase C, Metzler TJ, Neylan TC, Marmar CR. Positive and negative emotion prospectively predict trajectories of resilience and distress among high-exposure police officers. ACTA ACUST UNITED AC 2013; 13:545-53. [PMID: 23339621 DOI: 10.1037/a0031314] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Responses to both potentially traumatic events and other significant life stressors have been shown to conform to discrete patterns of response such as resilience, anticipatory stress, initial distress with gradual recovery, and chronic distress. The etiology of these trajectories is still unclear. Individual differences in levels of negative and positive emotion are believed to play a role in determining risk and resilience following traumatic exposure. In the current investigation, we followed police officers prospectively from academy training through 48 months of active duty, assessing levels of distress every 12 months. Using latent class growth analysis, we identified 4 trajectories closely conforming to prototypical patterns. Furthermore, we found that lower levels of self-reported negative emotion during academy training prospectively predicted membership in the resilient trajectory compared with the more symptomatic trajectories following the initiation of active duty, whereas higher levels of positive emotion during academy training differentiated resilience from a trajectory that was equivalently low on distress during academy training but consistently grew in distress through 4 years of active duty. These findings emerging from a prospective longitudinal design provide evidence that resilience is predicted by both lower levels of negative emotion and higher levels of positive emotion prior to active duty stressor exposure.
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Affiliation(s)
- Isaac R Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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70
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Inslicht SS, Metzler TJ, Garcia NM, Pineles SL, Milad MR, Orr SP, Marmar CR, Neylan TC. Sex differences in fear conditioning in posttraumatic stress disorder. J Psychiatr Res 2013; 47:64-71. [PMID: 23107307 PMCID: PMC3806498 DOI: 10.1016/j.jpsychires.2012.08.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/28/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women are twice as likely as men to develop Posttraumatic Stress Disorder (PTSD). Abnormal acquisition of conditioned fear has been suggested as a mechanism for the development of PTSD. While some studies of healthy humans suggest that women are either no different or express less conditioned fear responses during conditioning relative to men, differences in the acquisition of conditioned fear between men and women diagnosed with PTSD has not been examined. METHODS Thirty-one participants (18 men; 13 women) with full or subsyndromal PTSD completed a fear conditioning task. Participants were shown computer-generated colored circles that were paired (CS+) or unpaired (CS-) with an aversive electrical stimulus and skin conductance levels were assessed throughout the task. RESULTS Repeated measures ANOVA indicated a significant sex by stimulus interaction during acquisition. Women had greater differential conditioned skin conductance responses (CS + trials compared to CS- trials) than did men, suggesting greater acquisition of conditioned fear in women with PTSD. CONCLUSIONS In contrast to studies of healthy individuals, we found enhanced acquisition of conditioned fear in women with PTSD. Greater fear conditioning in women may either be a pre-existing vulnerability trait or an acquired phenomenon that emerges in a sex-dependent manner after the development of PTSD. Characterizing the underlying mechanisms of these differences is needed to clarify sex-related differences in the pathophysiology of PTSD.
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Affiliation(s)
- Sabra S Inslicht
- University of California, San Francisco, San Francisco, CA 94121, United States.
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71
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Maguen S, Metzler TJ, Bosch J, Marmar CR, Knight SJ, Neylan TC. Killing in combat may be independently associated with suicidal ideation. Depress Anxiety 2012; 29:918-23. [PMID: 22505038 PMCID: PMC3974930 DOI: 10.1002/da.21954] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 03/13/2012] [Accepted: 03/17/2012] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The United States military has lost more troops to suicide than to combat for the second year in a row and better understanding combat-related risk factors for suicide is critical. We examined the association of killing and suicide among war veterans after accounting for PTSD, depression, and substance use disorders. METHODS We utilized a cross-sectional, retrospective, nationally representative sample of Vietnam veterans from the National Vietnam Veterans Readjustment Study (NVVRS). In order to perform a more in depth analysis, we utilized a subsample of these data, the NVVRS Clinical Interview Sample (CIS), which is representative of 1.3 million veterans who were eligible for the clinical interview by virtue of living in proximity to an interview site, located within 28 standard metropolitan regions throughout the United States. RESULTS Veterans who had higher killing experiences had twice the odds of suicidal ideation, compared to those with lower or no killing experiences (OR = 1.99, 95% CI = 1.07-3.67), even after adjusting for demographic variables, PTSD, depression, substance use disorders, and adjusted combat exposure. PTSD (OR = 3.42, 95% CI = 1.09-10.73), depression (OR = 11.49, 95% CI = 2.12-62.38), and substance use disorders (OR = 3.98, 95% CI = 1.01-15.60) were each associated with higher odds of suicidal ideation. Endorsement of suicide attempts was most strongly associated with PTSD (OR = 5.52, 95% CI = 1.21-25.29). CONCLUSIONS Killing experiences are not routinely examined when assessing suicide risk. Our findings have important implications for conducting suicide risk assessments in veterans of war. Depression and Anxiety 00:1-6, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, San Francisco, California 94121, USA.
| | - Thomas J. Metzler
- San Francisco VA Medical Center, San Francisco, California,University of California, San Francisco, California
| | - Jeane Bosch
- San Francisco VA Medical Center, San Francisco, California
| | | | - Sara J. Knight
- San Francisco VA Medical Center, San Francisco, California,University of California, San Francisco, California
| | - Thomas C. Neylan
- San Francisco VA Medical Center, San Francisco, California,University of California, San Francisco, California
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Maia DB, Marmar CR, Henn-Haase C, Nóbrega A, Fiszman A, Marques-Portella C, Mendlowicz MV, Coutinho ESF, Figueira I. Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation. Braz J Psychiatry 2012; 33:362-6. [PMID: 22189925 DOI: 10.1590/s1516-44462011000400009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/23/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers. METHOD In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms. RESULTS Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found. CONCLUSIONS The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers.
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Affiliation(s)
- Deborah B Maia
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro, Brazil.
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Berger W, Coutinho ESF, Figueira I, Marques-Portella C, Luz MP, Neylan TC, Marmar CR, Mendlowicz MV. Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1001-11. [PMID: 21681455 PMCID: PMC3974968 DOI: 10.1007/s00127-011-0408-2] [Citation(s) in RCA: 348] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/30/2011] [Indexed: 01/09/2023]
Abstract
PURPOSE We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies. METHODS A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity. RESULTS A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers. CONCLUSIONS Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
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Affiliation(s)
- William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rua Almirante Saddock de Sá, 290/402 Ipanema, Rio de Janeiro, RJ, 22411-040, Brazil.
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Abstract
Self-efficacy is a key construct underlying healthy functioning and emotional well-being. Perceptions of uncontrollability, unpredictability, and low self-efficacy are consistently associated with negative mental health outcomes, such as post-traumatic stress disorder (PTSD). To test the causal relation between perceived coping self-efficacy and stress responses we employed a trauma film paradigm in which college students (N=33) viewed a graphic film of the aftermath of a motor vehicle accident following a high (HSE) or low self-efficacy (LSE) induction. Participants were tested for intrusions, distress, and memory recall for the film over the following 24 hours. LSE participants recalled more central details than HSE participants. Further, HSE participants reported fewer negative intrusions immediately following the film and at 24 hours. These findings suggest that strategies that increase perceived coping self-efficacy may reduce intrusive recollections of an aversive event, and also reduce the attentional bias associated with remembering aversive stimuli.
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Affiliation(s)
- Adam D Brown
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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Inslicht SS, Otte C, McCaslin SE, Apfel BA, Henn-Haase C, Metzler T, Yehuda R, Neylan TC, Marmar CR. Cortisol awakening response prospectively predicts peritraumatic and acute stress reactions in police officers. Biol Psychiatry 2011; 70:1055-62. [PMID: 21906725 PMCID: PMC3225122 DOI: 10.1016/j.biopsych.2011.06.030] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal axis is a major stress response system hypothesized to be involved in the pathogenesis of posttraumatic stress disorder (PTSD). However, few studies have prospectively examined the relationships among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and PTSD. METHODS Two hundred ninety-six police recruits were assessed during academy training before critical incident exposure and provided salivary cortisol at first awakening and after 30 minutes. A measure of cortisol awakening response (CAR) was computed as the change in cortisol level from the first to the second collection. At 12, 24, and 36 months following the start of active police service, officers were assessed for peritraumatic distress, peritraumatic dissociation, acute stress disorder (ASD) symptoms, and PTSD symptoms to their self-identified worst duty-related critical incident. Mixed models for repeated measures were used to analyze the effects of CAR on the outcome variables pooled across the three follow-up assessments. RESULTS After controlling for time of awakening, first awakening cortisol levels, and cumulative critical incident stress exposure, CAR during academy training was associated with greater peritraumatic dissociation, β = .14, z = 3.49, p < .0001, and greater ASD symptoms during police service assessed at 12, 24, and 36 months, β = .09, Z = 2.03, p < .05, but not with peritraumatic distress, β = .03, z = .81, p = .42, or PTSD symptoms, β = -.004, z = -.09, p = .93. CONCLUSIONS These findings suggest that greater cortisol response to awakening is a pre-exposure risk factor for peritraumatic dissociation and ASD symptoms during police service.
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Affiliation(s)
- Sabra S. Inslicht
- San Francisco VA Medical Center, San Francisco, CA
,University of California, San Francisco, CA
| | | | - Shannon E. McCaslin
- San Francisco VA Medical Center, San Francisco, CA
,University of California, San Francisco, CA
| | - Brigitte A. Apfel
- San Francisco VA Medical Center, San Francisco, CA
,University of California, San Francisco, CA
| | | | - Thomas Metzler
- San Francisco VA Medical Center, San Francisco, CA
,Northern California Institute for Research and Education, San Francisco, CA
| | - Rachel Yehuda
- Mount Sinai School of Medicine, New York, NY
,James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Thomas C. Neylan
- San Francisco VA Medical Center, San Francisco, CA
,University of California, San Francisco, CA
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76
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Brown AD, Dorfman ML, Marmar CR, Bryant RA. The impact of perceived self-efficacy on mental time travel and social problem solving. Conscious Cogn 2011; 21:299-306. [PMID: 22019214 DOI: 10.1016/j.concog.2011.09.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/17/2011] [Accepted: 09/27/2011] [Indexed: 11/19/2022]
Abstract
Current models of autobiographical memory suggest that self-identity guides autobiographical memory retrieval. Further, the capacity to recall the past and imagine one's self in the future (mental time travel) can influence social problem solving. We examined whether manipulating self-identity, through an induction task in which students were led to believe they possessed high or low self-efficacy, impacted episodic specificity and content of retrieved and imagined events, as well as social problem solving. Compared to individuals in the low self efficacy group, individuals in the high self efficacy group generated past and future events with greater (a) specificity, (b) positive words, and (c) self-efficacious statements, and also performed better on social problem solving indices. A lack of episodic detail for future events predicted poorer performance on social problem solving tasks. Strategies that increase perceived self-efficacy may help individuals to selectively construct a past and future that aids in negotiating social problems.
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Affiliation(s)
- Adam D Brown
- PTSD Research Program, Department of Psychiatry, New York University School of Medicine, USA.
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77
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Galatzer-Levy IR, Madan A, Neylan TC, Henn-Haase C, Marmar CR. Peritraumatic and trait dissociation differentiate police officers with resilient versus symptomatic trajectories of posttraumatic stress symptoms. J Trauma Stress 2011; 24:557-65. [PMID: 21898602 PMCID: PMC3974926 DOI: 10.1002/jts.20684] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has consistently demonstrated that stress reactions to potentially traumatic events do not represent a unified phenomenon. Instead, individuals tend to cluster into prototypical response patterns over time including chronic symptoms, recovery, and resilience. We examined heterogeneity in a posttraumatic stress disorder (PTSD) symptom course in a sample of 178 active-duty police officers following exposure to a life-threatening event using latent growth mixture modeling (LGMM). This analysis revealed 3 discrete PTSD symptom trajectories: resilient (88%), distressed-improving (10%), and distressed-worsening (2%). We further examined whether trait and peritraumatic dissociation distinguished these symptom trajectories. Findings indicate that trait and peritraumatic dissociation differentiated the resilient from the distressed-improving trajectory (trait, p < .05; peritraumatic, p < .001), but only peritraumatic dissociation differentiated the resilient from the distressed-worsening trajectory (p < .001). It is essential to explore heterogeneity in symptom course and its predictors among active-duty police officers, a repeatedly exposed group. These findings suggest that police officers may be a highly resilient group overall. Furthermore, though there is abundant evidence that dissociation has a positive linear relationship with PTSD symptoms, this study demonstrates that degree of dissociation can distinguish between resilient and symptomatic groups of individuals.
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Affiliation(s)
- Isaac R Galatzer-Levy
- Departmentof Psychiatry, PTSD Research Program, New York University School of Medicine, NY 10016, USA.
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78
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Komarovskaya I, Maguen S, McCaslin SE, Metzler TJ, Madan A, Brown AD, Galatzer-Levy IR, Henn-Haase C, Marmar CR. The impact of killing and injuring others on mental health symptoms among police officers. J Psychiatr Res 2011; 45:1332-6. [PMID: 21658717 PMCID: PMC3974970 DOI: 10.1016/j.jpsychires.2011.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/03/2011] [Accepted: 05/06/2011] [Indexed: 11/29/2022]
Abstract
This study examined the relationship between killing or seriously injuring someone in the line of duty and mental health symptoms in a sample of police officers (N = 400) who were first assessed during academy training and at five additional time points over three years. We found that nearly 10% of police officers reported having to kill or seriously injure someone in the line of duty in the first three years of police service. After controlling for demographics and exposure to life threat, killing or seriously injuring someone in the line of duty was significantly associated with PTSD symptoms (p < .01) and marginally associated with depression symptoms (p = .06). These results highlight the potential mental health impact of killing or seriously injuring someone in the line of duty. Greater attention to mental health services following these types of exposures can serve as a preventative measure for police officers who have been negatively impacted.
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Affiliation(s)
| | - Shira Maguen
- UCSF School of Medicine, SF VA Medical Center, San Francisco, CA, USA
| | | | | | - Anita Madan
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Adam D. Brown
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Isaac R. Galatzer-Levy
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Clare Henn-Haase
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Charles R. Marmar
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
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79
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Yuan C, Wang Z, Inslicht SS, McCaslin SE, Metzler TJ, Henn-Haase C, Apfel BA, Tong H, Neylan TC, Fang Y, Marmar CR. Protective factors for posttraumatic stress disorder symptoms in a prospective study of police officers. Psychiatry Res 2011; 188:45-50. [PMID: 21095622 PMCID: PMC3071439 DOI: 10.1016/j.psychres.2010.10.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 08/16/2010] [Accepted: 10/31/2010] [Indexed: 12/01/2022]
Abstract
Although police officers are frequently exposed to potentially traumatic incidents, only a minority will develop chronic posttraumatic stress disorder (PTSD). Identifying and understanding protective factors could inform the development of preventive interventions; however, few studies have examined this. In the present prospective study, 233 police officers were assessed during academy training and again following 2 years of police service. Caucasian race, less previous trauma exposure, and less critical incident exposure during police service as well as greater sense of self-worth, beliefs of greater benevolence of the world, greater social support and better social adjustment, all assessed during academy training, were associated with lower PTSD symptoms after 2 years of service. Positive personality attributes assessed during training with the NEO Five-Factor Personality Inventory were not associated with lower PTSD symptoms. In a hierarchical linear regression model, only Caucasian race, lower critical incident exposure during police service, greater assumptions of benevolence of the world and better social adjustment during training remained predictive of lower PTSD symptoms after 2 years of police service. These results suggest that positive world assumptions and better social functioning during training may protect police officers from critical incident related PTSD.
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Affiliation(s)
- Chengmei Yuan
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Zhen Wang
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States, Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sabra S. Inslicht
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Shannon E. McCaslin
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Thomas J. Metzler
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Clare Henn-Haase
- Department of Psychiatry, New York University, New York, NY, United States
| | - Brigitte A. Apfel
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States,Corresponding author: Brigitte Apfel, MD, Department of Psychiatry, Veterans Administration Medical Center, 4150 Clement St. (116P), San Francisco, CA 94121, Tel: (415) 221 4810, Fax: (415) 751-2297,
| | - Huiqi Tong
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States
| | - Thomas C. Neylan
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Yiru Fang
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-corresponding author: Yiru Fang, MD, Division of Mood Disorder, Shanghai Mental Health Center, Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China, Tel: (8621) 3428 9888, Fax: (8621) 6438 7986,
| | - Charles R. Marmar
- Department of Psychiatry, New York University, New York, NY, United States
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80
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Maguen S, Vogt DS, King LA, King DW, Litz BT, Knight SJ, Marmar CR. The impact of killing on mental health symptoms in Gulf War veterans. ACTA ACUST UNITED AC 2011. [DOI: 10.1037/a0019897] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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81
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Ballenger JF, Best SR, Metzler TJ, Wasserman DA, Mohr DC, Liberman A, Delucchi K, Weiss DS, Fagan JA, Waldrop AE, Marmar CR. Patterns and predictors of alcohol use in male and female urban police officers. Am J Addict 2011; 20:21-9. [PMID: 21175917 PMCID: PMC3592498 DOI: 10.1111/j.1521-0391.2010.00092.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In a large sample of urban police officers, 18.1% of males and 15.9% of females reported experiencing adverse consequences from alcohol use and 7.8% of the sample met criteria for lifetime alcohol abuse or dependence. Female officers had patterns of alcohol use similar to male officers and substantially more than females in the general population. Critical incident exposure and posttraumatic stress disorder (PTSD) symptoms were not associated with level of alcohol use. Greater psychiatric symptoms were related to adverse consequences from alcohol use. There was a noteworthy gender by work stress interaction: greater routine work stress related to lower current alcohol use in female officers.
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Affiliation(s)
- James F Ballenger
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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82
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Neylan TC, Metzler TJ, Henn-Haase C, Blank Y, Tarasovsky G, McCaslin SE, Lenoci M, Marmar CR. Prior night sleep duration is associated with psychomotor vigilance in a healthy sample of police academy recruits. Chronobiol Int 2010; 27:1493-508. [PMID: 20795888 DOI: 10.3109/07420528.2010.504992] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aviation, military, police, and health care personnel have been particularly interested in the operational impact of sleep restriction and work schedules given the potential severe consequences of making fatigue-related errors. Most studies examining the impact of sleep loss or circadian manipulations have been conducted in controlled laboratory settings using small sample sizes. This study examined whether the relationship between prior night sleep duration and performance on the psychomotor vigilance task could be reliably detected in a field study of healthy police academy recruits. Subjects (N = 189) were medically and psychiatrically healthy. Sleep-wake activity was assessed with wrist actigraphy for 7 days. Subjects performed the psychomotor vigilance task (PVT) for 5 min on a personal digital assistant (PDA) device before and after their police academy workday and on comparable times during their days off. Mixed-effects logistic regression was used to estimate the probability of having > or =1 lapse on the PVT as a function of the previous night sleep duration during the 7 days of field testing. Valid estimates of sleep duration were obtained for 1082 nights of sleep. The probability of a lapse decreased by 3.5%/h sleep the night prior to testing. The overall probability of having a lapse decreased by 0.9%/h since awakening, holding hours of sleep constant. Perceived stress was not associated with sleep duration or probability of performance lapse. These findings demonstrate the feasibility of detecting sleep and circadian effects on cognitive performance in large field studies. These findings have implications regarding the daytime functioning of police officers.
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Affiliation(s)
- Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.
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83
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Weiss DS, Brunet A, Best SR, Metzler TJ, Liberman A, Pole N, Fagan JA, Marmar CR. Frequency and severity approaches to indexing exposure to trauma: the Critical Incident History Questionnaire for police officers. J Trauma Stress 2010; 23:734-43. [PMID: 21171134 PMCID: PMC3974917 DOI: 10.1002/jts.20576] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Critical Incident History Questionnaire indexes cumulative exposure to traumatic incidents in police by examining incident frequency and rated severity. In over 700 officers, event severity was negatively correlated (r(s) = -.61) with frequency of exposure. Cumulative exposure indices that varied emphasis on frequency and severity-using both nomothetic and idiographic methods-all showed satisfactory psychometric properties and similar correlates. All indices were only modestly related to posttraumatic stress disorder (PTSD) symptoms. Ratings of incident severity were not influenced by whether officers had ever experienced the incident. Because no index summarizing cumulative exposure to trauma had superior validity, our findings suggest that precision is not increased if frequency is weighted by severity.
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Affiliation(s)
- Daniel S. Weiss
- Department of Psychiatry, University of California, San Francisco
| | - Alain Brunet
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute
| | | | - Thomas J. Metzler
- Mental Health Service, San Francisco Veterans Affairs Medical Center
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84
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Herbst E, Metzler TJ, Lenoci M, McCaslin SE, Inslicht S, Marmar CR, Neylan TC. Adaptation effects to sleep studies in participants with and without chronic posttraumatic stress disorder. Psychophysiology 2010; 47:1127-33. [PMID: 20456661 PMCID: PMC2925054 DOI: 10.1111/j.1469-8986.2010.01030.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The "first night effect" (FNE) is the alteration of sleep architecture observed on the first night of polysomnographic (PSG) studies. It is unclear whether the FNE reflects adaptation to the equipment, sleeping environment, or both. Moreover, it is possible that certain patient populations, such as those with posttraumatic stress disorder (PTSD), demonstrate greater adaptation effects that are highly context dependent. We assessed FNE in participants with PTSD and healthy controls in a cross-sectional study consisting of PSG testing at home and in the hospital. Contrary to our expectations, the PTSD group showed no adaptation effects in either setting. Only the control group assigned to the "hospital first" condition showed significant decreases in total sleep time on night 1 versus night 2 of the study. The results suggest that the FNE is related to adaptation to the combination of the hospital environment and the recording equipment.
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Affiliation(s)
- Ellen Herbst
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
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85
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Maguen S, Ren L, Bosch JO, Marmar CR, Seal KH. Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in veterans affairs health care. Am J Public Health 2010; 100:2450-6. [PMID: 20966380 DOI: 10.2105/ajph.2009.166165] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined gender differences in sociodemographic, military service, and mental health characteristics among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. We evaluated associations between these sociodemographic and service characteristics and depression and posttraumatic stress disorder (PTSD) diagnoses. METHODS In a retrospective, cross-sectional study, we used univariate descriptive statistics and log binominal regression analyses of Department of Veterans Affairs (VA) administrative data on 329 049 OEF and OIF veterans seeking VA health care from April 1, 2002, through March 31, 2008. RESULTS Female veterans were younger and more likely to be Black and to receive depression diagnoses than were male veterans, who were more frequently diagnosed with PTSD and alcohol use disorders. Older age was associated with a higher prevalence of PTSD and depression diagnoses among women but not among men. CONCLUSIONS Consideration of gender differences among OEF and OIF veterans seeking health care at the VA will facilitate more targeted prevention and treatment services for these newly returning veterans.
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Affiliation(s)
- Shira Maguen
- San Francisco Veterans Administration (VA) Medical Center, PTSD Program, San Francisco, California 94121, USA.
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86
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Berger W, Mehra A, Lenoci M, Metzler TJ, Otte C, Tarasovsky G, Mellon SH, Wolkowitz OM, Marmar CR, Neylan TC. Serum brain-derived neurotrophic factor predicts responses to escitalopram in chronic posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1279-84. [PMID: 20643177 PMCID: PMC2939182 DOI: 10.1016/j.pnpbp.2010.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/03/2010] [Accepted: 07/12/2010] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Some studies have found that antidepressants increase serum brain-derived neurotrophic factor (BDNF) levels in patients with major depression and the expression of BDNF mRNA in limbic structures of rats. OBJECTIVES This study addressed whether the SSRI escitalopram increases serum BDNF levels in subjects with PTSD and whether BDNF levels are associated with treatment response. METHODS Medically healthy male subjects (N=16) with chronic PTSD completed a 12 week open-label trial of flexible dose (5-20 mg/day) escitalopram monotherapy. BDNF levels were obtained at baseline, and at weeks 4, 8 and 12. RESULTS PTSD symptoms significantly declined over the course of the 12 week escitalopram treatment. Despite a substantial improvement in PTSD symptoms, there was virtually no change in BDNF levels over time. Nevertheless, mean BDNF levels across the trial were strongly correlated with the slope of PTSD symptoms over the 12 weeks (r=0.58, p=0.018). Lower mean BDNF was associated with a greater decrease in PTSD symptoms over the course of the trial. CONCLUSIONS PTSD subjects with low BDNF levels demonstrated the largest treatment response from an agent with putative neurotrophic effects.
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Affiliation(s)
- William Berger
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA, Department of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil
| | - Akhil Mehra
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA
| | - Maryann Lenoci
- Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA
| | - Thomas J. Metzler
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA
| | - Christian Otte
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Germany
| | - Gary Tarasovsky
- Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA
| | - Synthia H. Mellon
- Department of Obstetrics, Gynecology and Reproductive Endocrinology, University of California, San Francisco (UCSF), CA, USA
| | - Owen M. Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA
| | - Charles R. Marmar
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA, Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA,Corresponding author: Dr. Thomas C. Neylan, UCSF and SFVAMC (116P), 4150 Clement Street, San Francisco, CA 94121. Phone: (415) 750-6961; Fax: (415) 751-2297.
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87
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Meffert SM, Musalo K, Abdo AO, Alla OAA, Elmakki YOM, Omer AA, Yousif S, Metzler TJ, Marmar CR. Feelings of betrayal by the United Nations High Commissioner for Refugees and emotionally distressed Sudanese refugees in Cairo. Med Confl Surviv 2010; 26:160-72. [PMID: 20718287 DOI: 10.1080/13623699.2010.491395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thousands of Sudanese refugees have fled to Cairo, Egypt in the wake of Sudanese civil conflicts. Sudanese refugees were evaluated with respect to symptoms of depression, post-traumatic stress disorder (PTSD) and social stress. Four respondents (22%) indicated that their interactions with the United Nations High Commissioner for Refugees (UNHCR) in Cairo, Egypt were the worst experiences since war-related atrocities. Fourteen participants (63.6%) felt 'extremely' betrayed by the UNHCR on a four point scale. Greater feelings of betrayal by the UNHCR were associated with greater avoidance and arousal symptoms of PTSD, symptoms of depression and trait anger. This is the first study of which we are aware that examines the relationship between sense of betrayal by the UNHCR and symptoms of PTSD, depression and anger among asylum seekers.
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Affiliation(s)
- Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, California, USA.
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88
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Neylan TC, Mueller SG, Wang Z, Metzler TJ, Lenoci M, Truran D, Marmar CR, Weiner MW, Schuff N. Insomnia severity is associated with a decreased volume of the CA3/dentate gyrus hippocampal subfield. Biol Psychiatry 2010; 68:494-6. [PMID: 20598672 PMCID: PMC2921477 DOI: 10.1016/j.biopsych.2010.04.035] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 04/14/2010] [Accepted: 04/26/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prolonged disruption of sleep in animal studies is associated with decreased neurogenesis in the dentate gyrus. Our objective was to determine whether insomnia severity in a sample of posttraumatic stress disorder (PTSD) patients and control subjects was associated with decreased volume in the CA3/dentate hippocampal subfield. METHODS Volumes of hippocampal subfields in 17 veteran men positive for PTSD (41 +/- 12 years) and 19 age-matched male veterans negative for PTSD were measured with 4-T magnetic resonance imaging. Subjective sleep quality was measured by the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index. RESULTS Higher scores on the ISI, indicating worse insomnia, were associated with smaller volumes of the CA3/dentate subfields (r = -.48, p < .01) in the combined sample. Adding the ISI score as a predictor for CA3/dentate volume to a hierarchical linear regression model after first controlling for age and PTSD symptoms accounted for a 13% increase in incremental variance (t = -2.47, p = .02). CONCLUSIONS The findings indicate for the first time in humans that insomnia severity is associated with volume loss of the CA3/dentate subfields. This is consistent with animal studies showing that chronic sleep disruption is associated with decreased neurogenesis and dendritic branching in these structures.
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Affiliation(s)
- Thomas C. Neylan
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Susanne G. Mueller
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Zhen Wang
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA,Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Thomas J. Metzler
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Maryann Lenoci
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA
| | - Diana Truran
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA
| | - Charles R. Marmar
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Norbert Schuff
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
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89
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Schuff N, Zhang Y, Zhan W, Lenoci M, Ching C, Boreta L, Mueller SG, Wang Z, Marmar CR, Weiner MW, Neylan TC. Patterns of altered cortical perfusion and diminished subcortical integrity in posttraumatic stress disorder: an MRI study. Neuroimage 2010; 54 Suppl 1:S62-8. [PMID: 20483375 DOI: 10.1016/j.neuroimage.2010.05.024] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 05/02/2010] [Accepted: 05/11/2010] [Indexed: 11/26/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) accounts for a substantial proportion of casualties among surviving soldiers of the Iraq and Afghanistan wars. Currently, the assessment of PTSD is based exclusively on symptoms, making it difficult to obtain an accurate diagnosis. This study aimed to find potential imaging markers for PTSD using structural, perfusion, and diffusion magnetic resonance imaging (MRI) together. Seventeen male veterans with PTSD (45 ± 14 years old) and 15 age-matched male veterans without PTSD had measurements of regional cerebral blood flow (rCBF) using arterial spin labeling (ASL) perfusion MRI. A slightly larger group had also measurements of white matter integrity using diffusion tensor imaging (DTI) with computations of regional fractional anisotropy (FA). The same subjects also had structural MRI of the hippocampal subfields as reported recently (W. Zhen et al. Arch Gen Psych 2010;67(3):296-303). On ASL-MRI, subjects with PTSD had increased rCBF in primarily right parietal and superior temporal cortices. On DTI, subjects with PTSD had FA reduction in white matter regions of the prefrontal lobe, including areas near the anterior cingulate cortex and prefrontal cortex as well as in the posterior angular gyrus. In conclusion, PTSD is associated with a systematic pattern of physiological and structural abnormalities in predominantly frontal lobe and limbic brain regions. Structural, perfusion, and diffusion MRI together may provide a signature for a PTSD marker.
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Affiliation(s)
- Norbert Schuff
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center San Francisco, CA 94121, USA.
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90
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Wang Z, Neylan TC, Mueller SG, Lenoci M, Truran D, Marmar CR, Weiner MW, Schuff N. Magnetic resonance imaging of hippocampal subfields in posttraumatic stress disorder. ACTA ACUST UNITED AC 2010; 67:296-303. [PMID: 20194830 DOI: 10.1001/archgenpsychiatry.2009.205] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Most neuroimaging studies of posttraumatic stress disorder (PTSD) have focused on potential abnormalities in the whole hippocampus, but the subfields of this structure, which have distinctive histological characteristics and specialized functions, have not been investigated. Studies of individual subfields may clarify the role of the hippocampus in PTSD. OBJECTIVE To determine if PTSD is associated with structural alterations in specific subfields of the hippocampus. DESIGN Case-control study. PARTICIPANTS A total of 17 male veterans with combat trauma and PTSD (mean [SD] age, 41 [12] years) and 19 age-matched male veterans without PTSD who were recruited from the outpatient mental health clinic of the San Francisco Veterans Affairs Medical Center and by advertising in the community. INTERVENTIONS High-resolution magnetic resonance imaging at 4 T. MAIN OUTCOME MEASURE Volumes of hippocampal subfields. RESULTS Posttraumatic stress disorder was associated with 11.4% (1.5%) (P = .02) smaller mean (SD) cornu ammonis 3 (CA3)/dentate gyrus subfield volumes, irrespective of age-related alterations, whereas other subfields were spared. Age was associated with reduced volume of the CA1 subfield (P = .03). Total hippocampal volume was also reduced in PTSD by a mean (SD) of 6.5% (0.6%) but, related to both PTSD (P = .05) and age (P = .01), was consistent with the measurements in the subfields. CONCLUSIONS The findings indicate for the first time in humans that PTSD is associated with selective volume loss of the CA3/dentate gyrus subfields, consistent with animal studies, implying that chronic stress suppresses neurogenesis and dendritic branching in these structures.
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Affiliation(s)
- Zhen Wang
- Shanghai Mental Heath Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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91
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Wang Z, Inslicht SS, Metzler TJ, Henn-Haase C, McCaslin SE, Tong H, Neylan TC, Marmar CR. A prospective study of predictors of depression symptoms in police. Psychiatry Res 2010; 175:211-6. [PMID: 20044144 PMCID: PMC3974967 DOI: 10.1016/j.psychres.2008.11.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/31/2008] [Accepted: 11/19/2008] [Indexed: 11/29/2022]
Abstract
Police work is one of the most stressful occupations. Previous research has indicated that work stress and trauma exposure may place individuals at heightened risk for the development of depression symptomatology. This prospective longitudinal study was designed to examine predictors of depression symptoms in police service. Participants comprised 119 healthy police recruits from an ongoing prospective study. They completed baseline measures of depression symptoms, childhood trauma exposure, neuroticism, and self-worth during academy training. Follow-up measures of depression symptoms, PTSD symptoms, critical incident exposure, negative life events, and routine work environment stress were assessed after 12 months of police service. Hierarchical linear regression analysis was conducted to examine predictors of current levels of depression symptoms, controlling for baseline depression symptoms and current PTSD symptoms. Greater childhood trauma exposure, lower self-worth during training, and greater perceived work stress in the first year of police service predicted greater depression symptoms at 12 months. Depression symptoms at 1 year of police service were partly independent from PTSD symptoms at 12 months. Greater childhood trauma exposure and lower self-worth during training may be important variables to screen as risk factors for duty-related depression. Strategies to reduce routine work environment stress have the potential to decrease duty-related depression in law enforcement.
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Affiliation(s)
- Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghei, China.
| | - Sabra S. Inslicht
- San Francisco VA Medical Center,University of California, San Francisco
| | - Thomas J. Metzler
- San Francisco VA Medical Center,University of California, San Francisco
| | - Clare Henn-Haase
- San Francisco VA Medical Center,University of California, San Francisco
| | | | | | - Thomas C. Neylan
- San Francisco VA Medical Center,University of California, San Francisco
| | - Charles R. Marmar
- San Francisco VA Medical Center,University of California, San Francisco
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92
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Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, Bertenthal D, Marmar CR. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress 2010; 23:5-16. [PMID: 20146392 DOI: 10.1002/jts.20493] [Citation(s) in RCA: 224] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Little is known about mental health services utilization among Iraq and Afghanistan veterans receiving care at Department of Veterans Affairs (VA) facilities. Of 49,425 veterans with newly diagnosed posttraumatic stress disorder (PTSD), only 9.5% attended 9 or more VA mental health sessions in 15 weeks or less in the first year of diagnosis. In addition, engagement in 9 or more VA treatment sessions for PTSD within 15 weeks varied by predisposing variables (age and gender), enabling variables (clinic of first mental health diagnosis and distance from VA facility), and need (type and complexity of mental health diagnoses). Thus, only a minority of Iraq and Afghanistan veterans with new PTSD diagnoses received a recommended number and intensity of VA mental health treatment sessions within the first year of diagnosis.
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Affiliation(s)
- Karen H Seal
- Health Services Research and Development Research Enhancement Award Program, San Francisco VA Medical Center and the Department of Medicine, University of California, San Francisco, CA 94121, USA.
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93
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Maguen S, Lucenko BA, Reger MA, Gahm GA, Litz BT, Seal KH, Knight SJ, Marmar CR. The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. J Trauma Stress 2010; 23:86-90. [PMID: 20104592 DOI: 10.1002/jts.20434] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study examined the mental health impact of reported direct and indirect killing among 2,797 U.S. soldiers returning from Operation Iraqi Freedom. Data were collected as part of a postdeployment screening program at a large Army medical facility. Overall, 40% of soldiers reported killing or being responsible for killing during their deployment. Even after controlling for combat exposure, killing was a significant predictor of posttraumatic disorder (PTSD) symptoms, alcohol abuse, anger, and relationship problems. Military personnel returning from modern deployments are at risk of adverse mental health conditions and related psychosocial functioning related to killing in war. Mental health assessment and treatment should address reactions to killing to optimize readjustment following deployment.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center and University of California-San Francisco, San Francisco, CA 94121, USA.
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94
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Inslicht SS, McCaslin SE, Metzler TJ, Henn-Haase C, Hart SL, Maguen S, Neylan TC, Marmar CR. Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: a prospective study of police. J Psychiatr Res 2010; 44:22-31. [PMID: 19683259 PMCID: PMC2818084 DOI: 10.1016/j.jpsychires.2009.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/26/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies. METHOD Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms. RESULTS A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officer's self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress. CONCLUSION These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.
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95
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Cohen BE, Marmar CR, Neylan TC, Schiller NB, Ali S, Whooley MA. Posttraumatic stress disorder and health-related quality of life in patients with coronary heart disease: findings from the Heart and Soul Study. ACTA ACUST UNITED AC 2009; 66:1214-20. [PMID: 19884609 DOI: 10.1001/archgenpsychiatry.2009.149] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Posttraumatic stress disorder (PTSD) is increasingly recognized as a cause of substantial disability. In addition to its tremendous mental health burden, PTSD has been associated with worse physical health status and an increased risk of cardiovascular disease. OBJECTIVE To determine whether PTSD is associated with cardiovascular health status in patients with heart disease and whether this association is independent of cardiac function. DESIGN Cross-sectional study. SETTING The Heart and Soul Study, a prospective cohort study of psychological factors and health outcomes in adults with stable cardiovascular disease. PARTICIPANTS One thousand twenty-two men and women with coronary heart disease. MAIN OUTCOME MEASURES Posttraumatic stress disorder was assessed using the Computerized Diagnostic Interview Schedule for DSM-IV. Cardiac function was measured using left ventricular ejection fraction, treadmill exercise capacity, and inducible ischemia on stress echocardiography. Disease-specific health status was assessed using the symptom burden, physical limitation, and quality of life subscales of the Seattle Angina Questionnaire. We used ordinal logistic regression to evaluate the association of PTSD with health status, adjusted for objective measures of cardiac function. RESULTS Of the 1022 participants, 95 (9%) had current PTSD. Participants with current PTSD were more likely to report at least mild symptom burden (57% vs 36%), mild physical limitation (59% vs 44%), and mildly diminished quality of life (62% vs 35%) (all P < or = .001). When adjusted for cardiovascular risk factors and objective measures of cardiac function, PTSD remained independently associated with greater symptom burden (odds ratio, 1.9; 95% confidence interval, 1.2-2.9; P = .004); greater physical limitation (odds ratio, 2.2; 95% confidence interval, 1.4-3.6; P = .001); and worse quality of life (odds ratio, 2.5; 95% confidence interval, 1.6-3.9; P < .001). Results were similar after excluding participants with depression. CONCLUSIONS Among patients with heart disease, PTSD is more strongly associated with patient-reported cardiovascular health status than objective measures of cardiac function. Future studies should explore whether assessing and treating PTSD symptoms can improve function and quality of life in patients with heart disease.
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Affiliation(s)
- Beth E Cohen
- Department of Veterans Affairs Medical Center, General Internal Medicine, University of California, San Francisco, CA 94121, USA.
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96
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Abstract
Hundreds of thousands of Darfur people affected by the Sudanese genocide have fled to Cairo, Egypt, in search of assistance. Collaborating with Africa and Middle East Refugee Assistance (AMERA), the authors conducted a mental health care needs assessment among Darfur refugees in Cairo. Information was collected using individual and focus group interviews to identify gaps in mental health care and develop understandings of emotional and relationship problems. The refugee mental health care system has a piecemeal structure with gaps in outpatient services. There is moderate to severe emotional distress among many Darfur refugees, including symptoms of depression and trauma, and interpersonal conflict, both domestic violence and broader community conflict, elevated relative to pregenocide levels. Given the established relationships between symptoms of depression/traumatic stress and interpersonal violence, improving mental health is important for both preventing mental health decompensation and stemming future cycles of intra- and intergroup conflict.
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Affiliation(s)
- Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143, USA.
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Abstract
This study examined the mental health and functional consequences associated with killing combatants and noncombatants. Using the National Vietnam Veterans Readjustment Study (NVVRS) survey data, the authors reported the percentage of male Vietnam theater veterans (N = 1200) who killed an enemy combatant, civilian, and/or prisoner of war. They next examined the relationship between killing in war and a number of mental health and functional outcomes using the clinical interview subsample of the NVVRS (n = 259). Controlling for demographic variables and exposure to general combat experiences, the authors found that killing was associated with posttraumatic stress disorder symptoms, dissociation, functional impairment, and violent behaviors. Experiences of killing in war are important to address in the evaluation and treatment of veterans.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, and Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
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98
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Affiliation(s)
- Charles R Marmar
- University of California-San Francisco, CA, USA. charles.marmar.ucsf.edu
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99
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McCaslin SE, de Zoysa P, Butler LD, Hart S, Marmar CR, Metzler TJ, Koopman C. The relationship of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms among Sri Lankan university students. J Trauma Stress 2009; 22:334-9. [PMID: 19588514 DOI: 10.1002/jts.20426] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relationships of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms were examined in 93 Sri Lankan university students who had experienced a traumatic life event. Posttraumatic growth was associated with peritraumatic dissociation and posttraumatic stress symptoms, but was not associated with peritraumatic emotional distress. Results indicated a curvilinear relationship between peritraumatic dissociation and posttraumatic growth and between posttraumatic stress symptoms and posttraumatic growth. In a regression model predicting posttraumatic growth scores, each of the quadratic relationships of peritraumatic dissociation and posttraumatic stress symptoms to posttraumatic growth were statistically significant, and combined accounted for 22% of the variance. Results suggest that moderate levels of peritraumatic dissociation and symptoms are most associated with the greatest levels of growth.
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Affiliation(s)
- Shannon E McCaslin
- San Francisco Veterans Administration Medical Center, Mental Health Service, San Francisco, CA 94121, USA.
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100
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Boyd JE, Kanas NA, Salnitskiy VP, Gushin VI, Saylor SA, Weiss DS, Marmar CR. Cultural differences in crewmembers and mission control personnel during two space station programs. ACTA ACUST UNITED AC 2009; 80:532-40. [PMID: 19522363 DOI: 10.3357/asem.2430.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cultural differences among crewmembers and mission control personnel can affect long-duration space missions. We examine three cultural contrasts: national (American vs. Russian); occupational (crewmembers vs. mission control personnel); and organizational [Mir space station vs. International Space Station (ISS)]. METHODS The Mir sample included 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel. The ISS sample included 8 astronauts, 9 cosmonauts, and 108 American and 20 Russian mission control personnel. Subjects responded to mood and group climate questions on a weekly basis. The ISS sample also completed a culture and language questionnaire. RESULTS Crewmembers had higher scores on cultural sophistication than mission control personnel, especially American mission control. Cultural sophistication was not related to mood or social climate. Russian subjects reported greater language flexibility than Americans. Crewmembers reported better mood states than mission control, but both were in the healthy range. There were several Russian-American differences in social climate, with the most robust being higher work pressure among Americans. Russian-American social climate differences were also found in analyses of crew only. Analyses showed Mir-ISS differences in social climate among crew but not in the full sample. DISCUSSION We found evidence for national, occupational, and organizational cultural differences. The findings from the Mir space station were essentially replicated on the ISS. Alterations to the ISS to make it a more user-friendly environment have still not resolved the issue of high levels of work pressure among the American crew.
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Affiliation(s)
- Jennifer E Boyd
- Department of Psychiatry, University of California, San Francisco, San Francisco VAMC (116A), 4150 Clement Street, San Francisco, CA 94121-1545, USA.
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