51
|
Welsh JA, Olson JR, Perkins DF. Gender Differences in Post-deployment Adjustment of Air Force Personnel: The Role of Wartime Experiences, Unit Cohesion, and Self-efficacy. Mil Med 2019; 184:e229-e234. [PMID: 30371812 DOI: 10.1093/milmed/usy261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Janet A Welsh
- Bennett Pierce Prevention Research Center, Pennsylvania State University, 320 H Biobehavioral Health Building, University Park, PA
| | - Jonathan R Olson
- Department of Counseling and Health Psychology, Bastyr University, 14500 Juanita Dr. NE, Kenmore, WA
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University, 305 Marion Building, University Park, PA
| |
Collapse
|
52
|
Colic S, J Richardson D, James Reilly P, Gary Hasey M. Using Machine Learning Algorithms to Enhance the Management of Suicide Ideation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4936-4939. [PMID: 30441450 DOI: 10.1109/embc.2018.8513200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Combat veterans; especially those with mental health conditions are an at risk group for suicidal ideation and behaviour. This study attempts to use machine learning algorithm to predict suicidal ideation (SI) in a treatment seeking veteran population. Questionnaire data from 738 patients consisting of veterans, still serving members of the Canadian Forces (CF) and Royal Canadian Mountain Police (RCMP) were examined to determine the likelihood of suicide ideation and to identify key variables for tracking the risk of suicide. Unlike conventional approaches we use pattern recognition methods, known collectively as machine learning (ML), to examine multivariate data and identify patterns associate with suicidal ideation. Our findings show that accurate prediction of SI of over 84.4% can be obtained with 25 variables, and 81% using as little as 10 variables primarily obtained from the patient health questionnaire (PHQ). Surprisingly the best identifiers for SI did not come from occupational experiences but rather the patient quality of health, signifying that these findings could be applied to the general population. Our results suggest that ML could assist clinicians to develop a better screening aid for suicidal ideation and behaviour.
Collapse
|
53
|
Diffusion Imaging Findings in US Service Members With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. J Head Trauma Rehabil 2018; 33:393-402. [DOI: 10.1097/htr.0000000000000378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
54
|
Ogle AD, Reichwald R, Rutland JB. Psychological impact of remote combat/graphic media exposure among US Air Force intelligence personnel. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1502999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alan D. Ogle
- 480th Intelligence, Surveillance, and Reconnaissance Wing, Langley AFB, Virginia
| | - Reed Reichwald
- 480th Intelligence, Surveillance, and Reconnaissance Wing, Langley AFB, Virginia
| | - J. Brian Rutland
- 480th Intelligence, Surveillance, and Reconnaissance Wing, Langley AFB, Virginia
| |
Collapse
|
55
|
Schreurs BG, Smith-Bell C, Burhans LB. Sex differences in a rabbit eyeblink conditioning model of PTSD. Neurobiol Learn Mem 2018; 155:519-527. [PMID: 29702205 DOI: 10.1016/j.nlm.2018.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/12/2018] [Accepted: 04/22/2018] [Indexed: 01/18/2023]
Abstract
We have developed a rabbit model of posttraumatic stress disorder (PTSD) which recapitulates several core features of PTSD, particularly hyperarousal and conditioned responding to trauma-associated cues. The work conducted with this model has all been done in male rabbits and, given sex differences in PTSD prevalence, it is important to expand our animal model of PTSD to include female rabbits to determine if they develop core features of PTSD, and if those core features can be treated. This is particularly important because, contrary to human studies, nearly all animal studies have found that males are consistently more vulnerable to various forms of acute and chronic stress than females. Using eyeblink conditioning in which we paired tone with a brief periorbital shock, we found that although both male and female rabbits acquired identical levels of conditioning, females showed more hyperarousal after conditioning but seemed to respond somewhat better to treatment.
Collapse
Affiliation(s)
- Bernard G Schreurs
- Blanchette Rockefeller Neurosciences Institute, West Virginia University, United States; Department of Physiology, Pharmacology and Neuroscience, West Virginia University, United States.
| | - Carrie Smith-Bell
- Blanchette Rockefeller Neurosciences Institute, West Virginia University, United States; Department of Physiology, Pharmacology and Neuroscience, West Virginia University, United States
| | - Lauren B Burhans
- Blanchette Rockefeller Neurosciences Institute, West Virginia University, United States; Department of Physiology, Pharmacology and Neuroscience, West Virginia University, United States
| |
Collapse
|
56
|
Schreurs BG, Smith-Bell CA, Burhans LB. Delayed unpaired extinction as a treatment for hyperarousal of the rabbit nictitating membrane response and its implications for treating PTSD. J Psychiatr Res 2018; 99:1-9. [PMID: 29407282 PMCID: PMC5849523 DOI: 10.1016/j.jpsychires.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 11/15/2022]
Abstract
Treatment for PTSD (Post-traumatic stress disorder) is rarely available immediately after trauma and often delayed for weeks or months after an event. In a rabbit eyeblink conditioning model of PTSD, we have previously shown that presentations of a tone conditioned stimulus (CS) and shock unconditioned stimulus (US) in an explicitly unpaired manner known as unpaired extinction is effective in reducing CS responding and US hyperarousal even if shock intensity is reduced eight-fold and elicits only minimal responding. Here we determined if delayed delivery of unpaired extinction would still be effective in extinguishing hyperarousal. Rabbits were tested for sensitivity to shock before CS-US pairings and after six days of unpaired extinction presented a day, a week or a month after CS-US pairings. Hyperarousal was extinguished a day and a week after conditioning but not after a month suggesting a significant delay in "treatment" can make hyperarousal persist. We next assessed if this persistence of hyperarousal was associative by comparing rabbits given CS-US pairings to those given explicitly unpaired CS and US presentations, measuring hyperarousal a day and a month later, followed by unpaired extinction and hyperarousal assessment. After four weeks, there was an increase in responding for all rabbits but only rabbits receiving CS-US pairings showed a significant increase in associatively-mediated hyperarousal. Importantly, both paired and unpaired groups showed increased levels of responding after unpaired extinction suggesting treatment delayed for too long may no longer be effective and could cause generalized hyperarousal.
Collapse
Affiliation(s)
- Bernard G. Schreurs
- Blanchette Rockefeller Neurosciences Institute, West Virginia University,Department of Physiology, Pharmacology and Neuroscience, West Virginia University,Corresponding author: Bernard G. Schreurs, 1024 BRNI Building, 8 Medical Center Drive, Morgantown, WV 26505
| | - Carrie A. Smith-Bell
- Blanchette Rockefeller Neurosciences Institute, West Virginia University,Department of Physiology, Pharmacology and Neuroscience, West Virginia University
| | - Lauren B. Burhans
- Blanchette Rockefeller Neurosciences Institute, West Virginia University,Department of Physiology, Pharmacology and Neuroscience, West Virginia University
| |
Collapse
|
57
|
Mendoza C, Barreto GE, Iarkov A, Tarasov VV, Aliev G, Echeverria V. Cotinine: A Therapy for Memory Extinction in Post-traumatic Stress Disorder. Mol Neurobiol 2018; 55:6700-6711. [PMID: 29335846 DOI: 10.1007/s12035-018-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally threatening or unescapable horrifying events. Actual therapies fail to alleviate the emotional suffering and cognitive impairment associated with this disorder, mostly because they are ineffective in treating the failure to extinguish trauma memories in a great percentage of those affected. In this review, current behavioral, cellular, and molecular evidence supporting the use of cotinine for treating PTSD are reviewed. The role of the positive modulation by cotinine of the nicotinic acetylcholine receptors (nAChRs) and their downstream effectors, the protection of astroglia, and the inhibition of microglia in the PTSD brain are also discussed.
Collapse
Affiliation(s)
- Cristhian Mendoza
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Alexandre Iarkov
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - Vadim V Tarasov
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Severniy Proezd, Chernogolovka, Moscow Region, 1142432, Russia. .,"GALLY" International Biomedical Research Consulting LLC, San Antonio, TX, 78229, USA. .,School of Health Sciences and Healthcare Administration, University of Atlanta, Johns Creek, GA, 30097, USA.
| | - Valentina Echeverria
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile. .,Bay Pines VA Healthcare System, Research and Development, Bay Pines, FL, 33744, USA.
| |
Collapse
|
58
|
THE DEPENDENCE OF THE AFFECTIVE DISORDERS MANIFESTATION ON MORPHOFUNCTIONAL CONDITION OF THE BRAIN AFTER TRAUMATIC BRAIN INJURY. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2018-2-64-29-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
59
|
Rauch SA, Simon NM, Kim HM, Acierno R, King AP, Norman SB, Venners MR, Porter K, Phan KL, Tuerk PW, Allard C, Liberzon I, Rothbaum BO, Martis B, Stein MB, Hoge CW. Integrating biological treatment mechanisms into randomized clinical trials: Design of PROGrESS (PROlonGed ExpoSure and Sertraline Trial). Contemp Clin Trials 2018; 64:128-138. [DOI: 10.1016/j.cct.2017.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 01/07/2023]
|
60
|
Griffith J. Homecoming of Citizen Soldiers: Postdeployment Problems and Service Use Among Army National Guard Soldiers. Community Ment Health J 2017; 53:766-777. [PMID: 28341891 DOI: 10.1007/s10597-017-0132-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
Abstract
The present study described the types and amount of problems and services sought among returned deployed Army National Guard soldiers (4568 soldiers in 50 units). The study responds to gaps in the research literature to better understand community intervention needs of reservists. About half (48%) of the soldiers reported one or two problems, mostly those of psychological well-being, such as feelings of anger and frustration, upsetting memories, and troubled sleep (34% of the study sample), followed by problems of social support (18%), alcohol use (17%), feelings of isolation including suicidal thoughts (13%), and financial difficulties (11%). Having engaged in direct combat and having wounded or killed someone showed positive relationships with reported problems. One-third (35%) of soldiers who reported having used services went to one service and, generally, soldiers went to services related to their expressed problems. Variance in self-reported problems explained by service use was low, suggesting unsought postdeployment services.
Collapse
Affiliation(s)
- James Griffith
- National Center for Veterans Studies, University of Utah, Salt Lake City, UT, USA.
- , 229 North Forest Dune Drive, St. Augustine, FL, 32080, USA.
| |
Collapse
|
61
|
Servatius RJ, Handy JD, Doria MJ, Myers CE, Marx CE, Lipsky R, Ko N, Avcu P, Wright WG, Tsao JW. Stress-Related Mental Health Symptoms in Coast Guard: Incidence, Vulnerability, and Neurocognitive Performance. Front Psychol 2017; 8:1513. [PMID: 28959220 PMCID: PMC5603677 DOI: 10.3389/fpsyg.2017.01513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/21/2017] [Indexed: 11/17/2022] Open
Abstract
U.S. Coast Guard (CG) personnel face occupational stressors (e.g., search and rescue) which compound daily life stressors encountered by civilians. However, the degree CG personnel express stress-related mental health symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is understudied as a military branch, and little is known concerning the interplay of vulnerabilities and neurocognitive outcomes in CG personnel. The current study addressed this knowledge gap, recruiting 241 active duty CG personnel (22% female) to assess mental health, personality, and neurocognitive function. Participants completed a battery of scales: PTSD Checklist with military and non-military prompts to screen for PTSD, Psychological Health Questionnaire 8 for MDD, and scales for behaviorally inhibited (BI) temperament, and distressed (Type D) personality. Neurocognitive performance was assessed with the Defense Automated Neurobehavioral Assessment (DANA) battery. Cluster scoring yielded an overall rate of PTSD of 15% (95% CI: 11–20%) and 8% (95% CI: 3–9%) for MDD. Non-military trauma was endorsed twice that of military trauma in those meeting criteria for PTSD. Individual vulnerabilities were predictive of stress-related mental health symptoms in active duty military personnel; specifically, BI temperament predicted PTSD whereas gender and Type D personality predicted MDD. Stress-related mental health symptoms were also associated with poorer reaction time and response inhibition. These results suggest rates of PTSD and MDD are comparable among CG personnel serving Boat Stations to those of larger military services after combat deployment. Further, vulnerabilities distinguished between PTSD and MDD, which have a high degree of co-occurrence in military samples. To what degree stress-related mental healthy symptoms and attendant neurocognitive deficits affect operational effectiveness remains unknown and warrant future study.
Collapse
Affiliation(s)
- Richard J Servatius
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical CenterSyracuse, NY, United States.,Department of Psychiatry, State University of New York Upstate Medical UniversitySyracuse, NY, United States.,Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States
| | - Justin D Handy
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical CenterSyracuse, NY, United States.,Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States
| | | | - Catherine E Myers
- Department of Veterans Affairs, VA New Jersey Health Care SystemEast Orange, NJ, United States.,Department of Pharmacology, Physiology & Neuroscience, Rutgers Biomedical Health Sciences, Rutgers UniversityNewark, NJ, United States
| | - Christine E Marx
- Veterans Affairs Mid-Atlantic Mental Illness, Research Education and Clinical Center, Durham Veterans Affairs Medical CenterDurham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, United States
| | - Robert Lipsky
- Department of Neurosciences, INOVA Health SystemFairfax, VA, United States
| | - Nora Ko
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States.,Program of Neuroscience, Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, United States
| | - Pelin Avcu
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States.,Program of Neuroscience, Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, United States
| | - W Geoffrey Wright
- Neuromotor Sciences Program, Temple UniversityPhiladelphia, PA, United States
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science CenterMemphis, TN, United States.,Department of Neurology, Memphis Veteran Affairs Administration Medical CenterMemphis, TN, United States.,Children's Foundation Research Institute, Le Bonheur Children's HospitalMemphis, TN, United States
| |
Collapse
|
62
|
Johansen T. Core Competencies in VA Compensation and Pension Exams for PTSD and Other Mental Disorders. PSYCHOLOGICAL INJURY & LAW 2017. [DOI: 10.1007/s12207-017-9298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
63
|
Blount TH, Peterson AL, Monson CM. A Case Study of Cognitive-Behavioral Conjoint Therapy for Combat-Related PTSD in a Same-Sex Military Couple. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
64
|
Converging, Synergistic Actions of Multiple Stress Hormones Mediate Enduring Memory Impairments after Acute Simultaneous Stresses. J Neurosci 2017; 36:11295-11307. [PMID: 27807170 DOI: 10.1523/jneurosci.2542-16.2016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022] Open
Abstract
Stress influences memory, an adaptive process crucial for survival. During stress, hippocampal synapses are bathed in a mixture of stress-released molecules, yet it is unknown whether or how these interact to mediate the effects of stress on memory. Here, we demonstrate novel synergistic actions of corticosterone and corticotropin-releasing hormone (CRH) on synaptic physiology and dendritic spine structure that mediate the profound effects of acute concurrent stresses on memory. Spatial memory in mice was impaired enduringly after acute concurrent stresses resulting from loss of synaptic potentiation associated with disrupted structure of synapse-bearing dendritic spines. Combined application of the stress hormones corticosterone and CRH recapitulated the physiological and structural defects provoked by acute stresses. Mechanistically, corticosterone and CRH, via their cognate receptors, acted synergistically on the spine-actin regulator RhoA, promoting its deactivation and degradation, respectively, and destabilizing spines. Accordingly, blocking the receptors of both hormones, but not each alone, rescued memory. Therefore, the synergistic actions of corticosterone and CRH at hippocampal synapses underlie memory impairments after concurrent and perhaps also single, severe acute stresses, with potential implications to spatial memory dysfunction in, for example, posttraumatic stress disorder. SIGNIFICANCE STATEMENT Stress influences memory, an adaptive process crucial for survival. During stress, adrenal corticosterone and hippocampal corticotropin-releasing hormone (CRH) permeate memory-forming hippocampal synapses, yet it is unknown whether (and how) these hormones interact to mediate effects of stress. Here, we demonstrate novel synergistic actions of corticosterone and CRH on hippocampal synaptic plasticity and spine structure that mediate the memory-disrupting effects of stress. Combined application of both hormones provoked synaptic function collapse and spine disruption. Mechanistically, corticosterone and CRH synergized at the spine-actin regulator RhoA, promoting its deactivation and degradation, respectively, and destabilizing spines. Notably, blocking both hormones, but not each alone, prevented the enduring memory problems after acute concurrent stresses. Therefore, synergistic actions of corticosterone and CRH underlie enduring memory impairments after concurrent acute stresses, which might be relevant to spatial memory deficits described in posttraumatic stress disorder.
Collapse
|
65
|
Webber JM, Kitzinger R, Runte JK, Smith CM, Mascari JB. Traumatology Trends: A Content Analysis of Three Counseling Journals From 1994 to 2014. JOURNAL OF COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jcad.12139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Julia K. Runte
- Multicultural Division; Soong Ching Ling School; Shanghai China
| | | | | |
Collapse
|
66
|
McFarlane AC. Is screening for the psychological effects of war useful? Lancet 2017; 389:1372-1374. [PMID: 28215662 DOI: 10.1016/s0140-6736(17)30073-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Alexander C McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, SA 5000, Australia.
| |
Collapse
|
67
|
Petta LM. Resonance Frequency Breathing Biofeedback to Reduce Symptoms of Subthreshold PTSD with an Air Force Special Tactics Operator: A Case Study. Appl Psychophysiol Biofeedback 2017; 42:139-146. [DOI: 10.1007/s10484-017-9356-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
68
|
Unique Contributions of Body Diagram Scores and Psychosocial Factors to Pain Intensity and Disability in Patients With Musculoskeletal Pain. J Orthop Sports Phys Ther 2017; 47:88-96. [PMID: 27819193 DOI: 10.2519/jospt.2017.6778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Retrospective cross-sectional cohort of military patients with musculoskeletal pain. Background Body diagrams are used to document symptoms and can also serve as a proxy to assess psychological influence. However, literature to support this is conflicting. Objectives To (1) examine the unique contribution of pain and nonpain symptom distribution to magnitude of self-reported pain intensity and disability, and (2) assess the moderating influence of psychological factors and body diagram score on concurrent pain intensity and disability. Methods Pain, numbness, and tingling were denoted on a body diagram at initial evaluation. Fear-avoidance beliefs, pain catastrophizing, and region-specific self-reported disability measures were collected. The contributions of pain and nonpain symptom distribution to pain intensity and disability were assessed to determine which body diagram symptom scoring method (pain only, nonpain, or composite) was appropriate for subsequent analyses. Hierarchical linear regression analyses were then used to determine the moderating effects of the Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire and the body diagram score on concurrent pain and disability. Results The Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire explained between 16% and 17% of the variance in pain intensity, and 8% of variance in disability (all, P<.001). The composite symptom score explained an additional 4% to 5% variance in concurrent disability and pain intensity (all, P<.001). The Pain Catastrophizing Scale moderated the relationship between body diagram score and pain intensity. The positive relationship between composite symptom score and concurrent pain intensity is stronger for patients with low catastrophizing. Conclusion The clinical utility of body diagrams with low symptom distribution may be improved by concomitant assessment of pain catastrophizing and warrants further longitudinal investigation. Level of Evidence Symptom prevalence, level 2b. J Orthop Sports Phys Ther 2017;47(2):88-96. Epub 5 Nov 2016. doi:10.2519/jospt.2017.6778.
Collapse
|
69
|
Diehle J, Brooks SK, Greenberg N. Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents' secondary traumatic stress? Soc Psychiatry Psychiatr Epidemiol 2017; 52:35-44. [PMID: 27770173 PMCID: PMC5227001 DOI: 10.1007/s00127-016-1292-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/10/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE Previous research has mainly focused on veterans' mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran's experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans. METHODS We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles. RESULTS Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring's experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent's experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %. CONCLUSIONS Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail.
Collapse
Affiliation(s)
- Julia Diehle
- King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK.
| | | | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK ,Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
| |
Collapse
|
70
|
Olthuis JV, Wozney L, Asmundson GJG, Cramm H, Lingley-Pottie P, McGrath PJ. Distance-delivered interventions for PTSD: A systematic review and meta-analysis. J Anxiety Disord 2016; 44:9-26. [PMID: 27697658 DOI: 10.1016/j.janxdis.2016.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.
Collapse
Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada.
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS.
| | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON.
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS; Department of Psychiatry, Dalhousie University, Canada.
| | - Patrick J McGrath
- Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Canada; IWK Health Centre and Nova Scotia Health Authority, Halifax, NS.
| |
Collapse
|
71
|
Moazen-Zadeh E, Khoshdel A, Avakh F, Rahmani A. Increased blood pressures in veterans with post traumatic stress disorder. Int J Psychiatry Med 2016. [PMID: 28629292 DOI: 10.1177/0091217417696734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective Veterans of war affected by posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular diseases. We aimed to compare brachial and central blood pressures between veterans with PTSD and controls. Method In this case-control study on veterans of Iran-Iraq war, 50 veterans with PTSD and 50 veterans as controls were selected from an outpatient clinic and matched for age ±3 years. Exclusion criteria were malignancies, severe anatomical defects such as amputated extremities, history of PTSD before serving in war, comorbid psychiatric disorders other than anxiety or depressive disorders. Detailed history was taken concerning medical and social aspects. Beck Depression Inventory was used for depressive symptoms. Brachial blood pressures were measured using both auscultatory and oscillometric devices. Measures of central hemodynamics were estimated accordingly. Data on lipid profile were collected either through medical records or newly required lab tests. Results Brachial systolic, diastolic, and pulse pressures as well as estimated central systolic and diastolic pressures were significantly higher in the PTSD group. Beck Depression Inventory scores, frequency of diabetes mellitus, and hypertension were significantly higher in the PTSD group. PTSD status was an independent predictor of both brachial and central systolic and diastolic pressures. Conclusions We demonstrated increased measures of blood pressure in veterans with PTSD independent of depression and other risk factors. Further research is warranted to confirm our results.
Collapse
Affiliation(s)
- Ehsan Moazen-Zadeh
- 1 Modern Epidemiology Research Center, Aja University of Medical Sciences, Tehran, Iran
- 2 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
- 3 Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshdel
- 1 Modern Epidemiology Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Farhad Avakh
- 4 Faculty of Aerospace and Diving Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Arash Rahmani
- 3 Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
72
|
Stevens JS, Ely TD, Sawamura T, Guzman D, Bradley B, Ressler KJ, Jovanovic T. CHILDHOOD MALTREATMENT PREDICTS REDUCED INHIBITION-RELATED ACTIVITY IN THE ROSTRAL ANTERIOR CINGULATE IN PTSD, BUT NOT TRAUMA-EXPOSED CONTROLS. Depress Anxiety 2016; 33:614-22. [PMID: 27062552 PMCID: PMC4930398 DOI: 10.1002/da.22506] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND A deficit in the ability to inhibit fear has been proposed as a biomarker of posttraumatic stress disorder (PTSD). Previous research indicates that individuals with PTSD show reduced inhibition-related activation in rostral anterior cingulate cortex (rACC). The goal of the current study was to investigate differential influences of an early environmental risk factor for PTSD-childhood maltreatment-on inhibition-related brain function in individuals with PTSD versus trauma-exposed controls. METHODS Individuals with PTSD (n = 37) and trauma-exposed controls (n = 53) were recruited from the primary care waiting rooms of an urban public hospital in Atlanta, GA. Participants completed an inhibition task during fMRI, and reported childhood and adult traumatic experiences. The groups were matched for adult and child trauma load. RESULTS We observed an interaction between childhood maltreatment severity and PTSD status in the rACC (P < .05, corrected), such that maltreatment was negatively associated with inhibition-related rACC activation in the PTSD group, but did not influence rACC activation in the TC group. Rostral ACC activation was associated with inhibition-related task performance in the TC group but not the PTSD group, suggesting a possible contribution to stress resilience. CONCLUSIONS Findings highlight individual differences in neural function following childhood trauma, and point to inhibition-related activation in rostral ACC as a risk factor for PTSD.
Collapse
Affiliation(s)
- Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D. Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Takehito Sawamura
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Division of Behavioral Sciences, National Defense Medical College Research Institute, Japan
| | - Dora Guzman
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Cambridge, MA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
73
|
Thompson JM, VanTil LD, Zamorski MA, Garber B, Dursun S, Fikretoglu D, Ross D, Richardson JD, Sareen J, Sudom K, Courchesne C, Pedlar DJ. Mental health of Canadian Armed Forces Veterans: review of population studies. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2016. [DOI: 10.3138/jmvfh.3258] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction. The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods. Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results. Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion. The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.
Collapse
Affiliation(s)
- James M. Thompson
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Linda D. VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Bryan Garber
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Sanela Dursun
- Director General Military Personnel Research and Analysis (DGMPRA), Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Defense Research and Development Canada, Toronto, Ontario, Canada
| | - David Ross
- National Centre for Operational Stress Injuries, Veterans Affairs Canada, Sainte-Anne-de-Bellevue, QC
| | | | - Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis (DGMPRA), Ottawa, Ontario, Canada
| | - Cyd Courchesne
- Health Professionals, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - David J. Pedlar
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| |
Collapse
|
74
|
Brunet A, Monson E, Liu A, Fikretoglu D. Trauma Exposure and Posttraumatic Stress Disorder in the Canadian Military. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:488-96. [PMID: 26720506 PMCID: PMC4679129 DOI: 10.1177/070674371506001104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/01/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To estimate the lifetime prevalence of trauma exposure and posttraumatic stress disorder (PTSD) among a representative, active military sample, and to identify demographic and military variables that modulate rates of trauma exposure as well as PTSD rates and duration. METHOD A cross-sectional weighted sample of 5155 regular members and 3957 reservists (n = 8441) of the Canadian Armed Forces (CAF) was face-to-face interviewed using a lay-administered structured interview that generates Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychiatric diagnoses. RESULTS Within this sample, 85.6% reported 1 or more trauma exposure, with a median number of 3 or more exposures. Compared with males, females were less likely (P < 0.05) to be exposed to warlike trauma (adjusted odds ratio [AOR] 0.40), disasters (AOR 0.43), assaultive violence (AOR 0.52), and witnessing trauma (AOR 0.75). However, they were more likely to report sexual assault (AOR 7.36). The lifetime prevalence of PTSD was 6.6% and the conditional rate was 7.7%. Both lifetime and conditional PTSD rates were higher among female soldiers, but lower among the reserve forces, both male and female. Finally, the median duration of PTSD was negatively influenced by younger age of onset, but not influenced by whether the event occurred during deployment. CONCLUSIONS Active members of the CAF report a high degree of trauma exposure but a moderate rate of lifetime PTSD.
Collapse
Affiliation(s)
- Alain Brunet
- Director, Society and Mental Health Program, Douglas Mental Health University Institute, Montreal, Quebec; Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| | - Eva Monson
- Postdoctoral Trainee, Concordia University, Montreal, Quebec
| | - Aihua Liu
- Statistician, Douglas Mental Health University Institute, Montreal, Quebec
| | - Deniz Fikretoglu
- Defence Scientist, Defence Research and Development Canada, Toronto, Ontario
| |
Collapse
|
75
|
Caspi Y, Slobodin O, Klein E. Cultural Perspectives on the Aftereffects of Combat Trauma: Review of a Community Study of Bedouin IDF Servicemen and Their Families. Rambam Maimonides Med J 2015; 6:e0021. [PMID: 25973273 PMCID: PMC4422460 DOI: 10.5041/rmmj.10205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Combat trauma may affect servicemen from indigenous, traditional communities in ways that warrant special attention. The Bedouins, who enlist in the Israel Defense Forces (IDF) voluntarily, represent a unique, closed, collectivist cultural minority, potentially in a predicament in light of ongoing sociopolitical events. This paper summarizes findings and lessons learned from a community study of Bedouin IDF servicemen and their families residing in Israel's Western Galilee. This is the only research endeavor to have addressed trauma exposure and posttraumatic reactions in this community. The sampling strategies and interview schedule were designed in consideration of participation barriers typical of hard-to-reach populations. Data collection followed an extended phase of liaising with key informants and building trust. Study limitations are discussed in terms of the challenges presented by this type of research. Interviews conducted with 317 men, 129 wives, and 67 mothers revealed high levels of trauma exposure and posttraumatic stress disorder (PTSD) in the men, and related distress in wives and mothers, but not in the children. The role of aggression in mediating the impact of PTSD and concepts such as shame, the loss of personal resources, and beliefs about retribution are highlighted as key issues for a culturally relevant understanding of traumatized indigenous communities.
Collapse
Affiliation(s)
- Yael Caspi
- Department of Psychiatry, Rambam Medical Health Care Center, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Ortal Slobodin
- i-psy (intercultural psychiatry), Amsterdam, The Netherlands
| | - Ehud Klein
- Department of Psychiatry, Rambam Medical Health Care Center, Haifa, Israel
- The Bruce & Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
76
|
Brunet A, Monson E. Suicide risk among active and retired Canadian soldiers: the role of posttraumatic stress disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:457-9. [PMID: 25565691 PMCID: PMC4168807 DOI: 10.1177/070674371405900901] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/01/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Alain Brunet
- Associate Professor, Department of Psychiatry, McGill University; Director, Psychosocial Research Division, Douglas Institute, Montreal, Quebec
| | - Eva Monson
- Doctoral Student, Department of Psychiatry, McGill University, Montreal, Quebec
| |
Collapse
|