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Patel H, Holshausen K, Oshri A, Andrews K, Penta S, Raymond H, McKinnon M, Brasch J, MacKillop J, Amlung M. Posttraumatic Stress Disorder Symptomatology and Substance Use in an Outpatient Concurrent Disorders Sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:788-797. [PMID: 33878938 PMCID: PMC8504290 DOI: 10.1177/07067437211011851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) present a complex and often severe clinical presentation within a concurrent disorders context. The objective of this study was to examine associations between PTSD symptoms and SUD outcomes to better understand the clinical phenomenon of comorbid PTSD and SUD. Multivariate statistical methods were used to test the hypothesis that elevated PTSD symptoms, both at the level of global severity and specific PTSD symptom clusters, are associated with greater substance use and related problems. METHODS Data were collected from an intake assessment battery within a specialized concurrent disorders outpatient service in Hamilton, ON. The sample comprised 326 participants (mean age = 37.19, 45.4% female). Structural equation models examined associations between PTSD and alcohol, cannabis, and substance use frequency and problems, controlling for age and sex. Alcohol was ultimately dropped from the model due to non-significant bivariate associations. RESULTS Higher global PTSD symptomatology was significantly associated with higher cannabis and other substance use frequency and related problems. Analyses using PTSD cluster scores showed higher scores for alterations in arousal were positively associated with cannabis-related problems, drug-related problems, and cannabis and other substance use frequency. Avoidance was significantly associated with cannabis frequency and cannabis-related problems. In general, effect sizes were small in magnitude, accounting for between 9% and 25% of variance. CONCLUSION Significant cluster-level associations indicate the importance of specific PTSD symptoms (hyperarousal, avoidance) in relation to substance use when identifying therapeutic targets among individuals presenting with comorbid PTSD-SUD. This multivariate approach provides a higher resolution and potentially more clinically informative representation of the complex clinical presentation of PTSD and SUD in a concurrent disorder population and could guide the development of more effective treatment paths.
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Affiliation(s)
- Herry Patel
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Katherine Holshausen
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | - Krysta Andrews
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Penta
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Holly Raymond
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Margaret McKinnon
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Jennifer Brasch
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mental Health and Addictions Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph’s Healthcare Hamilton, Ontario, Canada
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
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Kim JI, Park H, Min B, Oh S, Lee JH, Kim JH. The mediation effect of depression and alcohol use disorders on the association between post-traumatic stress disorder and obstructive sleep apnea risk in 51,149 Korean firefighters: PTSD and OSA in Korean firefighters. J Affect Disord 2021; 292:189-196. [PMID: 34126310 DOI: 10.1016/j.jad.2021.05.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/19/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is shown to be linked to a higher risk of obstructive sleep apnea (OSA). Firefighters are at high risk for PTSD given the increased exposure to trauma. However, the relationship between PTSD and OSA remains unclear in firefighters. Moreover, alcohol use disorders (AUDs) and depression - also common in firefighters - show a high comorbidity rate with both PTSD and OSA. The purpose of this study was to investigate the association of PTSD, depression, and AUDs with OSA in a national sample of Korean firefighters. METHODS A total of 51,149 Korean firefighters completed self-reported questionnaires, assessing the severity of PTSD, OSA, depression, and alcohol misuse. Multivariable logistic regression and mediation analyses were performed. RESULTS PTSD, depression, and AUDs were significantly associated with OSA. In the mediation analyses, PTSD had both direct and indirect effects mediated by depression and AUDs on OSA. Depression had both direct and indirect effects on OSA, with the latter mediated by AUDs. LIMITATIONS First, high-risk of OSA was measured using the Berlin Questionnaire. Second, other medical comorbidities or mediation use were not considered. Third, self-report questionnaires were used for assessment, which are prone to subjectivity and recollection bias. Finally, the majority of the study population were male and all Korean, limiting generalizability. CONCLUSIONS PTSD had both direct and indirect effects on OSA, mediated by depression and AUDs. In patients with both PTSD and OSA, depression and AUD symptoms should be screened routinely.
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Affiliation(s)
- Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Heyeon Park
- Division of General Studies & Teaching Profession, Dongduk Women's University, 60, Hwarang-ro 13-gil, Seongbuk-gu, Seoul 02748, Republic of Korea
| | - Beomjun Min
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 5 gil, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Ji-Hye Lee
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Psychiatry, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
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53
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Hill ML, Loflin M, Nichter B, Norman SB, Pietrzak RH. Prevalence of cannabis use, disorder, and medical card possession in U.S. military veterans: Results from the 2019-2020 National Health and Resilience in Veterans Study. Addict Behav 2021; 120:106963. [PMID: 33964583 DOI: 10.1016/j.addbeh.2021.106963] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
More than half of U.S. states legalized medical or recreational sale and possession of cannabis since the prevalence of cannabis use was last estimated among U.S. military veterans in 2014. To provide updated estimates of the prevalence and correlates of cannabis use, cannabis use disorder (CUD), and medical cannabis card possession in this population, data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of 4,069 veterans ages 22-99 years who reported on their past-6-month cannabis use, CUD symptoms, and possession of a medical cannabis card. An estimated 11.9% [95% confidence interval (CI) = 10.9-12.9%)] of veterans reported using cannabis, 2.7% (95% CI = 2.3-3.3%) screened positive for CUD, and 1.5% (95% CI = 1.2-2.0%) reported possessing a medical card. Prevalence of cannabis use, CUD, and card possession were higher among younger veterans (use: 20.2%, CUD: 5.6%, card: 2.1%) and those with psychiatric conditions (use: 24.0%-30.0%, CUD: 8.9%-13.0%, card: 3.1%-4.0%). Younger age, alcohol use disorder, and childhood adversity explained a large proportion of variance in cannabis use and CUD, and depression was independently associated with CUD (odds ratio [OR] = 2.76). Physical disability (OR = 3.59), combat veteran status (OR = 2.84), and non-Hispanic black (OR = 0.23) relative to white race/ethnicity most strongly predicted using cannabis with a medical card. The estimated prevalence of cannabis use in veterans-nearly 12%-is higher than the most recently reported estimate (9% in 2014). Veteran cannabis use may be increasing and is particularly prevalent among veterans with psychiatric conditions.
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The hidden burden of social anxiety disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Affect Disord 2021; 291:9-14. [PMID: 34022553 DOI: 10.1016/j.jad.2021.04.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/08/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a chronic and disabling psychiatric disorder associated with low levels of help-seeking. To date, however, scarce research has examined the epidemiology of SAD in veterans. This study examined the prevalence, comorbidities and incremental burden of SAD in relation to suicidality and functioning in a representative sample of U.S. military veterans. METHODS A nationally representative sample of 3,157 U.S. veterans completed a web survey containing measures of SAD symptoms, trauma history, psychiatric history and functioning. Multivariable analyses were conducted to examine associations between SAD and psychiatric comorbidities, suicidality and functioning. RESULTS A total 9.5% (n = 272) of the sample screened positive for lifetime SAD. Veterans with SAD were more likely than those without SAD to be younger, female, single, racial/ethnic minorities and to have experienced childhood abuse. They also had substantially elevated rates of comorbid psychiatric disorders, particularly lifetime major depression (odds ratio [OR]=5.8) and posttraumatic stress disorder (OR=3.1), as well as current suicidal ideation (OR=3.3). Veterans with SAD scored lower on measures of functioning, particularly social, emotional and mental health functioning (d's=0.21-0.34). LIMITATIONS Data were collected cross-sectionally using self-report. CONCLUSIONS SAD in U.S. veterans is prevalent and associated with psychiatric comorbidities, functional impairment and a more than 3-fold greater risk for suicidal ideation . Given that SAD is associated with low treatment seeking and engagement, it may be undetected and undertreated relative to other psychiatric morbidities. These results underscore the importance of screening, monitoring and treating SAD in this population along with other prevalent mental disorders.
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Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
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Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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56
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Hilliard W, Gerardi MB, Jimenez RR. Options for Veterans Experiencing Sleep Impairment. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cassiello-Robbins C, Dillon KH, Blalock D, Calhoun PS, Beckham JC, Kimbrel NA. Exploring the role of anger in nonsuicidal self-injury in veterans. J Psychiatr Res 2021; 137:55-65. [PMID: 33652327 PMCID: PMC8830234 DOI: 10.1016/j.jpsychires.2021.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
Up to 14% of veterans engage in nonsuicidal self-injury (NSSI) in their lifetime and this behavior is a relatively strong predictor of suicidal behavior compared to other identified risk factors. Further, NSSI is a clinically relevant behavior in its own right; it is associated with more severe psychopathology as well as bodily harm that sometimes requires medical intervention. Therefore, a better understanding of NSSI may help inform suicide prevention efforts as well as mental healthcare strategies for veterans. Anger may be relevant to understanding NSSI in veterans. Over 60% of veterans report difficulties managing anger and this emotion is strongly associated with engagement in NSSI. However, no research has explored the extent to which anger is present prior to NSSI or whether anger is associated with specific NSSI methods or functions in veterans. The purpose of this study was to explore whether anger was associated with engagement in specific NSSI methods, and whether anger uniquely predicted any functions of NSSI while controlling for the presence of other basic negative emotions (fear and sadness). An existing dataset of 61 veterans who reported engaging in NSSI in the past year was analyzed. Results indicated anger was the most common emotional antecedent to NSSI. Further, anger was associated with several methods of NSSI including burning oneself with a cigarette, carving pictures, designs or other marks into skin, sticking sharp objects into skin, severely scratching oneself, head banging, punching oneself, and punching walls or objects. Finally, when controlling for the presence of other negative emotions, anger was associated with engaging in NSSI to relieve tension, stop feeling numb, communicate with others, feel alive, get help from others, and prove to oneself how bad things are. These results highlight the importance of assessing and treating dysregulated anger in veterans who engage in self-harming behavior.
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Affiliation(s)
- Clair Cassiello-Robbins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Kirsten H. Dillon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States,Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Daniel Blalock
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Patrick S. Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States,Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Jean C. Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States,Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Nathan A. Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States,Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
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Panza KE, Kline AC, Norman GJ, Pitts M, Norman SB. Subgroups of comorbid PTSD and AUD in U.S. military veterans predict differential responsiveness to two integrated treatments: A latent class analysis. J Psychiatr Res 2021; 137:342-350. [PMID: 33756376 DOI: 10.1016/j.jpsychires.2021.02.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. Integrated treatments are effective, but not all patients respond and predicting outcome remains difficult. In this study, latent class analysis (LCA) identified symptom-based subgroups of comorbid PTSD/AUD among 119 veterans with PTSD/AUD from a randomized controlled trial of integrated exposure therapy (I-PE) versus integrated coping skills therapy (I-CS). Multilevel models compared subgroups on PTSD severity and percentage of heavy drinking days at post-treatment and 3- and 6-month follow-up. LCA revealed three subgroups best fit the data: Moderate PTSD/Low AUD Impairment (21%), High PTSD/High AUD Impairment (48%), and Low PTSD/High AUD Impairment (31%). There was a three-way interaction between time, treatment condition, and subgroup in predicting PTSD outcomes (p < .05). For the Moderate PTSD/Low AUD Impairment class, outcomes at post-treatment and 3-months were similar (ds = 0.17, 0.55), however I-PE showed greater reductions at 6-months (d = 1.36). For the High PTSD/High AUD Impairment class, I-PE demonstrated better post-treatment (d = 0.83) but comparable follow-up (ds = -0.18, 0.49) outcomes. For the Low PTSD/High AUD Impairment class, I-PE demonstrated stronger outcomes at every timepoint (ds = 0.82-1.15). Heavy drinking days declined significantly through follow-up, with an effect of subgroup, but not treatment, on timing of response. This was the first study modeling how PTSD and AUD symptoms might cluster together in a treatment sample of veterans with PTSD/AUD. Symptom-based subgroups show promise in helping understand variability in treatment response among patients with PTSD/AUD and deserve further study.
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Affiliation(s)
- Kaitlyn E Panza
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Alexander C Kline
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Gregory J Norman
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Michelle Pitts
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Drive, White River Junction, VT, 05009, USA
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Alcohol to down-regulate negative and positive emotions: Extending our understanding of the functional role of alcohol in relation to posttraumatic stress disorder. Addict Behav 2021; 115:106777. [PMID: 33359633 DOI: 10.1016/j.addbeh.2020.106777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Functional models of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) underscore the role of internally-driven negative reinforcement. However, with the focus of these models being on negative emotions broadly, there is limited understanding of the effect of alcohol use to down-regulate specific forms of negative emotions or positive emotions generally. Among populations characterized by PTSD, there is growing evidence that positive emotions may elicit aversive reactions and thus be intentionally reduced, including via alcohol use. OBJECTIVE The current study examined the associations among PTSD symptom severity, alcohol use to down-regulate both negative (i.e., despondency and anger) and positive emotions, and alcohol misuse. METHOD Data were collected from 320 trauma-exposed, substance-using individuals in the community (M age = 35.78, 46.9% women). RESULTS Individuals with greater PTSD symptom severity reported significantly higher alcohol use to down-regulate despondency, anger, and positive emotions, which, in turn, were linked to greater alcohol misuse. CONCLUSIONS Alcohol use may serve to down-regulate both negative (i.e., despondency and anger) and positive emotions, and these functions may help to explain the association of PTSD symptom severity to alcohol misuse. PTSD-AUD models may benefit from specifying a negatively reinforcing function of alcohol use in the context of positive emotions.
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60
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Blakey SM, Tsai J, Elbogen EB. Drinking to Cope with Posttraumatic Stress: A Nationally Representative Study of Men with and without Military Combat Experience. J Dual Diagn 2021; 17:101-112. [PMID: 33730991 DOI: 10.1080/15504263.2021.1891360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Posttraumatic stress disorder (PTSD) and hazardous alcohol use are prevalent among trauma survivors. Despite higher rates of both PTSD and hazardous alcohol use among military combat veterans than civilians, scant research has examined whether military combat experience is associated with drinking alcohol to cope with PTSD symptoms. This study tested the hypothesis that compared to trauma-exposed men without combat experience, men with military combat experience would be more likely to endorse drinking alcohol to cope with their PTSD symptoms. Methods: Interview data from N = 11,474 men who reported at least one lifetime traumatic experience were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face interview study that recruited a nationally representative sample of adults living in the United States between 2004 and 2005. Results: Among men endorsing lifetime trauma exposure, men with military combat experience (n = 1,386) were more likely than men without combat experience (n = 10,088) to report drinking alcohol to cope (7.22 vs. 2.61% in unweighted analyses, 6.46 vs. 2.37% in weighted analyses). Total number of lifetime trauma types, lifetime PTSD severity, and lifetime alcohol abuse/dependence were significantly associated with drinking to cope in bivariate and multivariate analyses. Military combat experience was significantly associated with drinking to cope in multivariate analyses adjusting for lifetime PTSD diagnosis. Military combat experience was not significantly associated with drinking to cope in multivariate analyses adjusting for lifetime PTSD symptom count. Conclusions: Although military combat experience was significantly associated with drinking to cope in bivariate analyses, multivariate analyses yielded mixed findings: combat experience was significantly associated with drinking to cope in models adjusting for PTSD diagnosis, but not in models adjusting for PTSD symptom count. Findings highlight the importance of assessing and targeting PTSD symptom-related alcohol use, even in the absence of alcohol abuse/dependence. Results from this preliminary study could inform future research on drinking to cope with PTSD symptoms among military combat veterans and other trauma survivors.
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Affiliation(s)
- Shannon M Blakey
- Durham VA Health Care System, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA.,VA National Center on Homelessness Among Veterans, Tampa, Florida, USA
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA.,VA National Center on Homelessness Among Veterans, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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61
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Marshall LL, Hayslett RL. Post-traumatic Stress Disorder in Middle Age and Beyond. Sr Care Pharm 2021; 36:191-207. [PMID: 33766192 DOI: 10.4140/tcp.n.2021.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review the clinical manifestations and treatment of post-traumatic stress disorder (PTSD) in adults and older people. DATA SOURCES Articles indexed in PubMed, Embase, psychology databases, and the Cochrane library over the past 10 years using the key words "post-traumatic stress disorder," "stress disorders," and "post-traumatic stress disorder and treatment." STUDY SELECTION AND DATA EXTRACTION Sixty-seven publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS The literature included practice guidelines; review articles; original research articles; and product prescribing information for the clinical manifestations, diagnosis, and treatment of PTSD. CONCLUSION Psychotherapy is the first-line therapy for PTSD. Pharmacologic therapy is recommended, as second-line therapy, for adults living with PTSD who do not have access to psychotherapy or refuse psychotherapy. Pharmacologic therapy may also be considered in cases of partial, or no, response to psychotherapy. Current guidelines recommend prescribing one of 3 selective serotonin-reuptake inhibitors, either fluoxetine, paroxetine, or sertraline, or prescribing the serotonin norepinephrine reuptake inhibitor venlafaxine, for adult patients who do not have access to psychotherapy or prefer not to use psychotherapy. Unfortunately, these recommended medications have additional cautions for use in older people so may not be appropriate for many older people living with PTSD. Therapy for older people should be tailored to patient-specific symptoms, with careful consideration of the potential benefits and risks of the therapy and coexisting medical conditions of each patient.
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Affiliation(s)
- Leisa L Marshall
- 1Mercer University College of Pharmacy, Mercer Health Sciences Center, Atlanta, Georgia
| | - Renée L Hayslett
- 1Mercer University College of Pharmacy, Mercer Health Sciences Center, Atlanta, Georgia
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62
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Asch RH, Esterlis I, Southwick SM, Pietrzak RH. Risk and resilience factors associated with traumatic loss-related PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Psychiatry Res 2021; 298:113775. [PMID: 33578060 DOI: 10.1016/j.psychres.2021.113775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sudden death of a loved one is the most prevalent potentially traumatic event worldwide, yet little is known about risk and resilience factors associated with traumatic loss-related posttraumatic stress disorder (PTSD). METHODS Data from a nationally representative sample of U.S. military veterans were analyzed to identify sociodemographic, military, health and psychosocial correlates of traumatic loss-related PTSD. RESULTS Loneliness, somatic symptoms, and attachment style were the strongest correlates of PTSD symptom severity and positive screens for traumatic loss-related PTSD. CONCLUSION Loneliness, somatic symptoms, and attachment style may represent therapeutic targets to help mitigate traumatic loss-related PTSD in U.S. veterans.
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Affiliation(s)
- Ruth H Asch
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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63
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Kline AC, Panza KE, Harlé KM, Angkaw AC, Trim RS, Back SE, Norman SB. Within-treatment clinical markers of dropout risk in integrated treatments for comorbid PTSD and alcohol use disorder. Drug Alcohol Depend 2021; 221:108592. [PMID: 33618193 DOI: 10.1016/j.drugalcdep.2021.108592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integrated interventions for comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are effective, but many patients prematurely drop out from treatment. Little is known about within-treatment risk factors for dropout, limiting the ability during therapy to identify patients at risk for attrition. METHODS We examined measures assessing PTSD (PTSD Checklist for DSM-5; PCL-5), alcohol use (Substance Use Inventory; SUI), and patient satisfaction (Client Satisfaction Questionnaire; CSQ-8) as potential within-treatment markers of dropout risk, administered to 110 veterans in a randomized clinical trial of integrated exposure therapy versus integrated coping skills therapy for comorbid PTSD + AUD. Hierarchical Cox proportional hazard models with dropout status as the endpoint assessed effects of PCL-5, SUI, and CSQ-8 on dropout risk, and whether effects differed by treatment modality. RESULTS A significant interaction between treatment and changes in alcohol use was observed (HR = 2.86, p = .007), where between-session alcohol use was positively associated with dropout hazard rate for those receiving integrated exposure therapy (HR = 2.34, p = .004), but not coping skills therapy (HR = 0.73, p = .19). Specifically, an increase of one drink consumed per day in the interval since last assessment (typically 2-3 weeks) was associated with a 5-fold increase in dropout hazard rate. CONCLUSIONS The findings provide preliminary evidence of detectable within-treatment markers of dropout during integrated treatment for PTSD + AUD. Study of within-treatment indicators proximal to dropout may help identify at-risk patients and inform timely strategies to boost retention.
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Affiliation(s)
- Alexander C Kline
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Kaitlyn E Panza
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Katia M Harlé
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Abigail C Angkaw
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Dr, White River Junction, VT, 05009, USA
| | - Ryan S Trim
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA; Ralph H. Johnson Veteran Affairs Medical Center, 109 Bee St, Charleston, SC, 29401, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Dr, White River Junction, VT, 05009, USA
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64
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Taylor S, Paluszek MM, Rachor GS, McKay D, Asmundson GJ. Substance use and abuse, COVID-19-related distress, and disregard for social distancing: A network analysis. Addict Behav 2021; 114:106754. [PMID: 33310690 PMCID: PMC8164919 DOI: 10.1016/j.addbeh.2020.106754] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/14/2023]
Abstract
Research shows that there has been a substantial increase in substance use and abuse during the COVID-19 pandemic, and that substance use/abuse is a commonly reported way of coping with anxiety concerning COVID-19. Anxiety about COVID-19 is more than simply worry about infection. Research provides evidence of a COVID Stress Syndrome characterized by (1) worry about the dangers of COVID-19 and worry about coming into contact with coronavirus contaminated objects or surfaces, (2) worry about the personal socioeconomic impact of COVID-19, (3) xenophobic worries that foreigners are spreading COVID-19, (4) COVID-19-related traumatic stress symptoms (e.g., nightmares), and (5) COVID-19-related compulsive checking and reassurance-seeking. These form a network of interrelated nodes. Research also provides evidence of another constellation or "syndrome", characterized by (1) belief that one has robust physical health against COVID-19, (2) belief that the threat of COVID-19 has been exaggerated, and (3) disregard for social distancing. These also form a network of nodes known as a COVID-19 Disregard Syndrome. The present study, based on a population-representative sample of 3075 American and Canadian adults, sought to investigate how these syndromes are related to substance use and abuse. We found substantial COVID-19-related increases in alcohol and drug use. Network analyses indicated that although the two syndromes are negatively correlated with one another, they both have positive links to alcohol and drug abuse. More specifically, COVID-19-related traumatic stress symptoms and the tendency to disregard social distancing were both linked to substance abuse. Clinical and public health implications are discussed.
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65
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Sommer JL, Reynolds K, El-Gabalawy R, Pietrzak RH, Mackenzie CS, Ceccarelli L, Mota N, Sareen J. Associations between physical health conditions and posttraumatic stress disorder according to age. Aging Ment Health 2021; 25:234-242. [PMID: 31769298 DOI: 10.1080/13607863.2019.1693969] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories. METHODS We analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed past-year DSM-5 PTSD. Multiple regression analyses examined associations between PTSD (reference = no PTSD) with number and type of physical health conditions in each age category (18-34: "younger adults," 35-49: "middle-aged adults," 50-64: "young-old adults," 65+: "older adults"). RESULTS The prevalence of nearly all physical health conditions increased according to age, whereas the prevalence of PTSD tended to decrease with age. After adjustment, PTSD was associated with a greater number of physical health conditions among all age categories (b range: 0.62-1.29). Regardless of age category, PTSD was associated with increased odds of cardiovascular and musculoskeletal conditions (AOR range: 1.54-2.34). PTSD was also associated with increased odds of gastrointestinal, hepatobiliary, endocrine/metabolic, respiratory, neurologic conditions, cancer, sleep disorders, and anemia among select age categories (AOR range: 1.70-3.31). For most physical health conditions, the largest effect sizes emerged for younger and middle-aged adults. CONCLUSIONS PTSD is associated with many physical health conditions across the age spectrum, particularly among younger and middle-aged adults. Results may inform targeted screening and intervention strategies to mitigate risk of physical health conditions among adults with PTSD.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,U.S. Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Laura Ceccarelli
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
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66
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Bovin MJ, Kimerling R, Weathers FW, Prins A, Marx BP, Post EP, Schnurr PP. Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans. JAMA Netw Open 2021; 4:e2036733. [PMID: 33538826 PMCID: PMC7862990 DOI: 10.1001/jamanetworkopen.2020.36733] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/20/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. Objective To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. Design, Setting, and Participants This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. Exposures In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. Main Outcomes and Measures The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted κ values. Results In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. Conclusions and Relevance The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point.
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Affiliation(s)
- Michelle J. Bovin
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | | | - Annabel Prins
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
- Department of Psychology, San Jose State University, San Jose, California
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Edward P. Post
- Veterans Affairs Central Office, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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67
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Wittmann L, Dimitrijevic A, Ehlers A, Foa EB, Kessler H, Schellong J, Burgmer M. Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5). Eur J Psychotraumatol 2021; 12:1965339. [PMID: 34589176 PMCID: PMC8475123 DOI: 10.1080/20008198.2021.1965339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress. OBJECTIVE The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity. METHOD The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied. RESULTS The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5. CONCLUSIONS In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.
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Affiliation(s)
- Lutz Wittmann
- Department of Psychology, International Psychoanalytic University, Berlin, Germany
| | | | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadephia, PA, USA
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Münster, Münster, Germany.,University Hospital Münster, Münster, Germany
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68
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Sun Z, Yu C, Zhou Y, Liu Z. Psychological Interventions for Healthcare Providers With PTSD in Life-Threatening Pandemic: Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:697783. [PMID: 34393858 PMCID: PMC8358144 DOI: 10.3389/fpsyt.2021.697783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to evaluate the effect of psychological interventions on healthcare providers (HCP) with post-traumatic stress disorder (PTSD) due to their necessary exposure in life-threatening pandemic. Methods: We performed a systematic research on Medline, Embase, Cochrane Central, PsycInfo, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, ProQuest PTSD Pubs ProQuest Dissertations & Theses Global, and other gray databases by January 2021. Randomized controlled trials involving therapeutic interventions for HCP with PTSD were included. The primary outcome was PTSD symptom severity. Summary standardized mean differences (SMDs) and 95% confidence intervals were estimated using inverse variance meta-analysis with fixed effects. Risks of bias were assessed using Cochrane methods. Results: Among 773 citations, this review includes six studies, randomizing 810 participants. A meta-analysis of the effect of interventions compared to placebo showed a significant reduction of PTSD symptom severity: Cognitive Behavioral Therapy-Brief (CBT-B) (M = 27.80, 95% CI: 17.12, 38.48), Cognitive Behavioral Therapy-Long (CBT-L) (M = 26.50, 95% CI: 15.75, 37.25), and Mindfulness-Based Stretching and Deep Breathing Exercise (MBX) (M = 17.2, 95% CI: 6.57, 27.83). CBT-L and CBT-B also showed a significant effect on depression severity. Conclusions: The most effective and feasible treatment option for HCP with PTSD is still unclear, but CBT and MBX have displayed the most significant effects based on current limited evidence. Future research in this area-preferably large robust randomized controlled trials-is much needed.
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Affiliation(s)
- Zeyuan Sun
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Chuan Yu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yue Zhou
- Harvard Law School, Harvard University, Cambridge, MA, United States
| | - Zhenmi Liu
- West China School of Public Health, Sichuan University, Chengdu, China
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69
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Lozano BE, Allan NP, Gros DF, Jones J, Back SE. Treatment Goals and Alcohol Use Outcomes in Veterans With Comorbid Alcohol Dependence and Posttraumatic Stress Disorder. Am J Addict 2020; 30:131-137. [PMID: 33289961 DOI: 10.1111/ajad.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 10/09/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research demonstrates the utility of goals in attaining improved drinking outcomes. Considerably less is known about the association between substance use goals and outcomes among persons with comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). This secondary analysis examined the association between alcohol use outcomes and participants' treatment entry substance use goals to either abstain or reduce substance use in the context of treatment for comorbid SUD/PTSD. METHODS Participants (N = 39) were treatment-seeking veterans with current alcohol dependence and PTSD. Participants completed self-report and clinician-rated measures of substance use and PTSD as part of a larger randomized controlled trial. RESULTS Participants in both goal groups (abstain; reduce) achieved significant reductions in the likelihood of drinking and the likelihood of exceeding low-risk drinking levels. The primary analysis did not identify significant differences in outcome between goal groups; however, the exploratory analysis revealed that participants with reduced use goals were more likely to drink and more likely to exceed low-risk drinking levels. CONCLUSION AND SCIENTIFIC SIGNIFICANCE The findings suggest a moderately strong association between substance use goal and drinking outcome in the current study. Although the findings did not unequivocally support abstinence as a superior treatment goal, they offer a preliminary indication that abstinence may be an overall lower-risk option. These findings expand consideration of the utility of substance use goals and suggest that clinicians should invite consideration of abstinence but may need not limit integrated treatment for SUD/PTSD based on strict adherence to abstinence, particularly if low-risk use goals are targeted. (Am J Addict 2021;30:131-137).
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Affiliation(s)
- Brian E Lozano
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Medical University of South Carolina, Charleston, South Carolina
| | | | - Daniel F Gros
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Jones
- Medical University of South Carolina, Charleston, South Carolina
| | - Sudie E Back
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Medical University of South Carolina, Charleston, South Carolina
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70
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Simpson TL, Hawrilenko M, Goldberg S, Browne K, Lehavot K, Borowitz M. Treatment receipt patterns among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders. J Consult Clin Psychol 2020; 88:1039-1051. [PMID: 32790452 PMCID: PMC9851411 DOI: 10.1037/ccp0000600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine latent classes of treatment receipt among people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and describe each class by demographics, disease characteristics, and psychiatric diagnoses. METHOD Participants were National Epidemiologic Survey on Alcohol and Related Conditions-III respondents with lifetime PTSD and SUD (n = 1,349; mean age 40.3; 62.5% female; 30.9% non-White or Hispanic-White). Cross-sectional data were collected using the DSM-5 Alcohol Use Disorder and Associated Disabilities Interview Schedule. Latent class analysis was used to identify subgroups of participants with different patterns of treatment receipt. RESULTS Of the patients, 36% received at least 1 SUD treatment while 84% received at least 1 mental health (MH) treatment. Six latent classes were identified: no treatment (17.3%), outpatient MH (34.0%), outpatient + inpatient MH (17.9%), SUD (7.3%), SUD + outpatient MH (15.7%), and SUD + outpatient MH + inpatient MH (7.7%). The SUD treatment classes evidenced greater social instability, had higher alcohol use disorder symptom severity, and used more drug types than the non-SUD classes. Classes receiving inpatient MH treatment had a greater incidence of additional comorbid conditions and suicidal behaviors. Across all 6 classes, most respondents met diagnostic criteria for chronic PTSD (overall: 68.9%) while fewer met diagnostic criteria for chronic SUD (overall: 38.7%). CONCLUSIONS Most people with lifetime PTSD and SUD have sought either SUD or MH treatment or both, with substantially greater receipt of MH treatment. This comorbid group has complex clinical presentations that differ depending upon treatment subgroup, and for most, their PTSD persisted despite high rates of treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tracy L. Simpson
- Center of Excellence in Substance Addiction, Treatment, and Education (CESATE), VA Puget Sound Health Care, Seattle WA,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle WA
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle WA
| | - Simon Goldberg
- Department of Counseling, University of Wisconsin, Madison WI
| | - Kendall Browne
- Center of Excellence in Substance Addiction, Treatment, and Education (CESATE), VA Puget Sound Health Care, Seattle WA,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle WA
| | - Keren Lehavot
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle WA,Seattle / Denver Coin (HSR&D), VA Puget Sound Health Care, Seattle WA
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Smith BP, Coe E, Meyer EC. Acceptance and Commitment Therapy Delivered via Telehealth for the Treatment of Co-Occurring Depression, PTSD, and Nicotine Use in a Male Veteran. Clin Case Stud 2020. [DOI: 10.1177/1534650120963183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Symptoms of depression, posttraumatic stress, and substance use disorders commonly co-occur and are a tremendous health burden among the U.S. military veteran population. Acceptance and Commitment Therapy (ACT) is an evidence-based, transdiagnostic, integrated approach that has been used to treat these problems. Delivering psychotherapy via telehealth helps to break down barriers to care. This case study describes the application of ACT via telehealth with a male veteran with co-occurring symptoms of depression, PTSD and nicotine addiction. His depressive symptoms, PTSD symptoms, and nicotine use decreased substantially over the course of therapy. He demonstrated increased willingness to experience negatively evaluated internal experiences such as emotions and urges to use nicotine, defusion from self-critical and other unhelpful thoughts, more consistent engagement in values-consistent behaviors, and increased behavioral engagement in his social life. Treatment implications and unique aspects of the telehealth modality are discussed. Recommendations are made for training clinicians who may be considering providing services via telehealth or using ACT.
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Affiliation(s)
- Brandon P. Smith
- Baylor Scott & White Health, Waco, TX, USA
- Texas A&M University, College Station, TX, USA
| | | | - Eric C. Meyer
- Baylor Scott & White Health, Waco, TX, USA
- Texas A&M University Health Science Center, College Station, TX, USA
- Baylor University, Waco, TX, USA
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72
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Weiss NH, Contractor AA, Forkus SR, Goncharenko S, Raudales AM. Positive Emotion Dysregulation Among Community Individuals: The Role of Trauma Exposure and Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:741-749. [PMID: 32216154 PMCID: PMC9814231 DOI: 10.1002/jts.22497] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 01/11/2023]
Abstract
Existing literature has provided support for an association between posttraumatic stress disorder (PTSD) and emotion dysregulation. However, few studies have examined the relation between PTSD and emotion dysregulation that stems from positive emotions. Moreover, the role of trauma exposure, per se, on positive emotion dysregulation is unknown. Addressing these limitations, the current study compared levels of positive emotion dysregulation among (a) individuals without trauma exposure, (b) trauma-exposed individuals without probable PTSD, and (c) trauma-exposed individuals with probable PTSD. Participants were 400 community-dwelling individuals (M age = 43.76 years, 68.6% female; 24.2% Asian, 23.7% Black, 24.5% Hispanic, 27.6% White). Lower levels of positive emotion dysregulation were found among trauma-exposed participants without probable PTSD compared to trauma-exposed participants with probable PTSD, ds = 0.66-0.73, and unexposed participants, ds = 0.58-0.64. The present findings suggest the potential protective role of low levels of positive emotion dysregulation following trauma exposure. If replicated in longitudinal studies, these results may indicate the utility of enhancing skills for regulating positive emotions among individuals at risk for trauma exposure.
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Affiliation(s)
- Nicole H. Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Shannon R. Forkus
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Svetlana Goncharenko
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alexa M. Raudales
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Evaluation of an Implementation Intervention to Increase Reach of Evidence-Based Psychotherapies for PTSD in US Veterans Health Administration PTSD Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:450-463. [PMID: 32944814 DOI: 10.1007/s10488-020-01086-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
To evaluate an implementation intervention to increase the uptake, referred to as reach, of two evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) in Veterans Health Administration (VHA) PTSD specialty clinics. The implementation intervention was external facilitation guided by a toolkit that bundled strategies associated with high EBP reach in prior research. We used a prospective quasi-experimental design. The facilitator worked with local champions at two low-reach PTSD clinics. Each intervention PTSD clinic was matched to three control clinics. We compared the change in EBP reach from 6-months pre- to post-intervention using Difference-in-Difference (DID) effect estimation. To incorporate possible clustering effects and adjust for imbalanced covariates, we used mixed effects logistic regression to model the probability of EBP receipt. Analyses were conducted separately for PTSD and other mental health clinics. 29,446 veterans diagnosed with PTSD received psychotherapy in the two intervention and six control sites in the two 6-month evaluation periods. The proportion of therapy patients with PTSD receiving an EBP increased by 16.98 percentage points in the intervention PTSD clinics compared with .45 percentage points in the control PTSD clinics (DID = 16.53%; SE = 2.26%). The adjusted odd ratio of a patient receiving an EBP from pre to post intervention was almost three times larger in the intervention than in the control PTSD clinics (RoR 2.90; 95% CI 2.22-3.80). EBP reach was largely unchanged in other (not PTSD specialty) mental health clinics within the same medical centers. Toolkit-guided external facilitation is a promising intervention to improve uptake of EBPs in VHA. Toolkits that pre-specify targets for clinic change based on prior research may enhance the efficiency and effectiveness of external facilitation. Trial registration ISRCTN registry identifier: ISRCTN65119065. Available at https://www.isrctn.com/search?q=ISRCTN65119065 .
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74
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Stefanovics EA, Potenza MN, Pietrzak RH. PTSD and obesity in U.S. military veterans: Prevalence, health burden, and suicidality. Psychiatry Res 2020; 291:113242. [PMID: 32763532 DOI: 10.1016/j.psychres.2020.113242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
Post-traumatic stress disorder (PTSD) and obesity are prevalent among U.S. military veterans, though less is known about the mental and physical health burden and suicidality of co-occurring PTSD and obesity in this population. A nationally representative sample of the U.S. veterans was used to assess PTSD and obesity prevalence, co-occurrence and relationships with mental and physical health measures. A total of 16.4% of veterans screened positive for current PTSD, 32.7% for obesity, and 5.8% for co-occurring PTSD and obesity. Relative to obesity-only veterans, veterans with co-occurring PTSD and obesity had elevated likelihoods of mental and physical health concerns (most notably major depressive and generalized anxiety disorders), suicidality, and migraine headaches, and higher body mass indices. Relative to veterans with PTSD alone, individuals with comorbid PTSD and obesity had elevated likelihoods of suicidal ideation, nicotine dependence, mental health treatment, migraine headaches, diabetes, hypertension, and insomnia. A significant minority of U.S. veterans has co-occurring PTSD and obesity, which is associated with substantial mental and physical health burden, including elevated suicidality. Results underscore the importance of integrative assessment, monitoring, and treatment approaches for PTSD and obesity in this population.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, United States.
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Neuroscience and Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Connecticut Council on Problem Gambling, Wethersfield, CT, United States; Connecticut Mental Health Center, New Haven, CT, United States
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
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75
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Capone C, Tripp JC, Trim RS, Davis BC, Haller M, Norman SB. Comparing Exposure- and Coping Skills-Based Treatments on Trauma-Related Guilt in Veterans With Co-Occurring Alcohol Use and Posttraumatic Stress Disorders. J Trauma Stress 2020; 33:603-609. [PMID: 32521096 DOI: 10.1002/jts.22538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) commonly co-occur, and this comorbidity (PTSD-SUD) is associated with more severe symptoms and functional impairment than either disorder alone. Growing evidence indicates that trauma-related guilt, typically concerning negative appraisals of one's actions or inaction during a traumatic event, is associated with PTSD, depression, suicidality, and, possibly, substance use. The present study examined whether integrated treatment for PTSD-SUD was effective in reducing trauma-related guilt as measured by the Trauma-Related Guilt Inventory. Data were drawn from a randomized clinical trial comparing the effectiveness of two integrated therapies on treatment outcomes in a sample of U.S. veterans (N = 119) with comorbid PTSD and SUD. Participants were randomized to receive either Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE; n = 63) or Seeking Safety (SS; n = 56). The results indicated that global guilt decreased over time for the whole sample. However, there was a significant Treatment × Time interaction, such that participants in the COPE condition reported lower rates of global guilt, d = 0.940, over time compared to those in the SS condition, d = .498. To our knowledge, this was the first study to examine the effects of integrated PTSD-SUD treatment on trauma-related guilt. The findings highlight that exposure-based, trauma-focused treatment for comorbid PTSD-SUD can be more effective in decreasing trauma-related guilt, with potentially longer-lasting effects, than non-exposure-based treatment, adding evidence that patients with PTSD-SUD should be offered such treatment.
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Affiliation(s)
- Christy Capone
- Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jessica C Tripp
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Ryan S Trim
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Brittany C Davis
- James A Haley Veterans Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA.,National Center for PTSD, White River Junction, Vermont, USA.,Center of Excellence for Stress and Mental Health, San Diego, California, USA
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76
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Zamir O, Gewirtz AH, Cheng CH, Zhang N, Lavee Y. Psychological distress and communication quality in military couples after deployment to war. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:383-391. [PMID: 31424234 PMCID: PMC8869849 DOI: 10.1037/fam0000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Previous research has found elevated levels of psychological distress (i.e., posttraumatic stress, depressive and anxiety symptoms) among veterans. Existing theory and evidence show how psychological distress is associated with marital disruptions. Only a few studies, however, have tested the link between psychological distress and couple communication quality in military couples, most of which were cross-sectional and employed self-report measures. The current study investigated whether psychological distress predicts changes in observed communication quality across 1 year in 228 couples consisting of male service members, who were deployed to Iraq and/or Afghanistan, and their nondeployed female partners. Psychological distress was indicated by self-reported posttraumatic stress disorder, depressive, and anxiety symptoms. Communication quality was assessed using observed couple interactions. The results of an actor-partner interdependence model showed that men's psychological distress predicted men's lower communication quality at one year after accounting for baseline communication quality. Women's psychological distress did not predict their communication quality, and each partner's psychological distress did not predict changes in their partner's communication quality over time. Consistent with previous findings on civilian populations, our findings highlight the long-term effects of psychological distress among service members on their communication behaviors with their intimate partners, and emphasize the importance of targeting psychological symptoms of service members following deployment to war. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Osnat Zamir
- Paul Baerwald School of Social Work and Social Welfare
| | | | | | - Na Zhang
- Department of Family Social Science
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Weiss NH, Forkus SR, Raudales AM, Schick MR, Contractor AA. Alcohol misuse to down-regulate positive emotions: A cross-sectional multiple mediator analysis among US military veterans. Addict Behav 2020; 105:106322. [PMID: 32006684 PMCID: PMC7059215 DOI: 10.1016/j.addbeh.2020.106322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse presents a pervasive and clinically relevant concern among US military veterans. OBJECTIVE The current investigation sought to examine the role of positive emotion dysfunction in the relation between PTSD symptomatology and alcohol misuse. To do so, we examined the separate and sequential roles of positive emotional intensity and positive emotional avoidance in the relation between PTSD symptoms and alcohol misuse among US military veterans. METHOD Cross-sectional data were collected from 468 US military veterans (M age = 37.74, 70.5% male, 69.0% White) who responded to an online survey. RESULTS Findings suggest that positive emotional avoidance, separately, and positive emotional intensity and positive emotional avoidance, sequentially, mediated the relation between PTSD symptoms and alcohol misuse. CONCLUSIONS Findings advance theory on the role of positive emotions and related processes in the co-occurrence of PTSD and alcohol misuse, and highlight important avenues for future research and treatment focused on the PTSD-alcohol misuse co-occurrence.
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Sommer JL, El-Gabalawy R, Contractor AA, Weiss NH, Mota N. PTSD's risky behavior criterion: Associated risky and unhealthy behaviors and psychiatric correlates in a nationally representative sample. J Anxiety Disord 2020; 73:102247. [PMID: 32502805 DOI: 10.1016/j.janxdis.2020.102247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
Criterion E2 ("reckless or self-destructive behavior") was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2's associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58-3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65-2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2, Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2, Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX, 76203, United States
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, United States
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada.
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Hale AC, Nelson SM, Reckow J, Spencer RJ. Validation and extension of personality disorder spectra scales from MMPI‐2‐RF items. J Clin Psychol 2020; 76:1754-1774. [DOI: 10.1002/jclp.22953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew C. Hale
- Department of Physical Medicine and RehabilitationUniversity of Michigan Ann Arbor Michigan
- VA Center for Clinical Management ResearchHealth Services Research and Development Ann Arbor Michigan
| | - Sharon M. Nelson
- Mental Health ServiceVA Ann Arbor Healthcare System Ann Arbor Michigan
- Department of PsychologyEastern Michigan University Ypsilanti Michigan
| | - Jaclyn Reckow
- Mental Health ServiceVA Ann Arbor Healthcare System Ann Arbor Michigan
- Mercy Health Saint Mary'sHauenstein Neurosciences Grand Rapids Michigan
| | - Robert J. Spencer
- Mental Health ServiceVA Ann Arbor Healthcare System Ann Arbor Michigan
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Morland LA, Mackintosh MA, Glassman LH, Wells SY, Thorp SR, Rauch SAM, Cunningham PB, Tuerk PW, Grubbs KM, Golshan S, Sohn MJ, Acierno R. Home-based delivery of variable length prolonged exposure therapy: A comparison of clinical efficacy between service modalities. Depress Anxiety 2020; 37:346-355. [PMID: 31872563 DOI: 10.1002/da.22979] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study examined clinical and retention outcomes following variable length prolonged exposure (PE) for posttraumatic stress disorder (PTSD) delivered by one of three treatment modalities (i.e., home-based telehealth [HBT], office-based telehealth [OBT], or in-home-in-person [IHIP]). METHOD A randomized clinical trial design was used to compare variable-length PE delivered through HBT, OBT, or IHIP. Treatment duration (i.e., number of sessions) was determined by either achievement of a criterion score on the PTSD Checklist for Diagnostic and Statistical Manual-5 (DSM-5; PTSD Checklist for DSM-5) for two consecutive sessions or completion of 15 sessions. Participants received PE via HBT (n = 58), OBT (n = 59) or IHIP (n = 58). Data were collected between 2012 and 2018, and PTSD was diagnosed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), administered at baseline, posttreatment, and 6 months following treatment completion. The primary clinical outcome was CAPS-5 PTSD severity. Secondary outcomes included self-reported PTSD and depression symptoms, as well as treatment dropout. RESULTS The clinical effectiveness of PE did not differ by treatment modality across any time point; however, there was a significant difference in treatment dropout. Veterans in the HBT (odds ratio [OR] = 2.67; 95% confidence interval [CI] = 1.10, 6.52; p = .031) and OBT (OR = 5.08; 95% CI = 2.10; 12.26; p < .001) conditions were significantly more likely than veterans in IHIP to drop out of treatment. CONCLUSIONS Providers can effectively deliver PE through telehealth and in-home, in-person modalities although the rate of treatment completion was higher in IHIP care.
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Affiliation(s)
- Leslie A Morland
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | | | - Lisa H Glassman
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Stephanie Y Wells
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Steven R Thorp
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Sheila A M Rauch
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Phillippe B Cunningham
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Peter W Tuerk
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Kathleen M Grubbs
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Shahrokh Golshan
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Min Ji Sohn
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
| | - Ron Acierno
- Regional TeleMental Health Program, VA San Diego Healthcare System, San Diego, California
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81
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Extending our understanding of the association between posttraumatic stress disorder and positive emotion dysregulation: A network analysis approach. J Anxiety Disord 2020; 71:102198. [PMID: 32109828 PMCID: PMC7196007 DOI: 10.1016/j.janxdis.2020.102198] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/24/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) has empirically-established associations with positive emotion dysregulation. Extending existing research, we utilized a network approach to examine relations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive emotion dysregulation dimensions (nonacceptance, impulse control, goal-directed behavior). We identified (1) differential relations of PTSD symptom clusters with positive emotion dysregulation, and (2) central symptoms accounting for the PTSD and positive emotion dysregulation inter-group interconnections. Participants were 371 trauma-exposed community individuals (Mage = 43.68; 70.9 % females; 34.5 % white). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD symptom clusters and three nodes representing positive emotion dysregulation dimensions. Study results indicated the key role of AAR and intrusions clusters in the PTSD group and impulse control difficulties in the positive emotion dysregulation group. Regarding cross-group connectivity patterns, findings indicate the pivotal role of (1) AAR in its link with positive emotion dysregulation dimensions, and (2) nonacceptance of positive emotions and impairment in goal-directed behavior in the context of positive emotions in their link to PTSD symptom clusters. Thus, the current study indicates the potentially central role of particular PTSD symptom clusters and positive emotion dysregulation dimensions, informing assessment and treatment targets.
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82
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Turvey CL, Lund BC, Jones D, Arndt S. Community Treatment for Opioid Use Disorders in Urban and Rural Veterans. J Rural Health 2020; 36:167-176. [DOI: 10.1111/jrh.12406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carolyn L. Turvey
- Department of Veterans AffairsOffice of Rural Health Rural Resource Center Iowa City Iowa
- Iowa City VA Health Care SystemComprehensive Access and Delivery Research and Evaluation Center Iowa City Iowa
- Department of PsychiatryUniversity of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City Iowa
| | - Brian C. Lund
- Iowa City VA Health Care SystemComprehensive Access and Delivery Research and Evaluation Center Iowa City Iowa
- Department of EpidemiologyUniversity of Iowa College of Public Health Iowa City Iowa
| | - DeShauna Jones
- Iowa Consortium for Substance Abuse Research and EvaluationUniversity of Iowa Iowa City Iowa
| | - Stephan Arndt
- Department of PsychiatryUniversity of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City Iowa
- Department of BiostatisticsUniversity of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City Iowa
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83
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Evans EA, Goff SL, Upchurch DM, Grella CE. Childhood adversity and mental health comorbidity in men and women with opioid use disorders. Addict Behav 2020; 102:106149. [PMID: 31855783 PMCID: PMC7405712 DOI: 10.1016/j.addbeh.2019.106149] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/15/2019] [Accepted: 09/27/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION To examine gender differences in associations between mental health comorbidity and adverse childhood experiences (ACE) among adults with DSM-5 lifetime opioid use disorders (OUD). METHODS In 2018, we analyzed 2012-13 nationally-representative data from 388 women and 390 men with OUD (heroin, prescription opioid misuse). Using weighted multinomial logistic regression, we examined factors associated with mental health comorbidity, tested a gender-by-childhood-adversity interaction term, and calculated predicted probabilities, controlling for covariates. RESULTS Among adults with OUD, women are more likely than men to have comorbid mood or anxiety disorders (odds ratio [95% CI] 1.72 [1.20, 2.48]), and less likely to have conduct disorders. More women than men have prescription OUD (3.72 [2.24, 6.17]), and fewer have heroin use disorder (0.39 [0.27, 0.57]). Among both genders, ACE prevalence is high (>80%) and more than 40% are exposed to ≥3 types of ACE. Women more than men are exposed to childhood sexual abuse (4.22 [2.72, 6.56]) and emotional neglect (1.84 [1.20, 2.81]). Comorbid mood or anxiety disorders are associated with female gender (1.73 [1.18, 2.55]) and exposure to ≥3 types of ACE (3.71 [2.02, 6.85]), controlling for covariates. Moreover, exposure to more ACE elevates risk for comorbid mood or anxiety disorders more among women than men. CONCLUSION Among adults with OUD, ACE alters the gender gap in risk for comorbid mood or anxiety disorders. Using gender-tailored methods to address the harmful effects ACE on the mental health of individuals with OUD may help to prevent and ameliorate the current opioid epidemic.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA, USA.
| | - Sarah L Goff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Christine E Grella
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Bickel KE, Kennedy R, Levy C, Burgio KL, Bailey FA. The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis. J Gen Intern Med 2020; 35:505-513. [PMID: 31792872 PMCID: PMC7018872 DOI: 10.1007/s11606-019-05538-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 10/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization. OBJECTIVES To determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration. DESIGN Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center. SUBJECTS Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011. MAIN MEASURES Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life. KEY RESULTS Of 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138). CONCLUSIONS PTSD's association with increased end-of-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients. TRIAL REGISTRATION NCT00234286.
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Affiliation(s)
- Kathleen E Bickel
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA.
- Rocky Mountain Veterans Affairs Medical Center, Aurora, USA.
| | - Richard Kennedy
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cari Levy
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA
- Rocky Mountain Veterans Affairs Medical Center, Aurora, USA
| | - Kathryn L Burgio
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - F Amos Bailey
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
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85
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Silva Júnior FJGD, Monteiro CFDS. Alcohol and other drug use, and mental distress in the women’s universe. Rev Bras Enferm 2020; 73:e20180268. [DOI: 10.1590/0034-7167-2018-0268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/04/2018] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the relationship between alcohol and other drug use, and mental distress among women. Method: an analytical cross-sectional study conducted with 369 women in Piauí State. Alcohol Use Disorders Identification Test, Non-Student Drugs Use Questionnaire and Self-Reporting Questionnaire and inferential statistics were used. Results: women with heavy alcohol consumption (zone IV - possible dependence) are 2.1 times more likely to have mental distress. Consuming tobacco increases the odds of distress 3.5%, tranquilizers 2.6 times and cannabis 4.5 times. There is a statistically significant and positive correlation between the Alcohol Use Disorders Identification Test score and the Self-Reporting Questionnaire (p = 0.000; r = 0.250). Conclusion: alcohol, tobacco, tranquilizers and cannabis use is associated with mental distress. The more intense the alcohol consumption, the more intense the mental distress. Therefore, it is necessary to track alcohol and other drug consumption, and mental distress in the routine care of women.
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86
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Simons JS, Simons RM, Walters KJ, Keith JA, O'Brien C, Andal K, Stoltenberg SF. Nexus of despair: A network analysis of suicidal ideation among veterans. Arch Suicide Res 2020; 24:314-336. [PMID: 30734645 PMCID: PMC7206527 DOI: 10.1080/13811118.2019.1574689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of this study was to estimate a network model of risk and resilience factors of suicidal ideation among veterans. Two network models of suicidal ideation among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans (N = 276) incorporated key disorders, traumatic stress, and resilience constructs to contextualize suicidal ideation. Childhood trauma was positively connected with suicidal ideation and harassment and inversely connected with social support and distress tolerance. This exemplifies long-lasting associations between childhood trauma and re-victimization, emotion regulation, and ability to form supportive social relationships. A subsequent model including lower-order facets indicated that combat trauma was predominantly associated with posttraumatic stress disorder-intrusion symptoms. This study highlights the importance of addressing both risk and resilience to reduce suicide risk among veterans and increases understanding of factors that contribute to suicidal ideation.
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Affiliation(s)
- Jeffrey S Simons
- The University of South Dakota, Vermillion, South Dakota.,Sioux Falls VA Health Care System, Sioux Falls, South Dakota
| | - Raluca M Simons
- The University of South Dakota, Vermillion, South Dakota.,Sioux Falls VA Health Care System, Sioux Falls, South Dakota
| | - Kyle J Walters
- The University of South Dakota, Vermillion, South Dakota
| | | | | | - Kate Andal
- Sioux Falls VA Health Care System, Sioux Falls, South Dakota
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87
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Balachandran T, Cohen G, Le Foll B, Rehm J, Hassan AN. The effect of pre-existing alcohol use disorder on the risk of developing posttraumatic stress disorder: results from a longitudinal national representative sample. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:232-240. [PMID: 31860361 DOI: 10.1080/00952990.2019.1690495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There is inconsistent evidence in the literature as to whether or not Alcohol Use Disorder (AUD) is a risk factor for Post-Traumatic Stress Disorder (PTSD).Objectives: We evaluated the risk of developing PTSD after trauma exposure in individuals with AUD. As a secondary analysis, we also tested if alcohol dependence or alcohol abuse separately increased the risk of PTSD development. We also explored the effect of AUD on exposure to various traumas.Methods: Longitudinal data was obtained from 30,180 individuals with and without AUD from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) waves I and II. Using propensity score methods, we matched individuals with AUD (alcohol abuse and/or dependence using DSM-IV criteria) to those without AUD at baseline on demographic, familial, and clinical factors to estimate the risk of PTSD development after trauma exposure. Data were adjusted for complex survey methods.Results: Individuals with AUD had an increased risk of being exposed to various traumas between wave I and II (60.6% vs. 48.3% of controls). Among individuals exposed to trauma between the two waves (N = 14,107), AUD had no effect on subsequent PTSD development after matching and controlling for covariates (OR: 1.00; 95%CI: 0.72-1.39; p = .99). However, those with alcohol dependence only did have an effect on subsequent PTSD development (OR: 1.76; 95%CI: 1.05-2.95; p = .03).Conclusion: In individuals with alcohol dependence the experience of trauma increases the risk of developing PTSD. These findings suggest that prevention methods from PTSD after trauma exposure for individuals with alcohol dependence are needed.
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Affiliation(s)
- Thaneson Balachandran
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Science, University of Toronto at Scarborough, Toronto, Canada
| | - Gregory Cohen
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Departments of Family and Community Medicine, Pharmacology and Toxicology, University of Toronto, Toronto, Canada.,Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed N Hassan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, King Abdul-Aziz University, Jeddah, Saudi Arabia
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88
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Mota NP, Cook JM, Smith NB, Tsai J, Harpaz-Rotem I, Krystal JH, Southwick SM, Pietrzak RH. Posttraumatic stress symptom courses in U.S. military veterans: A seven-year, nationally representative, prospective cohort study. J Psychiatr Res 2019; 119:23-31. [PMID: 31546045 DOI: 10.1016/j.jpsychires.2019.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 08/12/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022]
Abstract
The current study examined the nature and correlates of seven-year posttraumatic stress disorder (PTSD) symptom courses in a nationally representative, prospective cohort of U.S. military veterans. Data were analyzed from 2,307 trauma-exposed veterans who completed at least one follow-up assessment over a 7-year period, a subsample of n = 3,157 veterans who participated in the first wave of the National Health and Resilience in Veterans Study. Latent growth mixture modeling (LGMM) was used to identify PTSD symptom courses over four survey waves conducted in 2011, 2013, 2015, and 2018. Sociodemographic, health, and psychosocial variables were examined as potential correlates of symptomatic trajectories. PTSD symptoms were best characterized by three courses: No/Low (89.2%), Moderate Symptom (7.6%), and High Symptom (3.2%). Relative to the No/Low Symptom course, symptomatic courses were positively associated with a greater number of lifetime traumatic events, higher scores on measures of physical health difficulties and lifetime psychiatric history (relative risk ratio [RRR] range = 1.19-2.74), and were negatively associated with time since index trauma, household income, and social connectedness (RRR range = 0.14-0.97). Veterans in the Moderate Symptom course additionally had lower scores on a measure of protective psychosocial characteristics (RRR = 0.78) and were more likely to have received mental health treatment (RRR = 1.62), while those in the High PTSD Symptom course were more likely to be exposed to combat and to more traumas since Wave 1 (RRR range = 1.23-4.63). Three PTSD symptom courses in U.S. veterans were identified, with more than 10% of veterans exhibiting a moderate or high symptom course. Prevention and treatment efforts targeting modifiable correlates, such as social connectedness, may help mitigate symptomatic PTSD symptom courses in this population.
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Affiliation(s)
- Natalie P Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada.
| | - Joan M Cook
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Noelle B Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs New England, Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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The role of gender in the associations among posttraumatic stress disorder symptom, severity, difficulties regulating emotions, and alcohol misuse. Addict Behav 2019; 99:106086. [PMID: 31445483 DOI: 10.1016/j.addbeh.2019.106086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/11/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement. METHOD The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (Mage = 35.62, 55.4% women, 77.0% White). RESULTS Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model. CONCLUSIONS Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.
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90
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Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry 2019; 6:1068-1080. [PMID: 31630984 PMCID: PMC7006178 DOI: 10.1016/s2215-0366(19)30222-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile; Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Katherine M Keyes
- Department of Epidemiology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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91
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Belsher BE, Beech E, Evatt D, Smolenski DJ, Shea MT, Otto JL, Rosen CS, Schnurr PP. Present-centered therapy (PCT) for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2019; 2019:CD012898. [PMID: 31742672 PMCID: PMC6863089 DOI: 10.1002/14651858.cd012898.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Present-centered therapy (PCT) is a non-trauma, manualized psychotherapy for adults with post-traumatic stress disorder (PTSD). PCT was originally designed as a treatment comparator in trials evaluating the effectiveness of trauma-focused cognitive-behavioral therapy (TF-CBT). Recent trials have indicated that PCT may be an effective treatment option for PTSD and that patients may drop out of PCT at lower rates relative to TF-CBT. OBJECTIVES To assess the effects of PCT for adults with PTSD. Specifically, we sought to determine whether (1) PCT is more effective in alleviating symptoms relative to control conditions, (2) PCT results in similar alleviation of symptoms compared to TF-CBT, based on an a priori minimally important differences on a semi-structured interview of PTSD symptoms, and (3) PCT is associated with lower treatment dropout as compared to TF-CBT. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register, the Cochrane Library, Ovid MEDLINE, Embase, PsycINFO, PubMed, and PTSDpubs (previously called the Published International Literature on Traumatic Stress (PILOTS) database) (all years to 15 February 2019 search). We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished and ongoing trials. Reference lists of included studies and relevant systematic reviews were checked. Grey literature searches were also conducted to identify dissertations and theses, clinical guidelines, and regulatory agency reports. SELECTION CRITERIA We selected all randomized clinical trials (RCTs) that recruited adults diagnosed with PTSD to evaluate PCT compared to TF-CBT or a control condition. Both individual and group PCT modalities were included. The primary outcomes of interest included reduced PTSD severity as determined by a clinician-administered measure and treatment dropout rates. DATA COLLECTION AND ANALYSIS We complied with the Cochrane recommended standards for data screening and collection. Two review authors independently screened articles for inclusion and extracted relevant data from eligible studies, including the assessment of trial quality. Random-effects meta-analyses, subgroup analyses, and sensitivity analyses were conducted using mean differences (MD) and standardized mean differences (SMD) for continuous data or risk ratios (RR) and risk differences (RD) for dichotomous data. To conclude that PCT resulted in similar reductions in PTSD symptoms relative to TF-CBT, we required a MD of less than 10 points (to include the 95% confidence interval) on the Clinician-Administered PTSD Scale (CAPS). Five members of the review team convened to rate the quality of evidence across the primary outcomes. Any disagreements were resolved through discussion. Review authors who were investigators on any of the included trials were not involved in the qualitative or quantitative syntheses. MAIN RESULTS We included 12 studies (n = 1837), of which, three compared PCT to a wait-list/minimal attention (WL/MA) group and 11 compared PCT to TF-CBT. PCT was more effective than WL/MA in reducing PTSD symptom severity (SMD -0.84, 95% CI -1.10 to -0.59; participants = 290; studies = 3; I² = 0%). We assessed the quality of this evidence as moderate. The results of the non-inferiority analysis comparing PCT to TF-CBT did not support PCT non-inferiority, with the 95% confidence interval surpassing the clinically meaningful cut-off (MD 6.83, 95% CI 1.90 to 11.76; 6 studies, n = 607; I² = 42%). We assessed this quality of evidence as low. CAPS differences between PCT and TF-CBT attenuated at 6-month (MD 1.59, 95% CI -0.46 to 3.63; participants = 906; studies = 6; I² = 0%) and 12-month (MD 1.22, 95% CI -2.17 to 4.61; participants = 485; studies = 3; I² = 0%) follow-up periods. To confirm the direction of the treatment effect using all eligible trials, we also evaluated PTSD SMD differences. These results were consistent with the primary MD outcomes, with meaningful effect size differences between PCT and TF-CBT at post-treatment (SMD 0.32, 95% CI 0.08 to 0.56; participants = 1129; studies = 9), but smaller effect size differences at six months (SMD 0.17, 95% CI 0.05 to 0.29; participants = 1339; studies = 9) and 12 months (SMD 0.17, 95% CI 0.03 to 0.31; participants = 728; studies = 5). PCT had approximately 14% lower treatment dropout rates compared to TF-CBT (RD -0.14, 95% CI -0.18 to -0.10; participants = 1542; studies = 10). We assessed the quality of this evidence as moderate. There was no evidence of meaningful differences on self-reported PTSD (MD 4.50, 95% CI 3.09 to 5.90; participants = 983; studies = 7) or depression symptoms (MD 1.78, 95% CI -0.23 to 3.78; participants = 705; studies = 5) post-treatment. AUTHORS' CONCLUSIONS Moderate-quality evidence indicates that PCT is more effective in reducing PTSD severity compared to control conditions. Low quality of evidence did not support PCT as a non-inferior treatment compared to TF-CBT on clinician-rated post-treatment PTSD severity. The treatment effect differences between PCT and TF-CBT may attenuate over time. PCT participants drop out of treatment at lower rates relative to TF-CBT participants. Of note, all of the included studies were primarily designed to test the effectiveness of TF-CBT which may bias results away from PCT non-inferiority.The current systematic review provides the most rigorous evaluation to date to determine whether PCT is comparably as effective as TF-CBT. Findings are generally consistent with current clinical practice guidelines that suggest that PCT may be offered as a treatment for PTSD when TF-CBT is not available.
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Affiliation(s)
- Bradley E Belsher
- Defense Health AgencyPsychological Health Center of ExcellenceSilver SpringMarylandUSA20910
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Erin Beech
- Defense Health AgencyPsychological Health Center of ExcellenceSilver SpringMarylandUSA20910
| | - Daniel Evatt
- Defense Health AgencyPsychological Health Center of ExcellenceSilver SpringMarylandUSA20910
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Derek J Smolenski
- Defense Health AgencyPsychological Health Center of ExcellenceSilver SpringMarylandUSA20910
| | - M Tracie Shea
- VA Medical CenterDepartment of Veterans AffairsProvidenceRIUSA
- Brown UniversityThe Warren Alpert Medical SchoolProvidenceUSA
| | - Jean Lin Otto
- Defense Health AgencyPsychological Health Center of ExcellenceSilver SpringMarylandUSA20910
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Craig S Rosen
- National Center for PTSDPalo AltoCaliforniaUSA
- Stanford University School of MedicinePalo AltoCaliforniaUSA
| | - Paula P Schnurr
- National Center for PTSDWhite River JunctionVermontUSA
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
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Scherrer JF, Salas J, Norman SB, Schnurr PP, Chard KM, Tuerk P, Schneider FD, van den Berk-Clark C, Cohen BE, Friedman MJ, Lustman PJ. Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes. JAMA Psychiatry 2019; 76:1159-1166. [PMID: 31433443 PMCID: PMC6704751 DOI: 10.1001/jamapsychiatry.2019.2096] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is associated with increased risk of type 2 diabetes (T2D). Improvement in PTSD has been associated with improved self-reported physical health and hypertension; however, there is no literature, to our knowledge, on whether PTSD improvement is associated with T2D risk. OBJECTIVE To examine whether clinically meaningful PTSD symptom reduction is associated with lower risk of T2D. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined Veterans Health Affairs medical record data from 5916 patients who received PTSD specialty care between fiscal years 2008 and 2012 and were followed up through fiscal year 2015. Eligible patients had 1 or more PTSD Checklist (PCL) scores of 50 or higher between fiscal years 2008 and 2012 and a second PCL score within the following 12 months and at least 8 weeks after the first PCL score of 50 or higher. The index date was 12 months after the first PCL score. Patients were free of T2D diagnosis or an antidiabetic medication use for 12 months before the index date and had at least 1 visit after the index date. Data analyses were completed during January 2019. EXPOSURES Reduction in PCL scores during a 12-month period was used to define patients as those with a clinically meaningful improvement (≥20-point PCL score decrease) and patients with less or no improvement (<20-point PCL score decrease). MAIN OUTCOMES AND MEASURES Incident T2D diagnosed during a 2- to 6-year follow-up. RESULTS Medical records from a total of 1598 patients (mean [SD] age, 42.1 [13.4] years; 1347 [84.3%] male; 1060 [66.3%] white) were studied. The age-adjusted cumulative incidence of T2D was 2.6% among patients with a clinically meaningful PCL score decrease and 5.9% among patients without a clinically meaningful PCL score decrease (P = .003). After control for confounding, patients with a clinically meaningful PCL score decrease were significantly less likely to develop T2DM compared with those without a clinically meaningful decrease (hazard ratio, 0.51; 95% CI, 0.26-0.98). CONCLUSIONS AND RELEVANCE The findings suggest that clinically meaningful reductions in PTSD symptoms are associated with a lower risk of T2D. A decrease in PCL score, whether through treatment or spontaneous improvement, may help mitigate the greater risk of T2D in patients with PTSD.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Sonya B. Norman
- National Center for PTSD, Veterans Affairs (VA) Center of Excellence for Stress and Mental Health, Department of Psychiatry, University of California, San Diego
| | - Paula P. Schnurr
- National Center for PTSD, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kathleen M. Chard
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center (VAMC), Cincinnati, Ohio,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Peter Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Beth E. Cohen
- School of Medicine, Department of Medicine, University of California, San Francisco,San Francisco VAMC, San Francisco, California
| | - Matthew J. Friedman
- National Center for PTSD, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri,The Bell Street Clinic Opioid Treatment Program, Mental Health Service, VA St Louis Health Care System, St Louis, Missouri
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Abstract
Current clinical practice guidelines for the treatment of posttraumatic stress disorder offer varying recommendations regarding the use of pharmacotherapy. Many direct head-to-head comparisons of pharmacotherapy are lacking, and recommendations are based on meta-analyses and small trials. While selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are considered first-line pharmacotherapy, clear distinctions do not exist when considering other classes of psychotropic medications. Ultimately, when selecting an appropriate medication for a patient diagnosed with posttraumatic stress disorder, the clinician needs to consider the current symptomatology being experienced, comorbid conditions, and evidence for efficacy of specific treatments prior to initiating medications.
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94
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Boden MT, Hoggatt KJ. Substance Use Disorders Among Veterans in a Nationally Representative Sample: Prevalence and Associated Functioning and Treatment Utilization. J Stud Alcohol Drugs 2019. [PMID: 30573015 DOI: 10.15288/jsad.2018.79.853] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Several epidemiological studies have reported that veterans and nonveterans have comparable substance use disorder (SUD) prevalence and SUD treatment rates for SUD and treatments of several types. No studies have compared functioning among veterans with SUD to veterans without SUD or to nonveterans. METHOD We investigated the prevalence of past-year and lifetime SUD (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), overall and by substance, and estimated the association with physical and mental health functioning and treatment utilization and need among veterans and nonveterans in a nationally representative sample. RESULTS Predicted prevalence of any past-year SUD, with and without tobacco use disorder (TUD), among veterans was 32.9% and 17.1%, and prevalence of any lifetime SUD, with and without TUD, was 52.5 and 38.7%, respectively. Veterans had higher prevalence of past-year and lifetime SUD for some substances (e.g., tobacco, alcohol) but not others (e.g., cannabis, opioid). Lower physical and mental health functioning was found among veterans, relative to nonveterans, and participants with SUD, relative to those without SUD, and veterans with SUD reported the lowest functioning across all domains. More veterans than nonveterans received any SUD treatment and SUD treatment in specific domains (e.g., self-help). About 70% of veterans with past-year SUD did not receive treatment, but only 5.4% reported needing and not receiving treatment. CONCLUSIONS Relative to nonveterans, veterans have higher prevalence of past-year TUD and lifetime alcohol use disorder or TUD and lower physical or mental health functioning. A minority of veterans receive SUD treatment, and few report unmet need for treatment.
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Affiliation(s)
- Matthew Tyler Boden
- Center for Innovation to Implementation, Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California
| | - Katherine J Hoggatt
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California
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95
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McLafferty M, Ross J, Waterhouse-Bradley B, Armour C. Childhood adversities and psychopathology among military veterans in the US: The mediating role of social networks. J Anxiety Disord 2019; 65:47-55. [PMID: 31158649 DOI: 10.1016/j.janxdis.2019.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/15/2022]
Abstract
Childhood adversities can impact negatively on psychological health across the lifespan. Many military veterans have a history of adverse childhood experiences, which when combined with deployment related traumas, can lead to high levels of psychopathology. Social networks can however be protective. The current study aimed to identify typologies of childhood adversity in U.S. military veterans (n = 3092) and explore relationships between the adversity typologies and PTSD, mood and anxiety disorders, utilising data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III). The mediating role of quality and quantity of social networks were examined. Latent class analysis identified four adversity classes; 1) baseline, 2) household dysfunction, 3) maltreatment, and 4) multi-adversity. Individuals in the adversity classes (2-4), especially those who experienced multi-adversity had higher rates of psychopathology. The quality of social networks played an important mediating role, while quantity of networks did not. Those who experienced adversity were less likely to have supportive social networks, therefore adversity had both a direct and indirect impact on psychopathology. The findings highlight the importance of developing and maintaining social networks following military life. Recommendations include interpersonal skills training and programmes which may help them engage back into the community and enhance relationships.
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Affiliation(s)
- M McLafferty
- Ulster University, Cromore Road, Coleraine, Northern Ireland, United Kingdom.
| | - J Ross
- Ulster University, Cromore Road, Coleraine, Northern Ireland, United Kingdom
| | | | - C Armour
- Ulster University, Cromore Road, Coleraine, Northern Ireland, United Kingdom
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Exploring patterns of alcohol misuse in treatment-seeking UK veterans: A cross-sectional study. Addict Behav 2019; 92:14-19. [PMID: 30572207 DOI: 10.1016/j.addbeh.2018.11.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/05/2018] [Accepted: 11/28/2018] [Indexed: 11/22/2022]
Abstract
AIMS To explore patterns of alcohol misuse in a sample of treatment-seeking veterans compared to the UK Armed Forces personnel population and the general public. Furthermore, the present study investigated which variables were associated with alcohol misuse in this sample, and in particular what factors were associated with increased or decreased severity of alcohol misuse. METHOD The present study investigated alcohol misuse in treatment-seeking veterans and compared it with the UK Armed Forces and the general public. In addition, it explored associations between sociodemographic, physical health and mental health variables and alcohol misuse. RESULTS Results suggested that treatment-seeking veterans report different patterns of alcohol misuse compared to the UK Armed Forces and the general public. This group was more likely to report alcohol dependence and alcohol-related harm. They also reported higher levels of overall alcohol misuse than the general public. Mental health problems including PTSD, anxiety and depression, as well as anger, functional impairment and being single were all related to greater alcohol misuse. Being older and not in work were related to reduced alcohol misuse. CONCLUSIONS These findings add further weight to the importance of ensuring appropriate support is provided to personnel leaving the Armed Forces. Treatment-seeking veterans have specific patterns of alcohol-related needs that should be addressed. Knowing more about the common alcohol-related problems in this group can help inform and improve mental health interventions. Findings on related variables will help in identifying those individuals who may be at most risk of alcohol-related problems.
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97
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Goldberg SB, Simpson TL, Lehavot K, Katon JG, Chen JA, Glass JE, Schnurr PP, Sayer NA, Fortney JC. Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras. Psychiatr Serv 2019; 70:358-366. [PMID: 30841842 PMCID: PMC6510540 DOI: 10.1176/appi.ps.201800444] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study compared delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder among post-9/11 veterans versus pre-9/11 veterans and civilians. METHODS The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative survey of U.S. noninstitutionalized adults, was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, or alcohol use disorder. Cox proportional hazard models, controlling for relevant demographic characteristics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment). RESULTS Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (adjusted hazard ratios [AHRs]=0.69 and 0.74, respectively) and civilians (AHRs=0.60 and 0.67, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol use disorder. In an exploratory analysis, post-9/11 veterans with past-year military health care coverage (e.g., Veterans Health Administration) had shorter delays for depression treatment compared with post-9/11 veterans without military coverage, pre-9/11 veterans regardless of health care coverage, and civilians, although past-year coverage did not predict treatment delay for PTSD or alcohol use disorder. CONCLUSIONS Post-9/11 veterans were less likely to delay treatment for some common psychiatric conditions compared with pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol use disorder, highlighting the need for further engagement efforts.
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Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Tracy L Simpson
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Keren Lehavot
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Jodie G Katon
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Jessica A Chen
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Joseph E Glass
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Paula P Schnurr
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - Nina A Sayer
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
| | - John C Fortney
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer)
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98
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Pajser A, Limoges A, Long C, Pickens CL. Individual differences in voluntary alcohol consumption are associated with conditioned fear in the fear incubation model. Behav Brain Res 2019; 362:299-310. [PMID: 30664887 PMCID: PMC6415663 DOI: 10.1016/j.bbr.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/24/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022]
Abstract
Previous research in male Long Evans rats has shown a relationship between low voluntary alcohol consumption and high conditioned fear after a single training session. Here, we determined whether chronic intermittent access (CIA) to alcohol during adolescence/early adulthood or during adulthood would alter or be associated with auditory-cued conditioned fear levels using an extended training fear incubation procedure. This training procedure leads to low fear soon after training that grows over one month. Rats received 6 weeks of CIA to 20% alcohol or water from PND 26-66. Ten or eleven days later, the rats began behavioral testing that included 10 sessions of tone-shock pairings. Rats then received 4 weeks of CIA exposure during the 1-month fear incubation period and were tested for conditioned fear 6 days after the end of alcohol access. We found no evidence that voluntary alcohol consumption during adolescence/early adulthood or adulthood altered fear expression. However, we found that rats that consumed more alcohol during early adulthood (PND 54-66) had lower fear than low-consumption rats on day 1 of conditioned fear training and in the day 2 and 1-month tests. This extends associations we previously found between individual differences in alcohol consumption and conditioned fear to a different fear conditioning procedure. Combined with our previous data that show that the rate of instrumental extinction is associated with both alcohol consumption and conditioned fear, these data provide further support for the generality and reliability of a pair of phenotypes that encompass a wide variety of learning traits.
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Affiliation(s)
- Alisa Pajser
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Aaron Limoges
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Charday Long
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Charles L Pickens
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA.
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99
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Kang B, Xu H, McConnell ES. Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: A systematic review. Int J Geriatr Psychiatry 2019; 34:522-538. [PMID: 30588665 DOI: 10.1002/gps.5055] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is associated with neurocognitive and psychiatric comorbidities, and older adults experience comorbid illnesses disproportionately. Little is known about the comorbidities of PTSD among older veterans. This systematic review examines the prevalence, incidence, and patterns of neurocognitive and psychiatric comorbidities of PTSD among older veterans and explores the factors associated with these comorbidities. METHODS A systematic literature review was performed using PubMed, CINAHL, and PsycINFO databases. The search was limited to peer-reviewed articles published in English from January 1980 to October 2018. Eligible studies examined the comorbid neurocognitive and psychiatric disorders of PTSD among veterans aged 60 and older. RESULTS Twenty-four studies met the criteria for inclusion. The risk for dementia was higher in veterans with PTSD than those without PTSD; hazard ratios ranged from 1.21 to 1.77. Depressive disorder was the most prevalent psychiatric comorbidity with estimates ranging from 33% to 52.3%, followed by generalized anxiety disorder (14%-15%) and substance use disorders (1.9%-11.3%). Factors consistently associated with PTSD comorbidities included age, combat-related exposures, clinical conditions, and health-related and psychosocial outcomes. CONCLUSIONS Despite heterogeneity in research designs and methodological limitations, this review highlights the need to consider comorbid neurocognitive and psychiatric disorders among older veterans with PTSD in order to individualize care approaches. Future research should incorporate factors associated with neurocognitive and psychiatric comorbidities of PTSD into study designs that can help improve prediction of comorbidity and generate evidence for developing and implementing tailored treatments in older veterans.
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Affiliation(s)
- Bada Kang
- School of Nursing, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center (GRECC), Durham Department of Veterans Affairs (VA) Medical Center, Durham, NC, USA
| | - Hanzhang Xu
- School of Nursing, Duke University, Durham, NC, USA.,Department of Community and Family Medicine, Duke University, Durham, NC, USA
| | - Eleanor S McConnell
- School of Nursing, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center (GRECC), Durham Department of Veterans Affairs (VA) Medical Center, Durham, NC, USA
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100
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Koek RJ, Luong TN. Theranostic pharmacology in PTSD: Neurobiology and timing. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:245-263. [PMID: 30529001 DOI: 10.1016/j.pnpbp.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
Recent reviews and treatment guidelines regard trauma-focused cognitive-behavior therapies as the treatments of choice for chronic post-traumatic stress disorder (PTSD). However, many patients do not engage in this treatment when it is available, drop out before completion, or do not respond. Medications remain widely used, alone and in conjunction with psychotherapy, although the limitations of traditional monoamine-based pharmacotherapy are increasingly recognized. This article will review recent developments in psychopharmacology for PTSD, with a focus on current clinical data that apply putative neurobiologic mechanisms to medication use-i.e., a theranostic approach. A theranostic approach however, also requires consideration of timing, pre, peri or post trauma in conjunction with underlying dynamic processes affecting synaptic plasticity, the HPA axis, hippocampal activation, PFC-amygdala circuitry and fear memory.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.
| | - Tinh N Luong
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Olive View Medical Center, Sylmar, CA, USA
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