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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Fischer IC, Davis LW, Cyders MA, Salyers MP, Rand KL. Posttraumatic stress and depressive symptoms and symptom clusters in a sample of treatment-seeking US veterans: Longitudinal associations with meaning in life and general self-efficacy. J Affect Disord 2023; 339:781-787. [PMID: 37479042 DOI: 10.1016/j.jad.2023.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES To quantify the associations between general self-efficacy, subjective meaning in life, and posttraumatic stress and depressive symptoms and symptom clusters in US veterans, both cross-sectionally and longitudinally. METHODS Data from a Veteran Affairs (VA) funded intervention study (n = 191) were examined. Self-report measures of depressive symptoms, general self-efficacy, and meaning in life were collected, along with clinician-rated symptoms of PTSD. RESULTS Meaning in life was consistently inversely associated with posttraumatic stress and depressive symptoms and symptom clusters cross-sectionally, whereas general self-efficacy was only inversely associated with some aspects of depressive symptoms. Longitudinal analyses further revealed that meaning in life was inversely associated with the cluster D symptoms of PTSD and the cognitive-affective symptoms of depression. CONCLUSIONS Higher meaning in life is associated with less severe symptoms of posttraumatic stress and depressive symptoms, particularly those related to mood. Additional research is needed to determine whether interventions designed to increase meaning in life attenuate these symptoms.
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Affiliation(s)
- Ian C Fischer
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA.
| | - Louanne W Davis
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa A Cyders
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Michelle P Salyers
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kevin L Rand
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA
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Vaillant J, Kalra N, Gurbuz Cuneo A, Rouanet L. Losing ground in the field: An exploratory analysis of the relationship between work and mental health amongst women in conflict affected Democratic Republic of the Congo. PLoS One 2023; 18:e0284088. [PMID: 37083679 PMCID: PMC10121043 DOI: 10.1371/journal.pone.0284088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Conflict affected populations, in particular women in such settings, face an increased risk of developing mental health disorders as well as well as economic vulnerability and reduced productivity. However, the link between the two has rarely been studied. DATA AND METHODS The data in this paper come from a cross-sectional dataset (n = 1053) and a panel dataset of (n = 499) women suffering from post-traumatic stress disorder (PTSD) in eastern Democratic Republic of the Congo. This paper investigates the association between mental health disorders (PTSD, depression and/or anxiety) and employment for women in a conflict-affected setting. RESULTS The study finds that worsened local functioning is associated with reduced likelihood of working, earnings, and engagement in paid work. Reduction in probable depression and/or anxiety and PTSD are both associated with increased likelihood of engaging in paid work compared to unpaid work. Reduction in probable depression and/or anxiety is also associated with engaging in a secondary economic activity, as well as with higher productivity. However, when controlling for daily (local) functioning impairment, the primary pathway through which mental health may impact working, we detect a positive relationship between work or working hours and increased symptoms of PTSD and depression and/or anxiety. Working women with worse PTSD and depression and/or anxiety symptoms are also less likely to be self-employed, especially in an off-farm setting, and more likely to be engaged in farming. CONCLUSION A complex relationship between working and mental health emerges. Our findings also suggest that in this population farming, particularly farm-based wage work, is positively associated with worse mental health even after accounting for wealth and other relevant socio-demographic factors. These findings highlight the importance of paying close attention to the mental health of beneficiaries of livelihood support projects in post-conflict settings, where the relationship between mental health and employment is not straightforward.
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Affiliation(s)
- Julia Vaillant
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
| | - Naira Kalra
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
| | - Alev Gurbuz Cuneo
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
| | - Léa Rouanet
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
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Analysis of the bidirectional relationships between posttraumatic stress and depression symptoms with physical health functioning in post-9/11 veteran men and women deployed to a war zone. J Psychosom Res 2022; 162:111034. [PMID: 36099750 DOI: 10.1016/j.jpsychores.2022.111034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Many war-zone deployed post-9/11 veterans report negative mental health symptoms related to their military service, which can have consequences for physical health symptoms and the impact of physical health on functioning. The current study examined the longitudinal, bidirectional relationships between mental health symptoms and physical health functioning in veteran men and women, allowing for exploration of gender differences. METHODS A sample of 1032 post-9/11 veterans (women: n = 554; men: n = 478) who recently returned from a war-zone deployment completed self-report measures of posttraumatic stress disorder (PTSD) symptoms, depression symptoms, and physical health functioning at 3 time points spanning approximately 7 years. Gender-stratified longitudinal cross-lagged panel analyses were used to examine bidirectional relationships. RESULTS PTSD symptom severity was negatively associated with physical health functioning across time. For women, associations were reciprocal, such that those reporting poorer physical health functioning reported more severe PTSD symptoms at later time points. Men with greater PTSD symptom severity reported poorer physical health functioning at later time points, but there was no evidence of bidirectionality. Men and women with more severe depression symptoms reported worse later physical health functioning, which further exacerbated depression symptoms across time. CONCLUSIONS Findings showed that individual differences in mental health symptoms both set the stage for and were impacted by physical health functioning in post-9/11 veterans. Although additional research is needed, the current study suggests that healthcare approaches that consider the whole person, such as through integration of mental and physical health treatments, may be particularly relevant for post-9/11 veterans.
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Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, Te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database Syst Rev 2021; 3:CD013522. [PMID: 33687070 PMCID: PMC8121093 DOI: 10.1002/14651858.cd013522.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. OBJECTIVES To examine the association between tobacco smoking cessation and change in mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow-up. Secondary outcomes included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS-I tool. For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). MAIN RESULTS We included 102 studies representing over 169,500 participants. Sixty-two of these were identified in the updated search for this review and 40 were included in the original version of the review. Sixty-three studies provided data on change in mental health, 10 were included in meta-analyses of incidence of mental health disorders, and 31 were synthesised narratively. For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD -0.28, 95% CI -0.43 to -0.13; 15 studies, 3141 participants; I2 = 69%; low-certainty evidence); depression symptoms: (SMD -0.30, 95% CI -0.39 to -0.21; 34 studies, 7156 participants; I2 = 69%' very low-certainty evidence); mixed anxiety and depression symptoms (SMD -0.31, 95% CI -0.40 to -0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence). These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time-varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD -0.19, 95% CI -0.34 to -0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%). AUTHORS' CONCLUSIONS Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.
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Affiliation(s)
- Gemma Mj Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amanda Farley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | | | - Katherine Sawyer
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | | | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Naomi King
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Chloe Burke
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Hu T, Xu S, Liu W. A senior high school-based survey on the long-term impact of the Wenchuan earthquake on survivors' quality of life: PTSD as a mediator. Psychiatry Res 2018; 270:310-316. [PMID: 30290316 DOI: 10.1016/j.psychres.2018.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
Previous earthquake-related studies mostly focused on the prevalence and risk factors of post-traumatic stress disorder (PTSD), and there are only a few articles on the subsequent long-term outcomes of earthquakes. This study aimed to investigate the long-term impact of the Wenchuan earthquake on the quality of life (QOL) of surviving senior high school students 2-3 years post-disaster and to clarify whether PTSD was a mediator in the relationship of earthquake-related exposure and QOL. The study collected 1031 survivors' self-report questionnaires on socio-demographic data, earthquake-related experiences, PTSD symptoms (PCL-C), and QOL (WHOQOL-BREF). The results showed that earthquake-related exposure experiences were negatively associated with QOL scores, and the severity of PTSD symptoms was significantly and negatively related to QOL scores. Structural equation model (SEM) analysis showed that earthquake-related exposure was directly related to the severity of PTSD symptoms, while insignificantly directly related to QOL. Therefore, earthquake-related exposure was indirectly related to QOL (totally mediated by severity of PTSD symptoms). PTSD was a mediator in the relationship between earthquake-related exposure and QOL among adolescents: earthquake-related exposure affected the survivors' QOL mainly mediated by the PTSD symptoms that developed. Therefore, to improve the QOL of the survivors after an earthquake, more attention should be paid to survivors who have PTSD symptoms.
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Affiliation(s)
- Ting Hu
- Faculty of Psychology and Mental Health, Second Military Medical University, Number 800, Xiangyin Road, Yangpu district, 200433 Shanghai, China
| | - Siyuan Xu
- Mathematics and Computational Science, Hunan First Normal University, Number 1015, Fenglin 3rd road, Yuelu district, 410000 Changsha, China
| | - Weizhi Liu
- Faculty of Psychology and Mental Health, Second Military Medical University, Number 800, Xiangyin Road, Yangpu district, 200433 Shanghai, China.
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Pericot-Valverde I, Elliott RJ, Miller ME, Tidey JW, Gaalema DE. Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis. Addict Behav 2018; 84:238-247. [PMID: 29753221 PMCID: PMC7285418 DOI: 10.1016/j.addbeh.2018.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/18/2018] [Accepted: 04/30/2018] [Indexed: 12/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) and tobacco use are prevalent conditions that co-occur at striking rates in the US. Previous reviews examined prevalence and factors associated with cigarette smoking among individuals with PTSD but have not been summarized since 2007. Moreover, none explored rates and factors associated with the use of other tobacco products. This study aimed to systematically review the most recent literature examining the comorbidity of PTSD and tobacco use to provide prevalence rates, as well as summarize the literature exploring other factors associated with tobacco use among individuals with PTSD. Studies were identified using a systematic search of keywords related to tobacco use and PTSD within the following databases: PubMed, PsycINFO, Web of Knowledge, CINAHL, PsycARTICLES, and Cochrane Clinical Trials Library. The studies included in this review (N = 66) showed that the prevalence of current use of tobacco products in individuals with PTSD was 24.0% and the rate of PTSD among users of tobacco products was 20.2%. Additionally, results demonstrated that individuals with PTSD present with high levels of nicotine dependence and heavy use of tobacco products, as well as underscore the importance of negative emotional states as a contributing factor to tobacco use among individuals with PTSD. It is imperative that future studies continue monitoring tobacco use among individuals with PTSD while also assessing factors identified as having a prominent role in tobacco use among individuals with PTSD. These findings also demonstrate the need for more innovative approaches to reduce the pervasive tobacco use among individuals with PTSD.
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Affiliation(s)
- Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States
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Li G, Wang L, Cao C, Fang R, Liu P, Luo S, Zhang J, Hall BJ, Elhai JD. DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors. Eur J Psychotraumatol 2018; 9:1468710. [PMID: 29736219 PMCID: PMC5933284 DOI: 10.1080/20008198.2018.1468710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/01/2018] [Indexed: 01/06/2023] Open
Abstract
It has been well-documented that posttraumatic stress symptoms cause impairments in health-related quality of life (HRQoL). Until now we have little data on how DSM-5 PTSD symptom dimensions relate to different aspects of HRQoL. Clarifying this question would be informative to improve the quality of life of PTSD patients. This study aimed to investigate the effects of dimensions of a well-supported seven-factor model of DSM-5 PTSD symptoms on physical and psychosocial HRQoL. A total of 1063 adult survivors of the 2008 Wenchuan earthquake took part in this study nine years after the disaster. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). HRQoL was measured by the Medical Outcomes Survey Short Form-36 (SF-36). The associations between PTSD symptom dimensions and HRQoL were examined using structural equation models. Dysphoric arousal symptoms were found to significantly relate to physical HRQoL. Other symptom dimensions were not associated with HRQoL. Our findings contribute to the relationship between DSM-5 PTSD and HRQoL, and carry implications for further clinical practice and research on trauma-exposed individuals.
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Affiliation(s)
- Gen Li
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chengqi Cao
- College of Psychology and Sociology, Shenzhen University, Shenzhen, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, China
| | - Shu Luo
- Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, China
| | - Jianxin Zhang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Brain J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Taipa, Macau (SAR) China.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA.,Department of Psychiatry, University of Toledo, Toledo, OH, USA
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Kelly MM, Jensen KP, Sofuoglu M. Co-occurring tobacco use and posttraumatic stress disorder: Smoking cessation treatment implications. Am J Addict 2015; 24:695-704. [PMID: 26584242 DOI: 10.1111/ajad.12304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/19/2015] [Accepted: 10/24/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- Megan M. Kelly
- Edith Nourse Rogers Memorial Veterans Hospital; Bedford Massachusetts
- Department of Psychiatry; University of Massachusetts Medical School; Worcester Massachusetts
| | - Kevin P. Jensen
- VA Connecticut Healthcare System; West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System; West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
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Abstract
Individuals with chronic pain often report using cigarettes to cope, and smoking and chronic pain appear prevalent among US veterans. Pain may be a barrier to cigarette cessation and abstinence in this population. Because of physiological effects, smoking cigarettes may also interfere with pain management. A better understanding of how cigarette use relates to pain may assist in veteran cigarette cessation and pain management efforts. To assist these efforts, we searched the literature using keywords, such as "pain," "smoking," and "veteran," to identify 23 journal articles published from 1993 to 2013 that reported on studies examining pain and smoking variables among military or veteran populations. Studies found that veterans reported using cigarettes to cope with pain, there was greater occurrence of pain and disability among smokers in the military, and smoking increased the odds of veterans receiving an opioid prescription for pain and misusing opioids. Studies also found increased odds of pain and smoking among Veterans Health Administration patients with post-traumatic stress disorder when compared with those without post-traumatic stress disorder. Studies support an interaction between pain and smoking among veterans. However, the mechanisms underlying this relationship remain unclear. Future studies focused on this interaction would benefit veteran populations.
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Heinzelmann M, Lee H, Rak H, Livingston W, Barr T, Baxter T, Scattergood-Keepper L, Mysliwiec V, Gill J. Sleep restoration is associated with reduced plasma C-reactive protein and depression symptoms in military personnel with sleep disturbance after deployment. Sleep Med 2014; 15:1565-70. [PMID: 25311836 DOI: 10.1016/j.sleep.2014.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/03/2014] [Accepted: 08/01/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Deployed military personnel are vulnerable to chronic sleep disturbance, which is highly comorbid with post-traumatic stress disorder (PTSD) and depression, as well as declines in health-related quality of life (HRQOL). Inflammation is associated with HRQOL declines and sleep-related comorbidities; however, the impact of sleep changes on comorbid symptoms and inflammation in this population is unknown. METHODS In this observational study, we examined the relationship between reported sleep changes and concentrations of inflammatory biomarkers, interleukin 6 (IL-6), and C-reactive protein (CRP) in peripheral blood. The sample was dichotomized into two groups: (1) decrease in Pittsburgh Sleep Quality Index (PSQI; restorative sleep) and (2) no change or increase in PSQI (no change). Mixed between-within subjects analysis of variance tests were used to determine group differences on changes of inflammation and comorbid symptoms. RESULTS In our sample of 66 recently deployed military personnel with insomnia, 34 participants reported restorative sleep whereas 32 reported no sleep changes. The two groups did not differ in demographic or clinical characteristics, with the exception of PTSD diagnosis at baseline. The restorative sleep group had significant reductions in CRP concentrations and depression symptoms, as well as reduced fatigue and improvements in emotional well-being, social functioning, and physical functioning at follow-up. CONCLUSIONS Military personnel who report sleep restoration after deployment have reduced CRP concentrations, decreased severity of depression, and improved HRQOL. These findings suggest that treatment for sleep disturbances may be associated with improvements in mental and physical health, thereby supporting continued study in this line of research.
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Affiliation(s)
- Morgan Heinzelmann
- National Institutes of Health, National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Hyunhwa Lee
- University of Nevada Las Vegas, 4505 Maryland Parkway, Box 453018, Las Vegas, NV 89154, USA.
| | - Hannah Rak
- National Institutes of Health, National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Whitney Livingston
- National Institutes of Health, National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Taura Barr
- West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Tristin Baxter
- Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA
| | - Lindsay Scattergood-Keepper
- National Institutes of Health, National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Vincent Mysliwiec
- Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA
| | - Jessica Gill
- National Institutes of Health, National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
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Gill J, Lee H, Barr T, Baxter T, Heinzelmann M, Rak H, Mysliwiec V. Lower health related quality of life in U.S. military personnel is associated with service-related disorders and inflammation. Psychiatry Res 2014; 216:116-22. [PMID: 24559851 DOI: 10.1016/j.psychres.2014.01.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/20/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
Military personnel who have combat exposures are at increased risk for the service-related disorders of post-traumatic stress disorder (PTSD), depression, sleep disturbances and decreased health related quality of life (HRQOL). Those with a traumatic brain injury (TBI) are at even greater risk. Inflammation is associated with these disorders and may underlie the risk for health declines. We evaluated 110 recently deployed, military personnel presenting with sleep disturbances for service-related disorders (TBI, PTSD, and depression) as well as HRQOL. ANOVA models were used to examine differences among military personnel with two or more service-related disorders (high comorbid group), or one or no disorders (low comorbid group). Logistic regression models were used to determine associations among interleukin-6 (IL-6) to HRQOL and service-related disorders. Approximately one-third of the sample had two or more service-related disorders. HRQOL was lower and IL-6 concentrations were higher in military personnel with PTSD or depression, with the most profound differences in those with more service-related disorders, regardless of sleep disorder. Having symptoms of depression and PTSD resulted in a 3.5-fold risk to be in the lower quartile of HRQOL and the highest quartile of IL-6. In a linear regression model, 41% of the relationship between HRQOL and IL-6 concentrations was mediated by PTSD and depression. Military personnel with PTSD and depression are at high risk for lower HRQOL, and higher IL-6 concentrations. Comprehensive treatment is required to address co-occurring service-related disorders in military personnel to promote health and well-being.
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Affiliation(s)
- Jessica Gill
- National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Hyunhwa Lee
- National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Taura Barr
- West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Tristin Baxter
- Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA
| | - Morgan Heinzelmann
- National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Hannah Rak
- National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA
| | - Vincent Mysliwiec
- Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA
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Veling W, Hall BJ, Joosse P. The association between posttraumatic stress symptoms and functional impairment during ongoing conflict in the Democratic Republic of Congo. J Anxiety Disord 2013; 27:225-30. [PMID: 23500002 PMCID: PMC4874641 DOI: 10.1016/j.janxdis.2013.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 12/08/2012] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
The Democratic Republic of Congo (DRC) has suffered from a bloody conflict for more than a decade. More than 5,400,000 people died from war-related causes since 1998 and exposure to violence was wide-spread. This study investigated the impact of posttraumatic stress disorder (PTSD) symptoms on perceived health and physical and social functioning, filling an important gap in the current literature. Data were collected from a sample of 93 adults living in Bunia, Eastern Democratic Republic of Congo. Structured in-person interviews included the PTSD section of the Composite International Diagnostic Interview and the World Health Organization Disability Assessment Scale. Additional questions were included to assess social resources. Study recruitment was balanced to achieve equal representation of both sexes and each quarter of town. Forty percent met symptom criteria for probable PTSD. Individuals with PTSD reported poor perceived general health and had high disability scores compared to those without PTSD. Of the three PTSD symptom clusters, hyperarousal was most strongly associated with disability. Individuals with PTSD were significantly more emotionally affected by their health problems than those without PTSD (85% versus 41%), had more difficulties in activities involving social contact (54% versus 16%) and in doing their daily work (54% versus 20%). The impact of war-related violence on mental health is severe in the DRC. Psychosocial interventions developed in conflict areas might be best targeted primarily to supporting social functioning and reducing hyperarousal. Implications for clinical treatment and future directions are discussed.
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Affiliation(s)
- Wim Veling
- Parnassia Group, The Hague, The Netherlands.
| | - Brian J. Hall
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health,, Baltimore, MD, USA
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