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Mejia CR, Serna-Alarcón V, Vilela-Estrada MA, Armada J, Ubillus M, Beraún-Barrantes J, Álvarez-Risco A, Del-Aguila-Arcentales S, Davies NM, Yáñez JA. Prevalence of post-traumatic stress disorder risk post-COVID-19 in 12 countries in Latin America: a cross-sectional survey. Front Public Health 2024; 11:1302694. [PMID: 38264243 PMCID: PMC10804613 DOI: 10.3389/fpubh.2023.1302694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Latin America was the region most affected by COVID-19 in the second quarter of 2020, and consequently, the impact on mental health requires evaluation. The aim of this study was to assess the risk of post-traumatic stress disorder (PTSD) caused by bereavement due to COVID-19 in 12 countries in Latin America. Methods The current study was an analytical cross-sectional study. Validated tests were applied for PTSD, depression, anxiety, and stress (DASS-21), questions about the respondent's condition or their environment, and demographic questions, as well as the length of the mourning period of suffering. Results The outcomes demonstrated that the PTSD risk increased for women (p < 0.001), when a friend or acquaintance had COVID-19 (p = 0.002), when a close relative died from COVID-19 (p = 0.010), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001), Costa Rica (p <0.001) or El Salvador (p = 0.005). On the other hand, there was less risk of PTSD at an older age (p <0.001) or if respondents had a sentimental partner (p = 0.025). In the case of severe PTSD, there was a greater gender risk for women (p <0.001), a close relative dying from COVID-19 (p = 0.017), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001) and Costa Rica (p = 0.002). It was also observed that there was less risk of severe PTSD at an older age demographic (p <0.001). Discussion It can be concluded that the percentages of PTSD are high in its clinical presentation as severe, especially among Latin American women.
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Affiliation(s)
| | - Víctor Serna-Alarcón
- Universidad Privada Antenor Orrego, Piura, Peru
- Hospital Regional José Cayetano Heredia, EsSalud, Piura, Peru
| | - Martín A. Vilela-Estrada
- Universidad Privada Antenor Orrego, Piura, Peru
- Hospital Regional José Cayetano Heredia, EsSalud, Piura, Peru
| | | | | | | | | | | | - Neal M. Davies
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
- Asociación Médica de Investigación y Servicios en Salud, Lima, Peru
| | - Jaime A. Yáñez
- Universidad Peruana de Ciencias Aplicadas, Facultad de Educación, Carrera de Educación y Gestión del Aprendizaje, Lima, Peru
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Hoppen TH, Lindemann AS, Morina N. Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events. Br J Psychiatry 2022; 221:1-10. [PMID: 35959698 DOI: 10.1192/bjp.2022.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking. AIMS To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD. METHOD We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms. RESULTS We included 56 RCTs (4230 patients). Incidences of harms were generally low (0-5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15-0.28) and active control conditions (RR = 0.36, 95% CI 0.14-0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive-behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31-0.95) and with no differential risk of deterioration and AEs. CONCLUSIONS The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.
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Nkhoma G, Lim CX, Kennedy GA, Stupans I. Attitudes and Knowledge of, and Preferences for Learning about Cultural Competence: A Study of Pharmacy Students from One Australian Pharmacy Program. PHARMACY 2022; 10:pharmacy10030066. [PMID: 35736780 PMCID: PMC9230435 DOI: 10.3390/pharmacy10030066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
Culturally and linguistically diverse populations, particularly asylum seekers, face challenges in accessing healthcare services. Pharmacists need to be capable of identifying and responding appropriately to the needs of diverse population groups. The aims of this study were to clarify student pharmacists’: knowledge of, and attitudes to, asylum seekers; their understanding of themselves with regard to cultural competence; their exposure to culturally and linguistically diverse clinical settings; their potential receptivity to learning opportunities directed towards cultural competence; and the extent to which they interpreted the current curriculum as improving their cultural competence. Pharmacy students’ viewpoints and perspectives were essential as emerging pharmacy professionals. This study employed mixed methods and convenience sampling. There were no significant (p > 0.05) associations between demographics and any of the survey items. Five themes emerged from the interviews: namely, exposure, formal vs. informal, positive views, conflict, and sufficiency. Pharmacy curriculum should ideally provide sufficient knowledge to meet culturally diverse healthcare consumers’ needs, especially asylum seekers. The most efficacious models for teaching cultural competence are as yet still undetermined. Interactive learning in cultural competence was recommended as essential.
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Affiliation(s)
- Gloria Nkhoma
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Correspondence:
| | - Chiao Xin Lim
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Institute of Health and Wellbeing, Federation University, P.O. Box 663, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, 145 Studley Rd., Heidelberg, VIC 3084, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
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Kohut AO, Chaban OS, Dolynskyi RG, Sandal OS, Bursa AI, Bobryk MI, Vertel AV. THE FEATURES OF POSTTRAUMATIC STRESS DISORDER DEVELOPMENT IN PATIENTS WITH DIABETES MELLITUS 2 TYPE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1903-1907. [PMID: 36089877 DOI: 10.36740/wlek202208115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: The revealing of the development of stress-related disorders in patients with type 2 diabetes mellitus (DM 2) to: identify the prevalence of stress-related disorders, particularly, posttraumatic stress disorder (PTSD); study the influence of psychosocial factors on the occurrence and course of stress-related disorders and increase the effectiveness of treatment in DM 2. PATIENTS AND METHODS Materials and methods: Research papers have been found by searching the PubMed database using the keywords ``ptsd and diabetes 2 type" with the result of 74 studies. Totally 25 of selected publications were analysed based on our criteria about the mechanisms through which the influence of psychosocial factors, permanent stressful or traumatic events on the probable risk of PTSD development and their analysis and relationships for the improvement of treatment effectiveness in DM 2 patients who have not been the veterans. CONCLUSION Conclusions: Given the complex neurophysiological relationships between the long-term stress and pathophysiological mechanisms of DM 2 - this group of patients has the higher risk of developing stress-related disorders, including PTSD.
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Affiliation(s)
- Anna O Kohut
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | - Oleg S Chaban
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | | | - Olha S Sandal
- KOSTIUK INSTITUTE OF PSYCHOLOGY OF NATIONAL ACADEMY OF EDUCATIONAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | | | - Anton V Vertel
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A.S. MAKARENKO, SUMY, UKRAINE
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Agyemang C, van der Linden EL, Bennet L. Type 2 diabetes burden among migrants in Europe: unravelling the causal pathways. Diabetologia 2021; 64:2665-2675. [PMID: 34657183 PMCID: PMC8563673 DOI: 10.1007/s00125-021-05586-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
European populations are ethnically and culturally diverse due to international migration. Evidence indicates large ethnic inequalities in the prevalence of type 2 diabetes. This review discusses the burden of type 2 diabetes and its related complications, and the potential explanatory mechanisms among migrants in Europe. The current available data suggest that the rate of type 2 diabetes is higher in all migrant groups and that they develop this disease at an earlier age than the host European populations. The level of diabetes awareness among migrant populations is high, but glycaemic control remains suboptimal compared with Europeans. The culturally adapted lifestyle modification intervention trials to prevent type 2 diabetes mainly focus on South Asian adults in Europe. Diabetes-related microvascular and macrovascular complications remain a major burden among migrant populations in Europe. Earlier studies found higher mortality rates among migrants, but recent studies seem to suggest a shifting trend in favour of first-generation migrants. However, the extent of the burden of type 2 diabetes varies across migrant groups and European countries. Despite the higher burden of type 2 diabetes among migrants, the key underlying factors are not well understood mainly due to limited investment in basic science research and development of prospective cohort studies. We hypothesise that the underlying risk factors for the high burden of type 2 diabetes and its related complications in migrants are multifaceted and include pre-migration factors, post-migration factors and genetic predispositions. Given the multi-ethnic nature of the current European population, there is a clear need for investment in research among migrant populations to gain insight into factors driving the high burden of type 2 diabetes and related complications to facilitate prevention and treatment efforts in Europe.
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Affiliation(s)
- Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eva L van der Linden
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Louise Bennet
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Clinical Research and Trial Centre, Lund University Hospital, Lund, Sweden
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Palmer BW, Shir C, Chang H, Mulvaney M, Hall JMH, Shu IW, Jin H, Lohr JB. Increased Prevalence of Metabolic Syndrome in Veterans with PTSD Untreated with Antipsychotic Medications. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021; 5:10.1080/00207411.2021.1965398. [PMID: 34711996 PMCID: PMC8547317 DOI: 10.1080/00207411.2021.1965398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is not solely a psychiatric disorder; it also includes significant medical morbidity. Although there is evidence of increased risk of metabolic syndrome (MetS) in PTSD, the interpretation of previous studies is confounded by inclusion of people on antipsychotic medications, which independently cause increased MetS. In this study we investigated whether Veterans with PTSD not treated with antipsychotic medications (n=115) demonstrate increased MetS compared to an age-comparable group of people from the U.S. National Health and Nutrition Examination Survey (NHNES; n=1005). Using standardized criteria (abnormal values in 3 out of the 5 domains of obesity, hypertension, high density lipoprotein, triglyceride and fasting glucose concentrations) we compared the prevalence of MetS across groups. Relative to the NHNES group, a significantly higher proportion of the Veteran PTSD group met criteria for MetS (26.9% vs. 41.7%) with a higher proportion of abnormal values in four out of five MetS domains (excepting glucose). Our results suggest that the elevation of MetS associated with PTSD cannot be fully explained by iatrogenic effects of antipsychotic medication. We suggest that extra attention be devoted to the clinical management of metabolic risk factors for morbidity in patients with PTSD.
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Affiliation(s)
- Barton W. Palmer
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Catherine Shir
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Hang Chang
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Mallory Mulvaney
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Joshua M. H. Hall
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - I-Wei Shu
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Hua Jin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - James B. Lohr
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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Rutherford BR, Zilcha-Mano S, Chrisanthopolous M, Salzman C, Zhu C, Cimino N, Yehuda R, Neria Y, Roose SP. Symptom profiles and treatment status of older adults with chronic post-traumatic stress disorder. Int J Geriatr Psychiatry 2021; 36:1216-1222. [PMID: 33577126 DOI: 10.1002/gps.5514] [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: 12/30/2020] [Accepted: 01/31/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Failure to diagnose and treat post-traumatic stress disorder (PTSD) may help explain the substantial disability, increased cognitive decline, and adverse health outcomes suffered by older adults with this disorder. To evaluate this possibility, we examined symptom differences among older and younger individuals with PTSD and measured the frequency with which older adults receive standard of care treatment. METHODS Clinician-Administered PTSD Scale for DSM (CAPS) scores were compared between younger and older adults with PTSD. Profiles were calculated for the most dominant CAPS symptom cluster reported by each participant, and the age cutoff best differentiating symptom clusters between individuals was determined. Clinical interview data (older adult sample only) were evaluated by trained raters to determine rates at which PTSD participants accessed treatment. RESULTS Among 108 individuals with PTSD, 69% of participants <67 years old had Criterion C (avoidance) symptoms as the most dominant cluster compared to 39% of participants ≥67 (p = 0.016). Eight percent of participants <67 years had Criterion E (hyperarousal) symptoms as the most dominant cluster compared to 30% of participants ≥67 (p = 0.016). Less than 25% of the older adults (N = 53 subsample) were receiving a first-line pharmacotherapy option for PTSD, and 0% of participants were currently participating in an evidence-based psychotherapy for PTSD. CONCLUSIONS Clinicians evaluating patients should be aware that different symptom profiles may be present between younger and older adults with PTSD. Despite their high risk for adverse neuropsychiatric and other health consequences, older adults with PTSD appear to infrequently receive first-line clinical treatment.
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Affiliation(s)
- Bret R Rutherford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | | | | | - Chloe Salzman
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Carlen Zhu
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Nicolas Cimino
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters VA Medical Center, Mt. Sinai School of Medicine, New York, New York, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Steven P Roose
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
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Basavaraju R, France J, Maas B, Brickman AM, Flory JD, Szeszko PR, Yehuda R, Neria Y, Rutherford BR, Provenzano FA. Right parahippocampal volume deficit in an older population with posttraumatic stress disorder. J Psychiatr Res 2021; 137:368-375. [PMID: 33761425 DOI: 10.1016/j.jpsychires.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is an increasingly prevalent condition among older adults and may escalate further as the general population including veterans from recent conflicts grow older. Despite growing evidence of higher medical comorbidity, cognitive impairment and dementia, and disability in older individuals with PTSD, there are very few studies examining brain cortical structure in this population. Hence, we examined cortical volumes in a cross-sectional study of veterans and civilians aged ≥50 years, of both sexes and exposed to trauma (interpersonal, combat, non-interpersonal). METHODS Cortical volumes were obtained from T1-weighted structural MRI and compared between individuals with PTSD and Trauma Exposed Healthy Controls (TEHC) adjusting for age, sex, estimated intracranial volume, depression severity, and time elapsed since trauma exposure. RESULTS The PTSD group (N = 55) had smaller right parahippocampal gyrus compared to TEHC (N = 36), corrected p(pFWER) = 0.034, with an effect size of 0.75 (Cohen's d), with no significant group differences in other cortical areas. CONCLUSIONS These findings are different from the structural brain findings reported in studies in younger age groups (larger parahippocampal volume in PTSD patients), suggesting a possible significant change in brain structure as PTSD patients age. These results need replication in longitudinal studies across the age-span to test whether they are neuroanatomical markers representing disease vulnerability, trauma resilience or pathological neurodegeneration associated with cognitive impairment and dementia.
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Affiliation(s)
- Rakshathi Basavaraju
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
| | - Jeanelle France
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
| | - Benjamin Maas
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, USA.
| | - Janine D Flory
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, USA.
| | - Philip R Szeszko
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, NY, USA; James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, USA.
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center & New York State Psychiatric Institute, USA.
| | - Bret R Rutherford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute, USA.
| | - Frank A Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
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Dixon HD, Michopoulos V, Gluck RL, Mendoza H, Munoz AP, Wilson JG, Powers A, Schwartz AC, Umpierrez GE, Gillespie CF. Trauma exposure and stress-related disorders in African-American women with diabetes mellitus. Endocrinol Diabetes Metab 2020; 3:e00111. [PMID: 32318631 PMCID: PMC7170451 DOI: 10.1002/edm2.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of the study was to assess demographic features, rates of trauma exposure, prevalence of post-traumatic stress and depressive symptoms in a group of urban, low-income, African-American women with type 1 or type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS We conducted a survey of (n = 290) low-income, African-American women seeking care in the diabetes clinic of an urban hospital and collected data on the demographic characteristics, childhood and nonchildhood abuse trauma exposure, and the severity of post-traumatic stress and depressive symptoms using the Post-traumatic Stress Disorder (PTSD) Symptom Scale (PSS) and the Beck Depression Inventory (BDI). In a subset of women with type 2 diabetes (n = 96), we assessed haemoglobin A1c to examine the relationship between psychopathology and glycaemic control. RESULTS Of the overall sample, 61.7% reported exposure to trauma in their lifetime, and 30.4% and 29.3% had current PTSD and MDD, respectively. Exposure to both childhood and nonchildhood abuse trauma was associated with an increased PTSD and depressive symptom severity (P's < .05). PTSD diagnosis, but not depression, was associated with increased haemoglobin A1c (P = .002). CONCLUSIONS These data document high levels of trauma exposure, PTSD and depressive symptoms in diabetic African-American women treated in a specialty clinic of an urban hospital setting. Furthermore, these data indicate that the presence of PTSD is negatively associated with glycaemic control.
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Affiliation(s)
- H. Drew Dixon
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
- Yerkes National Primate Research CenterAtlantaGeorgia
| | - Rachel L. Gluck
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Hadrian Mendoza
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Adam P. Munoz
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Joseph G. Wilson
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Abigail Powers
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Ann C. Schwartz
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Guillermo E. Umpierrez
- Division of EndocrinologyDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
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10
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Scherrer JF, Salas J, Norman SB, Schnurr PP, Chard KM, Tuerk P, Schneider FD, van den Berk-Clark C, Cohen BE, Friedman MJ, Lustman PJ. Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes. JAMA Psychiatry 2019; 76:1159-1166. [PMID: 31433443 PMCID: PMC6704751 DOI: 10.1001/jamapsychiatry.2019.2096] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is associated with increased risk of type 2 diabetes (T2D). Improvement in PTSD has been associated with improved self-reported physical health and hypertension; however, there is no literature, to our knowledge, on whether PTSD improvement is associated with T2D risk. OBJECTIVE To examine whether clinically meaningful PTSD symptom reduction is associated with lower risk of T2D. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined Veterans Health Affairs medical record data from 5916 patients who received PTSD specialty care between fiscal years 2008 and 2012 and were followed up through fiscal year 2015. Eligible patients had 1 or more PTSD Checklist (PCL) scores of 50 or higher between fiscal years 2008 and 2012 and a second PCL score within the following 12 months and at least 8 weeks after the first PCL score of 50 or higher. The index date was 12 months after the first PCL score. Patients were free of T2D diagnosis or an antidiabetic medication use for 12 months before the index date and had at least 1 visit after the index date. Data analyses were completed during January 2019. EXPOSURES Reduction in PCL scores during a 12-month period was used to define patients as those with a clinically meaningful improvement (≥20-point PCL score decrease) and patients with less or no improvement (<20-point PCL score decrease). MAIN OUTCOMES AND MEASURES Incident T2D diagnosed during a 2- to 6-year follow-up. RESULTS Medical records from a total of 1598 patients (mean [SD] age, 42.1 [13.4] years; 1347 [84.3%] male; 1060 [66.3%] white) were studied. The age-adjusted cumulative incidence of T2D was 2.6% among patients with a clinically meaningful PCL score decrease and 5.9% among patients without a clinically meaningful PCL score decrease (P = .003). After control for confounding, patients with a clinically meaningful PCL score decrease were significantly less likely to develop T2DM compared with those without a clinically meaningful decrease (hazard ratio, 0.51; 95% CI, 0.26-0.98). CONCLUSIONS AND RELEVANCE The findings suggest that clinically meaningful reductions in PTSD symptoms are associated with a lower risk of T2D. A decrease in PCL score, whether through treatment or spontaneous improvement, may help mitigate the greater risk of T2D in patients with PTSD.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Sonya B. Norman
- National Center for PTSD, Veterans Affairs (VA) Center of Excellence for Stress and Mental Health, Department of Psychiatry, University of California, San Diego
| | - Paula P. Schnurr
- National Center for PTSD, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kathleen M. Chard
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center (VAMC), Cincinnati, Ohio,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Peter Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Beth E. Cohen
- School of Medicine, Department of Medicine, University of California, San Francisco,San Francisco VAMC, San Francisco, California
| | - Matthew J. Friedman
- National Center for PTSD, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri,The Bell Street Clinic Opioid Treatment Program, Mental Health Service, VA St Louis Health Care System, St Louis, Missouri
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11
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Jager MJ, van der Sande R, Essink-Bot ML, van den Muijsenbergh METC. Views and experiences of ethnic minority diabetes patients on dietetic care in the Netherlands - a qualitative study. Eur J Public Health 2019; 29:208-213. [PMID: 30204883 PMCID: PMC6426026 DOI: 10.1093/eurpub/cky186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes type 2 is more prevalent in people from ethnic minorities in the Netherlands, and outcomes of care are worse compared with other Dutch people. Dieticians experience difficulties in managing these groups in self-management and adherence to dietary advice. The aim of this study was to explore the views regarding a healthy diet and dietetic care among ethnic minority type 2 diabetes patients. Methods Semi-structured interviews were held with 12 migrants with diabetes from Turkey, Morocco, Iraq and Curacao, who visited a dietician. Inclusion went on until saturation was reached. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model and Kleinman’s explanatory model of illness. Interviews were held in the language preferred by the respondent. Transcripts were coded and thematically analyzed. Results Several respondents expected a more rigorous, directive and technical approach of the dietician. All respondents acknowledged the importance of a healthy diet. What they considered healthy was determined by culturally influenced ideas about health benefits of specific foods. Important hindrances for dietary change were lack of self-efficacy and social support. Social influences were experienced both as supportive and a hindrance. Conclusions Migrant diabetic patients’ opinions about healthy food are determined by culturally influenced ideas rather than by dietary guidelines. Dutch dietary care is not tailored to the needs of these patients and should take into account migrants’ expectations, cultural differences in dietary habits and specifically address the role of family.
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Affiliation(s)
- Mirjam J Jager
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rob van der Sande
- Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Prevention and care programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
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12
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Pathak S, Shenoy S. Analysis of Cardiovascular Fitness, Sleep Quality, Depression, Fatigue, and Quality of Life among Individuals with Respect to the Glycated Hemoglobin Level in Type 2 Diabetes Mellitus. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000503607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Diabetes as a metabolic disorder can affect the various systems of the body, resulting in a decrease in cardiovascular fitness, sleep quality, and life quality that can lead to depression and fatigue. <b><i>Aim:</i></b> We analyzed cardiovascular fitness, sleep quality, depression, fatigue, and quality of life among individuals with a glycated hemoglobin (HBA1C) level >6.5% and ≤6.5%, as well as the relationship among glycated hemoglobin, maximal oxygen consumption (VO<sub>2</sub>max), obesity, sleep quality, depression, and duration of diabetes. <b><i>Method:</i></b> HBA1C (mean: 5.90 ± 0.93%) was studied in a total of 70 subjects (mean age: 62.37 ± 7.5 years). The 2 study groups were as follows: group A, HBA1C >6.5%, and group B, HBA1C ≤6.5%. BMI, VO<sub>2</sub>max, quality of sleep and life, depression, and fatigue were assessed in both groups. <b><i>Results:</i></b> There was a statistically significant difference between the groups at a significance level of <i>p</i> < 0.001. Group A had a lower cardiovascular fitness, a poor sleep quality, and increased depression compared to group B. A statistically significant negative linear correlation was found between VO<sub>2</sub>max and glycated hemoglobin, and a significant positive linear correlation was found between glycated hemoglobin and duration of diabetes, poor quality of sleep, and depression for all subjects, which was insignificant in the groups. <b><i>Conclusions:</i></b> A long duration of diabetes and an increased glycemic status may influence cardiovascular fitness, sleep quality, and life quality, leading to depression and fatigue.
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13
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Scherrer JF, Lustman PJ. Posttraumatic Stress Disorder and Incident Type 2 Diabetes: Is Obesity to Blame? ACTA ACUST UNITED AC 2019; 3. [PMID: 32395677 PMCID: PMC7213584 DOI: 10.1177/2470547019863415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.,Harry S. Truman Veterans Administration Medical Center, Columbia, MO, USA
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Bell Street Clinic Opioid Addiction Treatment Program, VA St. Louis Health Care System, St. Louis, MO, USA
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14
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Abebe DS, Elstad JI, Lien L. Utilization of somatic specialist services among psychiatric immigrant patients: the Norwegian patient registry study. BMC Health Serv Res 2018; 18:852. [PMID: 30424757 PMCID: PMC6234592 DOI: 10.1186/s12913-018-3672-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
Background Amongst psychiatric patients, the leading causes of reduced quality of life and premature death are chronic viral infections and cardiovascular diseases. In spite of this, there are extremely high levels of disparity in somatic healthcare amongst such populations. Little research has explored patterns of healthcare utilisation and, therefore, this study aims to examine the use of somatic specialist healthcare for infectious diseases and diseases of circulatory system among psychiatric patients from different immigrant groups and ethnic Norwegians. Methods Register data from the Norwegian Patient Registry and Statistics Norway were used. The sample (ages 0–90+) consisted of 276,890 native-born Norwegians and 52,473 immigrants from five world regions – Western countries, East Europe, Africa, Asia, and Latin America, all of whom had contacts with specialist mental healthcare during the period 2008–2011. Statistical analyses were applied using logistic regression models. Results Rates of outpatient consultation for circulatory system diseases were significantly lower amongst patients from Africa, Asia and Latin America compared with ethnic Norwegian psychiatric patients. Only patients from Eastern Europeans had a higher rate. With regard to hospital admission, all psychiatric patients had a lower rate than ethnic Norwegians with the exception of those from Africa where the finding was non-significant. In terms of infectious diseases, patients from African countries had significantly higher outpatient and admission rates than ethnic Norwegians. Outpatient consultation rates were lower amongst those from Western and Latin America and hospital admission rates were lower amongst those from Eastern Europe and Asia. Conclusions The findings suggest that the majority of immigrant psychiatric patients have lower hospitalization rates for circulatory system diseases than Norwegian psychiatric patients. This may suggest that poor access for immigrants is a contributing factor, though the findings were less pronounced for infectious diseases.
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Affiliation(s)
- Dawit Shawel Abebe
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway. .,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Public Health, Innlandet University College, Brumunddal, Norway
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15
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Scherrer JF, Salas J, Lustman PJ, van den Berk-Clark C, Schnurr PP, Tuerk P, Cohen BE, Friedman MJ, Norman SB, Schneider FD, Chard KM. The Role of Obesity in the Association Between Posttraumatic Stress Disorder and Incident Diabetes. JAMA Psychiatry 2018; 75:1189-1198. [PMID: 30090920 PMCID: PMC6248094 DOI: 10.1001/jamapsychiatry.2018.2028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is associated with an increased risk of type 2 diabetes mellitus (T2DM). Existing literature has adjusted for obesity in combination with other confounders, which does not allow estimating the contribution of obesity alone on the association of PTSD with incident T2DM. OBJECTIVE The current study was designed to determine if obesity accounted for the association between PTSD and incident T2DM. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from Veterans Health Administration medical records collected from patients with PTSD and without PTSD from 2008 to 2015. Patients were eligible for study inclusion if they were free of prevalent PTSD and T2DM for 12 months prior to index date. To estimate whether the association of PTSD and incident T2DM remained independent of obesity, Cox proportional hazard models were computed before and after adding obesity to the model and then further expanded by adding psychiatric disorders, psychotropic medications, physical conditions, smoking status, and demographics. Additional Cox models were computed to compare the risk of incident T2DM in patients with PTSD with and without obesity. Data analysis was completed from February 2018 to May 2018. EXPOSURES Two International Classification of Diseases, Ninth Revision (ICD-9) codes for PTSD in the same 12 months and obesity, defined by a body mass index of 30 or more or an ICD-9 code for obesity. MAIN OUTCOMES AND MEASURES Incident T2DM, as defined by ICD-9 codes. RESULTS Among 2204 patients without PTSD, the mean (SD) age was 47.7 (14.3) years; 1860 (84.4%) were men, 1426 (64.7%) were white, and 956 (43.4%) were married. Among 3450 patients with PTSD, the mean (SD) age was 42.8 (14.2) years; 2983 (86.5%) were men, 2238 (64.9%) were white, and 1525 (44.2%) were married. The age-adjusted association between PTSD and incident T2DM was significant (hazard ratio [HR], 1.33 [95% CI, 1.08-1.64]; P = .01), and after adding obesity to the model, this association was reduced and no longer significant (HR, 1.16 [95% CI, 0.94-1.43]; P = .18). Results of the full model, which included additional covariate adjustment, revealed no association between PTSD and incident T2DM (HR, 0.84 [95% CI, 0.64-1.10]; P = .19). Among patients with PTSD with obesity, the age-adjusted incidence of T2DM was 21.0 per 1000 person-years vs 5.8 per 1000 person-years in patients without obesity. In patients without PTSD, it was 21.2 per 1000 person-years for patients with obesity vs 6.4 per 1000 person-years in those without obesity. CONCLUSIONS AND RELEVANCE In this study of patients who use the Veterans Health Administration for health care, obesity moderated the association between PTSD and incident T2DM. The incidence of T2DM in patients with PTSD who are not obese is similar to the national incidence rate in the United States. These results suggest PTSD is not likely to have a causal association with incident T2DM. Future research is needed to determine if PTSD remission can lead to weight loss and reduced T2DM incidence.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Peter Tuerk
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco,San Francisco VA Medical Center, San Francisco, California
| | | | - Sonya B. Norman
- National Center for PTSD, White River Junction, Vermont,Department of Psychiatry, University of California, San Diego
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern, Dallas
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VA Medical Center, Cincinnati, Ohio,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
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16
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van Leijden MJ, Penninx BWJH, Agyemang C, Olff M, Adriaanse MC, Snijder MB. The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:921-930. [PMID: 29796849 PMCID: PMC6133160 DOI: 10.1007/s00127-018-1533-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/09/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Depression and posttraumatic stress disorder (PTSD) may be linked to the metabolic syndrome (MetS). Consistency of this association across ethnic groups and the influence of comorbidity of depression/PTSD were examined. METHODS Cross-sectional baseline data from the HELIUS study were used (4527 Dutch, 2999 South-Asian Surinamese, 4058 African Surinamese, 2251 Ghanaian, 3522 Turkish and 3825 Moroccan participants). The Patient Health Questionnaire-9 (PHQ-9) (score range 0-27) measured depressive symptoms. A 9-item questionnaire (score range 0-9) measured PTSD symptoms. The MetS was defined according to the International Diabetes Federation. The association of a depressed mood (PHQ-9 sum score ≥ 10) and severe PTSD symptoms (sum score ≥ 7) with the MetS was examined using logistic regression. Interaction with ethnicity and between a depressed mood and severe PTSD symptoms was tested. RESULTS A depressed mood was associated with the MetS [OR (95% CI) = 1.37 (1.24-1.51)] in the total sample and consistent across ethnic groups (p values for interaction all > 0.05). Severe PTSD symptoms were significantly associated with the MetS in the Dutch [OR (95% CI) = 1.71 (1.07-2.73)]. The South-Asian Surinamese, Turks and Moroccans showed weaker associations than the Dutch (p values for interaction all < 0.05). A depressed mood and severe PTSD symptoms did not interact in the association with the MetS (p values for interaction > 0.05). CONCLUSIONS A depressed mood was consistently associated with the MetS across ethnic groups, but the association between severe PTSD symptoms and the MetS maybe ethnicity dependent. The association with the MetS was not different in case of depressed mood/severe PTSD symptoms comorbidity.
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Affiliation(s)
- Marieke J. van Leijden
- 0000000404654431grid.5650.6Department of Public Health, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Brenda W. J. H. Penninx
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Oldenaller 1, 1081 HL Amsterdam, The Netherlands
| | - Charles Agyemang
- 0000000404654431grid.5650.6Department of Public Health, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Miranda Olff
- 0000000404654431grid.5650.6Department of Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- 0000 0004 1754 9227grid.12380.38Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Marieke B. Snijder
- 0000000404654431grid.5650.6Department of Public Health, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
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17
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Hong C, Schüffler A, Kauhl U, Cao J, Wu CF, Opatz T, Thines E, Efferth T. Identification of NF-κB as Determinant of Posttraumatic Stress Disorder and Its Inhibition by the Chinese Herbal Remedy Free and Easy Wanderer. Front Pharmacol 2017; 8:181. [PMID: 28428751 PMCID: PMC5382210 DOI: 10.3389/fphar.2017.00181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/20/2017] [Indexed: 01/09/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a mental disorder developing after exposure to traumatic events. Although psychotherapy reveals some therapeutic effectiveness, clinically sustainable cure is still uncertain. Some Chinese herbal formulae are reported to work well clinically against mental diseases in Asian countries, but the safety and their mode of action are still unclear. In this study, we investigated the mechanisms of Chinese remedy free and easy wanderer (FAEW) on PTSD. We used a reverse pharmacology approach combining clinical data to search for mechanisms of PTSD with subsequent in vitro verification and bioinformatics techniques as follows: (1) by analyzing microarray-based transcriptome-wide mRNA expression profiling of PTSD patients; (2) by investigating the effect of FAEW and the antidepressant control drug fluoxetine on the transcription factor NF-κB using reporter cell assays and western blotting; (3) by performing molecular docking and literature data mining based on phytochemical constituents of FAEW. The results suggest an involvement of inflammatory processes mediated through NF-κB in the progression of PTSD. FAEW was non-cytotoxic in vitro and inhibited NF-κB activity and p65 protein expression. FAEW's anti-inflammatory compounds, i.e., paeoniflorin, isoliquiritin, isoliquiritin apioside and ononin were evaluated for binding to IκK and p65-RelA in a molecular docking approach. Paeoniflorin, albiflorin, baicalin, isoliquiritin and liquiritin have been reported to relieve depression in vivo or in clinical trials, which might be the active ingredients for FAEW against PTSD.
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Affiliation(s)
- Chunlan Hong
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg UniversityMainz, Germany
| | - Anja Schüffler
- Institut für Biotechnologie und Wirkstoff Forschung gGmbHKaiserslautern, Germany.,Institute of Molecular Physiology, Johannes Gutenberg UniversityMainz, Germany
| | - Ulrich Kauhl
- Institute of Organic Chemistry, Johannes Gutenberg UniversityMainz, Germany
| | - Jingming Cao
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg UniversityMainz, Germany
| | - Ching-Fen Wu
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg UniversityMainz, Germany
| | - Till Opatz
- Institute of Organic Chemistry, Johannes Gutenberg UniversityMainz, Germany
| | - Eckhard Thines
- Institut für Biotechnologie und Wirkstoff Forschung gGmbHKaiserslautern, Germany.,Institute of Molecular Physiology, Johannes Gutenberg UniversityMainz, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg UniversityMainz, Germany
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18
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Lolk M, Byberg S, Carlsson J, Norredam M. Somatic comorbidity among migrants with posttraumatic stress disorder and depression - a prospective cohort study. BMC Psychiatry 2016; 16:447. [PMID: 27964720 PMCID: PMC5153678 DOI: 10.1186/s12888-016-1149-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/29/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In a cohort of migrants in Denmark, we compared somatic disease incidence among migrants diagnosed with posttraumatic stress disorder (PTSD) and depression with migrants without a diagnosed psychiatric disorder. METHODS The study builds on a unique cohort of migrants who obtained residence permit in Denmark from 1993 to 2010 (N = 92,104). The association with somatic disease was explored via register linkage. We used Poisson regression to model incidence rate ratios (IRR) adjusted for age, sex, income and region of origin. The Danish Data Protection Agency granted authorisation for the implementation of the project (No 2012-41-0065). RESULTS Our results showed that migrants diagnosed with PTSD and depression had significantly higher rates of somatic diseases compared with migrants without diagnosed psychiatric disorders - especially, infectious disease (IRR, 1.89; 95% CI, 1.45-2.48; p < 0.01), neurological disease (IRR, 2.35; 95% CI, 1.91-2.91; p < 0.01) and pulmonary disease (IRR, 1.69; 95% CI, 1.37-2.00; p < 0.01). We further saw differences in the IRRs according to region of origin. CONCLUSION Migrants with PTSD and depression had a significantly higher rates of somatic comorbidity compared with migrants without a diagnosed psychiatric disorder. The rates were especially high for infectious, neurological and pulmonary diseases. Our results further suggest difference in the rates of somatic comorbidity according to region of. Preventive and treatment services should pay special attention to improve the overall health of migrants with PTSD and depression.
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Affiliation(s)
- Mette Lolk
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark. .,Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevaenget 2, 2750, Ballerup, Denmark.
| | - Stine Byberg
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevaenget 2, 2750 Ballerup, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark ,Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Kettegård Allé 30, Copenhagen, Denmark
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19
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Aronson BD, Palombi LC, Walls ML. Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes. J Behav Med 2016; 39:694-703. [PMID: 27001254 PMCID: PMC4945379 DOI: 10.1007/s10865-016-9733-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.
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Affiliation(s)
- Benjamin D Aronson
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812, USA.
| | - Laura C Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812, USA
| | - Melissa L Walls
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
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20
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Abstract
Exposure to adversity in childhood (adverse childhood experiences [ACEs]) is linked to a number of chronic diseases in adulthood, yet there is limited research examining the impact of ACEs on diabetes. The current review sought to examine the association between ACEs, other trauma exposure or posttraumatic stress disorder (PTSD) diagnosis, and risk for diabetes. Thirty-eight studies are reviewed. Unlike in other diseases, several studies in diabetes show a threshold-response versus a dose-response relation, while other studies show a relation between greater abuse severity and diabetes risk. There were mixed results for studies examining abuse type and frequency. Chronic or comorbid PTSD was also related to increased diabetes risk among veterans, but in community samples, only trauma exposure predicted diabetes risk. While the research is still limited, diabetes researchers and clinicians should consider screening for ACEs and examine severity and frequency across abuse type as a predictor of both diabetes and poor diabetes outcomes.
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Affiliation(s)
- Lindsay Huffhines
- University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA
- Center for Children's Healthy Lifestyles and Development, 610 E. 22nd Street, Kansas City, MO, 64108, USA
| | - Amy Noser
- University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA
- Center for Children's Healthy Lifestyles and Development, 610 E. 22nd Street, Kansas City, MO, 64108, USA
| | - Susana R Patton
- Center for Children's Healthy Lifestyles and Development, 610 E. 22nd Street, Kansas City, MO, 64108, USA.
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
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21
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Frías Á, Martínez B, Palma C, Farriols N. Clinical impact of comorbid major depression in subjects with posttraumatic stress disorder: A review of the literature. NORDIC PSYCHOLOGY 2016. [DOI: 10.1080/19012276.2016.1162106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Affiliation(s)
- Michael Yafi
- Department of Pediatrics, Division of Pediatric Endocrinology; The University of Texas; Houston Texas United States
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23
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Wagner J, Berthold SM, Buckley T, Kong S, Kuoch T, Scully M. Diabetes among refugee populations: what newly arriving refugees can learn from resettled Cambodians. Curr Diab Rep 2015; 15:56. [PMID: 26143533 DOI: 10.1007/s11892-015-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A growing body of literature suggests that cardiometabolic disease generally and type 2 diabetes specifically are problems among refugee groups. This paper reviews rates of cardiometabolic disease and type 2 diabetes among refugees and highlights their unique risk factors including history of malnutrition, psychiatric disorders, psychiatric medications, lifestyle changes toward urbanization and industrialization, social isolation, and a poor profile on the social determinants of health. Promising interventions are presented for preventing and treating diabetes in these groups. Such interventions emphasize well-coordinated medical and mental health care delivered by cross-cultural and multidisciplinary teams including community health workers that are well integrated into the community. Finally, recommendations for service, policy, and research are made. The authors draw on local data and clinical experience of our collective work with Cambodian American refugees whose 30-year trajectory illustrates the consequences of ignoring diabetes and its risk factors in more recent, and soon to be arriving, refugee cohorts.
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Affiliation(s)
- Julie Wagner
- University of Connecticut Health Center, MC3910, 263 Farmington Ave., Farmington, CT, 06030, USA,
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24
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Lohr JB, Palmer BW, Eidt CA, Aailaboyina S, Mausbach BT, Wolkowitz OM, Thorp SR, Jeste DV. Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature. Am J Geriatr Psychiatry 2015; 23:709-25. [PMID: 25959921 PMCID: PMC4568841 DOI: 10.1016/j.jagp.2015.04.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) has major public health significance. Evidence that PTSD may be associated with premature senescence (early or accelerated aging) would have major implications for quality of life and healthcare policy. We conducted a comprehensive review of published empirical studies relevant to early aging in PTSD. METHOD Our search included the PubMed, PsycINFO, and PILOTS databases for empirical reports published since the year 2000 relevant to early senescence and PTSD, including: 1) biomarkers of senescence (leukocyte telomere length [LTL] and pro-inflammatory markers), 2) prevalence of senescence-associated medical conditions, and 3) mortality rates. RESULTS All six studies examining LTL indicated reduced LTL in PTSD (pooled Cohen's d = 0.76). We also found consistent evidence of increased pro-inflammatory markers in PTSD (mean Cohen's ds), including C-reactive protein = 0.18, Interleukin-1 beta = 0.44, Interleukin-6 = 0.78, and tumor necrosis factor alpha = 0.81. The majority of reviewed studies also indicated increased medical comorbidity among several targeted conditions known to be associated with normal aging, including cardiovascular disease, type 2 diabetes mellitus, gastrointestinal ulcer disease, and dementia. We also found seven of 10 studies indicated PTSD to be associated with earlier mortality (average hazard ratio: 1.29). CONCLUSION In short, evidence from multiple lines of investigation suggests that PTSD may be associated with a phenotype of accelerated senescence. Further research is critical to understand the nature of this association. There may be a need to re-conceptualize PTSD beyond the boundaries of mental illness, and instead as a full systemic disorder.
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Affiliation(s)
- James B. Lohr
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Barton W. Palmer
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Carolyn A. Eidt
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Smitha Aailaboyina
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Brent T. Mausbach
- University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | | | - Steven R. Thorp
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Dilip V. Jeste
- University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
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Ciocca G, Carosa E, Stornelli M, Limoncin E, Gravina GL, Iannarelli R, Sperandio A, Di Sante S, Lenzi A, Lauro D, Jannini EA. Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L'Aquila earthquake. Acta Diabetol 2015; 52:513-21. [PMID: 25408297 DOI: 10.1007/s00592-014-0686-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
AIM After natural and collective catastrophes, many behavioral phenomena can occur through psychobiological responses that involve also the diabetic condition.The aim of this study was to investigate post-traumatic stress disorder (PTSD) and coping strategies in type 2 diabetic patients after L'Aquila earthquake, with a particular attention to the newly diagnosed patients and to the gender differences. METHODS Among the local diabetic population, we recruited 100 diabetic patients (46 women and 54 men). Sixty of these had diabetes before the earthquake (pre-quake patients), and other 40 received diabetes diagnosis after the earthquake (post-quake patients). A psychometric protocol composed by Davidson Trauma Scale for PTSD and Brief-COPE for coping strategies was administered. RESULTS We found significant differences in the levels of PTSD when comparing both post-quake with pre-quake patients (post-quake = 51.72 ± 26.05 vs. pre-quake = 31.65 ± 22.59; p < 0.05) and the female patients with males (women = 53.50 ± 27.01 vs. men = 31.65 ± 23.06; p < 0.05) and also in the prevalence [post-quake = 27/40 (67.5 %) vs. pre-quake = 20/60 (33.3 %); p < 0.05], [women = 27/46 (58.69 %) vs. men = 16/54 (29.62 %); p < 0.05]. Moreover, maladaptive coping was a predictive factor for PTSD in the post-quake group only (OR 1.682; 95 % CI 1.155-2.450; p = 0.006). CONCLUSIONS Our results revealed that PTSD may be considered an important comorbidity factor in newly diagnosed patients and in diabetic women. Hence, a psychological support seems particularly important in these patients after a collective traumatic event to help them react to both PTSD and diabetes and to help them improve their coping skills.
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Affiliation(s)
- Giacomo Ciocca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Welch AE, Jasek JP, Caramanica K, Chiles MC, Johns M. Cigarette smoking and 9/11-related posttraumatic stress disorder among World Trade Center Health Registry enrollees, 2003-12. Prev Med 2015; 73:94-9. [PMID: 25655710 DOI: 10.1016/j.ypmed.2015.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/20/2015] [Accepted: 01/24/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Numerous studies have observed higher rates of smoking among adults with mental health conditions. We examined posttraumatic stress disorder (PTSD) and smoking over a 7-9year period among adults with firsthand exposure to the 9/11 attacks enrolled in the World Trade Center Health Registry. METHOD Data were collected at three waves: W1 (2003-04), W2 (2006-07), and W3 (2011-12). Enrollees aged ≥25 at W1 and who completed all three waves (n=34,458) were categorized by smoker-type: non-smoker, non-daily (smoked some days in last 30days), light (1-10 cigarettes per day (CPD)), or heavy (11+ CPD). Enrollees who smoked at W1 but not W3 were considered to have quit. PTSD was defined as a score of ≥44 on the PTSD Checklist-Civilian Version. RESULTS Smoking declined significantly from W1 (12.6%) to W3 (9.2%). Smoking prevalence was higher among enrollees with PTSD. In multivariable models, odds of quitting were 25-39% lower among heavy, light, and non-daily smokers with PTSD compared to those without. CONCLUSION PTSD was associated with reduced odds of quitting regardless of smoker-type. Disaster-exposed smokers with PTSD are likely in need of more supportive services in order to abstain from smoking.
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Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA.
| | - John P Jasek
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
| | - Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
| | - Mariana C Chiles
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
| | - Michael Johns
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, USA
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Roberts AL, Agnew-Blais JC, Spiegelman D, Kubzansky LD, Mason SM, Galea S, Hu FB, Rich-Edwards JW, Koenen KC. Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study. JAMA Psychiatry 2015; 72:203-10. [PMID: 25565410 PMCID: PMC4522929 DOI: 10.1001/jamapsychiatry.2014.2632] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is a common, debilitating mental disorder that has been associated with type 2 diabetes mellitus (T2D) and its risk factors, including obesity, in cross-sectional studies. If PTSD increases risk of incident T2D, enhanced surveillance in high-risk populations may be warranted. OBJECTIVE To conduct one of the first longitudinal studies of PTSD and incidence of T2D in a civilian sample of women. DESIGN, SETTING, AND PARTICIPANTS The Nurses' Health Study II, a US longitudinal cohort of women (N = 49,739). We examined the association between PTSD symptoms and T2D incidence over a 22-year follow-up period. MAIN OUTCOMES AND MEASURES Type 2 diabetes, self-reported and confirmed with self-report of diagnostic test results, symptoms, and medications, a method previously validated by physician medical record review. Posttraumatic stress disorder was assessed by the Short Screening Scale for DSM-IV PTSD. We examined longitudinal assessments of body mass index, smoking, alcohol intake, diet quality, physical activity, and antidepressant use as mediators of possible increased risk of T2D for women with PTSD. The study hypothesis was formulated prior to PTSD ascertainment. RESULTS Symptoms of PTSD were associated in a dose-response fashion with T2D incidence (1-3 symptoms: hazard ratio, 1.4 [95% CI, 1.2-1.6]; 4 or 5 symptoms; hazard ratio, 1.5 [95% CI, 1.3-1.7]; 6 or 7 symptoms: hazard ratio, 1.8 [95% CI, 1.5-2.1]). Antidepressant use and a higher body mass index associated with PTSD accounted for nearly half of the increased risk of T2D for women with PTSD. Smoking, diet quality, alcohol intake, and physical activity did not further account for increased risk of T2D for women with PTSD. CONCLUSIONS AND RELEVANCE Women with the highest number of PTSD symptoms had a nearly 2-fold increased risk of T2D over follow-up than women with no trauma exposure. Health professionals treating women with PTSD should be aware that these patients are at risk of increased body mass index and T2D. Comprehensive PTSD treatment should be expanded to address the health behaviors that contribute to obesity and chronic disease in affected populations.
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Affiliation(s)
- Andrea L. Roberts
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | | | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts3Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Susan M. Mason
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Frank B. Hu
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts5Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Janet W. Rich-Edwards
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Goosen S, Middelkoop B, Stronks K, Agyemang C, Kunst AE. High diabetes risk among asylum seekers in The Netherlands. Diabet Med 2014; 31:1532-41. [PMID: 24860962 DOI: 10.1111/dme.12510] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/05/2014] [Accepted: 05/21/2014] [Indexed: 02/03/2023]
Abstract
AIMS To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. METHODS We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. RESULTS The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardized prevalence ratios were found for asylum seekers from Somalia, Sudan and Sri Lanka. The standardized prevalence ratio was higher in asylum seekers aged ≥ 30 years. Incidence rates were higher compared with the reference population for all length-of-stay intervals. CONCLUSIONS Asylum seekers from the majority of countries of origin were at higher risk of diabetes compared with the general population in the Netherlands. Asylum seekers from Somalia were particularly at risk. This emerging public health issue requires attention from policy-makers and care providers.
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Affiliation(s)
- S Goosen
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam; Netherlands Association for Community Health Services, Utrecht
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Traumatic stress, oxidative stress and post-traumatic stress disorder: neurodegeneration and the accelerated-aging hypothesis. Mol Psychiatry 2014; 19:1156-62. [PMID: 25245500 PMCID: PMC4211971 DOI: 10.1038/mp.2014.111] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is associated with elevated risk for a variety of age-related diseases and neurodegeneration. In this paper, we review evidence relevant to the hypothesis that chronic PTSD constitutes a form of persistent life stress that potentiates oxidative stress (OXS) and accelerates cellular aging. We provide an overview of empirical studies that have examined the effects of psychological stress on OXS, discuss the stress-perpetuating characteristics of PTSD, and then identify mechanisms by which PTSD might promote OXS and accelerated aging. We review studies on OXS-related genes and the role that they may have in moderating the effects of PTSD on neural integrity and conclude with a discussion of directions for future research on antioxidant treatments and biomarkers of accelerated aging in PTSD.
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Rao MN, Chau A, Madden E, Inslicht S, Talbot L, Richards A, O’Donovan A, Ruoff L, Grunfeld C, Neylan TC. Hyperinsulinemic response to oral glucose challenge in individuals with posttraumatic stress disorder. Psychoneuroendocrinology 2014; 49:171-81. [PMID: 25108160 PMCID: PMC4165697 DOI: 10.1016/j.psyneuen.2014.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/23/2014] [Accepted: 07/08/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with a 2-4 fold increased risk of developing Type 2 diabetes mellitus. However, detailed assessments of glucose metabolism and insulin secretion in a study designed to minimize confounders are lacking. Furthermore, few studies examine potential mechanisms involved. We analyzed data from a case-control study of medically healthy, medication-free adults to determine whether individuals with PTSD had abnormal glucose or insulin response to oral glucose tolerance test (OGTT) compared to controls. Secondarily, we assessed potential mediators such as sleep, cortisol and adiponectin. METHODS Data was analyzed from 92 age and gender-matched subjects (44 PTSD, 48 controls). Chronic PTSD was diagnosed using the Structured Clinical Interview for DSM-IV and Clinician Administered PTSD Scale. Subjects underwent 75-g OGTT, actigraphy and sleep diary (to quantify sleep duration), polysomnography (to assess slow wave sleep [SWS] and delta power), and overnight blood sampling (for cortisol and adiponectin). RESULTS At baseline, individuals with PTSD had mildly increased insulin levels (by 19%, compared to controls, p=0.048) that was mediated primarily by weight. In response to OGTT, the PTSD group had higher levels of insulin at 120 min (by 44%, p=0.03) and insulin AUC (by 43%, p=0.015) compared to controls, after adjusting for confounders. Glucose levels were similar in the two groups. Although self-reported sleep duration, SWS, and delta power differed between PTSD subjects and controls, they did not mediate the effects of PTSD status on insulin response. CONCLUSION In this case-control study, individuals with PTSD had a hyperinsulinemic response to oral glucose challenge compared to controls, suggestive of insulin resistance.
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Affiliation(s)
- Madhu N. Rao
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, U.S.A,Corresponding Author: Madhu N. Rao, MD, San Francisco VA Medical Center (111F), 4150 Clement Street, San Francisco, CA 94121, , Ph: 415-750-2005, Fax: 415-476-4918
| | - Alanna Chau
- Albert Einstein College of Medicine, New York, NY, U.S.A
| | - Erin Madden
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Northern California Institute for Research and Education, San Francisco, CA, U.S.A
| | - Sabra Inslicht
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Lisa Talbot
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Anne Richards
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Aoife O’Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Leslie Ruoff
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A
| | - Carl Grunfeld
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, U.S.A
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, U.S.A,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, U.S.A
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31
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Wagner J, Burke G, Kuoch T, Scully M, Armeli S, Rajan TV. Trauma, healthcare access, and health outcomes among Southeast Asian refugees in Connecticut. J Immigr Minor Health 2014; 15:1065-72. [PMID: 22976796 DOI: 10.1007/s10903-012-9715-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Mental health problems among Southeast Asian refugees have been documented. However, longer term health consequences of mass violence as re-settled refugees age are less well described. This study investigated relationships among trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut. An internet phone directory was used to generate a list of names that was compared to 2000 census data to estimate the proportion of the population in each group. From these lists, 190 telephone listings were selected at random. Interviewers telephoned selected listings to screen for eligible participants and obtain an appointment for interview. Surveys were administered through face-to-face interviews during home visits conducted in Khmer or Vietnamese. The Harvard Trauma Questionnaire assessed trauma symptoms. Questions regarding the presence of physician diagnosed heart disease, hypertension, diabetes, and chronic pain were adapted as written from the Health Interview Survey. Healthcare access and occurrence were measured with questions regarding cost and access, patient-provider understanding, and interpretive services. Hierarchical modeling was used to account for respondent nesting within family. Analyses controlled for age, sex, and country of origin. Individuals who reported greater trauma symptoms were more likely to report heart disease by a factor of 1.82, hypertension by a factor of 1.41, and total count of diseases by a factor of 1.22, as well as lower levels of subjective health. Greater trauma symptoms were also associated with greater lack of understanding, cost and access problems, and the need for an interpreter. Although the majority of Southeast Asian immigrants came to the United States as refugees approximately 20-30 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for disease and decreased access to healthcare services.
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Affiliation(s)
- Julie Wagner
- University of Connecticut Health Center, MC3910, 263 Farmington Ave., Farmington, CT, 06030, USA,
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32
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Miller-Archie SA, Jordan HT, Ruff RR, Chamany S, Cone JE, Brackbill RM, Kong J, Ortega F, Stellman SD. Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster. Prev Med 2014; 66:34-8. [PMID: 24879890 DOI: 10.1016/j.ypmed.2014.05.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the temporal relationship between 9/11-related posttraumatic stress disorder (PTSD) and new-onset diabetes in World Trade Center (WTC) survivors up to 11 years after the attack in 2001. METHODS Three waves of surveys (conducted from 2003 to 2012) from the WTC Health Registry cohort collected data on physical and mental health status, sociodemographic characteristics, and 9/11-related exposures. Diabetes was defined as self-reported, physician-diagnosed diabetes reported after enrollment. After excluding prevalent cases, there were 36,899 eligible adult enrollees. Logistic regression and generalized multilevel growth models were used to assess the association between PTSD measured at enrollment and subsequent diabetes. RESULTS We identified 2143 cases of diabetes. After adjustment, we observed a significant association between PTSD and diabetes in the logistic model [adjusted odds ratio (AOR) 1.28, 95% confidence interval (CI) 1.14-1.44]. Results from the growth model were similar (AOR 1.37, 95% CI 1.23-1.52). CONCLUSION This exploratory study found that PTSD, a common 9/11-related health outcome, was a risk factor for self-reported diabetes. Clinicians treating survivors of both the WTC attacks and other disasters should be aware that diabetes may be a long-term consequence.
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Affiliation(s)
- Sara A Miller-Archie
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
| | - Hannah T Jordan
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Ryan R Ruff
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Shadi Chamany
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Robert M Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Joanne Kong
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Felix Ortega
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Steven D Stellman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
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Norredam M, Agyemang C, Hoejbjerg Hansen OK, Petersen JH, Byberg S, Krasnik A, Kunst AE. Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the 'healthy migrant effect' hypothesis. Trop Med Int Health 2014; 19:958-67. [PMID: 24889930 DOI: 10.1111/tmi.12340] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. METHODS We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. RESULTS Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. CONCLUSION Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included.
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Affiliation(s)
- Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Disease, University Hospital Copenhagen, Hvidovre, Denmark
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Eraly SA, Nievergelt CM, Maihofer AX, Barkauskas DA, Biswas N, Agorastos A, O’Connor DT, Baker DG, Team MRS. Assessment of plasma C-reactive protein as a biomarker of posttraumatic stress disorder risk. JAMA Psychiatry 2014; 71:423-31. [PMID: 24576974 PMCID: PMC4032578 DOI: 10.1001/jamapsychiatry.2013.4374] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) has been associated in cross-sectional studies with peripheral inflammation. It is not known whether this observed association is the result of PTSD predisposing to inflammation (as sometimes postulated) or to inflammation predisposing to PTSD. OBJECTIVE To determine whether plasma concentration of the inflammatory marker C-reactive protein (CRP) helps predict PTSD symptoms. DESIGN, SETTING, AND PARTICIPANTS The Marine Resiliency Study, a prospective study of approximately 2600 war zone-deployed Marines, evaluated PTSD symptoms and various physiological and psychological parameters before deployment and at approximately 3 and 6 months following a 7-month deployment. Participants were recruited from 4 all-male infantry battalions imminently deploying to a war zone. Participation was requested of 2978 individuals; 2610 people (87.6%) consented and 2555 (85.8%) were included in the present analysis. Postdeployment data on combat-related trauma were included for 2208 participants (86.4% of the 2555 included) and on PTSD symptoms at 3 and 6 months after deployment for 1861 (72.8%) and 1617 (63.3%) participants, respectively. MAIN OUTCOMES AND MEASURES Severity of PTSD symptoms 3 months after deployment assessed by the Clinician-Administered PTSD Scale (CAPS). RESULTS We determined the effects of baseline plasma CRP concentration on postdeployment CAPS using zero-inflated negative binomial regression (ZINBR), a procedure designed for distributions, such as CAPS in this study, that have an excess of zeroes in addition to being positively skewed. Adjusting for the baseline CAPS score, trauma exposure, and other relevant covariates, we found baseline plasma CRP concentration to be a highly significant overall predictor of postdeployment CAPS scores (P = .002): each 10-fold increment in CRP concentration was associated with an odds ratio of nonzero outcome (presence vs absence of any PTSD symptoms) of 1.51 (95% CI, 1.15-1.97; P = .003) and a fold increase in outcome with a nonzero value (extent of symptoms when present) of 1.06 (95% CI, 0.99-1.14; P = .09). CONCLUSIONS AND RELEVANCE A marker of peripheral inflammation, plasma CRP may be prospectively associated with PTSD symptom emergence, suggesting that inflammation may predispose to PTSD.
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Affiliation(s)
- Satish A. Eraly
- Department of Medicine, University of California San Diego, San Diego, CA,VA San Diego Healthcare System, San Diego, CA
| | - Caroline M. Nievergelt
- VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health, San Diego, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Adam X. Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Donald A. Barkauskas
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Nilima Biswas
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel T. O’Connor
- Department of Medicine, University of California San Diego, San Diego, CA,VA San Diego Healthcare System, San Diego, CA,Corresponding Author: Dewleen G. Baker, MD, VA Center for Stress and Mental Health (116A), 3350 La Jolla Village Dr, San Diego, CA 92161, Telephone: 858-552-8585, ext. 2230, Fax: 858-642-6442,
| | - Dewleen G. Baker
- VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health, San Diego, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA,Corresponding Author: Dewleen G. Baker, MD, VA Center for Stress and Mental Health (116A), 3350 La Jolla Village Dr, San Diego, CA 92161, Telephone: 858-552-8585, ext. 2230, Fax: 858-642-6442,
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Pfortmueller CA, Graf F, Tabbara M, Tabarra M, Lindner G, Zimmermann H, Exadaktylos AK. Acute health problems in African refugees: ten years' experience in a Swiss emergency department. Wien Klin Wochenschr 2012; 124:647-52. [PMID: 22893449 DOI: 10.1007/s00508-012-0227-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Over the last two decades, the total number of applications from Africans for asylum in the countries of the European Union has increased from 578,000 to more than 2.9 million. About 20 % (7,196/36,100) of the asylum seekers in Switzerland originate from Africa. The disease profile of African asylum seekers is remarkably different from that of the native population in the country of application. We have therefore conducted an analysis of African asylum seekers presenting themselves to our emergency department. METHODS In a retrospective analysis, the central patient registry database was searched for patients originating from Africa admitted from 1 January 2000 to 30 November 2011 and labelled as "Asylbewerber" (asylum seeker) or "Flüchtling" (refugee). RESULTS Three thousand six hundred and seventy-five African asylum seekers were admitted to our emergency department between 2000 and 2010. Thirty-four percent (n = 1,247) were female and 66 % (n = 2,426) male. Eighty percent (n = 1,940) of the men and 70 % (n = 823) of the women were younger than 40 years. Most of our patients originated from Algeria (n = 612). Forty-five percent (n = 1,628) of all patients presented with internal medical problems, 40 % (n = 1,487) with injuries. 3.5 % (n = 130) of all patients presented with psychiatric problems. Admission for psychiatric problems increased steadily from 2 % (n = 4) in 2001 to 10 % (n = 35) in 2011. CONCLUSION The causes of presentation are manifold, including internal medical problems and injuries. Admissions for psychiatric problems are increasing. Establishing simple screening scores for somatization should be a key priority in providing more focused treatment in emergency departments.
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