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Breneman CB, Valmas MM, Skalina LM, Cypel Y, Spiro A, Frayne SM, Magruder KM, Kilbourne AM, Kimerling R, Reinhard MJ. Mental Health and Cognition in Women Veterans Enrolled in the Health of Vietnam Era Veteran Women's Study (HealthViEWS). J Womens Health (Larchmt) 2024. [PMID: 38913339 DOI: 10.1089/jwh.2023.0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Objective: This analysis explored relationships between mental health symptoms and conditions and cognitive function in a cohort of Vietnam-era women veterans from the Health of Vietnam Era Veteran Women's Study (HealthViEWS). Methods: Vietnam-era women veterans completed a mail survey assessing self-reported symptom severity of posttraumatic stress disorder (PTSD) and depression. A telephone-based structured interview assessed mental health conditions and cognitive function (telephone interview for cognitive status [TICS]). Participants were categorized using a TICS threshold of ≤29 to designate possible cognitive impairment versus nonimpaired. Separate logistic regression models were used to determine associations between possible cognitive impairment and each self-reported and interviewer-rated assessment of PTSD and depression while adjusting for age, education, race, marital status, and wartime service location. Results: The sample consisted of 4,077 women veterans who were ≥60 years old and completed the TICS. Of these women, 7.20% were categorized with possible cognitive impairment. Logistic regression models indicated that self-reported PTSD and depression symptom severity were each significantly associated with higher odds of possible cognitive impairment (adjusted odds ratios [aOR]: 1.03 [95% confidence interval [CI]: 1.02-1.04] and 1.07 [95% CI: 1.04-1.09], respectively). Women veterans with a probable diagnosis of depression had higher odds of possible cognitive impairment compared to those without depression (aOR: 1.61 [95% CI: 1.07-2.42]). No association was found for probable diagnosis of PTSD. Conclusions: Although further examination remains necessary, results suggest that Vietnam-era women veterans with self-reported PTSD and depression symptom severity or a probable diagnosis of depression may benefit from screening of cognitive function to inform clinical care.
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Affiliation(s)
- Charity B Breneman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
| | - Mary M Valmas
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
- Department of Veterans Affairs, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Lauren M Skalina
- Department of Veterans Affairs, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Yasmin Cypel
- Department of Veterans Affairs, Health Outcomes Military Exposures, Veterans Health Administration, Washington, District of Columbia, USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, Massachusetts, USA
| | - Susan M Frayne
- National Center for PTSD and VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kathryn M Magruder
- Departments of Psychiatry and Behavioral Sciences and Public Health, Medical University of SC, Charleston, South Carolina, USA
| | - Amy M Kilbourne
- US Department of Veterans Affairs, Quality Enhancement Research Initiative (QUERI), Washington, District of Columbia, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rachel Kimerling
- National Center for PTSD and VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Matthew J Reinhard
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
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2
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Forsberg CW, Estrada SA, Baraff A, Magruder KM, Vaccarino V, Litz BT, Friedman MJ, Goldberg J, Smith NL. Risk factors for suicide in the Vietnam-era twin registry. Suicide Life Threat Behav 2022; 52:631-641. [PMID: 35499385 DOI: 10.1111/sltb.12848] [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: 05/17/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The risk of suicide among Veterans is of major concern, particularly among those who experienced a combat deployment and/or have a history of PTSD. DESIGN AND METHODS This was a retrospective cohort study of post-discharge suicide among Vietnam-era Veterans who are members of the Vietnam Era Twin (VET) Registry. The VET Registry is a national sample of male twins from all branches of the military, both of whom served on active duty between 1964 and 1975. Military service and demographic factors were available from the military records. Service in-theater was based on military records; combat exposure and PTSD symptoms were assessed in 1987 by questionnaire. Mortality follow-up, from discharge to 2016, is identified from Department of Veterans Affairs, Social Security Administration, and National Death Index records; suicide as a cause of death is based on the International Classification of Death diagnostic codes from the death certificate. Statistical analysis used Cox proportional hazards regression to estimate the association of Vietnam-theater service, combat exposure, and PTSD symptoms with suicide while adjusting for military service and demographic confounding factors. RESULTS From the 14,401 twins in the VET Registry, there were 147 suicide deaths during follow-up. In adjusted analyses, twins who served in the Vietnam theater were at similar risk of post-discharge suicide compared with non-theater Veterans; there was no association between combat and suicide. An increase in severity of PTSD symptoms was significantly associated with an increased risk of suicide in adjusted analyses (hazard ratio = 1.13 per five-point increase in symptom score; 95% CI: 1.02-1.27). CONCLUSIONS Service in the Vietnam theater is not associated with greater risk of suicide; however, PTSD symptom severity poses a degree of risk of suicide in Vietnam-era Veterans. Adequate screening for PTSD in Veterans may be promising to identify Veterans who are at increased risk of suicide.
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Affiliation(s)
- Christopher W Forsberg
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Santiago A Estrada
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Aaron Baraff
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Kathryn M Magruder
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, US Department of Veteran Affairs, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University, Boston, Massachusetts, USA
| | - Matthew J Friedman
- Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,National Center for PTSD, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
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3
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Suri P, Tanus AD, Torres N, Timmons A, Irimia B, Friedly JL, Korpak A, Daniels C, Morelli D, Hodges PW, Costa N, Day MA, Heagerty PJ, Jensen MP. The Flares of Low back pain with Activity Research Study (FLAReS): study protocol for a case-crossover study nested within a cohort study. BMC Musculoskelet Disord 2022; 23:376. [PMID: 35449043 PMCID: PMC9022413 DOI: 10.1186/s12891-022-05281-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although it is generally accepted that physical activity and flares of low back pain (LBP) are related, evidence for the directionality of this association is mixed. The Flares of Low back pain with Activity Research Study (FLAReS) takes a novel approach to distinguish the short-term effects of specific physical activities on LBP flares from the cumulative effects of such activities, by conducting a longitudinal case-crossover study nested within a cohort study. The first aim is to estimate the short-term effects (≤ 24 h) of specific physical activities on LBP flares among Veterans in primary care in the Veterans Affairs healthcare system. The second aim is to estimate the cumulative effects of specific activities on LBP-related functional limitations at 1-year follow-up. METHODS Up to 550 adults of working age (18-65 years) seen for LBP in primary care complete up to 36 "Scheduled" surveys over 1-year follow-up, and also complete unscheduled "Flare Window" surveys after the onset of new flares. Each survey asks about current flares and other factors associated with LBP. Surveys also inquire about activity exposures over the 24 h, and 2 h, prior to the time of survey completion (during non-flare periods) or prior to the time of flare onset (during flares). Other questions evaluate the number, intensity, duration, and/or other characteristics of activity exposures. Other exposures include factors related to mood, lifestyle, exercise, concurrent treatments, and injuries. Some participants wear actigraphy devices for weeks 1-4 of the study. The first aim will examine associations between 10 specific activity categories and participant-reported flares over 1-year follow-up. The second aim will examine associations between the frequency of exposure to 10 activity categories over weeks 1-4 of follow-up and long-term functional limitations at 12 months. All analyses will use a biopsychosocial framework accounting for potential confounders and effect modifiers. DISCUSSION FLAReS will provide empirically derived estimates of both the short-term and cumulative effects of specific physical activities for Veterans with LBP, helping to better understand the role of physical activities in those with LBP. TRIAL REGISTRATION ClinicalTrials.gov NCT04828330 , registered April 2, 2021.
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Affiliation(s)
- Pradeep Suri
- Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA, 98108, USA. .,Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 S. Columbian Way, S-RCS-117, Seattle, WA, 98108, USA. .,Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, 4333 Brooklyn Ave NE, Box 359455, Seattle, WA, 98104, USA. .,Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Box 359612, Seattle, WA, 98104, USA.
| | - Adrienne D. Tanus
- grid.413919.70000 0004 0420 6540Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA 98108 USA
| | - Nikki Torres
- grid.413919.70000 0004 0420 6540Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA 98108 USA
| | - Andrew Timmons
- grid.413919.70000 0004 0420 6540Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA 98108 USA
| | - Bianca Irimia
- grid.413919.70000 0004 0420 6540Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA 98108 USA
| | - Janna L. Friedly
- grid.34477.330000000122986657Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, 4333 Brooklyn Ave NE, Box 359455, Seattle, WA 98104 USA ,grid.34477.330000000122986657Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Box 359612, Seattle, WA 98104 USA
| | - Anna Korpak
- grid.413919.70000 0004 0420 6540Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA 98108 USA
| | - Clinton Daniels
- grid.413919.70000 0004 0420 6540Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 S. Columbian Way, S-RCS-117, Seattle, WA 98108 USA
| | - Daniel Morelli
- grid.413919.70000 0004 0420 6540Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152-E, Seattle, WA 98108 USA
| | - Paul W. Hodges
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, 84a Services Rd, St Lucia QLD 4067, Brisbane, QLD Australia
| | - Nathalia Costa
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, 84a Services Rd, St Lucia QLD 4067, Brisbane, QLD Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, The University of Sydney, A27 Fisher Rd NSW 2006, Sydney, NSW Australia
| | - Melissa A. Day
- grid.34477.330000000122986657Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Box 359612, Seattle, WA 98104 USA ,grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, Sir Fred Schonell Dr, St Lucia QLD 4072, Brisbane, QLD Australia
| | - Patrick J. Heagerty
- grid.34477.330000000122986657Department of Biostatistics, University of Washington, 1705 NE Pacific Street, Box 357232, Seattle, WA 98104 USA
| | - Mark P. Jensen
- grid.34477.330000000122986657Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Box 359612, Seattle, WA 98104 USA
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Gasperi M, Afari N, Goldberg J, Suri P, Panizzon MS. Pain and Trauma: The Role of Criterion A Trauma and Stressful Life Events in the Pain and PTSD Relationship. THE JOURNAL OF PAIN 2021; 22:1506-1517. [PMID: 34029685 PMCID: PMC8578317 DOI: 10.1016/j.jpain.2021.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
Chronic pain and post-traumatic stress disorder (PTSD) frequently co-occur, and research suggests that these 2 conditions exacerbate one another producing greater impact on normal functioning in combination than separately. The influence of traumatic experiences on both pain and PTSD has been shown, but the nature of this interplay remains unclear. Although Criterion A trauma is required for the diagnosis of PTSD, whether the association between PTSD and chronic pain is dependent on Criterion A is underexplored. In this observational cohort study, we examined the association between pain and PTSD-like symptoms in the context of Criterion A trauma in 5,791 men from the Vietnam Era Twin Registry. Correlations and mixed-effects regression models were used to evaluate the relationship between PTSD Checklist-Civilian Version symptoms and multiple indicators of pain from the Short Form McGill Pain Questionnaire across trauma history and chronic pain conditions. 53.21% of the participants experienced trauma consistent with DSM-IV Criterion A for PTSD. The associations between pain indicators and PTSD-like symptoms was stronger for individuals with a history of trauma but remained robust for individuals without trauma history. Small but significant interactions between past trauma and pain indicators and PTSD-like symptoms were observed. Findings were similar in a subsample of participants with history of chronic pain conditions. The relationship between PTSD-like symptoms and indicators of pain were largely independent of trauma consistent with Criterion A, highlighting the need to better understand and address stressful life events in chronic pain patients and pain concerns in individuals reporting trauma. PERSPECTIVE: This article demonstrates that the relationship between PTSD-like symptoms and indicators of pain is largely independent of trauma consistent with Criterion A. This finding highlights the need to better understand and address stressful life events in chronic pain patients and pain concerns in individuals reporting trauma.
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Affiliation(s)
- Marianna Gasperi
- VA Center of Excellence for Stress and Mental Health, San Diego, California; Research Service, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, La Jolla, California.
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, San Diego, California; Research Service, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Jack Goldberg
- University of Washington, Seattle, Washington; Vietnam Era Twin Registry, Seattle, Washington; Seattle Epidemiologic Research and Information Center (ERIC), Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Pradeep Suri
- Seattle Epidemiologic Research and Information Center (ERIC), Department of Veterans Affairs Office of Research and Development, Seattle, Washington; Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Matthew S Panizzon
- VA Center of Excellence for Stress and Mental Health, San Diego, California; Center for Behavior Genetics of Aging, University of California, San Diego, California
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5
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Afari N, Gasperi M, Dochat C, Wooldridge JS, Herbert MS, Schur EA, Buchwald DS. Genetic and environmental influences on posttraumatic stress disorder symptoms and disinhibited eating behaviors. Eat Disord 2021; 29:226-244. [PMID: 33404377 PMCID: PMC8257777 DOI: 10.1080/10640266.2020.1864587] [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] [Indexed: 01/23/2023]
Abstract
Posttraumatic stress disorder (PTSD) and eating disorders (ED) frequently co-occur, but the mechanisms underlying this association remain unclear. EDs are characterized by features of maladaptive eating behaviors including disinhibited eating and cognitive dietary restraint. Identifying the genetic overlap between PTSD symptoms and maladaptive eating behaviors may elucidate biological mechanisms and potential treatment targets. A community sample of 400 same-sex twins (102 monozygotic and 98 dizygotic pairs) completed the PTSD Checklist-Civilian (PCL-C) for PTSD symptoms and the Three-Factor Eating Questionnaire-Reduced (TFEQ-R18) for eating behaviors (uncontrolled eating, emotional eating, and cognitive dietary restraint). We used biometric modeling to examine the genetic and environmental relationships between PCL-C and TFEQ-R18 total and subscales scores. Heritability was estimated at 48% for PTSD symptoms and 45% for eating behavior overall. Bivariate models revealed a significant genetic correlation between PTSD symptoms and eating behavior overall (rg =.34; CI:.07,.58) and Uncontrolled Eating (rg =.53; CI:.24,.84), and a significant environmental correlation between PTSD symptoms and Emotional Eating (re =.30; CI:.12,.45). These findings suggest the influence of common etiology. Future research and clinical efforts should focus on developing integrated treatments.
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Affiliation(s)
- Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Marianna Gasperi
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Cara Dochat
- Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Jennalee S Wooldridge
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Matthew S Herbert
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Ellen A Schur
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dedra S Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington, USA
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6
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Cannabis use and posttraumatic stress disorder comorbidity: Epidemiology, biology and the potential for novel treatment approaches. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 157:143-193. [PMID: 33648669 DOI: 10.1016/bs.irn.2020.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cannabis use is increasing among some demographics in the United States and is tightly linked to anxiety, trauma, and stress reactivity at the epidemiological and biological level. Stress-coping motives are highly cited reasons for cannabis use. However, with increased cannabis use comes the increased susceptibility for cannabis use disorder (CUD). Indeed, CUD is highly comorbid with posttraumatic stress disorder (PTSD). Importantly, endogenous cannabinoid signaling systems play a key role in the regulation of stress reactivity and anxiety regulation, and preclinical data suggest deficiencies in this signaling system could contribute to the development of stress-related psychopathology. Furthermore, endocannabinoid deficiency states, either pre-existing or induced by trauma exposure, could provide explanatory insights into the high rates of comorbid cannabis use in patients with PTSD. Here we review clinical and preclinical literature related to the cannabis use-PTSD comorbidity, the role of endocannabinoids in the regulation of stress reactivity, and potential therapeutic implications of recent work in this area.
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7
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Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is highly comorbid with chronic pain conditions that often co-occur such as migraine headaches, temporomandibular disorder, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, chronic prostatitis/chronic pelvic pain syndrome, and tension headaches. Using a genetically informative sample, the current study evaluated the genetic and environmental factors contributing to the co-occurrence of PTSD and chronic pain conditions. METHODS Data from 4680 male twins in the Vietnam Era Twin Registry were examined. Biometric modeling was used to estimate genetic and environmental variance components and genetic and environmental correlations between PTSD and multiple chronic pain conditions. RESULTS Heritabilities were estimated at 43% (95% confidence interval [CI] = 15%-63%) for PTSD and 34% (95% CI = 27%-41%) for the combined history of any one or more pain condition. Specific pain condition heritabilities ranged from 15% (95% CI = 0%-48%) for tension headaches to 41% (95% CI = 27%-54%) for migraine headaches. Environmental influences accounted for the remaining variance in pain conditions. The genetic correlation between PTSD and combined history of any one or more pain condition was rg= 0.61 (95% CI = 0.46-0.89) and ranged for individual pain conditions from rg= 0.44 (95% CI = 0.24-0.77) for migraine headache to rg= 0.75 (95% CI = 0.52-1.00) for tension headaches. CONCLUSIONS PTSD and chronic pain conditions are highly comorbid, and this relationship can be explained by both genetic and environmental overlap. The precise mechanisms underlying these relationships are likely diverse and multifactorial.
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8
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Gratz KL, Berghoff CR, Richmond JR, Vidaña AG, Dixon‐Gordon KL. Examining posttraumatic stress disorder as a predictor of treatment response to dialectical behavior therapy. J Clin Psychol 2020; 76:1563-1574. [DOI: 10.1002/jclp.22961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kim L. Gratz
- Department of PsychologyUniversity of Toledo Toledo Ohio
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9
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Franz CE, Hatton SN, Hauger RL, Kredlow MA, Dale AM, Eyler L, McEvoy LK, Fennema-Notestine C, Hagler D, Jacobson KC, McKenzie RE, Panizzon MS, Gustavson DE, Xian H, Toomey R, Beck A, Stevens S, Tu X, Lyons MJ, Kremen WS. Posttraumatic stress symptom persistence across 24 years: association with brain structures. Brain Imaging Behav 2020; 14:1208-1220. [PMID: 30830577 PMCID: PMC6722032 DOI: 10.1007/s11682-019-00059-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Posttraumatic stress disorder (PTSD) is known to persist, eliciting early medical co-morbidity, and accelerated aging. Although PTSD diagnosis has been found to be associated with smaller volume in multiple brain regions, posttraumatic stress (PTS) symptoms and their associations with brain morphometry are rarely assessed over long periods of time. We predicted that persistent PTS symptoms across ~24 years would be inversely associated with hippocampal, amygdala, anterior cingulate volumes, and hippocampal occupancy (HOC = hippocampal volume/[hippocampal volume + inferior lateral ventricle volume]) in late middle age. Exploratory analyses examined prefrontal regions. We assessed PTS symptoms in 247 men at average ages 38 (time 1) and 62 (time 2). All were trauma-exposed prior to time 1. Brain volumes were assessed at time 2 using 3 T structural magnetic resonance imaging. Symptoms were correlated over time (r = 0.46 p < .0001). Higher PTS symptoms averaged over time and symptoms at time 1 were both associated with lower hippocampal, amygdala, rostral middle frontal gyrus (MFG), and medial orbitofrontal cortex (OFC) volumes, and a lower HOC ratio at time 2. Increased PTS symptomatology from time 1 to time 2 was associated with smaller hippocampal volume. Results for hippocampal, rostral MFG and medial OFC remained significant after omitting individuals above the threshold for PTSD diagnosis. Even at sub-diagnostic threshold levels, PTS symptoms were present decades after trauma exposure in parallel with highly correlated structural deficits in brain regions regulating stress responsivity and adaptation.
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Affiliation(s)
- Carol E Franz
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Sean N Hatton
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Richard L Hauger
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, 92093, USA
| | - M Alexandra Kredlow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Lisa Eyler
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
| | - Linda K McEvoy
- Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Christine Fennema-Notestine
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Donald Hagler
- Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Kristen C Jacobson
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, 60637, USA
| | - Ruth E McKenzie
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA
| | - Matthew S Panizzon
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
| | - Daniel E Gustavson
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, St Louis University, St Louis, MO, 60134, USA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA
| | - Asad Beck
- Department of Psychology, San Diego State University, San Diego, CA, 92182, USA
| | - Samantha Stevens
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
| | - Xin Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, 92093, USA
| | - Michael J Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA
| | - William S Kremen
- Department of Psychiatry MC 0738, University of California San Diego, La Jolla, CA, 92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, 92093, USA
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10
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Stepanovic K, Rogers B, Kiehl AL, Ely EW, Jackson J, Wilson JE. The Association Between Brain Volumes and Posttraumatic Stress Disorder in Intensive Care Unit Survivors: A Preliminary Study. Front Neurosci 2020; 14:690. [PMID: 32714139 PMCID: PMC7340156 DOI: 10.3389/fnins.2020.00690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Millions of Americans are admitted to the intensive care unit (ICU) per year. Many survivors of the ICU will experience posttraumatic stress disorder (PTSD); although volumetric hippocampal and amygdala studies have been conducted in other trauma survivors (i.e., veterans), the association between PTSD symptoms and hippocampal and amygdala volumes in ICU survivors has not been described. We hypothesize that the severity of posttraumatic stress symptoms in ICU survivors is associated with lower volumes of both the hippocampus and amygdala at 3 and 12 months. Methods Secondary analysis of the VISIONS study, a prospective sub-study of the BRAIN-ICU cohort, which included survivors of critical illness. The PTSD Checklist Specific was used at 3 and 12 months to evaluate the ICU as a traumatic experience. A Philips Achieva 3T MRI scanner was used to scan patients at both discharge and 3 months. To compare median brain volumes at discharge and 3 months for those with and without PTSD symptomatology, we used a Kruskal–Wallis (KW) test. Results At 3 month follow up, three patients had PTSD symptomatology and N = 1 at 12 month follow up. There was no difference between median brain volumes (hippocampus or amygdala) between individuals with PTSD symptomatology at either 3 or 12 months (p-values > 0.05). Discussion Although our study did not reveal significant differences in brain volumes between PTSD patients and non-PTSD patients, sample size was a major limitation and larger scale studies should be undertaken to elucidate possible neurobiological markers of PTSD in ICU survivors.
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Affiliation(s)
- Kristina Stepanovic
- Center for Critical Illness Brain Dysfunction and Survivorship, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Baxter Rogers
- Vanderbilt University Institute of Imaging Science, Vanderbilt University School of Medicine, Nashville, TN, United States.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Amy L Kiehl
- Center for Critical Illness Brain Dysfunction and Survivorship, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Division of Pulmonary and Critical Care, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - E Wesley Ely
- Center for Critical Illness Brain Dysfunction and Survivorship, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Division of Pulmonary and Critical Care, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States.,Veteran's Affairs TN Valley, Geriatrics Research, Education and Clinical Center, Nashville, TN, United States
| | - James Jackson
- Center for Critical Illness Brain Dysfunction and Survivorship, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Division of Pulmonary and Critical Care, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States.,Veteran's Affairs TN Valley, Geriatrics Research, Education and Clinical Center, Nashville, TN, United States
| | - Jo Ellen Wilson
- Center for Critical Illness Brain Dysfunction and Survivorship, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Stevens SM, Gustavson DE, Fang B, Tu X, Logue M, Lyons MJ, Reynolds CA, Kremen WS, Franz CE. Predicting Health-Related Quality of Life in Trauma-Exposed Male Veterans in Late Midlife: A 20 Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124554. [PMID: 32599875 PMCID: PMC7345107 DOI: 10.3390/ijerph17124554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022]
Abstract
Trauma-exposed adults with high levels of posttraumatic stress symptoms (PTSS) report poorer health-related quality of life (HRQOL), but less is known about the persistence of this relationship over time. Participants from the Vietnam Era Twin Study of Aging reported on PTSS, health, and sociodemographic characteristics at average age 38; 775 participants reported having been exposed to trauma. Later, at average ages 56 and 62, mental and physical HRQOL were assessed with the Short-Form 36. Premorbid risk for anxiety/neuroticism was evaluated with a polygenic risk score derived from a large genome-wide association study meta-analysis. In multivariate mixed models, having higher levels of PTSS, poorer self-rated health, lower income, and less education at age 38 were associated with worse physical and mental HRQOL two decades later. Chronic health problems at age 38 predicted midlife physical but not mental HRQOL. Although genetic risk for neuroticism was correlated with HRQOL and PTSS, it was no longer significant in multivariate models. Health-related quality of life (HRQOL) predicts morbidity and mortality independently of objective health measures; early interventions may help to mitigate the ongoing impact of trauma on quality of life.
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Affiliation(s)
- Samantha M. Stevens
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Psychology, The Pennsylvania State University, State College, PA 16801, USA
| | - Daniel E. Gustavson
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bin Fang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
| | - Xin Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Mark Logue
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Chandra A. Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA 92521, USA;
| | - William S. Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, University of California San Diego, La Jolla, CA 92093, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Correspondence: ; Tel.: +1-858-822-1793
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12
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Post-traumatic Stress Disorder Symptoms are Associated With Incident Chronic Back Pain: A Longitudinal Twin Study of Older Male Veterans. Spine (Phila Pa 1976) 2019; 44:1220-1227. [PMID: 30985567 PMCID: PMC7102423 DOI: 10.1097/brs.0000000000003053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A longitudinal cotwin control study of the Vietnam Era Twin Registry. OBJECTIVE The aim of this study was to examine the association of post-traumatic stress disorder (PTSD) symptoms with incident chronic back pain (CBP), while controlling for genetic factors and early family environment. SUMMARY OF BACKGROUND DATA It is unknown whether PTSD symptoms are associated with an increased incidence of CBP. METHODS In 2010 to 2012, a baseline survey was undertaken as part of a large-scale study of PTSD. Study participants completed the PTSD Symptom Checklist (PCL) and a self-report measure of CBP. In 2015 to 2017, a follow-up survey was sent to all 171 monozygotic (MZ) twin pairs (342 individuals) where both cotwins had no history of CBP at baseline, but only one cotwin in the pair met criteria for having current PTSD symptoms (one twin with PCL <30 and the cotwin with PCL ≥30). No other inclusion/exclusion criteria were applied. CBP at 5-year follow-up was defined as back pain of duration ≥3 months in the low back or mid/upper back. Covariates included age, race, education, income, Veterans Affairs health care use, disability compensation, smoking, body mass index, and depression. Statistical analysis estimated the cumulative incidence of CBP according to baseline PTSD symptoms. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were estimated in matched-pair cotwin control analyses adjusting for familial factors. RESULTS Among 227 males completing 5-year follow-up, including 91 MZ twin pairs, the mean age was 62 years. Five-year incidence of CBP in those without and with baseline PTSD symptoms was 40% and 60%, respectively. Baseline PTSD symptoms were significantly associated with incident CBP in crude and multivariable-adjusted within-pair analyses (RR 1.6, 95% CI 1.2-2.1; P = 0.002). CONCLUSION PTSD symptoms were associated with an increased incidence of CBP, without confounding by genetic factors or early family environment. PTSD symptoms may be a modifiable risk factor for prevention of CBP. LEVEL OF EVIDENCE 3.
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13
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Graham K, Searle A, Van Hooff M, Lawrence-Wood E, McFarlane A. The Value of Physical Symptoms in Screening For Posttraumatic Stress Disorder in the Military. Assessment 2019; 27:1139-1150. [PMID: 31328529 DOI: 10.1177/1073191119864662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical symptoms are highly comorbid with posttraumatic stress disorder (PTSD). As PTSD is underdiagnosed, this study explored the value of self-reported physical symptoms in screening for 30-day PTSD in military personnel. Two physical symptom scales were constructed using items from a 67-item health symptom checklist, clinical interviews were used as the diagnostic reference standard, and diagnostic utility of physical symptoms was compared with the current gold standard screen, the PTSD checklist (PCL). Receiver operating characteristic analyses showed that both a 9-item and a 10-item physical symptom scale were of value in predicting PTSD (areas under the curve 0.81 and 0.85). Importantly, two thirds of PTSD positive personnel missed by the PCL were captured with physical symptoms scales, and when physical symptoms were added to the PCL, prediction was improved (areas under the curve 0.90 to 0.92). Our findings highlight the value of including assessing physical symptoms in PTSD screening.
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Affiliation(s)
- Kristin Graham
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Amelia Searle
- The University of Adelaide, Adelaide, South Australia, Australia
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14
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Wolf EJ, Miller MW, Sullivan DR, Amstadter AB, Mitchell KS, Goldberg J, Magruder KM. A classical twin study of PTSD symptoms and resilience: Evidence for a single spectrum of vulnerability to traumatic stress. Depress Anxiety 2018; 35:132-139. [PMID: 29283198 PMCID: PMC5794534 DOI: 10.1002/da.22712] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/01/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine shared genetic and environmental risk factors across PTSD symptoms and resilience. METHODS Classical twin study of 2010-2012 survey data conducted among 3,318 male twin pairs in the Vietnam Era Twin Registry. Analyses included: (a) estimates of genetic and environmental influences on PTSD symptom severity (as measured by the PTSD Checklist) and resilience (assessed with the Connor-Davidson Resilience Scale-10); (b) development of a latent model of traumatic stress, spanning both PTSD and resilience; and (c) estimates of genetic and environmental influences on this spectrum. RESULTS The heritability of PTSD was 49% and of resilience was 25%. PTSD and resilience were correlated at r = -.59, and 59% of this correlation was attributable to a single genetic factor, whereas the remainder was due to a single non-shared environment factor. Resilience was also influenced by common and unique environmental factors not shared with PTSD, but there was no genetic factor specific to resilience. Confirmatory factor analysis supported the Development of a revised phenotype reflecting the broader dimension of traumatic stress, with biometric models suggesting increased heritability (66%) of this spectrum compared to PTSD or resilience individually. CONCLUSIONS Genetic factors contribute to a single spectrum of traumatic stress reflecting resilience at one end and high symptom severity at the other. This carries implications for phenotype refinement in the search for molecular genetic markers of trauma-related psychopathology. Rather than focusing only on genetic risk for PTSD, molecular genetics research may benefit from evaluation of the broader spectrum of traumatic stress.
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Danielle R. Sullivan
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Karen S. Mitchell
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System,Department of Epidemiology, University of Washington
| | - Kathryn M. Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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15
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Suri P, Boyko EJ, Smith NL, Jarvik JG, Williams FMK, Jarvik GP, Goldberg J. Modifiable risk factors for chronic back pain: insights using the co-twin control design. Spine J 2017; 17:4-14. [PMID: 27794503 PMCID: PMC6126929 DOI: 10.1016/j.spinee.2016.07.533] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inconsistent associations between modifiable risk factors and chronic back pain (CBP) may be due to the inability of traditional epidemiologic study designs to properly account for an array of potential genetic and environmental confounding factors. The co-twin control research design, comparing modifiable risk factors in twins discordant for CBP, offers a unique way to remove numerous confounding factors. PURPOSE The study aimed to examine the association of modifiable lifestyle and psychological factors with lifetime CBP. STUDY DESIGN/SETTING This is a cross-sectional co-twin control study in a nationwide sample of male twin members of the Vietnam Era Twin Registry. PATIENT SAMPLE The sample is composed of 7,108 participants, including 1,308 monozygotic (MZ) pairs and 793 dizygotic pairs. OUTCOME MEASURE The outcome measure is the self-reported lifetime history of CBP. METHODS Lifestyle factors included body mass index (BMI), smoking history, alcohol consumption, habitual physical activity, and typical sleep duration. Psychological factors included depression (Patient Health Questionnaire-9) and posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist). Covariates included age, race, education, and income. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the association of risk factors with lifetime CBP when considering twins as individuals, and a within-pair co-twin control analysis that accounted for familial and genetic factors. Funding was through VA Grant 5IK2RX001515; there were no study-specific conflicts of interest. RESULTS The mean age of respondents was 62 years and the prevalence of lifetime CBP was 28%. All lifestyle factors were associated with CBP in the individual level analysis. However, none of these persisted in the within-pair analyses, except for severe obesity (BMI ≥35.0), which was associated with lifetime CBP in both individual-level (OR=1.6, 95% CI: 1.3-1.9) and within-pair analyses (MZ analysis: OR=3.7, 95% CI: 1.2-11.4). Symptoms of PTSD and depression were strongly associated with lifetime CBP in both the individual-level (moderate or severe depression: OR=4.2, 95% CI: 3.6-4.9, and severe PTSD: OR=4.8, 95% CI: 4.0-5.7) and within-pair (MZ) analyses (moderate or severe depression: OR=4.6, 95% CI: 2.4-8.7, and severe PTSD: OR=3.2, 95% CI: 1.6-6.5). CONCLUSIONS Many associations between modifiable lifestyle risk factors and CBP are due to confounding by familial and genetic factors. Severe obesity, depression, and PTSD should be considered in the development of intervention strategies to reduce the prevalence of CBP.
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Affiliation(s)
- Pradeep Suri
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Division of Rehabilitation Care Services, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA 98104, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; General Medicine Service, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St Health Sciences Bldg, Box 357236, Seattle, WA 98195, USA
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Box #359455, Seattle, WA 98195, USA; Department of Radiology, University of Washington, 325 9th Ave, Seattle, WA 98104, USA; Department of Neurological Surgery, University of Washington, 325 9th Ave, Seattle, WA 98104, USA; Department of Health Services, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, Kings College London, Strand, London WC2R 2LS, UK
| | - Gail P Jarvik
- Department of Medicine (Medical Genetics), 3720 15th Ave NE, Seattle, WA 98105, USA; Department of Genome Sciences, University of Washington, 3720 15th Ave NE, Seattle, WA 98105, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St Health Sciences Bldg, Box 357236, Seattle, WA 98195, USA
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16
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Magruder KM, Goldberg J, Forsberg CW, Friedman MJ, Litz BT, Vaccarino V, Heagerty PJ, Gleason TC, Huang GD, Smith NL. Long-Term Trajectories of PTSD in Vietnam-Era Veterans: The Course and Consequences of PTSD in Twins. J Trauma Stress 2016; 29:5-16. [PMID: 26764215 PMCID: PMC5884065 DOI: 10.1002/jts.22075] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We estimated the temporal course of posttraumatic stress disorder (PTSD) in Vietnam-era veterans using a national sample of male twins with a 20-year follow-up. The complete sample included those twins with a PTSD diagnostic assessment in 1992 and who completed a DSM-IV PTSD diagnostic assessment and a self-report PTSD checklist in 2012 (n = 4,138). Using PTSD diagnostic data, we classified veterans into 5 mutually exclusive groups, including those who never had PTSD, and 4 PTSD trajectory groups: (a) early recovery, (b) late recovery, (c) late onset, and (d) chronic. The majority of veterans remained unaffected by PTSD throughout their lives (79.05% of those with theater service, 90.85% of those with nontheater service); however, an important minority (10.50% of theater veterans, 4.45% of nontheater veterans) in 2012 had current PTSD that was either late onset (6.55% theater, 3.29% nontheater) or chronic (3.95% theater, 1.16% nontheater). The distribution of trajectories was significantly different by theater service (p < .001). PTSD remains a prominent issue for many Vietnam-era veterans, especially for those who served in Vietnam.
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Affiliation(s)
- Kathryn M. Magruder
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Christopher W. Forsberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Matthew J. Friedman
- National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, White River Junction, Vermont, USA
- Departments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brett T. Litz
- Massachusetts Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Patrick J. Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Theresa C. Gleason
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - Grant D. Huang
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - Nicholas L. Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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