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Marsden J, Saunders L, Harman JJ. Pilot study of parental alienation items in the adverse childhood experiences scale. J Affect Disord 2024; 367:715-744. [PMID: 39245223 DOI: 10.1016/j.jad.2024.09.001] [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: 09/28/2023] [Revised: 06/25/2024] [Accepted: 09/01/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) and Parental Alienation (PA)are forms of adverse events negatively affecting children globally. The current study was to identify a revised ACEs measure that includes a screening item for PA. METHODS A total of 231 undergraduate students, ages 18 to 37, were surveyed for this analysis. A factor analyses was performed to identify what PA item, out of four, would correlate most strongly with existing ACEs scale items. Convergent and divergent validity was assessed. An exploratory factory analyses was conducted to identify factor structure of scale items and a confirmatory factory analysis of extracted factors was used to assess model fit. RESULTS Over half (60 %) of the sampled population reported at least one ACEs item. All four PA items were significantly correlated with converging constructs (r = 0.68, p < .01). Out of four PA items, one PA item significantly outperformed the other three items in relation to convergent validity and was used to create a new ACEs-PA scale item (r = 0.33, p < .01). A two factor solution was identified with the new PA item loading, accounting for 35 % of the variance, explaining more variance in both outcomes (R2 = 0.43 and R2 = 0.16) than the original ACEs scale when comparing the adjusted R2 values (R2 = 0.35 and R2 = 0.13). Limitations This study used participant self-reporting methods subjecting it to retrospective bias. CONCLUSION Within the population, the new PA item factored significantly with existing ACEs, suggesting the capture of an additional adverse childhood experience.
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Affiliation(s)
- Joshua Marsden
- Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523-1876, United States of America.
| | - Luke Saunders
- Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523-1876, United States of America
| | - Jennifer J Harman
- Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523-1876, United States of America
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Sullivan KS, Park Y, Richardson S, Stander V, Jaccard J. The role of problem solving appraisal and support in the relationship between stress exposure and posttraumatic stress symptoms of military spouses and service member partners. Stress Health 2024; 40:e3371. [PMID: 38183368 PMCID: PMC11285057 DOI: 10.1002/smi.3371] [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: 05/16/2023] [Revised: 11/15/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
Using a stress process lens, this paper considers the interrelationship between individual and family-level stress exposures and military spouse resources, including problem-solving appraisals and problem-solving support (PSS), and their associations with posttraumatic stress symptoms (PTSS) among both partners in military marital dyads. The study employs data from the Millennium Cohort Family Study, a longitudinal survey of married military dyads, with an initial panel of 9,872 spouses enroled from 2011 to 2013. A structural equation model explored the associations between service member and spouse childhood maltreatment exposure, nonmilitary and military stressors, as well as interactions with spouse resources on self-reported PTSS among both service member (SM) and spouse (SP). Among our findings, spouse childhood maltreatment muted later self-reported problem-solving appraisal and support. Spouse resources, in turn, had both protective (problem-solving appraisal) and promotive (problem-solving support) effects on PTSS for both service members and spouses. These findings emphasise the central role of spouses in military families, as more psychological resources among spouses appeared to buffer against the deleterious effects of stress exposure on both their own and their partners mental health.
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Affiliation(s)
| | - Yangjin Park
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Sabrina Richardson
- Center For Deployment Health Research, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Valerie Stander
- Center For Deployment Health Research, Naval Health Research Center, San Diego, California, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, New York, USA
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3
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Dodge J, Sullivan K, Miech E, Clomax A, Riviere L, Castro C. Exploring the Social Determinants of Mental Health by Race and Ethnicity in Army Wives. J Racial Ethn Health Disparities 2024; 11:669-684. [PMID: 36952121 PMCID: PMC10933139 DOI: 10.1007/s40615-023-01551-3] [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: 07/12/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To explore the social determinants of mental health (SDoMH) by race/ethnicity in a sample with equal access to healthcare. Using an adaptation of the World Health Organization's SDoMH Framework, this secondary analysis examines the socio-economic factors that make up the SDoMH by race/ethnicity. METHOD This paper employed configurational comparative methods (CCMs) to analyze various racial/ethnic subsets from quantitative survey data from (N = 327) active-duty Army wives. Data was collected in 2012 by Walter Reed Army Institute of Research. RESULTS Initial exploratory analysis revealed the highest-scoring factors for each racial/ethnic subgroup: non-Hispanic Black: employment and a history of adverse childhood events (ACEs); Hispanic: living off post and a recent childbirth; junior enlisted non-Hispanic White: high work-family conflict and ACEs; non-Hispanic other race: high work-family conflict and not having a military history. Final analysis showed four models consistently explained clinically significant depression symptoms and four models consistently explained the absence of clinical depression symptoms, providing a solution for each racial/ethnic minority group (non-Hispanic Black, Hispanic, junior enlisted non-Hispanic White, and non-Hispanic other). DISCUSSION These findings highlight that Army wives are not a monolithic group, despite their collective exposure to military-specific stressors. These findings also highlight the potential for applying configurational approaches to gain new insights into mental health outcomes for social science and clinical researchers.
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Affiliation(s)
- Jessica Dodge
- Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Kathrine Sullivan
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Edward Miech
- Regenstrief Institute, Center for Health Services Research, 1101 W 10th Street, Indianapolis, IN, 46202, USA
| | - Adriane Clomax
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
| | - Lyndon Riviere
- Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Carl Castro
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
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Gomes KD, Collette TL, Schlenk M, Judkins J, Sanchez-Cardona I, Channer B, Ross P, Fredrick G, Moore BA. Posttraumatic Stress Disorder, Suicidal ideation, and Stress: The Moderating Role of Dysfunctional and Recovery Cognitions. Arch Suicide Res 2024; 28:569-584. [PMID: 37073774 DOI: 10.1080/13811118.2023.2199798] [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] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Trauma and stressor-related behavioral health conditions are prevalent in military populations and have become a major public health concern in recent years. Individuals who commonly report suicidal ideation often have comorbid mental health diagnoses (i.e., posttraumatic stress disorder; PTSD). However, the mechanisms associated with stress, suicidal ideation, and PTSD are unclear. METHOD The present study examined the moderating role of dysfunctional and recovery cognitions between (i) PTSD and suicidal ideation, and (ii) stress and suicidal ideation in two distinct samples. Sample 1 was composed of civilians and military personnel (N = 322). Sample 2 was composed of (N = 377) student service members and veterans (SSM/Vs). RESULTS In Study 1, we found that low recovery cognitions at higher and moderate levels of PTSD symptoms were significantly associated with increased suicidal ideation. High dysfunctional cognitions were significantly associated with suicidal ideation at higher levels of PTSD symptoms. In Study 2, we found no differences in any level of recovery cognitions at low and moderate stress levels with suicidal ideation. Higher levels of stress were associated with high dysfunctional cognitions and suicidal ideation. CONCLUSION Promoting higher levels of recovery cognitions and reducing dysfunctional cognitions are important in addressing stress, suicidal ideation, and comorbid conditions such as PTSD. Future research should focus on examining the clinical utility of the Dispositional Recovery and Dysfunction Inventory (DRDI) in other populations (i.e., firefighters and paramedics). This could contribute to efforts of suicide prevention and the promotion of the well-being of individuals experiencing suicidal ideation.
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Caetano R, Cunradi C, Ponicki WR, Alter HJ. Gender moderates the association between posttraumatic stress disorder and mutual intimate partner violence in an emergency department sample. Acad Emerg Med 2024; 31:140-148. [PMID: 37881095 PMCID: PMC10922112 DOI: 10.1111/acem.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Patients in emergency departments (EDs) constitute a diverse population with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at-risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample. METHODS Research assistants surveyed 1037 married, cohabiting, or partnered patients in face-to-face interviews (87% response rate) regarding IPV exposure, alcohol and drug use, psychological distress, ACEs, and other sociodemographic features. IPV was measured with the Revised Conflict Tactics Scale. Interaction effects were examined in multinomial and logistic models. RESULTS Results showed a significant interaction of gender and PTSD (odds ratio [OR] 3.06, 95% CI 1.21-7.23, p < 0.05) for mutual IPV. Regarding main effects, there were also statistically significant positive associations between mutual physical IPV and at-risk drinking (OR 1.73, 95% CI 1.07-2.77, p < 0.05), having a hazardous drinker partner (OR 2.19, 95% CI 1.35-3.55, p < 0.01), illicit drug use (OR 2.09, 95% CI 1.18-3.71, p < 0.01), ACEs (OR 1.23, 95% CI 1.06-1.42, p < 0.01), days of cannabis use past in the 12 months (OR 1.003, 95% CI 1.002-1.005, p < 0.001), and impulsivity (OR 2.04, 95% CI 1.29-3.22, p < 0.01). CONCLUSIONS IPV risk assessment in EDs will be more effective if implemented with attention to patients' gender and the presence of various and diverse other risk factors, especially PTSD.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA 94704, USA
| | - Carol Cunradi
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA 94704, USA
| | - William R. Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA 94704, USA
| | - Harrison J. Alter
- Andrew Levitt Center for Social Emergency Medicine, Highland Hospital, Oakland CA, U.S.A
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Nazarov A, Fikretoglu D, Liu A, Born J, Michaud K, Hendriks T, Bélanger SA, Do MT, Lam Q, Brooks B, King K, Sudom K, Jetly R, Garber B, Thompson M. Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics. JMIR Res Protoc 2023; 12:e44299. [PMID: 37676877 PMCID: PMC10629501 DOI: 10.2196/44299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19-related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. OBJECTIVE This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. METHODS A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. RESULTS CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. CONCLUSIONS The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF-specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44299.
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Affiliation(s)
- Anthony Nazarov
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- HumanSystems Inc, Guelph, ON, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Aihua Liu
- HumanSystems Inc, Guelph, ON, Canada
| | - Jennifer Born
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Kathy Michaud
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Tonya Hendriks
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | | | - Minh T Do
- Directorate of Mental Health, Canadian Forces Health Services, Department of National Defence, Ottawa, ON, Canada
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quan Lam
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Brenda Brooks
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Kristen King
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Department of National Defence, Ottawa, ON, Canada
| | - Bryan Garber
- Directorate of Mental Health, Canadian Forces Health Services, Department of National Defence, Ottawa, ON, Canada
| | - Megan Thompson
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
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Leontopoulou S. Aftermath of the COVID-19 Pandemic: Resilience and Mental Health of Emerging Adult University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6911. [PMID: 37887649 PMCID: PMC10606035 DOI: 10.3390/ijerph20206911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
This study explored the relationship between COVID-19 impacts and resilience in emerging adulthood during the final two months of the pandemic. It aimed to examine whether mental health symptoms moderated this relationship. In total, 205 university students completed an online questionnaire survey. Regression analysis was used to examine the prediction of resilience by pandemic-related impacts, and moderation analysis was used to explore the potential moderating effect of mental health on the relationship between impacts and resilience. The findings failed to confirm the hypothesis that total COVID-19 impacts would predict resilience. Rather, resource-type impacts predicted resilience [B = 0.17, p < 0.5]. Significant partial correlations found among resource, financial, and psychological impacts may go some way toward clarifying connections between impacts and resilience [for resource-type impact with financial-type impact, r = 0.48, p < 0.01; for resource-type impact with psychological impact, r = 0.22, p < 0.01]. The results confirmed the hypothesis that mental health symptoms would moderate the relationship between pandemic impacts and resilience [for the overall model, R = 0.41, ΔR2 = 0.16, MSE = 0.76, F (4, 200) = 10.19, p < 0.001; for the interaction between total COVID impacts and resilience, ΔR2 = 0.017, F (1, 200) = 3.98, p < 0.05]. Thus, emerging adult students with low or moderate levels of symptomatology were more resilient, independently of the level of pandemic-related stressors they faced. Those experiencing higher levels of mental health symptoms, in tandem with high levels of pandemic-related impacts, exhibited increasingly higher resilience levels [b = 0.17, 95% CI [0.02, 0.32], t = 2.26, p = 0.025]. These youths may be better equipped to handle severe stress and adversity thanks to skills and resources they possess and are experienced in using. The implications of these findings for each group of young people are discussed for their usefulness in directing future research and interventions to foster resilience during current and future crises and health pandemics.
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Affiliation(s)
- Sophie Leontopoulou
- Department of Primary Education, University of Ioannina, 45110 Ioannina, Greece
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Sullivan KS, Park Y, Richardson S, Cederbaum J, Stander V, Jaccard J. Early and recent military and nonmilitary stressors associated with posttraumatic stress symptoms among military service members and their spouses. J Trauma Stress 2023; 36:943-954. [PMID: 37467117 PMCID: PMC10592439 DOI: 10.1002/jts.22958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023]
Abstract
Disparities in posttraumatic stress symptoms (PTSS) have been observed among military service members (SMs) and spouses (SPs) compared to their civilian peers, but exposure to military stressors does not adequately explain observed differences. Using a stress process framework, this study considered the associations between early and recent military and nonmilitary stressors and PTSS among SMs and SPs. We analyzed data from 3,314 SM-SP dyads in the Millennium Cohort and Millennium Cohort Family Studies. Accounting for covariates, multiple linear regression and dominance analyses were employed to consider the effects of SM and SP childhood maltreatment, recent nonmilitary stressors (e.g., financial difficulties), and recent military stressors (e.g., deployment) on their own and their partner's self-reported PTSS. For both SMs and SPs, childhood maltreatment was the strongest predictor of their own PTSS, followed by nonmilitary stressors. Couple crossover dynamics were evident as SP maltreatment and nonmilitary stressors significantly predicted SM PTSS, and SM maltreatment predicted SP PTSS. Maltreatment also multiplied the effects of SM, product term B = 0.92, p = .031, and SP, product term B = 0.75, p = .004, nonmilitary stressors. The findings emphasize the essential role of exposure to early adversity in understanding PTSS among SMs and SPs, as childhood maltreatment strongly predicted PTSS and exacerbated the effects of other stressors on PTSS. Providers should assess for early adversity among both SMs and SPs and consider the provision of services at the couple level given the potential for the transmission of stress within couples.
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Affiliation(s)
| | - Yangjin Park
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Sabrina Richardson
- Center for Deployment Health Research, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Julie Cederbaum
- Suzanne Dworak-Peck School of Social Work; University of Southern California, Los Angeles; Los Angeles, California, USA
| | - Valerie Stander
- Center for Deployment Health Research, Naval Health Research Center, San Diego, California, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, New York, USA
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Elisseou S. Trauma-Informed Care: A Missing Link in Addressing Burnout. J Healthc Leadersh 2023; 15:169-173. [PMID: 37637484 PMCID: PMC10455772 DOI: 10.2147/jhl.s389271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
The Covid-19 pandemic and national movements for health equity have highlighted the impact of trauma on public health as well as on health worker well-being. As burnout rates across healthcare climb, we seek creative and effective solutions. Current anti-burnout strategies focus on much needed systems solutions for employee success; however, they often lack a trauma-informed approach. Trauma is highly prevalent in society at large, and health workers are further exposed to trauma in the course of their professional studies and duties. Common symptoms of burnout may actually be manifestations of traumatic stress. Trauma-informed care (TIC) is a strategic framework and growing social movement for providing quality care to survivors of individual, interpersonal, collective, and structural trauma. Importantly, TIC has practical applications to address our healthcare burnout epidemic. In this perspective piece, an expert describes a trauma-informed lens through which to view burnout solutions using SAMHSA's 4 Rs of a trauma-informed approach: 1) Realize the widespread impact of trauma, 2) Recognize the signs and symptoms in patients and staff, 3) Respond by integrating knowledge about trauma into practice, and actively 4) Resist re-traumatization. Moving forward, key stakeholders must collaborate to build and refurbish efficient systems alongside a trauma-informed organizational model. TIC can transform the healthcare experience for patients and employees alike by fostering community, empowerment, and healing.
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Affiliation(s)
- Sadie Elisseou
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Jaffe AE, Walton TO, Walker DD, Kaysen DL. Social support and treatment utilization for posttraumatic stress disorder: Examining reciprocal relations among active duty service members. J Trauma Stress 2023; 36:537-548. [PMID: 36728194 PMCID: PMC10293030 DOI: 10.1002/jts.22908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023]
Abstract
Evidence-based treatments for posttraumatic stress disorder (PTSD) are underutilized by active duty service members in the United States. Social support may help service members overcome avoidance and facilitate treatment utilization. In turn, treatment utilization may improve social support. To evaluate these possibilities, the aim of the current study was to examine potential reciprocal associations between social support and treatment utilization among service members. Secondary analyses were conducted on a randomized controlled trial of 161 U.S. military service members with PTSD. Participants completed assessments of perceived social support and attendance at individual therapy sessions at baseline and 3- and 6-month follow-ups. To determine reciprocal relations between social support and treatment utilization, a Bayesian approach was used to estimate a random-intercept cross-lagged panel model with a two-part variable for treatment utilization (i.e., any therapy, and if so, dose). There were no between-person associations between average social support and treatment utilization. One prospective cross-lagged within-person association emerged as significant: social support at 3 months was negatively associated with any therapy use at 6 months; the model explained 26.1% of the variance in this observed variable. The findings revealed that low social support promoted subsequent treatment utilization, but such treatment did not lead to changes in social support. This suggests service members with PTSD may have been motivated to attend individual therapy in pursuit of social connection and support. Future research is needed to determine if reciprocal associations between various forms of social support and therapy utilization differ by treatment modality.
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Affiliation(s)
- Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, Nebraska, Lincoln, USA
| | - Thomas O Walton
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Denise D Walker
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Debra L Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, California, Stanford, USA
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, California, Menlo Park, USA
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Louie P, Upenieks L, Hill TD. Cumulative Pandemic Stressors, Psychosocial Resources, and Psychological Distress: Toward a More Comprehensive Test of a Pandemic Stress Process. SOCIETY AND MENTAL HEALTH 2023:21568693231165260. [PMCID: PMC10155051 DOI: 10.1177/21568693231165260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Although the mental health consequences of individual COVID-19 stressors (e.g., bereavement, job loss, or financial strain) have been well-documented, little is known about the cumulative toll of multiple pandemic stressors. Using national data from the Crime, Health, and Politics Survey (May–June 2021), we test whether the accumulation of pandemic stressors is associated with greater psychological distress. We also consider whether this association is moderated by psychosocial resources (i.e., mastery, self-esteem, and social support). Our findings suggest that individuals who report three or more pandemic stressors tend to exhibit greater psychological distress than those who report fewer pandemic stressors or no pandemic stressors. While mastery offsets the impact of pandemic stressors at higher levels of stress exposure (i.e., two or more COVID-19 stressors), social support and self-esteem played a stress-buffering role to a point, but became ineffective at the highest levels of pandemic stress. The current study provides new insights into the pandemic stress process by conceptualizing and operationalizing the cumulative impact of COVID-19 stressors. We also confirm the continued significance of traditional coping resources in the context of novel pandemic stressors.
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Carney JR, Miller-Graff LE, Napier TR, Howell KH. Elucidating the relations between adverse childhood experiences, age of exposure to adversity, and adult posttraumatic stress symptom severity in pregnant women. CHILD ABUSE & NEGLECT 2023; 136:105995. [PMID: 36566706 DOI: 10.1016/j.chiabu.2022.105995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities. OBJECTIVE, PARTICIPANTS, AND SETTING In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure. METHODS The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test. RESULTS The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t(134) = 2.69, p = .008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (ΔR2 = 0.07, p = .290). Age of first exposure did not significantly moderate the effects of the CM (β = 0.12, p = .140) or HD (β = -0.10, p = .238) ACEs subscales on PTSS. CONCLUSIONS Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity.
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Affiliation(s)
- Jessica R Carney
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA.
| | - Laura E Miller-Graff
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA; Kroc Institute for International Peace Studies, University of Notre Dame, 1110 Jenkins Nanovic Halls, Notre Dame, IN 46556, USA
| | - Taylor R Napier
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38111, USA
| | - Kathryn H Howell
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38111, USA
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Wilson-Genderson M, Heid AR, Cartwright F, Pruchno R. Adverse childhood experiences, adult trauma, and depressive symptom trajectories. Aging Ment Health 2022; 26:2170-2178. [PMID: 34541986 DOI: 10.1080/13607863.2021.1978926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Associations among adverse childhood experiences prior to age 18 (ACEs), subjective reports of trauma during Hurricane Sandy, and trajectories of depressive symptoms reported by community-dwelling older people were examined. METHODS We analyzed 6 waves of data from 5,688 people aged 50-74 recruited in 2006 and followed for 12-years using multilevel mixed effects models. RESULTS We found that: (1) people who experienced ACEs had trajectories of depressive symptoms in late life that were higher than people not having these experiences, (2) people experiencing two or more ACEs were more likely to report fear and distress when Hurricane Sandy hit than people experiencing either one or no adverse childhood experiences, and (3) while both ACE exposure and peri-traumatic stress were associated with trajectories having higher levels of depressive symptoms, the risk associated with ACEs (especially multiple ACEs) was greater. CONCLUSION Findings support life course stress theories including the cumulative inequality theory and stress proliferation theory, suggesting that inequalities are manifested over the life course and that people experiencing adversity during childhood are at increased risk of experiencing adversity in late life. By studying the relationship between adverse childhood experiences and response to Hurricane Sandy our findings demonstrate that adverse childhood experiences can alter the way traumatic events in adulthood are experienced. This finding in turn, has important implications for clinical practice, as it identifies a group of people likely to be at risk for adult trauma.
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Affiliation(s)
| | | | - Francine Cartwright
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
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14
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Ricciardelli R, Carleton RN, Anschuetz B, Gravel S, McKay B. Testifying after an Investigation: Shaping the Mental Health of Public Safety Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13643. [PMID: 36294223 PMCID: PMC9602447 DOI: 10.3390/ijerph192013643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/01/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
In this editorial, we draw on two Canadian cases to interrogate how mass causality events and investigations consume many responders before (e.g., public safety communicators, detachment service assistants), during (e.g., police, fire, paramedics), and after the incident (e.g., coroners, correctional workers, media coverage). Their well-being may suffer from the associated processes and outcomes. In the current article, we focus on the mass causality incident of 2020 in Nova Scotia, Canada, and the investigation following a prisoner death in 2019 in Newfoundland, Canada, to explore how testifying post-incident can be made more palatable for participating public safety personnel (PSP). Specifically, we study how testifying after an adverse event can affect PSP (e.g., recalling, vicarious trauma, triggers) and how best to mitigate the impact of testimony on PSP well-being, with a lens to psychological "recovery" or wellness. We focus here on how to support those who may have to testify in a judicial proceeding or official inquiry, given being investigated for best-intended actions can result in moral injury or a posttraumatic stress injury, both exacerbated by judicial review, charge, accusation, or inquiry.
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Affiliation(s)
- Rosemary Ricciardelli
- Fisheries and Marine Institute, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | | | | | | | - Brad McKay
- Badge of Life Canada, Orillia, ON L3V 5X6, Canada
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15
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Cunradi CB, Caetano R, Alter HJ, Ponicki WR. Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample. J Emerg Nurs 2022; 48:504-514. [PMID: 35667891 PMCID: PMC9464675 DOI: 10.1016/j.jen.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use. METHODS Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender. RESULTS Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization. DISCUSSION Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.
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Affiliation(s)
- Carol B. Cunradi
- Pacific Institute for Research & Evaluation, Prevention Research Center, 2150 Shattuck Avenue, Suite 601, Berkeley, CA
| | - Raul Caetano
- Pacific Institute for Research & Evaluation, Prevention Research Center, 2150 Shattuck Avenue, Suite 601, Berkeley, CA
| | - Harrison J. Alter
- Andrew Levitt Center for Social Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA
| | - William R. Ponicki
- Pacific Institute for Research & Evaluation, Prevention Research Center, 2150 Shattuck Avenue, Suite 601, Berkeley, CA
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16
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Bai Y, Fu M, Wang X, Liu D, Zhang Y, Liu C, Zhang B, Guo J. Relationship among Child Maltreatment, Parental Conflict, and Mental Health of Children during the COVID-19 Lockdown in China. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 16:1-10. [PMID: 36043150 PMCID: PMC9411843 DOI: 10.1007/s40653-022-00478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Children are more likely to experience maltreatment and parental conflict in a pandemic context, which can exacerbate their vulnerability to psychological disorders. The purpose of the present study was to examine mental health symptoms in children aged 0 to 10 years and consider related factors from the perspectives of maltreatment and parental conflict during the COVID-19 lockdown. Participants were 1286 parents aged 18 years and over with children aged 0 to 10 years were included. Several multivariable linear regressions were used to analyze the data. The largest variance in child mental health was explained by child maltreatment, as more maltreatment predicted higher reported psychological problems (standardized beta = 0.49, P < 0.001). Comparatively, parental conflict predicted less variance in mental health problems than maltreatment (standardized beta = 0.18, P < 0.001). Children who experienced more maltreatment experience and exposure to COVID-19 showed elevated levels of mental health symptoms (standardized beta = 0.06, p < 0.05), as did those who experienced parental conflict and pandemic exposure (standardized beta = 0.06, p < 0.05). The findings highlight that tailored programs that focus on a healthy family environment and strategic parental support services may be particularly effective in reducing children's mental health problems due to COVID-19 exposure.
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Affiliation(s)
- Yashuang Bai
- Department of Health Policy and Management, School of Public Health, Peking University, 100191 Beijing, China
| | - Mingqi Fu
- Center for Social Security Studies, Wuhan University, 430070 Wuhan, China
| | - Xiaohua Wang
- School of Social Development and Public Policy, Beijing Normal University, 100875 Beijing, China
| | - Danxia Liu
- School of Sociology, Huazhong University of Science and Technology, 430074 Wuhan, China
| | - Yanjun Zhang
- School of Sociology, Huazhong University of Science and Technology, 430074 Wuhan, China
| | - Chengbin Liu
- School of Sociology, Huazhong University of Science and Technology, 430074 Wuhan, China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children’s Hospital, Harvard Medical School, 02115 Boston, MA USA
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, 100191 Beijing, China
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17
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Children and adolescents' emotional problems during the COVID-19 pandemic in Brazil. Eur Child Adolesc Psychiatry 2022; 32:1083-1095. [PMID: 35618973 PMCID: PMC9135594 DOI: 10.1007/s00787-022-02006-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/04/2022] [Indexed: 11/21/2022]
Abstract
Brazil has been severely affected by the COVID-19 pandemic with one of the largest numbers of youth impacted by school closure globally. This longitudinal online survey assessed emotional problems in children and adolescents aged 5-17 years living in Brazil during the COVID-19 pandemic. Recruitment occurred between June to November 2020 and participants were invited for follow-up assessments every 15 days until June 2021. Participants were 5795 children and adolescents living across the country with mean age of 10.7 (SD 3.63) years at recruitment; 50.5% were boys and 69% of white ethnicity. Weighted prevalence rates of anxiety, depressive and total emotional symptoms at baseline were 29.7%, 36.1% and 36%, respectively. Longitudinal analysis included 3221 (55.6%) participants and revealed fluctuations in anxiety and depressive symptoms during one year follow-up, associated with periods of social mobility and mortality. Emotional problems significantly increased in July and September 2020 and decreased from December 2020 to February 2021 and then significantly increased in May 2021 relative to June 2020. Older age, feeling lonely, previous diagnosis of mental or neurodevelopmental disorder, previous exposure to traumatic events or psychological aggression, parental psychopathology, and sleeping less than 8/h a day were associated with increased rates of anxiety and depressive symptoms at baseline and over time. Food insecurity and less social contact with family and peers were associated with baseline anxiety and depressive symptoms, and lowest socio-economic strata, chronic disease requiring treatment and family members physically ill due to COVID-19 were associated with increasing rates over time. The pandemic severely affected youth, particularly those from vulnerable populations and in moments of increased mortality and decreased social mobility. Results underscore the need for allocation of resources to services and the continuous monitoring of mental health problems among children and adolescents.
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18
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Inoue Y, Stickley A, Yazawa A, Aida J, Koyanagi A, Kondo N. Childhood adversities, late-life stressors and the onset of depressive symptoms in community-dwelling older adults. Aging Ment Health 2022; 26:828-833. [PMID: 33522286 DOI: 10.1080/13607863.2021.1875190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Depression is common in older individuals though many factors associated with its occurrence remain under-researched. We examined whether childhood adversities (CAs) and late-life stressors are associated with the onset of depressive symptoms in adults aged ≥ 65 and if these early- and late-life stressors interact in the prediction of depressive symptoms. Methods: Data came from the 2010 and 2013 waves of the Japan Gerontological Evaluation Study (JAGES) (N = 8701). The Geriatric Depression Scale (GDS-15) was used to assess the presence of depressive symptoms (GDS ≥ 5). A Poisson regression analysis was used to examine associations. Results: Both CAs (1 event: incidence rate ratio [IRR] = 1.59, 95% confidence interval [CI]: 1.41-1.79; ≥ 2 events: IRR = 2.36, 95% CI = 1.80-3.10) and late-life stressful events (1 event: IRR = 1.13, 95% CI: 1.02-1.25; ≥ 2 events: IRR = 1.25, 95% CI = 1.05-1.50) were significantly associated with the onset of depressive symptoms. Borderline significant interactions between CAs and late-life stressors (e.g. ≥ 2 CAs and ≥ 2 late-life events: IRR = 0.61, p = 0.087) suggest that late-life stressors may be important in predicting the onset of depressive symptoms especially among individuals with no or fewer CAs compared to those with ≥ 2 CAs. Conclusions: Stressful events in childhood and late adulthood were independently associated with the onset of depressive symptoms in older adults. In addition, stressful experiences in childhood might affect how individuals respond to stressful events in later life.
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Affiliation(s)
- Yosuke Inoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Aki Yazawa
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Madrid, Spain
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan.,Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
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19
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George BA, Bountress KE, Brown RC, Hawn SE, Weida EAB, McDonald SD, Pickett T, Danielson CK, Sheerin CM, Amstadter AB. Does Prior Civilian Trauma Moderate the Relationship Between Combat Trauma and Post-deployment Mental Health Symptoms? JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP4604-NP4625. [PMID: 32954915 PMCID: PMC7979570 DOI: 10.1177/0886260520958659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan (N = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.
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Affiliation(s)
| | | | - Ruth C. Brown
- Virginia Commonwealth University, Richmond, VA, United States
| | - Sage E. Hawn
- Virginia Commonwealth University, Richmond, VA, United States
| | | | - Scott D. McDonald
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
| | - Treven Pickett
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, MD, United States
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20
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Gottschall S, Lee JEC, McCuaig Edge HJ. Adverse childhood experiences and mental health in military recruits: Exploring gender as a moderator. J Trauma Stress 2022; 35:659-670. [PMID: 35172034 DOI: 10.1002/jts.22784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 01/11/2023]
Abstract
Adverse childhood experiences (ACEs) have consistently been associated with adult psychopathology and are commonly reported among military populations, with women more likely to report many types of ACEs than men. Limited research has examined the role of gender in the association between ACEs and mental health in military populations. The current study assessed the significance of gender differences in ACEs and mental health and explored the associations among these variables in a sample of Canadian Armed Forces recruits/officer cadets. Analyses with cross-sectional Recruit Health Questionnaire (RHQ) data from 50,603 recruits/officer cadets indicated that women were more likely to report witnessing domestic violence, experiencing sexual abuse, and living with someone with mental health problems or alcohol misuse, odds ratios (ORs) = 1.22-4.35, ps < .001. Women were more likely to screen positive for depression, adjusted (aORs) = 1.25-1.49, p < .001-p = .002, and anxiety, aORs = 2.00-2.33, ps < .001, before basic military training. ACEs were associated with screening positive for probable mental health conditions, aORs = 1.54-6.13, p < .001-p = .017. A significant interaction suggested the association between childhood sexual abuse and depression was stronger for men, aOR = 2.49, p < .001, than women, aOR = 1.63, p = .002, as was the association between childhood sexual abuse and posttraumatic stress disorder, men: aOR = 6.06, p < .001, women: aOR = 3.36, p < .001. These results underscore the importance of considering gender and childhood trauma in mental health interventions with military personnel.
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21
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Stylianakis AA, Baker KD, Richardson R. Pharmacological Enhancement of Extinction Retention in Non-stressed Adolescent Rats but Not Those Exposed to Chronic Corticosterone. Front Neurosci 2022; 16:822709. [PMID: 35368276 PMCID: PMC8966583 DOI: 10.3389/fnins.2022.822709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals exposed to chronic adverse experiences in childhood and adolescence are at increased risk of developing neuropsychiatric illnesses such as mood and anxiety disorders. Symptoms of anxiety disorders can often be reduced through exposure therapy, which is based on the process of extinction. Although chronic stress in adolescence is known to exacerbate the impaired extinction of learned fear during this period of development, it remains unclear whether exposure to stressors in adolescence qualitatively affects the mechanisms underlying fear extinction. Brain-derived neurotrophic factor (BDNF) and its principle receptor, tropomyosin receptor kinase B (TrkB), are involved in neuroplasticity underlying fear extinction. The small-molecule TrkB agonist 7,8-dihydroxyflavone (7,8-DHF) improves fear extinction and reduces fear relapse (reinstatement) in adult mice when administered prior to extinction training but its effects in younger ages are unknown. In this study we tested whether 7,8-DHF enhances extinction retention and leads to less renewal in both stressed and non-stressed adolescent rats. Pre-extinction injection of 7,8-DHF led to lower levels of CS-elicited freezing in both the extinction and conditioning contexts in non-stressed adolescent male rats, but not in those given 7 days of corticosterone. These findings indicate that chronic stress interferes with the effectiveness of pharmacological agonism of TrkB in enhancing fear extinction in adolescence. A greater understanding of the mechanisms underlying extinction in adolescence and the effect of chronic corticosterone exposure on those mechanisms may inform a deeper understanding of the etiology and treatment of pediatric stress-related disorders.
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22
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Roth SL, Andrews K, Protopopescu A, Lloyd C, O'Connor C, Losier BJ, Lanius RA, McKinnon MC. Mental health symptoms in Public Safety Personnel: Examining the effects of adverse childhood experiences and moral injury. CHILD ABUSE & NEGLECT 2022; 123:105394. [PMID: 34808481 DOI: 10.1016/j.chiabu.2021.105394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/08/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) increase risk for negative mental health outcomes in adulthood; however, the mechanisms through which ACEs exert their influence on adult mental health are poorly understood. This is particularly true for Public Safety Personnel (PSP; e.g., police, firefighters, paramedics, etc.), a group with unique vulnerability to negative psychiatric sequalae given their chronic exposure to potentially traumatic, work-related events. OBJECTIVES To examine the role of moral injury (MI) and emotion regulation in the relation between ACEs and adult mental health symptoms in adulthood. PARTICIPANTS AND SETTING Participants (N = 294) included a community sample of Canadian and American PSP members aged 22 to 65. METHODS The current study uses cross-sectional data collection via retrospective self-report questionnaires administered between November, 2018 and November, 2019 to assess level of ACEs (ACE-Q), emotion regulation difficulties (DERS) and symptoms of post-traumatic stress (PCL-5), dissociation (MDI), depression, stress, and anxiety (DASS-21). Additionally, participants completed the Moral Injury Assessment for Public Safety Personnel, the first measure of MI developed specifically for PSP. RESULTS Path analysis revealed that ACEs significantly predicted adverse mental health symptoms in adulthood; this effect was mediated by symptoms of MI and moderated by difficulties with emotion regulation. CONCLUSIONS This study is the first to identify MI as a mechanism involved in the relation between ACEs and adult psychopathology and highlights the protective role of emotion regulation skills. These findings can inform the development of future research and clinical interventions in PSP populations.
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Affiliation(s)
- Sophia L Roth
- Departments of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada.
| | - Krysta Andrews
- Homewood Research Institute, Guelph, ON, Canada; Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Alina Protopopescu
- Departments of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada
| | - Chantelle Lloyd
- Departments of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada
| | - Charlene O'Connor
- Homewood Research Institute, Guelph, ON, Canada; Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, ON, Canada
| | - Bruno J Losier
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Ruth A Lanius
- Departments of Psychiatry, Western University, London, ON, Canada; Departments of Neuroscience, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Margaret C McKinnon
- Homewood Research Institute, Guelph, ON, Canada; Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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23
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Morgan NR, Aronson KR, Perkins DF, Doucette CE, Bleser JA, Davenport K, Vogt D, Copeland LA, Finley EP, Gilman CL. The interaction of exposure to adverse childhood and combat experiences on the current mental health of new post-9/11 veterans. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:204-220. [PMID: 33624843 DOI: 10.1002/jcop.22523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post-9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community-based mental health services are discussed.
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Affiliation(s)
- Nicole R Morgan
- Clearinghouse for Military Family Readiness at Penn State University, State College, Pennsylvania, USA
| | - Keith R Aronson
- Clearinghouse for Military Family Readiness at Penn State University, State College, Pennsylvania, USA
- Social Science Research Institute at Penn State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, Penn State University, University Park, Pennsylvania, USA
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness at Penn State University, State College, Pennsylvania, USA
- Social Science Research Institute at Penn State University, University Park, Pennsylvania, USA
- Department of Agricultural Economics, Sociology and Education, Penn State University, University Park, Pennsylvania, USA
| | - Carly E Doucette
- Clearinghouse for Military Family Readiness at Penn State University, State College, Pennsylvania, USA
| | - Julia A Bleser
- Clearinghouse for Military Family Readiness at Penn State University, State College, Pennsylvania, USA
| | - Katie Davenport
- Clearinghouse for Military Family Readiness at Penn State University, State College, Pennsylvania, USA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, UT Health San Antonio, San Antonio, Texas, USA
| | - Erin P Finley
- Veterans Evidence-based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Departments of Medicine and Psychiatry, UT Health San Antonio, San Antonio, Texas, USA
| | - Cynthia L Gilman
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
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Cruz DA, Williamson DE. Walking the Path Together with Matt Friedman. Psychiatry 2022; 85:183-186. [PMID: 35588480 DOI: 10.1080/00332747.2022.2068933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Family snapshot: Characteristics of the economic and social environment and their associations with mental health in Canadian military personnel with a history of deployment. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Danielson RA, Ray-Degges S. Aging in place among older adults with histories of traumatic experiences: A scoping review. THE GERONTOLOGIST 2021; 62:e1-e16. [PMID: 34436570 DOI: 10.1093/geront/gnab127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adverse childhood and adult experiences can have far-reaching impacts, and when coupled with typical aging-related changes, may impede achievement of a suitable person-environment fit for aging adults. The objective of our study was to determine if extant literature connects older adults with trauma history to successfully aging in place. RESEARCH DESIGN AND METHODS We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using six databases [key words older adult(s), aging in place, housing, trauma], with a full review of 32 articles. RESULTS Insights included: 1) Aging in place does not have to mean living in the same house over time. 2) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. 3) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. 4) Housing precarity is a traumatic experience. 5) Permanent supportive housing is an important resource for people in crisis. 6) Community supports are critical to aging in place. DISCUSSION AND IMPLICATIONS Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community living environments that provide equitable access to aging in place.
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Affiliation(s)
- Ramona A Danielson
- Department of Public Health, North Dakota State University, Fargo, North Carolina, USA
| | - Susan Ray-Degges
- Department of Apparel, Merchandising, Interior Design & Hospitality Management, North Dakota State University, Fargo, North Carolina, USA
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Whelan J, Eichler M, Norris D, Landry D. The Politics of Treatment: A Qualitative Study of Canadian Military PTSD Clinicians. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mirman A, Bick AS, Kalla C, Canetti L, Segman R, Dan R, Ben Yehuda A, Levin N, Bonne O. The imprint of childhood adversity on emotional processing in high functioning young adults. Hum Brain Mapp 2021; 42:615-625. [PMID: 33125770 PMCID: PMC7814751 DOI: 10.1002/hbm.25246] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
Adverse childhood experiences (ACEs) have been acknowledged as risk factors for increased mental health complications in adulthood, specifically increasing susceptibility to developing psychopathology upon exposure to trauma. Yet, little is known regarding the impact of mild ACEs on highly functioning population. In this study forty participants were selected from a group of 366 highly selected military parachute trainees using the self-report "childhood trauma questionnaire," and classified into two groups of 20 each, with and without ACEs. Behavioral measurements were obtained before and at the peak of an intensive combat training period, including anxiety, depression and executive function assessment. Functional MRI including a negative emotional face perception task was conducted at the first time point. Psychometric and cognitive measurements revealed higher levels of anxiety and depressive symptoms, and more difficulties in executive functioning in the ACE group at baseline. Slower reaction time to emotional faces presentation was found in the ACE group. Lower activation in response to negative emotional faces stimuli was found in this group in bilateral secondary visual areas, left anterior insula, left parietal cortex and left primary motor and sensory regions. In contrast, higher activation in the ACE group was found in the right ventral lateral prefrontal cortex (Vlpfc). No significant differences between groups were detected in the amygdala. To conclude, mild adverse childhood experiences produce long-term sequela on psychological wellbeing and neurocircuitry even in high functioning population. Brain regions modulated by childhood trauma may instigate avoidance mechanisms dampening the emotional and cognitive effects of intensive stress.
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Affiliation(s)
- Aron Mirman
- Functional Imaging Unit, Department of NeurologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
- Department of PsychiatryHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Atira S. Bick
- Functional Imaging Unit, Department of NeurologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Carmel Kalla
- Department of Mental HealthIsrael Defense ForcesRamat‐GanIsrael
| | - Laura Canetti
- Department of PsychologyHebrew University of JerusalemJerusalemIsrael
| | - Ronen Segman
- Molecular Psychiatry LaboratoryHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Rotem Dan
- Edmond and Lily Safra Center for Brain Sciences (ELSC)Hebrew University of JerusalemJerusalemIsrael
- Department of NeurologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | | | - Netta Levin
- Functional Imaging Unit, Department of NeurologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Omer Bonne
- Department of PsychiatryHadassah‐Hebrew University Medical CenterJerusalemIsrael
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Folke S, Nielsen ABS, Karstoft KI. PTSD and complex PTSD in treatment-seeking Danish soldiers: a replication of Folke et al. (2019) using the International Trauma Questionnaire. Eur J Psychotraumatol 2021; 12:1930703. [PMID: 34249244 PMCID: PMC8245103 DOI: 10.1080/20008198.2021.1930703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: While empirical support for the ICD-11 distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, empirical research into the ICD-11 model of CPTSD in military populations is scarce and inconsistent. Objective: To replicate a study from our own group identifying distinct classes based on CPTSD symptoms using the International Trauma Questionnaire (ITQ) and to identify predictors and functional outcomes associated with a potential distinction between PTSD and CPTSD. Method: Formerly deployed treatment-seeking Danish soldiers (N = 294) completed the ITQ and self-report measures of traumatic life events prior to treatment. Latent profile analysis (LPA) was used to extract classes based on CPTSD symptoms. Results: LPA revealed four classes; (1) high CPTSD symptoms ('CPTSD', 28.7%); (2) high PTSD symptoms and lower DSO symptoms ('PTSD', 23.5%); (3) high DSO symptoms ('DSO', 17.3%); and (4) low symptoms ('Low Symptoms', 30.5%). In comparison to the PTSD-class, CPTSD-class membership was not predicted by traumatic events in adult life and in childhood. The CPTSD class was more often single/divorced/widowed compared to the PTSD class. Moreover, the CPTSD class more often used psychotropic medicine compared to the DSO-class and Low Symptoms-class. Conclusion: Using the ITQ, this study yields empirical support for the ICD-11 model of CPTSD within a clinical sample of veterans. The results replicate findings from our previous study that also identified distinct profiles of ICD-11 PTSD and CPTSD.
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Affiliation(s)
- Sofie Folke
- Research and Knowledge Centre, Danish Veterans Centre, Ringsted, Denmark.,Department of Military Psychology, Danish Veterans Centre, Copenhagen, Denmark
| | - Anni B S Nielsen
- Research and Knowledge Centre, Danish Veterans Centre, Ringsted, Denmark.,The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Karen-Inge Karstoft
- Research and Knowledge Centre, Danish Veterans Centre, Ringsted, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Masheb RM, Sala M, Marsh AG, Snow JL, Kutz AM, Ruser CB. Associations between adverse childhood experiences and weight, weight control behaviors and quality of life in Veterans seeking weight management services. Eat Behav 2021; 40:101461. [PMID: 33352386 DOI: 10.1016/j.eatbeh.2020.101461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A neglected area of trauma research with Veterans is the study of Adverse Childhood Experiences (ACEs). The present study aimed to examine the prevalence of ACEs, and to explore relationships between ACEs and measures of weight, eating behaviors and quality of life in weight loss seeking Veterans. METHODS Participants were 191 Veterans [mean age 58.9 (SD = 12.8), mean Body Mass Index (BMI) 35.4 (SD = 6.1), 86.9% male, 33.7% racial/ethnic minority] receiving care at VA Connecticut Healthcare System (VA CT) who attended an orientation session of VA's behavioral weight management program. Participants completed a measure of ACEs and measures related to weight, eating and health. RESULTS Among completers, 68.6% endorsed at least one ACE. The average number of reported ACEs was 2.2 (SD = 2.5), with 48.7% of Veterans reporting more than one type of ACE. Women were more likely to report any ACE (88.0% vs. 65.6%, p = .025) and reported significantly more ACEs compared to males (4.2 vs. 1.9, p < .001). ACEs were associated with lower physical activity (p = .05), lower quality of life (p's < 0.05), and lower weight-related quality of life (p < .01), but not weight, weight control strategies, binge eating, or alcohol use. CONCLUSION ACEs are common among weight loss seeking Veterans, particularly among female Veterans. Findings suggest that there is a high rate of ACEs in Veterans, which are associated with exercise and quality of life outcomes, but not diet and weight outcomes.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America; Yale University School of Medicine, 333 Cedar St., New Haven, CT 06610, United States of America.
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, United States of America.
| | - Alison G Marsh
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America.
| | - Jennifer L Snow
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America.
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States of America.
| | - Christopher B Ruser
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America; Yale University School of Medicine, 333 Cedar St., New Haven, CT 06610, United States of America.
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Cunradi CB, Ponicki WR, Caetano R, Alter HJ. Frequency of Intimate Partner Violence among an Urban Emergency Department Sample: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E222. [PMID: 33396705 PMCID: PMC7796012 DOI: 10.3390/ijerph18010222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022]
Abstract
Intimate partner violence (IPV) is a pervasive public health problem. Within the U.S., urban emergency department (ED) patients have elevated prevalence of IPV, substance use, and other social problems compared to those in the general household population. Using a social-ecological framework, this cross-sectional study analyzes the extent to which individual, household, and neighborhood factors are associated with the frequency of IPV among a socially disadvantaged sample of urban ED patients. Confidential survey interviews were conducted with 1037 married/partnered study participants (46% male; 50% Hispanic; 29% African American) at a public safety-net hospital. Gender-stratified multilevel Tobit regression models were estimated for frequency of past-year physical IPV (perpetration and victimization) and frequency of severe IPV. Approximately 23% of participants reported IPV. Among men and women, impulsivity, adverse childhood experiences, substance use, and their spouse/partner's hazardous drinking were associated with IPV frequency. Additionally, household food insufficiency, being fired or laid off from their job, perceived neighborhood disorder, and neighborhood demographic characteristics were associated with IPV frequency among women. Similar patterns were observed in models of severe IPV frequency. IPV prevention strategies implemented in urban ED settings should address the individual, household, and neighborhood risk factors that are linked with partner aggression among socially disadvantaged couples.
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Affiliation(s)
- Carol B. Cunradi
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA; (W.R.P.); (R.C.)
| | - William R. Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA; (W.R.P.); (R.C.)
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA; (W.R.P.); (R.C.)
| | - Harrison J. Alter
- Andrew Levitt Center for Social Emergency Medicine, Berkeley, CA 94703, USA;
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McCuaig Edge HJ, Lee JEC. The Mediating Role of Alexithymia in the Association Between Adverse Childhood Experiences and Postdeployment Mental Health in Canadian Armed Forces Personnel. J Trauma Stress 2020; 33:1029-1038. [PMID: 32974957 DOI: 10.1002/jts.22547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/09/2022]
Abstract
Recent studies showing an association between adverse childhood experiences and the development of alexithymia in military personnel have generated interest regarding the role of alexithymia in the pathway linking childhood trauma exposure to mental health disorders. Accordingly, the current study was conducted to (a) examine the associations among adverse childhood experiences, alexithymia, and symptoms of depression and posttraumatic stress disorder (PTSD) among recently deployed Canadian military personnel and (b) assess the mediating role of alexithymia in these associations. Data collected from 2,927 members of the Canadian Armed Forces at baseline and after their return from an overseas deployment were subjected to a prospective path analysis. The results of the path analysis, R2 = .35, pointed to a significant direct effect of childhood adversity on postdeployment mental health symptoms. Contrary to our expectations, the results also pointed to a negative indirect effect of childhood neglect, suggesting that childhood neglect contributed to lower levels of postdeployment depression and PTSD symptoms through the dimension of alexithymia related to difficulty in describing feelings. These patterns of associations, for the most part, persisted even when accounting for combat exposure during recent deployments, R2 = .42. The present results are discussed in light of study limitations and methodological considerations, and policy and clinical implications are noted.
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Guo J, Fu M, Liu D, Zhang B, Wang X, van IJzendoorn MH. Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? A survey of rural Chinese adolescents. CHILD ABUSE & NEGLECT 2020; 110:104667. [PMID: 32859393 PMCID: PMC7440157 DOI: 10.1016/j.chiabu.2020.104667] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Since the COVID-19 outbreak at the end of 2019, it has evolved into a global pandemic with tremendous mental health impact besides the threats to people's physical health. OBJECTIVE The aims were to examine whether exposure to COVID-19 predicts elevated levels of anxiety and post-traumatic stress symptoms and whether pre-pandemic maltreatment experiences exacerbate this impact on mental health in adolescents. PARTICIPANTS AND SETTING The survey was conducted online from February 8 st to February 27th, 2020, and the questionnaires were distributed and retrieved through a web-based platform. This study includes a total of 6196 subjects, aged range from 11 to 18 years old. METHODS Several multivariable linear regressions were used to analyse the data. RESULTS The largest variance in PTSS and anxiety problems was explained by ACEs, with more pre-pandemic maltreatment experiences predicting more PTSS (effect size beta = 0.16∼0.27), and more anxiety (effect size beta = 0.32∼0.47). Experienced or subjective fear of exposure to COVID-19 predicted statistically significant variance in PTSS and anxiety, and standardized betas ranged from 0.04 to 0.09. Participants who had adverse childhood experiences and had experienced exposure to COVID-19 showed elevated PTSS. CONCLUSIONS After pre-pandemic maltreatment experiences the impact of exposure to COVID-19 on mental health may be stronger. Scars from the past seem to be vulnerabilities during societal upheaval. We therefore suggest that when exposed to COVID-19 rural adolescents should get prioritized professional family support and mental health counseling in particular when they have experienced family abuse and neglect in childhood, even though such support is more difficult to organize in rural areas.
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Affiliation(s)
- Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, 100191, Beijing, China
| | - Mingqi Fu
- Center for Social Security Studies, Wuhan University, 430070, Wuhan, China
| | - Danxia Liu
- School of Sociology, Huazhong University of Science and Technology, 430074, Wuhan, China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Xiaohua Wang
- School of Social Development and Public Policy, Beijing Normal University, 100875, Beijing, China.
| | - Marinus H van IJzendoorn
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3000 DR, Rotterdam, the Netherlands; School of Psychology, Capital Normal University, 100048, Beijing, China; School of Clinical Medicine, University of Cambridge, CB2 0SR, Cambridge, UK
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Nichter B, Hill M, Norman S, Haller M, Pietrzak RH. Associations of childhood abuse and combat exposure with suicidal ideation and suicide attempt in U.S. military veterans: a nationally representative study. J Affect Disord 2020; 276:1102-1108. [PMID: 32777648 DOI: 10.1016/j.jad.2020.07.120] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Military veterans with a history of childhood abuse are at increased risk for suicidality. To date, however, little research has examined whether exposure to childhood abuse may heighten veterans' susceptibility to the effects of combat exposure and increase risk for suicidal behavior. This study examined whether childhood abuse has an additive or interactive effect on the association between combat exposure and suicide-related outcomes in a national sample of veterans. METHODS Data were from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 3,157). Analyses compared veterans with/without current suicidal ideation and lifetime suicide attempts (SI/SA) on sociodemographic, military, and clinical characteristics; and examined the unique contribution of childhood physical and sexual abuse and combat exposure, and their interaction, with SI/SA. RESULTS After adjusting for sociodemographic characteristics and lifetime trauma burden, a significant interaction emerged between childhood sexual abuse and combat exposure predicting SI, such that combat-exposed veterans with histories of abuse were nearly three times more likely to currently be contemplating suicide relative to those without such histories. Childhood sexual abuse predicted lifetime suicide attempt, above and beyond sociodemographic characteristics, lifetime trauma burden, and combat exposure. LIMITATIONS Cross-sectional design precludes causal inference. CONCLUSIONS Results indicate that childhood sexual abuse exposure may operate both independently and synergistically with combat exposure to increase risk for suicidality among veterans. Findings suggest that veterans who experience childhood sexual abuse represent a subgroup that may be especially vulnerable to experiencing suicidal ideation following combat exposure.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California, San Diego, CA 92093, United States.
| | - Melanie Hill
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Sonya Norman
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; National Center for PTSD, White River Junction, VT, United States; VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States
| | - Moira Haller
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Cunradi CB, Caetano R, Alter HJ, Ponicki WR. Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:739-748. [PMID: 33186088 PMCID: PMC8432740 DOI: 10.1080/00952990.2020.1823989] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. OBJECTIVES To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. METHODS Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. RESULTS One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. CONCLUSION ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.
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Affiliation(s)
- Carol B Cunradi
- Prevention Research Center, Pacific Institute for Research & Evaluation , Berkeley, CA, USA
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research & Evaluation , Berkeley, CA, USA
| | - Harrison J Alter
- Alameda Health System, Andrew Levitt Center for Social Emergency Medicine , Oakland, CA, USA
| | - William R Ponicki
- Prevention Research Center, Pacific Institute for Research & Evaluation , Berkeley, CA, USA
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Stevens SM, Gustavson DE, Fang B, Tu X, Logue M, Lyons MJ, Reynolds CA, Kremen WS, Franz CE. Predicting Health-Related Quality of Life in Trauma-Exposed Male Veterans in Late Midlife: A 20 Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124554. [PMID: 32599875 PMCID: PMC7345107 DOI: 10.3390/ijerph17124554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022]
Abstract
Trauma-exposed adults with high levels of posttraumatic stress symptoms (PTSS) report poorer health-related quality of life (HRQOL), but less is known about the persistence of this relationship over time. Participants from the Vietnam Era Twin Study of Aging reported on PTSS, health, and sociodemographic characteristics at average age 38; 775 participants reported having been exposed to trauma. Later, at average ages 56 and 62, mental and physical HRQOL were assessed with the Short-Form 36. Premorbid risk for anxiety/neuroticism was evaluated with a polygenic risk score derived from a large genome-wide association study meta-analysis. In multivariate mixed models, having higher levels of PTSS, poorer self-rated health, lower income, and less education at age 38 were associated with worse physical and mental HRQOL two decades later. Chronic health problems at age 38 predicted midlife physical but not mental HRQOL. Although genetic risk for neuroticism was correlated with HRQOL and PTSS, it was no longer significant in multivariate models. Health-related quality of life (HRQOL) predicts morbidity and mortality independently of objective health measures; early interventions may help to mitigate the ongoing impact of trauma on quality of life.
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Affiliation(s)
- Samantha M. Stevens
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Psychology, The Pennsylvania State University, State College, PA 16801, USA
| | - Daniel E. Gustavson
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bin Fang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
| | - Xin Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Mark Logue
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Chandra A. Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA 92521, USA;
| | - William S. Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, University of California San Diego, La Jolla, CA 92093, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Correspondence: ; Tel.: +1-858-822-1793
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Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Nicholson JH, Moore BA, Dondanville K, Wheeler B, DeVoe ER. Examining Rates of Postpartum Depression in Active Duty U.S. Military Servicewomen. J Womens Health (Larchmt) 2020; 29:1530-1539. [PMID: 32343921 DOI: 10.1089/jwh.2019.8172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Postpartum depression (PPD) is understudied in military populations. The present descriptive transversal study evaluated the incidence of PPD diagnoses in U.S. military electronic health records, based on International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes, among active duty military servicewomen between 2001 and 2018. Methods: Data on 3,724 active duty military servicewomen who served between 2001 and 2018 were drawn from the Defense Medical Epidemiological Database and stratified by race, age, marital status, service branch, and military pay grade. Single sample chi squares were used to examine observed versus expected differences in diagnosis rates. Results: The incidence rate of PPD among all U.S. military servicewomen was the lowest in 2001 (1.96 per 1,000) and the highest in 2018 (29.95 per 1,000). Servicewomen most often diagnosed with PPD were white (60%), married (74%), in the enlisted pay grades of E-1 to E-4 (60%), in the Army (43%), and were between 20 and 24 years old (46%). Statistically significant differences (p < 0.001) were found between observed and expected counts across all five demographic variables. Conclusions: This is the first population-based study to assess the incidence rates of PPD among all active duty military servicewomen. Findings that some groups were over- and underdiagnosed within each demographic category, and that PPD incidence rates have increased between 2001 and 2018, underscore the importance of further research to inform policies and interventions supporting this vulnerable population.
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Affiliation(s)
| | - Brian A Moore
- Department of Psychiatry, the University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, the University of Texas at San Antonio, San Antonio, Texas, USA
| | - Katherine Dondanville
- Department of Psychiatry, the University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Brigid Wheeler
- Department of Psychology, the University of Texas at San Antonio, San Antonio, Texas, USA
| | - Ellen R DeVoe
- Boston University School of Social Work, Boston, Massachusetts, USA
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Acker ML, Nicholson J, DeVoe ER. Mothering very young children after wartime deployment: A case report. Infant Ment Health J 2020; 41:313-326. [PMID: 32242949 DOI: 10.1002/imhj.21837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Parenting very young children in the context of military service, deployment separations, and war-related trauma can be challenging for many families. Female active duty personnel represent one of the fastest growing segments of the military, and recent policy changes have led women to pursue serving in combat positions at much higher rates. While not much is known about service member mothers, some studies have shown that they experience significant symptoms of distress, depression, and anxiety during the deployment cycle, feelings of disconnection from family during reintegration, and higher rates of childhood trauma histories than their male counterparts. Service member mothers who experience the combined stressors of deployment separation, combat exposure, and adverse childhood experiences-a triple threat-may be at serious risk of posttraumatic stress and depressive symptomatology, which can negatively influence the quality and nature of their parenting and parent-child relationships. This case report describes the participation of a young single service member mother and her preschool-aged daughter in a home-based, reintegration program designed for military families with very young children (ages 0-5). The paper illustrates how this relationship-based, reflective parenting intervention was effective in increasing the mother's sense of competence in her parenting and strengthening the parent-child relationship.
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Affiliation(s)
- Michelle L Acker
- Private Practice, Newton, Massachusetts.,Boston University School of Social Work, Boston, Massachusetts
| | | | - Ellen R DeVoe
- Boston University School of Social Work, Boston, Massachusetts
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Syed Sheriff R, Van Hooff M, Malhi G, Grace B, McFarlane A. Childhood trauma and the impact of deployment on the development of mental disorder in military males. Psychol Med 2020; 50:818-826. [PMID: 30947764 DOI: 10.1017/s0033291719000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Childhood adversity is associated with mental disorder following military deployment. However, it is unclear how different childhood trauma profiles relate to developing a post-deployment disorder. We investigated childhood trauma prospectively in determining new post-deployment probable disorder. METHODS In total, 1009 Regular male ADF personnel from the Australian Defence Force (ADF) Middle East Area of Operations (MEAO) Prospective Study provided pre- and post-deployment self-report data. Logistic regression and generalised structural equation modelling were utilised to examine associations between childhood trauma and new post-deployment probable disorder and possible mediator pathways through pre-deployment symptoms. RESULTS There were low rates of pre-deployment probable disorder. New post-deployment probable disorder was associated with childhood trauma, index deployment factors (combat role and deployment trauma) and pre-deployment symptoms but not with demographic, service or adult factors prior to the index deployment (including trauma, combat or previous deployment). Even after controlling for demographic, service and adult factors prior to the index deployment as well as index deployment trauma, childhood trauma was still a significant determinant of new post-deployment probable disorder. GSEM demonstrated that the association between interpersonal childhood trauma and new post-deployment probable disorder was fully mediated by pre-deployment symptoms. This was not the case for those who experienced childhood trauma that was not interpersonal in nature. CONCLUSIONS To determine the risk of developing a post-deployment disorder an understanding of the types of childhood trauma encountered is essential, and pre-deployment symptom screening alone is insufficient.
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Affiliation(s)
- Rebecca Syed Sheriff
- Centre for Traumatic Stress Studies (CTSS), University of Adelaide, Level 1, Helen Mayo North, 30 Frome Road, SA 5000, Australia
- Child and Adolescent Psychiatric Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies (CTSS), University of Adelaide, Level 1, Helen Mayo North, 30 Frome Road, SA 5000, Australia
| | - Gin Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Sydney Medical School Northern, University of Sydney, NSW, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Blair Grace
- Department of Education and Child Development, 31 Flinders St, Adelaide, Australia
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies (CTSS), University of Adelaide, Level 1, Helen Mayo North, 30 Frome Road, SA 5000, Australia
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Trajectories of depression symptoms from pre- to post- deployment: Does previous trauma predict symptom increase? J Affect Disord 2020; 266:120-127. [PMID: 32056865 DOI: 10.1016/j.jad.2020.01.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/22/2019] [Accepted: 01/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND A significant minority of individuals experience depression following military deployment. The course of depression symptoms varies over time and across individuals; several factors including combat exposure influence depressions incidence and course. Importantly, previous trauma, especially in childhood, have been found increase the risk of post-deployment depression. METHODS In a prospective sample of 530 soldiers deployed to Afghanistan in 2009, we used latent growth mixture modeling (LGMM) to estimate trajectories of depression symptoms from before through 6.5 years after deployment. In a multinomial logistic regression model, we tested if childhood and adult life trauma predicted trajectory membership in combination with combat exposure and neuroticism. RESULTS We identified a large trajectory of few depression symptoms from before through 6.5 years after deployment (Low-stable, 86.5%), a trajectory with somewhat elevated symptoms (Medium-fluctuating, 4.0%), and a trajectory with few symptoms before deployment and a steep increase to a severe symptom level 6.5 years after deployment (Low-increasing, 9.4%). The Low-increasing trajectory was predicted by lower rank and childhood trauma, while the Medium-fluctuating trajectory was predicted by neuroticism, adult life trauma, and post-deployment PTSD symptoms. LIMITATIONS Attrition and use of self-report measures for depression and trauma. CONCLUSIONS Depression symptoms follow a heterogeneous course from before through 6.5 years after deployment with 9.4% experiencing symptom increase, resulting in severe symptoms 6.5 years after deployment. Trajectories are differentially predicted by rank, childhood and adult life trauma as well as neuroticism and PTSD symptoms, illustrating the clinical importance of taking individual differences of symptom course into account.
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Caetano R, Cunradi CB, Alter HJ, Mair C. Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department. West J Emerg Med 2020; 21:282-290. [PMID: 32191185 PMCID: PMC7081874 DOI: 10.5811/westjem.2019.10.44190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/07/2019] [Accepted: 10/03/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Urban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED. METHODS Research assistants surveyed patients regarding IPV exposure, associated risk factors, and other sociodemographic features. The joint occurrence of seven risk factors was measured by a variable scored 0-7 with the following risk factors: depression; adverse childhood experiences; drug use; impulsivity; post-traumatic stress disorder; at-risk drinking; and partner's score on the Alcohol Use Disorders Identification Test. The survey (N = 1037) achieved an 87.5% participation rate. RESULTS About 23% of the sample reported an IPV event in the prior 12 months. Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor (adjusted odds ratio [AOR] [3.09]; 95% confidence interval [CI], 1.47-6.50; p<.01); two risk factors (AOR [6.26]; 95% CI, 3.04-12.87; p<.01); three risk factors (AOR = 9.44; 95% CI, 4.44-20.08; p<.001); four to seven risk factors (AOR [18.62]; 95% CI, 9.00-38.52; p<001). Ordered logistic regression showed that IPV severity increased in a similar way, as follows: one risk factor (AOR [3.17]; 95% CI, 1.39-7.20; p<.01); two risk factors (AOR [6.73]; 95% CI, 3.04-14.90; p<.001); three risk factors (AOR [10.36]; 95%CI, 4.52-23.76; p<.001); four to seven risk factors (AOR [20.61]; 95% CI, 9.11-46.64; p<001). CONCLUSION Among patients in an urban ED, IPV likelihood and IPV severity increase with the number of reported risk factors. The best approach to identify IPV and avoid false negatives is, therefore, multi-risk assessment.
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Affiliation(s)
- Raul Caetano
- Pacific Institute for Research and Evaluation, Prevention Research Center, Berkeley, California
| | - Carol B. Cunradi
- Pacific Institute for Research and Evaluation, Prevention Research Center, Berkeley, California
| | - Harrison J. Alter
- Highland Hospital - Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Christina Mair
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
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Cunradi CB, Dellor E, Alter HJ, Caetano R, Mair C. Problem Drinking and Marijuana Use as Risks for Unidirectional and Bidirectional Partner Violence. PARTNER ABUSE 2020; 11:57-75. [PMID: 35330966 DOI: 10.1891/1946-6560.11.1.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite evidence that most who perpetrate intimate partner violence (IPV) also report victimization, little is known about bidirectional IPV among Emergency Department (ED) patients and its association with problem drinking and marijuana use. We conducted an observational, cross-sectional survey among low- and moderate-acuity patients at a Northern California safety-net ED. Physical IPV was measured with the Revised Conflict Tactics Scale (CTS2). We recorded patient's frequency of intoxication and marijuana use. Spouse/partner's problem drinking and marijuana use were measured dichotomously. Odds Ratios [ORs] and 95% confidence intervals [CIs] were estimated using multinomial logistic regression models of unidirectional and bidirectional IPV. Among 1,037 patients (53% female), perpetration only, victimization only, and bidirectional IPV were reported by 3.8%, 6.2%, and 13.3% of the sample, respectively. Frequency of intoxication was associated with perpetration (OR 1.50; 95% CI 1.18 to 1.92) and bidirectional IPV (OR=1.34; 95% CI 1.13 to 1.58). Days of marijuana use were associated with bidirectional IPV (OR=1.15; 95% CI 1.03 to 1.28). Patients whose partners were problem drinkers were at risk for victimization (OR=2.56; 95% CI=1.38, 4.76) and bidirectional IPV (OR=1.97; 95% CI 1.18, 3.27). Among patients who reported any past-year IPV, most experienced bidirectional aggression. ED staff should consider asking patients who are married, cohabiting, or in a dating relationship about their experience with past-year IPV and inquire about their substance use patterns and those of their romantic partner, to share information about potential linkages. Medical and recreational marijuana legalization trends underscore the importance of further research on IPV and marijuana.
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Affiliation(s)
- Carol B Cunradi
- Prevention Research Center, Pacific Institute for Research & Evaluation, Berkeley, CA
| | - Elinam Dellor
- College of Social Work, The Ohio State University, Columbus, OH
| | - Harrison J Alter
- Highland Hospital - Alameda Health System, Andrew Levitt Center for Social Emergency Medicine, Oakland, CA
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research & Evaluation, Berkeley, CA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Abstract
We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, were analyzed and compared using direct age standardization and logistic regression. A greater proportion of ADF reported childhood trauma, multiple trauma types, trauma onset below 12 years of age, and interpersonal trauma than civilian employed men. A greater proportion of ADF reported childhood noninterpersonal trauma, such as accidents, than civilian employed men, with a marked difference in those aged 45 to 54 years. In both populations, childhood disorder was associated with childhood trauma; however, childhood depression was not associated with childhood noninterpersonal trauma in either population. A deeper understanding of the longer-term risk and resilience conferred by different childhood trauma profiles is needed.
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45
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Behnke A, Rojas R, Karabatsiakis A, Kolassa IT. Childhood maltreatment compromises resilience against occupational trauma exposure: A retrospective study among emergency medical service personnel. CHILD ABUSE & NEGLECT 2020; 99:104248. [PMID: 31731138 DOI: 10.1016/j.chiabu.2019.104248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/20/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Childhood maltreatment (CM) compromises resilience against stress and trauma throughout life. Therefore, it could present a major risk factor for the health of frequently trauma-exposed professionals such as emergency medical service (EMS) personnel. OBJECTIVE We investigated, whether EMS personnel's history of CM increased their risk for mental and physical stress symptoms after occupational trauma exposure. PARTICIPANTS AND SETTING Data from 103 German EMS personnel (age: Mdn±QD = 26.00 ± 8.50 years) were collected as part of a cross-sectional survey distributed among employees of the regional German Red Cross EMS division (response rate 46.6%). The sample corresponded well to the division's entire staff in terms of socio-anagraphic characteristics. METHODS CM and occupational trauma exposure as well as posttraumatic, depressive, and somatic symptoms were assessed with self-report questionnaires. RESULTS Moderation analyses indicated stronger positive associations between occupational trauma exposure and the severity of posttraumatic (β = .30, p < .001), depressive (β = .20, p = .026), and somatic symptoms (β = .18, p = .059) among EMS personnel who reported a higher exposure to CM. CONCLUSIONS Our study provides initial evidence that CM could increase the EMS personnel's vulnerability to the detrimental consequences of critical incidents on duty. Future research is needed (i) to replicate and generalize our observation on various trauma-exposed professions as well as (ii) to develop preventive measures for targeting the mediating and protective factors which influence the relationship between CM and the negative consequences of occupational trauma exposure.
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Affiliation(s)
- Alexander Behnke
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Iris-Tatjana Kolassa
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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46
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Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander VA, LeardMann CA. Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry 2019; 19:396. [PMID: 31836015 PMCID: PMC6911296 DOI: 10.1186/s12888-019-2375-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/27/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, particularly major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD. METHODS Eligible participants (n = 1704) for the Millennium Cohort Study included those who screened positive at baseline for both PTSD (PTSD Checklist-Civilian Version) and MDD (Patient Health Questionnaire). Between 2001 and 2016, participants completed a baseline assessment and up to 4 follow-up assessments approximately every 3 years. Mixture modeling simultaneously determined trajectories of comorbid PTSD and MDD symptoms. Multinomial regression determined factors associated with latent class membership. RESULTS Four distinct classes (chronic, relapse, gradual recovery, and rapid recovery) described symptom trajectories of PTSD/MDD. Membership in the chronic class was associated with older age, service branch, deployment with combat, anxiety, physical assault, disabling injury/illness, bodily pain, high levels of somatic symptoms, and less social support. CONCLUSIONS Comorbid PTSD/MDD symptoms tend to move in tandem, and, although the largest class remitted symptoms, almost 25% of participants reported chronic comorbid symptoms across all time points. Results highlight the need to assess comorbid conditions in the context of PTSD. Future research should further evaluate the chronicity of comorbid symptoms over time.
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Affiliation(s)
- Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA.
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA.
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA.
| | - Kristen H Walter
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, 92106-3521, USA
| | - Toni Rose Geronimo-Hara
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Ben Porter
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Cynthia A LeardMann
- Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
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Syed Sheriff R, Van Hooff M, Malhi G, Grace B, McFarlane A. Associations Among Childhood Trauma, Childhood Mental Disorders, and Past-Year Posttraumatic Stress Disorder in Military and Civilian Men. J Trauma Stress 2019; 32:712-723. [PMID: 31590205 DOI: 10.1002/jts.22450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 12/12/2022]
Abstract
To identify early life factors associated with posttraumatic stress disorder (PTSD), we investigated the association between childhood trauma and mental disorders with International Classification of Diseases (ICD)-diagnosed past-year PTSD in employed military and civilian men. Data were derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (N = 1,356) and the 2007 Australian Bureau of Statistics (ABS) National Survey of Mental Health and Wellbeing Study (N = 2,120) and analyzed using logistic regression and generalized structural equation modeling. After controlling for demographics, PTSD was associated with childhood anxiety, adjusted odds ratio (AOR) = 3.94, 95% CI [2.36, 6.58]; and depression, AOR = 7.01, 95% CI [2.98, 16.49], but not alcohol use disorders, in the ADF. In civilians, PTSD was associated with childhood anxiety only, AOR = 7.06, 95% CI [3.50, 14.22]. These associations remained significant after controlling for childhood and adult trauma in both populations and service factors and deployment, combat, or adult trauma in the ADF. In both populations, PTSD was associated with more than three types of childhood trauma: AOR = 2.97, 95% CI [1.53, 5.75] for ADF and AOR = 5.92, 95% CI [3.00, 11.70] for ABS; and childhood interpersonal, but not noninterpersonal, trauma: AOR = 3.08, 95% CI [1.61, 5.90] for ADF and AOR = 6.63, 95% CI [2.74, 16.06] for ABS. The association between childhood trauma and PTSD was fully mediated by childhood disorder in the ADF only. Taking a lifetime perspective, we have identified that the risk of PTSD from childhood trauma and disorder is potentially predictable and, therefore, modifiable.
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Affiliation(s)
- Rebecca Syed Sheriff
- Centre for Traumatic Stress Studies (CTSS), University of Adelaide, Adelaide, Australia.,Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies (CTSS), University of Adelaide, Adelaide, Australia
| | - Gin Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St. Leonards, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, Australia.,Clinical Assessment Diagnostic Evaluation (CADE) Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, Australia
| | - Blair Grace
- Department of Education and Child Development, Adelaide, Australia
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies (CTSS), University of Adelaide, Adelaide, Australia
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Klaming R, Spadoni AD, Veltman DJ, Simmons AN. Expansion of hippocampal and amygdala shape in posttraumatic stress and early life stress. NEUROIMAGE-CLINICAL 2019; 24:101982. [PMID: 31437724 PMCID: PMC6706650 DOI: 10.1016/j.nicl.2019.101982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of Posttraumatic Stress Disorder (PTSD) and childhood adversity on brain structure. We assessed hippocampal and amygdala shape in veterans with varying levels of PTSD symptom severity and exposure to early life stressors (ELS). METHODS A total of 70 male veterans, who were deployed to a combat area during OIF/OEF/OND and who had been exposed to trauma during deployment, were included in the study. We applied a vertex-wise shape analysis of 3T MRI scans to measure indentation or expansion in hippocampal and amygdala shape. RESULTS Analyses showed a positive correlation between number of ELS and vertices in the right amygdala and the right hippocampus, as well as a positive correlation between PTSD symptom severity and right hippocampal vertices. There were no significant interactions between PTSD symptoms, ELS, and brain shape. DISCUSSION Results indicate a relationship between exposure to more childhood adversity and expansion in amygdala and hippocampal shape as well as between more severe PTSD symptoms and expansion in hippocampal shape. These findings may have important implications for the pathophysiology of trauma-related disorders.
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Affiliation(s)
- Ruth Klaming
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - Andrea D Spadoni
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Alan N Simmons
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Caetano R, Cunradi CB, Alter HJ, Mair C, Yau RK. Drinking and Intimate Partner Violence Severity Levels Among U.S. Ethnic Groups in an Urban Emergency Department. Acad Emerg Med 2019; 26:897-907. [PMID: 30706610 DOI: 10.1111/acem.13706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emergency departments (EDs) provide care to ethnically diverse populations with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic-specific 12-month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample. METHODS Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features. RESULTS The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98-2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25-2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV. CONCLUSIONS There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center Pacific Institute for Research and Evaluation Berkeley CA
| | - Carol B. Cunradi
- Prevention Research Center Pacific Institute for Research and Evaluation Berkeley CA
| | - Harrison J. Alter
- Department of Emergency Medicine Highland Hospital–Alameda Health System Oakland CA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Rebecca K. Yau
- Prevention Research Center Pacific Institute for Research and Evaluation Berkeley CA
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McLafferty M, Ross J, Waterhouse-Bradley B, Armour C. Childhood adversities and psychopathology among military veterans in the US: The mediating role of social networks. J Anxiety Disord 2019; 65:47-55. [PMID: 31158649 DOI: 10.1016/j.janxdis.2019.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/15/2022]
Abstract
Childhood adversities can impact negatively on psychological health across the lifespan. Many military veterans have a history of adverse childhood experiences, which when combined with deployment related traumas, can lead to high levels of psychopathology. Social networks can however be protective. The current study aimed to identify typologies of childhood adversity in U.S. military veterans (n = 3092) and explore relationships between the adversity typologies and PTSD, mood and anxiety disorders, utilising data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III). The mediating role of quality and quantity of social networks were examined. Latent class analysis identified four adversity classes; 1) baseline, 2) household dysfunction, 3) maltreatment, and 4) multi-adversity. Individuals in the adversity classes (2-4), especially those who experienced multi-adversity had higher rates of psychopathology. The quality of social networks played an important mediating role, while quantity of networks did not. Those who experienced adversity were less likely to have supportive social networks, therefore adversity had both a direct and indirect impact on psychopathology. The findings highlight the importance of developing and maintaining social networks following military life. Recommendations include interpersonal skills training and programmes which may help them engage back into the community and enhance relationships.
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Affiliation(s)
- M McLafferty
- Ulster University, Cromore Road, Coleraine, Northern Ireland, United Kingdom.
| | - J Ross
- Ulster University, Cromore Road, Coleraine, Northern Ireland, United Kingdom
| | | | - C Armour
- Ulster University, Cromore Road, Coleraine, Northern Ireland, United Kingdom
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