1
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Potik D, Einat T, Idisis Y. Posttraumatic Stress Disorder Symptom Clusters, Exposure to Potentially Morally Injurious Events, and Aggression Among Army Veterans. Clin Psychol Psychother 2024; 31:e3056. [PMID: 39312899 DOI: 10.1002/cpp.3056] [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: 07/20/2024] [Revised: 09/01/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE Very few studies have examined the association between posttraumatic stress disorder (PTSD) symptom clusters and aggression since the change in PTSD diagnosis criteria a decade ago. Furthermore, these studies have used measures based on PTSD criteria of the DSM-IV. The current study therefore examines the association between PTSD symptom clusters, exposure to potentially morally injurious events (PMIEs), and various types of aggression following the change in PTSD criteria and in accordance with the criteria of the DSM-5-TR. METHOD A sample of 167 Israeli combat veterans completed validated self-report questionnaires tapping PTSD symptoms, exposure to PMIEs, and aggression levels. RESULTS Our analysis revealed a significant positive relationship between the number of court-martials, betrayal-based PMIEs, all PTSD symptom clusters, and aggression. We also found that the arousal cluster, as well as the number of court-martials and age, predicted aggression, whereas the re-experiencing cluster predicted lower aggression levels. CONCLUSION Besides an updated understanding of the association between all PTSD symptom clusters and various forms of aggression, these findings emphasize the importance of targeting arousal symptoms and especially anger in treatment of veterans with PTSD symptoms and those who report experiences of betrayal. The findings also suggest clinicians to consider arousal symptoms, age, and history of court-martials when conducting either clinical or actuarial risk assessments of veterans.
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Affiliation(s)
- David Potik
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, The Psychiatric Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer Einat
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Yael Idisis
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
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2
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Kaufman CC, Vujanovic AA, Murphy JG, Rosmarin DH. The association between PTSD symptom clusters and religion/spirituality with alcohol use among first responders. J Psychiatr Res 2024; 176:304-310. [PMID: 38905763 DOI: 10.1016/j.jpsychires.2024.06.015] [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: 12/05/2023] [Revised: 04/23/2024] [Accepted: 06/08/2024] [Indexed: 06/23/2024]
Abstract
Alcohol misuse and posttraumatic stress disorder (PTSD) co-occur at high rates among first responders (e.g., law enforcement, firefighters, paramedics), underscoring the need to better understand these relations to inform intervention efforts. Identifying malleable processes relevant to the association between PTSD and alcohol among first responders could inform tailored interventions. An example of such a malleable process is spirituality. As such, the current study examined the unique relationships between PTSD symptom clusters and alcohol misuse, while also accounting for the role of select demographics and religion/spirituality, in a sample of first responders. A national online sample of first responders (N = 320) completed measures of PTSD symptomology, alcohol misuse, religion/spirituality and demographics. Hierarchical linear regression analyses revealed that PTSD Intrusion (Cluster B) symptom severity was associated with greater alcohol misuse and PTSD Avoidance (Cluster C) was associated with lower alcohol misuse. Additionally, positive and negative spiritual coping were also associated with alcohol misuse. In the context of similar research among military samples, findings suggest potentially unique associations between PTSD symptom clusters and alcohol misuse among first responders. Additionally, findings highlight the potentially protective role of religion/spirituality in this population. Future research should explore nuanced relationships between PTSD symptom clusters and alcohol misuse as well as the salience of spirituality/religion in this unique population.
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Affiliation(s)
- Caroline C Kaufman
- Department of Psychiatry, Harvard Medical School, USA; Spirituality and Mental Health Program, McLean Hospital, USA.
| | - Anka A Vujanovic
- Department of Psychological & Brain Sciences, Texas A&M University, USA
| | | | - David H Rosmarin
- Department of Psychiatry, Harvard Medical School, USA; Spirituality and Mental Health Program, McLean Hospital, USA
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3
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Wesemann U, Rowlands K, Renner KH, Konhäuser L, Köhler K, Himmerich H. Impact of life-threatening military incidents during deployments abroad on the relationships between military personnel and their families. Front Psychiatry 2024; 15:1419022. [PMID: 39091456 PMCID: PMC11291243 DOI: 10.3389/fpsyt.2024.1419022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/18/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction The influence of deployments on family relationships has hardly been investigated. Following a recently proposed new research strategy, military personnel with and without deployment-related life-threatening military incidents during deployment were compared. The hypothesis was that partner and family relationships of military personnel who experienced such an event would deteriorate more. Methods This study included N = 255 military personnel who had a romantic partner (n = 78 of them had children) when deployed to Afghanistan. Of these, n = 68 military personnel experienced a deployment-related critical event during the deployment, n = 187 did not. Partnership quality was assessed using a semi-structured pre- and post-deployment interview. Results The partner relationships of military personnel who experienced a deployment-related life-threatening military incident during deployment broke up significantly more often. The partner relationships of all military personnel deteriorated significantly, with greater deterioration after deployment in the group who faced such incidents. These results were independent of age, rank or number of previous deployments. In addition, there was a significant deterioration in the relationships between all military personnel and their children with greater deterioration after deployment in the group who faced such incidents. Conclusion Life-threatening military incidents during a deployment abroad appear to have a considerable influence on the quality and stability of the partner and family relationships of military personnel. These findings can be used to inform the development of specific pre- and post-deployment measures and training.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
| | - Karl-Heinz Renner
- Institute of Psychology, Faculty of Human Sciences, Bundeswehr University Munich, Neubiberg, Germany
| | - Lucas Konhäuser
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Kai Köhler
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Hubertus Himmerich
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
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Thompson LM, Slavish DC, Messman BA, Dietch JR, Kelly K, Ruggero C, Taylor DJ, Ramarushton B, Blumenthal H. Alcohol Use Predicts Longer But More Fragmented Sleep: A Daily Diary Study of Alcohol, Sleep, and PTSD in Nurses. Int J Behav Med 2024:10.1007/s12529-024-10308-z. [PMID: 38977540 DOI: 10.1007/s12529-024-10308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Due to the demanding nature of their profession, nurses are at risk of experiencing irregular sleep patterns, substance use, and fatigue. Evidence supports a reciprocal relationship between alcohol use and sleep disturbances; however, no research has examined such a link in a sample of nurses. One factor that may further impact the dynamic between alcohol and sleep patterns is posttraumatic stress disorder (PTSD) symptoms. We investigated the daily bidirectional associations between alcohol use and several sleep domains (i.e., self-report and actigraphy-determined sleep), and moderation by baseline PTSD symptom severity. METHOD Over a 14-day period, 392 nurses (92% female; 78% White) completed sleep diaries and actigraphy to assess alcohol use and sleep patterns. Within-person bidirectional associations between alcohol and sleep were examined using multilevel models, with symptoms of PTSD as a cross-level moderator. RESULTS Daily alcohol use (i.e., ≥ 1 alcoholic beverage; 25.76%) was associated with shorter self-reported sleep onset latency (b = -4.21, p = .003) but longer self-reported wake after sleep onset (b = 2.36, p = .009). Additionally, days with any alcohol use were associated with longer self-reported sleep duration (b = 15.60, p = .006) and actigraphy-determined sleep duration (b = 10.06, p = .037). No sleep variables were associated with next-day alcohol use. Bidirectional associations between alcohol consumption and sleep were similar regardless of baseline PTSD symptoms. CONCLUSION Our results suggested that on days when nurses drank alcohol, they experienced longer but also more fragmented sleep.
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Affiliation(s)
- Linda M Thompson
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
| | - Brett A Messman
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Camilo Ruggero
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, 1503 E University Blvd, Tucson, AZ, 85721, USA
| | - Banan Ramarushton
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Heidemarie Blumenthal
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
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5
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Elbogen EB, Graziano RC, LaRue G, Cohen AJ, Hooshyar D, Wagner HR, Tsai J. Food Insecurity and Suicidal Ideation: Results from a National Longitudinal Study of Military Veterans. Arch Suicide Res 2024; 28:644-659. [PMID: 37165670 PMCID: PMC10636240 DOI: 10.1080/13811118.2023.2200795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans. METHODS A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches. RESULTS Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%). CONCLUSION These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.
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6
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Flanagan JC, Hogan JN, Massa AA, Jarnecke AM. Examining the role of posttraumatic stress disorder symptoms in intimate partner violence among couples with alcohol use disorder. Aggress Behav 2024; 50:e22137. [PMID: 38358256 PMCID: PMC10871553 DOI: 10.1002/ab.22137] [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: 05/22/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/16/2024]
Abstract
Separate literatures indicate that both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are robust risk factors for using intimate partner violence (IPV). Despite the strength of these relative literatures, and the common co-occurrence of AUD and PTSD, their combined effects on IPV have rarely been examined. This study begins to address this gap by exploring the moderating effects of provisional PTSD diagnosis on the relation between heavy alcohol consumption and physical IPV using a multilevel modeling approach. Participants were adult romantic couples (N = 100) with current AUD and a history of physical IPV in their relationship. Results from the between-couple comparison indicate that couples who reported more heavy drinking days also experienced more physical IPV when at least one partner had probable PTSD. However, the within-couple comparison indicated that among partners without a provisional PTSD diagnosis, those with fewer heavy drinking days compared to their partner also reported more physical IPV perpetration. These preliminary and exploratory findings require replication and extension but provide new and important information regarding the complex intersection of heavy drinking, PTSD, and IPV among couples with AUD.
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Affiliation(s)
- Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Jasara N. Hogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Andrea A. Massa
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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7
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Livingston NA, Farmer SL, Mahoney CT, Marx BP, Keane TM. The role of PTSD symptom clusters and criterion in predicting future high-risk drug and alcohol use among returning veteran men and women. Psychol Serv 2022; 19:386-395. [PMID: 33844563 PMCID: PMC9048192 DOI: 10.1037/ser0000538] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The prevalence of co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) remains exceptionally high among returning veterans, with numerous studies linking PTSD, but not specific PTSD symptoms, to future SUD risk. Further explication of PTSD symptom effects on future SUD risk will likely promote intervention development and refinement while offsetting SUD risk. Accordingly, In this study we explored the prospective associations between PTSD symptom clusters, symptoms, and future SUD risk and use of specific drug classes. Returning veterans (N = 1,295; Mage = 42.3, SD = 9.89; 51% female; 66.8% White) completed structured diagnostic interviews to assess PTSD symptoms and self-report measures of substance use 14-36 months later (M = 24.59, SD = 2.97). Hyperarousal and reckless/self-destructive symptoms specifically predicted future high-risk drug use and binge drinking behavior, and avoidance of internal stimuli (i.e., of trauma memories, thoughts, and feelings) differentiated individuals classified as high-risk for alcohol use based on their AUDIT total score. Further, negative alterations in cognition and mood predicted future opioid (i.e., nightmares) and stimulant use (i.e., flashbacks), whereas concentration difficulties were inversely associated with future binge drinking. This longitudinal study identified prospective and enduring associations between specific PTSD symptom clusters, symptoms, and future high-risk substance use patterns among returning veterans. Accordingly, careful assessment of specific PTSD criteria and differential motivations for substance use is warranted, along with tailored interventions to offset risk for opioid, stimulant, and alcohol use among returning veterans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Nicholas A. Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine,Department of Veteran Affairs, VA Boston Healthcare System
| | - Stacey L. Farmer
- Department of Veteran Affairs, Albany Stratton VA Medical Center
| | | | - Brian P. Marx
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine,Department of Veteran Affairs, VA Boston Healthcare System
| | - Terence M. Keane
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine,Department of Veteran Affairs, VA Boston Healthcare System
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8
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Blakey SM, Dillon KH, Wagner HR, Simpson TL, Beckham JC, Calhoun PS, Elbogen EB. Psychosocial well-being among veterans with posttraumatic stress disorder and substance use disorder. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2022; 14:421-430. [PMID: 33661689 PMCID: PMC8417144 DOI: 10.1037/tra0001018] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Concurrent posttraumatic stress disorder and substance use disorder (PTSD/SUD) in U.S. military veterans represents an urgent public health issue associated with significant clinical challenges. Although previous research has shown that veterans with PTSD/SUD endorse more psychosocial risk factors and fewer protective factors than veterans with neither or only one of these disorders, no study has applied a comprehensive framework to characterize the vocational, financial, and social well-being of veterans with PTSD/SUD. Furthermore, it is not fully known how well-being among veterans with PTSD/SUD compares to that of veterans with posttraumatic stress disorder (PTSD) only, substance use disorder (SUD) only, or neither disorder. METHOD This cross-sectional observational study analyzed data from the National Post-Deployment Adjustment Survey, which recruited a random national sample of U.S. veterans who served on/after September 11, 2001. Participants (weighted N = 1,102) self-reported sociodemographic, clinical, and military background information in addition to aspects of their vocational, financial, and social well-being. RESULTS Veterans with PTSD/SUD were particularly likely to report lifetime experiences of homelessness, violent behavior, suicidal ideation, and suicide attempts. Veterans with PTSD/SUD reported worse social well-being than the PTSD-only, SUD-only, and neither-disorder groups. They also reported worse vocational and financial well-being than veterans with SUD only or with neither disorder but did not significantly differ from the PTSD-only group on vocational or financial well-being. CONCLUSIONS The findings underscore the importance of assessing multiple aspects of well-being in veterans with PTSD and/or SUD. The findings also point to promising treatment targets to improve psychosocial functioning and overall quality of life among veterans with PTSD and/or SUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Shannon M. Blakey
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
| | - Kirsten H. Dillon
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - H. Ryan Wagner
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - Tracy L. Simpson
- VA Puget Sound Health Care System, Seattle Division; Seattle, WA,VA Center of Excellence for Substance Addiction Treatment and Education; Seattle, WA,University of Washington, Department of Psychiatry and Behavioral Sciences; Seattle, WA
| | - Jean C. Beckham
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - Patrick S. Calhoun
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC
| | - Eric B. Elbogen
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences; Durham, NC,VA National Center on Homelessness Among Veterans; Tampa, FL
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9
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Kaplan J, Somohano V, Eddy A, Oken B, Wahbeh H. Mindful nonreactivity moderates the relationship between posttraumatic stress disorder and depression. JOURNAL OF LOSS & TRAUMA 2022; 27:593-607. [PMID: 36618880 PMCID: PMC9815478 DOI: 10.1080/15325024.2022.2030019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PTSD and depression represent major individual and societal burdens. Depression is commonly comorbid with PTSD among veterans, although buffers of this relationship are unclear. We evaluated whether facets of mindfulness moderated the relationship between PTSD and depression in veterans with PTSD (N = 70). Three facets - nonjudging, acting with awareness, and nonreactivity - were assessed as moderators. Results indicated nonreactivity significantly attenuated the relationship between PTSD and depression (p=.013), such that veterans with high nonreactivity (+1 SD) showed a nonsignificant relationship between PTSD and depression, whereas veterans with average (Mean; p<.001) and low (-1 SD; p<.001) nonreactivity exhibited a significant relationship.
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Affiliation(s)
- Josh Kaplan
- Department of Neurology, Oregon Health & Science University,Department of Neurology, Oregon Health & Science University, 3250 SW Sam Jackson Park Road, Portland, OR 97239,
| | - Vanessa Somohano
- Mental Health and Neuroscience Division, VA Portland Healthcare System
| | - Ashley Eddy
- School of Graduate Psychology, Pacific University
| | - Barry Oken
- Department of Neurology, Oregon Health & Science University
| | - Helané Wahbeh
- Department of Neurology, Oregon Health & Science University,Research, Institute of Noetic Sciences
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10
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Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. J Trauma Stress 2021; 34:1080-1098. [PMID: 34881461 DOI: 10.1002/jts.22782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.
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Affiliation(s)
- Kelsi F Rugo-Cook
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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11
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Wamser-Nanney R, Walker HE, Nanney JT. Trauma Exposure, Posttraumatic Stress Disorder, and Aggression Among Civilian Females. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9649-NP9669. [PMID: 31286814 DOI: 10.1177/0886260519860894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Trauma exposure and posttraumatic stress disorder (PTSD) have evinced ties to increased risk for aggressive behavior. However, very little information is known regarding the relations between trauma exposure, PTSD, and aggression among non-veteran women. Furthermore, research has not examined the associations between trauma exposure, PTSD symptoms, and aggression using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) PTSD criteria. The primary aim of the current study was to investigate the relationships between trauma exposure, PTSD symptoms, and aggression among women. The secondary aim was to examine the specific PTSD symptom clusters in relation to indices of aggression. A total of 217 civilian, trauma-exposed female undergraduate students participated in the study (Mage = 24.30, SD = 6.83, 63.2% White). Higher levels of trauma exposure and PTSD symptoms corresponded with anger (b = .47, 95% CI = [0.11-0.83]; b = .11, 95% CI = [0.05-0.16], respectively) and verbal aggression (b = .50, 95% CI = [0.21-0.78]; b = .06, 95% CI = [0.01-0.10], respectively). PTSD symptoms, but not cumulative trauma exposure, was associated with hostility (b = .23, 95% CI = [0.14-0.59]), whereas physical aggression was only related to trauma exposure (b = .69, 95% CI = [0.31-1.06]). Furthermore, there was a significant indirect effect of cumulative trauma through PTSD symptoms on anger and verbal aggression (b = .15, 95% CI = [0.05-0.32]; b = .09, 95% CI = [0.02-0.20], respectively). Trauma-exposed civilian females with higher levels of PTSD symptoms may be at increased risk for several indices of aggressive behavior. Furthermore, PTSD symptoms may better account for some, but not all, aspects of aggression in trauma-exposed women.
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12
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Sheehan AE, Bounoua N, Miglin R, Spielberg JM, Sadeh N. A multilevel examination of lifetime aggression: integrating cortical thickness, personality pathology and trauma exposure. Soc Cogn Affect Neurosci 2021; 16:716-725. [PMID: 33837772 PMCID: PMC8259263 DOI: 10.1093/scan/nsab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 01/24/2023] Open
Abstract
Aggression represents a significant public health concern, causing serious physical and psychological harm. Although many studies have sought to characterize the etiology of aggression, research on the contributions of risk factors that span multiple levels of analysis for explaining aggressive behavior is lacking. To address this gap, we investigated the direct and unique contributions of cortical thickness (level 1), pathological personality traits (level 2) and trauma exposure (level 3) for explaining lifetime physical aggression in a high-risk sample of community adults (N = 129, 47.3% men). First, the frequency of lifetime aggression was inversely associated with cortical thickness in regions of prefrontal and temporal cortices that have been implicated in executive functioning, inhibitory mechanisms and socio-emotional processing. Further, aggression was positively associated with pathological personality traits (antagonism and disinhibition) and exposure to assaultive trauma. Notably, all three levels of analysis (cortical thickness, pathological personality traits and assaultive trauma exposure) explained non-overlapping variance in aggressive behavior when examined simultaneously in integrative models. Together, the findings provide a multilevel assessment of the biopsychosocial factors associated with the frequency of aggression. They also indicate that cortical thickness explains novel variance in these harmful behaviors not captured by well-established personality and environmental risk factors for aggression.
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Affiliation(s)
- Ana E Sheehan
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19176, USA
| | - Nadia Bounoua
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19176, USA
| | - Rickie Miglin
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19176, USA
| | - Jeffrey M Spielberg
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19176, USA
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19176, USA
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13
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Levis M, Westgate CL, Gui J, Watts BV, Shiner B. Natural language processing of clinical mental health notes may add predictive value to existing suicide risk models. Psychol Med 2021; 51:1382-1391. [PMID: 32063248 PMCID: PMC8920410 DOI: 10.1017/s0033291720000173] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study evaluated whether natural language processing (NLP) of psychotherapy note text provides additional accuracy over and above currently used suicide prediction models. METHODS We used a cohort of Veterans Health Administration (VHA) users diagnosed with post-traumatic stress disorder (PTSD) between 2004-2013. Using a case-control design, cases (those that died by suicide during the year following diagnosis) were matched to controls (those that remained alive). After selecting conditional matches based on having shared mental health providers, we chose controls using a 5:1 nearest-neighbor propensity match based on the VHA's structured Electronic Medical Records (EMR)-based suicide prediction model. For cases, psychotherapist notes were collected from diagnosis until death. For controls, psychotherapist notes were collected from diagnosis until matched case's date of death. After ensuring similar numbers of notes, the final sample included 246 cases and 986 controls. Notes were analyzed using Sentiment Analysis and Cognition Engine, a Python-based NLP package. The output was evaluated using machine-learning algorithms. The area under the curve (AUC) was calculated to determine models' predictive accuracy. RESULTS NLP derived variables offered small but significant predictive improvement (AUC = 0.58) for patients that had longer treatment duration. A small sample size limited predictive accuracy. CONCLUSIONS Study identifies a novel method for measuring suicide risk over time and potentially categorizing patient subgroups with distinct risk sensitivities. Findings suggest leveraging NLP derived variables from psychotherapy notes offers an additional predictive value over and above the VHA's state-of-the-art structured EMR-based suicide prediction model. Replication with a larger non-PTSD specific sample is required.
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Affiliation(s)
- Maxwell Levis
- White River Junction VA Medical Center, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Bradley V. Watts
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- VA Office of Systems Redesign and Improvement, White River Junction, VT, USA
| | - Brian Shiner
- White River Junction VA Medical Center, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- VA Office of Systems Redesign and Improvement, White River Junction, VT, USA
- National Center for PTSD Executive Division, White River Junction, VT, USA
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14
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Traumatized attendings - When the doctor has the disease. Am J Surg 2021; 223:626-632. [PMID: 34116794 DOI: 10.1016/j.amjsurg.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to compare PTSD prevalence between seven medical specialties and to identify potential risk factors for PTSD. METHODS A cross-sectional national survey of attending physicians (n = 2216) was conducted and screened for PTSD using the Primary Care PTSD Screen. Stepwise multivariable regression analysis with backward elimination identified potential risk factors. RESULTS Overall prevalence of PTSD was 14% and ranged from 7% to 18% for psychiatrists and OBGYNs, respectively (p = 0.004). Six potential risk factors for PTSD included: emotional exhaustion, job dissatisfaction, lack of autonomy, working >60 h per week, poor camaraderie, and female gender (p < 0.05). CONCLUSIONS The prevalence of PTSD in attending physicians is more than double that of the general population. Higher risk specialties include OBGYN and general surgery. Specialty-specific interventions targeted at reducing physician burnout and improving the physician work-environment are needed to improve physician wellness and reduce PTSD.
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15
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Yuan G, Shi W, Lowe S, Chang K, Jackson T, Hall BJ. Associations between posttraumatic stress symptoms, perceived social support and psychological distress among disaster-exposed Chinese young adults: A three-wave longitudinal mediation model. J Psychiatr Res 2021; 137:491-497. [PMID: 33798977 DOI: 10.1016/j.jpsychires.2021.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 01/06/2023]
Abstract
Research has documented a strong association between perceived social support, posttraumatic stress symptoms (PTSS), and psychological distress (PD) among people exposed to natural disasters. However, the direction of associations between these factors remains unclear. This study examined possible mediational relationships among perceived social support, PTSS, and PD. A three-wave longitudinal design (6 months intervals) was employed in a sample of 341 Chinese university students (Mage = 21.24, SD = 2.72; 75.7% female) aged 18 to 34 who were directly exposed to a typhoon that occurred in Macao, China, during August 2017. Results indicated that perceived social support at T2 mediated the linkage between PTSS at T1 and PD at T3, and that PTSS at T2 significantly mediated the relationship between PD at T1 and perceived social support at T3. This three-wave longitudinal study highlights the key role of perceived social support on the aggravating effect of acute PTSS on long-term psychological problems, and demonstrates that adverse psychological health outcomes negatively affect the perception of supportive social resources in the context of a natural disaster.
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Affiliation(s)
- Guangzhe Yuan
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, People's Republic of China
| | - Sarah Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, USA
| | - Kay Chang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.
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16
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Sragovich S, Gershovits M, Lam JC, Li VO, Gozes I. Putative Blood Somatic Mutations in Post-Traumatic Stress Disorder-Symptomatic Soldiers: High Impact of Cytoskeletal and Inflammatory Proteins. J Alzheimers Dis 2021; 79:1723-1734. [DOI: 10.3233/jad-201158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: We recently discovered autism/intellectual disability somatic mutations in postmortem brains, presenting higher frequency in Alzheimer’s disease subjects, compared with the controls. We further revealed high impact cytoskeletal gene mutations, coupled with potential cytoskeleton-targeted repair mechanisms. Objective: The current study was aimed at further discerning if somatic mutations in brain diseases are presented only in the most affected tissue (the brain), or if blood samples phenocopy the brain, toward potential diagnostics. Methods: Variant calling analyses on an RNA-seq database including peripheral blood samples from 85 soldiers (58 controls and 27 with symptoms of post-traumatic stress disorder, PTSD) was performed. Results: High (e.g., protein truncating) as well as moderate impact (e.g., single amino acid change) germline and putative somatic mutations in thousands of genes were found. Further crossing the mutated genes with autism, intellectual disability, cytoskeleton, inflammation, and DNA repair databases, identified the highest number of cytoskeletal-mutated genes (187 high and 442 moderate impact). Most of the mutated genes were shared and only when crossed with the inflammation database, more putative high impact mutated genes specific to the PTSD-symptom cohorts versus the controls (14 versus 13) were revealed, highlighting tumor necrosis factor specifically in the PTSD-symptom cohorts. Conclusion: With microtubules and neuro-immune interactions playing essential roles in brain neuroprotection and Alzheimer-related neurodegeneration, the current mutation discoveries contribute to mechanistic understanding of PTSD and brain protection, as well as provide future diagnostics toward personalized military deployment strategies and drug design.
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Affiliation(s)
- Shlomo Sragovich
- The Elton Laboratory for Neuroendocrinology; Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Sagol School of Neuroscience and Adams Super Center for Brain Studies, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gershovits
- The Nancy & Stephen Grand Israel National Center for Personalized Medicine, Weizmann Institute of Science, Rehovot, Israel
| | - Jacqueline C.K. Lam
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Computer Science and Technology, The University of Cambridge, Cambridge, UK
| | - Victor O.K. Li
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Illana Gozes
- The Elton Laboratory for Neuroendocrinology; Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Sagol School of Neuroscience and Adams Super Center for Brain Studies, Tel Aviv University, Tel Aviv, Israel
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17
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Worthen M, Rathod SD, Cohen G, Sampson L, Ursano R, Gifford R, Fullerton C, Galea S, Ahern J. Risk and Protective Factors for Difficulty Controlling Violent Behavior in National Guard and Reserve Service Members. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:1049-1067. [PMID: 29294977 DOI: 10.1177/0886260517737552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Violent behavior is an important problem for military service members and veterans. A representative cohort of U.S. Reserve and National Guard personnel (N = 1,293) were interviewed to assess self-reported problems controlling violent behavior, deployment traumas, posttraumatic stress disorder (PTSD), alcohol abuse, and social support. Poisson regression models were used to estimate the associations of violent behavior with risk and protective factors. Problems controlling violent behavior were uncommon among male (3.3%) and female (1.7%) service members. Adjusted prevalence ratios (aPR) showed associations between violent behavior and deployment traumas (aPR = 1.67, 95% confidence interval [CI] = [1.34, 2.08]), PTSD (aPR = 9.95, 95% CI = [5.09, 19.48]), and PTSD symptom severity (aPR for each additional PTSD symptom = 1.07, 95% CI = [1.06, 1.09]). Social support was associated with lower prevalence of violent behavior (aPR = 0.62, 95% CI = [0.52, 0.76]). The association between violent behavior and alcohol abuse was not statistically significant (aPR = 1.94, 95% CI = [0.92, 4.09]). Results were consistent when the population was restricted to personnel who had deployed to a war zone. Problems controlling violent behavior were less common in this cohort than has been documented in other studies. Associations of violent behavior with risk and protective factors are consistent with prior research.
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Affiliation(s)
| | | | - Gregory Cohen
- Columbia University Mailman School of Public Health, New York, NY, USA
- Boston University School of Public Health, MA, USA
| | | | - Robert Ursano
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert Gifford
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carol Fullerton
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sandro Galea
- Boston University School of Public Health, MA, USA
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18
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Wamser-Nanney R, Walker HE, Nanney JT. Sexual Assault, Posttraumatic Stress Symptoms, and Indices of Aggression Among Women. J Trauma Stress 2020; 33:1121-1129. [PMID: 32790938 DOI: 10.1002/jts.22572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 11/12/2022]
Abstract
Sexual assault is associated with many adverse outcomes, including a higher risk for developing posttraumatic stress symptoms (PTSS). Although nonsexual trauma exposure has been linked to aggression, the associations between sexual assault and aggression are understudied. Further, the DSM-5 conceptualization of posttraumatic stress disorder (PTSD) includes a symptom related to aggression, and associations between symptom clusters and aggression with regard to the new criteria are underexplored. The present study aimed to (a) examine the relations between sexual assault and indices of aggression (i.e., physical/verbal aggression, anger, and hostility) after accounting for PTSS and (b) investigate PTSD symptom clusters in relation to aggression among 263 women (Mage = 29.03 years, SD = 11.71; 67.6% white). Path analysis revealed that sexual assault was unrelated to indices of aggression, βs = .003-.08; however, PTSS was consistently linked with increased aggression, βs = .22-.49. Results indicated specificity in the associations between the symptom clusters and aspects of aggression. Negative alterations in cognitions and mood corresponded with increased physical aggression, β = .28, and hostility, β = .38, and avoidance was related to verbal aggression, β = .19. Hyperarousal was also tied to higher levels of anger, hostility, and verbal aggression, βs = .21-.33. Nonetheless, lower levels of intrusion symptoms were associated with increased anger and hostility, β = -.26. With regard to understanding women's risk for aggression, PTSS may be more relevant than sexual assault. Further, there may be specificity related to the type of PTSD symptoms and aspects of aggression.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Hannah E Walker
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - John T Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri, USA
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19
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Caulfield NM, Martin RL, Norr AM, Capron DW. The Association Between Posttraumatic Stress Symptoms and Anxiety Sensitivity in a College Sample. Psychol Rep 2020; 124:1539-1558. [PMID: 32781893 DOI: 10.1177/0033294120948227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES One-half of all U.S. adults will experience at least one traumatic event, and of those, approximately 11% develop posttraumatic stress disorder (PTSD) symptoms. Despite efficacious treatments for PTSD, one-third of people diagnosed still express symptoms after treatment.Thus, it is important to identify underlying factors that may be associated with PTSD symptom clusters to improve treatment efficacy. One potential factor is anxiety sensitivity (AS), or "the fear of fear," and includes three different subfactors: physical, cognitive, and social concerns, yet few studies have examined this association using the Anxiety Sensitivity Index-3. METHOD Participants included 65 undergraduate students from a Southeastern University who were elevated on anxiety sensitivity cognitive concerns and experienced at least one traumatic event. Participants completed measures of trauma exposure, anxiety sensitivity, posttraumatic stress symptoms, and suicidal ideation. RESULTS Results revealed that AS physical symptoms had the most robust association with potential PTSD symptoms and individual PTSD symptom clusters with the exception of the avoidance and numbing cluster. CONCLUSIONS These findings may help clarify the nature of the relationship between PTSD symptoms and AS using the most updated measure of AS (ASI-3).
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Affiliation(s)
| | - Rachel L Martin
- 5104University of Southern Mississippi, Hattiesburg, MS, USA
| | - Aaron M Norr
- 20128VA Puget Sound Health Care System, Seattle, WA, USA
| | - Daniel W Capron
- 5104University of Southern Mississippi, Hattiesburg, MS, USA
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20
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Mahoney CT, Cole HE, Gilbar O, Taft CT. The Role of Impulsivity in the Association Between Posttraumatic Stress Disorder Symptom Severity and Substance Use in Male Military Veterans. J Trauma Stress 2020; 33:296-306. [PMID: 32339353 PMCID: PMC7299815 DOI: 10.1002/jts.22508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 01/16/2023]
Abstract
High rates of posttraumatic stress disorder (PTSD) and comorbid substance use disorder (SUD) are prevalent in military veterans. However, few studies have investigated impulsivity as a risk factor for engaging in substance use behavior for individuals who are experiencing PTSD symptoms. The present study evaluated impulsivity as a moderator of the association between PTSD symptoms and alcohol/drug use. Male military veterans (N = 106) completed self-report measures of alcohol use behavior, drug use behavior, and impulsivity. Participants also completed a structured diagnostic interview to assess for PTSD. The findings indicated that impulsivity moderated the relation between total PTSD symptoms and alcohol use, B = 0.01, p = .035, along with associations between alcohol use and two of the symptom clusters: PTSD reexperiencing symptoms, B = 0.01, p = .016; and PTSD avoidance/numbing symptoms, B = 0.01, p = .029. Veterans with high levels of impulsivity were at significantly higher risk of engaging in alcohol use than veterans with low-to-average levels. Impulsivity did not potentiate the relation between PTSD hyperarousal symptoms and alcohol use nor did it moderate the association between any of the PTSD variables and drug use. Impulsivity appears to serve as a significant risk factor for alcohol use, but not drug use, for male veterans experiencing PTSD symptoms. Future studies are necessary to replicate and expand upon these findings, particularly to facilitate the development of integrated evidence-based treatments that target both alcohol use and impulsivity within the context of PTSD.
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Affiliation(s)
- Colin T. Mahoney
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130,Boston University School of Medicine, Department of Psychiatry, 72 E. Concord Street, Boston, MA, USA, 02118
| | - Hannah E. Cole
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130
| | - Ohad Gilbar
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130,Boston University School of Medicine, Department of Psychiatry, 72 E. Concord Street, Boston, MA, USA, 02118
| | - Casey T. Taft
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130,Boston University School of Medicine, Department of Psychiatry, 72 E. Concord Street, Boston, MA, USA, 02118
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21
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Mathes BM, Quick AD, Albanese BJ, Morabito DM, Bedford CE, Schmidt NB. Hostility and Suicide Risk Among Veterans: The Mediating Role of Perceived Burdensomeness. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10082-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Contractor AA, Weiss NH, Dolan M, Mota N. Examination of the Structural Relations Between Posttraumatic Stress Disorder Symptoms and Reckless/Self-Destructive Behaviors. INTERNATIONAL JOURNAL OF STRESS MANAGEMENT 2020; 27:35-44. [PMID: 33776397 PMCID: PMC7993008 DOI: 10.1037/str0000133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, MB, CANADA
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23
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Elbogen EB, Molloy K, Wagner HR, Kimbrel N, Beckham JC, Van Male L, Leinbach J, Bradford DW. Psychosocial protective factors and suicidal ideation: Results from a national longitudinal study of veterans. J Affect Disord 2020; 260:703-709. [PMID: 31561113 PMCID: PMC6878990 DOI: 10.1016/j.jad.2019.09.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study investigates the empirical association between psychosocial protective factors and subsequent suicidal ideation in veterans. METHODS We conducted a national longitudinal survey in which participants were randomly drawn from over one million U.S. military service members who served after September 11, 2001. Data were provided by a total of 1090 veterans representative of all 50 states and all military branches in two waves of data collection one year apart (79% retention rate). RESULTS In chi-square analyses, psychosocial protective factors at wave 1 (employment, meeting basic needs, self-care, living stability, social support, spirituality, resilience, and self-determination) were significantly related to lower suicidal ideation at wave 2. In multivariable analyses controlling for covariates at wave 1 including suicidal ideation, the total number of protective factors endorsed at wave 1 significantly predicted reduced odds of suicidal ideation at wave 2. In multivariable analysis examining individual risk and protective factors, again controlling for covariates, results showed that money to cover basic needs and higher psychological resilience at wave 1 were associated with significantly lower odds of suicidal ideation at wave 2. LIMITATIONS The study measured the link between psychosocial protective factors and suicidal ideation but not suicide attempts, which would be an important next step for this research. CONCLUSIONS The results indicate that psychosocial rehabilitation and holistic approaches targeting financial well-being, homelessness, resilience, self-care, social support, spirituality, and work may offer a promising avenue in both veteran and non-veteran populations for treatment safety planning as well as suicide risk management and prevention.
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Affiliation(s)
- Eric B. Elbogen
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Kiera Molloy
- Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - H. Ryan Wagner
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Nathan Kimbrel
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Lynn Van Male
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, Washington, DC,Oregon Health & Sciences University, Department of Psychiatry, Portland, OR
| | - Jonathan Leinbach
- Durham VA Health Care System, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Daniel W. Bradford
- Durham VA Health Care System, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
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Wickramasuriya DS, Amin MR, Faghih RT. Skin Conductance as a Viable Alternative for Closing the Deep Brain Stimulation Loop in Neuropsychiatric Disorders. Front Neurosci 2019; 13:780. [PMID: 31447627 PMCID: PMC6692489 DOI: 10.3389/fnins.2019.00780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/11/2019] [Indexed: 01/17/2023] Open
Abstract
Markers from local field potentials, neurochemicals, skin conductance, and hormone concentrations have been proposed as a means of closing the loop in Deep Brain Stimulation (DBS) therapy for treating neuropsychiatric and movement disorders. Developing a closed-loop DBS controller based on peripheral signals would require: (i) the recovery of a biomarker from the source neural stimuli underlying the peripheral signal variations; (ii) the estimation of an unobserved brain or central nervous system related state variable from the biomarker. The state variable is application-specific. It is emotion-related in the case of depression or post-traumatic stress disorder, and movement-related for Parkinson's or essential tremor. We present a method for closing the DBS loop in neuropsychiatric disorders based on the estimation of sympathetic arousal from skin conductance measurements. We deconvolve skin conductance via an optimization formulation utilizing sparse recovery and obtain neural impulses from sympathetic nerve fibers stimulating the sweat glands. We perform this deconvolution via a two-step coordinate descent procedure that recovers the sparse neural stimuli and estimates physiological system parameters simultaneously. We next relate an unobserved sympathetic arousal state to the probability that these neural impulses occur and use Bayesian filtering within an Expectation-Maximization framework for estimation. We evaluate our method on a publicly available data-set examining the effect of different types of stress on peripheral signal changes including body temperature, skin conductance and heart rate. A high degree of arousal is estimated during cognitive tasks, as are much lower levels during relaxation. The results demonstrate the ability to decode psychological arousal from neural activity underlying skin conductance signal variations. The complete pipeline from recovering neural stimuli to decoding an emotion-related brain state using skin conductance presents a promising methodology for the ultimate realization of a closed-loop DBS controller. Closed-loop DBS treatment would additionally help reduce unnecessary power consumption and improve therapeutic gains.
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Affiliation(s)
| | | | - Rose T. Faghih
- Computational Medicine Laboratory, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, United States
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25
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Bhardwaj V, Angkaw AC, Franceschetti M, Rao R, Baker DG. Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans. Aggress Behav 2019; 45:417-426. [PMID: 30835866 DOI: 10.1002/ab.21827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/04/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
Abstract
Hostility, anger, and aggression are conceptually related but unique constructs found to occur more often among veterans with posttraumatic stress disorder (PTSD) than among civilians or veterans without PTSD. However, the pathways between PTSD, depression, hostility, anger, and aggression have not been comprehensively characterized. Therefore, drawing on a sample of returning Operation Enduring Freedom/Operation Iraqi Freedom combat veterans ( N = 175; 95% male; mean age 30 years), this study sought to examine the direct and indirect relationships among PTSD, depression, hostility, anger, and four types of aggression: verbal, and physical toward self, others, and objects. Functional modeling of direct effects was done using multiple least-squares regression and bootstrapped mediation analyses were carried out to test indirect effects. Results indicate that PTSD is not the overall direct contributor to different forms of aggression, supporting the mediating role of depression and trait anger. Depression symptoms explain part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward self and trait anger explains part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward others. Our findings support the importance of assessing for anger, depression, and different types of aggression among veterans presenting for PTSD treatment to develop individualized treatment plans that may benefit from early incorporation of interventions.
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Affiliation(s)
- Vinnu Bhardwaj
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Abigail C. Angkaw
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
| | - Massimo Franceschetti
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Ramesh Rao
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Dewleen G. Baker
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- VA Center of Excellence for Stress and Mental HealthSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
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26
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Locci A, Pinna G. Social isolation as a promising animal model of PTSD comorbid suicide: neurosteroids and cannabinoids as possible treatment options. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:243-259. [PMID: 30586627 DOI: 10.1016/j.pnpbp.2018.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by drastic alterations in mood, emotions, social abilities and cognition. Notably, one aspect of PTSD, particularly in veterans, is its comorbidity with suicide. Elevated aggressiveness predicts high-risk to suicide in humans and despite the difficulty in reproducing a complex human suicidal behavior in rodents, aggressive behavior is a well reproducible behavioral trait of suicide. PTSD animal models are based on a peculiar phenotype, including exaggerated fear memory and impaired fear extinction associated with neurochemical dysregulations in the brain circuitry regulating emotion. The endocannabinoid and the neurosteroid systems regulate emotions and stress responses, and recent evidence shows these two systems are interrelated and critically compromised in neuropsychiatric disorders. For instance, levels of the neurosteroid, allopregnanolone, as well as those of the endocannabinoids, anandamide and its congener, palmitoylethanolamide are decreased in PTSD. Similarly, the endocannabinoid system and neurosteroid biosynthesis are altered in suicidal individuals. Selective serotonin reuptake inhibitors (SSRIs), the only FDA-approved treatments for PTSD, fail to help half of the treatment-seeking patients. This highlights the need for developing biomarker-based efficient therapies. One promising alternative to SSRIs points to stimulation of allopregnanolone biosynthesis as a treatment and a valid end-point to predict treatment response in PTSD patients. This review highlights running findings on the role of the endocannabinoid and neurosteroid systems in PTSD and suicidal behavior both in a preclinical and clinical perspective. A specific focus is given to predictive PTSD/suicide animal models. Ultimately, we discuss the idea that disruption of neurosteroid and endocannabinoid biosynthesis may offer a novel promising biomarker axis to develop new treatments for PTSD and, perhaps, suicidal behavior.
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Affiliation(s)
- Andrea Locci
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612, USA.
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Currier JM, McDermott RC, Farnsworth JK, Borges LM. Temporal Associations Between Moral Injury and Posttraumatic Stress Disorder Symptom Clusters in Military Veterans. J Trauma Stress 2019; 32:382-392. [PMID: 30715755 DOI: 10.1002/jts.22367] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 07/12/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022]
Abstract
War zone veterans who experience posttraumatic stress disorder (PTSD) symptoms might struggle with co-occurring cognitive, emotional, and behavioral expressions of suffering that align with conceptual definitions of moral injury (MI). However, given that PTSD is a multidimensional condition, disentangling the apparent interplay with MI may inform clinical practice and research. This study incorporated a cross-lagged design to explore temporal associations between self- and other-directed outcomes related to MI and severity of DSM-5 PTSD symptom clusters while accounting for depressive symptoms. Drawing on the Expressions of Moral Injury Scale-Military Version in a community sample of 182 previously deployed veterans, MI-related outcomes were linked with severity of PTSD symptom clusters at two assessments spaced apart by 6 months, rs = .58-.62. Of possible models for conceptualizing the temporal nature of these associations, structural equation modeling analyses revealed a cross-lagged primary MI model best fit veterans' responses. Within this model, veterans' self-directed MI at Time 1 predicted greater PTSD symptoms at the 6-month follow-up. However, an equivalent cross-lagged path also emerged between Time 1 PTSD Cluster D symptoms and self-directed MI at Time 2, suggesting the value of a reciprocal MI model for this symptom domain. In contrast, other-directed outcomes of MI were not linked with PTSD in the presence of other variables. Overall, these findings support the prognostic value of assessing for MI-related outcomes among veterans who might be struggling with PTSD symptomatology, particularly with respect to self-directed problems associated with enduring moral distress.
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Affiliation(s)
- Joseph M Currier
- Psychology Department, University of South Alabama, Mobile, Alabama, USA
| | - Ryon C McDermott
- Department of Professional Studies, University of South Alabama, Mobile, Alabama, USA
| | | | - Lauren M Borges
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
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Ellison JM, Colvonen PJ, Haller M, Norman SB, Angkaw AC. Examining the relation between PTSD and insomnia on aggression. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1598220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Peter J. Colvonen
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Sonya B. Norman
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- VA Center of Excellence for Stress and Mental Health, San Diego, California
- National Center for PTSD, White River Junction, Vermont
| | - Abigail C. Angkaw
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- National Center for PTSD, White River Junction, Vermont
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Start AR, Allard Y, Adler A, Toblin R. Predicting Suicide Ideation in the Military: The Independent Role of Aggression. Suicide Life Threat Behav 2019; 49:444-454. [PMID: 29498089 DOI: 10.1111/sltb.12445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the longitudinal relationship between aggression and suicide ideation when controlling for other externalizing (i.e., alcohol misuse and risk-taking) and internalizing (i.e., depression and sleep problems) risk factors in an active duty, military sample. Preexisting data from a longitudinal study were analyzed to assess the wellness of service members across the deployment cycle. Participants were 944 active duty service members (95% male, 48% between 18 and 24 years old) who completed surveys upon initial return from deployment and approximately 3 months later. After controlling for other externalizing (alcohol misuse, risk-taking) and internalizing (depression, sleep problems) risk factors, service members reporting aggression were significantly more likely to report suicide ideation than those reporting no aggression (OR = 3.19; OR 95% CI: 1.16-8.80). The independent nature of the relationship between anger and suicidality suggests aggression may be an important indicator of suicidality for service members. Understanding the role of aggression in suicidality may improve the ability to identify at-risk service members and to develop effective interventions to reduce suicide risk.
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Affiliation(s)
- Amanda R Start
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Yvonne Allard
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Amy Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Robin Toblin
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Fidelity to Best Practices of Psychiatric Assessments in Army Behavioral Health Settings. J Psychiatr Pract 2019; 25:103-117. [PMID: 30849058 DOI: 10.1097/pra.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While civilian and military psychiatric clinical practice guidelines (CPGs) exist for psychiatric assessments, data are lacking on providers' adherence to these criteria. This study evaluated the use of psychiatric CPGs' assessment criteria by Army behavioral health providers (BHPs). In a weighted cross-sectional survey, 348 BHPs were evaluated on their assessment of a systematically selected patient on 15 total domains recommended by the Departments of Veterans Affairs and Defense CPGs for substance use disorders, posttraumatic stress disorder, and major depressive disorder. The proportion of BHPs providing high-quality assessment and the association between high-quality assessment and BHP and patient characteristics were examined. Using the weighted sample, 80% of BHPs provided a high-quality assessment. BHPs who saw ≥20 patients per week were significantly more likely to provide high-quality assessments compared with BHPs who saw <20 patients per week [odds ratio (OR)=1.72, 95% confidence interval (CI)=1.01-2.92]. Patients diagnosed with generalized anxiety disorder [adjusted OR (AOR)=0.42, 95% CI=0.18-0.96] or whose BHPs did not assess patients' current overall physical health (AOR=0.26, 95% CI=0.07-0.97) or lifetime duration of treatment for mental health (AOR=0.03, 95% CI=0.01-0.20) were less likely to receive high-quality assessments. A majority of Army BHPs are conducting high-quality assessments for the 3 most common mental disorders in military populations. If recommendations to increase fidelity to assessment could be implemented, more patients could receive optimized care.
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Using Next-Generation Sequencing Transcriptomics To Determine Markers of Post-traumatic Symptoms: Preliminary Findings from a Post-deployment Cohort of Soldiers. G3-GENES GENOMES GENETICS 2019; 9:463-471. [PMID: 30622122 PMCID: PMC6385974 DOI: 10.1534/g3.118.200516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Post-traumatic stress disorder is a concerning psychobehavioral disorder thought to emerge from the complex interaction between genetic and environmental factors. For soldiers exposed to combat, the risk of developing this disorder is twofold and diagnosis is often late, when much sequela has set in. To be able to identify and diagnose in advance those at “risk” of developing post-traumatic stress disorder, would greatly taper the gap between late sequelae and treatment. Therefore, this study sought to determine whether the transcriptome can be used to track the development of post-traumatic stress disorder in this unique and susceptible cohort of individuals. Gene expression levels in peripheral blood samples from 85 Canadian infantry soldiers (n = 58 participants negative for symptoms of post-traumatic stress disorder and n = 27 participants with symptoms of post-traumatic stress disorder) following return from deployment to Afghanistan were determined using RNA sequencing technology. Count-based gene expression quantification, normalization and differential analysis (with thorough correction for confounders) revealed genes associated to PTSD; LRP8 and GOLM1. These preliminary results provide a proof-of-principle for the diagnostic utility of blood-based gene expression profiles for tracking symptoms of post-traumatic stress disorder in soldiers returning from tour. It is also the first to report transcriptome-wide expression profiles alongside a post-traumatic symptom checklist.
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Typologies of PTSD clusters and reckless/self-destructive behaviors: A latent profile analysis. Psychiatry Res 2019; 272:682-691. [PMID: 30832187 DOI: 10.1016/j.psychres.2018.12.124] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/22/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is comorbid with diverse reckless and self-destructive behaviors (RSDBs). We examined the nature and construct validity (covariates of age, gender, depression severity, number of trauma types, functional impairment) of the optimal class solution categorizing participants based on PTSD symptom and RSDB endorsement. The sample included 417 trauma-exposed individuals recruited through Amazon's MTurk platform who completed the Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, the Posttrauma Risky Behaviors Questionnaire, and Patient Health Questionnaire-9. Latent profile analyses indicated an optimal three-class solution: the Low PTSD-RSDBs, High PTSD-Low RSDBs, and High PTSD-RSDBs classes. Multinomial logistic regression indicated that impairment and depression predicted the High PTSD-Low RSDBs vs. the Low PTSD-RSDBs classes. Impairment, age, being female, and depression predicted the High vs. Low PTSD-RSDBs classes. Number of trauma types, age, being female, and depression predicted the High PTSD-RSDBs vs. High PTSD-Low RSDBs classes. Results support the presence of a reckless behaviors subtype of PTSD (characterized by greater depression, greater impariment, greater number of trauma types, being male, and being younger), conducting comprehensive assessments of RSDBs for individuals reporting PTSD symptoms and of PTSD symptoms for individuals reporting RSDBs, and the need to tailor interventions to treat PTSD and RSDBs concurrently.
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Tobore TO. On the Neurobiological Role of Oxidative Stress in Alcohol-Induced Impulsive, Aggressive and Suicidal Behavior. Subst Use Misuse 2019; 54:2290-2303. [PMID: 31369300 DOI: 10.1080/10826084.2019.1645179] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: Alcohol abuse is known to result in behavioral impairments (such as increased impulsivity, aggressive, and suicidal behavior), but the neurobiological basis for these behavioral impairments remains unknown. The objective of this review is to propose a neurobiological basis for alcohol-induced aggression, impulsivity, and suicidal behavior. Methods: Search was done by accessing PubMed/Medline, EBSCO, and PsycINFO databases. The search string used was "(Alcohol OR Alcoholism* OR Alcohol Abuse) AND (Behavior* OR Behavioral Impairment or Disorder) AND (Oxidative Stress OR Reactive Oxygen Species)." The electronic databases were searched for titles or abstracts containing these terms in all published articles between January 1, 1960, and May 31, 2019. The search was limited to studies published in English and other languages involving both animal and human subjects. Articles selected included randomized clinical trials (RCTs), observational studies, meta-analyses, and both systemic and narrative reviews, providing both quantitative and qualitative information with a measure of alcohol abuse or alcoholism as an outcome. Exclusion criteria were unpublished data of any form, including conference proceedings and dissertation. New key terms were identified (new term included: "Antioxidants, Neurotransmitters, Dopamine, Serotonin, GABA, Glutamate. Aggression, Impulsivity, Suicidal Behavior, hippocampus, prefrontal cortex, limbic system, psychiatric disorders, PTSD, Anxiety, Depression. These new terms were searched with Alcohol or Alcoholism or Alcohol Abuse and Oxidative Stress separately resulting in the identification of over 3000 articles. 196 were included in this article. Results: Multiple lines of evidence indicate that oxidative stress (OS) plays a critical underlying role in alcohol toxicity and behavioral impairments. Conclusions/Importance: People diagnosed with PTSD, anxiety disorder, depression, and those with a personality high in psychoticism as measured by the P Scale of the Eysenck Personality Questionnaire, with comorbid alcohol abuse or alcohol use disorder (AUD), may display increased impulsivity, aggression, and suicidal behavior because of the potentiating effect of alcohol-induced OS on their elevated brain oxidative status. Antioxidant therapy should be an integral part of acute alcohol intoxication and AUD treatment. Further research is necessary to fully understand the relationship between OS and alcohol-induced behavioral impairments.
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Mild Traumatic Brain Injury Burden Moderates the Relationship Between Cognitive Functioning and Suicidality in Iraq/Afghanistan-Era Veterans. J Int Neuropsychol Soc 2019; 25:79-89. [PMID: 30444208 PMCID: PMC6349513 DOI: 10.1017/s1355617718000851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. METHODS Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. RESULTS Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. CONCLUSIONS Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79-89).
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Schuman DL, Bricout J, Peterson HL, Barnhart S. A systematic review of the psychosocial impact of emotional numbing in US combat veterans. J Clin Psychol 2018; 75:644-663. [DOI: 10.1002/jclp.22732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Donna L. Schuman
- College of Social Work; University of Kentucky; Lexington Kentucky
| | - John Bricout
- School of Social Work; University of Minnesota; Minneapolis Minnesota
| | | | - Sheila Barnhart
- College of Social Work; University of Kentucky; Lexington Kentucky
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Wesselmann ED, Ispas D, Olson MD, Swerdlik ME, Caudle NM. Does perceived ostracism contribute to mental health concerns among veterans who have been deployed? PLoS One 2018; 13:e0208438. [PMID: 30521584 PMCID: PMC6283591 DOI: 10.1371/journal.pone.0208438] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/17/2018] [Indexed: 11/18/2022] Open
Abstract
Posttraumatic stress-negative psychological experiences as a result of traumatic stressors-can hinder military veterans' reintegration into society and cause various mental health problems. Veterans need quality social relationships to facilitate reintegration and to cope with posttraumatic stress and related mental health problems; discrimination or other forms of interpersonal rejection can exacerbate these veterans' problems. Ostracism (i.e., being ignored and excluded) is a painful and psychologically distressing experience that may be one factor that contributes to the problems of veterans who are dealing with posttraumatic stress. To our knowledge, this connection has yet to be tested empirically. Thus, we investigated the correlation between posttraumatic stress, perceived ostracism, and other theoretically relevant variables (i.e., mental health problems, perceived social support, psychological need satisfaction) in a sample of veterans who have had at least one deployment. Our results provide preliminary empirical evidence suggesting that perceived ostracism may contribute to veteran' deployment-related psychological problems. Veterans' perceived ostracism correlated with psychological problems (i.e., posttraumatic stress symptoms, anxiety and psychological distress), and it explained additional variance in posttraumatic stress symptoms above and beyond common predictors of these symptoms (i.e., deployment stress, perceived military and civilian-based social support). Finally, perceived ostracism emerged as the most important predictor of posttraumatic stress symptoms in a relative weights analysis.
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Affiliation(s)
- Eric D. Wesselmann
- Department of Psychology, Illinois State University, Normal, Illinois, United States of America
| | - Dan Ispas
- Department of Psychology, Illinois State University, Normal, Illinois, United States of America
| | - Mark D. Olson
- School of Social Work, Illinois State University, Normal, Illinois, United States of America
| | - Mark E. Swerdlik
- Department of Psychology, Illinois State University, Normal, Illinois, United States of America
| | - Natasha M. Caudle
- Department of Psychology, Illinois State University, Normal, Illinois, United States of America
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Durham TA, Byllesby BM, Lv X, Elhai JD, Wang L. Anger as an underlying dimension of posttraumatic stress disorder. Psychiatry Res 2018; 267:535-540. [PMID: 29980134 DOI: 10.1016/j.psychres.2018.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Abstract
In this study, we examined the underlying role of anger in posttraumatic stress disorder (PTSD). Although anger is currently considered within two symptoms of PTSD (i.e., anger/irritability; and negative emotional state), some research has found that anger is more than just a diagnostic symptom of PTSD. The sample consisted of 375 trauma-exposed individuals that completed the PTSD Checklist-5 and Dimensions of Anger Reactions Scale. Confirmatory factor analysis was used to assess PTSD's factor structure based on the four-factor DSM-5 PTSD model. Subsequently, the model was re-tested, statistically controlling for anger by regressing PTSD's items on an observed anger score. Individual factor loading differences were then compared to determine anger's underlying role. Results indicated that a significant amount of variance in PTSD, at both the item level and factor level, was attributable to an underlying dimension of anger. The largest factor attenuation was for the symptom of irritability/anger and the smallest attenuation was recklessness. The results suggest that anger underlies more of PTSD than the two diagnostic symptom criteria.
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Affiliation(s)
- Tory A Durham
- VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA; Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA
| | - Brianna M Byllesby
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA; Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Xin Lv
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA.
| | - Li Wang
- Laboratory for Traumatic Stress studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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38
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Anger and Aggression in UK Treatment-Seeking Veterans with PTSD. Healthcare (Basel) 2018; 6:healthcare6030086. [PMID: 30037117 PMCID: PMC6164712 DOI: 10.3390/healthcare6030086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/03/2018] [Accepted: 07/18/2018] [Indexed: 11/30/2022] Open
Abstract
Prevalence rates of anger and aggression are often higher in military personnel. Therefore, it is important to understand more about why this is, and the factors with which it is associated. Despite this, there is little evidence relating to anger and aggression in UK veterans who are seeking treatment for mental health difficulties such as post-traumatic stress disorder (PTSD). This study investigated the prevalence rates of anger and aggression in this population, as well as the associations between anger and aggression, and various sociodemographic, functioning and mental health variables. A cross-sectional design was used, with participants completing a battery of self-report questionnaires. Prevalence rates for significant anger and aggression were 74% and 28% respectively. Both women and those over 55 were less likely to report difficulties. Those with high levels of PTSD and other mental health difficulties were more likely to report anger and aggression. Other factors related to anger and aggression included unemployment due to ill health, and a perceived lack of family support. Findings showed that veterans who are seeking support for mental health are likely to be experiencing significant difficulties with anger and aggression, especially if they have comorbid mental health difficulties. The associations between anger, aggression, and other variables, has implications for the assessment and treatment of military veterans.
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Sheth C, Prescot A, Bueler E, DiMuzio J, Legarreta M, Renshaw PF, Yurgelun-Todd D, McGlade E. Alterations in anterior cingulate cortex myoinositol and aggression in veterans with suicidal behavior: A proton magnetic resonance spectroscopy study. Psychiatry Res Neuroimaging 2018; 276:24-32. [PMID: 29723775 DOI: 10.1016/j.pscychresns.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Abstract
Studies investigating the neurochemical changes that correspond with suicidal behavior (SB) have not yielded conclusive results. Suicide correlates such as aggression have been used to explore risk factors for SB. Yet the neurobiological basis for the association between aggression and SB is unclear. Aggression and SB are both prevalent in veterans relative to civilian populations. The current study evaluated the relationship between brain chemistry in the anterior (ACC) and the posterior cingulate cortex (POC), as well as the relationship between aggression and SB in a veteran population using proton magnetic resonance spectroscopy (1H-MRS). Single-voxel MRS data at 3 Tesla (T) were acquired from the ACC and POC voxels using a 2-dimensional J-resolved point spectroscopy sequence and quantified using the ProFit algorithm. Participants also completed a structured diagnostic interview and a clinical battery. Our results showed that the myoinositol (mI)/H2O ratio in the ACC and POC was significantly higher in veterans who reported SB when compared to veterans who did not. The two groups did not differ significantly with regard to other metabolites. Second, verbal aggression and SB measures positively correlated with mI/H2O in the ACC. Finally, verbal aggression mediated the relationship between mI/H2O in the ACC and SB.
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Affiliation(s)
- Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA.
| | - Andrew Prescot
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elliott Bueler
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Jennifer DiMuzio
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
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Phelps AJ, Steele Z, Cowlishaw S, Metcalf O, Alkemade N, Elliott P, O'Donnell M, Redston S, Kerr K, Howard A, Nursey J, Cooper J, Armstrong R, Fitzgerald L, Forbes D. Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster. J Trauma Stress 2018; 31:401-409. [PMID: 29958337 DOI: 10.1002/jts.22299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 11/11/2022]
Abstract
Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four-factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3- and 9-month follow-ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, dRM = -0.61 and dRM = -0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, dRM = -0.36 and dRM = -0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3-month follow-up, dRM = -0.21. Intrusion and arousal symptoms also showed continued changes between 3- and 9-month follow-ups although these effects were very small, dRM = -0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma-focused therapy directly targeting intrusions as the core component of programmatic treatment.
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Affiliation(s)
- Andrea J Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Zachary Steele
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nathan Alkemade
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Peter Elliott
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Suzy Redston
- Psychological Trauma Recovery Service, Austin Health, Melbourne, Australia
| | - Katelyn Kerr
- Trauma Recovery Program, Toowong Private Hospital, Brisbane, Australia
| | - Alexandra Howard
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jane Nursey
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - John Cooper
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Renee Armstrong
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Lea Fitzgerald
- Trauma Recovery Centre, Mater Health Services, Townsville, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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41
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Van Voorhees EE, Wagner HR, Beckham JC, Bradford DW, Neal LC, Penk WE, Elbogen EB. Effects of social support and resilient coping on violent behavior in military veterans. Psychol Serv 2018; 15:181-190. [PMID: 29723020 DOI: 10.1037/ser0000187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Violence toward others has been identified as a serious postdeployment adjustment problem in a subset of Iraq- and Afghanistan-era veterans. In the current study, we examined the intricate links between posttraumatic stress disorder (PTSD), commonly cited psychosocial risk and protective factors, and violent behavior using a national randomly selected longitudinal sample of Iraq- and Afghanistan-era United States veterans. A total of 1,090 veterans from the 50 United States and all United States military branches completed 2 waves of self-report survey-data collection 1 year apart (retention rate = 79%). History of severe violent behavior at Wave 1 was the most substantial predictor of subsequent violence. In bivariate analyses, high correlations were observed among risk and protective factors, and between risk and protective factors and severe violence at both time points. In multivariate analyses, baseline violence (OR = 12.43, p < .001), baseline alcohol misuse (OR = 1.06, p < .05), increases in PTSD symptoms between Waves 1 and 2 (OR = 1.01, p < .05), and decreases in social support between Waves 1 and 2 (OR = .83, p < .05) were associated with increased risk for violence at Wave 2. Our findings suggest that rather than focusing specifically on PTSD symptoms, alcohol use, resilience, or social support in isolation, it may be more useful to consider how these risk and protective factors work in combination to convey how military personnel and veterans are managing the transition from wartime military service to civilian life, and at what point it might be most effective to intervene. (PsycINFO Database Record
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Affiliation(s)
- Elizabeth E Van Voorhees
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - H Ryan Wagner
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Jean C Beckham
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Daniel W Bradford
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Lydia C Neal
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Walter E Penk
- Psychiatry and Behavioral Sciences, Texas A&M College of Medicine
| | - Eric B Elbogen
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
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42
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Ford JD, Grasso DJ, Greene CA, Slivinsky M, DeViva JC. Randomized clinical trial pilot study of prolonged exposure versus present centred affect regulation therapy for PTSD and anger problems with male military combat veterans. Clin Psychol Psychother 2018; 25:641-649. [DOI: 10.1002/cpp.2194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Julian D. Ford
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Damion J. Grasso
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Carolyn A. Greene
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Michelle Slivinsky
- Department of Psychiatry; University of Connecticut Health Center; Farmington CT USA
| | - Jason C. DeViva
- Department of Psychology; Department of Veterans Affairs Connecticut Healthcare System and Yale School of Medicine; West Haven CT USA
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43
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Watkins LE, Sippel LM, Pietrzak RH, Hoff R, Harpaz-Rotem I. Clinically Significant Change in Posttraumatic Stress Disorder Symptoms Is Associated With Lower Levels of Aggression After Residential Treatment Discharge. J Trauma Stress 2018; 31:265-272. [PMID: 29603388 DOI: 10.1002/jts.22275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 11/04/2017] [Accepted: 12/09/2017] [Indexed: 11/08/2022]
Abstract
Although the link between posttraumatic stress disorder (PTSD) and aggression has been repeatedly demonstrated, to our knowledge no research has examined whether PTSD symptom reductions are linked to less aggression after treatment. The current study aimed to address this gap in the literature by examining the association between reductions in PTSD symptoms and posttreatment aggression among 2,275 veterans in residential treatment for PTSD across 35 Veterans Health Administration sites. We estimated a multilevel model that examined the effect of clinically significant PTSD symptom change on aggression at 4-month posttreatment follow-up, and found significant within-site and between-site contextual effects of clinically significant changes in PTSD symptoms on follow-up aggression. Findings revealed that veterans who reported clinically significant changes in their PTSD symptoms had lower levels of aggression at follow-up than veterans at the same treatment site who did not report clinically significant PTSD change. After we controlled for individual clinically significant PTSD change, participants in treatment sites where the rates of clinically significant PTSD change were higher overall had lower levels of aggression at follow-up. The model explained over one-fourth of the variability in aggression, R2 = .26. Findings from the current study extend previous research that has shown associations between PTSD and aggression, by revealing that clinically significant change in PTSD during residential treatment is associated with less aggression at follow-up. These findings suggest that interventions that effectively reduce PTSD symptoms may also help reduce risk for aggression.
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Affiliation(s)
- Laura E Watkins
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lauren M Sippel
- National Center for PTSD Executive Division, White River Junction, Vermont, USA.,Geisel School of Medicine, Dartmouth University, Hanover, New Hampshire, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rani Hoff
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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44
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Walton JL, Raines AM, Cuccurullo LAJ, Vidaurri DN, Villarosa-Hurlocker MC, Franklin CL. The relationship between DSM-5 PTSD symptom clusters and alcohol misuse among military veterans. Am J Addict 2017; 27:23-28. [PMID: 29251380 DOI: 10.1111/ajad.12658] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/15/2017] [Accepted: 11/29/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior research has revealed a strong relationship between Posttraumatic Stress Disorder (PTSD) and alcohol misuse. However, previous attempts to understand nuanced associations between PTSD symptom clusters and alcohol misuse within military veteran samples have produced mixed results. In an attempt to better understand the associations between PTSD and alcohol misuse, the current study examined the unique relationships between the newly classified Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD symptom clusters and alcohol misuse in an outpatient sample of military veterans seeking treatment for PTSD and Substance Use Disorders. METHODS Veterans (N = 100) were administered a brief battery of self-report questionnaires prior to receiving psychological services to aid in diagnostic assessment and treatment planning. RESULTS Hierarchical regression analyses revealed that PTSD intrusions (cluster B), negative alterations in cognition and mood (cluster D), and arousal/reactivity (cluster E) symptoms were associated with alcohol misuse. DISCUSSION AND CONCLUSIONS The positive association between alcohol misuse and PTSD symptom severity is consistent with a broader body of literature demonstrating the co-occurrence of these disorders, particularly in military samples. SCIENTIFIC SIGNIFICANCE Increased alcohol consumption may interfere with current front-line treatments for PTSD, which encourages patients to experience a full range of emotions. As such, future research should explore the impact of substance use on the effectiveness of trauma focused treatments in the alleviation of DSM-5 PTSD symptoms. (Am J Addict 2018;27:23-28).
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Affiliation(s)
- Jessica L Walton
- Southeast Louisiana Veterans Health Care System, PTSD Clinical Team, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.,South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, PTSD Clinical Team, New Orleans, Louisiana.,South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana
| | - Lisa-Ann J Cuccurullo
- Southeast Louisiana Veterans Health Care System, PTSD Clinical Team, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.,South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana
| | - Desirae N Vidaurri
- Southeast Louisiana Veterans Health Care System, PTSD Clinical Team, New Orleans, Louisiana
| | | | - C L Franklin
- Southeast Louisiana Veterans Health Care System, PTSD Clinical Team, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.,South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana
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45
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Dyches KD, Saboe KN, Anderson JA, Wilk JE, Hinman SJ, Sipos ML, Quartana PJ. Modeling the Indirect Association of Combat Exposure With Anger and Aggression During Combat Deployment: The Moderating Role of Perceived Unit Morale. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Karmon D. Dyches
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | | | - Joshua E. Wilk
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Sarah J. Hinman
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Maurice L. Sipos
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Phillip J. Quartana
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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46
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Pennings SM, Finn J, Houtsma C, Green BA, Anestis MD. Posttraumatic Stress Disorder Symptom Clusters and the Interpersonal Theory of Suicide in a Large Military Sample. Suicide Life Threat Behav 2017; 47:538-550. [PMID: 27982459 DOI: 10.1111/sltb.12317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 07/06/2016] [Indexed: 11/30/2022]
Abstract
Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5-factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5-factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.
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Affiliation(s)
| | - Joseph Finn
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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47
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Elbogen EB, Wagner HR, Kimbrel NA, Brancu M, Naylor J, Graziano R, Crawford E. Risk factors for concurrent suicidal ideation and violent impulses in military veterans. Psychol Assess 2017. [PMID: 28627921 DOI: 10.1037/pas0000490] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicide and violence are significant problems in a subset of Iraq/Afghanistan-era veterans. This study investigates how posttraumatic stress disorder (PTSD) and resilience in veterans are associated with suicidal ideation and violent impulses while controlling for known covariates of both adverse outcomes. Structured clinical interviews were conducted of N = 2,543 Iraq/Afghanistan-era U.S. veterans. Compared with veterans denying suicidal ideation or violent impulses (n = 1,927), veterans endorsing both (n = 171) were more likely to meet diagnostic criteria for PTSD, report childhood abuse, combat exposure, physical pain symptoms, and drug misuse, and less likely to endorse self-direction/life purpose. Veterans reporting concurrent suicidal ideation and violent impulses had higher odds of misusing drugs and reporting pain symptoms relative to veterans reporting suicidal ideation only (n = 186) and had lower odds of endorsing self-direction/life purpose compared with veterans reporting violent impulses only (n = 259). The findings underscore the importance of examining drug abuse, physical pain symptoms, and self-direction/life purpose, as well as PTSD and history of trauma, in the context of clinical assessment and empirical research aimed at optimizing risk management of suicide and violence in military veterans. (PsycINFO Database Record
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Affiliation(s)
- Eric B Elbogen
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - H Ryan Wagner
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Nathan A Kimbrel
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Mira Brancu
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Jennifer Naylor
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Robert Graziano
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Eric Crawford
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
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48
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Watkins LE, Sippel LM, Pietrzak RH, Hoff R, Harpaz-Rotem I. Co-occurring aggression and suicide attempt among veterans entering residential treatment for PTSD: The role of PTSD symptom clusters and alcohol misuse. J Psychiatr Res 2017; 87:8-14. [PMID: 27984702 DOI: 10.1016/j.jpsychires.2016.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/31/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022]
Abstract
Aggression and suicidality are two serious public health concerns among U.S. veterans that can co-occur and share many overlapping risk factors. The current study aims to elucidate the contribution of posttraumatic stress disorder (PTSD) symptom clusters defined by a five-factor model and alcohol misuse in predicting aggression and suicide attempts among veterans entering residential treatment for PTSD. Participants were 2570 U.S. veterans across 35 Veterans Health Administration sites. Multinomial logistic regression models were used to identify correlates of aggression only (n = 1471; 57.2%), suicide attempts only (n = 41; 1.6%), co-occurring aggression and suicide attempts (n = 202; 7.9%), and neither behavior (n = 856; 33.3%) over the past four months. When compared to veterans endorsing neither behavior, greater PTSD re-experiencing symptoms were related to suicide attempts (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.09-2.30), aggression (OR = 1.13, 95% CI = 1.02-1.26), and co-occurring aggression and suicide (OR = 1.38, 95% CI = 1.13-1.68), and higher PTSD dysphoric arousal symptoms and alcohol misuse symptoms were related to aggression (OR = 1.54, 95% CI = 1.38-1.71; OR = 1.30, 95% CI = 1.18-1.44, respectively) and co-occurring aggression and suicide (OR = 1.66, 95% CI = 1.35-2.04; OR = 1.50, 95% CI = 1.28-1.75, respectively). Our findings suggest that assessment of PTSD symptom clusters and alcohol misuse can potentially help to identify veterans who endorse suicide attempts, aggression, or both concurrently. These results have important implications for risk assessment and treatment planning with U.S. veterans seeking care for PTSD.
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Affiliation(s)
- Laura E Watkins
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Lauren M Sippel
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rani Hoff
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, USA
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49
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A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation. COGNITIVE THERAPY AND RESEARCH 2017; 41:645-653. [PMID: 28751798 PMCID: PMC5504127 DOI: 10.1007/s10608-016-9829-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13–15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.
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50
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Sommer J, Hinsberger M, Elbert T, Holtzhausen L, Kaminer D, Seedat S, Madikane S, Weierstall R. The interplay between trauma, substance abuse and appetitive aggression and its relation to criminal activity among high-risk males in South Africa. Addict Behav 2017; 64:29-34. [PMID: 27540760 PMCID: PMC5102240 DOI: 10.1016/j.addbeh.2016.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 07/04/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In persistently unsafe environments, the cumulative exposure to violence predicts not only the development of posttraumatic stress disorder (PTSD), but also of increased aggression and violent outbursts. Substance use disorders interact with these developments, as drug consumption may blunt symptoms and also reduce the threshold for violent acts. Investigating the interplay between these variables and the possible cumulative effect of drug abuse on the attraction to cruelty is a crucial step in understanding the cycle of violence and developing intervention programs that address this cycle in violence-troubled communities such as low-income urban areas in South Africa. METHODS Young males at risk (N=290) were recruited through a reintegration center for offenders in Cape Town. We assessed types of traumatic events experienced, PTSD symptom severity, appetitive aggression, committed offenses and patterns of drug abuse prior to the perpetration of violence. RESULTS Path-analyses confirmed a positive relationship between exposure to traumatic events and PTSD symptom severity, appetitive aggression, the number of committed offenses and drug abuse prior to violence. PTSD symptoms were positively associated with the propensity toward aggression. Furthermore, more severe drug abuse was related to higher attraction to violence and more committed offenses. CONCLUSIONS We conclude that like exposure to violence, drug abuse may play a key role in the attraction to aggression and criminal acts. Measures of violence prevention and psychotherapeutic interventions for trauma-related suffering may not be effective without enduring drug abuse rehabilitation.
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Affiliation(s)
- Jessica Sommer
- Department of Clinical Psychology, University of Konstanz, Germany.
| | | | - Thomas Elbert
- Department of Clinical Psychology, University of Konstanz, Germany.
| | - Leon Holtzhausen
- Department of Social Development, University of Cape Town, South Africa.
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, South Africa.
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