1
|
McGrory CM, Kram Mendelsohn A, Pineles SL, Lasko NB, Ivkovic V, Moon M, Cetinkaya D, Bazer O, Fortier E, Kelly A, Bragdon LB, Arditte Hall KA, Tanev K, Orr SP, Pace-Schott EF. Comparison of autonomic reactivity to trauma and nightmare imagery: A Pilot Study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae060. [PMID: 39246523 PMCID: PMC11380112 DOI: 10.1093/sleepadvances/zpae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/17/2024] [Indexed: 09/10/2024]
Abstract
Study Objectives Trauma-related nightmares (TRNs) are a hallmark symptom of PTSD and are highly correlated with PTSD severity and poor sleep quality. Given the salience and arousal associated with TRNs, they might be an effective target for imaginal exposures during Prolonged Exposure (PE) therapy. As a first step in this line of research, the current study compared participants' emotional reactivity during recollection of TRNs to their recollection of the index traumatic event. Methods Seventeen trauma-exposed participants with clinical or sub-clinical PTSD who reported frequent TRNs engaged in script-driven imagery using scripts depicting their index trauma and their most trauma-like TRN. Heart rate (HRR), skin conductance (SCR), corrugator EMG (EMGR) responses, and emotional ratings were recorded. Results HRR, SCR, and EMGR did not differ significantly between trauma-related and TRN scripts. Bayesian analyses confirmed support for the null hypothesis, indicating no differences. With the exception of "Sadness," for which TRNs elicited significantly lower ratings than trauma scripts, individual emotion ratings showed no significant differences, suggesting likely parity between the emotionality of trauma-related and TRN recollections. Conclusions Together, TRN content elicited psychophysiological reactivity similar to that of the index trauma in this pilot study. Upon replication, studies testing TRNs as potential targets for imaginal exposures during PE may be warranted.
Collapse
Affiliation(s)
- Christopher M McGrory
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, USA
| | | | - Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Vladimir Ivkovic
- Department of Psychiatry, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Mabelle Moon
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Doga Cetinkaya
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Oren Bazer
- Department of Psychiatry, Massachusetts General Hospital, USA
| | | | - Anne Kelly
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Laura B Bragdon
- Department of Psychiatry, Grossman School of Medicine, New York University, USA
| | | | - Kaloyan Tanev
- Department of Psychiatry, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Edward F Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| |
Collapse
|
2
|
Cox RC, Garcia AN, Jessup SC, Woronko SE, Rast CE, Olatunji BO. Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity. Behav Ther 2023; 54:863-875. [PMID: 37597963 PMCID: PMC10440416 DOI: 10.1016/j.beth.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.
Collapse
Affiliation(s)
- Rebecca C Cox
- University of Colorado-Boulder; Vanderbilt University.
| | | | | | | | | | | |
Collapse
|
3
|
Zalta AK, Vanderboll K, Dent AL, Contreras IM, Malek N, Lascano XN, Zellner KL, Grandhi J, Araujo PJ, Straka K, Liang CZ, Czarny JE, Martinez J, Burgess HJ. Sleep timing, chronotype, and posttraumatic stress disorder: An individual participant data meta-analysis. Psychiatry Res 2023; 321:115061. [PMID: 36706561 DOI: 10.1016/j.psychres.2023.115061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
Sleep disturbance is a major component of posttraumatic stress disorder (PTSD). The role of circadian disruption is largely overlooked, though many PTSD studies collect proxy markers of circadian timing. This individual participant data (IPD) meta-analysis examined the correlation between sleep timing / chronotype and PTSD severity among individuals diagnosed with PTSD, the standardized mean difference in sleep timing / chronotype for individuals with and without PTSD, and moderators of these relationships. A systematic search was conducted; authors provided IPD for 27 studies and aggregate data for 16 studies (3,011 participants with PTSD; 2,703 participants without PTSD). Two-step meta-analyses were conducted using a random-effects multivariate approach with robust variance estimation. Bedtime and wake time were not significantly associated with PTSD symptoms or diagnosis. Less total sleep time / time in bed was weakly associated with greater PTSD symptoms. Moderator analyses revealed that effect sizes were stronger in certain populations and when using wrist actigraphy to measure sleep timing; however, gap maps revealed few studies in moderator categories with the strongest effects. Only two studies measured chronotype, prohibiting strong conclusions. Our findings indicate that the relationship between sleep timing and PTSD is weak; however, key gaps in the literature warrant further study.
Collapse
Affiliation(s)
- Alyson K Zalta
- Department of Psychological Sciences, University of California, Irvine, United States.
| | | | - Amy L Dent
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Isaias M Contreras
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Nadia Malek
- Department of Psychological Sciences, University of California, Irvine, United States; Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Xrystyan N Lascano
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Kelly L Zellner
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Jyotsna Grandhi
- Department of Psychological Sciences, University of California, Irvine, United States; Department of Counseling and Psychological Services, Georgia State University, United States
| | - Precious J Araujo
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Kelci Straka
- Department of Psychological Sciences, University of California, Irvine, United States; School of Social Work, Virginia Commonwealth University, United States
| | - Cathy Z Liang
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Jordyn E Czarny
- Kresge Hearing Research Institute and Department of Otolaryngology, University of Michigan, Ann Arbor, United States; Department of Psychiatry, University of Michigan, United States
| | - Jazmin Martinez
- Department of Psychological Sciences, University of California, Irvine, United States
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, United States
| |
Collapse
|
4
|
Niu X, Snyder HR. The role of maladaptive emotion regulation in the bidirectional relation between sleep and depression in college students during the COVID-19 pandemic. ANXIETY, STRESS, AND COPING 2023; 36:83-96. [PMID: 35536737 DOI: 10.1080/10615806.2022.2073441] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Emotion regulation deficits are an outcome and risk factor for both insomnia and depression, suggesting that maladaptive emotion regulation might in part explain the bi-directional links between sleep and depression. The current study tests this hypothesis during the COVID-19 pandemic in emerging adult undergraduate students, a high-risk population for both depression and sleep disturbance.Methods: A sample of 154 undergraduate students completed a series of online questionnaires bi-weekly on sleep, depression, and emotion regulation strategies across eight weeks during the early days of the COVID-19 pandemic (April 2nd to June 27th, 2020).Results: Sleep disturbance and depression prospectively predicted one another across eight weeks, and both directions were mediated by maladaptive emotion regulation. However, sleep and depression failed to predict change in one another controlling for baseline measures, directly or via emotion regulation.Conclusions: The results suggest that maladaptive emotion regulation is a potential mechanism through which sleep disturbance and depression help maintain high levels of one another in college students during the COVID-19 pandemic. Therefore, emotion regulation deficits are potentially an important target for interventions to interrupt the sleep disturbance-depression cycle.
Collapse
Affiliation(s)
- Xinran Niu
- Department of Psychology, Brandeis University, Waltham, MA, USA
| | - Hannah R Snyder
- Department of Psychology, Brandeis University, Waltham, MA, USA
| |
Collapse
|
5
|
Hall KAA, Werner KB, Griffin MG, Galovski TE. Exploring Predictors of Sleep State Misperception in Women with Posttraumatic Stress Disorder. Behav Sleep Med 2023; 21:22-32. [PMID: 35007171 PMCID: PMC9271136 DOI: 10.1080/15402002.2021.2024193] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Insomnia is a common symptom of posttraumatic stress disorder (PTSD) that is resistant to first-line cognitive behavioral interventions. However, research suggests that, among individuals with PTSD, self-reported sleep impairment is typically more severe than what is objectively observed, a phenomenon termed sleep state misperception. Relatively little research has examined which individuals with PTSD are most likely to exhibit sleep state misperception. This study explored clinical predictors of sleep state misperception in a sample of 43 women with PTSD and clinically significant sleep impairment. METHOD During a baseline assessment, participants' PTSD symptoms were assessed using a clinical interview and their sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Objective sleep, self-reported sleep, and PTSD symptoms were then assessed over a 1-week period using actigraphy and daily diaries. RESULTS Consistent with previous research, women in the study exhibited total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) sleep state misperception. For TST and SE, but not SOL, discrepancies between actigraphy and the PSQI were associated with each clinician-rated PTSD symptom cluster, whereas discrepancies between actigraphy and daily diary were only associated with clinician-rated reexperiencing symptoms. The only self-reported PTSD symptom that was uniquely associated with sleep state misperception was nightmares. This association was no longer significant after controlling for sleep-related anxiety. CONCLUSIONS Results suggest that women with more severe reexperiencing symptoms of PTSD, particularly nightmares, may be more likely to exhibit TST and SE sleep state misperception, perhaps due to associated sleep-related anxiety.
Collapse
Affiliation(s)
| | | | - Michael G. Griffin
- Department of Psychology, Center for Trauma Recovery, University of Missouri – St. Louis
| | - Tara E. Galovski
- VA National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine
| |
Collapse
|
6
|
Schenker MT, Theoswin PM, Qian H, Jordan AS, Nicholas CL, Felmingham KL. Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults. Eur J Psychotraumatol 2023; 14:2202058. [PMID: 37096587 PMCID: PMC10132228 DOI: 10.1080/20008066.2023.2202058] [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] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. OBJECTIVE Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). METHODS Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0-53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. RESULTS Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. DISCUSSION These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.
Collapse
Affiliation(s)
- Maya T Schenker
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | | | - Hang Qian
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| |
Collapse
|
7
|
Short NA, Austin AE, Wolfson AR, Rojo-Wissar DM, Munro CA, Eaton WW, Bienvenu OJ, Spira AP. The association between traumatic life events and insomnia symptoms among men and women: Results from the Baltimore Epidemiologic Catchment Area follow-up study. Sleep Health 2022; 8:249-254. [PMID: 35151605 PMCID: PMC8995334 DOI: 10.1016/j.sleh.2021.11.008] [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: 03/18/2021] [Revised: 10/29/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVES Trauma exposure likely contributes to poor sleep, but relatively few studies have empirically tested this, instead focusing on posttraumatic stress disorder. Moreover, little is known about sex differences in sleep after trauma. The current study used a cross-sectional and retrospective design to test hypotheses that trauma exposure would be associated with subsequent insomnia symptoms, particularly among women, even after accounting for important covariates. METHOD Data from Wave 3 (1993-1996) of the Baltimore Epidemiologic Catchment Area Study (N = 1920) were used to examine associations between remote (prior to past year) and recent (past year) trauma and current sleep disturbance (insomnia, hypersomnia symptoms) in the total sample (Mage= 55, 63.2% women, 57.7% white), and separately in men and women. Sensitivity analyses were conducted among individuals with no pretrauma sleep disturbance to examine incident sleep disturbance. RESULTS Among all participants, both remote (odds ratio [OR] = 1.95, 95% confidence interval [CI] [1.34, 2.85]) and recent (OR = 1.94, 95% CI [1.31, 2.87]) trauma exposure were associated with increased odds of insomnia (OR = 2.41, 95% CI [1.54, 3.76]) but not hypersomnia. Associations between trauma and insomnia were particularly strong among women, but null among men. The relationship between trauma exposure and insomnia symptoms persisted among individuals with no pretrauma history of insomnia. CONCLUSION Results suggest women may be vulnerable to insomnia symptoms as sequelae of trauma. Future research should examine prospective associations between trauma and sleep in larger samples and how assessment and treatment of insomnia among women trauma survivors reduces the public health impact of trauma and poor sleep.
Collapse
Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland, USA
| | - Darlynn M Rojo-Wissar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William W Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center for Aging and Health, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Deforges C, Noël Y, Eberhard-Gran M, Garthus-Niegel S, Horsch A. Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study. J Affect Disord 2021; 295:305-315. [PMID: 34488084 DOI: 10.1016/j.jad.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Certain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. METHODS This prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. RESULTS The relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LIMITATIONS This study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. CONCLUSION Prenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.
Collapse
Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Yvonnick Noël
- Laboratory of Psychology, Cognition, Behavior and Communication, Univ Rennes, Rennes, France.
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
9
|
Abstract
Abstract. Posttraumatic stress disorder (PTSD) is characterized by intrusive re-experiencing of emotional memories of a traumatic event. Such memories are formed after exposure to trauma in the context of a cascading stress response including high levels of emotional arousal and stress hormone release. Sleep could be a key modulator of early memory formation and re-consolidation processes. Initial studies have investigated this association in this early time period, that is, hours and days after trauma exposure, and its role in modulating trauma memories and PTSD. The time is thus ripe to integrate findings from these studies. The current review consolidated evidence from five experimental and seven naturalistic studies on the association between trauma, sleep, and the development of intrusive emotional memories and PTSD, respectively. Together, the studies point to a potential protective role of sleep after trauma for the development of intrusive memories and PTSD. Findings regarding key sleep architecture features are more mixed and require additional investigation. The findings are important for prevention and intervention science.
Collapse
Affiliation(s)
- Yasmine Azza
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Sleep & Health Zurich, University of Zurich, Switzerland
| | - Ines Wilhelm
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Birgit Kleim
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Sleep & Health Zurich, University of Zurich, Switzerland
| |
Collapse
|
10
|
Carmassi C, Dell'Oste V, Bertelloni CA, Foghi C, Diadema E, Mucci F, Massimetti G, Rossi A, Dell'Osso L. Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors. Front Psychiatry 2020; 11:492006. [PMID: 33304278 PMCID: PMC7701044 DOI: 10.3389/fpsyt.2020.492006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma.
Collapse
Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | | | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
11
|
Richards A, Kanady JC, Neylan TC. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology 2020; 45:55-73. [PMID: 31443103 PMCID: PMC6879567 DOI: 10.1038/s41386-019-0486-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
The current report provides an updated review of sleep disturbance in posttraumatic stress disorder and anxiety-related disorders. First, this review provides a summary description of the unique and overlapping clinical characteristics and physiological features of sleep disturbance in specific DSM anxiety-related disorders. Second, this review presents evidence of a bidirectional relationship between sleep disturbance and anxiety-related disorders, and provides a model to explain this relationship by integrating research on psychological and neurocognitive processes with a current understanding of neurobiological pathways. A heuristic neurobiological framework for understanding the bidirectional relationship between abnormalities in sleep and anxiety-related brain pathways is presented. Directions for future research are suggested.
Collapse
Affiliation(s)
- Anne Richards
- The San Francisco VA Health Care System, San Francisco, CA, USA.
- The University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer C Kanady
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
12
|
Guina J, Nahhas RW, Kawalec K, Farnsworth S. Are Gender Differences in DSM-5 PTSD Symptomatology Explained by Sexual Trauma? JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:4713-4740. [PMID: 27827321 DOI: 10.1177/0886260516677290] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although many studies have assessed gender differences in posttraumatic stress disorder (PTSD) prevalence, few examine individual PTSD symptoms (PTSSs). Hypothesizing that trauma differences explain many gender differences in symptomatology, this is the first known study to adjust PTSSs for trauma type, and to compare gender differences in those with sexual traumas. Using a cross-sectional survey methodology in a sample of adult outpatients (n = 775), we examined gender, trauma type, PTSSs, suicide, alcohol, and tobacco. Among those with trauma (n = 483), women generally had more severe symptoms than men, but after adjusting for trauma type, only physical reactivity (p = .0002), excessive startle (p = .0005), external avoidance (p = .0007), internal avoidance (p = .0008), psychological reactivity (p = .0009), and suicide attempts (p = .001) remained significantly worse among women, whereas men more commonly reported alcohol problems (p = .007). Among those with PTSD (n = 164), there were no significant PTSS gender differences. Those with sexual trauma had worse symptoms (particularly amnesia) compared with non-sexual trauma (p < .0001 for PTSD diagnosis and total severity), including within each gender. Among those with sexual trauma (n = 157), men had worse recklessness (p = .004) and more commonly reported tobacco (p = .02), whereas women more commonly attempted suicide (p = .02) and had worse avoidance (p = .04). However, when isolating the effects of sexual trauma beyond other traumas, there were no significant symptom difference-in-differences between genders. Our findings suggest that, while women have higher PTSD rates, men with PTSD present similarly. In addition, while women have higher sexual trauma rates, men may have similarly severe responses. Most gender differences in PTSD presentation appear to be explained by trauma type, particularly women having higher rates of sexual trauma. We discuss potential biopsychosocial explanations.
Collapse
Affiliation(s)
- Jeffrey Guina
- Wright-Patterson Air Force Base, OH, USA
- Wright State University, Dayton, OH, USA
| | | | | | | |
Collapse
|
13
|
Impacts of sex and the estrous cycle on associations between post-fear conditioning sleep and fear memory recall. Behav Brain Res 2019; 378:112156. [PMID: 31593790 DOI: 10.1016/j.bbr.2019.112156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/17/2019] [Indexed: 01/18/2023]
Abstract
Women are at greater risk than men for developing posttraumatic stress disorder (PTSD) after trauma exposure. Sleep, especially rapid-eye-movement sleep (REMS), has been considered a contributing factor to the development of PTSD symptoms through its effects on the processing of emotional memories. However, it remains unknown if sex and sex hormones play a role in the hypothesized impact of sleep on the development of PTSD. Animal models have methodological advantages over human studies in investigating this research question; however, animal models of sleep in PTSD have been tested only with males. C57BL/6 mice (7 males and 15 females) were exposed to 15 footshocks in a footshock chamber, and 5 min after the last footshock, were returned to their home cages for telemetric electroencephalographic sleep recording. Nine to thirteen days later, mice were returned to the footshock chamber for 10 min without footshocks. Fear recall rates were computed by comparing freezing behaviors in the footshock chamber immediately after the footshocks to those during fear context reexposure. Males had significantly lower recall rates compared to metestrous females (that received footshocks on metestrus). Overall, males slept more than both proestrous females (that received footshocks on proestrus) and metestrous females during the dark period. Regression analyses revealed that average REMS episode durations after footshocks were differentially associated with recall rates across groups, such that the association was positive in males, but negative in proestrous females. Results suggest that both sex and the estrous cycle modulate the associations between REMS continuity and fear memory consolidation.
Collapse
|
14
|
Gibson CJ, Richards A, Villanueva C, Barrientos M, Neylan TC, Inslicht SS. Subjective Sleep Related to Post Traumatic Stress Disorder Symptoms among Trauma-Exposed Men and Women. Behav Sleep Med 2019; 17:492-501. [PMID: 29172723 DOI: 10.1080/15402002.2017.1409223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective/Background: Sleep difficulty is both a common symptom of posttraumatic stress disorder (PTSD) and a risk factor for the development and maintenance of PTSD symptomatology. Gender differences in sleep following trauma exposure have been posited to contribute to the increased risk for the development of PTSD among women, but the persistence and long-term contributions of these potential differences to the maintenance and severity of PTSD symptoms is unclear. Participants: Men and women reporting a history of trauma exposure (n = 112, 63% female) participated in this study. Methods: Subjective sleep complaints and PTSD symptom severity were assessed using well-validated measures (Pittsburgh Sleep Quality Index, PTSD Symptom Checklist). Multivariable regression models (full sample and gender-stratified) were used to predict PTSD symptom severity from global, subscale, and individual item sleep parameters, adjusted for gender, age, race/ethnicity, education, and body mass index. Results: In the full sample, traditional measures of sleep quality and sleep disturbance were associated with PTSD symptom severity. Difficulty falling asleep, poor sleep quality, and sleep disturbance from a variety of sources were related to higher PTSD symptom severity in men, while self-reported sleep disturbance related to nightmares and emotional regulation were associated with PTSD symptom severity among women. Conclusions: These findings add to the limited literature on gender-specific risk factors related to sleep and PTSD, and may inform intervention development and implementation related to PTSD severity among vulnerable adults.
Collapse
Affiliation(s)
- Carolyn J Gibson
- a Mental Health Service, San Francisco VA Health Care System , San Francisco , CA , USA.,b Department of Psychiatry, San Francisco School of Medicine , University of California , San Francisco , CA , USA
| | - Anne Richards
- a Mental Health Service, San Francisco VA Health Care System , San Francisco , CA , USA.,b Department of Psychiatry, San Francisco School of Medicine , University of California , San Francisco , CA , USA
| | - Cynthia Villanueva
- a Mental Health Service, San Francisco VA Health Care System , San Francisco , CA , USA
| | - Maureen Barrientos
- a Mental Health Service, San Francisco VA Health Care System , San Francisco , CA , USA
| | - Thomas C Neylan
- a Mental Health Service, San Francisco VA Health Care System , San Francisco , CA , USA.,b Department of Psychiatry, San Francisco School of Medicine , University of California , San Francisco , CA , USA
| | - Sabra S Inslicht
- a Mental Health Service, San Francisco VA Health Care System , San Francisco , CA , USA.,b Department of Psychiatry, San Francisco School of Medicine , University of California , San Francisco , CA , USA
| |
Collapse
|
15
|
REM deprivation but not sleep fragmentation produces a sex-specific impairment in extinction. Physiol Behav 2018; 196:84-94. [PMID: 30144468 DOI: 10.1016/j.physbeh.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/31/2023]
Abstract
REM sleep is essential for learning and memory processes, particularly emotional learning. Manipulations of REM sleep impair learning and memory and sleep architecture is often altered following a learning experience; for example, short term REM deprivation immediately after fear conditioning results in impaired extinction. In light of research demonstrating sex-dependent differences in fear conditioning as well as differences in sleep architecture, the present study investigated the effects of short term REM deprivation on the extinction of conditioned fear in male and female rats. In addition, given evidence that sleep fragmentation, which is a consequence of REM deprivation, can negatively impact learning and memory, this manipulation was compared to REM deprivation and a control condition. Male and female rats were exposed to fear conditioning followed by 6 h of REM deprivation, sleep fragmentation, or a control condition. Two extinction sessions were conducted at 48 h intervals after conditioning. REM deprivation, but not sleep fragmentation or the control condition, impaired extinction of conditioned fear. However, this effect was seen only in male rats. This study is the first to explore the effects of sleep manipulations on memory in female rats and suggests that female rats are more resilient to the deleterious effects of REM deprivation. In addition, it demonstrates that REM deprivation but not fragmentation of sleep is responsible for impairment in extinction of conditioned fear.
Collapse
|
16
|
Abstract
After exposure to traumatic stress, women are at greater risk than men for developing symptoms of some psychiatric disorders, including insomnia and nightmares. Sleep disturbance is one of the most refractory symptoms of posttraumatic stress disorder. Women were included in a few studies that examined efficacy of psychological or pharmacologic interventions for trauma-related sleep disturbances. Studies demonstrated preliminary evidence for efficacy of cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and combinations of these techniques in treating insomnia and nightmares in trauma-exposed women. Prazosin as an adjunct to ongoing treatment is a potentially efficacious strategy for treating trauma-related nightmares in women.
Collapse
|
17
|
Carmassi C, Corsi M, Bertelloni CA, Carpita B, Gesi C, Pedrinelli V, Massimetti G, Peroni DG, Bonuccelli A, Orsini A, Dell'Osso L. Mothers and fathers of children with epilepsy: gender differences in post-traumatic stress symptoms and correlations with mood spectrum symptoms. Neuropsychiatr Dis Treat 2018; 14:1371-1379. [PMID: 29872304 PMCID: PMC5973431 DOI: 10.2147/ndt.s158249] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and post-traumatic stress spectrum have been recently applied to understand the impact of life-threatening disease or injury in one's child; nevertheless, scant data are available on a particular chronic illness such as epilepsy whose phenotypic expression is seizures, which are acute, sudden, and unpredictable manifestations. Subjects with bipolar disorders or with mood spectrum symptoms demonstrated to be more vulnerable to develop PTSD in the aftermath of a trauma. OBJECTIVES The main aim of this study was to evaluate post-traumatic symptoms among 134 parents of children with a diagnosis of epilepsy, followed at the outpatient neurologic unit of Department of Pediatrics in Santa Chiara Hospital in Pisa, as well as gender differences. The second aim of this study was to estimate the impact of lifetime mood spectrum on post-traumatic stress symptoms in the same study sample after fulfillment of the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Mood Spectrum-Self Report (MOODS-SR) lifetime version. RESULTS Results showed 10.4% and 37.3% of PTSD full and partial, respectively. Demographic characteristics and clinical features of the study sample did not show any impact on stress symptomatology. Mothers presented higher rates at all Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 PTSD symptoms' clusters except avoidance. Nevertheless, noteworthy correlations between post-traumatic symptomatology and mood spectrum symptoms detected with the self-report tools, emerged only in the subgroup of the fathers. CONCLUSION These findings corroborate the need to provide assistance to caregivers of pediatric patients and confirm the hypothesis that lifetime mood spectrum may have an impact on reaction to traumas.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Diego Giampietro Peroni
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | |
Collapse
|
18
|
Birkeland MS, Blix I, Solberg Ø, Heir T. Gender Differences in Posttraumatic Stress Symptoms after a Terrorist Attack: A Network Approach. Front Psychol 2017; 8:2091. [PMID: 29250014 PMCID: PMC5717368 DOI: 10.3389/fpsyg.2017.02091] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 01/26/2023] Open
Abstract
Background: Posttraumatic stress symptoms are more prevalent in women than in men. To improve our understanding of gender differences in PTSD, detailed knowledge about the underlying symptom networks and gender specific symptom profiles is needed. Objective: We aimed to describe the gender differences in levels of individual posttraumatic stress symptoms after a terrorist attack, as well as identify possible gender differences in associations between posttraumatic stress symptoms. Method: This study used survey data from ministerial employees directly (n = 190) and indirectly (n = 1,615) exposed to the 2011 Oslo bombing. Data was collected approximately 10 months after the event. In order to investigate gender differences in levels of symptoms, we used bootstrapped means and standard deviations. Network analyses were conducted to identify gender differences in the associations between posttraumatic stress symptoms. Results: Women reported higher levels of all symptoms, and the strongest effect sizes were found for symptoms of re-experiencing, and anxious and dysphoric arousal. Among individuals with considerable levels of posttraumatic stress symptoms, women reported higher levels of physiological cue activity and exaggerated startle response. No significant gender differences in the networks of posttraumatic stress were found. Conclusions: The present results find no indication that the gender difference in prevalence of PTSD can be explained by differences in associations between symptoms. In order to determine if this finding can be applied to other participants and circumstances, future studies should seek to replicate this study in both community and clinical samples.
Collapse
Affiliation(s)
| | - Ines Blix
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Øivind Solberg
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Sleep disturbances are core features of posttraumatic stress disorder (PTSD). This review aims to characterize sleep disturbances, summarize the knowledge regarding the relationships between trauma exposure and sleep difficulties, and highlight empirically supported and/or utilized treatments for trauma-related nightmares and insomnia. RECENT FINDINGS Trauma-related nightmares and insomnia, and other sleep disorders, are frequently reported among trauma survivors. The roles of fear of sleep, REM density, and decreased parasympathetic activity are beginning to inform the relationship between trauma exposure and sleep difficulties. Additionally, the potential adaptive role of sleep loss immediately following a traumatic experience is being recognized. Interventions targeting these sleep disturbances show promise in reducing symptoms. Research in understanding the role of sleep on the development, course, and treatment of PTSD is expanding. Longitudinal investigations are needed to further elucidate these relationships and identify treatments most effective in ameliorating symptoms.
Collapse
|
20
|
Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
Collapse
Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
| |
Collapse
|
21
|
Werner KB, Griffin MG, Galovski TE. Objective and subjective measurement of sleep disturbance in female trauma survivors with posttraumatic stress disorder. Psychiatry Res 2016; 240:234-240. [PMID: 27124208 PMCID: PMC4885771 DOI: 10.1016/j.psychres.2016.04.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 03/30/2016] [Accepted: 04/15/2016] [Indexed: 12/16/2022]
Abstract
Sleep disturbance may be the most often endorsed symptom of posttraumatic stress disorder (PTSD). Much of this research is based on subjective reports from trauma survivors; however, objective measures of sleep-related impairment have yielded findings inconsistent with self-report data. More studies investigating subjective and objective assessments concordantly are needed to understand sleep impairment in PTSD. The current study examined PTSD-related sleep disturbance in a female interpersonal violence cohort with full PTSD diagnoses (N=51) assessing subjective (global and daily diary measures) and objective (actigraphy) sleep measures concurrently. PTSD severity was positively associated with global, subjective reports of sleep impairment and insomnia. Subjective measures of sleep (including global sleep impairment, insomnia, and daily sleep diary reports of total sleep time, sleep efficiency, and sleep onset latency) were moderately to strongly correlated. However, no significant correlations between subjective and objective reports of sleep impairment were found in this cohort. Analyses demonstrated an overall elevation in subjectively reported sleep impairment when compared to objective measurement assessed concurrently. Findings demonstrate a lack of agreement between subjective and objective measurements of sleep in a PTSD-positive female cohort, suggesting objective and subjective sleep impairments are distinct sleep parameters that do not necessarily directly co-vary.
Collapse
Affiliation(s)
- Kimberly B. Werner
- George Warren Brown School of Social Work, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Michael G. Griffin
- Department of Psychology, Center for Trauma Recovery, University of Missouri – Saint Louis, Saint Louis, Missouri, USA
| | - Tara E. Galovski
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
22
|
Bourn LE, Sexton MB, Raggio GA, Porter KE, Rauch SAM. Posttraumatic stress disorder and somatic complaints: Contrasting Vietnam and OIF/OEF Veterans' experiences. J Psychosom Res 2016; 82:35-40. [PMID: 26944397 DOI: 10.1016/j.jpsychores.2016.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To replicate and expand upon the relationship of somatic symptoms and posttraumatic stress disorder (PTSD) by comparing symptoms among service eras in US Veterans. METHOD Data were collected from 226 Vietnam and 132 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who were referred to a Veterans Affairs (VA) hospital PTSD outpatient clinic between 2005 and 2013. Veterans were administered self-report inventories and a clinical interview to measure somatic symptoms and PTSD severity. A subset of Veterans (n=185) screening positive for PTSD were administered the Clinician Administered PTSD Scale (CAPS) to measure PTSD severity. Multiple moderated linear regressions were used to examine the influence of service era on the relationship between somatic and PTSD symptoms. RESULTS There were no significant differences between service eras in pain severity, pain interference, and total somatic symptoms reported. Vietnam Veterans were more likely to report limb/join pain (p<.05), fainting (p<.01), and shortness of breath (p<.001), whereas OIF/OEF Veterans were more likely to complain of headaches (p<.001). A significant interaction effect occurred between service era and dizziness (p<.05) and chest pain (p<.01), with OIF/OEF Veterans reporting higher levels of these symptoms significantly more likely than Vietnam Veterans to also experience more severe PTSD. CONCLUSION Findings are consistent with previous research demonstrating the relationship of somatic symptoms and PTSD across service eras but provide additional data concerning similarities and differences of somatic symptoms between eras. Potential explanations for observed service era differences in somatic symptoms are discussed.
Collapse
Affiliation(s)
- Laura E Bourn
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; University of Michigan Medical School Department of Psychiatry, Ann Arbor, MI, United States
| | - Minden B Sexton
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; University of Michigan Medical School Department of Psychiatry, Ann Arbor, MI, United States
| | - Greer A Raggio
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; University of Michigan Medical School Department of Psychiatry, Ann Arbor, MI, United States
| | - Katherine E Porter
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; University of Michigan Medical School Department of Psychiatry, Ann Arbor, MI, United States
| | - Sheila A M Rauch
- Emory University School of Medicine, Atlanta, GA, United States; Atlanta VA Medical Center, Atlanta, GA, United States
| |
Collapse
|
23
|
Impact of childhood abuse on adult sleep quality among low-income women after Hurricane Ike. Sleep Health 2015; 1:293-299. [PMID: 29073404 DOI: 10.1016/j.sleh.2015.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/06/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective was to investigate the association between childhood abuse and poor sleep quality in the month following adulthood exposure to a natural disaster. DESIGN Cross-sectional. SETTING Six University of Texas Medical Branch family planning clinics located in Southeast Texas. PARTICIPANTS A subgroup of 375 low-income women aged 18 to 31 years who experienced Hurricane Ike while participating in the Stress and Health Longitudinal Study (2006-2012). MEASUREMENTS Risk profiles considering types and frequency of childhood abuse were identified in latent class analysis performed on the Childhood Trauma Questionnaire, which was measured upon entry to the study. Associations between abuse classes with a global indicator and 7 individual components of sleep quality measured after Hurricane Ike were estimated in adjusted logistic regression models. RESULTS Prevalence of poor sleep quality in the month following Hurricane Ike was 39.7%. Of the 5 classes of childhood abuse identified, the most extreme abuse class--frequent combined emotional, physical, and sexual abuse--exhibited the strongest associations with poor sleep quality after the hurricane (odds ratio: 4.30; 95% confidence interval: 1.72-10.72). Occasional emotional abuse alone was also significantly associated with poor sleep quality after the hurricane (odds ratio: 2.70; 95% confidence interval: 1.48-4.91). Several profiles of childhood abuse were also significantly associated with 6 of the 7 component indicators of sleep quality, including sleep duration, disturbances, onset latency, subjective quality, use of sleep medication, and daytime dysfunction. CONCLUSIONS Low-income women with histories of frequent childhood abuse, or emotional abuse specifically, have increased risk of poor sleep quality following exposure to a hurricane in adulthood.
Collapse
|
24
|
Garthus-Niegel S, Ayers S, von Soest T, Torgersen L, Eberhard-Gran M. Maintaining factors of posttraumatic stress symptoms following childbirth: A population-based, two-year follow-up study. J Affect Disord 2015; 172:146-52. [PMID: 25451409 DOI: 10.1016/j.jad.2014.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous research has established a number of risk factors that are associated with the onset of PTSD following childbirth. However, little is known about factors that maintain PTSD symptoms. METHODS This study is part of the Akershus Birth Cohort. Questionnaire data from pregnancy week 17, 8 weeks postpartum and 2 years postpartum were used. 1473 women completed all these three questionnaires and were included in the analyses. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Potential maintaining factors were personality, sleep, support and life events. The factors that were significantly correlated with post-traumatic stress symptoms were entered into regression analyses. Mediation analyses were run to test whether significant predictors would serve as mediator of post-traumatic stress symptoms at 8 weeks postpartum to post-traumatic stress symptoms at 2 years postpartum. RESULTS We found several low to moderate associations between maintaining factors and PTSD symptoms two years postpartum. Adjusting for the starting point - PTSD symptoms 8 weeks postpartum - only insomnia remained significantly associated. Further, insomnia mediated a small portion of the effect of PTSD symptoms 8 weeks postpartum to PTSD symptoms 2 years postpartum. LIMITATIONS Limitations of the study include a relative homogeneous sample, modest effect sizes, low internal consistency of some of the measures and the challenge to distinguish insomnia from PTSD symptoms. CONCLUSIONS Treatment of postpartum PTSD might benefit from addressing insomnia if present. Alleviating insomnia may itself reduce daytime symptoms of PTSD and it may also increase the efficacy of primary PTSD treatments.
Collapse
Affiliation(s)
- Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine, Fetscherstr. 74, 01307 Dresden, Germany; Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway.
| | - Susan Ayers
- Centre for Maternal and Child Health, School of Health Sciences, City University London, London, UK
| | - Tilmann von Soest
- Department of Childhood, Development, and Cultural Diversity, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Norway
| | - Leila Torgersen
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway
| | - Malin Eberhard-Gran
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway
| |
Collapse
|
25
|
Why some patients are unhappy: part 1. Relationship of preoperative nasal deformity to number of operations and a history of abuse or neglect. Plast Reconstr Surg 2014; 134:823-835. [PMID: 25357039 DOI: 10.1097/prs.0000000000000512] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma (neglect or abuse) can create body shame (different from body dissatisfaction), driving some patients to seek aesthetic surgery. We hypothesized that a trauma history would be related to the severity of the original deformity and the drive to undergo repeated operations. METHODS Descriptive statistics were computed for 100 secondary rhinoplasty patients, 50 of whom originally had dorsal humps, 21 of whom had straight, functional noses, and 29 of whom had subjectively normal noses but underwent multiple rhinoplasties. This latter group fulfills criteria for body dysmorphic disorder. RESULTS Compared with patients with hump noses, patients with normal primary noses were 2.9 times more likely to be demanding 2.5 times more likely to be depressed, had undergone 3.0 times more rhinoplasties and other aesthetic operations, and were 3.8 times more likely to have confirmed trauma histories. Patients who had undergone more than three operations were 92.7 percent women; 85 percent originally had straight noses and had undergone an average of 7.56 rhinoplasties and 5.78 aesthetic operations; 85.4 percent had histories of abuse or neglect. CONCLUSIONS Secondary rhinoplasty patients with normal preoperative noses, who fulfill the criteria for body dysmorphic disorder, had significantly higher prevalences of depression, demanding conduct, previous rhinoplasties and other aesthetic operations, and confirmed trauma histories than patients who originally had dorsal deformities or straight noses with functional symptoms. To the authors' knowledge, this is the first report of such associations. A history of childhood trauma may impact adult patient behavior and therefore the surgical experience.
Collapse
|
26
|
Constantian MB, Lin CP. Why some patients are unhappy: part 2. Relationship of nasal shape and trauma history to surgical success. Plast Reconstr Surg 2014; 134:836-851. [PMID: 25357040 DOI: 10.1097/prs.0000000000000552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A previous report indicated that secondary rhinoplasty patients with normal preoperative noses displayed significantly higher prevalences of depression, demanding behavior, previous aesthetic operations, and confirmed trauma (abuse/neglect) histories than patients who originally had dorsal deformities or straight noses with functional symptoms. The authors hypothesized that abuse or neglect might also influence patient satisfaction and suggest screening criteria. METHODS One hundred secondary rhinoplasty patients stratified by their original nasal shapes were examined by bivariate analysis to determine the characteristics associated with surgical satisfaction. Mediation analysis established intervening factors between total surgery number and patients' perceived success. Random forests identified important patient attributes that predicted surgical success; logistic regression confirmed these effects. RESULTS Satisfied patients originally had dorsal humps, three or fewer previous operations, were not demanding or depressed, were not looking for perfect noses, and had no trauma histories. Dissatisfied patients originally had subjectively normal noses, more than three operations, were depressed, had demanding personalities, and had trauma histories. Patients who had undergone the most operations were most likely to request more surgery and least likely to be satisfied. A trauma (abuse/neglect) history was the most significant mediator between patient satisfaction and number of operations and the most prominent factor driving surgery in patients with milder deformities. CONCLUSIONS Potentially causative links exist between trauma (abuse/neglect), body image disorders, and obsessive plastic surgery. Body dysmorphic disorder may be a model of the disordered adaptation to abuse or neglect, a variant of posttraumatic stress disorder. Our satisfied and dissatisfied patients shared common characteristics and therefore may be identifiable preoperatively.
Collapse
Affiliation(s)
- Mark B Constantian
- Nashua, N.H.; and Madison, Wis. From the Department of Surgery (Plastic Surgery), St. Joseph Hospital; and the Division of Plastic Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison
| | | |
Collapse
|
27
|
Tamanna S, Parker JD, Lyons J, Ullah MI. The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA). J Clin Sleep Med 2014; 10:631-6. [PMID: 24932142 DOI: 10.5664/jcsm.3786] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Post-Traumatic Stress Disorder (PTSD) is increasingly prevalent among Veterans characterized by recurrent nightmare and disrupted sleep. Veterans with PTSD also have a high prevalence of obstructive sleep apnea (OSA) and untreated OSA worsens the sleep-related symptoms of PTSD. In our study, we hypothesized that among PTSD-afflicted Veterans with OSA, CPAP therapy may reduce the frequency of nightmares and a better CPAP compliance may be associated with increased symptom improvement. METHODS We retrospectively reviewed medical records to identify OSA patients treated in a VA medical center who also carried a diagnosis of PTSD (n = 69). Data about patient characteristics and polysomnographic findings were extracted. Repeated-measures t-tests were performed, comparing mean nightmare frequency and Epworth sleepiness score (ESS) before and after CPAP treatment. Multiple linear regressions were done to identify factors predicting CPAP compliance. A logistic regression analysis was also done to estimate the odds of subjective improvement in PTSD symptoms with CPAP. RESULTS CPAP therapy reduced the mean ESS from 14.62 to 8.52 (p < 0.001) and the mean number of nightmares per week from 10.32 to 5.26 (p < 0.01). Reduced nightmare frequency after CPAP treatment was best predicted by CPAP compliance (p < 0.001). Every 10% increase in CPAP compliance almost doubled the odds of benefitting by CPAP (odds ratio = 1.92, 95% CI = 1.47-2.5). CONCLUSIONS In Veterans with PTSD and OSA, CPAP therapy reduces PTSD-associated nightmares and improves overall PTSD symptoms. We recommend that all PTSD patients should be screened clinically for symptoms of OSA and receive CPAP treatment whenever possible to improve PTSD symptoms.
Collapse
Affiliation(s)
- Sadeka Tamanna
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS ; Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Jefferson D Parker
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS ; Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS
| | - Judith Lyons
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS
| | - M I Ullah
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS ; Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| |
Collapse
|
28
|
Carmassi C, Akiskal HS, Bessonov D, Massimetti G, Calderani E, Stratta P, Rossi A, Dell'Osso L. Gender differences in DSM-5 versus DSM-IV-TR PTSD prevalence and criteria comparison among 512 survivors to the L'Aquila earthquake. J Affect Disord 2014; 160:55-61. [PMID: 24709023 DOI: 10.1016/j.jad.2014.02.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Post-traumatic Stress Disorder (PTSD) has demonstrated gender-specific prevalence and expressions across the different DSM definitions, since its first introduction in DSM-III. The DSM-5 recently introduced important revisions to PTSD symptomatological criteria. Aim of the present study is to explore whether gender moderates rates of DSM-5 PTSD expression in a non-clinical sample of survivors to a massive earthquake in Italy. METHODS 512 survivors of the L'Aquila 2009 earthquake, previously investigated for the presence DSM-IV-TR PTSD, were reassessed according to DSM-5 criteria in order to explore gender differences. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR). RESULTS Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in 8 of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior). Considering the impact of the three new DSM-5 symptoms on the diagnosis, significant gender differences emerged with these being crucial in almost half of the PTSD diagnoses in males but in about one-fourth in females. By using ROC curves, DSM-5 criteria E and D showed the highest AUC values in males (.876) and females (.837), respectively. LIMITATIONS The use of self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment. CONCLUSIONS This study provides a contribution to the ongoing need for reassessment on how gender moderates rates of expression of particular disorders such as PTSD.
Collapse
Affiliation(s)
- C Carmassi
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 65, 56100 Pisa, Italy.
| | - H S Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA, USA
| | - D Bessonov
- International Mood Center, University of California at San Diego, La Jolla, CA, USA
| | - G Massimetti
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 65, 56100 Pisa, Italy
| | - E Calderani
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 65, 56100 Pisa, Italy
| | - P Stratta
- Section of Psychiatry, Department of Experimental Medicine, University of L׳Aquila, L׳Aquila, Italy
| | - A Rossi
- Section of Psychiatry, Department of Experimental Medicine, University of L׳Aquila, L׳Aquila, Italy
| | - L Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 65, 56100 Pisa, Italy
| |
Collapse
|