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Tng GYQ, Koh J, Soh XC, Majeed NM, Hartanto A. Efficacy of digital mental health interventions for PTSD symptoms: A systematic review of meta-analyses. J Affect Disord 2024; 357:23-36. [PMID: 38679205 DOI: 10.1016/j.jad.2024.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/30/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The present systematic review aimed to synthesize the results of meta-analyses which examine the effects of digital mental health interventions (DMHIs) on post-traumatic stress disorder (PTSD) symptoms, and investigate whether intervention characteristics (i.e., technique, timeframe, and therapeutic guidance) and methodological characteristics including outcome measures and sample inclusion criteria (age, gender, socioeconomic status, country, comorbidity) moderate the efficacy of digital interventions. METHODS A systematic search of various sources (ECSCOhost PsycInfo, PubMed, Web of Science, Scopus, EBSCOhost ERIC, Google Scholar, ProQuest Dissertations & Theses) including five peer-reviewed journals was conducted to identify relevant meta-analyses up to December 2023, and 11 meta-analyses were included in the final review. RESULTS Overall, our review elucidates that DMHIs are appropriate for alleviating PTSD symptoms in adults, with more consistent evidence supporting the efficacy of cognitive behavioral therapy (CBT)-based, compared to non-CBT-based, interventions when compared to control conditions. However, we found inconclusive evidence that the efficacy of DMHIs varied according to intervention timeframe, therapeutic guidance, or sample characteristics. LIMITATIONS A relatively limited number of different populations was sampled across meta-analyses. Further, while our review focused on PTSD symptoms to indicate the efficacy of digital interventions, other indices of effectiveness were not examined. CONCLUSION Our findings indicate the clinical utility of DMHIs for managing PTSD symptoms particularly when CBT-based intervention techniques are employed.
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Affiliation(s)
| | - Jerica Koh
- Singapore Management University, Singapore
| | - Xun Ci Soh
- Singapore Management University, Singapore
| | - Nadyanna M Majeed
- Singapore Management University, Singapore; National University of Singapore, Singapore
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2
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MacConnachie L, Zhang YS, Farina M, Gutierrez C, Hoover A, He Y, Aiello AE, Noppert GA. The association between incarceration and housing insecurity and advanced immune age during late life. Soc Sci Med 2024; 347:116698. [PMID: 38461610 PMCID: PMC11164318 DOI: 10.1016/j.socscimed.2024.116698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
Emerging evidence suggests that psychosocial stress ages the immune system. Accordingly, immune aging may be an important potential mechanism linking psychosocial stress to aging-related decline and disease. Incarceration and housing insecurity represent severe and complex experiences of a multitude of psychosocial stressors, including discrimination, violence, and poverty. In this study, we investigated the association between incarceration and/or housing insecurity and advanced immune age in adults aged 55 and older. Our sample was derived from the Health and Retirement Survey (HRS), with n = 7003 individuals with valid housing insecurity data and n = 7523 with valid incarceration data. From 2016 Venous Blood Study data, we assessed immune aging using a comprehensive set of immune markers including inflammatory markers (IL-6, CRP, s-TNFR1), markers of viral control (CMV IgG antibodies), and ratios of T cell phenotypes (CD8+:CD4+, CD+ Memory: Naïve, CD4+ Memory: Naïve, CD8+ Memory: Naïve ratios). We found that both incarceration and housing insecurity were strongly associated with more advanced immune aging as indicated by increased inflammation, reduced viral control, and reduction in naïve T cells relative to memory T cells. Given that those who experienced incarceration, housing insecurity, and/or are racialized minorities were less likely to be included in this study, our results likely underestimated these associations. Despite these limitations, our study provided strong evidence that experiencing incarceration and/or housing insecurity may accelerate the aging of the immune system.
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Affiliation(s)
- Lauren MacConnachie
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| | - Yuan S Zhang
- Department of Sociomedical Sciences and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Mateo Farina
- Department of Human Development and Family Sciences, Population Research Center, University of Texas at Austin, Austin, TX, USA.
| | - Carmen Gutierrez
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Andrew Hoover
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| | - Yuelin He
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| | - Allison E Aiello
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Grace A Noppert
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
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Greenwald A, Kelly A, Thomas L. Trauma-informed care in the emergency department: concepts and recommendations for integrating practices into emergency medicine. MEDICAL EDUCATION ONLINE 2023; 28:2178366. [PMID: 36799730 PMCID: PMC9946309 DOI: 10.1080/10872981.2023.2178366] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/08/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
The experience of psychological trauma is common and has become even more prevalent during the COVID-19 pandemic for both health care workers and the general population [1-3]. Traumatic experiences can have varied and lasting physical and mental health effects on patients, beyond what we are privy to in the acute environment of the emergency department. The effects of these prior traumatic experiences can be exacerbated by interaction with the healthcare system, and yet emergency medicine physicians have no standardized methods for working with patients in a trauma-informed way. The systematic implementation of trauma-informed care (TIC) practice requires the cooperation of multiple domains within the health care system, including focus on the physical environment, direct care, and administrative practices. Here we provide recommendations specific to emergency medicine for the development and implementation of TIC in the regular patient-clinician interaction, situated within the context of the TIC framework as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) [4].
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Affiliation(s)
- Audria Greenwald
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Amber Kelly
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Listy Thomas
- Department of Social Work, Quinnipiac University School for Health Sciences, North Haven, CT, USA
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4
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Ásgeirsdóttir TL, Hardardottir H, Jonbjarnardóttir B. Putting a price on pain: The monetary compensation needed to offset welfare losses due to violence. Soc Sci Med 2023; 336:116268. [PMID: 37806149 DOI: 10.1016/j.socscimed.2023.116268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
Efficiency calculations of violence prevention are likely to be severely biased if the hard-to-measure value of utility reductions due to victimization is not included. We measure the monetary compensation needed to offset the welfare loss associated with being subjected to violence, by applying the compensating-income-variation method to data from an Icelandic health-and-lifestyle survey carried out in 2017. We examine differences in the monetary compensation needed by (i) types of violence, (ii) duration since the exposure, and (iii) the relationship with the perpetrator. Our results show that the average compensation needed to offset the welfare loss due to psychological violence is $43,750 per year, $22,202 per year for sexual violence, and $10,938 per year for physical violence. Further, we find that the monetary compensation needed is highest when the perpetrator is a spouse or an ex-spouse, and when the violence happened recently.
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Affiliation(s)
| | - Hjördis Hardardottir
- Department of Economics, University of Iceland, Oddi v/Sturlugotu, 101 Reykjavík, Iceland
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5
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ter Kuile AR, Hübel C, Cheesman R, Coleman JR, Peel AJ, Levey DF, Stein MB, Gelernter J, Rayner C, Eley TC, Breen G. Genetic Decomposition of the Heritable Component of Reported Childhood Maltreatment. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:716-724. [PMID: 37881567 PMCID: PMC10593925 DOI: 10.1016/j.bpsgos.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/15/2023] [Accepted: 03/11/2023] [Indexed: 10/27/2023] Open
Abstract
Background Decades of research have shown that environmental exposures, including self-reports of trauma, are partly heritable. Heritable characteristics may influence exposure to and interpretations of environmental factors. Identifying heritable factors associated with self-reported trauma could improve our understanding of vulnerability to exposure and the interpretation of life events. Methods We used genome-wide association study summary statistics of childhood maltreatment, defined as reporting of abuse (emotional, sexual, and physical) and neglect (emotional and physical) (N = 185,414 participants). We calculated genetic correlations (rg) between reported childhood maltreatment and 576 traits to identify phenotypes that might explain the heritability of reported childhood maltreatment, retaining those with |rg| > 0.25. We specified multiple regression models using genomic structural equation modeling to detect residual genetic variance in childhood maltreatment after accounting for genetically correlated traits. Results In 2 separate models, the shared genetic component of 12 health and behavioral traits and 7 psychiatric disorders accounted for 59% and 56% of heritability due to common genetic variants (single nucleotide polymorphism-based heritability [h2SNP]) of childhood maltreatment, respectively. Genetic influences on h2SNP of childhood maltreatment were generally accounted for by a shared genetic component across traits. The exceptions to this were general risk tolerance, subjective well-being, posttraumatic stress disorder, and autism spectrum disorder, identified as independent contributors to h2SNP of childhood maltreatment. These 4 traits alone were sufficient to explain 58% of h2SNP of childhood maltreatment. Conclusions We identified putative traits that reflect h2SNP of childhood maltreatment. Elucidating the mechanisms underlying these associations may improve trauma prevention and posttraumatic intervention strategies.
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Affiliation(s)
- Abigail R. ter Kuile
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Christopher Hübel
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
- National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Rosa Cheesman
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Jonathan R.I. Coleman
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Alicia J. Peel
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Daniel F. Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Murray B. Stein
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, California
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher Rayner
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Thalia C. Eley
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
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Sullivan MC, Wirtz MR, McKetchnie SM, Hart TA, Fitch C, Lazkani S, Boroughs MS, O’Cleirigh C. The impact of depression and post-traumatic stress symptoms on physical health perceptions and functional impairment among sexual minority men living with HIV with histories of trauma. AIDS Care 2022; 34:1288-1296. [PMID: 34403289 PMCID: PMC8850536 DOI: 10.1080/09540121.2021.1967852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mental health symptoms may compromise health-related quality of life (HRQOL), including among men who have sex with men (MSM) living with HIV, who experience high rates of trauma and other stressors. This study sought to examine the relative contributions of post-traumatic stress disorder (PTSD) symptoms, depression symptoms, and biological indices of HIV disease status on HRQOL in this population. Participants were 79 MSM with HIV (49% White; 35% Black; 8% Hispanic/Latinx) with trauma histories (52% met current PTSD diagnostic criteria). HRQOL outcomes were general perceptions of health (0-100 visual analog scale) and functional disability (WHODAS 2.0). Dominance analysis was applied to examine the relative share of variance in these outcomes accounted for by PTSD symptom severity, depression symptom severity, viral suppression status, and CD4 count. Depression symptom severity accounted for 70% and 92% of variance in perceived health, respectively, across models (p's < 0.05). Both PTSD symptom severity (45%) and depression symptom severity (43%) scores also accounted for significant variance in functional disability (p's < 0.05). Medical indices of HIV disease progression did not explain significant variance in HRQOL in any model. A trauma-informed approach may aid clinicians in interpreting reports of health and physical functioning in MSM with HIV.
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Affiliation(s)
- Matthew C. Sullivan
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA,Harvard Medical School, Boston, MA
| | - Megan R. Wirtz
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA
| | - Samantha M. McKetchnie
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA
| | - Trevor A. Hart
- Ryerson University, Department of Psychology, Toronto, ON,University of Toronto, Dalla Lana School of Public Health, Toronto, ON
| | - Calvin Fitch
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA
| | - Samer Lazkani
- Ryerson University, Department of Psychology, Toronto, ON
| | | | - Conall O’Cleirigh
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA,The Fenway Institute, Fenway Health, Boston, MA,Harvard Medical School, Boston, MA
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7
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Pascale A, Stephenson M, Barr P, Latvala A, Aaltonen S, Piirtola M, Viken R, Rose RJ, Kaprio J, Maes H, Dick DM, Salvatore JE. Exploring the relationships between adolescent alcohol misuse and later life health outcomes. Alcohol Clin Exp Res 2022; 46:1753-1765. [PMID: 36115067 PMCID: PMC9509441 DOI: 10.1111/acer.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to clarify the impact of adolescent alcohol misuse on adult physical health and subjective well-being. To do so, we investigated both the direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction and the indirect effects on these outcomes attributable to subsequent alcohol problems. METHOD The sample included 2733 twin pairs (32% monozygotic; 52% female) from the FinnTwin16 study. Adolescent alcohol misuse was a composite of frequency of drunkenness, frequency of alcohol use, and alcohol problems at ages 16, 17, and 18.5. The early midlife outcomes included somatic symptoms, self-rated health, and life satisfaction at age 34. The mediators examined as part of the indirect effect analyses included alcohol problems from the Rutgers Alcohol Problem Index at ages 24 and 34. Serial mediation and co-twin comparison models were applied and included covariates from adolescence and early midlife. RESULTS There were weak direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction. However, there was stronger evidence for indirect effects, whereby young adult and early midlife alcohol problems serially mediated the relationship between adolescent alcohol misuse and early midlife somatic symptoms (β = 0.03, 95% CI [0.03, 0.04]), self-rated health (β = -0.02, 95% CI [-0.03, -0.01]), and life satisfaction (β = -0.03, CI [-0.04, -0.02]). These serial mediation effects were robust in co-twin comparison analyses. CONCLUSIONS These results provide evidence that alcohol problems are a primary driver linking adolescent alcohol misuse and poor health outcomes across the lifespan.
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Affiliation(s)
- Angela Pascale
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Mallory Stephenson
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Virginia Institute for Psychiatric and Behavioral GeneticsRichmondVirginiaUSA
| | - Peter Barr
- Department of Psychiatry and Behavioral SciencesSUNY Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Antti Latvala
- Institute of Criminology and Legal PolicyUniversity of HelsinkiHelsinkiFinland
| | - Sari Aaltonen
- Institute for Molecular Medicine Finland (FIMM)University of HelsinkiHelsinkiFinland
| | - Maarit Piirtola
- Institute for Molecular Medicine Finland (FIMM)University of HelsinkiHelsinkiFinland
- UKK Institute for Health Promotion ResearchTampereFinland
| | - Richard Viken
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIndianaUSA
| | - Richard J. Rose
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIndianaUSA
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM)University of HelsinkiHelsinkiFinland
| | - Hermine Maes
- Virginia Institute for Psychiatric and Behavioral GeneticsRichmondVirginiaUSA
| | - Danielle M. Dick
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Human and Molecular GeneticsVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jessica E. Salvatore
- Department of PsychiatryRutgers Robert Wood Johnson School of MedicinePiscatawayNew JerseyUSA
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Alper HE, Feliciano L, Millien L, Pollari C, Locke S. Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9737. [PMID: 35955093 PMCID: PMC9368472 DOI: 10.3390/ijerph19159737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.
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Affiliation(s)
- Howard E. Alper
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| | - Leen Feliciano
- Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Lucie Millien
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| | - Cristina Pollari
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
| | - Sean Locke
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY 11101, USA
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Weinberg M, Kimchy Elimellech A. Civilian Military Security Coordinators Coping with Frequent Traumatic Events: Spirituality, Community Resilience, and Emotional Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148826. [PMID: 35886676 PMCID: PMC9322548 DOI: 10.3390/ijerph19148826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023]
Abstract
Civilian military security coordinators are a unique kind of first responders. They live in communities that are close to the border and are responsible for the security of their community in routine and emergency situations until the arrival of the army or the police. Their role puts them at an elevated risk of experiencing emotional distress and developing PTSD. The present study, which was conducted in Israel following terror incidents over the year 2018, aimed to examine the relationships between spirituality and perceived community resilience, on the one hand, and PTSD symptoms and stress, on the other, among civilian military security coordinators. One hundred and thirteen (n = 113) civilian military security coordinators living up to 12.4 miles from the border who are routinely exposed to terror and other traumatic events completed demographic, spirituality, community resilience, PTSD, and stress questionnaires. Structural-equation-model analyses showed that spirituality was negatively associated with PTSD symptoms and stress. However, perceived community resilience was not associated with PTSD symptoms or stress. In addition, age was negatively associated with PTSD symptoms and stress. Financial situation was also negatively associated with PTSD symptoms and stress and incidence of exposure to terror and security threats was associated only with PTSD symptoms. Theoretical and practical implications are discussed.
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Affiliation(s)
- Michael Weinberg
- School of Social Work, Faculty of Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
- Correspondence:
| | - Adi Kimchy Elimellech
- School of Social Work, Faculty of Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
- Sha’ar Menashe Mental Health Center, Haifa 3785000, Israel
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10
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Udo I, Javinsky TR, Awani T. Eye movement desensitisation and reprocessing: part 1 – theory, procedure and use in PTSD. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
SUMMARY
Eye movement desensitisation and reprocessing (EMDR) is an established psychotherapy developed in the late 1980s to treat post-traumatic stress disorder (PTSD). It involves the use of repetitive eye movements or other bilateral stimulation to aid in the reprocessing of traumatic memories. It is unique in that it does not require extended exposure to or discussion of distressing memories and may result in symptom resolution in fewer sessions than other psychotherapies. In the decades since its initial development, a wealth of high-quality evidence has suggested that EMDR is a safe and effective treatment for trauma- and stress-based conditions, resulting in its inclusion in various treatment guidelines. This article reviews the theory behind how EMDR works, how it is conducted, the evidence supporting its use in the treatment of PTSD and its approved indications and contraindications.
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11
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Lawn RB, Nishimi KM, Sumner JA, Chibnik LB, Roberts AL, Kubzansky LD, Rich‐Edwards JW, Koenen KC, Thurston RC. Sexual Violence and Risk of Hypertension in Women in the Nurses' Health Study II: A 7-Year Prospective Analysis. J Am Heart Assoc 2022; 11:e023015. [PMID: 35189695 PMCID: PMC9075082 DOI: 10.1161/jaha.121.023015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
Background Hypertension is a prevalent condition in women and an important modifiable risk factor for cardiovascular disease. Despite women's experiences of sexual violence being common, no prospective studies have examined lifetime sexual assault and workplace sexual harassment in relationship to hypertension in large civilian samples with extended follow-up. Here, we examined whether these experiences were prospectively associated with greater risk of developing hypertension over 7 years. Methods and Results Data are from a substudy of the Nurses' Health Study II and include women free of hypertension at the time of sexual assault and workplace sexual harassment assessment in 2008 (n=33 127). Hypertension was defined as self-reported doctor diagnosis or initiating antihypertensive medication use, assessed biennially through 2015. We performed Cox proportional hazards regression models to predict time to developing hypertension associated with sexual violence exposure, adjusting for relevant covariates. Over follow-up, 7096 women developed hypertension. Sexual assault and workplace sexual harassment were prevalent (23% and 12%, respectively; 6% of women experienced both). Compared with women with no exposure, women who experienced both sexual assault and workplace sexual harassment had the highest risk of developing hypertension (hazard ratio [HR], 1.21; 95% CI, 1.09-1.35), followed by women who experienced workplace sexual harassment (HR, 1.15; 95% CI, 1.05-1.25) and then by women who experienced sexual assault (HR, 1.11; 95% CI, 1.03-1.19), after adjusting for relevant covariates. Conclusions Sexual assault and workplace sexual harassment are prospectively associated with greater risk of hypertension. Reducing such violence is important in its own right and may also improve women's cardiovascular health.
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Affiliation(s)
- Rebecca B. Lawn
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
| | - Kristen M. Nishimi
- Mental Health ServiceSan Francisco Veterans Affairs Medical CenterSan FranciscoCA
- Department of Psychiatry and Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCA
| | | | - Lori B. Chibnik
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Andrea L. Roberts
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
| | - Laura D. Kubzansky
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMA
| | - Janet W. Rich‐Edwards
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s HealthDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
| | - Karestan C. Koenen
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMA
- Psychiatric and Neurodevelopmental Genetics UnitDepartment of PsychiatryMassachusetts General HospitalBostonMA
| | - Rebecca C. Thurston
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPA
- Department of EpidemiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghPA
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Musanabaganwa C, Wani AH, Donglasan J, Fatumo S, Jansen S, Mutabaruka J, Rutembesa E, Uwineza A, Hermans EJ, Roozendaal B, Wildman DE, Mutesa L, Uddin M. Leukocyte methylomic imprints of exposure to the genocide against the Tutsi in Rwanda: a pilot epigenome-wide analysis. Epigenomics 2022; 14:11-25. [PMID: 34875875 PMCID: PMC8672329 DOI: 10.2217/epi-2021-0310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim & methods: We conducted a pilot epigenome-wide association study of women from Tutsi ethnicity exposed to the genocide while pregnant and their resulting offspring, and a comparison group of women who were pregnant at the time of the genocide but living outside of Rwanda.Results: Fifty-nine leukocyte-derived DNA samples survived quality control: 33 mothers (20 exposed, 13 unexposed) and 26 offspring (16 exposed, 10 unexposed). Twenty-four significant differentially methylated regions (DMRs) were identified in mothers and 16 in children. Conclusions:In utero genocide exposure was associated with CpGs in three of the 24 DMRs: BCOR, PRDM8 and VWDE, with higher DNA methylation in exposed versus unexposed offspring. Of note, BCOR and VWDE show significant correlation between brain and blood DNA methylation within individuals, suggesting these peripherally derived signals of genocide exposure may have relevance to the brain.
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Affiliation(s)
- Clarisse Musanabaganwa
- Centre for Human Genetics, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda,Department of Clinical Psychology, College of Medicine & Health Sciences, University of Rwanda, Huye, Rwanda,Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA,Department of Cognitive Neuroscience, Radboud University Medical Center – Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Agaz H Wani
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Janelle Donglasan
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Segun Fatumo
- London School of Hygiene & Tropical Medicine, London, UK,Uganda Medical Informatics Centre-MRC/UVRI, Entebbe, Uganda
| | - Stefan Jansen
- Directorate of Research & Innovation, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, College of Medicine & Health Sciences, University of Rwanda, Huye, Rwanda
| | - Eugene Rutembesa
- Department of Clinical Psychology, College of Medicine & Health Sciences, University of Rwanda, Huye, Rwanda
| | - Annette Uwineza
- Centre for Human Genetics, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Erno J Hermans
- Department of Cognitive Neuroscience, Radboud University Medical Center – Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Benno Roozendaal
- Department of Cognitive Neuroscience, Radboud University Medical Center – Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Derek E Wildman
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Leon Mutesa
- Centre for Human Genetics, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA,Author for correspondence:
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Alhussaini NW, Riaz M. Effectiveness of pharmacological and psychological interventions for treating post-traumatic stress disorder in adults with childhood abuse: protocol for a systematic review and network meta-analysis. BMJ Open 2021; 11:e048790. [PMID: 34903534 PMCID: PMC8671926 DOI: 10.1136/bmjopen-2021-048790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that develops after being exposed to a traumatic event. PTSD is common among adults who have experienced physical/sexual childhood abuse. Several psychological and pharmacological interventions are used for treating PTSD in this particular group, and it is important to identify what interventions, whether alone or in combination with other treatments, are more effective compared with others. Therefore, this review aims to provide synthesis of evidence on the effectiveness of different interventions used for treating PTSD following childhood abuse. METHODS AND ANALYSIS Electronic search will be conducted using different databases such as PubMed, EMBASE, PsycINFO to identify randomised controlled trials (RCTs) used for assessing interventions for PTSD following childhood abuse. Data on treatment effectiveness for PTSD with childhood abuse and other variables will be extracted from each paper and reported as appropriate. Extracted effect-size estimates will be combined using Bayesian network meta-analysis (NMA). Risk of bias will be assessed through the Cochrane Collaboration tool for RCTs tool. NMA assumptions (heterogeneity, transitivity, inconsistency) will be assessed and reported. Meta-regression and subgroup analyses will be performed to explore and explain possible sources of heterogeneity. ETHICS AND DISSEMINATION This research is based on literature review and does not require the approval of ethical board as it does not involve dealing with humans or animals. Findings of this review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020207409.
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Affiliation(s)
- Nour Waleed Alhussaini
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Muhammad Riaz
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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14
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Axinn WG, Chardoul S. Improving reports of health risks: Life history calendars and measurement of potentially traumatic experiences. Int J Methods Psychiatr Res 2021; 30:e1853. [PMID: 32940393 PMCID: PMC7992281 DOI: 10.1002/mpr.1853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/26/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Recall error biases reporting of earlier life experiences, even potentially traumatic experiences (PTEs). Better tools for accurate retrospective reporting of PTEs and other health risk factors have the potential for broad scientific and health intervention benefits. METHODS We designed a life history calendar (LHC) to support this task and randomized more than 1000 individuals to each arm of a retrospective diagnostic interview, including detailed measures of PTEs, with and without the LHC. This is one of the largest experiments ever done to assess the benefit of an LHC approach and the only large-scale experiment done in a poor, agrarian, non-Western setting (rural Nepal). RESULTS Results demonstrate use of an LHC in retrospective measurement can significantly increase lifetime reports of PTEs, especially reports of two or more PTEs. The LHC increases PTE reporting more for men and those with less education. CONCLUSIONS The LHC approach is practical for many uses ranging from large surveys of the general population to clinical intake of new patients. It significantly increases reporting of health risk factors.
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Affiliation(s)
- William G Axinn
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephanie Chardoul
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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15
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Schwetlik SN, Baldock KL, Hill CL, Ferrar K. Chronic stress and arthritis: a scoping review. Arthritis Care Res (Hoboken) 2020; 74:982-996. [PMID: 33278062 DOI: 10.1002/acr.24528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/02/2020] [Accepted: 12/01/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Emerging research supports the role of chronic stress in chronic disease development. This scoping review aimed to map the field of research exploring relationships between chronic stress and the development of arthritis in adult populations. METHODS Five electronic databases were systematically searched without publication limits based on three key concepts: stress, arthritis and adults. Eligible qualitative studies investigated individuals' perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by two independent reviewers and data were narratively synthesised. RESULTS Of 1819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods and 45 used quantitative methods. Studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorised as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self-reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development. CONCLUSION Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease aetiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiological framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions.
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Affiliation(s)
- Sarah N Schwetlik
- UniSA: Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Katherine L Baldock
- UniSA: Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Catherine L Hill
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
| | - Katia Ferrar
- UniSA: Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
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16
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Crosswell AD, Lockwood KG. Best practices for stress measurement: How to measure psychological stress in health research. Health Psychol Open 2020; 7:2055102920933072. [PMID: 32704379 PMCID: PMC7359652 DOI: 10.1177/2055102920933072] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite the strong evidence linking psychological stress to disease risk, health researchers often fail to include psychological stress in models of health. One reason for this is the incorrect perception that the construct of psychological stress is too vague and broad to accurately measure. This article describes best practices in stress measurement, detailing which dimensions of stressor exposures and stress responses to capture, and how. We describe when to use psychological versus physiological indicators of stress. It is crucial that researchers across disciplines utilize the latest methods for measuring and describing psychological stress in order to build a cumulative science.
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17
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State-of-the-Science Review of Non-Chemical Stressors Found in a Child's Social Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224417. [PMID: 31718056 PMCID: PMC6888402 DOI: 10.3390/ijerph16224417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children’s health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child’s social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000–2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child’s social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children’s health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child’s social environment when addressing children’s environmental health considerations.
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18
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Zhang HH, Meng SQ, Guo XY, Zhang JL, Zhang W, Chen YY, Lu L, Yang JL, Xue YX. Traumatic Stress Produces Delayed Alterations of Synaptic Plasticity in Basolateral Amygdala. Front Psychol 2019; 10:2394. [PMID: 31708835 PMCID: PMC6824323 DOI: 10.3389/fpsyg.2019.02394] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/07/2019] [Indexed: 12/19/2022] Open
Abstract
Acute traumatic event exposure is a direct cause of post-traumatic stress disorder (PTSD). Amygdala is suggested to be associated with the development of PTSD. In our previous findings, different activation patterns of GABAergic neurons and glutamatergic neurons in early or late stages after stress were found. However, the neural plastic mechanism underlying the role of basolateral amygdala (BLA) in post-traumatic stress disorder remains unclear. Therefore, this study mainly aimed at investigating time-dependent morphologic and electrophysiological changes in BLA during the development of PTSD. We used single prolonged stress (SPS) procedure to establish PTSD model of rats. The rats showed no alterations in anxiety behavior as well as in dendritic spine density or synaptic transmission in BLA 1 day after SPS. However, 10 days after SPS, rats showed enhancement of anxiety behavior, and spine density and frequency of miniature excitatory and inhibitory postsynaptic currents in BLA. Our results suggested that after traumatic stress, BLA displayed delayed increase in both spinogenesis and synaptic transmission, which seemed to facilitate the development of PTSD.
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Affiliation(s)
- Huan-Huan Zhang
- Department of Psychiatry, Tianjin Medical University, Tianjin, China.,Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shi-Qiu Meng
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Xin-Yi Guo
- Department of Psychiatry, Tianjin Medical University, Tianjin, China.,Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing-Liang Zhang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China.,Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy and Purdue Institute for Integrative Neuroscience, West Lafayette, IN, United States
| | - Wen Zhang
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Ya-Yun Chen
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- National Institute on Drug Dependence, Peking University, Beijing, China.,Peking University Sixth Hospital/Peking University Institute of Mental Health, Peking University, Beijing, China
| | - Jian-Li Yang
- Department of Psychiatry, Tianjin Medical University, Tianjin, China.,Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence, Peking University, Beijing, China
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19
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Weiss NH, Walsh K, DiLillo DD, Messman-Moore TL, Gratz KL. A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:975-986. [PMID: 30771054 PMCID: PMC6474756 DOI: 10.1007/s10508-019-1392-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 05/02/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.
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Affiliation(s)
- Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Kate Walsh
- Department of Psychology, Yeshiva University, Bronx, NY, USA
| | - David D DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Mail Stop 948, 2801 West Bancroft Street, Toledo, OH, 43606, USA.
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20
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Lee J, Brazeal M, Choi H, Rehner TA, McLeod ST, Jacobs CM. Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center. SOCIAL WORK IN HEALTH CARE 2018; 57:834-850. [PMID: 30136904 DOI: 10.1080/00981389.2018.1508113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study is to examine the prevalence of depression and physical and psychosocial factors associated with depression among adults with Type 2 Diabetes Mellitus (T2DM). METHODS The sample included 421 patients with T2DM at a Federally Qualified Healthcare Center in a southern state. The Patient Health Questionnaire (PHQ-9) was used to measure the severity of depression. RESULTS The multiple logistic regression analyses revealed that the likelihood of depression increased as the level of pain increased and as the level of ambulation difficulties increased. The likelihood of depression increased as the number of traumatic events increased and as the number of SES-related stressors increased. Expectedly, the likelihood of depression decreased as levels of self-esteem increased. CONCLUSIONS The findings support that health care providers developing care plans for individuals with diabetes need to include assessments and interventions that address both the physical and psychosocial needs of patients.
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Affiliation(s)
- Joohee Lee
- a School of Social Work , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Michelle Brazeal
- b School of Social Work, Mississippi Integrated Health and Disaster Program , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Hwanseok Choi
- c Department of Public Health , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Tim A Rehner
- a School of Social Work , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Stephanie T McLeod
- b School of Social Work, Mississippi Integrated Health and Disaster Program , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Christina M Jacobs
- a School of Social Work , University of Southern Mississippi , Hattiesburg , MS , USA
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21
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Sommer JL, Mota N, El-Gabalawy R. Maladaptive Eating in Posttraumatic Stress Disorder: A Population-Based Examination of Typologies and Medical Condition Correlates. J Trauma Stress 2018; 31:708-718. [PMID: 30338565 DOI: 10.1002/jts.22323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/15/2018] [Accepted: 05/20/2018] [Indexed: 01/01/2023]
Abstract
Posttraumatic stress disorder (PTSD) and eating pathology are frequently comorbid, and both are independent risk factors for various medical conditions. Using population-based data collected as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309), the primary objectives of this study were to (a) identify eating pathology classes among PTSD and (b) investigate associations between maladaptive eating and medical conditions among PTSD. Using the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5), we assessed PTSD and maladaptive eating symptoms in accordance with the DSM-5. We used a latent class analysis to identify maladaptive eating typologies among adults with lifetime PTSD (n = 2,339; 6.1%) and multivariable logistic regression models to examine associations between each of the six emergent maladaptive eating typologies and medical conditions. Results revealed that over 40% of individuals with PTSD endorsed indicators of maladaptive eating. In addition, each maladaptive eating typology among PTSD was significantly associated with unique sociodemographic characteristics and increased odds of medical conditions relative to no PTSD and no eating disorder, adjusted odds ratios (AORs) = 1.34-6.55, and PTSD with no eating psychopathology, AORs = 1.43-5.11. Results of this study provide a better understanding of maladaptive eating in adults with PTSD and potential medical sequelae. Results indicate maladaptive eating may be an important mechanism in the association between PTSD and medical conditions, which may inform targeted interventions among individuals with these comorbidities.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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22
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Penz M, Kirschbaum C, Buske-Kirschbaum A, Wekenborg MK, Miller R. Stressful life events predict one-year change of leukocyte composition in peripheral blood. Psychoneuroendocrinology 2018; 94:17-24. [PMID: 29751249 DOI: 10.1016/j.psyneuen.2018.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 01/13/2023]
Abstract
A plethora of cross-sectional studies suggest that psychological stress resulting from experiencing stressful life events (SLE) can result in an altered immune response. Potential maladaptive immune changes may outlast the event and affect the organism long after stress cessation. As a consequence, an increased vulnerability for immune-mediated pathologies (e.g. arthritis, diabetes) may develop over the life span. The objective of the present study was to monitor the longitudinal kinetics of peripheral white blood cells (WBCs; neutrophils, lymphocytes, and monocytes) in response to SLE. Here we present blood, hair, and behavioural measures obtained in the Dresden Burnout Study, at first visit (T1; N = 446) and one year later (T2; N = 173). Cumulative impact of SLE was assessed at T1 with the Life Stressor Checklist (LSC-R). Results indicate a significant increase in neutrophils (+2.8% per each 10 LSC-R points) between T1 and T2 in association with reported SLE. The change in neutrophils tended to correlate with the change in hair cortisol (Coheńs f = 0.6). We propose that SLE trigger immunological alterations that persist across time and thereby promote a continuous effect on WBC distribution. Such an effect might advance subclinical inflammatory processes, reduce an individualś immune defence, and promote a link between psychological stress and physical disease.
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Affiliation(s)
- Marlene Penz
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany.
| | | | | | | | - Robert Miller
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
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23
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Ellis J, Zaretsky A. Assessment and Management of Posttraumatic Stress Disorder. ACTA ACUST UNITED AC 2018; 24:873-892. [PMID: 29851883 DOI: 10.1212/con.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The goal of this article is to increase clinicians' understanding of posttraumatic stress disorder (PTSD) and improve skills in assessing risk for and diagnosing PTSD. The importance and sequelae of lifetime trauma burden are discussed, with reference to trends in prevention, early intervention, and treatment. RECENT FINDINGS PTSD has different clinical phenotypes, which are reflected in the changes in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. PTSD is almost always complicated by comorbidity. Treatment requires a multimodal approach, usually including medication, different therapeutic techniques, and management of comorbidity. Interest is growing in the neurobiology of childhood survivors of trauma, intergenerational transmission of trauma, and long-term impact of trauma on physical health. Mitigation of the risk of PTSD pretrauma in the military and first responders is gaining momentum, given concerns about the cost and disability associated with PTSD. Interest is also growing in screening for PTSD in medical populations, with evidence of improved clinical outcomes. Preliminary research supports the treatment of PTSD with repetitive transcranial magnetic stimulation. SUMMARY PTSD is a trauma-related disorder with features of fear and negative thinking about the trauma and the future. Untreated, it leads to ongoing disruption of life due to avoidance, impaired vocational and social functioning, and other symptoms, depending on the phenotype. Despite a theoretical understanding of underlying mechanisms, PTSD remains challenging to treat, although evidence exists for benefit of pharmacologic agents and trauma-focused therapies. A need still remains for treatments that are more effective and efficient, with faster onset.
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Fitch TJ, Yu X, Chien LC, Karim MM, Alamgir H. Traumatic life events and development of post-traumatic stress disorder among female factory workers in a developing country. Int J Soc Psychiatry 2018. [PMID: 29517393 DOI: 10.1177/0020764018761502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) may be more prevalent and burdensome in developing countries. AIMS The goals of this study were to (1) determine the prevalence of PTSD, (2) identify types and number of traumas related to screening positive for PTSD and (3) determine other sociodemographic risk factors and health/medical conditions that may be correlated to PTSD among garment-factory workers and a comparable working population in Bangladesh. METHOD A survey was administered to a convenient sample of 607 lower socio-economic status (SES) working women in Bangladesh, 310 of who were garment workers. The primary outcome PTSD was measured by the PTSD Checklist. The Life Events Checklist determined the number and type of traumatic events. RESULTS The prevalence of PTSD was found to be 17.79% - 7.25% in garment workers and 21.55% in the comparison worker group. In multivariate analysis, PTSD was found to be significantly associated with age, income, chronic pain and number of stressful events. Participants between 45-50 years of age had the greatest odds of reporting PTSD - 15.68 fold (95% confidence interval (CI) = 4.08, 60.29) compared with those younger than 24 years. PTSD was more common in those with lower income (2,000-4,000 taka) (odds ratio (OR) = 1.60; 95% CI = 0.79, 3.26), who had chronic pain (OR = 2.48; 95% CI = 1.51, 4.07) and who experienced over three traumatic life events (OR = 11.25; 95% CI = 4.59, 27.59). The mean number of traumatic events experienced by this entire population was 4.9 with PTSD being more likely in those who experienced physical assault (OR = 6.35; 95% CI = 4.07, 9.90), who caused serious harm or death to someone else (OR = 4.80; 95% CI = 1.36, 16.87) and who had exposure to combat or war (OR = 4.76; 95% CI = 1.17, 19.34). CONCLUSION Undiagnosed and untreated PTSD impacts the quality of life and decrease worker productivity among working-age women in this developing country.
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Affiliation(s)
| | - Xiao Yu
- 2 Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lung-Chang Chien
- 3 Epidemiology and Biostatistics Program, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | | | - Hasanat Alamgir
- 5 Department of Health Policy and Management, New York Medical College, Valhalla, NY, USA
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More than a feeling: A unified view of stress measurement for population science. Front Neuroendocrinol 2018; 49:146-169. [PMID: 29551356 PMCID: PMC6345505 DOI: 10.1016/j.yfrne.2018.03.001] [Citation(s) in RCA: 435] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022]
Abstract
Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes alone have been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic - and more precise language for dimensions of stress measurement.
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Flores-Torres MH, Lynch R, Lopez-Ridaura R, Yunes E, Monge A, Ortiz-Panozo E, Cantu-Brito C, Hauksdóttir A, Valdimarsdóttir U, Lajous M. Exposure to Violence and Carotid Artery Intima-Media Thickness in Mexican Women. J Am Heart Assoc 2017; 6:e006249. [PMID: 28862944 PMCID: PMC5586461 DOI: 10.1161/jaha.117.006249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Violence against women has become a global public health threat. Data on the potential impact of exposure to violence on cardiovascular disease are scarce. METHODS AND RESULTS We evaluated the association between exposure to violence and subclinical cardiovascular disease in 634 disease-free women from the Mexican Teachers' Cohort who responded to violence-related items from the Life Stressor Checklist and underwent measures of carotid artery intima-media thickness in 2012 and 2013. We defined exposure to violence as having ever been exposed to physical and/or sexual violence. Intima-media thickness was log-transformed, and subclinical carotid atherosclerosis was defined as intima-media thickness ≥0.8 mm or plaque. We used multivariable linear and logistic regression models adjusted for several potential confounders. Mean age was 48.9±4.3 years. Close to 40% of women reported past exposure to violence. The lifetime prevalence of sexual violence was 7.1%, and prevalence of physical violence was 23.5% (7.7% reported both sexual and physical violence). Relative to women with no history of violence, exposure to violence was associated with higher intima-media thickness (adjusted mean percentage difference=2.4%; 95% confidence interval 0.5, 4.3) and subclinical atherosclerosis (adjusted odds ratio=1.60; 95% confidence interval 1.10, 2.32). The association was stronger for exposure to physical violence, especially by mugging or physical assault by a stranger (adjusted mean % difference=4.6%; 95% confidence interval 1.8, 7.5, and odds ratio of subclinical carotid atherosclerosis=2.06; 95% confidence interval 1.22, 3.49). CONCLUSIONS Exposure to violence, and in particular assault by a stranger, was strongly associated with subclinical cardiovascular disease in Mexican middle-aged women.
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Affiliation(s)
- Mario H Flores-Torres
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Rebekka Lynch
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ruy Lopez-Ridaura
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Elsa Yunes
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Adriana Monge
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Center of Research and Innovation, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Eduardo Ortiz-Panozo
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Carlos Cantu-Brito
- Department of Neurology and Psychiatry, National Institute of Nutrition and Medical Sciences, Mexico City, Mexico
| | - Arna Hauksdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Unnur Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
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Choi KR, Kim D, Jang EY, Bae H, Kim SH. Reliability and Validity of the Korean Version of the Lifetime Stressor Checklist-Revised in Psychiatric Outpatients with Anxiety or Depressive Disorders. Yonsei Med J 2017; 58:226-233. [PMID: 27873517 PMCID: PMC5122641 DOI: 10.3349/ymj.2017.58.1.226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/02/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Traumatic events and adverse stressful experiences are major etiological factors in a wide variety of physical and mental disorders. Developing psychological instruments that can be easily administered and that have good psychometric properties have become an integral part for research and practice. This study investigated the reliability and validity of the Korean version of the Lifetime Stressor Checklist-Revised (LSC-R) in a consecutive sample of psychiatric outpatients. The LSC-R is a 30-item self-reporting questionnaire examining lifetime traumatic and non-traumatic stressors. MATERIALS AND METHODS A final sample of 258 outpatients with anxiety or depressive disorders was recruited at the psychiatric department of a university-affiliated teaching hospital. Self-reported data included the Life Events Checklist (LEC), the Zung Self-Rating Depression and Anxiety Scales, and the Impact of Events Scale-Revised, in addition to the LSC-R. A convenience sample of 50 college students completed the LSC-R on two occasions separated by a three week-interval for test-retest reliability. RESULTS Mean kappa for temporal stability was high (κ=0.651) and Cronbach alpha was moderate (α=0.724). Convergent validity was excellent with corresponding items on the LEC. Concurrent validity was good for symptoms of post-traumatic stress disorder, depression, and anxiety. An exploratory factor analysis revealed that 11 factors explained 64.3 % of the total variance. CONCLUSION This study demonstrated good psychometric properties of the Korean version of the LSC-R, further supporting its use in clinical research and practice with a Korean speaking population.
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Affiliation(s)
- Kang Rok Choi
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea
| | - Daeho Kim
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea.
| | - Eun Young Jang
- Department of Counseling Psychology, Honam University, Gwangju, Korea
| | - Hwallip Bae
- Workplace Mental Health Institute, Gangbuk Samsung Medical Center, Seoul, Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea
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Atwoli L, Platt JM, Basu A, Williams DR, Stein DJ, Koenen KC. Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study. BMC Psychiatry 2016; 16:214. [PMID: 27389090 PMCID: PMC4936266 DOI: 10.1186/s12888-016-0929-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/20/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important. METHODS Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions. RESULTS After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06-2.07) for arthritis and 2.07 (95 % CI: 1.57-2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions. CONCLUSIONS Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors.
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Affiliation(s)
- Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, PO Box 1493, Eldoret, 30100, Kenya. .,Department of Psychiatry and Mental Health, MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Cape Town, South Africa.
| | - Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Cape Town, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA ,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA USA
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Lee YC, Agnew-Blais J, Malspeis S, Keyes K, Costenbader K, Kubzansky LD, Roberts AL, Koenen KC, Karlson EW. Post-Traumatic Stress Disorder and Risk for Incident Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:292-8. [PMID: 26239524 PMCID: PMC4740283 DOI: 10.1002/acr.22683] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 06/24/2015] [Accepted: 07/28/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the association between symptoms of post-traumatic stress disorder (PTSD) and rheumatoid arthritis (RA) risk in a prospective cohort and to characterize the role of smoking in this relationship. METHODS A subset (n = 54,224) of the Nurses' Health Study II, a prospective cohort of female nurses, completed the Brief Trauma Questionnaire and a screen for PTSD symptoms. Participants were categorized based on trauma exposure and number of PTSD symptoms. Incident RA cases (n = 239) from 1989 to 2011 were identified. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) between PTSD symptoms and incident RA. To identify the impact of smoking, secondary and subgroup analyses were performed. In all analyses, PTSD and smoking were lagged 2 years before the development of RA. RESULTS Compared to no history of trauma/PTSD symptoms, the HR for ≥4 PTSD symptoms and incident RA was 1.76 (95% CI 1.16-2.67) in models adjusted for age, race, and socioeconomic status. The risk for RA increased with an increasing number of PTSD symptoms (P = 0.01). When smoking was added to the model, the HR for RA remained elevated (HR 1.60 [95% CI 1.05-2.43]). In a subgroup analysis, excluding women who smoked before PTSD onset, results were unchanged (HR 1.68 [95% CI 1.04-2.70]). CONCLUSION This study suggests that women with high PTSD symptomatology have an elevated risk for RA, independent of smoking, adding to emerging evidence that stress is an important determinant of physical health.
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Affiliation(s)
- Yvonne C. Lee
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA
| | | | - Susan Malspeis
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Karen Costenbader
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Andrea L. Roberts
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Elizabeth W. Karlson
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA
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Shrira A, Palgi Y, Bodner E, Shmotkin D. Which category of lifetime adversity accelerates physical impairment among Israeli older adults? Eur J Ageing 2016; 13:323-334. [PMID: 28804386 DOI: 10.1007/s10433-016-0366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Preliminary evidence suggests that exposure to lifetime cumulative adversity is related to faster increase in physical impairment with time, especially when depressive symptoms are present. Nevertheless, it is still unclear whether different adversity categories accelerate impairment. The current study capitalized on the unique accounts of adversity available in the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) by focusing on different categories of adversity, while accounting for their interaction with depressive symptoms in predicting trajectories of physical impairment (i.e., chronic medical conditions and disability). Data of 1665 participants (mean age = 63.08, SD = 10.04 at Wave 1) were drawn from the first three waves of SHARE-Israel. Respondents reported exposure to bereavement (e.g., experiencing the death of a spouse), war and terrorism (e.g., being wounded in terrorist attack), and victimization (e.g., being a victim of abuse or assault). Other measures assessed depressive symptoms, chronic medical conditions, and disability. Growth-curve models showed that bereavement and exposure to war and terrorism were related to specific measures of physical impairment. Moreover, three-way interactions showed that clinical level of depressive symptoms coupled with exposure to either bereavement or war and terrorism predicted a faster increase in chronic medical conditions and disability. The findings offer a differentiated outlook on the effect of adversity on age-related increase in physical impairment. Practitioners should consider that older adults previously exposed to bereavement, war and terrorism are at risk for a hastened physical decline, especially when they suffer from depressive symptoms.
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Affiliation(s)
- Amit Shrira
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, 5290002 Ramat Gan, Israel
| | - Yuval Palgi
- Department of Gerontology and the Center for Research and Study of Aging, University of Haifa, Haifa, Israel
| | - Ehud Bodner
- Interdisciplinary Department of Social Sciences and Department of Music, Bar-Ilan University, Ramat Gan, Israel
| | - Dov Shmotkin
- School of Psychological Sciences and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
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Benjet C, Bromet E, Karam EG, Kessler RC, McLaughlin KA, Ruscio AM, Shahly V, Stein DJ, Petukhova M, Hill E, Alonso J, Atwoli L, Bunting B, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Huang Y, Lepine JP, Kawakami N, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Shalev A, Slade T, ten Have M, Torres Y, Viana MC, Zarkov Z, Koenen KC. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol Med 2016; 46:327-343. [PMID: 26511595 PMCID: PMC4869975 DOI: 10.1017/s0033291715001981] [Citation(s) in RCA: 614] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. METHOD General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. RESULTS Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. CONCLUSIONS Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
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Affiliation(s)
- C. Benjet
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - E. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, New York, NY, USA
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - R. C. Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - A. M. Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - V. Shahly
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - M. Petukhova
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - E. Hill
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - L. Atwoli
- Moi University School of Medicine, Eldoret, Uasin Gishu, Kenya
| | - B. Bunting
- School of Psychology, University of Ulster, Northern Ireland, UK
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - J. M. Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre, Brescia, Italy
| | - S. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, People’s Republic of China
| | - J. P. Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - M. E. Medina-Mora
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - F. Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M. Piazza
- National Institute of Health, Lima, Peru
| | | | - K. M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - A. Shalev
- NYU School of Medicine, New York, NY, USA
| | - T. Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M. ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Z. Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - K. C. Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW This review discusses recent findings from epidemiological surveys of traumatic events and posttraumatic stress disorder (PTSD) globally, including their prevalence, risk factors, and consequences in the community. RECENT FINDINGS A number of studies on the epidemiology of PTSD have recently been published from diverse countries, with new methodological innovations introduced. Such work has not only documented the prevalence of PTSD in different settings, but has also shed new light on the PTSD conditional risk associated with specific traumatic events, and on the morbidity and comorbidities associated with these events. SUMMARY Recent community studies show that trauma exposure is higher in lower-income countries compared with high-income countries. PTSD prevalence rates are largely similar across countries, however, with the highest rates being found in postconflict settings. Trauma and PTSD-risk factors are distributed differently in lower-income countries compared with high-income countries, with sociodemographic factors contributing more to this risk in high-income than low-income countries. Apart from PTSD, trauma exposure is also associated with several chronic physical conditions. These findings indicate a high burden of trauma exposure in low-income countries and postconflict settings, where access to trained mental health professionals is typically low.
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Abstract
Traumatic events are ubiquitous exposures that interact with life course events to increase risk of acute psychopathology and alter mental health trajectories. While the majority of persons exposed to trauma experience mild to moderate psychological distress followed by a return to pre-trauma health, many persons exposed to trauma experience substantial distress that lasts for several years. Therefore, in an effort to understand why exposure to trauma can provoke such a range of reactions, we apply a life course approach that considers the complex accumulation and interaction of life experiences that range from social to biological factors, which occur over the life span-from gestation to death and across generations. We present this evidence in three categories: genetics and biology, individual exposures, and community experiences, followed by discussing challenges in existing research and directions for future study.
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Abstract
BACKGROUND Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depression/anxiety symptoms and diabetes in two separate samples. METHODS The First National Health and Nutrition Examination Survey enrolled 3233 participants aged 25 to 74 years from 1971 to 1974. Depression and anxiety symptoms were measured via General Well Being schedule subscales. Incident diabetes for 17 years was defined by the following: a) death certificate, b) participant self-report, or c) health care facility discharge. The Detroit Neighborhood Health Study enrolled 1054 participants 18 years or older from 2008 to 2010. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 assessed depression and anxiety. Participants' self-reported physician-diagnosed prevalent diabetes. RESULTS In the First National Health and Nutrition Examination Survey, the risk ratio (RR; 95% confidence interval) for incident diabetes among men with high versus low anxiety symptoms was 0.85 (0.56-1.29) and that among women was 2.19 (1.17-4.09; p for interaction = .005). RRs comparing high versus low depressive symptoms for men and women were 0.69 (0.43-1.100) and 2.11 (1.06-4.19); p for interaction = .007. In the Detroit Neighborhood Health Study, the RRs for prevalent diabetes comparing those with high versus low anxiety symptoms were 0.24 (0.02-2.42) for men and 1.62 (0.61-4.32) for women (p for interaction = < .001), whereas RRs for depression were 1.30 (0.46-3.68) for men and 2.32 (1.10-4.89) for women (p for interaction = .16). CONCLUSIONS In two separate samples, depressive symptoms were related to increased diabetes risk among women but not men. Although less robust, findings for anxiety were differentially associated with diabetes by sex.
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Patten SB, Wilkes TCR, Williams JVA, Lavorato DH, el-Guebaly N, Schopflocher D, Wild C, Colman I, Bulloch AGM. Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions. Epidemiol Psychiatr Sci 2015; 24:158-65. [PMID: 24480045 PMCID: PMC6998119 DOI: 10.1017/s2045796014000018] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Considerable evidence now links childhood adversity to a variety of adult health problems. Unfortunately, almost all of these studies have relied upon retrospective assessment of childhood events, creating a vulnerability to bias. In this study, we sought to examine three associations using data sources that allowed for both prospective and retrospective assessment of childhood events. METHODS A 1994 national survey of children between the ages of 0 and 11 collected data from a 'person most knowledgeable' (usually the mother) about a child. It was possible to link data for n = 1977 of these respondents to data collected from the same people in a subsequent adult study. The latter survey included retrospective reports of childhood adversity. We examined three adult health outcomes in relation to prospectively and retrospectively assessed childhood adversity: major depressive episodes, excessive alcohol consumption and painful conditions. RESULTS A strong association between childhood adversities (as assessed by both retrospective and prospective methods) and major depression was identified although the association with retrospective assessment was stronger. Weaker associations were found for painful conditions, but these did not depend on the method of assessment. Associations were not found for excessive alcohol consumption irrespective of the method of assessment. CONCLUSIONS These findings help to allay concerns that associations between childhood adversities and health outcomes during adulthood are merely artefacts of recall bias. In this study, retrospective and prospective assessment strategies produced similar results.
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Affiliation(s)
- S. B. Patten
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - T. C. R. Wilkes
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - J. V. A. Williams
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - D. H. Lavorato
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - N. el-Guebaly
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - D. Schopflocher
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - C. Wild
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - I. Colman
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - A. G. M. Bulloch
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
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Taylor-Clift A, Hobfoll SE, Gerhart JI, Richardson D, Calvin JE, Powell LH. Posttraumatic stress and depression: potential pathways to disease burden among heart failure patients. ANXIETY, STRESS, AND COPING 2015; 29:139-52. [PMID: 25599115 PMCID: PMC4550578 DOI: 10.1080/10615806.2015.1006206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) are associated with high disease burden. Pathways by which PTSD and MDD contribute to disease burden are not understood. DESIGN Path analysis was used to examine pathways between PTSD symptoms, MDD symptoms, and disease burden among 251 low-income heart failure patients. METHODS In Model 1, we explored the independent relationship between PTSD and MDD symptoms on disease burden. In Model 2, we examined the association of PTSD symptoms and disease burden on MDD symptoms. We also examined indirect associations of PTSD symptoms on MDD symptoms, mediated by disease burden, and of PTSD symptoms on disease burden mediated by MDD symptoms. RESULTS Disease burden correlated with PTSD symptoms (r = .41; p < .001) and MDD symptoms (r = .43; p < .001) symptoms. Both models fit the data well and displayed comparable fit. MDD symptoms did not mediate the association of PTSD symptoms with disease burden. Disease burden did mediate the relationship between PTSD symptoms and MDD symptoms. CONCLUSIONS Results support the importance of detection of PTSD in individuals with disease. Results also provide preliminary models for testing longitudinal data in future studies.
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Affiliation(s)
- April Taylor-Clift
- a Behavioral Sciences Department , Rush University Medical Center , 1645 West Jackson Boulevard, Suite 400, Chicago , IL 60612 , USA
| | - Stevan E Hobfoll
- a Behavioral Sciences Department , Rush University Medical Center , 1645 West Jackson Boulevard, Suite 400, Chicago , IL 60612 , USA
| | - James I Gerhart
- a Behavioral Sciences Department , Rush University Medical Center , 1645 West Jackson Boulevard, Suite 400, Chicago , IL 60612 , USA
| | - DeJuran Richardson
- b Lake Forest College , Young Hall 125, 555 Sheridan Road, Lake Forest , IL 60045 , USA
- c Preventive Medicine Department , Rush University Medical Center , 1700 West Van Buren Street, Suite 470, Chicago , IL 60612 , USA
| | - James E Calvin
- c Preventive Medicine Department , Rush University Medical Center , 1700 West Van Buren Street, Suite 470, Chicago , IL 60612 , USA
| | - Lynda H Powell
- c Preventive Medicine Department , Rush University Medical Center , 1700 West Van Buren Street, Suite 470, Chicago , IL 60612 , USA
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Prospective study of predictors of poor self-rated health in a 23-year cohort of earthquake survivors in Armenia. J Epidemiol Glob Health 2015; 5:265-74. [PMID: 26231402 PMCID: PMC7320530 DOI: 10.1016/j.jegh.2014.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/23/2014] [Accepted: 12/21/2014] [Indexed: 11/24/2022] Open
Abstract
Long-term prospective studies exploring general health outcomes among disaster survivors are rare. Self-rated health (SRH) – a proven correlate of morbidity and mortality prognosis – was used to investigate predictors of perceived health status among a 23-year cohort of survivors of 1988 Spitak earthquake in Armenia. A geographically-stratified subsample of 725 adults from a larger initial cohort was followed during the period of 1990–2012. A logistic regression model identified predictors of SRH. Adjusted relative risks for the long-term predictors of SRH were calculated. The rate of poor SRH among the survivors was 18.8%, fair 56.5%, and good/excellent 24.7%. In the fitted model, long-term risk factors of poor SRH included baseline body mass index, baseline multi-morbidity, number of experienced stressful life events, and perceived poor living standards during the post-earthquake decade, while participation in sports in the early 1990s was a protective factor. Short-term protective factors included socio-economic status score, social support, employment and dignity, while current household size was a risk factor for poor SRH. No association was found between earthquake exposure severity and SRH after 23 years. However, the identified predictors included a number of modifiable lifestyle, material and psychological factors. Thus, interventions targeting these factors could have a long-lasting impact on disaster victims’ health status.
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Suglia SF, Sapra KJ, Koenen KC. Violence and cardiovascular health: a systematic review. Am J Prev Med 2015; 48:205-212. [PMID: 25599905 PMCID: PMC4300436 DOI: 10.1016/j.amepre.2014.09.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 12/30/2022]
Abstract
CONTEXT Violence, experienced in either childhood or adulthood, has been associated with physical health outcomes, including cardiovascular disease. However, the consistency of the existing literature has not been evaluated. EVIDENCE ACQUISITION In 2013, the authors conducted a PubMed and Web of Science review of peer-reviewed articles published prior to August 2013 on the relation between violence exposure, experienced in either childhood or adulthood, and cardiovascular outcomes. To meet inclusion criteria, articles had to present estimates for the relation between violence exposure and cardiovascular outcomes (e.g., hypertension, blood pressure, stroke, coronary disease, or myocardial infarction) adjusted for demographic factors. Articles focusing on violence from television, video games, natural disasters, terrorism, or war were excluded. EVIDENCE SYNTHESIS The initial search yielded 2,273 articles; after removing duplicates and applying inclusion and exclusion criteria, 30 articles were selected for review. A consistent positive relation was noted on the association between violence experienced during childhood and cardiovascular outcomes in adulthood (i.e., hypertension, coronary heart disease, and myocardial infarction). Associations across genders with varying types of violence exposure were also noted. By contrast, findings were mixed on the relation between adult violence exposure and cardiovascular outcome. CONCLUSIONS Despite varying definitions of violence exposure and cardiovascular endpoints, a consistent relation exists between childhood violence exposure, largely assessed retrospectively, and cardiovascular endpoints. Findings are mixed for the adult violence-cardiovascular health relation. The cross-sectional nature of most adult studies and the reliance of self-reported outcomes can potentially be attributed to the lack of findings among adult violence exposure studies.
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Affiliation(s)
- Shakira F Suglia
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Katherine J Sapra
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Karestan C Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Karatzias T, Yan E, Jowett S. Adverse life events and health: a population study in Hong Kong. J Psychosom Res 2015; 78:173-7. [PMID: 25498319 DOI: 10.1016/j.jpsychores.2014.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/28/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Although the effects of adverse life events on mental health have been well documented in the literature, there has never been a population based study that investigated systematically the association between history of adverse life events and physical health (objective and subjective) in adults. METHOD Cross-sectional, face-to-face household population based survey of adults (18+) in Hong Kong (N=1147). Participants were asked if they had a diagnosis of six health conditions including hypertension, heart disease, arthritis, diabetes, eyesight degeneration, and hearing loss. They were also asked if they had experienced five adverse life events including death of a partner or spouse, abuse, natural disaster, life threatening illness or injury, and family disruption. Interviews also included the Short-Form 12 Health Survey (SFHS-12) and the short version of the Centre for Epidemiologic Studies Depression Scale (CES-D). RESULTS Overall, results indicate that specific adverse life events may be associated with specific health conditions. However, all tested life events were associated with subjective physical and mental health. Death of partner or parent and life threatening illness or injury were found to have the strongest association with physical health problems. A dose-response relationship between adverse life events and physical health in general was evident but more so for heart disease and eyesight degeneration. CONCLUSION Considering the high prevalence of traumatic events and how common the conditions associated with such events are in the general population, screening for adverse life events as part of comprehensive assessment will allow a deeper understanding of patients' needs.
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Affiliation(s)
- Thanos Karatzias
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, Edinburgh UK; NHS Lothian, Rivers Centre, Edinburgh, UK.
| | - Elsie Yan
- Hong Kong University, Department of Social Work and Social Administration, Hong Kong
| | - Sally Jowett
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, Edinburgh UK
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Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits. J Psychosom Res 2014; 77:90-6. [PMID: 25077848 DOI: 10.1016/j.jpsychores.2014.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors were prospectively associated with an increased number of doctor visits and nights spent in the hospital. METHODS Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50+ in the United States (n=7168). We analyzed the data using a generalized linear model with a gamma distribution and log link. RESULTS A higher number of potentially traumatic events and serious life stressors were associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8% increase in doctor visits after controlling for sociodemographic factors (RR=1.08, 95% CI=1.06-1.11; p<.001). Each additional potentially traumatic event or serious life stressor was also associated with an 18% increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR=1.18, 95% CI=1.10-1.27; p<.001). CONCLUSION Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care.
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Brackbill RM, Cone JE, Farfel MR, Stellman SD. Chronic physical health consequences of being injured during the terrorist attacks on World Trade Center on September 11, 2001. Am J Epidemiol 2014; 179:1076-85. [PMID: 24561992 DOI: 10.1093/aje/kwu022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003-2004 and 2006-2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5-6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002-2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.
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Elevated systemic expression of ER stress related genes is associated with stress-related mental disorders in the Detroit Neighborhood Health Study. Psychoneuroendocrinology 2014; 43:62-70. [PMID: 24703171 PMCID: PMC4106129 DOI: 10.1016/j.psyneuen.2014.01.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The role of endoplasmic reticulum (ER) stress response in mental illness is not well understood. Human studies and animal models of depression show elevated brain ER stress response. In addition, some ER stress associated disorders (e.g. cardiovascular disease) show higher rates of depression compared to the general population, raising the possibility that ER stress response contributes to depression risk. It remains unknown, however, if ER stress response is present among individuals suffering from other stress-related mental illness, and whether such a response would be evident in a non-clinical sample. This study tests for systemic changes in ER stress response associated with Major Depressive Disorder (MDD) or post-traumatic stress disorder (PTSD) among community-dwelling individuals. METHODS We analyzed expression of BiP, EDEM1, CHOP, and XBP1, the major indicators of ER stress response, with real-time PCR in leukocyte-derived RNA samples from 86 participants of the Detroit Neighborhood Health Study. Participants were selected based on the presence of either past year MDD or past year PTSD; controls were age and sex matched. RESULTS Relative to controls, MDD is associated with a 1.34-fold increase in BiP (P=0.004), 1.35-fold increase in EDEM1 (P=0.001), 1.68-fold increase in CHOP (P=0.002), and 1.60-fold increase in XBP1 (P=0.004). These results remained significant after correction for multiple testing. In contrast, PTSD is associated with a 1.27-fold increase in EDEM1 expression only (P=0.027), a result that is attenuated to non-significance following adjustment for multiple testing; however, a subsample of participants with past month PTSD showed elevated expression of BiP and EDEM1 (uncorrected P value 0.049 and 0.017, respectively). CONCLUSIONS These data indicate systemic and persistent activation of the ER stress response pathway in MDD among community-dwelling individuals. Systemic activation of the ER stress response may also occur in PTSD among persons with more recent symptoms.
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Associations between lifetime traumatic events and subsequent chronic physical conditions: a cross-national, cross-sectional study. PLoS One 2013; 8:e80573. [PMID: 24348911 PMCID: PMC3864645 DOI: 10.1371/journal.pone.0080573] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022] Open
Abstract
Background Associations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries. Methods Cross-sectional, face-to-face household surveys of adults (18+) were conducted in 14 countries (n = 38, 051). The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders. Findings A dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 [95% CI: 1.4–1.5] for 1 LTE; 2.1 [2.0–2.3] for 5+ LTEs), independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience), nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 [1.2–1.5] to 1.7 [1.4–2.0]) and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 [1.3–2.4] to 3.6 [2.0–6.5]), the exceptions being cancer and stroke. Conclusions Traumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.
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