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Beattie E, Thomas K, Ponder WN, Meyer EC, Kimbrel NA, Cammarata C, Coe E, Pennington ML, Sacco A, Nee B, Leto F, Ostiguy W, Yockey RA, Carbajal J, Schuman DL, Gulliver SB. Network analysis of posttraumatic stress disorder in a treatment-seeking sample of US firefighters and emergency medical technicians. J Affect Disord 2023; 340:686-693. [PMID: 37595896 DOI: 10.1016/j.jad.2023.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND First responders, including firefighters and emergency medical technicians (EMTs), are under extreme stress from repeated exposure to potentially traumatic events. To optimize treatment for this population, it is critical to understand how the various posttraumatic stress disorder (PTSD) symptom factors are associated with one another so these relations may be targeted in treatment. METHOD Using a sample of treatment-seeking firefighters/EMTs (N = 342), we conducted a partial correlation network analysis of the eight-factor model. A Bayesian directed acyclic graph (DAG) was used to estimate causal associations between clusters. RESULTS Approximately 37 % of the sample screened positive for probable PTSD. Internal re-experiencing and external re-experiencing had the strongest edges. In the DAG, internal re-experiencing was the parent node and was potentially predictive of external re-experiencing, negative affect, dysphoric arousal, and avoidance. LIMITATIONS Data were drawn from a treatment-seeking sample that may not generalize to all firefighters/EMTs. CONCLUSIONS The current findings are consistent with prior research suggesting re-experiencing plays a critical role in developing and maintaining PTSD symptoms. Future research should investigate non-treatment-seeking first responders, as well as EMTs and firefighters as individual populations.
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Affiliation(s)
- Emily Beattie
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA.
| | - Katharine Thomas
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | | | - Eric C Meyer
- Department of Counseling and Behavioral Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Claire Cammarata
- New York City Office of Labor Relations Employee Assistance Program, USA
| | - Elizabeth Coe
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | | | - Angelo Sacco
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - Brian Nee
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - Frank Leto
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - William Ostiguy
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - R Andrew Yockey
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jose Carbajal
- Stephen F. Austin State University, Nacogdoches, TX, USA
| | | | - Suzy B Gulliver
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA; Texas A&M University Health Science Center, College of Medicine, College Station, TX, USA
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Forkus SR, Raudales AM, Rafiuddin HS, Weiss NH, Messman BA, Contractor AA. The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:110-121. [PMID: 37378352 PMCID: PMC10292741 DOI: 10.1037/cps0000111] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.
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Affiliation(s)
| | | | | | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, RI, USA
| | - Brett A. Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
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Korem N, Duek O, Ben-Zion Z, Kaczkurkin AN, Lissek S, Orederu T, Schiller D, Harpaz-Rotem I, Levy I. Emotional numbing in PTSD is associated with lower amygdala reactivity to pain. Neuropsychopharmacology 2022; 47:1913-1921. [PMID: 35945274 PMCID: PMC9485255 DOI: 10.1038/s41386-022-01405-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with altered pain perception, namely increased pain threshold and higher pain response. While pain consists of physiological and affective components, affective components are often overlooked. Similar patterns of increased threshold-high response in PTSD were shown in response to emotional stimuli, i.e., emotional numbing. As both emotional numbing and pain processing are modulated by the amygdala, we aimed to examine whether individuals diagnosed with PTSD show lower amygdala activation to pain compared with combat controls, and whether the amygdala responses to pain correlates with emotional numbing. To do so, two independent samples of veterans (original study: 44 total (20 PTSD); conceptual replication study: 40 total (20 PTSD)) underwent threat conditioning, where a conditioned stimulus (CS+; visual stimulus) was paired with an unconditioned stimulus (US; electric-shock). We contrasted the amygdala activity to the CS + US pairing with the CS+ presented alone and correlated it with emotional numbing severity. In both samples, the PTSD group showed a robust reduction in amygdala reactivity to shock compared to the Combat Controls group. Furthermore, amygdala activation was negatively correlated with emotional numbing severity. These patterns were unique to the amygdala, and did not appear in comparison to a control region, the insula, a pivotal region for the processing of pain. To conclude, amygdala response to pain is lower in individuals with PTSD, and is associated with emotional numbing symptoms. Lower amygdala reactivity to mild pain may contribute to the "all-or-none" reaction to stressful situations often observed in PTSD.
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Affiliation(s)
- Nachshon Korem
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA.
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
- Yale University School of Medicine, Departments of Comparative Medicine and Neuroscience, New Haven, CT, 06511, USA.
| | - Or Duek
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Ziv Ben-Zion
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | | | - Shmuel Lissek
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Temidayo Orederu
- The Nash Family Department of Neuroscience, Department of Psychiatry, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Daniela Schiller
- The Nash Family Department of Neuroscience, Department of Psychiatry, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ilan Harpaz-Rotem
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Yale University Department of Psychology, New Haven, CT, 06511, USA
- Wu Tsai Institute, Yale University New Haven, New Haven, CT, 06510, USA
| | - Ifat Levy
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Yale University School of Medicine, Departments of Comparative Medicine and Neuroscience, New Haven, CT, 06511, USA
- Yale University Department of Psychology, New Haven, CT, 06511, USA
- Wu Tsai Institute, Yale University New Haven, New Haven, CT, 06510, USA
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Examining the associations between PTSD symptom clusters and alcohol-related problems in a sample of low-SES treatment-seeking Black/African American adults. J Psychiatr Res 2022; 154:261-267. [PMID: 35963024 PMCID: PMC9481727 DOI: 10.1016/j.jpsychires.2022.07.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often co-occur. This comorbidity negatively influences treatment outcomes, functioning, and quality of life. To better understand the relation between PTSD and AUD, research has begun to examine the influence of PTSD symptom clusters on alcohol-related problems. The current study is the first to analyze the associations between PTSD symptom clusters and alcohol consumption and AUD symptom severity in a treatment-seeking sample of Black/African American (AA) adults with co-occurring AUD and PTSD symptoms. Examination of these associations may help to facilitate greater recovery in this underserved population by identifying more precise targets for treatment. PTSD symptom clusters were identified from both the current 4-factor model identified in the DSM-5 and from a recently proposed 7-factor model. Participants were Black/AA adults (50.6% male) who endorsed trauma exposure and were seeking treatment for alcohol misuse. The majority (66%) were unemployed and almost half (45%) reported an income at or lower than $20,000. In the 4-factor model, results showed Cluster D symptoms of PTSD (i.e., negative alterations in cognitions and mood) were independently associated with alcohol consequences. Use of the 7-factor model, which divides Cluster D into symptoms of negative affect and anhedonia, further demonstrated that only anhedonic symptoms were independently associated with alcohol consequences. No symptom clusters were uniquely associated with alcohol consumption. Results suggest the absence of positive emotions, rather than the presence of negative emotions, are primarily associated with alcohol-related problems in a sample of trauma-exposed, Black/AA adults seeking treatment for alcohol misuse.
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Gross GM, Pietrzak RH, Hoff RA, Katz IR, Harpaz-Rotem I. Risk for PTSD symptom worsening during new PTSD treatment episode in a nationally representative sample of treatment-seeking U.S. veterans with subthreshold PTSD. J Psychiatr Res 2022; 151:304-310. [PMID: 35526446 DOI: 10.1016/j.jpsychires.2022.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Previous research has examined risk factors associated with poorer treatment outcomes for military Veterans with PTSD. However, work has not examined risk for symptom worsening among Veterans with subthreshold PTSD. The aim of this study was to examine demographic, psychiatric, physical health, and pre-treatment PTSD symptom clusters associated with clinically significant worsening of PTSD among a nationally representative sample of United States (U.S.) Veterans with subthreshold PTSD. Participants were Veterans (weighted N = 3162; unweighted N = 236) with subthreshold PTSD entering a new episode of treatment at U.S. Veterans Affairs PTSD specialty clinics during fiscal years 2018 and 2019. Data was collected as part of the Veterans Outcome Assessment, a yearly baseline and 3-month follow-up telephone survey. Analyses used weighted calculations to support the use of VOA data to draw inferences about all eligible Veterans, and binary logistic regression was used to examine risk factors for symptom worsening. Over 1/3 (37.7%) of Veterans with subthreshold PTSD experienced clinically significant symptom worsening from baseline to follow-up. Adjusted analyses revealed several risk factors for symptom worsening, including demographic (e.g., male sex, White race), psychiatric (personality and anxiety disorders), health care utilization (e.g., more primary care encounters in the previous year), physical health disability, and specific baseline PTSD symptom clusters (negative affect and anxious arousal). Findings suggest that Veterans with subthreshold symptoms seeking treatment for PTSD are at risk for symptom worsening, and highlight the importance of assessment, prevention, and treatment in targeting veterans with PTSD symptoms below the diagnostic threshold.
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Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA.
| | - Robert H Pietrzak
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA
| | - Rani A Hoff
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
| | - Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA; Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Ilan Harpaz-Rotem
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
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Staniaszek K, Cyniak-Cieciura M, Zawadzki B. Posttraumatic stress disorder symptom profiles – The role of temperament, traumatization, and cognitive factors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Palmisano AN, Norman SB, Panza KE, Petrakis IL, Pietrzak RH. PTSD symptom heterogeneity and alcohol-related outcomes in U.S. military veterans: Indirect associations with coping strategies. J Anxiety Disord 2022; 85:102496. [PMID: 34775167 DOI: 10.1016/j.janxdis.2021.102496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study investigated the role of coping strategies in mediating the relationship between the 7-factor model of posttraumatic stress disorder (PTSD) symptoms and alcohol misuse in veterans. METHODS Data were analyzed from 615 veterans from a nationally representative study of U.S. veterans who met criteria for probable full or subthreshold PTSD. Path analyses examined the role of self-sufficient, socially-supported, and avoidant coping strategies in mediating associations between PTSD symptom clusters and alcohol use disorder (AUD), alcohol consumption, and alcohol-related consequences. RESULTS Negative affect PTSD symptoms were associated with AUD through increased use of avoidant coping. Additionally, dysphoric arousal PTSD symptoms were associated with AUD; avoidant coping was associated with AUD and increased alcohol consumption; self-sufficient coping was associated with reduced AUD likelihood anhedonia symptoms with decreased use of self-sufficient coping; and negative affect with decreased use of socially-supported coping and increased use of avoidant coping. CONCLUSIONS Results underscore the importance of avoidant coping strategies as potential mediators of the relation between PTSD symptoms and AUD. Interventions designed to mitigate engagement in avoidant coping strategies, and to bolster engagement in self-sufficient and socially-supported strategies may help reduce alcohol misuse in veterans with full or subthreshold PTSD.
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Affiliation(s)
- Alexandra N Palmisano
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, White River Junction, VT, USA; VA San Diego Healthcare System, San Diego, CA
| | - Kaitlyn E Panza
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA
| | - Ismene L Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Christ NM, Byllesby BM, Elhai JD. The Effect of Cognitive-Affective Factors on PTSD and Alcohol Use Symptoms: An Investigation on Rumination, Suppression, and Reappraisal. Subst Use Misuse 2022; 57:2053-2062. [PMID: 36305851 DOI: 10.1080/10826084.2022.2129997] [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: 10/31/2022]
Abstract
Background: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are mental health conditions that often co-occur. The complexity of this comorbidity is well-documented, though the role of malleable cognitive-affective factors in PTSD/AUD warrants further study. Specifically, attaining a more comprehensive understanding of the role of malleable cognitive-affective factors in individuals with symptoms of PTSD/AUD may have important implications for future research, such as in treatment-seeking individuals. Extant examinations of cognitive-affective factors have demonstrated unique associations of cognitive reappraisal, expressive suppression, and rumination in PTSD symptom severity, though these effects had yet to be explored in subgroups of comorbid PTSD/AUD.Methods: In a sample of trauma-exposed individuals (n = 334) recruited to participate through an internet labor market, we first empirically examined latent subgroups of PTSD/AUD symptoms using latent profile analysis, then included expressive suppression, cognitive reappraisal, and four dimensions in the model to elucidate their role in specific profile patterns of PTSD/AUD symptom typologies.Results: Our results support a four-class model of PTSD/AUD symptoms, with unique predictive effects of expressive suppression, problem-focused thoughts, repetitive thoughts, and anticipatory thoughts on latent profile status.Conclusions: These findings may have important implications for future research focused on examining cognitive-affective patterns as they apply to intervention techniques in treatment-seeking individuals with symptoms of PTSD/AUD.
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Affiliation(s)
- Nicole M Christ
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Brianna M Byllesby
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Disentangling the association between PTSD symptom heterogeneity and alcohol use disorder: Results from the 2019-2020 National Health and Resilience in Veterans Study. J Psychiatr Res 2021; 142:179-187. [PMID: 34359013 DOI: 10.1016/j.jpsychires.2021.07.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/06/2021] [Accepted: 07/31/2021] [Indexed: 12/25/2022]
Abstract
Veterans are at increased risk of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) relative to civilians. Few studies have explored the association between distinct PTSD symptoms and AUD in veterans, and existing findings are highly discrepant. This study aimed to address this gap and equivocal association by evaluating which PTSD symptom clusters are most associated with AUD in a veteran sample using the 7-factor 'hybrid' model of PTSD. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), a nationally representative survey of 4069 U.S. veterans. Veterans completed self-report measures to assess current PTSD symptoms and AUD. Multivariable logistic regression and relative importance analyses were conducted to examine associations between the 7-factor model of PTSD symptoms and AUD. Adjusting for sociodemographic, military, trauma factors, and depressive symptoms, scores on the dysphoric arousal (20.7% relative variance explained [RVE]) and externalizing behaviors (19.0% RVE) symptom clusters were most strongly associated with AUD in the full sample, while externalizing behaviors (47.7% RVE), anxious arousal (23.9% RVE), and dysphoric arousal (12.4%) accounted for the majority of explained variance in veterans who screened positive for PTSD. Results of this nationally representative study of U.S. veterans highlight the importance of externalizing behaviors and arousal symptoms of PTSD as potential drivers of AUD in this population. The 7-factor hybrid model of PTSD provides a more nuanced understanding of PTSD-AUD associations, and may help inform risk assessment and more personalized treatment approaches for veterans with and at-risk for AUD.
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Panza KE, Kline AC, Norman GJ, Pitts M, Norman SB. Subgroups of comorbid PTSD and AUD in U.S. military veterans predict differential responsiveness to two integrated treatments: A latent class analysis. J Psychiatr Res 2021; 137:342-350. [PMID: 33756376 DOI: 10.1016/j.jpsychires.2021.02.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. Integrated treatments are effective, but not all patients respond and predicting outcome remains difficult. In this study, latent class analysis (LCA) identified symptom-based subgroups of comorbid PTSD/AUD among 119 veterans with PTSD/AUD from a randomized controlled trial of integrated exposure therapy (I-PE) versus integrated coping skills therapy (I-CS). Multilevel models compared subgroups on PTSD severity and percentage of heavy drinking days at post-treatment and 3- and 6-month follow-up. LCA revealed three subgroups best fit the data: Moderate PTSD/Low AUD Impairment (21%), High PTSD/High AUD Impairment (48%), and Low PTSD/High AUD Impairment (31%). There was a three-way interaction between time, treatment condition, and subgroup in predicting PTSD outcomes (p < .05). For the Moderate PTSD/Low AUD Impairment class, outcomes at post-treatment and 3-months were similar (ds = 0.17, 0.55), however I-PE showed greater reductions at 6-months (d = 1.36). For the High PTSD/High AUD Impairment class, I-PE demonstrated better post-treatment (d = 0.83) but comparable follow-up (ds = -0.18, 0.49) outcomes. For the Low PTSD/High AUD Impairment class, I-PE demonstrated stronger outcomes at every timepoint (ds = 0.82-1.15). Heavy drinking days declined significantly through follow-up, with an effect of subgroup, but not treatment, on timing of response. This was the first study modeling how PTSD and AUD symptoms might cluster together in a treatment sample of veterans with PTSD/AUD. Symptom-based subgroups show promise in helping understand variability in treatment response among patients with PTSD/AUD and deserve further study.
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Affiliation(s)
- Kaitlyn E Panza
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Alexander C Kline
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Gregory J Norman
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Michelle Pitts
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Drive, White River Junction, VT, 05009, USA
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Fogle BM, Tsai J, Mota N, Harpaz-Rotem I, Krystal JH, Southwick SM, Pietrzak RH. The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions. Front Psychiatry 2020; 11:538218. [PMID: 33362593 PMCID: PMC7755975 DOI: 10.3389/fpsyt.2020.538218] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population.
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Affiliation(s)
- Brienna M. Fogle
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Natalie Mota
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - John H. Krystal
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Steven M. Southwick
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Robert H. Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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Su YJ, Kung YW, Hung FC, Chen SH. Dimensionality of DSM-5 PTSD symptoms: Validation of the Chinese version of the posttraumatic diagnostic scale for DSM-5 across multiple trauma samples. J Anxiety Disord 2020; 74:102261. [PMID: 32580119 DOI: 10.1016/j.janxdis.2020.102261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 11/24/2022]
Abstract
The Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) is an updated DSM-5 version of the PDS, a widely used measure for PTSD. The PDS-5 has recently been shown to possess sound psychometric properties and awaits cross-cultural validation. The present study aimed first, to evaluate the psychometric properties of the Chinese version of the PDS-5; second, to evaluate alternative factor models of DSM-5 PTSD symptoms with multiple trauma samples. Data were collected from five samples of Taiwanese trauma-exposed individuals (total N = 903): 138 burn injury survivors, 403 earthquake survivors, 181 trauma-exposed young adults, 91 trauma-exposed undergraduates, and 90 female domestic violence survivors. The Chinese PDS-5 possessed excellent internal consistency (α s = .94-.95) and satisfactory five-week (r = .80) and one-year temporal stability (r = 0.76). Convergent, concurrent, and discriminant validity were also established. Consistent with recent studies, confirmatory factor analyses demonstrated the best fit of a seven-factor Hybrid model, followed by a six-factor Anhedonia model across multiple trauma samples.
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Affiliation(s)
- Yi-Jen Su
- Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, ROC.
| | - Yi-Wen Kung
- Department of Psychology, Fo Guang University, Yilan, Taiwan, ROC
| | - Fu-Chien Hung
- Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan, ROC
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, Taipei, Taiwan, ROC
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13
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Correia-Santos P, Morgado D, Maia ÂC, Levendosky A, Jongenelen I, Pinto RJ. Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity. J Trauma Stress 2019; 32:908-917. [PMID: 31814166 DOI: 10.1002/jts.22469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/11/2022]
Abstract
The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.
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Affiliation(s)
| | - Diogo Morgado
- School of Psychology, University of Minho, Braga, Portugal
| | - Ângela C Maia
- School of Psychology, University of Minho, Braga, Portugal
| | - Alytia Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Inês Jongenelen
- Faculty of Psychology, HEI-Lab, University Lusófona of Porto, Porto, Portugal
| | - Ricardo J Pinto
- Faculty of Psychology, HEI-Lab, University Lusófona of Porto, Porto, Portugal
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14
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Ibrahim H, Catani C, Ismail AA, Neuner F. Dimensional Structure and Cultural Invariance of DSM V Post-traumatic Stress Disorder Among Iraqi and Syrian Displaced People. Front Psychol 2019; 10:1505. [PMID: 31354564 PMCID: PMC6629925 DOI: 10.3389/fpsyg.2019.01505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
While the factor structure of post-traumatic stress disorder (PTSD) symptoms has been investigated among various traumatized populations in Western and high-income countries, knowledge regarding the validity of factor structure of PTSD among culturally diverse populations in low-and-middle-income countries is limited. The current study examined the factor structure and cultural invariance of PTSD in 521 Iraqi and 993 Syrian war-affected displaced people who were living in the Kurdistan Region of Iraq. Results from confirmatory factor analyses demonstrated that alternative factor models for PTSD, including a new model derived from this population (anhedonia and affect model) resulted in a better fit than the current DSM V models. Taken together, the results showed that a good fit, as well as the measurement invariance of PTSD factors, could be obtained by applying the anhedonia and hybrid model. This study provides further support for the anhedonia and hybrid model of PTSD and fills an important gap in knowledge about the validity of PTSD symptom clusters among Arab and Kurdish populations.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq.,Vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Vivo International, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Vivo International, Konstanz, Germany
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15
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Destoop M, Morrens M, Coppens V, Dom G. Addiction, Anhedonia, and Comorbid Mood Disorder. A Narrative Review. Front Psychiatry 2019; 10:311. [PMID: 31178763 PMCID: PMC6538808 DOI: 10.3389/fpsyt.2019.00311] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Recently, anhedonia has been recognized as an important Research Domain Criterion (RDoC) by the National Institute of Mental Health. Anhedonia is proposed to play an essential role in the pathogenies of both addictive and mood disorders, and possibly their co-occurrence with a single individual. However, up to now, comprehensive information about anhedonia concerning its underlying neurobiological circuitries, the neurocognitive correlates, and their role in addiction, mood disorder, and comorbidity remains scarce. Aim: In this literature review of human studies, we bring together the current state of knowledge with respect to anhedonia in its relationship with disorders in the use of substances (DUS) and the comorbidity with mood disorders. Method: A PubMed search was conducted using the following search terms: (Anhedonia OR Reward Deficiency) AND ((Drug Dependence OR Abuse) OR Alcohol OR Nicotine OR Addiction OR Gambling OR (Internet Gaming)). Thirty-two articles were included in the review. Results: Anhedonia is associated with substance use disorders, and their severity is especially prominent in DUS with comorbid depression. Anhedonia may be both a trait and a state dimension in its relation to DUS and tends to impact DUS treatment outcome negatively.
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Affiliation(s)
- Marianne Destoop
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Psychiatric Hospital Multiversum, Campus Alexianen, Boechout, Belgium
| | - Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,University Department of Psychiatry, Campus Duffel, Duffel, Belgium
| | - Violette Coppens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,University Department of Psychiatry, Campus Duffel, Duffel, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Psychiatric Hospital Multiversum, Campus Alexianen, Boechout, Belgium
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Ross J, Kaliská L, Halama P, Lajčiaková P, Armour C. Examination of the latent structure of DSM-5 posttraumatic stress disorder symptoms in Slovakia. Psychiatry Res 2018; 267:232-239. [PMID: 29940453 DOI: 10.1016/j.psychres.2018.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
Abstract
The latent structure of posttraumatic stress disorder (PTSD) has been widely discussed, with the majority of studies in this area being conducted in the US. The current study aimed to extend this area of research by comparing seven existing PTSD factor models in a sample of 754 trauma-exposed university students from Slovakia, where similar research has not been conducted yet. The sample was predominantly female (83.69%), with a mean age of 22.68 years. The comparison of competing models revealed that the Anhedonia model, consisting of six inter-correlated factors of reexperiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, provided the best fit. Several factors of the Anhedonia model also showed differential relationships with the external variables of anxiety and depression. The study contributes to the limited literature on the latent structure of PTSD in Eastern Europe.
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Affiliation(s)
- Jana Ross
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK.
| | - Lada Kaliská
- Department of Psychology, Faculty of Education, Matej Bel University, Banská Bystrica, Slovakia
| | - Peter Halama
- Department of Psychology, Faculty of Arts, Trnava University in Trnava, Trnava, Slovakia
| | - Petra Lajčiaková
- Department of Psychology, Faculty of Arts and Letters, Catholic University in Ružomberok, Slovakia
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK.
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