151
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Wahlberg Å, Andreen Sachs M, Johannesson K, Hallberg G, Jonsson M, Skoog Svanberg A, Högberg U. Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey. BJOG 2016; 124:1264-1271. [PMID: 27562912 DOI: 10.1111/1471-0528.14259] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine post-traumatic stress reactions among obstetricians and midwives, experiences of support and professional consequences after severe events in the labour ward. DESIGN Cross-sectional online survey from January 7 to March 10, 2014. POPULATION Members of the Swedish Society of Obstetrics and Gynaecology and the Swedish Association of Midwives. METHODS Potentially traumatic events were defined as: the child died or was severely injured during delivery; maternal near-miss; maternal mortality; and other events such as violence or threat. The validated Screen Questionnaire Posttraumatic Stress Disorder (SQ-PTSD), based on DSM-IV (1994) 4th edition, was used to assess partial post-traumatic stress disorder (PTSD) and probable PTSD. MAIN OUTCOME MEASURES Partial or probable PTSD. RESULTS The response rate was 47% for obstetricians (n = 706) and 40% (n = 1459) for midwives. Eighty-four percent of the obstetricians and 71% of the midwives reported experiencing at least one severe event on the delivery ward. Fifteen percent of both professions reported symptoms indicative of partial PTSD, whereas 7% of the obstetricians and 5% of the midwives indicated symptoms fulfilling PTSD criteria. Having experienced emotions of guilt or perceived insufficient support from friends predicted a higher risk of suffering from partial or probable PTSD. Obstetricians and midwives with partial PTSD symptoms chose to change their work to outpatient care significantly more often than colleagues without these symptoms. CONCLUSIONS A substantial proportion of obstetricians and midwives reported symptoms of partial or probable PTSD after severe traumatic events experienced on the labour ward. Support and resilience training could avoid suffering and consequences for professional carers. TWEETABLE ABSTRACT In a survey 15% of Swedish obstetricians and midwives reported PTSD symptoms after their worst obstetric event.
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Affiliation(s)
- Å Wahlberg
- Department of Women's and Children's Health/Obstetrics & Gynaecology, Uppsala University, Uppsala, Sweden.,Department of Gynaecology and Obstetrics, Skåne University Hospital, Malmö, Sweden
| | - M Andreen Sachs
- LIME/Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - K Johannesson
- Neuroscience/Psychiatry, Uppsala University, Uppsala, Sweden
| | - G Hallberg
- Department of Women's and Children's Health/Obstetrics & Gynaecology, Uppsala University, Uppsala, Sweden.,Department of Gynaecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden
| | - M Jonsson
- Department of Women's and Children's Health/Obstetrics & Gynaecology, Uppsala University, Uppsala, Sweden.,Department of Gynaecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden
| | - A Skoog Svanberg
- Department of Women's and Children's Health/Obstetrics & Gynaecology, Uppsala University, Uppsala, Sweden
| | - U Högberg
- Department of Women's and Children's Health/Obstetrics & Gynaecology, Uppsala University, Uppsala, Sweden
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152
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Young LB, Timko C, Tyler KA, Grant KM. Trauma in Veterans With Substance Use Disorder: Similar Treatment Need Among Urban and Rural Residents. J Rural Health 2016; 33:314-322. [DOI: 10.1111/jrh.12199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/17/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Lance Brendan Young
- Communication Department; Western Illinois University-Quad Cities; Moline Illinois
| | - Christine Timko
- Center for Innovation to Implementation; VA Palo Alto Health Care System; Menlo Park California
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Palo Alto California
| | - Kimberly A. Tyler
- Department of Sociology; University of Nebraska-Lincoln; Lincoln Nebraska
| | - Kathleen M. Grant
- Substance Use Disorders Program; VA Nebraska-Western Iowa Health Care System; Omaha Nebraska
- Department of Internal Medicine; University of Nebraska Medical Center; Omaha Nebraska
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153
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Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, Pickering RP, Ruan WJ, Huang B, Grant BF. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1137-48. [PMID: 27106853 PMCID: PMC4980174 DOI: 10.1007/s00127-016-1208-5] [Citation(s) in RCA: 323] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/16/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD). METHODS Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. RESULTS Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with <high school education and lower incomes, and rural residents. PTSD was significantly associated with a broad range of substance use, mood, anxiety, and personality disorders, and past-month disability. Among respondents with lifetime PTSD, 59.4 % sought treatment; an average of 4.5 years elapsed from disorder onset to first treatment. CONCLUSIONS DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help.
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Affiliation(s)
- Risë B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892,Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd., Room 7B13C, Bethesda, MD 20892
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892,Translational Blood Science and Resources Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Dr., Bethesda, MD 20892
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
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154
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Weitlauf J, Frayne SM, Lee T, Ruzek J, Finney J, Thrailkill A. Challenges of Research on Women Veterans with Traumatic Stress Disorders. J Empir Res Hum Res Ethics 2016; 2:54-7. [DOI: 10.1525/jer.2007.2.1.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Julie Weitlauf
- VA Palo Alto Health Care System, Center for Health Care Evaluation
- VA Palo Alto Health Care System, Women's Health Center
- Stanford University School of Medicine.]
| | - Susan M. Frayne
- VA Palo Alto Health Care System, Center for Health Care Evaluation
- VA Palo Alto Health Care System, Women's Health Center
- Stanford University School of Medicine.]
| | - Tina Lee
- VA Palo Alto Health Care System, Women's Health Center
- National Center for PTSD, Education Division
| | - Josef Ruzek
- VA Palo Alto Health Care System, Center for Health Care Evaluation
- National Center for PTSD, Education Division
| | - John Finney
- VA Palo Alto Health Care System, Center for Health Care Evaluation
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155
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Farhood L, Dimassi H, Lehtinen T. Exposure to War-Related Traumatic Events, Prevalence of PTSD, and General Psychiatric Morbidity in a Civilian Population From Southern Lebanon. J Transcult Nurs 2016; 17:333-40. [PMID: 16946115 DOI: 10.1177/1043659606291549] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The South of Lebanon has experienced prolonged armed conflict. The current study aims to investigate the degree of exposure to traumatic events and prevalence of posttraumatic stress disorder (PTSD) and nonspecific general psychiatric morbidity in a civilian population from the South of Lebanon. The design was cross-sectional with random sampling. War-related traumatic events and symptoms of PTSD were assessed by the Harvard Trauma Questionnaire and general psychiatric morbidity by the General Health Questionnaire (GHQ-28). Almost all participants, 97.7%, had experienced, witnessed, or heard of a war-related traumatic event. Current PTSD prevalence was 29.3%. PTSD symptoms correlated highly with GHQ-28 symptoms, r = .73 (p < .0001). The present study indicates a need for psychological interventions in the population and studies to assess such interventions.
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156
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Oglesby ME, Boffa JW, Short NA, Raines AM, Schmidt NB. Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. J Anxiety Disord 2016; 41:82-7. [PMID: 26803928 DOI: 10.1016/j.janxdis.2016.01.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/15/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022]
Abstract
Intolerance of uncertainty (IU) has been associated with elevated post-traumatic stress symptoms (PTSS) in the extant literature. However, no research to date has investigated whether pre-trauma IU predicts PTSS following trauma exposure. The current study prospectively examined the relationship between IU and PTSS within a sample of individuals with various levels of exposure to a university campus shooting. We hypothesized that pre-trauma IU would predict elevated PTSS following a campus shooting, even after covarying for anxiety sensitivity (AS), a known correlate of PTSS. Participants included undergraduates (n=77) who completed a self-report battery in Introductory Psychology. After a campus shooting, they were invited to complete measures of PTSD symptoms and level of exposure to the shooting. As anticipated, results revealed pre-trauma IU as a significant predictor of elevated PTSS following the campus shooting. These results remained significant after covarying for pre-trauma levels of AS. Our results are the first to demonstrate that elevated pre-trauma levels of IU predict later PTSS following exposure to a traumatic event. This finding is discussed in terms of promising directions for future research and treatment strategies.
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157
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Mathew AR, Cook JW, Japuntich SJ, Leventhal AM. Post-traumatic stress disorder symptoms, underlying affective vulnerabilities, and smoking for affect regulation. Am J Addict 2016; 24:39-46. [PMID: 25823634 DOI: 10.1111/ajad.12170] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/11/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Post-traumatic stress disorder (PTSD) is overrepresented among cigarette smokers. It has been hypothesized that those with PTSD smoke to alleviate negative affect and counteract deficient positive affect commonly associated with the disorder; however, limited research has examined associations between PTSD symptoms, smoking motives, and affective vulnerability factors. In the current study, we examined (1) whether PTSD symptoms were associated with positive reinforcement and negative reinforcement smoking motives; and (2) whether two affective vulnerability factors implicated in PTSD-anxiety sensitivity and anhedonia-mediated relationships between PTSD symptoms and smoking motives. METHODS Data were drawn from a community sample of non-treatment-seeking smokers recruited without regard for trauma history (N = 342; 10+ cig/day). We used the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) to assess overall PTSD symptom severity as well as individual PTSD subfactors. RESULTS Overall, PTSD symptom severity was significantly associated with negative reinforcement, but not positive reinforcement, smoking motives. Variation in anxiety sensitivity significantly mediated the relation between PTSD symptom severity and negative reinforcement smoking motives, whereas anhedonia did not. Regarding PTSD subfactors, emotional numbing was the only PTSD subfactor associated with smoking rate, while re-experiencing symptoms were uniquely associated with both positive reinforcement and negative reinforcement smoking motives. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Findings suggest that anxiety sensitivity may be an important feature associated with PTSD that enhances motivation to smoke for negative reinforcement purposes. Smoking cessation interventions that alleviate anxiety sensitivity and enhance coping with negative affect may be useful for smokers with elevated PTSD symptoms.
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Affiliation(s)
- Amanda R Mathew
- Departments of Neurosciences and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, Souuth Carolina
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158
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Humpston CS, Walsh E, Oakley DA, Mehta MA, Bell V, Deeley Q. The relationship between different types of dissociation and psychosis-like experiences in a non-clinical sample. Conscious Cogn 2016; 41:83-92. [DOI: 10.1016/j.concog.2016.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
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159
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Overstreet C, Berenz EC, Sheerin C, Amstadter AB, Canino G, Silberg J. Potentially Traumatic Events, Posttraumatic Stress Disorder, and Depression among Adults in Puerto Rico. Front Psychol 2016; 7:469. [PMID: 27064295 PMCID: PMC4815006 DOI: 10.3389/fpsyg.2016.00469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 03/16/2016] [Indexed: 11/13/2022] Open
Abstract
The aims of the current study were to examine the prevalence of potentially traumatic events (PTEs), posttraumatic stress disorder (PTSD; data available in males only), and depressive symptoms in a Puerto Rican sample of 678 adult caretakers (50% female) of twins participating in the Puerto Rican Infant Twin Study. The World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was utilized to assess rates of PTEs, PTSD, and depression among male participants while an abbreviated version of the CIDI 3.0 and the Mood and Feelings Questionnaire were administered to females to assess PTEs and depressive symptoms. Significantly more males than females reported exposure to a PTE (76.6% vs. 44.2%, χ(2) = 64.44, p < 0.001). In males, endorsement of multiple PTEs was associated with increased level of PTSD symptomatology (β = 0.33, p < 0.001). With regard to depression, a similar dose-response relationship was found in both males and females, with depressive symptoms increasing as number of PTEs increased (βs = 0.15, 0.16, ps < 0.05). Exposure to an attack with a weapon was significantly associated with increased depression symptoms in both males and females (βs = 0.24, 0.20, ps < 0.01, respectively). These findings highlight the need for identification of putative risk and resilience factors among PTE-exposed individuals in Puerto Rico.
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Affiliation(s)
- Cassie Overstreet
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA
| | - Erin C Berenz
- Developmental Pediatrics, University of Virginia, Charlottesville VA, USA
| | - Christina Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan PR, USA
| | - Judy Silberg
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA
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160
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Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, Quintana MI, Bressan RA, Andreoli SB, Mari JJ, Figueira I. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res 2016; 72:51-7. [PMID: 26540404 DOI: 10.1016/j.jpsychires.2015.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/17/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conditional risk for PTSD is the risk of developing PTSD after exposure to traumatic events. This epidemiological study of the general urban population from the two largest cities in Brazil reports exposure to traumatic events; conditional risk for PTSD; and proportion/estimated number of PTSD cases secondary to each type of traumatic event. METHOD Cross-sectional study of general population (15-75 y.o.) from Rio de Janeiro and São Paulo. PTSD was assessed through Composite International Diagnostic Interview 2.1. RESULTS Our main findings, from 3744 participants, were: 1) high prevalence of traumatic events (86%), urban violence being the most common; 2) conditional risk for PTSD was 11.1%; 3) women (15.9%) have overall conditional risk 3 times higher than men (5.1%); 4) war-related trauma (67.8%), childhood sexual abuse (49.1%) and adult sexual violence (44.1%) had the highest conditional risks; 5) 35% of PTSD cases (estimated 435,970 individuals) were secondary to sudden/unexpected death of a close person, and 40% secondary to interpersonal violence. CONCLUSIONS Brazilian urban population is highly exposed to urban violence, and overall conditional risk for PTSD was 11.1%. Violence prevention and enhancement of resilience should be part of public policies, and mental health sequelae of trauma should be better recognized and treated.
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Affiliation(s)
- Mariana Pires Luz
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil.
| | - Evandro S F Coutinho
- National School of Public Health (ENSP/FIOCRUZ), Rua Leopoldo Bulhões 1480/823, Manguinhos, Rio de Janeiro, RJ 21041-210, Brazil
| | - William Berger
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Mauro V Mendlowicz
- Fluminense Federal University (UFF), Rua Miguel de Frias 9, Icaraí, Niterói, RJ 24220-008, Brazil
| | - Liliane M P Vilete
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Marcelo F Mello
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Maria Inês Quintana
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Sérgio B Andreoli
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Jair J Mari
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Ivan Figueira
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
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161
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Reynolds K, Pietrzak RH, Mackenzie CS, Chou KL, Sareen J. Post-Traumatic Stress Disorder Across the Adult Lifespan: Findings From a Nationally Representative Survey. Am J Geriatr Psychiatry 2016; 24:81-93. [PMID: 26706912 DOI: 10.1016/j.jagp.2015.11.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20-34), middle-aged (ages 35-64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health-related quality of life. METHODS We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715). RESULTS The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health-related quality of life across the adult lifespan. CONCLUSION Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.
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Affiliation(s)
- Kristin Reynolds
- Departments of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Corey S Mackenzie
- Departments of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kee Lee Chou
- Department of Asian and Policy Studies, University of Hong Kong, Pokfulam, Hong Kong
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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162
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Handley TE, Kelly BJ, Lewin TJ, Coleman C, Stain HJ, Weaver N, Inder KJ. Long-term effects of lifetime trauma exposure in a rural community sample. BMC Public Health 2015; 15:1176. [PMID: 26607329 PMCID: PMC4660633 DOI: 10.1186/s12889-015-2490-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022] Open
Abstract
Background This study examines the long-term outcomes of lifetime trauma exposure, including factors that contribute to the development of PTSD, in a sample of rural adults. Methods In 623 rural community residents, lifetime trauma exposure, PTSD, other psychiatric disorders and lifetime suicidal ideation were assessed using the World Mental Health Composite International Diagnostic Interview. Logistic regressions were used to examine relationships between potentially traumatic events (PTEs) and lifetime PTSD and other diagnoses. Results 78.2 % of participants reported at least on PTE. Rates were broadly comparable with Australian national data: the most commonly endorsed events were unexpected death of a loved one (43.7 %); witnessing injury or death (26.3 %); and life-threatening accident (19.3 %). While the mean age of the sample was 55 years, the mean age of first trauma exposure was 19 years. The estimated lifetime rate of PTSD was 16.0 %. Events with the strongest association with PTSD were physical assault and unexpected death of a loved one. Current functioning was lowest among those with current PTSD, with this group reporting elevated psychological distress, higher mental health service use, a greater number of comorbidities, and lower perceived social support. Respondents with a past PTE but no PTSD history were generally similar in terms of their current wellbeing to those with no lifetime PTE. Conclusions PTEs may have diverse psychological and social consequences beyond the development of PTSD. Ensuring that adequate support services are available in rural areas, particularly in the period immediately following a PTE, may reduce the long-term impact of traumatic events.
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Affiliation(s)
- Tonelle E Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Level 5 McAuley Building, Callaghan, 2308, NSW, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Terry J Lewin
- Hunter New England Mental Health Services, Newcastle, NSW, Australia.
| | - Clare Coleman
- Sydney Centre for ATSI Statistics, University of Sydney, Sydney, NSW, Australia.
| | - Helen J Stain
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK.
| | - Natasha Weaver
- Research Services, University of Newcastle, Newcastle, NSW, Australia.
| | - Kerry J Inder
- Centre for Rural and Remote Mental Health, University of Newcastle, Level 5 McAuley Building, Callaghan, 2308, NSW, Australia. .,School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
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163
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Maeng LY, Milad MR. Sex differences in anxiety disorders: Interactions between fear, stress, and gonadal hormones. Horm Behav 2015; 76:106-17. [PMID: 25888456 PMCID: PMC4823998 DOI: 10.1016/j.yhbeh.2015.04.002] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/26/2015] [Accepted: 04/06/2015] [Indexed: 12/22/2022]
Abstract
This article is part of a Special Issue "SBN 2014". Women are more vulnerable to stress- and fear-based disorders, such as anxiety and post-traumatic stress disorder. Despite the growing literature on this topic, the neural basis of these sex differences remains unclear, and the findings appear inconsistent. The neurobiological mechanisms of fear and stress in learning and memory processes have been extensively studied, and the crosstalk between these systems is beginning to explain the disproportionate incidence and differences in symptomatology and remission within these psychopathologies. In this review, we discuss the intersect between stress and fear mechanisms and their modulation by gonadal hormones and discuss the relevance of this information to sex differences in anxiety and fear-based disorders. Understanding these converging influences is imperative to the development of more effective, individualized treatments that take sex and hormones into account.
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Affiliation(s)
- Lisa Y Maeng
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129, USA.
| | - Mohammed R Milad
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129, USA.
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Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:29. [PMID: 26510473 PMCID: PMC4624599 DOI: 10.1186/s12914-015-0064-9] [Citation(s) in RCA: 463] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 09/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are several million war-refugees worldwide, majority of whom stay in the recipient countries for years. However, little is known about their long-term mental health. This review aimed to assess prevalence of mental disorders and to identify their correlates among long-settled war-refugees. METHODS We conducted a systematic review of studies that assessed current prevalence and/or factors associated with depression and anxiety disorders in adult war-refugees 5 years or longer after displacement. We searched Medline, Embase, CINAHL, PsycINFO, and PILOTS from their inception to October 2014, searched reference lists, and contacted experts. Because of a high heterogeneity between studies, overall estimates of mental disorders were not discussed. Instead, prevalence rates were reviewed narratively and possible sources of heterogeneity between studies were investigated both by subgroup analysis and narratively. A descriptive analysis examined pre-migration and post-migration factors associated with mental disorders in this population. RESULTS The review identified 29 studies on long-term mental health with a total of 16,010 war-affected refugees. There was significant between-study heterogeneity in prevalence rates of depression (range 2.3-80%), PTSD (4.4-86%), and unspecified anxiety disorder (20.3-88%), although prevalence estimates were typically in the range of 20% and above. Both clinical and methodological factors contributed substantially to the observed heterogeneity. Studies of higher methodological quality generally reported lower prevalence rates. Prevalence rates were also related to both which country the refugees came from and in which country they resettled. Refugees from former Yugoslavia and Cambodia tended to report the highest rates of mental disorders, as well as refugees residing in the USA. Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression. CONCLUSIONS There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.
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Affiliation(s)
- Marija Bogic
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, E13 8SP, London, UK.
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, E13 8SP, London, UK.
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165
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Sundberg T, Hussain-Alkhateeb L, Falkenberg T. Usage and cost of first-line drugs for patients referred to inpatient anthroposophic integrative care or inpatient conventional care for stress-related mental disorders--a register based study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:354. [PMID: 26467204 PMCID: PMC4604619 DOI: 10.1186/s12906-015-0865-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/16/2015] [Indexed: 12/28/2022]
Abstract
Background Stress-related mental disorders (SRMD) are common and costly. Rehabilitation strategies, including pharmacotherapy, may be complicated to evaluate. Previous research has indicated increased quality of life and self-rated health for SRMD patients that receive a combination of conventional and complementary therapies, i.e. integrative care. The aim of this retrospective registry study was to explore and contrast the prescription of first-line drugs for SRMD patients referred to hospital inpatient anthroposophic integrative care (AIC) or inpatient conventional care (CC). Methods SRMD patients that had received AIC or CC were identified through high-quality inpatient registry data from Stockholm County Council and matched by available background characteristics including diagnosis (ICD-10: F43), age, gender and socio-economics. General disease load was estimated by analysis of ICD-10 chapter data. The Swedish Prescribed Drug Register was then used to investigate purchased defined daily doses (DDD) and cost of drugs from 90-days before/after, and 180-days before/after, the first visits (index) to AIC and CC respectively. First-line drug categories were Anatomical Therapeutic Chemical classification codes N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives) and N06A (antidepressants). Results There were no statistically significant differences between the AIC (n = 161) and the CC (n = 1571) cohorts in terms of background characteristics and the overall disease loads were similar between the groups the preceding year. At baseline, the prescription of first-line anxiolytics and antidepressants were not statistically different between groups whereas the prescription of antipsychotics and hypnotics/sedatives were lower for the AIC cohort. The overall change in drug prescriptions and costs during the investigated periods, both for the 90-days before/after and for the 180-days before/after the index visit, showed a general decrease within the AIC cohort with significantly less prescribed anxiolytics and hypnotics/sedatives. During the same time periods there was a general increase in prescriptions and costs of first-line drugs within the CC cohort. The overall disease loads were generally stable within both cohorts over time, except that the CC cohort had increased visits registered with an ICD-10 F-chapter diagnosis the year after index. Conclusions The results suggests that there may be different drug utilization patterns for SRMD patients referred to AIC or CC. Different management strategies between AIC and CC providers, different SRMD disease severities and different preferences of patients referred to AIC and CC are hypothetical differentiating factors that may influence drug outcomes over time. Additional studies including prospective and randomized clinical trials are warranted to determine if there is a causal link between inpatient AIC and reduced drug utilization.
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166
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Shao D, Gao QL, Li J, Xue JM, Guo W, Long ZT, Cao FL. Test of the stress sensitization model in adolescents following the pipeline explosion. Compr Psychiatry 2015; 62:178-86. [PMID: 26343483 DOI: 10.1016/j.comppsych.2015.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The stress sensitization model states that early traumatic experiences increase vulnerability to the adverse effects of subsequent stressful life events. This study examined the effect of stress sensitization on development of posttraumatic stress disorder (PTSD) symptoms in Chinese adolescents who experienced the pipeline explosion. METHODS A total of 670 participants completed self-administered questionnaires on demographic characteristics and degree of explosion exposure, the Childhood Trauma Questionnaire (CTQ), and the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). Associations among the variables were explored using MANOVA, and main effects and interactions were analyzed. RESULTS Overall MANOVA tests with the PCL-C indicated significant differences for gender (F=6.86, p=.000), emotional abuse (F=6.79, p=.000), and explosion exposure (F=22.40, p=.000). There were significant interactions between emotional abuse and explosion exposure (F=3.98, p=.008) and gender and explosion exposure (F=2.93, p=.033). CONCLUSIONS Being female, childhood emotional abuse, and a high explosion exposure were associated with high PTSD symptom levels. Childhood emotional abuse moderated the effect of explosion exposure on PTSD symptoms. Thus, stress sensitization influenced the development of PTSD symptoms in Chinese adolescents who experienced the pipeline explosion as predicted by the model.
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Affiliation(s)
- Di Shao
- School of Nursing, Shandong University, P.R. China
| | | | - Jie Li
- School of Nursing, Shandong University, P.R. China
| | - Jiao-Mei Xue
- School of Nursing, Shandong University, P.R. China
| | - Wei Guo
- School of Nursing, Shandong University, P.R. China
| | | | - Feng-Lin Cao
- School of Nursing, Shandong University, P.R. China.
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167
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Husky MM, Lépine JP, Gasquet I, Kovess-Masfety V. Exposure to Traumatic Events and Posttraumatic Stress Disorder in France: Results From the WMH Survey. J Trauma Stress 2015; 28:275-82. [PMID: 26179388 DOI: 10.1002/jts.22020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined the prevalence of traumatic events and the conditional probability of posttraumatic stress disorder (PTSD) associated with both specific and broad classes of events in a nationally representative sample from France. The sample (N = 1,436) was a part of the European Study of the Epidemiology of Mental Disorders Survey (ESEMeD), under the WHO World Mental Health Surveys-2000 initiative. Overall, exposure to any traumatic event was 72.7%, which appeared to be lower than what has been reported in Sweden (80.8%), similar to data from the Netherlands (71.1%), and higher than what has been reported in Spain (54.0%), Italy (56.1%), Northern Ireland (60.6%) or the U.S (55.9%). Lifetime prevalence of PTSD was 3.9%, lower than in the United States (7.8%), Sweden (5.6%), or Northern Ireland (8.8%), but higher than in Spain (2.2%) or Italy (2.4%). Being beaten up by a romantic partner (25.0%), having a child with serious illness (23.5%), and rape (21.5%) were associated with the highest risk of PTSD. The average duration of PTSD was 5.3 years (0.2-28.1). The burden of PTSD in France appeared to come from the consequences of violence and social network events suggesting that prevention efforts might focus on limiting the occurrence of exposure to avoidable events such as violence as well as provide support for persons exposed to social network events.
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Affiliation(s)
- Mathilde M Husky
- Institut de Psychologie de Paris Descartes (EA 4057), Institut Universitaire de France, Boulogne Billancourt, France
| | | | | | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique, Institut de Psychologie de Paris Descartes (EA 4057), Paris, France
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168
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Flanagan S, Patterson TG, Hume IR, Joseph S. A longitudinal investigation of the relationship between unconditional positive self-regard and posttraumatic growth. PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 2015. [DOI: 10.1080/14779757.2015.1047960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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169
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Ljungman L, Hovén E, Ljungman G, Cernvall M, von Essen L. Does time heal all wounds? A longitudinal study of the development of posttraumatic stress symptoms in parents of survivors of childhood cancer and bereaved parents. Psychooncology 2015; 24:1792-8. [PMID: 26042579 PMCID: PMC5033007 DOI: 10.1002/pon.3856] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/23/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022]
Abstract
Background A lack of longitudinal studies has hampered the understanding of the development of posttraumatic stress symptoms (PTSS) in parents of children diagnosed with cancer. This study examines level of PTSS and prevalence of posttraumatic stress disorder (PTSD) from shortly after diagnosis up to 5 years after end of treatment or child's death, in mothers and fathers. Methods A design with seven assessments (T1–T7) was used. T1–T3 were administered during treatment and T4–T7 after end of treatment or child's death. Parents (N = 259 at T1; n = 169 at T7) completed the PTSD Checklist Civilian Version. Latent growth curve modeling was used to analyze the development of PTSS. Results A consistent decline in PTSS occurred during the first months after diagnosis; thereafter the decline abated, and from 3 months after end of treatment only minimal decline occurred. Five years after end of treatment, 19% of mothers and 8% of fathers of survivors reported partial PTSD. Among bereaved parents, corresponding figures were 20% for mothers and 35% for fathers, 5 years after the child's death. Conclusions From 3 months after end of treatment the level of PTSS is stable. Mothers and bereaved parents are at particular risk for PTSD. The results are the first to describe the development of PTSS in parents of children diagnosed with cancer, illustrate that end of treatment is a period of vulnerability, and that a subgroup reports PTSD 5 years after end of treatment or child's death. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.
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Affiliation(s)
- Lisa Ljungman
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Hovén
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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170
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Exposure to violence among women with unwanted pregnancies and the association with post-traumatic stress disorder, symptoms of anxiety and depression. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:50-3. [DOI: 10.1016/j.srhc.2014.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 08/04/2014] [Accepted: 08/20/2014] [Indexed: 11/18/2022]
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171
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Reich CM, Blackwell N, Simmons CA, Beck JG. Social problem solving strategies and posttraumatic stress disorder in the aftermath of intimate partner violence. J Anxiety Disord 2015; 32:31-7. [PMID: 25840140 DOI: 10.1016/j.janxdis.2015.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/12/2015] [Accepted: 02/23/2015] [Indexed: 11/28/2022]
Abstract
Social factors are often associated with the development or maintenance of posttraumatic stress disorder (PTSD) in the aftermath of interpersonal traumas. However, social problem solving strategies have received little attention. The current study explored the role of social problem solving styles (i.e., rational approaches, impulsive/careless strategies, or avoidance strategies) as intermediary variables between abuse exposure and PTSD severity among intimate partner violence survivors. Avoidance problem solving served as an intermediating variable for the relationship between three types of abuse and PTSD severity. Rational and impulsive/careless strategies were not associated with abuse exposure. These findings extend the current understanding of social problem solving among interpersonal trauma survivors and are consistent with more general avoidance coping research. Future research might examine whether avoidance problem solving tends to evolve in the aftermath of trauma or whether it represents a longstanding risk factor for PTSD development.
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Affiliation(s)
| | | | | | - J Gayle Beck
- Department of Psychology, University of Memphis, Memphis, TN, USA.
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172
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Association between traumatic events and post-traumatic stress disorder: results from the ESEMeD-Spain study. Epidemiol Psychiatr Sci 2015; 24:172-83. [PMID: 24565167 PMCID: PMC4143480 DOI: 10.1017/s2045796014000092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The relative importance of traumatic events (TEs) in accounting for the social burden of post-traumatic stress disorder (PTSD) could vary according to cross-cultural factors. In that sense, no such studies have yet been conducted in the Spanish general population. The present study aims to determine the epidemiology of trauma and PTSD in a Spanish community sample using the randomly selected TEs method. METHODS The European Study of the Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional household survey of a representative sample of adult population. Lifetime prevalence of self-reported TEs and lifetime and 12-month prevalence of PTSD were evaluated using the World Health Organization (WHO) Composite International Diagnostic Interview. Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. RESULTS Road accident was the most commonly self-reported TE (14.1%). Sexual assault had the highest conditional risk of PTSD (16.5%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (36.4% of all cases) and sexual assault (17.2%). Being female and having a low educational level were associated with low risk of overall TE exposure and being previously married was related to higher risk. Being female was related to high risk of PTSD after experiencing a TE. CONCLUSIONS Having an accident is commonly reported among Spanish adults, but two TE are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.
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173
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Asselmann E, Wittchen HU, Lieb R, Höfler M, Beesdo-Baum K. The role of behavioral inhibition and parenting for an unfavorable emotional trauma response and PTSD. Acta Psychiatr Scand 2015; 131:279-89. [PMID: 25039395 DOI: 10.1111/acps.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The role of behavioral inhibition (BI) and parenting for an unfavorable emotional trauma response (DSM-IV criterion A2) and post-traumatic stress disorder (PTSD) development is unclear. METHOD A community sample of adolescents and young adults (aged 14-24) was followed up over 10 years (N=2378). Traumatic events, criterion A2, and PTSD (according to DSM-IV-TR) were assessed using the M-CIDI. BI and parenting were assessed using the Retrospective Self-Report of Inhibition and the Questionnaire of Recalled Parenting Rearing Behavior. Multiple logistic regressions adjusted for sex, age, and number of traumata were used to examine associations of BI as well as maternal and paternal overprotection, rejection, and reduced emotional warmth with (i) criterion A2 in those with trauma (N=1794) and (ii) subsequent PTSD in those with criterion A2 (N=1160). RESULTS Behavioral inhibition (BI; odds ratio, OR=1.32) and paternal overprotection (OR=1.27) predicted criterion A2 in those with trauma, while only BI (OR=1.53) predicted subsequent PTSD. BI and paternal emotional warmth interacted on subsequent PTSD (OR=1.32), that is, BI only predicted PTSD in those with low paternal emotional warmth. CONCLUSION Our findings suggest that BI and adverse parenting increase the risk of an unfavorable emotional trauma response and subsequent PTSD. Paternal emotional warmth buffers the association between BI and PTSD development.
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Affiliation(s)
- E Asselmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
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174
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Bolu A, Balikci A, Erdem M, Öznur T, Çelik C, Uzun Ö. Cortical Excitability and Agressive Behavior in Post-Traumatic Stress Disorder. Noro Psikiyatr Ars 2015; 52:73-77. [PMID: 28360680 DOI: 10.5152/npa.2015.7031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hyperarousal and alertness play an important role in the clinical presentation of Post-traumatic stress disorder (PTSD). Strenuous effort has been made to shed light on the mechanisms that cause these symptoms of patients. Based on the claim that there is a relationship between some subtypes of hyperarousal symptoms and aggression in patients with PTSD, we aimed to examine the relationship between electrophysiological measurements that was measured through transcranial magnetic stimulation (TMS) and aggression scale scores of PTSD patients in this study. METHODS The study included 37 patients with a diagnosis of PTSD according to DSM-IV criteria and 25 healthy volunteers. Electrophysiological measurements of participants were made with TMS. The Buss Perry Aggression Questionnaires was administered to patients and control group. RESULTS In the patient group, a positive correlation was found between scores of aggression and arousal symptoms. Motor excitability threshold, one of TMS measurements, which is a sign of cortical excitability, was significantly lower in the patient group than the control group. There was a negative correlation between aggression scale scores and the parameters of motor excitability threshold and cortical silent period which both shows cortical excitability of the patients. CONCLUSION We concluded that there was an increase in cortical excitability in PTSD patients and we suggest that this increase might be associated with hyperarousal symptoms and aggressive behavior.
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Affiliation(s)
- Abdullah Bolu
- Department of Psychiatry, Aircrew Health Research and Training Center, Eskişehir, Turkey
| | - Adem Balikci
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
| | - Murat Erdem
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
| | - Taner Öznur
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
| | - Cemil Çelik
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
| | - Özcan Uzun
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
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175
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Foran HM, Whisman MA, Beach SRH. Intimate partner relationship distress in the DSM-5. FAMILY PROCESS 2015; 54:48-63. [PMID: 25582661 DOI: 10.1111/famp.12122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over the past 40 years, a large body of literature has documented intimate partner relationship distress as a primary reason for seeking mental health services as well as an integral factor in the prognosis and treatment of a range of mental and physical health conditions. In recognition of its relevance to clinical care, the description of intimate partner relationship distress has been expanded in the DSM-5. Nonetheless, this is irrelevant if the DSM-5 code for intimate partner relationship distress is not reliably used in clinical practice and research settings. Thus, with the goal of dissemination in mind, the purpose of this paper was to provide clinicians and researchers with specific guidelines on how to reliably assess intimate partner relationship distress and how this information can be used to inform treatment planning. In addition to the implications for direct clinical care, we discuss the importance of reliable assessment and documentation of intimate partner relationship distress for future progress in epidemiology, etiology, and public health research.
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Affiliation(s)
- Heather M Foran
- Institute for Psychology, University of Braunschweig, Braunschweig, Germany
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176
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Maeng LY, Cover KK, Landau AJ, Milad MR, Lebron-Milad K. Protocol for studying extinction of conditioned fear in naturally cycling female rats. J Vis Exp 2015. [PMID: 25741747 DOI: 10.3791/52202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Extinction of conditioned fear has been extensively studied in male rodents. Recently, there have been an increasing number of studies indicating that neural mechanisms for certain behavioral tasks and response behaviors are different in females and males. Using females in research studies can represent a challenge because of the variation of gonadal hormones during their estrous cycle. This protocol describes well-established procedures that are useful in investigating the role of estrogen in fear extinction memory consolidation in female rats. Phase of the estrous cycle and exogenous estrogen administration prior to extinction training can influence extinction recall 24 hr later. The vaginal swabbing technique for estrous phase identification described here aids the examination and manipulation of naturally cycling gonadal hormones. The use of this basic rodent model may further delineate the mechanisms by which estrogen can modulate fear extinction memory in females.
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Affiliation(s)
- Lisa Y Maeng
- Department of Psychiatry, Massachusetts General Hospital; Harvard Medical School
| | - Kara K Cover
- Department of Psychiatry, Massachusetts General Hospital
| | - Aaron J Landau
- Department of Psychiatry, Massachusetts General Hospital
| | - Mohammed R Milad
- Department of Psychiatry, Massachusetts General Hospital; Harvard Medical School
| | - Kelimer Lebron-Milad
- Department of Psychiatry, Massachusetts General Hospital; Harvard Medical School;
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177
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Wallin Lundell I, Öhman SG, Sundström Poromaa I, Högberg U, Sydsjö G, Skoog Svanberg A. How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress. EUR J CONTRACEP REPR 2015; 20:211-22. [PMID: 25666812 DOI: 10.3109/13625187.2014.1002032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.
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Affiliation(s)
- Inger Wallin Lundell
- * Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
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178
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Developing the PTSD Checklist-I/F for the DSM-IV (PCL-I/F): Assessing PTSD Symptom Frequency and Intensity in a Pilot Study of Male Veterans with Combat-Related PTSD. Behav Sci (Basel) 2015; 5:59-69. [PMID: 25654696 PMCID: PMC4384063 DOI: 10.3390/bs5010059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/16/2015] [Accepted: 01/27/2015] [Indexed: 11/17/2022] Open
Abstract
The widely used posttraumatic stress disorder (PTSD) Checklist (PCL) has established reliability and validity, but it does not differentiate posttraumatic symptom frequency from intensity as elements of posttraumatic symptom severity. Thus, the PCL in its existing form may not provide a comprehensive appraisal of posttraumatic symptomatology. Because of this, we modified the PCL to create the PCL-I/F that measures both frequency and intensity of PTSD symptoms via brief self-report. To establish validity and internal consistency of the PCL-I/F, we conducted a pilot study comparing PCL-I/F scores to structured diagnostic interview for PTSD (the Clinician Administered PTSD Scale [CAPS]) in a male combat veteran sample of 92 participants. Statistically significant correlations between the PCL-I/F and the CAPS were found, suggesting initial validation of the PCL-I/F to screen and assess frequency and intensity of combat-related PTSD symptoms. Implications are discussed for screening and assessment of PTSD related to combat and non-combat trauma.
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179
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Kraan T, Velthorst E, Smit F, de Haan L, van der Gaag M. Trauma and recent life events in individuals at ultra high risk for psychosis: review and meta-analysis. Schizophr Res 2015; 161:143-9. [PMID: 25499046 DOI: 10.1016/j.schres.2014.11.026] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/11/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Childhood trauma and recent life-events have been related to psychotic disorders. The aim of the present study was to examine whether childhood trauma and recent life-events are significantly more prevalent in patients at Ultra High Risk (UHR) of developing a psychotic disorder compared to healthy controls. METHOD A search of PsychInfo and Embase was conducted, relevant papers were reviewed, and three random-effects meta-analyses were performed. One meta-analysis assessed the prevalence rate of childhood trauma in UHR subjects and two meta-analyses were conducted to compare UHR subjects and healthy control subjects on the experience of childhood trauma and recent life-events. RESULTS We found 12 studies on the prevalence of (childhood) trauma in UHR populations and 4 studies on recent life-events in UHR populations. We performed a meta-analysis on 6 studies (of which trauma prevalence rates were available) on childhood trauma in UHR populations, yielding a mean prevalence rate of 86.8% (95% CI 77%-93%). Childhood trauma was significantly more prevalent in UHR subjects compared to healthy control groups (Random effects Hedges' g=1.09; Z=4.60, p<.001). In contrast to our hypothesis, life-event rates were significantly lower in UHR subjects compared to healthy controls (Random effects Hedges' g=-0.53; Z=-2.36, p<.02). CONCLUSIONS Our meta-analytic results illustrate that childhood trauma is highly prevalent among UHR subjects and that childhood trauma is related to UHR status. These results are in line with studies on childhood trauma in psychotic populations. In contrast to studies on recent life-events in psychotic populations, our results show that recent life-events are not associated with UHR status.
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Affiliation(s)
- Tamar Kraan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, The Netherlands; Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands
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180
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Peltzer K, Pengpida S. Multiple health risk behaviours and posttraumatic stress disorder symptoms among university students from 22 countries. JOURNAL OF PSYCHOLOGY IN AFRICA 2015. [DOI: 10.1080/14330237.2014.997038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- University of Limpopo, Turfloop Campus, South Africa
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
| | - Supa Pengpida
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand
- University of Limpopo, Turfloop Campus, South Africa
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181
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Reijnen A, Geuze E, Vermetten E. The effect of deployment to a combat zone on testosterone levels and the association with the development of posttraumatic stress symptoms: A longitudinal prospective Dutch military cohort study. Psychoneuroendocrinology 2015; 51:525-33. [PMID: 25128222 DOI: 10.1016/j.psyneuen.2014.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is limited evidence on the association of the activity of HPG-axis with stress and symptoms of stress-related disorders. The aim of the current study was to assess the effect of deployment to a combat zone on plasma testosterone levels, and the possible association with the development of symptoms of posttraumatic stress disorder (PTSD). METHODS A total of 918 males were included in the study before deployment to a combat zone in Afghanistan. The effect of deployment on testosterone was longitudinally assessed; starting prior to deployment and follow-up assessments were preformed at 1 and 6 months after return. Furthermore, the association with PTSD symptoms reported at 1 and 2 years post-deployment was assessed. RESULTS Plasma testosterone levels were significantly increased after deployment compared with pre-deployment levels. Although no difference was found between individuals reporting high or low levels of PTSD symptoms, pre-deployment testosterone levels predicted the development of PTSD symptoms at 1 and 2 years post-deployment. CONCLUSION This study provides evidence that not the alterations in testosterone levels shortly after deployment, but the pre-deployment testosterone levels are associated with PTSD symptoms, which is of value in the identification of biological vulnerability factors for the development of PTSD.
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Affiliation(s)
- Alieke Reijnen
- Research Centre-Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - Elbert Geuze
- Research Centre-Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eric Vermetten
- Research Centre-Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Arq, Psychotrauma Expert Group, Diemen, The Netherlands
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182
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Reichert E, Segal C, Flannery-Schroeder E. Trauma, attentional biases, and revictimization among young adults. J Trauma Dissociation 2015; 16:181-96. [PMID: 25734365 DOI: 10.1080/15299732.2014.975308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with previous histories of trauma are at increased risk for subsequent victimization and the development of posttraumatic stress disorder, depression, and anxiety disorders. Attentional biases to threat-related stimuli are thought to impact one's ability to recognize future risk in his or her environment and may explain high rates of revictimization. Although the literature has identified three possible types of attentional biases among victims of trauma (i.e., interference, facilitation, and avoidance), findings are mixed. The current study examined attentional biases to threats among a sample of men and women with no, some, and multiple incident interpersonal and non-interpersonal trauma histories. It was hypothesized that those with multiple incident interpersonal trauma histories would demonstrate an interference effect (i.e., slower response times to threat-related words). Participants (N = 309) were 18- to 29-year-old college students. Self-report measures assessed trauma history, posttraumatic stress, and other psychological sequelae. Attentional biases were assessed using a dot probe computer task. Contrary to hypotheses, no significant differences in response times in the presence of threat-related words or neutral words were found among groups. Results suggest that multiple traumatized individuals do not exhibit attentional bias to threats compared to individuals with some or no trauma.
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Affiliation(s)
- Elizabeth Reichert
- a Department of Psychology , University of Rhode Island , Kingston , Rhode Island , USA
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183
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Ranjbar V, Näslund MS, Vingare EL, Hagelthorn C, Englund L, Karlsson I. The Swedish Psychotrauma Society: joining forces for a national psychotrauma platform from a multidisciplinary and holistic approach. Eur J Psychotraumatol 2015; 6:28546. [PMID: 26073210 PMCID: PMC4466305 DOI: 10.3402/ejpt.v6.28546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vania Ranjbar
- Angered Hospital, Gothenburg, Sweden.,Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden;
| | - Monika S Näslund
- Crisis and Disaster Psychology Unit, Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden
| | - Emme-Li Vingare
- Department of Social Work, Linnaeus University, Växjö, Sweden.,Swedish Psychotrauma Society, Sweden
| | | | - Liselotte Englund
- Department of Environmental and Life Sciences, Karlstad University, Karlstad, Sweden
| | - Ingvar Karlsson
- Swedish Psychotrauma Society, Sweden.,Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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184
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Garey L, Bakhshaie J, Vujanovic AA, Leventhal AM, Schmidt NB, Zvolensky MJ. Posttraumatic stress symptoms and cognitive-based smoking processes among trauma-exposed, treatment-seeking smokers: the role of dysphoria. J Addict Med 2015; 9:68-74. [PMID: 25525942 PMCID: PMC4310782 DOI: 10.1097/adm.0000000000000091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite the co-occurrence and clinically significant relationship between trauma exposure and smoking, there is little understanding of the mechanisms underlying the posttraumatic stress symptoms-smoking relationship. This study examined whether dysphoria (ie, a psychopathologic symptom dimension that reflects depression's core affective, cognitive, and psychomotor features) accounted for the covariance between posttraumatic stress symptom severity and an array of smoking processes among trauma-exposed daily smokers. METHODS Participants (n = 189; 47.6% female; Mage = 41.15; SD = 12.47) were trauma-exposed, treatment-seeking daily cigarette smokers who completed measures of posttraumatic stress symptom severity, dysphoria, and 4 cognitive-based smoking processes that interfere with smoking cessation-avoidance/inflexibility to smoking, perceived barriers to smoking cessation, negative affect reduction motivation for smoking, and negative affect reduction/negative reinforcement expectancies from smoking. RESULTS Dysphoria indirectly and significantly accounted for the relationship between posttraumatic stress symptom severity and smoking outcomes. CONCLUSIONS The present results provide initial empirical support that dysphoria accounts for the covariance between posttraumatic symptom severity and various clinically relevant smoking variables in trauma-exposed, treatment-seeking smokers. The findings suggest the potential importance of targeting dysphoria during smoking cessation among trauma-exposed individuals.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, United States
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, Texas, United States
| | - Anka A. Vujanovic
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States
| | - Adam M. Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, California, United States
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, United States
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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185
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Hogg D, Kingham S, Wilson TM, Griffin E, Ardagh M. Geographic variation of clinically diagnosed mood and anxiety disorders in Christchurch after the 2010/11 earthquakes. Health Place 2014; 30:270-8. [DOI: 10.1016/j.healthplace.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/06/2014] [Accepted: 10/11/2014] [Indexed: 11/24/2022]
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186
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Tracy M, Morgenstern H, Zivin K, Aiello AE, Galea S. Traumatic event exposure and depression severity over time: results from a prospective cohort study in an urban area. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1769-82. [PMID: 24816599 PMCID: PMC6684030 DOI: 10.1007/s00127-014-0884-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/14/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE A substantial proportion of adults experience traumatic events each year, yet little is known about the effects of different types of traumatic events on depression severity over time. We prospectively assessed the effects of traumatic event exposure during a 1-year period on changes in depression severity during that period among a representative sample of adults living in Detroit, Michigan in the United States. METHODS We used data from 1,054 participants in the first two waves of the Detroit Neighborhood Health Study (2008-2010). Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Negative binomial regression was used to estimate the effect of traumatic event exposure on depression severity at Wave 2, adjusting for Wave 1 PHQ-9 score and potential confounders. RESULTS The mean depression severity score at Wave 2 among those exposed to at least one traumatic event during follow-up was 1.71 times higher than among those with no traumatic event exposure [95 % confidence interval (CI) 1.27-2.29]. Also positively associated with depression severity at Wave 2 (vs. no traumatic events) were assaultive violence (mean ratio 2.49, 95 % CI 1.41-4.38), injuries and other directly experienced shocking events (mean ratio 2.59, 95 % CI 1.62-3.82), and three or more traumatic events (mean ratio 2.58, 95 % CI 1.62-4.09). CONCLUSIONS Violence, injuries, and other directly experienced traumatic events increase depression severity and may be useful targets for interventions to alleviate the burden of depression in urban areas.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Room 515, New York, NY, 10032, USA,
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA,Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA,Department of Urology, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kara Zivin
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA,Department of Veterans Affairs, Ann Arbor, MI 48113, USA
| | - Allison E. Aiello
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Room 515, New York, NY 10032, USA
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187
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Ewens BA, Hendricks JM, Sundin D. Never ending stories: visual diarizing to recreate autobiographical memory of intensive care unit survivors. Nurs Crit Care 2014; 22:8-18. [PMID: 25294316 DOI: 10.1111/nicc.12093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/22/2014] [Accepted: 02/25/2014] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to explore the potential use of visual diarizing to enable intensive care unit (ICU) survivors to create their story of recovery. BACKGROUND An ICU experience can have deleterious psychological and physical effects on survivors leading to reductions in quality of life which for some may be of significant duration. Although there has been exploration of many interventions to support recovery in this group, service provision for survivors remains inconsistent and inadequate. DESIGN AND PARTICIPANTS A qualitative interpretive biographical exploration of the ICU experience and recovery phase of ICU survivors using visual diarizing as method. This paper is a component of a larger study and presents an analyses of one participant's visual diary in detail. METHODS Data collection was twofold. The participant was supplied with visual diary materials at 2 months post-hospital discharge and depicted his story in words and pictures for a 3-month period, after which he was interviewed. The interview enabled the participant and researcher to interpret the visual diary and create a biographical account of his ICU stay and recovery journey. FINDINGS The analysis of one participant's visual diary yielded a wealth of information about his recovery trajectory articulated through the images he chose to symbolize his story. The participant confirmed feelings of persecution whilst in ICU and was unprepared for the physical and psychological disability which ensued following his discharge from hospital. However, his story was one of hope for the future and a determination that good would come out of his experience. He considered using the visual diary enhanced his recovery. CONCLUSIONS The participant perceived that visual diarizing enhanced his recovery trajectory by enabling him to recreate his story using visual imagery in a prospective diary. RELEVANCE TO CLINICAL PRACTICE Prospective visual diarizing with ICU survivors may have potential as an aid to recovery.
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Affiliation(s)
- Beverley A Ewens
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Joyce M Hendricks
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Deb Sundin
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
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188
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Lian Y, Xiao J, Wang Q, Ning L, Guan S, Ge H, Li F, Liu J. The relationship between glucocorticoid receptor polymorphisms, stressful life events, social support, and post-traumatic stress disorder. BMC Psychiatry 2014; 14:232. [PMID: 25113244 PMCID: PMC4149199 DOI: 10.1186/s12888-014-0232-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/05/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is debatable whether or not glucocorticoid receptor (GR) polymorphisms moderate susceptibility to PTSD. Our objective was to examine the effects of stressful life events, social support, GR genotypes, and gene-environment interactions on the etiology of PTSD. METHODS Three tag single nucleotide polymorphisms, trauma events, stressful life events, and social support were assessed in 460 patients with PTSD and 1158 control subjects from a Chinese Han population. Gene-environment interactions were analyzed by generalized multifactor dimensionality reduction (GMDR). RESULTS Variation in GR at rs41423247 and rs258747, stressful life events, social support, and the number of traumatic events were each separately associated with the risk for PTSD. A gene-environment interaction among the polymorphisms, rs41423247 and rs258747, the number of traumatic events, stressful life events, and social support resulted in an increased risk for PTSD. High-risk individuals (a large number of traumatic events, G allele of rs258747 and rs41423247, high level stressful life events, and low social support) had a 3.26-fold increased risk of developing PTSD compared to low-risk individuals. The association was statistically significant in the sub-groups with and without childhood trauma. CONCLUSIONS Our data support the notion that stressful life events, the number of trauma events, and social support may play a contributing role in the risk for PTSD by interacting with GR gene polymorphisms.
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Affiliation(s)
- Yulong Lian
- Division of Occupational and Environmental Health, College of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Jing Xiao
- Division of Occupational and Environmental Health, College of Public Health, Nantong University, Nantong, Jiangsu China
| | - Qian Wang
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang China
| | - Li Ning
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang China
| | - Suzhen Guan
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang China
| | - Hua Ge
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang China
| | - Fuye Li
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang China
| | - Jiwen Liu
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang China
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189
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Mechanisms of estradiol in fear circuitry: implications for sex differences in psychopathology. Transl Psychiatry 2014; 4:e422. [PMID: 25093600 PMCID: PMC4150242 DOI: 10.1038/tp.2014.67] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/02/2014] [Accepted: 06/23/2014] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades, substantial knowledge has been attained about the mechanisms underlying the acquisition and subsequent extinction of conditioned fear. Knowledge gained on the biological basis of Pavlovian conditioning has led to the general acceptance that fear extinction may be a useful model in understanding the underlying mechanisms in the pathophysiology of anxiety disorders and may also be a good model for current therapies treating these disorders. Lacking in the current knowledge is how men and women may or may not differ in the biology of fear and its extinction. It is also unclear how the neural correlates of fear extinction may mediate sex differences in the etiology, maintenance, and prevalence of psychiatric disorders. In this review, we begin by highlighting the epidemiological differences in incidence rate. We then discuss how estradiol (E2), a primary gonadal hormone, may modulate the mechanisms of fear extinction and mediate some of the sex differences observed in psychiatric disorders.
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190
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Anatomical deficits in adult posttraumatic stress disorder: a meta-analysis of voxel-based morphometry studies. Behav Brain Res 2014; 270:307-15. [PMID: 24859173 DOI: 10.1016/j.bbr.2014.05.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 02/05/2023]
Abstract
Evidence from previous anatomical studies indicate that widespread brain regions are involved in the pathogenesis of posttraumatic stress disorder (PTSD). The aim of the present study was to quantitatively integrate the literature on structural abnormalities seen on individuals with PTSD. Twenty voxel-based analysis studies were analysed through a comprehensive series of meta-analyses. Compared with healthy controls, PTSD patients showed a significant reduction in grey matter (GM) in the left anterior cingulate gyrus (ACC) at the whole-brain level. Several brain regions, including the left ACC, the left insula and the right parahippocampal gyrus were significantly smaller in individuals with PTSD than in trauma-exposed healthy subjects. Furthermore, the clinician-administered PTSD scale scores were negatively correlated with GM in the left ACC and positively correlated with GM in the left insula. In addition, PTSD patients who experienced accidental or non-accidental trauma had anatomical changes in different brain regions. These results suggest that the smaller ACC and insular cortex within the limbic-prefrontal circuit contribute to the pathogenesis of PTSD. Moreover, the PTSD patients with different types of trauma may have different cerebral deficits.
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191
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Peirce JM, Schacht RL, Brooner RK, King VL, Kidorf MS. Prospective risk factors for traumatic event reexposure in community syringe exchange participants. Drug Alcohol Depend 2014; 138:98-102. [PMID: 24629781 PMCID: PMC4001832 DOI: 10.1016/j.drugalcdep.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/10/2014] [Accepted: 02/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic event reexposure in injecting drug users is associated with increased drug use and potential for psychiatric symptoms. This is the first study to examine fixed and time-varying factors that are prospectively associated with new traumatic event reexposure in injecting drug users. METHODS Injecting drug users registered in a syringe exchange program were enrolled in a 16-month parent study comparing strategies to increase drug abuse treatment enrollment. Participants (N=162) completed baseline measures of demographics, psychiatric treatment history, and lifetime traumatic event exposure. Monthly follow-ups assessed past-month traumatic event exposure, days of heroin and cocaine use, criminal activity, and drug abuse treatment participation. Generalized estimating equations models tested the influence of fixed baseline and time-varying factors on traumatic event reexposure in the same month, the following month, and two months later. RESULTS Significant fixed risk factors for traumatic event reexposure include female gender and past psychiatric treatment. In addition, each past traumatic event exposure was associated with an increased likelihood of reexposure. After accounting for all other factors, each day of cocaine use was associated with a small but persistent increased risk of traumatic event reexposure. Reexposure to a traumatic event in the prior month more than doubled the risk of subsequent reexposure. CONCLUSIONS Injecting drug users experience a pattern in which drug use is associated with increased risk of subsequent traumatic event reexposure, and traumatic event reexposure is associated with further drug use and continued reexposure. Implications for addressing these concerns in injecting drug users are presented.
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Affiliation(s)
- Jessica M. Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Rebecca L. Schacht
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Math/Psychology Building, Room 312, Baltimore, MD 21250
| | - Robert K. Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Van L. King
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Michael S. Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
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192
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Frijling JL, van Zuiden M, Koch SBJ, Nawijn L, Goslings JC, Luitse JS, Biesheuvel TH, Honig A, Bakker FC, Denys D, Veltman DJ, Olff M. Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial. BMC Psychiatry 2014; 14:92. [PMID: 24679046 PMCID: PMC3986606 DOI: 10.1186/1471-244x-14-92] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 03/18/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Currently few evidence based interventions are available for the prevention of PTSD within the first weeks after trauma. Increased risk for PTSD development is associated with dysregulated fear and stress responses prior to and shortly after trauma, as well as with a lack of perceived social support early after trauma. Oxytocin is a potent regulator of these processes. Therefore, we propose that oxytocin may be important in reducing adverse consequences of trauma. The 'BONDS' study is conducted in order to assess the efficacy of an early intervention with intranasal oxytocin for the prevention of PTSD. METHODS/DESIGN In this multicenter double-blind randomized placebo-controlled trial we will recruit 220 Emergency Department patients at increased risk of PTSD. Trauma-exposed patients are screened for increased PTSD risk with questionnaires assessing peri-traumatic distress and acute PTSD symptoms within 7 days after trauma. Baseline PTSD symptom severity scores and neuroendocrine and psychophysiological measures will be collected within 10 days after trauma. Participants will be randomized to 7.5 days of intranasal oxytocin (40 IU) or placebo twice a day. Follow-up measurements at 1.5, 3 and 6 months post-trauma are collected to assess PTSD symptom severity (the primary outcome measure). Other measures of symptoms of psychopathology, and neuroendocrine and psychophysiological disorders are secondary outcome measures. DISCUSSION We hypothesize that intranasal oxytocin administered early after trauma is an effective pharmacological strategy to prevent PTSD in individuals at increased risk, which is both safe and easily applicable. Interindividual and contextual factors that may influence the effects of oxytocin treatment will be considered in the analysis of the results. TRIAL REGISTRATION Netherlands Trial Registry: NTR3190.
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Affiliation(s)
- Jessie L Frijling
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
| | - Mirjam van Zuiden
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Saskia BJ Koch
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jan S Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tessa H Biesheuvel
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam 1061 AE, The Netherlands,Department of Psychiatry, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Fred C Bakker
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands,Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands,Arq Psychotrauma Expert Group, Nienoord 5, Diemen 1112 XE, Netherlands
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Greimel E, Dorfer M, Lambauer M, Bjelic-Radisic V, Gramm S, Lahousen M, Lang U. Posttraumatic stress disorder in female cancer patients: an inappropriate diagnosis in oncology? PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:271-2. [PMID: 23735976 DOI: 10.1159/000348610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/02/2013] [Indexed: 11/19/2022]
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194
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Hucklenbroich K, Burgmer M, Heuft G. Psychische Folgen von früheren und akuten Traumatisierungen bei Älteren. Z Gerontol Geriatr 2014; 47:202-8. [DOI: 10.1007/s00391-014-0625-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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195
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Determinants of the development of post-traumatic stress disorder, in the general population. Soc Psychiatry Psychiatr Epidemiol 2014; 49:447-57. [PMID: 24022753 DOI: 10.1007/s00127-013-0762-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/30/2013] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess (1) the lifetime prevalence of exposure both to trauma and post-traumatic stress disorder (PTSD); (2) the risk of PTSD by type of trauma; and (3) the determinants of the development of PTSD in the community. METHODS The Diagnostic Interview for Genetic Studies was administered to a random sample of an urban area (N = 3,691). RESULTS (1) The lifetime prevalence estimates of exposure to trauma and PTSD were 21.0 and 5.0%; respectively, with a twice as high prevalence of PTSD in women compared to men despite a similar likelihood of exposure in the two sexes; (2) Sexual abuse was the trauma involving the highest risk of PTSD; (3) The risk of PTSD was most strongly associated with sexual abuse followed by preexisting bipolar disorder, alcohol dependence, antisocial personality, childhood separation anxiety disorder, being victim of crime, witnessing violence, Neuroticism and Problem-focused coping strategies. After adjustment for these characteristics, female sex was no longer found to be significantly associated with the risk of PTSD. CONCLUSIONS The risk for the development of PTSD after exposure to traumatic events is associated with several factors including the type of exposure, preexisting psychopathology, personality features and coping strategies which independently contribute to the vulnerability to PTSD.
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196
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Traumatic events and their relative PTSD burden in Northern Ireland: a consideration of the impact of the 'Troubles'. Soc Psychiatry Psychiatr Epidemiol 2014; 49:435-46. [PMID: 23959590 DOI: 10.1007/s00127-013-0757-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/06/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE Over a 30-year period in its recent history, daily life in Northern Ireland (NI) was characterised by civil violence, colloquially termed as the 'Troubles'. The current report examines exposure to 29 traumatic event types and the associated conditional prevalence of post-traumatic stress disorder (PTSD) among the Northern Ireland population, with a focus on the impact of traumatic events that were characteristic of the NI 'Troubles'. METHOD Results presented are based on analysis of data from the Northern Ireland Study of Health and Stress (NISHS). The NISHS is a representative epidemiological study of mental health among the NI adult population (N = 4,340) and part of the World Mental Health Survey Initiative. RESULTS Perpetration of violence, physical assault by a spouse or partner and private events were the event types associated with the highest conditional prevalence of PTSD. Despite this elevated risk, collectively these events accounted for just 16.8% of the overall public burden of PTSD, given their low prevalence among the general population. Events that were characteristic of civil conflict, including unexpected death of a loved one, witnessing death or a dead body or someone seriously injured and being mugged or threatened with a weapon accounted for the highest proportion of the overall public health burden of PTSD (18.6, 9.4 and 7.8%, respectively). These findings are a feature of the higher prevalence of these events among the general population coupled with their moderate to above average risk of PTSD. CONCLUSIONS Despite the formal end to conflict in NI in 1999, a substantial proportion of the adult population continue to suffer the adverse mental health effects of chronic trauma exposure. Given rates of recovery of PTSD in the absence of evidence-based treatments, it is likely that the legacy of mental ill health associated with conflict, if not adequately addressed, will endure for many years.
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197
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Epigenetic modulation of glucocorticoid receptors in posttraumatic stress disorder. Transl Psychiatry 2014; 4:e368. [PMID: 24594779 PMCID: PMC3966043 DOI: 10.1038/tp.2014.3] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 11/27/2013] [Accepted: 01/06/2014] [Indexed: 12/28/2022] Open
Abstract
Some individuals suffering from posttraumatic stress disorder (PTSD) exhibit lower basal salivary cortisol and higher glucocorticoid receptor (GR) sensitivity. Recent studies suggest that epigenetic mechanisms regulate the activity of cortisol and GR. As a means to combine and cross-validate those findings, we compared cortisol, GR expression and promoter methylation levels in peripheral T lymphocytes of healthy controls versus individuals endorsing a diagnosis of lifetime PTSD. Thirty subjects with lifetime (current or remitted) PTSD and 16 subjects never exposed to trauma were recruited. Salivary cortisol was collected at six time points over the course of a single weekday and analyzed utilizing a time-resolved fluorescence immunoassay. GR expression (GRtotal, 1B, 1C, 1F and 1H) was measured by quantitative RT-PCR. DNA methylation levels in human glucocorticoid receptor (hGR) 1B and 1C variant's promoter were quantified by epityper in T lymphocytes isolated by magnetic-assisted cell sorting. Individuals with lifetime PTSD have lower morning cortisol release, higher mRNA expression of hGRtotal, 1B, and 1C and lower overall methylation levels in hGR 1B and 1C promoters. Cortisol levels were inversely correlated with hGR 1B mRNA expression. Moreover, overall and CpG site-specific methylation levels were inversely correlated with hGRtotal and 1B mRNA expression. There was no difference between current and remitted PTSD across cortisol, GR expression mRNA and DNA methylation data. Traumatic events induce DNA methylation alterations in distinct promoters of hGR with transcriptional modifications that associate with hypoactive hypothalamus-pituitary-adrenal axis in individuals with PTSD. Our results also point toward an important role of hGR 1B variant in PTSD.
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198
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Gisladottir A, Harlow BL, Gudmundsdottir B, Bjarnadottir RI, Jonsdottir E, Aspelund T, Cnattingius S, Valdimarsdottir UA. Risk factors and health during pregnancy among women previously exposed to sexual violence. Acta Obstet Gynecol Scand 2014; 93:351-8. [DOI: 10.1111/aogs.12331] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 12/30/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Agnes Gisladottir
- Center of Public Health Sciences; University of Iceland; Reykjavik Iceland
| | - Bernard L. Harlow
- Department of Epidemiology; University of Minnesota School of Public Health; Minneapolis Minnesota USA
| | - Berglind Gudmundsdottir
- Center of Public Health Sciences; University of Iceland; Reykjavik Iceland
- Psychology Department; University of Iceland; Reykjavik Iceland
- Rape Trauma Service; Accident and Emergency Department; Landspitali University Hospital; Reykjavik Iceland
| | - Ragnheidur I. Bjarnadottir
- Icelandic Birth Register; Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | - Eyrun Jonsdottir
- Rape Trauma Service; Accident and Emergency Department; Landspitali University Hospital; Reykjavik Iceland
| | - Thor Aspelund
- Center of Public Health Sciences; University of Iceland; Reykjavik Iceland
- Icelandic Heart Association; Kopavogur Iceland
| | - Sven Cnattingius
- Unit of Clinical Epidemiology; Karolinska Institute; Stockholm Sweden
| | - Unnur A. Valdimarsdottir
- Center of Public Health Sciences; University of Iceland; Reykjavik Iceland
- Department of Epidemiology; Harvard School of Public Health; Boston Massachusetts USA
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199
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Wallin Lundell I, Georgsson Öhman S, Frans Ö, Helström L, Högberg U, Nyberg S, Sundström Poromaa I, Sydsjö G, Östlund I, Skoog Svanberg A. Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study. BMC WOMENS HEALTH 2013; 13:52. [PMID: 24364878 PMCID: PMC3879178 DOI: 10.1186/1472-6874-13-52] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/18/2013] [Indexed: 12/04/2022]
Abstract
Background Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. Methods This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups. Results The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. Conclusion Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.
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Affiliation(s)
- Inger Wallin Lundell
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
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Abstract
Posttraumatic stress disorder (PTSD) may develop as a serious long-term consequence of traumatic experiences, even many years after trauma exposure. The objectives of this study were to examine the prevalence of lifetime and current PTSD as well as to detect the most stressful life events and sociodemographic risk factors of PTSD in a general adult Serbian population. The sample consisted of 640 subjects chosen by random walk technique in five regions of the country. The Mini International Neuropsychiatric Interview 5 revealed an 18.8% prevalence rate of current PTSD and a 32.3% prevalence rate of lifetime PTSD. According to the Life Stressor Checklist-Revised, the bombardment, being expelled from home, siege, and participation in combat were the stressful events most likely to be associated with PTSD. The prevalence of PTSD increased among widows and widowers, divorced persons, unemployed persons, and retired persons. The high level of PTSD a few years after the trauma exposure classifies as a significant health problem that can cause serious consequences for families and the community as a whole.
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