Post-traumatic Stress Disorder, Race/Ethnicity, and Coronary Artery Disease Among Older Patients with Depression

Genetic correlation and causality assessment between post-traumatic stress disorder and coronary artery disease-related traits

Consistent evidence from observational studies supports a risk-increasing association between post-traumatic stress disorder (PTSD) and coronary artery disease (CAD); however, the mechanisms underlying their relationship remain poorly understood. This study assesses the genetic correlation and potential causal relationship between PTSD and CAD-related traits. We analysed genome-wide associated study summary data of PTSD (cases = 23,212, controls = 151,447) with CAD-related traits (sample size up to 408,458 individuals) to achieve our study objectives. Findings revealed a significant and positive genetic correlation between PTSD and CAD (r_G = 0.19, p = 3.47 × 10-2), and between PTSD and CAD traits of ischemic heart disease (genetic correlation [r_G] = 0.42, p = 5.17 × 10^-10), coronary arteriosclerosis (r_G = 0.32, p = 3.78 × 10^-7), and angina pectoris (r_G = 0.48, p = 1.14 × 10^-9). However, Mendelian randomisation (MR) analysis found no evidence for a significant causal association between PTSD and CAD traits, regardless of analysis direction (PTSD or CAD traits as the exposure or outcome variable). Findings from MR sensitivity analyses were consistent, suggesting that genetic liability to PTSD has no causal influence on any CAD trait and vice versa. In summary, our study provides evidence implicating a positive genetic correlation between PTSD with CAD-related traits, supporting evidence of a risk-increasing but non-causal association between them.

Residential Segregation, Social Cohesion, and Aging in Place: Health and Mental Health Inequities

BACKGROUND AND OBJECTIVES

Research shows that living in segregated neighborhoods may have deleterious health outcomes via social, physical, and socioeconomic contexts that deepen existing inequities. However, there has been limited scholarship examining the effects of segregation on older adults, despite an increasing focus on aging in place. Guided by the Ecological Model of Aging, we examined the effects of segregation on older adults' self-rated health and mental health, accounting for both individual characteristics and neighborhood opportunities and risks (e.g., social cohesion) and the potential moderating role of race and economic vulnerability.

RESEARCH DESIGN AND METHODS

We used data from the first four rounds of the National Health & Aging Trends Study (2011-2014) merged with tract-level census data for a final sample size of 3084 community-dwelling older adults in urban areas. We conducted multivariate regression analyses after conditioning on residential location selection variables.

RESULTS

There was no significant association between neighborhood segregation and self-rated health or between segregation and anxiety and depression symptoms. Consistent with the literature, perceived social cohesion was protective of health in each model.

DISCUSSION AND IMPLICATIONS

Our findings highlight the need for more rigorous research on segregation and older residents that utilize longitudinal and spatial data. Our findings also have implications for policies and programs that aim to support the ability to age in place for older adults who have different racial identities and live in different neighborhood contexts. Since social cohesion can be a protective factor for older adults' health and mental health, policymakers and practitioners should support initiatives to increase social cohesion.

American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors

PURPOSE

The top causes of death for American Indians (AIs), including heart and liver disease, are associated with alcohol use. Using the culturally based Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this article was to examine AI alcohol use from a sex-specific wellness approach, exploring its associated physical, behavioral, and mental risk and protective factors.

METHOD

Data were drawn from a cross-sectional survey with 479 AI adults in South Dakota. We employed a series of multiple hierarchical regression analyses to assess the associations of demographic (sex, age, marital status, income, and educational attainment), physical (Body Mass Index and cardiovascular risk), behavioral (smoking and health self-efficacy) and mental (depressive symptoms) factors with alcohol use.

RESULTS

Results indicated that surveyed males tended to drink three times that of females, and depressive symptoms were associated with higher levels of alcohol use.

DISCUSSION

This study highlights the need to examine AI alcohol use with sex in mind.

Cardiovascular Health among U.S. Indigenous Peoples: A Holistic and Sex-Specific Systematic Review

PURPOSE

The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples.

METHODS

A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n= 15; Sociocultural, n =17; Behavioral/Physical, n =19).

RESULTS

This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment-including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors.

DISCUSSION

Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.

The Framework of Historical Oppression, Resilience and Transcendence to Understand Disparities in Depression Amongst Indigenous Peoples

Given chronic experiences of historical oppression, Indigenous peoples tend to experience much higher rates of depression than the general US population, which then, drives disproportionately high rates of suicide and other health disparities. The purpose of this research was to examine the core components of the culturally grounded Framework of Historical Oppression, Resilience, and Transcendence as they relate to depressive symptoms experienced by Indigenous peoples. As part of a larger convergent mixed-methods study, in this quantitative survey component, we utilised data from a sample of 127 Indigenous adults across two Southeastern US tribes. Regression analysis results signified support for the framework, indicating that historical oppression and proximal stress (daily stressors and lower incomes) were risk factors, whereas family resilience and life satisfaction (a measure of transcendence) were protective factors related to depressive symptoms. The results provide a foundation for future research to build upon in identifying culturally relevant risk and protective factors to ameliorate depression and other health disparities.

Association of Post-Traumatic Stress Disorder Symptoms Following Hurricane Katrina With Incident Cardiovascular Disease Events Among Older Adults With Hypertension

OBJECTIVE

To determine the association of post-traumatic stress disorder (PTSD) symptoms following Hurricane Katrina with incident cardiovascular disease (CVD) events in older, hypertensive, community-dwelling adults both overall and stratified by age, sex, and race.

METHODS

This was a prospective cohort study performed in Southeastern Louisiana 12-24 months following Hurricane Katrina through February 2011. Participants were community-dwelling older adults (n = 2,073) enrolled in the Cohort Study of Medication Adherence Among Older Adults with no known history of CVD events. PTSD symptoms were assessed via telephone interview 12-24 months following Hurricane Katrina using the PTSD CheckList-Specific Version. The presence of PTSD symptoms was defined by scores greater than or equal to 37. Incident CVD events (stroke, myocardial infarction, hospitalization for congestive heart failure, or CVD death) were identified and adjudicated over a median 3.8-year follow-up period.

RESULTS

Overall, 8.6% of participants screened positive for PTSD symptoms, and 11.6% had an incident CVD event during follow-up. PTSD symptoms were associated with an adjusted hazard ratio (aHR) for CVD events of 1.7 (95% confidence interval [CI], 1.1, 2.6). The association was present among blacks (aHR, 3.3, 95% CI, 1.7, 6.3) but not whites (aHR, 0.9, 95% CI, 0.4, 1.9); the interaction of PTSD symptoms and race on CVD events was statistically significant.

CONCLUSION

PTSD symptoms following Hurricane Katrina were associated with a higher risk of incident CVD in older adults with hypertension, with a stronger association in blacks compared with whites.

Racial Differences in the Associations of Posttraumatic Stress and Insomnia With Body Mass Index Among Trauma-Exposed Veterans

Posttraumatic stress is associated with increased body mass index (BMI) and rates of obesity. Black adults are at greater risk for obesity, trauma exposure, development of posttraumatic stress disorder, and comorbid sleep problems compared to White adults. Accordingly, Black adults with a history of trauma exposure may be at greater risk for elevated BMI associated with posttraumatic stress and insomnia. Multiple linear regression was used to examine race as a moderator of the relationship between posttraumatic symptoms and insomnia with BMI in a sample of Black and White trauma-exposed Veterans (N = 171), controlling for age and sex. There was a significant interaction of race with PTSD (p = 0.042) and insomnia symptoms (p = 0.045) on BMI. Simple slopes showed a significant positive association of posttraumatic stress and BMI among Black (p = 0.003), but not White Veterans (p = 0.590). Similarly, insomnia was significantly associated with greater BMI for Black (p = 0.023), but not White Veterans (p = 0.496). Posttraumatic stress and insomnia may play a particularly important role in the development of weight related health problems among Black Veterans. Early identification and treatment of these symptoms may reduce the risk of obesity among this vulnerable population.

Depressive Symptoms Increase the Risk of Mortality for White but Not Black Older Adults

Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality is not similar across racial groups. The current study uses data from a national study of Black and White older adults to examine racial differences in the effect of baseline depressive symptoms on mortality risk over three years in the United States. Methods. This study used a longitudinal prospective design and followed 1493 older adults who were either White (n = 759) or Black (n = 734) for three years from 2001 to 2004. Depressive symptoms measured at baseline was the independent variable. Demographic factors, socio-economic characteristics (education, income, marital status), health behaviors (smoking and drinking), and health (self-rated health) measured at baseline in 2001 were covariates. The dependent variable was all-cause mortality between 2001 and 2004. Race was the moderator. Logistic regressions were used for data analysis. Results. In the pooled sample, high depressive symptoms at baseline were not associated with the three-year risk of mortality. In the pooled sample, we found a significant interaction between race and depressive symptoms on mortality, suggesting a stronger effect for Whites in comparison to Blacks. In race stratified models, depressive symptoms at baseline were predictive of mortality risk for Whites, but not Blacks. Conclusions. In the United States, Black-White differences exist in the effects of depressive symptoms on mortality risk in older adults. White older adults may be more vulnerable to the effects of depressive symptoms on mortality risk.