1
|
Kihumuro RB, Kellen P, Chun S, Wakida EK, Obua C, Ainamani HE. Cognitive impairment and the associated factors among women with a history of pregnancy complications in rural southwestern Uganda. PLoS One 2023; 18:e0293258. [PMID: 37906567 PMCID: PMC10617700 DOI: 10.1371/journal.pone.0293258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Worldwide, there is a growing concern about the rising number of people with declining cognitive functioning. However, findings on this phenomenon are inconclusive. Our study aimed to assess the prevalence of cognitive impairment and the associated factors in women with a history of pregnancy complications in rural southwestern Uganda. METHODS This was a cross-sectional study carried out among women above 40 years of age in the greater Kabale district of southwestern Uganda between March and April 2022. Study participants were identified using a consecutive sampling method. Predictor variables included pregnancy complications and other social demographic factors that were assessed by semi-structured interviews while cognitive functioning as an outcome variable was assessed by Montreal Cognitive Assessment (MoCA-B) tool. Data were analyzed using STATA at a 95% Confidence level. Logistic regression analyses were selected for statistical modelling while odds ratios were calculated to assess the strength of associations between the predictor and outcome variables. RESULTS In total, 75% (212/280) of participants had some form of cognitive impairment, with 45% (123/280) falling into mild CI, 31% (86/280) moderate CI and 4% (10/280) severe CI. Twenty-three percent (68/280) of participants fell into category of normal cognitive functioning. Participants with >65 years of age had higher odds of developing cognitive impairment (OR = 2.94; 95%CI: 0.96-9.04, p = 0.06) than those with < 65 years of age. Protective factors to cognitive impairment include delivering from a health facility (OR = 0.31,95% CI:0.16-0.60, p = < .001), primary and post primary levels of education (OR = 0.05; 95% CI: 0.02-0.13, p<0.001, OR = 0.04; 95%CI: 0.02-0.23, p<0.001) respectively. CONCLUSION Results from this study show a high prevalence of cognitive impairment among women with a history of pregnancy complications in rural southwestern Uganda. Interventions geared toward preventing cognitive impairment among females with a history of pregnancy complications should be emphasized.
Collapse
Affiliation(s)
| | - Peace Kellen
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sarah Chun
- Department of Medicine, California University of Science and Medicine, Northridge, California, United States of America
| | - Edith K. Wakida
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, California University of Science and Medicine, Northridge, California, United States of America
- California University of Science and Medicine, Northridge, California, United States of America
| | - Celestino Obua
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Pharmacology and Therapeutic, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Herbert E. Ainamani
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| |
Collapse
|
2
|
Bernardsdóttir B, Sandahl H, Carlsson J, Mortensen EL, Palic S. Psychotherapy readiness domains as predictors of psychotherapy outcome in trauma-affected refugees. J Affect Disord 2023; 325:248-255. [PMID: 36586606 DOI: 10.1016/j.jad.2022.12.130] [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: 01/20/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Little is known about predictors of psychotherapy outcome in trauma-affected refugees. Knowledge on outcome predictors can help clinicians identify patients prior to treatment who are not likely to benefit from standardized psychotherapy and take additional measures to adjust treatment to the individual patient. Given the dynamic nature of psychotherapy readiness domains, they represent potential targets to be worked with in therapy in order to improve outcomes. METHODS Psychotherapy readiness domains (locus of control, cognitive functioning, motivation for therapy, and personality functioning) were examined as potential predictors of psychotherapy outcome in trauma-affected refugees. Secondary analyses were conducted on data from a pragmatic randomized controlled trial. Study participants (N = 190) were refugees with PTSD who received flexible manual-based Cognitive Behavioral Therapy (CBT) at a psychiatric outpatient clinic in Denmark. Psychotherapy readiness domains were assessed via semi-structured interviews at the beginning of psychotherapy. Outcome variables were pre-post change in PTSD symptomology and global level of functioning. RESULTS Multiple regression analyses revealed that higher motivation for psychotherapy predicted improvement in PTSD symptomology and global level of functioning. Moreover, higher cognitive functioning predicted improvement in global level of functioning. LIMITATIONS The predictor rating scales need further psychometric evaluations in cross-cultural contexts. CONCLUSIONS These findings highlight the importance of considering motivation in psychotherapy offered to trauma-affected refugees. Further research is needed to identify potential barriers to motivation in this diverse patient population and to determine whether motivational interventions can lead to improved treatment outcomes.
Collapse
Affiliation(s)
- Berglind Bernardsdóttir
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
| | - Hinuga Sandahl
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sabina Palic
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| |
Collapse
|
3
|
Pupat A, Dewailly A, Guidot F, Duagani Y, Kawesa E, Carriere R, Mbazzi FB. Global initiative for stress and trauma treatment - traumatic stress relief training for allied and para-professionals to treat traumatic stress in underserved populations: A case study. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2021.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Scharpf F, Mueller SC, Hecker T. The executive functioning of Burundian refugee youth: Associations with individual, family and community factors. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2022. [DOI: 10.1016/j.appdev.2022.101399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Esterlis I, DeBonee S, Cool R, Holmes S, Baldassari SR, Maruff P, Pietrzak RH, Davis MT. Differential Role of mGluR5 in Cognitive Processes in Posttraumatic Stress Disorder and Major Depression. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221105804. [PMID: 35958037 PMCID: PMC9358555 DOI: 10.1177/24705470221105804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022]
Abstract
Background A robust literature supports the role of the metabotropic glutamate receptor type 5 (mGluR5) in cognitive functioning. mGluR5 is also implicated in the pathophysiology of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), which are characterized by cognitive alterations. However, the relationship between mGluR5 and cognition in MDD and PTSD has not yet been directly investigated. To address this gap, we examined the relationship between in vivo mGluR5 availability and cognition in PTSD, MDD, and matched healthy adults (HA). Methods Individuals with PTSD (N = 28) and MDD (N = 21), and HA (N = 28) were matched for age, gender, and smoking status. Participants completed 18F-FPEB positron emission tomography (PET) scan, psychiatric and cognitive assessments. Results Across models examining the relationship between mGluR5 availability and different domains of cognition across diagnostic groups, only the interaction of diagnosis*attention was significant (F 4,64 = 3.011, P = .024). Higher mGluR5 availability was associated with poorer attention in PTSD in 4 frontolimbic regions of interests (ROI's: OFC (r = -.441, P = .016), vmPFC (r = -.408, P = .028), dlPFC (r = -.421, P = .023), hippocampus (r = -.422, P = .025). By contrast, mGluR5 availability in the MDD group was positively related to Attention (ATTN) in the OFC (r = .590, P = .006), vmPFC (r = .653, P = .002), and dlPFC (r = .620, P = .004). Findings in the hippocampus for MDD followed the same pattern but did not survive correction for multiple comparisons (r = .480, P = .036). ATTN and mGluR5 availability were not significantly related in the HA group. Of note, in MANOVA analyses group*ATTN interaction results in the OFC did not survive multiple comparisons (P = .046). All other findings survived correction for multiple comparisons and remained significant when covarying for potential confounds (eg, depressed mood). Conclusions We observed a significant relationship between frontolimbic mGluR5 availability and performance on tests of attention in individuals with MDD and PTSD. This finding aligns with animal work showing dysregulation in mGluR5 in cognitive functioning, and differed as a function of diagnosis. Results suggest interventions targeting mGluR5 may help bolster cognitive difficulties, highlighting the importance of employing different mGluR5 directed treatment strategies in MDD and PTSD.
Collapse
Affiliation(s)
- Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Sarah DeBonee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Ryan Cool
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sophie Holmes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Stephen R. Baldassari
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Margaret T. Davis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs, West Haven, CT, USA
| |
Collapse
|
6
|
Ainamani HE, Weierstall-Pust R, Bahati R, Otwine A, Tumwesigire S, Rukundo GZ. Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda. Eur J Psychotraumatol 2022; 13:2007730. [PMID: 35028113 PMCID: PMC8751492 DOI: 10.1080/20008198.2021.2007730] [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] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda. METHODS In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables. RESULTS In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005). CONCLUSION Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children.
Collapse
Affiliation(s)
- Herbert E Ainamani
- Department of Mental Health, Kabale University-School of Medicine, Kabale, Uganda
| | - Roland Weierstall-Pust
- Medical School of Hamburg Department of Clinical Psychology and Psychotherapy, Germany and Oberberg Group, Berlin, Germany
| | - Ronald Bahati
- Department of Public Health and Bio Medical Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Anne Otwine
- Department of Public Health and Bio Medical Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Sam Tumwesigire
- Department of Pediatrics, Kabale University School of Medicine, Kabale, Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
7
|
Working memory and emotional interpretation bias in a sample of Syrian refugee adolescents. Eur Child Adolesc Psychiatry 2021; 30:1885-1894. [PMID: 33025075 DOI: 10.1007/s00787-020-01656-8] [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: 06/05/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022]
Abstract
The number of adolescent refugees around the world has been continuously increasing over the past few years trying to escape war and terror, among other things. Such experience not only increases the risk for mental health problems including anxiety, depression, and post-traumatic stress disorder (PTSD), but also may have implications for socio-cognitive development. This study tested cognitive-affective processing in refugee adolescents who had escaped armed conflict in Syria and now resided in Istanbul, Turkey. Adolescents were split into a high trauma (n = 31, 12 girls, mean age = 11.70 years, SD = 1.15 years) and low trauma (n = 27, 14 girls, mean age = 11.07 years, SD = 1.39 years) symptom group using median split, and performed a working memory task with emotional distraction to assess cognitive control and a surprise faces task to assess emotional interpretation bias. The results indicated that high (vs. low) trauma symptom youth were ~ 20% worse correctly remembering the spatial location of a cue, although both groups performed at very low levels. However, this finding was not modulated by emotion. In addition, although all youths also had a ~ 20% bias toward interpreting ambiguous (surprise) faces as more negative, the high (vs. low) symptom youth were faster when allocating such a face to the positive (vs. negative) emotion category. The findings suggest the impact of war-related trauma on cognitive-affective processes essential to healthy development.
Collapse
|
8
|
Familiar I, Muniina PN, Dolan C, Ogwal M, Serwadda D, Kiyingi H, Bahinduka CS, Sande E, Hladik W. Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda - a respondent driven sampling survey. Confl Health 2021; 15:42. [PMID: 34039400 PMCID: PMC8157662 DOI: 10.1186/s13031-021-00377-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda. METHODS Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence. RESULTS Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67-78%) met symptom criteria for PTSD, 57% (95% CI: 51-63%) for depression, and 65% reported thoughts of ending one's life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01). CONCLUSIONS Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.
Collapse
Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI USA
| | | | - Chris Dolan
- Refugee Law Project, School of Law, Makerere University, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control, School of Public Health, Makerere University, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, MS E-30, 1600 Clifton Rd, Atlanta, GA-30333 USA
| |
Collapse
|
9
|
Lee J, Jeon S, Kim S, Seo Y, Park J, Lee YJ, Kim SJ. Polysomnographic Sleep and Attentional Deficits in Traumatized North Korean Refugees. Nat Sci Sleep 2021; 13:635-645. [PMID: 34079408 PMCID: PMC8163968 DOI: 10.2147/nss.s308968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Attentional deficits and sleep problems are common in refugees who have experienced trauma. In the present study, we used polysomnography (PSG) to investigate the relationship between attentional deficits and objective measures of sleep structure in traumatized North Korean refugees. METHODS We recruited 32 North Korean refugees (mean age = 33.78 ± 14.33 years) and 39 South Korean participants (mean age = 35.03 ± 11.08 years). Sustained attention and divided attention were assessed using the Computerized Attention Test. We conducted an overnight PSG to objectively assess sleep structure. The participants also completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Impact of Event Scale-Revised (IES-R), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI). RESULTS The North Korean refugees showed more commission errors (CEs, p < 0.05) and a larger standard deviation (SD) of the reaction time (RT) (p < 0.05) in the sustained attention task compared to the South Korean participants. Furthermore, the North Korean refugees showed a shorter period of wake after sleep onset (WASO, p < 0.01), less time spent in N1 (p < 0.05), and more time spent in N2 (p < 0.05). The larger SD of RT in the sustained attention task in the North Korean refugees was positively correlated with WASO (r = 0.62, p < 0.01) and N1 stage (r = 0.47, p < 0.05) after controlling for age, sex, BDI, BAI, and IES-R. CONCLUSION The North Korean refugees showed poorer performance on the sustained attention task. Nocturnal PSG revealed shorter WASO and time spent in N1 in this population, which are independently associated with the preservation of attentional capacity. These data suggest that traumatized refugees may compensate for attentional deficits induced by their traumatic experiences via increased sleep continuity.
Collapse
Affiliation(s)
- Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Somin Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yumin Seo
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jinme Park
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
10
|
Child maltreatment, cognitive functions and the mediating role of mental health problems among maltreated children and adolescents in Uganda. Child Adolesc Psychiatry Ment Health 2021; 15:22. [PMID: 33941232 PMCID: PMC8091686 DOI: 10.1186/s13034-021-00373-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Child maltreatment poses high risks to the mental health and cognitive functioning of children not only in childhood but also in later life. However, it remains unclear whether child maltreatment is directly associated with impaired cognitive functioning or whether this link is mediated by mental health problems. Our study aimed at examining this research question among children and adolescents in Uganda. METHODS A sample of 232 school-going children and adolescents with a mean age of 14.03 (SD = 3.25) was assessed on multiple forms of maltreatment using the Maltreatment and Abuse Chronology Exposure-Pediatric Version (pediMACE). Executive functions were assessed by the Tower of London task and working memory by the Corsi Block Tapping task, while mental health problems were assessed using the Child PTSD Symptom Scale for PTSD and the Center for Epidemiological Studies Depression Scale for Children (CES-DC). RESULTS In total, 232 (100%) of the participant reported to have experienced at least one type of maltreatment in their lifetime including emotional, physical, and sexual violence as well as neglect. We found a negative association between child maltreatment and executive functions (β = - 0.487, p < 0.001) and working memory (β = - 0.242, p = 0.001). Mental health problems did not mediate this relationship. CONCLUSIONS Child maltreatment seems to be related to lower working memory and executive functioning of affected children and adolescents even after controlling for potential cofounders. Our study indicates that child maltreatment the affects children's cognitive functionality beyond health and well-being.
Collapse
|
11
|
Mordeno IG, Gallemit IMJS, Ferolino MAL, Sinday JV. DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals. Psychiatr Q 2021; 92:347-362. [PMID: 32748123 DOI: 10.1007/s11126-020-09804-8] [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] [Indexed: 11/28/2022]
Abstract
There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.
Collapse
Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University - Iligan Institute of Technology, Andres Bonifacio Ave., Tibanga, 9200, Iligan City, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Michelle Anne L Ferolino
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Jonahliza V Sinday
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| |
Collapse
|
12
|
Hantke N, Adamson MM, Noda A, Lazzeroni LC, Beaudreau SA, Yutsis M, Fairchild JK, Kinoshita LM, Kong J, Sheng T, Waltzman D, Ashford JW, Yesavage JA. Posttraumatic Stress Disorder-Associated Cognitive Deficits on the Repeatable Battery for the Assessment of Neuropsychological Status in a Veteran Population. Fed Pract 2021; 38:28-34. [PMID: 33574646 DOI: 10.12788/fp.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Posttraumatic stress disorder (PTSD) is a frequent problem of veterans receiving care and is often associated with cognitive deficits. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a well-validated cognitive screening measure often used in the US Department of Veterans Affairs (VA), particularly in neurorehabilitation settings. However, the influence of PTSD on RBANS performance is unclear, particularly within a heterogeneous VA outpatient population in which PTSD and traumatic brain injury (TBI) may not be the primary focus of care. Methods Participants included 153 veterans with complex deployment-related health problems, including a diagnosis of PTSD (n = 98) and a history of TBI (n = 92). All veterans completed a targeted cognitive battery that included the Wechsler Test of Adult Reading, the Wechsler Adults Intelligence Scale, measure assessing processing speed, attention, and cognitive flexibility, and RBANS. Results A diagnosis of PTSD was associated with worse performance on the Story Recall subtest of the RBANS, but not on any other cognitive measures. A diagnosis of mild TBI, or co-occurring PTSD and TBI did not predict cognitive performance on any measures. Conclusions The RBANS best captured cognitive deficits associated with PTSD compared with a history of mild TBI or co-occurring mild TBI and PTSD. These findings may provide insight into the interpretation and attribution of cognitive deficits in the veteran population.
Collapse
Affiliation(s)
- Nathan Hantke
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Maheen M Adamson
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Art Noda
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Laura C Lazzeroni
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Sherry A Beaudreau
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Maya Yutsis
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - J Kaci Fairchild
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Lisa M Kinoshita
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Jennifer Kong
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Tong Sheng
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Dana Waltzman
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - John Wesson Ashford
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| | - Jerome A Yesavage
- is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. is a Postdoctoral Fellow, is a Clinical Director, is the Director, and is the Executive Director; all at the War Related Illness and Injury Study Center; is a Clinical Neuropsychologist at the VA Memory Clinic; is a Program Analyst in Polytrauma System of Care; is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): is an Associate Director, is the Director; all at the MIRECC; is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland
| |
Collapse
|
13
|
Xulu KR, Womersley JS, Sommer J, Hinsberger M, Elbert T, Weierstall R, Kaminer D, Malan-Müller S, Seedat S, Hemmings SMJ. DNA methylation and psychotherapy response in trauma-exposed men with appetitive aggression. Psychiatry Res 2021; 295:113608. [PMID: 33290938 DOI: 10.1016/j.psychres.2020.113608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Exposure to violence can lead to appetitive aggression (AA), the positive feeling and fascination associated with violence, and posttraumatic stress disorder (PTSD), characterised by hyperarousal, reexperience and feelings of ongoing threat. Psychotherapeutic interventions may act via DNA methylation, an environmentally sensitive epigenetic mechanism that can influence gene expression. We investigated epigenetic signatures of psychotherapy for PTSD and AA symptoms in South African men with chronic trauma exposure. Participants were assigned to one of three groups: narrative exposure therapy for forensic offender rehabilitation (FORNET), cognitive behavioural therapy or waiting list control (n = 9-10/group). Participants provided saliva and completed the Appetitive Aggression Scale and PTSD Symptom Severity Index at baseline, 8-month and 16-month follow-up. The relationship, over time, between methylation in 22 gene promoter region sites, symptom scores, and treatment was assessed using linear mixed models. Compared to baseline, PTSD and AA symptom severity were significantly reduced at 8 and 16 months, respectively, in the FORNET group. Increased methylation of genes implicated in dopaminergic neurotransmission (NR4A2) and synaptic plasticity (AUTS2) was associated with reduced PTSD symptom severity in participants receiving FORNET. Analyses across participants revealed a proportional relationship between AA and methylation of TFAM, a gene involved in mitochondrial biosynthesis.
Collapse
Affiliation(s)
- Khethelo R Xulu
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jessica Sommer
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | | | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Konstanz, Germany; Clinical Psychology & Psychotherapy, Medical School Hamburg, Hamburg, Germany.
| | - Debbie Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - Stefanie Malan-Müller
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| |
Collapse
|
14
|
Alper HE, Tuly RA, Seil K, Brite J. Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197330. [PMID: 33049920 PMCID: PMC7579594 DOI: 10.3390/ijerph17197330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Numerous studies report elevated levels of chronic mental health conditions in those exposed to the World Trade Center attacks of 11 September 2001 (9/11), but few studies have examined the incidence of confusion or memory loss (CML) or its association with mental health in 9/11 attack survivors. We investigated the incidence of CML and its association with the number of post-9/11 mental health conditions (PTSD, depression, and anxiety) in 10,766 World Trade Center Health Registry (Registry) enrollees aged 35–64 at the time of the wave 4 survey (2015–2016) that completed all four-wave surveys and met the study inclusion criteria. We employed log-binomial regression to evaluate the associations between CML and the number of mental health conditions. A total of 20.2% of enrollees in the sample reported CML, and there was a dose-response relationship between CML and the number of mental health conditions (one condition: RR = 1.85, 95% CI (1.65, 2.09); two conditions: RR = 2.13, 95% CI (1.85, 2.45); three conditions: RR = 2.51, 95% CI (2.17, 2.91)). Survivors may be experiencing confusion or memory loss partly due to the mental health consequences of the 9/11 attacks. Clinicians treating patients with mental health conditions should be aware of potential cognitive impairment.
Collapse
Affiliation(s)
- Howard E. Alper
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
- Correspondence: ; Tel.: +1-718-786-4387; Fax: +1-718-786-4006
| | - Rifat A. Tuly
- School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Kacie Seil
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
| | - Jennifer Brite
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
| |
Collapse
|
15
|
Li Y, Zhu H, Ren Z, Lui S, Yuan M, Gong Q, Yuan C, Gao M, Qiu C, Zhang W. Exploring memory function in earthquake trauma survivors with resting-state fMRI and machine learning. BMC Psychiatry 2020; 20:43. [PMID: 32013935 PMCID: PMC6998246 DOI: 10.1186/s12888-020-2452-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Traumatized earthquake survivors may develop poor memory function. Resting-state functional magnetic resonance imaging (rs-fMRI) and machine learning techniques may one day aid the clinical assessment of individual psychiatric patients. This study aims to use machine learning with Rs-fMRI from the perspectives of neurophysiology and neuroimaging to explore the association between it and the individual memory function of trauma survivors. METHODS Rs-fMRI data was acquired for eighty-nine survivors (male (33%), average age (SD):45.18(6.31) years) of Wenchuan earthquakes in 2008 each of whom was screened by experienced psychiatrists based on the clinician-administered post-traumatic stress disorder (PTSD) scale (CAPS), and their memory function scores were determined by the Wechsler Memory Scale-IV (WMS-IV). We explored which memory function scores were significantly associated with CAPS scores. Using simple multiple kernel learning (MKL), Rs-fMRI was used to predict the memory function scores that were associated with CAPS scores. A support vector machine (SVM) was also used to make classifications in trauma survivors with or without PTSD. RESULTS Spatial addition (SA), which is defined by spatial working memory function, was negatively correlated with the total CAPS score (r = - 0.22, P = 0.04). The use of simple MKL allowed quantitative association of SA scores with statistically significant accuracy (correlation = 0.28, P = 0.03; mean squared error = 8.36; P = 0.04). The left middle frontal gyrus and the left precuneus contributed the largest proportion to the simple MKL association frame. The SVM could not make a quantitative classification of diagnosis with statistically significant accuracy. LIMITATIONS The use of the cross-sectional study design after exposure to an earthquake and the leave-one-out cross-validation (LOOCV) increases the risk of overfitting. CONCLUSION Spontaneous brain activity of the left middle frontal gyrus and the left precuneus acquired by rs-fMRI may be a brain mechanism of visual working memory that is related to PTSD symptoms. Machine learning may be a useful tool in the identification of brain mechanisms of memory impairment in trauma survivors.
Collapse
Affiliation(s)
- Yuchen Li
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hongru Zhu
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China ,0000 0004 1770 1022grid.412901.fMental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China ,0000 0004 1770 1022grid.412901.fHuaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhengjia Ren
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China ,0000 0004 1760 6682grid.410570.7Department of Clinical Psychology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing, China
| | - Su Lui
- 0000 0004 1770 1022grid.412901.fHuaxi MR Research Center (HMRRC), Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Minlan Yuan
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- 0000 0004 1770 1022grid.412901.fHuaxi MR Research Center (HMRRC), Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Cui Yuan
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Gao
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
| | - Wei Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
16
|
Gender differences in response to war-related trauma and posttraumatic stress disorder - a study among the Congolese refugees in Uganda. BMC Psychiatry 2020; 20:17. [PMID: 31924182 PMCID: PMC6954516 DOI: 10.1186/s12888-019-2420-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The wars in the Democratic Republic of Congo have left indelible marks on the mental health and functioning of the Congolese civilians that sought refuge in Uganda. Even though it is clear that civilians who are exposed to potentially traumatizing events in war and conflict areas develop trauma-related mental health problems, scholarly information on gender differences on exposure to different war-related traumatic events, their conditional risks to developing PTSD and whether the cumulative exposure to traumatic events affects men and women differently is still scanty. METHODS In total, 325 (n = 143 males, n = 182 females) Congolese refugees who lived in Nakivale, a refugee settlement in the Southwestern part of Uganda were interviewed within a year after their arrival. Assessment included exposure to war-related traumatic events, and DSM-IV PTSD symptom severity. RESULTS Our main findings were that refugees were highly exposed to war-related traumatic events with experiencing dangerous flight as the most common event for both men (97%) and women (97%). The overall high prevalence of PTSD differed among women (94%) and men (84%). The highest conditional prevalence of PTSD in women was associated with experiencing rape. The dose-response effect differed significantly between men and women with women showing higher PTSD symptom severity when experiencing low and moderate levels of potentially traumatizing event types. CONCLUSION In conflict areas, civilians are highly exposed to different types of war-related traumatic events that expose them to high levels of PTSD symptoms, particularly women. Interventions focused at reducing mental health problems resulting from war should take the context of gender into consideration.
Collapse
|
17
|
Greene MC, Rees S, Likindikoki S, Bonz AG, Joscelyne A, Kaysen D, Nixon RDV, Njau T, Tankink MTA, Tiwari A, Ventevogel P, Mbwambo JKK, Tol WA. Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania. Confl Health 2019; 13:38. [PMID: 31428190 PMCID: PMC6697920 DOI: 10.1186/s13031-019-0222-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/05/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting. METHODS Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV (n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability (n = 24), inter-rater reliability (n = 5 interviews), internal consistency, and construct validity (n = 60). RESULTS We designed an 8-session intervention, termed Nguvu ('strength'), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity. CONCLUSIONS We found it feasible to develop and implement an integrated, multi-sectoral mental health and IPV intervention in a refugee camp setting. Implementation challenges were identified and may be informative for future implementation and evaluation of multi-sectoral strategies for populations facing ongoing adversity. TRIAL REGISTRATION ISRCTN65771265, June 27, 2016.
Collapse
Affiliation(s)
- M. Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Department of Psychiatry, Columbia University Medical Center & New York State Psychiatric Institute, 40 Haven Avenue, Rm. 171, New York, NY 10005 USA
| | - Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, NSW Australia
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ann G. Bonz
- HIAS, Silver Spring, MD USA
- International Rescue Committee, New York, NY USA
| | - Amy Joscelyne
- Program for Survivors of Torture, Bellevue Hospital/New York University School of Medicine, New York, NY USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | | | - Tasiana Njau
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Marian T. A. Tankink
- Consultant Anthropological Research & Training on Gender, Violence and Health, Amsterdam, the Netherlands
| | - Agnes Tiwari
- School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Jessie K. K. Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wietse A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Peter C. Alderman Foundation, HealthRight International, New York, NY USA
| |
Collapse
|
18
|
A Cognitive Reserve and Social Support-Focused Latent Class Analysis to Predict Self-Reported Confusion or Memory Loss among Middle-Aged World Trade Center Health Registry Enrollees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081401. [PMID: 31003460 PMCID: PMC6517899 DOI: 10.3390/ijerph16081401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 01/19/2023]
Abstract
The World Trade Center Health Registry includes 9/11 survivors who have been surveyed about their health conditions over time. The prevalence of posttraumatic stress disorder (PTSD) remains high among the cohort and is a risk factor for cognitive impairment or dementia. We thus sought to examine the degree to which confusion or memory loss (CML)—potential symptoms of cognitive decline—are occurring among enrollees aged 35–64 years. Cognitive reserve theory suggests that higher levels of education and engaging in cognitively challenging activities can create stronger neural connections, offering protection against cognitive decline. We hypothesized that enrollees with less cognitive reserve would be more likely to report CML. In this study, we: (1) estimated the incidence of CML in our study sample; (2) identified indicators of cognitive reserve (e.g., indicators of educational attainment, social support); and (3) determined whether CML is associated with cognitive reserve level, stratified by PSTD status. First, we described demographics of the study sample (n = 14,574) and probable PTSD status, also stratifying by CML. Next, we conducted a latent class analysis on two groups: those with probable PTSD and those without probable PTSD, creating classes with varying cognitive reserve levels. Finally, using adjusted log binomial models, we predicted risk of CML based on cognitive reserve level. The probable PTSD group (n = 1213) and not probable PTSD group (n = 13,252) each had four latent classes: low, medium-low, medium-high, and high cognitive reserve. In the probable PTSD model, compared to the high cognitive reserve class, those with medium-low cognitive reserve were 35% more likely to report CML (relative risk (RR) = 1.4, 95% confidence interval (CI): 1.1, 1.7). Among the not probable PTSD group, those with low and medium levels of cognitive reserve were significantly more likely to report CML (RR = 1.8 and 1.4, respectively). Overall, those with less cognitive reserve were more likely to report CML regardless of PTSD status.
Collapse
|
19
|
Hecker T, Huber S, Maier T, Maercker A. Differential Associations Among PTSD and Complex PTSD Symptoms and Traumatic Experiences and Postmigration Difficulties in a Culturally Diverse Refugee Sample. J Trauma Stress 2018; 31:795-804. [PMID: 30431683 DOI: 10.1002/jts.22342] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 11/07/2022]
Abstract
Forced migration is one of the major challenges currently facing the international community. Many refugees have been affected by traumatic experiences at home and during their flight, putting them at a heightened risk of developing trauma-related disorders. The new version of the International Classification of Diseases (ICD-11) introduced two sibling disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). So far, little is known about risk and protective factors in refugees that are specifically associated with the disturbances in self-organization (DSO) characteristic of CPTSD. In this study, we aimed to investigate the association between PTSD and DSO symptoms and traumatic experiences, postmigration difficulties, and social support in a culturally diverse sample of refugees who resettled in Switzerland. A total of 94 refugees (85.1% male; M age = 31.60 years, SD = 10.14, range: 18-61 years) participated in this study. Trained assessors performed either guided questionnaire assessments or structured interviews. In our advice- and help-seeking sample, 32.9% of individuals suffered from PTSD and 21.3% from CPTSD. After controlling for potential gender differences, we found positive associations between PTSD symptoms and trauma exposure, β = .22, as well as between DSO symptoms and postmigration living difficulties, β = .42, and lack of social support, β = .22. Our findings support the notion that it is highly important to consider differential associations among PTSD and DSO symptoms and risk and protective factors to gain a deeper understanding of the trauma-related problems refugees face.
Collapse
Affiliation(s)
- Tobias Hecker
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Stephanie Huber
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Thomas Maier
- Psychiatric Services of the Canton of St. Gallen-North, Wil, Switzerland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
Budde H, Akko DP, Ainamani HE, Murillo-Rodríguez E, Weierstall R. The impact of an exercise training intervention on cortisol levels and post-traumatic stress disorder in juveniles from an Ugandan refugee settlement: study protocol for a randomized control trial. Trials 2018; 19:364. [PMID: 29986761 PMCID: PMC6038242 DOI: 10.1186/s13063-018-2753-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/20/2018] [Indexed: 01/06/2023] Open
Abstract
Background Latest research demonstrates a significant improvement in stress-related symptoms in psychological disorders as a result of exercise training (ET). Controlled clinical trials further validate the significance of ET by demonstrating lower salivary cortisol levels in patients with post-traumatic stress disorder (PTSD) after intervention. A significant change in cortisol and dehydroepiandrosterone (DHEA) levels can already be found after an 8–12-week ET program. The proposed study aims to investigate the impact of an 8-week ET on PTSD symptoms and changes in cortisol levels in a juvenile refugee sample from the Democratic Republic of the Congo (DRC) at an Ugandan refugee settlement. It is the first to implement an ET intervention in a resource-poor, post-conflict setting. Methods/design In a randomized controlled trial, 198 adolescent participants aged 13–16 years from the DRC who, suffer from PTSD, will be investigated. The participants are based at the Nakivale refugee settlement, an official refugee camp in Uganda, Africa, which is among the largest in the world. The participants will be randomized into an Exercise Training (ET) group with a maximum heart rate (HRmax) of > 60%, an Alternative Intervention (AI) group with low-level exercises, and a Waiting-list Control (WC) group. After the 8-week interventional phase, changes in cortisol awakening response (CAR) and DHEA in the ET group that correspond to an improvement in PTSD symptoms are expected that remain at follow-up after 3 months. Discussion To date, there is no controlled and reliable longitudinal study examining the effects of an ET program on symptom severity in individuals with PTSD that can be explained with a harmonization of cortisol secretion. The presented study design introduces an intervention that can be implemented with little expenditure. It aims to provide a promising low-threshold and cost-effective treatment approach for the application in resource-poor settings. Trial registration German Trials Register, ID: DRKS00014280. Registered prospectively on 15 March 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2753-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Henning Budde
- Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany.,Sports Science Department, School of Science and Engineering, Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Reykjavik University, Reykjavik, Iceland.,Lithuanian Sports University, Kaunas, Lithuania
| | - Davin P Akko
- Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Herbert E Ainamani
- Department of Psychology and Development Management, Bishop Stuart University, Mbarara, Uganda
| | - Eric Murillo-Rodríguez
- Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab Mérida, Mérida, Yucatán, Mexico
| | - Roland Weierstall
- Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany
| |
Collapse
|
21
|
Boyd JE, Protopopescu A, O’Connor C, Neufeld RWJ, Jetly R, Hood HK, Lanius RA, McKinnon MC. Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD. Eur J Psychotraumatol 2018; 9:1463794. [PMID: 29805778 PMCID: PMC5965037 DOI: 10.1080/20008198.2018.1463794] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations. Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment. Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses. Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment. Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization.
Collapse
Affiliation(s)
- Jenna E. Boyd
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Alina Protopopescu
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Charlene O’Connor
- Homewood Research Institute, Guelph, Canada
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, Canada
| | - Richard W. J. Neufeld
- Department of Neuroscience, Western University, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Department of Psychology, Western University, London, Canada
| | - Rakesh Jetly
- Defence Research and Development Canada, Toronto, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Heather K. Hood
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ruth A. Lanius
- Homewood Research Institute, Guelph, Canada
- Department of Neuroscience, Western University, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Imaging Division, Lawson Health Research Institute, London, Canada
| | - Margaret C. McKinnon
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| |
Collapse
|