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Hoeboer CM, Kullberg MLJ, Oprel DA, Schoorl M, van Minnen A, Antypa N, Mouthaan J, de Kleine RA, van der Does W. Impact of three variants of prolonged exposure therapy on comorbid diagnoses in patients with childhood abuse-related PTSD. Cogn Behav Ther 2024; 53:377-393. [PMID: 38411129 PMCID: PMC11090154 DOI: 10.1080/16506073.2024.2318729] [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: 08/03/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
Recent studies indicated that Prolonged Exposure (PE) is safe and effective for posttraumatic stress disorder (PTSD). It is unclear whether PE also leads to a reduction in comorbid diagnoses. Data from a large randomized controlled trial (N = 149) on the effects of three variants of PE for PTSD were used. We examined the treatment effects on co-morbid diagnoses of depressive, anxiety, obsessive compulsive, substance abuse, psychotic, eating and personality disorders in a sample of patients with PTSD related to childhood abuse. Outcomes were assessed with clinical interviews at baseline, post-treatment and at 6- and 12-month follow-up. All variants of PE led to a decrease from baseline to post-treatment in diagnoses of depressive, anxiety, substance use and personality disorders. Improvements were sustained during follow-up. We found an additional decrease in the number of patients that fulfilled the diagnostic criteria of a depressive disorder between 6- and 12-month follow-up. No significant changes were observed for the presence of OCD, psychotic and eating disorders. Findings suggest that it is effective to treat PTSD related to childhood abuse with trauma-focused treatments since our 14-to-16 weeks PE for PTSD resulted in reductions in comorbid diagnoses of depressive, anxiety, substance use and personality disorders.
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Affiliation(s)
- Chris M. Hoeboer
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Danielle A.C. Oprel
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- PsyQ, Parnassia Groep, The Hague, The Netherlands
| | - Maartje Schoorl
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Agnes van Minnen
- PSYTREC, Bilthoven, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Joanne Mouthaan
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Rianne A. de Kleine
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- PsyQ, Parnassia Groep, The Hague, The Netherlands
| | - Willem van der Does
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- PsyQ, Parnassia Groep, The Hague, The Netherlands
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Kline AC, Otis N, Panza KE, McCabe CT, Glassman L, Campbell JS, Walter KH. PTSD, depression, and treatment outcomes: A latent profile analysis among active duty personnel in a residential PTSD program. J Psychiatr Res 2024; 173:71-79. [PMID: 38508035 DOI: 10.1016/j.jpsychires.2024.03.010] [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: 11/07/2023] [Revised: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist-Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction ps < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (ps < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (ps < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment.
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Affiliation(s)
- Alexander C Kline
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Nicholas Otis
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Kaitlyn E Panza
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, San Diego, CA, USA
| | - Cameron T McCabe
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA
| | - Lisa Glassman
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | | | - Kristen H Walter
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA.
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Kline AC, Otis NP, Norman SB, Hunt WM, Walter KH. Dropout in a clinical trial for comorbid PTSD and MDD among US service members: Are pretreatment characteristics predictive? Psychother Res 2024:1-13. [PMID: 38497740 DOI: 10.1080/10503307.2024.2325519] [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: 10/06/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Despite effective treatment options for posttraumatic stress disorder (PTSD), many patients do not complete therapy. This includes U.S. active duty service members, yet factors linked to attendance in this population remain understudied and dropout remains difficult to predict. Additionally, most studies have not examined samples with PTSD and co-occurring major depressive disorder (MDD) despite high rates of comorbidity. METHOD The current study explored predictors of dropout among service members with comorbid PTSD and MDD (N = 94) randomized to cognitive processing therapy enhanced with behavioral activation (BA + CPT) or CPT as part of a clinical trial. RESULTS Using the Fournier approach, only two predictors were associated with lower dropout risk among over 20 examined: shorter duration between pretreatment assessment and Session 1 (p = .041) and past 3-month PTSD treatment engagement (p = .036). CONCLUSION Results suggest the possible utility of early momentum in starting therapy and leveraging recent treatment to improve attendance. However, this study also highlights the possible limitations of commonly assessed pretreatment factors in predicting attendance and current challenges in measuring dropout risk. Strategies to improve prediction, such as shifting focus to assess modifiable factors and processes more proximal to dropout during treatment, may be needed.Trial registration: ClinicalTrials.gov identifier: NCT02874131.
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Affiliation(s)
- Alexander C Kline
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Nicholas P Otis
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- National Center for PTSD, Executive Division, White River Junction, VT, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - W Michael Hunt
- Directorate of Mental Health, Naval Medical Center San Diego, San Diego, CA, USA
| | - Kristen H Walter
- Psychological Health and Readiness, Naval Health Research Center, San Diego, CA, USA
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Horan KA, Schlenk MA, Collette TL, Channer BC, Sanchez-Cardona I, Moore BA. Expanding Behavioral and Occupational Health Research in Military Police. Mil Med 2024; 189:e267-e273. [PMID: 37572102 DOI: 10.1093/milmed/usad312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/14/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION It is important to understand the behavioral and occupational health needs of military police personnel, a high-risk and understudied population. MATERIALS AND METHODS The incidence rates of behavioral and occupational conditions were examined from the years of 2005 to 2021 from the Defense Medical Epidemiology Database. Single-sample chi-square analyses were performed to analyze the differences in the incidence rates across demographic groups relative to population density. RESULTS There were moderate-to-large increases in sleep-related disorders and mood or stress-related disorders. There were also patterns of overrepresentation or underrepresentation in diagnoses of various conditions by sex, age group, marital status, race, service branch, and pay grade. CONCLUSIONS It is important to provide tailored resources and programming to employees in high-stress settings to help prevent or manage behavioral and occupational health conditions and reduce the stigma surrounding the utilization of such resources and programs.
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Affiliation(s)
- Kristin A Horan
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Michael A Schlenk
- The Center for the Advancement of Military and Emergency Services Research, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Tyler L Collette
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Bianca C Channer
- Department of Social Work and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | | | - Brian A Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA 30144, USA
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Hamblen JL, Szafranski S, Ranney RM, Grubaugh AL. Development and feasibility pilot of Considering PTSD Treatment: An online intervention with peer support. Internet Interv 2023; 34:100684. [PMID: 37920732 PMCID: PMC10618498 DOI: 10.1016/j.invent.2023.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Considering PTSD Treatment is an online program adapted from the National Center for PTSD's AboutFace website. Developed to help veterans overcome barriers to seeking treatment for posttraumatic stress disorder (PTSD), the program features videos of veterans describing PTSD and what treatment was like. Peer specialists are available at the beginning and end to chat with participants. We describe initial pilot feasibility data in 50 veterans recruited through online ads who screened positive for PTSD and were not currently in treatment. Eighty percent of participants who consented enrolled in the program and 64.0 % completed all modules. On average, participants rated the program at least "moderately" helpful and over 90 % reported feeling more knowledgeable about PTSD and PTSD treatment. Of the 21 participants who completed the one month follow-up, 52.4 % said they had talked to or were assessed by a provider and 61.9 % said they started treatment. There was not a significant change in stigma scores from baseline to follow-up. Results provide initial support for the feasibility, acceptability, and effectiveness of Considering PTSD Treatment for increasing treatment seeking readiness and support the need for a larger randomized controlled trial.
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Affiliation(s)
- Jessica L. Hamblen
- National Center for PTSD, VA Medical Center (166D), 215 North Main Street, White River Junction, VT 05059, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Sarah Szafranski
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Rachel M. Ranney
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA
- University of California – San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
- Sierra Pacific Mental Illness Research Education, and Clinical Center, 150 Clement St, San Francisco, CA 94121, USA
| | - Anouk L. Grubaugh
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425, USA
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Stoycos SA, Straud CL, Stanley IH, Marx BP, Resick PA, Young-McCaughan S, Peterson AL, Sloan DM. Benchmarking secondary outcomes to posttraumatic stress disorder symptom change in response to cognitive processing and written exposure therapy for posttraumatic stress disorder. J Anxiety Disord 2023; 100:102794. [PMID: 37980801 DOI: 10.1016/j.janxdis.2023.102794] [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: 07/12/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
Posttraumatic stress disorder (PTSD) has high comorbidity with other psychiatric conditions, including depression, generalized anxiety, and suicidality. Evidence-based treatments (EBTs) for PTSD are effective at reducing PTSD symptoms. However, evidence on the impact of PTSD EBTs on comorbid conditions is mixed and often uses pre-post analyses, which disregards PTSD symptom response. This study replicated and extended prior work on benchmarking quality of life to PTSD symptom response to a broader range of secondary outcomes using a research-based metric of clinically meaningful PTSD symptom change. Ninety-five active duty military members seeking treatment for PTSD participated in a randomized noninferiority trial examining two cognitive behavioral therapies for PTSD: Written Exposure Therapy and Cognitive Processing Therapy. Participants completed clinician-administered and self-rating assessments at baseline and 10 weeks post-first treatment session and were classified as PTSD treatment responders or nonresponders. Data were analyzed using generalized linear mixed effects models with repeated measures with fixed effects of time and PTSD symptom response category. PTSD treatment responders experienced significant improvements in secondary outcomes; nonresponders demonstrated statistically significant, but not clinically meaningful, comorbid symptom change. Our findings provide evidence that successfully treating PTSD symptoms may also positively impact psychiatric comorbidity.
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Affiliation(s)
- Sarah A Stoycos
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, United States; Research and Development Service, South Texas Veterans Health Care System, United States; Department of Psychology, University of Texas at San Antonio, United States
| | - Ian H Stanley
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, United States; Center for COMBAT Research, University of Colorado Anschutz Medical Campus, United States
| | - Brian P Marx
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, United States
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, United States; Research and Development Service, South Texas Veterans Health Care System, United States
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, United States; Research and Development Service, South Texas Veterans Health Care System, United States; Department of Psychology, University of Texas at San Antonio, United States
| | - Denise M Sloan
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States.
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McKenzie A, Burdett H, Croak B, Rafferty L, Greenberg N, Stevelink SAM. Adjustment disorder in the Armed Forces: a systematic review. J Ment Health 2023; 32:962-984. [PMID: 36330797 DOI: 10.1080/09638237.2022.2140792] [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: 02/10/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the UK military, adjustment disorder (AjD) is reported as one of the most diagnosed mental disorders, alongside depression, in personnel presenting to mental health services. Despite this, little is understood about what may predict AjD, common treatment or outcomes for this population. AIM The systematic review aimed to summarise existing research for AjD in Armed Forces (AF) populations, including prevalence and risk factors, and to outline clinical and occupational outcomes. METHOD A literature search was conducted in December 2020 to identify research that investigated AjD within an AF population (serving or veteran) following the PRISMA guidelines. RESULTS Eighty-three studies were included in the review. The AjD prevalence estimates in AF populations with a mental disorder was considerably higher for serving AF personnel (34.9%) compared to veterans (12.8%). Childhood adversities were identified as a risk factor for AjD. AjD was found to increase the risk of suicidal ideation, with one study reporting a risk ratio of 4.70 (95% Confidence Interval: 3.50-6.20). Talking therapies were the most common treatment for AjD, however none reported on treatment effectiveness. CONCLUSION This review found that AjD was commonly reported across international AF. Despite heterogeneity in the results, the review identifies several literature gaps.
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Affiliation(s)
- Amber McKenzie
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Howard Burdett
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Bethany Croak
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Askovic M, Soh N, Elhindi J, Harris AW. Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes. Eur J Psychotraumatol 2023; 14:2257435. [PMID: 37732560 PMCID: PMC10515677 DOI: 10.1080/20008066.2023.2257435] [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: 02/24/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
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Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, NSW, Australia
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nerissa Soh
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthony W.F. Harris
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
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Pruiksma KE, Taylor DJ, Wachen JS, Straud CL, Hale WJ, Mintz J, Young-McCaughan S, Peterson AL, Yarvis JS, Borah EV, Dondanville KA, Litz BT, Resick PA. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med 2023; 19:1389-1398. [PMID: 36988304 PMCID: PMC10394372 DOI: 10.5664/jcsm.10584] [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: 04/26/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Sleep disturbances are common in military personnel with posttraumatic stress disorder (PTSD) and may persist following treatment. This study examined service members seeking treatment for PTSD, reporting insomnia symptoms, nightmares, excessive daytime sleepiness, and potential obstructive sleep apnea at baseline and the impact of sleep disturbances on a course of PTSD treatment. METHODS In this secondary analysis, sleep was evaluated in 223 service members who participated in a randomized clinical trial comparing Cognitive Processing Therapy for PTSD delivered in individual or group formats. Sleep assessments included the Insomnia Severity Index, the Trauma-Related Nightmare Survey, and Epworth Sleepiness Scale administered at baseline and 2 weeks posttreatment. RESULTS Following PTSD treatment, there were significant improvements for insomnia symptoms (MΔ = -1.49; d = -0.27), nightmares (MΔ = -0.35; d = -0.27), and excessive daytime sleepiness (MΔ = -0.91; d = -0.16). However, mean scores remained in clinical ranges at posttreatment. Participants with baseline insomnia symptoms had worse PTSD severity throughout treatment. Participants with baseline excessive daytime sleepiness or probable obstructive sleep apnea had greater PTSD severity reductions when treated with Cognitive Processing Therapy individually vs. in a group. Those with insomnia symptoms, nightmare disorder, and sleep apnea had greater depressive symptoms throughout treatment. CONCLUSIONS Insomnia symptoms, nightmares, and excessive daytime sleepiness were high at baseline in service members seeking treatment for PTSD. While sleep symptoms improved with PTSD treatment, these sleep disorders were related to worse treatment outcomes with regards to symptoms of PTSD and depression. Individual Cognitive Processing Therapy is recommended over group Cognitive Processing Therapy for patients with either excessive daytime sleepiness or probable obstructive sleep apnea. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Group vs. Individual Cognitive Processing Therapy for Combat-related PTSD; URL: https://clinicaltrials.gov/ct2/show/NCT02173561; Identifier: NCT02173561. CITATION Puriksma KE, Taylor DJ, Wachen JS, et al. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med. 2023;19(8):1389-1398.
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Affiliation(s)
- Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
| | - Jennifer Schuster Wachen
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
| | - Elisa V. Borah
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- School of Social Work, University of Texas at Austin, Austin, Texas
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brett T. Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - on behalf of the STRONG STAR Consortium
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
- School of Social Work, University of Texas at Austin, Austin, Texas
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
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Bottari SA, Trifilio ER, Janicke DM, Porges EC, Cohen RA, Jaffee MS, Williamson JB. Effects of sleep disturbance on trauma-focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review. Ann N Y Acad Sci 2023; 1526:30-49. [PMID: 37393069 DOI: 10.1111/nyas.15029] [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] [Indexed: 07/03/2023]
Abstract
This study aimed to synthesize existing research on the effects of sleep disturbances on trauma-focused psychotherapy outcomes in adults with posttraumatic stress disorder (PTSD). A systematic review using PubMed, PsycINFO, Embase, Web of Science, and PTSDpubs was performed up to April 2021. Two independent reviewers screened articles for inclusion, performed data extraction, and assessed risk of bias and certainty of the evidence. Narrative synthesis was conducted based on the type of sleep disorder symptom assessed. Sixteen primary studies were included in this review, the majority of which had a high overall risk of bias. Results suggested that sleep disorder symptoms were associated with higher overall PTSD severity across treatment; however, they did not interfere with treatment effectiveness, with the exception of sleep-disordered breathing. Improvements in insomnia, sleep duration, and sleep quality during treatment were associated with greater treatment gains. Certainty of the evidence ranged from low to very low. These results suggest that it may not be necessary to address sleep disorder symptoms prior to initiating trauma-focused psychotherapy. Instead, concurrent treatment of sleep- and trauma-related symptoms may be most beneficial. Continued research is needed to clarify the mechanistic relationship between sleep and treatment outcomes and to guide clinical decision-making.
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Affiliation(s)
- Sarah A Bottari
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Erin R Trifilio
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Department of Neurology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - David M Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Michael S Jaffee
- Department of Neurology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - John B Williamson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for OCD, Anxiety, and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, College of Medicine, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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11
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Grove AB, Sheerin CM, Wallace RE, Green BA, Minnich AH, Kurtz ED. The effect of a reduction in irrational beliefs on Posttraumatic Stress Disorder (PTSD), depression, and anxiety symptoms in a group treatment for post-9/11 Veterans. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37486709 DOI: 10.1080/08995605.2023.2236924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Previous research has indicated that a Rational Emotive Behavior Therapy (REBT)-Informed Group focused on changing irrational beliefs to address comorbid depression and anxiety (as well as anger and guilt) in a combat Veteran population diagnosed with Posttraumatic Stress Disorder (PTSD) demonstrated significant reductions in depression and PTSD symptoms at posttreatment. However, mechanisms of change associated with improvement have not been evaluated. REBT theory suggests that a decline in irrational beliefs predicts a decrease in PTSD, depression, and anxiety symptoms. This study aimed to test this tenet of REBT theory in a naturalistic treatment setting. Participants (N = 86) were post-9/11 combat Veterans, engaged in the REBT-Informed Group between October 2016 and February 2020. Results of hierarchical multiple regression analyses indicated that a reduction in irrational beliefs predicted notable decreases in PTSD, depression, and anxiety symptoms controlling for several covariates. This study extends previous research demonstrating the success of the REBT-Informed Group with combat Veterans and gives support to REBT theory regarding the effect of a decline in irrational beliefs. Future directions include replication of findings with Veterans who experienced military sexual trauma (MST), pre-9/11 Veterans, those at other military or Veterans Affairs (VA) medical centers, and civilians to determine generalizability.
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Affiliation(s)
- Allen B Grove
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia
| | - Christina M Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Rachel E Wallace
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia
| | - Brooke A Green
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia
| | - Angela H Minnich
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia
| | - Erin D Kurtz
- Department of Mental Health, Central Virginia VA Health Care System, Richmond, Virginia
- Department of Mental Health, VA St. Louis Health Care System, St. Louis, Missouri
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12
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Tran DD, Davis JP, Tucker JS, Bricker JB, Lee DS, Fitzke RE, Pedersen ER. Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder. Nicotine Tob Res 2023; 25:1496-1504. [PMID: 37094359 PMCID: PMC10347971 DOI: 10.1093/ntr/ntad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/09/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%-15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population. AIMS AND METHODS Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020-August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%-83.3% across waves). RESULTS Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3-5 as well as greater depression across all time points. CONCLUSIONS Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial. IMPLICATIONS This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.
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Affiliation(s)
- Denise D Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CAUSA
| | | | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Department of Psychology, University of Washington, Seattle, WA USA
| | - Daniel S Lee
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
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13
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Walter KH, Hunt WM, Otis NP, Kline AC, Miggantz EL, Thomsen CJ, Glassman LH. Comparison of behavioral activation-enhanced cognitive processing therapy and cognitive processing therapy among U.S. service members: A randomized clinical trial. Psychiatry Res 2023; 326:115330. [PMID: 37418778 DOI: 10.1016/j.psychres.2023.115330] [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: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) frequently co-occur and can cause significant impairment. Data are lacking as to whether interventions targeting both PTSD and MDD may improve treatment outcomes among individuals with this comorbidity compared with existing evidence-based PTSD treatments alone. This randomized trial compared the effectiveness of cognitive processing therapy (CPT) enhanced with behavioral activation (BA+CPT) versus CPT among 94 service members (52 women and 42 men; age M = 28.5 years) with comorbid PTSD and MDD. The primary outcome was clinician-administered depression symptom severity on the Montgomery-Åsberg Depression Rating Scale (MADRS) from pretreatment through 3-month follow-up. Intent-to-treat analyses using multilevel models showed statistically and clinically significant decreases in MADRS scores for both conditions over time, with no significant differences between BA+CPT and CPT. Secondary depression and PTSD symptom outcomes followed a similar pattern of results. For diagnostic MDD and PTSD outcomes using available data, no statistically significant differences between treatments emerged at posttreatment or 3-month follow-up. Sessions attended, dropout rate, and treatment satisfaction did not significantly differ between treatments. Outcomes were comparable for both treatments, suggesting that BA+CPT and CPT were similarly effective psychotherapy options for comorbid PTSD and MDD.
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Affiliation(s)
- Kristen H Walter
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA.
| | - W Michael Hunt
- Directorate of Mental Health, Naval Medical Center San Diego, San Diego, CA, USA
| | - Nicholas P Otis
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Alexander C Kline
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Erin L Miggantz
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Cynthia J Thomsen
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA
| | - Lisa H Glassman
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
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Koenig HG. "Spiritual Readiness" in the U.S. Military: A Neglected Component of Warrior Readiness. JOURNAL OF RELIGION AND HEALTH 2023; 62:1561-1577. [PMID: 35488076 DOI: 10.1007/s10943-022-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
Recent events have led to concerns about whether U.S. service members are "ready" to engage in combat operations. With most discussions now focused on military readiness, attention paid to warfighter readiness may have fallen behind. Service members typically receive extensive training in the tactical, physical, mental, social, and behavioral aspects of readiness, while the spiritual aspects are often ignored. This review examines (1) recent concerns over warfighter readiness, (2) mental health problems that are common among members of the U.S. military, (3) definitions and determinants of "spiritual readiness" (SR), (4) the impact of SR on human flourishing (HF) and warfighter readiness, (5) research on the effects of religious/spiritual involvement on HF, and (6) those responsible for building and sustaining SR in the military. An extensive body of research over the past 30 years has documented the impact of religious/spiritual (R/S) involvement on many aspects of human flourishing, thereby affecting the warfighter's readiness to perform duties at the highest level. Military chaplains, mental health professionals, and medical providers all play important roles in building and sustaining the spiritual readiness of those in the U.S. military, thereby ensuring that these individuals perform in a way that maximizes their success during combat operations.
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Affiliation(s)
- Harold G Koenig
- Departments of Psychiatry and Medicine, Duke University Health System, Box 3400, Durham, NC, 27705, USA.
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
- School of Public Health, Ningxia Medical University, Yinchuan, People's Republic of China.
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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Coimbra BM, Hoeboer CM, van Zuiden M, Williamson RE, D'Elia AT, Mello AF, Mello MF, Olff M. The relationship between tonic immobility and the development, severity, and course of posttraumatic stress disorder: Systematic and meta-analytic literature review. J Anxiety Disord 2023; 97:102730. [PMID: 37229971 DOI: 10.1016/j.janxdis.2023.102730] [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] [Received: 11/22/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Tonic immobility (TI) is a reflexive, involuntary response that causes motor inhibition, vocal suppression, and analgesia. TI is elicited by extreme fear and perception of entrapment in a life-threatening situation. Research suggests that TI is a frequent peritraumatic response and may be related to subsequent posttraumatic stress disorder (PTSD). However, findings are mixed and, as of yet, no systematic or meta-analytic review examining associations between TI and PTSD has been published. OBJECTIVE We systematically and meta-analytically reviewed the literature and investigated whether TI is associated with the development, severity, and course of PTSD. Additionally, we evaluated whether different types of traumatic events are differentially associated with TI, and whether TI severity differs according to sex. METHODS A systematic literature search was conducted using Embase, PubMed, PsycINFO, and Scopus. Meta-analyses were performed on the included articles. RESULTS We identified 27 eligible articles. We found a significant association between TI and PTSD symptom severity (r = 0.39, 95% CI: 0.34-0.44; p < .0001). TI was more severe among females (Cohen's d=0.37, 95% CI: 0.25-0.48; p < .0001) and was more often elicited in situations involving interpersonal violence. We found limited longitudinal data to perform a meta-analysis of the association between TI and the development and/or course of PTSD. However, the literature available seems to support the role of TI in both the development and course of PTSD. CONCLUSIONS Peritraumatic TI is associated with PTSD symptom severity, occurs more often during interpersonal violence, and is more severe among females. More longitudinal research is needed to investigate the role of TI in psychopathology development and course.
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Affiliation(s)
- Bruno Messina Coimbra
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands; Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Chris Maria Hoeboer
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands
| | - Mirjam van Zuiden
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Rachel E Williamson
- Department of Psychology, University of Montana, Missoula, MT, United States
| | - Ana Teresa D'Elia
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Miranda Olff
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
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16
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Duffy FF, Sudom K, Jones M, Fear NT, Greenberg N, Adler AB, Hoge CW, Wilk JE, Riviere LA. Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results. BMJ Open 2023; 13:e068619. [PMID: 37130676 PMCID: PMC10163557 DOI: 10.1136/bmjopen-2022-068619] [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: 05/04/2023] Open
Abstract
OBJECTIVES Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers. DESIGN Cross-sectional pre/post-deployment survey data were used. SETTINGS Comprised Army locations in Canada and UK, and selected US Army units. PARTICIPANTS Included soldiers in each of the above-mentioned settings. OUTCOME MEASURES Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed. RESULTS Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed. CONCLUSION This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.
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Affiliation(s)
- Farifteh Firoozmand Duffy
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- TechWerks LLC, Arlington Heights, Illinois, USA
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
| | - Margaret Jones
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
- ADMMH, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Charles W Hoge
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Joshua E Wilk
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lyndon A Riviere
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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17
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deMello RAF, Coimbra BM, Pedro BDM, Benvenutti IM, Yeh MSL, Mello AF, Mello MF, Poyares DR. Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4240-4266. [PMID: 35899768 DOI: 10.1177/08862605221114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
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Affiliation(s)
- Ricardo A F deMello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bianca D M Pedro
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Isabella M Benvenutti
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mary S L Yeh
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dalva R Poyares
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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18
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Chinoy ED, Carey FR, Kolaja CA, Jacobson IG, Cooper AD, Markwald RR. The bi-directional relationship between post-traumatic stress disorder and obstructive sleep apnea and/or insomnia in a large U.S. military cohort. Sleep Health 2022; 8:606-614. [PMID: 36163136 DOI: 10.1016/j.sleh.2022.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 05/27/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Determine if a bi-directional relationship exists between the development of sleep disorders (obstructive sleep apnea [OSA] and/or insomnia) and existing post-traumatic stress disorder (PTSD), and vice versa; and examine military-related factors associated with these potential relationships. DESIGN Longitudinal analyses of a prospective representative U.S. military cohort. PARTICIPANTS Millennium Cohort Study responders in 2011-2013 (Time 1 [T1]) and 2014-2016 (Time 2 [T2]) without insomnia or OSA at T1 (N = 65,915) or without PTSD at T1 (N = 71,256). MEASUREMENTS Provider-diagnosed OSA, self-reported items for insomnia, provider-diagnosed PTSD, and current PTSD symptoms were assessed at T1 and T2. Adjusted multivariable models identified military-related factors associated with new-onset PTSD in those with OSA and/or insomnia, and vice versa. RESULTS Self-reported history of provider-diagnosed PTSD without current symptoms at T1 was associated with new-onset OSA only and comorbid OSA/insomnia at T2, while current PTSD symptoms and/or diagnosis was associated with new-onset insomnia only. OSA/insomnia at T1 was consistently associated with newly reported PTSD symptoms or diagnosis except that insomnia only was not associated with newly reported provider-diagnosed PTSD. Military-related risk factors significantly associated with the bi-directional relationship for new-onset PTSD or OSA/insomnia included prior deployment with higher combat exposure and recent separation from the military; being an officer was protective for both outcomes. CONCLUSIONS In this large military cohort, findings suggest that PTSD and OSA and/or insomnia are bi-directionally predictive for their development, which was sometimes revealed by health care utilization. Relevant military-related risk factors should be considered in efforts to prevent or treat PTSD and/or sleep disorders.
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Affiliation(s)
- Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA
| | - Felicia R Carey
- Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Adam D Cooper
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Innovative Employee Solutions, San Diego, California, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA.
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19
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Cramer RJ, Montanaro E, VanSickle M, Cacace S, Zabelski S, Smith EL, Franks M, Grover S, Cunningham CA. A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ). Psychiatry Res 2022; 317:114849. [PMID: 36166945 DOI: 10.1016/j.psychres.2022.114849] [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: 05/20/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 01/04/2023]
Abstract
Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.
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Affiliation(s)
- Robert J Cramer
- Department of Public Health Sciences, Associate Professor & Irwin Belk Distinguished Scholar in Health Research, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA.
| | - Erika Montanaro
- Department of Psychological Sciences, University of North Carolina Charlotte; Charlotte, NC, USA
| | - Marcus VanSickle
- Center for Behavioral Forensic Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Sam Cacace
- Department of Public Health Sciences, Associate Professor & Irwin Belk Distinguished Scholar in Health Research, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, Associate Professor & Irwin Belk Distinguished Scholar in Health Research, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Emily L Smith
- Center for Family and Community Engagement, North Carolina State University; Raleigh, NC, USA
| | - Michael Franks
- Psychology Training Programs, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, USA
| | - Shawna Grover
- Nursing Research and Consultation Services, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, USA
| | - Craig A Cunningham
- Nursing Research and Consultation Services, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, USA
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20
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Walter KH, McCabe CT, Watrous JR, Kohen CB, Beltran JL, Kirk A, Campbell JS. Psychological comorbidity: Predictors of residential treatment response among U.S. service members with posttraumatic stress disorder. J Trauma Stress 2022; 35:1381-1392. [PMID: 35470514 PMCID: PMC9790433 DOI: 10.1002/jts.22838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
Residential posttraumatic stress disorder (PTSD) research in military samples generally shows that in aggregate, PTSD symptoms significantly improve over the course of treatment but can remain at elevated levels following treatment. Identifying individuals who respond to residential treatment versus those who do not, including those who worsen, is critical given the extensive resources required for such programs. This study examined predictors of treatment response among 282 male service members who received treatment in a U.S. Department of Defense residential PTSD program. Using established criteria, service members were classified as improved, indeterminate (referent), or worsened in terms of self-reported PTSD symptoms. Multinomial logistic regression results showed that for PTSD symptoms, higher levels of pretreatment PTSD symptom severity were associated with significantly lower odds of being in the improved group, adjusted odds ratio (aOR) = 0.955, p = .018. In addition, service members who completed treatment were significantly more likely to be in the improved group, aOR = 2.488, p = .048. Longer average pretreatment nightly sleep duration, aOR = 1.157, p = .035, and more severe pretreatment depressive symptoms, aOR = 1.109, p = .014, were associated with significantly higher odds of being in the improved group. These findings reveal clinical characteristics better suited for residential PTSD treatment and highlight implications for comorbid conditions.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Cameron T. McCabe
- LeidosRestonVirginiaUSA,Medical Modeling, Simulation, and Mission Support DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Jessica R. Watrous
- LeidosRestonVirginiaUSA,Medical Modeling, Simulation, and Mission Support DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Casey B. Kohen
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Jessica L. Beltran
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Alex Kirk
- Directorate of Mental HealthNaval Medical Center San DiegoSan DiegoCaliforniaUSA
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21
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LoSavio ST, Holder N, Wells SY, Resick PA. Clinician Concerns About Cognitive Processing Therapy: A Review of the Evidence. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Jaffe AE, Tao R, Page SC, Maynard KR, Pattie EA, Nguyen CV, Deep-Soboslay A, Bharadwaj R, Young KA, Friedman MJ, Williamson DE, Shin JH, Hyde TM, Martinowich K, Kleinman JE. Decoding Shared Versus Divergent Transcriptomic Signatures Across Cortico-Amygdala Circuitry in PTSD and Depressive Disorders. Am J Psychiatry 2022; 179:673-686. [PMID: 35791611 PMCID: PMC10697016 DOI: 10.1176/appi.ajp.21020162] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a debilitating neuropsychiatric disease that is highly comorbid with major depressive disorder (MDD) and bipolar disorder. The overlap in symptoms is hypothesized to stem from partially shared genetics and underlying neurobiological mechanisms. To delineate conservation between transcriptional patterns across PTSD and MDD, the authors examined gene expression in the human cortex and amygdala in these disorders. METHODS RNA sequencing was performed in the postmortem brain of two prefrontal cortex regions and two amygdala regions from donors diagnosed with PTSD (N=107) or MDD (N=109) as well as from neurotypical donors (N=109). RESULTS The authors identified a limited number of differentially expressed genes (DEGs) specific to PTSD, with nearly all mapping to cortical versus amygdala regions. PTSD-specific DEGs were enriched in gene sets associated with downregulated immune-related pathways and microglia as well as with subpopulations of GABAergic inhibitory neurons. While a greater number of DEGs associated with MDD were identified, most overlapped with PTSD, and only a few were MDD specific. The authors used weighted gene coexpression network analysis as an orthogonal approach to confirm the observed cellular and molecular associations. CONCLUSIONS These findings provide supporting evidence for involvement of decreased immune signaling and neuroinflammation in MDD and PTSD pathophysiology, and extend evidence that GABAergic neurons have functional significance in PTSD.
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Affiliation(s)
- Andrew E. Jaffe
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Genetic Medicine, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Center for Computational Biology, Johns Hopkins University, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ran Tao
- Lieber Institute for Brain Development, Baltimore, MD
| | | | | | | | | | | | | | - Keith A. Young
- Department of Psychiatry and Behavioral Sciences, Texas A&M College of Medicine, Bryan TX
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Central Texas Veterans Health Care System, Temple, TX, 76504, USA
- Baylor Scott & White Psychiatry, Temple, TX
| | - Matthew J. Friedman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth Hanover, NH
- National Center for PTSD, U.S. Department of Veterans Affairs
| | - Douglas E. Williamson
- Duke Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 300 North Duke St, Durham, North Carolina
- Durham VA Healthcare System, 508 Fulton St, Durham, North Carolina
| | | | - Joo Heon Shin
- Lieber Institute for Brain Development, Baltimore, MD
| | - Thomas M. Hyde
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Keri Martinowich
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Joel E. Kleinman
- Lieber Institute for Brain Development, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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23
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Walter KH, Levine JA, Madra NJ, Beltran JL, Glassman LH, Thomsen CJ. Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. Sailors and Marines. J Trauma Stress 2022; 35:988-998. [PMID: 35218250 PMCID: PMC9306964 DOI: 10.1002/jts.22807] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 01/24/2023]
Abstract
Psychological comorbidity, the co-occurrence of mental health disorders, is more often the rule than the exception among individuals with posttraumatic stress disorder (PTSD). Research shows that prevalence estimates for specific psychological disorders differ by gender; however, little is known about whether these patterns persist in the presence of a comorbid PTSD diagnosis. This study examined gender differences in prevalence estimates for conditions comorbid with PTSD using medical records for 523,626 active duty U.S. Sailors and Marines who entered the military over an 8-year period. Using chi-square tests of independence, we detected statistically significant gender differences for specific comorbid conditions in the subsample of 9,447 service members with a PTSD diagnosis. Women were more likely than men to have PTSD with comorbid adjustment, OR = 1.35; depressive, OR = 1.71; and generalized anxiety or other anxiety disorders, OR = 1.16, with the largest effects for eating, OR = 12.60, and personality disorders, OR = 2.97. In contrast, women were less likely than men to have a diagnosis of PTSD with comorbid alcohol use, OR = 0.69, and drug use disorders, OR = 0.72, with the largest effects for insomnia, OR = 0.42, and traumatic brain injury, OR = 0.17. No significant gender differences emerged for comorbid bipolar, obsessive-compulsive, panic/phobic, psychotic, or somatoform/dissociative disorders, ps = .029-.314. The results show gender differences in conditions comorbid with PTSD generally align with internalizing and externalizing dimensions. Differences in comorbidities with PTSD between women and men could have implications for treatment development and delivery.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Jordan A. Levine
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Naju J. Madra
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Jessica L. Beltran
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Lisa H. Glassman
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Cynthia J. Thomsen
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
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24
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Rahnejat AM, Ebrahimi M, Khoshdel A, Noorbala AA, Shahmiri Barzoki H, Avarzamani L, Avakh F, Taghva A. The prevalence of depression among iran-iraq war veterans, combatants and former prisoners of war: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2022; 57:295-305. [PMID: 34608645 DOI: 10.1002/ijop.12813] [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: 02/03/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023]
Abstract
By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran-Iraq war (1980-1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full-text review. Eventually, 19 studies were included in our systematic review and meta-analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval = 15.0-32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs.
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Affiliation(s)
- Amir Mohsen Rahnejat
- Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
| | | | - Alireza Khoshdel
- Department of Epidemiology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Farhad Avakh
- School of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Arsia Taghva
- Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
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25
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Eder-Moreau E, Zhu X, Fisch CT, Bergman M, Neria Y, Helpman L. Neurobiological Alterations in Females With PTSD: A Systematic Review. Front Psychiatry 2022; 13:862476. [PMID: 35770056 PMCID: PMC9234306 DOI: 10.3389/fpsyt.2022.862476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
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Affiliation(s)
- Elizabeth Eder-Moreau
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Xi Zhu
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Chana T Fisch
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Maja Bergman
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Yuval Neria
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Liat Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.,Psychiatric Research Unit, Tel Aviv Medical Center, Tel Aviv, Israel
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26
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Miggantz EL, Materna K, Herbert MS, Golshan S, Hernandez J, Peters J, Delaney E, Webb-Murphy J, Wisbach G, Afari N. Characteristics of Active Duty Service Members Referred to the Navy's Weight-Management Program. Mil Med 2021; 188:e174-e181. [PMID: 34910186 PMCID: PMC9825239 DOI: 10.1093/milmed/usab523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Rates of overweight and obesity have increased in the military, particularly in the U.S. Navy. While the Navy has implemented weight-management programs like ShipShape, findings on the effectiveness of these programs are mixed. Further knowledge on the characteristics of service members (SMs) who participate in these programs may help inform course curricula and improve outcomes. This study aimed to (1) examine characteristics of SMs referred to the Navy's ShipShape program at a large military treatment facility, (2) compare these characteristics among SMs who did and did not enroll in a randomized clinical trial of ShipShape (ShipShape study participants), and (3) compare demographic and health characteristics of ShipShape study participants to that of a random and similarly sized sample of Navy SMs who responded to the 2015 DoD Health-Related Behaviors Survey (HRBS). MATERIALS AND METHODS Data from active duty Navy SMs referred to the ShipShape program at a large military treatment facility were evaluated (n = 225). A subset of these SMs enrolled in the ShipShape study (n = 187). Among enrolled SMs, data from 147 who completed all measures were compared to that of HRBS respondents. Univariate ANOVA and chi-square analyses were used to examine (1) demographic and motivational differences between SMs who did and did not enroll in the ShipShape study and (2) differences in demographics and medical and mental health conditions between ShipShape study participants and Navy HRBS respondents. RESULTS The majority of SMs referred to ShipShape were female with an average age of 28.3 years. Compared to SMs who did not enroll in the ShipShape study (n = 38), ShipShape study participants were more likely to be female, less likely to be Hispanic, and had higher motivation and emotional eating scores. Compared to Navy HRBS respondents (n = 164), ShipShape study participants (n = 147) were younger, more likely to be female, non-Hispanic, enlisted, and obese. Further, ShipShape study participants reported significantly fewer medical health conditions but higher rates of probable depression, anxiety, and PTSD and were more likely to report receiving current mental health treatment than HRBS respondents. CONCLUSION Overweight or obese SMs seeking weight loss in the ShipShape study were relatively young, female, non-Hispanic, motivated, but with greater emotional eating. ShipShape study participants endorsed few medical health conditions but had higher rates of probable mental health conditions compared to the HRBS sample. These findings suggest that SMs referred to Navy weight-management programs are likely experiencing comorbid mental health conditions which may interfere with the effectiveness of their weight loss efforts. The descriptive nature of this study and the focus on Navy SMs in only one ShipShape program may decrease the generalizability of our findings to participants at other locations. Nonetheless, these findings demonstrate the potential need for Navy weight-management programs that incorporate mental health treatment and address the specific needs of female and diverse SMs. A more comprehensive curriculum could improve the results of weight-management efforts, increase SM quality of life and fitness and thereby operational readiness.
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Affiliation(s)
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA
| | | | - Joshua Peters
- Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Eileen Delaney
- Naval Center for Combat & Operational Stress Control, San Diego, CA 92134, USA
| | | | - Gordon Wisbach
- Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
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27
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Schein J, Houle C, Urganus A, Cloutier M, Patterson-Lomba O, Wang Y, King S, Levinson W, Guérin A, Lefebvre P, Davis LL. Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. Curr Med Res Opin 2021; 37:2151-2161. [PMID: 34498953 DOI: 10.1080/03007995.2021.1978417] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study synthesized evidence regarding the prevalence of post-traumatic stress disorder (PTSD) in the United States (US). METHODS A systematic literature review (SLR) identified recently published (2015-2019) observational studies of PTSD prevalence in the US via the MEDLINE, EMBASE, and PsycINFO databases. Eligible studies' most recent data were collected no earlier than 2013. Data elements extracted included study design, sample size, location, data source/year(s), study population(s), traumatic event type, prevalance estimates with corresponding look-back periods, and clinical metrics. RESULTS Data from 38 identified articles were categorized by population, diagnostic criteria, and lookback period. Among civilians, point prevalence ranged from 8.0% to 56.7%, 1-year prevalence from 2.3% to 9.1%, and lifetime prevalence from 3.4% to 26.9%. In military populations, point prevalence ranged from 1.2% to 87.5%, 1-year prevalence from 6.7% to 50.2%, and lifetime prevalence from 7.7% to 17.0%. Within these ranges, several estimates were derived from relatively high quality data; these articles are highlighted in the review. Prevalence was elevated in subpopulations including emergency responders, refugees, American Indian/Alaska Natives, individuals with heavy substance use, individuals with a past suicide attempt, trans-masculine individuals, and women with prior military sexual trauma. Female sex, lower income, younger age, and behavioral health conditions were identified as risk factors for PTSD. CONCLUSIONS PTSD prevalence estimates varied widely, partly due to different study designs, populations, and methodologies, and recent nationally representative estimates were lacking. Efforts to increase PTSD screening and improve disease awareness may allow for a better detection and management of PTSD.
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Affiliation(s)
- Jeffrey Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | | | | | | | - Yao Wang
- Analysis Group, Inc, Boston, MA, USA
| | | | | | | | | | - Lori L Davis
- Tuscaloosa Veteran Affairs Medical Center, Tuscaloosa, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
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28
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Wells SY, Brennan CL, Van Voorhees EE, Beckham JC, Calhoun PS, Clancy CP, Hertzberg MA, Dillon KH. The Impact of Hostility on Quality of Life, Functioning, and Suicidal Ideation Among Male Veterans with Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:1171-1177. [PMID: 34091962 PMCID: PMC8645654 DOI: 10.1002/jts.22691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022]
Abstract
Veterans with posttraumatic stress disorder (PTSD) often experience high levels of hostility. Although studies have found that PTSD is associated with poorer quality of life (QoL), increased functional impairment, lower levels of social support, and increased suicidal ideation, it is unclear if hostility impacts these domains in veterans with PTSD above and beyond the impact from PTSD and depressive symptoms. The present study aimed to examine whether hostility is related to several indices of poorer QoL and functioning after controlling for demographic characteristics, PTSD symptoms, and depressive symptoms. Participants (N = 641) were male U.S. veterans seeking PTSD treatment through a specialty clinic in the Veterans Affairs Healthcare System. Veterans completed the Davidson Trauma Scale for DSM-IV (DTS), Personality Assessment Inventory (PAI), Quality of Life Inventory, and the Sheehan Disability Scale. Hierarchical regressions were conducted to examine the impact of PAI measures of hostility on QoL, functioning, social support, and suicidal ideation beyond DTS, depression, race, and age. After covarying for DTS total score, depression symptoms, age, and race, higher levels of hostility were significantly associated with higher degrees of functional impairment and lower degrees of social support, ΔR2 = .01 and ΔR2 = .02, respectively. Higher levels of hostility were significantly related to diminished functioning and lower social support beyond PTSD and depressive symptoms in veterans seeking treatment for PTSD. These findings highlight the importance of assessing and treating hostility in veterans with PTSD.
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Affiliation(s)
- Stephanie Y. Wells
- Durham VA Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC,Duke University Medical Center, Durham, NC,Correspondence concerning this article should be sent to: Stephanie Y. Wells, Ph.D, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705,
| | | | | | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC,Duke University Medical Center, 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 Medical Center, Durham, NC,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | | | - Michael A. Hertzberg
- Durham VA Health Care System, Durham, NC,Duke University Medical Center, Durham, NC
| | - Kirsten H. Dillon
- Durham VA Health Care System, Durham, NC,Duke University Medical Center, Durham, NC
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29
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Pascual Cuadrado D, Todorov H, Lerner R, Islami L, Bindila L, Gerber S, Lutz B. Long-term molecular differences between resilient and susceptible mice after a single traumatic exposure. Br J Pharmacol 2021; 179:4161-4180. [PMID: 34599847 DOI: 10.1111/bph.15697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE PTSD is a heterogeneous disorder induced by trauma, resulting in severe long-term impairments of an individual's mental health. Interestingly, PTSD does not develop in every individual; thus, some individuals are more resilient than others. However, the underlying molecular mechanisms are poorly understood. Here, we aimed at shedding light on these processes. EXPERIMENTAL APPROACH We used a single-trauma PTSD model in mice to induce long-term maladaptive behaviours and profiled the mice four weeks post-trauma into resilient or susceptible individuals. The phenotype's classification was based on their individual responses in different behavioural experiments. We analysed microbiome, circulating endocannabinoids, and long-term changes in brain phospholipid and transcript levels. KEY RESULTS We found a plethora of molecular differences between resilient and susceptible individuals across multiple molecular domains, including lipidome, transcriptome, and gut microbiome. Some of these differences were stable even several weeks after the trauma, indicating the long-term impact of traumatic stimuli on the organism's physiology. Furthermore, the integration of these multi-layered molecular data revealed that resilient and susceptible individuals have very distinct molecular signatures across various physiological systems. CONCLUSIONS AND IMPLICATIONS We showed that trauma induces individual-specific behavioural responses that, in combination with a longitudinal characterization of mice, can be used to identify distinct sub-phenotypes within the trauma-exposed group. These groups differ significantly not only in their behaviour but also in specific molecular aspects across a variety of tissues and brain regions. This approach may reveal new targets and predictive biomarkers for the pharmacological treatment and prognosis of stress-related disorders.
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Affiliation(s)
- Diego Pascual Cuadrado
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Hristo Todorov
- Institute of Human Genetics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Raissa Lerner
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | | | - Laura Bindila
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Susanne Gerber
- Institute of Human Genetics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Beat Lutz
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Leibniz Institute for Resilience Research; Mainz, Germany
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Bajjani-Gebara J, Wilcox SL, Williams JW, Kosinski AS, Allard RJ, Wilson C, Landoll R. Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018. Womens Health Issues 2021; 31 Suppl 1:S33-S42. [PMID: 34454702 DOI: 10.1016/j.whi.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. METHODS We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. RESULTS After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. CONCLUSIONS ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.
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Affiliation(s)
- Jouhayna Bajjani-Gebara
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland.
| | - Sherrie L Wilcox
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Department of Preventive Medicine and Biostatistics, Bethesda, Maryland
| | - John W Williams
- Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, North Carolina
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resource Center, Bethesda, Maryland
| | - Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland
| | - Ryan Landoll
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland
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31
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Zegel M, Lebeaut A, Healy N, Tran JK, Vujanovic AA. Mental Health Correlates of Probable Posttraumatic Stress Disorder, Probable Alcohol Use Disorder, and Their Co-Occurrence among Firefighters. Behav Modif 2021; 46:395-421. [PMID: 34323099 DOI: 10.1177/01454455211033517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firefighters demonstrate high rates of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Research has yet to compare how these diagnoses and their co-occurrence relate to firefighter mental health. This study evaluated trauma load, PTSD, alcohol use, depression, sleep, suicide risk, anger, and occupational stress across four discrete groups of firefighters (N = 660): (1) trauma-exposed only (n = 471), (2) probable PTSD-only (n = 36), (3) probable AUD-only (n = 125), and (4) probable PTSD-AUD (n = 28). Firefighters completed an online survey. Firefighters with probable PTSD-AUD demonstrated higher scores on all criterion variables, except trauma load, compared to firefighters with probable AUD-only or trauma-only. Firefighters with probable PTSD-AUD and probable PTSD-only reported similar levels of all indices, except alcohol use severity and suicide risk, which were higher among the probable PTSD-AUD group. Results provide preliminary empirical evidence of the deleterious impact of PTSD-AUD comorbidity among firefighters.
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Affiliation(s)
| | | | | | - Jana K Tran
- National Aeronautics and Space Administration (NASA), Houston, TX, USA
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32
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Integration of peripheral transcriptomics, genomics, and interactomics following trauma identifies causal genes for symptoms of post-traumatic stress and major depression. Mol Psychiatry 2021; 26:3077-3092. [PMID: 33963278 DOI: 10.1038/s41380-021-01084-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/26/2021] [Indexed: 02/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating syndrome with substantial morbidity and mortality that occurs in the aftermath of trauma. Symptoms of major depressive disorder (MDD) are also a frequent consequence of trauma exposure. Identifying novel risk markers in the immediate aftermath of trauma is a critical step for the identification of novel biological targets to understand mechanisms of pathophysiology and prevention, as well as the determination of patients most at risk who may benefit from immediate intervention. Our study utilizes a novel approach to computationally integrate blood-based transcriptomics, genomics, and interactomics to understand the development of risk vs. resilience in the months following trauma exposure. In a two-site longitudinal, observational prospective study, we assessed over 10,000 individuals and enrolled >700 subjects in the immediate aftermath of trauma (average 5.3 h post-trauma (range 0.5-12 h)) in the Grady Memorial Hospital (Atlanta) and Jackson Memorial Hospital (Miami) emergency departments. RNA expression data and 6-month follow-up data were available for 366 individuals, while genotype, transcriptome, and phenotype data were available for 297 patients. To maximize our power and understanding of genes and pathways that predict risk vs. resilience, we utilized a set-cover approach to capture fluctuations of gene expression of PTSD or depression-converting patients and non-converting trauma-exposed controls to find representative sets of disease-relevant dysregulated genes. We annotated such genes with their corresponding expression quantitative trait loci and applied a variant of a current flow algorithm to identify genes that potentially were causal for the observed dysregulation of disease genes involved in the development of depression and PTSD symptoms after trauma exposure. We obtained a final list of 11 driver causal genes related to MDD symptoms, 13 genes for PTSD symptoms, and 22 genes in PTSD and/or MDD. We observed that these individual or combined disorders shared ESR1, RUNX1, PPARA, and WWOX as driver causal genes, while other genes appeared to be causal driver in the PTSD only or MDD only cases. A number of these identified causal pathways have been previously implicated in the biology or genetics of PTSD and MDD, as well as in preclinical models of amygdala function and fear regulation. Our work provides a promising set of initial pathways that may underlie causal mechanisms in the development of PTSD or MDD in the aftermath of trauma.
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Abramovitz LM, Lutgendorf MA, Bukowinski AT, Gumbs GR, Conlin AMS, Hall C. Posttraumatic Stress Disorder in a Cohort of Pregnant Active Duty U.S. Military Servicewomen. J Trauma Stress 2021; 34:586-595. [PMID: 33544939 DOI: 10.1002/jts.22656] [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: 05/21/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 01/04/2023]
Abstract
The present study aimed to describe the demographic and occupational characteristics, comorbidities, and psychotropic medication receipt associated with posttraumatic stress disorder (PTSD) diagnosis during pregnancy among a sample of active duty U.S. military servicewomen. Data from the U.S. Department of Defense Birth and Infant Health Research program were used to identify pregnancies in active duty servicewomen from 2007 through 2014. Demographic and occupational data were linked with electronic medical and pharmacy records to capture mental health diagnoses and medication receipt dates. Cases of PTSD were identified by the presence of ICD-9-CM Diagnostic Code 309.81 on maternal records from 1 year before the date of the last menstrual period through the end of pregnancy. Of 134,244 identified pregnancies among active duty servicewomen, 2,240 (1.7%) met the case criteria for PTSD. Women with a PTSD diagnosis compared to those without a PTSD diagnosis were more likely to be White non-Hispanic (51.3% vs. 47.4%), unmarried (33.3% vs. 28.2%), in the Army (49.6% vs. 35.8%) or Marine Corps (10.9% vs. 8.0%), in a service and supply occupation (18.2% vs. 13.6%), and to have a junior enlisted rank (56.3% vs. 50.1%) and have been previously deployed (51.2% vs. 39.6%), RRs = 1.15-1.75. Among PTSD cases, the most common mental health comorbidities were depressive disorder (60.9%), adjustment disorder (43.4%), and anxiety disorder (39.3%). During pregnancy, 44.2% of PTSD cases and 7.2% of noncases received psychotropic medications. Demographic and occupational characteristics, comorbidities, and psychotropic medication use differed substantially among PTSD cases and noncases in this large records-based study.
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Affiliation(s)
- Lisa M Abramovitz
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
| | - Anna T Bukowinski
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Gia R Gumbs
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Clinton Hall
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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34
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Li H, Flynn DM, Highland KB, Barr PK, Langford DJ, Doorenbos AZ. Relationship between Post-Traumatic Stress Disorder Symptoms and Chronic Pain Related Symptom Domains among Military Active Duty Service Members. PAIN MEDICINE 2021; 22:2876-2883. [PMID: 33690851 DOI: 10.1093/pm/pnab087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examined the relationships between symptom domains relevant to PTSD diagnosis, PTSD screening, and chronic pain-related symptoms (pain intensity, pain interference, physical function, fatigue, depression, anxiety, anger, satisfaction with social roles) experienced by active duty military service members with chronic pain. DESIGN Cross-sectional study. SETTING The Interdisciplinary Pain Management Center (IPMC) at Madigan Army Medical Center between 2014 and 2018. SUBJECTS Active duty service members receiving care at IPMC (N = 2,745). METHODS Independent sample t test was conducted to compare pain intensity and pain-related measures of physical, emotional and social functioning among patients with and without a PTSD diagnosis or PTSD positive screen (≥3 symptoms). Relative weight analysis was used to identify the relative importance of each PTSD symptom cluster (e.g., intrusion, avoidance, hyperarousal, emotional numbness) to pain and related domains. RESULTS Approximately 27.9% patients had a positive screen for PTSD, and 30.5% of the patients had a PTSD diagnosis. Patients with PTSD diagnosis and positive screening had higher Pain Interference and lower Physical Function and Social Satisfaction scores (P < 0.001), and had increased Anger, Anxiety, Fatigue, and Depression scores (P < 0.001). Emotional numbness accounted for the largest proportion of variance in average pain intensity, pain interference, and psychological functioning; while avoidance accounted for the largest proportion of variance in physical function. CONCLUSION To improve treatment effectiveness and overall functioning for active duty military patients, integrated treatment and therapies targeted to reducing chronic pain, and PTSD symptoms (focus on emotional numbness and avoidance) are recommended.
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Affiliation(s)
- Hongjin Li
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago.,University of Illinois Cancer Center, Chicago
| | - Diane M Flynn
- Department of Rehabilitative Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland.,Henry M. Jackson Foundation, Rockville, Maryland
| | - Patricia K Barr
- Department of Rehabilitative Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Dale J Langford
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago.,University of Illinois Cancer Center, Chicago
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Highfill-McRoy RM, Levine JA, Larson GE, Norman SJ, Schmied EA, Thomsen CJ. Predictors of Symptom Increase in Subsyndromal PTSD Among Previously Deployed Military Personnel. Mil Med 2021; 187:e711-e717. [PMID: 33580699 PMCID: PMC9071097 DOI: 10.1093/milmed/usab034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/11/2021] [Accepted: 01/24/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Subsyndromal PTSD (sub-PTSD) is associated with functional impairment and increased risk for full PTSD. This study examined factors associated with progression from sub-PTSD to full PTSD symptomatology among previously deployed military veterans. Materials and Methods Data were drawn from a longitudinal survey of Navy and Marine Corps personnel leaving military service between 2007 and 2010 administered immediately before separation (baseline) and ~1 year later (follow-up). Survey measures assessed PTSD symptoms at both times; the baseline survey also assessed potential predictors of symptom change over time. Logistic regression models were used to identify predictors of progression from sub-PTSD to full PTSD status. Results Compared to those with no or few PTSD symptoms at baseline, individuals with sub-PTSD were almost three times more likely to exhibit full PTSD symptomatology at follow-up. Risk factors for symptom increase among those with sub-PTSD included moderate or high levels of combat exposure and utilization of fewer positive coping behaviors. Use of prescribed psychotropic medication was protective against symptom increase. Conclusion This study identified several predictors of symptom increase in military veterans with sub-PTSD. Interventions targeting modifiable risk factors for symptom escalation, including behavioral and pharmacological treatments, may reduce rates of new-onset PTSD in this population.
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Affiliation(s)
- Robyn M Highfill-McRoy
- Leidos, San Diego, CA 92106-3521, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Jordan A Levine
- Leidos, San Diego, CA 92106-3521, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Gerald E Larson
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Sonya J Norman
- National Center for PTSD, 215 North Main St., White River Junction, VT 05009, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161-0002, USA.,UCSD School of Medicine, La Jolla, CA 92093-0602, USA
| | | | - Cynthia J Thomsen
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92106-3521, USA
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36
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Petereit-Haack G, Bolm-Audorff U, Romero Starke K, Seidler A. Occupational Risk for Post-Traumatic Stress Disorder and Trauma-Related Depression: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9369. [PMID: 33327657 PMCID: PMC7765156 DOI: 10.3390/ijerph17249369] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83-2.60) for PTSD and 1.15 (95% CI 1.06-1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76-5.76) and for depression (RR = 1.73; 95% CI 1.44-2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.
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Affiliation(s)
- Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
- Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Giessen, Justus-Liebig-University, 35392 Giessen, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
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Judkins JL, Moore BA, Collette TL, Hale WJ, Peterson AL, Morissette SB. Incidence Rates of Posttraumatic Stress Disorder Over a 17-Year Period in Active Duty Military Service Members. J Trauma Stress 2020; 33:994-1006. [PMID: 32598575 DOI: 10.1002/jts.22558] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) affects approximately 8% of the general population. The prevalence of PTSD is twice as high in active duty service members and military veterans. Few studies have investigated the incidence rates of PTSD in active duty military personnel. The present study evaluated the incidence of PTSD diagnoses and the differences between demographic factors for service members between 2001 and 2017. Data on 182,400 active duty service members between 2001 and 2017 were drawn from the Defense Medical Epidemiological Database and examined by sex, age, service branch, military pay grade, marital status, and race. From 2001 to 2017, the incidence rates of PTSD in the active force (per 1,000 service members) steadily climbed, with a low of 1.24 in 2002 to a high of 12.94 in 2016. Service members most often diagnosed with PTSD were in the U.S. Army, with the enlisted pay grades of E-5-E-9, White, married, male, and between 20 and 24 years old. Statistically significant differences, ps < .001, were found between observed and expected counts across all examined demographic variables. The present study is the first to our knowledge to provide a comprehensive examination of PTSD incidence rates in an active duty military population.
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Affiliation(s)
- Jason L Judkins
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,United States Army, 187th Medical Battalion, Medical Professional Brigade, Joint Base San Antonio Fort Sam Houston, San Antonio, Texas, USA
| | - Brian A Moore
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Tyler L Collette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Office of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
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Capone C, Tripp JC, Trim RS, Davis BC, Haller M, Norman SB. Comparing Exposure- and Coping Skills-Based Treatments on Trauma-Related Guilt in Veterans With Co-Occurring Alcohol Use and Posttraumatic Stress Disorders. J Trauma Stress 2020; 33:603-609. [PMID: 32521096 DOI: 10.1002/jts.22538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) commonly co-occur, and this comorbidity (PTSD-SUD) is associated with more severe symptoms and functional impairment than either disorder alone. Growing evidence indicates that trauma-related guilt, typically concerning negative appraisals of one's actions or inaction during a traumatic event, is associated with PTSD, depression, suicidality, and, possibly, substance use. The present study examined whether integrated treatment for PTSD-SUD was effective in reducing trauma-related guilt as measured by the Trauma-Related Guilt Inventory. Data were drawn from a randomized clinical trial comparing the effectiveness of two integrated therapies on treatment outcomes in a sample of U.S. veterans (N = 119) with comorbid PTSD and SUD. Participants were randomized to receive either Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE; n = 63) or Seeking Safety (SS; n = 56). The results indicated that global guilt decreased over time for the whole sample. However, there was a significant Treatment × Time interaction, such that participants in the COPE condition reported lower rates of global guilt, d = 0.940, over time compared to those in the SS condition, d = .498. To our knowledge, this was the first study to examine the effects of integrated PTSD-SUD treatment on trauma-related guilt. The findings highlight that exposure-based, trauma-focused treatment for comorbid PTSD-SUD can be more effective in decreasing trauma-related guilt, with potentially longer-lasting effects, than non-exposure-based treatment, adding evidence that patients with PTSD-SUD should be offered such treatment.
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Affiliation(s)
- Christy Capone
- Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jessica C Tripp
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Ryan S Trim
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Brittany C Davis
- James A Haley Veterans Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, California, USA.,School of Medicine, University of California, San Diego, La Jolla, California, USA.,National Center for PTSD, White River Junction, Vermont, USA.,Center of Excellence for Stress and Mental Health, San Diego, California, USA
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Walter KH, Glassman LH, Wells SY, Thorp SR, Morland LA. The Impact of Depression Severity on Treatment Outcomes Among Older Male Combat Veterans with Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:345-352. [PMID: 32216149 DOI: 10.1002/jts.22503] [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: 02/27/2019] [Revised: 10/21/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) and depression are highly comorbid within the veteran population. Research studies have yielded divergent findings regarding the effect of depression on PTSD treatment outcomes. The present study investigated the influence of pretreatment depression severity on PTSD and depression symptom trajectories among 85 older (i.e., ≥ 60 years) male veterans with military-related PTSD who received either prolonged exposure or relaxation training as part of a randomized controlled trial. Participants were categorized as having no/mild depression (n = 23) or moderate/severe depression (n = 62). The PTSD Checklist (PCL-S) and Patient Health Questionnaire (PHQ-9) were completed at pretreatment, each of 12 therapy sessions, posttreatment, and 6-month follow-up, for a total of up to 15 data points per participant. Multilevel modeling (MLM) was used to evaluate the impact of pretreatment depression severity on piecewise symptom trajectories (i.e., active treatment and follow-up periods) over time and to determine whether treatment condition moderated the trajectories. The final MLM results showed significant main effects of depression severity on PCL-S scores, B = 10.84, p = .043 and PHQ-9 scores, B = 7.09, p = .001, over time. No significant interactions emerged for either the PCL-S or PHQ-9, indicating that although older veterans with more severe depression endorsed higher PTSD and depression scores across time, the symptom trajectories were not moderated by depression severity, treatment condition, or their interaction.
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Affiliation(s)
- Kristen H Walter
- Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA.,Veterans Medical Research Foundation, San Diego, California, USA
| | - Lisa H Glassman
- Veterans Medical Research Foundation, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Stephanie Y Wells
- Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Steven R Thorp
- Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA.,Veterans Medical Research Foundation, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,California School of Professional Psychology at Alliant International University, San Diego, California, USA
| | - Leslie A Morland
- Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,National Center for PTSD-Pacific Island Healthcare, Honolulu, Hawaii, USA
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Rae Olmsted KL, Bartoszek M, Mulvaney S, McLean B, Turabi A, Young R, Kim E, Vandermaas-Peeler R, Morgan JK, Constantinescu O, Kane S, Nguyen C, Hirsch S, Munoz B, Wallace D, Croxford J, Lynch JH, White R, Walters BB. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:130-138. [PMID: 31693083 PMCID: PMC6865253 DOI: 10.1001/jamapsychiatry.2019.3474] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. OBJECTIVE To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. DESIGN, SETTING, AND PARTICIPANTS This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. INTERVENTIONS Paired right-sided SGB or sham procedures at weeks 0 and 2. MAIN OUTCOMES AND MEASURES Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). RESULTS Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was -12.6 points (95% CI, -15.5 to -9.7 points) for the group receiving SGB treatments, compared with -6.1 points (95% CI, -9.8 to -2.3 points) for those receiving sham treatment (P = .01). CONCLUSIONS AND RELEVANCE In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03077919.
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Affiliation(s)
| | | | - Sean Mulvaney
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Ali Turabi
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ryan Young
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Eugene Kim
- Womack Army Medical Center, Fort Bragg, North Carolina
| | | | | | | | - Shawn Kane
- John F. Kennedy Special Warfare Center and School, Fort Bragg, North Carolina
| | | | - Shawn Hirsch
- RTI International, Research Triangle Park, North Carolina
| | - Breda Munoz
- RTI International, Research Triangle Park, North Carolina
| | - Dennis Wallace
- RTI International, Research Triangle Park, North Carolina
| | - Julie Croxford
- RTI International, Research Triangle Park, North Carolina
| | - James H. Lynch
- US Army Special Operations Command, Fort Bragg, North Carolina
| | - Ronald White
- Landstuhl Regional Medical Center, Landstuhl, Germany
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Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander VA, LeardMann CA. Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry 2019; 19:396. [PMID: 31836015 PMCID: PMC6911296 DOI: 10.1186/s12888-019-2375-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/27/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, particularly major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD. METHODS Eligible participants (n = 1704) for the Millennium Cohort Study included those who screened positive at baseline for both PTSD (PTSD Checklist-Civilian Version) and MDD (Patient Health Questionnaire). Between 2001 and 2016, participants completed a baseline assessment and up to 4 follow-up assessments approximately every 3 years. Mixture modeling simultaneously determined trajectories of comorbid PTSD and MDD symptoms. Multinomial regression determined factors associated with latent class membership. RESULTS Four distinct classes (chronic, relapse, gradual recovery, and rapid recovery) described symptom trajectories of PTSD/MDD. Membership in the chronic class was associated with older age, service branch, deployment with combat, anxiety, physical assault, disabling injury/illness, bodily pain, high levels of somatic symptoms, and less social support. CONCLUSIONS Comorbid PTSD/MDD symptoms tend to move in tandem, and, although the largest class remitted symptoms, almost 25% of participants reported chronic comorbid symptoms across all time points. Results highlight the need to assess comorbid conditions in the context of PTSD. Future research should further evaluate the chronicity of comorbid symptoms over time.
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Affiliation(s)
- Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA.
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA.
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA.
| | - Kristen H Walter
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, 92106-3521, USA
| | - Toni Rose Geronimo-Hara
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Ben Porter
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Cynthia A LeardMann
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
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Willing AE, Girling SA, Deichert R, Wood-Deichert R, Gonzalez J, Hernandez D, Foran E, Sanberg PR, Kip KE. Brazilian Jiu Jitsu Training for US Service Members and Veterans with Symptoms of PTSD. Mil Med 2019; 184:e626-e631. [PMID: 31004163 PMCID: PMC6910885 DOI: 10.1093/milmed/usz074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/15/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction The United States has been actively involved in major armed conflicts over the last 15 years. As a result, a significant proportion of active duty service personnel and returning veterans have endured combat, putting them at risk for developing post-traumatic stress disorder (PTSD), a disabling disorder that may occur after exposure to a traumatic event. Current therapies often require long-term, time-intensive and costly commitment from the patient and have variable degrees of success. There remains an ongoing need for better therapies, including complementary medicine approaches that can effectively reduce PTSD symptoms. While anecdotal evidence suggests that routine practice of Brazilian Jiu Jitsu (BJJ) can reduce symptoms of PTSD, there have been no formal studies to address this. Materials and Methods This study was approved by the University of South Florida Institutional Review Board (#PRO00019430). Male US active duty service members and veterans from the Tampa area participated in a 5-month (40 sessions) BJJ training program. Before beginning and again midway through and upon completion of training the participants completed several validated self-report measures that addressed symptoms of PTSD and other co-morbid conditions. Effect size and 95% confidence intervals were determined using a within-person single-group pretest–posttest design. Results Study participants demonstrated clinically meaningful improvements in their PTSD symptoms as well as decreased symptoms of major depressive disorder, generalized anxiety and decreased alcohol use; effect sizes varied from 0.80 to 1.85. Conclusions The results from this first-of-kind pilot study suggest that including BJJ as a complementary treatment to standard therapy for PTSD may be of value. It will be necessary to validate these promising results with a larger subject cohort and a more rigorous experimental design before routinely recommending this complementary therapy.
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Affiliation(s)
- Alison E Willing
- Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher, Tampa, FL 33613
| | - Sue Ann Girling
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612
| | - Ryan Deichert
- Tampa Jiu Jitsu, LLC, 4210 Carnal Ave, Tampa, FL 33618
| | | | - Jason Gonzalez
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612
| | - Diego Hernandez
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612
| | - Elspeth Foran
- Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher, Tampa, FL 33613
| | - Paul R Sanberg
- Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher, Tampa, FL 33613.,Office of Research, Innovation & Knowledge Enterprise, University of South Florida, 3702 Spectrum Blvd. Ste. 165, Tampa, FL 33612
| | - Kevin E Kip
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL 33612
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Madhombiro M, Musekiwa A, January J, Chingono A, Abas M, Seedat S. Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review. Syst Rev 2019; 8:244. [PMID: 31661030 PMCID: PMC6819454 DOI: 10.1186/s13643-019-1176-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH. METHODS A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls. RESULTS A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out. CONCLUSION This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD 42017063856 .
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Alfred Musekiwa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James January
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alfred Chingono
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Melanie Abas
- King's College London, Centre for Global Mental Health, David Goldberg Centre H1.12, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zijl Avenue, 7505, Cape Town, South Africa
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Taylor MK, Hernández LM, Stump J, Tschiffely AE, Goforth CW, Laver DC, Ahlers ST. Blast exposure interacts with genetic variant 5HTTLPR to predict posttraumatic stress symptoms in military explosives personnel. Psychiatry Res 2019; 280:112519. [PMID: 31442670 DOI: 10.1016/j.psychres.2019.112519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/18/2022]
Abstract
The first of its kind, this study determined whether blast exposure interacts with genetic variant 5HTTLPR to predict posttraumatic stress (PTS) symptoms in 78 military explosives operators. In all models, blast-exposed 5HTTLPR S carriers registered definitively higher PTS symptoms in comparison to non-exposed S carriers, as well as exposed and non-exposed LL carriers (all p < 0.01). All findings were robust to confounding influences of age and traumatic brain injury diagnosis. Not only is blast exposure prevalent in EOD personnel, but it also interacts with genetic predisposition to predict trauma symptoms in this unique, at-risk military population.
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Affiliation(s)
- Marcus K Taylor
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Lisa M Hernández
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA.
| | - Jeremy Stump
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Anna E Tschiffely
- Neurotrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - Carl W Goforth
- Neurotrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - D Christine Laver
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Stephen T Ahlers
- Neurotrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
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Liu L, Thorp SR, Moreno L, Wells SY, Glassman LH, Busch AC, Zamora T, Rodgers CS, Allard CB, Morland LA, Agha Z. Videoconferencing psychotherapy for veterans with PTSD: Results from a randomized controlled non-inferiority trial. J Telemed Telecare 2019; 26:507-519. [PMID: 31216210 DOI: 10.1177/1357633x19853947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Veterans with post-traumatic stress disorder (PTSD) face significant barriers that make it less likely for them to pursue treatment. A randomized controlled non-inferiority trial was used to determine if providing psychotherapy for PTSD via videoconference (VC) is as effective as in-person (IP) psychotherapy. METHODS All eligible veterans (n = 207) received cognitive processing therapy (CPT) to treat PTSD symptoms in one of the two treatment modalities. Participant symptoms were collected at baseline, post-treatment, and six months after treatment completion. The primary outcome measure, the Clinician-Administered PTSD Scale (CAPS), was used to assess PTSD diagnosis and symptom severity. Secondary outcomes included two self-report measures of symptom severity, the Post-traumatic Stress Disorder Checklist - Specific (PCL-S) for PTSD and the Patient Health Questionnaire - 9 (PHQ-9) for depressive symptoms. A linear mixed-effects model was used to assess non-inferiority for participants who completed treatment (completers) and those who were randomized to treatment (intention-to-treat (ITT)). RESULTS Both completer and ITT analyses showed that improvement in CAPS scores in the VC condition was non-inferior to that in the IP condition at six-month follow-up, but VC was inferior to IP for improvement in CAPS at post-treatment. Non-inferiority was supported by completer analyses for PCL-S and PHQ-9 in both post-treatment change and six-month follow-up change, and the ITT analysis supported the significant non-inferiority for PCL at post-treatment change. DISCUSSION These findings generally suggest that CPT delivered via VC can be as effective as IP for reducing the severity of PTSD symptoms.
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Affiliation(s)
- Lin Liu
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Steven R Thorp
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA.,California School of Professional Psychology, Alliant International University, San Diego, CA, USA
| | - Lucy Moreno
- VA San Diego Healthcare System, San Diego, CA, USA.,California Primary Care Association, Sacramento, CA, USA
| | - Stephanie Y Wells
- VA San Diego Healthcare System, San Diego, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lisa H Glassman
- VA San Diego Healthcare System, San Diego, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA
| | - Angela C Busch
- Veterans Medical Research Foundation, San Diego, CA, USA
| | - Tania Zamora
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Carie S Rodgers
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,PsychArmor Institute, San Diego, CA, USA
| | - Carolyn B Allard
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Leslie A Morland
- VA San Diego Healthcare System, San Diego, CA, USA.,Veterans Medical Research Foundation, San Diego, CA, USA
| | - Zia Agha
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,West Health Institute, San Diego, CA, USA
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