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Dubourdieu AP, Annette S, Wojtecki A, Doutrelon C, Sence E, Colas MD. Concordance Study of Diagnoses and Therapeutic Management for Military Personnel Evacuated for Medico-psychological Reasons: From the Theater of Operations to the Military Training Hospital. Mil Med 2024:usae330. [PMID: 38966938 DOI: 10.1093/milmed/usae330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/18/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION The evolving global landscape has led to increased involvement of the French armed forces, exposing military personnel to operational challenges that can affect their mental well-being. As a result, psychiatry has become the second most common reason for Medical Evacuation (MEDEVAC). In war zones where specialized medico-psychological consultations may not be readily available, medical officers play a vital role in providing initial care. Therefore, there is a growing emphasis on the precise evaluation of these practices. MATERIALS AND METHODS In this retrospective observational study, we analyzed MEDEVAC request files from the Operational Health Headquarters (Patient Medical Request sheets), Aeromedical Evacuation Mission Order sheets, and hospital records from the entire military hospital complex in the Île-de-France region for French military personnel who underwent low-priority MEDEVAC (P3) for medico-psychological reasons from a non-metropolitan area to metropolitan France. The study spanned from January 1, 2013, to December 31, 2016. The primary objective is to evaluate the concordance of diagnoses between general practitioners and psychiatrists. The secondary objective is a detailed description of the introduction of psychotropic drugs, especially benzodiazepines, by the medical officer in the field. RESULTS In total, our study included 610 patients. Significant differences were observed between diagnoses made by military general practitioners and military psychiatrists, except for "psychotic disorders" and "other diagnoses" categories. During hospitalization, benzodiazepines were prescribed to 26.5% of repatriated patients, antidepressants to 12.7%, hypnotics to 17.6%, neuroleptics to 24.23%, and hydroxyzine to 18.8%. Upon discharge, benzodiazepines were prescribed to 23.5% of patients, antidepressants to 17.8%, hypnotics to 9.9%, neuroleptics to 28.9%, and hydroxyzine to 19.7%. The chi-squared test revealed significant differences in prescription between military operations and hospitalization for all molecules except hydroxyzine. Among patients diagnosed with Psychological Disorder Related to a Traumatic Event (TPRET) (<1 and >1 month) by psychiatrists during hospitalization, 66.2% were prescribed benzodiazepines during operational theaters, 24.3% continued during hospitalization, and 16.8% received a prescription upon discharge.The duration of missions often hinders precise psychiatric diagnoses, leading medical officers to transmit clinical data for optimized specialized care at military training hospitals. Furthermore, significant differences in therapeutic administration between medical officers and psychiatrists, particularly in benzodiazepine prescriptions for patients with TPRET, highlight the importance of prioritizing psychotropic prescription modalities in the training of medical officers on mental disorders. Strengthening operational preparations in recent years could enable more practitioners to benefit from these measures. CONCLUSIONS We suggest several measures to enhance the transmission of medical information between medical officers and military psychiatrists. First, optimizing the drafting of Patient Movement Requests could involve implementing pre-filled drop-down menus or providing an adapted bilingual lexicon, facilitating the optimal transmission of clinical information for repatriated patients. Second, strengthening the training of medical officers before deployment and sharing the "Emergency Psy Kit," a comprehensive support tool developed by French military psychiatrists, would further enhance the tool kit available to field practitioners for judiciously prescribing psychiatric drugs.
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Affiliation(s)
| | - Sophie Annette
- Psychiatry Department, Percy Military Training Hospital, Clamart 92140, France
| | | | - Caroline Doutrelon
- Internal Medicine Department, Percy Military Training Hospital, Clamart 92140, France
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Rahnejat AM, Ebrahimi M, Salimi SH, Fathi Ashtiani A, Taghva A, Mohammadi T, Shahed Hagh Ghadam H, Shahmiri Barzoki H. Comparing the effect of prolonged exposure therapy (PET) and metacognitive therapy (MCT) on the quality of life among veterans with PTSD. MILITARY PSYCHOLOGY 2024; 36:422-430. [PMID: 38913765 PMCID: PMC11197894 DOI: 10.1080/08995605.2023.2195328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/17/2023] [Indexed: 06/26/2024]
Abstract
Veterans' quality of life (QoL) can be drastically affected by posttraumatic stress disorder (PTSD). We compared prolonged exposure therapy (PET) with metacognitive therapy (MCT) in their effects on quality of life (QoL) among veterans with post-traumatic stress disorder (PTSD). Overall, 57 veterans with PTSD were randomly assigned to three groups MCT (N = 17), PET (N = 17), and Control (N = 23). The 36-item short-form survey (SF-36) was used to evaluate QoL pretest, posttest, and after a 3-month follow-up. The MCT was based on the practice of detached mindfulness, controlling rumination/anxiety, and challenging negative beliefs about symptoms. The PET was based on in-vivo and imaginal exposure to trauma-related events, and discontinuation of avoidance-oriented coping strategies. Both MCT and PET groups significantly improved QoL at posttest and follow-up, compared with the control group (P < .001); however, the MCT and PET groups showed no significant difference at posttest (P = .644) or follow-up (P = .646). Our results support the efficacy of PET as the standard for PTSD treatment, while also signifying the effectiveness of MCT at increasing the QoL in war-related PTSD at a 3-month follow-up.
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Affiliation(s)
- Amir Mohsen Rahnejat
- Behavioral and Cognitive Science Research Center, Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ebrahimi
- Behavioral and Cognitive Science Research Center, Department of Psychiatry, Aja University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Salimi
- Research Center for Exercise Physiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Fathi Ashtiani
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Arsia Taghva
- Behavioral and Cognitive Science Research Center, Department of Psychiatry, Aja University of Medical Sciences, Tehran, Iran
| | - Tina Mohammadi
- Faculty of Psychology and Educational Sciences, Allameh Tabataba’i University, Tehran, Iran
| | | | - Hassan Shahmiri Barzoki
- Behavioral and Cognitive Science Research Center, Department of Psychiatry, Aja University of Medical Sciences, Tehran, Iran
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Gaffey AE, Burg MM, Skanderson M, Deviva JC, Brandt CA, Bastian LA, Haskell SG. Electronic Health Record Concordance with Survey-Reported Military Sexual Trauma Among Younger Veterans: Associations with Health Care Utilization and Mental Health Diagnoses. J Womens Health (Larchmt) 2024. [PMID: 38946553 DOI: 10.1089/jwh.2023.0993] [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: 07/02/2024] Open
Abstract
Introduction: Military sexual trauma (MST) is more common among post-9/11 Veterans and women versus older Veterans and men. Despite mandatory screening, the concordance of electronic health record (EHR) documentation and survey-reported MST, and associations with health care utilization and mental health diagnoses, are unknown for this younger group. Materials and Methods: Veterans' Health Administration (VHA) EHR (2001-2021) were merged with data from the observational, nationwide WomenVeterans Cohort Study (collected 2016-2020, n = 1058; 51% women). Experiencing MST was defined as positive endorsement of sexual harassment and/or assault. From the EHR, we derived Veterans' number of primary care and mental health visits in the initial two years of VHA care and diagnoses of posttraumatic stress disorder (PTSD), depression, and anxiety. First, the concordance of EHR MST screening and survey-reported MST was compared. Next, multivariate analyses tested the cross-sectional associations of EHR screening and survey-reported MST with Veterans' health care utilization, and compared the likelihood of PTSD, depression, and anxiety diagnoses by MST group, while covarying demographics and service-related characteristics. With few MST cases among men, multivariate analyses were only pursued for women. Results: Overall, 29% of women and 2% of men screened positive for MST in the EHR, but 64% of women and 9% of men had survey-reported MST. Primary care utilization was similar between women with concordant, positive MST reports in the EHR and survey versus those with survey-reported MST only. Women with survey-reported MST only were less likely to have a PTSD or depression diagnosis than those with concordant, positive MST reports. There was no group difference in women's likelihood of anxiety. Conclusions: EHR MST documentation is discordant for many post-9/11 Veterans-both for men and women. Improving MST screening and better supporting MST disclosure are each critical to provide appropriate and timely care for younger Veterans, particularly women.
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Affiliation(s)
- Allison E Gaffey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Matthew M Burg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Jason C Deviva
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (General Medicine), Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine (General Medicine), Yale School of Medicine, New Haven, Connecticut, USA
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Mordeno IG, Luzano JGC. Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents. BMC Psychol 2023; 11:353. [PMID: 37875987 PMCID: PMC10594924 DOI: 10.1186/s40359-023-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 10/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) construes PTSD symptoms into 4 clusters (intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity; Model 1). However, recent literature has shown that this symptom structure does not best represent PTSD. Unfortunately, the findings of studies investigating the proposed alternative models are from consensus. Adding to the complexity of the issue of symptom-grouping models is the identification of specific and non-specific symptoms of PTSD. The present study aims to address these gaps by identifying the best-fitting PTSD model and subsequently examining what symptoms are considered specific and non-specific to PTSD in adolescent-survivors of armed political conflict and violence. METHODS The study utilized a sample of 641 adolescent victim survivors. We conducted CFA analyses and compared nested models through the scaled χ2 difference test, while comparison of non-nested models was done using the Bayesian information criterion (BIC). The best-fitted model was used in the consequent analysis, where we statistically controlled for the effect of non-specific psychological distress on PTSD by comparing the factor loadings and factor correlations before and after accounting for distress using the Aroian z-test. RESULTS The results provide support for the 7-factor hybrid model of PTSD over other proposed models for the current sample. Moreover, the data reveal that only 7 items could be construed as core symptoms, while the rest of the symptoms can be considered non-PTSD specific. CONCLUSIONS Overall, the findings provide support for the validity of the hybrid PTSD model among political conflict-exposed adolescents. The results also show that the DSM-5 PTSD has both specific and non-specific features in the present sample of conflict-exposed adolescents. This has potential implications for theory, practice, and treatment of the disorder.
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Affiliation(s)
- Imelu G Mordeno
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines.
| | - Jelli Grace C Luzano
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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Pavlacic JM, Witcraft SM, Allan NP, Gros DF. Anxiety sensitivity and social support in veterans with emotional disorders. J Clin Psychol 2023; 79:2337-2350. [PMID: 37310172 PMCID: PMC10527913 DOI: 10.1002/jclp.23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE An understanding of the incremental value of social support in predicting psychopathology above transdiagnostic risk factors could speak to the benefit of leveraging social factors into existing, evidence-based interventions in veterans with emotional disorders. This cross-sectional study aimed to expand our understanding of associations between domains of anxiety sensitivity and facets of psychopathology in veterans with emotional disorders. We also determined whether social support predicted psychopathology above anxiety sensitivity domains and combat exposure and explored these relationships with a path model. METHODS One hundred and fifty-six treatment-seeking veterans with emotional disorders completed diagnostic interviews and assessments of demographics, social support, symptom measures (e.g., PTSD, depression, anxiety, and stress), and transdiagnostic risk factors (i.e., anxiety sensitivity). After data screening, 150 were included in regressions. RESULTS Using regression analyses with cross-sectional data, cognitive anxiety sensitivity concerns predicted PTSD and depression above combat exposure. Cognitive and physical concerns predicted anxiety, and cognitive and social concerns predicted stress. Above combat exposure and anxiety sensitivity, social support predicted PTSD and depression. CONCLUSION Focusing on social support in tandem with transdiagnostic mechanisms in clinical samples is critical. These findings inform transdiagnostic interventions and recommendations related to incorporation of assessment of transdiagnostic factors in clinical contexts.
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Affiliation(s)
- Jeffrey M. Pavlacic
- Mental Health Service, Ralph H. Johnson, VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychology & Behavioral, Sciences, Medical University of South, Carolina, Charleston, South Carolina, USA
| | - Sara M. Witcraft
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P. Allan
- Department of Psychiatry and Behavioral, Health, Ohio State University, Columbus, Ohio, USA
- VA Center of Excellence for Suicide, Prevention, VA Finger Lakes Healthcare, System, Canandaigua, New York, USA
| | - Daniel F. Gros
- Mental Health Service, Ralph H. Johnson, VA Healthcare System, Charleston, South Carolina, USA
- Department of Psychology & Behavioral, Sciences, Medical University of South, Carolina, Charleston, South Carolina, USA
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Makale MT, Abbasi S, Nybo C, Keifer J, Christman L, Fairchild JK, Yesavage J, Blum K, Gold MS, Baron D, Cadet JL, Elman I, Dennen CA, Murphy KT. Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans. Heliyon 2023; 9:e18943. [PMID: 37609394 PMCID: PMC10440537 DOI: 10.1016/j.heliyon.2023.e18943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Emerging data suggest that post-traumatic stress disorder (PTSD) arises from disrupted brain default mode network (DMN) activity manifested by dysregulated encephalogram (EEG) alpha oscillations. Hence, we pursued the treatment of combat veterans with PTSD (n = 185) using an expanded form of repetitive transcranial magnetic stimulation (rTMS) termed personalized-rTMS (PrTMS). In this treatment methodology spectral EEG based guidance is used to iteratively optimize symptom resolution via (1) stimulation of multiple motor sensory and frontal cortical sites at reduced power, and (2) adjustments of cortical treatment loci and stimulus frequency during treatment progression based on a proprietary frequency algorithm (PeakLogic, Inc. San Diego) identifying stimulation frequency in the DMN elements of the alpha oscillatory band. Following 4 - 6 weeks of PrTMS® therapy in addition to routine PTSD therapy, veterans exhibited significant clinical improvement accompanied by increased cortical alpha center frequency and alpha oscillatory synchronization. Full resolution of PTSD symptoms was attained in over 50% of patients. These data support DMN involvement in PTSD pathophysiology and suggest a role in therapeutic outcomes. Prospective, sham controlled PrTMS® trials may be warranted to validate our clinical findings and to examine the contribution of DMN targeting for novel preventive, diagnostic, and therapeutic strategies tailored to the unique needs of individual patients with both combat and non-combat PTSD.
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Affiliation(s)
- Milan T. Makale
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Shaghayegh Abbasi
- Department of Electrical Engineering, University of Portland, Portland, OR, 97203, USA
| | - Chad Nybo
- CrossTx Inc., Bozeman, MT, 59715, USA
| | | | | | - J. Kaci Fairchild
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Medical Center, Palo Alto, CA, 94304, USA
| | - Jerome Yesavage
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Kenneth Blum
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
- Department of Clinical Psychology and Addiction, Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Hungary
- Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH, USA
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
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Kuo J, Block T, Nicklay M, Lau B, Green M. Interventional Mental Health: A Transdisciplinary Approach to Novel Psychiatric Care Delivery. Cureus 2023; 15:e43533. [PMID: 37719598 PMCID: PMC10501497 DOI: 10.7759/cureus.43533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Mental health disorders are among the most common health conditions in the United States. Traditional clinical treatments rely on psychiatric counseling and, in many cases, prescription medications. We propose an innovative model, Interventional Mental Health, which employs a combination of modalities through a multifaceted approach to treat conditions that have exhibited limited responsiveness to traditional methods and individuals afflicted with multiple comorbidities simultaneously. We hypothesize that creating a unique treatment algorithm combining current therapeutic modalities such as Stellate Ganglion Blocks (SGB), Transcranial Magnetic Stimulation (TMS) therapy, and ketamine therapy, within a consolidated timeframe, will yield synergistic outcomes among patients presenting with comorbid post-traumatic stress disorder (PTSD), depression, and/or anxiety.
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Affiliation(s)
- Jonathann Kuo
- Regenerative and Anti-Aging Medicine, Hudson Health, New York, USA
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Nieforth LO, Craig EA, Behmer VA, Wadsworth SM, O’Haire ME. PTSD service dogs foster resilience among veterans and military families. CURRENT PSYCHOLOGY 2023; 42:13207-13219. [PMID: 37583981 PMCID: PMC10424767 DOI: 10.1007/s12144-021-01990-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
Military deployment and reintegration challenges permeate the lives and relationships of Veterans, their spouses, and their families. Among these challenges, 23% of post-9/11 Veterans have been diagnosed with posttraumatic stress disorder (PTSD). Psychiatric service dogs have been found to help clinically alleviate PTSD symptoms when used as a complementary intervention. However, minimal research exists that explores the role of the service dog as a mechanism for cultivating resilience within the military family system. Researchers utilized a qualitative, constant comparative approach to analyze self-reported experiences of 101 individuals, including Veterans (n = 67) and their spouses (n = 34). Analyzed through the framework of the Theory of Resilience and Relational Load (Afifi et al., 2016), findings suggest complex communication processes that facilitate relational and family adaptation. These processes encompassed (a) the role of the service dog in building emotional reserves, (b) relational load introduced when caring for the service dog, and (c) the service dog's facilitation of relational maintenance behaviors among family members that contributed to communal orientation. Based on the results of this qualitative analysis, researchers suggest educational interventions where service dog trainers and mental health practitioners can incorporate relational maintenance strategies and family-focused approaches to integrating service dogs as military family members.
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Affiliation(s)
- Leanne O. Nieforth
- Center for the Human Animal Bond, College of Veterinary Medicine, Purdue University, 725 Harrison St CPB/VPTH, West Lafayette, IN 47906, USA
| | - Elizabeth A. Craig
- Department of Communication, North Carolina State University, Raleigh, NC, USA
| | - Virginia A. Behmer
- Center for the Human Animal Bond, College of Veterinary Medicine, Purdue University, 725 Harrison St CPB/VPTH, West Lafayette, IN 47906, USA
| | | | - Marguerite E. O’Haire
- Center for the Human Animal Bond, College of Veterinary Medicine, Purdue University, 725 Harrison St CPB/VPTH, West Lafayette, IN 47906, USA
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Makunts T, Dahill D, Jerome L, de Boer A, Abagyan R. Concomitant medications associated with ischemic, hypertensive, and arrhythmic events in MDMA users in FDA adverse event reporting system. Front Psychiatry 2023; 14:1149766. [PMID: 37275981 PMCID: PMC10233020 DOI: 10.3389/fpsyt.2023.1149766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
3,4-Methylenedioxymethamphetamine (MDMA) is currently being investigated as an adjunctive treatment to therapy for posttraumatic stress and other anxiety related disorders in clinical trials. Within the next few years MDMA-assisted therapy is projected for approval by regulatory authorities. MDMA's primary mechanism of action includes modulation of monoamine signaling by increasing release and inhibiting reuptake of serotonin, norepinephrine, and, to a lesser extent, dopamine. This pharmacology affects sympathomimetic physiology. In controlled trials, special attention has been given to cardiovascular adverse events (AEs), because transient increases in heart rate and blood pressure have been observed during the MDMA-assisted therapy sessions. Finding and quantifying the potential drivers of cardiac AEs in clinical trials is difficult since only a relatively small number of participants have been included in these studies, and a limited set of allowed concomitant drugs has been studied. In this study a more diverse set of reports from the FDA Adverse Event Reporting System was surveyed. We found 17 cases of cardiovascular AEs, in which the individuals had taken one or more substances in addition to MDMA. Interestingly, all of those concomitant medications and illicit substances, including opioids, stimulants, anticholinergics, and amphetamines, had been previously associated with cardiovascular AEs. Furthermore, in none of the reports MDMA was marked as the primary suspect.
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Affiliation(s)
- Tigran Makunts
- MAPS Public Benefit Corporation, San Jose, CA, United States
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
| | - Diane Dahill
- MAPS Public Benefit Corporation, San Jose, CA, United States
| | - Lisa Jerome
- MAPS Public Benefit Corporation, San Jose, CA, United States
| | | | - Ruben Abagyan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
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Sullivan-Baca E, Rehman R, Towne AR, Haneef Z. Psychiatric co-morbidity of drug-resistant epilepsy in Veterans. Epilepsy Behav 2023; 139:109059. [PMID: 36577335 DOI: 10.1016/j.yebeh.2022.109059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Psychiatric conditions are frequently co-morbid in epilepsy and studies examining Veterans with epilepsy suggest this population may present with unique psychiatric and clinical features Drug-resistant epilepsy (DRE) may confer a greater risk of psychiatric dysfunction; however, there is a paucity of literature documenting this. To expand our clinical understanding of Veterans with DRE, we assessed a comprehensive Veterans Health Administration (VHA)-wide sample, describing psychiatric conditions, medications, and healthcare utilization. METHODS Psychiatric and hospitalization data were collected on 52,579 Veterans enrolled in VHA healthcare between FY2014-2ndQtr.FY2020 from the VHA Corporate Data Warehouse administrative data. Data examined include psychiatric diagnosis, psychotropic medication use, and utilization of hospital services. RESULTS At least one psychiatric diagnosis was present in 70.2% of patients, while 49.8% had two or more diagnoses. Depression (51.7%), posttraumatic stress disorder (PTSD) (38.8%), and anxiety (38.0%) represented the most common psychiatric co-morbidities. Psychiatric medication use was present in 73.3%. Emergency room (ER) visits were highest in those with suicidality (mean 14.9 visits), followed by bipolar disorder (10.3), and schizophrenia (12.1). Psychiatric-related hospitalizations were highest for schizophrenia (mean 2.5 admissions) and bipolar disorder (2.3). Females had more psychiatric diagnoses (2.4 vs. 1.6, p < 0.001), psychiatric medications (3.4 vs. 2.3, p < 0.001), and ER utilization than males (6.9 vs. 5.5, p < 0.001). SIGNIFICANCE A substantial psychiatric burden exists among Veterans with DRE. Compared to prior epilepsy literature, results suggest that Veterans with DRE evidence more prevalent psychiatric comorbidity, emergency care usage, and inpatient psychiatric admissions. Females were especially impacted, with greater rates of psychiatric conditions and treatment. Considering the relationship of psychiatric comorbidities in epilepsy with psychosocial functioning and quality of life, our findings highlight the need for screening and provision of services for those with DRE.
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Affiliation(s)
- Erin Sullivan-Baca
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Rizwana Rehman
- Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, United States; Epilepsy Centers of Excellence, Veteran's Health Administration, United States.
| | - Alan R Towne
- Epilepsy Centers of Excellence, Veteran's Health Administration, United States; Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Epilepsy Centers of Excellence, Hunter Holmes McGuire VA Medical Center, United States.
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Epilepsy Centers of Excellence, Veteran's Health Administration, United States; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States.
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Pierce B, Kirsh T, Ferguson AR, Neylan TC, Ma S, Kummerfeld E, Cohen BE, Nielson JL. Causal discovery replicates symptomatic and functional interrelations of posttraumatic stress across five patient populations. Front Psychiatry 2023; 13:1018111. [PMID: 36793783 PMCID: PMC9924232 DOI: 10.3389/fpsyt.2022.1018111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/30/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction Approximately half of individuals with posttraumatic stress disorder (PTSD) may meet criteria for other psychiatric disorders, and PTSD symptoms are associated with diminished health and psychosocial functioning. However, few studies examine the longitudinal progression of PTSD symptoms concurrent with related symptom domains and functional outcomes, such that may neglect important longitudinal patterns of symptom progression beyond PTSD specifically. Methods Therefore, we used longitudinal causal discovery analysis to examine the longitudinal interrelations among PTSD symptoms, depressive symptoms, substance abuse, and various other domains of functioning in five longitudinal cohorts representing veterans (n = 241), civilians seeking treatment for anxiety disorders (n = 79), civilian women seeking treatment for post-traumatic stress and substance abuse (n = 116), active duty military members assessed 0-90 days following TBI (n = 243), and civilians with a history of TBI (n = 43). Results The analyses revealed consistent, directed associations from PTSD symptoms to depressive symptoms, independent longitudinal trajectories of substance use problems, and cascading indirect relations from PTSD symptoms to social functioning through depression as well as direct relations from PTSD symptoms to TBI outcomes. Discussion Our findings suggest PTSD symptoms primarily drive depressive symptoms over time, tend to show independence from substance use symptoms, and may cascade into impairment in other domains. The results have implications for refining conceptualization of PTSD co-morbidity and can inform prognostic and treatment hypotheses about individuals experiencing PTSD symptoms along with co-occurring distress or impairment.
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Affiliation(s)
- Benjamin Pierce
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Thomas Kirsh
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Adam R. Ferguson
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Beth E. Cohen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica L. Nielson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
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12
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Patel TA, Grubaugh AL, Cougle JR. Demographic and clinical correlates of social anxiety disorder among US veterans: findings from the NESARC-III study. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02420-4. [PMID: 36680574 DOI: 10.1007/s00127-023-02420-4] [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: 08/26/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Social anxiety disorder (SAD) is among the most highly prevalent and debilitating psychiatric disorders within the US population, but SAD has gone relatively unnoticed within the US veteran population. Preliminary research has demonstrated that SAD is related to decreased mental and physical functioning as well as posttraumatic stress disorder (PTSD) and depression among veterans. METHODS The present study investigated SAD and its relationship with demographic factors, psychiatric disorders, suicidality, treatment seeking, and social support among veterans. Multivariate survey weighted logistic regression analyses were conducted to observe these associations utilizing data from National Epidemiologic Survey on Alcohol and Related Conditions which contained data on 3119 veterans. RESULTS SAD was found to be strongly related to PTSD and other anxiety disorder, and these disorders were related to increased treatment seeking for SAD. Further, SAD was associated with lifetime suicide attempts and decreased perceived social support in multivariate models adjusting for demographic factors and psychiatric comorbidities. CONCLUSION This study highlights the relationships of SAD among veterans by demonstrating its associations with other psychiatric disorders, treatment seeking, suicide attempts, and social support. A deeper understanding of the impact of SAD within the veteran population will inform future prevention and treatment efforts.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL, 32304, USA
| | - Anouk L Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL, 32304, USA.
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13
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Bhattacharya S, Goicoechea C, Heshmati S, Carpenter JK, Hofmann SG. Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-Analysis of Recent Literature. Curr Psychiatry Rep 2023; 25:19-30. [PMID: 36534317 PMCID: PMC9834105 DOI: 10.1007/s11920-022-01402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Effective treatment of anxiety-related disorders is crucial, considering the prevalence of such disorders and their association with poor psychosocial functioning. To evaluate the most recent evidence on the efficacy of cognitive behavioral therapy (CBT) for anxiety-related disorders in adults, we conducted a meta-analysis of randomized placebo-controlled trials published since 2017. RECENT FINDINGS Ten studies with a total of 1250 participants met the inclusion criteria. Seven of these studies examined PTSD. The findings demonstrated small placebo-controlled effects of CBT on target disorder symptoms (Hedges' g = 0.24, p < 0.05) and depression (Hedges' g = 0.15, p = n.s). When examining only PTSD studies, effects were reduced (Hedges' g = 0.14, p < 0.05). Heterogeneity in most analyses was very low, and no publication bias was found. Effect sizes from placebo-controlled trials from the past 5 years appear to be smaller than those in prior meta-analyses. The findings are largely driven by research on PTSD, with few placebo-controlled trials of other anxiety-related disorders published since 2017.
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Affiliation(s)
- Shalini Bhattacharya
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Carmen Goicoechea
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Saeideh Heshmati
- Department of Psychology, Claremont Graduate University, Claremont, CA USA
| | - Joseph K. Carpenter
- National Center for PTSD Women’s Health Sciences Division, VA Boston Healthcare System, Boston, MA USA ,Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Stefan G. Hofmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany ,Department of Psychological and Brain Sciences, Boston University, Boston, MA USA
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14
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Mallory JB, Ponder WN, Sherrill T, Carbajal J, Schuman DL, Jetelina KK, Stafford J. The Impact of COVID-19 on Veterans’ Resilience, Attachment, and Negative Affect. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Patel TA, Schubert FT, Hom MA, Cougle JR. Correlates of treatment seeking in individuals with social anxiety disorder: Findings from a nationally representative sample. J Anxiety Disord 2022; 91:102616. [PMID: 36007388 DOI: 10.1016/j.janxdis.2022.102616] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/23/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Despite the availability of well-established and efficacious treatments for social anxiety disorder, most socially anxious individuals do not seek treatment and those who do often suffer for years before seeking treatment. A more comprehensive understanding of the factors related to treatment seeking for social anxiety disorder is needed. This study utilized the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a large representative U.S. adult sample, to examine the relationships between treatment seeking for social anxiety disorder and demographic characteristics, psychiatric comorbidities, social anxiety disorder symptomatology, and specific feared situations. Socially anxious individuals (n = 1,255) were identified using DSM-V criteria and treatment seeking was measured by either seeking help from a professional or being prescribed medication for social anxiety disorder symptoms. Results indicate key relationships between treatment seeking and age as well as comorbid anxiety disorders. Importantly, this study found that specific feared situations such as fear of small groups (AOR = 1.78) and speaking in social gatherings (AOR = 1.66), and specific social anxiety disorder symptoms such as panic attacks (AOR = 2.92) were significantly and uniquely associated with increased treatment seeking for social anxiety disorder.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Melanie A Hom
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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16
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Patel P, Kennedy A, Carr S, Gillard S, Harris P, Sweeney A. Service user experiences of mental health assessments: a systematic review and thematic synthesis of qualitative literature. J Ment Health 2022:1-14. [PMID: 35965480 DOI: 10.1080/09638237.2022.2069691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Successive governments have placed service users' experiences at the heart of mental health services delivery and development. However, little is known about service users' experiences of assessments and there is some evidence that assessments can cause harm. AIMS To synthesise the qualitative literature on service users' experiences of undergoing mental health service assessments. METHODS Literature was systematically searched, screened and extracted, following PRISMA guidelines. Several search strategies were employed, including electronic database searches, handsearching, and forward and backward citation tracking, to identify literature which contained data on service users' experiences of mental health assessments. Thematic synthesis was used to derive a set of themes underpinning these experiences. RESULTS Of the 10,137 references screened, 47 were identified as relevant to the review. Two main themes were identified: the importance of humanising assessment processes and experiences of service user agency, with each theme containing four sub-themes. CONCLUSIONS Findings highlight key factors determining service user experience. We identify key practice implications, contextualised within the literature on trauma-informed approaches and conclude that trauma-informed approaches may aid understanding and improvement of people's assessment experiences. Further research into the experiences of people from Black and minority ethnic communities is indicated.
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Affiliation(s)
- Paras Patel
- Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Angela Kennedy
- Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Sarah Carr
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, England
| | - Steve Gillard
- Centre for Mental Health Research, City, University of London, London, UK
| | - Poppy Harris
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Angela Sweeney
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, England
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17
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Žuljević MF, Vidak M, Vukojević J, Hren D, Poklepovic Pericic T. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD) in adults. Hippokratia 2022. [DOI: 10.1002/14651858.cd015345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Marin Vidak
- Department of Research in Biomedicine and Health; University of Split School of Medicine; Split Croatia
| | | | - Darko Hren
- Department of Psychology; Faculty of Humanities and Social Sciences; Split Croatia
| | - Tina Poklepovic Pericic
- Department of Research in Biomedicine and Health; University of Split School of Medicine; Split Croatia
- Cochrane Croatia; University of Split School of Medicine; Split Croatia
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18
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Mellor R, Saunders-Dow E, Mayr HL. Scope of Use and Effectiveness of Dietary Interventions for Improving Health-Related Outcomes in Veterans: A Systematic Review. Nutrients 2022; 14:nu14102094. [PMID: 35631235 PMCID: PMC9147269 DOI: 10.3390/nu14102094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 01/13/2023] Open
Abstract
Military veterans often have numerous physical and mental health conditions and can face unique challenges to intervention and management. Dietary interventions can improve the outcomes in many health conditions. This study aimed to evaluate the scope of health conditions targeted with dietary interventions and the effectiveness of these interventions for improving health-related outcomes in veterans. A systematic literature review was performed following PRISMA guidelines to identify and evaluate studies related to veterans and dietary interventions. Five electronic databases were searched, identifying 2669 references. Following screening, 35 studies were evaluated, and 18 were related to a US national veteran weight-loss program. The included studies were critically appraised, and the findings were narratively synthesized. Study designs ranged from randomised controlled trials to cohort studies and were predominantly U.S. based. The intervention durations ranged from one to 24 months. The mean subject age ranged from 39.0 to 69.7 years, with often predominantly male participants, and the mean body mass index ranged from 26.4 to 42.9 kg/m2. Most dietary interventions for veterans were implemented in populations with overweight/obesity or chronic disease and involved single dietary interventions or dietary components of holistic lifestyle interventions. The most common primary outcome of interest was weight loss. The success of dietary interventions was generally moderate, and barriers included poor compliance, mental health conditions and large drop-out rates. The findings from this review illustrate the need for further refinement of dietary and lifestyle interventions for the management of veterans with chronic health conditions.
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Affiliation(s)
- Rebecca Mellor
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, QLD 4021, Australia;
- Correspondence:
| | - Elise Saunders-Dow
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, QLD 4021, Australia;
| | - Hannah L. Mayr
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia;
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD 4102, Australia
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19
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Fear of Sleep Inventory- Short Form (FoSI-SF): A validation study for Turkish speaking populations. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Gran-Ruaz SM, Taylor RJ, Jacob G, Williams MT. Lifetime Trauma Exposure and Posttraumatic Stress Disorder Among African Americans and Black Caribbeans by Sex and Ethnicity. Front Psychiatry 2022; 13:889060. [PMID: 35800025 PMCID: PMC9253828 DOI: 10.3389/fpsyt.2022.889060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a debilitating disorder requiring timely diagnosis and treatment, with special attention needed for Black populations in the U.S. Yet, stakeholders often fail to recognize Black communities' heterogeneous ethnic composition, thus not allowing diverse sociocultural realities to inform PTSD interventions. This study aims to characterize sex and ethnic differences in lifetime trauma exposure, lifetime PTSD diagnosis and symptoms, and help-seeking among the African Americans and Black Caribbeans in the U.S. METHOD This study relied on data from the National Survey of American Life 2001-2003 (NSAL) to investigate the lifetime exposure to traumatic events and prevalence of a clinical PTSD diagnosis based on the DSM-IV among African American (n = 3,570) and Black Caribbean (n = 1,623) adults. 44.5% of respondents were men and 55.5% were women. Logistic regression was utilized to investigate the impact of traumatic events on PTSD. RESULTS Several ethnic and sex differences in exposure to potentially traumatic events were identified. African American respondents were more likely to experience spousal abuse and toxin exposure than their Black Caribbean counterparts. Black Caribbeans reported higher lifetime exposure to muggings, natural disasters, harsh parental discipline, being a civilian living in terror and/or being a refugee than African American respondents. Specific to sex, Black men reported more events of combat, a peacekeeper/relief worker, being mugged, toxin exposure, seeing atrocities, and/or injuring someone. Black women were more likely to have been rape/sexual assault and/or intimate partner violence victims. The assaultive violence trauma type was most predictive of lifetime PTSD diagnosis among Black Americans. African American women were more likely to report PTSD symptoms than men, with almost no significant differences in Black Caribbean men and women. Approximately half of Black Americans sought help for their worst traumatic event, commonly engaging family/friends, psychiatrists, and mental health professionals. Further, there were almost no ethnic and sex differences related to professional and non-professional help sought. CONCLUSION Future PTSD-related research should aim to characterize the heterogenous experiences of potentially traumatic events within different Black communities. Clinicians working with Black clients should strive to understand the limitations within their tools/interventions in meeting the needs of diverse groups.
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Affiliation(s)
| | | | - Grace Jacob
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Monnica T Williams
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,School of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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21
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Leekoff M, Culpepper W, Jin S, Lee-Wilk T, Wallin M. Impact of comorbid post traumatic stress disorder on multiple sclerosis in military veterans: A population-based cohort study. Mult Scler 2021; 28:1257-1266. [PMID: 34854320 DOI: 10.1177/13524585211058361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS). OBJECTIVES To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort. METHODS Military Veterans with MS and PTSD prior to symptom onset (MSPTSD, n = 96) were identified using the Department of Veterans Affairs MS databases. MSPTSD cases were matched to MS controls without PTSD (n = 95). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019. RESULTS The mean annualized relapse rate was greater in the MSPTSD group versus controls (0.23 vs 0.06, respectively; p < 0.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; p < 0.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5 years, p < 0.05) in relapsing MS patients with PTSD. CONCLUSION Patients with MSPTSD have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.
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Affiliation(s)
- Mark Leekoff
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA/Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Culpepper
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA/Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shan Jin
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA /Department of Neurology,School of Medicine,University of Maryland,Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terry Lee-Wilk
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA /Department of Neurology,School of Medicine,University of Maryland,Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mitchell Wallin
- Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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22
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Coenen P, van der Molen HF. What work-related exposures are associated with post-traumatic stress disorder? A systematic review with meta-analysis. BMJ Open 2021; 11:e049651. [PMID: 34433603 PMCID: PMC8388294 DOI: 10.1136/bmjopen-2021-049651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although there is evidence that work-related exposures cause post-traumatic stress disorder (PTSD), there are few quantitative studies assessing the degree to which these factors contribute to PTSD. This systematic review with meta-analysis identified work-related exposures associated with PTSD, and quantified their contribution to this disorder. METHODS We searched Medline, PsycINFO, Embase, PILOTS and Web of Science (2005-10 September 2019) for longitudinal studies on work-related exposures and PTSD. We described included articles, and conducted meta-analyses for exposures with sufficient homogeneous information. We performed subgroup analyses for risk of bias, study design and PTSD ascertainment. We assessed evidence quality using Grades of Recommendations, Assessment, Development and Evaluation, and estimated population attributable fractions. RESULTS After screening 8590 records, we selected 33 studies (n=5 719 236). From what was moderate quality evidence at best, we identified various work-related exposures that were associated with PTSD, mainly involving individuals in the military and first responder (eg, police or fire brigade) occupations. These exposures included the number of army deployments (OR: 1.15 (95% CI 1.14 to 1.16)), combat exposure (OR 1.89 (95% CI 1.46 to 2.45)), army deployment (OR 1.79 (95% CI 1.45 to 2.21)) and confrontation with death (OR 1.63 (95% CI 1.41 to 1.90)). Effects were robust across subgroups and exposures attributed modestly (7%-34%) to PTSD. We identified additional exposures in other occupations, including life threats, being present during an attack, and hearing about a colleague's trauma. CONCLUSIONS We identified various work-related exposures associated with PTSD and quantified their contribution. While exposure assessment, PTSD ascertainment and inconsistency may have biased our findings, our data are of importance for development of preventive interventions and occupational health guidelines.
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Affiliation(s)
- Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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The hidden burden of social anxiety disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Affect Disord 2021; 291:9-14. [PMID: 34022553 DOI: 10.1016/j.jad.2021.04.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/08/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a chronic and disabling psychiatric disorder associated with low levels of help-seeking. To date, however, scarce research has examined the epidemiology of SAD in veterans. This study examined the prevalence, comorbidities and incremental burden of SAD in relation to suicidality and functioning in a representative sample of U.S. military veterans. METHODS A nationally representative sample of 3,157 U.S. veterans completed a web survey containing measures of SAD symptoms, trauma history, psychiatric history and functioning. Multivariable analyses were conducted to examine associations between SAD and psychiatric comorbidities, suicidality and functioning. RESULTS A total 9.5% (n = 272) of the sample screened positive for lifetime SAD. Veterans with SAD were more likely than those without SAD to be younger, female, single, racial/ethnic minorities and to have experienced childhood abuse. They also had substantially elevated rates of comorbid psychiatric disorders, particularly lifetime major depression (odds ratio [OR]=5.8) and posttraumatic stress disorder (OR=3.1), as well as current suicidal ideation (OR=3.3). Veterans with SAD scored lower on measures of functioning, particularly social, emotional and mental health functioning (d's=0.21-0.34). LIMITATIONS Data were collected cross-sectionally using self-report. CONCLUSIONS SAD in U.S. veterans is prevalent and associated with psychiatric comorbidities, functional impairment and a more than 3-fold greater risk for suicidal ideation . Given that SAD is associated with low treatment seeking and engagement, it may be undetected and undertreated relative to other psychiatric morbidities. These results underscore the importance of screening, monitoring and treating SAD in this population along with other prevalent mental disorders.
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24
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Gibert L, El Hage W, Verdonk C, Levy B, Falissard B, Trousselard M. The negative association between trait mindfulness and post-traumatic stress disorder: A 4.5-year prospective cohort study. Brain Behav 2021; 11:e02163. [PMID: 34363334 PMCID: PMC8413811 DOI: 10.1002/brb3.2163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to investigate the association between trait mindfulness and PTSD over a period of 54 months. The secondary objective is to provide an exhaustive description of PTSD trajectories after the Bataclan attack. METHODS We designed a prospective cohort study of 133 subjects present in the Bataclan concert hall during the November 2015 terrorist attack in Paris, France. Data were recorded 6, 18, 30, and 54 months after the attack. The primary endpoint was evaluated using the PTSD Check List Scale. Trait mindfulness was measured by the 14-item Freiburg Mindfulness Inventory. RESULTS FMI scores were consistently, significantly, and negatively associated with PCL-5 scores. Adjusted odds ratios were at 0.81 (6 months), 0.88 (18 months) 0.82 (30 months), and 0.81 (54 months). PTSD prevalence 6 months after the event was 77%; it remained at 41% after 54 months. PTSD status of subjects is fluctuating. Latent class analysis divided the cohort into 3 groups: 21% of subject who remained below PTSD threshold throughout, 30% who remained above throughout, and 49% who steadily reduced their PTSD scores over time. CONCLUSION In our cohort, mindfulness is negatively associated with PTSD. Mindfulness programs are designed to improve global resilience and treat anxiety and mood disorders. Further research is needed to investigate if improving trait mindfulness is possible and beneficial for patients suffering from PTSD.
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Affiliation(s)
- Lionel Gibert
- IRBA: Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.,INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre Hospitalier Universitaire Paul Brousse, Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD, Villejuif, France
| | - Wissam El Hage
- INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre Hospitalier Universitaire de Tours, Tours, France
| | - Charles Verdonk
- IRBA: Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
| | - Bernard Levy
- INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Bruno Falissard
- INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Marion Trousselard
- IRBA: Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
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25
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Pregnancy and Binge Drinking: An Intersectionality Theory Perspective Using Veteran Status and Racial/Ethnic Identity. Matern Child Health J 2021; 25:1345-1351. [PMID: 33945080 DOI: 10.1007/s10995-021-03171-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Alcohol use during pregnancy is a critical public health issue that results in several adverse outcomes for both mother and child. While the prevalence of and consequences of binge drinking among pregnant women is well-documented in the literature, little is known about the intersectional effect of racial/ethnic identity and veteran status. The purpose of this study was to examine the prevalence of binge drinking among pregnant women using the intersectionality of racial/ethnic identity and veteran status. METHODS This study utilized combined data from the 2016, 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a telephone survey that collects health-related risk behaviors, chronic health conditions and use of preventative services among U.S residents. Generalized linear mixed models were used to examine the prevalence of binge drinking using the interaction between race/ethnicity and veteran status. RESULTS Overall binge drinking prevalence was 3.60% among the sample of 6101 pregnant women. Binge drinking prevalence was the highest among racial/ethnic minority veterans at 17.42%, compared to 5.34% among white veterans, 4.05% among non-veteran racial/ethnic minorities and 3% among non-veteran whites, supporting the theory of intersectionality. CONCLUSIONS Intersectionality Theory suggests that the stressors from membership in two vulnerable groups may lead to increased disparities. The results of this study highlight the unique experience of being a veteran and identifying as a member of a racial/ethnic minority group. This calls for a need to customize preventative measures that address the combined impact of both racial/ethnic minority group status and veteran status.
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McCunn P, Richardson JD, Jetly R, Dunkley B. Diffusion Tensor Imaging Reveals White Matter Differences in Military Personnel Exposed to Trauma with and without Post-traumatic Stress Disorder. Psychiatry Res 2021; 298:113797. [PMID: 33582526 DOI: 10.1016/j.psychres.2021.113797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a debilitating mental health condition that develops in response to exposure to a traumatic event. The purpose of this study was to investigate white matter differences using diffusion tensor imaging (DTI) in trauma exposed military personnel with and without PTSD. METHODS Data were acquired in compliance with the Hospital for Sick Children and Canadian Armed Forces Research Ethics Boards for the following groups: military personnel with PTSD (PTSD, n = 23), trauma exposed military personnel with no PTSD diagnosis (TE, n = 25) and civilian controls (CC, n =13) . All participants were male. DTI was acquired on a Siemens Trio 3T MRI. Maps of Fractional Anisotropy (FA), Mean Diffusivity (MD), Axial Diffusivity (AD), and Radial Diffusivity (RD) were analyzed using Tract-Based Spatial Statistics (TBSS). RESULTS In the PTSD and TE groups, FA was significantly greater within the hippocampus, corpus callosum, cingulum, and several associated white matter tracts. Elevated FA was shown to be largely due to reduced RD suggesting a possible structural substrate that underscores neurophysiological connectivity. CONCLUSIONS This study reinforces previous findings showing differences in DTI metrics within the limbic system in military personnel exposed to trauma with and without PTSD.
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Affiliation(s)
- Patrick McCunn
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario.
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario; Department of Psychiatry, Western University, London, Ontario; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario; Operational Stress Injury Clinic, St. Joseph's Health Care, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces Health Services Group HQ, Department of National Defence, Ottawa, Ontario
| | - Benjamin Dunkley
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario; Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, Ontario; Department of Medical Imaging, University of Toronto, Toronto, Ontario
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McDonald SE, O’Connor KE, Matijczak A, Tomlinson CA, Applebaum JW, Murphy JL, Zsembik BA. Attachment to Pets Moderates Transitions in Latent Patterns of Mental Health Following the Onset of the COVID-19 Pandemic: Results of a Survey of U.S. Adults. Animals (Basel) 2021; 11:ani11030895. [PMID: 33801041 PMCID: PMC8004029 DOI: 10.3390/ani11030895] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The COVID-19 pandemic has contributed to elevated rates of mental health problems and distress among the U.S. population. Pets may be an important source of social support to combat social isolation. This cross-sectional study used latent profile analysis to identify subgroups of U.S. pet owners based on their perceived mental health symptoms prior to and after the onset of the pandemic. Latent transition analysis was used to determine the stability of subgroup membership and examine the effect of attachment to pets on transition probabilities. Five subgroups were identified: low symptoms, mild symptoms, moderate symptoms, high symptoms, and severe symptoms. Evidence of moderation was found, X2(16) = 41.47, p = 0.04. Specifically, results indicated that attachment to pets functioned as a protective factor for individuals exhibiting moderate and high levels of mental health symptoms, as above average attachment to pets was associated with greater odds of transitioning to a less severe symptom profile. However, individuals with severe symptom profiles and high attachment to pets fared worst in the context of COVID-19 restrictions. This study has important implications for future research investigating the role of pets on mental health and for those providing services to pet owners during the COVID-19 pandemic. Abstract This cross-sectional study examined whether, and to what extent, attachment to pets was associated with changes in latent patterns of adults’ perceived mental health symptoms during the COVID-19 pandemic (n = 1942). We used latent transition analysis to determine the stability of subgroup membership pre- and post-COVID and the effect of attachment to pets on transition probabilities. Mental health before COVID-19 was measured retrospectively. Five subgroups were identified: low symptoms, mild symptoms, moderate symptoms, high symptoms, and severe symptoms. Among individuals in the moderate and high symptoms subgroups, those who reported high attachment to pets generally had greater odds of transitioning to a less severe symptom profile (OR = 2.12) over time than those with low attachment to pets (OR = 1.39). However, those who had a severe symptom profile and high attachment to pets had lower odds of transitioning to a less severe symptom profile (OR = 0.30) and higher odds of maintaining a severe symptom profile (OR = 3.33) than those with low attachment to pets. These findings suggest that the protective and risk effects of attachment to pets differ based on individuals’ psychological symptom patterns across multiple indicators. We discuss the implications of these findings for research, policy, and practice.
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Affiliation(s)
- Shelby E. McDonald
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave, Richmond, VA 23284, USA; (A.M.); (C.A.T.); (J.L.M.)
- Correspondence:
| | - Kelly E. O’Connor
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., Richmond, VA 23284, USA;
| | - Angela Matijczak
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave, Richmond, VA 23284, USA; (A.M.); (C.A.T.); (J.L.M.)
| | - Camie A. Tomlinson
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave, Richmond, VA 23284, USA; (A.M.); (C.A.T.); (J.L.M.)
| | - Jennifer W. Applebaum
- Department of Sociology and Criminology & Law, University of Florida, 3219 Turlington Hall, Gainesville, FL 32611, USA; (J.W.A.); (B.A.Z.)
| | - Jennifer L. Murphy
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave, Richmond, VA 23284, USA; (A.M.); (C.A.T.); (J.L.M.)
| | - Barbara A. Zsembik
- Department of Sociology and Criminology & Law, University of Florida, 3219 Turlington Hall, Gainesville, FL 32611, USA; (J.W.A.); (B.A.Z.)
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28
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Makunts T, Jerome L, Abagyan R, de Boer A. Reported Cases of Serotonin Syndrome in MDMA Users in FAERS Database. Front Psychiatry 2021; 12:824288. [PMID: 35140642 PMCID: PMC8820588 DOI: 10.3389/fpsyt.2021.824288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
3,4-Methylenedioxymethamphetamine (MDMA), is investigated as a treatment for post-traumatic stress disorder and other anxiety-related conditions in multiple placebo-controlled and open label studies. MDMA-assisted therapy is projected for approval by the United States Food and Drug Administration (FDA) and other regulatory agencies worldwide within the next few years. MDMA is a monoamine releaser and uptake inhibitor affecting serotonin, potentially increasing the risk of serotonin syndrome (SS). No instances of SS have occurred in clinical trials. The relatively small number of patients in controlled trials warranted a survey of FDA Adverse Event Reporting System data for the occurrence of SS in a larger database. We found 20 SS cases in people exposed to MDMA, all of which had also taken one or more substances with serotonergic properties in addition to MDMA, including amphetamines, stimulants, and opioids. There were no cases of SS associated with MDMA where MDMA was the sole reported compound taken.
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Affiliation(s)
- Tigran Makunts
- MAPS Public Benefit Corporation, San Jose, CA, United States.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
| | - Lisa Jerome
- MAPS Public Benefit Corporation, San Jose, CA, United States
| | - Ruben Abagyan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
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29
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Yuan Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, Cheung T, Jackson T, Jiang GQ, Xiang YT. Prevalence of Post-traumatic Stress Symptoms and Its Associations With Quality of Life, Demographic and Clinical Characteristics in COVID-19 Survivors During the Post-COVID-19 Era. Front Psychiatry 2021; 12:665507. [PMID: 34093279 PMCID: PMC8176302 DOI: 10.3389/fpsyt.2021.665507] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The prevalence of post-traumatic stress symptoms (PTSS) in COVID-19 survivors is unclear. This study examined the prevalence of PTSS and its association with quality of life (QOL) among COVID-19 survivors during the post-COVID-19 era in China. Methods: This was a comparative, cross-sectional study. PTSS, depressive symptoms, and QOL were assessed with standardized instruments. Results: A total of 134 COVID-19 survivors and 214 non-infected controls (healthy controls hereafter) were recruited. Among COVID-19 survivors, the PTSS prevalence was 18.66% (95%CI: 11.98-25.34%), which was significantly higher than that (5.61%, 95%CI: 2.50-8.71%) of healthy controls (P < 0.001). After controlling for covariates, an analysis of covariance (ANCOVA) showed that COVID-19 survivors had a higher PTSS total score than did healthy controls [F (1,348) = 4.664, P = 0.032]. A separate ANCOVA revealed there were no significant differences in overall QOL between COVID-19 survivors with and without PTSS [F (1,348) = 1.067, P = 0.304]. A multiple logistic regression analysis showed that more severe depressive symptoms were significantly associated with PTSS in COVID-19 survivors (OR = 1.425, P < 0.001). Conclusions: PTSS were more severe in COVID-19 survivors compared to healthy controls in the post-COVID-19 era. Considering their negative impact on daily life and functional outcomes, regular assessment and appropriate treatments of PTSS should be conducted in COVID-19 survivors.
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Affiliation(s)
- Yuan Yuan
- Chongqing Mental Health Center, Chongqing, China
| | - Zi-Han Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders, School of Mental Health, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.,The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders, School of Mental Health, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.,The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macau, China
| | | | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
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30
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Loupy KM, Cler KE, Marquart BM, Yifru TW, D'Angelo HM, Arnold MR, Elsayed AI, Gebert MJ, Fierer N, Fonken LK, Frank MG, Zambrano CA, Maier SF, Lowry CA. Comparing the effects of two different strains of mycobacteria, Mycobacterium vaccae NCTC 11659 and M. vaccae ATCC 15483, on stress-resilient behaviors and lipid-immune signaling in rats. Brain Behav Immun 2021; 91:212-229. [PMID: 33011306 PMCID: PMC7749860 DOI: 10.1016/j.bbi.2020.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
Stress-related disorders, such as posttraumatic stress disorder (PTSD), are highly prevalent and often difficult to treat. In rodents, stress-related, anxiety-like defensive behavioral responses may be characterized by social avoidance, exacerbated inflammation, and altered metabolic states. We have previously shown that, in rodents, subcutaneous injections of a heat-killed preparation of the soil-derived bacterium Mycobacterium vaccae NCTC 11659 promotes stress resilience effects that are associated with immunoregulatory signaling in the periphery and the brain. In the current study, we sought to determine whether treatment with a heat-killed preparation of the closely related M. vaccae type strain, M. vaccae ATCC 15483, would also promote stress-resilience in adult male rats, likely due to biologically similar characteristics of the two strains. Here we show that immunization with either M. vaccae NCTC 11659 or M. vaccae ATCC 15483 prevents stress-induced increases in hippocampal interleukin 6 mRNA expression, consistent with previous studies showing that M. vaccae NCTC 11659 prevents stress-induced increases in peripheral IL-6 secretion, and prevents exaggeration of anxiety-like defensive behavioral responses assessed 24 h after exposure to inescapable tail shock stress (IS) in adult male rats. Analysis of mRNA expression, protein abundance, and flow cytometry data demonstrate overlapping but also unique effects of treatment with the two M. vaccae strains on immunological and metabolic signaling in the host. These data support the hypothesis that treatment with different M. vaccae strains may immunize the host against stress-induced dysregulation of physiology and behavior.
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Affiliation(s)
- Kelsey M Loupy
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Kristin E Cler
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Brandon M Marquart
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Tumim W Yifru
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Heather M D'Angelo
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Mathew R Arnold
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Ahmed I Elsayed
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Matthew J Gebert
- Department of Ecology and Evolutionary Biology, Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, CO 80309, USA; Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Noah Fierer
- Department of Ecology and Evolutionary Biology, Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, CO 80309, USA; Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Laura K Fonken
- Division of Pharmacology and Toxicology, University of Texas at Austin, Austin, TX 78712, USA
| | - Matthew G Frank
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Cristian A Zambrano
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Steven F Maier
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Christopher A Lowry
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO 80045, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO 80045, USA; inVIVO Planetary Health, of the Worldwide Universities Network (WUN), West New York, NJ 07093, USA.
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31
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From the perspective of Traditional Chinese Medicine: Treatment of mental disorders in COVID-19 survivors. Biomed Pharmacother 2020; 132:110810. [PMID: 33053508 PMCID: PMC7524684 DOI: 10.1016/j.biopha.2020.110810] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/19/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this study is to explore the possible benefits of traditional Chinese medicine on the pathogenesis of psychological and mental health of COVID-19 survivors. METHODS A literature search was conducted to confirm the effects of COVID-19 on psychological and mental health of survivors. In addition to this, on the basis of signs and symptoms, TCM were used on treat mental disorder as per suggested clinical and animal experimental data plus relevant records in classical Chinese medicine books written by Zhang Zhongiing during Han Dynasty. A series of treatment plans were prescribed for COVID-19 survivors with psychological and mental disorders. RESULTS According to previous extensive studies focusing on effects on mental health of survivors, high incidence was observed in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) survivors. During investigations of mental health of COVID-19 patients and survivors, it is observed that they also had symptoms of mental disorders and immune dysfunction. Furthermore, it was also proposed that depression, anxiety and post-traumatic stress disorder (PTSD) were most common mental disorders requiring special attention after the recovery from COVID-19. The symptoms of COVID-19 were analyzed, and the TCM syndrome of the depression, anxiety and PTSD after recovered from COVID19 was interpreted as internal heat and Yin deficiency. These three mental disorders pertains the category of "Lily disease", "hysteria" and "deficient dysphoria" in TCM. CONCLUSION Lily Bulb, Rhizoma Anemarrhena Decoction and Ganmai Dazao Decoction were used to treat depression. Suanzaoren Decoction, Huanglian Ejiao Decoction and Zhizi Chi Decoction were suggested for anxiety. Moreover, Lily Bulb, Rehmannia Decoction and Guilu Erxian Decoction were the formula for PTSD.
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32
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Theal R, Kerin JL, Romaniuk M. Psychosocial Outcomes of Australian Male and Female Veterans Following Participation in Peer-Led Adventure-Based Therapy. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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33
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Valentine SE, Marques L, Wang Y, Ahles EM, Dixon De Silva L, Alegría M. Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group. Gen Hosp Psychiatry 2019; 61:60-68. [PMID: 31715388 PMCID: PMC6870874 DOI: 10.1016/j.genhosppsych.2019.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a robust literature base documenting gender differences and racial/ethnic differences in exposure to potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) diagnosis. Yet, to the best of our knowledge, this is the first study to evaluate the risk of PTEs and PTSD between genders, stratified by race/ethnicity. We aimed to better understand whether factors associated with poor psychological adjustment following PTEs (e.g., PTE type, sociodemographic factors, social support) varied by gender and race/ethnicity. METHOD Data were collected from three U.S.-based national studies comprising the Collaborative Psychiatric Epidemiologic Surveys (CPES; N = 13,649). Trained lay interviewers administered questionnaires and collected data on PTE exposure, PTSD, and psychosocial covariates. Regression analyses were conducted to investigate relations between PTEs, PTSD, and gender, stratified by race/ethnicity. RESULTS Adjusting for sociodemographic variables, mental health comorbidity, social support, and PTE frequency, White, African-American, and Afro-Caribbean women had higher odds of PTSD than men in their respective racial/ethnic groups, whereas gender differences were not observed for Latinos or Asians. CONCLUSION Findings suggest that risk of exposure to PTEs and PTSD may differ by gender and race/ethnicity. Future studies should consider the contributions of social, cultural, and contextual factors in estimating PTSD risk.
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Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America.
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ye Wang
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Emily M Ahles
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, United States of America
| | - Louise Dixon De Silva
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Margarita Alegría
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
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34
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Moring JC, Nason E, Hale WJ, Wachen JS, Dondanville KA, Straud C, Moore BA, Mintz J, Litz BT, Yarvis JS, Young-McCaughan S, Peterson AL, Resick PA. Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members. J Affect Disord 2019; 256:541-549. [PMID: 31280079 PMCID: PMC6750963 DOI: 10.1016/j.jad.2019.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/07/2019] [Accepted: 06/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among active duty service members and veterans with PTSD, depression is the most commonly diagnosed comorbid psychiatric condition. More research is warranted to investigate the relationship between PTSD and depression to improve treatment approaches. Byllesby et al. (2017) used confirmatory factor analyses in a sample of trauma-exposed combat veterans with PTSD and found that only the general distress factor, and not any specific symptom cluster of PTSD, predicted depression. This study seeks to replicate Byllesby et al. (2017) in a sample of treatment-seeking active duty soldiers. METHODS Confirmatory factor analyses, bifactor modeling, and structural equation modeling (SEM) were used with data gathered at pretreatment and posttreatment as part of a large randomized clinical trial. RESULTS Confirmatory factor analyses and bifactor modeling demonstrated that PTSD symptom clusters, Negative Alterations in Cognition and Mood (NACM) and Alterations in Arousal and Reactivity (AAR), as well as the general distress factor significantly predicted depression at pretreatment and posttreatment. LIMITATIONS The current study was predominantly male, limiting the generalizability to female service members with PTSD. Also, self-report measures were used, which may introduce response-bias. CONCLUSIONS The current study did not replicate Byllesby et al. (2017). Results demonstrated that the relationship between PTSD and depression among active duty service members can be explained by both transdiagnostic factors and disorder-specific symptoms.
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Affiliation(s)
- John C. Moring
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Corresponding author: John C. Moring, Department
of Psychiatry, University of Texas Health Science Center at San Antonio, 7550
IH-10 West, Suite 1325, San Antonio, TX 78229, USA. Tel.: +1 210-562-6700. Fax:
+1 210-562-6710. (J.C. Moring)
| | - Erica Nason
- School of Social Work, Texas State University, San Marcos,
TX, USA
| | - Willie J. Hale
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Psychology, University of Texas at San
Antonio, San Antonio, TX, USA
| | - Jennifer Schuster Wachen
- National Center for PTSD, VA Boston Healthcare System,
Boston, MA, USA,Deparment of Psychiatry, Boston University School of
Medicine, Boston, MA, USA
| | - Katherine A. Dondanville
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA
| | - Casey Straud
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA
| | - Brian A. Moore
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Psychology, University of Texas at San
Antonio, San Antonio, TX, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Epidemiology and Biostatistics, University of
Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brett T. Litz
- Deparment of Psychiatry, Boston University School of
Medicine, Boston, MA, USA,Massachusetts Veterans Epidemiological Research and
Information Center, VA Boston Healthcare System, Boston, MA, USA,Department of Psychological and Brain Sciences, Boston
University, Boston, MA, USA
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army
Medical Center, Fort Hood, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Psychology, University of Texas at San
Antonio, San Antonio, TX, USA,Research and Development Service, South Texas Veterans
Health Care System, San Antonio, TX, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, NC, USA
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35
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Forbes D, Pedlar D, Adler AB, Bennett C, Bryant R, Busuttil W, Cooper J, Creamer MC, Fear NT, Greenberg N, Heber A, Hinton M, Hopwood M, Jetly R, Lawrence-Wood E, McFarlane A, Metcalf O, O'Donnell M, Phelps A, Richardson JD, Sadler N, Schnurr PP, Sharp ML, Thompson JM, Ursano RJ, Hooff MV, Wade D, Wessely S. Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward. Int Rev Psychiatry 2019; 31:95-110. [PMID: 31043106 DOI: 10.1080/09540261.2019.1595545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.
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Affiliation(s)
- David Forbes
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - David Pedlar
- b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada
| | - Amy B Adler
- c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Clare Bennett
- d New Zealand Defence Force , Wellington , New Zealand
| | - Richard Bryant
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,e School of Psychology , University of New South Wales , Sydney , Australia
| | | | - John Cooper
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mark C Creamer
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Nicola T Fear
- g King's Centre for Military Health Research, King's College London , London , UK.,h Academic Centre for Military Mental Health Research , London , UK
| | - Neil Greenberg
- g King's Centre for Military Health Research, King's College London , London , UK
| | - Alexandra Heber
- i Veterans Affairs Canada , Charlottetown , Canada.,j Department of Psychiatry , University of Ottawa , Ottawa , Canada
| | - Mark Hinton
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mal Hopwood
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Rakesh Jetly
- k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada
| | - Ellie Lawrence-Wood
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Alexander McFarlane
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Olivia Metcalf
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Meaghan O'Donnell
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Andrea Phelps
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - J Don Richardson
- m Department of Psychiatry , Western University , London , Canada.,n McDonald/Franklin OSI Research Centre , London , Canada
| | - Nicole Sadler
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Paula P Schnurr
- o National Center for PTSD , White River Junction , VT , USA.,p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA
| | - Marie-Louise Sharp
- g King's Centre for Military Health Research, King's College London , London , UK
| | - James M Thompson
- i Veterans Affairs Canada , Charlottetown , Canada.,q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Robert J Ursano
- r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA
| | - Miranda Van Hooff
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Darryl Wade
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Simon Wessely
- g King's Centre for Military Health Research, King's College London , London , UK
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Sancassiani F, Giovanni Carta M, Montisci R, Machado S, Marchetti MF, Meloni L. The Aim was About the Association with Psychiatric Disorders not on the Pathogenesis of Takotsubo - Author's Reply. Clin Pract Epidemiol Ment Health 2019; 15:5-7. [PMID: 30972135 PMCID: PMC6407661 DOI: 10.2174/1745017901915010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/25/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University, Niterói, Brazil
| | | | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge. Healthcare (Basel) 2018; 6:healthcare6030102. [PMID: 30131470 PMCID: PMC6164108 DOI: 10.3390/healthcare6030102] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022] Open
Abstract
Service members who transition out of the military often face substantial challenges during their transition to civilian life. Leaving military service requires establishing a new community as well as sense of connectedness to that community. Little is known about how social connectedness may be related to other prominent transition outcomes, particularly symptoms of posttraumatic stress disorder (PTSD). The purpose of this study was to explore the role of social connectedness in the development of PTSD, as well as its relationship to the known risk factors of combat exposure and discharge status. Data used were drawn from a needs assessment survey of 722 veterans. A path model was specified to test direct and indirect effects of combat experiences, non-honorable discharge status, and social connectedness on PTSD symptoms. Results demonstrated positive direct effects for combat experiences and non-honorable discharge status on PTSD symptoms while social connectedness demonstrated a negative direct effect. Both combat experiences and non-honorable discharge status demonstrated negative direct effects on social connectedness and indirect on PTSD through the social connectedness pathway. Study findings indicate social connectedness may be an important factor related to PTSD in veterans as well as an intervention point for mitigating risk related to combat exposure and discharge status.
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