Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers

Heterogeneity in the co-occurrence of depression and anxiety among adolescents: Results of latent profile analysis

BACKGROUND

Depression and anxiety co-occur frequently and there is heterogeneity in the co-occurrence of such symptoms; however, few previous studies investigated the heterogeneity based on person-centered perspectives in adolescents. The primary aim of our study was to explore it using latent profile analysis (LPA), a person-centered statistical approach.

METHOD

The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to examine depression and anxiety symptoms in 7422 Chinese adolescents from 23 primary and secondary schools. To investigate latent profiles and assess profile validity, we employed Latent Profile Analysis (LPA), multinomial logistic regression, and analysis of variance.

RESULTS

A three-profile model was suggested as the optimum: low (69.9 %), moderate (21.6 %), and high depression/anxiety (8.5 %). Female with higher negative cognitive bias and higher emotional regulation difficulty are more likely to be categorized in the high depression/anxiety group. Internet addiction, academic "Lying flat" and involution are significantly and positively linked with the severity of anxiety and depression.

LIMITATIONS

Reliance on self-reported measures may lead to response bias; the cross-sectional design limits our ability to study how symptom profiles and category membership change over time.

CONCLUSIONS

Three latent profiles of the co-occurrence of depression and anxiety presented a parallel pattern, which serves as a poignant reminder of the imperative need to identify Chinese adolescents who may be at elevated risk for depression and/or anxiety, and promoting intervention that are meticulously tailored to address the unique symptom presentations of each individual.

Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis

BACKGROUND

Firefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea.

METHODS

A total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership.

RESULTS

The LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities.

LIMITATIONS

The cross-sectional design and usage of self-reported questionnaires are limitations of this study.

CONCLUSIONS

The severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.

Validating the Spanish translation of the posttraumatic stress disorder checklist (PCL-5) in a sample of individuals with traumatic brain injury

Introduction

There is controversy regarding the comorbidity of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The present study translated the PTSD Checklist for DSM-5 (PCL-5) to Spanish and validated it in a sample of patients with TBI 6 months after the injury.

Methods

The study included 233 patients (162 males and 71 females) recruited from four Spanish hospitals within 24 h of traumatic brain injury. A total of 12.2% of the sample met the provisional PTSD diagnostic criteria, and the prevalence was equal between male and female participants.

Results

The analysis confirmed the internal consistency of the translated instrument (α = 0.95). The concurrent validity of the instrument was confirmed based on high correlation coefficients of 0.7 and 0.74 with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9), respectively. Exploratory factor analysis also confirmed that the items on the PCL-5 can be differentiated from the GAD-7 and PHQ-9 items. Confirmatory factor analysis (CFA) was used to examine the structural validity of the Spanish translation of the PCL-5 with three different models. CFA partially confirmed the four-factor PTSD model, whereas both the six-factor anhedonia model and the seven-factor hybrid model showed adequate fit. However, the difference between the anhedonia and hybrid models was not statistically significant; moreover, both models showed signs of overfitting. Therefore, the utility of these models should be reexamined in future studies.

Conclusion

Overall, the results suggest that the Spanish translation of the PCL-5 is a reliable and valid instrument for screening PTSD symptoms among Spanish TBI patients. The Spanish translation of the PCL-5 is also presented in the manuscript.

Exploring heterogeneity in PTSD symptoms and associated predictors and outcomes in Afghanistan veterans: A latent profile analysis

Research on posttraumatic stress symptoms (PTSS) typically focuses on diagnosis or symptom severity, however, this overlooks the variety of symptom patterns that exist. Latent profile analysis was used to explore PTSS profiles in a sample of Norwegian Afghanistan veterans (n = 4052, 91.7% males). Multinomial logistic regression analyses were conducted to examine predictors and outcomes associated with PTSS profile membership. Three profiles emerged: Low Symptoms profile (85%); High Numbing and Arousal profile (13%); and High Symptoms profile (2%). Being female, lower number of deployments, barriers to disclose war-related experiences, and higher number of potentially morally injurious events (PMIEs) were associated with belonging to the High Symptoms profile compared to the High Numbing and Arousal (Male gender: OR = 0.37, p < .05; Number of deployments: OR = 0.68, p < .05; Barriers to disclose: OR = 1.39, p < .001; PMIEs: OR = 1.15. p < .05), or Low Symptoms profile (Male gender: OR = 0.36, p < .05; Number of deployments: OR = 0.67, p < .01; Barriers to disclose: OR = 1.80, p < .001; PMIEs: OR = 1.32. p < .001). Participants in the High Symptoms profile had the highest probability of mental health service use (0.37) and endorsing suicidal ideation (0.38), compared to the two other profiles (p < .01). Participants in the High Numbing and Arousal profile had a higher probability of seeking professional mental health care (0.17), endorsing suicidal ideation (0.16), and reporting more suicide attempts compared to the Low Symptom profile (0.02 vs. 0.00, p < .001). These findings highlight the importance of considering the heterogeneity of PTSS profiles and understanding the predictors and responses of individuals who exhibit elevated PTSS symptoms.

PTSD, depression, and treatment outcomes: A latent profile analysis among active duty personnel in a residential PTSD program

Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist-Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction ps < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (ps < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (ps < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment.

Mental health profiles of depressive symptoms and personal well-being among active-duty military families

Although some research has examined the mental health of individual family members in military families, additional research is needed that considers mental health among multiple members of the family system simultaneously and that characterizes subsets of families with distinct patterns. Mental health patterns of depressive symptoms and well-being in and among families were identified using latent profile analysis with a community sample of 236 military families with a service member (SM) parent, civilian partner, and adolescent. Drawing from the Family Adjustment and Adaptation Response model, we examined several military-related family demands (e.g., relocations, deployments) and capabilities (e.g., family cohesion, social support outside the family) as correlates of the family profiles. Three profiles emerged: thriving families (62.3% of the sample where all three family members reported relatively low depressive symptoms and high personal well-being), families with a relatively distressed SM (24.2%), and families with a relatively distressed adolescent (13.5%). Overall, there were no differences between the groups of families regarding military-related demands, yet there were differences between the groups regarding their capabilities, namely family cohesion and social support. In general, families in the thriving profile tended to have higher family cohesion and social support as reported by multiple family members compared to the other two profiles. Findings can inform the development of family needs assessments and tailored interventions (and intervention points) based on family profiles and current capabilities.

Posttraumatic stress and depression symptom classes in parents of trauma-exposed children: a transdiagnostic perspective using pooled individual participant data

Background: In the aftermath of child trauma, post-traumatic stress (PTS) and depression symptoms often co-occur among trauma exposed children and their parents. Studies have used latent class analysis (LCA) to examine PTS and depression symptoms and identify homogeneous subgroups among trauma exposed children. However, little is known about subgroups or classes of PTS and depression reactions of parents of traumatised children.Objectives: (1) Determine PTS and depression symptom classes at 2-9 months post-trauma, and (2) to examine sociodemographic covariates among parents of trauma exposed children.Methods: Using harmonised individual participant data (n = 702) from eight studies (Australia, UK, US) included in the Prospective studies of Acute Child Trauma and Recovery Data Archive (PACT/R), we modelled these phenomena at the symptom level using LCA.Results: Our LCA yielded three solutions: 'high internalizing symptom' class (11%); 'low PTS-high depression' class (17%); and 'low internalizing symptom' class (72%). Parents of children in the 'low PTS-high depression' class were more likely to have children of older age and be part of an ethnic minority, compared to the 'low internalizing symptoms' class. Mothers were more likely to be in the 'high internalizing symptom' class compared to the 'low internalizing symptoms' class.Conclusions: These findings reveal a qualitative structure and relationship between depression and PTS symptoms that highlights the importance of assessing and targeting a broad range of internalising symptoms in post-trauma psychological treatment.

Cortisol Sensitizes Cochlear Hair Cells to Gentamicin Ototoxicity Via Endogenous Apoptotic Pathway

BACKGROUND

The widespread use of aminoglycosides is a prevalent cause of sensorineural hearing loss. Patients receiving aminoglycosides usually have elevated levels of circulating stress hormones due to disease or physiological stress; however, whether the stress hormone cortisol impacts aminoglycoside-mediated injury of cochlear hair cells has not been fully investigated.

METHODS

House Ear Institute-Organ of Corti 1 (HEI-OC1) cells with or without cortisol pretreatment were exposed to gentamicin, we investigated the effect of cortisol pretreatment on gentamicin ototoxicity by assessing cell viability. Molecular pathogenesis was explored by detecting apoptosis and oxidative stress. Meanwhile, by inhibiting glucocorticoid receptors (GR) and mineralocorticoid receptors (MR), the potential roles of receptor types in cortisol-mediated sensitization were evaluated.

RESULTS

Cortisol concentrations below 75 μmol/l did not affect cell viability. However, pretreatment with 50 μmol/l cortisol for 24 hours sensitized hair cells to gentamicin-induced apoptosis. Further mechanistic studies revealed that cortisol significantly increased hair cell apoptosis and oxidative stress, and altered apoptosis-related protein expressions induced by gentamicin. In addition, blockade of either GR or MR attenuated cortisol-induced hair cell sensitization to gentamicin toxicity.

CONCLUSION

Cortisol pretreatment increased mammalian hair cell susceptibility to gentamicin toxicity. Sensitization was related to the activation of the intrinsic apoptotic pathway and excessive generation of reactive oxygen species. Cortisol may exacerbate aminoglycoside ototoxicity.

Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors

OBJECTIVE

Studies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes.

METHOD

Participants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety.

RESULTS

Latent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe.

CONCLUSIONS

Results suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of Veterans

OBJECTIVE

Veterans can present at nongovernment (Department of Defense, Department of Veterans Affairs) mental health agencies with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no veteran study has validated these measures on a treatment-seeking sample of veterans outside the DoD and VA.

METHODS

We used a treatment-seeking sample of veterans ( N = 493) to validate measures that assess these constructs (PTSD Checklist 5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7).

RESULTS

The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting model of the depression measure was a two-factor structure, cognitive-affective, and somatic depression. The measure of generalized anxiety was a unidimensional model.

LIMITATIONS

Follow-up studies should validate these measures on nontreatment-seeking discharged veterans.

CONCLUSIONS

We interpret these findings within the veteran scholarship and explore clinical implications for providers.

A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents

Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.

Latent emotion profiles of PTSD and specific emotions predicting differential therapy outcomes in a dismantling study of cognitive processing therapy

Posttraumatic stress disorder (PTSD) is theoretically maintained by avoidance of emotions elicited from trauma-related beliefs. Whether PTSD symptom profiles and specific emotions predict treatment response is unknown. This secondary data analysis examined: a) whether individuals with PTSD can be sub-classified based on symptom clusters and specific emotions, and b) if these subgroups predict differential responses to cognitive versus exposure-based PTSD interventions. Women with physical or sexual assault-related PTSD were randomized to CPT (cognitive processing therapy elements only), CPT with written accounts (CPT+A), or written accounts (WA) only (n = 150). Participants completed baseline measures of PTSD, state anxiety, internalized anger, externalized anger, shame, and guilt, and weekly PTSD measures during and 6 months after treatment. Latent profile analyses revealed four subgroups: low symptoms and emotions; moderate-high reexperiencing, low internalized emotions (i.e., moderate-high reexperiencing, moderate avoidance/hyperarousal/guilt, low shame/internalized anger/anxiety); low reexperiencing, moderate emotions (i.e., low re-experiencing, moderate avoidance/hyperarousal/guilt, moderate other emotions); and high symptoms and emotions (high symptoms and emotions except moderate externalized anger). The high symptom and emotion subgroup experienced greater PTSD symptom improvements in cognitive conditions than WA. Other groups did not exhibit differential change across conditions. Cognitive interventions may be well-suited for severe PTSD with high self-directed emotions. CLINICALTRIALS.GOV IDENTIFIER: NCT00245232.

Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms After Potentially Traumatic Events: Latent Classes and Cognitive Correlates

People exposed to potentially traumatic events (PTEs) may develop distinct symptom patterns, which may require different therapeutic approaches. We aimed to identify classes of people exposed to PTEs based on the presence of posttraumatic stress disorder (PTSD) clusters, anxiety, and depression and to explore which cognitive factors (rumination, worry, and negative cognitions) are associated with class membership. Latent class analyses were conducted to identify subgroups of 258 PTE-exposed Spanish adults. A three-class solution emerged: a resilient class with low odds of all symptoms ( n = 188); a partial PTSD class, characterized by partial PTSD clusters, moderate anxiety, and low depression ( n = 36); and a high symptom class, characterized by high PTSD, moderate anxiety, and low depression ( n = 34). These classes related meaningfully to rumination, worry, and negative cognitions. Distinct symptom patterns of PTSD clusters, anxiety, and depression can be distinguished in people exposed to PTEs and relate to cognitive risk factors of psychopathology.

Efficacy of traumatic memory reactivation with or without propranolol in PTSD with high dissociative experiences

Background: Post-traumatic stress disorder (PTSD) with dissociative symptoms is now a full-fledged subtype of this disorder. The dissociative subtype is associated with a greater number of psychiatric comorbidities. To date, the impact of dissociation on the efficacy of PTSD treatment remains unclear.Objective: The aim of this study was to compare the efficacy of a traumatic memory reactivation procedure with the administration of propranolol or a placebo once a week for six consecutive weeks in reducing PTSD and MDE symptoms between PTSD subjects with or without high dissociative symptoms.Method: For that, we conducted a randomized clinical trial in 66 adults diagnosed with longstanding PTSD and measured the SCID PTSD module, the PTSD Checklist (PCL-S), Beck's Depression Inventory-II (BDI-II), and the Dissociative Experiences Scale (DES).Results: Patients with and without high dissociative experience had significant improvement in their PCL-S scores over the 6 treatment sessions, and PCL-S scores continued to decline in all patients during the post-treatment period. However, there was no correlation between the presence/absence of high dissociative experiences and no specific effect of propranolol treatment. We found exactly the same results for MDE symptoms. Interestingly, patients with high dissociative experiences before treatment exhibited very significant improvement in their DES scores after the 6 treatment sessions, and patients maintained this improvement 3 months post-treatment.Conclusions: The traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD, and improvement of these dissociative symptoms was associated with a decrease in both PTSD and depression severity.

An in-depth look at latent classes of DSM-5 psychiatric comorbidity among individuals with PTSD: Clinical indicators and treatment utilization

OBJECTIVE

Posttraumatic stress disorder (PTSD) is associated with high comorbidity rates across the full range of psychiatric disorders. However, little is known about how psychiatric comorbidity manifests among people with PTSD, particularly with regard to concurrent diagnoses.

METHOD

Latent class analysis (LCA) was used to characterize discrete classes of PTSD comorbidity using past year DSM-5 diagnostic standards among a large nationally representative epidemiologic sample of U.S. adults. Follow-up analyses compared participant characteristics across latent classes.

RESULTS

The LCA was best characterized by five classes: low comorbidity, distress-fear, distress-externalizing, mania-fear-externalizing, and mania-externalizing. Excluding the low comorbidity class, proportions of borderline and schizotypal personality disorder were high across classes.

CONCLUSION

Participant characteristics across classes of past year PTSD comorbidity are explored through the lens of case conceptualization and treatment planning utility.

Brain Responses to a Self-Compassion Induction in Trauma Survivors With and Without Post-traumatic Stress Disorder

Self-compassion (SC) is a mechanism of symptom improvement in post-traumatic stress disorder (PTSD), however, the underlying neurobiological processes are not well understood. High levels of self-compassion are associated with reduced activation of the threat response system. Physiological threat responses to trauma reminders and increased arousal are key symptoms which are maintained by negative appraisals of the self and self-blame. Moreover, PTSD has been consistently associated with functional changes implicated in the brain's saliency and the default mode networks. In this paper, we explore how trauma exposed individuals respond to a validated self-compassion exercise. We distinguish three groups using the PTSD checklist; those with full PTSD, those without PTSD, and those with subsyndromal PTSD. Subsyndromal PTSD is a clinically relevant subgroup in which individuals meet the criteria for reexperiencing along with one of either avoidance or hyperarousal. We use electroencephalography (EEG) alpha-asymmetry and EEG microstate analysis to characterize brain activity time series during the self-compassion exercise in the three groups. We contextualize our results with concurrently recorded autonomic measures of physiological arousal (heart rate and skin conductance), parasympathetic activation (heart rate variability) and self-reported changes in state mood and self-perception. We find that in all three groups directing self-compassion toward oneself activates the negative self and elicits a threat response during the SC exercise and that individuals with subsyndromal PTSD who have high levels of hyperarousal have the highest threat response. We find impaired activation of the EEG microstate associated with the saliency, attention and self-referential processing brain networks, distinguishes the three PTSD groups. Our findings provide evidence for potential neural biomarkers for quantitatively differentiating PTSD subgroups.

Examining the dimensionality of anxiety and depression: A latent profile approach to modeling transdiagnostic features

Depression and anxiety are highly prevalent psychological disorders; our understanding of these conditions remains limited. Efforts to explain anxiety and depression have been constrained in part by binary classification systems. Dimensional approaches to understanding psychopathology may be more effective. The present study used latent profile analysis (LPA) to assess whether unique subgroups exist within a tri-level model of anxiety and depression. Participants (N=627) completed self-report questionnaires from which tri-level model factors were derived. LPA was conducted on those factors. A 4-profile model offered optimal fit to the data at baseline. This model was replicated at a second time point. Models derived included profiles labelled 'Mixed Fears,' 'Anxious Arousal,' 'Low Mood/Anhedonia,' and 'Sub-Clinical.' Profiles were validated at Time 1 using diagnostic status and clinical severity ratings associated with mood and anxiety presentations. Profiles demonstrated flexibility in accommodating breadth in clinical presentations and common comorbidities. Latent variable models may offer more ecologically valid approaches to understanding psychopathology.

Posttraumatic stress disorder symptom expression in racially and ethnically diverse women veterans

The number of racial/ethnic and women minorities entering the military continues to grow and more research is needed to properly assess, conceptualize, and treat posttraumatic stress disorder (PTSD) in diverse women. Recently, typological approaches have been useful in revealing distinct PTSD symptom presentations; however, existing research has not examined racial/ethnic differences among women veterans. We examined PTSD symptom expression and whether it differed by race/ethnicity in a sample of 407 women veterans that were recruited as part of a larger study on veterans' health. We conducted a series of model-based cluster analyses by race/ethnicity. Most racial/ethnic groups had between two- and four-group typologies that differed primarily in symptom severity. Latina veterans were found to have a unique eight-group PTSD typology differing not only in overall symptom severity but also in elevations of avoidance and hyperarousal symptoms. Racial and ethnic minority trauma survivors may present with a variety of posttraumatic symptom expressions. Better understanding these varying PTSD typologies will allow us to provide more tailored assessment and treatment for diverse women veterans with PTSD.

Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors

Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors' aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator's experience, identifying with the perpetrator's aggression, and replacing one's agency with that of the perpetrator were significantly associated with survivors' inward and outward aggression. Moreover, profile type-that is, having high versus low levels of identification with the aggressor-was implicated in participants' SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.

Prevalence and prediction of PTSD and depression in mothers of children surviving a motor vehicle crash

Introduction: Few studies have examined the psychopathological consequences for parents of children who were survivors of a motor vehicle crash (MVC). This study assessed the impact of dissociation and peritraumatic distress on the severity of PTSD and post-traumatic major depressive episode (MDE) symptoms in mothers during the first years after the MVC and the role that cortisol response might play in this association. Methods: 125 mothers were included. Peritraumatic distress and dissociation were assessed. Morning salivary cortisol was tested at the baseline. Participants were assessed for a probable diagnosis of PTSD and MDE at 5 weeks, 6 months and 12 months. Results: At 5 weeks, 12 (13.6%) mothers exhibited probable PTSD. During the first year, the PCL score was higher when the (i) Peritraumatic Distress Inventory (PDI) score increased and (ii) the Peritraumatic Dissociation Experience Questionnaire (PDEQ) score increased. Cortisol levels were lower when the PDI score increased. Conclusion: This is the first study to assess the mothers of MVC survivors for one year following the trauma. We confirm that peritraumatic responses are useful for predicting the severity of PTSD symptoms. These results could encourage the implementation of follow-up programmes not only for survivors but also for their mothers. HIGHLIGHTS Mothers of children involved in motor vehicle accident are at risk for developing PTSD.Peritraumatic responses (distress and dissociation) are associated to the severity of PTSD symptoms.Low salivary cortisol levels were associated with high peritraumatic distress.

The Effect of Cognitive-Affective Factors on PTSD and Alcohol Use Symptoms: An Investigation on Rumination, Suppression, and Reappraisal

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.

Longitudinal transitions in patterns of post-traumatic stress disorder symptoms and psychological distress among South Korean adults with traumatic experiences

This study aimed to investigate transitions in patterns of post-traumatic stress disorder (PTSD) symptoms and psychological distress among South Koreans with traumatic experiences. This study consists of two parts: In Part 1 the time since trauma ranged between 0 and 41 years, while in Part 2 participants experienced at least one traumatic event within the previous three years. We identified subgroups and transitions between classes over a one-year period using latent profile analysis and latent transition analysis. First, in Part 1, four classes were identified at T1 and T2. Second, we explored whether age, sex, time since trauma, and time perspective (TP) predicted class membership at T1. Age, past-negative (PN), present-fatalistic, and future TPs were significant predictors of class membership at T1. Finally, sex, PN, and future TPs were identified as significant predictors of class transition over time. The same analysis was conducted in Part 2 with individuals chosen from the Part 1 participants. Differential effects of TP on class membership and transitions in PTSD symptoms and psychological distress indicated the need for intervention programs that consider the TP profiles of individuals with traumatic experiences.

Suicidality in childhood abuse survivors - the contribution of identification with the aggressor

OBJECTIVE

Childhood abuse survivors are at risk for suicidal ideation and suicide attempts. Research has indicated that posttraumatic stress disorder (PTSD) symptoms and dissociation are related to elevated suicidal ideation and behavior (SIB) among this population. At the same time, although the theoretical and clinical literature in the trauma field have suggested that survivors' pathological attachment to their perpetrators, known as identification with the aggressor, might explain SIB, this supposition has not been investigated to date.

METHOD

Filling this gap, this study explored the associations between identification with the aggressor, PTSD symptoms, dissociation, and SIB among 589 adult survivors of childhood abuse.

RESULTS

Identification with the aggressor, PTSD symptoms, and dissociation were related to elevated levels in suicidal ideation and behavior. Furthermore, profile type (namely, having high versus medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation) was implicated in participants' SIB: Participants who adhered to a profile characterized by high levels of identification with the aggressor, PTSD symptoms, and dissociation had higher levels of suicide risk and suicidal ideation, as well as higher odds of reporting a history of suicide attempts, compared to participants who adhered to the other two profiles (i.e., characterized by medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation).

LIMITATIONS

This study relied on convenience sampling and a cross-sectional design.

CONCLUSIONS

Identification with the aggressor might serve, alongside PTSD symptoms and dissociation, as a risk factor for suicidal ideation and behavior among childhood abuse survivors.

Heterogeneity in the co-occurrence of depression and anxiety symptoms among youth survivors: A longitudinal study using latent profile analysis

AIM

Depression and anxiety are both common psychological outcomes triggered via trauma-related experience. The current study aimed to identify the prevalence of depression and anxiety among youth survivors, explore the heterogeneity patterns of depression and anxiety symptoms in the chronic phase, and integrate early available information to predict patterns.

METHODS

The study is a longitudinal study conducted at 2 weeks and 12 months after the Lushan earthquake. Finally, 1725 children and adolescents' survivors who accomplished both two-time stages assessments were included. The heterogeneous patterns of depression and anxiety symptoms assessed by latent profile analysis (LPA) were used to predict heterogeneity patterns of depression and anxiety symptoms by early attained variables.

RESULTS

A three-class solution characterized mild depression/mild anxiety (64.3%), moderate depression/moderate anxiety (25.9%), and high depression/high anxiety (9.8%) parallel patterns was the most suitable model in our research. Demographic characteristics, earthquake-related exposures, sleep, and somatic symptoms were variables that can be used to predict the parallel profiles.

CONCLUSIONS

Detection of heterogeneity patterns, especially for youth survivors at high risk, based on the self-reported measurement attained at the early stage, is feasible. Our study may promote operational strategies by enabling targeted intervention.

A data-driven framework for mapping domains of human neurobiology

Functional neuroimaging has been a mainstay of human neuroscience for the past 25 years. Interpretation of fMRI data has often occurred within knowledge frameworks crafted by experts, which have the potential to amplify biases that limit the replicability of findings. Here, we employ a computational approach to derive a data-driven framework for neurobiological domains that synthesizes the texts and data of nearly 20,000 human neuroimaging articles. Across multiple levels of domain specificity, the structure-function links within domains better replicate in held-out articles than those mapped from dominant frameworks in neuroscience and psychiatry. We further show that the data-driven framework partitions the literature into modular subfields, for which domains serve as generalizable prototypes of structure-function patterns in single articles. The approach to computational ontology we present here is the most comprehensive characterization of human brain circuits quantifiable with fMRI and may be extended to synthesize other scientific literatures.

Cohort profile: the Ohio Army National Guard Mental Health Initiative (OHARNG-MHI)

PURPOSE

Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population.

METHODS

OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews.

RESULTS

Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated.

CONCLUSION

Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.

Effects of bodily arousal on desire to drink alcohol among trauma-exposed college students

INTRODUCTION

Alcohol consumption on college campuses is a major public health concern. Extant literature has identified trauma exposure as a robust risk factor for problematic alcohol use in this at-risk population. However, the mechanisms underlying this association are less well-studied. Research indicates that bodily arousal is a fundamental feature of trauma exposure, and posits that internal stimuli (e.g., heart pounding) at the time of trauma may manifest into conditioned cues that can trigger posttraumatic responding and related symptomatology, including alcohol use. However, past work supporting these assertions has used paradigms purposefully designed to evoke memories of the trauma, making it difficult to ascertain whether the mechanism driving subsequent alcohol craving is the explicit memory cue or the associated bodily arousal.

METHODS

The current study examined whether an implicit, trauma-relevant cue of bodily arousal (via voluntary hyperventilation) - independent of any explicit memory cue - would elicit increased desire to drink among 104 (M_age = 20.30; 61.5% female) trauma-exposed undergraduates.

RESULTS

Results found no statistically significant difference in change in alcohol craving between the hyperventilation and control tasks. However, secondary analyses indicated that trauma type (i.e., interpersonal/non-interpersonal) may play an influential role in this relationship. More specifically, individuals reporting interpersonal trauma as their most traumatic event evidenced a significantly greater increase in desire to drink following hyperventilation compared to the non-interpersonal index trauma group.

DISCUSSION

Generally, these findings suggest that bodily arousal may only serve as an implicit, trauma-relevant interoceptive cue that increases desire to drink within a specific subset of trauma-exposed college students (i.e., individuals indexing interpersonal trauma). Replication and extension are needed to further understand the influence of bodily arousal on subsequent alcohol use behavior, which will be critical to PTSD-alcohol use modeling and, ultimately, help in informing prevention- and treatment-oriented intervention efforts aimed at reducing problematic alcohol use on college campuses.

Anxiety, depression, insomnia, and trauma-related symptoms following COVID-19 infection at long-term follow-up

A developing finding from the novel coronavirus 2019 (COVID-19) pandemic is the burden of neuropsychiatric symptoms seen in COVID-19 survivors. While studies have shown clinically significant rates of depression, anxiety, insomnia, and trauma-related symptoms such as post-traumatic stress disorder (PTSD) after COVID-19, little is known about how these symptoms evolve over time. Here, we report findings from a cohort study of 52 participants recruited from the greater New York City area following acute COVID-19 infection. Participants completed the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety-related symptoms, the Insomnia Severity Scale (ISS) for sleep-related symptoms, and the PTSD Checklist-Civilian version (PCL-C) for trauma-related symptoms both at baseline and at long-term (24-60 weeks post-infection) follow-up. We found a high degree of correlation between psychiatric symptom scales within participants. More participants met established cutoffs for clinically significant insomnia and post-traumatic stress at follow-up compared to baseline. Symptom scales for depression, insomnia, and PTSD were increased at long-term follow-up, with only increased PCL-C scores surviving correction for multiple comparisons (Z ​= ​2.92, W ​= ​434, p ​= ​0.004). Our results present evidence from a small cohort that neuropsychiatric symptoms, particularly those related to PTSD, may worsen over time in COVID-19 survivors. Future studies should continue to investigate these questions in broader populations, while additionally exploring the potential biological and sociological mechanisms that may contribute to neuropsychiatric pathology after COVID-19 infection.

Psychopathology in a treatment-seeking sample of homicidally bereaved individuals: Latent class analysis

BACKGROUND

Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables.

METHODS

We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis.

RESULTS

Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05).

LIMITATIONS

The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample.

CONCLUSIONS

Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively.

Latent classes of posttraumatic psychiatric comorbidity in the general population

Some narrow patterns of posttraumatic psychiatric comorbidity are well-established (e.g., posttraumatic stress disorder and substance use). However, broad multi-diagnosis profiles of posttraumatic comorbidity are poorly characterized. The goal of the current study was to use latent class analysis (LCA) to identify profiles of posttraumatic psychopathology from 11 International Classification of Diseases (ICD-10) diagnostic categories (e.g., stress, substance, depressive, psychosis, personality). Danish national registries were used to identify 166,539 individuals (median age = 41 years, range = <1 to >100) who experienced a traumatic event between 1994 and 2016 and were diagnosed with one or more mental disorders within 5 years. Two through 14-class LCA solutions were evaluated. A 13-class solution (a) provided the best fit, with the Bayes and Akaike Information Criteria reaching a minimum, (b) was broadly consistent with prior LCA studies, and (c) included several novel classes reflecting differential patterns of posttraumatic psychopathology. Three classes were characterized by high comorbidity: broad high comorbidity (M # diagnoses = 4.3), depression with stress/substance use/personality/neurotic disorders (M# diagnoses = 3.8), and substance use with personality/stress/psychotic disorders (M # diagnoses = 3.1). The other 10 classes were characterized by distinct patterns of mild comorbidity or negligible comorbidity. Compared to the mild and negligible comorbidity classes, individuals in high comorbidity classes were younger, had lower income, and had more pre-event psychiatric disorders. Results suggest that several different comorbidity patterns should be assessed when studying and treating posttraumatic psychopathology.

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Active-Duty Service Members Improves Depressive Symptoms

OBJECTIVES

Current research on the efficacy of repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a noninvasive therapy for treatment-resistant depression is largely settled science. However, little is known about its efficacy with active-duty service members (ADSMs) with major depressive disorder. In a retrospective chart review, we examined depressive symptom ratings in ADSMs seeking treatment at the US Army Outpatient Behavioral Health Service Clinic at Eisenhower Army Medical Center, Fort Gordon, Ga.

METHODS

We reviewed 121 consecutive outpatient charts, which yielded 61 ADSMs who completed a minimum of 20 rTMS sessions for refractory depression, and for whom both pretreatment and posttreatment depressive symptom ratings were available. Pre- and post-Patient Health Questionnaire 9 (PHQ-9) scores were subjected to a paired t test, and Reliable Change Indices were calculated to determine both reliable and clinical significance.

RESULTS

Average (SD) pretreatment and posttreatment PHQ-9 scores were 15.8 (6.2) and 12.6 (7.6), respectively. Statistically significant reduction in post-PHQ-9 was demonstrated (P < 0.001), with 69% of patients lowering their ratings and 31% demonstrating reliable change (improvement >5.64). Additionally, 20% demonstrated a reliable change that placed them in the nondysfunctional range (post-PHQ-9 <9.6), demonstrating clinical significance.

CONCLUSIONS

These data confirm a course of standard rTMS to ADSMs with major depression is promising in reducing depressive symptoms. Given that success and completion rates from this clinic are similar to those reported in civilian populations (80%), rTMS may be an adequate additional treatment or augmentation strategy for refractory depression in ADSMs.

Symptom structure of PTSD and co-morbid depressive symptoms - a network analysis of combat veteran patients

BACKGROUND

Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.

METHODS

PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.

RESULTS

The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.

CONCLUSIONS

Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.

Heterogeneous patterns of posttraumatic stress symptoms and depression in cancer patients

BACKGROUND

Studies suggest that posttraumatic stress symptoms (PTSSs) and depression are common psychological outcomes in cancer patients and have high co-occurring prevalence. However, it is unclear whether PTSSs and depression always co-occur in cancer patients. This study aimed to clarify these co-occurring patterns.

METHODS

Participants were 270 cancer patients who completed self-report questionnaires. Latent profile analysis was used to examine co-occurring patterns of PTSSs and depression.

RESULTS

The results indicated four patient types: a low symptom group (n = 34, 13.0%), a depression symptom group (n = 99, 37.8%), a moderate co-occurring symptom group (n = 97, 37.0%), and a severe co-occurring symptom group (n = 32, 12.2%). Multinomial logistic regression was used to examine the role of social support, core belief challenge, and intrusive rumination in differentiating these groups. Intrusive rumination was more likely to be associated with depression symptoms, moderate co-occurring symptoms, and severe co-occurring symptoms. Core belief challenge was more likely to be associated with both moderate and severe co-occurring symptoms, and social support was less likely to be associated with moderate co-occurring symptoms.

LIMITATIONS

All variables were measured using self-report scales.

CONCLUSIONS

The coexisting patterns of PTSSs and depression in cancer patients are heterogeneous. Core belief challenge and intrusive rumination effectively differentiated PTSSs and depression patterns. Social support differentiated the low symptom group from the moderate co-occurring symptom group.

Severity profiles of posttraumatic stress, depression, anxiety, and somatization symptoms in treatment seeking traumatized refugees

BACKGROUND

Western countries are facing many challenges hosting refugees from several regions in the world. Many of them are severely traumatized and suffer from a variety of mental health symptoms, which complicates the identification and treatment of refugees at risk. This study examined subgroups based on a broad range of psychopathology, and several predictors, including trauma characteristics and gender.

METHODS

Participants were 1147 treatment-seeking, traumatized refugees. Latent profile analysis was conducted to identify different subgroups based on levels of posttraumatic stress disorder (PTSD), depression, anxiety, and somatic symptoms. Multinomial logistic regression was used to identify predictors of subgroup membership.

RESULTS

Three distinct subgroups were identified, reflecting Moderate (10.2%), Severe (43.0%), and Highly Severe (45.9%) symptom severity levels, respectively. Symptom severity of all psychopathology dimensions was distributed equally between the subgroups. Participants in the Severe and Highly Severe Symptoms subgroups reported more types of traumatic events compared to the Moderate subgroup. In particular, traumatic events associated with human right abuses, lack of human needs and separation from others predicted subgroup membership, as did gender.

LIMITATIONS

The results are confined to treatment-seeking, traumatized refugee populations.

CONCLUSIONS

Distinguishable symptom severity profiles of PTSD, depression, anxiety and somatic complaints could be identified in this large treatment-seeking refugee population, without qualitative differences in symptom distribution. Instead of focusing on specific mental disorders, classification based on overall symptom severity is of interest in severely traumatized patients. This knowledge will help to identify individuals at risk and to enhance existing treatment programs for specific patient groups.

Comparison of latent typologies of posttraumatic stress disorder and depression symptoms across military personnel from India and the US

Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity.

Association between the OXTR rs53576 genotype and latent profiles of post-traumatic stress disorder and depression symptoms in a representative sample of earthquake survivors

Background and Objectives: Post-traumatic stress disorder (PTSD) and major depressive disorder are commonly experienced mental disorders among psychological trauma victims. Few studies have investigated the genetic basis for population heterogeneity of trauma-related psychopathology, including PTSD and depression. This study examined the main and interaction effects of the OXTR rs53576 genotype in distinguishing four subgroups identified by symptom profiles of PTSD and depression symptoms using latent profile analysis.Design: A cross-sectional design with a gene-environment interaction approach was adopted in the current study.Methods: This study was a secondary data analysis conducted on a sample of 1196 adult earthquake survivors. Participants completed assessments of earthquake exposure, PTSD symptoms, and depression symptoms. The rs53576 polymorphism of OXTR was genotyped using a custom-by-design 2×48-Plex SNPscan^TMKit.Results: Multinomial logistic regression analyses revealed the main effects of the rs53576 genotype on symptom profiles. Specifically, G allele carriers were more likely in the combined PTSD-depression group than in the low symptom, predominantly depression, and predominantly PTSD groups. No significant interaction effects between this genotype and earthquake exposure on symptom profiles were found.Conclusions: Our findings support a genetic basis for trauma-related psychopathology heterogeneity. Furthermore, results provide preliminary evidence for the role of OXTR in PTSD/depression comorbidity.

Cyr K, Sareen J, Elhai JD, Zamorski MA. Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel

OBJECTIVE

Posttraumatic stress disorder (PTSD) is often accompanied by other mental health conditions, including major depressive disorder (MDD), substance misuse disorders, and anxiety disorders. The objective of the current study is to delineate classes of comorbidity and investigate predictors of comorbidity classes amongst a sample of Canadian Armed Forces (CAF) Regular Force personnel.

METHODS

Latent class analyses (LCAs) were applied to cross-sectional data obtained between April and August 2013 from a nationally representative random sample of 6700 CAF Regular Force personnel who deployed to the mission in Afghanistan.

RESULTS

MDD was the most common diagnosis (8.0%), followed by PTSD (5.3%) and generalized anxiety disorder (4.7%). Of those with a mental health condition, LCA revealed 3 classes of comorbidity: a highly comorbid class (8.3%), a depressed-only class (4.6%), and an alcohol use-only class (3.1%). Multinomial logit regression showed that women (adjusted relative risk ratio [ARRR] = 2.77; 95% CI, 2.13 to 3.60; P < 0.01) and personnel reporting higher trauma exposure (ARRR = 4.18; 95% CI, 3.13 to 5.57; P < 0.01) were at increased risk of membership in the comorbid class compared to those without a mental health condition. When compared to those with no mental health condition, experiencing childhood abuse increased the risk of being in any comorbidity class.

CONCLUSIONS

Results provide further evidence to support screening for and treatment of comorbid mental health conditions. The role of sex, childhood abuse, and combat deployment in determining class membership may also prove valuable for clinicians treating military-related mental health conditions.

Cortisol Excess-Mediated Mitochondrial Damage Induced Hippocampal Neuronal Apoptosis in Mice Following Cold Exposure

Cold stress can induce neuronal apoptosis in the hippocampus, but the internal mechanism involving neuronal loss induced by cold stress is not clear. In vivo, male and female C57BL/6 mice were exposed to 4 °C, 3 h per day for 1 week. In vitro, HT22 cells were treated with different concentrations of cortisol (CORT) for 3 h. In vivo, CORT levels in the hippocampus were measured using ELISA, western blotting, and immunohistochemistry to assess the neuronal population and oxidation of the hippocampus. In vitro, western blotting, immunofluorescence, flow cytometry, transmission electron microscopy, and other methods were used to characterize the mechanism of mitochondrial damage induced by CORT. The phenomena of excessive CORT-mediated oxidation stress and neuronal apoptosis were shown in mouse hippocampus tissue following cold exposure, involving mitochondrial oxidative stress and endogenous apoptotic pathway activation. These processes were mediated by acetylation of lysine 9 of histone 3, resulting in upregulation involving Adenosine 5'-monophosphate (AMP)-activated protein kinase (APMK) phosphorylation and translocation of Nrf2 to the nucleus. In addition, oxidation in male mice was more severe. These findings provide a new understanding of the underlying mechanisms of the cold stress response and explain the apoptosis process induced by CORT, which may influence the selection of animal models in future stress-related studies.

Temporal Transitions in Patterns of Posttraumatic Stress Disorder and Depression Among Adolescents Following the Wenchuan Earthquake

Posttramatic stress disorder (PTSD) and depression are persistent disorders with heterogeneous comorbidity. Cross-sectional design limitations have prevented previous studies from examining symptom pattern transitions, which limits the understanding on the change of mental health over time since trauma. This study examined transition patterns of PTSD and depression comorbidity and assessed the role of personality. PTSD, depression, and personality scales were used to assess 619 adolescents 1 year after the Wenchuan earthquake and then to longitudinally assess 332 adolescents 2 years post-earthquake. Data were analyzed using latent transition analysis and logistic regression. Four PTSD and depression comorbidity patterns were identified at both times: moderate comorbidity, high comorbidity, no symptoms, and depression. Patterns of PTSD and depression changed in 23.4% of adolescents: 4.4% and 7.1% transitioned from no symptoms to depression and from depression to moderate comorbidity, respectively; 7.5% transitioned from moderate comorbidity to depression. Extraversion and conscientiousness were more likely and openness was less likely to be associated with moderate comorbidity symptoms transitioned to depression symptoms. These findings indicated that patterns of PTSD and depression in adolescents are heterogeneous and show temporal change.

PTSD symptom profiles among Louisiana women affected by the 2010 Deepwater Horizon Oil Spill: A latent profile analysis

BACKGROUND

Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms.

METHODS

To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes.

RESULTS

Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis.

LIMITATIONS

This study was limited by use of self-reported data and one-time assessment of PTSD symptoms.

DISCUSSION

Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted.

Heterogeneity in the Co-occurrence of Substance Use and Posttraumatic Stress Disorder: A Latent Class Analysis Approach

Objective: Posttraumatic stress disorder (PTSD) often co-occurs with substance use (SU). Although there has been independent research on subgroups of participants based on their PTSD or SU responses, rarely are PTSD-SU typologies examined consistent with a precision medicine approach (and corresponding person-centered statistical approaches). The current study examined the nature and construct validity (covariates of depression, physical aggression, verbal aggression, anger, hostility, reckless and self-destructive behaviors [RSDB]) of the best-fitting latent class solution in categorizing participants based on PTSD (PTSD Checklist for DSM-5) and alcohol/drug use responses (Alcohol Use and Disorders Identification Test Alcohol Consumption Questions, Drug Abuse Screening Test). Methods: The sample included 375 trauma-exposed participants recruited from Amazon's Mechanical Turk online labor market. Results: Latent class analyses indicated an optimal three-class solution (low PTSD/SU, moderate PTSD/drug and high alcohol, and high PTSD/SU). Multinomial logistic regressions indicated that depression (OR = 1.22) and frequency of RSDBs (OR = 1.20) were significant predictors of the moderate PTSD/drug and high alcohol class versus the low PTSD/SU class. Depression (OR = 1.55) and frequency of RSDBs (OR = 1.19) were significant predictors of the high PTSD/SU class versus the low PTSD/SU class. Only depression (OR = 1.27) was a significant predictor of the high PTSD/SU class versus the moderate PTSD/drug and high alcohol class. Conclusions: Results provide construct validity support for three meaningful latent classes with unique relations with depression and RSDBs. These findings improve our understanding of heterogeneous PTSD-SU comorbidity patterns and highlight acknowledgment of such subtyping (subgrouping) in considering differential treatment options, treatment effectiveness, and resource allocation.

Symptom severity in PTSD and comorbid psychopathology: A latent profile analysis among traumatized veterans

Individuals diagnosed with posttraumatic stress disorder (PTSD) show remarkably different symptom presentations. Identification of diagnostic profiles of PTSD may contribute to knowledge about treatment modifications to enhance treatment effectiveness. The present study aimed to identify symptom severity classes among 236 Dutch veterans based on a broad range of psychopathology outcomes, including PTSD, using Latent Profile Analysis (LPA). Moreover, multinomial logistic regression was used to test whether class membership could be predicted by the number and characteristics of traumatic event types, coping and personality dimensions. LPA identified three classes of individuals, defined as average, severe, and highly severe symptom severity classes, respectively. No qualitative differences in the symptom dimensions emerged between classes. Veterans with higher amounts of traumatic experiences and specifically with regard to lack of basic human needs, as well as those using more avoidant and problem-focused coping strategies and with more dysfunctional personality characteristics regarding neuroticism and agreeableness were significantly more often in the severe and/or highly severe symptom classes. In conclusion, general symptom severity was found to be an important diagnostic characteristic in this population. Integrated treatments targeting the broad spectrum of mental health problems may be of importance in treating patients that show low therapeutic recovery.

Typologies of PTSD clusters and reckless/self-destructive behaviors: A latent profile analysis

Posttraumatic stress disorder (PTSD) is comorbid with diverse reckless and self-destructive behaviors (RSDBs). We examined the nature and construct validity (covariates of age, gender, depression severity, number of trauma types, functional impairment) of the optimal class solution categorizing participants based on PTSD symptom and RSDB endorsement. The sample included 417 trauma-exposed individuals recruited through Amazon's MTurk platform who completed the Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, the Posttrauma Risky Behaviors Questionnaire, and Patient Health Questionnaire-9. Latent profile analyses indicated an optimal three-class solution: the Low PTSD-RSDBs, High PTSD-Low RSDBs, and High PTSD-RSDBs classes. Multinomial logistic regression indicated that impairment and depression predicted the High PTSD-Low RSDBs vs. the Low PTSD-RSDBs classes. Impairment, age, being female, and depression predicted the High vs. Low PTSD-RSDBs classes. Number of trauma types, age, being female, and depression predicted the High PTSD-RSDBs vs. High PTSD-Low RSDBs classes. Results support the presence of a reckless behaviors subtype of PTSD (characterized by greater depression, greater impariment, greater number of trauma types, being male, and being younger), conducting comprehensive assessments of RSDBs for individuals reporting PTSD symptoms and of PTSD symptoms for individuals reporting RSDBs, and the need to tailor interventions to treat PTSD and RSDBs concurrently.

The symptoms at the center: Examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis

Comorbid mental health disorders are highly common in trauma-exposed individuals with posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) among the most common co-occurring conditions. Network models of psychopathology offer a novel method to understand how this comorbidity manifests. The present study examined the presence of symptom communities (groups of highly connected symptoms) within a network of these disorders and hub symptoms (symptoms that connect such communities). Cross-sectional data were obtained from a community sample (N = 1184) of trauma exposed adults. Network analyses identified 5 communities: 1 containing all depression and GAD symptoms and 4 for PTSD. The PTSD communities corresponded to symptoms of intrusion and avoidance, hyperarousal, dysphoria, and negative affect. These communities had varying levels of connectivity to the Depression & GAD community. Symptoms of GAD (inability to relax) and PTSD (restricted or diminished positive emotion) were identified as key hub symptoms for the network. The results suggest symptoms of depression and GAD are highly interrelated and that PTSD is heterogeneous. The comorbidity among these diagnoses is thought to stem from their overlap with negative affect.

Latent classes of PTSD symptoms in veterans undergoing residential PTSD treatment

Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Relations between PTSD and depression symptom clusters in samples differentiated by PTSD diagnostic status

Co-occurring posttraumatic stress disorder (PTSD) and depression following traumatic experiences are cumulatively associated with functional impairment. To examine mechanisms for the PTSD-depression comorbidity, we investigated their cluster-level associations. Using data obtained from Amazon's Mechanical Turk platform, 368 trauma-exposed participants were split into two subsamples: those with (n = 163) and without (n = 185) probable PTSD. In both subsamples, confirmatory factor analyses indicated an optimal seven-factor PTSD Hybrid Model. Results of Wald tests of parameter constraints indicated that, in both subsamples, PTSD's dysphoric arousal cluster strongly related to somatic depression compared to all/most other PTSD Hybrid Model clusters. Additionally, in both subsamples, PTSD's negative affect, externalizing behaviors, and anhedonia clusters each strongly related to non-somatic depression compared to PTSD's anxious arousal cluster. Our results indicated that PTSD's dysphoric arousal symptoms mainly accounted for PTSD's shared variance with somatic depression, while the negative alterations in cognitions and mood (NACM)/dysphoria and arousal symptoms (primarily externalizing behaviours) mainly accounted for PTSD's shared variance with non-somatic depression. Our findings have implications for the discussion on PTSD's specific/non-specific clusters tied to diagnostic modifications, for understanding mechanisms underlying PTSD-depression comorbidity, and for the use of transdiagnostic and multi-component treatment protocols for PTSD-depression symptoms.

Long-term programing of psychopathology-like behaviors in male rats by peripubertal stress depends on individual's glucocorticoid responsiveness to stress

Experience of adversity early in life and dysregulation of hypothalamus-pituitary-adrenocortical (HPA) axis activity are risk factors often independently associated with the development of psychopathological disorders, including depression, PTSD and pathological aggression. Additional evidence suggests that in combination these factors may interact to shape the development and expression of psychopathology differentially, though little is known about underlying mechanisms. Here, we studied the long-term consequences of early life stress exposure on individuals with differential constitutive glucocorticoid responsiveness to repeated stressor exposure, assessing both socio-affective behaviors and brain activity in regions sensitive to pathological alterations following stress. Two rat lines, genetically selected for either low or high glucocorticoid responsiveness to repeated stress were exposed to a series of unpredictable, fear-inducing stressors on intermittent days during the peripuberty period. Results obtained at adulthood indicated that having high glucocorticoid responses to repeated stress and having experience of peripuberty stress independently enhanced levels of psychopathology-like behaviors, as well as increasing basal activity in several prefrontal and limbic brain regions in a manner associated with enhanced behavioral inhibition. Interestingly, peripuberty stress had a differential impact on aggression in the two rat lines, enhancing aggression in the low-responsive line but not in the already high-aggressive, high-responsive rats. Taken together, these findings indicate that aberrant HPA axis activity around puberty, a key period in the development of social repertoire in both rats and humans, may alter behavior such that it becomes anti-social in nature.

Risk Factors, Clinical Presentations, and Functional Impairments for Generalized Anxiety Disorder in Military Personnel and the General Population in Canada

OBJECTIVE

This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP).

METHOD

Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 ( N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 ( N = 8,161; response rate = 79.8%).

RESULTS

The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD.

CONCLUSION

GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile.

Latent comorbid depression and anxiety symptoms across sex and race/ethnic subgroupings in a national epidemiologic study

The heterogeneity of mood and anxiety disorders has been widely documented and epidemiologic studies have found different prevalence rates for psychiatric disorders across subgroups (i.e. sex and race/ethnic). The current study compares the latent class structure across sex and race/ethnic groups to determine group differences in these latent class configurations. This study utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample from the United States (N = 43,093). First, latent class analyses (LCAs) were used to assess subtypes of symptoms of depression and anxiety that characterize a latent class structure for the population represented by NESARC. Second, group LCAs were conducted across sex and race/ethnicity to compare the latent class structure across these groups. The results suggest a 7-class model is the best fit for the population as well as for the male, non-Hispanic White, and Black subgroups. Females fit best an 11-class model, Hispanics a 5-class model and Asian and American Indian subgroups a 4-class model. These results indicate that subgroups of sex and race/ethnicity do not share the same latent construct for symptoms of anxiety and depression. Understanding the variability in the presentation of comorbid mood and anxiety across subgroups has the potential to inform person-centered approaches to care as well as targeted and multicultural interventions to improve population health.