Ambulatory cardiovascular activity and hostility ratings in women with chronic posttraumatic stress disorder

Evaluation of posttraumatic stress disorder diagnosis and therapy on diurnal blood pressure patterns from 24-hour ambulatory blood pressure monitoring

Introduction

The veteran population has a high incidence of posttraumatic stress disorder (PTSD), which is associated with increased risk of hypertension and cardiovascular death. Ambulatory blood pressure monitoring (ABPM) can identify abnormal diurnal blood pressure (BP) patterns, which are associated with increased risk of cardiovascular events. The intent of this evaluation was to examine prior ABPM studies to determine whether veterans with PTSD are more likely to have abnormal nocturnal dipping patterns compared with the general veteran population.

Methods

Retrospective chart review was performed on all archived ABPM studies and classified by nocturnal dipping status and BP control rates. Pertinent patient demographics of age, sex, concomitant PTSD, and use of selected PTSD therapies were identified at the time of ABPM study. Association between dipping status, BP control rates, and patient demographics were analyzed using appropriate statistical tests.

Results

A total of 470 ABPM studies were determined to be valid and included. There were no differences in the distribution of nocturnal dipping patterns in veterans with or without PTSD. Likewise, rates of nocturnal, awake, and 24-hour hypertension were similar between groups. In patients with PTSD who were treated with evening PTSD therapy, there was a higher rate of normal dipping status compared with those without treatment (66.7% vs 29.7%, P = .03).

Discussion

Veterans with PTSD had similar distributions of dipping patterns and rates of overall, awake, and nocturnal hypertension compared with the general veteran population. The association of nocturnal PTSD therapy prescription in patients with PTSD and higher rates of normal dipping status may warrant further investigation.

Characterizing anger-related affect in individuals with posttraumatic stress disorder using ecological momentary assessment

This study employed secondary analyses of existing ecological momentary assessment (EMA) data to characterize hostile and irritable affect in the day-to-day experience of 52 smokers with, and 65 smokers without, posttraumatic stress disorder (PTSD). EMA monitoring occurred over a mean of 8.2 days, and participants responded to an average of 2.8 random prompts/day. Analyses included Wilcoxon rank sum tests of group differences, and path analyses of cross-lagged multilevel models. Participants with PTSD endorsed a significantly higher proportion of total EMA entries indicating hostile affect and irritable affect than did individuals without PTSD. Cross-lagged analyses indicated that over a period of hours, PTSD symptoms significantly predicted subsequent hostile and irritable affect, but hostile and irritable affect did not predict subsequent PTSD symptoms. Findings suggest that day-to-day exposure to PTSD-related trauma cues may contribute to chronically elevated levels of anger-related affect. Such heightened affective arousal may, in turn, underlie an increased risk for verbal or physical aggression, as well as other health and quality-of-life related impairments associated with PTSD. Clinical implications include conceptualizing anger treatment in the broader context of trauma history and symptoms, and specifically targeting physiological arousal and maladaptive hostile cognitions triggered by trauma reminders in patients with PTSD.

Subclinical Posttraumatic Stress Disorder Symptoms: Relationships with Blood Pressure, Hostility, and Sleep

The purpose of this study was to examine the relationships among subclinical PTSD symptoms, blood pressure, and several variables linked to both frank PTSD and the basic psychobiological adaptation to stress. The authors recruited a sample of 91 healthy, young men and women between 18 and 35 years. We examined links among subclinical posttraumatic stress disorder symptoms, blood pressure, sleep quality, and hostility. Posttraumatic stress disorder symptoms were associated with poorer sleep quality and higher hostility scores in both women and men. In men, PTSD symptoms were also associated with elevated resting diastolic blood pressure, and sex was an important moderator of that relationship. Moreover, sleep quality and hostility are substantive mediators of the relationship between diastolic blood pressure and PTSD. Behavioral interventions designed to increase sleep quality and restructure hostile attitudes could potentially serve as preventive interventions for PTSD and the underlying cardiovascular comorbidities in young adults.

Bayesian Analysis of Ambulatory Blood Pressure Dynamics with Application to Irregularly Spaced Sparse Data

Ambulatory cardiovascular (CV) measurements provide valuable insights into individuals' health conditions in "real-life," everyday settings. Current methods of modeling ambulatory CV data do not consider the dynamic characteristics of the full data set and their relationships with covariates such as caffeine use and stress. We propose a stochastic differential equation (SDE) in the form of a dual nonlinear Ornstein-Uhlenbeck (OU) model with person-specific covariates to capture the morning surge and nighttime dipping dynamics of ambulatory CV data. To circumvent the data analytic constraint that empirical measurements are typically collected at irregular and much larger time intervals than those evaluated in simulation studies of SDEs, we adopt a Bayesian approach with a regularized Brownian Bridge sampler (RBBS) and an efficient multiresolution (MR) algorithm to fit the proposed SDE. The MR algorithm can produce more efficient MCMC samples that is crucial for valid parameter estimation and inference. Using this model and algorithm to data from the Duke Behavioral Investigation of Hypertension Study, results indicate that age, caffeine intake, gender and race have effects on distinct dynamic characteristics of the participants' CV trajectories.

Autonomic arousal during actigraphically estimated waking and sleep in male veterans with PTSD

Physiological hyperarousal is manifested acutely by increased heart rate, decreased respiratory sinus arrhythmia, and increased skin conductance level and variability. Yet it is uncertain to what extent such activation occurs with the symptomatic hyperarousal of posttraumatic stress disorder (PTSD). We compared 56 male veterans with current PTSD to 54 males who never had PTSD. Subjects wore ambulatory devices that recorded electrocardiograms, finger skin conductance, and wrist movement while in their normal environments. Wrist movement was monitored to estimate sleep and waking periods. Heart rate, but not the other variables, was elevated in subjects with PTSD equally during waking and during actigraphic sleep (effect sizes, Cohen's d, ranged from 0.63 to 0.89). The length of the sleep periods and estimated sleep fragmentation did not differ between groups. Group heart rate differences could not be explained by differences in body activity, PTSD hyperarousal symptom scores, depression, physical fitness, or antidepressant use.

The impact of race on metabolic disease risk factors in women with and without posttraumatic stress disorder

The literature on PTSD and metabolic disease risk factors has been limited by lacking investigation of the potential influence of commonly comorbid disorders and the role of race. In this study data were provided by a sample of 134 women (63 PTSD and 71 without PTSD). Separate sets of models examining associations of psychiatric disorder classifications with metabolic disease risk factors were used. Each model included race (African American or Caucasian), psychiatric disorder, and their interaction. There was an interaction of race and PTSD on body mass index, abdominal obesity, and triglycerides. While PTSD was not generally associated with deleterious health effects in African American participants, PTSD was related to worse metabolic disease risk factors in Caucasians. MDD was associated with metabolic disease risk factors, but there were no interactions with race. Results support the importance of race in the relationship between PTSD and metabolic disease risk factors. Future research would benefit from analysis of cultural factors to explain how race might influence metabolic disease risk factors in PTSD.

Nocturnal blood pressure non-dipping, posttraumatic stress disorder, and sleep quality in women

Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. The frequency of non-dippers did not differ by diagnostic status (d = .15). However, non-dippers endorsed more traumatic event categories (d = .53), more PTSD hyperarousal symptoms (d = .53), poorer overall sleep quality (d = .59), more frequent use of sleep medication (d = .62), greater sleep-related daytime dysfunction (d = .58), and longer sleep onset latencies (d = .55) than dippers. Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.

Social support and trait personality are independently associated with resting cardiovascular function in women

OBJECTIVES

Social support is thought to positively influence appraisals of stressors and coping resources, thereby attenuating the harmful effects of stress. Notably, perceived available support (rather than actually received support) is believed to benefit well-being independent of the sense of obligation or threats to self-esteem that receiving support may entail. This study examined whether perceived support levels were associated with reduced cardiovascular levels, an important predictor of cardiovascular disease risk, independent of broad trait personality variables frequently reported to overlap with perceived support. In doing so, we sought to determine whether the effects of perceived support are independent of links between personality and social support.

DESIGN

A cross-sectional design was employed.

METHODS

Resting cardiovascular levels were measured using a Finometer in a sample of healthy women (N = 145). The Short-Form Social Support Questionnaire and the Revised Eysenck's Personality Questionnaire were used to assess support levels and personality. Regression was used to compare associations with psychometric indices of support (namely, perceived network size and perceived satisfaction with support) and personality (psychoticism, extraversion and neuroticism).

RESULTS

Support independently predicted systolic blood pressure (SBP; p = .03) and HR (p = .02) when personality was controlled for, while personality also predicted SBP (p = .01) and DBP (p = .02). Support effects were not mediated by personality.

CONCLUSIONS

The findings corroborate previous research indicating links between support and resting cardiovascular levels and additionally demonstrate these to be independent of associations between support and personality.

The dimensionality of PTSD symptoms and their relationship to health-related quality of life in Chinese earthquake survivors

The current study investigated the latent structure of PTSD symptoms with a sample of 326 Chinese survivors who lost their children during a deadly earthquake. The results of confirmatory factor analysis indicated that a five-factor intercorrelated model comprised of intrusion, avoidance, emotional numbing, dysphoric arousal, and anxiety arousal provided significant better fit than both the four-factor numbing model of King, Leskin, King, and Weathers (1998) and the four-factor dysphoria model of Simms, Watson, and Doebbeling (2002). Further analyses with structural equation modeling showed that the PTSD factors were differentially associated with external measures of psychosocial and physical health-related quality of life. The findings provide further empirical support for the novel five-factor PTSD model, and carry implications for conceptualizing and assessing PTSD for the upcoming DSM-5.

Associations between parental posttraumatic stress disorder and both offspring internalizing problems and parental aggression within the National Comorbidity Survey-Replication

Data from the National Comorbidity Survey-Replication were used to evaluate links between parental posttraumatic stress disorder (PTSD) and elevated (1) offspring internalizing problems and (2) parental physical aggression toward children. We extended prior tests via the use of an independent nationally representative sample and by examining specific associations between these outcomes and PTSD above and beyond variance accounted for by several theoretically relevant demographic factors and PTSD-related comorbidity. As hypothesized, offspring anxiety and depression was elevated among parents with PTSD compared to those without the condition. Parents with PTSD also were more likely to endorse the use of both moderate (e.g., pushing) and severe (e.g., hitting with a fist) physical aggression with their children. These findings advance work in the area by suggesting that there is a unique relation between PTSD and these outcomes, which sets the stage for research to elucidate factors uniquely introduced by PTSD.

Childhood traumatic stress and obesity in women: the intervening effects of PTSD and MDD

In this study, symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were modeled as intervening variables in the relationship between childhood traumatic stress and weight outcomes in civilian women in the United States. Of the 148 participants, 72 had current PTSD, 64 had current MDD, and 32 had neither disorder. In separate single indirect effect models, there were significant indirect effects of both PTSD and depressive symptoms on body mass index and waist-hip ratio. When models included both PTSD and depressive symptoms, an indirect effect of PTSD symptoms was evident in the relationship between childhood traumatic stress and waist-hip ratio. Posttraumatic stress disorder may play a particularly important role in the development of central adiposity.

Adaptation to extreme stress: post-traumatic stress disorder, neuropeptide Y and metabolic syndrome

The prevalence rates of obesity and metabolic syndrome are on the rise in the United States. Epidemiological surveys suggest that the rates of these medical conditions are especially high among persons with psychiatric disorders, including post-traumatic stress disorder (PTSD). A variety of factors are thought to contribute to the risk for metabolic syndrome, including excessive caloric intake, decreased activity and energy expenditure, use of certain medications, stress and genetic influences. Recent research demonstrates that stress, acting through the neuropeptide Y (NPY) and glucocorticoid systems, potentiates the development of obesity and other aspects of metabolic syndrome in mice fed a high caloric, fat and sugar diet. Alterations in the NPY and glucocorticoid systems also impact behavioral adaptation to stress, as indicated by studies in animals and persons exposed to severe, life-threatening or traumatic stress. The following review examines the biology of the NPY and neuroactive steroid systems as physiological links between metabolic syndrome and PTSD, a paradigmatic neuropsychiatric stress disorder. Hopefully, understanding the function of these systems from both a translational and systems biology point of view in relation to stress will enable development of more effective methods for preventing and treating the negative physical and mental health consequences of stress.

Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence

BACKGROUND

Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease.

PURPOSE

The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes.

METHODS

A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted.

RESULTS

The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers.

CONCLUSIONS

Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.

Sleep disturbance and baroreceptor sensitivity in women with posttraumatic stress disorder

In a previous study, women with posttraumatic stress disorder (PTSD) had greater objective sleep disturbance than those without PTSD. In a separate previous study, women with PTSD were also found to have lower baroreceptor sensitivity (BRS), an index of blood pressure regulation. In the present study, the authors concurrently assessed BRS and objective sleep by diagnostic status. A comparison of 32 women with PTSD with 21 women without PTSD revealed an interaction between BRS and sleep efficiency, wake after sleep onset percentage, and sleep fragmentation. Lower BRS was associated with poorer sleep in women with PTSD, but not in those without. Future research should investigate causal relationships between sleep and blood pressure regulation in those with PTSD.

Effects of posttraumatic stress disorder status and covert hostility on cardiovascular responses to relived anger in women with and without PTSD

Previous literature has found greater heart rate (HR) and blood pressure (BP) responses during relived anger, and a positive association between covert hostility and relived anger, in male veterans with posttraumatic stress disorder (PTSD). This study investigated hostility and cardiovascular responses to a relived anger task in 120 women (70 with PTSD and 50 without PTSD). Women with PTSD reported greater hostile beliefs and covert hostility than non-PTSD controls, reported greater anger and anxiety during the anger recall task, and had higher resting HR. In general, the relationship between PTSD and cardiovascular response was moderated by covert hostility, which was associated with greater baseline diastolic BP and greater HR during relived anger and anger recovery among women with PTSD, but not among non-PTSD controls. Results suggest that the relationship between PTSD and cardiovascular response is moderated by hostility.

Diagnostic efficiency of the personality assessment inventory LOGIT function for posttraumatic stress disorder in women

In this study, we examined the diagnostic efficiency of the Personality Assessment Inventory (PAI; Morey, 1991) for the assessment of posttraumatic stress disorder (PTSD) in a community-based sample of women (n = 128). Receiver operating characteristic curves (ROC) were generated to examine the efficiency of the PAI PTSD LOGIT function as a tool for diagnosing PTSD. Using the Clinician Administered PTSD Scale as the reference standard, the PTSD LOGIT function performed well (area under the curve [AUC] = .856, standard error [SE] = .034). This represents performance consistent with more commonly used self-report PTSD scales, the Davidson Trauma Scale (AUC = .863, SE = .033) and the PAI Anxiety subscale Anxiety-Related Disorders Traumatic Experiences (AUC = .861; S.E. = .033). Results of this study suggest that the PAI PTSD LOGIT function may be a useful tool in assessing PTSD.

Self-reported health and physician diagnosed illnesses in women with posttraumatic stress disorder and major depressive disorder

Posttraumatic stress disorder has been associated with poor physical health. Depression is also associated with poor health, and may be responsible for the apparent relationship between PTSD and health outcomes. The current study examined self-reported and physician diagnosed medical morbidity in women. Women with PTSD alone were compared to three other groups of women: women with PTSD and comorbid major depressive disorder (MDD), women with MDD only, or women with neither diagnosis (comparison group). Results suggest that PTSD, with or without MDD, is associated with poor health in women. Posttraumatic stress disorder severity was related to health complaints beyond the effects of both somatization and depressive symptoms among women with PTSD. Findings and implications are discussed in relation to previous research in the area.