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Melani MS, Paiva JM, Mendlowicz MV, Vilete L, Luz MP, Ventura PR, Passos RBF, Berger W. Are There Differences Among Evidence-Based Psychotherapies for Treating Different DSM-5 PTSD Symptom Clusters? A Systematic Review and Meta-analysis of Controlled Clinical Trials. J Nerv Ment Dis 2024; 212:332-343. [PMID: 38810096 DOI: 10.1097/nmd.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
ABSTRACT Posttraumatic stress disorder (PTSD) is a heterogeneous disease defined by four Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) symptom clusters: reexperiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal. There are effective evidence-based psychotherapies (EBPs) for PTSD. However, given the variety of PTSD clinical presentations, we conducted the first meta-analysis investigating whether DSM-5 PTSD symptom clusters show different responses to EBPs. We systematically reviewed the literature for controlled clinical trials in five databases, performed a meta-analysis, and evaluated the methodological quality of the studies. We screened 633 studies and included seven. Three showed high risk, two showed some concerns, and one showed a low risk of bias. The symptom clusters do not seem to respond differently to EBPs (SMD cluster B: -0.40; 95% confidence interval [CI], -0.87 to 0.08; cluster C: -0.49; 95% CI, -0.90 to -0.08; cluster D: -0.44; 95% CI, -0.94 to 0.05; cluster E: -0.54; 95% CI, -1.07 to -0.0), even when analyzed by the therapeutic focuses. The findings dovetail nicely with the network theory of PTSD symptom, as although it is a heterogeneous disorder, the EBPs seem to promote a kind of cascade of symptom improvement.
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Affiliation(s)
- Marina S Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | - Jéssica M Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | | | - Liliane Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | - Mariana P Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | - Paula Rui Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | | | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
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Seligowski AV, Grewal SS, Abohashem S, Zureigat H, Qamar I, Aldosoky W, Gharios C, Hanlon E, Alani O, Bollepalli SC, Armoundas A, Fayad ZA, Shin LM, Osborne MT, Tawakol A. PTSD increases risk for major adverse cardiovascular events through neural and cardio-inflammatory pathways. Brain Behav Immun 2024; 117:149-154. [PMID: 38218349 PMCID: PMC10932910 DOI: 10.1016/j.bbi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
While posttraumatic stress disorder (PTSD) is known to associate with an elevated risk for major adverse cardiovascular events (MACE), few studies have examined mechanisms underlying this link. Recent studies have demonstrated that neuro-immune mechanisms, (manifested by heightened stress-associated neural activity (SNA), autonomic nervous system activity, and inflammation), link common stress syndromes to MACE. However, it is unknown if neuro-immune mechanisms similarly link PTSD to MACE. The current study aimed to test the hypothesis that upregulated neuro-immune mechanisms increase MACE risk among individuals with PTSD. This study included N = 118,827 participants from a large hospital-based biobank. Demographic, diagnostic, and medical history data collected from the biobank. SNA (n = 1,520), heart rate variability (HRV; [n = 11,463]), and high sensitivity C-reactive protein (hs-CRP; [n = 15,164]) were obtained for a subset of participants. PTSD predicted MACE after adjusting for traditional MACE risk factors (hazard ratio (HR) [95 % confidence interval (CI)] = 1.317 [1.098, 1.580], β = 0.276, p = 0.003). The PTSD-to-MACE association was mediated by SNA (CI = 0.005, 0.133, p < 0.05), HRV (CI = 0.024, 0.056, p < 0.05), and hs-CRP (CI = 0.010, 0.040, p < 0.05). This study provides evidence that neuro-immune pathways may play important roles in the mechanisms linking PTSD to MACE. Future studies are needed to determine if these markers are relevant targets for PTSD treatment and if improvements in SNA, HRV, and hs-CRP associate with reduced MACE risk in this patient population.
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Affiliation(s)
- Antonia V Seligowski
- Deparment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Simran S Grewal
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hadil Zureigat
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Iqra Qamar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wesam Aldosoky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erin Hanlon
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Omar Alani
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Antonis Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA; Broad Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Deparment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychology, Tufts University, Medford, MA, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Chen P, Zhang L, Feng Y, An FR, Su Z, Cheung T, Lok KI, Ungvari GS, Jackson T, Xiang YT, Zhang Q. Prevalence and network structure of post-traumatic stress symptoms and their association with suicidality among Chinese mental health professionals immediately following the end of China's Dynamic Zero-COVID Policy: a national survey. Transl Psychiatry 2023; 13:395. [PMID: 38102131 PMCID: PMC10724192 DOI: 10.1038/s41398-023-02680-3] [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: 05/11/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
Studies on post-traumatic stress symptoms (PTSS) among mental health professionals (MHPs) are limited, particularly since restrictions due to coronavirus disease (COVID-19) have been lifted such as the recent termination of China's Dynamic Zero-COVID Policy. The current study filled this gap by exploring the prevalence, correlates, and network structure of PTSS as well as its association with suicidality from a network analysis perspective. A cross-sectional, national survey was conducted using a convenience sampling method on MHPs between January 22 and February 10, 2023. PTSS were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian version, while suicidality was assessed using standardized questions related to ideation, plans, and attempts. Univariate and multivariate analyses examined correlates of PTSS. Network analysis explored the structure of PTSS and suicidality. The centrality index of "Expected influence" was used to identify the most central symptoms in the network, reflecting the relative importance of each node in the network. The "flow" function was adopted to identify specific symptoms that were directly associated with suicidality. A total of 10,647 MHPs were included. The overall rates of PTSS and suicidality were 6.7% (n = 715; 95% CI = 6.2-7.2%) and 7.7% (n = 821; 95% CI = 7.2-8.2%), respectively. Being married (OR = 1.523; P < 0.001), quarantine experience (OR = 1.288; P < 0.001), suicidality (OR = 3.750; P < 0.001) and more severe depressive symptoms (OR = 1.229; P < 0.001) were correlates of more PTSS. Additionally, higher economic status (e.g., good vs. poor: OR = 0.324; P = 0.001) and health status (e.g., good vs. poor: OR = 0.456; P < 0.001) were correlates of reduced PTSS. PCL6 ("Avoiding thoughts"; EI = 1.189), PCL7 ("Avoiding reminders"; EI = 1.157), and PCL11 ("Feeling emotionally numb"; EI = 1.074) had the highest centrality, while PCL12 ("Negative belief"), PCL 16 ("Hypervigilance") and PCL 14 ("Irritability") had the strongest direct, positive associations with suicidality. A high prevalence of lingering PTSS was found among MHPs immediately after China's "Dynamic Zero-COVID Policy" was terminated. Avoidance and hyper-arousal symptoms should be monitored among at-risk MHPs after the COVID-19 pandemic and serve as potential targets for the prevention and treatment of PTSS in this population.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ka-In Lok
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Mordeno IG, Luzano JGC. Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents. BMC Psychol 2023; 11:353. [PMID: 37875987 PMCID: PMC10594924 DOI: 10.1186/s40359-023-01389-8] [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: 12/17/2022] [Accepted: 10/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) construes PTSD symptoms into 4 clusters (intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity; Model 1). However, recent literature has shown that this symptom structure does not best represent PTSD. Unfortunately, the findings of studies investigating the proposed alternative models are from consensus. Adding to the complexity of the issue of symptom-grouping models is the identification of specific and non-specific symptoms of PTSD. The present study aims to address these gaps by identifying the best-fitting PTSD model and subsequently examining what symptoms are considered specific and non-specific to PTSD in adolescent-survivors of armed political conflict and violence. METHODS The study utilized a sample of 641 adolescent victim survivors. We conducted CFA analyses and compared nested models through the scaled χ2 difference test, while comparison of non-nested models was done using the Bayesian information criterion (BIC). The best-fitted model was used in the consequent analysis, where we statistically controlled for the effect of non-specific psychological distress on PTSD by comparing the factor loadings and factor correlations before and after accounting for distress using the Aroian z-test. RESULTS The results provide support for the 7-factor hybrid model of PTSD over other proposed models for the current sample. Moreover, the data reveal that only 7 items could be construed as core symptoms, while the rest of the symptoms can be considered non-PTSD specific. CONCLUSIONS Overall, the findings provide support for the validity of the hybrid PTSD model among political conflict-exposed adolescents. The results also show that the DSM-5 PTSD has both specific and non-specific features in the present sample of conflict-exposed adolescents. This has potential implications for theory, practice, and treatment of the disorder.
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Affiliation(s)
- Imelu G Mordeno
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines.
| | - Jelli Grace C Luzano
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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Fung HW, Chau AKC, Hung SL, Lam SKK, Chien WT, Lee VWP. Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms: a one-year follow-up study. Eur J Psychotraumatol 2023; 14:2263314. [PMID: 37818716 PMCID: PMC10569344 DOI: 10.1080/20008066.2023.2263314] [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: 05/04/2023] [Accepted: 08/04/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. OBJECTIVE This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. METHODS We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). RESULTS More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r = .286 to .528, p < .001) and longitudinally (r = .181 to .462, p < .001) correlated with depressive symptoms. A sense of current threat (β = .146, p < .05) and negative self-concept (β = .173, p < .05) at baseline significantly predicted depressive symptoms after one year. CONCLUSIONS These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Anson Kai Chun Chau
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Valentine SE, Alshabani N, Godfrey LB, Paul E, Clark C, Giovannini K, Nillni YI. Considerations for the provision of PTSD treatment among pregnant women with substance use histories: A clinical conceptual model based on case consultation field notes. Gen Hosp Psychiatry 2023; 84:3-11. [PMID: 37270989 PMCID: PMC10527811 DOI: 10.1016/j.genhosppsych.2023.05.013] [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: 01/13/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Increasing prevalence of substance use in pregnancy presents a public health crisis that is compounded by posttraumatic stress disorder (PTSD) comorbidity. We aimed to detail the clinical complexities of PTSD treatment provision among pregnant women with substance use histories. METHODS We conducted a qualitative study using clinical case consultation field notes (N = 47 meetings) which were gathered during a hybrid effectiveness-implementation pilot study of Written Exposure Therapy (WET) for PTSD among pregnant women seen in an obstetrics-SUD clinic [2019-2021]. Patient baseline survey data (N = 25) were used to characterize the sample and contextualize engagement. RESULTS Participants were exposed to a high number of trauma/adversity event types. There was no association between number of trauma/adversity event types and treatment response or dropout. Qualitative findings revealed clinical features relevant to PTSD treatment, including multi-system involvement; parental trauma and substance use; relevance of substance use to trauma context and posttraumatic cognitions, emotions, and behaviors; impact of trauma on experiences of pregnancy, attachment, and child rearing; limited social networks placing women at risk of ongoing violence; and experiences of substance use discrimination. CONCLUSION PTSD treatment among pregnant women with substance use histories is highly important to maternal-child health.
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Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine Boston MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Nuha Alshabani
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Caitlin Clark
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Karissa Giovannini
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yael I Nillni
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine Boston MA, USA; National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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Fung HW, Chien WT, Lam SKK, Ross CA. Investigating post-traumatic stress disorder (PTSD) and complex PTSD among people with self-reported depressive symptoms. Front Psychiatry 2022; 13:953001. [PMID: 36339839 PMCID: PMC9627202 DOI: 10.3389/fpsyt.2022.953001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Trauma has been increasingly linked to depression. Previous studies have suggested that comorbid post-traumatic stress disorder (PTSD) may be associated with poor outcomes in depression treatment. However, the prevalence and correlates of ICD-11 PTSD and complex PTSD (CPTSD) in people with depression remain unclear. METHODS This study examined the prevalence and correlates of ICD-11 PTSD and CPTSD in an online convenience sample of 410 adults from 18 different countries/regions who reported clinically significant levels of depressive symptoms (indicated by a Patient Health Questionnaire-9 score ≥10). RESULTS According to the International Trauma Questionnaire results, 62.68% of participants met the ICD-11 criteria for PTSD/CPTSD (5.6% PTSD, 57.1% CPTSD). Participants with CPTSD reported more types of trauma and higher levels of interpersonal stress than those without PTSD. Participants with CPTSD also reported higher levels of mental health problems, including depressive, dissociative and psychotic symptoms, than those without PTSD. Only disturbances in self-organization (DSO) symptoms but not classical PTSD symptoms had a significant relationship with depressive symptoms, when other major variables (including trauma, interpersonal stress, and comorbid psychotic and dissociative symptoms) were controlled for. CONCLUSIONS Trauma-related symptoms should be regularly screened for in clients who report depressive symptoms. Depressed clients who have comorbid trauma disorders have more trauma and interpersonal stress and exhibit more severe mental health problems. They may require specific trauma-focused interventions in addition to standard depression treatments.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, TX, United States
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Wang K, Zhang A, Cuevas AG, De Fries CM, Hinton L, Falcón LM. The Association Between Post-Traumatic Stress and Depressive Symptoms Among Older Puerto Ricans in Boston: How Does Loneliness Matter? J Aging Health 2021; 34:786-793. [PMID: 34949131 DOI: 10.1177/08982643211064123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the association between post-traumatic stress and depression and whether such an association differs by level of loneliness among older Puerto Ricans. METHODS Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, loneliness, and depressive symptoms. RESULTS Post-traumatic stress was significantly associated with higher levels of depression. The association between post-traumatic stress and depression was stronger for those experiencing a higher degree of loneliness. DISCUSSION In working with older Puerto Ricans experiencing post-traumatic stress, it is important for mental health professionals to incorporate the assessment of loneliness and to prevent and reduce comorbid depression by addressing loneliness through improving social skills, enhancing social support, and reducing maladaptive social cognition.
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Affiliation(s)
- Kaipeng Wang
- Graduate School of Social Work, 2927University of Denver, CO, USA
| | - Anao Zhang
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
| | - Adolfo G Cuevas
- Department of Community Health, 1810Tufts University, Medford, MA, USA
| | | | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, 8789University of California Davis, CA, USA
| | - Luis M Falcón
- College of Fine Arts, Humanities, and Social Sciences, 14710University of Massachusetts Lowell, MA, USA
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10
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Klein Breteler J, Ikani N, Becker ES, Spijker J, Hendriks G. Comorbid depression and treatment of anxiety disorders, OCD, and PTSD: Diagnosis versus severity. J Affect Disord 2021; 295:1005-1011. [PMID: 34706408 DOI: 10.1016/j.jad.2021.08.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/10/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although anxiety and depression are highly comorbid disorders, it remains unclear whether and how a concurrent depression affects the outcome of anxiety treatment. METHOD Using anonymized routine outcome monitoring (ROM) data of 740 patients having received specialized treatment for an anxiety disorder, OCD, or PTSD, this study investigates whether a comorbid diagnosis of depression and/or self-reported depression severity levels relate to the patients' improvement following anxiety treatment. RESULTS The results show that both the patients with and those without comorbid depression had profited similarly from the anxiety, OCD, or PTSD treatment, regardless of whether depression was merely diagnosed prior to treatment or based on self-reported severity (and assuming a smallest effect size of interest of d = 0.35/r = .2). Importantly, the post-treatment reductions in self-reported depressive symptoms were strongly and positively related to the reductions in self-reported anxiety symptoms and disorder-related disability. LIMITATIONS Causal inferences cannot be made due to the retrospective cross-sectional design. CONCLUSIONS The outcomes obtained in a naturalistic patient sample support current treatment guidelines recommending evidence-based treatment for anxiety disorders, OCD, and PTSD in patients with and without a comorbid depression. Future treatment studies are recommended for investigate the (bi)directionality of anxiety and depressive symptoms throughout treatment.
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Affiliation(s)
- J Klein Breteler
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Overwaal, Center of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands.
| | - N Ikani
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Overwaal, Center of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands; Center of Expertise for Depression, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands
| | - E S Becker
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands
| | - J Spijker
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Center of Expertise for Depression, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands
| | - G Hendriks
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Overwaal, Center of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands
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Youngstedt SD, Kline CE, Reynolds AM, Crowley SK, Burch JB, Khan N, Han S. Bright Light Treatment of Combat-related PTSD: A Randomized Controlled Trial. Mil Med 2021; 187:e435-e444. [PMID: 33511988 DOI: 10.1093/milmed/usab014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a prevalent consequence of combat with significant associated morbidity. Available treatments for PTSD have had limitations, suggesting a need to explore alternative or adjuvant treatments. Numerous rationales for bright light treatment of PTSD include its benefits for common PTSD comorbidities of depression, anxiety, and circadian misalignment and its relative ease of use with few side effects. The primary aims of this research were to examine the effects of bright light treatment for combat-related PTSD and associated morbidity. MATERIALS AND METHODS A randomized controlled trial was performed in N = 69 veterans with PTSD attributable to combat in Afghanistan and/or Iraq. Following a 1-week baseline, participants were randomized to 4 weeks of daily morning bright light treatment (10,000 lux for 30 min/day) or a control treatment (inactivated negative ion generator). At baseline and at the end of treatment, participants were rated blindly on the Clinician Assessed PTSD Scale (CAPS), the Clinical Global Impressions Scale (CGI), and the Hamilton Depression Scale and rated themselves on the PTSD Checklist-Military (PCL-M). Following baseline and each treatment week, participants completed self-reported scales of state anxiety, depression, and sleep, and sleep and the circadian rhythm of wrist activity were also assessed with wrist actigraphy. RESULTS Compared with the control treatment, bright light elicited significantly greater improvements in the CAPS and CGI-Improvement. The bright light also elicited a significantly greater rate of treatment response (reduction ≥33%) for the CAPS (44.1% vs. 8.6%) and PCL-M (33% vs. 6%), but no participant had remission from PTSD. Changes in depression, anxiety, and sleep did not differ between treatments. Improvement in CAPS was significantly correlated with a phase advance of the circadian rhythm of wrist activity. CONCLUSIONS The most comprehensive study on the topic to date indicated significant short-term efficacy of bright light treatment on the primary variables (CAPS and CGI) with clinical relevance (i.e., treatment response) in veterans with chronic PTSD who did not report extremely high habitual light exposure. No significant effects were found for anxiety, depression, or sleep disturbance. Further research is warranted, particularly exploration of circadian phase-shifting mechanisms of bright light for PTSD.
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Affiliation(s)
- Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.,Phoenix VA Health Care System, Phoenix, AZ 85012, USA
| | - Christopher E Kline
- Department of Health and Human Development, Research Service, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Alexandria M Reynolds
- Department of Psychology, University of Virginia's College at Wise, Wise, VA 24293, USA
| | - Shannon K Crowley
- Department of Exercise Science, Department of Health Promotion, North Carolina Wesleyan College, Rocky Mount, NC 27804, USA
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA
| | - Nidha Khan
- Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - SeungYong Han
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
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