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Bourassa KJ, Sbarra DA. Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory. Transl Psychiatry 2024; 14:285. [PMID: 38997260 PMCID: PMC11245531 DOI: 10.1038/s41398-024-03004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
Although stress and adversity are largely universal experiences, people exposed to greater hardship are at increased risk for negative health consequences. Recent studies identify accelerated biological aging as a mechanism that could explain how trauma and adversity gives rise to poor health, and advances in this area of study coincide with technological innovations in the measurement of biological aging, particularly epigenetic profiles consistent with accelerated aging derived from DNA methylation. In this review, we provide an overview of the current literature examining how adversity might accelerate biological aging, with a specific focus on social and health behaviors. The most extensive evidence in this area suggests that health-compromising behaviors, particularly smoking, may partially explain the association between adversity and accelerated aging. Although there is relatively less published support for the role of social behaviors, emerging evidence points to the importance of social connection as a mechanism for future study. Our review highlights the need to determine the extent to which the associations from adversity to accelerated aging are consistent with causal processes. As we consider these questions, the review emphasizes methodological approaches from the causal inference literature that can help deepen our understanding of how stress and trauma might result in poor health. The use of these methodologies will help provide evidence as to which behavioral interventions might slow aging and improve health, particularly among populations that more often experience adversity and trauma.
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Affiliation(s)
- Kyle J Bourassa
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
- Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA.
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
| | - David A Sbarra
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Bublitz MH, Anderson MR, Sanapo L, Scarfo VN, Bourjeily G. Symptoms of Posttraumatic Stress Disorder are Associated with Altered Glucose Parameters in Early and Late Gestation. Am J Perinatol 2024; 41:e2651-e2657. [PMID: 37619599 DOI: 10.1055/s-0043-1772749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with increased risk for insulin resistance and the development of diabetes outside of pregnancy. In pregnancy, emerging evidence suggests that PTSD is associated with increased risk for gestational diabetes; however, it is not yet known how PTSD is associated with disruptions in glucose processing across gestation. Therefore, the aim of the current study was to test associations between PTSD symptoms and glucose parameters in early and late gestation among pregnant people without a history of pregestational diabetes. STUDY DESIGN Two 34 participants were included in these analyses. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5) in early gestation. Fasting blood samples were collected at approximately 12 and 32 gestational weeks and were used to calculate β-cell function and insulin sensitivity. RESULTS Participants were 31 years old (standard deviation [SD] = 6) with body mass index (BMI) of 36 kg/m2 (SD = 7) at enrollment, 26% reported their ethnicity as Hispanic, 62% reported their race as White, 17% Black, 2% Asian, 3% Native American, 9% more than one race, and 11% unknown/not reported. Hierarchical linear regression analyses revealed that, after adjusting for several covariates including maternal age, race, ethnicity, BMI, apnea hypopnea index, and depressive symptoms, PTSD symptoms were positively associated with β-cell function in early (β = 0.230, p = 0.016) and late gestation (β = 0.238, p = 0.037). CONCLUSION Higher PTSD symptoms were associated with greater insulin secretion over pregnancy in this sample. More research is needed to replicate these findings and evaluate the effects of treatment of PTSD on mitigating the risk for gestational diabetes. KEY POINTS · We examined associations among symptoms of PTSD and glucose parameters over pregnancy.. · Symptoms of PTSD were positively associated with β-cell function over pregnancy.. · Symptoms of PTSD were not associated with insulin resistance over pregnancy..
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Affiliation(s)
- Margaret H Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, The Miriam Hospital - Women's Medicine Collaborative, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Micheline R Anderson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Laura Sanapo
- Department of Medicine, Warren Alpert Medical School of Brown University, The Miriam Hospital - Women's Medicine Collaborative, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Victoria N Scarfo
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, The Miriam Hospital - Women's Medicine Collaborative, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
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O'Neill RM, Cundiff JM, Wendel CJ, Schmidt AT, Cribbet MR. An Examination of Sleep as a Mediator of the Relationship between Childhood Adversity and Depression in Hispanic and Non-Hispanic Young Adults. Behav Med 2024; 50:106-117. [PMID: 36278905 DOI: 10.1080/08964289.2022.2131707] [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: 11/02/2021] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/02/2022]
Abstract
The current study integrates previous research on adverse childhood experiences (ACEs) and long-term health outcomes to examine associations between ACEs, sleep duration, and depression in a diverse, mostly healthy, sample of young adults. We examine whether sleep duration mediates the association between ACEs and depression among young adults, and whether ethnicity may moderate observed relationships between ACEs, sleep duration and depression. Data were collected from 518 young adults (66.8% female, Mage=19.79 years, SDage=3.43 years) enrolled in undergraduate Psychology courses at a large Southwestern university. Participants primarily reported their racial/ethnic background as Non-Hispanic White (60.6%) and Hispanic/Latino (25.1%). Participants self-reported their ACEs exposure, sleep characteristics, and depressive symptoms. In addition to calculating overall exposure to ACEs, scores for the specific dimensions of adversity were also calculated (Abuse, Neglect, Exposure to Violence). Results supported a mediation model whereby higher reports of ACEs were associated with depressive symptoms both directly and through sleep duration. Results were not moderated by ethnicity. Findings provide support for sleep duration as one potential pathway through which ACEs may be associated with depressive symptoms in young adulthood, and suggest that this pathway is similar in Hispanic and non-Hispanic young adults.
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Affiliation(s)
| | | | | | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University
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Jelsma EB, Varner FA, Benner AD. Relationships between sleep duration and health among U.S. adults with a history of household incarceration during childhood. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 94:212-221. [PMID: 38059994 PMCID: PMC10922323 DOI: 10.1037/ort0000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The rate of incarceration in the United States has increased at an alarming rate in the past 30 years and thus so has the number of children having a household member incarcerated (referred to as household incarceration). Associations between experiencing household incarceration in childhood and later negative health and developmental outcomes are well-documented; however, the underlying mechanisms linking this childhood stressor and adult outcomes have been less well studied. Using state Behavioral Risk Factor Surveillance System survey data (N = 145,102), this study examines how experiencing household incarceration during childhood is associated with mental and physical health in adulthood and mediational pathways through suboptimal sleep (short or long sleep). Results indicate there were significant indirect effects of household incarceration to physical and mental distress through short sleep (≤ 6 hr per 24 hr) and long sleep (≥ 10 hr per 24 hr), and a significant indirect effect of household incarceration to body mass index through short sleep. Findings from the present study highlight indirect pathways through which household incarceration in childhood is linked with sleep health in adulthood and, in turn, to negative mental and physical health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Elizabeth B Jelsma
- Department of Psychological, Health, and Learning Sciences, University of Houston
| | - Fatima A Varner
- Department of Human Development and Family Sciences, University of Texas at Austin
| | - Aprile D Benner
- Department of Human Development and Family Sciences, University of Texas at Austin
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Wamser RA, Walker HE, Sager J. Physical Health Outcomes of Trauma Exposure Across the Lifespan. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:12025-12045. [PMID: 37565310 DOI: 10.1177/08862605231190670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Trauma exposure and posttraumatic stress symptoms (PTSS) are established risk factors for poorer physical health. Prior work has focused on childhood adversities and PTSS in relation to physical health conditions, but trauma exposure over the lifespan has been overlooked. Further, the associations between trauma and PTSS and other physical health markers, such as diet and exercise, are less clear. Very little is known regarding how different trauma types (i.e., interpersonal, non-interpersonal), may be tied to aspects of physical health. To expand this area of research, this study aimed to: (a) examine the links between cumulative trauma and PTSS, and body mass index (BMI), diet, and exercise; and (b) investigate the relations between interpersonal and non-interpersonal trauma and these three health indices, while controlling for PTSS. Participants were 493 Midwestern University students (Mage = 23.87, standard deviation [SD] = 6.90, range = 18-63; 79.3% female; 57.4% White). Cumulative trauma corresponded with higher BMIs and less exercise use (B = 0.10; B = -0.09), while PTSS were unrelated. Conversely, PTSS were tied to greater consumption of added sugars (B = 0.11), and cumulative trauma was not linked with diet. Interpersonal and non-interpersonal traumas were not tied to BMI or exercise, although interpersonal trauma and PTSS were linked with greater sugar intake and non-interpersonal trauma was associated with fruit and vegetable consumption. Trauma exposure and PTSS may have complicated and distinct associations with physical health indices, such as BMI, diet, and exercise, and additional research is needed to further parse out these relations.
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Wiseman M, Hinks M, Hallett D, Blundell J, Sweeney E, Thorpe CM, Walling SG, Swift-Gallant A. Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder. J Psychiatr Res 2023; 168:213-220. [PMID: 37918034 DOI: 10.1016/j.jpsychires.2023.10.048] [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: 04/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow's Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis.
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Affiliation(s)
- Megan Wiseman
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Meagan Hinks
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Darcy Hallett
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ellen Sweeney
- Atlantic PATH, Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Christina M Thorpe
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Susan G Walling
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ashlyn Swift-Gallant
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada.
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Soremekun O, Musanabaganwa C, Uwineza A, Ardissino M, Rajasundaram S, Wani AH, Jansen S, Mutabaruka J, Rutembesa E, Soremekun C, Cheickna C, Wele M, Mugisha J, Nash O, Kinyanda E, Nitsch D, Fornage M, Chikowore T, Gill D, Wildman DE, Mutesa L, Uddin M, Fatumo S. A Mendelian randomization study of genetic liability to post-traumatic stress disorder and risk of ischemic stroke. Transl Psychiatry 2023; 13:237. [PMID: 37391434 PMCID: PMC10313806 DOI: 10.1038/s41398-023-02542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
Observational studies have shown an association between post-traumatic stress disorder (PTSD) and ischemic stroke (IS) but given the susceptibility to confounding it is unclear if these associations represent causal effects. Mendelian randomization (MR) facilitates causal inference that is robust to the influence of confounding. Using two sample MR, we investigated the causal effect of genetic liability to PTSD on IS risk. Ancestry-specific genetic instruments of PTSD and four quantitative sub-phenotypes of PTSD, including hyperarousal, avoidance, re-experiencing, and total symptom severity score (PCL-Total) were obtained from the Million Veteran Programme (MVP) using a threshold P value (P) of <5 × 10-7, clumping distance of 1000 kilobase (Mb) and r2 < 0.01. Genetic association estimates for IS were obtained from the MEGASTROKE consortium (Ncases = 34,217, Ncontrols = 406,111) for European ancestry individuals and from the Consortium of Minority Population Genome-Wide Association Studies of Stroke (COMPASS) (Ncases = 3734, Ncontrols = 18,317) for African ancestry individuals. We used the inverse-variance weighted (IVW) approach as the main analysis and performed MR-Egger and the weighted median methods as pleiotropy-robust sensitivity analyses. In European ancestry individuals, we found evidence of an association between genetic liability to PTSD avoidance, and PCL-Total and increased IS risk (odds ratio (OR)1.04, 95% Confidence Interval (CI) 1.007-1.077, P = 0.017 for avoidance and (OR 1.02, 95% CI 1.010-1.040, P = 7.6 × 10-4 for PCL total). In African ancestry individuals, we found evidence of an association between genetically liability to PCL-Total and reduced IS risk (OR 0.95 (95% CI 0.923-0.991, P = 0.01) and hyperarousal (OR 0.83 (95% CI 0.691-0.991, P = 0.039) but no association was observed for PTSD case-control, avoidance, or re-experiencing. Similar estimates were obtained with MR sensitivity analyses. Our findings suggest that specific sub-phenotypes of PTSD, such as hyperarousal, avoidance, PCL total, may have a causal effect on people of European and African ancestry's risk of IS. This shows that the molecular mechanisms behind the relationship between IS and PTSD may be connected to symptoms of hyperarousal and avoidance. To clarify the precise biological mechanisms involved and how they may vary between populations, more research is required.
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Affiliation(s)
- Opeyemi Soremekun
- The African Computational Genomics (TACG) Research group, MRC/UVRI and LSHTM, Entebbe, Uganda
- Discipline of Pharmaceutical Chemistry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Annette Uwineza
- Department of Biochemistry, Molecular Biology and Genetics, CMHS, University of Rwanda, Kigali, Rwanda
- Center for Human Genetics at the College of Medicine and Health Sciences-University of Rwanda, Kigali, Rwanda
| | - Maddalena Ardissino
- Department of Epidemiology and Biostatistics, Medical School Building, St Mary's Hospital, Imperial College London, London, UK
| | - Skanda Rajasundaram
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Agaz H Wani
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Stefan Jansen
- Directorate of Research and Innovation, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, University of Rwanda, Kigali, Rwanda
| | - Eugene Rutembesa
- Department of Clinical Psychology, University of Rwanda, Kigali, Rwanda
| | - Chisom Soremekun
- The African Computational Genomics (TACG) Research group, MRC/UVRI and LSHTM, Entebbe, Uganda
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria
| | - Cisse Cheickna
- The African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mamadou Wele
- The African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | | | - Oyekanmi Nash
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria
| | | | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology (NCDE), London School of Hygiene and Tropical Medicine, London, UK
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Austin, USA
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Austin, USA
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, Medical School Building, St Mary's Hospital, Imperial College London, London, UK
| | - Derek E Wildman
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Leon Mutesa
- Center for Human Genetics at the College of Medicine and Health Sciences-University of Rwanda, Kigali, Rwanda
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research group, MRC/UVRI and LSHTM, Entebbe, Uganda.
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria.
- MRC/UVRI and LSHTM, Entebbe, Uganda.
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The relationships between screen time and mental health problems among Chinese adults. J Psychiatr Res 2022; 146:279-285. [PMID: 34785040 DOI: 10.1016/j.jpsychires.2021.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/03/2021] [Accepted: 11/05/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study aimed to examine the specific relationships between screen time and various mental health problems among community-dwelling adults in China. METHODS Self-reports of weekday and weekend screen time (TV, computer use and cell phone/tablet use), symptoms of PTSD, depression, and ADHD, and psychotic-like experiences (PLEs) were completed by 7121 Chinese adults. Logistic regression was used to examine specific relationships between screen time and mental health problems with demographics, physical activity, drinking, smoking, and sleep duration as covariates. RESULTS On weekdays, the participants spending at least 3 h on watching TV, computer use and cell phone/tablet use respectively accounted for 6.8%, 15.9% and 45.9%. On weekends, the proportions were 15.5%, 12.1% and 50.0%. Computer use on weekends was associated with higher risk of PTSD (OR = 1.81); cell phone/tablet use on weekdays and weekends was related to increased depression (OR = 1.38, OR = 1.28, respectively), while only computer use on weekends was related to depression (OR = 1.33); cell phone/tablet use both on weekdays and weekends was also connected to ADHD (OR = 1.56, OR = 1.48, respectively); on weekdays and weekends, more time TV viewing (OR = 1.76-1.79, OR = 1.46-1.71, respectively) and less cell phone/tablet use (OR = 0.66, OR = 0.65, respectively) were associated with higher numbers of PLEs. CONCLUSIONS The relationships between different types of screen time and mental health problems are variant. Future longitudinal studies should subdivide screen time on the basis of content and explore the specific causal relationship between screen time and mental health problems.
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Browne J, Morey MC, Beckham JC, Bosworth HB, Porter Starr KN, Bales CW, McDermott J, Sloane R, Gregg JJ, Hall KS. Diet quality and exercise in older veterans with PTSD: a pilot study. Transl Behav Med 2021; 11:2116-2122. [PMID: 34487181 PMCID: PMC8846334 DOI: 10.1093/tbm/ibab116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
| | - Miriam C Morey
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jean C Beckham
- Mental Illness Research, Education, and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Health Services Research and Development Service, Center of Innovation to Accelerate Discovery and Practice Transformation, VA Durham Healthcare System, Durham, NC, USA
| | - Kathryn N Porter Starr
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Connie W Bales
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jessica McDermott
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jeffrey J Gregg
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA
- Mental and Behavioral Health Service, Durham VA Health Care System, Durham, NC, USA
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Bell BM, Spruijt-Metz D, Naya CH, Lane CJ, Wen CKF, Davis JN, Weigensberg MJ. The mediating role of emotional eating in the relationship between perceived stress and dietary intake quality in Hispanic/Latino adolescents. Eat Behav 2021; 42:101537. [PMID: 34225165 PMCID: PMC8380719 DOI: 10.1016/j.eatbeh.2021.101537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
Obesity rates have steadily increased over the past three decades, and large racial/ethnic disparities in childhood obesity rates-specifically for Hispanic/Latino youth-highlight the major need for identifying and examining key mechanisms of obesogenic behaviors for this at-risk population. This study investigates the relationship between stress and dietary quality in Hispanic/Latino adolescents and seeks to determine the mediating role of emotional eating as a behavioral mechanism. Baseline data from 169 adolescents enrolled in the Imagine HEALTH trial were used to investigate these relationships. Perceived stress and emotional eating were assessed with age-validated questionnaires, and dietary quality was measured via 24-hour recall dietary assessments (later calculated as individual Healthy Eating Index-2015 scores). Nonparametric bootstrapping was used to test the primary hypothesis that emotional eating partially or fully mediates the relationship between perceived stress and dietary quality in this sample, and to test the significance of the mediating effect. Results indicate that emotional eating partially mediates the relationship between perceived stress and dietary quality. The total effect of perceived stress scores on dietary quality scores was -0.24 (p = .006); the direct effect of perceived stress scores on dietary quality scores (controlling for emotional eating scores) was -0.16 (p = .107), and the mediating (indirect) effect of emotional eating was -0.09 (p = .001). The proportion of mediation was 0.36 (36%) (p = .008). This study identifies an important mechanism of obesogenic behavior and can be used to inform future obesity prevention and intervention strategies tailored for the Hispanic/Latino adolescent population.
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Affiliation(s)
- Brooke M. Bell
- USC Keck School of Medicine, Department of Preventive Medicine, United States,Address correspondence to: Brooke M. Bell, Ph.D., University of Southern California, 635 Downey Way, Suite 405, Building Code: VPD 3332, Los Angeles, CA 90089-3332. Phone: 213-821-8861.
| | - Donna Spruijt-Metz
- USC Keck School of Medicine, Department of Preventive Medicine, United States,USC Dornsife Center for Economic and Social Research, Department of Psychology, United States
| | - Christine H. Naya
- USC Keck School of Medicine, Department of Preventive Medicine, United States
| | - Christianne J. Lane
- USC Keck School of Medicine, Department of Preventive Medicine, Division of Biostatistics, United States
| | | | - Jaimie N. Davis
- University of Texas at Austin, Department of Nutritional Sciences, United States
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11
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Marquez FD, Risica PM, Mathis KJ, Sullivan A, Gobin AP, Tyrka AR. Do measures of healthy eating differ in survivors of early adversity? Appetite 2021; 162:105180. [PMID: 33684530 PMCID: PMC8058294 DOI: 10.1016/j.appet.2021.105180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Early life adversity has been linked to poor health, including obesity. Understanding the role of unhealthy food intake, may elucidate the importance of self-soothing behaviors in explaining the association between early life adversity and poor health in adulthood. The purpose of this study was to assess the association between early life adversity and dietary quality in a sample of adults from the Lifestyle Influences of Family Environment study. Early life adversity, demographic, and dietary data were obtained for 145 participants using formal interviews and two days of interviewer-administered 24-h recalls. Dietary quality was measured using the 2015 Healthy Eating Index (HEI) scoring algorithm to compute total and component scores. The association between early life adversity and dietary quality was assessed through linear regression and in models adjusted for age and sex. The mean ± SD HEI score for all participants was 54.6 ± 12.8. Individuals with early life adversity had a 4.51 lower overall HEI score when compared to those without early life adversity, 95% CI (0.35, 8.68). After adjusting for age and sex, early life adversity was associated with a 4.6 lower HEI score, 95% CI (0.45, 8.73). HEI component scores indicated that individuals with early life adversity were significantly more likely to have lower whole grain (0.7 versus 2.4) and total dairy (4.3 versus 6.1) scores compared to those without early life adversity. ELA was associated with lower measures of dietary quality. Results warrant future research on dietary and behavioral factors that underly the association between early life adversity and poor health outcomes.
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Affiliation(s)
- Francisco D Marquez
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Patricia M Risica
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Karen Jennings Mathis
- College of Nursing, University of Rhode Island. 350 Eddy Street, Providence, RI, 02908, USA.
| | - Adam Sullivan
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Asi Polly Gobin
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital. 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Audrey R Tyrka
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital. 345 Blackstone Boulevard, Providence, RI, 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University. Center for Health Promotion and Health Equity Research, Box G-BH, 700 Butler Drive, Providence, RI, 02912, USA
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12
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Bleil ME, Spieker SJ, Booth-LaForce C. Targeting Parenting Quality to Reduce Early Life Adversity Impacts on Lifespan Cardiometabolic Risk. Front Psychol 2021; 12:678946. [PMID: 34149571 PMCID: PMC8211431 DOI: 10.3389/fpsyg.2021.678946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Mounting evidence that early life adversity (ELA) exposures confer risk for cardiometabolic disease over the lifespan motivated this narrative review to examine parenting quality as a potential intervention target to reduce ELA exposures or mitigate their impact as a way of reducing or preventing cardiometabolic disease. We describe findings from the limited number of family-based intervention studies in ELA-exposed children that have tested parenting impacts on cardiometabolic health outcomes. We then describe the implications of this work and make recommendations for future research that will move this field forward.
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Affiliation(s)
- Maria E. Bleil
- Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
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13
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Trauma, Sleep and Mental Health Problems in Low-Income Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031145. [PMID: 33525425 PMCID: PMC7908203 DOI: 10.3390/ijerph18031145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
Low-income young adults are more likely to have exposure to trauma, which increases risk for mental health problems. Although adequate sleep promotes good health, people with histories of trauma are more likely to have sleep problems. The current study explored whether poor sleep mediated the relationship between trauma exposure and mental health. A sample of 143 low-income 18-24-year-old young adults completed depression, anxiety, and trauma exposure measures and wore sleep monitors for four nights. Structural equation modeling (SEM) was used to examine both direct and indirect effects of variables. Results showed that higher trauma exposure was associated with depression and anxiety. Mean sleep hours per night was fewer than six, far below recommended guidelines for optimal health and functioning. Fewer sleep hours partially mediated the relationship between both trauma exposure and depression and anxiety, and the direct effect from trauma remained significant after adjusting for the partial mediation from sleep.
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Kim Y, Roberts AL, Rimm EB, Chibnik LB, Tworoger SS, Nishimi KM, Sumner JA, Koenen KC, Kubzansky LD. Posttraumatic stress disorder and changes in diet quality over 20 years among US women. Psychol Med 2021; 51:310-319. [PMID: 31769371 PMCID: PMC8063582 DOI: 10.1017/s0033291719003246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Individuals with posttraumatic stress disorder (PTSD) are at increased risk of various chronic diseases. One hypothesized pathway is via changes in diet quality. This study evaluated whether PTSD was associated with deterioration in diet quality over time. METHODS Data were from 51 965 women in the Nurses' Health Study II PTSD sub-study followed over 20 years. Diet, assessed at 4-year intervals, was characterized via the Alternative Healthy Eating Index-2010 (AHEI). Based on information from the Brief Trauma Questionnaire and Short Screening Scale for DSM-IV PTSD, trauma/PTSD status was classified as no trauma exposure, prevalent exposure (trauma/PTSD onset before study entry), or new-onset (trauma/PTSD onset during follow-up). We further categorized women with prevalent exposure as having trauma with no PTSD symptoms, trauma with low PTSD symptoms, and trauma with high PTSD symptoms, and created similar categories for women with new-onset exposure, resulting in seven comparison groups. Multivariable linear mixed-effects spline models tested differences in diet quality changes by trauma/PTSD status over follow-up. RESULTS Overall, diet quality improved over time regardless of PTSD status. In age-adjusted models, compared to those with no trauma, women with prevalent high PTSD and women with new-onset high PTSD symptoms had 3.3% and 3.6% lower improvement in diet quality, respectively, during follow-up. Associations remained consistent after adjusting for health conditions, sociodemographics, and behavioral characteristics. CONCLUSIONS PTSD is associated with less healthy changes in overall diet quality over time. Poor diet quality may be one pathway linking PTSD with a higher risk of chronic disease development.
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Affiliation(s)
- Yongjoo Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lori B Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kristen M Nishimi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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Epperson CN, Duffy KA, Johnson RL, Sammel MD, Newman DK. Enduring impact of childhood adversity on lower urinary tract symptoms in adult women. Neurourol Urodyn 2020; 39:1472-1481. [PMID: 32368829 DOI: 10.1002/nau.24375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/22/2022]
Abstract
AIMS To determine whether childhood adversity is associated with self-reported lower urinary tract symptoms (LUTS) among older adult women. METHODS A convenience sample of women (≥55 years old) who presented to an academic urology practice or who had participated in a previous bladder health prevention study completed questionnaires including the LUTS Tool (on frequency and bother of LUTS), the Adverse Childhood Experiences (ACEs) Questionnaire, the Spielberger State-Trait Anxiety Inventory, and the Center for Epidemiologic Studies Depression Scale. RESULTS The average age (SD) of participants (N = 151) was 64.7 (6.9) years. The total number of ACEs predicted the total number of LUTS, β = .39 (95% confidence interval [CI] = 0.14, 0.64), P = .003, as well as LUTS frequency, β = .09 (95% CI = 0.04, 0.13), P < .001. ACEs predicted bother for nocturia, β = 0.12 (95% CI = 0.03, 0.22), P = .008. Negative affect symptoms did not mediate the relationship between the total number of ACEs and the total number of LUTS. Rather, ACEs predicted LUTS and negative affect symptoms through (at least partially) independent pathways. Analyses controlled for tobacco use, number of vaginal deliveries, hypertension, overactive bladder medication use, body mass index, income, and race because these variables were significantly associated with the total number of ACEs or total number of LUTS. CONCLUSIONS Childhood adversity has an enduring impact on risk for LUTS in adulthood even when controlling for potential confounds and this relationship cannot be explained by negative affect symptoms.
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Affiliation(s)
- C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Department of Family Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Mary D Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Ämmälä AJ, Urrila AS, Lahtinen A, Santangeli O, Hakkarainen A, Kantojärvi K, Castaneda AE, Lundbom N, Marttunen M, Paunio T. Epigenetic dysregulation of genes related to synaptic long-term depression among adolescents with depressive disorder and sleep symptoms. Sleep Med 2019; 61:95-103. [DOI: 10.1016/j.sleep.2019.01.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 12/14/2022]
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17
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Abstract
The developmental period constitutes a critical window of sensitivity to stress. Indeed, early-life adversity increases the risk to develop psychiatric diseases, but also gastrointestinal disorders such as the irritable bowel syndrome at adulthood. In the past decade, there has been huge interest in the gut-brain axis, especially as regards stress-related emotional behaviours. Animal models of early-life adversity, in particular, maternal separation (MS) in rodents, demonstrate lasting deleterious effects on both the gut and the brain. Here, we review the effects of MS on both systems with a focus on stress-related behaviours. In addition, we discuss more recent findings showing the impact of gut-directed interventions, including nutrition with pre- and probiotics, illustrating the role played by gut microbiota in mediating the long-term effects of MS. Overall, preclinical studies suggest that nutritional approaches with pro- and prebiotics may constitute safe and efficient strategies to attenuate the effects of early-life stress on the gut-brain axis. Further research is required to understand the complex mechanisms underlying gut-brain interaction dysfunctions after early-life stress as well as to determine the beneficial impact of gut-directed strategies in a context of early-life adversity in human subjects.
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18
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Taylor JL, Makarem N, Shimbo D, Aggarwal B. Gender Differences in Associations Between Stress and Cardiovascular Risk Factors and Outcomes. GENDER AND THE GENOME 2018; 2:111-122. [PMID: 34136738 PMCID: PMC8204799 DOI: 10.1177/2470289718820845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Psychological stress, a subjective perception of an adverse environmental change, is a hallmark of modern society. Although psychological stress has previously been established as a risk factor for cardiovascular disease (CVD), it is unclear whether stress influences cardiovascular risk differently in men versus women. Gender disparities exist in the prevalence of stress as well as in the prevalence and prognosis of CVD; therefore, associations between stress and CVD risk and mortality may vary by sex. The purpose of this review was to summarize the evidence from recent and landmark studies on gender differences in the associations of stress with CVD risk factors and end points and to highlight clinical and public health implications as well as future research directions in this field. Taken together, research to date indicates that while stress is associated with poorer cardiovascular health metrics in both men and women, the influence of stress on measures of glucose regulation and dyslipidemia and on overall CVD risk may be stronger among women. However, men may be more susceptible to the influence of stress on body adiposity, blood pressure, and CVD mortality. In terms of behavioral risk factors for CVD, associations between stress and diet quantity and quality appear to be stronger among women, but the influence of stress on sedentary behaviors and sleep may be stronger among men. Given that gender disparities exist in the prevalence of overall and different types of stress (eg, financial stress, caregiving stress, and occupational stress), future studies should decipher the potential differential associations between types of stress and cardiovascular risk among men and women to identify vulnerable populations and develop targeted interventions.
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Affiliation(s)
| | - Nour Makarem
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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19
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Duffy KA, McLaughlin KA, Green PA. Early life adversity and health-risk behaviors: proposed psychological and neural mechanisms. Ann N Y Acad Sci 2018; 1428:151-169. [PMID: 30011075 PMCID: PMC6158062 DOI: 10.1111/nyas.13928] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022]
Abstract
Early life adversity (ELA) is associated with poorer health in adulthood, an association explained, at least in part, by increased engagement in health-risk behaviors (HRBs). In this review, we make the case that ELA influences brain development in ways that increase the likelihood of engaging in HRBs. We argue that ELA alters neural circuitry underpinning cognitive control as well as emotional processing, including networks involved in processing threat and reward. These neural changes are associated psychologically and behaviorally with heightened emotional reactivity, blunted reward responsivity, poorer emotion regulation, and greater delay discounting. We then demonstrate that these adaptations to ELA are associated with an increased risk of smoking cigarettes, drinking alcohol, and eating high-fat, high-sugar foods. Furthermore, we explore how HRBs affect the brain in ways that reinforce addiction and further explain clustering of HRBs.
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Affiliation(s)
- Korrina A. Duffy
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Paige A. Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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20
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Mellon SH, Gautam A, Hammamieh R, Jett M, Wolkowitz OM. Metabolism, Metabolomics, and Inflammation in Posttraumatic Stress Disorder. Biol Psychiatry 2018; 83:866-875. [PMID: 29628193 DOI: 10.1016/j.biopsych.2018.02.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 02/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is defined by classic psychological manifestations, although among the characteristics are significantly increased rates of serious somatic comorbidities, such as cardiovascular disease, immune dysfunction, and metabolic syndrome. In this review, we assess the evidence for disturbances that may contribute to somatic pathology in inflammation, metabolic syndrome, and circulating metabolites (implicating mitochondrial dysfunction) in individuals with PTSD and in animal models simulating features of PTSD. The clinical and preclinical data highlight probable interrelated features of PTSD pathophysiology, including a proinflammatory milieu, metabolomic changes (implicating mitochondrial and other processes), and metabolic dysregulation. These data suggest that PTSD may be a systemic illness, or that it at least has systemic manifestations, and the behavioral manifestations are those most easily discerned. Whether somatic pathology precedes the development of PTSD (and thus may be a risk factor) or follows the development of PTSD (as a result of either shared pathophysiologies or lifestyle adaptations), comorbid PTSD and somatic illness is a potent combination placing affected individuals at increased physical as well as mental health risk. We conclude with directions for future research and novel treatment approaches based on these abnormalities.
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Affiliation(s)
- Synthia H Mellon
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California
| | - Aarti Gautam
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland
| | - Rasha Hammamieh
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland
| | - Marti Jett
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland.
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California-San Francisco, San Francisco, California
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21
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Theal R, Tay VXP, Hickman IJ. Conflicting relationship between dietary intake and metabolic health in PTSD: A systematic review. Nutr Res 2018; 54:12-22. [PMID: 29914663 DOI: 10.1016/j.nutres.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a disabling psychological condition associated with significant physical comorbidities. There has been growing evidence to support the relationship between PTSD and cardiometabolic disease. Disordered eating behaviors often seen in people with PTSD symptoms may explain increased cardiometabolic risk. This systematic review aimed to assess the quality of evidence surrounding dietary intake of individuals with symptoms or a diagnosis of PTSD and their associated risk with cardiometabolic health outcomes. Online databases Scopus, ProQuest (Health), Embase, Medline, PsycINFO, and CINAHL with Full Text were searched for peer-reviewed English articles prior to December 2017 that examined dietary intake and cardiometabolic health outcomes in adults with PTSD symptoms or diagnosis. The quality of each study was graded based on the design and methodology using adapted quality assessment tools. Seven studies with five unique participant samples were included in the review. Study methods, design, populations, and outcomes were inconsistent across studies. Dietary intake was considerably varied and limited associations were demonstrated between dietary intake and cardiometabolic risk factors in the PTSD cohorts. Due to the variability of measures and study outcomes, there was insufficient evidence to determine the relationship between dietary intake and PTSD-related cardiometabolic health outcomes. Future studies are needed to examine these associations in individuals with PTSD: specifically higher quality descriptive studies are necessary to confirm a link between diet and cardiometabolic disease in PTSD.
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Affiliation(s)
- Rebecca Theal
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, 4120, Queensland, Australia.
| | - Valerie Xin Pei Tay
- Queensland University of Technology, 2 George Street, Brisbane City, 4000, Queensland, Australia.
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Queensland, Australia; Mater Research Institute - The University of Queensland, Aubigny Place, Raymond Terrance, South Brisbane, 4101, Queensland, Australia.
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22
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Lee SY, Park CL. Trauma exposure, posttraumatic stress, and preventive health behaviours: a systematic review. Health Psychol Rev 2017; 12:75-109. [PMID: 28854859 DOI: 10.1080/17437199.2017.1373030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Psychological trauma has implications for many aspects of physical health, including preventive health behaviours (PHBs). However, whether trauma exposure additionally contributes to PHBs above and beyond the effects of posttraumatic stress disorder (PTSD) symptoms remains unclear. In this systematic review, 32 studies were analysed to characterise: (1) the relationships between trauma exposure and PHBs, (2) the relationships between PTSD symptoms and PHBs, (3) the unique associations between trauma exposure and PHBs, independent of PTSD symptoms, and (4) the unique associations between PTSD symptoms and PHBs, independent of trauma exposure. Findings were variable across the three examined PHBs (physical activity, diet, medical screening) when only trauma exposure or PTSD symptoms were taken into account. Clearer relationships emerged between trauma exposure and PHBs when PTSD symptoms were taken into account, demonstrating that trauma exposure is related to PHB engagement above and beyond the effects of PTSD symptoms. Additionally, PTSD symptoms shared unique associations with physical activity and screening frequency, which were not explained by trauma exposure. Our review reveals that teasing apart the effects of trauma exposure and PTSD symptoms on PHBs brings greater clarity to the strength and direction of these associations.
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Affiliation(s)
- Sharon Y Lee
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Crystal L Park
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
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23
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Panetta P, Berry A, Bellisario V, Capoccia S, Raggi C, Luoni A, Longo L, Riva MA, Cirulli F. Long-Term Sex-Dependent Vulnerability to Metabolic challenges in Prenatally Stressed Rats. Front Behav Neurosci 2017; 11:113. [PMID: 28706476 PMCID: PMC5489562 DOI: 10.3389/fnbeh.2017.00113] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022] Open
Abstract
Prenatal stress (PNS) might affect the developmental programming of adult chronic diseases such as metabolic and mood disorders. The molecular mechanisms underlying such regulations may rely upon long-term changes in stress-responsive effectors such as Brain-Derived Neurotrophic Factor (BDNF) that can affect neuronal plasticity underlying mood disorders and may also play a role in metabolic regulation. Based upon previous data, we hypothesized that PNS might lead to greater vulnerability to an obesogenic challenge experienced at adulthood. In order to investigate our hypothesis, pregnant Sprague-Dawley female rats underwent a chronic procedure of restraint stress during the last week of gestation. The adult offspring were then challenged with a high fat diet (HFD) over 8 weeks and tested for metabolic and emotional endpoints. Moreover, brain specific changes in Bdnf expression levels were also assessed. Overall, HFD resulted in increased caloric intake, insulin resistance, impaired glucose tolerance and higher circulating levels of leptin, while PNS increased the leptin/adiponectin ratio, an index of metabolic risk in adult male subjects. Interestingly, HFD consumption increased anxiety-like behaviors in the Elevated Plus Maze, particularly in males, and this effect was buffered by PNS. Levels of Bdnf were finely modulated by PNS and HFD in a region- and sex-dependent fashion: female offspring overall showed greater plasticity, possibly mediated through increased total Bdnf mRNA expression both in the hippocampus and in the hypothalamus. In conclusion, while the experience of maternal stress during intrauterine life promotes metabolic dysfunction induced by a HFD at adulthood, the interaction between PNS and HFD is positive in male subjects, and in agreement with the match-mismatch hypothesis, resulting in a reduction of anxious behaviors.
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Affiliation(s)
- Pamela Panetta
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di SanitàRome, Italy
| | - Alessandra Berry
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di SanitàRome, Italy
| | - Veronica Bellisario
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di SanitàRome, Italy
| | - Sara Capoccia
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di SanitàRome, Italy
| | - Carla Raggi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di SanitàRome, Italy
| | - Alessia Luoni
- Department of Pharmacological and Biomolecular Sciences, University of MilanMilan, Italy
| | - Linda Longo
- Department of Pharmacological and Biomolecular Sciences, University of MilanMilan, Italy
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of MilanMilan, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di SanitàRome, Italy
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24
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Jackson DB, Vaughn MG. Parental Incarceration and Child Sleep and Eating Behaviors. J Pediatr 2017; 185:211-217. [PMID: 28396029 DOI: 10.1016/j.jpeds.2017.03.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine whether parental incarceration is significantly associated with a number of sleep and eating behaviors among offspring during early childhood. STUDY DESIGN Data from the Fragile Families and Child Well-Being Study, an at-risk sample of parents and their offspring, were employed to test this possibility. Both maternal and paternal incarceration history were examined as predictors of whether children manifested high levels of the following 7 health behaviors: sleep problems, short sleep duration, salty snack consumption, starch consumption, sweets consumption, soda consumption, and fast food consumption. Logistic regression techniques were used to carry out the analyses. RESULTS Both maternal and paternal incarceration significantly increased the odds of a number of risky sleep and eating behaviors during childhood. Ancillary analysis also revealed that the predicted probability of exhibiting multiple risky behaviors across the sleep and eating domains was twice as large among children whose parents had both been incarcerated, relative to children whose parents had not been incarcerated. CONCLUSIONS Parental incarceration may have important implications for the sleep and eating behaviors of offspring. Both scholars and practitioners may, therefore, want to consider the possible negative repercussions of parental incarceration for the sleep and eating behaviors of children, and the potential for these high-risk health behaviors to compromise the health and well-being of children as they age.
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Affiliation(s)
- Dylan B Jackson
- Department of Criminal Justice, The University of Texas at San Antonio, San Antonio, TX.
| | - Michael G Vaughn
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
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Farr OM, Mantzoros CS. Sleep apnea in relation to metabolism: An urgent need to study underlying mechanisms and to develop novel treatments for this unmet clinical need. Metabolism 2017; 69:207-210. [PMID: 28190524 PMCID: PMC5865071 DOI: 10.1016/j.metabol.2017.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Olivia M Farr
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
| | - Christos S Mantzoros
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
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Cirulli F. Interactions between early life stress and metabolic stress in programming of mental and metabolic health. Curr Opin Behav Sci 2017. [DOI: 10.1016/j.cobeha.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Wu JHY, Zheng M, Catterall E, Downs S, Thomas B, Veerman L, Barendregt JJ. Contribution of Trans-Fatty Acid Intake to Coronary Heart Disease Burden in Australia: A Modelling Study. Nutrients 2017; 9:nu9010077. [PMID: 28106762 PMCID: PMC5295121 DOI: 10.3390/nu9010077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 11/21/2022] Open
Abstract
Trans-fatty acids (TFAs) intake has been consistently associated with a higher risk of coronary heart disease (CHD) mortality. We provided an updated assessment of TFA intake in Australian adults in 2010 and conducted modeling to estimate CHD mortality attributable to TFA intake. Data of the 2011–2012 National Nutrition and Physical Activity Survey was used to assess TFA intake. The CHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution of 0.5% energy. The average TFA intake among adults was 0.59% energy, and overall 10% of adults exceeded the World Health Organization (WHO) recommended limit of 1% energy. Education and income were moderately and inversely associated with TFA intake (p-value ≤ 0.001), with one in seven adults in the lowest income and education quintile having >1% energy from TFA. Australia had 487 CHD deaths (95% uncertainty interval, 367–615) due to TFA exposure, equivalent to 1.52% (95% uncertainty limits: 1.15%–1.92%) of all CHD mortality. The relative impact of TFA exposure on CHD mortality in Australia is limited, but, in absolute terms, still substantial. Policies aimed at reducing industrial TFA exposure can reduce socioeconomic inequalities in health and may therefore be desirable.
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Affiliation(s)
- Jason H Y Wu
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney 2042, Australia.
| | - Miaobing Zheng
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney 2042, Australia.
| | - Elise Catterall
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney 2042, Australia.
| | - Shauna Downs
- Earth Institute and Institute of Human Nutrition, Columbia University, New York, NY 10025, USA.
| | - Beth Thomas
- National Heart Foundation of Australia, Heart Health & Research, Brisbane 4006, Australia.
| | - Lennert Veerman
- School of Public Health, the University of Queensland, Brisbane 4006, Australia.
| | - Jan J Barendregt
- School of Public Health, the University of Queensland, Brisbane 4006, Australia.
- Epigear International, Sunrise Beach 4567, Australia.
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Abstract
Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.
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Hall KS, Gregg J, Bosworth HB, Beckham JC, Hoerster KD, Sloane R, Morey MC. Physical Activity Counseling Promotes Physical and Psychological Resilience in Older Veterans with Posttraumatic Stress Disorder. Ment Health Phys Act 2016; 11:53-59. [PMID: 28458721 PMCID: PMC5404826 DOI: 10.1016/j.mhpa.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD. METHODS Older (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months. RESULTS Primary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 minutes/week to 161 minutes/week among participants in the intervention arm (p=0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p<0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p<0.05). CONCLUSIONS Given the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.
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Affiliation(s)
- Katherine S. Hall
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Gregg
- Mental Health Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Hayden B. Bosworth
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jean C. Beckham
- VA Research Service/Veterans Integrated Service Network 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Katherine D. Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA , USA
| | - Richard Sloane
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
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Wolf EJ, Bovin MJ, Green JD, Mitchell KS, Stoop TB, Barretto KM, Jackson CE, Lee LO, Fang SC, Trachtenberg F, Rosen RC, Keane TM, Marx BP. Longitudinal associations between post-traumatic stress disorder and metabolic syndrome severity. Psychol Med 2016; 46:2215-2226. [PMID: 27087657 PMCID: PMC4925183 DOI: 10.1017/s0033291716000817] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is associated with elevated risk for metabolic syndrome (MetS). However, the direction of this association is not yet established, as most prior studies employed cross-sectional designs. The primary goal of this study was to evaluate bidirectional associations between PTSD and MetS using a longitudinal design. METHOD A total of 1355 male and female veterans of the conflicts in Iraq and Afghanistan underwent PTSD diagnostic assessments and their biometric profiles pertaining to MetS were extracted from the electronic medical record at two time points (spanning ~2.5 years, n = 971 at time 2). RESULTS The prevalence of MetS among veterans with PTSD was just under 40% at both time points and was significantly greater than that for veterans without PTSD; the prevalence of MetS among those with PTSD was also elevated relative to age-matched population estimates. Cross-lagged panel models revealed that PTSD severity predicted subsequent increases in MetS severity (β = 0.08, p = 0.002), after controlling for initial MetS severity, but MetS did not predict later PTSD symptoms. Logistic regression results suggested that for every 10 PTSD symptoms endorsed at time 1, the odds of a subsequent MetS diagnosis increased by 56%. CONCLUSIONS Results highlight the substantial cardiometabolic concerns of young veterans with PTSD and raise the possibility that PTSD may predispose individuals to accelerated aging, in part, manifested clinically as MetS. This demonstrates the need to identify those with PTSD at greatest risk for MetS and to develop interventions that improve both conditions.
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Affiliation(s)
- E J Wolf
- National Center for PTSD at VA Boston Healthcare System,Boston, MA,USA
| | - M J Bovin
- National Center for PTSD at VA Boston Healthcare System,Boston, MA,USA
| | - J D Green
- Department of Psychiatry,Boston University School of Medicine,Boston, MA,USA
| | - K S Mitchell
- National Center for PTSD at VA Boston Healthcare System,Boston, MA,USA
| | - T B Stoop
- Boston VA Research Institute,Boston, MA,USA
| | - K M Barretto
- VA Boston Healthcare System,Research Service,Boston, MA,USA
| | - C E Jackson
- Department of Psychiatry,Boston University School of Medicine,Boston, MA,USA
| | - L O Lee
- Department of Psychiatry,Boston University School of Medicine,Boston, MA,USA
| | - S C Fang
- New England Research Institutes,Watertown, MA,USA
| | | | - R C Rosen
- New England Research Institutes,Watertown, MA,USA
| | - T M Keane
- National Center for PTSD at VA Boston Healthcare System,Boston, MA,USA
| | - B P Marx
- National Center for PTSD at VA Boston Healthcare System,Boston, MA,USA
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31
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Nobles CJ, Valentine SE, Borba CPC, Gerber MW, Shtasel DL, Marques L. Black-white disparities in the association between posttraumatic stress disorder and chronic illness. J Psychosom Res 2016; 85:19-25. [PMID: 27212665 PMCID: PMC4879687 DOI: 10.1016/j.jpsychores.2016.03.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD. METHODS We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales. RESULTS The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI -0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p=0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p=0.051). CONCLUSION A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela.
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Affiliation(s)
- Carrie J Nobles
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
| | - Sarah E Valentine
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Christina P C Borba
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Monica W Gerber
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA
| | - Derri L Shtasel
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
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Wilker S, Pfeiffer A, Elbert T, Ovuga E, Karabatsiakis A, Krumbholz A, Thieme D, Schelling G, Kolassa IT. Endocannabinoid concentrations in hair are associated with PTSD symptom severity. Psychoneuroendocrinology 2016; 67:198-206. [PMID: 26923850 DOI: 10.1016/j.psyneuen.2016.02.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/26/2022]
Abstract
The endocannabinoid system has been implicated in the regulation of the stress response, fear memory formation, and inflammatory processes. Posttraumatic stress disorder (PTSD) can result from exposure to extreme stress and is characterized by strong, associative memories for the traumatic events experienced. Furthermore, an elevated physical disease risk has been observed in PTSD, likely to be mediated by inflammatory processes. Therefore, altered endocannabinoid regulation can be expected in individuals with PTSD. However, attempts to assess PTSD-associated differences in the endocannabinoid system from human blood samples have provided inconsistent results, possibly due to fluctuating levels of endocannabinoids. In hair, these neuromodulators are accumulated over time and thus give access to a more stable and reliable assessment. We therefore investigated PTSD-associated differences in hair concentrations of endocannabinoids (N-acyl-ethanolamides palmitoylethanolamide [PEA], oleoylethanolamide [OEA] and stearoylethanolamide [SEA]) in 38 rebel war survivors from Northern Uganda suffering from PTSD and N=38 healthy rebel war survivors without current and lifetime PTSD. PTSD diagnosis and symptom severity were assessed in structured clinical interviews employing the Posttraumatic Diagnostic Scale (PDS). A significant group difference was observed for OEA, with PTSD patients showing reduced hair concentrations. Regression analyses further revealed strong negative relationships between all investigated N-acyl-ethanolamides and symptom severity of PTSD. The observed reductions in endocannabinoids might account for the increased inflammatory state as well as for the failure to extinguish fear memories observed in PTSD. Our findings add to the accumulating evidence suggesting the endocannabinoid system as a target for pharmacological enhancement of exposure-based psychotherapy for PTSD.
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Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology & Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany.
| | - Anett Pfeiffer
- Clinical Psychology, University of Konstanz, Universitätsstr. 10, 78457 Konstanz, Germany
| | - Thomas Elbert
- Clinical Psychology, University of Konstanz, Universitätsstr. 10, 78457 Konstanz, Germany
| | - Emilio Ovuga
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Alexander Karabatsiakis
- Clinical & Biological Psychology, Institute of Psychology & Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Aniko Krumbholz
- Institute of Doping Analysis and Sports Biochemistry Dresden, 01731 Kreischa, Germany
| | - Detlef Thieme
- Institute of Doping Analysis and Sports Biochemistry Dresden, 01731 Kreischa, Germany
| | - Gustav Schelling
- Department of Anaesthesiology, Ludwig-Maximilians University, 82131 Munich, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology & Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
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Increased anticipatory contingent negative variation in posttraumatic stress disorder. Biol Psychol 2016; 117:80-88. [DOI: 10.1016/j.biopsycho.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 02/04/2023]
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