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Zhu X, Suarez-Jimenez B, Lazarov A, Such S, Marohasy C, Small SS, Wager TD, Lindquist MA, Lissek S, Neria Y. Sequential fear generalization and network connectivity in trauma exposed humans with and without psychopathology. Commun Biol 2022; 5:1275. [PMID: 36414703 PMCID: PMC9681725 DOI: 10.1038/s42003-022-04228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
While impaired fear generalization is known to underlie a wide range of psychopathology, the extent to which exposure to trauma by itself results in deficient fear generalization and its neural abnormalities is yet to be studied. Similarly, the neural function of intact fear generalization in people who endured trauma and did not develop significant psychopathology is yet to be characterized. Here, we utilize a generalization fMRI task, and a network connectivity approach to clarify putative behavioral and neural markers of trauma and resilience. The generalization task enables longitudinal assessments of threat discrimination learning. Trauma-exposed participants (TE; N = 62), compared to healthy controls (HC; N = 26), show lower activity reduction in salience network (SN) and right executive control network (RECN) across the two sequential generalization stages, and worse discrimination learning in SN measured by linear deviation scores (LDS). Comparison of resilient, trauma-exposed healthy control participants (TEHC; N = 31), trauma exposed individuals presenting with psychopathology (TEPG; N = 31), and HC, reveals a resilience signature of network connectivity differences in the RECN during generalization learning measured by LDS. These findings may indicate a trauma exposure phenotype that has the potential to advance the development of innovative treatments by targeting and engaging specific neural dysfunction among trauma-exposed individuals, across different psychopathologies.
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Affiliation(s)
- Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | | | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,School School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Sara Such
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Caroline Marohasy
- Department of Neuroscience, University of Rochester, Rochester, NY, USA
| | - Scott S Small
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Tor D Wager
- Neuroscience Department, Dartmouth College, Hanover, NH, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Shmuel Lissek
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA. .,New York State Psychiatric Institute, New York, NY, USA. .,Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
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Mendoza NB, Mordeno IG, Nalipay MJN. The Transdiagnostic Role of Rumination in the Comorbidity of PTSD and Depression. JOURNAL OF LOSS & TRAUMA 2021. [DOI: 10.1080/15325024.2021.2018197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Imelu G. Mordeno
- Mindanao State University–Iligan Institute of Technology, Iligan, Philippines
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3
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Sampson L, Cohen GH, Fink DS, Conroy C, Calabrese JR, Wryobeck JM, Elhai JD, King AP, Liberzon I, Galea S. Cohort profile: the Ohio Army National Guard Mental Health Initiative (OHARNG-MHI). Soc Psychiatry Psychiatr Epidemiol 2021; 56:2107-2116. [PMID: 34480595 PMCID: PMC8577754 DOI: 10.1007/s00127-021-02166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. METHODS OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. RESULTS Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. CONCLUSION Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.
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Affiliation(s)
- Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gregory H. Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, U.S.A
| | - David S. Fink
- New York State Psychiatric Institute, New York, NY, U.S.A
| | - Carla Conroy
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - Joseph R. Calabrese
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - John M. Wryobeck
- Department of Psychiatry, University of Toledo, Toledo, OH, U.S.A
| | - Jon D. Elhai
- Department of Psychology, University of Toledo, Toledo, OH, U.S.A
| | - Anthony P. King
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - Israel Liberzon
- Department of Psychiatry, College of Medicine, Texas A&M, College Station, TX, U.S.A
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, MA, U.S.A
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Rzeszutek M, Lis-Turlejska M, Krajewska A, Zawadzka A, Lewandowski M, Szumiał S. Long-Term Psychological Consequences of World War II Trauma Among Polish Survivors: A Mixed-Methods Study on the Role of Social Acknowledgment. Front Psychol 2020; 11:210. [PMID: 32174863 PMCID: PMC7055398 DOI: 10.3389/fpsyg.2020.00210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background The research on the psychological consequences of World War II (WWII) trauma has predominantly focused on concentration camp and Holocaust survivors. Only a few studies have been undertaken among civilian survivors of WWII. Objectives The purpose of this study was to examine the association between perceived social acknowledgment of WWII trauma and the level of post-traumatic stress disorder (PTSD) and depressive symptoms among Polish survivors of WWII by employing a mixed-methods design (i.e., a quantitative analysis supported by qualitative interviews). Method In the quantitative part, 123 participants filled out: the list of WWII-related traumatic events, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), the shortened version of the Geriatric Depression Scale (GDS), and the Social Acknowledgment Questionnaire (SAQ). In the qualitative part, an interpretative phenomenological analysis (IPA) of participants’ reminiscences of WWII was examined. Results Although we observed a direct positive association between the number of WWII-related traumatic events and the intensity of PTSD and depressive symptoms, these relationships changed when we entered the social acknowledgment construct into the model. Specifically, we found that perceived social acknowledgment (general disapproval) was a mediator of the relationship between the number of WWII traumatic events and the intensity of PTSD symptoms only, and not of depressive symptoms. In the qualitative part, three themes relating to traumatic reminiscences emerged among the participants: parental efficacy, parental betrayal, and support from the invader. Conclusion Our study showed the significance of the general social acknowledgment in the long-term mental consequences of the WWII trauma in Poland. In addition, the results of our study may be an adjunct to the discussion on the long-term impact of WWII trauma in Poland and the factors that hindered its social recognition.
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Affiliation(s)
| | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | | | | | - Szymon Szumiał
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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5
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Greenblatt-Kimron L, Cohen M. The role of cognitive processing in the relationship of posttraumatic stress symptoms and depression among older Holocaust survivors: a moderated-mediation model. ANXIETY STRESS AND COPING 2019; 33:59-74. [DOI: 10.1080/10615806.2019.1669787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lee Greenblatt-Kimron
- School of Social Work, Ariel University, Ariel, Israel
- School of Social Work, University of Haifa, Haifa, Israel
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
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Richardson JD, Thompson A, King L, Ketcheson F, Shnaider P, Armour C, St. Cyr K, Sareen J, Elhai JD, Zamorski MA. Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:501-510. [PMID: 30599762 PMCID: PMC6610565 DOI: 10.1177/0706743718816057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is often accompanied by other mental health conditions, including major depressive disorder (MDD), substance misuse disorders, and anxiety disorders. The objective of the current study is to delineate classes of comorbidity and investigate predictors of comorbidity classes amongst a sample of Canadian Armed Forces (CAF) Regular Force personnel. METHODS Latent class analyses (LCAs) were applied to cross-sectional data obtained between April and August 2013 from a nationally representative random sample of 6700 CAF Regular Force personnel who deployed to the mission in Afghanistan. RESULTS MDD was the most common diagnosis (8.0%), followed by PTSD (5.3%) and generalized anxiety disorder (4.7%). Of those with a mental health condition, LCA revealed 3 classes of comorbidity: a highly comorbid class (8.3%), a depressed-only class (4.6%), and an alcohol use-only class (3.1%). Multinomial logit regression showed that women (adjusted relative risk ratio [ARRR] = 2.77; 95% CI, 2.13 to 3.60; P < 0.01) and personnel reporting higher trauma exposure (ARRR = 4.18; 95% CI, 3.13 to 5.57; P < 0.01) were at increased risk of membership in the comorbid class compared to those without a mental health condition. When compared to those with no mental health condition, experiencing childhood abuse increased the risk of being in any comorbidity class. CONCLUSIONS Results provide further evidence to support screening for and treatment of comorbid mental health conditions. The role of sex, childhood abuse, and combat deployment in determining class membership may also prove valuable for clinicians treating military-related mental health conditions.
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Affiliation(s)
- J. Don Richardson
- Department of Psychiatry, Western University, London, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University,
Hamilton, Ontario
- Parkwood Institute Operational Stress Injury Clinic, London, Ontario
- MacDonald/Franklin OSI Research Centre, London, Ontario
| | | | - Lisa King
- Parkwood Institute Operational Stress Injury Clinic, London, Ontario
| | - Felicia Ketcheson
- Parkwood Institute Operational Stress Injury Clinic, London, Ontario
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University,
Hamilton, Ontario
- Anxiety Treatment and Research Centre, St. Joseph’s Healthcare Hamilton,
Hamilton, Ontario
| | | | - Kate St. Cyr
- Parkwood Institute Operational Stress Injury Clinic, London, Ontario
| | - Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences,
University of Manitoba, Winnipeg
- Deer Lodge Centre Operational Stress Injury Clinic, Winnipeg, Manitoba
| | - Jon D. Elhai
- Departments of Psychology and Psychiatry, University of Toledo, Toledo, OH,
USA
| | - Mark A. Zamorski
- MacDonald/Franklin OSI Research Centre, London, Ontario
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
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7
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Differential effects of unipolar versus bipolar depression on episodic memory updating. Neurobiol Learn Mem 2019; 161:158-168. [PMID: 31004802 DOI: 10.1016/j.nlm.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
Abstract
Episodic memories, when reactivated, can be modified or updated by new learning. Since such dynamic memory processes remain largely unexplored in psychiatric disorders, we examined the impact of depression on episodic memory updating. Unipolar and bipolar depression patients, and age/education matched controls, first learned a set of objects (List-1). Two days later, participants in all three groups were either reminded of the first learning session or not followed by the learning of a new set of objects (List-2). Forty-eight hours later, List-1 recall was impaired in unipolar and bipolar patients compared to control participants. Further, as expected, control participants who received a reminder spontaneously recalled items from List-2 during recall of List-1, indicative of an updated List-1 memory. Such spontaneous intrusions were also seen in the unipolar and bipolar patients that received the reminder, suggesting that memory updating was unaffected in these two patient groups despite impaired recall of List 1. Unexpectedly, we observed a trend towards higher intrusions, albeit statistically insignificant, not only in the reminder but also in the no-reminder subgroups of bipolar patients. We probed this further in a second cohort by testing recall of List-2, which was also impaired in both depression groups. Again bipolar patients showed intrusions, but this time in the reverse order from List-1 into List-2, independent of a reminder. Taken together, despite impaired recall, updating of episodic memories was intact and unidirectional in unipolar depression. In contrast, indiscriminate updating, as evidenced by bidirectional interference between episodic memories, was seen in bipolar depression. These findings reveal a novel distinction between unipolar versus bipolar depression using a reactivation-dependent memory updating paradigm.
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Dekel R, Shaked O, Ben-Porat A, Itzhaky H. The Interrelations of Physical and Mental Health: Self-Rated Health, Depression, and PTSD Among Female IPV Survivors. Violence Against Women 2019; 26:379-394. [PMID: 30940066 DOI: 10.1177/1077801219832916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Researchers have found that intimate partner violence (IPV) is associated with low self-rated health (SRH), which is correlated with increased medication usage, and has tremendous social consequences. IPV and low SRH are associated with posttraumatic stress disorder (PTSD) and depression, and the current study examined the interrelations between these variables among 505 Israeli women in shelters. To assess mediation, three regressions were designed. Traumatic events, Russian ethnicity, and chronic illness all contributed to low SRH. The direct effect of depression on SRH was insignificant when PTSD entered the regression. Our findings suggest that PTSD is a more fundamental factor than depression when predicting SRH among IPV survivors.
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9
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Contractor AA, Greene T, Dolan M, Elhai JD. Relations between PTSD and depression symptom clusters in samples differentiated by PTSD diagnostic status. J Anxiety Disord 2018; 59:17-26. [PMID: 30142474 DOI: 10.1016/j.janxdis.2018.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Co-occurring posttraumatic stress disorder (PTSD) and depression following traumatic experiences are cumulatively associated with functional impairment. To examine mechanisms for the PTSD-depression comorbidity, we investigated their cluster-level associations. Using data obtained from Amazon's Mechanical Turk platform, 368 trauma-exposed participants were split into two subsamples: those with (n = 163) and without (n = 185) probable PTSD. In both subsamples, confirmatory factor analyses indicated an optimal seven-factor PTSD Hybrid Model. Results of Wald tests of parameter constraints indicated that, in both subsamples, PTSD's dysphoric arousal cluster strongly related to somatic depression compared to all/most other PTSD Hybrid Model clusters. Additionally, in both subsamples, PTSD's negative affect, externalizing behaviors, and anhedonia clusters each strongly related to non-somatic depression compared to PTSD's anxious arousal cluster. Our results indicated that PTSD's dysphoric arousal symptoms mainly accounted for PTSD's shared variance with somatic depression, while the negative alterations in cognitions and mood (NACM)/dysphoria and arousal symptoms (primarily externalizing behaviours) mainly accounted for PTSD's shared variance with non-somatic depression. Our findings have implications for the discussion on PTSD's specific/non-specific clusters tied to diagnostic modifications, for understanding mechanisms underlying PTSD-depression comorbidity, and for the use of transdiagnostic and multi-component treatment protocols for PTSD-depression symptoms.
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Affiliation(s)
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Israel
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jon D Elhai
- Department of Psychology and Department of Psychiatry, University of Toledo, Toledo, OH, USA
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10
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Durham TA, Byllesby BM, Lv X, Elhai JD, Wang L. Anger as an underlying dimension of posttraumatic stress disorder. Psychiatry Res 2018; 267:535-540. [PMID: 29980134 DOI: 10.1016/j.psychres.2018.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Abstract
In this study, we examined the underlying role of anger in posttraumatic stress disorder (PTSD). Although anger is currently considered within two symptoms of PTSD (i.e., anger/irritability; and negative emotional state), some research has found that anger is more than just a diagnostic symptom of PTSD. The sample consisted of 375 trauma-exposed individuals that completed the PTSD Checklist-5 and Dimensions of Anger Reactions Scale. Confirmatory factor analysis was used to assess PTSD's factor structure based on the four-factor DSM-5 PTSD model. Subsequently, the model was re-tested, statistically controlling for anger by regressing PTSD's items on an observed anger score. Individual factor loading differences were then compared to determine anger's underlying role. Results indicated that a significant amount of variance in PTSD, at both the item level and factor level, was attributable to an underlying dimension of anger. The largest factor attenuation was for the symptom of irritability/anger and the smallest attenuation was recklessness. The results suggest that anger underlies more of PTSD than the two diagnostic symptom criteria.
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Affiliation(s)
- Tory A Durham
- VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA; Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA
| | - Brianna M Byllesby
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA; Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Xin Lv
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA.
| | - Li Wang
- Laboratory for Traumatic Stress studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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11
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Hurlocker MC, Vidaurri DN, Cuccurullo LAJ, Maieritsch K, Franklin CL. Examining the latent structure mechanisms for comorbid posttraumatic stress disorder and major depressive disorder. J Affect Disord 2018; 229:477-482. [PMID: 29334642 DOI: 10.1016/j.jad.2017.12.076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 12/27/2017] [Accepted: 12/31/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a complex psychiatric illness that can be difficult to diagnose, due in part to its comorbidity with major depressive disorder (MDD). Given that researchers have found no difference in prevalence rates of PTSD and MDD after accounting for overlapping symptoms, the latent structures of PTSD and MDD may account for the high comorbidity. In particular, the PTSD Negative Alterations in Cognition and Mood (NACM) and Hyperarousal factors have been characterized as non-specific to PTSD. Therefore, we compared the factor structures of the Diagnostic and Statistical Manual of Mental Disorders, 5thedition (DSM-5) PTSD and MDD and examined the mediating role of the PTSD NACM and Hyperarousal factors on the relationship between MDD and PTSD symptom severity. METHODS Participants included 598 trauma-exposed veterans (Mage = 48.39, 89% male) who completed symptom self-report measures of DSM-5 PTSD and MDD. RESULTS Confirmatory factor analyses indicated an adequate-fitting four-factor DSM-5 PTSD model and two-factor MDD model. Compared to other PTSD factors, the PTSD NACM factor had the strongest relationship with the MDD Affective factor, and the PTSD NACM and Hyperarousal factors had the strongest association with the MDD Somatic factor. Further, the PTSD NACM factor explained the relationship between MDD factors and PTSD symptom severity. More Affective and Somatic depression was related to more NACM symptoms, which in turn were related to increased severity of PTSD. LIMITATIONS Limitations include the reliance on self-report measures and the use of a treatment-seeking, trauma-exposed veteran sample which may not generalize to other populations. CONCLUSIONS Implications concerning the shared somatic complaints and psychological distress in the comorbidity of PTSD and MDD are discussed.
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Affiliation(s)
- Margo C Hurlocker
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA
| | - Desirae N Vidaurri
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA
| | - Lisa-Ann J Cuccurullo
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal Street., New Orleans, LA 70119, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Kelly Maieritsch
- Edward Hines Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA
| | - C Laurel Franklin
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal Street., New Orleans, LA 70119, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
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12
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ICU-related PTSD – A review of PTSD and the potential effects of collaborative songwriting therapy. J Crit Care 2017; 42:78-84. [DOI: 10.1016/j.jcrc.2017.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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13
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Wooten NR, Adams RS, Mohr BA, Jeffery DD, Funk W, Williams TV, Larson MJ. Pre-deployment Year Mental Health Diagnoses and Treatment in Deployed Army Women. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:582-594. [PMID: 27368233 PMCID: PMC5203968 DOI: 10.1007/s10488-016-0744-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT. During the pre-deployment year, a substantial percentage of Army women had MHDX and at least one MHT encounter or stay. Future research should determine if pre-deployment MHDX among Army women reflect vulnerability to future MHDX, or if pre-deployment MHT results in protection from chronic symptoms.
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Affiliation(s)
- Nikki R Wooten
- College of Social Work, University of South Carolina, Columbia, SC, 29208, USA.
| | - Rachel Sayko Adams
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA
| | - Beth A Mohr
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA
| | - Diana D Jeffery
- Clinical Support Division, Healthcare Operations Directorate, Defense Health Agency (DHA), Office of the Assistant Secretary of Defense (Health Affairs), Department of Defense, Falls Church, VA, 22042, USA
| | - Wendy Funk
- Kennell and Associates, Incorporated, Falls Church, VA, 22041, USA
| | - Thomas V Williams
- Defense Health Agency, Department of Defense, Falls Church, VA, 20042, USA
| | - Mary Jo Larson
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA
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14
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Horesh D, Aiello AE, Koenen KC, Uddin M, Uddin M, Koenen KC. An in-depth look into PTSD-depression comorbidity: A longitudinal study of chronically-exposed Detroit residents. J Affect Disord 2017; 208:653-661. [PMID: 27816322 PMCID: PMC6684032 DOI: 10.1016/j.jad.2016.08.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/24/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although PTSD-major depressive disorder (MDD) co-morbidity is well-established, the vast majority of studies have examined comorbidity at the level of PTSD total severity, rather than at the level of specific PTSD symptom clusters. This study aimed to examine the long-term associations between MDD and PTSD symptom clusters (intrusion, avoidance, hyperarousal), and the moderating role of gender in these associations. METHODS 942 residents of urban Detroit neighborhoods were interviewed at 3 waves, 1 year apart. At each wave, they were assessed for PTSD, depression, trauma exposure, and stressful life events. RESULTS At all waves, hyperarousal was the PTSD cluster most strongly correlated with MDD. For the full sample, a reciprocal relationship was found between MDD and all three PTSD clusters across time. Interestingly, the relative strength of associations between MDD and specific PTSD clusters changed over time. Women showed the same bidirectional MDD-PTSD pattern as in the entire sample, while men sometimes showed non-significant associations between early MDD and subsequent PTSD clusters. LIMITATIONS First, our analyses are based on DSM-IV criteria, as this was the existing edition at the time of this study. Second, although this is a longitudinal study, inferences regarding temporal precedence of one disorder over another must be made with caution. CONCLUSIONS Early identification of either PTSD or MDD following trauma may be crucial in order to prevent the development of the other disorder over time. The PTSD cluster of hyper-arousal may require special therapeutic attention. Also, professionals are encouraged to develop more gender-specific interventions post-trauma.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University & Depratment of Psychiatry, NYU School of Medicine.
| | | | | | - Monica Uddin
- Department of Psychology, University of Illinois at Urbana-Champaign.
| | - Monica Uddin
- Department of Psychology, University of Illinois at Urbana-Champaign.
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health.
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Rajan G, Ljunggren G, Wändell P, Wahlström L, Svedin CG, Carlsson AC. Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm. J Epidemiol Community Health 2017; 71:592-598. [PMID: 28077602 DOI: 10.1136/jech-2016-208105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions. METHODS Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated. RESULTS Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 0-17 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1). CONCLUSIONS Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.
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Affiliation(s)
- Gita Rajan
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Academic Primary Healthcare Centre
| | - Gunnar Ljunggren
- Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Per Wändell
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Academic Primary Healthcare Centre
| | - Lars Wahlström
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Göran Svedin
- Barnafrid, Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Axel C Carlsson
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
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16
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Suri P, Boyko EJ, Smith NL, Jarvik JG, Williams FMK, Jarvik GP, Goldberg J. Modifiable risk factors for chronic back pain: insights using the co-twin control design. Spine J 2017; 17:4-14. [PMID: 27794503 PMCID: PMC6126929 DOI: 10.1016/j.spinee.2016.07.533] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inconsistent associations between modifiable risk factors and chronic back pain (CBP) may be due to the inability of traditional epidemiologic study designs to properly account for an array of potential genetic and environmental confounding factors. The co-twin control research design, comparing modifiable risk factors in twins discordant for CBP, offers a unique way to remove numerous confounding factors. PURPOSE The study aimed to examine the association of modifiable lifestyle and psychological factors with lifetime CBP. STUDY DESIGN/SETTING This is a cross-sectional co-twin control study in a nationwide sample of male twin members of the Vietnam Era Twin Registry. PATIENT SAMPLE The sample is composed of 7,108 participants, including 1,308 monozygotic (MZ) pairs and 793 dizygotic pairs. OUTCOME MEASURE The outcome measure is the self-reported lifetime history of CBP. METHODS Lifestyle factors included body mass index (BMI), smoking history, alcohol consumption, habitual physical activity, and typical sleep duration. Psychological factors included depression (Patient Health Questionnaire-9) and posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist). Covariates included age, race, education, and income. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the association of risk factors with lifetime CBP when considering twins as individuals, and a within-pair co-twin control analysis that accounted for familial and genetic factors. Funding was through VA Grant 5IK2RX001515; there were no study-specific conflicts of interest. RESULTS The mean age of respondents was 62 years and the prevalence of lifetime CBP was 28%. All lifestyle factors were associated with CBP in the individual level analysis. However, none of these persisted in the within-pair analyses, except for severe obesity (BMI ≥35.0), which was associated with lifetime CBP in both individual-level (OR=1.6, 95% CI: 1.3-1.9) and within-pair analyses (MZ analysis: OR=3.7, 95% CI: 1.2-11.4). Symptoms of PTSD and depression were strongly associated with lifetime CBP in both the individual-level (moderate or severe depression: OR=4.2, 95% CI: 3.6-4.9, and severe PTSD: OR=4.8, 95% CI: 4.0-5.7) and within-pair (MZ) analyses (moderate or severe depression: OR=4.6, 95% CI: 2.4-8.7, and severe PTSD: OR=3.2, 95% CI: 1.6-6.5). CONCLUSIONS Many associations between modifiable lifestyle risk factors and CBP are due to confounding by familial and genetic factors. Severe obesity, depression, and PTSD should be considered in the development of intervention strategies to reduce the prevalence of CBP.
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Affiliation(s)
- Pradeep Suri
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Division of Rehabilitation Care Services, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA 98104, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; General Medicine Service, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St Health Sciences Bldg, Box 357236, Seattle, WA 98195, USA
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Box #359455, Seattle, WA 98195, USA; Department of Radiology, University of Washington, 325 9th Ave, Seattle, WA 98104, USA; Department of Neurological Surgery, University of Washington, 325 9th Ave, Seattle, WA 98104, USA; Department of Health Services, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, Kings College London, Strand, London WC2R 2LS, UK
| | - Gail P Jarvik
- Department of Medicine (Medical Genetics), 3720 15th Ave NE, Seattle, WA 98105, USA; Department of Genome Sciences, University of Washington, 3720 15th Ave NE, Seattle, WA 98105, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St Health Sciences Bldg, Box 357236, Seattle, WA 98195, USA
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17
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Therapeutic Effects of Extinction Learning as a Model of Exposure Therapy in Rats. Neuropsychopharmacology 2016; 41:3092-3102. [PMID: 27417516 PMCID: PMC5101557 DOI: 10.1038/npp.2016.127] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 01/05/2023]
Abstract
Current treatments for stress-related psychiatric disorders, such as depression and posttraumatic stress disorder (PTSD), are inadequate. Cognitive behavioral psychotherapies, including exposure therapy, are an alternative to pharmacotherapy, but the neurobiological mechanisms are unknown. Preclinical models demonstrating therapeutic effects of behavioral interventions are required to investigate such mechanisms. Exposure therapy bears similarity to extinction learning. Thus, we investigated the therapeutic effects of extinction learning as a behavioral intervention to model exposure therapy in rats, testing its effectiveness in reversing chronic stress-induced deficits in cognitive flexibility and coping behavior that resemble dimensions of depression and PTSD. Rats were fear-conditioned by pairing a tone with footshock, and then exposed to chronic unpredictable stress (CUS) that induces deficits in cognitive set-shifting and active coping behavior. They then received an extinction learning session as a therapeutic intervention by repeated exposure to the tone with no shock. Effects on cognitive flexibility and coping behavior were assessed 24 h later on the attentional set-shifting test or shock-probe defensive burying test, respectively. Extinction reversed the CUS-induced deficits in cognitive flexibility and coping behavior, and increased phosphorylation of ribosomal protein S6 in the medial prefrontal cortex (mPFC) of stress-compromised rats, suggesting a role for activity-dependent protein synthesis in the therapeutic effect. Inhibiting protein synthesis by microinjecting anisomycin into mPFC blocked the therapeutic effect of extinction on cognitive flexibility. These results demonstrate the utility of extinction as a model by which to study mechanisms underlying exposure therapy, and suggest these mechanisms involve protein synthesis in the mPFC, the further study of which may identify novel therapeutic targets.
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18
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Durham TA, Byllesby BM, Armour C, Forbes D, Elhai JD. Relations between anger and DSM-5 posttraumatic stress disorder symptoms. Psychiatry Res 2016; 244:403-9. [PMID: 27525831 DOI: 10.1016/j.psychres.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
Abstract
The present study investigated the relationship between posttraumatic stress disorder (PTSD) and anger. Anger co-occurring with PTSD is found to have a severe effect across a wide range of traumatic experiences, making this an important relationship to examine. The present study utilized data regarding dimensions of PTSD symptoms and anger collected from a non-clinical sample of 247 trauma-exposed participants. Confirmatory factor analysis (CFA) was used to determine the underlying factor structure of both PTSD and anger by examining anger in the context of three models of PTSD. Results indicate that a five-factor representation of PTSD and one-factor representation of anger fit the data best. Additionally, anger demonstrated a strong relationship with the dysphoric arousal and negative alterations in cognitions and mood (NACM) factors; and dysphoric arousal was differentially related to anger. Clinical implications include potential need to reevaluate PTSD's diagnostic symptom structure and highlight the potential need to target and treat comorbid anger in individuals with PTSD. In regard to research, these results support the heterogeneity of PTSD.
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Affiliation(s)
- Tory A Durham
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | | | - Cherie Armour
- School of Psychology, University of Ulster, Coleraine Campus, Northern Ireland, UK
| | - David Forbes
- Australian Centre for Posttraumatic Mental Health, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA. http://www.jon-elhai.com
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19
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The Underlying Role of Negative Affect in the Association between PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9555-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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20
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Frías Á, Martínez B, Palma C, Farriols N. Clinical impact of comorbid major depression in subjects with posttraumatic stress disorder: A review of the literature. NORDIC PSYCHOLOGY 2016. [DOI: 10.1080/19012276.2016.1162106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Latent dimensions of posttraumatic stress disorder and their relations with alcohol use disorder. Soc Psychiatry Psychiatr Epidemiol 2016; 51:421-9. [PMID: 26520448 DOI: 10.1007/s00127-015-1135-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this study was to evaluate the relationship between factors of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) using confirmatory factor analysis (CFA) in order to further our understanding of the substantial comorbidity between these two disorders. METHODS CFA was used to examine which factors of PTSD's dysphoria model were most related to AUD in a military sample. Ohio National Guard soldiers with a history of overseas deployment participated in the survey (n = 1215). Participants completed the PTSD Checklist and a 12-item survey from the National Survey on Drug Use used to diagnosis AUD. RESULTS The results of the CFA indicated that a combined model of PTSD's four factors and a single AUD factor fit the data very well. Correlations between PTSD's factors and a latent AUD factor ranged from correlation coefficients of 0.258-0.285, with PTSD's dysphoria factor demonstrating the strongest correlation. However, Wald tests of parameter constraints revealed that AUD was not more correlated with PTSD's dysphoria than other PTSD factors. CONCLUSIONS All four factors of PTSD's dysphoria model demonstrate comparable correlations with AUD. The role of dysphoria to the construct of PTSD is discussed.
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22
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Di Blasio P, Camisasca E, Caravita SCS, Ionio C, Milani L, Valtolina GG. The Effects of Expressive Writing on Postpartum Depression and Posttraumatic Stress Symptoms. Psychol Rep 2015; 117:856-82. [DOI: 10.2466/02.13.pr0.117c29z3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Paola Di Blasio
- C.R.I.d.e.e., Dipartimento di Psicologia, Università Cattolica del Sacro Cuore
| | | | | | - Chiara Ionio
- C.R.I.d.e.e., Dipartimento di Psicologia, Università Cattolica del Sacro Cuore
| | - Luca Milani
- C.R.I.d.e.e., Dipartimento di Psicologia, Università Cattolica del Sacro Cuore
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23
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Schnyder U, Müller J, Morina N, Schick M, Bryant RA, Nickerson A. A Comparison of DSM-5 and DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder in Traumatized Refugees. J Trauma Stress 2015; 28:267-74. [PMID: 26194738 DOI: 10.1002/jts.22023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to compare the prevalence rate and factor structure of posttraumatic stress disorder (PTSD) based on the diagnostic criteria of the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; DSM-5; American Psychiatric Association, , ) in traumatized refugees. There were 134 adult treatment-seeking, severely and multiply traumatized patients from various refugee backgrounds were assessed in their mother tongue using a computerized set of questionnaires consisting of a trauma list, the Posttraumatic Diagnostic Scale, and the new PTSD items that had been suggested by the DSM-5 Task Force of the American Psychiatric Association. Using DSM-IV, 60.4% of participants met diagnostic criteria for PTSD; using DSM-5, only 49.3% fulfilled all criteria (p < .001). Confirmatory factor analysis of DSM-IV and DSM-5 items showed good and comparable model fits. Furthermore, classification functions in the DSM-5 were satisfactory. The new Cluster D symptoms showed relatively high sensitivity, specificity, positive predictive power, and negative predictive power. The DSM-5 symptom structure appears to be applicable to traumatized refugees. Negative alterations in cognitions and mood may be especially useful for clinicians, not only to determine the extent to which an individual refugee is likely to meet criteria for PTSD, but also in providing targets for clinical intervention.
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Affiliation(s)
- Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital, University of Zurich, Zurich, Switzerland
| | - Julia Müller
- Psychiatric Hospital, Münsterlingen, Switzerland
| | - Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital, University of Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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24
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Durham TA, Elhai JD, Fine TH, Tamburrino M, Cohen G, Shirley E, Chan PK, Liberzon I, Galea S, Calabrese JR. Posttraumatic stress disorder's dysphoria dimension and relations with generalized anxiety disorder symptoms. Psychiatry Res 2015; 228:150-5. [PMID: 25983285 DOI: 10.1016/j.psychres.2015.04.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/06/2014] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
Abstract
The present study investigated symptom relations between two highly comorbid disorders--posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD)--by exploring their underlying dimensions. Based on theory and prior empirical research it was expected that the dysphoria factor of PTSD would be more highly related to GAD. As part of a longitudinal project of mental health among Ohio National Guard Soldiers, 1266 subjects were administered the Posttraumatic Stress Disorder Checklist (PCL) and Generalized Anxiety Disorder-7 scale (GAD-7). Confirmatory factor analyses (CFAs) were conducted to examine two models of PTSD and to determine which PTSD factors were more related to the GAD factor. The results indicate that the GAD factor was significantly more highly correlated with PTSD's dysphoria factor than with all other PTSD factors, including PTSD's reexperiencing factor, avoidance factor, and hyperarousal factor. Results indicate GAD was not significantly more highly correlated with numbing than most other factors of PTSD. The results are consistent with prior research. Implications of the results are discussed in regards to PTSD in DSM-5, comorbidity and diagnostic specificity.
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Affiliation(s)
- Tory A Durham
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA. http://www.jon-elhai.com
| | - Thomas H Fine
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | | | - Gregory Cohen
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Edwin Shirley
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA; University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Philip K Chan
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA; University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Israel Liberzon
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
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Roley ME, Claycomb MA, Contractor AA, Dranger P, Armour C, Elhai JD. The relationship between rumination, PTSD, and depression symptoms. J Affect Disord 2015; 180:116-21. [PMID: 25898331 DOI: 10.1016/j.jad.2015.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are highly comorbid (Elhai et al., 2008. J. Clin. Psychiatry, 69, (4), 597-602). Rumination is a cognitive mechanism found to exacerbate and maintain both PTSD and MDD (Elwood et al., 2009. Clin. Psychol. Rev. 29, (1), 87-100; Olatunji et al., 2013. Clin. Psychol.: Sci. Pract. 20, (3), 225-257). AIMS Assess whether four rumination subtypes moderate the relationship between comorbid PTSD and MDD symptoms. METHOD We consecutively sampled patients (N=45) presenting to a mental health clinic using self-report measures of PTSD and MDD symptoms, and rumination in a cross-sectional design. RESULTS Repetitive rumination moderates the relationship between PTSD and MDD symptoms at one standard deviation above the mean (β=.044, p=.016), while anticipatory rumination moderates the relationship between PTSD and MDD symptoms at mean levels and higher levels of anticipatory rumination (mean β=.030, p=.042; higher β=.060, p=.008). DISCUSSION Repetitive and anticipatory rumination should be assessed in the context of comorbid PTSD and MDD and interventions should focus on reducing these rumination subtypes. LIMITATIONS Results should be replicated with other trauma populations because the number and complexity of traumatic events may impact the assessed symptoms. Constructs should also be assessed longitudinally, in order to establish causality. We are unable to confirm why rumination styles moderated the relationship between PTSD and depression or why counterfactual thinking and problem-focused thinking did not moderate the relationship between the two constructs.
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Affiliation(s)
| | | | - Ateka A Contractor
- University of Toledo, Department of Psychology, Toledo, OH, USA; Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Paula Dranger
- Choices! Counseling Services, Porter, LaPorte and Lake County, Valparaiso, IN, USA
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine Campus, Coleraine, Northern Ireland, United Kingdom
| | - Jon D Elhai
- University of Toledo, Department of Psychology, Toledo, OH, USA.
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Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep 2015; 17:37. [PMID: 25876141 DOI: 10.1007/s11920-015-0575-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.
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Affiliation(s)
- Rajeev Ramchand
- RAND Corporation, 1100 South Hayes Street, Arlington, VA, 22202-5050, USA,
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27
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Elhai JD, Contractor AA, Tamburrino M, Fine TH, Cohen G, Shirley E, Chan PK, Liberzon I, Calabrese JR, Galea S. Structural relations between DSM-5 PTSD and major depression symptoms in military soldiers. J Affect Disord 2015; 175:373-8. [PMID: 25665497 DOI: 10.1016/j.jad.2015.01.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are frequently comorbid. One explanation for this comorbidity is that PTSD has a constellation of "dysphoria" symptoms resembling depression. METHOD Using confirmatory factor analysis we tested the role of DSM-5 PTSD׳s dysphoria factor in relation to MDD symptom dimensions of somatic and non-somatic psychopathology. 672 Ohio National Guard soldiers completed DSM-5 measures of PTSD and MDD symptoms in an epidemiological study. RESULTS Results indicated that in contrast to other PTSD factors, PTSD׳s dysphoria factor was more related to MDD׳s somatic and non-somatic factors. LIMITATIONS Limitations include generalizability to the epidemiological population of trauma-exposed military veterans rather than civilians, and reliance on self-report measures. CONCLUSIONS Implications concerning clinical psychopathology and comorbidity of PTSD are discussed, including whether PTSD should be refined by removing its non-specific symptoms.
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Affiliation(s)
- Jon D Elhai
- Department of Psychology, University of Toledo, United States; Department of Psychiatry, University of Toledo, United States
| | | | | | - Thomas H Fine
- Department of Psychiatry, University of Toledo, United States
| | - Gregory Cohen
- Department of Epidemiology, Columbia University, United States
| | - Edwin Shirley
- Department of Psychiatry, Case Western Reserve University, United States; University Hospitals Case Medical Center, United States
| | - Philip K Chan
- Department of Psychiatry, Case Western Reserve University, United States; University Hospitals Case Medical Center, United States
| | - Israel Liberzon
- VA Ann Arbor Health System, Ann Arbor, Michigan, United States; Department of Psychiatry, University of Michigan, United States
| | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, United States
| | - Sandro Galea
- School of Public Health, Boston University, United States
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Walsh K, Galea S, Cerda M, Richards C, Liberzon I, Tamburrino MB, Calabrese J, Koenen KC. Unit support protects against sexual harassment and assault among national guard soldiers. Womens Health Issues 2014; 24:600-4. [PMID: 25442705 DOI: 10.1016/j.whi.2014.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/22/2014] [Accepted: 05/29/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Despite concerns about increased sexual harassment and assault after the 2013 legislation repealing the ban on women in combat, little research has examined military factors that could prevent sexual harassment and assault during deployment. This study examined whether unit support, which reflects the quality of service members' relationships within their unit, protects against sexual harassment and assault during deployment. METHODS Participants were 1,674 Ohio Army National Guard service members who reported at least one deployment during a telephone survey conducted in 2008 and 2009. Participants completed measures of sexual harassment/assault, unit support, and psychosocial support. Logistic regression was used to model odds of sexual harassment/assault. RESULTS Approximately 13.2% of men (n = 198) and 43.5% of women (n = 74) reported sexual harassment, and 1.1% of men (n = 17) and 18.8% of women (n = 32) reported sexual assault during their most recent deployment. Greater unit support was associated with decreased odds of sexual harassment and assault. CONCLUSIONS A substantial proportion of men and women reported sexual harassment/assault. Greater unit support was associated with diminished odds of sexual harassment/assault during deployment. Programming designed to improve unit cohesion has the potential to reduce sexual harassment and assault.
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Affiliation(s)
- Kate Walsh
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Magdalena Cerda
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Catherine Richards
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Israel Liberzon
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | | | - Joseph Calabrese
- Department of Psychiatry, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Karestan C Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Distinctiveness of prolonged grief disorder symptoms among survivors of the Great East Japan Earthquake and Tsunami. Psychiatry Res 2014; 217:67-71. [PMID: 24661977 DOI: 10.1016/j.psychres.2014.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 01/19/2023]
Abstract
Prolonged Grief Disorder (PGD) has been proposed for diagnostic classification as an independent psychiatric disorder. Previous research has investigated it in relation to other axis I disorders in order to determine whether it could be considered an independent nosological entity. The distinctiveness of this condition was apparent in cases of ordinary bereavement and in those following human-made disasters. However, this disorder may be expanded to include bereavement resulting from natural disasters. The present study aims to explore the differences between this disorder and posttraumatic stress disorder or major depressive disorder as experienced after the Great East Japan Earthquake and Tsunami. The subjects were 82 hospital workers. Each type of disorder was assessed by means of the Inventory of Complicated Grief, the Impact of Event Scale-Revised, and the Center for Epidemiological Studies Depression Scale. Exploratory factor analysis showed 3 dimensions, with PGD items independently clustering in the same dimension. Our findings support the uniqueness of PGD even in a post-natural disaster situation in a non-Western culture and warrant grief intervention for high-risk bereaved survivors.
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Assessing Latent Level Associations Between PTSD and Dissociative Factors: Is Depersonalization and Derealization Related to PTSD Factors More So than Alternative Dissociative Factors? PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9196-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The dimensional structure of posttraumatic stress symptomatology in 323,903 U.S. veterans. J Psychiatr Res 2014; 49:31-6. [PMID: 24275548 DOI: 10.1016/j.jpsychires.2013.10.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
There is ongoing debate regarding the optimal dimensional structure of posttraumatic stress disorder symptomatology. A better understanding of this structure has significant implications, as it can provide more refined phenotypic measures for use in studies of the etiology and neurobiology of PTSD, as well as for use as endpoints in treatment studies of this disorder. In this study we analyzed the dimensional structure of PTSD symptomatology, as assessed using the PTSD Symptom Checklist-Military Version in 323,903 Veterans. Confirmatory factor analyses were used to compare two 4-factor models and a newly proposed 5-factor model to the 3-factor DSM-IV model of PTSD symptom dimensionality. To evaluate the external validity of the best-fitting model, we then conducted a structural equation model examining how the symptom dimensions of this model related to diagnoses of depression, anxiety, and substance use disorder. Results indicated that a newly proposed 5-factor 'dysphoric arousal' model comprised of separate re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptom clusters provided a significantly better fit to the data compared to the DSM-IV and the two alternative four-factor models. External validity analyses revealed that numbing symptoms were most strongly related to diagnoses of depression and substance use disorder, and that dysphoric arousal symptoms were most strongly related to a diagnosis of anxiety disorder. Thus the dimensional structure of PTSD may be best represented by five symptom dimensions. The clinical implications of these results and implications for further refinement of extant PTSD assessment instruments are discussed.
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Contractor AA, Durham TA, Brennan JA, Armour C, Wutrick HR, Frueh BC, Elhai JD. DSM-5 PTSD's symptom dimensions and relations with major depression's symptom dimensions in a primary care sample. Psychiatry Res 2014; 215:146-53. [PMID: 24230994 DOI: 10.1016/j.psychres.2013.10.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/20/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022]
Abstract
Existing literature indicates significant comorbidity between posttraumatic stress disorder (PTSD) and major depression. We examined whether PTSD's dysphoria and mood/cognitions factors, conceptualized by the empirically supported four-factor DSM-5 PTSD models, account for PTSD's inherent relationship with depression. We hypothesized that depression's somatic and non-somatic factors would be more related to PTSD's dysphoria and mood/cognitions factors than other PTSD model factors. Further, we hypothesized that PTSD's arousal would significantly mediate relations between PTSD's dysphoria and somatic/non-somatic depression. Using 181 trauma-exposed primary care patients, confirmatory factor analyses (CFA) indicated a well-fitting DSM-5 PTSD dysphoria model, DSM-5 numbing model and two-factor depression model. Both somatic and non-somatic depression factors were more related to PTSD's dysphoria and mood/cognitions factors than to re-experiencing and avoidance factors; non-somatic depression was more related to PTSD's dysphoria than PTSD's arousal factor. PTSD's arousal did not mediate the relationship between PTSD's dysphoria and somatic/non-somatic depression. Implications are discussed.
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Affiliation(s)
| | - Tory A Durham
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Julie A Brennan
- St. Luke's Family Medicine Center, St. Luke's Hospital, Maumee, OH, USA; Department of Family Medicine, University of Toledo, Toledo, OH, USA
| | - Cherie Armour
- School of Psychology, University of Ulster at Coleraine Campus, Northern Ireland, UK; The National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Hanna R Wutrick
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii at Hilo, HI, USA; The Menninger Clinic, Houston, TX, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA.
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Contractor AA, Mehta P, Tiamiyu MF, Hovey JD, Geers AL, Charak R, Tamburrino MB, Elhai JD. Relations Between PTSD and Distress Dimensions in an Indian Child/Adolescent Sample Following the 2008 Mumbai Terrorist Attacks. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:925-35. [DOI: 10.1007/s10802-013-9846-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clin Psychol Rev 2013; 34:87-98. [PMID: 24486520 DOI: 10.1016/j.cpr.2013.12.002] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.
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Biehn TL, Elhai JD, Seligman LD, Tamburrino M, Armour C, Forbes D. Underlying Dimensions of DSM-5 Posttraumatic Stress Disorder and Major Depressive Disorder Symptoms. PSYCHOLOGICAL INJURY & LAW 2013. [DOI: 10.1007/s12207-013-9177-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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