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Cheng P, Wang L, Zhou Y, Ma W, Li W. Exploring the differential effects of psychological resilience and social support in mitigating post-traumatic psychiatric symptoms: real-world network analysis of front-line rescuers. BJPsych Open 2024; 10:e109. [PMID: 38725358 PMCID: PMC11094433 DOI: 10.1192/bjo.2024.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Although both psychological resilience and social support are widely believed to be effective in alleviating post-traumatic psychiatric symptoms in individuals with traumatic events, there has been a lack of comparative analysis of their intervention effects on different post-traumatic psychiatric symptoms. Furthermore, previous studies have mostly failed to control for potential confounding effects caused by different traumatic events. AIMS We used the novel network analysis approach to examine the differential moderating effects of psychological resilience and social support on post-traumatic psychiatric symptoms, controlling for the confounding effects of traumatic events. METHOD We recruited 264 front-line rescuers who experienced the same traumatic event. Quantified edge weights and bridge expected influence (BEI) were applied to compare the alleviating effects of psychological resilience and social support. RESULTS Our study revealed distinct correlations in a sample of front-line rescuers: social support negatively correlates more with psychosomatic symptoms, notably fatigue in depressive networks and sleep disturbance in post-traumatic stress disorder (PTSD) networks, whereas psychological resilience shows fewer such correlations. Quantitative analysis using BEI indicated that psychological resilience more effectively suppresses depressive and anxiety symptom networks, whereas social support more significantly inhibits PTSD symptom networks. CONCLUSIONS The current study represents the first attempt to examine the differential effects of psychological resilience and social support on post-traumatic outcomes in real-world emergency rescuers, controlling for the confounding effect of traumatic events. Our results can act as the theoretical reference for future precise and efficient post-trauma psychological interventions.
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Affiliation(s)
- Peng Cheng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, China
| | - Lirong Wang
- Department of Thyroid Surgery, The Xiangya Hospital of Central South University, China
| | - Ying Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, China
| | - Wenjing Ma
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, China
| | - Weihui Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, China
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Gielkens EMJ, Sobczak S, Gerrits N, Rosowsky E, Stas L, Rossi G, van Alphen SPJ. Feasibility of EMDR toward Personality Functioning in Older Adults with PTSD. Clin Gerontol 2024:1-12. [PMID: 38656832 DOI: 10.1080/07317115.2024.2344793] [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] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Severe posttraumatic stress disorder (PTSD) in older adults (≥60 years) has been found to be associated with maladaptive personality functioning and personality disorders (PD). Emerging evidence in adults supports that reprocessing adverse events with Eye Movement Desensitization and Reprocessing (EMDR) could improve personality functioning and reduce full PDdiagnosis. METHODS A multicenterfeasibilitystudy in 24 older PTSD-patients receiving weekly EMDR-sessions for either 3, 6 or 9 months. A linear-mixed-model was used with personality functioning (SIPP-SF) as dependent variable and time, PTSD-severity (CAPS-5), and "othertreatment" as predictor variables. Secondary, pre- and posttreatment percentages were calculated for the PDspresence. RESULTS Symptom changes over time showed a significant influence of CAPS-5 on SIPP-SF (b = -1.40, 95% CI=[-2.48 to -0.33], p = .012), no significant effect of time for total SIPP-SF, and a significant improvement of SIPP-SF "identityintegration"-scale over time (b = 9.20, 95% CI=[0.97-17.42], p = .029). There was a marginal significant effect of "othertreatment" (b = 8.42, 95% CI=[-0.30-17.13], p = .058). There was 31% full PDs-decrease. CONCLUSIONS Observed improvements in personality functioning from pre to post EMDRtreatment were explained by PTSD-severity. Identityintegration improved significantly over time. Results suggest that participants with "othertreatment" showed more severe baseline-pathology and thus lower personality functioning. CLINICAL IMPLICATIONS EMDR, in addition to being a feasible treatment option for older adults with PTSD, improves personality functioning and reduces the presence of PDs over time.'
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Affiliation(s)
- Ellen M J Gielkens
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - Sjacko Sobczak
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience; School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Rotterdam Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Nienke Gerrits
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
| | - Erlene Rosowsky
- William James College, Department of Clinical Psychology, Newton, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Lara Stas
- Vrije Universiteit Brussel (VUB), Biostatistics and Medical Informatics Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Core Facility - Support for Quantitative and Qualitative Research (SQUARE), Brussels, Belgium
| | - Gina Rossi
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Brooks SK, Greenberg N. Recurrence of post-traumatic stress disorder: systematic review of definitions, prevalence and predictors. BMC Psychiatry 2024; 24:37. [PMID: 38195482 PMCID: PMC10777598 DOI: 10.1186/s12888-023-05460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Many people will experience a potentially traumatic event in their lifetime and a minority will go on to develop post-traumatic stress disorder (PTSD). A wealth of literature explores different trajectories of PTSD, focusing mostly on resilient, chronic, recovered and delayed-onset trajectories. Less is known about other potential trajectories such as recurring episodes of PTSD after initial recovery, and to date there has been no estimate of what percentage of those who initially recover from PTSD later go on to experience a recurrence. This systematic review aimed to synthesise existing literature to identify (i) how 'recurrence' of PTSD is defined in the literature; (ii) the prevalence of recurrent episodes of PTSD; and (iii) factors associated with recurrence. METHODS A literature search of five electronic databases identified primary, quantitative studies relevant to the research aims. Reference lists of studies meeting pre-defined inclusion criteria were also hand-searched. Relevant data were extracted systematically from the included studies and results are reported narratively. RESULTS Searches identified 5,398 studies, and 35 were deemed relevant to the aims of the review. Results showed there is little consensus in the terminology or definitions used to refer to recurrence of PTSD. Because recurrence was defined and measured in different ways across the literature, and prevalence rates were reported in numerous different ways, it was not possible to perform meta-analysis to estimate the prevalence of recurrence. We also found no consistent evidence regarding predictors of PTSD recurrence. CONCLUSION A clear and consistent evidence-based definition of recurrence is urgently needed before the prevalence and predictors of recurrence can be truly understood.
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Affiliation(s)
- Samantha K Brooks
- Department of Psychological Medicine, King's College London, Weston Education Centre, SE5 9RJ, London, United Kingdom.
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, Weston Education Centre, SE5 9RJ, London, United Kingdom
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Fire NT, Alkalay S, Gvion Y, Zalsman G. The association between school staff's coping strategies following a student's suicide, school climate, and previous experience with suicide. PSYCHOLOGY IN THE SCHOOLS 2023. [DOI: 10.1002/pits.22898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
| | - Sarit Alkalay
- Department of Psychology Yezreel Valley Academic College Emek Yezreel Israel
| | - Yari Gvion
- Department of Psychology Bar Ilan University Ramat Gan Israel
| | - Gil Zalsman
- Geha Mental Health Center Petach Tikwa Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Psychiatry, Division of Molecular Imaging and Neuropathology Columbia University and New York State Psychiatric Institute New York New York USA
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Havermans DC, van Alphen SP, Olff M, Van der Velden-Daamen M, Verhey F, Rutten BP, Stuijts P, Cook JM, Sobczak S. The Need for a Diagnostic Instrument to Assess Post-Traumatic Stress Disorder in People with Dementia: Findings from a Delphi Study. J Geriatr Psychiatry Neurol 2023; 36:129-142. [PMID: 35713096 PMCID: PMC9941654 DOI: 10.1177/08919887221103583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive and behavioral aspects may mask posttraumatic stress disorder (PTSD) in people with dementia. PTSD severely lowers quality of life in people with dementia. Proper recognition of PTSD is essential to ensure adequate treatment. However, a valid diagnostic tool for PTSD in dementia is lacking. A Delphi study was conducted among 20 Dutch and 6 international experts in the field of PTSD and dementia care or research. The aim was to reach consensus in 3 rounds on the added value, form, content, and application for developing such an instrument. The first round confirmed the need for a new diagnostic tool for research and clinical practice. Consensus was reached on 23 statements regarding the support base and 19 related to content of the instrument. In the third round, opinions on several conceptual problems were gathered. Based on the experts' opinions, a draft version of an instrument, the TRAuma and DEmentia-interview (TRADE-interview), was developed. Clinical and research implications of this new measure are discussed.
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Affiliation(s)
- Demi C.D. Havermans
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen, The Netherlands
- Demi C.D. Havermans, MSc, Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen, The Netherlands. Kloosterkensweg 10, 6419PJ Heerlen.
| | - Sebastiaan P.J. van Alphen
- Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen, The Netherlands
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Miranda Olff
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - Mariëlle Van der Velden-Daamen
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Department of Psychogeriatrics, Cicero-Zorggroep, Brunssum, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bart P.F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Joan M Cook
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sjacko Sobczak
- Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Lewis AM. Modified Prolonged Exposure Therapy for Posttraumatic Stress Disorder with an 85-Year-Old Native American Cajun Man With Late-Onset Deafness: A Case Report. Clin Gerontol 2023:1-8. [PMID: 36732327 DOI: 10.1080/07317115.2023.2173693] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Few studies of exposure therapy with adults 85 years and older exist. This case report presents results of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) modified for an 85-year-old Native American Cajun man with late-onset deafness, who used a cochlear implant, and reported high Western/non-Native American acculturation. The following modifications were made primarily in response to the client's individual, disability-related barriers to completing the standard PE protocol: (a) inclusion of the client's spouse in aspects of treatment planning and homework assignments; (b) variable session length and frequency; (c) homework was limited to the daily practice of breathing retraining and in vivo exposure to triggering images; and (d) therapist reliance on nonverbal indicators of distress during imaginal exposures. METHODS The PTSD Checklist for DSM-5 (PCL-5) and 15-item Geriatric Depression Scale (GSD-15) were primary progress and outcome measures. RESULTS The modified treatment was associated with clinically significant decreases in baseline PTSD (19 points) and depressive (8 points) symptoms. CONCLUSIONS PE protocol modifications did not compromise treatment outcomes for this client. CLINICAL IMPLICATIONS PE protocols should be modified based on the individual needs of diverse older adults underrepresented in efficacy research.
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Affiliation(s)
- Adam M Lewis
- Alexandria VA Health Care System, Pineville, Louisiana
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The Safety and Efficacy of Psychedelic-Assisted Therapies for Older Adults: Knowns and Unknowns. Am J Geriatr Psychiatry 2023; 31:44-53. [PMID: 36184377 DOI: 10.1016/j.jagp.2022.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023]
Abstract
Psychedelics and related compounds have shown efficacy for the treatment of a variety of conditions that are prevalent among older adults, including mood disorders, the psychological distress associated with a serious medical illness, post-traumatic stress disorder (PTSD), and prolonged grief disorder. Psychedelics also have properties that could help provide therapeutic benefits for patients with dementing disorders, as well as promoting personal growth among healthy older adults. This article focuses on psilocybin, a classic psychedelic, and MDMA, a substituted amphetamine with properties similar to classic psychedelics. Both act on the 5HT2A receptor. Psychedelics can be safely administered to healthy adults in controlled conditions. However, both psilocybin and MDMA can increase blood pressure and heart rate, which could be a concern if used in older adults with cardiovascular disease. Very few older adults or patients with serious comorbidities have been included in clinical trials of psychedelics to date, raising the question of how generalizable study results are for the patients that most geropsychiatrists will be treating. Research on the neurophysiologic and mechanistic effects of psychedelics in older adults could also provide insights into the aging brain that could have clinical applications in the future. Given the potential of psychedelic compounds to benefit older adults, more research is needed to establish safety and efficacy among older adults, particularly those with multi-morbidity.
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Smits HJH, Seelen-de Lang BL, Penterman EJM, Nijman HLI, Noorthoorn EO. Improvement in the quality of life of outpatients with severe mental illness in conjunction with intellectual disabilities and post-traumatic stress disorder. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:58-67. [PMID: 36173126 DOI: 10.1111/jar.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Elucidating the influence of mild intellectual disability (MID; IQ 50-70)/borderline intellectual functioning (BIF; IQ 70-85) and (comorbid) post-traumatic stress disorder (PTSD) on the quality of life of patients with serious mental illness (SMI) could improve their mental health care. METHOD This study comprises a prospective longitudinal cohort study using routine outcome monitoring data. The cohort comprised 601 patients who had undertaken at least one Manchester Short Assessment of Quality of Life (MANSA). The scores for screeners to detect MID/BIF and PTSD were analysed, and a repeated measures analysis of variance and a multi-level linear regression was performed on the MANSA scores. RESULTS The average quality of life for all patient groups increased significantly over time. A between-subject effect on quality of life was observed for PTSD, but not MID/BIF. CONCLUSIONS PTSD but not MID/BIF is associated with a lesser quality of life over time.
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Affiliation(s)
- Hedwig J H Smits
- Teams FACT Uden, FACT DAS, GGZ Oost Brabant, Boekel, The Netherlands
| | | | | | - Henk L I Nijman
- Fivoor, Den Dolder, The Netherlands.,Forensic Psychology, Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands
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Carmassi C, Conti L, Gravina D, Nardi B, Dell'Osso L. Emotional dysregulation as trans-nosographic psychopathological dimension in adulthood: A systematic review. Front Psychiatry 2022; 13:900277. [PMID: 36104987 PMCID: PMC9464828 DOI: 10.3389/fpsyt.2022.900277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Emotional dysregulation (ED) is characterized by inappropriate emotional reactions related to environmental or cognitive stimuli. In most recent years, increasing interest has been devoted to its definition and detection across mental disorders for its detrimental role progressively highlighted in both neurodevelopment and adult mental disorders, with implications on the severity of clinical manifestations. The aim of this systematic review was to evaluate and gather the scientific evidence about ED in adult psychiatric population to elucidate the concept of ED as trans-nosographic entity. Methods The electronics databases PubMed, Scopus and Web of Science was reviewed to identify studies in accordance with the PRISMA guidelines; at the end of the selection process a total of 29 studies (N = 709; N = 658; N = 1,425) was included. All studies included assessed the presence of ED symptoms, by means of a validate scale in adult (>18 years of age), in clinically diagnosed patients as well as healthy control participants. Results Our results suggest ED as a trans-diagnostic factor across multiple mental disorders, such as bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorder, personality disorders; a better definition of this concept could be helpful to interpret and clarify many clinical cases and improve their diagnostic and therapeutic management.
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Affiliation(s)
| | - Lorenzo Conti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Alba B, Lyons A, Waling A, Minichiello V, Hughes M, Barrett C, Fredriksen-Goldsen K, Edmonds S, Savage T, Pepping CA, Blanchard M. Factors Associated with Self-Reported PTSD Diagnosis among Older Lesbian Women and Gay Men. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:129-142. [PMID: 34114944 DOI: 10.1080/01634372.2021.1939218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
Lesbian women and gay men are at greater risk of post-traumatic stress disorder (PTSD) than heterosexual people, however few studies have examined PTSD in older lesbian women and gay men. This study examined predictors of having ever been diagnosed with PTSD, as well as relationships to current quality of life, among 756 lesbian women and gay men aged 60 years and older in Australia. Participants were surveyed on their sociodemographic characteristics, experiences of sexual orientation discrimination over their lifetime, whether they had ever been diagnosed with PTSD, whether they were currently receiving treatment for PTSD, and their current quality of life. After adjusting for sociodemographic variables, participants who reported having a PTSD diagnosis (11.2%) had significantly more frequent experiences of discrimination over their lifetime and were significantly less likely to currently be in a relationship. Older lesbian women were significantly more likely than older gay men to report ever having had a PTSD diagnosis. Additionally, having ever been diagnosed with PTSD significantly predicted current poorer quality of life. These findings suggest that a history of PTSD among older lesbian women and gay men is linked to experiences of discrimination and other factors, with associated links to current quality of life.
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Affiliation(s)
- Beatrice Alba
- School of Psychology, Deakin University, Melbourne Australia
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Victor Minichiello
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- School of Justice, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Mark Hughes
- School of Arts and Social Sciences, Southern Cross University, Gold Coast, Australia
| | | | | | | | - Teresa Savage
- Silver Rainbow, LGBTIQ+ Health Australia, Sydney, Australia
| | | | - Michelle Blanchard
- SANE Australia, Melbourne, Australia
- Anne Deveson Research Centre, Melbourne, Australia
- Melbourne School of Psychological Sciences, the University of Melbourne, Melbourne, Australia
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11
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Fox R, Hyland P, Coogan AN, Cloitre M, Power JM. Posttraumatic stress disorder, complex PTSD and subtypes of loneliness among older adults. J Clin Psychol 2022; 78:321-342. [PMID: 34287862 PMCID: PMC8770684 DOI: 10.1002/jclp.23225] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Research examining the relationship between loneliness and Complex Posttraumatic Stress Disorder (CPTSD) is scarce, particularly among older adults. CPTSD includes the core symptoms of PTSD along with additional symptoms reflecting "disturbances in self-organisation" (DSO). This study examined the cross-sectional relationships between loneliness (emotional and social loneliness) and CPTSD symptoms (i.e., PTSD and DSO symptoms) in older adults. METHODS Structural equation modelling was used to examine these relationships in a nationally representative sample of US adults aged 60-70 years (n = 456). RESULTS Controlling for covariates, emotional loneliness was associated with PTSD (β = 0.31) and DSO (β = 0.57) symptoms whereas social loneliness was only associated with DSO symptoms (β = 0.25). The model explained 35.0% of the variance in PTSD symptoms and 71.3% in DSO symptoms. CONCLUSION These findings have important implications for treating and understanding PTSD/CPTSD and their correlates among older adults.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland,Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Marylène Cloitre
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA,Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
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12
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Wang K, Zhang A, Cuevas AG, De Fries CM, Hinton L, Falcón LM. The Association Between Post-Traumatic Stress and Depressive Symptoms Among Older Puerto Ricans in Boston: How Does Loneliness Matter? J Aging Health 2021; 34:786-793. [PMID: 34949131 DOI: 10.1177/08982643211064123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the association between post-traumatic stress and depression and whether such an association differs by level of loneliness among older Puerto Ricans. METHODS Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, loneliness, and depressive symptoms. RESULTS Post-traumatic stress was significantly associated with higher levels of depression. The association between post-traumatic stress and depression was stronger for those experiencing a higher degree of loneliness. DISCUSSION In working with older Puerto Ricans experiencing post-traumatic stress, it is important for mental health professionals to incorporate the assessment of loneliness and to prevent and reduce comorbid depression by addressing loneliness through improving social skills, enhancing social support, and reducing maladaptive social cognition.
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Affiliation(s)
- Kaipeng Wang
- Graduate School of Social Work, 2927University of Denver, CO, USA
| | - Anao Zhang
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
| | - Adolfo G Cuevas
- Department of Community Health, 1810Tufts University, Medford, MA, USA
| | | | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, 8789University of California Davis, CA, USA
| | - Luis M Falcón
- College of Fine Arts, Humanities, and Social Sciences, 14710University of Massachusetts Lowell, MA, USA
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Ojeahere MI, Uwakwe R, Piwuna CG, Audu M, Goar SG, Armiyau A, Afolaranmi T. Assessment of full and subsyndromal PTSD and quality of life of internally displaced older adults in northern Nigeria. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Kaiser AP, O’Malley K, Moye J, Etchin AG, Korsun L, Weiskittle R, Bashian H, Kemp K, Sager ZS. Hospice and palliative care clinicians' perceptions of posttraumatic stress disorder at end-of-life in military veterans. PROGRESS IN PALLIATIVE CARE 2021; 2021:1-7. [PMID: 35493974 PMCID: PMC9047186 DOI: 10.1080/09699260.2021.1980649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms.
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Affiliation(s)
- Anica Pless Kaiser
- VA National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kelly O’Malley
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Anna G. Etchin
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders, Boston, MA, USA
| | - Lynn Korsun
- VA Boston Healthcare System, Boston, MA, USA
| | - Rachel Weiskittle
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
| | - Hannah Bashian
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
| | - Katherine Kemp
- National Hospice and Palliative Care Organization, Alexandria, VA, USA
| | - Zachary S. Sager
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
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15
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Kim MD, Jung YE. Factors Associated With Health-Related Quality of Life Among Older People Exposed to the Jeju 4·3 Incident. Psychiatry Investig 2021; 18:809-817. [PMID: 34500510 PMCID: PMC8473863 DOI: 10.30773/pi.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We explored factors associated with health-related quality of life (HRQOL), including socio-demographic and clinical characteristics, in among older people exposed to the Jeju 4·3 incident, and aimed to determine the effects of depression, posttraumatic stress disorder (PTSD) and perceived social support on HRQOL. METHODS We obtained data from 110 survivors and 1,011 immediate family members of the victims of the Jeju April 3 incident (mean age, 75.1 years), and evaluated the relationships of HRQOL with sociodemographic and clinical characteristics including posttraumatic and depressive symptoms, and perceived social support. RESULTS Poorer physical health, psychological health, social relationships, and environment HRQOL domain scores were strongly associated with older age, being a woman, poor socioeconomic status, and symptoms of depression and PTSD. The regression analyses indicated that, when relevant factors were controlled for, perceived social support moderated the negative association between HRQOL and psychiatric symptoms. CONCLUSION Our results suggest the importance of sociodemographic characteristics, in addition to psychiatric symptoms, for understanding HRQOL in older people exposed to the Jeju 4·3 incident. These results have important implications for interventions aiming to improve the HRQOL of the victims of the Jeju 4·3 incident.
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Affiliation(s)
- Moon-Doo Kim
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Young-Eun Jung
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Republic of Korea.,4·3 Trauma Center, Jeju, Republic of Korea
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16
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Browne J, Medenblik A, Pebole M, Gregg JJ, Hall KS. Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD. Am J Geriatr Psychiatry 2021; 29:565-572. [PMID: 33162307 DOI: 10.1016/j.jagp.2020.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention. DESIGN Qualitative study. SETTING Face-to-face semistructured interviews conducted after the Warrior Wellness trial was completed. PARTICIPANTS Fifteen veterans (100% male, 93% African American or Black, 100% non-Hispanic or Latinx, average age = 68.7 years) who completed the Warrior Wellness exercise program. MEASUREMENTS Semistructured interviews were conducted using an interview guide that assessed veterans' experience in Warrior Wellness and recommendations for future intervention modifications. Interviews were subsequently transcribed and analyzed by thematic analysis. RESULTS Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains. Finally, veterans provided several suggestions for modifying the intervention such as increasing its duration, adding a nutritional component, and including significant others in enrollment. CONCLUSIONS This study offers valuable insights into the intervention and interpersonal factors that veterans view as important for their engagement in exercise, the perceived benefits of exercise, and the ways in which interventions designed for this population can be refined.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System (JB, MP, KH), Durham, NC
| | - Alyssa Medenblik
- Department of Psychology, University of Tennessee (AM), Knoxville, TN
| | - Michelle Pebole
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System (JB, MP, KH), Durham, NC; Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign (MP), Champaign, IL
| | - Jeffrey J Gregg
- Mental and Behavioral Health Service, Durham VA Health Care System (JJG), Durham, NC; Geriatrics Division, Department of Medicine, Duke University (JJG, KH), Durham, NC
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System (JB, MP, KH), Durham, NC; Geriatrics Division, Department of Medicine, Duke University (JJG, KH), Durham, NC; Center for the Study of Aging and Human Development, Duke University (KH), Durham, NC.
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17
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Fox R, McHugh Power J, Coogan AN, Beekman ATF, van Tilburg TG, Hyland P. Posttraumatic stress disorder and loneliness are associated over time: A longitudinal study on PTSD symptoms and loneliness, among older adults. Psychiatry Res 2021; 299:113846. [PMID: 33706195 DOI: 10.1016/j.psychres.2021.113846] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
Loneliness has a pernicious effect on mental health in later life and is likely to have a bidirectional relationship with psychopathology. However, longitudinal research examining loneliness and posttraumatic stress symptoms among older adults is scarce. This study aimed to examine the longitudinal relationship between different types of loneliness (social and emotional) and posttraumatic stress symptoms. Using two waves of an older adult sample (n = 1,276) from the Longitudinal Aging Study Amsterdam (LASA), this longitudinal relationship was examined using a multivariate two wave-latent change score (2W-LCS) model. There were significant, however, very small increases in both posttraumatic stress symptoms and emotional loneliness over time, whereas, average social loneliness scores did not significantly increase/decrease over time. Changes in both social (β = .16) and emotional loneliness (β = .15) were associated with small changes in posttraumatic stress symptoms, consistent with the existence of a longitudinal association between the constructs, net of covariate effects. Results provide evidence of the existence of a longitudinal association between subtypes of loneliness and posttraumatic stress symptoms, among older adults. Results have implications for clinicians who should identify individuals at risk of developing posttraumatic stress symptoms, and for the theory of both posttraumatic stress disorder and loneliness.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland; Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin.
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland; UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; GGZ inGeest, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
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18
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Gielkens EMJ, de Jongh A, Sobczak S, Rossi G, van Minnen A, Voorendonk EM, Rozendaal L, van Alphen SPJ. Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults. J Clin Med 2021; 10:jcm10061246. [PMID: 33802898 PMCID: PMC8002665 DOI: 10.3390/jcm10061246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60–78 years) and 62 younger PTSD patients (19–58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).
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Affiliation(s)
- Ellen M. J. Gielkens
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Correspondence:
| | - Ad de Jongh
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
- School of Health Sciences, Salford University, Manchester M6 6PU, UK
- Institute of Health and Society, University of Worcester, Worcester WR2 6AJ, UK
- School of Psychology, Queen’s University, 18-30 Malone Road, Belfast BT9 5 BN, UK
| | - Sjacko Sobczak
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Gina Rossi
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
| | - Agnes van Minnen
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Eline M. Voorendonk
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Linda Rozendaal
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
| | - Sebastiaan P. J. van Alphen
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
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19
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Sobczak S, Olff M, Rutten B, Verhey F, Deckers K. Comorbidity rates of Posttraumatic Stress Disorder in dementia: a systematic literature review. Eur J Psychotraumatol 2021; 12:1883923. [PMID: 33968318 PMCID: PMC8075086 DOI: 10.1080/20008198.2021.1883923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: Post Traumatic Stress Disorder (PTSD) has been described as an independent risk factor for cognitive decline and dementia. At the same time, cognitive deterioration and increased loss experiences in dementia may increase liability for the reactivation of traumatic memories and thereby PTSD symptoms. Objective: In order to investigate co-occurrence of PTSD in dementia this systematic literature review summarizes all the available evidence on reported comorbidity rates of PTSD in patients with dementia. Method: PubMed, Embase, PsycINFO and CINAHL were searched for potential publications investigating the co-occurrence of PTSD in dementia until 25 November 2019. Cohort and cross-sectional studies were included. To assure current comorbidity of PTSD in dementia, only publications with a recent PTSD diagnosis (<2 years before onset of dementia) were selected. Results: Of the 860 identified abstracts, three studies (0.35%) met the eligibility criteria and were included. These three studies concerned only military veteran populations, and they comprised two cross-sectional cohort studies and one prospective cohort study. The estimated comorbidity rate of PTSD in veterans with dementia varied between 4.7% and 7.8%. Conclusions: The limited research available shows comorbidity rates only in military veterans, which were possibly dependent on investigated population with respect to dementia severity and possibly associated behavioural and psychiatric symptoms of dementia (BPSD). In dementia patients the comorbidity with PTSD may be high and we suggest that worldwide the impact of PTSD in dementia is high and probably underestimated. Research and care on this topic should improve urgently with the current expanding prevalence of dementia. A first step to improve quality of dementia research and care would be to develop a structured tool to diagnose PTSD in these patients.
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Affiliation(s)
- Sjacko Sobczak
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands.,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen, Maastricht, The Netherlands
| | - Miranda Olff
- Arq Psychotrauma Research, AMC/University of Amsterdam, Amterdam
| | - Bart Rutten
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands
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20
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Holder N, Shiner B, Li Y, Madden E, Neylan TC, Seal KH, Lujan C, Patterson OV, DuVall SL, Maguen S. Determining the median effective dose of prolonged exposure therapy for veterans with posttraumatic stress disorder. Behav Res Ther 2020; 135:103756. [PMID: 33157475 DOI: 10.1016/j.brat.2020.103756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Prolonged exposure therapy (PE) is an effective treatment for posttraumatic stress disorder (PTSD). Identifying metrics of treatment response can guide treatment delivery. The median effective dose represents the number of sessions at which there is a 50% probability of clinically meaningful improvement (i.e., 10-point reduction in PTSD checklist). The goal of the current study was to investigate the median effective dose of PE. We identified a cohort of Iraq and Afghanistan war veterans who received psychotherapy for PTSD in the Veterans Health Administration between 2001 and 2017. From this cohort, 10,234 veterans who received PE (as identified using natural language processing) and had ≥2 PTSD symptom measures were included in analyses. To determine how the number of PE sessions and covariates affected clinically meaningful improvement, we utilized a Cox proportional hazards regression, followed by Kaplan-Meier curves to determine the median effective dose. The median effective dose of PE was four sessions. Although some covariates were found to be statistically significant predictors of clinically meaningful improvement (e.g., age, gender, PTSD medications, and depressive disorder comorbidity), these effects were small. Clinicians and patients should consider evaluating treatment response after four sessions to determine preliminary effectiveness of PE.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States; University of California San Francisco School of Medicine, United States.
| | - Brian Shiner
- White River Junction Veterans Affairs Medical Center, United States; Geisel School of Medicine at Dartmouth, United States; National Center for Posttraumatic Stress Disorder, Executive Division, United States
| | - Yongmei Li
- San Francisco Veterans Affairs Health Care System, United States
| | - Erin Madden
- San Francisco Veterans Affairs Health Care System, United States
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States; University of California San Francisco School of Medicine, United States
| | - Karen H Seal
- San Francisco Veterans Affairs Health Care System, United States; University of California San Francisco School of Medicine, United States
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System, United States
| | - Olga V Patterson
- Department of Veterans Affairs Salt Lake City Health Care System, United States; University of Utah School of Medicine, United States
| | - Scott L DuVall
- Department of Veterans Affairs Salt Lake City Health Care System, United States; University of Utah School of Medicine, United States
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States; University of California San Francisco School of Medicine, United States
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21
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Fox R, Hyland P, McHugh Power J, Coogan AN. Patterns of comorbidity associated with ICD-11 PTSD among older adults in the United States. Psychiatry Res 2020; 290:113171. [PMID: 32526516 DOI: 10.1016/j.psychres.2020.113171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 11/16/2022]
Abstract
Little research has been conducted on posttraumatic stress disorder (PTSD) comorbidity among older adults regarding the description of PTSD in the 11th version of the International Classification of Diseases (ICD-11). This study sought to provide evidence of a dimensional model of psychopathology using the 'Hierarchical Taxonomy of Psychopathology' (HiTOP) model as a theoretical framework to explain patterns of ICD-11 PTSD comorbidity. Distinct patterns of ICD-11 PTSD comorbidity among a nationally representative sample (n = 530) of adults aged 60 years and older from the United States were examined using latent class analysis (LCA). Covariates associated with comorbidity classes were assessed through multinomial logistic regression. ICD-11 PTSD was highly comorbid with other psychopathologies. LCA results favoured a two-class solution. Class 1 (71.7%) was characterised by moderate probabilities for major depressive disorder and alcohol use disorder; Class 2 (28.3%) was characterised by a moderate-high probability of general psychopathology and was associated with lower social support, spousal/partner physical abuse, and history of attempted suicide. PTSD was highly comorbid with other disorders among older adults. Distinct patterns of PTSD comorbidity exist among this cohort and these findings can aid clinicians and researchers in understanding and predicting maladaptive responses to trauma and associated psychopathology.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland; UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland.
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22
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Panisch LS, Hai AH. The Effectiveness of Using Neurofeedback in the Treatment of Post-Traumatic Stress Disorder: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:541-550. [PMID: 29890906 DOI: 10.1177/1524838018781103] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neurofeedback is an innovative treatment for post-traumatic stress disorder (PTSD) that is readily accessible to mental health therapists. As a widespread mental health concern with potentially devastating long-term consequences on psychosocial functioning, PTSD can also adversely impact biophysiological processes, particularly those related to the brain. Neurofeedback has shown promise in alleviating overall PTSD symptoms, including these underlying neurobiological consequences. Successful results have been found among clients with PTSD who have not been responsive to prior treatment modalities. While a strong base of clinical anecdotes and case studies supports its success in treating PTSD, intervention studies on neurofeedback have been critiqued for lack of rigor and poor methodological design. A current systematic review of the literature on the effectiveness of neurofeedback in treating PTSD was conducted. Unlike prior reviews which emphasized neurobiological changes, this study was written for the mental health therapist and focused solely on behavioral outcomes. Ten studies met the criteria for inclusion in this review. Neurofeedback demonstrated salubrious results in at least one outcome measure for the majority of participants across all studies. Interpretations, however, are limited by wide discrepancies in sample sizes, study designs, outcome measures, and the extent of reported results. Future research in this area would benefit from prioritizing randomized controlled trials with larger sample sizes and longitudinal follow-up results.
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Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Audrey Hang Hai
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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23
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Glassman LH, Mackintosh MA, Wells SY, Wickramasinghe I, Walter KH, Morland LA. Predictors of Quality of Life Following Cognitive Processing Therapy Among Women and Men With Post-Traumatic Stress Disorder. Mil Med 2020; 185:e579-e585. [PMID: 32077948 DOI: 10.1093/milmed/usz474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The effect of evidence-based post-traumatic stress disorder (PTSD) treatments on quality of life (QOL) is not well understood. In light of mixed findings on QOL after PTSD interventions, little is known about why some individuals experience functional and QOL improvements while others do not. This study examined treatment-related changes in depression, anger, and PTSD following cognitive processing therapy (CPT) as potential predictors of QOL change. MATERIALS AND METHODS Data from two randomized controlled trials, one examining CPT among female civilians and veterans (women's study NCT02362477; n = 126) and the other on CPT delivered to male veterans (men's study NCT00879255; n = 125), were used to test study aims. Linear mixed modeling examined changes in depression, anger, and PTSD as predictors of post-treatment QOL while controlling for baseline QOL. The VA Pacific Island Health Care System's Institutional Review Board approved all study procedures. RESULTS Among women, reductions in depression from pre- to post-treatment had the strongest predictive value of post-treatment QOL (B = -1.15, 95% confidence interval (-1.71, -0.60), t = -4.07, P < .001). For men, reductions in trait anger from pre- to post-treatment predicted post-treatment QOL (B = -0.55, 95% confidence interval (-0.90, -0.19), t = -3.00, P = .003). CONCLUSIONS Improvements in QOL may be predicted by different symptoms for men and women following evidence-based PTSD treatment. Our findings suggest that change in depression symptoms is an important predictor of post-treatment QOL among women, while anger symptoms are more influential for men. QOL and functioning is underresearched within the context of PTSD treatment, and this study suggests that these domains should be examined within the context of gender.
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Affiliation(s)
- Lisa H Glassman
- Department of Psychiatry, University of California, San Diego: 9500 Gilman Dr, La Jolla, CA 92093.,Department of Psychology, VA San Diego Healthcare System: 3350 La Jolla Village Drive (664BU), San Diego, CA 92161
| | - Margaret-Anne Mackintosh
- Dissemination and Training Division, National Center for PTSD: 795 Willow Rd (NC-PTSD), Building 334, Menlo Park, CA 94025
| | - Stephanie Y Wells
- Department of Psychiatry, University of California, San Diego: 9500 Gilman Dr, La Jolla, CA 92093.,Department of Psychology, VA San Diego Healthcare System: 3350 La Jolla Village Drive (664BU), San Diego, CA 92161.,Department of Psychology, San Diego State University: 5500 Campanile Dr, San Diego, CA 92182
| | - Induni Wickramasinghe
- Department of Psychiatry, University of California, San Diego: 9500 Gilman Dr, La Jolla, CA 92093.,Department of Psychology, VA San Diego Healthcare System: 3350 La Jolla Village Drive (664BU), San Diego, CA 92161
| | - Kristen H Walter
- Department of Psychology, VA San Diego Healthcare System: 3350 La Jolla Village Drive (664BU), San Diego, CA 92161
| | - Leslie A Morland
- Department of Psychiatry, University of California, San Diego: 9500 Gilman Dr, La Jolla, CA 92093.,Department of Psychology, VA San Diego Healthcare System: 3350 La Jolla Village Drive (664BU), San Diego, CA 92161.,Department of Psychology, San Diego State University: 5500 Campanile Dr, San Diego, CA 92182.,Department of Veterans Affairs Pacific Islands Healthcare System, National Center for PTSD - Pacific Islands Division: 3375 Koapaka Street, Suite I-560 Honolulu, Hawaii 96819
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24
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Manett A. Comorbidités psychiatriques et somatiques du PTSD chez le sujet âgé. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2015.09.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Le trouble de stress post-traumatique (TSPT) est un trouble sous-diagnostiqué chez le sujet âgé. La prévalence du TSPT est estimée à environ 2 % dans cette population . Il est très souvent associé à des comorbidités psychiatriques : au premier rang desquelles l’épisode dépressif majeur, possiblement accompagné d’idéations suicidaires, mais aussi les troubles anxieux (trouble anxieux généralisé, trouble panique avec agoraphobie), ou encore aux mésusages d’alcool, et de benzodiazépines . Ce trouble impacte la qualité de vie et entraîne une invalidité significative , affectant principalement 5 dimensions de fonctionnement : la compréhension et la communication, le déplacement, les soins personnels, l’activité et la participation sociale [1,2]. Il existe également des comorbidités somatiques importantes au premier rang desquelles les pathologies cardiovasculaires. Celles-ci sont le plus souvent en lien avec une augmentation des troubles métaboliques : le diabète, l’hypertriglycéridémie, l’hypertension . Ces comorbidités sont le plus souvent sous-diagnostiquées. Les sujets présentant un TSPT ont ainsi un risque accru d’infarctus du myocarde ou d’angine de poitrine [3,4]. Au-delà de la prise en charge du trouble psychiatrique, ces données rappellent l’importance de prendre en charge le sujet dans sa globalité. Il semble donc particulièrement important de mieux dépister ce trouble ainsi que ses comorbidités fréquentes chez le sujet âgé afin d’améliorer la qualité de vie et de diminuer la morbi-mortalité du TSPT. La prise en charge du TSPT chez le sujet âgé repose sur un traitement pharmacologique, au premier rang desquels les ISRS, et sur les psychothérapies. En particulier, les thérapies cognitives et comportementales peuvent être une proposition d’autant plus intéressante qu’il existe des comorbidités addictives ou somatiques.
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Pencea I, Munoz AP, Maples-Keller JL, Fiorillo D, Schultebraucks K, Galatzer-Levy I, Rothbaum BO, Ressler KJ, Stevens JS, Michopoulos V, Powers A. Emotion dysregulation is associated with increased prospective risk for chronic PTSD development. J Psychiatr Res 2020; 121:222-228. [PMID: 31865212 PMCID: PMC6957226 DOI: 10.1016/j.jpsychires.2019.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
While emotion dysregulation is associated with many psychological disorders, including posttraumatic stress disorder (PTSD), it remains uncertain whether pre-existing emotion dysregulation increases individual risk for prospectively developing PTSD in the aftermath of trauma exposure. Thus, the objective of the current study was to determine whether emotion dysregulation could prospectively predict the development of chronic PTSD symptoms following a traumatic event above and beyond other known associated factors, including depressive symptoms, baseline PTSD symptoms, total traumas experienced, and exposure to interpersonal trauma. Participants (N = 135) were recruited from the emergency department (ED) at Grady Memorial Hospital in Atlanta and follow-up assessments were conducted at 1-, 3-, 6-, and 12-months following trauma exposure. Latent Growth Mixture Modeling was used to identify PTSD symptom trajectories based on symptoms assessed at 1, 3, 6, and 12 months; three trajectories emerged: "chronic", "recovery", and "resilient". For the present study, probability of chronic PTSD symptoms was used as the outcome variable of interest. Linear regression modeling showed that emotion dysregulation was significantly associated with probability of developing chronic PTSD symptoms (p = 0.001) and accounted for an additional 7% of unique predictive variance when controlling for trauma exposure, baseline PTSD, and depressive symptoms. Our findings suggest that emotion dysregulation can be used as both a predictor of chronic PTSD and as a treatment target. Thus, identifying individuals with high levels of emotion dysregulation at the time of trauma and implementing treatments designed to improve emotion regulation could aid in decreasing the development of chronic PTSD among these at-risk individuals.
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Affiliation(s)
- Ioana Pencea
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | - Adam P Munoz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | - Devika Fiorillo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | | | - Isaac Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | - Kerry J Ressler
- Mclean Hospital, Harvard Medical School, Belmont, MA, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA; Yerkes National Primate Research Center, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, New York, USA.
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Wall PH, Convoy SP, Braybrook CJ. Military Service–Related Post-traumatic Stress Disorder: Finding a Way Home. Nurs Clin North Am 2019; 54:503-515. [DOI: 10.1016/j.cnur.2019.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Insights Following Implementation of an Exercise Intervention in Older Veterans with PTSD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142630. [PMID: 31340588 PMCID: PMC6678353 DOI: 10.3390/ijerph16142630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 12/23/2022]
Abstract
Individuals with post-traumatic stress disorder (PTSD) face numerous barriers to exercise. Little is known about behavioral strategies to promote participation in this population. This is a secondary analysis of individual barriers and goals, exercise prescription characteristics, and patient perceptions of a 12-week, community-based, randomized controlled exercise trial targeting older adults with PTSD, (N = 45; mean age = 68; male = 91%). The most common cited goals for participating included weight loss (65%) and increasing strength (65%). Exercise mode varied among those who completed the program (n = 37), with 14 (38%) using exclusively treadmill; eight (22%) using only bike, and 15 (41%) utilizing a combination. Patient-reported exercise duration and intensity progressively increased over the 12 weeks, and duration differed by mode of exercise. We observed high rates of attendance (84%) and completion (88%) to the program. Patient-reported barriers to attendance most often included health problems (62%) and medical appointments (55%). Participant responses to a program evaluation revealed high levels of satisfaction, preferences for group-based programs, and insights about the acceptability of the exercise environment (physical and social). This study is the first to report on goals, barriers, exercise prescription needs, and individual responses to supervised exercise training in a unique population, that is, older veterans with PTSD. Results of this study can inform future health promotion programs targeting older veterans with PTSD.
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Abstract
Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.
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Affiliation(s)
- Anica Pless Kaiser
- National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Joan M. Cook
- Department of Psychiatry, Yale School of Medicine and National Center for PTSD, West Haven, CT, USA
| | | | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Pilot randomized controlled trial of exercise training for older veterans with PTSD. J Behav Med 2019; 43:648-659. [PMID: 31264055 DOI: 10.1007/s10865-019-00073-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/19/2019] [Indexed: 01/22/2023]
Abstract
Exercise training positively impacts mental health, yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD. Fifty-four veterans ≥ 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks. There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise (Cohen's d = 0.36-0.81). Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.
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A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD. J Anxiety Disord 2019; 64:45-54. [PMID: 30978622 DOI: 10.1016/j.janxdis.2019.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population. METHOD This study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session. RESULTS Multi-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions. CONCLUSIONS PE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00539279.
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Gibson CJ, Huang AJ, McCaw B, Subak LL, Thom DH, Van Den Eeden SK. Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women. JAMA Intern Med 2019; 179:80-87. [PMID: 30453319 PMCID: PMC6583410 DOI: 10.1001/jamainternmed.2018.5233] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues. OBJECTIVE To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause symptoms among midlife and older women. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of data from a multiethnic cohort of 2016 women 40 to 80 years of age in the Kaiser Permanente Northern California health care system was conducted from November 15, 2008, to March 30, 2012. Statistical analysis was conducted from June 8, 2016, to September 6, 2017. EXPOSURES Lifetime physical or emotional IPV, sexual assault, and current symptoms of posttraumatic stress disorder, assessed with standardized questionnaires. MAIN OUTCOMES AND MEASURES Difficulty sleeping, vasomotor symptoms, and vaginal symptoms, assessed with standardized questionnaires. RESULTS Among the 2016 women enrolled, the mean (SD) age was 60.5 (9.5) years, and 792 of 2011 with race/ethnicity data (39.4)% were non-Latina white (403 [20.0%] Latina, 429 [21.3%] black, and 387 [19.2%] Asian). Lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 women (15.7%), sexual assault was reported by 382 women (18.9%), and 450 of 2000 women (22.5%) had current clinically significant symptoms of posttraumatic stress disorder. In multivariable analyses adjusted for age, race/ethnicity, educational level, body mass index, menopause status, hormone therapy, and parity, symptoms of posttraumatic stress disorder were associated with difficulty sleeping (odds ratio [OR], 3.02; 95% CI, 2.22-4.09), vasomotor symptoms (hot flashes: OR, 1.69; 95% CI, 1.34-2.12; night sweats: OR, 1.72; 95% CI, 1.37-2.15), and vaginal symptoms (vaginal dryness: OR, 1.73; 95% CI, 1.37-2.18; vaginal irritation: OR, 2.20; 95% CI, 1.66-2.93; pain with intercourse: OR, 2.16; 95% CI, 1.57-2.98). Emotional IPV was associated with difficulty sleeping (OR, 1.36; 95% CI, 1.09-1.71), night sweats (OR, 1.50; 95% CI, 1.19-1.89), and pain with intercourse (OR, 1.60; 95% CI, 1.14-2.25). Physical IPV was associated with night sweats (OR, 1.33; 95% CI, 1.03-1.72). Sexual assault was associated with vaginal symptoms (vaginal dryness: OR, 1.41; 95% CI, 1.10-1.82; vaginal irritation: OR, 1.42; 95% CI, 1.04-1.95; pain with intercourse: OR, 1.44; 95% CI, 1.00-2.06). CONCLUSIONS AND RELEVANCE Lifetime history of IPV or sexual assault and current clinically significant symptoms of posttraumatic stress disorder are common and are associated with menopause symptoms. These findings highlight the need for greater recognition of these exposures by clinicians caring for midlife and older women.
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Affiliation(s)
- Carolyn J Gibson
- Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Alison J Huang
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Brigid McCaw
- Division of Research, Kaiser Permanente, Oakland, California
| | - Leslee L Subak
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - David H Thom
- Department of Family and Community Medicine, University of California, San Francisco
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Hu T, Xu S, Liu W. A senior high school-based survey on the long-term impact of the Wenchuan earthquake on survivors' quality of life: PTSD as a mediator. Psychiatry Res 2018; 270:310-316. [PMID: 30290316 DOI: 10.1016/j.psychres.2018.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
Previous earthquake-related studies mostly focused on the prevalence and risk factors of post-traumatic stress disorder (PTSD), and there are only a few articles on the subsequent long-term outcomes of earthquakes. This study aimed to investigate the long-term impact of the Wenchuan earthquake on the quality of life (QOL) of surviving senior high school students 2-3 years post-disaster and to clarify whether PTSD was a mediator in the relationship of earthquake-related exposure and QOL. The study collected 1031 survivors' self-report questionnaires on socio-demographic data, earthquake-related experiences, PTSD symptoms (PCL-C), and QOL (WHOQOL-BREF). The results showed that earthquake-related exposure experiences were negatively associated with QOL scores, and the severity of PTSD symptoms was significantly and negatively related to QOL scores. Structural equation model (SEM) analysis showed that earthquake-related exposure was directly related to the severity of PTSD symptoms, while insignificantly directly related to QOL. Therefore, earthquake-related exposure was indirectly related to QOL (totally mediated by severity of PTSD symptoms). PTSD was a mediator in the relationship between earthquake-related exposure and QOL among adolescents: earthquake-related exposure affected the survivors' QOL mainly mediated by the PTSD symptoms that developed. Therefore, to improve the QOL of the survivors after an earthquake, more attention should be paid to survivors who have PTSD symptoms.
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Affiliation(s)
- Ting Hu
- Faculty of Psychology and Mental Health, Second Military Medical University, Number 800, Xiangyin Road, Yangpu district, 200433 Shanghai, China
| | - Siyuan Xu
- Mathematics and Computational Science, Hunan First Normal University, Number 1015, Fenglin 3rd road, Yuelu district, 410000 Changsha, China
| | - Weizhi Liu
- Faculty of Psychology and Mental Health, Second Military Medical University, Number 800, Xiangyin Road, Yangpu district, 200433 Shanghai, China.
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Mining latent information in PTSD psychometrics with fuzziness for effective diagnoses. Sci Rep 2018; 8:16266. [PMID: 30389985 PMCID: PMC6214927 DOI: 10.1038/s41598-018-34573-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 10/19/2018] [Indexed: 02/05/2023] Open
Abstract
The options of traditional self-report rating-scale, like the PTSD Checklist Civilian (PCL-C) scale, have no clear boundaries which might cause considerable biases and low effectiveness. This research aimed to explore the feasibility of using fuzzy set in the data processing to promote the screening effectiveness of PCL-C in real-life practical settings. The sensitivity, specificity, Youden's index etc., of PCL-C at different cutoff lines (38, 44 and 50 respectively) were analyzed and compared with those of fuzzy set approach processing. In practice, no matter the cutoff line of the PCL-C was set at 50, 44 or 38, the PCL-C showed good specificity, but failed to exhibit good sensitivity and screening effectiveness. The highest sensitivity was at 65.22%, with Youden's index being 0.64. After fuzzy processing, the fuzzy-PCL-C's sensitivity increased to 91.30%, Youden's index rose to 0.91, having seen marked augmentation. In conclusion, this study indicates that fuzzy set can be used in the data processing of psychiatric scales which have no clear definition standard of the options to improve the effectiveness of the scales.
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McDonald SD, Mickens MN, Goldberg-Looney LD, Mutchler BJ, Ellwood MS, Castillo TA. Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries. J Spinal Cord Med 2018; 41:691-702. [PMID: 28287932 PMCID: PMC6217469 DOI: 10.1080/10790268.2017.1293868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. DESIGN Cross-sectional. SETTING A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. PARTICIPANTS/METHODS Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. RESULTS Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. CONCLUSIONS Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.
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Affiliation(s)
- Scott D. McDonald
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melody N. Mickens
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Brian J. Mutchler
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael S. Ellwood
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Teodoro A. Castillo
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Glick DM, Cook JM, Moye J, Kaiser AP. Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life. Am J Hosp Palliat Care 2018; 35:1133-1139. [PMID: 29463090 PMCID: PMC6546161 DOI: 10.1177/1049909118756656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature1-3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.
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Affiliation(s)
- Debra M. Glick
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Joan M. Cook
- National Center for PTSD, VA Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer Moye
- VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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Platts-Mills TF, Nebolisa BC, Flannigan SA, Richmond NL, Domeier RM, Swor RA, Hendry PL, Peak DA, Rathlev NK, Jones JS, Lee DC, Jones CW, McLean SA. Post-Traumatic Stress Disorder among Older Adults Experiencing Motor Vehicle Collision: A Multicenter Prospective Cohort Study. Am J Geriatr Psychiatry 2017; 25:953-963. [PMID: 28506605 PMCID: PMC5563265 DOI: 10.1016/j.jagp.2017.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To characterize risk factors for and consequences of post-traumatic stress disorder (PTSD) among older adults evaluated in the emergency department (ED) following motor vehicle collision (MVC). DESIGN Prospective multicenter longitudinal study (2011-2015). SETTING 9 EDs across the United States. PARTICIPANTS Adults aged 65 years and older who presented to an ED after MVC without severe injuries. MEASUREMENTS PTSD symptoms were assessed 6 months after the ED visit using the Impact of Event Scale-Revised. RESULTS Of 223 patients, clinically significant PTSD symptoms at 6 months were observed in 21% (95% CI 16%-26%). PTSD symptoms were more common in patients who did not have a college degree, had depressive symptoms prior to the MVC, perceived the MVC as life-threatening, had severe ED pain, and expected their physical or emotional recovery time to be greater than 30 days. Three factors (ED pain severity [0-10 scale], perceived life-threatening MVC [0-10 scale], and pre-MVC depressive symptoms [yes to either of two questions]), predicted 6-month PTSD symptoms with an area under the curve of 0.76. Compared to patients without PTSD symptoms, those with PTSD symptoms were at higher risk for persistent pain (72% versus 30%), functional decline (67% versus 42%), and new disability (49% versus 18%). CONCLUSIONS Among older adults treated in the ED following MVC, clinically significant PTSD symptoms at 6 months were present in 21% of patients and were associated with adverse health outcomes. Increased risk for PTSD development can be identified with moderate accuracy using information readily available in the ED.
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Affiliation(s)
| | - Bo C. Nebolisa
- University of North Carolina at Chapel Hill, School of Medicine
| | - Sean A. Flannigan
- University of North Carolina at Chapel Hill, Department of Emergency Medicine
| | | | | | - Robert A. Swor
- William Beaumont Hospital, Department of Emergency Medicine
| | - Phyllis L. Hendry
- University of Florida College of Medicine Jacksonville, Department of Emergency Medicine
| | - David A. Peak
- Massachusetts General Hospital, Department of Emergency Medicine
| | | | - Jeffrey S. Jones
- Spectrum Health — Butterworth Campus, Department of Emergency Medicine
| | - David C. Lee
- North Shore University Hospital, Department of Emergency Medicine
| | | | - Samuel A. McLean
- University of North Carolina at Chapel Hill, Department of Emergency Medicine
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Abstract
This study aims to investigate the relationships of personality and social support with posttraumatic stress disorder (PTSD) after traffic accidents.The 90 Symptom Checklist (SCL-90) and Eysenck Personality Questionnaire (EPQ) were completed 1 week after trauma. The Checklist-Civilian Version (PCL-C) was surveyed 3 months after discharge.PCL-C score of 38 was used as cutoff point. The older age and lower education significantly increased the PTSD incidence. SCL-90 score was positively correlated with PTSD symptom score. The psychoticism (P) (0.230) and neuroticism (N) (0.302) was positively correlated with PTSD symptom score in a linear relationship. Objective support, subjective support, exploitation degree, and social support were negatively associated with PTSD scores. Force symptoms, psychoticism, subjective support, introversion, and extroversion could explain 65.0% of degree of variation for PTSD with the estimated standard error of 4.758.PTSD associated social factors include force symptoms, psychoticism, subjective support, introversion, and extroversion.
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Knaevelsrud C, Böttche M, Pietrzak RH, Freyberger HJ, Kuwert P. Efficacy and Feasibility of a Therapist-Guided Internet-Based Intervention for Older Persons with Childhood Traumatization: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2017; 25:878-888. [PMID: 28365000 DOI: 10.1016/j.jagp.2017.02.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/12/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although cognitive-behavioral treatment approaches for post-traumatic stress disorder (PTSD) exist, only a small proportion of older adults seeks psychological treatment. Alternative treatment approaches are thus needed to fill the gap between provision and use of psychological interventions. This study aimed to investigate the efficacy and feasibility of an Internet-based, therapist-guided cognitive-behavioral therapy (Internet-based CBT) for older individuals with PTSD symptoms. METHODS Patients with clinically meaningful (i.e., subsyndromal or greater) PTSD symptoms were randomly assigned to a 6-week treatment group of therapist-guided Internet-based CBT (N = 47; treatment group) or a wait-list group (N = 47; WL). The treatment group was assessed pre- and post-treatment as well as at 3-, 6- and 12-month follow-ups. RESULTS Linear mixed-effects analyses showed a significant interaction between group (treatment versus WL) and time (pre versus post) for PTSD symptoms with a moderate between-group effect size in favor of the treatment group (d = 0.42). Effects in the treatment group were maintained up to the 12-month follow-up. Findings indicate a significant interaction (group × time) for quality of life (d = 0.39) and self-efficacy (d = 0.38). With regard to the feasibility, attrition rate was very low in both groups (treatment group: 12.8%, WL: 6.4%) and working alliance was very high. CONCLUSIONS Results suggest that therapist-guided Internet-based CBT is associated with a substantial reduction in PTSD symptoms, and increase in resource-related variables in older adults with (subsyndromal) PTSD. This Internet-based intervention may offer a promising option in a stepped-care approach for older trauma-affected persons who may otherwise not pursue mental health treatment.
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Affiliation(s)
| | - Maria Böttche
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Germany; Center UEBERLEBEN (former Berlin Center for Torture Victims, Berlin, Germany.
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Harald Jürgen Freyberger
- Department of Psychosomatic Medicine and Psychotherapy, HELIOS Hansehospital Stralsund, University Medicine Greifswald, Greifswald, Germany
| | - Philipp Kuwert
- Department of Psychosomatic Medicine and Psychotherapy, HELIOS Hansehospital Stralsund, University Medicine Greifswald, Greifswald, Germany
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Flatt JD, Gilsanz P, Quesenberry CP, Albers KB, Whitmer RA. Post-traumatic stress disorder and risk of dementia among members of a health care delivery system. Alzheimers Dement 2017. [PMID: 28627380 DOI: 10.1016/j.jalz.2017.04.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is associated with an increased risk of dementia in male veterans, but little is known in females and civilians. METHODS PTSD and comorbidities were abstracted from medical records from 1/1/1996 to 12/31/2001. Dementia incidence from 1/1/2002 to 12/31/2014 in 499,844 health care members aged 60+ years over an average of 8.2 years. Cox proportional hazard models were adjusted for age, demographics, and comorbidities. RESULTS PTSD was associated with increased risk of dementia over an average of 8 years of follow-up (females: hazard ratio [HR] = 1.59, 95% confidence interval [CI] = 1.30-1.95; males: HR = 1.96, 95% CI = 1.51-2.55). There was a two-fold risk of dementia in those with both PTSD and depression (females: HR = 2.08; 95% CI = 1.66-2.59; males: HR = 2.06; 95% CI = 1.47-2.91) versus those without. DISCUSSION PTSD was a risk factor for dementia in both sexes, with a heightened risk in those with comorbid depression.
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Affiliation(s)
- Jason D Flatt
- Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Rachel A Whitmer
- Kaiser Permanente Division of Research, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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Lamoureux-Lamarche C, Vasiliadis HM. Lifetime traumatic events, health-related quality of life, and satisfaction with life in older adults. Qual Life Res 2017; 26:2683-2692. [PMID: 28534094 DOI: 10.1007/s11136-017-1593-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 01/07/2023]
Abstract
PURPOSES The aims were to assess the association between lifetime traumatic events and post-traumatic stress syndrome (PTSS) and health-related quality of life (HRQOL) and satisfaction with life stratified by gender among a community-dwelling sample of older adults. METHODS Data used came from the ESA-Services study (2011-2013) and included a large convenience sample of 1811 older adults. Traumatic events were measured using a list of 14 events. PTSS was measured using the Impact of Event Scale-Revised. HRQOL and life satisfaction were measured with the EQ-5D-3L and the Satisfaction With Life Scale. Multivariate regression analyses were used to assess the association between traumatic events, PTSS, and quality of life. RESULTS Respondents had a mean age of 73.90 years (SD: 6.13, range 65-97). Our results showed that exposure to violence (OR 4.88, CI 2.72-8.77), an accident (OR 2.33, CI 1.29-4.22), and sexual abuse (OR 2.26 CI 1.17-4.37) was associated with PTSS only in women. No traumatic event was associated only in men. The interaction between gender and exposure to violence and life-threatening disease of a close one was significant. Experiencing violence (β = -0.04, p < 0.01), a natural disaster (β = -0.04, p = 0.02), a life-threatening disease (β = -0.04, p < 0.01), and sexual abuse (β = -0.04, p < 0.01) were associated with a lower HRQOL only in women. No traumatic event was associated in men. Interactions between event and gender were significant for natural disaster, life-threatening disease of a close one, sexual abuse, and other type of traumatic events. A life-threatening disease (β = -0.90, p < 0.01) was associated with a reduced life satisfaction only in men and the exposure of violence (β = -1.18, p < 0.01) was associated with lower life satisfaction in women. CONCLUSION Our study could help healthcare professionals to identify and monitor traumatic events that are at higher risk to be associated with PTSS and a lower quality of life for older men and women.
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Affiliation(s)
- Catherine Lamoureux-Lamarche
- Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada. .,Research Centre, Charles-Le Moyne Hospital, 150 Place Charles-Le Moyne, Bureau 200, Longueuil, QC, J4K 0A8, Canada.
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.,Research Centre, Charles-Le Moyne Hospital, 150 Place Charles-Le Moyne, Bureau 200, Longueuil, QC, J4K 0A8, Canada
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Bock K, Bendstrup E, Hilberg O, Løkke A. Screening tools for evaluation of depression in Chronic Obstructive Pulmonary Disease (COPD). A systematic review. Eur Clin Respir J 2017; 4:1332931. [PMID: 28649311 PMCID: PMC5475296 DOI: 10.1080/20018525.2017.1332931] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/08/2017] [Indexed: 01/13/2023] Open
Abstract
Background: Anxiety and depression are common comorbid disorders in patients with chronic obstructive pulmonary disease (COPD), though estimates of their prevalence vary considerably. Depressive symptoms/depression are important comorbidities in COPD and an increasing interest is shown to these disorders. Depression may lead to reduced quality of life and increased morbidity and mortality. These statements underline the importance of implementing the use of screening instruments for depressive symptoms in a clinical setting. This systematic review evaluates four commonly used screening tools for depression in COPD. Furthermore we assess the prevalence of depression in COPD in the evaluated studies. Design: A literature search identified studies dealing with screening for depression in patients with COPD. We focused on the instruments: Beck Depression Inventory, Geriatric depression scale, Centre for Epidemiological Studies scale on Depression and Hospital and Anxiety Depression Scale. Results: Overall prevalence of depression was 30%. Demographic variations and severity of COPD influenced prevalence. The inter-prevalence of the four screening tools was consistent. We found a low variation between studies using the same tool. Few studies used control groups or compared the screening tool to a psychiatrist evaluation. Conclusions: This article calls for further investigation of the association between COPD and depressive symptoms. The subject is highly relevant for everyday life of patients with COPD and attention needs to be drawn to this issue in both an out- and in-patients.
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Affiliation(s)
- K. Bock
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - E. Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - O. Hilberg
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - A. Løkke
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
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Lamoureux-Lamarche C, Vasiliadis HM, Préville M, Berbiche D. Post-traumatic stress syndrome in a large sample of older adults: determinants and quality of life. Aging Ment Health 2016; 20:401-6. [PMID: 25803227 DOI: 10.1080/13607863.2015.1018864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aims of this study are to assess in a sample of older adults consulting in primary care practices the determinants and quality of life associated with post-traumatic stress syndrome (PTSS). METHOD Data used came from a large sample of 1765 community-dwelling older adults who were waiting to receive health services in primary care clinics in the province of Quebec. PTSS was measured with the PTSS scale. Socio-demographic and clinical characteristics were used as potential determinants of PTSS. Quality of life was measured with the EuroQol-5D-3L (EQ-5D-3L) EQ-Visual Analog Scale and the Satisfaction With Your Life Scale. Multivariate logistic and linear regression models were used to study the presence of PTSS and different measures of health-related quality of life and quality of life as a function of study variables. RESULTS The six-month prevalence of PTSS was 11.0%. PTSS was associated with age, marital status, number of chronic disorders and the presence of an anxiety disorder. PTSS was also associated with the EQ-5D-3L and the Satisfaction with Your Life Scale. CONCLUSION PTSS is prevalent in patients consulting in primary care practices. Primary care physicians should be aware that PTSS is also associated with a decrease in quality of life, which can further negatively impact health status.
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Affiliation(s)
- Catherine Lamoureux-Lamarche
- a Clinical Sciences Program, Community Health Sciences Department, Faculty of Medicine and Health Sciences , University of Sherbrooke , Longueuil , Canada.,c Research Centre , Charles-Le Moyne Hospital , Longueuil , Canada
| | - Helen-Maria Vasiliadis
- b Community Health Sciences Department, Faculty of Medicine and Health Sciences , University of Sherbrooke , Longueuil , Canada.,c Research Centre , Charles-Le Moyne Hospital , Longueuil , Canada
| | - Michel Préville
- b Community Health Sciences Department, Faculty of Medicine and Health Sciences , University of Sherbrooke , Longueuil , Canada.,c Research Centre , Charles-Le Moyne Hospital , Longueuil , Canada
| | - Djamal Berbiche
- c Research Centre , Charles-Le Moyne Hospital , Longueuil , Canada
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Association of Chronic Pain and Community Integration of Returning Veterans With and Without Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:E1-12. [PMID: 26098259 DOI: 10.1097/htr.0000000000000152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the association between community integration and pain in veterans with and without mild blast-related traumatic brain injury (TBI). DESIGN AND PARTICIPANTS A cross-sectional study of 198 Operation Enduring Freedom/Operation Iraqi Freedom veterans, 135 with mild TBI and 63 without TBI exposure. MAIN MEASURES Community Integration Questionnaire (CIQ), Community Reintegration of Injured Service Members Instrument, Brief Pain Inventory. RESULTS Pain interference was significantly associated with CIQ social integration (P = .037), and pain severity was significantly associated with CIQ home integration (P = .038) and CIQ social integration (P = .044). Pain interference and pain severity had a significant interaction as related to the CIQ total score (P = .046), CIQ job score (P = .034), and CIQ productivity score (P = .034). Pain interference (P = .042) and pain severity (P = .015) were associated with community participation, but not perceived limitations (P > .05) or satisfaction (P > .05) as measures by the Community Reintegration of Injured Service Members Instrument. There was a significant interaction between TBI status and pain severity (P = .021) with community participation. CONCLUSIONS Chronic pain has a negative association with the community integration of returning veterans. Although TBI status was associated with overall community integration ratings, depression had a stronger association with impairments. These findings suggest, above and beyond the treatment of depression, the importance of effectively managing TBI-related pain to foster improved social functioning and to promote the psychological and social well-being of returning veterans.
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Benzodiazepine use associated with co-morbid post-traumatic stress syndrome and depression in older adults seeking services in general medical settings. Int Psychogeriatr 2016; 28:913-20. [PMID: 26804712 DOI: 10.1017/s1041610216000016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Benzodiazepines (BZD) should be limited in older adults. This study aimed to determine the association between BZD use and the presence of a probable post-traumatic stress syndrome (PTSS) and whether this association is dependent on gender and co-morbid physical and mental conditions. METHODS Data were retained from the Étude sur la Santé des Aînés (ESA) - Services study (2011-2013) and included 1,453 older adults (≥65 years) who completed a face to face at-home interview, who were covered under Quebec's public drug insurance plan, and had given permission to access their Régie de l'Assurance Maladie du Québec (RAMQ) medical and pharmaceutical services data. The presence of a PTSS was measured using the Impact of Event Scale-Revised (IES-R). The use of BZD and antidepressants in the year prior to interview was ascertained from data reported in the RAMQ drug registry. The presence of depression and an anxiety disorder was assessed with the ESA-Questionnaire which was based on DSM-5 criteria. The interaction between PTSS and gender, depression, anxiety, and multi-morbidity was also assessed. RESULTS The prevalence of PTSS and BZD use reached 4.5% and 31.2%. Participants with PTSS were 1.9 (95% CI = 1.1-3.2) times more likely to use BZD. The presence of depression had a negative impact on the association between BZD use and PTSS (p = 0.04). CONCLUSION The use of BZD in older adults with PTSS is still prevalent today. Differences in benzodiazepine prescribing practices for more complex co-morbid psychiatric cases needs to be further studied.
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Goldberg J, Magruder KM, Forsberg CW, Friedman MJ, Litz BT, Vaccarino V, Heagerty PJ, Gleason TC, Huang GD, Smith NL. Prevalence of Post-Traumatic Stress Disorder in Aging Vietnam-Era Veterans: Veterans Administration Cooperative Study 569: Course and Consequences of Post-Traumatic Stress Disorder in Vietnam-Era Veteran Twins. Am J Geriatr Psychiatry 2016; 24:181-91. [PMID: 26560508 PMCID: PMC5928006 DOI: 10.1016/j.jagp.2015.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 05/01/2015] [Accepted: 05/12/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The prevalence of post-traumatic stress disorder (PTSD) among aging Vietnam-era veterans is not well characterized. METHODS In a cross-sectional study, 5,598 male Vietnam-era veterans and members of the Vietnam Era Twin Registry were assessed for PTSD using the Composite International Diagnostic Interview. Current symptoms were measured with the PTSD Checklist (PCL). PTSD was estimated according to age (<60 or ≥ 60) and Vietnam theater service. RESULTS The lifetime prevalence of PTSD in theater veterans aged at least 60 years was 16.9% (95% CI: 13.9%-20.5%) and higher than the 5.5% (95% CI: 4.3%-7.0%) among nontheater veterans. Among veterans younger than 60 years, the comparable prevalence was 22.0% for theater (95% CI: 16.7%-28.4%) and 15.7% for nontheater (95% CI: 13.4%-18.2%) veterans. Similar results were found for theater service and current PTSD prevalence (past 12 months). PCL scores were significantly higher in theater compared with nontheater veterans in both younger and older cohorts. In both the younger and older cohorts significant differences in lifetime and current PTSD prevalence and PCL scores persisted in theater service discordant twin pairs. CONCLUSION Vietnam service is related to elevated PTSD prevalence and current symptom burden in aging veterans. More than 30 years after the end of the Vietnam conflict, many veterans continue to suffer from PTSD, which highlights the need for continuing outreach throughout the life course.
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Affiliation(s)
- Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
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Smith NB, Cook JM, Pietrzak R, Hoff R, Harpaz-Rotem I. Mental Health Treatment for Older Veterans Newly Diagnosed with PTSD: A National Investigation. Am J Geriatr Psychiatry 2016; 24:201-12. [PMID: 25772341 DOI: 10.1016/j.jagp.2015.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Older veterans are the largest cohort served by the U.S. Department of Veterans Affairs (VA). The aim of this study was to examine mental health service utilization among older veterans recently diagnosed with posttraumatic stress disorder (PTSD), with an interest in sociodemographic and clinical characteristics related to receipt and type of mental health treatment. DESIGN VA National administrative data set and pharmacy records. SETTING VA Healthcare System. PARTICIPANTS The sample comprised 96,249 veterans aged 50+ years who received a new diagnosis of PTSD between fiscal years 2008-2011. MEASUREMENTS Demographic/clinical characteristics and treatment variables (receipt of mental health treatment; number of days before first appointment; receipt of psychotherapy, medication, or combination treatment; type of medication; number of psychotherapy visits) were assessed and relations were examined using logistic, negative binomial, and Cox regressions. RESULTS The majority of older veterans with newly diagnosed PTSD received at least one follow-up mental health visit. Increasing age was associated with decreased odds of receipt of any type of mental health treatment, and psychiatric comorbidities and greater number of medical appointments were associated with increased odds of treatment. Among veterans who received treatment, increased age was associated with decreased odds of receiving both psychotherapy and pharmacotherapy, decreased number of psychotherapy visits, and increased waiting times. CONCLUSION Among older veterans recently diagnosed with PTSD in the VA healthcare system, older individuals, particularly those over 80 years old, are at risk of not receiving timely and appropriate mental health treatment, indicating targeted outreach to this population could be helpful in improving care.
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Affiliation(s)
- Noelle B Smith
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
| | - Joan M Cook
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Robert Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Rani Hoff
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT; VA Northeast Program Evaluation Center
| | - Ilan Harpaz-Rotem
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT; VA Northeast Program Evaluation Center
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Depressionen im höheren Lebensalter, Teil 1. Z Gerontol Geriatr 2016; 49:335-48. [DOI: 10.1007/s00391-015-1019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/11/2015] [Accepted: 12/22/2015] [Indexed: 12/29/2022]
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Pless Kaiser A, Seligowski A, Spiro III A, Chopra M. Health status and treatment-seeking stigma in older adults with trauma and posttraumatic stress disorder. ACTA ACUST UNITED AC 2016; 53:391-402. [DOI: 10.1682/jrrd.2015.03.0039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/31/2015] [Indexed: 11/05/2022]
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Sachs-Ericsson N, Joiner TE, Cougle JR, Stanley IH, Sheffler JL. Combat Exposure in Early Adulthood Interacts with Recent Stressors to Predict PTSD in Aging Male Veterans. THE GERONTOLOGIST 2015. [DOI: 10.1093/geront/gnv036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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