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Jarkas DA, Robillard R, Malenfant CR, Richards C, Lanthier M, Beaurepaire C, Nicholson AA, Jaworska N, Cassidy CM, Shlik J, Kaminsky Z, McQuaid RJ. Exploring the dissociative subtype of PTSD: The role of early-life trauma, cortisol, and inflammatory profiles. Psychoneuroendocrinology 2025; 175:107406. [PMID: 40010078 DOI: 10.1016/j.psyneuen.2025.107406] [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: 09/16/2024] [Revised: 02/14/2025] [Accepted: 02/15/2025] [Indexed: 02/28/2025]
Abstract
Post-traumatic stress disorder (PTSD) is a heterogeneous mental health condition, characterized by diverse symptom profiles and biological underpinnings. A dissociative subtype of PTSD has been identified, though the potential risk factors and underlying neurobiology are yet to be understood. The current study comprised Canadian Armed Forces (CAF) members and Veterans with a history of deployment, and with diagnoses of non-dissociative (n = 31) and dissociative subtypes of PTSD (n = 19), in addition to non-deployed healthy controls (n = 14). Participants completed questionnaires assessing clinical symptoms and experiences of trauma, and provided saliva and blood samples for cortisol and inflammatory marker assessments. Individuals with dissociative PTSD displayed elevated PTSD and depression symptom severity, and greater reports of specific forms of childhood trauma compared to individuals with non-dissociative PTSD and controls. Morning cortisol was elevated in both PTSD groups compared to controls, however the PTSD groups did not differ from one another. Evening cortisol concentrations were elevated in both PTSD groups compared to controls, and in the dissociative PTSD subtype compared to the non-dissociative PTSD subtype when controlling for depression symptoms. PTSD diagnostic group moderated the relationship between awakening cortisol levels and PTSD symptom severity, such that the non-dissociative PTSD group displayed a negative correlation between awakening cortisol levels and PTSD symptom severity, while no significant relation was identified in the dissociative PTSD group. C-reactive protein (CRP) levels did not differ across diagnostic groups when accounting for body mass index (BMI). However, CRP positively correlated with depressive symptoms only among individuals with dissociative PTSD. Together, examining PTSD subtypes may help inform more effective and personalized treatment strategies in the future.
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Affiliation(s)
- Dana A Jarkas
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada; University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada.
| | - Rebecca Robillard
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Claude-Richard Malenfant
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Carley Richards
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada
| | - Malika Lanthier
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Cecile Beaurepaire
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada
| | - Andrew A Nicholson
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada; Atlas Institute for Veterans and Families, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Natalia Jaworska
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada; University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Clifford M Cassidy
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada; Renaissance School of Medicine, Stony Brook University, 100 Nicolls Rd., Stony Brook, NY 11794, USA
| | - Jakov Shlik
- The Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Zachary Kaminsky
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada
| | - Robyn J McQuaid
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada; University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z7K4, Canada; School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada.
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Dell L, Madden K, Baur J, Sbisa A, McFarlane A, VanHooff M, Bryant R, Lawrence-Wood E. Trauma, resilience and significant relationships: Sex differences in protective factors for military mental health. Aust N Z J Psychiatry 2025; 59:48-59. [PMID: 39392240 DOI: 10.1177/00048674241286818] [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] [Indexed: 10/12/2024]
Abstract
BACKGROUND Military service is historically a male-dominated occupation, as such, the majority of research examining the development of mental disorder in Australian Defence Force members has had primarily male samples. While there have been mixed findings internationally regarding sex differences in rates of mental disorder and subthreshold symptoms among military personnel, across studies, the evidence tends to suggest that female military members are at least as likely as males to experience subthreshold mental health symptoms and have similar or higher rates of posttraumatic stress disorder despite the differences in roles during service. What is less understood is the impact of sex differences in symptom emergence over time and in predictors of clinical disorder. METHOD The sample included a longitudinal cohort of Australian Defence Force members (N = 8497) surveyed at Time 1 (2010) and followed up at Time 2 (2015) on measures of anger, self-perceived resilience, trauma exposure, deployment exposure, suicidality, help-seeking, relationship satisfaction and mental health disorder symptoms. Outcomes included Subthreshold Disorder (above the optimal screening cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist) and Probable Disorder (above the epidemiological cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist). RESULTS Results found that while lifetime trauma exposure remained the strongest predictor of later probable disorder emergence among both males and females, for females specifically, self-reported resilience was also a significant protective factor. In contrast, being in a significant relationship at Time 1 was a protective factor against the development of subthreshold disorder in males. CONCLUSION For the first time, sex differences in mental health symptom emergence over time have been explored in a large Australian cohort of military members. The capacity to adapt and bounce back after adversity emerged as a proactive factor against poor mental health for females in the military and could be addressed as part of routine skills training. Social support from significant relationship was particularly important for males' mental health, suggesting that maintaining positive relationships and supporting military spouses and partners are critical for males' mental health.
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Affiliation(s)
- Lisa Dell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Kelsey Madden
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Jenelle Baur
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Alyssa Sbisa
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Alexander McFarlane
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Miranda VanHooff
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide and The University of South Australia, Adelaide, SA, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
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Lawson SC, Arif M, Hoopsick RA, Homish DL, Homish GG. Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans. J Racial Ethn Health Disparities 2024; 11:2945-2957. [PMID: 37603224 PMCID: PMC10879463 DOI: 10.1007/s40615-023-01753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.
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Affiliation(s)
- Schuyler C Lawson
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Mehreen Arif
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Assistant Professor, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, Champaign, IL, USA
| | - D Lynn Homish
- Project Director, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Professor and Chair, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Getahun M, Mathai MA, Rota G, Allen A, Burger RL, Opiyo E, Oluoch D, Wangia J, Wambura R, Mbwayo A, Muchembre P, Obura RR, Neylan TC, Aarons GA, Ongeri L, Meffert SM. "The peace that I wanted, I got": Qualitative insights from patient experiences of SMART DAPPER interventions for major depression and traumatic stress disorders in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002685. [PMID: 39236052 PMCID: PMC11376547 DOI: 10.1371/journal.pgph.0002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/26/2024] [Indexed: 09/07/2024]
Abstract
SMART DAPPER is an implementation science study responding to mental health treatment gaps for depression and trauma-related disorders in Sub-Saharan Africa (SSA). We report on patient experiences in a study using a Sequential, Multiple Assignment Randomized Trial (SMART) design to test first and second line non-specialist treatment using psychotherapy (Interpersonal Psychotherapy [IPT] or medication (fluoxetine [FLX]), integrated within public sector primary care in western Kenya. An embedded qualitative study conducted in-depth interviews (n = 17) and three (n = 3) focus group discussions with participants (May to October 2021). Audio-recorded interviews were transcribed and translated into English; we deductively and inductively analyzed transcripts guided by grounded theoretical approaches and content analysis. We drew on the health belief model and socio-ecological framework to present findings, including perceived severity (motivations for taking part in the intervention), impacts of the intervention at the individual, interpersonal, and community and health systems levels as well as barriers and facilitators. Participants discussed family and marital conflict, loss of a child, loss of income or a job, and traumatic events such as a death or illness. Impacts at the individual level included reduced headaches, improved appetite and weight management, increased energy, improved sleep, better self-efficacy, and improved concentration, which was reported to lead to increased economic opportunities. At the interpersonal level, participants noted a reduction in conflict, better conflict management and resolution, increased harmony with family and community members, and improved relationships with their partners and children. Perceived challenges included balancing the intervention with livelihoods, preference for traditional medicines, actual or anticipated side effects with medication (FLX), mental health stigma, major life events, and perceived inadequate counseling and challenges with providers. The findings demonstrate the potential of the SMART DAPPER intervention for depression and trauma-related disorder treatments and underscore the challenges and barriers that must be addressed when scaling similar interventions. Trial registration: ClinicalTrials.gov identifier: NCT03466346.
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Affiliation(s)
- Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | - Grace Rota
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Ammon Allen
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth Opiyo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Dennis Oluoch
- Global Programs for Research and Training, Nairobi, Kenya
| | - Josyline Wangia
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Thomas C Neylan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Susan M Meffert
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, United States of America
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Kim JI, Min B, Lee JH, Park H, Kim JH. Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis. J Affect Disord 2024; 356:338-345. [PMID: 38583597 DOI: 10.1016/j.jad.2024.03.159] [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: 11/16/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
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.
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Affiliation(s)
- Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea
| | - Beomjun Min
- Chung Psychiatry Clinic, Seocho-daero 77-gil 17 Block 77, Seoul, Republic of Korea
| | - Ji-Hye Lee
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Heyeon Park
- Division of General Studies & Teaching Profession, Dongduk Women's University, Seoul, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Psychiatry, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Harwood-Gross A, Nordstrand AE, Bøe HJ, Gjerstad CL. How do you see me? The impact of perceived societal recognition on PTSD symptoms amongst Norwegian peacekeepers. Eur J Psychotraumatol 2024; 15:2314442. [PMID: 38682255 PMCID: PMC11060006 DOI: 10.1080/20008066.2024.2314442] [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: 05/30/2023] [Accepted: 01/26/2024] [Indexed: 05/01/2024] Open
Abstract
Background: The peacekeeper role is different to that of traditional combat, however, peacekeepers, like combat soldiers, may also be exposed to high levels of dangerous and/or potentially morally injurious events (PMIEs).Objective: It was hypothesized that given the centrality of societal approval for the peacekeeping mission, in addition to the known relevance of perceived social support, perceived societal recognition would influence PTSD symptoms (PTSS) and depression. It was hypothesized that perceived societal recognition would moderate the effect of exposure to potentially traumatic events and PMIEs on psychological outcomes.Method: 8341, predominantly male, former UNIFIL peacekeepers, almost three decades following deployment, answered a survey to determine the impact of perceived social support and perceived societal recognition, on PTSS and depression symptoms. Hierarchical regression analyses were performed for PTSS and depression separately and moderation analysis was performed for perceived societal recognition.Results: Exposure to potentially traumatic events showed the greatest predictive value for PTSS and exposure to PMIEs and potentially traumatic events were equally predictive of depression symptoms. While perceived social support presented the strongest buffer for PTSS and depression symptoms following UNIFIL deployment, perceived societal recognition also significantly contributed to the prediction of both PTSS and depression symptoms. There was a weak moderation effect of perceived societal recognition on trauma type in the development of PTSS.Conclusions: Even decades following peacekeeping deployment, military experiences have a significant impact on psychological functioning. This impact is both from the types of events experienced and from the perception of social and societal support upon return home.
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Affiliation(s)
- Anna Harwood-Gross
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
| | - Andreas Espetvedt Nordstrand
- Institute of Military Psychiatry, Norwegian Armed Forces, Joint Medical Services, Oslo, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hans Jakob Bøe
- Institute of Military Psychiatry, Norwegian Armed Forces, Joint Medical Services, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Christer Lunde Gjerstad
- Institute of Military Psychiatry, Norwegian Armed Forces, Joint Medical Services, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Zhao Y, Sun X, Yuan GF, Jin J, Miao J. Joint developmental trajectories of depression and post-traumatic stress disorder symptoms among Chinese children during COVID-19. Arch Psychiatr Nurs 2024; 49:118-125. [PMID: 38734447 DOI: 10.1016/j.apnu.2024.02.005] [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: 04/07/2023] [Revised: 08/20/2023] [Accepted: 02/18/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND In early 2020, Chinese children started to demonstrate severe depression and post-traumatic stress disorder symptoms (PTSS) caused by lockdown and self-isolation (measures taken at the beginning of the COVID-19 pandemic). OBJECTIVES Concerning the significant impact of the pandemic on children's physical and mental development, the study aimed to explore children's depression and PTSS during the COVID-19 pandemic and the protective effects of family resilience on the trajectories. METHODS 883 children participated and completed three waves of online follow-up questionnaires. The latent growth mixture modeling (LGMM) analysis was used to explore the trajectories of children's depression and PTSS based on the individual approach. RESULTS Two types of depression trajectories were identified and defined as the resilient group (83.01 %) and the recovery group (16.99 %); Two types of PTSS trajectories were identified and defined as the resilient group (71.12 %) and the recovery group (28.88 %); Two types of the joint trajectories of depression and PTSS were identified and defined as the resilient group (83.47 %) and the chronic group (16.53 %). The results indicated that maintaining a positive outlook (a dimension of family resilience) was the potential predictor of PTSS trajectories. CONCLUSION The trajectories of depression and PTSS among Chinese children during the COVID-19 pandemic were heterogeneous, and there were similar evolving subtypes. Family resilience could be a critical protective factor for children and families.
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Affiliation(s)
- Yi Zhao
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
| | - Xun Sun
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
| | - Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, 778 Binhe road, Shizhong District, Leshan 614000, China
| | - Jialu Jin
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
| | - Jiandong Miao
- School of Education Science, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China.
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Reed-Fitzke K, Ferraro AJ, Duncan JM, Wojciak AS, Hamilton A, Pippert HD. Resilience in Army STARRS: Evaluating psychometrics of a multi-dimensional resilience measure. MILITARY PSYCHOLOGY 2023; 35:521-528. [PMID: 37903165 PMCID: PMC10617280 DOI: 10.1080/08995605.2022.2131187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/23/2022] [Indexed: 10/24/2022]
Abstract
As policymakers and the U.S. military continue to place an emphasis on the resilience of servicemembers, it is critical to utilize psychometrically sound and valid scales to measure resilience. Using two independent samples of Army soldiers-in-training, this study explored the measurement of resilience in the Army Study to Assess Risk and Resilience among Servicemembers (Army STARRS) New Soldier Study Component (NSS). Exploratory factor analysis (EFA) was used to identify the factor structure of a measure of resilience within the Army STARRS NSS. Confirmatory factor analysis (CFA) was then used to confirm the factor structure, then internal reliability was assessed. Convergent validity of the identified resilience factors was examined using two-tailed bivariate correlations. The EFA identified a three-factor structure of a measure of resilience. The CFA confirm the first-order three-factor structure of stress tolerance, positive orientation, and social resources. Each factor was uniquely distinct from measures of the likelihood of generalized anxiety disorder and major depressive disorder, lifetime stressful events, and social network. Findings highlights the utility of a three-factor aggregate measure of resilience in the Army STARRS NSS and provide practitioners with a more nuanced picture of the role of resilience among soldiers-in-training.
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Affiliation(s)
- Kayla Reed-Fitzke
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa
| | - Anthony J. Ferraro
- Department of Applied Human Sciences, Kansas State University, Manhattan, Kansas
| | - James M. Duncan
- School of Human Environmental Sciences, University of Arkansas, Fayetteville
| | - Armeda S. Wojciak
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa
| | - Alexus Hamilton
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa
| | - Hilary D. Pippert
- Department of Applied Human Sciences, Kansas State University, Manhattan, Kansas
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Crede M, Tynan M, Harms PD, Lester PB. Clarifying the association between adverse childhood experiences and postdeployment posttraumatic stress disorder symptom severity: A meta-analysis and large-sample investigation. J Trauma Stress 2023; 36:700-711. [PMID: 37282808 DOI: 10.1002/jts.22940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 06/08/2023]
Abstract
We report on two studies designed to shed light on the association between adverse childhood experiences (ACEs) and posttraumatic stress disorder (PTSD) symptom severity in military personnel. In particular, we examined the evidence for both additive and multiplicative associations between ACEs and combat exposure in predicting PTSD symptom severity. Study 1 was a meta-analysis of 50 samples (N > 50,000), and we found evidence for a moderate linear association between ACEs and PTSD symptom severity, ρ = .24. We also found that ACEs explained substantial variance in PTSD symptom severity after controlling for combat exposure, ΔR2 = .048. In Study 2, which is preregistered, we relied on a large sample of combat-deployed U.S. soldiers (N > 6,000) to examine evidence of a multiplicative association between ACEs and combat exposure in predicting PTSD symptom severity. In line with theoretical arguments that individuals who have experienced childhood trauma are more vulnerable to subsequent trauma exposure, we found a weak but meaningful interaction effect, ΔR2 = .00, p < .001, between ACEs and deployment-related traumatic events in the prediction of PTSD symptom severity. Implications for clinical applications and future research are discussed.
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Affiliation(s)
- Marcus Crede
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Michael Tynan
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Peter D Harms
- School of Management, University of Alabama, Tuscaloosa, Alabama, USA
| | - Paul B Lester
- Graduate School of Defense Management, Naval Postgraduate School, Monterey, California, USA
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Impact of traumatic life events and polygenic risk scores for major depression and posttraumatic stress disorder on Iraq/Afghanistan Veterans. J Psychiatr Res 2023; 158:15-19. [PMID: 36542982 DOI: 10.1016/j.jpsychires.2022.12.014] [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: 02/15/2022] [Revised: 10/29/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Traumatic experiences and genetic heritability are among the most widely acknowledged risk factors leading to the development of psychopathology; including posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). The purpose of this study was to investigate if polygenic risk scores (PRS) among Veterans interacted with traumatic stress to predict PTSD and MDD. 1,389 Iraq-Afghanistan military service Veterans from the Mental Illness Research Education and Clinical Center dataset were analyzed. Genome-wide association study (GWAS) statistics were utilized to generate PRS for PTSD (PRSPTSD) and PRS for MDD (PRSMDD) in order to analyze PRS-by-environment (PRSxE) with trauma exposure to predict PTSD and MDD diagnoses. Trauma exposure and PRSPTSD, were independently associated with a current PTSD diagnosis (p < 0.001 and p < 0.001, respectively). The interaction between trauma exposure and PRSMDD to predict a current diagnosis of PTSD trended towards significance (p = 0.053). Stratifying by trauma thresholds, among those within the lowest trauma load, the association of PRSMDD with PTSD was found to be nominally significant (p = 0.03). For a MDD diagnosis, there was a significant association with trauma exposure (p < 0.001); and the association with PRSMDD was found to be nominally significant (p = 0.03). No significant PRSxE effects were found with MDD. Our findings corroborate previous research highlighting trauma exposure, and genetic heritability, as risk factors for the development of PTSD and MDD in a Veteran population. Additionally, findings suggest that genetic vulnerability may be less important as trauma exposure increases, with high levels of trauma likely to result in PTSD and MDD, regardless of genetic vulnerability.
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11
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Pankratz L, Sommer JL, Bolton SL, Sareen J, Enns MW, Afifi TO, El-Gabalawy R, Mota N. Prevalence and predictors of anxiety disorder courses in the Canadian Armed Forces. J Anxiety Disord 2022; 92:102612. [PMID: 36252350 DOI: 10.1016/j.janxdis.2022.102612] [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: 12/23/2021] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022]
Abstract
Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a 16-year follow-up of n = 2941 participants from the Canadian Community Health Survey: Canadian Forces Supplement in 2002. Diagnoses of any DSM-IV anxiety disorder (i.e., generalized anxiety, social anxiety, and/or panic disorder) in 2002 and 2018 were used to create four anxiety course groups. A large proportion of the sample (36.3 %; new onset = 24.6 %, remitting = 6.9 %, and persistent/recurrent = 4.8 %) met criteria for an anxiety disorder during one or both time points. Factors at baseline and/or between 2002 and 2018, including income, education, military rank, comorbidity of PTSD or depression, deployment history, and traumatic events, were positively associated with most anxiety courses relative to no anxiety in analyses. Targeted interventions are needed to help mitigate anxiety disorders among this population. Social support and active coping were protective factors for most anxiety courses and may need to be incorporated into targeted interventions.
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Affiliation(s)
- Lily Pankratz
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Jordana L Sommer
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Community Health Sciences, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Community Health Sciences, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Natalie Mota
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
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12
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Chen S, Bi K, Lyu S, Sun P, Bonanno GA. Depression and PTSD in the aftermath of strict COVID-19 lockdowns: a cross-sectional and longitudinal network analysis. Eur J Psychotraumatol 2022; 13:2115635. [PMID: 36186164 PMCID: PMC9518634 DOI: 10.1080/20008066.2022.2115635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are two highly comorbid psychological outcomes commonly studied in the context of stress and potential trauma. In Hubei, China, of which Wuhan is the capital, residents experienced unprecedented stringent lockdowns in the early months of 2020 when COVID-19 was first reported. The comorbidity between PTSD and MDD has been previously studied using network models, but often limited to cross-sectional data and analysis. Objectives: This study aims to examine the cross-sectional and longitudinal network structures of MDD and PTSD symptoms using both undirected and directed methods. Methods: Using three types of network analysis - cross-sectional undirected network, longitudinal undirected network, and directed acyclic graph (DAG) - we examined the interrelationships between MDD and PTSD symptoms in a sample of Hubei residents assessed in April, June, August, and October 2020. We identified the most central symptoms, the most influential bridge symptoms, and causal links among symptoms. Results: In both cross-sessional and longitudinal networks, the most central depressive symptoms included sadness and depressed mood, whereas the most central PTSD symptoms changed from irritability and hypervigilance at the first wave to difficulty concentrating and avoidance of potential reminders at later waves. Bridge symptoms showed similarities and differences between cross-sessional and longitudinal networks with irritability/anger as the most influential bridge longitudinally. The DAG found feeling blue and intrusive thoughts the gateways to the emergence of other symptoms. Conclusions: Combining cross-sectional and longitudinal analysis, this study elucidated central and bridge symptoms and potential causal pathways among PTSD and depression symptoms. Clinical implications and limitations are discussed.
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Affiliation(s)
- Shuquan Chen
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Kaiwen Bi
- Department of Psychology, School of Social Sciences, Tsinghua University, Beijing, People’s Republic of China
| | - Shibo Lyu
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Pei Sun
- Department of Psychology, School of Social Sciences, Tsinghua University, Beijing, People’s Republic of China
| | - George A. Bonanno
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
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13
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Nichter B, Stein MB, Monteith LL, Herzog S, Holliday R, Hill ML, Norman SB, Krystal JH, Pietrzak RH. Risk factors for suicide attempts among U.S. military veterans: A 7-year population-based, longitudinal cohort study. Suicide Life Threat Behav 2022; 52:303-316. [PMID: 34873738 DOI: 10.1111/sltb.12822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Population-based data on risk factors for suicide attempts among veterans remains limited. METHODS A national probability sample of 2307 veterans was followed over the course of four timepoints spanning seven years to examine how a range of baseline risk factors predict incident suicide attempt. Suicide attempt data were aggregated into a single follow-up timepoint. RESULTS Sixty-two veterans (3.1%) reported attempting suicide during the 7-year period. The strongest risk factors for suicide attempts were higher baseline levels of loneliness, lower baseline levels of adaptive psychosocial traits (e.g., dispositional gratitude), baseline thoughts of self-harm, and greater post-baseline trauma exposures (12.3%-41.3% of explained variance). Veterans with multiple co-occurring risk factors were at greatest risk for attempts; of veterans with 0, 1, 2, 3, and all 4 of these factors, the predicted probability of suicide attempt was 2.0%, 5.3%, 13.5%, 30.4%, and 55.0%, respectively. CONCLUSIONS Baseline loneliness, dispositional gratitude, thoughts of self-harm, and new-onset traumas emerged as the strongest risk factors for suicide attempts among veterans, underscoring the potential importance of targeting these factors in prevention efforts. Veterans with multiple co-occurring risk factors have substantially greater risk for suicide attempts, suggesting that examination of multiple coinciding vulnerability factors may help improve suicide risk prediction models.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah Herzog
- Columbia University Irving Medical Center, Columbia University, New York, New York, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York, USA
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA
| | - John H Krystal
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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14
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PTSD, rumination, and psychological health: examination of multi-group models among military veterans and college students. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Qi J, Sun R, Zhou X. Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima. J Affect Disord 2021; 295:594-603. [PMID: 34509075 DOI: 10.1016/j.jad.2021.08.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/30/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types. OBJECTIVE This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic. METHODS Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively. RESULTS COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network. CONCLUSIONS PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.
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Affiliation(s)
- Junjun Qi
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Rui Sun
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China.
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16
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Kuhlman KR, Straka K, Mousavi Z, Tran ML, Rodgers E. Predictors of Adolescent Resilience During the COVID-19 Pandemic: Cognitive Reappraisal and Humor. J Adolesc Health 2021; 69:729-736. [PMID: 34384704 PMCID: PMC8460169 DOI: 10.1016/j.jadohealth.2021.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The COVID-19 pandemic and efforts to slow the spread of disease have particularly affected the lives of adolescents. Many studies have recently identified the risks to adolescent mental health posed by the COVID-19 pandemic, yet few have identified the markers of resilience to the events and concerns associated with the pandemic's lived experience. This study examined the moderating role of psychosocial resources in the association between the tangible and emotional experiences of the COVID-19 pandemic and symptoms of common psychiatric problems during adolescence (depression, anxiety, proactive and reactive aggression, and sleep problems). METHODS Participants were adolescents in the United States who were oversampled for early life adversity before the COVID-19 pandemic. The psychosocial resources assessed were humor styles, emotion regulation, social support, optimism, and purpose in life, which have previously been identified as protective in the acute aftermath of stressful events. RESULTS Greater COVID-19 impact was associated with more anxiety, depressive symptoms, sleep disturbance, and proactive aggression. COVID-19 impact and psychiatric symptoms were unrelated among youth reporting high self-enhancing humor and cognitive reappraisal. CONCLUSIONS Adolescents high in humor and cognitive reappraisal may be protected against the mental health correlates of the COVID-19 pandemic and other prolonged stressors. Importantly, these factors are known to be modifiable through behavioral interventions. Attention to their effectiveness in prevention and intervention studies is needed as the pandemic continues to exert its impact on individuals and society.
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Affiliation(s)
- Kate R. Kuhlman
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California,Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California Irvine, Irvine, California,Address correspondence to: Kate R. Kuhlman, University of California, 4201 Social & Behavioral Sciences Gateway, Irvine, CA 92697-7085
| | - Kelci Straka
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
| | - Zahra Mousavi
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
| | - Mai-Lan Tran
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
| | - Emma Rodgers
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California
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17
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Radell ML, Hamza EA, Moustafa AA. Depression in post-traumatic stress disorder. Rev Neurosci 2021; 31:703-722. [PMID: 32866132 DOI: 10.1515/revneuro-2020-0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.
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Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, USA
| | - Eid Abo Hamza
- Department of Mental Health, Faculty of Education, Tanta University, Tanta, Egypt
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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18
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Na PJ, Norman SB, Nichter B, Hill ML, Rosen MI, Petrakis IL, Pietrzak RH. Prevalence, risk and protective factors of alcohol use disorder during the COVID-19 pandemic in U.S. military veterans. Drug Alcohol Depend 2021; 225:108818. [PMID: 34171825 PMCID: PMC9758576 DOI: 10.1016/j.drugalcdep.2021.108818] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There have been reports of increased alcohol consumption during the COVID-19 pandemic in the general population. However, little is known about the impact of the pandemic on the prevalence of alcohol use disorder (AUD), especially in high-risk samples such as U.S. military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 U.S. veterans. Pre-pandemic and 1-year peri-pandemic risk and protective factors associated with incident and chronic probable AUD were examined. RESULTS A total of 6.9 % (n = 183) of veterans were classified as chronic probable AUD, 3.2 % (n = 85) as remitted from AUD, and 2.7 % (n = 71) as incident probable AUD during the pandemic; the prevalence of probable AUD in the full sample remained stable -10.1 % pre-pandemic and 9.6 % peri-pandemic. Younger age, greater pre-pandemic alcohol use severity, and COVID-related stressors were associated with incident AUD during the pandemic, whereas higher pre-pandemic household income was associated with lower risk of this outcome. Younger age, combat experience, lifetime substance use disorder, greater drug use severity, lower dispositional optimism, and more COVID-related worries and social restriction stress were associated with higher risk of chronic AUD. CONCLUSIONS Nearly 1-in-10 US veterans screened positive for AUD 1-year into the pandemic; however, the pre- and 1-year peri-pandemic prevalence of probable AUD remained stable. Veterans who are younger, have served in combat roles, endorse more COVID-related stressors, and have fewer socioeconomic resources may be at higher risk for AUD during the pandemic.
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Affiliation(s)
- Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Sonya B Norman
- National Center for PTSD, White River Junction, VT, USA; VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Brandon Nichter
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Melanie L Hill
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Marc I Rosen
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ismene L Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, 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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19
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Nichter B, Norman SB, Maguen S, Pietrzak RH. Moral injury and suicidal behavior among US combat veterans: Results from the 2019-2020 National Health and Resilience in Veterans Study. Depress Anxiety 2021; 38:606-614. [PMID: 33666315 DOI: 10.1002/da.23145] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Recent research suggests that exposure to potentially morally injurious experiences (PMIEs) may be associated with increased risk for suicidal behavior among US combat veterans, but population-based data on these associations are scarce. This study examined the association between PMIEs with current suicidal ideation (SI), lifetime suicide plans (SP), and suicide attempts (SA) in a contemporary, nationally representative sample of combat veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US combat veterans (n = 1321). PMIEs were assessed using the Moral Injury Events Scale (MIES). Multivariable logistic regression analyses were conducted to examine associations between MIES total scores and specific types of PMIEs with suicidal behavior. RESULTS Thirty-six point three percent of veterans reported at least one PMIE. Perceived transgressions by self, others, and betrayal were associated with SI, SP, and SA (odds ratios [ORs] = 1.21-1.27, all p s < .05), after adjusting for sociodemographic, trauma, and psychiatric characteristics. MIES total scores were significantly, albeit weakly, associated with SP (OR = 1.03, p < .01), but not SI/SA. Depression, posttraumatic stress disorder (PTSD), and age emerged as the strongest correlates of SI/SP/SA (14.9%-38.1% of explained variance), while PMIEs accounted for a comparatively modest amount of variance (3.3%-8.9%). CONCLUSIONS Reports of potentially morally injurious experiences are prevalent among US combat veterans, and associated with increased risk for suicidal behavior, above and beyond severity of combat exposure, PTSD, and depression. Implications for clinical practice and future research are discussed, including the need for methodological advancements in the measurement of moral injury.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,National Center for PTSD, Vermont, Vermont, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California-San Francisco, San Francisco, California, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Abramovitz LM, Lutgendorf MA, Bukowinski AT, Gumbs GR, Conlin AMS, Hall C. Posttraumatic Stress Disorder in a Cohort of Pregnant Active Duty U.S. Military Servicewomen. J Trauma Stress 2021; 34:586-595. [PMID: 33544939 DOI: 10.1002/jts.22656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 01/04/2023]
Abstract
The present study aimed to describe the demographic and occupational characteristics, comorbidities, and psychotropic medication receipt associated with posttraumatic stress disorder (PTSD) diagnosis during pregnancy among a sample of active duty U.S. military servicewomen. Data from the U.S. Department of Defense Birth and Infant Health Research program were used to identify pregnancies in active duty servicewomen from 2007 through 2014. Demographic and occupational data were linked with electronic medical and pharmacy records to capture mental health diagnoses and medication receipt dates. Cases of PTSD were identified by the presence of ICD-9-CM Diagnostic Code 309.81 on maternal records from 1 year before the date of the last menstrual period through the end of pregnancy. Of 134,244 identified pregnancies among active duty servicewomen, 2,240 (1.7%) met the case criteria for PTSD. Women with a PTSD diagnosis compared to those without a PTSD diagnosis were more likely to be White non-Hispanic (51.3% vs. 47.4%), unmarried (33.3% vs. 28.2%), in the Army (49.6% vs. 35.8%) or Marine Corps (10.9% vs. 8.0%), in a service and supply occupation (18.2% vs. 13.6%), and to have a junior enlisted rank (56.3% vs. 50.1%) and have been previously deployed (51.2% vs. 39.6%), RRs = 1.15-1.75. Among PTSD cases, the most common mental health comorbidities were depressive disorder (60.9%), adjustment disorder (43.4%), and anxiety disorder (39.3%). During pregnancy, 44.2% of PTSD cases and 7.2% of noncases received psychotropic medications. Demographic and occupational characteristics, comorbidities, and psychotropic medication use differed substantially among PTSD cases and noncases in this large records-based study.
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Affiliation(s)
- Lisa M Abramovitz
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
| | - Anna T Bukowinski
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Gia R Gumbs
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Clinton Hall
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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Na P, Tsai J, Harpaz-Rotem I, Pietrzak R. Mental health and suicidal ideation in US military veterans with histories of COVID-19 infection. BMJ Mil Health 2021; 168:15-19. [PMID: 34035155 PMCID: PMC8154290 DOI: 10.1136/bmjmilitary-2021-001846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There have been reports of increased prevalence in psychiatric conditions in non-veteran survivors of COVID-19. To date, however, no known study has examined the prevalence, risk and protective factors of psychiatric conditions among US military veterans who survived COVID-19. METHODS Data were analysed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 US veterans. Prepandemic and 1-year peripandemic risk and protective factors associated with positive screens for peripandemic internalising (major depressive, generalised anxiety and/or posttraumatic stress disorders) and externalising psychiatric disorders (alcohol and/or drug use disorders) and suicidal ideation were examined using bivariate and multivariate logistic regression analyses. RESULTS A total of 233 veterans (8.6%) reported having been infected with COVID-19. Relative to veterans who were not infected, veterans who were infected were more likely to screen positive for internalising disorders (20.5% vs 13.9%, p=0.005), externalising disorders (23.2% vs 14.8%, p=0.001) and current suicidal ideation (12.0% vs 7.6%, p=0.015) at peripandemic. Multivariable analyses revealed that greater prepandemic psychiatric symptom severity and COVID-related stressors were the strongest independent predictors of peripandemic internalising disorders, while prepandemic trauma burden was protective. Prepandemic suicidal ideation, greater loneliness and lower household income were the strongest independent predictors of peripandemic suicidal ideation, whereas prepandemic community integration was protective. CONCLUSION Psychiatric symptoms and suicidal ideation are prevalent in veterans who have survived COVID-19. Veterans with greater prepandemic psychiatric and substance use problems, COVID-related stressors and fewer psychosocial resources may be at increased risk of these outcomes.
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Affiliation(s)
- Peter Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - J Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, Florida, USA.,School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, USA
| | - I Harpaz-Rotem
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - R Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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22
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Affiliation(s)
- John Tully
- Faculty of Medicine and Health Sciences, University of Nottingham
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London
| | - Stephanie J Lewis
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London
- South London and Maudsley NHS Foundation Trust
| | | | - Sarah Markham
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London
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23
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Park CL, Sacco SJ, Finkelstein-Fox L, Sinnott SM, Scoglio AAJ, Lee SY, Gnall KE, Mazure C, Shirk SD, Hoff RA, Kraus SW. Post-9/11 military veterans' adjustment to civilian life over time following separation from service. J Clin Psychol 2021; 77:2077-2095. [PMID: 33871869 DOI: 10.1002/jclp.23144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES US military veterans face many challenges in transitioning to civilian life; little information is available regarding veterans' reintegration experiences over time. The current study characterized veterans' postdeployment stressful life events and concurrent psychosocial wellbeing over one year and determined how stressors and wellbeing differ by demographic factors. METHODS Recent Post-911 veterans (n = 402) were assessed approximately every three months for 1 year. Participants were 60% men, primarily White (78%), and 12% Latinx; the average age was 36 years. RESULTS The frequency of stressful events decreased over time but was higher for men and minority-race veterans (independent of time since separation). Veterans reported high mean levels of posttraumatic stress disorder, anxiety, and insomnia symptoms, which improved slightly over time. Minority-race and Latinx veterans had higher symptom levels and slower rates of symptom reduction. CONCLUSION Veterans remain distressed in their overall transition to civilian life. Interventions to promote resilience and help veterans manage readjustment to civilian life appear urgently needed.
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Affiliation(s)
- Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Shane J Sacco
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lucy Finkelstein-Fox
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sinead M Sinnott
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Arielle A J Scoglio
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts, USA
| | - Sharon Y Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carolyn Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Steven D Shirk
- Division of Addiction, VISN1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital and University of Massachusetts Medical School, Bedford, Massachusetts, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
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24
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Klein AB, Dutra SJ, Bovin MJ, Keane TM, Marx BP. The Role of Negative Affect in Differentiating Posttraumatic Stress Disorder, Depression, and Their Comorbidity Among United States Veterans. J Trauma Stress 2021; 34:322-332. [PMID: 33174307 DOI: 10.1002/jts.22612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022]
Abstract
Following trauma exposure, two frequently co-occurring forms of psychopathology include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Although these diagnoses have been identified as distinct constructs, the proper classification of these disorders remains a challenge due to overlapping symptoms. Instead, systematically establishing higher- and lower-order personality traits associated with each diagnosis may avoid this confound and improve differential diagnosis. In the present study, we examined how higher-order negative affect and its lower-order facets (i.e., anxiousness, emotional lability, and separation insecurity) may be associated with a diagnosis of PTSD only, MDD only, both diagnoses, or neither diagnosis. Participants were 1,175 veterans enrolled in the Veterans After Discharge Longitudinal Registry. Higher- and lower-order negative affect were assessed using the Personality Inventory for DSM-5 (PID-5), and PTSD and MDD diagnoses were based on the Structured Clinical Interview for DSM-5 (SCID-5). Multinomial logistic regressions were used to model the association between higher- and lower-order negative affect and diagnostic status, after controlling for potential covariates. Diagnostic utility analyses were conducted to examine the degree to which higher- and lower-order negative affect classified participants across groups. Higher-order negative affect and lower-order anxiousness differentiated diagnostic groups, ORs = 1.76-4.66, and had strong specificity and negative predictive value for individuals with PTSD and MDD and those with MDD only. These findings help explain the role of higher-order negative affect and lower-order anxiousness in differentiating PTSD from MDD and comorbid PTSD and MDD and may have implications for assessment, differential diagnosis, and treatment planning.
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Affiliation(s)
- Alexandra B Klein
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sunny J Dutra
- Department of Clinical Psychology, William James College, Newton, Massachusetts, USA
| | - Michelle J Bovin
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Terence M Keane
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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25
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Warrener CD, Valentin EM, Gallin C, Richey L, Ross DB, Hood CJ, Lori A, Cubells J, Rauch SA, Rilling JK. The role of oxytocin signaling in depression and suicidality in returning war veterans. Psychoneuroendocrinology 2021; 126:105085. [PMID: 33582574 PMCID: PMC8483597 DOI: 10.1016/j.psyneuen.2020.105085] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
Many war veterans struggle with depression and suicidality, and separation from the military is a time of particularly high risk. Based on research in non-human animals, we hypothesized that reduced oxytocin signaling would mediate symptoms of depression and suicidality in war veterans recently separated from their close comrades. We also hypothesized that veterans with more frequent contact with comrades would have fewer symptoms of depression and suicidality. In this cross-sectional study, male veterans from the Iraq and Afghanistan wars (n = 86) provided blood and urine samples for measurement of peripheral oxytocin (OT) levels, as well as saliva samples for DNA extraction followed by genotyping of oxytocin receptor gene (OXTR) Single Nucleotide Polymorphisms, and CpG-methylation assessment. Participants also completed a series of mental health questionnaires and interviews. Veterans reported feeling very close to their comrades during war, and missing them greatly upon returning home. Neither peripheral OT levels nor OXTR genotypes were related to symptoms of depression or suicidality. On the other hand, methylation at OXTR CpG -924 was negatively correlated with depressive symptomology, after controlling for possible confounds. Veterans who socialized with comrades more frequently had higher levels of urinary, but not plasma OT, as well as less depressive symptomology. Social connectedness was a strong negative predictor of symptoms of both depression and suicidality, eclipsing the predictive power of other variables such as post-deployment social support, the degree to which participants reported missing their comrades, and the frequency with which they socialized with comrades. Our results suggest that veteran mental health is more impacted by lack of social connectedness than by separation from close comrades per se. While there is some evidence that OXTR methylation relates to depressive symptomology, decreased OT signaling does not appear to mediate the relationship between social disconnectedness and depression or suicidality. Sleep quality and anxiety disorders were also significantly associated with mental health symptoms, independent of social connectedness. Our findings suggest that efforts aimed at alleviating the burden of depression and suicidality in returning war veterans should focus on re-integrating veterans into society and establishing a feeling of social connectedness, as well as on treating anxiety disorders and sleep problems.
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Affiliation(s)
- Corinne D. Warrener
- The Whitney M. Young, Jr. School of Social Work, Clark Atlanta University, USA
| | - Edward M. Valentin
- The Whitney M. Young, Jr. School of Social Work, Clark Atlanta University, USA
| | - Camilla Gallin
- Program in Neuroscience and Behavioral Biology, Emory University, USA
| | | | | | - Chelsea J. Hood
- The Whitney M. Young, Jr. School of Social Work, Clark Atlanta University, USA
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA
| | - Joseph Cubells
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA,Department of Human Genetics, Emory University School of Medicine, USA
| | - Sheila A.M. Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA,Mental Health Service Line, VA Atlanta Healthcare System, USA
| | - James K. Rilling
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA,Department of Anthropology, Emory University, USA,Center for Behavioral Neuroscience, Emory University, USA,Center for Translational Social Neuroscience, Emory University, USA,Silvio O. Conte Center for Oxytocin and Social Cognition, USA,Yerkes National Primate Research Center, USA,Corresponding author at: Department of Anthropology, Emory University, USA. (J.K. Rilling)
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26
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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: 26] [Impact Index Per Article: 5.2] [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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27
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de Moraes Costa G, Zanatta FB, Ziegelmann PK, Soares Barros AJ, Mello CF. Pharmacological treatments for adults with post-traumatic stress disorder: A network meta-analysis of comparative efficacy and acceptability. J Psychiatr Res 2020; 130:412-420. [PMID: 32891916 DOI: 10.1016/j.jpsychires.2020.07.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study was to compare efficacy and acceptability among drug treatments for adults with post-traumatic stress disorder (PTSD) through a systematic review, random-effects pairwise and network meta-analyses. METHODS Double-blind randomized controlled trials comparing pharmacological interventions for adults with PTSD were searched from database inception through Aug. 28, 2018, on Cochrane (Central), Embase, LILACS, PILOTS, PsycINFO, PubMed, and Web of Science. Clinical trial registries and the websites of pharmaceutical companies were also searched. The GRADE system was used to assess the quality of the evidence. RESULTS The systematic review included 58 studies comprising 6766 patients randomized to 26 different interventions. Regarding efficacy, topiramate (SMD = -0.57; 95%CrI: -1.07,-0.10), risperidone (SMD = -0.53; 95%CrI: -0.93,-0.15), quetiapine (SMD = -0.59; 95%CrI: -1.06,-0.11), paroxetine (SMD = -0.35; 95%CrI: -0.48,-0.21), venlafaxine (SMD = -0.25; 95%CrI: -0.44,-0.05), fluoxetine (SMD = -0.28; 95%CrI: -0.46,-0.08), and sertraline (SMD = -0.21; 95%CrI: -0.33,-0.09) outperformed placebo. Moreover, phenelzine (RR = 3.39; 95%CrI: 1.43,11.09), lamotrigine (RR = 4.39; 95%CrI: 1.18,26.38), and fluoxetine (RR = 1.28%CrI: 1.01,1.59) outperformed placebo in terms of acceptability. CONCLUSIONS The NMA supports topiramate, risperidone, quetiapine, paroxetine, venlafaxine, fluoxetine and sertraline as effective pharmacological choices for the treatment of PTSD. Quetiapine and topiramate have the shortcoming of relying on a few small studies, but the clinically meaningful change in symptoms is noteworthy and merits further investigation. Among the pharmacological treatments with evidence of efficacy compared to placebo, fluoxetine achieved a relatively high rank regarding acceptability. To the best of our knowledge, this is the largest contemporary NMA on the subject and the addition of new medications is an important extension of previous meta-analyses, enabling a larger number of drug comparisons.
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Affiliation(s)
- Gabriela de Moraes Costa
- Department of Neuropsychiatry, Center of Health Sciences, Assistant Professor, Federal University of Santa Maria (UFSM), Roraima Avenue, nº1000, Building 26, room 1445, Zip code 97105-900, Santa Maria, Rio Grande do Sul, Brazil.
| | - Fabricio Batistin Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry, Adjunct Professor, Federal University of Santa Maria (UFSM), Roraima Avenue, nº1000, Building 26 F, Zip code 97105-900, Santa Maria, Rio Grande do Sul, Brazil.
| | - Patricia Klarmann Ziegelmann
- Statistics Department, Postgraduate Program in Epidemiology, Full Professor, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos Street, no 2400, Zip code 90035003, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Alcina Juliana Soares Barros
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos Street, nº 2400, Zip code 90035003, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Carlos Fernando Mello
- Department of Physiology and Pharmacology, Center of Health Sciences, Postgraduate Program in Pharmacology, Full Professor, Federal University of Santa Maria (UFSM), Roraima Avenue, nº1000, Building 21, room 5118, Zip code 97105-900, Santa Maria, Rio Grande do Sul, Brazil.
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28
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Kan RLD, Zhang BBB, Zhang JJQ, Kranz GS. Non-invasive brain stimulation for posttraumatic stress disorder: a systematic review and meta-analysis. Transl Psychiatry 2020; 10:168. [PMID: 32467579 PMCID: PMC7256039 DOI: 10.1038/s41398-020-0851-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
Approximately 7-9% of people develop posttraumatic stress disorder in their lifetime, but standard pharmacological treatment or psychotherapy shows a considerable individual variation in their effectiveness. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) hold promise for the treatment of posttraumatic stress disorder. The objective of this meta-analysis was to summarize the existing evidence on the therapeutic effects of these brain stimulation treatments on posttraumatic core symptoms. We systematically retrieved articles published between 1st January 2000 and 1st January 2020 comparing the effects of active with sham stimulation or no intervention in posttraumatic patients from eight databases. Random-effects model was used for meta-analysis. Meta-regression and subgroup meta-analysis was performed to investigate the influence of stimulation dose and different stimulation protocols, respectively. 20 studies were included in this review, where of 11 randomized controlled trials were subjected to quantitative analysis. Active stimulation demonstrated significant reductions of core posttraumatic symptoms with a large effect size (Hedge's g = -0.975). Subgroup analysis showed that both excitatory and inhibitory rTMS of the right dorsolateral prefrontal cortex led to symptom reductions with a large (Hedges' g = -1.161, 95% CI, -1.823 to -0.499; p = 0.015) and medium effect size (Hedges' g = -0.680, 95% CI: -0.139 to -0.322; p ≤ 0.001) respectively. Results further indicated significant durability of symptom-reducing effects of treatments during a two to four weeks period post stimulation (Hedges' g = -0.909, 95% CI: -1.611 to -0.207; p = 0.011). rTMS of the right dorsolateral prefrontal cortex appears to have a positive effect in reducing core symptoms in patients with posttraumatic stress disorder.
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Affiliation(s)
- Rebecca L D Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Bella B B Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Jack J Q Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China.
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China.
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